Advance Medical Directives in Singapore

An Advance Medical Directive (AMD) is a legal document signed by persons aged 21 years and above and who are not mentally disordered, to refuse extraordinary life-sustaining treatment or medical intervention if terminally or unconscious.

The Advance Medical Directive Act (the AMDA) was passed in 1996, authorising the use of AMDs in Singapore.

What is ‘Extraordinary Life-Sustaining Treatment’?

‘Extraordinary life-sustaining treatment’ refers to any medical procedure or measure which, when administered to a terminally ill patient, will only prolong the process of dying when death is imminent, but excludes palliative care.

What is a Terminal Illness?

‘Terminal illness’ is defined in the AMDA 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 would be imminent even if extraordinary life-sustaining measures were used. These measures would only serve to postpone the death of the patient.

Who Can Make an AMD?

Any person who is not mentally disordered and aged 21 years old and above can make an AMD.

Do note that making an AMD is a voluntary decision – it is entirely up to you whether or not you wish to make one.

It is a criminal offence for any person to force you to make one against your will. Forcing or misleading another person into signing an AMD is an offence punishable under the law. If convicted, such a person can be fined and imprisoned as well as disqualified as a beneficiary.

If you have made an AMD regardless of objections from members of your family, the doctors will have to respect your AMD.

Do I Need a Lawyer to Make an AMD?

It is not necessary to engage a lawyer when making an AMD. However, for general estate planning, it is usually advisable to consult a lawyer. Legal advice may be sought to draw up a will, or to implement a lasting power of attorney.

How Can I Make an AMD?

To make an AMD, you will need to complete the following steps:

1. Obtain an AMD Form

You will first need to obtain the form, which is available from any medical clinic, polyclinic or hospital. You can also ask your doctor for the form if you have decided to make an AMD or download a copy of the form online.

2. Consult a doctor with a witness

An AMD must be made through a doctor, and two witnesses must be present at the signing. The signer’s doctor must be one of the two witnesses. The doctor will ensure that the signer is not forced into making the AMD, is of sound mind, and understands the nature and implications of making an AMD.

The second witness must be at least 21 years old or above, and can be the doctor’s nurse or any other suitable person.

Additionally, do note that both witnesses must not have any vested interests in the signer’s death. Specifically, the witness must not:

• Be a beneficiary under the signer’s will or any policy of insurance;
• Have any interest under any instrument under which the signer is the donor, settlor or grantor;
• Be entitled to an interest in the estate of the signer on the signer’s death without a will;
• Be entitled to an interest in the moneys of the signer held in the CPF or other provident fund on the death of that signer; and
• Have registered an objection to the AMD (a doctor who for any reason objects to the AMD and registers his objection can refuse to witness the signing of an AMD).

Even if the witness is a relative of the signer, they would be allowed to act as witness so long as they have no vested interests in the signer’s death.

3. Return the form to the Registrar of AMD

The completed form should be sent in a sealed envelope – either by mail or by hand – to the Registrar of Advance Medical Directives.

Do note that your AMD is only valid when it is registered with the Registrar. You will receive an acknowledgement from the Registrar when your AMD has been registered.

How Much Does it Cost to Make an AMD?

As an AMD must be made through a doctor – in terms of assessing your mental capacity and serving as one of the witnesses to the signing of the AMD – you may have to pay a fee to the doctor for this service. There are no other charges, however, with making an AMD.

Is an AMD Confidential? 

An AMD is a confidential document. 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.

However, if your attending doctor has reasons to believe that you are terminally ill and unable to make your wishes known to them, they can check with the Registrar of AMD as to whether you have an AMD in place.

Is it Possible to Make an AMD When I am Overseas?

As long as the first witness is a doctor currently registered with the Singapore Medical Council, and the AMD is filed with the AMD Registry in Singapore, the AMD is considered legally valid.

When Will the AMD Not Have Any Effect?

A medical practitioner has a duty to inform a patient who is conscious and capable of exercising a rational judgement of all the various forms of treatment that may be available in their particular case. The patient may then make an informed judgement as to whether a particular form of treatment should, or should not, be undertaken. The patient’s decision in this instance will override the AMD that they had previously made.

Can an AMD be Revoked?

An AMD can be revoked at any time in the presence of at least one witness, by completing the AMD revocation form. Alternatively, the person or their witness could write a letter to the Registrar of AMDs.

Where a person is unable to submit a written letter, the AMD may be revoked orally or in any other way in which he can communicate. It is then the responsibility of the witness to the revocation to submit the notice of revocation using the revocation form or the letter. The witness should also state the reason why the person revoking the AMD could not do so by themself.

For more information on revoking an AMD, refer to the FAQ section of the Ministry of Health website. You can also read our other article for more facts on AMDs that you may not have known about.