Planning future care: Farewell to life with dignity
When facing an irreversible condition, patients can plan their preferred future care in advance to complete their life journey with dignity. The Advance Decision on Life-sustaining Treatment Ordinance (the Ordinance) came into operation on 31 July this year, establishing legal frameworks for Advance Medical Directives (AMD) and Do-Not-Attempt Cardiopulmonary Resuscitation (DNACPR) orders, while providing legal protection for healthcare professionals. Dr Doris Tse Man-wah, Chairman of the Hospital Authority (HA) Clinical Ethics Committee, states: "This is an important milestone in end-of-life care. It allows mentally competent adults to autonomously decide to refuse life-sustaining treatment when their health deteriorates and they lose mental capacity, provided that the specified preconditions are met." She notes that healthcare professionals can reach a consensus on AMD and DNACPR orders through Advance Care Planning (ACP) discussions with patients and their families. The HA has provided guidelines, a quick reference guide, and continuous training to deepen staff understanding of the Ordinance.
Under what circumstances should staff execute an AMD or DNACPR order?
Patients are responsible for presenting their AMD or DNACPR orders to healthcare professionals. Medical staff will only comply with the document when they are aware of its existence and have verified that it is properly completed, signed, and undamaged; the patient has lost mental capacity; the patient meets the specified preconditions; and the condition is not caused by an accident. If medical staff have any doubts, saving lives comes first.
Does making an AMD mean the medical staff will give up on treating the patient?
No. Medical staff will continue to provide effective treatment for pain relief and symptom management. As death is inevitable in cases of incurable terminal illnesses, the focus of care shifts from curative to palliative care to ensure the patient passes away peacefully and with dignity.
How does withholding or withdrawing futile life-sustaining treatment differ from euthanasia?
They are fundamentally different. Euthanasia involves a doctor deliberately administering drugs or substances to end a patient's life as a part of medical care, which is illegal in Hong Kong. Withholding or withdrawing futile life-sustaining treatment respects the patient's refusal of ineffective treatment, allowing them to pass away naturally from their underlying disease.
Can an AMD be modified or revoked after signing?
Yes. The Ordinance upholds the principle of 'cautious making, easy revoking'. It ensures that patients fully understand the implications of every instruction in the AMD when making autonomous decisions, while revocation is relatively simple. As long as the maker retains mental capacity, they may revoke an AMD at any time in writing, verbally, or by destruction of the document, and should notify the medical team as soon as possible. If the patient has stored a paper AMD to eHealth, they must ensure that all physical copies and the electronic AMD are revoked simultaneously. Making a new AMD will automatically revoke any existing AMD.
Can medical staff override a patient's AMD or DNACPR order on the grounds of the patient's best interests?
No. Neither healthcare professionals nor family members, guardians, or friends have the authority to override a valid AMD or DNACPR order. They must respect a valid and applicable AMD.
