Advance Medical Directives (AMDs) are legal documents that allow individuals to outline their preferences for medical treatment in the event that they become terminally ill and are unable to communicate their wishes. In Singapore, the process and confidentiality surrounding AMDs are governed by the Advance Medical Directive Act. One of the key aspects of this law is the strict confidentiality maintained regarding whether an individual has made an AMD. This confidentiality is crucial to ensuring that the patient’s autonomy and privacy are respected. Here, we will explore how this system works within Singapore hospitals.
Confidentiality of AMDs
One of the foundational principles of the AMD system in Singapore is confidentiality. When an individual makes an AMD, it is registered with the Registrar of Advance Medical Directives. However, this information is kept strictly confidential. Hospital staff, including doctors and nurses, do not have access to a patient's AMD status as a matter of routine. They are not allowed to ask patients if they have made an AMD, ensuring that the patient’s privacy is protected.
How the AMD System Works in Practice
Routine Medical Care
In the course of routine medical care, hospital staff will not know if a patient has made an AMD. This confidentiality is maintained to ensure that patients receive unbiased care without any assumptions or judgments based on their end-of-life preferences. The primary focus remains on providing the best possible treatment based on the patient’s current medical needs and circumstances.
Situations of Terminal Illness
The confidentiality of AMDs becomes particularly significant in situations where a patient is terminally ill and unable to communicate their wishes. In such cases, three doctors, who have the responsibility to act in the best interest of the patient, may need to know if an AMD exists. This is where the process allows for a controlled breach of confidentiality for the purpose of upholding the patient’s wishes.
Verification Process
If three doctors have unanimous reason to believe that a patient is terminally ill and unable to communicate, they can initiate a verification process to check the existence of an AMD. This process involves contacting the Registrar of Advance Medical Directives. The doctors must provide sufficient reasons to justify the need for this information. Once the request is validated, the Registrar will confirm whether an AMD has been made, but will not disclose the specific contents of the directive.
Ensuring Compliance with the AMD
Upon confirmation that an AMD exists, the attending doctor must comply with the directive’s instructions. This ensures that the patient's predetermined wishes regarding end-of-life care are honoured. The doctor will follow the stipulated preferences, such as withholding extraordinary life-sustaining measures, thereby respecting the patient's autonomy and previously expressed wishes.
Legal and Ethical Considerations
The confidentiality and verification process of AMDs in Singapore is designed to balance ethical and legal considerations. The law ensures that:
Patient Autonomy: The patient’s right to make their own medical decisions is respected.
Privacy: The details of whether an individual has made an AMD remain private and are not disclosed without valid reasons.
Non-Discrimination: Hospital staff provide care without prejudice or assumptions based on the existence of an AMD.
Respect for Wishes: In cases of terminal illness, the patient's wishes as outlined in their AMD are honoured.
Conclusion
The system of maintaining the confidentiality of AMDs in Singapore hospitals is a thoughtful approach that respects patient privacy and autonomy. By ensuring that hospital staff do not have routine access to information about AMDs and can only check under specific circumstances, the system strikes a balance between providing necessary medical care and respecting end-of-life wishes. This process ensures that patients can make their end-of-life decisions with confidence, knowing that their preferences will be honoured without compromising their privacy.
If you want to know more about the process of having an Advance Medical Directive, contact The Life Legacy today!
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