Advance Medical Directive - DementiaHub.SG

Advance Medical Directive

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An Advance Medical Directive (AMD) is a legal document signed by a person in advance, informing their doctor that they do not want any extraordinary life-sustaining treatment to be used in the event that they become terminally ill and unconscious.

Making an AMD is a voluntary decision. As medical technology advances, there are increasingly many ways of extending a person’s life. This means that people can live longer even with a terminal illness. Extraordinary life-sustaining treatment is any medical treatment which serves only to prolong the lifespan of terminally ill patients but does not cure the illness. For example, a respirator connected to a patient to assist with breathing is not a treatment and does not bring about healing for the patient.

A person living with dementia may not be able to express their wishes to continue or stop treatment. Some people may prefer to pass away naturally in peace and not extend treatment. In the situation that a person living with dementia is not able to communicate their wishes to the doctor in the future, the doctor will be guided by their AMD.

How to Make an AMD

• Patients must be above the age of 21 and of sound mind.
• Three doctors (including the hospital doctor) must all certify that patients are terminally ill.* Two of the doctors must be specialists.
• Patients need to complete and sign the AMD form in the presence of two witnesses – the doctor in-charge and someone who is above 21. Both witnesses cannot stand to gain anything from the patient’s passing.

If there is a disagreement between the doctors:

• The doctor-in-charge will review the AMD
• If there is still no agreement, the Ministry of Health will appoint three additional specialists to review the patient’s case.
• If all the three appointed specialists are unable to certify that the patient is terminally ill, the AMD cannot take effect.

More information can be found on the Ministry of Health’s website.

An AMD can be cancelled at any time. The person who has made the AMD can do this by completing a form or writing a letter to the Registrar of AMDs, and having a witness who can testify to their cancellation. The caregiver themself may opt to be a witness.

If the person who has made the AMD is unable to write, they may communicate their wishes to cancel the AMD by speaking or using sign language. The witness will have to submit the notice and explain why they are unable to submit it themselves.

For more information on the Advance Medical Directive, please visit the Ministry of Health’s page on the AMD.

Additional Resources

Planning Ahead: Advance Directives in Singapore
This video provides information on how sharing your wishes and values in advance helps your loved ones understand what treatment decisions you would prefer in a medical crisis. In this talk, Dr Chua will explain the importance of Advance Care Planning (ACP), how it complements the Lasting Power of Attorney (LPA) and AMD and how you can get started on planning ahead.

Source: Council for Third Age (C3A)

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