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 可否略談倫理與醫療的關係? 兩者可說是唇齒相依。有些課題就在日常身邊，例如照顧一位有吞嚥困難 的腦退化病人，小心緩慢餵食，須冒病人嗆到的風險；用餵食管輸營養表 面上很安全，代價卻可能要約束長者以免拔掉餵食管，但這又是否病人期 望的生活質素？ 中大生命倫理學中心關注哪些議題？ 社會日漸老齡化，長者及晚期照顧是重點之一；中心也關注方興未艾的生 物科技，基因組編輯可去除有問題的基因，幹細胞研究有助研發新療法， 但同時會衍生倫理問題，我們希望協助大眾從多角度探討相關議題。 生命倫理學上的爭議不易定論，上過生命倫理課的學生會減少困惑，還是 更加困惑？ 生命倫理學着重理性分析，不是由權威人士一錘定音，需要各方一同尋 求共識。我在醫療管理學碩士課程任教生命倫理課，學生不少是醫生、 護士、物理治療師等醫護人員，他們本身也很成熟，相信不會愈討論愈 困惑。 學生比較熱衷討論哪些議題？ 主要是晚期照顧及兒童病人權益等倫理議題。我會提點學生留意容易被 忽略的倫理議題，留意不同觀點的合理性。例如鄧桂思的女兒希望捐肝救 母，但未達器官捐贈年齡，隨即有下調捐贈年齡的輿論，但這可能與立法 保障兒童免於被迫捐贈器官的原意相矛盾。 當末期病人拒絕維生治療，其意願與家屬的訴求互相矛盾時，如何理解「病 人最佳利益」？ 搶救過程有可能會令病人相當痛苦，醫生須判斷這等痛苦能否令病人得 益，並認真考慮病人意願。如果病人、家人和醫護團隊就晚期照顧安排預 先好好溝通，會很有幫助。 香港的醫療制度如何可持續發展？ 很多人以為政府長遠投放更多醫療資源便可，其實關鍵也在於醫療水平和 醫護人員的專業操守。「濫檢查、濫診治」不單對病人構成身心負擔，也浪 費資源。 你在辦公室掛起「慎始」的字畫。《禮記‧經解》的「君子慎始」對你有何 啟迪？ 傳統中國書法重中鋒，運筆要沉穩，但萬青力教授此作自然發揮，不在乎 墨色深淺，我喜愛其中不受規條所囿的精神。「慎始」並非只是時間的起 點，也是內心的起點，這未必算是特別的啟迪，但也是一點體會。 中大生命倫理學中心總監 Director of the CUHK Centre for Bioethics 區醫生在公營醫療系統行醫三十多年，退休前任醫管局質素及安全 總監，在2017年3月加入中大生命倫理學中心，積極推動大眾關注生 命倫理議題，發展研究項目，並聯繫各地相關機構交流研討。 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. 區結成醫生 Dr. Derrick Au 口 談 實 錄 / V iva V oce