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32 / Our Community

Though the government proposes that treatment
providers will not incur liabilities for withdrawing treat-
ment from patients in the presence of an advance direc-
tive, family members might be reluctant to let their loved
ones go. These all come down to the cultural and ethical
issues that cannot be regulated and measured.
“Medical professionals won’t mechanically follow
what the directive states. They will keep checking on pa-
tients and take appropriate actions at the request of family
members,” says Lee. He also stresses that communication
with clients is important for medical personnel to resolve
any misunderstandings about the advance directive.
In view of the overloaded medical system, each con-
sultation only lasts for a few minutes. “Healthcare per-
sonnel is unable to map out details of advance directive
even when patients and their families want to learn more
about it,” says Yuen Siu-lam, the chairperson of the Self-
Help Group for the Brain Damaged.

Legislation lacks legal power
The government proposes that the original copy of
advance directive, which may be revoked at any time by
the patient, should be presented to paramedics as proof
of its validity. Otherwise, they will continue to provide
clinically indicated emergency life-sustain-
ing treatment. The requirement causes
inconvenience to elderlies who live Wan Sin-man and her “Body Donation Card”
alone.
“Once they fall into a coma or be- “The problem can be resolved by either
come unconscious, they are unable to removing ‘resuscitate’ from the ordinance
show valid documents to paramedics,” or establishing a new law to reinterpret
says Yuen. He points out that revoca- ‘resuscitate’ so that the ordinance won’t
Yuen Siu-lam tion of the directive adds trouble to override the advance directive,” says Roger
the elderly. He suggests replacing a Chung Yat-nork, associate professor of the
valid advance directive with a QR code on a wristband or Jockey Club School of Public Health and
a necklace that stops the paramedics from doing Cardio- Primary Care. The Mental Health Ordi-
pulmonary Resuscitation (CPR). nance, the only law dealing with mental
Paramedics from the Fire and Service Department health matters in Hong Kong, defines men-
(FSD) carry out CPR and other relevant treatment proce- tal incapacity as “mental disorder” or “men-
dures to resuscitate patients in need of immediate medi- tal handicap”.
cal attention before arriving at hospitals. Then, they con- Chung explains, “a person with mental
vey patients to hospitals for appropriate treatment. illness doesn’t necessarily mean he or she
In the current protocol, doctors also sign the Do-Not- cannot make decision on medical treat-
Attempt Cardiopulmonary Resuscitation (DNACPR) if ments. We should resolve the uncertain-
the patient stated their preferences in their advance di- ties with definitions to make the advance
rectives. But the paramedics may revoke the advance di- directive valid and applicable.” He takes
rective if they deem the patient falls outside the directive. the Mental Capacity Act from the UK as
In other words, the paramedics do not have to follow the an example, “under the Act, the advance
guidelines of DNACPR. This leads to conflicts between directive has legal backing when the per-
patients’ wishes expressed in advance directive and para- son signing it is losing his mental capacity.
medics’ duty to aid the patient.