End-of-life directives to go on eHealth as new law takes effect in Hong Kong

Hospital Authority’s Doris Tse says Advance Decision on Life-sustaining Treatment Ordinance ‘milestone for Hong Kong’s end-of-life care’ The Hospital Authority's Doris Tse says the new ordinance provides clearer legal protection for both patients and healthcare professionals. Photo: Elizabeth Cheung Hongkongers will be able to upload orders specifying which life-sustaining treatments they do not wish to receive when terminally ill to the city’s electronic health record platform from next Friday, when the new law comes into effect. The move marks a significant step in formalising end-of-life care arrangements, more than 20 months after the Advance Decision on Life-sustaining Treatment Ordinance was passed by lawmakers. “This legislation is a milestone for Hong Kong’s end-of-life care,” Dr Doris Tse Man-wah, chairwoman of the Hospital Authority’s clinical ethics committee, said on Wednesday. While advance medical directives and do-not-attempt cardiopulmonary resuscitation (DNACPR) orders – the two instruments key for end-of-life decisions – had been in place in public hospitals based on common law since 2010, Tse said the new ordinance provided clearer legal protection for both patients and healthcare professionals. “The legislation could help rule out all uncertainties, and protect people who draft [the directives] as well as rescue personnel,” Tse said. From July 31, patients who have drafted advance medical directives can have the images of the documents uploaded to the eHealth platform. The upload must be done by a registered doctor. The Hospital Authority offers yellow bags to patients to store documents related to advance care planning. Photo: Elizabeth Cheung Authorities plan to allow patients to sign the directive electronically on eHealth at a later stage, although no timetable has been announced. An advance medical directive allows a mentally capable adult to specify which life-sustaining treatments they wish to refuse in the future, such as cardiopulmonary resuscitation, artificial ventilation, pacemakers and other measures. It takes effect only when the patient loses mental capacity and reaches a specific clinical state, such as a persistent vegetative state. A DNACPR order instructs rescuers not to perform CPR in out-of-hospital environments when the patient suffers cardiopulmonary arrest. But unlike advance directives, DNACPR orders are not available in electronic form and must be kept as a hard copy by patients or their carers. Unhandled type: inline-plus-widget {"type":"inline-plus-widget"} Since last year, the Hospital Authority has issued standardised yellow bags to patients who have signed either, or both, of these orders to facilitate proper storage. The bags carry a reminder authorising rescuers to search them in emergencies. “Family members or carers should not lock the bag away in a safe, but keep it in a place that is secure and easily identifiable,” Tse said. “For example, elderly people who live alone can hang the bag near the entrance of their flat.” The number of such documents signed in public hospitals has increased in the past decade, with signed advance directives rising from 325 in 2013 to 2,070 in 2025 and DNACPR orders up from 325 to 5,084 over the same period. Patients requiring these documents were mostly from three specialties – medicine and geriatrics, oncology and palliative medicine. Tse said more than 90 per cent of patients with advance medical directives specified that CPR should be withheld when they are nearing the end of life. Under the new legislation, patients are encouraged to use standard model forms when making advance directives, while DNACPR orders must be completed using statutory forms. The Hospital Authority has converted DNACPR orders signed by more than 4,800 patients into the statutory format ahead of the legislation’s taking effect. It has also updated its guidelines on end-of-life care. Designated staff, including doctors, nurses, dentists, allied health professionals and personnel in non-emergency ambulance transfer services, are required to undergo training on end-of-life care documents every two years. Dicky Chow Ka-chun, assistant research director at think tank Our Hong Kong Foundation, said the move of uploading advance medical directives onto the eHealth system was a step in the right direction, as it would facilitate the flow of medical information. However, he said patients’ preferences should also be clearly recorded in public hospitals’ clinical management and emergency services systems. He added that healthcare professionals should remind patients to discuss their directives with family members to minimise potential conflicts in future.