An AMD is a legal document that records the maker’s personal medical preferences. It aims to inform healthcare professionals and family members of the maker’s wishes regarding life-sustaining treatment, in case the maker loses mental capacity. It helps to reduce unnecessary medical procedures (such as CPR) that could cause pain and suffering, allowing the maker to maintain dignity during the final stages of life while ensuring medical autonomy.
Euthanasia refers to the direct and intentional act of ending someone’s life, usually through medication, as part of medical care, which is illegal under current Hong Kong law. AMDs, on the other hand, specify that when a person loses mental capacity under certain irreversible conditions, life-sustaining treatment should not be provided, stopped, or withdrawn to prevent prolonging suffering.
To create an AMD, you must be 18 years old or above and mentally capable. The AMD must be in writing and signed by at least two witnesses, one of whom must be a registered doctor. The doctor must confirm that you have the mental capacity to make decisions and that you understand the nature of the directive.
Alongside offers Advance Medical Directive (AMD) drafting and witnessing services, where a registered doctor will explain the entire AMD and certify that you have the mental capacity to make the directive at the time of signing.
You can revoke an AMD at any time as long as you have mental capacity. You can revoke it verbally, in writing, by destroying the AMD, signing the relevant section (Part 5) of the directive, or by making a new AMD to replace the old one.
A valid AMD must: • Be made by a person aged 18 or older who has mental capacity; • Be in writing and clearly express the instructions; • Be signed by the maker and dated; and • Be witnessed by two individuals, one of whom must be a registered doctor, and neither can be someone with an interest in the maker’s estate.
Your AMD must be witnessed by two people, one of whom must be a registered doctor. The witnesses must not have any vested interest, meaning they cannot be beneficiaries of your estate, co-owners of joint properties, or joint account holders with you.
Loss of mental capacity means the person is unable to understand or make decisions about their medical treatment. Common examples include falling into a coma, severe dementia, brain hemorrhage, or serious psychiatric disorders.
An AMD applies when the maker has lost mental capacity and meets the specified conditions, including: • Terminal illness; • Persistent vegetative state or irreversible coma; or • Other end-stage irreversible life-limiting conditions.
A terminal illness refers to a serious, progressive, and irreversible condition where no treatment can improve the situation, and life expectancy is measured in days, weeks, or months. Any life-sustaining treatment in this situation only delays death.
A persistent vegetative state or irreversible coma means the brain has suffered severe damage, resulting in a state of unconsciousness where the person cannot respond to their environment. The condition is “persistent” and “irreversible,” meaning the person has no hope of regaining consciousness.
This refers to conditions that are not terminal illnesses or persistent vegetative states but are still end-stage, progressive, and irreversible, leading to limited life expectancy. Examples include end-stage kidney failure, requiring daily dialysis, or advanced chronic obstructive pulmonary disease (COPD), requiring oxygen support.
In your AMD, you can specify which life-sustaining treatments you wish to refuse if you lose mental capacity, such as cardiopulmonary resuscitation (CPR) or intubation, and under what conditions the directive applies (i.e., terminal illness, persistent vegetative state and irreversible coma, and other end-stage life limiting conditions).
Life-sustaining treatment refers to medical measures that aim to prolong life, such as CPR, mechanical ventilation, intubation, or artificial feeding, but it does not include basic care or palliative treatment.
Common life-sustaining treatments include: • Cardiopulmonary Resuscitation (CPR) • Endotracheal Intubation (Insertion of a breathing tube) • Mechanical Ventilation • Vasopressors & Inotropes (Medications to strengthen the heart) • Pacemakers • Renal Dialysis (commonly known as “kidney dialysis”) • Antibiotics Treatment • *Artificial Nutrition & Hydration (Providing nutrition and fluids artificially) Artificial nutrition and hydration refer to supplying food or liquids to the patient through tubes, such as feeding through a gastric tube or intravenous infusion of nutrient solutions.
An AMD cannot refuse basic care (e.g., food, cleaning) or palliative care (e.g., pain relief), as these are essential for the patient’s survival and comfort and are not considered life-sustaining treatments.
The maker is responsible for safekeeping the AMD. You should ensure that either you or your family can present the original or certified true copy of the directive to healthcare providers when needed.
According to the Bill, a certified true copy of the AMD, certified by a registered doctor or a practicing lawyer in Hong Kong, is considered a validating copy, and healthcare providers must accept it.
No, as long as you had mental capacity when making the directive, your family cannot override your legally valid Advance Medical Directive (AMD). Healthcare professionals are also required to follow the instructions in the AMD when making medical decisions. The Code of Professional Conduct for Registered Medical Practitioners in Hong Kong emphasizes the importance of respecting the rights of terminally ill patients. It states that the patient and their immediate family should be fully involved, and in the case of conflicts, the patient’s autonomy and self determination should take precedence over the wishes of their family.
Unless someone has been legally appointed as a legal guardian, your attending doctor will make decisions based on your best interests if you lose mental capacity.
No, under Hong Kong law, individuals aged 18 or above with mental capacity have full autonomy over their medical decisions. If you lose mental capacity, your family cannot make decisions on your behalf; your attending doctor will make decisions based on your best interests after consulting with your family and to reach a shared decision making.
No, an AMD applies only in specific conditions. Falling into a coma due to an accident does not automatically meet the criteria for a “persistent vegetative state or irreversible coma.” Therefore, healthcare providers will still provide necessary emergency care until they confirm the validity and applicability of the directive.
To specifically tackle the challenges faced by the LGBTQIA+ community is the very reason why we established Alongside, to connect a group of gender/sexual minority-friendly professional service providers. We offer a one-stop, professional, and non-discriminatory service covering pre-life planning and post-life support.
