Advance medical directive and why is it so important?

The long-awaited Advance Decision on Life-sustaining Treatment Ordinance (Cap 651) came into effect on 31 July 2026. It gives statutory effect to advance medical directives (AMD) and do-not-attempt cardiopulmonary resuscitation (DNACPR) orders.

What is an advance medical directive?

Under this framework, AMDs allow an adult to refuse specified life-sustaining treatments in advance, if four conditions are met:

• • Condition 1: A mentally capable adult.
  • Condition 2: Made in writing and in paper form, with the instructions clearly presented.
  • Condition 3: The maker signed and dated it.
  • Condition 4: Witnessed by two adults with no personal interests. One of whom is a doctor.

If the maker later becomes mentally incapable and a precondition is met—terminal illness, persistent vegetative state or irreversible coma, or another end-stage irreversible condition—the named treatments (e.g. CPR, artificial ventilation, artificial nutrition and hydration) must not be given. However, basic care and palliative care cannot be refused.

A valid and applicable AMD binds treatment providers who have notice of it. By design, making is cautious; revocation is easy while capacity remains.

What is a DNACPR?

Under the new framework, DNACPR orders are instruments with continuing effect that direct rescuers not to perform cardiopulmonary resuscitation if the patient suffers cardiopulmonary arrest. They may be AMD-based when the patient was still conscious, or non-AMD-based for those who are incapable and minors.

They are issued by two registered medical practitioners (one a specialist) once the patient meets the specified preconditions and after appropriate communication. Their main purpose is to give practical effect to a “no-CPR” instruction in an advance medical directive, especially outside hospital and when no healthcare professional is present.

A valid DNACPR order binds those who have notice of it. The Ordinance’s “if in doubt, save lives first” principle protects professionals and rescuers who act honestly and reasonably.

Why AMD or DNACPR?

The formalised AMDs and DNACPR orders represent a major healthcare advancement in Hong Kong because patients lose the ability to speak for themselves precisely when the hardest decisions arise. Without a clear, binding record of their wishes, families may disagree, doctors face legal uncertainty, and aggressive treatments that only prolong dying can continue by default. The Ordinance converts a competent adult’s carefully considered refusal into a legally enforceable instrument. It removes doubt for healthcare professionals and rescuers, protects them when they act in good faith, and lets patients retain control over their final medical care with dignity.

Why do patients need to formalise their wishes in an AMD?

Many patients may think that as long as they have expressed their wishes clearly to their loved ones or their doctors beforehand, there is no need to prepare a legal document like an AMD. In reality, doctors often face difficult decisions between the patient’s changing medical condition and the patient’s will. Typically, families are consulted, who might fail to form an agreement amongst themselves and might also hold very different views from those of the patient.

In fact, without a valid AMD, a patient’s wish is not legally binding and could be overridden. The new legislation ensured that patients’ living wills can be respected, preserving their dignity while preventing unnecessary suffering through aggressive resuscitation attempts in their final moments.

Advance medical directives are now changing the medicolegal landscape of Hong Kong. Patients, families, and doctors should familiarise themselves with how it works and its importance.