Medical Futility and Palliative Care Gain Momentum in China

In facing the global ageing population and escalating healthcare costs, it is quite fascinating to learn how China, a country with one-fifth of the world’s population, addresses the problems related to end-of-life decision-making in general, and medical futility in particular.

In China, around 160 to 200 million patients are diagnosed with cancer every year, and there are more than 300 million existing cancer patients with an increasing trend of 3% per year. The number of deaths among cancer patients is about 1.4 million per annum. However, it is important to mention that China has improved the health status of their population by using only 1% of the world’s health expenditure, and life expectancy is currently 74 years, one of the best in the world (Ministry of Health 2009). In fact, in almost 60 years, the average life expectancy doubled (from 35 years in 1949 to 74 years in 2011).

In Chinese society, the traditional Chinese view of death, the idea of “cherishing life but dreading death” has influenced the attitudes of the public as well as healthcare professionals about end-of-life decision-making and medical futility. Consequently, in clinical settings, request for prolonging a patient’s life by applying modern medical technology explains how overtreatment is relatively common in China (Shi et al. 2013). However, like some other countries, due to the absence of the terminology of medical futility, futile treatment is dealt with under the issue of hospice care.

In order to provide some empirical data about end-of-life care and decisions about futile treatment in China, Shi Yongxing and his colleagues conducted a study, in which a questionnaire was sent to 950 healthcare providers in 66 medical and healthcare institutions, in eight cities in different provinces, including Beijing and Shanghai.

The questions were designed to gather some demographic data and to cover five aspects of terminal care: ethics and policies in terminal care, as well as social response to terminal care, medical futility, hospice care and finally euthanasia. Of the 904 participants who responded with their view on legislation and policy regarding terminal care, more than 90 per cent said that the “Ministry of Health” should stipulate regulation on end-of-life care, and 81 respondents thought that the “state government” should adopt legislation on terminal care. Of them, almost 79 per cent of the participants believed that a professional standard and code of conduct should be developed for dealing with medical futility. However, 53.2 per cent responded that in the case of medical futility, a joint decision by doctors and the patient’s family was necessary and 46 per cent of the participants believed that the patients should have the right to make their own decisions. Of them, 21.6 per cent thought that family members should make the decisions and only 5.6 per cent believed that physicians can make a unilateral decision regarding futile medicine.

As mentioned, in China, the issue of medical futility is dealt with under the issue of hospice care; however, compared to basic medical care, hospice care is less regulated, and this has a negative impact on futility decisions and patient referrals to hospice care.

Several commentators have mentioned that in China, the lack of regulations in some bioethical issues, i.e. end of life, are challenging to deal with. As Qiu Renzong observes, one of the major features of the bioethical approach in China is “challenging the inadequacies or drawbacks of existing laws, regulations or policies related to bioethical issues” (Qiu 2014).

On 24 and 25 May, the Shanghai Medical Ethics Association, Shanghai Community Health Association, Shanghai Clinical Research Center and Chinese Association for Live Care hosted an international symposium on Ethics in Palliative Care, chaired by Hu Qingli, a member of the Ministry of Health’s ethics committee. The symposium was very well-attended by physicians, nurses, health policymakers and researchers. Participations of several international well-known scholars from China, the United States, Brazil, Canada, Belgium, Iran, Japan and Australia used this event as a platform for an exchange of experiences in dealing with...