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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。
PrintWhat is an “Advance Directive”?
Within the healthcare context, an advance directive is a statement, usually in writing, in which a mentally competent person indicates the form of healthcare he or she would like to have, or would like not to have, at a future time when he or she is no longer mentally competent to make decisions or instruct a doctor (e.g. when terminally ill, in an irreversible coma or persistent vegetative state). Through advance directives people may express clearly their wishes to their families and healthcare professionals. A terminal cancer patient, for example, can indicate through advance directives that, in case his or her heart stops beating, he or she is not to be resuscitated.
An advance directive has many advantages. First, it facilitates people’s self-determination (that is, the right to have control over their own lives). Second, it does away the stress that the families of a patient (or a person wounded) bear when having to make life and death decisions for the patient. Third, it helps healthcare professionals to make difficult choices, for example, whether life-sustaining treatment should be withheld or withdrawn in the best interests of the patient.
The concept of advance directives is based on the principle that everyone should have the right to make an informed determination of his own healthcare decisions. Australia, Canada, England, Singapore and the United States have already embraced this concept. In comparison, there is currently no legislation or case law establishing the legal status of advance directives in Hong Kong, and Hong Kong people are relatively new to this concept. Thus, in August 2006, the Law Reform Commission of Hong Kong published a report on this subject called “Substitute Decision-making and Advance Directives in Relation to Medical Treatment”, and in December 2009, the Food and Health Bureau also issued a relevant consultation document called the “Introduction of the Concept of Advance Directives in Hong Kong”.