End-of-life planning may be easier than we thought
Feng Chi-shun says making our wishes clear about the circumstances of our death is sensible, and also not as painful as some might imagine
Not everyone enjoys perfect health in old age, then dies in their sleep. Most of us suffer from some diseases as we age, and die when they become terminal.
Since death is inevitable, it makes sense to be well prepared for it, including thinking through what we want from our doctors in the final stages of our lives.
End-of-life planning is such an important part of health care that US doctors are now being paid by insurance companies to discuss these issues with their patients. These include drawing up directives for all aspects of terminal care, such as tube feeding, cardiac resuscitation, and other aggressive and often costly treatments.
In the US, end-of-life planning has evolved from what's commonly known as the "living will" to a third-generation of legal documents. The most popular third-generation documents are the "Five Wishes", described by admirers as a living will with heart and soul; and "MyDirectives", a mobile application that has the advantage of being paperless and more convenient for updating.
Awareness in Hong Kong of this aspect of patient care - known here as an "advance directive" - is relatively recent. In response to the Law Reform Commission's recommendations in 2006, the Food and Health Bureau published a consultation paper on advanced directives in 2009. While most of the feedback was in favour of the concept, all realised the devil was in the detail.
The Hospital Authority's experience with advanced directives has so far been limited because of poor participation by both patients and doctors, which is understandable. When grandma is in the intensive-care unit, it's more likely for visiting relatives to say to her, "Get well soon", than to ask her, "What do you want us to do if your heart stops beating?"
The correct way to do this is to have an advance directive in place when we are reasonably healthy and of sound mind, rather than rushing it when we are on the verge of death.
Given that death is a taboo subject for most Hongkongers, the government decided it was not the right time to require an advance directive by law.
I did not wait for the government to act; I took matters into my own hands. And it was easier than I thought.
Why agonise over the details when I could simply copy from the best, and for free? I downloaded the Five Wishes template and filled it in. I appointed my executors (wish No 1); named my preferences, if I am critically ill or in coma, for: life-support treatments (2); comfort measures (3); how I want people to treat me (4); and, what I want my loved ones to know (5). Then I signed the document in front of two witnesses. Mission accomplished.
In the US, this document has legal status. In Hong Kong, it may not have, but it will definitely be legally persuasive. I have even gone a step further. Of all the disabilities associated with ageing, the one I dread most is Alzheimer's disease. For me, life with Alzheimer's would not be worth living.
In addition to my five wishes, I have granted my family the power of attorney to carry out euthanasia on me in a country where it is legal (there are quite a few), if I ever become terminally senile.
