【生死教育第三講】
講題 Title：預設醫療指示與預設照顧計劃 Advance Directive and Advance Care Planning

報名鏈接Registration Link: https://bit.ly/3tE9RgE

日期 Date：12/6/2021(Sat)
時間 Time：3:00-4:30pm
地點 Venue：沙田澤祥街12號香港中文大學鄭裕彤樓地下演講廳1A (LT1A)
Lecture Theatre 1A, Level 1, Cheng Yu Tung Building, The Chinese University of Hong Kong, 12 Chak Cheung Street, Shatin, N.T.

講者 Speaker：陳裕麗教授 Prof Helen Chan / 鍾一諾教授 Prof Roger Chung
主持 Moderator：伍桂麟先生 Mr Pasu Ng

講座內容 Synopsis:
現今醫療科技發達，很多疾病均可治癒或受控制。當疾病到了末期，醫療科技有時只能提供維持生命治療，但延長死亡過程對病人可能沒有意義，甚至增加痛楚。面對這情況，病人、家屬和醫護人員可以商討是否中止對生活質素沒有幫助的維持生命治療，讓病人安詳離世。香港中文大學醫學院那打素護理學院副教授陳裕麗博士和香港中文大學公共衛生及基層醫療學院助理教授鍾一諾博士會在由中大公共衞生及基層醫療學院主辦的公眾「生死教育」四講系列的第三講和大家分享『預設醫療指示』 (Advance Directive)和『預設照顧計劃』（Advance Care Planning）的概念與應用。這兩種健康護理選擇不但可以免卻家屬決定病者死時所受到的困難和壓力，減少作出決定後感到矛盾和內疚的機會，亦體現對病者生命和意願的尊重。

Thanks to the advancement of medical technology, most diseases can be cured or subsided. However, there are times that medical technology could only prolong one’s life but could not cure the terminal illness. Facing such situation, patients, family members, and medical staff can discuss whether to withhold or withdraw from life-sustaining treatments that may not help improve patients’ quality of life so that they can die peacefully. Professor Helen Chan, Associate Professor from The Nethersole School of Nursing and Professor Roger Chung, Assistant Professor of the School of Public Health and Primary Care of the Chinese University of Hong Kong, will share with us the concepts and values behind Advance Directive and Advance Care Planning in the third public seminar of the four-lecture series on life and death education organized by the School of Public Health and Primary Care, CUHK. These two health care options aim not only to reduce the pressure faced by patients’ family when making end-of-life healthcare decision, but also show respect to patients’ will.

講者介紹：
Professor Helen Chan’s research interests focus on end-of-life care, gerontology as well as care ethics. She has conducted a number of research projects on promoting palliative and end-of-life care, especially advance care planning, among older adults and people with advanced progressive diseases.
陳裕麗教授的主要研究範疇集中在臨終護理、老年病學和護理倫理學上。她的研究項目包括推廣有關老人和晚期疾病患者的紓緩照顧和臨終護理服務，尤其是預設照顧計劃。

Professor Roger Chung’s research aims to empirically inquire into the social determinants of health inequalities, as well as aging‐related issues on multimorbidity and long‐term/end‐of‐life care, and to utilize such evidence to inform health services and policy, domestically and beyond.
鍾一諾教授的主要研究範疇為健康不平等的社會決定因素，與老年有關的多重疾病，和晚期與臨終護理政策，並運用研究成果為本地及國際公共衛生服務和政策提供意見。

生死教育 X 伍桂麟

今早為Asian Medical Students Association Hong Kong (AMSAHK)的新一屆執行委員會就職典禮作致詞分享嘉賓，題目為「疫情中的健康不公平」。
感謝他們的熱情款待以及為整段致詞拍了影片。以下我附上致詞的英文原稿：

It's been my honor to be invited to give the closing remarks for the Inauguration Ceremony for the incoming executive committee of the Asian Medical Students' Association Hong Kong (AMSAHK) this morning. A video has been taken for the remarks I made regarding health inequalities during the COVID-19 pandemic (big thanks to the student who withstood the soreness of her arm for holding the camera up for 15 minutes straight), and here's the transcript of the main body of the speech that goes with this video:

//The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, continues to be rampant around the world since early 2020, resulting in more than 55 million cases and 1.3 million deaths worldwide as of today. (So no! It’s not a hoax for those conspiracy theorists out there!) A higher rate of incidence and deaths, as well as worse health-related quality of life have been widely observed in the socially disadvantaged groups, including people of lower socioeconomic position, older persons, migrants, ethnic minority and communities of color, etc. While epidemiologists and scientists around the world are dedicated in gathering scientific evidence on the specific causes and determinants of the health inequalities observed in different countries and regions, we can apply the Social Determinants of Health Conceptual Framework developed by the World Health Organization team led by the eminent Prof Sir Michael Marmot, world’s leading social epidemiologist, to understand and delineate these social determinants of health inequalities related to the COVID-19 pandemic.

According to this framework, social determinants of health can be largely categorized into two types – 1) the lower stream, intermediary determinants, and 2) the upper stream, structural and macro-environmental determinants. For the COVID-19 pandemic, we realized that the lower stream factors may include material circumstances, such as people’s living and working conditions. For instance, the nature of the occupations of these people of lower socioeconomic position tends to require them to travel outside to work, i.e., they cannot work from home, which is a luxury for people who can afford to do it. This lack of choice in the location of occupation may expose them to greater risk of infection through more transportation and interactions with strangers. We have also seen infection clusters among crowded places like elderly homes, public housing estates, and boarding houses for foreign domestic helpers. Moreover, these socially disadvantaged people tend to have lower financial and social capital – it can be observed that they were more likely to be deprived of personal protective equipment like face masks and hand sanitizers, especially during the earlier days of the pandemic. On the other hand, the upper stream, structural determinants of health may include policies related to public health, education, macroeconomics, social protection and welfare, as well as our governance… and last, but not least, our culture and values. If the socioeconomic and political contexts are not favorable to the socially disadvantaged, their health and well-being will be disproportionately affected by the pandemic. Therefore, if we, as a society, espouse to address and reduce the problem of health inequalities, social determinants of health cannot be overlooked in devising and designing any public health-related strategies, measures and policies.

Although a higher rate of incidence and deaths have been widely observed in the socially disadvantaged groups, especially in countries with severe COVID-19 outbreaks, this phenomenon seems to be less discussed and less covered by media in Hong Kong, where the disease incidence is relatively low when compared with other countries around the world. Before the resurgence of local cases in early July, local spread of COVID-19 was sporadic and most cases were imported. In the earlier days of the pandemic, most cases were primarily imported by travelers and return-students studying overseas, leading to a minor surge between mid-March and mid-April of 874 new cases. Most of these cases during Spring were people who could afford to travel and study abroad, and thus tended to be more well-off. Therefore, some would say the expected social gradient in health impact did not seem to exist in Hong Kong, but may I remind you that, it is only the case when we focus on COVID-19-specific incidence and mortality alone. But can we really deduce from this that COVID-19-related health inequality does not exist in Hong Kong? According to the Social Determinants of Health Framework mentioned earlier, the obvious answer is “No, of course not.” And here’s why…

In addition to the direct disease burden, the COVID-19 outbreak and its associated containment measures (such as economic lockdown, mandatory social distancing, and change of work arrangements) could have unequal wider socioeconomic impacts on the general population, especially in regions with pervasive existing social inequalities. Given the limited resources and capacity of the socioeconomically disadvantaged to respond to emergency and adverse events, their general health and well-being are likely to be unduly and inordinately affected by the abrupt changes in their daily economic and social conditions, like job loss and insecurity, brought about by the COVID-19 outbreak and the corresponding containment and mitigation measures of which the main purpose was supposedly disease prevention and health protection at the first place. As such, focusing only on COVID-19 incidence or mortality as the outcomes of concern to address health inequalities may leave out important aspects of life that contributes significantly to people’s health. Recently, my research team and I collaborated with Sir Michael Marmot in a Hong Kong study, and found that the poor people in Hong Kong fared worse in every aspects of life than their richer counterparts in terms of economic activity, personal protective equipment, personal hygiene practice, as well as well-being and health after the COVID-19 outbreak. We also found that part of the observed health inequality can be attributed to the pandemic and its related containment measures via people’s concerns over their own and their families’ livelihood and economic activity. In other words, health inequalities were contributed by the pandemic even in a city where incidence is relatively low through other social determinants of health that directly concerned the livelihood and economic activity of the people. So in this study, we confirmed that focusing only on the incident and death cases as the outcomes of concern to address health inequalities is like a story half-told, and would severely truncate and distort the reality.

Truth be told, health inequality does not only appear after the pandemic outbreak of COVID-19, it is a pre-existing condition in countries and regions around the world, including Hong Kong. My research over the years have consistently shown that people in lower socioeconomic position tend to have worse physical and mental health status. Nevertheless, precisely because health inequality is nothing new, there are always voices in our society trying to dismiss the problem, arguing that it is only natural to have wealth inequality in any capitalistic society. However, in reckoning with health inequalities, we need to go beyond just figuring out the disparities or differences in health status between the poor and the rich, and we need to raise an ethically relevant question: are these inequalities, disparities and differences remediable? Can they be fixed? Can we do something about them? If they are remediable, and we can do something about them but we haven’t, then we’d say these inequalities are ultimately unjust and unfair. In other words, a society that prides itself in pursuing justice must, and I say must, strive to address and reduce these unfair health inequalities. Borrowing the words from famed sociologist Judith Butler, “the virus alone does not discriminate,” but “social and economic inequality will make sure that it does.” With COVID-19, we learn that it is not only the individuals who are sick, but our society. And it’s time we do something about it.

Thank you very much!//

Please join me in congratulating the incoming executive committee of AMSAHK and giving them the best wishes for their future endeavor!

Roger Chung, PhD
Assistant Professor, CUHK JC School of Public Health and Primary Care, @CUHK Medicine, The Chinese University of Hong Kong 香港中文大學 - CUHK
Associate Director, CUHK Institute of Health Equity

正當新型冠狀病毒在全球多處蔓延開來，人們的心靈也開始自主隔離了。其實，現在就是閉關修練、在家邊吃芭樂邊好好讀書的時刻。讓我們推一下台大人類系林開世老師的［關於傳染病的人類學著作］書單。
★要從頭到尾看完，後面有同場加映★

#基本的讀本
1.The Anthropology of Epidemics
2.Anthropology of Infectious Disease

#考古學與演化的觀點
3.Emerging Pathogens: The Archaeology, Ecology and Evolution of Infectious Disease
4.The Archaeology of Disease
5.瘟疫的歷史 (有中文)
6.Plagues and Peoples

#全球不平等的結構
7.Unprepared: Global Health in a Time of Emergency
8.Infections and Inequalities: The Modern Plagues,

#三個最近的個案茲卡伊波拉豬流感
9.Zika: From the Brazilian Backlands to Global Threat
10.Ebola: How a People's Science Helped End an Epidemic
11.The Viral Network: A Pathography of the H1N1 Influenza Pandemic

#動物與傳染病的關聯
12.Zoobiquity: The Astonishing Connection Between Human and Animal Health
13.Framing Animals as Epidemic Villains: Histories of Non-Human Disease Vectors

#疾病與恐慌
14.Stories in the Time of Cholera: Racial Profiling During a Medical Nightmare
15.When Germs Travel: Six Major Epidemics That Have Invaded America and the Fears They Have Unleashed

#當地人如何看醫師
16.The Collectors of Lost Souls: Turning Kuru Scientists into Whitemen

#快出版的新書有關中國、香港與台灣的人如何對抗禽流感
17.Avian Reservoirs: Virus Hunters and Birdwatchers in Chinese Sentinel Posts

以上謝謝林老師提供。

🍐🍐【同場加映】

劉紹華老師的兩本著作：
《麻風醫生與巨變中國：後帝國實驗下的疾病隱喻與防疫歷史》
《我的涼山兄弟：毒品、愛滋與流動青年》

?賭Sir 幫你急救 DSE 數學： http://www.HermanToMath.com
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?️賭Sir是杜氏數學Herman To Math的始創人
?全港唯一「完爆」【DSE Core+M1+M2】、【IAL 12科Maths】、【AL Pure+Applied】、【CE Maths+A.Maths】的數學導師
?全港第一最多訂閱粉絲的數學教育YouTuber
?YouTube觀看次數超越700萬、訂閱粉絲超過70000人
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? Mensa Club member
? 中文大學 數學碩士畢業（Big Data stream）
? 中文大學 風險管理學士畢業
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?流行文學作家，出版著作：
《賭馬男人嫁得過》?（2020）
《YouTuber新手到網紅》?（2019、2020再版增訂本）
《5**數學男人嫁得過》?（2019）
《碌葛男人嫁得過》?（2018）
《賭波男人嫁得過》?（2018、同年再版）
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賭Sir考試戰績:

新制中六DSE: (2016 M2 + 2017 M1)
?數學必修 (Mathematics) 一take過 奪5**
?數學延伸M1 (Calculus and Statistics) 一take過 奪5**
?數學延伸M2 (Algebra and Calculus) 一take過 奪5**

國際高考International Advanced Level: (2017 + 2018)
?Core Math 1 2 一take過 奪A
?Core Math 3 4 一take過 奪A
?Further Pure Math 1 一take過 奪A
?Further Pure Math 2 一take過 奪A
?Further Pure Math 3 一take過 奪A
?Mechanics 1 一take過 奪A
?Mechanics 2 一take過 奪A
?Mechanics 3 一take過 奪A
?Statistics 1 一take過 奪A
?Statistics 2 一take過 奪A
?Statistics 3 一take過 奪A
?Decision Math 1 一take過 奪A

舊制中七高考: (2011)
?純粹數學 (Pure Mathematics) 一take過 奪A
?應用數學 (Applied Mathematics) 一take過 奪A

舊制中五會考: (2009)
?數學 (Mathematics) 一take過 奪A
?附加數學 (Additional Mathematics) 一take過 奪A

#未來半年會每周出神技片 #直至DSE2021 #立即訂閱同分享