{"id":3264,"date":"2020-10-26T04:47:46","date_gmt":"2020-10-26T04:47:46","guid":{"rendered":"http:\/\/54.255.27.20\/?page_id=3264"},"modified":"2020-12-04T09:31:09","modified_gmt":"2020-12-04T09:31:09","slug":"mrtse","status":"publish","type":"page","link":"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/mrtse\/","title":{"rendered":"Cases:MrTse"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3264\" class=\"elementor elementor-3264\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-6e0e8d9 header-banner elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6e0e8d9\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ee9cc73\" data-id=\"ee9cc73\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5589bda banner-title elementor-widget elementor-widget-heading\" data-id=\"5589bda\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Jockey Club End-of-Life Community Care Project<br>\nJCECC Capacity Building and Education Programmes on End-of-Life Care<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-530e890 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"530e890\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-810a70a\" data-id=\"810a70a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c4d9322 quick-links elementor-widget elementor-widget-wp-widget-nav_menu\" data-id=\"c4d9322\" data-element_type=\"widget\" data-widget_type=\"wp-widget-nav_menu.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"menu-second-menu-container\"><ul id=\"menu-second-menu\" class=\"menu\"><li id=\"menu-item-126\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-126\"><a href=\"https:\/\/www.ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/\">Home<\/a><\/li>\n<li id=\"menu-item-6666\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6666\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/academic-output\/\">Academic Output<\/a><\/li>\n<li id=\"menu-item-6671\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-6671\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/\">Capacity Building Programme<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-6758\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-6758\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-doctors\/\">Training for Doctors<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-6870\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6870\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-doctors\/interactive-workshops\/\">Interactive Workshops<\/a><\/li>\n\t\t<li id=\"menu-item-6868\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6868\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-doctors\/seminars-and-lectures\/\">Seminars and Lectures<\/a><\/li>\n\t\t<li id=\"menu-item-6867\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6867\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-doctors\/symposia\/\">Symposia<\/a><\/li>\n\t\t<li id=\"menu-item-6869\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6869\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-doctors\/online-training\/\">Online Training<\/a><\/li>\n\t\t<li id=\"menu-item-6873\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6873\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-doctors\/death-audits\/\">Death Audits<\/a><\/li>\n\t\t<li id=\"menu-item-6871\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6871\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-doctors\/evaluation-quantitative\/\">Evaluation (Quantitative)<\/a><\/li>\n\t\t<li id=\"menu-item-6872\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6872\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-doctors\/evaluation-qualitative\/\">Evaluation (Qualitative)<\/a><\/li>\n\t\t<li id=\"menu-item-8279\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-8279\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-doctors\/webinar\/\">Webinar<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-6757\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-6757\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-nurses\/\">Training for Nurses<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-6862\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6862\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-nurses\/train-the-trainer-series\/\">Train-the-trainer Series<\/a><\/li>\n\t\t<li id=\"menu-item-6864\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6864\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-nurses\/interactive-workshops\/\">Interactive Workshops<\/a><\/li>\n\t\t<li id=\"menu-item-6863\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6863\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-nurses\/online-training\/\">Online Training<\/a><\/li>\n\t\t<li id=\"menu-item-6865\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6865\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-nurses\/evaluation-quantitative\/\">Evaluation (Quantitative)<\/a><\/li>\n\t\t<li id=\"menu-item-6866\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6866\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-nurses\/evaluation-qualitative\/\">Evaluation (Qualitative)<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-6756\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-6756\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-allied-health-professionals\/\">Training for Allied Health Professionals<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-6859\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6859\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-allied-health-professionals\/experiential-learning-activities\/\">Experiential Learning Activities<\/a><\/li>\n\t\t<li id=\"menu-item-6858\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6858\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-allied-health-professionals\/talks-and-information-sessions\/\">Talks and Information Sessions<\/a><\/li>\n\t\t<li id=\"menu-item-6860\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6860\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-allied-health-professionals\/evaluation-quantitative\/\">Evaluation (Quantitative)<\/a><\/li>\n\t\t<li id=\"menu-item-6861\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6861\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/capacity-building-programme\/training-for-allied-health-professionals\/evaluation-qualitative\/\">Evaluation (Qualitative)<\/a><\/li>\n\t<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-6679\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-6679\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/public-education\/\">Public Education<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-6771\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6771\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/public-education\/interactive-workshops\/\">Interactive Workshops<\/a><\/li>\n\t<li id=\"menu-item-6791\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6791\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/public-education\/advance-care-planning-workshops\/\">Advance Care Planning Workshops<\/a><\/li>\n\t<li id=\"menu-item-6790\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6790\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/public-education\/talks-and-information-sessions\/\">Talks and Information Sessions<\/a><\/li>\n\t<li id=\"menu-item-6789\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6789\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/public-education\/roving-exhibitions\/\">Roving Exhibitions<\/a><\/li>\n\t<li id=\"menu-item-6788\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6788\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/public-education\/evaluation-quantitative\/\">Evaluation (Quantitative)<\/a><\/li>\n\t<li id=\"menu-item-6787\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6787\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/public-education\/evaluation-qualitative\/\">Evaluation (Qualitative)<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-313\" class=\"hide menu-item menu-item-type-post_type menu-item-object-page menu-item-313\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/?page_id=228\">Activities<\/a><\/li>\n<li id=\"menu-item-6689\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-6689\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/resources\/\">Resources<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-7193\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-7193\"><a href=\"#\">For Healthcare Professionals<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-6762\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6762\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/resources\/for-healthcare-professionals-videos\/\">Videos<\/a><\/li>\n\t\t<li id=\"menu-item-6761\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6761\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/resources\/for-healthcare-professionals-leaflet\/\">Leaflet<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-7194\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-7194\"><a href=\"#\">For General Public<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-6759\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6759\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/resources\/for-general-public-videos\/\">Videos<\/a><\/li>\n\t\t<li id=\"menu-item-6760\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-6760\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/resources\/for-general-public-leaflet\/\">Leaflet<\/a><\/li>\n\t<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-699\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-699\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/ethics-casebook\/\">Ethics Casebook<\/a><\/li>\n<li id=\"menu-item-1411\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1411\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/dying-matters-awareness-event\/\">Dying Matters Awareness Event<\/a><\/li>\n<li id=\"menu-item-1311\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1311\"><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/useful-materials\/\">Useful Materials<\/a><\/li>\n<\/ul><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7f62ad4 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7f62ad4\" data-element_type=\"section\" id=\"Ethics\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-18496cf col-intro\" data-id=\"18496cf\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6b2ed61 elementor-align-justify btn1 elementor-widget elementor-widget-button\" data-id=\"6b2ed61\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"\/end-of-life-care\/ethics-casebook\/#Ethics\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Introduction<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-10d3bec\" data-id=\"10d3bec\" data-element_type=\"column\" id=\"col-intro2\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6385323 elementor-align-justify btn2 elementor-widget elementor-widget-button\" data-id=\"6385323\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"\/end-of-life-care\/ethics-casebook-cases\/#Ethics\" elementor-tab-content-2642=\"\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Cases<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-3cbc989\" data-id=\"3cbc989\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b6f813d elementor-align-justify btn3 elementor-widget elementor-widget-button\" data-id=\"b6f813d\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"\/end-of-life-care\/ethics-casebook-backgrounds\/#Ethics\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\"> Backgrounders<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-7d2f27e\" data-id=\"7d2f27e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c612781 elementor-align-justify btn4 elementor-widget elementor-widget-button\" data-id=\"c612781\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"\/end-of-life-care\/ethics-casebook-themes\/#Ethics\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Themes<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-06e2774 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"06e2774\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e44b0d0\" data-id=\"e44b0d0\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3e7735b mrtse-title elementor-widget elementor-widget-text-editor\" data-id=\"3e7735b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h3 style=\"text-align: left; padding-left: 80px;\">Case: Mr Tse<\/h3>\n<h3 style=\"text-align: left; padding-left: 80px;\">Mentally Incapable of Making End of Life Care Decisions<\/h3>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2ccae7c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2ccae7c\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-defb140 mrtse-tab\" data-id=\"defb140\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-666a7b2 mrtse-tab-themes elementor-tabs-view-horizontal elementor-widget elementor-widget-tabs\" data-id=\"666a7b2\" data-element_type=\"widget\" data-widget_type=\"tabs.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-tabs\">\n\t\t\t<div class=\"elementor-tabs-wrapper\" role=\"tablist\" >\n\t\t\t\t\t\t\t\t\t<div id=\"elementor-tab-title-1071\" class=\"elementor-tab-title elementor-tab-desktop-title\" aria-selected=\"true\" data-tab=\"1\" role=\"tab\" tabindex=\"0\" aria-controls=\"elementor-tab-content-1071\" aria-expanded=\"false\">Case Description<\/div>\n\t\t\t\t\t\t\t\t\t<div id=\"elementor-tab-title-1072\" class=\"elementor-tab-title elementor-tab-desktop-title\" aria-selected=\"false\" data-tab=\"2\" role=\"tab\" tabindex=\"-1\" aria-controls=\"elementor-tab-content-1072\" aria-expanded=\"false\">Commentary<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t<div class=\"elementor-tabs-content-wrapper\" role=\"tablist\" aria-orientation=\"vertical\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-tab-title elementor-tab-mobile-title\" aria-selected=\"true\" data-tab=\"1\" role=\"tab\" tabindex=\"0\" aria-controls=\"elementor-tab-content-1071\" aria-expanded=\"false\">Case Description<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-1071\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-1071\" tabindex=\"0\" hidden=\"false\"><p>Mr. Tse, a 70-year-old man, was brought to hospital and admitted to the medical ward by his son. Mr. Tse complained of not being able to swallow. He lived alone, had a history of drinking many cans of beer, and his son visited him occasionally. The history of the swallowing problem was uncertain. He appeared emaciated. An OGD was carried out and a tumour obstructing the oesophagus was found. The surgical team concluded that Mr. Tse was too frail to undergo any palliative stenting procedure. The Medical Oncology team recommended that a course of chemotherapy might be tried, but that his nutritional status should be optimized first. His body mass index was 12 kg\/m2 and he was unable to ambulate, being dependent for the basic activities of daily living.<\/p><p>In the meantime a nasogastric tube was inserted since Mr. Tse was unable to tolerate any food. However, he kept pulling the tube out and had to be restrained. Several conversations with Mr. Tse were attempted to elicit his preferences. Conflicting stories were obtained: sometimes he wished to do whatever the doctors recommended; sometimes he wanted to eat chicken and demanded this; sometimes he refused all treatment and wanted to be left alone. His son was consulted for an opinion on his feeding method, but was unsure what to do. After a few weeks a Mini Mental State Examination was carried out, revealing a score of 10.<\/p><p>How would ethical considerations guide the management of this patient?<\/p><p>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/p><p><span style=\"font-size: inherit;\"><ul class=\"lcp_catlist\" id=\"lcp_instance_0\"><li><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/substituted-judgement\/\">Substituted judgement<\/a><\/li><li><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/nutrition-and-hydration\/\">Nutrition and hydration<\/a><\/li><li><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/dementia\/\">Dementia<\/a><\/li><li><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/decision-making-capacity\/\">Decision-making capacity<\/a><\/li><li><a href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/cancer\/\">Cancer<\/a><\/li><\/ul><\/span><\/p><\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-tab-title elementor-tab-mobile-title\" aria-selected=\"false\" data-tab=\"2\" role=\"tab\" tabindex=\"-1\" aria-controls=\"elementor-tab-content-1072\" aria-expanded=\"false\">Commentary<\/div>\n\t\t\t\t\t<div id=\"elementor-tab-content-1072\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"tabpanel\" aria-labelledby=\"elementor-tab-title-1072\" tabindex=\"0\" hidden=\"hidden\"><p>&#8211; Dr. Christopher Lum, Consultant Geriatrician, Shatin Hospital<\/p><p>The case of Mr. Tse posed an ethical dilemma for clinical care and management.\u00a0Most specialty textbooks focus on disease treatment and doctors are trained to\u00a0treat a disease or a single problem. Thus the Oncology team recommended that\u00a0\u201ca course of chemotherapy may be tried, but that his nutritional status should be\u00a0optimized first\u201d. As per the recommendation, the primary care team inserted a\u00a0nasogastric tube but this was repeatedly pulled out by Mr. Tse. Although\u00a0attempts were made to explore the wishes of the patient (it was uncertain what\u00a0wishes were explored, re: on feeding mode, whether to receive chemotherapy or\u00a0not, etc.), replies were inconsistent. The team attempted to consult Mr. Tse\u2019s son,\u00a0but he was unable to give an answer on what to do. Should the team continue to\u00a0enforce the method of nasogastric tube feeding in attempt for later\u00a0chemotherapy despite Mr. Tse struggling with this? Or should the team\u00a0\u201cabandon\u201d Mr. Tse in view of his reluctance to receive treatment?<\/p><p>The four principles of Beauchamp and Childress (2001) on medical ethics, namely\u00a0autonomy, beneficence, non-maleficence, and justice, have been pillars in this\u00a0area for decades. These four pillars are inter-related and not standalone\u00a0principles. For example, while we are to respect an individual\u2019s autonomy on\u00a0decision-making, he\/she should be given adequate and truthful information on\u00a0beneficence and non-maleficence before making the decision. As a prerequisite,\u00a0Mr. Tse needed to have the mental capacity to make judgements and decisions.\u00a0As for the situation of Mr. Tse, his decision was inconsistent and there was doubt\u00a0on his mental capacity to make judgement. His cognitive function was assessed\u00a0with Mini Mental State Examination (MMSE), in which he scored 10\/30, showing\u00a0that he was at a level of severe cognitive impairment by convention. However,\u00a0one has to rule out the possibility that he was suffering from pseudo-dementia\u00a0(e.g. depression related to the diagnosis or current treatment received) that was reversible. Even if his cognitive impairment was irreversible, a low score does not\u00a0exclude him from having the ability to make decisions on his own. Proper\u00a0assessment of his ability to retain, comprehend and balance information was\u00a0required before being able to judge whether Mr. Tse was capable of making\u00a0decisions on his medical treatment. Assuming Mr. Tse was genuinely not able to\u00a0make judgement, it was reasonable to seek opinion from his son who should act\u00a0as the surrogate for Mr. Tse, i.e. to make decisions as if he were Mr. Tse.<\/p><p>However, in recent years, there are concerns that the four principles alone are\u00a0not sufficient in themselves. There are also debates about what constitutes\u00a0\u201cbeneficence\u201d or \u201cnon-maleficence\u201d. Should an extension of life be the only\u00a0outcome of such interests? A study has shown that for some, being handicapped\u00a0or not being able to live independently are more intolerable than death (Tsevat J,\u00a02004). Furthermore, more than 95% of the local population is Chinese, which\u00a0follows the philosophy of filial piety in Confucianism. It is difficult to adopt an\u00a0individualistic approach and neglect the views of family members. A practical\u00a0\u201cfour quadrants\u201d approach that takes into account the medical indications,\u00a0patient preference, quality of life, and contextual features is advocated (Sokol\u00a0DK, 2008; Jonsen AR, 2010; Tse CY 2016).<\/p><p>On medical indications for treatment, the medical team should be the best party\u00a0to make recommendations based on the principles of beneficence and non-maleficence. Recommendations should not be based on an \u201caverage\u201d patient but\u00a0should be based specifically on Mr. Tse. As illustrated in this case, chemotherapy\u00a0for oesophageal cancer may extend the median survival for a certain duration.\u00a0The trade-off comes with the side effects of the chemotherapy. Yet, in the case of\u00a0Mr. Tse who at that point was so emaciated, debilitated and generally frail, it was\u00a0highly unlikely that he could tolerate chemotherapy or that chemotherapy would\u00a0extend his overall survival. Medical indications for chemotherapy are debatable,\u00a0so was the indication for a nasogastric tube for nutrition build-up, which serves as\u00a0a primer to chemotherapy.<\/p><p>As to the patient\u2019s preference, it was clear that Mr. Tse had repeatedly pulled out\u00a0the nasogastric tube. That was obviously not his preference. As indicated, he\u00a0wanted to eat chicken and demanded it. Was there a reason why he was not\u00a0allowed to have chicken as he preferred? Had there been discussion with Mr. Tse\u00a0on his preference to receive chemotherapy? Had he been given adequate\u00a0information on not only the \u201csuccess rate\u201d and side effects of chemotherapy, but\u00a0also the \u201csuccess rate\u201d and side effects of priming with nasogastric tube, as well\u00a0as the expected life conditions after a \u201csuccessful\u201d chemotherapy? In other\u00a0words, Mr. Tse needed to be discussed on the whole \u201cmanagement package\u201d\u00a0instead of on each of the individual procedures by isolation. If Mr. Tse was\u00a0incapable to understand and judge, his previously expressed goals, values and\u00a0preferences in life might be sought from his son. The information should then be\u00a0used to evaluate whether the procedures (use of nasogastric tube, giving\u00a0chemotherapy) violated the previously expressed goals, values and preferences of\u00a0Mr. Tse, and to help his son arrive at a decision for Mr. Tse.<\/p><p>Quality of life (QOL) may pose a difficult issue as individuals may vary on what\u00a0constitutes a good QOL, or on what life conditions are considered unacceptable. If\u00a0a patient is cognitively sound, then one may discuss with him\/her wishes or\u00a0values, and what is considered an intolerable lifestyle over an estimated life span.\u00a0In the case of Mr. Tse who could not give a sound decision, previously expressed\u00a0opinions on the above matters could be sought from the son.<\/p><p>As alluded to above, the Chinese have a strong culture of filial piety which is\u00a0largely influenced by Confucianism. This contextual feature has to be considered,\u00a0especially given that the family\u2019s view is sought when a patient has not expressed\u00a0prior wishes. This presents the family members with the most difficult decision or\u00a0unbearable responsibility when it comes to \u201crefusing\u201d a course of treatment\u00a0which is \u201cmedically indicated\u201d. However, the focus should NOT be on \u201caccepting\u201d\u00a0or \u201crefusing\u201d a conventional treatment. Rather, the family should be discussed on\u00a0different options of management directions, and arrive at a joint decision that is\u00a0in the best interests of Mr. Tse based on the above three areas. It would be\u00a0worthwhile reviewing the following aspects with the son:<\/p><table border=\"1\" cellpadding=\"10\"><tbody><tr><td><ol><li>Current diagnosis;<\/li><li>Usual treatment of the condition and the particular circumstances of Mr. Tse\u00a0resulting in the need of special consideration;<\/li><li>Explore whether Mr. Tse had expressed any prior wishes, preferences and views in life;<\/li><li>Discuss and suggest management options in the light of any known wishes,\u00a0preferences and valued aspects in life, as well as any limitations that may not\u00a0be acceptable to Mr. Tse;<\/li><li>Family should be supported in reaching a difficult decision that is in the best\u00a0interests of Mr. Tse and is based on the best guess of his wishes. It should also\u00a0be made clear how the team and family are to work together towards fulfilling\u00a0the final wishes for Mr. Tse in his final journey.<\/li><\/ol><\/td><\/tr><\/tbody><\/table><p>References<\/p><ol><li>Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 5th\u00a0edition, Oxford University Press, Oxford 2001.<\/li><li>Tsevat J, Cook EC, Green ML, et al. Health values of the seriously ill. Ann Intern Med 1994; (122): 514-520<\/li><li>Sokol DK. The \u201cfour quadrants\u201d approach to clinical ethics case analysis; an application and review. J Med Ethics 2008; 34: 513-516<\/li><li>Jonsen AR, Siegler M, Winslade WJ. Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. 7th\u00a0edition. New York: McGraw-Hill\u00a0Medical 2010<\/li><li>Tse CY. Practical Approach to Clinical Ethics at the Bedside for General\u00a0Physicians. Synapse 2016 (August) 3-7. Accessed on 8 April 2020 at\u00a0http:\/\/www.hkcp.org\/hkcp\/publications.html<\/li><\/ol><\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Jockey Club End-of-Life Community Care Project JCECC Capacity Building and Education Programmes on End-of-Life Care Introduction Cases Backgrounders Themes Case: Mr Tse Mentally Incapable of Making End of Life Care Decisions Case Description Commentary Case Description Mr. Tse, a 70-year-old man, was brought to hospital and admitted to the medical ward by his son. Mr. [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":"","_links_to":"","_links_to_target":""},"class_list":["post-3264","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Cases:MrTse - IOA EOL<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ioa.cuhk.edu.hk.w26.ysdhost.com\/end-of-life-care\/mrtse\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cases:MrTse - IOA EOL\" \/>\n<meta property=\"og:description\" content=\"Jockey Club End-of-Life Community Care Project JCECC Capacity Building and Education Programmes on End-of-Life Care Introduction Cases Backgrounders Themes Case: Mr Tse Mentally Incapable of Making End of Life Care Decisions Case Description Commentary Case Description Mr. Tse, a 70-year-old man, was brought to hospital and admitted to the medical ward by his son. 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