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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):

     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?


     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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