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Following is a question by the Hon Mrs Sophie Leung and a reply by the Secretary for Food and Health, Dr York Chow, in the Legislative Council today (June 13):
Question:
In response to the report on Substitute Decision-making and Advance Directives in Relation to Medical Treatment (the Report) released by the Law Reform Commission of Hong Kong in 2006, the Food and Health Bureau published in 2009 a consultation paper on the Introduction of the Concept of Advance Directives in Hong Kong to conduct public consultation on this subject. In this connection, will the Government inform this Council:
(a) given that the aforesaid public consultation was completed in 2010, of the outcome of the consultation; when the consultation report will be published;
(b) given that the Government indicated in its reply to my question in 2009 that no patient admitted to hospitals under the Hospital Authority had shown advance directives to the healthcare professionals in the course of receiving treatment or healthcare services, nor had any of them initiated the making of an advance directive, according to the latest information of the authorities, of the number of patients so far who have shown advance directives to healthcare professionals or made advance directives in the course of receiving treatment or healthcare services; among such advance directives, the number of those which were carried out by the hospitals or doctors; the measures in place to ensure that healthcare professionals understand the concept of advance directives; whether the authorities at present make reference to the model form proposed to be adopted in the report and prepared a form for use by patients; if so, where the form can be obtained; and
(c) since the publication of the report, of the details and progress of the specific work of the authorities in implementing the 12 recommendations made therein?
Reply:
President,
It is imperative to maintain effective communication and establish mutual trust among patients and their family members and healthcare professionals throughout the whole treatment process. In case of conflict between a patient and his/her family members over the treatment recommended by healthcare professionals, a patient's right of self-determination should prevail over the wishes of his/her relatives, and a doctor's professional decision should always be guided by the best interest of the patient.
Under the common law, a patient may, while mentally competent to make decisions, give advance directives to specify that apart from receiving basic and palliative care, he/she chooses not to receive any life-sustaining treatment or any other treatment he/she has specified when he/she is terminally ill, in a state of irreversible coma or in a persistent vegetative state, or to specify the withholding or withdrawal of futile treatment under specific conditions, which merely postpones his/her death.
The concept of advance directives is based on the principle of self-determination by patients, sparing healthcare professionals, the patients' relatives, or both, making difficult healthcare decisions on the patients' behalf, in particular the decisions of withholding or withdrawing life-sustaining treatment. To this end, the Code of Professional Conduct for the Guidance of Registered Medical Practitioners formulated by the Medical Council of Hong Kong has provided guidelines on care for the terminally ill. Where death is imminent, it is the doctor's responsibility to take care that a patient dies with dignity and with as little suffering as possible.
Withholding/withdrawing life-sustaining treatment after taking into account the patient's benefits, wishes of the patient and family, and the principle of futility of treatment for a terminal patient, is legally acceptable and appropriate.
My reply to the various parts of the question is as follows:
(a) and (c) In a report entitled "Substitute Decision-making and Advance Directives in Relation to Medical Treatment" (the Report) published by the Law Reform Commission (LRC) in 2006, LRC put forward 12 recommendations which include introduction of the concept of advance directives in Hong Kong by non-legislative means, as well as development of a guidance note and preparation of a model form of advance directives to assist frontline healthcare professionals in making their judgment as to the applicability of advance directives. Progress of our follow-ups on the 12 recommendations in the Report is set out at Annex.
In general, the Administration shares LRC's views. In Hong Kong, 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. As the making of an advance directive is in fact entirely a personal decision, we must respect individuals' freedom of making personal decisions. At the same time we should promote suitable public education on this subject with care and allow sufficient time and room for healthcare professionals and the public to understand and familiarise themselves with the concept of advance directives, with a view to introducing the concept of advance directives in Hong Kong in a gradual and progressive manner.
To follow up on LRC's recommendations, we briefed the Legislative Council Panel on Health Services on the Administration's position on advance directives on December 8, 2008. In December 2009, we also issued a consultation paper entitled "Introduction of the Concept of Advance Directives in Hong Kong" to seek views of the healthcare sector, legal profession, patient groups, and non-governmental organisations providing healthcare-related services for patients.
At the close of the consultation period on March 22, 2010, we received a total of 52 submissions from organisations and individuals. Most of the submissions showed no objection to introducing the concept of advance directives by non-legislative means in Hong Kong. The Medical Council of Hong Kong indicated that its Ethics Committee would study this subject in greater details and to consider whether guidelines on executing advance directives should be drawn up for reference by healthcare professionals.
Recently the Medical Council of Hong Kong advised the Administration that its Ethics Committee had encountered a lot of difficulties in drafting the guidelines on advance directives, such as ascertaining the validity of an advance directive. The Medical Council of Hong Kong is of the view that a legal framework should be formulated for advance directives to afford protection to both patients and healthcare professionals. In this connection, we will continue to follow up with the Medical Council of Hong Kong on the matter.
On the other hand, the Hospital Authority (HA) had formulated a guidance note and prepared a model form and a set of concise questions and answers on advance directives in July 2010 for reference by its healthcare professionals and the public.
(b) As mentioned above, HA already formulated the guidance note and prepared the model form and the set of concise questions and answers on advance directives in July 2010. Such information is available on the Internet for access by the public. In addition, HA had organised a total of 10 rounds of forums at its Head Office and hospital clusters to enhance the understanding of its healthcare professionals and staff about advance directives.
At present, when discussing the arrangements for terminal care with patients who are suffering from terminal or serious irreversible diseases, HA's healthcare professionals will provide information on advance directives and the model form as necessary for reference by the patients. Nevertheless, HA has not kept statistical data on patients showing their advance directives to HA's healthcare professionals, or requesting HA's healthcare professionals for making or executing their advance directives when the patients were receiving treatment or care in hospitals under HA.
Thank you, President.
Ends/Wednesday, June 13, 2012
Issued at HKT 14:58
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