According to Macao's mental health law, mentally ill patients have a right to accept or refuse diagnostic and/or therapeutic intervention, except in cases of compulsive hospitalization or in emergency situations where non-intervention is likely to create serious risks to patients or to others. As these patients may lack the capacity to make healthcare decisions, their health rights are eventually exercised by tutors who are legally appointed. This paper indicates a problem of current procedure: a potential risk of making a wrong decision by tutors, against the true will of mentally ill patients, who would not make the same decision when capable. The decisions made by tutors may not fully express the true will of mentally ill patients. It implies a significant impact on self-decisions and a reduction of autonomy. 

This paper proposes a binding nature of prior will in Macao, since a prior will is only taken into account and may not be respected in actual circumstances, as well as the use of Psychiatric Advance Directives in Macao, to resolve the existing problem outlined above. These two proposals are very important in empowering the autonomy of mentally ill patients to make their own healthcare decisions according to a true prior will. The proposal of implementation with facilitation, education and legal support, of which Macao Health Bureau plays an important role, is also critical for practical use of Psychiatric Advance Directives.