Starting July 31, residents in Hong Kong will be able to upload advance medical directives specifying which life-sustaining treatments they wish to refuse to the city’s electronic health record platform, marking a significant development in the management of end-of-life care. This digital integration coincides with the enforcement of the Advance Decision on Life-sustaining Treatment Ordinance, which was passed by lawmakers over 20 months ago.
The ordinance allows mentally capable adults to outline specific treatments they do not want to receive once they lose mental capacity and reach certain clinical conditions, such as a persistent vegetative state. These treatments include cardiopulmonary resuscitation (CPR), artificial ventilation, pacemakers, and other life-sustaining measures. Unlike prior practice where advance directives were based on common law since 2010, the new legislation provides clearer legal protections for both patients and healthcare professionals.
Dr. Doris Tse Man-wah, chairwoman of the Hospital Authority’s clinical ethics committee, characterized the ordinance as a milestone in Hong Kong’s approach to end-of-life care, emphasizing that it helps resolve uncertainties and safeguards individuals who draft these directives as well as the medical personnel responding to emergencies.
Under the new system, registered doctors will upload scanned images of patients’ advance medical directives onto the eHealth platform. Authorities have indicated plans to enable electronic signing of directives on the platform in the future, though no specific timeline has been announced.
The ordinance also covers do-not-attempt cardiopulmonary resuscitation (DNACPR) orders, which instruct responders not to perform CPR during out-of-hospital cardiac arrests. However, DNACPR orders will remain in physical form, to be kept by patients or their carers, as they have not yet been incorporated into the electronic system. Since early last year, the Hospital Authority has distributed standardized yellow bags to patients holding either advance directives or DNACPR orders to ensure safe and easily identifiable storage. These bags include reminders allowing emergency responders to search them if needed.
Dr. Tse advised that family members or carers should keep the yellow bags accessible rather than locked away. She suggested that elderly individuals living alone might hang the bags near their flat entrances for quick location.
Data indicates that over 90 percent of patients with advance directives request withholding CPR when nearing the end of life. The new regulation encourages the use of standardized forms for advance directives and mandates compulsory signature forms for DNACPR orders.
In preparation for the ordinance’s implementation, the Hospital Authority has converted more than 4,800 existing DNACPR orders into the required statutory format and updated clinical guidelines related to end-of-life care. Designated healthcare personnel—including doctors, nurses, dentists, allied health professionals, and non-emergency ambulance staff—are now required to receive training on managing these care documents at least every two years.
Dicky Chow Ka-chun, assistant research director at Our Hong Kong Foundation, welcomed the digital uploading of advance directives as a positive step toward improving medical information flow. He noted, however, that it is important for patients’ end-of-life preferences to be explicitly recorded within public hospitals’ clinical management and emergency service systems to ensure comprehensive adherence to their wishes.