Tuesday, September 29, 2009

Asia's Attitude to Assisted Suicide - bbc online

Asia's attitude to assisted suicide

The authorities in Britain are due to issue guidance to clarify the law on assisted suicide. As more and more countries in the West are grappling with how to legislate on this difficult issue, the BBC's Vaudine England looks at how assisted suicide and euthanasia are viewed in Asia.

Tang Siu-pun, Queen Mary Hospital, Hong Kong, 26 August 2009
Ah Bun wants the right to choose death but will not discuss it with his family

Tang Siu-pun, also known as Ah Bun, wants the right to decide whether he might live or die.

He once wrote a letter to Hong Kong's leader, then Chief Executive Tung Chee-hwa, demanding the right to choose.

But he has never talked it over with his family - showing how strong the taboo is on talking about death, and individual choice, in Chinese and most other Asian cultures.

Between every few words, he takes a breath, thanks to a machine strapped to his body.

It gives his strong views on life and death an added poignancy, each phrase interjected by a breath.

"I could not do what I want. I must be helped to live. Even going to toilet. I was ashamed, shame on my life. I was very confused. But I was conscious.

"If I was still alive I must, I must be helped by others. Until I die. I didn't want to have this life. What can I do. Only euthanasia.

"Because it was my choice. I can decide by myself. Not others. Only thing I can do," he said, reinforcing the view that being given a choice often makes a person feel stronger and want to live longer.

Ah Bun has since received better treatment in hospital, and using a computer - and by moving his eyelids - he has written a book.

In "I Want To Have Euthanasia", he argues that choosing how and when to die is a basic human right.


But he knows the chance of legislative change is almost non-existent.

"Tradition does not allow us to talk about dying. Our tradition is conservative. More than the West. Our society seldom discusses the issue.

Here, life is more a collective thing, we are less individualistic. Your life is part of the family. Even if you want to die, your family would not let you die
Dr Timothy Kwok, Hong Kong geriatrician

"In China, even if they are not Christian, they do not have any religion, they think dying, death, is a natural thing," says Ah Bun.

When Dr Philip Nistchke, Australia's best-known euthanasia advocate, came to Hong Kong recently, the Society for the Promotion of Hospice Care and related groups refused to join discussions with him.

"We support rational discussions on euthanasia in the community," they said in a statement, but added that the emphasis should be on improving palliative care.

Ah Bun's case has helped bring more subsidies and support to other quadriplegics, allowing some to live in the community - just as Ah Bun will do when a public housing flat is found for him.

But many more in poorer Asian societies are not so lucky - the expense of treatment often leads to people dying a slow death.

'Not ready'

Dr Timothy Kwok, a geriatrician who has worked in the UK and Hong Kong, believes there are not enough people pressing for greater openness toward either active or passive euthanasia for a substantial change to take place any time soon.

Highrise residential property in Hong Kong
About 300 people commit suicide a year in Hong Kong

Dr Kwok notes that in Hong Kong, for those who are able-bodied enough to take their own life, there is a surprisingly high suicide rate, about 300 cases a year, with high-rise apartment buildings making jumping easy.

But he says that for those who do not have this option, family structures in Asian societies are much more focused on keeping people alive than they are in the West.

"It's very rare a family would want somebody to die. They would try to preserve life as long as possible," he says.

In his clinical practice he is constantly coming across cases where families will provide daily, detailed care to people who are frail and almost vegetative.

Euthanasia: taking deliberate action, such as an injection, or withdrawing medical treatment to end a person's life
Assisted suicide: providing the means, e.g. medicine, to allow a patient to end their own life

Assisted suicide: Global debate

"Whereas in the UK, people tend to be more willing to let them go, more likely to let go," says Dr Kwok.

This is not because of a less caring society but a difference in perspective, he says.

In the West, there is "a higher respect for individuals' rights and quality of life," he believes. "Whereas here, life is more a collective thing, we are less individualistic. Your life is part of the family. Even if you want to die, your family would not let you die.

"You are part of the family. If you die there's a consequence to your family, to the people around you," says Dr Kwok.

That attitude applies even when the patient would rather end it all.

'Face' and faith

And in Asia, he thinks, people are more concerned about what others might think, the 'face' aspect.

Paradoxically perhaps, doctors suggest from anecdotal evidence that some Christians in Asia are more likely to let their elderly relatives go, or at least the more westernised care-givers are.

Another difference is that many older people in Asia lack the education required to fully debate the issues.

The 40-year old Ah Bun wants the right to choose - but does not want to hurt his parents.

"I never discuss with my family. I think, why can our lives not be decided by ourselves? Life is our property," he says.

But he will spend many more years "facing the ceiling only", before any laws in Asia will give him a choice.

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