Quick Guide to the New Legislation on Advance Medical Directives (AMD)

Patient after resuscitation and his transport to the hospital.

1. Importance

Currently, Advance Directives (ADs) do not have statutory power and are only guidelines within the Hospital Authority, governed under common law. Non-compliance may result in civil liability. 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.

2. Making and Revocation of AMDs

The legislation adopts a principle of “cautious making, easy revoking.”

  • Making: AMDs must be made in writing by adults aged 18 or above who have the mental capacity to decide on life-sustaining treatment. The directive must be in hardcopy, signed, clearly dated, and witnessed by at least two individuals.

  • Revocation: AMDs can be revoked through written communication, destruction (burning or tearing), or verbal or other expressed intent witnessed by others. Future electronic systems will also allow revocation via designated steps.

3. Witness Requirements

An AMD must be signed in the presence of at least two witnesses, one of whom must be a registered medical practitioner.

 

  • The medical practitioner must explain the nature and implications of the AMD to the individual and confirm their mental capacity to make decisions about life-sustaining treatment.
  • Witnesses must not be an interested person, for example being beneficiaries of the person’s will, relatives, insurance beneficiaries, or co-owners of assets like joint bank accounts or property.
1
2
3
4
5
6
7
8

4. Scope of Application

AMDs only apply when the individual loses mental capacity to decide on life-sustaining treatment due to conditions like accidents, strokes leading to comas, or severe dementia.

 

They also require one of the following conditions to be met:

  • Terminal illness.
  • Persistent vegetative state or irreversible coma.
  • Other end-stage, irreversible life-limiting diseases.

5. Life-Sustaining Treatment

Individuals can specify in the AMD whether they refuse all or specific forms of life-sustaining treatment. Common treatments include:

 

  • Cardiopulmonary Resuscitation（CPR）
  • Endotracheal Intubation
  • Mechanical Ventilation
  • Vasopressors & Inotropes
  • Pacemakers
  • Renal Dialysis (commonly known as kidney dialysis).
  • Antibiotics Treatment
  • Artificial Nutrition & Hydration: Refers to feeding or providing fluids through tubes or catheters, such as a gastric tube or intravenous nutrition.

The updated standard AMD form includes new checkboxes, allowing individuals to refuse all life-sustaining treatments except artificial nutrition and hydration.

6. Significant Amendments

During the second reading in the Legislative Council, several amendments proposed by the Government were passed. Notably, the definition of “cohabiting relationship” and “cohabitant” was added. This enables cohabitants, like immediate family members, to apply to the court for declarations regarding AMDs without needing permission. This is particularly meaningful for same-sex couples who were previously not legally recognized.

 

“Immediate family members” as defined in the ordinance include spouses, parents, children, siblings, grandparents, and grandchildren.

Our Services

Alongside advocates for “medical autonomy”, ensuring that everyone, regardless of gender, sexual orientation, or social status, can walk the final stage of life with dignity.

 

We provide non-discriminatory services for the making of Advance Medical Directives (AMDs), where our registered medical practitioners explain the content of AMDs, offer professional consultations, review medical histories and backgrounds, and ensure that each individual possesses the relevant mental capacity to sign the document. We also provide witness signatures for the process.

Contact Us