For Zhu, patients choosing to come and stay in the palliative care center normally already know about their disease and have decided to pass away in a relatively peaceful way. However, medical universities normally attach less importance to the education in this field, and as a result it is hard to get enough well-trained staff and volunteers from colleges often cannot work permanently.

Luo says the lack of palliative treatment training in most of China's medical schools makes it hard to push the concept forward.

"The teachers only try to teach would-be doctors how to save a person's life and not how to help dying patients leave the world in a comfortable and dignified manner," said Luo, whose views are echoed by Xi Xiuming, President of Fuxing Hospital affiliated to Capital Medical University in Beijing.

"The hi-tech aspect of medical science today has largely led to the deconstruction of human nature in the post-industrial era, and medicine has deviated from its original intent to provide of humanistic care and created many ethical dilemmas," Xi said.

Legal powers

"When we talk about death with dignity, people always connect this with euthanasia, which is not the same thing at all," Luo said. "We encourage people to make their own choice on their medical treatment at the end of their lives and euthanasia is only one of the many choices that a patient can decide on."

On June 25, with the permission of Beijing Civil Affairs Bureau, the Beijing Living Will Promotion Association was set up after six years of effort from Luo and Chen Xiaolu. Some key hospitals including Peking Union Medical College Hospital and Fuxing Hospital affiliated to Capital Medical University joined the association as part of a pilot program for promoting living wills.

However, this does not give the association or the living wills of patients any legal power. "If relatives of a dying patient refuse to follow his or her living will, we can't do anything," Luo said.

Xi said that living wills have raised the profile of such discussions and will become vital as the country sees more patients suffering from incurable diseases that need to consider how to spend last days of their lives.

In 2010, Xi started the practice of encouraging dying patients to sign a document allowing doctors to withdraw or withhold medical treatment. More than 10 patients signed the document in 2010.

However, he admitted that besides discussing this topic with a few of his very close friends or patients, his only attempt to promote this concept among a bigger group of cancer patients was met with resistance.

Xi said that there are many complicated situations that have to be considered when promoting living wills.

"When people make their living wills, they are mostly in a relatively healthy condition, but their feelings and decisions might change when they are in a serious condition. What if they want to change their stance but can't express it?" asked Xi.

Luo, however, said that she still feels confident that the concept will be gradually recognized as more and more people pursue a higher quality of life.

"We are not encouraging everybody to give up efforts in prolonging their life or that of their relatives. We are also not encouraging them to give up all medical treatment. Our priority is to give patients the right to choose," Luo said. "No matter what their choice is, we should respect that. We call this dignity."

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