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.

"Terminal illness" is defined in the Act as an incurable condition caused by injury or disease from which there is no reasonable prospect of a temporary or permanent recovery. For such a condition, death is imminent even if extraordinary life-sustaining measures were used. These measures would only serve to postpone the moment of death for the patient.

"Extraordinary life-sustaining treatment" is any medical treatment which serves only to prolong the process of dying for terminally ill patients but does not cure the illness.

An example is the respirator that is connected to a patient to assist him/her to breathe. It serves only to artificially prolong the life of a terminally ill patient.

Anyone who is 21 years old and above, and is not mentally disordered can make an AMD. All you need to do is to complete an AMD form, sign in the presence of two witnesses, and return it to the Registrar of AMDs.

The forms are available from medical clinics, polyclinics and hospitals.  You may also ask your doctor for a form when you have decided to make an AMD.  Alternatively, you can also download the AMD form online at here.

N.B.: When printing out the form, please print it on both sides of one sheet of paper.

No, you do not need a lawyer to make an AMD. 

Yes. The doctor whom you consult will act as the first witness, whose responsibility is to ensure that:

1. You are not being forced into making the AMD;
2. You are of sound mind;
3. You understand the nature and implications of making an AMD.

One of the two witnesses must be a doctor, preferably the patient's family doctor. The other witness must be at least 21 years old.

Both witnesses must not have any vested interests in the patient's death. If the witnesses are relatives, so long as they have no vested interests in the patient's death, they would be allowed to act as witness. 

Yes, both witnesses must be present together to witness the person signing the AMD, as well as to sign the AMD form. As the first witness is your doctor, the second witness may be his nurse or any other suitable person.

You can fill in your details on the Form 1 first. However, the two witnesses and you must sign the form at the same sitting.

To make an AMD, you will have to consult a doctor who, as a witness, is required to explain the AMD. You may have to pay the doctor for the services rendered. However, the AMD form itself is free.

It is best to make an AMD when there is no pressure to do so - when you are well and healthy. If your family opposes it, you may wish to obtain their understanding before making the AMD. If you do not wish to inform your family, you can still proceed to make an AMD, which will remain confidential, until you wish to disclose it to someone.

No, it is NOT compulsory. The AMD is valid only when it is made voluntarily. No one can force another person to make an AMD.

No one can make an AMD on behalf of another person, whether child or adult.

If you have made an AMD, regardless of objections from members of your family, the doctors will have to respect your AMD.  Hence, while an making an AMD is a very personal decision, 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.

It is the doctor's responsibility to fully explain and discuss the matter with the person and to ensure that he/she fully understands what he/she is signing.

Forcing or misleading another person into signing an AMD is an offence punishable under the law. If convicted, such a person shall be fined and imprisoned and disqualified as a beneficiary.

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. Hence, you are encouraged, to inform the hospital staff 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.

When you are overseas, the legal status of the AMD will depend on the local laws of the country where you are.  Thus, the AMD is usually only applied/effected when you are in Singapore.

No, AMD is NOT 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 form, you instruct your doctor in advance, 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.

No, the AMD Act does NOT encourage euthanasia. On the contrary, the AMD Act is explicitly and categorically against euthanasia. The Act states :

Section 17(1) - Nothing in the Act shall authorise an act that causes or accelerates death as distinct from an act that permits the dying process to take its natural course. Section 17(2) - It is hereby declared that nothing in this Act shall condone, authorise or approve abetment of suicide, mercy killing or euthanasia.

A terminally ill patient CANNOT use the AMD to commit suicide, nor does the AMD allow doctors to assist in any suicide attempt. This is punishable by law.

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.

No, the AMD cannot take effect if the second panel cannot agree unanimously that the patient is terminally ill. The patient's life will continue to be sustained and he will receive medical treatment as normal.

You do not have to pay for their services.

You are not required to disclose your AMD to anyone. However, it is advisable that you discuss with your family and loved ones before making an AMD.

Doctors will continue to provide care (i.e. treat and relieve pain and suffering of a patient with terminal illness).

Even if the AMD has taken effect, palliative care and medication will continue to be provided.

Palliative care helps to improve the quality of life of patients with terminal illness and their family members through prevention, assessment, and treatment of pain and other physical, psychological and spiritual problems.

The AMD Act specifies that palliative care includes:

• provision of reasonable medical procedures for the relief of pain, suffering or discomfort; and
• reasonable provision of food and water.

It is the professional responsibility of every doctor to ensure that all necessary treatment be given as long as the patient is not certified terminally ill and there is a possibility of recovery. Even if the patient is considered terminally ill, the doctor has the responsibility to provide treatment to minimise pain and suffering.

This is the current practice, and will continue whether or not the patient has made an AMD.

An AMD can be revoked at any time in the presence of at least one witness. The person making the revocation should do so by filling in 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, the person or his witness could write a simple letter to the Registrar of AMD.

 

The letter should contain the following information:

1. the 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.

In this situation, an 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.

Section 7(4) - It is the duty of the person "who has witnessed a revocation, whether made in writing, orally, or in any other way in which the patient can communicate, to inform the Registrar" of the revocation.