Editorial | Welcome proposal on end-of-life directives in Hong Kong
- Change is long overdue in legally recognising the final wishes of Hong Kong patients on whether to accept life-sustaining medical treatments
Planning is an essential life skill, but relatively few people prepare for the inevitable stage of death. Fear and taboos often prevent early discussions about advance medical directives, which allow a dying patient to specify treatments they want or refuse. But legal obstacles arise when documents are disputed by the families of those concerned. In Hong Kong, such instructions are only legally binding based on the general requirement of patients’ consent for medical treatment under common law.
So it is good that health authorities have taken steps to give terminally ill patients more legal power. A proposal submitted to lawmakers for approval last Wednesday would give statutory backing to directives about resuscitation or other life-sustaining medical treatments at the final stage. Decisions to not receive such care would also need to be respected by paramedics outside hospital settings.
Such change is long overdue, having been raised at a public consultation in 2019 and set aside during the pandemic. Although Hong Kong may lag other places, advance directives have become more common since the Hospital Authority issued guidelines aligned with a Law Reform Commission recommendation. The number of people signing documents rejecting cardiopulmonary resuscitation climbed from 325 in 2013 to 1,742 in 2021.
Our fast ageing society and overburdened public healthcare system also underscore a need to address the issue. By 2066, one in three people will be aged 65 or above, and the annual number of deaths is projected to hit 98,000. The current default option for terminally ill patients is to go to hospital, where about 96 per cent of deaths occur.
There is a need to raise awareness and acceptance of advance directives as well as safeguards to ensure patients are making informed decisions and understand the consequences of their decisions. Care homes must also prepare for more patients wanting to spend their final days in the community rather than hospital.
Clarifying the law seems sensible as a way to support those who plan ahead for as much quality of life as possible and a final journey with dignity.