On the 6th of June, an elderly Hong Kong man was arrested on suspicion of killing his chronically ill and disabled wife. The suspect, Kwok-Man Wong – an 80-year-old retiree – was the sole caretaker of his 76-year-old wife Mei-Kam Lam after she suffered from a stroke three years ago, and their only son passed away a year back.

“Half of her body was paralysed. My brother gave her massages, cooked for her and bathed her,” Wong’s younger brother said.

Due to Lam’s declining health condition, the increasing burden became too much for Wong – who eventually decided to strangle his wife to death in the morning before turning himself in to the police.

Following the incident, the issue of euthanasia is once again brought to light within the Hong Kong mass media. Legislator Fernando Cheung Chiu-hung described it as “domestic violence that was probably caused by insufficient support.” Meanwhile, social welfare sector lawmaker Shiu Ka-chun criticised the government for not providing sufficient support and resources to struggling families.

Which ‘definition’ of euthanasia is the public referring to?

Euthanasia has always been a heated topic of debate and contention – not just in Hong Kong; but, all around the world. With a growing ageing population, the topic is once again gaining traction as more and more individuals struggle with difficult end-of-life decisions. While various definitions exist, euthanasia is widely defined in the medical field as the intentional killing of a patient – by act or omission – as part of the medical care.

Furthermore, the definition of euthanasia can be further expanded to its various categories as follows:-

1. Active euthanasia – a direct act of killing
2. Passive euthanasia – omission of treatment
3. Voluntary euthanasia – carried out at the voluntary request of the patient
4. Non-voluntary euthanasia – carried out where the patient is unable to or did not request to be killed
5. Involuntary euthanasia – carried out against the wishes of the patient

Amongst these categories, the most commonly referred to form of euthanasia is “voluntary active euthanasia” when discussed from a medical and legal standpoint. Meanwhile, “passive euthanasia” remains as a more confusing issue where it is legal in most countries as standard medical practice; nonetheless, the line that it draws can often be rather hazy, leading to several ethical issues. For example, forgoing cardiopulmonary resuscitation (CPR) in a dying patient is clear-cut; while, ceasing ventilator support for a paralysed patient is not, and it often raises many controversial issues.

The debate in legalising active voluntary euthanasia

With the exception of passive euthanasia, all other practices of euthanasia are illegal in Hong Kong. Even then, passive euthanasia has to be carried out under strict rules and in appropriate circumstances via the forgoing of life-sustaining treatment (LST). Only when forgoing LST is the wish of the patient (mentally competent and informed) and where treatment is considered futile – may the process be carried out. That being said, the situation is not always as simple as it seems because patients are often not of sound mind, and their decisions and that of their family members may differ.

Nevertheless, there are countries around the world that legalise euthanasia – namely, Netherland, Belgium and Luxembourg, where active voluntary euthanasia has been legalised since 2002, 2002 and 2009, respectively. There are always two sides when it comes to a debate and the same can be said about the reasons for supporting the legalisation of euthanasia. These include:-

1. Respecting the patient’s decision to relieve suffering
2. In situations where treatment is futile, active euthanasia is the best last resort
3. The value of human life is duly respected if euthanasia is carried out voluntarily and as a last resort
4. Denying euthanasia to patient who cannot physically commit it is seen as unfair and deprivation of the patient’s rights

Meanwhile, reasons which refute the legalisation of euthanasia stand on the grounds of maintaining the values of life from a societal view. These reasons include:-

1. Modern medicine and palliative care has improved a great deal and is now able to relief a great majority of symptoms
2. Licensing killing in non-war situations will have long lasting societal impacts
3. Vulnerable populations would be pressured into carrying out euthanasia as they are deemed unneeded by society
4. Forming a negative implications towards medical resource allocation
5. The “slippery slope” conundrum where legalisation would lead to abuse and acceptance of non-voluntary active euthanasia

Moreover, under the laws of Hong Kong, euthanasia which involves the intentional killing of another individual or an attempt to commit suicide is a criminal offence under the Offences Against the Person Ordinance. While, the Code of Professional Conduct for the Guidance of Registered Medical Practitioners makes it clear that euthanasia is “illegal and unethical”.

Hong Kong lacking quality end-of-life care

Moving forward from this incident, the government has reaffirmed its cause to provide palliative care for terminally ill patients, and emphasised it has no plans to legalise euthanasia or organise any public consultations on the topic. Instead of legalising euthanasia, the government claims they aim to provide holistic care of patients with multi-disciplinary teams comprising of doctors, nurses, medical social workers, clinical psychologists, physiotherapists and occupational therapists.

In an effort to improve its coverage, the Hong Kong government has expanded palliative care services to patients with end-stage organ failure since 2010 – 2011. Since 2015 – 2016, the hospital authorities have begun collaborating with residential care homes for the elderly to strengthen and support the care for terminally ill patients. In addition, although the legal status of Advance Directives is yet to be established – Advanced Care Planning is now becoming more accessible with formulated guidelines, allowing patients and their families to plan the forgoing of LST in the event of futile life-sustaining treatment and in respect of the patient’s wishes to pass away peacefully. All of this is with the main aim of providing patients with a peaceful way of living out the final days of their lives in dignity.

Despite all these efforts, access to palliative care still remains to be an issue where a long queue of applicants for home care services results in one to two years of waiting time. This issue is compounded by the fact that vulnerable populations often do not have the means or knowledge of such healthcare services. With only 21 palliative care specialists in the city, Hong Kong is at a severely understaffed and undertrained situation to handle the countries ageing population. While the government has put forth positive initiatives, the manpower is unfortunately not adequate. This matter is exacerbated further by the fact that there is no private market for palliative care as it is not profitable.

“Services are there, but not adequate. We don’t have thorough planning now,” remarked Hospital Authority chairman Professor John Chi-Yan Leong, perfectly echoing the situation that Hong Kong is facing in light of its growing ageing population. MIMS

Read more:
Palliative care: An option outside hospitals
Palliative and hospice care in Hong Kong: The struggle between longevity and quality of life
When the final journey begins: of challenges
End-of-life issues should be openly addressed