Fasting with Dignity: Choosing How We Leave
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We live in an age where dying well is as important as living well.What preparations shoudl we make in order to live happily,grow old with dignity,and die peacefully?
“I miss my mother,but she would have suffered much more if she had not chosen to die with dignity by fasting. That puts my heart at ease.” These are the words of Biryu Ying, a Taiwanese doctor.
In 2001, Biryu Ying was diagnosed with progressive cerebellar ataxia, a disease that robs a person of bodily control. She asked her family to “help me leave on my own when the time is right,” and 20 years later, that ‘time’ arrived. Unable to eat, use the toilet, or bathe independently, she faced a future of being bedridden and reliant on tubes. She hated that prospect more than death itself, and so she stopped eating. She gradually reduced her intake – from two meals a day to one, then half a meal, and just a sip of lotus root water. Driven by impatience, she even ceased drinking water. She died at home at the age of 83, 21 days after telling her family, “Don’t cry.” her family,having supported her choice to “leave in a hurry,” didn’t strongly discourage her fasting and ultimately,didn’t weep.
This wasn’t simply starvation. Medical staff were present, managing her diet and providing pain relief. Biryuying’s eldest daughter, a Taiwanese rehabilitation medicine doctor, facilitated this farewell. The story is recounted in the book ‘fasting with Dignity,’ translated and published last year. In the medical world, this method of death is known as ‘Voluntarily Stopping Eating and Drinking’ (VSED). VSED is being implemented in some…
Choosing Dignity: A Daughter’s Story of Accompanying Her Mother’s Fast
My mother’s declining health led to a meaningful reduction in her swallowing function, making eating nearly impossible.She resorted to pinching her nose just to manage, a practice she deeply disliked. She believed, as was once common, that ceasing to eat was a natural part of the end-of-life process.Forcing nourishment when the body can no longer digest or absorb it, she argued, only prolongs suffering. “Can you force your family to endure that?” she asked. My mother’s death wasn’t a result of starvation, but a deliberate shortening of her pain, a decision made with the support of her family and medical team. Knowing her time was limited, she prioritized meaningful moments and a peaceful farewell.She also calmly and deliberately organized her final affairs.
Q.If physician-assisted suicide through drug injection etc. had been legal in Taiwan, would the mother’s choice have been different?
Interestingly, in countries like the United States where both options exist, many individuals choose death with dignity through fasting, perceiving drug injection as more inhumane and unnatural. The process of medical assistance in dying can be complex, involving multiple applications, reviews, and potential rejections.Furthermore, seeking this option abroad presents challenges related to language barriers and financial costs. While fasting is also a arduous and prolonged process, it offered a path forward when other options felt inadequate. My activism stems from a desire to highlight the lack of respect for the right to a dignified death.
Q. Wasn’t it painful to watch? I also wonder how this is different from assisting suicide.
The initial stages of the fast brought a surprising clarity and strength to my mother. However, after approximately two weeks, the physical strain became overwhelming. She expressed her frustration, questioning why a quicker exit wasn’t possible. It was profoundly heartbreaking to witness.Yet, she believed, and I came to understand, that experiencing the pain inherent in the dying process is unavoidable. A U.S. survey suggests that the pain associated with a dignified fast rates around a 2 out of 10, while the pain of prolonged, life-sustaining terminal treatment often reaches 8 or 9.
A Doctor’s Choice: Facilitating Dignified Death
A growing movement is challenging conventional medical practices, advocating for the right to refuse life-sustaining treatment and choose a dignified death.Spearheaded by one doctor, this initiative supports individuals wishing to end their lives peacefully, either at home or through fasting, especially when facing incurable conditions.Having assisted approximately 200 people, the doctor acknowledges facing criticism but remains resolute, believing legal reforms will accelerate with increased public awareness.
The core of this practice rests on a re-evaluation of a doctor’s role. While historically focused on preserving life, the doctor argues that alleviating suffering and respecting patient autonomy are equally vital vocations. Questioning the ethics of prolonging pain and the right to dictate another’s self-determination, thay frame death not as a medical failure, but as a natural conclusion. Some colleagues even refer to aggressive interventions like intubation and CPR as “death set punishment,” acknowledging their own reluctance to employ them in certain cases, often citing fear of medical litigation.
This movement raises a critical question: how do we balance “my right to die” with the potential for “your duty to die”? The doctor’s work highlights the need for open conversations about end-of-life care and the importance of ensuring individuals are aware of their rights regarding refusing treatment.
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South Korea Faces Critical doctor Shortage and healthcare System Strain
South Korea is grappling with a severe shortage of doctors, particularly in essential medical fields, leading to increased strain on the healthcare system and concerns about access to timely care. A recent surge in medical school applications, followed by government plans to increase medical school enrollment, has sparked protests from doctors who fear oversupply and a decline in income. This complex situation demands a complete solution to ensure lasting and equitable healthcare for all citizens.
The Growing Doctor Shortage
For years, South Korea has maintained one of the lowest doctor-to-population ratios among developed nations. According to OECD data, South Korea had 2.6 doctors per 1,000 population in 2023, significantly lower than the OECD average of 3.7. This shortage is particularly acute in essential areas like pediatrics, emergency medicine, and surgery, especially in rural areas. the lack of doctors in these critical fields leads to longer wait times, increased workloads for existing physicians, and potential compromises in patient care.
factors Contributing to the Shortage
- Low Doctor-to-Population Ratio: Historically, South Korea has intentionally limited the number of medical school places.
- Uneven Distribution: Doctors tend to concentrate in lucrative specialties and urban areas, leaving rural communities underserved.
- Aging Population: South Korea’s rapidly aging population is increasing the demand for healthcare services. Statista projects a significant increase in the elderly population in the coming decades.
- Burnout and workload: Doctors often face long hours and high levels of stress, contributing to burnout and early retirement.
Government Response and Doctor Protests
In response to the growing crisis, the South Korean government announced plans in February 2024 to increase the number of medical school admissions by 2,000 per year, bringing the total to 10,000. The Hankyoreh reported on the government’s decision and the subsequent backlash. the government argues this increase is crucial to address the doctor shortage and improve healthcare access. However, the Korean Medical Association (KMA) and many doctors strongly oppose the plan, arguing that it will lead to an oversupply of doctors, lower incomes, and a decline in the quality of medical education.
doctors have staged large-scale protests, including walkouts and resignations, disrupting hospital operations and causing significant inconvenience to patients.These protests have raised concerns about the potential impact on public health, particularly during critical times. The government has threatened legal action against doctors participating in the strikes,but the situation remains unresolved as of December 2024.
The Path Forward: Finding a Sustainable Solution
Resolving the doctor shortage and healthcare system strain requires a multifaceted approach that addresses the concerns of both the government and the medical community. Simply increasing medical school admissions is not a panacea.
Key Considerations for a Sustainable Solution:
- Strategic Increase in Admissions: A phased and carefully planned increase in medical school admissions, coupled with investments in infrastructure and faculty, is essential.
- Incentivizing Rural Practice: Financial incentives, improved working conditions, and support for professional advancement can encourage doctors to practice in underserved rural areas.
- Expanding the role of Allied Health Professionals: Empowering nurses, physician assistants, and other allied health professionals can help alleviate the burden on doctors and improve healthcare efficiency.
- addressing Workload and Burnout: Implementing policies to reduce doctors’ workloads, improve work-life balance, and provide mental health support is crucial.
- Fair Compensation and Regulation: Ensuring fair compensation for doctors across all specialties and implementing appropriate regulations to prevent oversupply are important considerations.
Key Takeaways
- South Korea faces a critical shortage of doctors, particularly in essential medical fields.
- The government’s plan to increase medical school admissions has sparked protests from doctors.
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