With just days to go before implementation, Hong Kong’s healthcare system is finalising its operational protocols, including vital updates to cross-departmental procedures.
Under the Advance Decision on Life-sustaining Treatment Ordinance, documented choices made by terminally-ill patients regarding their care will carry binding legal weight – even if they later lose the ability to communicate.
But beyond bolstering patient autonomy, the law offers a critical safeguard for frontline workers. Doctors, nurses, and rescue personnel who act in good faith and comply with a valid Advance Medical Directive (AMD) or Do-Not-Attempt Cardiopulmonary Resuscitation (DNACPR) order are explicitly protected from civil, criminal or professional liability.
Doris Tse, chairperson of the Hospital Authority’s clinical ethics committee, said the ordinance does more than clarify legal rights – it also resolves practical hurdles that have long complicated end-of-life care.
She pointed specifically to amendments made to the Fire Services Ordinance, which previously barred ambulance crews from recognising patient-signed forms.
“With the legislation, the ambulance will now recognise the standard or the prescribed DNACPR form, and they have to follow a standard procedure. If the form is valid and applicable, they have to respect that,” she said.
That change is critical for patients being transported to hospital from elsewhere, who in the past might have received unwanted CPR en route.
“From the legal perspective… any rescuer who act in good faith and has assessment that the forms are valid and applicable, and if they follow the instructions, they are not liable to any civil or criminal responsibility or professional misconduct. The same will apply to the ambulance crew,” she said.
The ordinance also enables patients to “die in place”. In residential care homes, for instance, cases that once had to be referred to the coroner can now be exempted if the patient is terminally ill and has been seen by a doctor within two weeks of death.
Addressing frontline concerns about verifying patient wishes in life-or-death emergencies, Tse noted that while a physical copy of the AMD remains the primary proof, electronic versions will also be stored in the eHealth system, allowing public and private doctors quick access.
For DNACPR orders – which do not yet have an electronic equivalent – the Hospital Authority has introduced a standardised yellow pouch for storing documents, a system already familiar to ambulance crews.
Tse also pushed back against the misconception that a DNACPR order means abandoning a patient.
“We are not abandoning the patient,” she said. “We are only not applying to futile life-sustaining treatment because applying those treatment actually add more distress… and prolong their suffering.”
She emphasised that comfort care, including palliative services, remains a top priority.
On the sensitive issue of family pressure, Tse said doctors are trained to ensure patients are not signing directives due to financial strain or coercion.
She reiterated that health professionals always advocate for open, thorough communication before any document is signed.
