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When a loved one is dying, advance directives matter
It is said that Chiung Yao, the popular Taiwanese romance novelist, had a melodramatic dispute with her stepchildren over putting her husband on life support.
The "tug war of love", as Yao put it, occurred after her husband suffered from severe dementia and serious stroke.
The doctor diagnosed that without intubation, the husband would naturally die in two to three months.
Her husband had also indicated in his will: "When I am dying, please do not send me to the intensive care unit. I do not want any tube and medical equipment to maintain my life... I don't need tracheostomy, electric shock, intubation, nasogastric tube, urinary catheter... Let me pass away peacefully."
However, his children insisted that their father only had dementia, he was not terminally ill, and therefore needed intubation.
In the 2015 Quality of Death Index, published by The Economist, Taiwan ranked first in Asia. In fact, subjects where life and death as well as ethical life are discussed have been part of the school curriculum since 2000 upon the initiative of the island's Ministry of Education.
What's the situation in Hong Kong?
Early in 2006, The Law Reform Commission of Hong Kong submitted a report, Substitute Decision-making and Advance Directives in Relation to Medical Treatment, for consultation.
"Advance directive" (AD) refers to advance decision-making by an individual regarding the health care or medical treatment he wishes to receive at a later stage in his life when he is no longer capable of making such decisions.
It is based on the principle of self-determination by patients, which spares medical staff and family members of making the difficult medical decision of continuing or withdrawing life-sustaining treatment.
The commission recommended that the concept of AD be promoted in a non-legislative manner for public awareness before legislation is considered.
In 2012, Dr. York Chow Yat-Ngok, a former health minister, told the Legislative Council: "Some people still regard it a taboo to discuss the issue of terminal care and death and the public at large are not fully familiar with the concept of advance directives. As such, we agree that it is not the appropriate time to implement advance directives at this stage through any form of legislation."
Without legislation on AD, healthcare workers may fear that they would bear the legal responsibility of not saving life according to instruction.
Dr. Chow also said the Ethics Committee of the Medical Council of Hong Kong had difficulties in formulating the guidelines on AD, including how to determine its validity.
The Medical Council believes that a legal framework should be developed for AD to protect both patients and healthcare workers.
It is now 11 years since the commission made its last consultation. Is this the right time for Hong Kong to move forward on the matter?
The Electronic Health Record Sharing System was officially launched more than a year ago, and it is now in process of being made more comprehensive.
If we can decide an effective AD when we are healthy, and enter it into the system for the healthcare personnel and family members to follow, we can avoid the "tug war of love" among family members when the time comes.
It allows both the dying and the loved ones they are leaving behind to have peace of mind.
Dr. Winnie Tang
Honorary Professor, Department of Computer Science, The University of Hong Kong