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歡迎大家收聽「長者法網智多聲」。各位老友記，是否聽過「長者三寶」？對了，長者三寶分別是持久授權書、遺囑、和預設醫療指示。這一節我們會為大家介紹三寶之中的預設醫療指示。
預設醫療指示是協助精神健全的老友記，預早決定將來一旦因為重病或意外，陷入昏迷或植物人狀況，無能力做決定時，您想醫生怎樣醫治您或拯救您，甚至不再救您。好像說，如果不幸患了末期癌症，病人可以透過預設醫療指示，指明如果心跳停頓，醫生不用再為他急救。
老友記可能會問，醫生會選擇最好的方法醫治病人，就算將來有甚麼事，家人拿主意就行了。其實不一定的，好像說，如果一個病人已經陷入昏迷無法拯救，但靠儀器就可以維持生命，那麼醫護人員和病人的家人，怎樣決定何時取走儀器呢？如果病人在預設醫療指示中說清楚要怎樣做，就可以幫助醫護人員和家人，在這些艱難的時刻做決定。
那麼預設醫療指示應該怎樣訂立呢？雖然現時仍未有法例規定，但政府已經有指引，讓我們來介紹一下。
任何精神健全的成年人，隨時可以在家人及兩名見證人在場下，作出預設醫療指示。主診醫生要先確保您精神健全。您要在知情和沒有受到不當壓力之下做決定，並且完全知道預設醫療指示有甚麼效用、怎樣更改或撤銷。預設醫療指示這麼重要，最好是白紙黑字寫清楚了。政府已經準備了表格範本，大家可以到長者社區法網下載。
那麼老友記可以給予甚麼指示呢？政府的建議是，如果您出現三種情況，包括病情到了末期、已經昏迷不會再甦醒、或成為植物人，您可以要求，除了基本護理和紓緩治療外，您不同意接受任何維持生命或其他您指定的治療。預設指示只會在您不幸處於剛才所提及的其中一種情況下，才會生效，而且必須要得到最少兩名醫生的確認及證明，才會執行。但要留意了，預設醫療指示並不能夠要求安樂死的，即不能要求醫生主動做一些事，結束病人的生命，否則醫生就會犯了謀殺或協助自殺罪。
老友記在訂立預設醫療指示之後，將來如果想更改或撤銷，只要還是精神健全，隨時都可以這樣做，最重要是白紙黑字寫清楚，以及要告訴醫生和家人。政府也有表格範本，用作撤銷預設醫療指示，大家可以在長者社區法網下載。
很多老友記思想都很開通，不怕談及生老病死。所以，在考慮是否要作出預設醫療指示之前，記得要問清楚醫生，亦可以問問律師。最重要的，是要跟疼愛您的家人談談，讓他們知道您的想法，尤其在某些情況下，您希望或不希望接受甚麼護理，萬一將來有甚麼事，他們也會明白和尊重您的意願。
如果想知道更多有關預設醫療指示的詳情，可以到長者社區法網文字版慢慢看。這一節就講到這裡。拜拜。
PrintMaking an advance directive
Since making an advance directive is a matter of grave importance, the Government encourages those who wish to make advance directives to seek legal advice and to discuss the matter with their families first. Family members are also encouraged to be present when the individual makes the advance directive. Once a patient (or person) decides to make a directive, the steps listed below should be followed:
1. The first thing to be done is that the attending doctor must ensure that you are mentally competent when you make the directive. Roughly put, a mentally competent adult is defined as one with decision making capacity, which consists of the elements of:
(a) the ability to understand the medical information presented;
(b) the ability to reason and consider this information in relation his or her own personal values and goals; and
(c) the ability to communicate meaningfully.
2. When making an advance directive, you should be given sufficient and accurate information so that you may make an informed decision free from inappropriate pressure. You should be informed clearly what the effect of an advance directive will be and how you could alter or revoke that directive, should you ever want to do so.
3. Whenever possible, an advance directive should be made in writing. Whilst you have the right to make your own advance directive in the way you like, for the sake of preventing uncertainty and disputes, the government recommends that the public use the model form that it proposes (click here to download the form).
4. Advance directives should be made in the presence of two witnesses. Among the witnesses, one of them should be a medical doctor, and none of them should have any interest in your estate (stand to gain anything from your estate).
5. If you cannot make the advance directive in writing, you may make the directive verbally in the presence of a doctor, lawyer or any other independent person who does not have an interest in your estate. Such a directive should be properly documented, that is, it should be written down by one of the people present who hear it, if possible.
6. The government recommends that as the person making an advance directive, you may specify in the directive that when you are in any of the three conditions stated below:
(a) terminally ill;
(b) in a state of irreversible coma; or
(c)in a persistent vegetative state,
you do not agree to receive any life-sustaining treatment or any treatment that you specify except for basic and pain-relieving care (The advance directive will be carried out only when you are in one of those three conditions, unfortunately)
In the absence of any evidence to the contrary, advance directives that follow the above procedures will generally be considered as having been duly made and valid. To ensure the smooth carrying-out of the directive, you should provide a copy of your directive to your family members, lawyer and attorney/trustee, if any, in addition to your healthcare professionals.