Wallis Wang
The legal framework provided by a controversial bill that allows patients to make medical directives in advance will be gazetted tomorrow and scrutinized in the Legislative Council on December 6.
The Health Bureau said the bill will specify that mentally capable adults may make an advance medical directive, deciding they will not receive any life-sustaining treatment specified in the instruction when they are critically ill and are no longer capable of making such a decision.
If a person has made a do-not-attempt cardiopulmonary resuscitation order in their AMD, registered medical practitioners may then act based on the instructions to refuse CPR on the patient.
Currently, the Hospital Authority allows its patients to make AMDs when necessary and an increasing number of patients has been making such decisions since 2012. The number of refusals of CPR rose to 1,742 in 2021 from 325 in 2013.
Since there is no legislation concerning the practice, both patients and medics may face practical and legal challenges when implementing the directives, the bureau said.
It said AMDs are different from euthanasia, as the instructions on them only allow withdrawal of life-sustaining treatment in specified circumstances and patients cannot refuse basic care or request to end their lives.
”To uphold patient self-determination, we adopt the principle of ‘cautious making, easy revoking’ in respect of AMDs, and propose in the bill stringent safeguards for making AMDs while facilitating revocation, should the maker subsequently change their mind,” the bureau said.
Although the bill currently specifies that AMDs must be made in writing, the bureau said it is planning to enable the directives to be made electronically in due course.
At least two witnesses are required when a person makes an AMD, and one of them must be a registered medical practitioner who confirms the person’s mental capability to decide on life-sustaining treatment and awareness of the nature of the directive.
The witnesses must not be, to the best of their knowledge, immediate beneficiaries of the AMD applicant’s estate, the bureau added.
”As for revocation, the bill will provide that an AMD maker can revoke the AMD at any time by verbal or written means or by destroying the AMD, as long as they are mentally capable of deciding on a life-sustaining treatment at the time,” it said.
The bureau said it is analyzing the feasibility of AMD made in digital form, the mechanism for making and revoking AMDs by electronic means and the effects of having both paper and digital AMD forms.
But lawmakers are skeptical, saying that rescuers will perform resuscitation anyway if they cannot find the AMD forms on the patient.
”There will be problems arising from the paper form of an AMD. What if patients do not carry it? Emergency personnel would not and should not search their body so they might not be aware of their directives,” said medical and health sector lawmaker David Lam Tzit-yuen.
”It would be a waste of time if rescuers have to check whether a patient has made an AMD while they also have to prepare the [automated external defibrillator] device and medications,” Lam said.
Social welfare sector lawmaker Tik Chi-yuen said the digitized AMD would be convenient for health professionals.
”If the medical directives must be made in writing, patients may sign many documents. It would be hard to make changes or figure out which one is the latest,” he said.
wallis.wang@singtaonewscorp.com
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