Advance Medical Directive (AMD)

New advances in medical knowledge and technology create new choices for both patients and healthcare providers. Some of these choices raise new ethical and legal issues.

One issue is that modern medical technology can technically prolong life in the final stages of a terminal illness. However, it cannot stop the dying process. In such situations, further medical intervention would be medically ineffective, and a decision has to be made whether to withdraw such futile medical intervention. Some terminally ill persons who are unable to express their wishes at that time, may want to be spared further suffering and be allowed to die naturally, in peace and with dignity.

Anyone who is 21 years old and above, and who is not mentally disordered can make an AMD.

What is an AMD?

An Advance Medical Directive (AMD) is a legal document that you sign in advance to inform the doctor treating you (in the event you become terminally ill and unconscious) that you do not want any extraordinary life-sustaining treatment to be used to prolong your 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.

How do I make an AMD?

Anyone who is aged 21 years old and above and is not mentally disordered can make an AMD. Simply follow these steps:.

Step 1: Obtain an AMD 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 ↗ (opens in new tab) online (print both sheets on a single sheet of paper front and back).

Step 2: Consult a doctor with a 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 at the same sitting. 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.

Both witnesses of the AMD must:

• be above the age of 21;

• not be a beneficiary under your will or any policy of insurance;

• not be an immediate family member (i.e. parent, child, adopted child; spouse or sibling);

• have no interest under any instrument under which you are the donor, settler or grantor;

• not be entitled to an interest in your moneys held the Central Provident Fund or other provident fund on your death; and

• not have registered an objection under section 10(1) of the Advance Medical Directive Act 1996.

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.

Step 3: Return the form to the 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.

For further information, please refer to the AMD Booklet ↗ (opens in new tab).

How do I revoke an AMD?

An AMD can be revoked at any time in the presence of at least one witness. Simply follow these steps:.

Step 1: Obtain an AMD Revocation Form

You may ask your doctor for the form if you have decided to revoke an AMD. You can also download the AMD Revocation Form ↗ (opens in new tab). Alternatively, you or your witness can write a simple letter to the Registrar of AMD.

The letter should contain the following information:

1. Name and NRIC of both the person revoking the AMD and the witness, along with their addresses and home and office telephone numbers

2. Time, date and place where the revocation was made

3. 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). The witness should also state the reason why the person revoking the AMD could not do so himself.

Step 2: Complete the AMD revocation in the presence of witness

You need to have at least one person to witness you revoke the directive in writing, orally, or in any other way in which the person can communicate.

Step 3: Return the form to the Registrar of AMD

The completed form or letter 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. The Registrar will send you an acknowledgement when the notice of revocation is received.