網上版請按此
A pressing need to improve quality of death in Hong Kong
Discussion about the issue of terminal care and our own mortality is seen as a taboo among Chinese. But with increasing ageing population, we need to look into the matter more liberally.
Though having four times higher than the global average in per capita income, Hong Kong has lagged behind in handling our mortality. According to the 2015 Quality of Death Index published by The Economist, Hong Kong ranked 22nd among 80 countries and communities in the world in this aspect.
One of the unsatisfactory issues is where to spend our last days of life.
The media once quoted 70-year-old Dr Yeoh Eng-kiong, former Secretary for Health, Welfare and Food: "When I pass away, I want to be at home ... you know how crowded a hospital is...". This echoes a study carried out by The Economist and Kaiser Family Foundation, an American think tank, aiming to find out where people around the world want to spend the last days of their lives. More than half of the 4,000 or more respondents from Japan, the United States, Brazil and Italy also wanted to stay at home when they are dying.
However, to pass away at home in Hong Kong actually poses a lot of problems. Prof Joseph Lee Kok-long, member of the Legislative Council representing health service sector, pointed out that less than 3% of the patients participated in the Home End-of-Life Care Programme of which the original idea was to enable elderly patients suffering from chronic diseases to choose to stay at home to enjoy a peaceful time during the last days of their lives.
The reason behind the low take-up rate is that many people "worried about handling the official procedures" when death does not occur in a hospital, according to Prof Lee. In addition, people may worry that the spirit of the dead would attach to his home, turning the property into a "haunted house" and thus affecting the price of the property.
On the other hand, with an ageing population, chronic diseases such as dementia is becoming increasingly common in Hong Kong – according to government information, where death caused by such as cerebrovascular disease and chronic lower respiratory disease have been declining from 2001 to 2016, people with dementia who eventually pass away increased from 2.6 per 100,000 people to almost five times today. People with dementia could endure for 10 to 15 years before their last day, and would therefore pose a heavy burden to the caregivers.
A study by the Stanford University found that caregivers suffer from great mental stress, irritability, guilt, and so on, and they are more likely to have depression and suffer from illness. As a result, they may die earlier than the patient – 4% of dementia caregivers are in such case.
The recent family tragedy in Yiu Tung Estate, Shau Kei Wan earlier in which an 80-year-old man being unable to bear his wife's torture after stroke strangled her may just be the tip of an iceberg.
While Taiwan ranked 6th globally and 1st in Asia in the Quality of Death Index, Hong Kong needs to catch up, no matter in regulations, hospice care, advance directives, life and death education, etc.
On the other hand, Information Technology can help – telehealth can reduce the fatigue of both patients and caregivers, big data analysis helps predict the development of the disease; sensor network at home can safeguard the patient, in case no motion is detected in the bathroom or kitchen for say half an hour, a signal would be sent out to alert the relevant parties. Moreover, a Partnership among the Public (the government), the Private (corporations and civic associations) and the People (friends and relatives) or "4P" could be formed to help improve the life of patients and caregivers.
When facing our own mortality, everyone is a novice, so we need to have more discussions. We came to this world surrounded by love, we want to pass away with dignity and peace. This is the essence of a people-oriented smart city.
Dr. Winnie Tang
Honorary Professor, Department of Computer Science, The University of Hong Kong