Advance directives on medical treatments likely to catch on

In the US, it appears, life is not complete without an advance directive. Recent research from the University of Michigan shows that record numbers of Americans are completing the documents, which specify what types of treatment a person would like to receive - or prefer not to - if they become unable to make such decisions for themselves.

Between 2000 and 2010, the proportion of people with advance directives rose from 47 to 72 per cent, according to a study of more than 6,100 Americans aged 60 and older who died in that period. The results were published in the April issue of the Journal of the American Geriatrics Society.

One of the main reasons for advance directives' immense popularity in the US is the Patient Self-Determination Act, introduced in 1990, which requires a wide range of health care institutions to provide information about them to patients on admittance.

In Hong Kong there has only been a tiny trickle of the documents, and hardly anyone has even heard of them.

But with an ageing population and end-of-life health care costs spiralling as we get better at staying alive - but not necessarily at improving our quality of life - their use is likely to grow. A legal framework governing their use in Hong Kong is already a matter of lively debate.

Also known as living wills and advance decisions, advance directives were proposed in the US in 1969 to ensure that terminally ill people's wishes are respected; to give them the choice to opt out of treatment if the prognosis is particularly bad.

According to a 2010 study published in the New England Journal of Medicine, 30 per cent of people who need to make these sorts of decisions towards the end of their lives are not in a fit state to do so. One option is to appoint a surrogate to make the decisions for you, but patients can also choose to mention specific treatments they don't want to receive, or talk more generally in terms of preferred outcomes.