In-House Services

ADVANCE MEDICAL DIRECTIVE (AMD)

An Advance Medical Directive (AMD) is a legal document you sign in advance to inform your doctor that you do not want the use of any life-sustaining treatment to be used to prolong your life in the event you become terminally ill and unconscious and where death is imminent.

Making an AMD is a voluntary decision. It is entirely up to you whether you wish to make one. In fact, it is a criminal offence for any person to force you to make one against your will.

New advances in medical knowledge and technology create new choices for both patients and health care providers. Some of these choices raise new ethical and legal issues.

One issue is that modern medical technology can technically prolong life in the final stages of a terminal illness. However, it cannot stop the dying process. In such situations, further medical intervention would be medically ineffective, and a decision has to be made whether to withdraw such futile medical intervention. Some terminally ill persons who are unable to express their wishes at that time, may want to be spared further suffering and be allowed to die naturally, in peace and with dignity.

The law in Singapore allows Singaporeans who wish to make an advance medical directive to do so. The AMD Act was passed in Parliament in May 1996.

The AMD can be made by any person, aged 21 years and above, and is not mentally disordered. The AMD form is a legal document which must be completed and signed in the presence of two witnesses before it is returned to the Registrar of AMDs. The patient’s doctor must be one of the two witnesses, while the other witness must be at least 21 years old. In addition, both witnesses must not have any vested interests in the patient’s death.

An AMD can be revoked at any time in the presence of at least one witness. The person making the revocation should do so by completing Form 3, which is the standard form for revocation of an AMD. (Those who have made an AMD will receive Form 3 together with Form 2, which confirms that their AMD has been registered by the Registry of AMDs)

Alternatively, the person or his 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)

Revocations should be sent to the Registry of AMDs as soon as possible.

For persons who are in a condition where they are unable to write, the AMD can be revoked orally or in any other way in which you can communicate. It is then the responsibility of the witness to the revocation to submit the notice of revocation using Form 3 or the letter as described above. The witness should also state the reason why the person revoking the AMD could not do so himself.

Please download AMD form from Ministry of Health Singapore website.

Lasting Power Of Attorney (LPA)

A lasting power of attorney is a legal document that gives authority to the person you appoint (called your “donee”) to make decisions and act for you when you lack mental capacity.

You may authorise your donee(s) to make decisions about your

• personal welfare (which may include health care) and/or
• property and affairs (including financial matters).

This is the lasting power of attorney (LPA) Form 1. It gives your donee very wide powers. Your donee may act as fully as you can, subject to basic restrictions set out in the lasting power of attorney and the Mental Capacity Act (Cap. 177A). If you do not want to give such wide powers and want to give restricted or specific powers instead, you should use LPA Form 2.

This document must be registered the Office of the Public Guardian (OPG). The application to register must be made in the prescribed form within 6 months from the date you (the person giving the power) sign this document.

Both yourself and your donee(s) need to be present in the clinic and you will need to make an appointment with Dr Mok.

Your donee can use the lasting power of attorney only after it has been registered and only where you lack mental capacity or your donee reasonably believes you lack such capacity.

Your donee’s authority is governed by the terms of this document and the provisions of the Act.

Your donee must follow the principles of the Act, which include the principle that your donee must act in your best interests.

Your donee cannot make certain decisions as provided in the Act, such as make a will on your behalf.

Guidance about the Act is found in the Mental Capacity Act Code of Practice, which is available from the OPG or at www.publicguardian.gov.sg. Your donee must have regard to the Code of Practice.

You can revoke your lasting power of attorney at any time as long as you have mental capacity to do so. You must inform your donee in writing so he/she will know you have terminated his/her authority. You must also inform the Public Guardian in writing for the registration of the lasting power of attorney to be cancelled.