Brief Introduction on Advance Decision on Life-sustaining Treatment Bill
Advance Medical Directives (“AMDs”) and do-not-attempt cardiopulmonary resuscitation (“DNACPR”) orders are all important policy measures to honour patients’ decisions and enhance patients’ quality of life during their final days. Currently, AMDs are only considered legally binding under the common law in Hong Kong. The Hospital Authority has been allowing patients to make AMDs when necessary in accordance with common law practices. There is no legislation providing the legal status of AMDs and DNACPR orders. It is unclear whether an AMD may supersede statutory provisions when there is conflict. Some healthcare professionals may be reluctant to follow AMDs made in accordance with common law practices due to concerns over the lack of protection.
The Advance Decision on Life-sustaining Treatment Bill seeks to set up a legislative framework for AMDs and DNACPR orders to safeguard patients, medical professionals and rescuers. The Bill seeks to enhance the quality of life of patients until death and to promote the well-being of patients’ families during and after the death of their loved ones. The Bill was published in the Gazette on 24 November 2023 and was introduced into the Legislative Council on 6 December 2023 for first reading and second reading.
Advance medical directives
According to the Bill, any person aged 18 or above and who is mentally capable of deciding on a life-sustaining treatment may make an AMD. Upon meeting the specified precondition of the instruction as stated on the AMD, no medical professionals can perform any life-sustaining treatment specified in the instructions at the time the person concerned is mentally incapable of deciding on a life-sustaining treatment.
The making of an AMD will adhere to the principle of “cautious making, easy revoking”. No less than two witnesses (who must satisfy certain conditions) should be in attendance when an AMD is made, with one of the witnesses being a registered medical practitioner. The AMD must be made in writing. With regard to revocation, as long as the maker is mentally capable of deciding on a life-sustaining treatment, he or she can revoke the AMD at any time verbally or by written or destroying the AMD.
Do-not-attempt cardiopulmonary resuscitation orders
As defined in the Bill, a DNACPR order is an instrument that directs not to perform cardiopulmonary resuscitation (CPR) on a person suffering from cardiopulmonary arrest (person-in-arrest). That order must be made by two registered medical practitioners (one of whom must be a specialist) in writing by using a physical statutory form as specified in the legislation. A DNACPR order can be revoked upon certain acts of the maker (such as destroying the order) when he or she is mentally capable of deciding on a life-sustaining treatment.
Further, the Bill will also safeguard the medical professionals and rescuers (including lay rescuers), such that they will be protected from any legal liability as to whether they should provide a life-sustaining treatment or not to a patient when specified conditions are met.
The Bill is still under consideration by the Legislative Council. Before the Bill takes effect, the government has to enhance public education and promote the Bill to the public and the healthcare sector. Please feel free to contact us should you have any enquiries.
