Advance Decision on Life-sustaining Treatment Ordinance comes into effect today
The Advance Decision on Life-sustaining Treatment Ordinance (Cap. 651) (the Ordinance) comes intoeffect today (July 31), providing a legal framework for advance medical directives (AMDs) and do-not-attempt cardiopulmonary resuscitation (DNACPR) orders, as well as legal protection for healthcare professionals and rescuers when complying with the directives and orders.
A spokesperson for the Health Bureau (HHB) said, "The Government's policy objective is to ensure that terminally ill patients and their families receive appropriate end-of-life care services and support. The purpose of AMDs and DNACPR orders under the Ordinance is to respect patients' autonomous choices regarding life-sustaining treatment (LST), allowing them to conclude their life's voyage with peace and dignity. The commencement of the Ordinance marks a new milestone in Hong Kong's end-of-life care services."
An AMD allows an adult patient suffering from an advanced and irreversible disease, while he/she is mentally capable of deciding on an LST, to indicate in advance the LST(s) (for example, cardiopulmonary resuscitation, artificial ventilation, and artificial nutrition and hydration) that he/she wishes to refuse should he/she subsequently lose mental capacity and the preconditions specified in the AMD are met. An AMD does not, however, allow the refusal of basic care or palliative care. In line with the principle of "cautious making, easy revoking", the maker must, before making an AMD, fully understand and carefully weigh the implications of each instruction for his/her own condition to make an informed decision, and the AMD must comply with a number of statutory requirements. The maker may also revoke the AMD at any time in the manner specified in the Ordinance.
A DNACPR order, made by registered medical practitioners for a patient who has met the specified preconditions, seeks to ensure that, in settings outside hospitals and even when no healthcare professionals are present, rescuers will act in accordance with the relevant DNACPR order and will not perform cardiopulmonary resuscitation on the patient.
Upon commencement of the Ordinance, healthcare professionals and rescuers are required to act in accordance with the patient's AMD or DNACPR order when they have notice of it and the preconditions specified in the Ordinance are met. Under the principle of"if in doubt, save lives first", the Ordinance provides legal protection for healthcare professionals and rescuers, exempting them from the relevant legal liability where, for example, they administer an LST to a patient because they do not have notice of a valid and applicable AMD or DNACPR order, or they withhold an LST from a patient because they honestly and reasonably believe that the patient has a valid and applicable AMD or DNACPR order.
The Ordinance was passed by the Legislative Council in November 2024. The Government subsequently provided a preparatory period of about one and a half years for stakeholders to get ready for its implementation, and gazetted on May 22, 2026, appointing July 31 as the date on which the Ordinance comes into operation. In preparation for the commencement of the Ordinance, the HHB has worked in collaboration with relevant stakeholders, including policy bureaux and departments, public and private healthcare institutions, residential care homes (RCHs), professional bodies and emergency rescue service organisations, to take forward a range of preparatory work. This includes organising professional training seminars for the personnel concerned (such as healthcare professionals of public and private healthcare institutions, frontline rescue and management staff of government departments and organisations involved in emergency rescues, and staff of RCHs), and updating the relevant service and operational guidelines. The Government has also promoted public understanding of the Ordinance through interdepartmental and cross-sectoral public education and publicity activities, and will continue with these efforts.
Members of the public who wish to learn more about AMDs and DNACPR orders, or who are considering making an AMD, may discuss the matter with a doctor familiar with their condition, who will offer suitable advice having regard to the patient's circumstances. Further information on the Ordinance is available on the HHB's thematic webpage at www.healthbureau.gov.hk/en/press_and_publications/otherinfo/241100_adlto/index.html.
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