Policy and Advance Medical Directives in Hong Kong

Due to rapidly ageing population, Hong Kong has been facing various health challenges, including the intensifying demand for comprehensive end of life (EoL) care. An Advance Medical Directive (AMD), also known as an advance directive (AD), is a document in which a mentally competent adult provides instructions in advance about personal preferences over medical treatments to be followed in the future. An AMD upholds patient autonomy and ensures that individuals receive EoL care consistent with their wishes, such as avoiding futile life-sustaining treatments and dying with dignity. Many jurisdictions have implemented legally binding frameworks for AMDs for integration into healthcare practice. The policy development of legal support for EOL arrangements in Hong Kong has been slow as compared with its Asian counterparts or other jurisdictions. In November 2024, the bill of “Advance Decision on Life-Sustaining Treatment Ordinance” was gazetted as Cap. 651. The Ordinance provides statutory backing for AMD and do-not-attempt cardiopulmonary resuscitation (DNACPR) orders. This landmark development moves Hong Kong from a non-legislative approach to a comprehensive legislative framework for AMDs and signifies maturation of Hong Kong’s healthcare system in recognising that quality of death is an integral part of quality of life. This chapter examines Hong Kong’s current legal and policy landscape for AMDs and compares it with experiences in the UK, Taiwan, and Australia. The effectiveness of key measures related to AMDs would be evaluated, including the necessity of legal clarity, the profound influence of culture and the need to shift norms about discussing death, the importance of integrating directives into healthcare practice and records, as well as the multi-stakeholder effort required - government, medical professionals, and families, all have vital roles. The chapter ends with proposing recommendations which attempt to bolster the system, reduce unwanted aggressive interventions for patients in their final days, and better align healthcare resources with patient-centered values.