Hong Kong Doctors' Guide to the Advance Decision on Life-Sustaining Treatment Ordinance: DNACPR Orders, Advance Medical Directives and Legal Protection Before 31 July 2026

Healthcare Law Knowledge Article | Hong Kong Doctors | DNACPR Orders | Advance Medical Directives | End-of-Life Care

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Author: Rendy Ng, Dr. Alan Wong

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The Advance Decision on Life-Sustaining Treatment Ordinance will come into operation in Hong Kong on 31 July 2026. For doctors in Hong Kong, including private doctors, specialists, general practitioners, doctors practising in private hospitals and doctors providing palliative or community care, the Ordinance introduces an important statutory framework for handling advance medical directives and do-not-attempt cardiopulmonary resuscitation orders, commonly referred to as DNACPR orders.

The Ordinance affects how doctors discuss end-of-life care with patients, assess and document patient wishes, issue or act on DNACPR orders, verify advance medical directives, manage family disagreement, use eHealth records, and protect themselves from civil, criminal and professional misconduct liability.

Key Points for Hong Kong Doctors

• The Advance Decision on Life-Sustaining Treatment Ordinance will take effect on 31 July 2026.
• The Ordinance provides statutory rules for the making, issuing, revocation, validity and applicability of advance medical directives and DNACPR orders.
• An advance medical directive allows an adult patient, while mentally capable, to refuse specified life-sustaining treatment in advance.
• A DNACPR order is issued by a doctor based on the patient’s autonomous wishes or best interests, where the prescribed preconditions are met.
• Existing advance medical directives made before commencement will remain valid if they comply with legal requirements.
• Existing DNACPR orders must be reissued using the new prescribed form to remain valid after the Ordinance commences.
• Advance medical directives will be digitalised in phases through eHealth.
• DNACPR orders will remain in paper form only, because they are often needed in urgent out-of-hospital situations.
• Doctors and rescue personnel will receive legal protection when acting in accordance with a valid and applicable directive or order.
• Doctors and rescue personnel will also be protected where they do not know of a valid and applicable directive or order and provide treatment under the principle of “if in doubt, save life first.”
• Doctors should prepare now by reviewing DNACPR documentation, clinic procedures, patient communication scripts, eHealth access and staff training.

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Why the Ordinance Matters to Doctors in Hong Kong

End-of-life care decisions place doctors in a difficult position. A doctor may need to decide whether to provide, withhold or discontinue life-sustaining treatment at a time when the patient is critically ill, family members are distressed, and clinical decisions must be made quickly.

The Ordinance is designed to provide greater legal clarity in these situations. It recognises the patient’s right to make decisions about life-sustaining treatment and provides a framework for doctors to respect those decisions.

For Hong Kong doctors, the Ordinance matters because it affects:

• Patient autonomy and informed decision-making;
• Doctor-patient communication;
• Mental capacity assessment;
• Documentation of end-of-life care discussions;
• DNACPR order issuing procedures;
• Emergency treatment decisions;
• Family communication and dispute management;
• Professional misconduct risk;
• Civil and criminal liability exposure;
• eHealth record checking; and
• Internal clinic and hospital protocols.

Doctors should not treat the Ordinance as only a hospital administration issue. It is directly relevant to daily clinical practice, particularly for doctors who care for elderly patients, terminally ill patients, patients with advanced chronic disease, oncology patients, patients receiving palliative care, and patients in residential or community care settings.

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What Is an Advance Medical Directive?

An advance medical directive allows an adult patient to refuse specified life-sustaining treatment in advance.

In practical terms, a patient may make an advance medical directive while he or she still has mental capacity to decide on life-sustaining treatment. The directive may then become relevant if the patient later loses mental capacity and the specified medical conditions are met.

For doctors, the key point is that an advance medical directive is not merely a general expression of preference. It is a legally significant document that must be assessed carefully before it is acted upon. Before relying on an advance medical directive, a doctor should consider:

• Whether the patient was an adult when the directive was made;
• Whether the patient had mental capacity when making the directive;
• Whether the directive was validly made;
• Whether the directive has been revoked;
• Whether the patient’s current medical condition falls within the specified circumstances;
• Whether the life-sustaining treatment in question is covered by the directive;
• Whether there is any conflicting information in the medical records;
• Whether eHealth records should be checked; and
• Whether the basis for the decision has been properly documented.

A doctor should also consider whether communication with family members or carers is appropriate, while remembering that the patient’s valid and applicable directive is a legal expression of the patient’s own decision.

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What Is a DNACPR Order?

A DNACPR order is an order stating that cardiopulmonary resuscitation should not be performed on a patient in applicable circumstances.

Under the Ordinance, a DNACPR order is issued by a doctor. It may be based on:

• The patient’s autonomous wishes; or
• The patient’s best interests.

The patient must also satisfy the prescribed preconditions.

For doctors, it is important to distinguish a DNACPR order from an advance medical directive. An advance medical directive is made by the patient in advance. A DNACPR order is issued by a doctor. Both may relate to end-of-life care, but they are not the same document and should not be treated as interchangeable.

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The “Cautious Entry, Easy Exit” Principle

The Hong Kong Government’s Health Bureau has described the Ordinance as following a principle of “cautious entry, easy exit.”

This principle is important for doctors because it reflects the expected standard of discussion, documentation and care when handling advance medical directives and DNACPR orders.

Cautious Entry

“Cautious entry” means that making an advance medical directive or issuing a DNACPR order should be approached carefully. Patients should understand the nature of life-sustaining treatment, the available treatment choices, and the consequences of refusing treatment in specified circumstances.

Doctors should avoid treating these discussions as a routine form-signing exercise. A patient should have a meaningful opportunity to ask questions, understand the clinical context and consider the impact of the decision.

This is particularly important because the Health Bureau has noted that generally healthy individuals may find it difficult to predict what terminal illness or treatment needs they may face in the future. Doctors should therefore be cautious when discussing advance directives with patients who do not yet have a relevant clinical context.

Easy Exit

“Easy exit” means that the Ordinance provides flexible revocation mechanisms. A patient may later wish to change his or her decision.

Doctors should therefore make sure that clinical records, paper files and electronic systems are kept up to date. If a patient revokes or changes an advance medical directive, outdated documents should not continue to influence clinical decisions.

Legal Protection for Doctors and Rescue Personnel

One of the most important features of the Ordinance is the legal protection it gives to doctors, healthcare professionals and rescue personnel.

The Heath Bureau has stated that healthcare and rescue personnel will be protected from civil liability, criminal liability and professional misconduct liability where they act in accordance with a valid and applicable advance medical directive or DNACPR order by not providing life-sustaining treatment.

The Ordinance also recognises the reality of emergency care. Where doctors or rescue personnel do not know that a valid and applicable directive or order exists, and they provide treatment under the principle of “if in doubt, save life first,” they will also be protected.

However, doctors should not assume that legal protection is automatic in every situation. The protection depends on acting within the statutory framework. Proper verification, clinical judgment and documentation remain essential.

Professional Misconduct Risk: What Doctors Should Watch

Although the Ordinance provides protection in specified circumstances, complaints may still arise if patients, family members or other parties believe that a doctor acted improperly. The risk may be higher where communication is poor, documentation is incomplete, or the doctor’s decision-making process is unclear.

Potential risk areas include:

• Acting on an advance medical directive without checking whether it is applicable;
• Failing to consider whether the patient had revoked the directive;
• Using an outdated DNACPR form after commencement;
• Failing to reissue an existing DNACPR order on the prescribed form;
• Poor documentation of patient discussions;
• Inadequate recording of mental capacity assessment;
• Unclear documentation of best interests;
• Failure to communicate appropriately with family members or carers;
• Confusion between an advance medical directive and a DNACPR order;
• Failure to check available eHealth information where appropriate;
• Not escalating an uncertain case; and
• Inconsistent practice within a clinic or medical group.

Doctors should ensure that their records show the clinical and legal basis for their decisions. Good documentation may be a doctor’s most important protection if a decision is later questioned.

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What Doctors Should Document

Doctors should consider documenting the following when discussing or acting on an advance medical directive or DNACPR order:

• The patient’s diagnosis and clinical condition;
• The patient’s prognosis, where relevant;
• The patient’s mental capacity at the time of discussion;
• The information explained to the patient;
• The patient’s questions and responses;
• The treatment options discussed;
• The life-sustaining treatment being refused or considered;
• The circumstances in which the decision is intended to apply;
• Whether family members or carers were involved in the discussion;
• Whether there was any disagreement or concern;
• Whether an advance medical directive was reviewed;
• Whether a DNACPR order was issued;
• Whether the prescribed form was used;
• Whether the patient’s wishes or best interests formed the basis of the decision;
• Whether eHealth or other records were checked;
• Whether the directive or order was communicated to relevant staff; and
• Any plan for review or follow-up.

Doctors should also ensure that nurses, clinic staff and other healthcare personnel know where relevant documents are stored and how to escalate urgent questions.

What Private Doctors in Hong Kong Should Do Before 31 July 2026

Private doctors should prepare early for the commencement of the Ordinance. This is especially important for doctors who practise in solo clinics, group practices, private hospitals, specialist centres, nursing homes or community care settings.

Recommended steps include:

1. Review Existing DNACPR Orders

Doctors should identify patients under their care who already have DNACPR orders. Existing orders must be reissued using the new prescribed form to remain valid after the Ordinance takes effect.

2. Prepare to Use the Prescribed DNACPR Form

Private doctors should ensure they know when and how to use the new prescribed form. Clinics and medical groups should update internal procedures so that outdated forms are not used after commencement.

3. Review Advance Medical Directives

Where patients already have advance medical directives, doctors should review whether those documents are accessible, complete and consistent with the patient’s current wishes.

4. Update Clinic Protocols

Clinic procedures should address how staff respond when a patient or family member raises an advance directive, DNACPR order or end-of-life care question.

5. Train Clinic Staff

Nurses, healthcare assistants and administrative staff may be the first to receive documents or questions from patients. They should know what to do, what not to say, and when to refer the matter to the doctor.

6. Check eHealth Readiness

Doctors should consider whether they and their practice have appropriate access to eHealth and whether staff understand how electronic advance medical directives may be stored, retrieved or checked.

7. Create an Escalation Pathway

Difficult cases should be escalated promptly. Examples include family disagreement, uncertainty over capacity, unclear documents, inconsistent records, or urgent treatment decisions.

8. Review Patient Communication Materials

Doctors may wish to prepare patient information sheets explaining advance medical directives, DNACPR orders, revocation and the role of advance care planning.

eHealth and Electronic Advance Medical Directives

The Ordinance provides for phased digitalisation of advance medical directives through eHealth.

After commencement, individuals who have already made advance medical directives may choose whether to store them electronically. When the relevant system functions are fully ready, electronic advance medical directives may be made directly through the designated system.

Why DNACPR Orders Will Remain Paper-Based

Unlike advance medical directives, DNACPR orders will remain in paper form only.

The Government has explained that DNACPR orders are often used in urgent situations outside hospitals. A paper document allows rescuers and healthcare personnel to identify the order immediately.

For doctors, this means the physical handling of the DNACPR form remains critical. Doctors should consider:

• Whether the prescribed form has been properly completed;
• Where the form will be kept;
• Whether the patient and family understand the importance of accessibility;
• Whether residential care staff or home-care providers know where the form is;
• Whether the order has been communicated to relevant carers;
• Whether the order should be reviewed if the patient’s condition changes; and
• Whether an existing order needs to be reissued before commencement.

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Transitional Arrangements Doctors Should Know

The transitional arrangements are particularly important for doctors.

Existing Advance Medical Directives

Advance medical directives made before the Ordinance takes effect will continue to be valid if they comply with legal requirements. They do not need to be remade solely because the Ordinance is commencing.

However, doctors should still consider reviewing existing directives with patients where appropriate, especially if the patient’s medical condition, treatment options or personal wishes may have changed.

Existing DNACPR Orders

Existing DNACPR orders must be reissued using the new prescribed form in order to remain valid after the Ordinance takes effect. This is one of the most important action points for doctors before 31 July 2026. Private doctors should not wait until the commencement date to identify affected patients.

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Common Risk Scenarios for Hong Kong Doctors

Scenario 1: A Patient Has an Old DNACPR Order

A patient in a private clinic or residential care setting has an existing DNACPR order made before commencement. The doctor should check whether it needs to be reissued using the new prescribed form before the Ordinance takes effect.

Scenario 2: Family Members Disagree with the Patient’s Directive

A patient has a valid advance medical directive, but family members object when the patient becomes critically ill. The doctor should assess validity and applicability, communicate carefully, document the position and escalate where necessary.

Scenario 3: The Doctor Cannot Confirm Whether a Directive Exists

In an urgent situation, the doctor cannot confirm whether the patient has made an advance medical directive. The “if in doubt, save life first” principle may be relevant, but the doctor should document the information available at the time.

Scenario 4: Paper and Electronic Records Conflict

A doctor sees a paper directive but eHealth records appear inconsistent. The doctor should avoid assumptions, verify the position where possible, check for revocation and record the steps taken.

Scenario 5: A Healthy Patient Requests an Advance Directive

A generally healthy patient asks a doctor to help prepare an advance medical directive. The doctor should explain the limitations of predicting future illness and ensure that any discussion is properly informed and not reduced to a standard form exercise.

Checklist for Hong Kong Doctors Before 31 July 2026

Doctors and medical practices should consider the following steps:

• Identify patients with existing DNACPR orders.
• Arrange review and reissuance using the new prescribed form where appropriate.
• Review existing advance medical directives held in patient records.
• Update clinic policies on advance directives and DNACPR orders.
• Train nurses, assistants and administrative staff.
• Prepare patient communication materials.
• Review eHealth access and internal procedures.
• Establish a process for checking revocation.
• Clarify how documents will be stored and retrieved.
• Document mental capacity and informed discussions carefully.
• Create an escalation pathway for uncertain or disputed cases.
• Review professional indemnity and risk management arrangements.
• Monitor further Government guidance, prescribed forms and implementation updates.

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FAQs for Hong Kong Doctors

When does the Advance Decision on Life-Sustaining Treatment Ordinance start?

The Ordinance is scheduled to commence on 31 July 2026.

What should Hong Kong doctors do before the Ordinance starts?

Doctors should review existing DNACPR orders, prepare to use the new prescribed form, check advance medical directives in patient records, update clinic procedures, train staff and prepare for eHealth-related workflows.

Can a Hong Kong doctor rely on an advance medical directive?

A doctor may rely on an advance medical directive if it is valid and applicable in the patient’s circumstances. The doctor should check whether the directive has been revoked, whether the relevant medical conditions are met, and whether the treatment in question is covered.

Do doctors need to reissue existing DNACPR orders?

Yes. Existing DNACPR orders must be reissued using the new prescribed form to remain valid after the Ordinance takes effect.

Are DNACPR orders electronic?

No. DNACPR orders will remain paper-based only because they are often needed in urgent out-of-hospital situations.

Are advance medical directives electronic?

Advance medical directives will be digitalised in phases through eHealth. Individuals may choose whether to store existing directives electronically after commencement. Later, electronic directives may be made directly through the system once the relevant functions are ready.

Are doctors protected if they withhold CPR in accordance with a DNACPR order?

The Ordinance provides protection for healthcare and rescue personnel who act in accordance with a valid and applicable DNACPR order.

Are doctors protected if they provide CPR because they did not know about a DNACPR order?

The Government has stated that protection also applies where healthcare or rescue personnel do not know of a valid and applicable directive or order and provide treatment under the principle of “if in doubt, save life first.”

What should doctors document when discussing an advance medical directive?

Doctors should document the patient’s capacity, the information explained, treatment options discussed, the patient’s wishes, family involvement where relevant, the specific treatment being refused, and any review or revocation issues.

Should doctors encourage healthy patients to make advance medical directives early?

Doctors should be cautious. The Government has noted that generally healthy individuals may find it difficult to predict future terminal illness or treatment needs. Advance directives should be based on informed discussion and appropriate clinical context.

How Our Healthcare Law Team Can Help Hong Kong Doctors

The commencement of the Advance Decision on Life-Sustaining Treatment Ordinance is a significant development for doctors in Hong Kong. It creates new legal clarity, but it also requires careful preparation.

Our healthcare law team advises Hong Kong doctors, private medical practices, specialists, medical groups and private healthcare institutions on clinical governance, regulatory compliance and professional risk management.

We can assist doctors with:

• DNACPR order policies and procedures;
• Reissuance of existing DNACPR orders using the prescribed form;
• Advance medical directive workflows;
• Patient communication and consent documentation;
• Mental capacity and best-interests documentation;
• eHealth record-checking procedures;
• Clinic staff training;
• Professional misconduct risk management;
• Medical Council complaint prevention;
• End-of-life care dispute management;
• Review of clinic protocols and patient-facing documents; and
• Legal advice on complex or disputed cases.

If you are a doctor in Hong Kong and need advice on DNACPR orders, advance medical directives, end-of-life care documentation, patient communication or professional liability before the Ordinance commences on 31 July 2026, our healthcare law team can provide practical, doctor-focused legal guidance.

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Disclaimer: Nothing herein shall be interpreted as legal advice to any person. Readers are encouraged to consult their legal representatives for independent advice. The information provided is based on overall observations and the experience of the practitioners of the firm at the time of writing. The content may change without prior notification depending on changes in the law. If there are two versions of the article in different languages, the English version will prevail in case of discrepancies.

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