Majority of Hongkongers willing to sign document setting out end-of-life treatment, survey finds

Academic says government needs to enact legislation to back up such documents

PUBLISHED : Saturday, 01 October, 2016, 5:02pm
UPDATED : Sunday, 02 October, 2016, 1:24am

More than 60 per cent of Hongkongers wish to sign a document that gives more control on how they spend their final moments when they are terminally ill, the city’s first territory-wide end-of-life survey has found.

The findings are set to reignite the debate on whether the government should enact a law to ensure a patient’s will to die peacefully will be respected by his or her family and doctor.

Patients can sign a document called advance directives under the supervision of a doctor if they do not want to receive emergency procedures like cardiopulmonary resuscitation and tube feeding.

There is currently no law to back up the execution of a patient’s will. Hospitals may fail to execute it if there is a dispute over the decision or it is challenged by a patient’s family.

“We would urge the government to legislate [advance directives] ... Our phone survey indicates that many people would want to have it if they know what it is,” said Roger Chung Yat-nork, assistant professor at Chinese University’s school of public health and primary care who led the survey.

Among the 1,067 adults aged 30 or older interviewed over the phone from April to June this year, over 60 per cent said they would sign the document if it was backed up by legislation. About 74 per cent agreed the document was a “good approach” for people with incurable diseases.

The survey also found 87 per cent of people preferred receiving palliative care giving them comfort rather than prolonging their life. One-third said they wanted to die at home.

The survey is part of a study commissioned by the Food and Health Bureau on elderly care, which is spearheaded by former health minister Professor Yeoh Eng-kiong.

A full report of the study, ready in a year, will recommend ways that the government can improve health care services for the elderly.

Singapore – the city’s long-time rival – passed the Advance Medical Directive Act in 1996 to give better protection to people who have signed the document.

End-of-life planning may be easier than we thought

Carmen Yau, who has been suffering from spinal muscular atrophy – an incurable neuromuscular disorder – signed the document in May this year. She declared she did not want a hole to be opened so she could breathe or the insertion of a feeding tube if her condition became irreversible.

“I don’t want to suffer and get [artificially] ventilated for 24 hours ... That is not the quality of life I want,” Yau said.

While her parents were shocked at first when she revealed her wish to sign the document, they later supported her idea.

“They felt good when they respected my decision,” she said.

Survey findings showed a possible swing in public opinion as a public consultation held in 2009 found “no clear public support” for the idea. While the Hospital Authority introduced guidelines for doctors on advance directives in 2010, the bureau said there was “no substantial change” in public attitude towards legislation.

Dr Michael Sham Mau-kwong, a specialist in palliative medicine, agreed the city needed legislation in the long run because of some grey areas.

He said, for example, doctors could be in a difficult position if a patient, who previously declared he did not want to receive a blood transfusion if he fell into a coma, became unconscious after a car accident and needed extra blood to continue living.

“There is still a need for lots of discussion as doctors are always concerned about the best interests of patients,” said Sham.

But he said there should first be more public education and debate.

“Many people might not be able to imagine the exact condition when they suffer a terminal illness ... Most patients still avoid talking about it.”

Dr Edward Leung Man-fuk, president of the Association of Gerontology, said lawyers and medical workers also needed education on when and in what circumstances the agreement should be signed. For example, a doctor is required to witness the signing and the patient should be conscious without being influenced by any other parties.

A bureau spokesman said the government would promote public discussion on the matter in a “gradual and progressive manner”, adding it would study the university’s recommendations later.