End-of-life choices ?????

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End-of-life choices?????

• TSE Chun-Yan
• ???

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• 70???,????,????
• ??????
• ??????????
• ?????????
• ????
• ???????????,???????????

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Why should we not vote at this stage?

• What do you mean when you say euthanasia?

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To relieve the suffering of the patient

• Should we provide good palliative care (????),
  including the provision of strong opioids, e.g.
  morphine?
• Should futile (???) life-sustaining treatment
  (??????) be forgone (??)?
• Should we kill the patient by a lethal injection?

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Which option is classified as euthanasia?

• Euthanasia could be defined narrowly or broadly

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• Medical and legal field narrow definitions

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Medical Council of Hong Kong does not support
euthanasia, which is defined as direct
intentional killing of a person as part of the
medical care being offered

• The term refers to active euthanasia

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One says Euthanasia is legalized in the
Netherlands and Belgium

• The term refers to voluntary active euthanasia

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In public debates and in bioethics literature

• forgoing life-sustaining treatment (LST) is often
  considered as one form of euthanasia, labeled as
  passive euthanasia

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Problems

• forgoing LST is legally acceptable in most parts
  of the world in appropriate situations
• wish of a mentally competent patient
• when the treatment is futile
• active euthanasia is illegal in most parts of the
  world

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To avoid any unnecessary confusing connotations

• the term passive euthanasia is not recommended
  by the medical and legal field
• the term is not used in relevant guidelines and
  legislations

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Forgoing LST is itself a complex ethical issue,
and what constitutes futility is not easy to
define

• non-controversial forgoing cardiopulmonary
  resuscitation in a terminally ill
• controversial withdrawal of ventilator support
  in a conscious quadriplegic patient

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• It would not help public discussion to lump all
  these together under the label of euthanasia

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• Forgoing futile LST is a necessary sequel of
  advancement of medical technology.
• Acceptance of forgoing futile LST does not
  necessarily lead to the acceptance of euthanasia.

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Loose usage of the Chinese term???

• sometimes used to describe the state of the dying
  process or even palliative or hospice care

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• Such a loose usage of the term euthanasia or ???
  leads to difficulties in public discussion.
• Public opinion in support of euthanasia may
  actually include support for forgoing futile
  life-sustaining treatment and support for
  palliative care.

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• This confusion is totally unnecessary and should
  be avoided.

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To relieve the suffering of the patient

• Should we provide good palliative care (????),
  including the provision of strong opioids, e.g.
  morphine?
• Should futile (???) life-sustaining treatment
  (??????) be forgone (??)?
• Should we kill the patient by a lethal injection?

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Forgoing (??) life-sustaining treatment(??????)

• Life-sustaining treatment (LST) refers to all
  treatments that have the potential to postpone
  the patients death.

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Appropriate to withhold (???) or withdraw (??)
LST

• When it is the wish of a mentally competent
  patient principle of autonomy
• When the treatment is futile (???) principles of
  beneficence and non-maleficence

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Determination of futility

• balancing the burdens and benefits of the
  treatment towards the patient, and asking whether
  the treatment is in the best interests of the
  patient.
• involves quality of life considerations and can
  be value-laden.

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• The decision-making process in most cases is thus
  a consensus building process between the
  healthcare team and the patient and family.

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• Forgoing futile LST implies the acceptance of the
  fact that human is mortal.
• This is medically and legally distinct from
  euthanasia.
• Many medically advanced countries in the world
  have issued guidelines on this.

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Hospital Authority guidelines of 2002 If the
patient is not mentally competent

• Medical decisions are based on the best interests
  of the patient.
• A decision on futility of LST involves consensus
  building between the healthcare team and the
  family if possible.

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Sometimes, such decisions are difficult
especially if the prior view of the patient is
not known.

• In the recent years, the concepts of advance
  care planning ?????? and advance directives
  ?????? are promoted in various parts of the world.

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Special points

• There are no legal or necessary morally relevant
  differences between withdrawing and withholding
  LST.
• The withdrawal of artificial nutrition and
  hydration is controversial except when death is
  imminent and inevitable, or it is the wish of a
  mentally competent patient.

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Must remember

• Forgoing LST in appropriate circumstances does
  not at all mean abandoning the patient.
• Basic care, symptom control, care and concern
  should always be offered.

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• Thank you!