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The End of Life Care from the Perspectives of Asian Bioethics

Abstract

The aging population is a new reality in the world.  Asian countries are facing the question of how to take care of their senile citizens who, when younger, used to  contributing a lot to society yet now needing much medical attention consuming a growing portion of health care budget. How to extend a care to these growing numbers of citizens is a new social issue.

This paper will first give a brief discussion of the substance of Asian bioethics and then use a new legislation adopted in Taiwan on Dec 18, 2015 as an example to discuss the end of life care ethics from the perspectives of Asian bioethics. This act, named Patient Self-determination Act, allows patients to say no to life sustaining treatments. This act is a revised version of Taiwan’s original Palliative Care Act adopted in July, 2000.

Humanization and harmonization are the two main emphases of Asian bioethics. These two characters reflect the social ethos of those societies that somehow are influenced by the teaching of Confucianism and Taoism, such as Korea, Japan, China, Singapore, Vietnam, Hong Kong and Taiwan.

Humanization is a process whereby all are treated with kindness and compassion and harmonization refers to a mutually respected interaction among people. With these two teachings in mind, the care of the elderly or the dying has to be based on the bioethical principles of autonomy and beneficence.

The bioethical principle of autonomy is not a familiar theme to Asian. Asians emphasize a virtue of respect toward the elderly. If the elderly has any preference, the younger will always try to fulfill it as an expression of filial piety. Is it an expression of humanization and harmonization?  How do we apply these two characters to the care of the elderly or the dying in Asia ?

The new legislation in Taiwan, a first in Asia, allows patients to refuse treatment if they suffer with the following conditions : terminally ill, irreversible comatose, severely mentally incapacitated, untreatable and suffering unbearable pain. As long as the patient has willed the request not to be treated, this wish will be respected. Is this act ethically viable? Does it reflect the Asian ethical characters of humanization and harmonization? At the end, this paper will discuss how should we treat the diseased aging elderly with respect that is really humanized and harmonized.

Dr.Tai is a chair professor of medical humanities and bioethics at the Chungshan Medical University in Taiwan. Dr. Tai received his Ph.D. from Concordia University in Montreal, Canada. He has taught at Concordia University, Montreal, University of Saskatchewan, Saskatoon, Canada and King College, Tennessee, USA for many years before returning to his birth country Taiwan in 1997.  Since then, he has served as the dean of the College of Medical Humanities and Social Sciences, dean of the Faculty of General Education, chairman of the Institute of Medical Sociology and Social Work of Chungshan Medical University where he has been appointed as the university chair profession since 2013.

Dr.Tai has been elected the president of International Society for Clinical Bioethics from 2006 to 2010 and has served on the editorial board of Journal of Medical Ethics ( London, UK), Journal of Medicine and Philosophy ( China), Journal of Medical Education ( Tawan), Tzuchi Journal of Medicine (Taiwan) and is an advisor to the European Journal of Bioethics (Croatia). Currently, he is the chief editor of the Formosan Journal of Medical Humanities (Taiwan). Dr.Tai plays a very important role on Taiwan’s national Biobanking project serving on IRB and EGC and is also the convener of the section of Education and International Relation of Taiwan Biobank EGC. He is also a member of the Committee of Medical Affairs on New Medical Technology, Committee on professional Conduct… etc of the Ministry of Health and Welfares, Taiwan.

Dr.Tai has published many books and articles. Among them are Way of Asian Bioethics ( Princeton International, Taiwan), In Search of Justice ( Griffin, Canada), The Medical Ethics on Life and Death ( Health World, Taiwan) and a frequent speakers at the various international conferences.