Replies to LegCo questions
LCQ4: Euthanasia
Following is a question by the Hon Chung Kwok-pan and a reply by the Secretary
for Food and Health, Dr Ko Wing-man, in the Legislative Council today (December
14):
Question:
It can be seen for many years patients suffering from terminal illnesses and
their family members expressing the hope that euthanasia may be legally
performed in Hong Kong. Although considerable controversies surround the issue
of euthanasia, several countries have now enacted legislation to permit the
performance of euthanasia under certain circumstances. In this connection, will
the Government inform this Council:
(1) whether it knows the number of patients requesting for euthanasia in each of
the past three years, with a breakdown by the illness suffered by and the age of
the patients;
(2) of the support currently provided by the Government to patients suffering
from terminal illnesses, and whether it will enhance the relevant support; and
(3) of the Government's justifications for refusing to permit the performance of
euthanasia on patients; whether it will study the enactment of legislation to
permit euthanasia so as to relieve the constant pain and suffering of patients
with special circumstances or terminal illnesses; if it will not, of the reasons
for that?
Reply:
President,
Euthanasia is a highly complex and controversial issue involving implications in
various dimensions including medical, social, moral, ethical, legal, etc. Any
subject matters concerning life must be dealt with care.
Under the laws of Hong Kong, euthanasia involves a third party's acts of
intentional killing, manslaughter, or aiding, abetting, counselling or procuring
the suicide of another, or an attempt by another to commit suicide. These are
unlawful acts, possibly liable to criminal offence(s) under the Offences Against
the Person Ordinance. The Code of Professional Conduct for the Guidance of
Registered Medical Practitioners (Code) has made it clear that euthanasia is
"illegal and unethical".
My reply to the various parts of the question is as follows:
(1) The Hospital Authority (HA) does not compile statistics on the number of
patients wishing for euthanasia.
(2) Upholding the principle of "providing holistic care for patients", the HA
offers appropriate comprehensive services to terminally ill patients and their
families in an integrated service mode through palliative care teams comprising
doctors, nurses, medical social workers, clinical psychologists,
physiotherapists and occupational therapists. At present, all seven clusters of
the HA provide palliative care services for terminally ill patients, including
in-patient service, out-patient service, day care service, home care service,
bereavement counselling, etc. Since 2010-11, the HA has extended the targets of
its palliative care services from mainly cancer patients to patients with other
end-stage organ failure.
Palliative care in-patient services are mainly provided for terminally ill
patients with severe symptoms and multiple needs. The HA uses drugs and other
supportive therapies to reduce the patients' physical pain and discomfort, so as
to help them spend the final stage of life in peace and with dignity. Public
hospitals of the HA offer a total of over 360 palliative care beds. Terminally
ill patients admitted to other specialties and in need of palliative care
services can also receive palliative treatment.
The HA will also arrange palliative care out-patient services for discharged
patients in need to follow up on their conditions. At the same time, the HA has
set up various Palliative Day Care Centres to strengthen the emotional and
psychosocial support for patients and their families.
We understand that some terminally ill patients may wish to stay with their
families in a familiar environment until their passing away. The HA will respect
patients' will and provide support, including palliative care services and home
visits, as appropriate for discharged patients in need in the light of
individual circumstances.
We have all along been committed to enhancing palliative care services and has
continued to improve its service delivery model and strengthen the provision of
multi-disciplinary services over the years. Since 2015-16, the HA, in
collaboration with residential care homes for the elderly (RCHEs), has
strengthened the service of the Community Geriatric Assessment Team in phases to
provide better support for terminally ill residents living in RCHEs to improve
the quality of care.
Besides, the HA communicates with patient self-help groups on a regular basis to
understand their needs.
We will continue to review the demands for various medical services and plan its
services according to factors such as population growth and changes, advancement
of medical technology and healthcare manpower. Improvements will also be made
while ensuring efficient use of resources.
On the other hand, in 2015, the Food and Health Bureau commissioned the Chinese
University of Hong Kong to conduct a three-year research study on the quality of
healthcare services for the ageing. With the aim of enhancing healthcare
services for the elderly population, the study will help the Government set its
long-term development direction of healthcare services in response to the
challenges of an ageing population, including services for elderly people with
chronic diseases and end-of-life care.
(3) Paragraph 34 of the Code provides 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. A terminally
ill patient's right to adequate symptom control should be respected. This
includes problems arising from physical, emotional, social and spiritual
aspects.
According to paragraph 34.2 of the Code, euthanasia is defined as "direct
intentional killing of a person as part of the medical care being offered". The
Code clearly states that euthanasia is illegal and unethical.
In Hong Kong, there may be occasional cases of terminally ill patients
requesting euthanasia when their physical and mental pain goes unmanaged.
However, most of these patients will change their mind and give up their
requests when their pain is under control after receiving suitable palliative
care treatment. We should therefore look for ways to improve our palliative care
services for terminally ill patients who are in both physical and mental pain,
so that more of them can receive suitable treatment, instead of considering how
to implement the so-called euthanasia.
According to our understanding, euthanasia is currently not allowed in the vast
majority of countries and areas in the world. Only a very small number of
countries (e.g. the Netherlands, Belgium and Luxembourg) allow euthanasia to be
conducted under statutory regulation. Switzerland, Canada and a minority number
of states in the United States (e.g. the states of Oregon, Washington, Vermont,
California, etc.) allow doctors to assist terminally ill patients in committing
suicide under statutory regulation, while maintaining euthanasia as an illegal
act. The Government has no plans to carry out any study or consultation on the
issue of legalising euthanasia for the time being.
Under common law, a patient may, while mentally competent to make decisions,
give an advance directive to specify that apart from basic and palliative care,
he chooses not to receive any life-sustaining treatment or any other specified
treatment when he 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 which merely postpones his death under specific conditions.
This is not equivalent to euthanasia.
The Advance Care Planning allows healthcare staff of the HA to discuss with
terminally ill patients and their families, in the best interest of the
patients, the withholding or withdrawal of futile treatment which merely
postpones death. A patient can also sign an advance directive to specify that
when he is terminally ill, in a state of irreversible coma or in a persistent
vegetative state, or under other specific circumstances, he chooses not to
receive any futile life-sustaining treatment and wishes to pass away peacefully.
The HA has formulated guidelines on advance directives and the Advance Care
Planning.
Thank you, President.
Ends/Wednesday, December 14, 2016
Issued at HKT 16:30
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