Mentally competent Hong Kong adults can legally refuse end-of-life interventions from next Friday

Hong Kong adults who have full mental capacity will be able to set advance directives from next Friday to refuse specified life-sustaining treatments when terminally ill, the Hospital Authority (HA) said.

The HA hosted a press conference about the Advance Decision on Life-sustaining Treatment Ordinance on Wednesday, a new law effective from July 31.

The law sets a statutory framework to protect the Advance Directives (ADs) of terminally ill patients, as well as Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders. The HA said that medics and paramedics have been trained to recognise and respect the directives.

Under the law, mentally competent Hong Kong residents aged 18 or above can specify in writing, in advance, whether or not life-sustaining treatments may be supplied if they fall terminally ill and lose their mental capacity.

According to the ADs form, an adult who is terminally ill can declare that they do not wish to receive cardiopulmonary resuscitation, any life-sustaining treatment except artificial nutrition and hydration, or any life-sustaining treatment at all.

‘Strict entry, easy exit’

Doris Tse, chairperson of the HA’s Clinical Ethics Committee, said the core spirit of the law is “strict entry, easy exit.” A mentally competent adult must sign an AD form in the presence of at least two witnesses, one of whom must be a registered medical practitioner.

In contrast, revoking a directive is flexible: a patient can revoke it at any time by tearing up the document, issuing a written declaration, or simply expressing their wish verbally to an adult witness, Tse said.

“The new legislation is a milestone in end-of-life care services,” Tse said in Cantonese.

Currently, Hongkongers may also issue an AD form and DNACPR under common law. However, the decisions are usually only recognised in hospitals. When terminally ill persons lose consciousness at home or in residential care homes, paramedics arriving on the scene would still provide emergency resuscitation.

The government previously amended relevant legislation, including the Fire Services Ordinance and the Coroners Ordinance, to align with the implementation of the new law, Tse said.

She added the HA would provide patients who sign an AD form with a dedicated “yellow folder.” The folder is printed with authorisation terms allowing paramedics to search for documents within it under urgent circumstances.

“If a patient who has signed an AD passes away naturally in a residential care home, the case does not need to be reported to the Coroner’s Court,” Tse said.

The legislature passed the new law in November 2024. The government announced that it would take effect in July 2026, allowing time for medical staff and paramedics to receive training and for the HA to update its guidelines.