Pamela TinandQueenie Li

Opinion | For Hong Kong’s elderly to die with dignity, much better end-of-life care is needed

The government’s proposals to improve end-of-life care, such as allowing for dying at home, is only the first step. Better public education and a greater provision of options, particularly in the community, are needed to relieve the burden on public hospitals

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Nearly 90 per cent of people surveyed said they would want to spend their final days in the familiar surroundings of their community. Photo: Dickson Lee

Pamela TinandQueenie Li

Published: 1:00pm, 12 Jan 2020Updated: 1:00pm, 12 Jan 2020

Longevity is a blessing if there is quality of life and dignity. Hongkongers enjoy an average life expectancy of 85 years, the highest in the world according to the World Bank, better than in Japan and Sweden. But, with the proportion of chronic diseases rising by age group, how Hong Kong achieves active ageing and dignified death is particularly pertinent.

The World Health Organisation defines palliative care as the relief from pain and the care and support of patients and their families facing life-threatening illnesses, and which includes psychological, social and spiritual support. End-of-life care integrates palliative care and social welfare services within the last years of life.

Both concepts prioritise the quality of life for patients and their families, putting them in conflict with Hong Kong’s treatment-centric care model. This ideological mismatch, coupled with severe resource constraints in our public health care system and fragmented medical-social services, impede the development of palliative and end-of-life care services in Hong Kong. There is much to be done to improve end-of-life care, and to banish headlines of suicides by chronic patients and carers due to stress and inadequate support.

While the government’s latest public consultation on advance directives and dying-in-place is a good step forwards, it is woefully inadequate given Hong Kong’s overburdened public health care system, and there is an urgent need to explore practical service models that better meet policy ideals.

Our Hong Kong Foundation therefore commissioned the Hong Kong Institute of Asia-Pacific Studies at the Chinese University of Hong Kong to conduct a poll on the public’s knowledge and experience of end-of-life care in community settings.

The results showed that most citizens have a poor knowledge of end-of-life care. Over half have little confidence in handling such issues, and only one in five is aware of related services in community settings. Most are unfamiliar with what end-of-life care involves, except for funeral assistance.