What is Advance Medical Directive?
Advance Medical Directive (AMD) is a legal document, which is also known as a “Living Will”. AMD states that no extraordinary life-sustaining treatment is to be done to artificially prolong one’s life in the event of terminal illness, where death is inevitable and impending.
Why make an AMD?
Making an AMD is a voluntary decision. As medical technology advances, there are many ways to extend a person’s life even when terminally ill. For example, a patient may use a respirator because he cannot breathe on his own. It only prolongs the patient’s life but he will not get better or heal.
A person may not be able to express his or her wishes to continue or stop treatment at that stage. With an AMD, even if you are not able to communicate your wishes, your doctor will be guided by it.
Making an AMD
To make an AMD,
- You must be 21 years old and above, and is not mentally disordered.
- Use Form 1 AMD, also downloadable from Ministry of Health (MOH) website.
- The AMD form is signed in the presence of two witnesses, one of them being a registered medical practitioner. All must be above 21. Both witnesses cannot stand to gain anything from your death.
When does it take effect?
First, an AMD is only valid when it is registered with the Registrar of Advance Medical Directives. The AMD can only take effect when the patient loses the capacity to make decisions, is terminally ill and is an impending death. Otherwise, this document is irrelevant.
Certification of a terminal condition is prepared by the doctor-in-charge of care. A prescribed form is used and submitted to the Registrar of AMD, who will, in turn, conduct a search if the patient is on the register. A total of 3 doctors are required to concur on ‘terminality’, and at least 2 of them must be specialists. In case of disagreement, Director of Medical Services (DMS) can appoint 3 specialists to deliberate on this. The assessment must be unanimous before AMD can take effect.
Limitations of AMD
As it is an offence for the doctor to inquire whether an AMD has been made, or is to be made by the patient, in the event when a patient loses capacity, family members must be the one informing the doctor. Hence, it is important for one to keep the family members aware of the presence of an AMD.
However, it may not be practical in real life clinical practice as it plays little or no role in an emergency practice or resuscitation processes as the hospital can only check with Registrar during office hours.
Cancelling an AMD
You may cancel or revoke your AMD at any time. You will need at least one witness. You may either use the Form 3 for Revocation of an AMD or write a letter to the Registrar of AMDs.
Also read: Making an AMD
I have an advance directive, not because I have a serious illness, but because I have a family. – Ira Byock, MD