More empathy, understanding needed before euthanasia conversation can start in Hong Kong

Patients in need should be informed of all the options they have and get access to professional advice and appropriate services before ending their lives
Seeking to end their life without thorough consideration and adequate support is not really a choice but a compromise

Joyce LiuandPaul Yip

Published: 3:35pm, 27 Sep 2022

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A recent court case of a man killing his terminally ill wife has brought our attention to the debate around euthanasia again. Undoubtedly, no one would want to see such disheartening tragedy happen again. The question is whether euthanasia is really the only way out for these families with seemingly unsolvable suffering. Are there any better options to alleviate their pain?

Many people who support legalising euthanasia, or doctor-assisted suicide, would argue that severely ill patients should have the autonomy to determine their own death. Especially for those suffering from intolerable chronic pain or losing the ability to care for themselves, euthanasia could bring relief and allow them to die with dignity.

Before looking into the possibility of legalising euthanasia, we should try to understand why a person might want to end their life. Most of those who seek death tend to be elderly, whose suicide rate has been the highest among all age groups, with physical health being a major concern.

However, many elderly people have at least one chronic illness. Hence, the presence of physical illness does not necessarily lead to a wish to die.

From some suicide notes, we see not only a person’s suffering and despair but also their fear and worries arising from uncertainty. Fear of progression of diseases could come along with the diagnosis of a terminal illness.

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The patient might also worry about becoming a burden to their family over the potential medical costs, creating trouble for the family members who provide the support and mourning the loss of being able to take care of themselves. In some cases, family members might also feel some guilt from missing the opportunity to care for them.

Therefore, there are two issues that we should focus on: treating their physical pain and reducing their mental suffering. To tackle these concerns, both public hospitals and non-government organisations in Hong Kong provide end-of-life care services.

Palliative care is provided to patients who are suffering from life-limiting conditions, focusing on treating the symptoms. While early identification and medical treatment prevent diseases from worsening, palliative care relieves pain and improves quality of life for those in the last mile.

Unfortunately, public healthcare resources in Hong Kong are scarce and support for our ageing population is inadequate. At the same time, many people are not informed about end-of-life care. Some of them are reluctant to seek help, too.

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In addition, their carers often lack support, and they themselves are under lots of stress from providing the care. The elderly might feel guilty seeing their family getting desperate and frustrated.

Hence, it is vital to raise public awareness and improve the public’s perception of palliative care. It does not mean giving up on the patient but providing the most suitable treatment for their comfort and their dignity.

Patients in need should be informed of all the options they have and get access to professional advice and appropriate services. Seeking to end their life without thorough consideration and adequate support is not really a choice but a compromise.

Besides, there are many practical issues to address before the implementation of end-of-life medical practices. Countries that currently allow euthanasia vary greatly in their regulation and administration. There are many disputes regarding the issue.

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For instance, a 61-year-old man in Canada was recently “put to death”, as his family put it, and the reason listed on his application for euthanasia was “hearing loss”. The family reported the case to police and authorities, arguing it was improper for the hospital staff to process his request as it was beyond his capability to fully understand the process and his suffering was not unbearable.

Self-determination and the autonomy of a patient are highly valued. It is not a sufficient reason for euthanasia, though, especially when it seems to be a compromise rather than a genuine choice.

To build the foundation of a meaningful discussion on euthanasia, we have to make sure adequate healthcare services are available and everyone is well-informed of such services, including palliative care. After all, our ultimate goal is to lessen the suffering and improve the quality of life of terminally ill patients, helping them make the most of their limited time.

Everyone is going to face the inevitable, so let’s handle it with lots of empathy, care and support. Start well and finish well.

Joyce Liu is a project manager at the Hong Kong Jockey Club Centre for Suicide Research and Prevention at the University of Hong Kong

Paul Yip is director of the Hong Kong Jockey Club Centre for Suicide Research and Prevention