Advance Medical Directive (AMD) in Singapore: Why and How to Make

Planning for the future is not always easy, especially when it involves decisions about end-of-life care. By planning ahead, you can help your loved ones understand the medical care you would want if you become terminally ill.

At Parkway Shenton, you can consult a doctor who will guide you through making an AMD. The doctor will advise you on the three simple steps to ensure you get the medical care you want.

What is an Advance Medical Directive?

An Advance Medical Directive is a legal document that you make in advance. It tells your treating doctor that you do not want extraordinary life-sustaining treatment to prolong your life if:

• you are terminally ill;
• you are unconscious or unable to exercise rational judgement;
• and you cannot communicate your wishes.

Making an AMD is voluntary. No one can force you to make one, and you must understand its nature and implications before signing it. You may also revoke your AMD if you change your mind after making one.

While an AMD is also typically seen as a ‘living will’, your medical treatment will not be affected by it. Hospital doctors and nurses will not know if you have made an AMD, and will provide all treatment and care to you. Your doctor will check if you have an AMD only if you have been certified as terminally ill by three doctors.

What are the benefits of an AMD?

An AMD lets you record your decision while you are able to think through your options and express your wishes.

It helps you:

1. Make your wishes known: Your doctors have a legal record of your decision about extraordinary life-sustaining treatment.
2. Reduce uncertainty for your family: Your loved ones do not have to guess what treatment you would have wanted during a medical emergency.
3. Support clear medical decision-making: Your healthcare team can refer to your registered wishes when the legal and medical conditions for the AMD are met.
4. Minimise suffering: The AMD applies when there is a terminal illness and the treatment would not cure it. It instructs your doctor not to provide extraordinary life-sustaining treatment. You will still be given palliative care.
5. Reduce financial uncertainty: By making your wishes clear, you can help your family manage financials with a better understanding your treatment preferences.

An AMD can also support conversations with your family about your values and desires for future care.

When should you make an AMD?

You do not need to wait until you have a serious illness.

The Ministry of Health recommends making an AMD when you are well and there is no pressure to decide. This gives you time to understand the directive, ask questions and discuss your wishes with your loved ones.

You may wish to consider an AMD when you are:

• Reviewing your future healthcare preferences
• Preparing other planning documents, such as a lasting power of attorney or will
• Discussing ageing or end-of-life care with your family
• Thinking about the types of treatment you would accept if recovery were no longer possible

Making an AMD remains a personal choice. It is not compulsory.

3 simple steps to make an AMD at Parkway Shenton clinics

If you are wondering where you can make an AMD, you may do so at Parkway Shenton, where our doctors will guide you through the process.

Step 1: Consult a doctor about the AMD

Book an appointment or walk in to a Parkway Shenton clinic to make an AMD.

During your appointment, the doctor will explain what the AMD means, when it applies and what may happen after it takes effect. You can also ask any questions you may have.

Step 2: The doctor will guide you through the form, witnesses and submission

Parkway Shenton doctors will help you fill up the form, find witnesses, and submit it.

The doctor will check that you:

• Understand the nature and implications of the AMD;
• Are making it voluntarily; and
• Are able to make the decision.

The form must be signed in the presence of two witnesses. One witness must be the doctor. Parkway Shenton clinics may help provide the second witness, usually the clinic nurse or assistant.

Under MOH’s current guidance, the witnesses must be at least 21 years old and meet the eligibility requirements. They must not have a financial or other interest in your death. They must not be members of your immediate family, such as your spouse, parent, child or sibling. The clinic team can assist you with the witness requirement.

Step 3: Submit the AMD form

After the form has been signed, your doctor will help you submit the AMD to the Ministry of Health (MOH).

You may also send it to the MOH Registrar of Advance Medical Directives in a sealed envelope by post or by hand.

After your AMD has been registered, you will receive an acknowledgement from the Registrar.

You can also revoke the AMD if you change your mind in the future.

How much does it cost to make an AMD at Parkway Shenton?

You may make an AMD at Parkway Shenton for $68 (after GST).

To complete your medical planning, you may also make a lasting power of attorney (LPA) for $55 (after GST) in the same visit.

Who can make an AMD in Singapore?

You may make an AMD when you:

• are at least 21 years old;
• are able to understand the nature and implications of the AMD;
• are making the decision voluntarily; and
• are not being pressured or forced by another person.

The doctor witnessing your AMD must assess that you understand the directive and are making it of your own free will.

An AMD is not only for seniors or people who are already unwell. Any eligible adult may consider making one so that their wishes are clear to their loved ones.

Singapore citizens, Permanent Residents (PRs) and all eligible residents in Singapore may make an AMD.

What is the difference between an AMD and LPA?

An Advance Medical Directive and a Lasting Power of Attorney (LPA) serve different purposes.

You may make both an AMD and LPA as part of your future planning. Having an AMD does not replace an LPA, and vice versa.

For AMD, extraordinary life-sustaining treatment refers to treatment that would only prolong the process of dying when death is imminent. You will still receive treatment to cure the illness, palliative care, or pain relief.

Make your own decisions with an AMD

In the event of a terminal illness, an AMD grants you autonomy to decide on your medical care while you are still able to express your wishes clearly.

Book an appointment at a Parkway Shenton clinic near you to make an Advance Medical Directive. Our GPs will guide you through the 3 simple steps.

FAQs about AMD

Q: Will my medical care be affected if I have an AMD?

No, your medical care will not be affected with an AMD. Hospital doctors, nurses and staff do not know who has made an AMD or ask you if you have made an AMD. The patient’s life will continue to be sustained and they will receive medical treatment as usual. Even if the AMD is applied, palliative care and medication will continue to be provided.

Q: Will every doctor automatically know that I have an AMD?

No, AMD records are kept strictly confidential. A treating doctor may check with the Registrar only when there is reason to believe that you are terminally ill and unable to communicate your wishes. You may also choose to tell your family or healthcare providers that you have made one.

Q: Can I make an AMD and LPA at Parkway Shenton clinics?

Yes, you can make an AMD and lasting power of attorney (LPA) at Parkway Shenton clinics in the same visit.

Q: Can I have both an AMD and an LPA?

Yes, the AMD and LPA cover different situations. Your AMD records your wishes about extraordinary life-sustaining treatment under specific terminal circumstances. Your LPA appoints someone to make permitted personal welfare or financial decisions if you lose mental capacity.

Q: Where and how do I make an AMD?

You may make an AMD at a Parkway Shenton clinic near you. Our clinics around Singapore, from the CBD to the heartlands, have accredited GPs and family doctors who can guide you throughout the process.

Q: Can I complete the AMD in one visit?

Yes, Parkway Shenton GPs and family doctors will help you fill up the AMD form, arrange the witnesses, and submit it during the same consultation, where applicable.

Q: Can my family make an AMD for me?

No one can make an AMD on another person’s behalf. You must personally understand, agree to and sign the directive while you have the ability to do so.

Q: Can my family overrule my AMD?

A valid AMD records your own legal decision. Your doctors must respect it when all the conditions for it to take effect have been met, even when family members object. It can still help to discuss your decision with your loved ones so they understand your wishes.

Q: Do I need a lawyer?

No, a lawyer is not required. A doctor must explain and witness the AMD, together with a second eligible witness.

Q: Is an AMD compulsory?

No, making an AMD is entirely voluntary and personal. It is not required for hospital admission and does not affect your insurance policy.

Q: Can I change my mind or revoke the AMD?

Yes, you may change your mind and revoke your AMD at any time in the future.

Q: Must I already have a terminal illness to make an AMD?

You may make an AMD while you are well. Making it before a health emergency gives you time to consider your decision without pressure and provides peace of mind early to your loved ones.