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Terminally ill patients will get more say in the treatments they receive under proposed amendments to the law. Photo: Sam Tsang

Hong Kong’s terminally ill will have more say in medical treatments and deaths under proposed amendment to law

  • Proposed amendments aim to give legal status to advance directives, a medical document allowing dying patients to choose their treatments
  • New law will protect healthcare professionals from lawsuits if they respect the patients’ wishes
Hong Kong patients suffering from terminal illnesses will be granted more legal power to stop receiving medical treatment if they wish under law amendments proposed by health authorities on Wednesday.
Their decision not to receive resuscitation or other life-sustaining medical treatments at the final stage should also be respected by paramedics outside hospital settings, according to a paper submitted for lawmakers’ approval.

The proposed amendments, long overdue after a public consultation in 2019, aim to give advance directives, medical documents used by dying patients to specify which treatments they want or refuse, statutory power.

Patients will be allowed to decide whether they receive cardiopulmonary resuscitation (CPR). Photo: Shutterstock

The discussion was reignited after the directives became more popular among patients. The number of people rejecting cardiopulmonary resuscitation (CPR) jumped from 325 in 2013 to 1,742 in 2021.

But without legal status, the directives have been subject to dispute by patients’ families.

The document at present is only legally binding based on the general requirement of patients’ consent for medical treatment under the common law.

“People will need to follow the instructions in the advance directive if it has legal status,” said Roger Chung Yat-nork, an associate professor from Chinese University’s school of public health.

“[Currently] the document doesn’t have a legislative status, and whether people should follow it is murky.”

Hong Kong policies on terminally ill should be reviewed: judge

Late Nobel Prize-winning physicist Professor Charles Kao Kuen and his wife Gwen Kao Wong May-wan had also signed an advance directive in the United States to skip traumatic and unnecessary medical interventions when they reached an irreversible stage.

According to the advance directive template used by public hospitals, patients can choose not to receive CPR or other life-sustaining treatments when terminally ill or in a persistent vegetative state. But euthanasia, which is illegal in Hong Kong, would not be performed.

But under the existing Fire Services Ordinance, paramedics should resuscitate or sustain a person’s life even when they have a valid document rejecting the medical procedure. The proposed law amendment will protect healthcare professionals from lawsuits if they respect the patients’ wishes according to their directives.

Chung said he believed the legislative amendments would encourage people to draft advance directives for their end-of-life care.

‘Make clear who is mentally fit to decide end-of-life treatments’

“As more people become aware of this [document], more would go for a draft,” he said. “An advance directive aims to respect a patient’s autonomy and dignity.”

Deaths of residents in care homes for the elderly or disabled will be regarded as natural under the proposed amendments, provided they have been diagnosed with terminal illness, have been treated by a doctor within 14 days, and a medical practitioner has confirmed it was not suspicious.
It means the death does not need to be reported to police or followed up by forensic pathologists. No postmortem examination would be required.
The government is drafting the Advance Decision on Life-Sustaining Treatment Bill and plans to submit the proposal with other legal amendments to Legco for scrutiny this year.

According to a survey, elderly care home residents were, on average, admitted to hospital 2.6 times within the six months before their death.

“The whole point of this legislative [change] is to let people pass away in a place they feel more comfortable, rather than in a hospital or emergency setting,” Elderly Commission chairman Dr Donald Li Kwok-tung said, adding that he believed more people would choose to die in care homes.

Elderly Services Association chairman Kenneth Chan Chi-yuk welcomed the legislative proposal, saying the suggested changes had been dragged out for years.

Chan said about 30 per cent of care homes were equipped with individual rooms that could provide end-of-life care to residents in their final days.

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“If end-of-life care becomes more popular in the community, services at elderly care homes could be enhanced … and operators would be motivated to provide appropriate services,” Chan said.

He said medical care for terminally ill patients would not be an issue as many care homes had doctor visits daily or every other day.

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