Navigating the Advance Decision on Life-sustaining Treatment Ordinance – PlanningAhead for Your End-of-Life Care
Contents：
Executive Summary
The Advance Decision on Life-sustaining Treatment Ordinance (Cap. 651)
will take effect on 31 July 2026, providing a clear legal framework for
individuals to plan their end-of-life medical care. This landmark law
allows adults to make legally binding advance medical directive (AMD)
regarding life-sustaining treatments in the event they lose mental capacity.
It also establishes a formal framework for Do-Not-Attempt Cardiopulmonary Resuscitation (DNACPR) orders, while providing legal protection to medical professionals who follow these valid directives.
What is this Law About?
In simple terms, this law gives you the right to “speak” for yourself even when you can no longer communicate. It allows you to state in advance whether you want to decline specific life-sustaining treatments (such as artificial feeding or CPR), or ALL such treatments, if you ever become mentally incapable due to terminal illness, persistent vegetative state, irreversible coma, or other “end-stage, irreversible, life-limiting” condition.
Crucially, the law ensures that your natural dying process is respected without crossing the line into euthanasia. It explicitly states that the law does not authorize any act that actively causes or accelerates death, nor does it allow you to refuse basic comfort care (like hygiene, pain relief, or being offered food & water by mouth).
The 3 Main Tools: AMD vs. DNACPR
The Ordinance introduces three distinct legal instruments to manage end-of-life care:
Feature | 1. AMD | 2. AMD-based DNACPR | 3. Non-AMD-based DNACPR |
What is it? | A directive made by you while mentally capable, declining specific life-sustaining treatments. | A medical order made by 2 doctors not to perform CPR, based on your existing AMD. | A medical order made by 2 doctors not to perform CPR for a patient who never made an AMD (e.g., a minor or an adult who has lost capacity). |
Who makes the decision? | Yourself. | 2 doctors (based on your prior AMD). | 2 doctors (in consultation with family/responsible persons). |
Model forms | Schedule 2 Form 1 (general treatments) or Form 2 (CPR refusal only). | Schedule 3 Form 1. | Schedule 3 Form 2 (for adults) or Form 3 (for minors). |
While using the statutory model forms is not mandatory, the law presumes your instructions are “clear” if you use them, so they are highly recommended.
How to Set Them Up?
A. Setting up an AMD (Your Personal Directive)
To make a valid AMD, you must be at least 18 and mentally capable. The process requires strict formalities to ensure your wishes are genuine:
In Writing: Must be in paper form or via a designated electronic system.
Signatures: You must sign and date the document.
Two Witnesses: You must sign in front of at least 2 adult witnesses:
Witness 1: A registered medical practitioner (doctor) who explains the nature and effect of the directive to you and confirms your mental capacity.
Witness 2: An adult who is NOT an “interested person”. A person is “interested” if he/she is named in your will or life insurance policy, or would otherwise inherit your money or property.
B. Setting up a DNACPR Order (Medical Orders)
You cannot draft a DNACPR order yourself; it must be issued by medical professionals:
Two Doctors: 2 registered medical practitioners (at least one must be a specialist) must jointly diagnose the patient and agree that CPR is not appropriate.
Family Consultation: For Non-AMD-based orders (where the patient cannot make an AMD), a “responsible person” (e.g., immediate family) or an “eligible person” must be consulted and agree that CPR is not in the patient’s best interests.
How to Revoke (Cancel) Them
While setting up an AMD requires strict formalities, cancelling it is relatively flexible to respect your ongoing autonomy.
Revoking an AMD: You can cancel your AMD at any time as long as you are mentally capable. You can do this by: writing a revocation notice; signing the revocation section (Part 5) of the form; physically destroying the document (burning, tearing); crossing out and signing every page; verbally stating your wish to cancel it in front of adult witnesses; simply making a new AMD; or using the designated electronic system.
Revoking a DNACPR: Generally revoked by 2 doctors crossing out and signing the pages. An AMD-based DNACPR order is automatically cancelled if you revoke your underlying AMD.
Other Important Matters to Know
No Euthanasia: The law only allows withholding/withdrawing treatments to let nature take its course. It does not permit assisted suicide or lethal injections.
Doctors Are Protected: Medical staff are protected from civil or criminal liability if they follow a valid AMD/DNACPR order in good faith, or if they provide treatment because they reasonably did not know about the directive.
No Duty to Search: Paramedics and doctors are not required to search your body, belongings, or electronic databases for an AMD. It is your responsibility (or your family’s) to ensure the treating medical team is presented with a valid copy.
Insurance Protection: Making an AMD will not invalidate, void, or affect your life insurance policies.
Pre-Existing HA Directives: Advance directives made using previous Hospital Authority forms remain legally valid, provided they were properly signed, dated, and witnessed by a doctor and an uninterested adult at the time they were created.
The Role of the Court: If there is a dispute among family members or doctors about whether an AMD is valid or applicable, the High Court may upon application step in to make a declaration.
Comprehensive Estate Planning
An AMD only covers medical decisions. To fully protect yourself and your loved ones, a comprehensive estate plan is essential. Our firm provides end-to-end advisory services, including:
Wills: Ensuring your assets are distributed exactly as you wish.
Enduring Powers of Attorney (EPOA): While an AMD covers medical decisions, an EPOA allows you to appoint a trusted person to manage your financial and property affairs if you lose mental capacity.
Probate & Estate Administration: Assisting executors and families in navigating the probate process smoothly and efficiently.
Trust Arrangement: Establishing family or discretionary trusts to protect wealth, manage tax implications, and provide for vulnerable beneficiaries.
Key Contacts
For further information or to discuss how these legal tools can protect you and your family, please contact:
Mr. Charles Chu | Partner Mr. Eddie Lau | Partner
Tel.: +852 2877 3283
Website: ccks.hk
Address: Room 4111, 41st Floor, Hopewell Centre, 183 Queen’s Road East, Hong Kong
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