The Legal and Ethical Grounds for Promotion of the End of Life Issue in HKSAR

The Legitimacy of Promotion of Advance Directive and Voluntary Active Euthanasia in HKSAR

在香港特别行政区推广预设医疗指示及自愿主动安乐死的合法性

1. Advance Directive is recommended by the Hong Kong Law Reform Commission in 2006 to be promoted through non-legislative means. There is no formal legislation on the relevant laws in Hong Kong. Therefore, its promotion is NOT against any Hong Kong Laws. 香港法律改革委员会在2006年通过並推荐以非立法手段推广预设医疗指示。而香港现时並无相关的正规立法。因此，它的推广并不违反任何香港法律。

2. Dr. Kwok-Hay Kwong v The Medical Council of HK [2008] In the Ratio Decidendi of the Hon. Ma CJHC (Geoffrey Ma), he laid down these points:- 1. The freedom of expression includes the right to advertise and there is so even where the intention is for personal financial gain. 2. Where the public interest is in favour of allowing advertising, the fact that the person who places the advertisement will be incidentally benefit is no reason to justify restrictions. 3. The European Court of Human Rights referred to the provision of information to the public on a matter of general medical interest as being desirable. 4. A total and absolute ban on all advertising, irrespective of whether the information provided is misleading or not is much more than is necessary to achieve the legitimate purpose. 5. The prohibition against advertising when a doctor referred to his experiences, skills, qualifications or reputation constituted an unjustifiable restriction on the freedom of expression. 6. Concerning the liability of a doctor on advertising by his organisation, there is no justification for imposing such strict liability if a doctor has done everything to prevent a contravention of the code. The Hong Kong Medical Council is a quasi-judiciary organisation but the Court of Appeal is on a higher legal hierarchy. This case laid down the legitimacy of promotion or advertisement by the medical professional in Hong Kong.

鄺国熙医生对香港医务委员会[2008]

在马道立法官的判词中，他有以下的判决：

1. 言论自由包括廣告宣传的权利，即使它的最终目的是为了个人经济利益。

2. 当允许廣告宣传符合公众利益，不能因为宣传者无意中得益而设置限制。

3. 欧洲人权法庭认为提供一般医疗资讯与公众是理想的。

4. 全面及绝对的禁止所有广告宣传而不理会所提供的资讯是否有误導成分已超越了一般监管的合理目的。

5. 禁止医生推广自己的经验，技术，资历及声誉对言论自由构成不合理的限制。

6. 考虑到当医生为自己的机构进行推广，如果医生已经尽力设法避免违反相关条文，不应负上法律责任。

香港医务委员会是准司法机构而上诉法庭在法律架构上属于更高层次。此案例对医务人员在香港进行广告推广奠定合法性。

3. Freedom of Expression is protected by Article 27 of the Hong Kong Basic Laws. 言论自由受香港基本法第27条保障。

4. The act of Voluntary Active Euthanasia is illegal, based on Offences Against the Person Ordinance [Cap 212]: a person aids, abets, counsels or procures the suicide of another, shall be guilty of an offence. But its relevant promotion or education is protected by the Laws as it does not target on a particular person.自愿主动安乐死的实际行动是违法的，根据侵害人身罪条例[公文212]：任何人士协助，教唆，辅导或促使他人自杀即属犯法。但是相关的推广及教育则受法律保障，因它並没有针对个人行为。

Legal and Ethical Grounds for Voluntary Active Euthanasia

自愿主动安乐死的法律及道德依据

1. Autonomy and self-determination should be respected. It is protected by the Part 1 (Article 1) of the Hong Kong Bill of Rights Ordinance [Cap 383] enacted in 1991 that is the local adaptation of the provisions of the International Covenant on Civil and Political Rights (ICCPR) in 1976. 自主权及自决权受保障。受1991年香港人权法案条例[公文383]第一条第一章保障，它是1976年国际公民权利及政治权利合约（ICCPR）的本地演绎。

2. Principle of beneficence, it is patient’s best interest as it alleviates pain and suffering. 基于仁慈的原则，符合为病人免除痛苦及痛楚的最佳利益。

3. Sanctity and dignity of life. 符合人生的尊严及圣洁。

4. Hippocratic Oath:

5. Full ability and judgment to carry out the duty

6. Help the sick and injured

7. Not to about against patient’s will and wrong intention

8. Not to give poison against patient’s will and wrong intention

Is Voluntary Active Euthanasia against Hippocratic Oath？

It is NOT against Hippocratic Oath:

1. The duty here is to relieve patient’s pain and suffering, euthanasia is only a means to achieve this purpose.

2. The purpose (intention) here is to relieve the pain and suffering of the sick and injured.

3. It is at patient’s voluntary request and it is not against their will.

4. The medication given is a kind of ‘Peaceful Pill’ and we should not call it a poison. For example, the morphine frequently prescribed in the terminal care. If it is given at a low dose, it will relieve the respiratory distress or pain. But if it is given at a high dose, it can lead to respiratory arrest and even death. So, should we abandon its use clinically? As I explained previously, it is the purpose (intention) that counts.

根据希波克拉底誓言：

1. 医生必须有全面的能力及判断力去履行责任

2. 帮助有疾病及受伤的

3. 不能违反病人的意愿或有错务的意图

4. 不能违反病人的意愿给予毒药或有错误的意图

自愿主动安乐死是否违反希波克拉底誓言？

自愿主动安乐死並不违反希波克拉底誓言：

1. 医生在这里的责任是免除病人的痛苦及痛楚，安乐死只是一种手段。

2. 医生这里的意图是免除病人的痛苦及免受疾病和受伤的煎熬。

3. 並不违反病人的意愿，因为是病人主动提出的。

4. 药物並不是毒药，只能称它为‘平安药’。举例说吗啡常用与末期疾病。在低剂量时，它能免除疼痛及呼吸困难。但在高剂量时，它能导致呼吸停顿及死亡。那是否应该停止临床应用呢？正如刚才所说，应该关注的是意图所在.

5. Slippery slope (the worry of non-voluntary euthanasia) was counteracted by the fact that it is not increasing in the Netherlands over so many years of practice of Voluntary Active Euthanasia since 1993.滑坡理论（对非自愿安乐死的忧虑）在荷兰自1993年开始这么多年对自愿主动安乐死的实际经验上证明，它並没有明显的增加。