Advanced Medical Directive(AMD)

What will you do if you have the power to decide letting a person’s heartbeat to go on beating and let him live or to stop the heart beat and let him die?

The following scenarios may not be pleasant to many people but let’s take a minute to visualise it and understand the purpose as well as importance of Advanced Medical Directive(AMD). Imagine our love one is terminally ill and in coma. He or she is on a life-support machine to prolong his life and the attending doctor said further medical intervention would be medically ineffective. A decision had to be made –  Will you pull the plug or will you hang in there for a miracle?

Now, we shall reverse the scenario, assuming the person terminally ill, unconscious and hanging there on the life-support machine is none other than ourselves. What will we do if we can still voice our decision? Will you want to stop being a liability and ask your love ones to pull the plug or will you ask them to hang in there cos you are waking up soon?

It is never an easy decision to make in either scenario. I’ve known people who had asked to pull the plug off the love ones and felt guilty for a long long time. And that is one reason why we should make our AMD.

AMD was enacted in Singapore in 1996 under the Advance Medical Directive Act . The AMD Act does NOT encourage euthanasia. In fact,  it is a criminal offence for someone to force you into making an AMD.  There are many reasons for a person not to get an AMD done and most commonly, it is due to religious or personal beliefs. And the main reasons to have an AMD is the person do not wish to be a financial burden to the family or he prefers to end his sufferings.

AMD is oftenly confused with Lasting Power of Attorney(LPA) and Advance Care Planning(ACP).

What is an Advanced Medical Directive(AMD)?

Adavance Medical Directive, also known as a “living will”, 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.

Who can make an AMD?

• Anyone who is aged 21 years old and above.
• Not mentally disordered.

How can I make an AMD

• It must be made voluntarily and be consulted with a doctor.
• It must be witness by the doctor and another witness who is above the age of 21 who is not of an unsound mind.
• Return the completed AMD form to the Registrar of AMD.

The doctors can be from any medical clinics, polyclinics and hospitals. If you do not have any doctor to help you with the application of AMD, you can consider getting it witnessed and certified by doctors from Raffles Medical.

When will an AMD be enforced?

The AMD will be effective when a Certificate of Terminal illness has been issued when you have been determined to have a terminal illness.

The patient’s attending doctor with another two specialist must unanimously certify the patient to be terminally ill. Ministry of Health will appoint another panel consist of three specialist if the the first panel of three doctors cannot agree unanimously that the patient is terminally ill. The AMD cannot take effect if the second panel of doctor also cannot agree unanimously that the patient is terminally ill.

Can I change my mind after an AMD is made?

Yes. An AMD can be revoked at any time in the presence of at least one witness. 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.)

Another easier and preferred way is to complete AMD Form 3. Either the letter or AMD Form 3 should be sent to the Registry of AMDs as soon as possible.

An AMD is confidential. Most of our love ones are usually emotionally and mentally distraught in such a situation and  may not accept the decision of your AMD. Thus, it is encourage to discuss your decision on AMD with them so that they are aware of it and respect your decision when it is enforced.

More information on AMD can be found in MOH website and you can read up the legal aspect of AMD here.

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