Advance Medical Directive (AMD): A Complete Guide

by YDCare Homecare Team | July 21,2026

Since the implementation of Hong Kong's Advance Decision on Life-sustaining Treatment Ordinance, more people have become aware of Advance Medical Directives (AMD). However, many still wonder what an AMD is, whether it means giving up treatment, or if it is only for people at the end of life.

In fact, an Advance Medical Directive is not about giving up treatment. It is an important planning tool that allows adults with mental capacity to record their wishes regarding future life-sustaining treatment. This helps ensure that future healthcare decisions reflect their own values and preferences.

What is an Advance Medical Directive (AMD)?

An Advance Medical Directive (AMD) is a legally recognised document that allows an adult with mental capacity to record their wishes regarding life-sustaining treatment should they lose the capacity to make healthcare decisions in the future.

Life-sustaining treatment (LST) refers to medical treatments that may prolong a person's life, including:

• Cardiopulmonary resuscitation (CPR);
• Artificial ventilation;
• Artificial nutrition and hydration;
• Cardiac pacing;
• Blood products;
• Vasopressors;
• Dialysis;
• Disease-specific treatments (such as chemotherapy); and
• Antibiotics for potentially life-threatening infections.

An AMD allows a person to make important healthcare decisions while they still have mental capacity. If they later lose the capacity to make healthcare decisions and the specified clinical circumstances arise, healthcare professionals will act in accordance with the person's previously expressed wishes.

Hong Kong's Advance Decision on Life-sustaining Treatment Ordinance establishes the legal framework governing the making, validity, revocation and implementation of Advance Medical Directives, ensuring that patients' wishes are respected in accordance with the law.

Who Can Make an Advance Medical Directive?

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

In general, all adults are presumed to have mental capacity. A Registered Medical Practitioner (RMP) will assess whether, at the time of signing, the person is able to:

• understand the relevant information relating to the AMD;
• retain that information long enough to make the decision;
• use or weigh the information as part of the decision-making process; and
• communicate their decision by any means.

Having dementia or another neurological condition does not necessarily prevent a person from making an AMD. The key consideration is whether the person has the mental capacity to make the relevant decision at the time the AMD is made.

Who Should Consider an Advance Medical Directive?

Although any eligible adult may plan ahead, an Advance Medical Directive (AMD) is often particularly appropriate for people in the following situations:

• 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.

Whether an AMD is appropriate depends on the individual's medical condition, future healthcare needs and personal wishes. Discussing future care early with healthcare professionals and family members can help ensure that the person's wishes are respected in the future.

When patients, family members or healthcare professionals begin discussing future healthcare arrangements or anticipate decisions about life-sustaining treatment, it is generally an appropriate time to consider making an AMD. Waiting until a person's condition has significantly deteriorated or mental capacity has been lost may mean they are no longer able to make one.

How Can an Advance Medical Directive (AMD) Help?

The primary purpose of an AMD is to allow a person to express their wishes regarding future healthcare while they still have mental capacity.

If the person later loses mental capacity, healthcare professionals may follow a valid and applicable AMD, helping to respect the person's wishes while reducing the burden of difficult decisions on family members.

For the Patient

• Respect personal autonomy by making healthcare decisions in advance.
• Reflect personal values by stating which life-sustaining treatments should be refused under specified circumstances.
• Avoid unwanted treatment when the AMD is valid and applicable.

For Family Members

• Reduce decision-making pressure by clearly documenting the person's wishes.
• Encourage early communication about future healthcare.
• Reduce family disagreement over important medical decisions.

How to Make an Advance Medical Directive (AMD)?

Making an AMD involves more than completing a form. It generally consists of four steps.

Step 1 – Have an Advance Care Planning (ACP) Discussion

Before making an Advance Medical Directive (AMD), it is recommended that the maker discuss relevant matters with the healthcare team, family members and caregivers through Advance Care Planning (ACP). Topics may include:

• How the condition may progress;

• Possible treatment options and goals of care;

• Personal values, beliefs and preferences;

• Views on life-sustaining treatment; and

• How care should be provided if the maker can no longer make decisions for themselves.

Advance Care Planning (ACP) is a process of discussion and planning. Its purpose is to help the maker understand the available options and their implications before deciding whether to make an Advance Medical Directive (AMD).

Step 2: Complete the Form with Medical Explanation

The Hong Kong Government provides both a Short AMD Form and a Full AMD Form. The Short Form is intended for people who wish only to refuse cardiopulmonary resuscitation (CPR), while the Full Form allows the maker to refuse CPR and/or other life-sustaining treatments.

A doctor will explain the AMD, the circumstances in which it may apply, and the possible implications of refusing life-sustaining treatment to ensure that the decision is informed and voluntary.

Step 3: Sign in the Presence of Two Qualified Witnesses

An Advance Medical Directive (AMD) must be signed in the presence of at least two witnesses.

One witness must be a registered medical practitioner in Hong Kong. A private doctor familiar with the person's medical condition may also act as the medical witness.

The second witness must be an adult who does not have an interest in the maker's estate or other potential financial interests, such as being a beneficiary of a will or insurance policy. If there is any uncertainty about a potential conflict of interest, it is generally advisable to choose another adult, such as a friend or a nurse.

In practice, the arrangement is usually straightforward: one doctor and one adult witness with no conflict of interest.

Step 4: Keep the Document Safe and Inform Others

After signing the AMD, the maker should keep the original document safely and ensure that family members and relevant healthcare professionals are aware of its existence so that it can be located when needed.

The Hong Kong Government is introducing electronic arrangements for Advance Medical Directives (AMD) in phases through the eHealth system. Initially, individuals may choose to store a paper Advance Medical Directive (AMD) electronically in eHealth. Once the relevant functions are fully implemented, it will be possible to create an electronic Advance Medical Directive (AMD) directly through the system.

When Is an Advance Medical Directive Valid and Applicable?

An AMD that has been properly made in accordance with the statutory requirements may be legally valid. However, healthcare professionals will only follow the AMD when they have determined that it is both valid and applicable to the maker's clinical circumstances.

Healthcare professionals will first determine whether the AMD remains valid, including whether it:

· • contains clear instructions;

· • has been properly signed and dated in accordance with the legal requirements;

· • has not been revoked or destroyed;

· • is not affected by any suspicion of fraud, undue influence or foul play; and

• is not inconsistent with the maker's subsequent wishes or actions.

They will then determine whether the AMD is applicable by confirming that:

• the person has lost the mental capacity to make decisions regarding life-sustaining treatment;
• the clinical circumstances specified in the AMD have arisen; and
• the person's current condition falls within the scope of the AMD.

Healthcare professionals must also be aware of the existence of the AMD and be able to access its contents before acting on it.

Frequently Asked Questions

Does an Advance Medical Directive Mean Giving Up Treatment?

No. An AMD only applies to specified life-sustaining treatments. It does not mean that all treatment or care will stop.

Even when an AMD is applicable, healthcare professionals will continue to provide basic care, palliative care and other appropriate medical treatment.

Can Family Members Cancel an Advance Medical Directive?

No. If an AMD is valid and applicable, family members cannot revoke or amend the maker's healthcare decisions on their behalf.

An Advance Medical Directive is not about giving up treatment. It is a way for adults with mental capacity to plan ahead and make informed decisions about future healthcare.

By discussing future care with family members and healthcare professionals and making an AMD where appropriate, individuals can help ensure that their wishes are respected while reducing the burden of difficult decisions on their loved ones.

If you would like to learn more about Advance Medical Directives or discuss whether an AMD may be appropriate for yourself or a loved one, feel free to contact YDCare for more information and support.