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Hong Kong health care and hospitals

Elderly Hongkongers could have more say in end-of-life care under policy address proposal

The Post has learned that the city’s leader could ask for a review of options for elderly or terminally ill residents, including DNRs or requests to die at home

PUBLISHED : Sunday, 08 October, 2017, 12:38pm
UPDATED : Monday, 09 October, 2017, 10:02am

New initiatives to allow Hong Kong’s elderly or terminally ill patients to spend their final moments in a more comfortable way, including the option to die at home, could be made possible by a review promised in the chief executive’s maiden policy address on Wednesday, the Post has learned.

These measures could include giving patients the right to tell medics not to administer potentially damaging emergency treatment such as cardiopulmonary resuscitation (CPR).

For frail patients, especially the elderly, these urgent revival techniques often lead to broken ribs or collapsed lungs.

End-of-life care in Hong Kong severely lacking, doctors warn

Under the Fire Services Ordinance ambulance workers are required to provide prompt medical attention to “resuscitate or sustain” a person who appears to need help.

Dr Lam Ching-choi, chairman of the Elderly Commission, a government advisory, said it had been “actively in talks” with officials to remove such barriers, among other suggestions which aim to enhance the city’s end-of-life care.

He said he hoped the number of unnecessary hospital admissions could be cut by half – from up to five visits for each elderly patient before death – to improve the well-being of patients, as well as ease the strain on overloaded hospitals.

A study on end-of-life care, commissioned by the government and led by former health minister Professor Yeoh Eng-kiong, advised the government to amend the ordinance, removing barriers for ambulance workers to respect advance directives. These refer to non-legally binding documents which state a patient’s wishes for medical care when he or she is terminally ill or in a coma.

“[Paramedics] have a duty to resuscitate,” said Roger Chung Yat-nork, assistant professor from Chinese University’s school of public health and primary care, who took part in the study. The results were submitted to the government in August.

“If a patient has expressed a wish stating ‘do-not-attempt cardiopulmonary resuscitation’, [the ordinance] would be in conflict with the patient’s wish.”

Lam, who is also an Executive Council member, said the Security Bureau is also reviewing the interpretation of the ordinance.

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“We need to see if there are sufficient legal causes to protect ambulance workers from liability if they [do not administer] CPR on patients [who have stated their advance directives],” Lam said.

There is currently no law to back up the execution of a patient’s will regarding end-of-life matters and hospitals may fail to act if there is a dispute over the decision or it is challenged by a patient’s family.

The study suggested introducing legislation regarding advance directives and ensuring wider public awareness of planning ahead for such situations.

As the first step, Lam believed it would be easier to adopt such practices in an elderly care home, while in the long term he believed other legislation may have to be amended or enacted to allow patients an easier option to die outside hospital.

One such example includes relaxing the Coroners Ordinance time frame requirement stating that a medical practitioner must visit a dying patient at home within 14 days before his or her death.

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Both Lam and Chung said they hoped to see Chief Executive Carrie Lam Cheng Yuet-ngor adopt their proposals, but they did not know how many details would be stipulated in her coming address.

“There will be mention of [care services for the dying] in the policy address on Wednesday,” a government source told the Post. A spokeswoman for the Food and Health Bureau did not comment on the matter.

Earlier, Carrie Lam said the government was working to enhance the provision of palliative care, pointing out that Hong Kong was facing an escalating demand in the sector.

Last year, a survey commissioned by the bureau found that more than 60 per cent of Hongkongers who took part in the study wished to sign a document that gave them more control over how they spent their final moments if they were terminally ill.

Some 87 per cent of those polled said they would prefer to receive palliative care that gave them comfort rather than prolonging their life. One-third said they wanted to die at home.