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OHKF agrees that a mandatory set of procedures, including a clear indication in written format
(consultation question 9), the presence of witnesses (consultation question 11) and the
involvement of medical professionals (consultation question 12) is essential for making ADs.
These factors are understood to facilitate the decision-making process of individuals, allowing
them sufficient room to thoroughly consider all consequences, reach a consensus with family
members, and ensure the validity of the AD form. Such procedures would safeguard the best
interests of individuals and health professionals, ultimately ensuring that an individual’s end-of-
life will is effectively and fully honoured without misunderstanding or doubt.

The Government’s current proposal is largely aligned with international protocols for making a
legitimate AD. For instance, the National Health Services (NHS) in the UK has specified that to
refuse life-sustaining treatment, an AD must be written and signed by the individual and a
witness (NHS, 2019). We believe that in Hong Kong, the requirement of two witnesses with one
necessarily being a medical practitioner, could provide greater assistance to individuals
especially considering the broadly unfamiliar concept of ADs in Hong Kong today.

Whilst the establishment of certain laws is palpably grounded, there are still practical barriers to
overcome for actual realisation. In recent years, there were roughly 46,000 – 47,000 deaths per
year in Hong Kong (Census and Statistics Department, 2019). Yet, statistics from the Hospital
Authority (HA) showed that public hospitals handled almost 37,000 deaths in 2016/17 (Hospital
Authority, 2017a), a proportion close to 80% of total cases. However, the growth rate of public
hospital doctors lags behind the upsurge in service demand which contributes to the consistent
overburdening of public hospitals. This was reflected in a report published by OHKF earlier this
year on the severe shortage of doctors in Hong Kong’s public hospitals. We reported that our
current ratio of 1.9 doctors for every 1,000 people in Hong Kong is far below the Organisation
for Economic Cooperation and Development (OECD) average of 3.4. In other words, an
addition of approximately 10,000 doctors are needed in our healthcare workforce to catch up
with the norm of other well-developed regions (OHKF, 2019b). Regarding this austere
constraint, the capacity of current staff in public hospitals to discuss ADs with patients and co-
manage end-of-life issues is uncertain.

Further reiterating the limited capacity of hospitals to handle matters related to EoLC, current
palliative care services in public hospitals are scarce with less than 400 inpatient beds available
(Hospital Authority, 2017b). The HA’s Strategic Service Framework for Palliative Care stated
that in 2012/13, only 68% cancer patients received palliative care against the 80% threshold set
by the World Health Organization (WHO) (WHO, 2007). Worryingly, a less-than-half figure
(44%) was observed among end-stage renal failure patients (Hospital Authority, 2017b).

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