Death is a natural part of life, but in many communities, a lingering reluctance to discuss this fundamental truth stands in the way of dignified care for terminally ill people. It is good that Hong Kong has enacted a formal legal framework giving patients the power to reject specified life-sustaining treatments when they are terminally ill and mentally incapable of making decisions.The Advance Decision on Life-sustaining Treatment Ordinance officially took effect on July 31 and Hong Kong people have since been able to formally sign advance medical directives. The landmark measure was passed in late 2024 but delayed for 18 months to allow frontline medical workers, hospitals and emergency services adequate time to prepare.Advance medical directives allow mentally capable adults to formally state they will refuse specified future treatments, such as blood transfusions, artificial nutrition and hydration. The documents only take effect when a patient loses mental capacity and enters a defined clinical condition, such as a persistent vegetative state, an irreversible coma or a life-limiting illness like end-stage renal failure.Crucially, the legislation also formalises do-not-attempt cardiopulmonary resuscitation (DNACPR) orders for non-hospital settings. The orders sensibly draw a line regarding acute emergencies. They only apply if a rescuer on site agrees that the patient’s cardiopulmonary arrest is not caused by a suspected suicide attempt, homicide or an accident, ensuring the law strictly applies to end-of-life care.Implementing the legislation understandably creates major operational challenges for frontline medical personnel. Even before it went into effect, these dedicated professionals anticipated difficulties verifying patient wishes during high-pressure emergency situations where they often must make split-second, life-and-death decisions.Fortunately, emergency workers from the Fire Services Department and other agencies have been studying the new law and adapting their protocols. Their goal is to ensure readiness to legally honour the final wishes of those who sign directives without sacrificing their core mission to save lives.