Reformers say families of the comatose should also get scope to decide for them People should have the right to draw up 'living wills' saying whether they want to be kept on life support or die naturally if they become terminally ill or fall into irreversible comas later in life, the Law Reform Commission says. The proposal aims to clarify the legal rights of such patients and remove the confusion and tension between doctors and patients' families about what to do in such situations. Hong Kong people are being asked to give their views in the next three months on the proposals, contained in a paper which includes a draft form for people to say what they want to happen to them. The commission proposes a person would be able to state clearly that artificial ventilation or other life-sustaining measures should not be used to prolong life when death is imminent and there is no reasonable prospect of recovery. Such advance directives have legal force in several countries, including Singapore. However, mercy killing, or euthanasia, would remain illegal. The Mental Health Ordinance should be amended, the paper says, to include comatose patients under the definition of 'mentally incapacitated' people. Where they have not written advance directives, this would enable close family members to seek legal guardianship, make medical decisions and manage their property and other affairs. Doctors are directed by their code of ethics to act in the 'patient's best interest' in consultation with relatives when a decision has to be made on whether to remove artificial life support. But if there is disagreement, there is little in law to advise either party of their rights and duties. Law Reform Commission secretary Stuart Stoker said including comatose patients in the Mental Health Ordinance would have many practical benefits. 'The next of kin [would be able to] apply to court to act on behalf of the patient or to use the patient's funds for medical treatment, for example. There is a clear procedure, the court can intervene and the Guardianship Board can appoint a guardian if there is no next of kin.' Mr Stoker said the commission also outlined a system for people to change their minds about their directives at any point while they are still considered mentally fit to do so. 'Revocation should also be in writing, unless there is an emergency situation,' he said. Patients' rights advocate Tim Pang Hung-cheong, of the Society for Community Organisation, welcomed the proposal to extend the Mental Health Ordinance to include vegetative patients, but said great care would be needed in promoting the system of advance directives. 'We have heard of some difficulties in carrying out such terms in other countries - for example, when a person establishes such a directive but after that [decides] he would not want the directive to be carried out, but suddenly falls into a coma and is unable to make changes,' he said. Mr Pang suggested other interested parties be allowed to appeal against execution of the directive. But Mr Stoker said: 'My guess is that if you are minded to draw up advanced directives, it is not something you are going to forget about and neglect to change if your views change.' Since its establishment in 1980, 27 of the commission's 45 reports have resulted in the enactment of legislation, though none has been enacted since 1997. The consultation paper can be accessed on the commission's website at www.info.gov.hk/hkreform .