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Consultation Question 30

Do you think that the proposed safeguard* for RCHE residents is sufficient if deaths in
RCHEs may be exempted from reportable deaths?
*if a resident who, before his/her death, was diagnosed as having a terminal illness,
dies in RCHE, such death should remain reportable to the Coroner if there had been no
registered medical practitioner who attended to him/her within 14 days prior to his/her
death.

Our Hong Kong Foundation [✔] Agree [ ] Disagree

OHKF agrees on the need to lift certain legal barriers in dying in place as we see that there is an
unequivocal preference for people to die outside of hospitals, contrasting with the current
situation. In 2016/17, our public hospitals looked after nearly 96% of all inpatient deaths
(Hospital Authority, 2017a). However, a local population-based survey published in the same
year discovered that merely half of Hong Kong citizens wished to pass away in hospital settings
(51.8%), the other half showed preference for passing away at ‘home’ (30.8%) or in ‘aged or
nursing home/ hospice’ (16.2%) (Chung et al., 2017). The stark discrepancy between people’s
preferences and the prevalence of death in hospitals could be attributed to factors such as the
reluctance of imposing an extra burden upon family members (66.3%), and the lack of medical
professional support (18.4%) (Chung et al, 2017). Furthermore, existing RCHEs had further
indicated obstacles that will hinder dying-in-place in communities that include the absence of
understanding and established protocols between RCHEs and HA on the timing of collaboration
in advance care planning, as well as a lack of physicians to support imminently dying elders
(Fang et al, 2016). Thus, in addition to legal barriers, these hindrances to dying in place in
community settings should also be addressed.

Our recent study suggested that with sufficient support, nearly 90% of respondents of our
3
telephone survey preferred to stay within their communities until the end of their lives. (OHKF,
2019a). Correspondingly, respondents indicated “a comfortable environment” as the most
imperative support at end of life (48.9%), followed by having “professional guidelines” (41.1%)
and “regular community healthcare services” (38.0%) (OHKF, 2019a). This reveals public
preference and readiness to receive EoLC in community settings outside of overcrowded hospital
settings, and a promising opportunity to shift care burden from hospitals into the community.

3 The term ‘communities’ is understood as outside of hospitals, including nursing homes and individual homes.

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