Modern medicine emphasizes patient autonomy. While conscious, all medical decisions must respect the patient’s will. However, when someone loses mental capacity due to accidents, coma, or illness, healthcare providers may be unsure of the patient’s wishes. In such situations, they are required to make decisions based on the patient’s best interest from a clinical perspective. Doctors may consult family members, but the patient’s true preferences about how they wish to approach the final stage of life may not align with those of their family or healthcare team. You may wish to pass peacefully, but your loved ones may push for prolonged treatment out of reluctance to let go.
Through an Advance Medical Directive, anyone with mental capacity can clearly document their choices regarding life-sustaining treatment. This ensures that even if they can no longer speak for themselves, medical decisions reflect their true wishes. It also helps avoid unnecessary suffering or invasive treatments, prevents family conflicts and confusion, and relieves loved ones from the emotional burden of making such difficult decisions.
Advance Medical Directive
Under the current laws in Hong Kong, adults aged 18 or above have full autonomy over their own medical decisions, and can independently choose to accept or refuse any treatment. However, in situations where a person loses mental capacity — such as due to brain injury, stroke, coma, or severe dementia — the patient can no longer make medical decisions themselves. In such cases, the medical team will make decisions based on the patient’s “best interests”. While they will try to consult family members or relatives during the process, the final decision ultimately rests with the healthcare professionals.
When there are disagreements among family members, or if their views differ from the doctor’s, or if the patient has no relatives at all, the medical team may not be able to understand the patient’s wishes regarding life-sustaining treatment. This can result in unnecessary invasive procedures, inadvertently prolonging the patient’s suffering.
An Advance Medical Directive (AMD) is a legally binding document that clearly states a person’s wishes regarding life-sustaining treatment in advance — in the event they suffer from an irreversible condition and can no longer express their own will. It helps avoid unnecessary treatment, reduces suffering at the end of life, and allows the individual to walk the final stage of life with dignity.
How to Make an Advance Medical Directive (AMD)?
To make a valid Advance Medical Directive, the individual must be an adult aged 18 or above and must have mental capacity at the time of making the directive. The document must be signed in the presence of two independent witnesses for it to be legally binding.
One of the witnesses must be a registered medical practitioner in Hong Kong. This doctor is responsible for fully explaining the contents and options of the Advance Medical Directive to the individual and confirming that the person has sufficient mental capacity at the time of signing. Neither witness can be an “interested person”, meaning they must not be a beneficiary of the person’s estate, insurance policy, or similar.
Our Fees
Alongside offers Advance Medical Directive services, including a detailed explanation of the directive by a registered doctor and witnessing.
Standard Fee: HK$2,000*
3rd Anniversary Limited 30% Off Offer: HK$1,400 (Offer valid until August 31, 2026)
*Certified true copy service (HK$100 per copy) and eHealth electronic upload service (HK$300 per copy) are available
*To enjoy this offer, bookings must be completed and a HK$500 deposit paid on or before August 31. Please refer to the Terms & Conditions for details.
Scope of Application of an Advance Medical Directive (AMD)
An Advance Medical Directive will only take effect when the individual has lost mental capacity and the specific medical condition selected in the directive is met.
The three pre-defined conditions are:
Terminal Illness
A terminal illness refers to an irreversible, end-stage condition — such as advanced, metastatic cancer — that cannot be cured with current medical treatment, and where life expectancy is limited to a few days, weeks, or months.
Persistent Vegetative State or Irreversible Coma
This refers to a permanent loss of consciousness caused by severe brain injury, where the person has no self-awareness or response to external stimuli, and no possibility of recovery.
Note: Irreversible coma does not include coma caused by drugs or metabolic issues, which may be reversible.
Other End-Stage Irreversible Life-Limiting Conditions
This includes diseases other than terminal illness or persistent vegetative state that are in their final stages, medically irreversible, and where life expectancy is extremely limited.
Examples include end-stage kidney failure, advanced motor neuron disease, or late-stage chronic obstructive pulmonary disease (COPD).
Free Advance Medical Directives for Eligible Persons funded by the SIE fund
The free advance medical directive service is funded by the SIE Fund. Places are limited and offered on a first-come, first-served basis.
Eligible Persons include：
- Elderly households
- Persons with chronic diseases and their carers
- Single parents
- Subdivided unit households
About Refusing Life-Sustaining Treatment
Euthanasia is not legal in Hong Kong, and therefore making an Advance Medical Directive (AMD) is not equivalent to euthanasia. A person making an AMD can only specify in the directive their wish to refuse part or all of life-sustaining treatments.
Life-sustaining treatment refers to medical procedures used to prolong life, but which do not cure the underlying illness. Common examples include:
CPR
Mechanical ventilation
Intubation
Inotropic (heart-stimulating) drugs
Blood transfusions
Pacemakers
Dialysis
Antibiotics
Artificial nutrition or hydration
Other specialised treatments
Treatments That Cannot Be Refused
The purpose of an Advance Medical Directive (AMD) is to reduce suffering at the end of life and allow for a dignified passing. Therefore, even if an AMD has been signed, basic nursing care (such as cleaning the body or repositioning) and palliative treatments (such as morphine and other pain relief) will still be provided.
How to Revoke an Advance Medical Directive
Following the principle of “cautious making, easy revoking,” a signed Advance Medical Directive can be revoked at any time, as long as the individual still has mental capacity.
Methods of revocation include:
- Destroying the original document
- Signing a written revocation statement
- Declaring revocation in the presence of witnesses
- Creating a new AMD to replace the existing one
Questions?
We are eager to hear from you and provide any assistance you may need. We look forward to connecting with you soon!