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1.
Semin Nephrol ; 42(4): 151268, 2022 07.
Article in English | MEDLINE | ID: mdl-36577641

ABSTRACT

Despite the effectiveness of solid organ transplantation, progress to close the gap between donor organs and demand remains slow. An organ shortage increases the waiting time for transplant and involves significant costs including patient morbidity and mortality. Against the background of a low deceased organ donation rate, this article discusses the option of introducing incentives and removing disincentives to deceased organ donation. Perspectives from ethics, general public opinion, and the health care profession are examined to ensure a comprehensive appraisal and illustrate different facets of opinion on this complex area. Special cultural and psychosocial considerations in Asia, including the family based consent model, are discussed.


Subject(s)
Organ Transplantation , Tissue and Organ Procurement , Humans , Tissue Donors , Motivation , Attitude
2.
J Med Ethics ; 48(3): 169-172, 2022 03.
Article in English | MEDLINE | ID: mdl-34815318

ABSTRACT

Since the World Health Organization (WHO) first declared the novel coronavirus a pandemic, diverse strategies have emerged to address it. This paper focuses on two leading strategies, elimination and mitigation, and examines their ethical basis. Elimination or 'Zero-COVID' dominates policies in Pacific Rim societies. It sets as a goal zero deaths and seeks to contain transmission using stringent short-term lockdowns, followed by strict find, test, trace and isolate methods. Mitigation, which dominates in the US and most European nations, sets targets for community transmission and lifts restrictions once targets are met. This approach takes calculated risks and regards a certain amount of disease and death as ethically justified. Section I examines different societal responses to risk that underlie these different policy approaches. Section II focuses on ethical arguments favouring Zero-COVID and raises health equity objections. Section III proposes a long-term strategy that balances the twin goals of promoting population health and health equity.


Subject(s)
COVID-19 , Health Equity , Communicable Disease Control , Humans , Pandemics , SARS-CoV-2
3.
BMC Med Educ ; 20(1): 451, 2020 Nov 23.
Article in English | MEDLINE | ID: mdl-33228655

ABSTRACT

BACKGROUND: Training has been found effective in improving healthcare professionals' knowledge, confidence, and skills in conducting advance care planning (ACP). However, the association between training and its actual practice in the clinical setting has not been well demonstrated. To fill this gap, this paper examines the association between their readiness for ACP, in terms of perceived relevancy of ACP with their clinical work, attitudes toward and confidence and willingness to perform it, based on the Theory Planned Behavior and relevant training experiences. METHODS: An online survey about experiences about ACP of healthcare professionals, including physicians, nurses, social workers, and allied healthcare professionals, currently working in hospital and community care in Hong Kong was conducted. RESULTS: Of 250 respondents, approximately half (52.0%) had received ACP-related training. Those with relevant training reported significantly more positive in the perceived clinical relevance, willingness, and confidence in conducting ACP and different levels of agreement with 19 out of the 25 statements in a questionnaire about attitudes toward ACP than those without (ps ≤ 0.001-0.05). Respondents who received training only in a didactic format reported a significantly lower level of confidence in conducting ACP than did others who received a blended mode of learning (p = 0.012). Notwithstanding significant differences between respondents with and without relevant training, respondents generally acknowledged their roles in initiating conversations and appreciated ACP in preventing decisional conflict in surrogate decision-making regardless of their training experience. CONCLUSIONS: This paper revealed the association between training and higher level of readiness toward ACP among healthcare professionals. The findings showed that training is a predictor of their readiness for ACP in terms of perceived relevancy, willingness, and confidence. Those who had received training were less likely to consider commonly reported barriers such as time constraints, cultural taboos, and avoidance among patients and family members as hindrances to ACP implementation.


Subject(s)
Advance Care Planning , Attitude of Health Personnel , Cross-Sectional Studies , Health Personnel , Hong Kong , Humans
5.
Dev World Bioeth ; 20(2): 105-114, 2020 06.
Article in English | MEDLINE | ID: mdl-31241234

ABSTRACT

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient-centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision-making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end-of-life care.


Subject(s)
Culture , Decision Making/ethics , Dementia , Enteral Nutrition/ethics , Ethics, Medical , Terminal Care/ethics , Withholding Treatment/ethics , Advance Directives , Asian People , China , Cultural Competency , Frailty , Hong Kong , Humans , Islam , Malaysia , Mental Competency , United States
8.
Clin Rehabil ; 20(3): 191-200, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16634338

ABSTRACT

OBJECTIVE: To study the efficacy of the motor relearning approach in promoting physical function and task performance for patients after a stroke. DESIGN: Matched-pair randomized controlled trial. SETTING: An outpatient rehabilitation centre in Hong Kong. PARTICIPANTS: Fifty-two outpatients with either a thrombotic or haemorrhagic stroke who completed either the study or control group. INTERVENTIONS: The patients received 18 2-h sessions in six weeks of either the motor relearning programme or a conventional therapy programme. MAIN OUTCOME MEASURES: The Berg Balance Scale, the Timed Up and Go Test, the Functional Independence Measure (FIM), the modified Lawton Instrumental Activities of Daily Living (IADL) test, and the Community Integration Questionnaire. RESULTS: Patients in the motor relearning group showed significantly better performance on all but the Timed Up and Go Test when compared with the control group (F(1,150) = 6.34-41.86, P < or = 0.015). The interactions between group and occasion were significant on all five outcome measures, indicating that the rates of change across time between the motor relearning and control groups differed (F(3,150) = 3.60-33.58, P < 0.015). CONCLUSION: The motor relearning programme was found to be effective for enhancing functional recovery of patients who had a stroke. Both 'sequential' and 'function-based' concepts are important in applying the motor relearning approach to the rehabilitation of stroke patients.


Subject(s)
Motor Skills , Physical Therapy Modalities , Stroke Rehabilitation , Analysis of Variance , Female , Humans , Male , Matched-Pair Analysis , Middle Aged
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