Changing End-of-Life Care in Hong Kong

People no longer have to die in hospitals in Hong Kong

About 10 years ago when a relative was nearing the end of her life, my uncle told me that she could not die at home in Hong Kong -- it would have to be reported to the coroner's court, complicating things, particularly in terms of paperwork and getting a death certificate.

Instead it was best that she passed in a hospital, which sounds like a horrible place to be, taking your last breaths surrounded by loved ones in a sterile room shared by other patients in a similar situation.

But things are slowly starting to change. Last year the Legislative Council passed amendments in the cases of where residents who died in care homes for the elderly and met certain criteria are no longer required to be reported to the coroner. 

There are suggestions on end-of-life care

Legislation was also passed in 2024 to legally empower patients to state their medical care wishes for their last days in advance directives.

Now a think tank says Hong Kong has come up with a financial reason why seniors should be allowed to die at home or in care facilities.

Our Hong Kong Foundation released a research report on end-of-life care and suggested the city could save more than HK$90,000 per patient in medical expenses if dying patients spent their last days outside a hospital setting.

"If we have a comprehensive end-of-life care system, it could help reduce the usage of hospital services," foundation vice-president Ryan Ip Man-ki said.

That could hep the healthcare system save HK$91,460 per individual in medical expenses, the foundation said, citing data from a Hong Kong Jockey Club program supporting end-of-life care in the community.

Death doulas help people have "good deaths"

As a result that would help reduce hospitalisation by 11.91 days, accident and emergency admissions by 0.95 times, and intensive care unit stays by 0.29 days.

While these statistics are admirable, what about bringing some humanity to someone's last days on earth?

In North America there are some people who are "death doulas", who help others or their loved ones to prepare for "a good death". 

They educate and empower people on how they would like to die -- would that be at home, who would they like to be there, what kind of music would be played, and so on. It would also include what kind of funeral or service they would like and if they would prefer cremation or burial. 

This is a relatively new concept, but it is something Hong Kong should also consider. We should be giving our end-of-life patients the dignity of choosing how they want to spend their last moments, not in a hospital setting (if possible).

While my relative had planned everything else, from what she wanted to wear in the casket to the music played in her funeral, I'm sure my relative would have appreciated the chance to die in the comfort of her own home.