Advanced Medical Directive (AMD)

The AMD, or Advanced Medical Directive, is a legal document which a person signs in advance, to inform his or her doctor that:

• in the event of a terminal (incurable) illness,
• when the person becomes unconscious and death is deemed to be imminent
• the person does not want any extraordinary life-sustaining treatment to be used merely to prolong life.

Extraordinary life-sustaining treatment refers to medical treatments which serves only to prolong the process of dying but does not actually cure the illness. A common example used is the respirator, which is connected to the patient to help him or her to breath, but does not reverse the underlying cause of the patient’s coma.The implication here is that even if all available equipment is used, life will merely be artificially prolonged and death will eventually occur anyway because the patient’s condition or illness is terminal (as certified by 3 different doctors, including at least 2 specialists).

The AMD is only activated when all the 3 conditions are met.

FAQs

1) Should I make an AMD?

Making the AMD should be a purely voluntary decision. Nobody should force you to do it (it is actually a criminal offence to force another person to make the AMD against his will!)

If you have any doubts or queries, you may wish to take a look at the Ministry of Heath (Singapore) website. We also welcome you to drop in and speak with our doctor regarding the AMD and decide if this is something which may help in your end-of-life planning.

Not everyone agrees with signing the AMD. Opponents of the scheme argue that patients often change their minds about the level of care they want after being hospitalised and making a pre-decision with the AMD assumes that you can predict your own choices many years ahead, which may not be true. They argue that having your loved ones make the decision only when it is needed, based on their understanding of your thoughts and needs and fears and priorities at that point in time, would more likely reflect what you would have chosen for yourself.

I would like to suggest an alternative way of looking at the AMD. Making the AMD (or alternatively, consciously deciding NOT to make it), is primarily to help your family and loved ones avoid the sticky situation of having to decide on your behalf. In other words, you make the decision for yourself now so that should the time come, your loved ones will not have to make it for you. Why? Because it is never easy to make these decisions on behalf on someone else. Think about it – if you don’t even trust your present self to make the decision for your future self, why would you trust the future versions of your children or next of kin to make the same decision for you?

The difficulty is compounded if there are many individuals involved in a joint decision making, such as several next-of-kin, or your spouse and your child, or several children together. Can all your loved ones agree on the same plan? Or will one blame and begrudge another for the difficult decision? Will your children be plagued with self doubt years down the road?

2) Should family and/or close friends be informed that you have made the AMD?

For reasons of their own, the persons who sign their own AMD may or may not wish their family to be informed. It is not compulsory to inform your family members that you have signed the AMD.

I believe that it can be useful to involve your family or loved ones in the decision, as well as to inform them of your decision when it is made. This will help reduce the probability of misunderstandings occurring between different family members or between medical staff and your family should the time come for the AMD to take effect. Even if, after an open discussion with your loved ones, you decide NOT to go ahead with the AMD, the discussion itself will likely have helped your family make the decision on your behalf in the future, should the need arise.

The final decision, however, lies with you, and we are committed to assist you whether you choose to involve your loved ones or not.

3) What if I change my mind after I have made the AMD. How do I revoke (cancel) it?

Here is the link to the MOH (Singapore) site for revoking the AMD. Essentially, you can revoke the AMD at any time, in the presence of at least 1 witness. The AMD can be revoked by:

Completing Form 3 (which would have been sent to you after your AMD is registered with the Registry of AMDs).
Writing a simple Revocation Letter addressed to the Registrar of AMD (our clinic can assist in this, if you are unable to find a copy of your Form 3).
Orally (or in any other reasonable manner of communication ) to the witness(es).

In the 3rd scenario, the witness should then complete Form 3 or write a Revocation Letter to the Registrar of AMD. In addition, the witness should explain why the person revoking the AMD is unable to do so himself/herself. These should be sent to the Registry as soon as possible.

The completed Form 3 or Revocation Letter can be sent to:

The Registry of Advance Medical Directives
Ministry of Health, Singapore
College of Medicine Building,
16 College Road,
Singapore 169854
Tel: 6325 9136 / Fax: 6325 9212

If a Revocation Letter is sent in place of Form 3, it 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)

4) Where do I get the form for making the AMD?

You may download the form from the Ministry of Health (Singapore) website — link.

Advanced Medical Directive (AMD)

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