Title: End-of-life choices ?????
1End-of-life choices?????
2- 70???,????,????
- ??????
- ??????????
- ?????????
- ????
- ???????????,???????????
3Why should we not vote at this stage?
- What do you mean when you say euthanasia?
4To 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?
5Which option is classified as euthanasia?
- Euthanasia could be defined narrowly or broadly
6- Medical and legal field narrow definitions
7Medical 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
8One says Euthanasia is legalized in the
Netherlands and Belgium
- The term refers to voluntary active euthanasia
9In public debates and in bioethics literature
- forgoing life-sustaining treatment (LST) is often
considered as one form of euthanasia, labeled as
passive euthanasia
10Problems
- 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
11To 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
12Forgoing 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
13- It would not help public discussion to lump all
these together under the label of euthanasia
14- 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.
15Loose usage of the Chinese term???
- sometimes used to describe the state of the dying
process or even palliative or hospice care
16- 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.
17- This confusion is totally unnecessary and should
be avoided.
18To 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?
19Forgoing (??) life-sustaining treatment(??????)
- Life-sustaining treatment (LST) refers to all
treatments that have the potential to postpone
the patients death.
20Appropriate 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
21Determination 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.
22- The decision-making process in most cases is thus
a consensus building process between the
healthcare team and the patient and family.
23- 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.
24Hospital 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.
25Sometimes, 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.
26Special 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.
27Must 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.
28