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Chinese Nobel Peace Prize-winning dissident Liu Xiaobo is in critical condition and his breathing is failing, the hospital treating him said on Wednesday.
Liu, a prominent participant in the Tiananmen pro-democracy protests of 1989, was jailed for 11 years in 2009 for "inciting subversion of state power" after helping to write a petition known as "Charter 08" calling for sweeping political reforms.
He was recently moved from jail to a hospital to be treated for late-stage liver cancer.
Liu's kidney and liver functions are failing and he suffers from blood clots, among other ailments, the hospital in the city of Shenyang said on its website.
However, Liu's family has declined the use of intubation machinery to help him breathe with the aid of a plastic tube in his windpipe, the hospital said.
"The patient is in a critically ill condition, the hospital is doing all it can to save him, and his family members understand the situation and have given their signatures," it added, without elaborating.
The announcement suggested a significant deterioration in Liu's health since early on Wednesday, when the hospital said he was being treated for worsening liver function, septic shock and organ dysfunction.
Rights groups and Western governments have urged China to allow Liu and his wife, Liu Xia, to leave the country to be treated abroad, as Liu has said he wants.
But the government has warned against interference and has said Liu is being treated by renowned Chinese cancer experts.
Liu's international counsel Jared Genser told Reuters that getting him out of China for treatment was a realistic possibility if approval was granted soon.
"But time is of the essence," he said. "Every moment that passes makes that possibility more difficult.
White House spokeswoman Sarah Sanders repeated a call for Liu to be free to travel abroad for treatment.
"We remain concerned that Mr. Liu and his family are unable to communicate with the outside world and that he is not free to seek the medical treatment of his choosing," she told a regular news briefing.
A White House official said U.S. President Donald Trump raised Liu's case in a July 2 telephone call with Chinese President Xi Jinping, while the U.S. national security adviser, H.R. McMaster, raised it with his Chinese counterpart at the G20 meeting last week.
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John Kamm, of the San Francisco-based Dui Hua Foundation, which promotes prisoners' rights in China, said that based on what he had heard from official and unofficial sources, "I do not think the chance that (Liu) will be allowed to leave China for medical treatment is big".
China's state-backed Global Times tabloid said the "confrontational tone" of those in the West voicing their opinions on Liu failed to focus on his illness.
"China has already taken the feelings of relevant Western forces into consideration, and has no obligation to meet their unreasonable demands," it said.
The government allowed two foreign doctors, from the United States and Germany, to visit Liu on Saturday and they later said they considered it was safe for him to be moved overseas.
After the doctors' Sunday statement, China released short videos of their visit, apparently taken without their knowledge, in which the German doctor appeared to praise the care Liu had received.
'Keep calling'
Hu Jia, a dissident and friend of Liu's, said he was deeply saddened to hear the news of his worsening condition but vowed to do all he could to push for Liu's freedom.
"So long as Liu is still breathing and conscious, we should keep calling for him to be released and go abroad with Liu Xia, even if it is the last thing he does," Hu said.
Taiwan's President Tsai Ing-wen said on Twitter that the self-ruled island, which China claims as its own, called on Beijing to free Liu and Taiwan was willing to provide medical assistance.
Liu's friends voiced suspicion about the hospital's earlier statement, which suggested a worsening of his health soon after two foreign doctors said he was well enough to travel abroad.
"We do not know how reliable these accounts are, or if they mean Liu Xiaobo cannot travel," one family friend told Reuters, declining to be identified because of the sensitivity of the situation.
No one answered the telephone at the hospital's publicity department on Wednesday.
In Hong Kong, about 50 protesters sat outside the Beijing representative office surrounded by placards demanding Liu's release. Some protesters had been there for a third day.
"I feel scared. If we lose Liu Xiaobo, nobody could replace him," said 17-year-old student Anson Hui. "If there's no Liu Xiaobo we can't unite the whole world to speak out ... The world will lose a spiritual leader."
