On 31 July 2026, advance medical directives in Hong Kong will finally sit on a statutory footing. The main provisions of the Advance Decision on Life-sustaining Treatment Ordinance (Cap. 651), passed back in November 2024, come into operation on that date under a commencement notice gazetted on 22 May 2026. The Judiciary has moved in step: on 29 June 2026, the Chief Justice issued a new Practice Direction 40, which sets out how court applications about advance medical directives will be handled from the same date.
If you have been putting off the conversation about end-of-life care, or you signed a Hospital Authority advance directive form years ago and forgot about it, this is a sensible moment to look at where you stand. You would not be alone: Hospital Authority patients made just over 2,000 advance directives in 2025, up from 325 in 2013, and the new law is likely to push those numbers well beyond the hospital setting.
What an Advance Medical Directive Actually Does
An advance medical directive (AMD) is a written instruction made while you still have mental capacity. It says that if you later lose the capacity to decide for yourself, and your condition meets a precondition you have specified, you are not to be given certain life-sustaining treatments. Life-sustaining treatment covers things like cardiopulmonary resuscitation (CPR), artificial ventilation and tube feeding.
The model forms in Schedule 2 of the Ordinance (there are two: a full form, and a shorter one refusing CPR only) offer three preconditions to choose from: terminal illness, a persistent vegetative state or irreversible coma, and other end-stage, irreversible, life-limiting conditions (end-stage dementia falls in this third category).
Two things an AMD is not. It is not euthanasia, and it does not let anyone end a life. It also cannot refuse basic care or palliative care: you cannot use an AMD to refuse being offered food and water by mouth, and comfort care continues regardless.
An AMD also has sensible limits in a crisis it never contemplated. Your instruction only applies where your condition meets the precondition you chose and the situation is one you could reasonably have anticipated. Say you made an AMD refusing CPR after a terminal cancer diagnosis, and you are later knocked down crossing the road. If the doctors judge that the emergency comes from the accident rather than the cancer, they can treat you. The law does not read one diagnosis as a blanket refusal of all future care.
Until now, AMDs in Hong Kong rested on the common law. A clear advance refusal of treatment by a mentally capable adult was already binding on doctors, but no statute said how an AMD had to be made, when it applied, or what protection those who complied with one (or missed one) had. Cap. 651 answers those questions. It also protects treatment providers and rescuers from liability where they withhold treatment honestly and reasonably believing an AMD instruction or a do-not-attempt CPR (DNACPR) order is valid and applicable, and where they treat because they do not know of the document or are not satisfied it applies.
How to Make One That Actually Holds Up
The formalities matter, and they are stricter than most people expect.
You must be an adult with the mental capacity to decide on life-sustaining treatment at the time of signing. For now the AMD must be a paper document, signed and dated in the presence of at least two adult witnesses. One witness must be a registered medical practitioner, whose job is to explain the nature and effect of each instruction and to be satisfied that you have capacity. Neither witness can be an “interested person”: broadly, anyone who takes under your will or would take on your intestacy, a beneficiary of any insurance policy of yours, anyone you have granted or settled an interest to, or anyone who would receive an interest on your death by survivorship (a joint tenant of your flat, for example). In practice that disqualifies spouses, children and many close relatives, which surprises many clients. A friend or a nurse with no such interest is usually the safer choice.
The Government encourages people to use the model forms, and we would too. A homemade form can still be valid if the instructions are clearly presented and the statutory requirements are met, but it invites exactly the kind of dispute that ends up in court.
Revoking an AMD is deliberately easy. The Ordinance follows a “cautious making, easy revoking” principle: so long as you still have capacity, you can revoke in writing, orally in front of an adult witness, by destroying the document, or simply by making a new AMD. In time, the Government will add electronic AMDs through eHealth, with paper AMDs and electronic storage coming first.
Already Signed One? It Probably Survives
AMDs made before 31 July 2026 are not wiped out. A pre-existing directive remains valid if it meets the conditions in the Ordinance, and directives made on Hospital Authority forms are expressly catered for. That said, if yours is more than a few years old, it is worth reviewing it against the new requirements and, where sensible, remaking it on the statutory model form. Treat a new diagnosis, a changed prognosis, major surgery or a change in family circumstances as a prompt to read it again. An AMD that is clearly valid, and clearly current, is one your family will never have to litigate about.
A Directive No One Can Find Helps No One
One practical point tends to get overshadowed by the legal formalities: doctors and paramedics are not required to search your belongings for an AMD. If no one knows the document exists, the working principle is exactly what you would want it to be for everyone else: if in doubt, save lives first. So tell your family, your carer and your family doctor that you have made an AMD and where it is kept.
The Ordinance also defines what counts as proof, called a validating copy: the original, a copy certified as true by a doctor or a Hong Kong solicitor, or (once electronic storage arrives) a legible copy stored in eHealth. Keeping a certified copy with someone you trust is cheap insurance. And if your real concern is refusing CPR outside a hospital, ask your doctor about an AMD-based do-not-attempt CPR order as well: ambulance crews act on the prescribed order form, not on an AMD sitting in a drawer at home.
When the Court Comes In: Practice Direction 40
Most AMDs will never see a courtroom. But disputes happen: a family member doubts the directive was properly made, a hospital is unsure whether an instruction still applies, or there is a suggestion of pressure on the person who signed.
Section 21 of the Ordinance lets the Court of First Instance declare whether a purported AMD was in fact made by the person, or whether an instruction in it is valid, applicable, or both. Treatment providers, those contractually responsible for the patient’s medical care (a care home, for instance), immediate family members, a cohabiting partner (the Ordinance recognises unmarried and same-sex partners here), and an adult whom the doctor in charge of the patient determines is sufficiently closely connected can all apply without leave; anyone else needs the court’s permission.
Practice Direction 40 is the Judiciary’s procedural rulebook for these applications, and it is built for speed and protection of the person at the centre of the case. A few features stand out.
The maker of the AMD will normally be joined as a defendant, and every application must be served on the Official Solicitor, who will consider whether the maker needs a guardian ad litem (someone appointed to protect the maker’s interests in the proceedings) and whether to take on that role. Unless the matter is urgent, the court will list a first directions hearing before a judge within 28 days of the action being commenced. And for genuinely urgent cases, the application is routed through the Clerk of Court to an available judge during registry hours, with a Duty Judge handling matters outside those hours. These are cases where days can matter, and the procedure reflects that.
For families, the practical takeaway is reassuring: there is now a clear, fast route to an authoritative answer if an AMD is ever questioned, rather than leaving hospitals and families to work it out under the general law.
Where an AMD Fits in Your Wider Planning
We see the AMD as the third leg of a stool that most Hong Kong adults never quite finish building. A will deals with your estate after death. An enduring power of attorney deals with your finances if you lose capacity. An AMD deals with your medical treatment in your final stages. Each covers ground the others cannot, and none of them can be made once capacity is lost. That last point is the one that catches families out: by the time an AMD is clearly needed, it is usually too late to make one.
If you are reviewing your will or putting an enduring power of attorney in place, it costs little extra effort to deal with all three at once. There is a quiet litigation-proofing benefit too: when the solicitor who drafts your will also witnesses your AMD and keeps proper notes of your instructions and your capacity, a later challenge becomes much harder to run. Our Hong Kong estate planning checklist walks through how the three documents fit together.
TITUS advises on estate planning, mental capacity matters and disputes involving advance medical directives. If you would like to discuss making an AMD alongside your will or enduring power of attorney, or you are facing a dispute about one, contact us or book a consultation.
Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal advice, and reading it does not create a solicitor-client relationship. Laws and regulations are complex and fact-specific. Please consult a qualified solicitor at TITUS regarding your specific circumstances.