Hong Kong’s new Advance Decision on Life-sustaining Treatment Ordinance took effect on August 1, granting legal recognition to advance medical directives for the first time. The legislation aims to provide clearer guidance and legal protection for patients and healthcare professionals regarding end-of-life care decisions.
Among the first to engage with the new law was Chan Yiu-kuen, an 89-year-old resident who has chosen to outline her treatment preferences should she become terminally ill. Mentally competent and free from major illness, Chan stated she wishes to forgo interventions such as cardiopulmonary resuscitation (CPR) and intubation when approaching the end of life. Before signing her directive, her doctor conducted a videotaped assessment to confirm her mental capacity, during which she was able to identify family members and provide the date, time, and location of the filming.
Chan had intended to formalize her directive on the day the ordinance commenced but postponed her appointment due to heavy rain. Her eldest son, Hillman Tam Shui-wah, a 67-year-old family therapist, said the family began discussing advance directives about six months prior after learning about the option through a television program. Tam emphasized the advantage of consensus among family members regarding his mother’s wishes, reducing potential conflict during critical medical decisions. He noted that some acquaintances had experienced family disputes over end-of-life care, underscoring the importance of clear directives.
Advance medical directives and do-not-attempt CPR (DNACPR) orders have existed under Hong Kong common law since 2010 but lacked statutory clarity. The new ordinance specifies legal requirements for these documents, urging doctors to use government-recommended model forms for advance directives and mandating statutory forms for DNACPR orders. The Hospital Authority has issued directives under the new framework, though the total number has not been disclosed.
According to the Hospital Authority, patients signing advance directives generally come from oncology, palliative care, and geriatric medicine specialties. Private practitioner Wilson Fung Chi-pun, who regularly assists patients with drafting directives, noted that many of his clients require palliative or home care. Fung welcomed the new legislation for providing clearer standards but observed no recent surge in advance directive signings.
Medical sector legislator Dr. David Lam Tzit-yuen expressed reservations about encouraging healthy individuals to draft such directives due to uncertainties about future health and family circumstances. He highlighted the difficulty in making definitive decisions without knowing one’s mental capacity timeline or potential illnesses, as well as changes in family dynamics that could affect preferences over time.
The new legal framework marks a significant step in formalizing patient autonomy at the end of life in Hong Kong, aiming to ease decision-making for families and medical professionals alike. However, uptake remains gradual, with healthcare providers continuing to navigate the complexities of future care planning under the revised legal provisions.