With the enactment of the Advance Decision on Life-Sustaining Treatment Ordinance in Hong Kong, more people are beginning to learn about Advance Medical Directive (AMD). However, for many people, AMD remains an unfamiliar concept and is often misunderstood.  

For example:

• “Will doctors stop saving me after I sign an Advance Medical Directive?”
• “Does it mean that I am giving up all treatment?”
• “Is it only for people who are terminally ill?”

In fact, an Advance Medical Directive (AMD) does not mean giving up treatment. It is an important arrangement that allows adults, while they still have mental capacity, to express their wishes regarding future medical decisions in advance.

To understand what an Advance Medical Directive is, you may read: Complete Guide to Advance Medical Directive (AMD)

Below are 5 common misunderstandings about AMD to help you better understand its purpose and meaning.

Misunderstanding 1: Will doctors stop saving me after I sign an Advance Medical Directive?

No.

Signing an Advance Medical Directive does not mean that healthcare professionals will stop caring for the person, nor does it mean that treatment will not be provided under any circumstances.

An Advance Medical Directive only becomes applicable when the person has lost the mental capacity to make decisions regarding life-sustaining treatment, and the person’s circumstances meet the specified circumstances stated in the AMD.

The specified circumstances may include:

1. Terminal illness

An advanced, progressive and irreversible condition with a limited life expectancy, where life-sustaining treatment would only postpone death. 

2. Persistent vegetative state or irreversible coma

A prolonged loss of consciousness with no reasonable prospect of recovery.

3. Other advanced irreversible life-limiting conditions

For example, end-stage renal failure, end-stage motor neurone disease, end-stage chronic obstructive pulmonary disease (COPD), or end-stage dementia.

Even when an Advance Medical Directive is valid and applicable, healthcare professionals will only withhold or withdraw the specific life-sustaining treatments that the maker has previously refused, such as cardiopulmonary resuscitation (CPR) or assisted ventilation. Other appropriate medical care, basic care and palliative care will continue to be provided.

Misunderstanding 2: Does an Advance Medical Directive mean giving up all treatment?

No.

The purpose of an Advance Medical Directive is to allow a person to express their wishes regarding certain life-sustaining treatments while they still have mental capacity. It does not mean refusing all medical care.

Even when an Advance Medical Directive applies, healthcare professionals will continue to provide appropriate care, including:

• Basic care, such as assistance with eating, drinking, personal hygiene and oral care;
• Palliative care, such as managing pain and other symptoms to improve comfort and quality of life;
• Psychological, social and spiritual support according to the needs of the person and their family.

An Advance Medical Directive does not mean “doing nothing”. Instead, it allows a person to refuse specific life-sustaining treatments that they have previously decided they do not wish to receive under certain circumstances.

Misunderstanding 3: Is an Advance Medical Directive only suitable for people at the end stage of life?

No.

Although Advance Medical Directive is often discussed in situations involving serious illness or end-of-life care, it is not limited to people in the final stage of life.

Any adult aged 18 or above who has the mental capacity to make decisions regarding life-sustaining treatment may consider making an Advance Medical Directive.

In general, the following people may benefit from discussing and considering AMD earlier:

•     ·   Being diagnosed with a life-limiting condition, such as advanced cancer;

      ·   Progressive deterioration in health, with increasing symptoms or declining quality of life;

      ·   Recurrent hospital admissions or episodes of serious illness;

      ·   A shift in care goals towards comfort-focused or palliative care;

      ·   Early cognitive decline while the person can still understand and express their wishes;

      ·   Situations where the individual, family members, or healthcare team have started discussing future decisions about life-sustaining treatment.

Every person's situation is unique. Whether an AMD is appropriate depends on the individual's medical condition, future healthcare needs, and personal wishes. It is recommended that the maker discuss these issues with healthcare professionals and family members before making an informed decision. Most importantly, planning ahead while mental capacity is still intact helps ensure that the maker's wishes can be respected if they are no longer able to communicate or make decisions in the future.

Misunderstanding 4: Does an Advance Medical Directive mean doctors can no longer make any medical decisions?

No.

An Advance Medical Directive records a person’s wishes regarding future medical arrangements while they still have mental capacity.

When an Advance Medical Directive becomes applicable, healthcare professionals will follow the person’s previously expressed wishes regarding the life-sustaining treatments covered by the AMD.

However, healthcare professionals still need to assess:

• Whether the Advance Medical Directive is valid;
• Whether the person has lost the relevant decision-making capacity;
• Whether the person’s condition falls within the specified circumstances stated in the AMD;
• Whether the relevant medical treatment falls within the scope covered by the AMD.

An Advance Medical Directive does not replace the clinical judgement of healthcare professionals. Instead, it provides a legal framework to help healthcare professionals understand and respect the person’s previously expressed medical wishes.

Misunderstanding 5: Can family members decide whether an Advance Medical Directive should be followed or cancelled on behalf of the person?

No.

An Advance Medical Directive is a medical decision made by the person themselves while they still have mental capacity.

As long as the Advance Medical Directive is valid and applicable, family members cannot replace the person in withdrawing or changing the medical decisions they have previously made.

However, an Advance Medical Directive does not mean that the role of family members disappears.

Early discussion through Advance Care Planning (ACP) can help family members understand the person’s values, treatment preferences and future care arrangements, allowing them to better support the person when needed.

Advance Medical Directive Is Not About Giving Up Treatment, but Expressing Your Choices in Advance

The core value of an Advance Medical Directive is to allow a person, while they still have mental capacity, to plan important future medical decisions in advance.

It does not mean giving up treatment, nor does it mean asking healthcare professionals to stop providing care. Instead, it allows the person’s medical wishes to be respected in specific circumstances in the future.

Understanding Advance Medical Directive early, and discussing personal values and care preferences with family members and healthcare professionals, can help reduce uncertainty when important medical decisions need to be made in the future.

Read More:

Advance Medical Directive (AMD): A Complete Guide

What Is Advance Care Planning (ACP)? How Is It Different from an Advance Medical Directive (AMD)?