The Advance Decision on Life-sustaining Treatment Ordinance took effect on 31 July, establishing Hong Kong’s first legal framework for advance medical directives (AMDs) and do‑not‑attempt cardiopulmonary resuscitation (DNACPR) orders.
How the new ordinance works
Under the ordinance, a mentally capable adult who has an advanced, irreversible disease may sign an AMD that specifies which life‑sustaining treatments they wish to refuse should they later lose the ability to make decisions. The directive applies only when the patient’s condition meets the statutory criteria defined in the law.
Patients cannot use an AMD to decline basic or palliative care, and they may revoke the directive at any time. A DNACPR order, by contrast, is issued by a registered doctor for a patient who satisfies particular medical conditions. It instructs rescuers not to perform CPR, even if the patient is outside a hospital and no medical staff are present.
From the commencement date forward, healthcare professionals must comply with an AMD or DNACPR order once they are notified of its existence and the relevant conditions are satisfied. If a provider is uncertain whether an order applies, the law defaults to “if in doubt, save lives first.” This protects them from liability when they act on a reasonable belief that a valid order exists.
Legal safeguards for clinicians
The ordinance shields doctors, nurses, and other responders from civil or criminal liability when they follow a properly issued AMD or DNACPR order. This protection extends to situations where a professional administers treatment because they were unaware of a valid directive, as well as to cases where they withhold treatment based on a reasonable belief that an order is in force.
For DNACPR orders, a registered doctor must assess the patient against the specified criteria before issuing the order. Once issued, the order is recorded in the patient’s medical record and must be communicated to emergency services.
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Although the law introduces new procedural steps, it aims to respect patient autonomy while ensuring that medical staff are not placed in legally precarious positions.
From a broader perspective, the ordinance reflects a growing global trend toward formalizing patients’ rights to decline certain treatments. By codifying these choices, Hong Kong aligns itself with jurisdictions that have already adopted similar mechanisms, offering a clearer pathway for individuals to express end‑of‑life preferences without fear of legal repercussions for the providers who honor them.
Implementation timeline and next steps
The Legislative Council passed the ordinance in November 2024. After a preparatory period of roughly 18 months, the government gazetted 31 July 2026 as the official start date. During the interim, hospitals have been instructed to update their policies, train staff, and establish systems for recording and retrieving AMDs and DNACPR orders.
Legal experts note that the ordinance’s success will depend on how effectively it is communicated to both medical professionals and the public. Without widespread awareness, the intended protections could be underused, leaving patients without the ability to enforce their wishes.
It marks a significant shift in Hong Kong’s approach to end‑of‑life care.