CHINA - A group advocating living wills, in which people can dictate whether their lives may be artificially extended, has vowed to promote the practice among more people in China, despite technical and institutional challenges.
The Beijing Living Will Advocacy Association, established in July, now works under the management of the Beijing Health Bureau.
"The first thing the association is going to do is to improve its online registry to ensure that testators' information is safe with us, that they can change their decision at any time, and that their will is available when it is time," said Luo Diandian, co-founder of the association and Choices and Dignity, a website created in 2006 to promote living wills.
As of 3 pm Sunday, 10,428 people had created a living will using the website. They included information such as what kind of treatment they do or do not want at the end of their lives, and whether they would want to be placed on life support to prolong their lives.
People are advised to make living wills because they often won't be able to express what they want when they are near death.
"With such a large number of people registered, our workload will sharply increase," she said, adding that TV and newspaper reports over the years have helped increase the number of testators.
The website sends an annual e-mail to testators when it is time to renew their wills, which they can change or revoke at any time. Yet Luo admitted the website is not able to verify that every e-mail is received.
The website also urges testators and the people they have entrusted to make healthcare decisions for them when the time comes to sign paper copies of their living will.
Many patients spend their last days relying on life support, which extends a person's dying process, Luo said.
Li Gang, director of the intensive care unit at China-Japan Friendship Hospital in Beijing, said one patient who was about 80 years old spent six years in the intensive care unit.
"A person who has a stroke, falls unconscious and losses autonomous respiration can survive for a long time, as long as their heart is good enough," Li said. "The progress of medicine has greatly changed how long a person can live."
He doubts many Chinese will create a living will.
"Most people spend their last days in ICU because their family members feel they have tried all possible means. Most of the time when family members give up treatment, it's because they don't have enough money to continue," he said.
"They don't simply stop treatment because there is no hope" the patient will survive without life support, he added.
Wu Lijuan, deputy director of the department, said: "Many people believe their family members, even those in their 80s or 90s, must be saved once they enter the ICU. It seems like they don't believe life ends."
Luo said the fear of death is deeply rooted, so more needs to be done to educate people to accept death.
Her team found that about 80 per cent of medical costs are spent on life support treatment.
Liu Lin, a lawyer, believes living wills are unethical.
"One can dispose of their own life, but is it moral to have others help them do so?" he asked.
According to the Choices and Dignity website: "What we suggest is only adults can choose not to use life support treatment in vain, such as a ventilator or cardiopulmonary resuscitation, at the terminal stage of their disease or at the end of their lives. The suggestion does not mean we oppose or belittle other choices."
A living will is "just another choice", Luo said. "All the choices, whether giving up or hanging on, should be respected."