The Tetralemma of Doing and Talking

Doctors need to provide options to patients before we treat them.  It was the ratio decidendi of the Montgomery case.  I always wonder, how comprehensive should the list of options be?  Of course we need to explain options that are effective and evidence-based.  However, there are forever the so-called-experts’ difficult-to-measure alternative treatments and state-of-art novel advances.  Is it our duty to mention such options?  Don’t forget that there should be an option of conservative treatment, which literally includes “no treatment”.  This is in contrast to the famous quote that “Quitting is not an option.”  So it is important to think out of the box.  Smart people always do that.  And sometimes they physically go out of the boxes.  You know what I mean.

Many a time, patients are in difficult positions when they need to make the decision of to treat or not to treat.  It is equally difficult for doctors to help them to make the informed choices.  This is called a dilemma.  Neither of the two possibilities offered is unambiguously preferable.  In Greek, dilemma means double proposition.  In Buddhist teachings, there is a kind of logic called tetralemma.  It does not carry the hint of negative sense of dilemma.  It just denotes the four possibilities of an event.  Thus “tetra” and “lemma”.  Let the event be “A”, then the four possibilities are: “A”; “non-A”; “both A and non-A”; “neither A nor non-A”.  This is in contrast to the traditional Three Laws of Thought: the Law of Identity; the Law of Non-contradiction; and the Law of Excluded Middle.  However, tetralemma logic is not very comprehensive to everyone and thus not really useful.

I am going into tetralemma.  It is just that while I am watching news, I think of an interesting set of four combinations.  It is about “doing” and “talking about”.  As we all know, for some kinds of things, we can only talk about them but not really put them into action.  Actually there are four combinations.  “Can talk about and can do”; “Cannot talk about but can do”; “Can talk about but cannot do”; “Cannot talk about and cannot do”.  It is interesting (sorry, I can only think of “interesting” as the description) to use this set of four to look at different events.  For example, about privileges, it all depends on how powerful you are.  Some can only talk about it; some can only do it but need to keep their mouths shut.  And of course there are always a few who can enjoy privileges while showing off to others.  Another example, the hot but forbidden topic of dependence.  Previously, it was generally understood that this was a topic that could be talked about but could not be actualized.  A few thought that it could be propagandized and acted upon.  However, now it is proposed that such topic is illegal even to talk about.

Life is not simple.  While we were students, professors repeatedly taught “one man one disease”.  This means that when a patient has several symptoms and signs, we cannot explain them by saying that the patient is suffering from more than one disease.  We have to think hard to find one condition that can explain all the findings.  However, when we become doctors, every day we see patients suffering from more than one disease.  We have to apply a different set, or in fact different sets, of upgraded and complicated logic to make a diagnosis of whether there is one disease to explain all, two different diseases in play, more diseases, or even normal variations.  This is also the case for tetralemma.  Apart from the “A”; “Non-A”; “Both A and non-A”; “Neither A nor non-A”; Nagarjuna, a famous Buddhist philosopher, came up with another set of four to the original one.  They are: “Not-A”; “Non-not-A”; “Both not-A and non-not-A”; “Neither not-A nor non-not-A”.  He found out that there was something that belonged to none of these eight groups.  That was his famous Eight Negations.

I am not a great thinker.  But to enrich my set of four, I add some by-standers.  Take the example of enjoying privileges again.  While someone is able to enjoy some privileges and talk about it matter-of-factly, others of course cannot enjoy the same.  More than that, they are not allowed to talk about this unfair situation.  There are altogether sixteen combinations.  I woon’t list them all out here.  Some of them look absurd.  However, apart from being complicated, life is sometime absurd.  What you always believe and enjoy might no longer exist when there is a change in space or time.

Both Tetralemma and the Eight Negations originated from Buddhism.  My sixteen combinations of doing and talking about came about with the aforementioned two.  Thus, they all share the same characteristics of Buddhist teachings.  You have to get the meanings and feelings of them by cultivation of your own wisdom.  I cannot explain further.

 

(Source: HKMA News June 2016)

「史」無前例

(Source: HKMA News May 2016)

Intent to kill

I would like to share with you a decision from the Supreme Court of the United Kingdom in February this year.  The decision was on two appeals (R v Jogee [2016 UKSC 8 and Ruddock v The Queen [2016] UKPC7) from two appellants who were found guilty of murder when they each acted in a joint enterprise.  This meant that the appellant did not actually do the murder, but was said to have encouraged or assisted the principal to do so.  The issue before the Supreme Court was on the proof of intent for the secondary party to a crime.  The law of secondary liability for crime has always been confusing.  To make sure that readers follow, I try to explain from scratch.

In criminal law, to find a defendant guilty of murder, two components need to be proved beyond reasonable doubt by the prosecution.  First, there has been an act of killing.  The defendant has killed the subject, or has acted in a way causing (not too indirectly) his death.  This component is called the actus reus. Second is the presence of intent.  The defendant has the intention to kill, or should have foreseen the causing of death from his action.  This component is called the mens rea.

In a joint enterprise, the law takes it that persons who are indeed together responsible for a crime are all guilty of it, whether as principals or secondary parties.  This is because it may not be possible to determine exactly whose hand performed the vital act.  For example, in an armed attack by two attackers, it is not possible to tell which one of them indeed killed the victim.  Taking the rule for actus reus in the strictest sense might lead to the injustice of finding both of them not guilty.  Thus, it suffices to prove that each defendant either did it himself or intentionally assisted or encouraged it.  In these cases, mens rea is relied on more heavily.

However, reality is always not as simple.  Under the basic principle of joint-enterprise, there exist cases where the intent of the secondary party is difficult to determine.  In Jogee, a drunk confrontation turned into a fight.  The victim was killed by the principal with a knife picked up in the victim’s kitchen while Jogee was yelling outside the house.  In Ruddock, the principal cut the throat of a taxi driver while Ruddock was present and was a party to the robbery.  Both Jogee and Ruddock were found guilty of murder.  The decisions were made following a precedent case: Chan Wing-Siu v R [1985] AC 168.  Chan Wing-Siu was a Hong Kong case in 1985.  The appellants were members of a gang who had gone to the victim's house to commit a robbery, arming themselves with knives.  During the robbery the victim was stabbed to death by a member of the gang and the defendants were convicted as accomplices to the murder.  The Privy Council dismissed their appeals.  It was held that for an accomplice to be guilty of murder it was sufficient for the prosecution to establish that he foresaw death or grievous bodily harm as a possible incident of the common design being carried out.

31 years later, the Supreme Court ruled that Chan Wing-Siu was decided wrongly and allowed the appeals of Jogee and Ruddock.  The error in Chan Wing-Siu was to treat foresight of the murder as automatic authorization of it.  In other words there was no need to consider whether the secondary party intended to kill the victim or not.  There was no actus reaus, nor actual mens rea.  Chan Wing-Siu also created a situation where the secondary party could be found guilty more easily than the principal.  For the principal, the prosecution needed to prove his intent to kill.  For the secondary party, the prosecution instead needed only to prove that he could foresee a real chance of the principal killing the victim, though he might have no intention at all to see the victim dead.  The unanimous conclusion of the Supreme Court pointed out that “foresight is simply evidence (albeit sometimes strong evidence) of intent to assist or encourage, which is the proper mental element for establishing secondary liability”.  The difference might be subtle but real.  In many cases, the continued participation in the crime and the foresight of a more serious second crime were strong pointers to intent.  However, distinguishing foresight and intent set the rule straight and in line with other areas of criminal law.

Note that even if the prosecution fails to prove intent, the secondary party will not be set free.  He would be found guilty of a lesser charge such as manslaughter.

Readers may wonder, why do I write on this topic which is ambiguous and unrelated to our practice?  The Supreme Court has specified that this rule is not confined to cases of homicide, or indeed to cases of violence.  I read this judgment while I was watching TV news.  Many people were charged with riot.  I remembered writing in the Editorial of July 2013 about doctors taking part in Occupy Central: “More important, what is going to happen during the movement will also be unpredictable.   The doctor needs to make sure he is not involved in anything drastic.   Even so, while he is looking at charges like ‘unlawful assembly’, the prosecution might charge him with more serious charges like ‘riot’”.  Luckily, that did not happen.  Unfortunately, in the Mong Kok Incident this year, many were arrested and charged with riot.  I just hope that this Supreme Court decision can help those who took part in a demonstration that turned into acts of violence. 

(Source: HKMA News April 2016)

Montgomery and Medical Council Reform

Doctors and lawyers are still talking about the Montgomery case.  On March 11, 2015 the UK Supreme Court decided that the Bolam test no longer applied to the consent for medical treatment.  Doctors could not rely on common practice or support from responsible medical opinion to omit rare but significant risks when getting consent from their patients.  Instead, we now have to take “reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments.”

If you have studied law after 1997, or if you have read a bit about Bolam, you would not be shocked by the Montgomery case.  Bolam was decided in 1957. Since then, and especially in the recent 30 years, the Bolam test has been said to be “out” and no longer applied in various areas of medical negligence cases too frequently.  After reading Montgomery, I am happy that Bolam test is still treated as the rule with more than a few exceptions.  I foresee that soon Bolam test will become the exception in the decision of the standard of care in medical negligence.

Tracing back to 1985, in Sidaway, Lord Scarman, though as minority in dissent, had said that the Bolam principle should not apply to the issue of informed consent.  A doctor should have a duty to tell the patient of the inherent and material risk of the treatment proposed.  To me, the most important limitation set on Bolam was by Bolitho in 1997.  In Bolitho, medical opinions were divided on whether the claimant, a child in respiratory failure, should have been intubated.  If Bolam was followed, the defendant doctor should automatically be deemed not fallen below standard as she was supported by respectable medical opinion.  However, the House of Lords took the chance to announce that it was the Courts that set the law and not the medical profession.  Even if the medical practice was supported by a body of respectable medical opinion, it needed to be logically defensible.  Whether that particular medical practice stood on logic would be decided by the Courts. The decision would include the weighing of risks against benefits.

Embraced in the Bolitho decision is the insurance principle.  If the consequence of a risk is grave when materialized, it should be insured against especially when the cost of insurance is low.  Thus, in Montgomery, shoulder dystocia was considered a grave consequence of vaginal delivery of big baby that should have been communicated to the patient.  This 10% risk should have been insured against by letting the patient choose whether to adopt other modes of delivery or to take the risk.  In Sidaway, Lord Scarman insisted that a less than 1% risk of paraplegia should have been told as the consequence was grave.  For the patient to make a real and informed choice, the doctor needed to make sure that the patient understood what the risk was and how avoidable it would be.

Note that the risk here is the inherent risk of an intervention.  Although human factors do count, we are talking about unavoidable risk even in the best hands.  Stressing on the character or the skill of the doctor cannot dispense of the requirement of informed consent.

Interestingly, or sadly, I see from discussion on the recent Medical Council reform proposal that some doctors do not understand the concept of intrinsic risks and the insurance principle stressed in the above mentioned string of court cases.  To put it frankly, the reform proposal is to change the composition of the Medical Council.  The purpose of doing so is to facilitate the passing of policies in-line with the government.  This has been openly announced by a lawmaker and it is not denied by the government.  By adding 4 lay members, the composition of the Medical Council is changed in 2 aspects.  First, the number of lay members is increased while doctors are still in majority.  Second, the number of appointed members will be in majority by 4 to elected members.  It is the change to appointed member majority that would serve the purpose of railroading government policies.

Those “for” the proposal put forward arguments mainly on 2 fronts.  First, some appointed members do go through some process of selection.  Second, appointed members have their integrity and would not rubber-stamp proposals by the government.  These arguments stand no chance if Montgomery applies.  The intrinsic “risk” of appointed members is that they are pro-government.  It is nothing about right or wrong.  The government will naturally select those expected to behave in-line with it.  It will also keep them for another term and discontinue to appoint those who have “misbehaved”.  Any selection or election process will not be of much help so long as the members needed to be appointed.  To insist that appointing is mere formality is to ignore the facts in the cases of HKTV and Johannes Chan in the HKU pro-vice-chancellor selection.

On the other side of the same coin, elected members are no saints.  Voters would have a natural tendency to elect those behaving in ways beneficial to them.  Elected members would have a natural “risk” of appeasing, or at least not upsetting, their voters especially when the system allows re-election after members serve their terms.

I am not talking about which kinds of members are better, nor which forms of election better serve the society.  I am looking at changing a balanced council to one with appointed member majority.  There exists a material risk that decision making by the Medical Council will be dominated by government policies.  Of course this might not happen.  But this is the intrinsic risk of the system once the composition is changed according to the present proposal.

I am not sure whether Dr. KO Wing Man needs to explain to the medical profession about this intrinsic risk.  I am not sure whether he needs to make sure lawmakers understand the consequence before they vote to support the proposal.  I wonder if the lawmakers who are minority in the Legco and are busy filibustering will agree to a change in composition of the Medical Council to give the government a majority vote.  I envy Alvin YEUNG Ngok Kiu who is elected to Legco to prevent a foreseeable change to the Rules of Procedure in case there is a minority created.  

Again, it is not about vaginal delivery or not. It is all about informed consent.

(Source: HKMA News March 2016)

不如歸去

“不如歸去，不如歸去……”  It was said that cuckoo birds sang like this.  I had heard cuckoo sang.  I could not link together the sounds it made and the four Chinese words spelling out the desire to leave and to return to wherever one belonged.  Not until this month. 

A neurosurgeon one year senior than me collapsed and died during a hiking trip.  A hall-mate in his fifties chose to end his life.  A colleague had a sudden stroke and stayed in ICU for a few days.  We were all sad to hear such news.  Dormant Whatsapp groups became active again with self-debriefing messages.  Some stressed on the impermanence of lives, recalling the brief encounters few days before those tragic incidents.  Some wrote canned encouraging proverbs, reminding everyone to treasure what we had.  Some literally turned the Whatsapp group into Personal Emergency Link Service and asked everyone to call for help there no matter what devastating problem they faced.

Suddenly, 不如歸去 rang in my head.  If you said it in Putonghua, it matched.  There was even a tingle of sadness and helplessness in it.  It was our mind that painted the world.  It was perception that mattered.  Tired and weary travelers were homesick.  Whatever the cuckoo sang, they could fill in similar lyrics.  The cuckoo reminded me of 歸去，也無風雨也無晴。Working diligently or chasing for goals seemed meaningless.  Was it time to leave all these and return to tranquility, where glory or hardship did not matter?

Cuckoos sang via Whatsapp also.  Many friends got the message of 不如歸去.  Retiring became a hot topic in discussion groups.  Work was stressful physically and mentally.  Performing surgery pumped your adrenalin, but it also exhausted you.  Post operative management disturbed sleep.  Family doctors had very long working hours and virtually deprived them of private lives.  What if we retired and left work alone?  Most said that they would do things they were interested in but did not have time to enjoy before.  I had heard this vague idea from my patients too often.  Reality was that most of them became depressed after retiring for a while, as they had all along been absorbed in work and what they thought they were interested in were all fantasies.  As we had not retired yet, sharing fantasies did no harm.  Some said that they wanted to travel around the world.  Others challenged that one could not wander for years.  One said that he would like to run a coffee shop, so that he could chat everyday with customers.  I hinted that he could continue his practice as family doctor, as patients from all walks of life paid to chat with him already.  Some wanted to learn something new.  Others then posted information on CME and various courses.  Finally, an ophthalmologist honestly admitted that he was most interested in going to clinic and seeing patients everyday.  Messages gradually tailed off with most of us realizing working was not that bad.  We might just need to adjust our schedules and attitudes. 

不如歸去 was more than retiring.  Life was more than work.  You might get more frustration if you stopped working and had more time, unless you cut yourselves off from all the news and social media.  I was not talking about the inequalities and wrongs done that appeared too often.  We were not living in a utopia.  These things were bound to happen.  They made you sad or angry.  They would not frustrate you.  It was how the society reacted to such wrongs that frustrated you.  Prevarication was introduced and worshiped.  Eventually, while people still maintained the common sense interpretation of right and wrong, they spinned that there was no act of wrong-doing; or at least they did not see any cogent evidence of such act.  Finally, people decided to dispense of all the trouble.  As morality was common belief of the society, just worked on to change the meaning of “wrong” would do.  Facing such corruption, one could do nothing.  It was this learned helplessness that called for  不如歸去.  I was sure that Professor Yuen heard that cuckoo songs clearly when he decided to quit.  But, where to go?  Where to hide from one’s consciousness?

Cuckoos, please keep singing.  Please keep singing to those people.  Hope that one day, they would realize that what they seemingly gained did not worth what they had done.  不如，歸去。

(Source: HKMA News February 2016)

Medical Council Deformed

The first shocking news of the medical profession in 2016 was the announcement, interestingly via news media, of proposed reform of the Medical Council by the government through introduction of an Amendment Bill to the Medical Registration Ordinance (MRO).  In this issue of the News, you must read the page from Lai Eve.  She had nicely summarized the content of the reform proposal and divided them into “controversial” and “straight-forward” categories.  The most ingenious was the title she coined this reform proposal:  The Medical Council Deform.

You might say that it was exaggeration to describe the proposal as deforming the Medical Council.  Or some might argue that it is necessary to deform the Medical Council if there is a need to do so, so as to serve the public better.  I shall high-light a few points before going into discussion.  

1. It was stated that this proposed Amendment Bill was only an interim action.  More thorough reform might be introduced after the review from the Steering Committee on Strategic Review on Healthcare Manpower Planning and Profession Development in Hong Kong.
2. This interim action was called for because there was a recent High Court case in which the judge severely criticized the delay by the Medical Council in handling complaints, and there had been mounting public pressure for urgent improvements.  
3. Another immediate concern was that the Medical Council needed more flexibility in approving a longer period of up to 3 years for application for limited registration of non-locally trained doctors to practice in Hong Kong.  
4. In the proposed Amendment Bill, the most controversial item is to increase the number of appointed lay members in the Medical Council from 4 to 8.

I am not going to argue whether there are urgent needs to introduce reform while the report of the Steering Committee is due to complete.  I have to point out that the increase in appointed lay members from 4 to 8 vastly disturbed the balance in the composition of the Medical Council, while serving no actual purpose in addressing the 2 stated objectives.  

Complaint handling is but one important function of the Medical Council.  Complaints are first screened by the Preliminary Investigation Committee (PIC).  The PIC would refer the case for an inquiry if a decision on whether the doctor is guilty is needed.  It is statutory requirement for a lay member to form the quorum both in a PIC meeting and in an inquiry.  Therefore, there seems a need to increase the number of lay members in the Medical Council if more PIC meetings and inquiries are to be held.  However, this complaint handling function is purposely segregated from the other functions of the Medical Council for fairness and for the guarantee of independent decision making by individual members.  PIC cases and inquiry details are never discussed in policy meetings or among members.  Therefore the issue of needing more lay members to meet PIC and inquiry quorums can be addressed by adjusting the role of assessors.  

Assessors are persons who can take part in an inquiry.  They will not take part in any other meetings or decision making of the Medical Council.  One of the purposes of such design is to relieve the workload of members of the Medical Council.  In the proposed reform, there are important modifications to the numbers and roles of assessors.  A lay assessor can replace the lay member in a PIC meeting or an inquiry to form the quorum.  The number of lay assessors appointed would be raised from 4 to 14.  All these changes can in fact address the issue of lay persons in complaint handling without disturbing the composition of the Medical Council.

Another often proclaimed problem about complaint handling not mentioned in the reasons for reform is “doctors protecting doctors”.  It is argued and propagandized that increasing the number of lay members is important and useful to address this issue.  However, the proposed reform keeps the majority of doctors in both PIC meetings and inquiries.  Therefore, increasing the number of lay members is irrelevant in this respect.

Increasing the number of lay members from 4 to 8 changes the ratio of lay members to doctor members from 4:24 to 8:24 (1/6 to 1/3).  Lay members are still the minority.  However, one should not overlook the fact that all lay members are appointed by the government.  Within the Medical Council, there exists a delicate balance of appointed member to elected member of 14:14.  When the number of lay members is increased by 4, the ratio of appointed members to elected members would be 18:14, with clear majority votes by appointed members.  

It has been hinted by some, and overtly expressed by many, that elected members in the Medical Council tend to protect the interest of doctors rather than the public.  A too often quoted example is that non-locally trained doctors are not allowed to practice in Hong Kong without sitting for an examination because of oppositions from doctors in the Medical Council.  This is frankly inaccurate and the example is inappropriate.  The power of the Medical Council originates from the MRO.  The Medical Council simply does not have the power to allow non-locally trained doctors to practice in Hong Kong without sitting for an examination and fulfilling certain requirements.  In certain situations, such as the applications for limited registration, the Medical Council can approve non-locally trained doctors to practice in the 2 Universities and Hospital Authority (HA) without sitting for an examination.  In the past few years, the HA has used this mechanism (with objections from a significant number of Hong Kong doctors) to  employ non-locally trained doctors to work in various departments.  So far, the Medical Council has posted practically no resistance to the applications.  The non-locally trained doctors are also able to successfully renew their limited registrations yearly.

While it certainly undermines the wisdom of doctor voters, it is to a certain extend true to say that elected members have an inclination to take interests of the profession more seriously.  However, by the same token, members appointed by the government will incline to support government proposals.  It is this delicate balance in power of difference stake-holders that decisions acceptable to all parties can be negotiated.  Having a clear majority of appointed members will distort the Medical Council to the extent that professional autonomy is affected.

Adding lay members to the Medical Council does not address the “urgent” needs stated in the proposal.  However, the HKMA is not against adding more lay members.  We have a deeper understanding of the proposal.  To safe-guard professional autonomy, we insist that the ratio of appointed members to elected members be maintained.  One simple method is to add 4 elected doctor members together with the addition of 4 appointed lay members. 

(Source: HKMA News January 2016)

Big Guns, Tree-gun, and Election

 

I wish you a Merry Christmas and a Happy New Year!

Wish all members Merry Christmas and Happy New Year.  The blessing goes particularly to one of our young member, Dr. KWONG, who defeated the Kowloon City District Council Chairman LAU Wai Wing in Whampoa West in the 2015 District Council Election.  My wish also go to “Tree Gun”, which is the name better known of the ex-District Councilor Christopher CHUNG Shu Kun.  He was defeated by a newbie TSUI Chi Kin in Yue Wan District.  It was said that TSUI decided to run the election to challenge the “big gun” only on the last day of the nomination period.  What newspapers described TSUI was that he was that he was almost never heard of in the political field.  Of course my wish here is not slightly comparable to the celebration held outside Tree Gun’s to-be-ex-office when the news broke out that he was voted out.  Champagne bottles were opened, poppers were set off, and there came as usual Paula TSUI Siu Fung’s celebration song for losers.

Elections are too common.  When you read this Editorial, the results of the Medical Council election should have been known.  There is only one young candidate this year.  See if he can make it.  Next Year, in 2016, which is just a few days ahead, there will be new office bearers election for the HKMA, the Medical Functional Constituency election for the Legislative Council, and the Election Committee Subsector election for electing the Chief Executive.  

It is always interesting to speculate potential candidates and results of elections.  Legislative Council election is for big guns.  I wonder if any young doctor or newbie will run for the Medical Constituency election.  LEUNG Ka Lau has been our Legislator for 2 terms.  He was first elected in 2008 (2217 votes) when he ran against KWOK Ka Ki (1869 votes), who was the Councilor of the Medical Constituency at that time, HO Pak Leung (2138 votes) and YEUNG Chiu Fat (580 votes).  LEUNG succeeded to stay in the LEGCO in 2012 by beating TSE Hung Hing by a lead of 2336 votes (4541 against 2205 votes).  Although the 2012 result was promising, I speculate that LEUNG will not run for another term.

It would be a wise bet to put your money on Ho Pak Leung.  From limited statistics, HO shared the same group of voters with LEUNG (adding up to around 4500).  Although he is a microbiologist, I guess he has the macroscopic wisdom to enter the playing field.  If you are to bet on who would come out as candidates, a better bet would be on TSE Hung Hing.  TSE is the Immediate Past President of the HKMA.  He might also run for the Presidency of the HKMA just like in 2012.  However, he has added advantage compared to 2012 as he is now a Justice of Peace and might gain much support from pro-governmental voters.

If my memory does not fail me, I remember reading in newspaper some time ago that CHOI Kin would like to run for the LEGCO and the HKMA Presidency in 2016.  Appeared as the “Angry Man” of the HKMA, CHOI has an out-spoken image.  This has been more so with his full-of-sound-bites-if-not-wisdom criticism against the current President of the HKMA.  CHOI has been very successful in various elections.  However, he has never been a candidate for the LEGCO.  If CHOI Has not changed his mind, he needs to take care of the fact that TSE shares the same group of voters with him from the private sector and from the HKMA.  One obvious difference between CHOI and TSE would be their attitude towards the Umbrella Movement.

Of course, there can be other candidates who are surely capable of getting more than 2000 votes to take part.  There can also be spoilers to intervene.  Prediction is never easy.  

While it is interesting to speculate about the LEGCO election, it is difficult to arouse discussion in lunch meetings about the HKMA Presidency election.  Between 2004 and 2015, we have CHOI Kin as President for 3 terms, TSE Hung Hing for 2 terms, and SHIH Tai Cho whose term will end in 2016.  We were only given the chance to cast our votes twice.  Once was CHOI Kin against FUNG Yee Leung in 2004, and the other was CHOI Kin against YEUNG Chiu Fat in 2010.  For the 2 terms of TSE, for one term of CHOI, and for the current term of Presidency of SHIH, they were all “elected” ipso facto.  Each time, there was only one candidate nominated for the post and no voting was needed.  I speculated that it did not happen that there was only one person coming out to take the challenge.  However, negotiation was preferred to election.  Deals were made among a few.  For members, they could not ask what believes the candidates held towards important issues.  The only candidate did not need to make any promise to all and there was no problem of failure to cash his promise in his term.  In the term 2012 to 2014, there was election of the Chief Executive.  In the current term of 2014 to 2016, there was the Hong Kong Electoral Reform consultation and legislative proposal.  The role of the President was vital in leading the HKMA to take part in these issues.  We were not able to ask, to understand, to challenge or to choose.  We could not even vote the candidate out because there was no other choice.  Some might view this as a sign of unity.  However, something that feels good does not mean that it is healthy.  For example, gaining weight continuously is surely not healthy.

The traditional view is that elections are for big guns.  However, with the recent “Tree-gun Incident”, let us see if this view point will hold true in the coming elections.  

(Source: HKMA News December 2015)