Advance Medical Directive in Hong Kong: A Family Guide

What an advance medical directive is

An advance medical directive is a written statement in which a mentally capable adult records, in advance, which life-sustaining treatments they do not want to receive if they later lose the ability to decide. It is a choice made while the person can still make it, so it does not fall on a family member during a crisis.

The point of the document is to move the decision earlier, while the person is able, so a family is not left guessing what a parent would have wanted.

The law that now governs it

The Advance Decision on Life-sustaining Treatment Ordinance (Cap. 651) was passed by the Legislative Council in November 2024 and took effect on 31 July 2026. It gives two instruments a statutory framework: the advance medical directive, and a do-not-attempt cardiopulmonary resuscitation (DNACPR) order that a doctor can issue.

Before the ordinance, a mentally capable adult’s advance refusal of treatment already carried weight at common law, but no statute said how such a directive should be made or when it binds. The ordinance answers both questions, and adds protection for the people who honour it.

When a directive applies

A directive does not take effect the day it is signed. It applies only when the person has lost the mental capacity to decide on the treatment, and only when the medical situation named in the directive has arisen. The ordinance sets out the preconditions a directive can cover:

• A terminal illness — a severe, progressive and irreversible disease where life-sustaining treatment would only delay the moment of death.
• A persistent vegetative state, or an irreversible coma.
• Another late-stage, irreversible life-limiting condition, such as late kidney failure, late motor neurone disease or late chronic obstructive pulmonary disease.

What can and cannot be refused

The treatments a directive can refuse are the ones that sustain life without restoring it: cardiopulmonary resuscitation, artificial ventilation, and artificial nutrition and hydration.

What it cannot refuse is basic care and palliative care. Comfort, pain relief, food and drink offered by mouth, and ordinary nursing care continue regardless of the directive. That boundary matters: the document declines specific life-sustaining treatments, not care itself.

Who can make one, and how

Anyone aged 18 or over who is mentally capable of deciding about life-sustaining treatment can make a directive. It must be in writing and clearly expressed, signed and dated in the presence of at least two witnesses.

One witness must be a doctor registered in Hong Kong, who explains the nature and effect of the directive and is satisfied the person has the capacity to make it. Neither witness may stand to benefit from the person’s estate — which in practice rules out a spouse, children and many close relatives.

• Aged 18 or over, and mentally capable at the time of signing.
• In writing and clearly expressed, signed and dated, before two witnesses.
• One witness a Hong Kong registered doctor; neither witness a beneficiary of the estate.

How a directive is revoked

The ordinance is deliberately easier to leave than to enter. While the person still has capacity, the directive can be revoked at any time: in writing, by destroying the document, by crossing it out and signing, or orally in front of a witness. A newer directive can also replace an older one.

Because revocation is this loose, the people close to the person need to know which copy is current. A directive nobody can find, or an old copy that contradicts a newer one, is the gap that causes trouble at the bedside.

Where the document lives and who knows

A directive only works if the people who would act on it can find it quickly. In Hospital Authority hospitals a signed directive is kept in a designated pouch that travels with the patient; outside that setting the same practical rule applies — the signed original sits with the family’s emergency documents checklist, and at least two people know exactly where.

A do-not-attempt CPR order, if one has been issued, should be kept somewhere visible and easy to reach, because a rescuer outside a hospital will not search belongings for it.

How it differs from a power of attorney

An advance medical directive and a power of attorney do different jobs, and families often confuse them. A power of attorney lets someone else manage a person’s property and money; it does not let that person refuse medical treatment on the patient’s behalf. The directive is the document that speaks to medical treatment.

A family with one and not the other has a gap. Our guide to power of attorney for ageing parents covers the financial side; what happens when a parent loses capacity explains why both need to be in place before capacity is lost.

Where to go next

Start with the doctor who knows your parent, because the ordinance requires a doctor’s involvement and the conversation is where the directive’s content actually gets decided. Then file the signed document with everything else the family keeps.

Legaris keeps a parent’s documents in one place and shows which are still missing; the pricing page explains what stays free and what Break Glass costs. When the day comes, the hospital admission checklist shows where the directive slots into an actual emergency.