What is Advance Medical Directive (AMD) and do you need it in Singapore?

An Advance Medical Directive (AMD) is a legal document you sign in advance to inform your doctor that, when the time comes and you are terminally ill, unconscious and approaching death, you do not want the use of any life-sustaining treatment to prolong your life.

Over the years and watching plenty of cheesy Channel 8 hospital dramas, this topic has come up on several occasions with my family and friends. “If the time comes, please pull my plug. I don’t want to suffer like 李南星/郑惠玉/(insert actor’s name) like that”

No, I’m not talking about euthanasia. As far as I know, that is 100% illegal in Singapore (I think?). It is definitely something that I am in favour of legalising but there should be plenty of safeguards and legal requirements to prevent abuse but I digress.

Enacted in Singapore in 1996, the AMD Act provides an avenue for Singaporeans to calcify their preference for their end-of-life (EOL) care in the event they are incapacitated or otherwise unable to make these decision on their own.

So while I am still (hopefully) not at the stage of life where such matters should concern me, I have decided to move forward with this decision.

The scope of an AMD is very specific so I do not believe there’s any particular cause of concern for malice if you do opt for the AMD.

Terminal illness is defined as an incurable condition from which there is no reasonable prospect of a recovery, and for which death is imminent even if extraordinary life-sustaining measures were applied.

Extraordinary life-sustaining treatment refers to any medical procedure which serves to only prolong the process of dying in terminally ill patients and does not cure or heal the illness. It specifically excludes palliative care.

Your AMD is also confidential. In fact, not even the hospital doctors or nurses would know if you made an AMD. They are also not allowed to ask the patient if he or she has made an AMD.

It is only when you are determined unanimously terminally ill by 3 doctors (2 of which must be specialists), and your attending doctor, then will the AMD come into effect.

Whilst it is considered a legal document, you do not need a lawyer nor do you need to pay for the AMD (aside from the doctor’s consultation fees).

As long as you are above the age of 21 and NOT mentally unsound, you can simply fill up the AMD form and obtain the signature of the doctor and another witness (can be doctor’s nurse/assistant) and submit the completed form to the Registrar of AMD in a sealed envelope by mail or by hand.

You will receive an acknowledgement from the Registrar of AMD once your AMD has been registered.

So if you believe this option is something that you’d like, please do not feel uncomfortable discussing it with your loved ones.

You can get more information and download the AMD form from the MOH website.

28 January 2019

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