Advance Directives

What is an “Advance Directive”?

Within the healthcare context, an advance directive is a statement, usually in writing, in which a mentally competent person indicates the form of healthcare he or she would like to have, or would like not to have, at a future time when he or she is no longer mentally competent to make decisions or instruct a doctor (e.g. when terminally ill, in an irreversible coma or persistent vegetative state).  Through advance directives people may express clearly their wishes to their families and healthcare professionals.  A terminal cancer patient, for example, can indicate through advance directives that, in case his or her heart stops beating, he or she is not to be resuscitated.

An advance directive has many advantages. First, it facilitates people’s self-determination (that is, the right to have control over their own lives). Second, it does away the stress that the families of a patient (or a person wounded) bear when having to make life and death decisions for the patient. Third, it helps healthcare professionals to make difficult choices, for example, whether life-sustaining treatment should be withheld or withdrawn in the best interests of the patient.

The concept of advance directives is based on the principle that everyone should have the right to make an informed determination of his own healthcare decisions. Australia, Canada, England, Singapore and the United States have already embraced this concept.  In comparison, there is currently no legislation or case law establishing the legal status of advance directives in Hong Kong, and Hong Kong people are relatively new to this concept.  Thus, in August 2006, the Law Reform Commission of Hong Kong published a report on this subject called “Substitute Decision-making and Advance Directives in Relation to Medical Treatment”, and in December 2009, the Food and Health Bureau also issued a relevant consultation document called the “Introduction of the Concept of Advance Directives in Hong Kong”.