Shenzhen has legislated to allow terminally ill patients to refuse treatments that will extend or save their lives in accordance to their living wills, becoming the first city in China to pass such a local law.
The legislative breakthrough, among other new rules, is among the newly revised Medical Regulations of Shenzhen Special Economic Zone, which were recently passed by the city’s legislature. The new regulations will go into force Jan. 1, 2023.
As per the new legislation, medical institutions should respect patients’ living wills when carrying out medical treatments for those who are terminally ill or near the end of life.
However, a living will is not an instrument of euthanasia, but an advanced request to doctors that specifies a patient’s medical care preferences, which include whether to adopt traumatic rescue measures such as intubation and cardiopulmonary resuscitation, use life support systems, and carry out extended therapies.
Wang Yue, deputy dean of the School of Health Humanities at Peking University, said making a living will is an important part of hospice care, which gives dying patients an independent decision-making right.
“It neither accelerates nor delays death, and the decision is made when the patient is conscious,” Wang said.
“The premise of enforcing a living will is that the patient is 'terminally ill or at the end of life,' which must be a professional judgment made by the medical institution,” said Lin Zhengmao, deputy director of the legal work committee of the Standing Committee of the Shenzhen Municipal People’s Congress. He said guidance from health departments is needed for implementation as there are still many details that require improvement.
Additionally, the city’s new medical regulations have also given clinical nurse specialists the right to write prescriptions.
Nurses who have obtained a clinical nurse specialist certificate are allowed to issue examination and treatment application forms and write prescriptions of drugs for external use in specialist clinics or community health service institutions. At present, only doctors can issue prescriptions, and nurses can provide corresponding nursing services only after doctors had prescribed medications in specialist clinics.
Registered medical professionals from Hong Kong and Macao are also allowed to practice in more than one medical institution in Shenzhen and should have permission from their major employer for short-term practice, according to the revised regulations.
At present, doctors from Hong Kong, Macao and Taiwan who practice in Shenzhen are subject to regular assessments, but foreign doctors are not subject to such a requirement.