New end-of-life care law to recognize patients’ treatment refusals from July 31

Hong Kong’s new end-of-life care law, the Advance Decision on Life-sustaining Treatment Ordinance, will come into effect on July 31. The legislation establishes a statutory framework for advance medical directives and do-not-attempt cardiopulmonary resuscitation (DNACPR) orders, granting mentally competent adults aged 18 or above the legal power to make binding decisions to refuse specified life-sustaining treatments. Under the new law, individuals can outline their treatment preferences while they have decision-making capacity, ensuring these instructions are honored if they later lose capacity and face conditions such as terminal illness, a persistent vegetative state, an irreversible coma, or another advanced, incurable disease. Crucially, the ordinance provides clear legal protections for healthcare professionals and emergency personnel who comply with these valid directives.

To be legally recognized, an advance directive must be signed in the presence of at least two witnesses, one of whom must be a registered medical practitioner, explained Dr. Doris Tse Man-wah, chairwoman of the Hospital Authority Clinical Ethics Committee. She emphasized that individuals retain the absolute right to revoke their directives at any time while they remain mentally capable. Revocation can be carried out through written or verbal declarations, by executing a new directive, or by physically destroying or canceling the original document in accordance with statutory requirements.

Dr. Tse highlighted that healthcare professionals are legally and professionally mandated to follow a valid, applicable directive, even if the patient's family members disagree. Despite this legal requirement, she strongly encourages anyone considering a directive to discuss their wishes with relatives and involve them in medical consultations early on. To ensure smooth execution during medical emergencies, related laws including the Fire Services Ordinance and the Coroners Ordinance have already been updated.

To help ambulance and emergency personnel rapidly identify these documents on site, the Hospital Authority has prepared distinct yellow pouches for patients to store their paper directives and DNACPR orders. With the patient's consent, these paper records can also be uploaded to the electronic eHealth platform. Operational preparations are already well underway, with the authority converting over 4,800 existing DNACPR forms into the new statutory format and training more than 44,000 staff members, who will receive refresher training every two years. Tse warned that healthcare or emergency staff who knowingly disregard a valid directive could face legal consequences. According to the SAR government, the new law marks a major milestone in strengthening patient autonomy and advancing Hong Kong’s end-of-life care services.