Medical ethical principles may drive improvement of quality of dying in Hong Kong

Abstract

Population ageing raises concern regarding the quality of end of life care (EOLC), not only for people with cancer but for all dying of end stage chronic diseases, particularly for dementia. Medical ethical principles, legal and cultural factors affect the quality of end of life care. This article discusses how these three factors currently contribute to EOLC in Hong Kong, in the context of differing trajectories of development in China, other Asian countries, and the USA.

EOLC for non cancer patients has only recently been highlighted, where ethical, legal, and cultural issues are being debated. Although there is no statute or case law that directly govern the legal status of advance directives in Hong Kong, a validly made advance directive is generally recognized at common law. However, there is a range of other legal barriers to providing EOLC according to medical ethical principles. There is little discussion among health care providers or the public regarding advance directives, euthanasia, physician assisted suicide, or withdrawal of life support, particularly for those with dementia. It is hoped that a continuing medical ethics discourse regarding EOLC issues may provide momentum to overcome current inertia or avoidance of EOLC issues, such that population aging may not be accompanied by increasingly poor quality of care in the dying process.