Advance Medical Directive Cap. 651: Hong Kong AMD Form

An advance medical directive is made by an adult who is still mentally capable. It contains instructions that a named life-sustaining treatment is not to be given once two conditions hold together: the maker has lost the mental capacity to decide on it, and the precondition written into the instruction has been reached. Cap. 651 shortens the term to AMD and treats the instrument as a refusal, never a request. It cannot demand a treatment your doctors consider futile, and it cannot refuse basic care, meaning food and drink by mouth and help in taking them, or palliative care.

Hong Kong practice keeps three neighbouring documents apart, and confusing them is why families arrive at hospital holding the wrong paper. An enduring power of attorney under Cap. 501 and its Prescribed Form Regulation covers property and financial affairs only, so the attorney cannot refuse treatment for you. A Hong Kong will drawn to section 5 of the Wills Ordinance operates after death, not in the weeks before it. The AMD fills the gap. A DNACPR order is different again: two registered medical practitioners, one a specialist, sign it on a prescribed form so that rescuers can act on a refusal of resuscitation in seconds.

The Legislative Council passed Cap. 651 on 20 November 2024, but section 1(2) left commencement to the Secretary for Health. The Commencement Notice was gazetted on 22 May 2026 and appointed 31 July 2026. Until then an advance directive rested on common law and Hospital Authority policy. It now rests on statute, and a valid and applicable instruction changes what a doctor is permitted to do rather than what a doctor is advised to consider.

The scheme runs on the principle of cautious making and easy revoking. To make an AMD you must be an adult, mentally capable of deciding on a life-sustaining treatment, and your instructions must be in writing and clear enough to act on. The directive must be signed before two witnesses, and neither witness may be an interested person of the maker, which rules out the relatives and beneficiaries most people instinctively ask. One of the two witnesses must be a registered medical practitioner. That doctor carries statutory duties: satisfaction that you are mentally capable of the decision, an explanation of what following each instruction would mean for your own condition, and a declaration in the directive that both were done.

Schedule 2 provides two model forms, a full version and a short one limited to refusal of cardiopulmonary resuscitation, and neither is compulsory. A directive in another format holds good where the substance meets the statutory conditions. Earlier directives survive too: Hospital Authority forms signed before commencement are grandfathered, and other pre-existing forms are respected where they satisfied Part 2 of Schedule 1. Revocation is easy by design, in writing, orally, or by destroying the document. Obstructing compliance with an instruction, or misleading someone into complying or not complying with an advance decision instrument, is an offence. Doctors and rescuers who honestly and reasonably believe a directive is valid and applicable are protected from civil, criminal and disciplinary liability, as are those who treat because they had no notice of it. The Health Bureau thematic page on the Advance Decision on Life-sustaining Treatment Ordinance carries the implementation material.

The usual trigger is a diagnosis. A patient told that an illness is advanced, progressive and irreversible often wants the ventilator question settled while the conversation is still calm, and a directive signed in a clinic room after a full discussion is worth far more than one signed in a crisis. Admission to a residential care home is the second common moment, because homes will ask what documentation exists before a night shift has to call an ambulance.

Household structure drives the rest. Residents living alone, or with adult children settled overseas, sign a directive so that a hospital does not have to guess and a distant relative does not have to decide by telephone. Couples often prepare together, alongside a section 7 general power of attorney under the Powers of Attorney Ordinance for the banking side of the same exercise. One edge case deserves attention. Anaesthesia routinely involves interventions that resemble resuscitation, so a blanket refusal of CPR must be discussed with the anaesthetist before the day.

• The identification and capacity block records your name, Hong Kong identity card particulars and date of birth, then states that you are an adult and mentally capable of deciding on a life-sustaining treatment at the moment of signing.
• The specified preconditions are the trigger conditions you choose, and the template offers the three from the statutory model form: terminal illness, meaning an advanced, progressive and irreversible condition with a life expectancy measured in days, weeks or months; a persistent vegetative state or a state of irreversible coma; and any other end stage, irreversible, life limiting condition, which must be named rather than left blank.
• The treatment instructions set out what you refuse against each precondition, whether cardiopulmonary resuscitation alone, named treatments such as artificial ventilation or dialysis, every form of life-sustaining treatment except artificial nutrition and hydration, or every form of it. Do not tick the widest option without discussing artificial nutrition and hydration with your doctor. A reservation clause confirms that nothing refuses basic care or palliative care.
• The attestation block gives separate panels to the two witnesses, with the doctor's declaration on capacity and explanation, their registration particulars, and a declaration by each witness that they are not an interested person.
• The revocation and notification schedule lists who holds a copy, revokes any earlier directive, and adds a wallet card and a covering letter to your family doctor so the document can be found.

Public hospitals are the setting the Ordinance was designed around, and the Hospital Authority has the longest experience of advance directives. Voluntary storage of an electronic copy in the electronic Health Record Sharing System is what makes a directive visible to a hospital you have never attended. Notice is the operative concept throughout Cap. 651: a treatment provider who never sees a validating copy, and is never told one is stored electronically, is protected for treating you.

Private hospitals and residential care homes have had less exposure to advance directives than the public sector. Hand a copy to the admitting office in writing. Care home staff are not registered medical practitioners and cannot determine that a precondition has been met, which is why a resident who has refused resuscitation is normally also assessed for a DNACPR order signed by two doctors.

Out of hospital rescue is the reason that order exists as a separate instrument. Ambulance crews act on a validating copy of the order, not on a reading of a directive. The Ordinance also preserves the reflex to resuscitate where the arrest may have arisen from an unnatural cause or a self-inflicted injury.

At home, the question is who is present. Many households rely on a domestic helper as the daytime carer, and that helper should know where the document is kept and whom to telephone. Employers in that position often review the domestic helper hiring and termination pack for Hong Kong at the same time, so that caring duties and the employment contract stay consistent.

You begin by choosing between the full directive and the short version limited to refusal of cardiopulmonary resuscitation, which is the right starting point for most people whose only firm decision is about CPR. The form asks for your particulars, then takes the three specified preconditions one at a time, so you can attach different instructions to different conditions.

The document is generated in Word and PDF. Print it, but do not sign it before your witnessing appointment: Cap. 651 requires the signature to be made in the presence of the two witnesses, and a form signed at home is defective on its face. Take it to the doctor who knows your condition, work through the explanation the Ordinance requires, then sign with the second witness present. Keep the original, give copies to your family doctor and to the person you would want contacted, and carry the wallet card. The rest of your personal and family paperwork for Hong Kong can be prepared in the same sitting.

The witnessing rules account for most defective directives. Two friends, or a solicitor and a spouse, will not do: one witness must be a registered medical practitioner, and neither may be an interested person. Asking the daughter who stands to inherit to witness the document destroys it. The next failure is silence: a directive locked in a drawer at home protects nobody, since a doctor with no notice of it is expressly protected for administering treatment.

The remaining errors are conceptual. People assume an AMD covers money as well as medicine, and discover on the ward that financial decisions need an enduring power of attorney registered with the High Court. They assume a refusal of resuscitation stops an ambulance crew, when what stops an ambulance crew is a DNACPR order signed by two doctors on a prescribed form. And they leave outdated copies circulating among relatives. A fresh AMD revokes the earlier one, so collect the old copies.