Advance Directive

Patients and their family members can, through advance care planning and consultation with a registered medical practitioner, establish an Advance Directive. This directive ensures that patients' wishes to refuse specified life-sustaining treatments are respected, should they become mentally incapable of making decisions, provided certain pre-specified conditions are met.

The three pre-specified conditions are:

1. Terminal illness, with a life expectancy limited to a few months or less.
2. Persistent vegetative state or irreversible coma.
3. Other advanced, irreversible, life-limiting illnesses.

“Life-sustaining treatment” refers to any medical procedure or intervention that may delay the death of a patient. These include cardiopulmonary resuscitation (CPR), mechanical ventilation, blood products, cardiac pacemakers, vasopressors, specialized treatments for specific illnesses (e.g., chemotherapy or dialysis), antibiotics administered to treat potentially life-threatening infections, and artificial nutrition and hydration (i.e., providing food and fluids via tube feeding).

A person making an Advance Directive can refuse one or more types of life-sustaining treatment.

Patients may specify their refusal of specific life-sustaining treatments in the Advance Directive.

CPR	Mechanical ventilation	Blood products	Cardiac pacemaker
Vasopressors	Antibiotics	Specialized treatments	Artificial nutrition & hydration

⚠ The legal enforceability of an AD ensures that healthcare institutions honor the patient's decisions unless there is clear evidence that the directive has been revoked.

If providing life-sustaining treatments is not in the best interests of a terminally ill patient, or if the patient has clearly expressed their wish in advance to refuse life-sustaining treatment, withholding or withdrawing such treatments is ethically and legally acceptable. However, an individual cannot use an Advance Directive to refuse basic care (such as oral feeding, provision of water by mouth, and assistance with eating and drinking) and palliative care. Healthcare professionals should continue providing basic and palliative care to patients to maintain their fundamental comfort and dignity.

Patient - Living with Dignity until the End

An Advance Directive lets patients express their wishes regarding future medical care. It ensures that even when they can no longer communicate decisions, their medical treatment remains aligned with their values and expectations, thus preventing misunderstandings or disputes among family members. By specifying in advance that they refuse futile life-sustaining treatments, patients can avoid unnecessary medical interventions and suffering during their final days, significantly reducing physical and emotional burdens. It allows them to approach the end of life in greater comfort, peace, and dignity. Furthermore, clear medical decisions made by patients can help preserve valuable medical resources for other patients in greater need, fulfilling their personal values and social responsibility.

Family Members - Reducing the Burden of Decision-Making

Patients can relieve their family members of the emotional and ethical burden of making critical end-of-life decisions by setting up an AD in advance. Benefits include:

• Eliminating uncertainty and emotional distress: Family members will not have to guess what the patient would have wanted.
• Reducing guilt and self-doubt: Clear documentation of the patient’s wishes helps prevent family members from second-guessing their decisions.
• Minimizing external pressure: An AD provides legal and ethical justification for family members, shielding them from external criticism or social judgment (e.g., accusations of not doing enough to save the patient).

Medical Crew - Ensuring Medical Decisions Align with the Patient’s Wishes

From the patient’s perspective, an AD ensures that medical care respects their values and preferences, preventing unwanted interventions such as:

• Avoiding futile life-sustaining treatments: When an illness reaches an irreversible stage, excessive interventions may prolong suffering rather than improve quality of life.
• Minimizing unnecessary medical interventions: Invasive procedures such as repeated intubation or defibrillation may cause additional pain without offering long-term benefits.
• Preserving dignity and the right to a peaceful passing: Ensuring the patient can experience a natural and dignified end-of-life process.

Individuals considering an AD should consult medical professionals or legal experts to ensure their wishes are documented and legally enforceable, allowing healthcare providers to honor their preferences appropriately.

⚠ ADs apply only to "specified conditions" and do not constitute a blanket refusal of all medical treatment. Healthcare providers will still offer palliative care to relieve pain and discomfort, including pain management and oxygen therapy.

⚠ An AD is not equivalent to euthanasia or assisted suicide. Patients cannot use an AD to request active measures to end their life, as euthanasia remains illegal in Hong Kong.

⚠ An AD must be signed while the patient is mentally competent, and it requires two witnesses, including at least one registered doctor, to ensure the patient fully understands their decision.

Respecting Autonomy and Ensuring Medical Decisions Are Honored

Every individual has the right to make decisions regarding their medical care. By establishing an Advance Directive (AD), you can pre-determine whether to receive specific life-sustaining treatments during critical medical situations, ensuring your wishes are respected even if you cannot express them yourself.

For more information or professional assistance regarding Advance Directives, please contact HEAL Medical.