The Advance Decision on Life-sustaining Treatment Bill was published in the Gazette today, while amendments to the Coroners Ordinance and the Births & Deaths Registration Ordinance will be published on December 1.

The bill and the relevant legislative amendments seek to set the legislative framework for safeguarding patients, medical professionals and rescuers as well as facilitating the choice of dying in place for terminally ill patients in residential care homes.

Advance medical directives (AMDs), do-not-attempt cardiopulmonary resuscitation (DNACPR) orders and dying in place are all important policy measures to honour patients' decisions and enhance patients' quality of life during their final days.

The Advance Decision on Life-sustaining Treatment Bill specifies that any person aged 18 or above who is mentally capable of deciding on a life-sustaining treatment may make an AMD.

Upon meeting the specified precondition of the instruction stated in the directive, no medical professionals can perform any life-sustaining treatment specified in the instructions at the time the person concerned is mentally incapable of deciding on a life-sustaining treatment.

No less than two witnesses who must satisfy certain conditions, including, to the best of his/her knowledge, not being a beneficiary of the maker's estate, should be in attendance when an AMD is made, with one of the witnesses being a registered medical practitioner.

That registered medical practitioner should be satisfied that the maker, when signing on the AMD, is mentally capable of deciding on a life-sustaining treatment and has been informed of its nature and the effect on oneself upon following each of the instructions therein.

The AMD must be made in writing. A scanned and digitised copy of the paper form can be stored in a designated electronic system as a proof of validity of the instructions. The Health Bureau is exploring the feasibility of enabling the making of the directive direct in digital form.

As long as an AMD maker is mentally capable of deciding on a life-sustaining treatment, he or she can revoke it at any time by verbal/written means or destroying it.

Noting that AMDs and euthanasia are two distinct concepts, the bureau said the former allows withdrawal or withholding of life-sustaining treatment for terminally ill patients in specified situations.

Nevertheless, directive makers cannot refuse basic/palliative care or request the administration or prescription of a substance to end their life through an AMD, it added.

The bill also covers do-not-attempt cardiopulmonary resuscitation (DNACPR) orders, an instrument that directs not to perform cardiopulmonary resuscitation on a person suffering from cardiopulmonary arrest.

That order must be made by two registered medical practitioners in writing by using a physical statutory form as specified in the legislation, with one of the medical practitioners being a specialist.

A DNACPR order can be revoked upon certain acts of the maker, such as destroying the order when he or she is mentally capable of deciding on a life-sustaining treatment.

As medical professionals and rescuers may often need to make split-second decisions especially during rescue operations, and under the "if in doubt, save life first” principle, the bill will safeguard medical professionals and rescuers, including lay rescuers, such that they will be protected from any legal liability for whether they have subjected a patient to a life-sustaining treatment or not when specified conditions are met.

Additionally, amendments are proposed to the Coroners Ordinance and the Births & Deaths Registration Ordinance to facilitate the choice of dying in place for terminally ill patients in residential care homes.

If a resident who passes away in a residential care home is diagnosed as having a terminal illness when he or she is alive and is attended to by a registered medical practitioner within 14 days before passing away, and his or her cause of death certificate states that he or she died of natural causes, the case will no longer be considered as a reportable death to the Coroners Court.

The bill will be introduced into the Legislative Council for first and second readings on December 6 and the two legal amendments will be introduced for negative vetting on the same day.