Hong Kong Adults Can Legally Refuse End-of-Life Rescue From July 31 Under New Law

Mentally competent adults in Hong Kong will soon have the legal right to refuse life-sustaining treatments when terminally ill. Starting July 31, a new law will allow individuals to set advance directives, ensuring their end-of-life wishes are respected.

The Advance Decision on Life-sustaining Treatment Ordinance establishes a statutory framework for these directives, including Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders. Medical professionals and paramedics have been trained to recognize and honor these directives. The law permits adults aged 18 and above to formally declare in writing whether they wish to receive treatments like CPR, artificial nutrition and hydration, or any other life-sustaining measures if they become terminally ill and lose their mental capacity.

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The new legislation is a milestone in end-of-life care services.

Doris Tse, chairperson of the Hospital Authority's Clinical Ethics Committee, described the law's principle as "strict entry, easy exit." While creating an advance directive requires signing a form in the presence of at least two witnesses, one of whom must be a registered medical practitioner, revoking it is straightforward. Patients can cancel a directive at any time by destroying the document, issuing a written statement, or stating their wish verbally to an adult witness.

This legislation is considered a significant step for end-of-life care in Hong Kong. Previously, such decisions were often based on common law and primarily recognized within hospitals. Paramedics attending to patients at home or in care facilities might still provide emergency resuscitation, even if the individual had expressed a wish otherwise. The government has amended related ordinances to align with the new law, and the Hospital Authority will provide patients with a "yellow folder" to store their directives for urgent access by medical personnel. The law, passed in November 2024, allows time for training and guideline updates before its effective date.

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strict entry, easy exit