LCQ12: Advance medical directives – MIL Asia Pacific Publishing Engine

Source: Hong Kong Government special administrative region

LCQ12: Advance medical directives
Question:

The Advance Decision on Life-sustaining Treatment Ordinance (the Ordinance), which was passed by this Council on November 20 last year, aims to establish legislative frameworks for “advance medical directives” (AMDs) and “do-not-attempt cardiopulmonary resuscitation (DNACPR) orders” and provide legal protection to patients, medical professionals, as well as rescuers, where terminally-ill patients are empowered with a greater degree of autonomy. However, a survey has discovered that approximately 75 per cent of adult respondents have never heard of AMDs. There are views that given the complex medical ethics and legal issues involved in the Ordinance, the Government should enhance public awareness of the Ordinance and establish supporting systems in the long run. In this connection, will the Government inform this Council:

(1) whether it knows the respective numbers of AMDs signed by and DNACPR orders issued to patients of the Hospital Authority each year since 2019;

(2) whether the Government has currently provided necessary training for frontline staff of medical institutions and relevant organisations regarding the implementation of the Ordinance; if so, of the details; if not, the reasons for that; whether it knows the progress made by relevant stakeholders in updating their protocols, records and systems in response to the implementation of the Ordinance;

(3) given that the Ordinance will come into effect in May next year, whether the Government has formulated specific plans to publicise the importance and signing procedure of AMDs among the public; if so, of the details (including publicity channels); if not, the reasons for that;

(4) whether the authorities will consider strengthening life and death education among the public, and incorporating the content of the Ordinance into such education (particularly by updating the existing curriculum framework for primary and secondary schools) to promote rational discussions in society over the right to a good death; if so, of the details; if not, the reasons for that; and

(5) given that the Government plans to progressively introduce the full electronic route of AMDs, with the Electronic Health Record Sharing System (eHealth) serving as the designated electronic system to support the making, storage, revocation and retrieval of electronic AMDs, of the authorities’ specific plans and implementation timetable for the relevant work?

Reply:

President,

The Government’s policy objective is to provide quality and comprehensive end-of-life (EoL) care services to patients and their families. Advance decision instruments (i.e. advance medical directives (AMDs) and do-not-attempt cardiopulmonary resuscitation (DNACPR) orders) are integral components of EoL care, aiming to respect patients’ autonomy and shield them from enduring ineffective and unnecessary treatments in their final stages of life, thereby enhancing the quality of life of terminally-ill patients. Since 2010, the Hospital Authority (HA) has been allowing its patients to make or sign advance decision instruments when necessary according to common law practices. Passed by the Legislative Council in November 2024, the Advance Decision on Life-sustaining Treatment Ordinance (the Ordinance) establishes a corresponding legal framework for and provides clearer legal status for advance decision instruments, safeguarding the makers and subject patients of advance decision instruments, as well as providing legal protection for healthcare professionals in following the directives and orders. The Ordinance is planned to take effect 18 months after its passage (i.e. around mid-2026).

In consultation with the Department of Health (DH), the HA, the Education Bureau and the Security Bureau, the reply to the question raised by Hon Edward Leung is as follows:

(1) According to the Ordinance, pre-existing advance decision instruments made before the commencement of the Ordinance will remain valid and applicable after its commencement, provided that they meet the specific conditions set out in the Ordinance. The number of AMDs made within the HA from 2019 to 2024 is tabulated as follows:

Year The number of DNACPR orders made within the HA from 2019 to 2024 is tabulated as follows:

Year(2) To ensure smooth implementation of the Ordinance, the Health Bureau (HHB) is arranging briefing and training sessions for relevant organisations, such as disciplined services departments and other rescue teams, regarding the legal framework and protection provisions outlined in the Ordinance. The HHB is also co-ordinating with various stakeholders to update relevant guidelines. For instance, the Hong Kong Academy of Medicine released the “Best Practice Guidelines on Advance Medical Directives” (BPG) in April this year. The BPG offers practical advice on clinical decision-making, doctor-patient communication and ethical considerations for healthcare professionals’ reference, with a view to enhancing their professional capabilities in handling advance decision instruments while upholding patients’ autonomy and complying with the legal framework of the Ordinance. Moreover, relevant policy bureaux, departments, the HA and other related organisations are currently formulating services and operational guidelines in alignment with their specific operational needs. These guidelines will among other things encompass protocols and precautions for implementing DNACPR orders outside hospital settings. Training sessions will also be conducted for rescue personnel to ensure their readiness to make prompt and accurate decisions in accordance with the legal requirements during emergencies.

(3) and (4) To enhance public understanding of the Ordinance, the HHB, in collaboration with the Jockey Club End-of-Life Community Care Project (JCECC) and the Faculty of Social Sciences of the University of Hong Kong, co-organised a series of eight community talks to elucidate the provisions of the Ordinance. Additionally, the HHB further disseminated information about the Ordinance to the general public through promotional pamphlets, mobile van publicity campaigns and a designated website.

In fact, advance decision instruments under the Ordinance form part of advance care planning (ACP), which is an overarching and preceding process for patients to communicate their preferences regarding medical and personal care. The scope of ACP includes not only the advance decisions concerning life-sustaining treatments documented in AMDs, but also the patient’s previously expressed wishes, personal goals to be accomplished, preferences for EoL care, and treatment expectations, among other aspects. The Ordinance presents an opportunity for patients and their families, as well as the society as a whole, to understand and engage in discussions about ACP, enabling carers to provide suitable EoL care according to patients’ wishes.

By fostering collaboration across departments and sectors, the Government is proactively implementing a range of public education and promotional initiatives within the community and establishing collaborative networks with social service organisations to enhance public awareness and understanding of topics like ACP and life and death education, thereby facilitating rational discussions on life and death matters within society. The DH also disseminates public education on life and death issues through various channels including media interviews, websites, publications, and online videos. In the meantime, the HA actively organises seminars, events, and talks on life and death education, including the advocacy of ACP concept.

Beyond promotional campaigns targeting the general public, the Government has also implemented other targeted promotional initiatives. Specifically tailored for the elderly population, the multidisciplinary Visiting Health Teams of the Elderly Health Service (EHS) of the DH deliver health education on ageing, life and death education, managing loss and grief, and psychological needs of patients needing EoL care. These health talks are conducted for the elderly and their carers at residential care homes for the elderly, elderly centres and elderly health centres. From 2008 to 2025, the EHS has organised over 2 600 relevant health talks.

As for patients, the HA’s “Smart Patient Website” provides diverse information related to palliative care, such as symptom management, caregiving tips and community resources for patients and carers to reference. In mid-2025, the HA will launch a “Smart Patient” talk series on EoL care for patient groups and the general public.

In the context of school education, life education (including life and death education) is an integral part of values education. The Values Education Curriculum Framework (Pilot Version) (2021) has identified “enhancing life education” as one of its major focuses and has included “understanding the course of life: birth, ageing, illness, and death” as one of the suggested proposed learning expectations for students. Relevant learning elements have been incorporated into the primary and secondary school curricula. Schools will align with students’ cognitive development and life experiences to help them understand topics related to ACP both within and beyond classroom.

(5) The Ordinance provides that the Secretary for Health may designate an electronic system, enabling makers to electronically make, store and revoke AMDs. The HHB is currently enhancing eHealth, which will serve as the designated electronic system, to support the implementation of AMDs.

We will introduce electronic AMDs in phases. In the first phase, paper AMDs and the electronic storage of such AMDs will be implemented. After making a paper AMD, the public can opt to electronically store an electronic image of the paper AMD, such as a scanned copy or a photo, on eHealth to serve as a validating copy of the paper directive. The electronic storage will allow both the makers and medical institutions to access the directives through eHealth whenever needed. We plan to launch the first phase with the commencement of the Ordinance in mid-2026. Once the relevant functions of eHealth, along with the electronic systems of medical institutions and related organisations, are in place, we will proceed to enable the electronic making and storing of AMDs directly within eHealth.
Issued at HKT 16:00

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