Newsletter No. 525

10 # 5 2 5 | 1 9 . 1 0 . 2 0 1 8 How does ethics relate to medicine? Very closely. Some issues are right around the corner. Taking care of dementia patients with swallowing difficulty, for instance, could leave you in a dilemma. No matter how slow the feeding is, there will always be the risk of choking. Tube feeding seems to be safer, but it’s at the cost of restraining the elderly’s movement. Is it the quality of life they expect? What are the foci of the Centre? With an increasingly ageing population, care of the elderly and end-of-life patients is one of the foci. It also takes note of the burgeoning biotechnology. Genome editing helps remove defective genes. Stem cell research catalyzes innovative therapies. But there may be moral implications. We hope to assist the public to explore the issues from various perspectives. Bioethics addresses a range of controversial topics. Are bioethics students less or more perplexed after discussions? Bioethics is very much about logical reasoning. Instead of leaving the final say to the professionals, different stakeholders should communicate to reach a consensus. I teach bioethics in the master's programme in Health Services Management. Many students are healthcare workers like doctors, nurses and physiotherapists. They’re quite mature. I trust they won’t get more perplexed as they explore the issues. What kind of topics engage your students? Mainly ethical issues such as end-of-life care and children’s rights. I’ll remind my students of issues easily neglected and the reasoning behind different perspectives. Take Tang Kwai-sze’s case as an example. Tang’s daughter, who was below the minimum legal age of organ donation, intended to donate part of her liver to save her mother. The public view wavered towards lowering the bar of legal age. But it may be contradictory to the legislative intent of protecting children from being forced to donate organs. What are end-of-life patients’ best interests, when their will of rejecting life-sustaining treatments is contested by their families? Resuscitation process can be very painful. Doctors need to judge whether the process benefits their patients and take their will into account. It’d be helpful if the patients, their families and the healthcare team can communicate on advance care planning beforehand. How can the healthcare system in Hong Kong be sustainable? Many think that the government’s long-term allocation of medical resources can address the need. Actually the key lies in healthcare standard and the code of conduct of healthcare professionals. Unnecessary screenings and overdiagnoses not only make the patients suffer, but also waste resources. A piece of calligraphy Shenchi (literally ‘cautious of the beginning’) is mounted in your office. What does it mean to you? Centred and calm brushwork is significant in Chinese calligraphy. I like Prof. Wan Qingli’s carefree spirit in his natural brushstrokes. I think what one should be cautious about is not only the beginning of time but also the beginning of one’s inner self. It’s just my own interpretation, which may not be a revelation. J. Lau 可否略谈伦理与医疗的关系? 两者可说是唇齿相依。有些课题就在日常身边,例如照顾一位有吞咽困难 的脑退化病人,小心缓慢喂食,须冒病人呛到的风险;用喂食管输营养表 面上很安全,代价却可能要约束长者以免拔掉喂食管,但这又是否病人期 望的生活质素? 中大生命伦理学中心关注哪些议题? 社会日渐老龄化,长者及晚期照顾是重点之一;中心也关注方兴未艾的生 物科技,基因组编辑可去除有问题的基因,干细胞研究有助研发新疗法, 但同时会衍生伦理问题,我们希望协助大众从多角度探讨相关议题。 生命伦理学上的争议不易定论,上过生命伦理课的学生会减少困惑,还是 更加困惑? 生命伦理学着重理性分析,不是由权威人士一锤定音,需要各方一同寻 求共识。我在医疗管理学硕士课程任教生命伦理课,学生不少是医生、 护士、物理治疗师等医护人员,他们本身也很成熟,相信不会愈讨论愈 困惑。 学生比较热衷讨论哪些议题? 主要是晚期照顾及儿童病人权益等伦理议题。我会提点学生留意容易被 忽略的伦理议题,留意不同观点的合理性。例如邓桂思的女儿希望捐肝救 母,但未达器官捐赠年龄,随即有下调捐赠年龄的舆论,但这可能与立法 保障儿童免于被迫捐赠器官的原意相矛盾。 当末期病人拒绝维生治疗,其意愿与家属的诉求互相矛盾时,如何理解「病 人最佳利益」? 抢救过程有可能会令病人相当痛苦,医生须判断这等痛苦能否令病人得 益,并认真考虑病人意愿。如果病人、家人和医护团队就晚期照顾安排预 先好好沟通,会很有帮助。 香港的医疗制度如何可持续发展? 很多人以为政府长远投放更多医疗资源便可,其实关键也在于医疗水平和 医护人员的专业操守。「滥检查、滥诊治」不单对病人构成身心负担,也浪 费资源。 你在办公室挂起「慎始」的字画。《礼记‧经解》的「君子慎始」对你有何 启迪? 传统中国书法重中锋,运笔要沉稳,但万青力教授此作自然发挥,不在乎 墨色深浅,我喜爱其中不受规条所囿的精神。「慎始」并非只是时间的起 点,也是内心的起点,这未必算是特别的启迪,但也是一点体会。 中大生命伦理学中心总监 Director of the CUHK Centre for Bioethics 区医生在公营医疗系统行医三十多年,退休前任医管局质素及安全 总监,在2017年3月加入中大生命伦理学中心,积极推动大众关注生 命伦理议题,发展研究项目,并联系各地相关机构交流研讨。 Dr. Au has served in the public healthcare system for over three decades. He worked as director of Quality and Safety before his retirement from the Hospital Authority. After joining the CUHK Centre for Bioethics in March 2017, he has been helping the general public understand bioethical issues, developing research projects and engaging in dialogue with organizations worldwide. 区结成医生 Dr. Derrick Au 口 谈 实 录 / V iva V oce