Seventy-eight-year-old Fung Ho-chu has been hoping to put her wishes on end-of-life treatment into writing ever since she learned that a new law on advance medical directives (AMD) came into effect in late July. But as a senior living on government welfare in low-income Sham Shui Po, the costs of the process have forced her to reconsider.

78-year-old senior Fung Ho-chu lives alone in Sham Shui Po. Photo: Kyle Lam/HKFP.

Fung considered the legislation a major milestone, as it allows competent adults in Hong Kong to refuse unwanted life-sustaining treatment or request that it be withheld or withdrawn.

 “We never talked about things like death or end-of-life with elderly people in the past – people believed it was a taboo,” Fung told HKFP in Cantonese. “Now things have changed.”

While she remains generally healthy, she believes it wise to establish a directive now, given that individuals approaching 80 could see a rapid deterioration in health. She does not want to suffer from pain or undergo invasive interventions such as intubation in her final moments. 

Through social workers, Fung learned that it costs around HK$3,000 to have a general practitioner set up an AMD. “That is a lot… Could the government provide any subsidy for low-income people?” Fung asked. She hesitated when she realised there was no such allowance.

The model form of advance medical directive. Photo: Kyle Lam/HKFP.

Fan Ning, a surgeon and the founder of Forget Thee Not, an NGO advocating for proactive planning around end-of-life journeys, told HKFP that AMDs are not new to Hong Kong. 

Public hospitals have been using AMDs since around 2008 under common law, which respects individuals’ autonomy in decisions regarding end-of-life treatment, but previously the services were mainly for patients diagnosed with terminal illness.

In late 2024, Hong Kong passed the Advance Decision on Life-sustaining Treatment Ordinance, a statute law that clearly states Hongkongers’ right to refuse aggressive life-sustaining treatment, and medics’ obligation to follow the decisions of patients with AMDs. 

According to the law, a mentally competent adult can establish an AMD by signing a form in the presence of two witnesses, one of whom must be a registered medical practitioner. 

Fan said he noticed, after the landmark legislation, that some seniors and people with chronic illnesses hoped to make AMDs as soon as possible, but were left uncertain about the process.

Fan Ning, a surgeon and founder of local charity Forget Thee Not. Photo: Kyle Lam/HKFP.

“The public hospital system is very busy. Now, only terminally ill patients will be assisted with making an AMD, usually when they are receiving palliative care,” Fan said in Cantonese, referring to specialised support for people living with a life-limiting illness.

Others, he advised, can reach out to their family doctors.

“However, many low-income people do not have a family doctor, which is still a middle-class thing in Hong Kong,” Fan said, adding that not every family physician in the private sector will help to make AMDs for new patients. 

Unclear process

One month after the advance directive law came into effect, Lee Suk Hing and her younger sister set up AMDs in a private clinic, paying HK$3,000 each. 

Lee, 83, had always wanted to leave instructions to withhold aggressive life-sustaining treatment. Her husband passed away a few years ago and she now lives alone in public housing, relying on government welfare.

83-year-old senior Lee Suk Hing sets up advance medical directive soon after the law comes into effect. Photo: Kyle Lam/HKFP.

“Life is unpredictable,” Lee said in Cantonese. “In my final moments, I do not want chest compressions or intubation. I am worried that, when the time comes, I will not be allowed to die.” Her children, she added, supported her decision.

She recalled volunteering in senior care homes years ago and seeing patients lie in bed unconscious and attached to tubes for years. She was terrified of ending up the same way. 

Making an AMD takes time and communication. First, a nurse tested Lee and her sister to ensure they had the mental capacity to make the decision. Then a doctor explained the new law and form in detail before guiding them through end-of-life options. The process took two hours.

Walking out of the clinic, Lee felt relieved that she had left instructions for her future care.  However, she also felt the cost was too high for elderly people like her with little income.  

Elderly people in Hong Kong’s Mong Kok. Photo: Kyle Lam/HKFP.

Lee called on the government to provide more support services, such as subsidies for low-income patients and seniors who want to implement a directive. 

“I think this would also be a good thing for the government,” Lee added. “By setting up an AMD, there may be fewer people lying unconscious in hospitals waiting for death, right? That would reduce the government’s financial burden.”

Ivan Lin, a social worker serving seniors at local NGO the Society for Community Organization (SoCO), told HKFP that more and more elderly people are interested in setting up AMDs, but public awareness still lags behind, and it is not clear to many how to exercise their rights.

According to Lin, patients diagnosed with terminal illness such as stage 4 cancer can get help making an AMD from medics in public hospital oncology departments. For those with other severe or long-term conditions, however, there is not a clear path. 

Recently, a senior with advanced diabetes who had to undergo regular haemodialysis told Lin that he was turned down when he asked for help making an AMD. Medical staff at a public hospital told him that the service was mainly for people with terminal illnesses. 

Ivan Lin, a social worker serving seniors at local NGO Society for Community Organization (SoCO). Photo: Kyle Lam/HKFP.

For those in residential care, things are more difficult. A registered nurse who works closely with care homes told HKFP that many seniors in care want to make AMDs but struggle to find doctors to sign the form.

Raising awareness

Hong Kong’s government allowed an 18-month period for briefing and training of medics on the practice of AMD after the legislation was passed in late 2024.

In a statement introducing the law in late July, the government said it had cooperated with different parties to provide seminars for healthcare professionals in the public and private sectors, including those in residential care homes. 

HKFP reached out in October to 12 private clinics, including five general practitioners’ clinics and five geriatrics clinics, asking if they could assist a healthy senior to make an AMD. Most said they do not provide this service.

At five clinics, the receptionists or nurses who answered the phone said they did not know what an AMD is.

Elderly people walk out of a public hospital in Hong Kong in October 2026. Photo: Kyle Lam/HKFP.

Forget Thee Not founder Fan said that support services are necessary to promote a culture of planning in advance for care and treatment options near the end of life.

The doctor also said there should be more education and communication before the setup of an AMD, making it clear that the directives do not entail either euthanasia or a blanket refusal of life-saving treatments.

Under the new law, signatories can choose what kinds of medical care they want to refuse in different scenarios, such as if they are terminally ill or in a persistent vegetative state. They could refuse any form of life-sustaining treatment or only certain approaches, like CPR. The directive only becomes effective if the signer is unconscious and in one of these scenarios.

The new legislation marks a milestone for end-of-life care in Hong Kong, according to Roger Chung, an associate professor at CUHK’s School of Public Health and Primary Care and co-director of the university’s Centre for Bioethics.

“In Chinese culture, when someone reaches their final moments, it is usually family members who decide on treatments – and many family members will naturally insist on doing everything possible to save their beloved one,” Chung said in Cantonese. 

Roger Chung, Associate Professor of the School of Public Health and Primary Care (SPHPC) of CUHK and co-director of the CUHK Centre for Bioethics. Photo: Kyle Lam/HKFP.

“Now people can say ‘no’ – we can decide not to be kept on life support at the end of life,” Chung said. “But passing the legislation is just the beginning.”

Over the past few years, Chung has observed a growing willingness among Hongkongers to discuss death and how to prepare for it, noting that The Last Dance – a film that explores the death-care industry and challenges cultural taboos – broke box-office records last year.

Over the long term, Chung hopes there will be a designated area in public hospitals to assist people in need to set up an advance directive, or even more comprehensive care plans. 

Advance care planning

As a developed economy with a declining birth rate, Hong Kong has one of the most rapidly ageing populations in the world. In 2039, there will be around 2.52 million people aged above 65, accounting for 31 per cent of the population, according to government estimates.

This has made the need for better preparation in handling chronic illnesses, end-of-life care and death increasingly urgent.

Forget Thee Not’s Fan said Hong Kong has lagged in primary healthcare, with few people visiting family doctors regularly and a general lack of training among general practitioners.

Hong Kong seniors and their caretakers leave a public hospital in October 2026. Photo: Kyle Lam/HKFP.

“Now [the government] is starting to develop the whole primary healthcare sector,” Fan said. 

In 2023, Hong Kong launched the Chronic Disease Co-Care Pilot Scheme, which aims to create a family doctor system and develop District Health Centres to meet the health needs of residents aged 45 and above. Under the scheme, patients diagnosed with high blood pressure or high blood glucose will be matched with a family doctor for follow-up under co-pay fees. Lin, the social worker, suggested authorities consider folding in services such as AMD assistance.

Professor Chung at CUHK said AMDs should be seen as part of advance care planning (ACP), the process by which people make future care plans with caretakers and medical professionals.

More NGOs like Forget Thee Not are now promoting the concept of ACP in Hong Kong. Apart from making AMDs, people can also consider drawing up a will and registering an Enduring Power of Attorney (EPA) – a legal document that allows an individual to appoint a trusted person to manage their financial and property affairs if they lose mental capacity.

Fung Ho-chu struggles over setting up advance medical directive because of financial restraints. Photo: Kyle Lam/HKFP.

AMDs and EPAs, together with wills, are collectively known as the “three instruments of peace.” But while people can draft and sign wills on their own, doctors and lawyers are required to sign and witness EPAs, which usually adds up to more than the fees for AMDs.

Fast approaching 80, Fung Ho-chu wanted to get all three done while she is healthy and has a clear mind. She has recently begun discussing her thoughts and preferences with her children.

Due to financial constraints, she is weighing up which to prioritise and how much she can spend.