PUBLISHED : Saturday, 11 July, 2009, 12:00am
UPDATED : Saturday, 11 July, 2009, 12:00am

End-of-life care needs overhaul in Hong Kong

Only a century ago, death often followed the onset of an illness or injury that, with modern medicine, is no longer life-threatening. Life expectancy for men and women in Hong Kong has increased to 79 and 85, respectively. This has prompted discussions about the right of people to live the way they want until their death.

For a patient in the United States with an advanced disease like cancer, stroke or organ failure, their last year, on average, consumes about 30 per cent of that person's lifetime expenditure on medicare. People in this advanced stage will have their own set of priorities, such as spiritual concerns, living longer but not suffering unduly and handling unfinished business.

We call this advance-care planning.

On one level, such planning for a terminally ill patient is concerned with legal matters. But in America broader issues are considered, with in-depth discussions between patients, families and health care providers about the goals of care.

Patients may also discuss advance directives, that is, what treatment they wish to have. And they may consider a living will - a document written by an individual still legally capable of asking that he be allowed to die in the event of undue suffering.

In many western countries advance directives have been recognised as an integral part of patient care for more than 20 years. In America, it is mandatory to ask patients admitted to a hospital if they have advance directives.

However, this is not the case in Hong Kong. Patients, family members and some health care professionals still refrain from discussing dying and advance directives.

This lack of communication can cause some patients to receive expensive but unwanted medical treatment prior to death.

Family members and patients may not know that they have the right to participate in the clinical decision-making process. In Chinese culture death is a taboo subject. That attitude and the poor level of public awareness of advanced-care planning may cause a terminal patient needless suffering.

This state of affairs must change and the government has an important role to play.

It must provide training opportunities to health care professionals so they understand the importance of end-of-life care.

This will enhance the quality of care and reduce health care costs for terminally ill patients.

Carmen W. H. Chan, professor; Chair Sek-ying, associate professor; Caroline Y. Y. Chui, assistant professor; Nethersole school of nursing, faculty of medicine, Chinese University of Hong Kong

Simple job requirement

A number of correspondents have replied to Hans Ebert's original letter ('Language rule a bad move', June 16) including the latest one from Klaus-B. Jotz ('English is an official language', July 8).

It seems as if one minor complaint about language requirements has turned into a big debate about what should be the official language of Hong Kong. I believe the whole point of Mr Ebert's letter was actually quite simply complaining about job requirements.

I just have to say that I find it rather petty for someone to whine about such an issue and to feel that himself and his fellow westerners are discriminated against because of the so-called 'language barrier'. They may think they have adequate skills for a certain job and are better candidates than everyone else, but they apparently don't if they lack Chinese skills.

Chinese proficiency is indeed essential for most jobs in Hong Kong, especially now that Hong Kong is part of China, and has been for the last 12 years.

If you do not have the necessary skills for a particular job, that is simply your problem and something you have to deal with, like it or not.

Andrew Nunn, Stanley

A lot of concrete and hot air

Here we go again. The chief executive is determined to pour more concrete along with bucket-loads of public money to make sure his six [new economic] pillars get raised. Doesn't anyone near him speak clearly to him or are they all just 'Yes sir!' advisers?

I thought Hong Kong was a place where the government facilitates what the market wants, not goes out and starts telling the market what some think tank decides it should want and then throws money and promotional blurbs to kick-start it all. I suspect the market has considered all these pillars before and has taken them on as much as it wants and come to its own conclusions as to their suitability.

Facilitation is best provided through good policy and good governance, not by promoting specific industries and egos.

Shane Kelly, Mid-Levels

Time to dim the bright lights

I refer to the letter by Kwok Chun-wing and Wong Kin-fung ('Dream of clean skies for HK', June 29). It is important that there is greater public awareness of the harmful effects of light pollution.

Some residents in areas where light pollution is a problem have difficulty sleeping. This can lead to physical and psychological ill-health.

We need to be able to have a darkened bedroom so that we can get a good night's sleep.

If lights are flickering through the curtains and it is difficult to sleep, then it will affect your performance at work during the day.

People who are deprived of sleep lack energy and cannot perform efficiently.

The government must address this problem.

If we reduce the level of light pollution, then we will have the added bonus of being able to see the night sky again.

Johnny Chiu, Sha Tin

Awards scheme will be incentive

I refer to the letter by Kwok Chun-wing and Wong Kin-fung ('Dream of clean skies for HK', June 29).

I think that the problem of light pollution in Hong Kong has become very serious.

Signboards outside restaurants and spotlights above shops, especially boutiques, illuminate the night sky.

I would suggest that the government passes legislation placing restrictions on businesses and the lights they use.

It could also set up an awards scheme, rewarding those shops that control their use of lights.

I think that recycling is another important issue.

We should follow the example set by Japan, where there is a comprehensive system enabling citizens to recycle their refuse.

If we improve our recycling programmes, less waste will go to landfills and incinerators.

The government and Hong Kong citizens must try harder to improve the city's environment.

Helen Ng, Ma On Shan

Smokers still flout the law

Why is it that, despite the introduction of the new anti-smoking law, some people show not only disregard for the law but complete disrespect for others?

I have been out a few times in the last week alone and have been into more than one place (in major areas, that is, Wan Chai and Lan Kwai Fong) where people continue to puff away and the management turns a blind eye.

This not very encouraging given that Hong Kong is supposed to be Asia's world city, with the locals seemingly the worst offenders.

It seems as if this law will take some getting used to.

Anthony Arrigo, Causeway Bay