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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.
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.
This article was originally published in No. 525, Newsletter in Oct 2018.