An Advance Medical Directive (AMD) in Singapore is a legal document that one signs in advance to inform the doctor treating the individual (in the event one becomes terminally ill and unconscious) that one does not want any extraordinary life-sustaining treatment to be used to prolong one's life.
Making an AMD is a voluntary decision. It is entirely up to you whether you wish to make one. In fact, it is a criminal offence for any person to force you to make one against your will.
Anyone who is aged 21 years old and above, and is not mentally disordered can make an AMD.
Procedure[]
The following three steps need to be taken to make an AMD:
Obtain form[]
The forms are available from medical clinics, polyclinics and hospitals. You may also ask your doctor for the form if you have decided to make an AMD. Alternatively, you can also download the AMD form online (print both sheets on a single sheet of paper front and back).
Consult doctor with witness[]
The AMD must be made through a doctor (you do not need either a lawyer or legal advice to make an AMD). The doctor has the responsibility to ensure that:
1. You are not being forced into making the AMD.
2. You are not mentally disordered.
3. You understand the nature and implications of making an AMD.
You need to have two people witness you sign the AMD and they must sign the form as witnesses in your presence. One witness must be the doctor. The second witness must be 21 years or above and can be the doctor’s nurse, or any other suitable person.
If the witnesses are relatives, so long as they have no vested interests in your demise, they would be allowed to act as witness.
A doctor who for any reason objects to the AMD and registers his objection with the Registrar can refuse to witness the signing of an AMD. You can then approach another doctor to witness your AMD.
Return form to Registrar of AMD[]
The completed form should be sent in a sealed envelope by mail or by hand to the Registrar of Advance Medical Directives at Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854.
Your AMD is only valid when it is registered with the Registrar of Advance Medical Directives. The Registrar will send you an acknowledgement when the directive has been registered.
Cost[]
To make an AMD, you will have to consult a doctor who, as a witness, is required to explain the AMD to you. You may have to pay the doctor for the services rendered. However, the AMD form itself is free.
Making AMD overseas[]
As long as the first witness is a doctor currently registered with the Singapore Medical Council (SMC), and the AMD is filed with the AMD Registry in Singapore, the AMD is considered valid.
Family objection[]
If you have made an AMD regardless of objections from members of your family, the doctors will have to respect your AMD. We encourage you to discuss it with your family members and loved ones. This will help them to understand and respect your wishes should you become terminally ill.
Hospitals' knowledge of AMD[]
Hospital staff, including doctors and nurses, do not know who has made an AMD as it is confidential and they are NOT allowed to ask you if you have made an AMD. However, if your attending doctor has reasons to believe that you are terminally ill and unable to make your wishes known to him, he can check with the Registrar of Advance Medical Directives on whether you have made an AMD.
AMD used as euthanasia or mercy killing[]
Euthanasia/mercy killing is the deliberate ending of the life of a person suffering from an incurable and painful disease by unnatural means, such as the administration of lethal chemicals. An AMD acts as advanced instruction for your doctor not to prolong your life with extraordinary life-sustaining treatment, and to let the dying process take its natural course when you become terminally ill and unconscious. The AMD Act does NOT encourage euthanasia. On the contrary, the AMD Act is explicitly and categorically against euthanasia.
Enforcement of AMD[]
The AMD will only come into force once you have been determined to have a terminal illness and a Certificate of Terminal illness has been issued.
Three doctors, including the patient's hospital doctor, must unanimously certify a patient's terminal illness. Two of the doctors must be specialists.
If the first panel of three doctors cannot agree unanimously that the patient is terminally ill, the doctor-in-charge will review his diagnosis. If he is still of the opinion that the patient is terminally ill, the matter will be referred to a second panel of three specialists, to be appointed by the Ministry of Health.
If the second panel of doctors also cannot agree unanimously that the patient is terminally ill, the AMD CANNOT take effect. The patient's life will continue to be sustained and he will receive medical treatment as normal.
Change of mind and revocation of AMD[]
An AMD can be revoked at any time in the presence of at least one witness. You should do so by completing AMD Form 3, which is the standard form for revocation of an AMD. (Those who have made an AMD will receive Form 3 together with Form 2, which confirms that their AMD has been registered by the Registry of AMDs)
Alternatively, you or your witness could write a simple letter to the Registrar of AMDs.
The letter should contain the following information:
The name and NRIC of both the person revoking the AMD and the witness, along with their addresses and home and office telephone numbers.
Time, date and place where the revocation was made.
If the letter is written by the witness, the method of communication which the person used to communicate his intention to revoke the AMD (e.g. orally, sign language, etc.)
Revocations should be sent to the Registry of AMDs as soon as possible.
Inability to write[]
In this case, the AMD can be revoked orally or in any other way in which you can communicate. It is then the responsibility of the witness to the revocation to submit the notice of revocation using Form 3 or the letter as described above. The witness should also state the reason why the person revoking the AMD could not do so himself.