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Setting up an AD is understandably not a straightforward process that typically requires back-
and-forth communication between the patient, family members and medical practitioners.
Achieving the rigour of the proposed steps in setting up a legally-binding advance directive
form has implications on the required time and expertise of healthcare professionals. In fact,
many existing papers reflect concerns that healthcare professionals have towards establishing an
AD. One common need highlighted is a cultural shift that will facilitate non-palliative staff in
acute hospitals to overcome the reluctance of talking to patients and their relatives; as well as
their own insecurity in discussing psychological, spiritual or religious matters deemed as areas
outside of their expertise (Woo et al., 2009).

The antidote to the above resource concerns could be found in community settings. Our recent
study revealed that in terms of the most trusted type of personnel for EoLC advice, citizens
predominantly chose relatives and acquaintances from non-religious affiliations (55.2%), with
medical professionals in community settings being the next most popular option (40.8%), even
more popular than hospital-based medical professionals (39.6%) (OHKF, 2019a). This
underlines a promising implication of how we could lift the burden of public hospitals through
leveraging community resources in EoLC service provision.

In short, whilst OHKF concurs with the necessity of a rigorous process for making a legal AD,
it would be challenging for the Government’s legislative proposal to reach its goals without
a stringent healthcare manpower capacity plan in place to facilitate implementation. .
Without the readiness of required human resources and adequate training for our workforce, the
sole existence of an improved legal framework will be of limited impact.

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