Advance Medical Directive (AMD)
When you are healthy, expressing your wishes may be easy. But when terminal illnesses take away your ability to make decisions, it can be difficult for your loved ones and doctor to know what you would want.
An Advance Medical Directive (AMD) in Singapore provides a way to record your preferences about life-sustaining treatment. It gives you the legal autonomy to decide how you would want medical care to proceed, should you become terminally ill, unable to express decisions, and when death is imminent.
If you are looking for how to make an AMD, this guide explains the process—and if you desire to have an AMD, our doctors at Prologue The Lifestyle Medical Clinic are certified to do so.
What is an Advance Medical Directive (AMD)?
An Advance Medical Directive (AMD) is a legal document that you sign in advance to inform healthcare professionals that you do not want to receive life-sustaining treatment when you become terminally ill and recovery is no longer possible.
Life-sustaining treatment includes a ventilator, dialysis, CPR, and artificial nutrition and hydration – measures given to prolong the process of dying for the terminally ill patient but does not cure the illness.
By signing an AMD, you are expressing your decision to refuse these interventions. The choice must be made voluntarily and without any form of coercion.
Reasons Behind the Advance Medical Directive Act Introduction
The final stage of a terminal illness, when recovery is no longer possible, affects not only the person who is ill but also their caregivers. Their loved ones may feel uncertain if withdrawing life support is the right decision, even when death is inevitable.
This is why the Advance Medical Directive Act 1996 (AMDA) was introduced by the Singapore Parliament – meant to uphold a person’s dignity by allowing them to make their own medical decisions, such as refusing extraordinary life-sustaining treatment, and to give their loved ones clarity during a difficult time.
The Advance Medical Directive Act includes several important terms to understand, such as:
- “Terminal illness” refers to an incurable condition caused by injury or disease where there is no chance of recovery, and death is imminent even when extraordinary life-sustaining treatment is given.
- “Extraordinary life-sustaining treatment” refers to medical procedures or interventions that prolong the process of dying for the terminally ill patient but does not cure the illness. This does not include palliative care, which focuses on relieving pain and maintaining comfort.
If you need clarification regarding these terms, please drop us a message.
Who Can Make an AMD and When Does it Take Effect
Anyone who is 21 years old or above and not mentally disordered (i.e., capable of making rational decisions) can make an AMD. The choice should be made voluntarily, without any coercion.
If you have signed an AMD, it only takes effect when you become terminally ill, unconscious, or incapable of making end-of-life care decisions. This condition must be confirmed by your attending doctor.
An AMD is strictly confidential. Healthcare professionals are not allowed to ask whether you have made one, and they can only access this information once the necessary conditions are met.
How to Make an AMD in Singapore – Step‑by‑Step
Expressing your wishes and preferences for end-of-life care early can help your loved ones and healthcare professionals understand and respect your choices. Here is how to apply for an Advance Medical Directive (AMD) in Singapore:
1
Obtain the AMD form. It is available at clinics, polyclinics, hospitals, or you can download the AMD form online.
2
Find a doctor and a witness to be present when you sign the form. The witness must be an adult aged 21 or older with no vested interest (i.e., not a beneficiary of your estate, insurance, or CPF).
3
Submit the completed form in a sealed envelope to the Registrar of Advance Medical Directive, Ministry of Health, at 16 College Road, College of Medicine Building, Singapore 169854.
4
Wait for an acknowledgement letter from the Registrar. Once registration is complete, your Advance Medical Directive becomes legally valid.
Need more details?
AMD in Practice, Limitations, and Considerations
How an AMD is Practised
Having a valid AMD means that once you are confirmed to be terminally ill and become unconscious or unable to express your end-of-life care decisions, your attending doctors will access your AMD and act according to your directive—by not providing extraordinary life-sustaining treatment.
However, this does not include palliative care. Your attending physicians will still provide medical care and pain relief measures to keep you comfortable.
What AMD Does not Cover
An AMD is not the same as euthanasia or assisted suicide. It also does not apply to non-terminal or reversible conditions. It only takes effect in cases of terminal illness, and its activation must be confirmed by the attending doctors.
Why Planning for an AMD Matters
The decision to live should be respected just as much as the decision to decline life-prolonging treatment. Planning ahead through an Advance Medical Directive provides clarity for your loved ones, doctors, and all involved when you are no longer able to express your wishes.
During such times, your family may experience emotional distress and uncertainty in making difficult decisions. Having an AMD helps relieve them of this burden, ensuring that your dignity and preferences are respected when recovery from a terminal illness or condition is no longer possible.
It also offers legal clarity for healthcare professionals, allowing them to act in accordance with your end-of-life wishes confidently and without hesitation.
Ensure your healthcare decisions are honoured. Speak with our team at Prologue to set up your Advance Medical Directive.
Further Resources About an Advance Medical Directive
For more information about the Advance Medical Directive (AMD) and related materials, you may refer to the following official resources:
- Legislation: Advance Medical Directive Act 1996
- Official AMD Form: Download the Advance Medical Directive form online
- Official AMD Revocation Form: Download the AMD revocation form online
Educational Resources: Learn more about AMDs and end-of-life planning at HealthXchange and the Singapore Hospice Council.
FAQ
Do I need a lawyer to make an AMD?
No, you do not need a lawyer to make an AMD. You just need two witnesses—one must be a doctor, and the other must be an adult of at least 21 years old with no vested interest (i.e., not a beneficiary of your estate, insurance, or CPF)—who will be present when you sign the form.
Can I change my mind after making an AMD?
Yes, you can revoke or change your AMD even when it has become legally valid. Obtain and complete the revocation form from your doctor or download it online. There must be at least one witness present to sign and confirm it.
What if my family objects to my AMD?
Your AMD remains valid even if your family disagrees with it. However, it is always best to discuss your decision with your family early, as this helps them understand your wishes and respect your end-of-life care choice.
Does an AMD cover every medical situation?
No. An AMD only applies to terminal illnesses where recovery is no longer possible, and death is imminent even with life-sustaining treatment.
Is the AMD the same as an Advanced Care Plan (ACP)?
No, AMD and ACP are different. An AMD is a legal document stating your refusal of extraordinary life-sustaining treatment if you become terminally ill and unable to make decisions.
An ACP is a written record of your care preferences. It helps your loved ones and healthcare team make decisions that align with your wishes, but it is not legally binding like an AMD.
What is the difference between AMD and LPA?
An Advance Medical Directive (AMD) is different from a Lasting Power of Attorney (LPA) in terms of who makes the medical decisions. With an AMD, you decide your own end-of-life preferences in advance, while with an LPA, you appoint one or more individuals to make medical decisions on your behalf when you’re no longer capable to do so.