Advance Medical Directive

An AMD allows an adult patient to make instructions in advance for situations where they are mentally capable of deciding on a life-sustaining treatment (“LST”), following in-depth discussions with family members and healthcare professionals. The adult may refuse one or more life-sustaining treatments. The model AMD forms can be in paper form or in electronic form (when the designated electronic system is in operation).

In Hong Kong, a mentally competent patient aged 18 and above can make an AMD. This is for the patient to explicitly express their wish to refuse specified life-sustaining treatment (LST) in pre-specified conditions when they are in an end-stage condition and mentally incapable of making health care decisions. In the event of the patient’s health deteriorating, healthcare professionals will adhere to the patient’s AMD regarding the withholding or withdrawal of pertinent LSTs, provided that the specified preconditions in the AMD are met.

The Hong Kong Government introduced the Advance Decision on Life-sustaining Treatment Ordinance (“the Ordinance”) and it will be effective in May 2026.  After legislation, the new AMD legislation grants statutory power to AMDs, specifying their making, revocation, scope, and definitions within the law. Any deliberate obstruction of the execution of an AMD will result in potential criminal liability.

Do-Not-Attempt Cardiopulmonary Resuscitation (DNACPR)

To facilitate adherence to instructions in an AMD in situations demanding immediate decisions without the presence of medical professionals (e.g. outside the hospital setting), registered medical practitioners (RMPs ) may make AMD-based DNACPR orders for AMD makers who have specified in their underlying AMDs a refusal of cardiopulmonary resuscitation (CPR). AMD-based DNACPR orders instruct not to perform CPR on the subject person under applicable circumstances when that person is in a cardiopulmonary arrest.

Given that minors and adults who are mentally incapable of deciding on LSTs cannot make AMDs, RMPs may make a non-AMD-based DNACPR order for them if a consensus is reached among the patient’s attending RMPs and family members that CPR would not be in the patient’s best interests. A responsible person (e.g. family members) has to agree with the decision and co-sign the non-AMD-based DNACPR order.

DNACPR orders must be made in writing using a prescribed form for easy identification and verification. Otherwise, the orders will be considered invalid.

The life-sustaining treatments (LST) could be very painful to both the patient and the family especially for the advanced cancer patients. For example, the advanced cancer patients who receive Cardiopulmonary Resuscitation (CPR) may have higher risk to experience the ribs and sternal fractures and the pain. In this case, the patient and the family may have different views on life as well as LST. If they can manage any disagreement through open communication with the medical clinicians as early as possible, it not only acknowledges the patient’s wish, but also ensures the patient’s right to a peaceful death. This is also the important step to respect and express true love to the patient and their family members.

The model forms of AMDs provide three specified preconditions for the maker to choose from under the advice of the witnessing RMP. AMD will be applicable when the patient falls into the specified precondition(s) specified in the instructions and becomes mentally incapable of deciding on an LST. The three specified preconditions provided in the model form are as follows :

1. Being terminally ill (i.e. the patient suffers from an advanced, progressive and irreversible medical condition with a short life expectancy in terms of days, weeks or months, where any form of LST would only serve to postpone the person’s death);
2. Being in a persistent vegetative state and state of irreversible coma; or
3. Being in other end-stage, irreversible, life-limiting condition (distinct from the above two categories, specifying the medical condition of the patient is progressive and irreversible and has reached its end-stage and limits the survival of the person), for example, a patient with end-stage renal failure, end-stage motor neuron disease, or end-stage chronic obstructive pulmonary disease. Where these patients may receive dialysis treatment or assisted ventilation to prolong life, such conditions are not categorised as the first category.

• The model forms of AMDs are advised to be used, ensuring that all instructions in the AMD are clearly presented and comply with legal requirements.
• The maker must be at least 18 and competent to make informed decision.
• Two witnesses are required. One of whom must be a medical practitioner in Hong Kong. Neither witness should have an interest in the estate of the person making the AMD
• The patient can change his/her mind after making an AMD

The Ordinance follows the “cautious making, easy revoking” principle. Even if the maker has already made an AMD, they may, as long as remaining mentally competent, alter or revoke the AMD they made at any time. Once the patient has made a new, valid AMD, the new one will replace the old one. The patient should keep their healthcare professionals and family informed of any amendment or revocation.

• The maker revokes the AMD in writing (whether in paper form or in electronic form);
• The maker signs Part 5 of the model form of AMD;
• The maker (or an adult in the maker’s presence and by the maker’s direction) burns, tears or crosses out the content and signs each page of, the AMD;
• The maker, in the presence of one or more witnesses who are adults, revokes the AMD verbally or expresses his/her intention to revoke the AMD by other means (e.g. nodding, shaking head and using sign language);
• The maker makes another AMD; or
• Once the designated electronic system commences operation, the maker (or an adult in the maker’s presence and by the maker’s direction) revokes the AMD in the electronic system.
• Once the original AMD is revoked, a new directive may be made according to the aforementioned procedures.

Advance medical directives are a very important legal document. Therefore, the maker should keep it safe and inform their family of their wishes and where it is stored, ensuring that medical personnel can find it and that medical personnel/rescuers can follow the person's wishes in an emergency.

To aid patients in carrying DNACPR orders, the Hospital Authority will prepare eye-catching designed pouches. The pouches will be clearly labelled as containing a DNACPR order, permitting rescuers (e.g. fire and ambulance personnel of the Fire Services Department) and other relevant individuals to search for the order therein. DNACPR orders should be positioned in a highly visible location for easy identification and quick access by family members or rescuers.

Model Forms of Advance Medical Directive (AMD)

• Advance Medical Directive (AMD)
• AMD (For Refusal of Cardiopulmonary Resuscitation Only)

Statutory Forms and Continuation Sheets of Do-Not-Attempt Cardiopulmonary Resuscitation (DNACPR) Order

• DNACPR order (AMD-based)
• DNACPR order (not AMD-based) (For Mentally Incapable Adult)
• DNACPR order (not AMD-based) (For Minor)
• Continuation Sheet for DNACPR order (For Adult)
• Continuation Sheet for DNACPR order (For Minor)

Health Bureau: Advance Decision on Life-sustaining Treatment Ordinance

Hong Kong e-legistration: Advance Decision on Life-sustaining Treatment Ordinance