While answering questions in the legislature recently, Department of Health Minister Yaung Chih-liang (楊志良) said that putting terminally ill cancer patients on ventilators or giving them electric shock defibrillation is a waste of life and medical resources. He talked about the issue from a medical perspective, but there is more to it than that. Since Yaung approached the question from a utilitarian standpoint, testing the public’s reaction by raising the matter of medical resources, the backlash from his political opponents and those who seek to uphold the dignity of life was quite predictable. In the US, President Barack Obama’s push for a national health insurance system faced a similar reaction from Republican opponents, who accused him of pushing to take patients off life support and promoting euthanasia.
When former minister of justice Wang Ching-feng (王清峰) resigned over her opposition to the death penalty, her decision actually resulted in more executions — and more quickly, than would otherwise have been the case. Yaung’s off-the-cuff remarks about the complicated issue of how to treat the terminally ill may likewise produce the opposite effect.
Although Yaung referred to terminal cancer patients, they are not the only ones nearing the end of their life. The case of Liao Feng-teh (廖風德) comes to mind. Liao — President Ma Ying-jeou’s (馬英九) choice for minister of the interior when he won the elections in 2008 — died of heart failure a few days before Ma’s inauguration. Doctors tried for five hours to resuscitate him, despite his having been declared dead on arrival at the hospital. The futility of this drama is another example of how unwilling society and the healthcare system are to break with the notion of the absolute sanctity of life.
Modern medical resources are very expensive and in limited supply. Although medical ethics calls for the just and reasonable distribution of available resources, it is still common for terminal patients to be given emergency treatment, put on life support, injected with tranquilizers to make them sleep, given antibiotics and cardiac stimulants, and put in intensive care units where they are separated from their families and kept alive by any means available. Put simply, the failure of patients to make a living will, their families’ unrealistic expectations and doctors who are unwilling to communicate or don’t do it very well, are all factors that together create such everyday tragedies.
Not many terminal patients want to die, but there are those who feel their lives no longer have any quality or dignity and wish to end their suffering. No advancement in medical technology can improve their predicament. Worse, excessive medical treatment leaves them in the tragic situation of not being able to die with dignity. A number of doctors around the world, including Taiwan, have admitted to supplying patients with lethal doses of sedatives and painkillers, but these are all veiled in secrecy and usually, only family members of doctors have access to this “service.” Physician-assisted suicide is rarely discussed in public. People who wish to die quietly can only do so if they are lucky enough to have the right connections.
Taiwan’s legal system, social structure and healthcare system are still immature. The right to die with dignity requires a lot of knowledge, debate and public effort. If the true face of death remains hidden and if the terminally ill are all given emergency treatment whatever their situation, including needlessly applying extra-corporeal membrane oxygenation and undergoing magnetic resonance imaging, as was done with Liao, the financial pressures forcing up premium rates in the second-generation health insurance scheme will soon bring about an even costlier third-generation scheme.
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