Planning an Advance Medical Directive (AMD) is a crucial step in ensuring your healthcare wishes are respected when you're unable to communicate them. So, what are the key reasons why planning an AMD is vital? First, it provides clear instructions to your healthcare providers and loved ones, reducing the burden of making difficult decisions during stressful times.
Second, it ensures your medical care aligns with your values and preferences, avoiding unwanted treatments. Finally, it offers peace of mind, knowing that your wishes will be honoured even when you are unable to express them yourself.
Interested in learning more about the importance of an AMD? Read on for the ultimate guide, detailing key reasons to plan your Advance Medical Directive and offering practical steps to ensure your healthcare decisions are respected.
What Are the Things You Need to Know Before Making an Advance Medical Directive?
The Ministry of Health (MOH) in Singapore offers the Advance Medical Directive (AMD) program to empower individuals to make informed decisions about their end-of-life care. Here's a breakdown of crucial aspects to understand before creating an AMD:
Scope and Purpose:
An AMD is a legal document expressing your wishes regarding the use of extraordinary life-sustaining treatment in the event of a terminal illness.
Terminal illness: Defined as an incurable condition with no hope of recovery, where death is imminent even with aggressive medical interventions.
Extraordinary life-sustaining treatment: Any medical procedure that solely prolongs the dying process in terminally ill patients, excluding palliative care (pain and symptom management).
Decision and Confidentiality:
Creating an AMD is entirely voluntary. Coercion to make an AMD is a criminal offence.
AMDs are confidential. Healthcare professionals, including hospital doctors and nurses, cannot inquire about your AMD status.
Your AMD is only accessed if you're terminally ill, unconscious, unable to communicate wishes, and your attending physician seeks confirmation from the Registrar of AMD.
Distinction from Euthanasia:
An AMD is not euthanasia, which is the intentional act of ending a life due to a terminal illness.
An AMD guides your doctor to withhold extraordinary life-sustaining treatment, allowing natural death when terminally ill and unconscious. Palliative care ensures comfort and pain relief during this time.
By understanding these key points, you can make an informed decision about creating an AMD and ensure your end-of-life wishes are respected within the legal framework of Singapore.
Notes for AMD Witness
To ensure the validity of the AMD and avoid potential conflicts of interest, a witness must meet the following qualifications:
Financial Independence:
Not a Beneficiary: The witness cannot be named as a beneficiary in the patient's Will or any insurance policies.
No Instrument Interest: The witness cannot have a financial interest in any legal documents where the patient acts as the donor, grantor, or settlor (creator of a trust).
Estate and CPF Exclusion: The witness cannot be entitled to a share of the patient's estate if they die without a Will (intestate) or have a claim on the patient's Central Provident Fund (CPF) savings upon their death.
Objection-Free Status:
No Registered Objection: The witness cannot have previously registered an official objection to the AMD under Section 10(1) of the Advance Medical Directive Act 1996.
Fulfilling these requirements ensures impartiality and upholds the integrity of the AMD process.
Additional Notes:
The first witness must be the patient's chosen doctor, while the second witness must be at least 21 years old.
Witnesses should be prepared to sign a declaration confirming their understanding of the AMD and their eligibility to witness the signing.
For further information on AMDs and witness qualifications, refer to the official MOH resources.
Why Should You Consider to Make an Advance Medical Directive (AMD)?
Here's why considering an AMD might be beneficial:
1. Autonomy and Control:
The AMD allows you to clearly express your preferences regarding medical treatment during a terminal illness, even if you are unable to communicate them later.
2. Respecting Your Wishes:
A legally recognised AMD ensures your chosen course of action is followed, even in a state of incapacity.
3. Natural Death with Dignity:
In the face of a terminal illness, some individuals prefer a natural and peaceful passing instead of aggressive medical interventions that prolong life artificially. An AMD reflects this preference by preventing unwanted suffering associated with extraordinary life-sustaining treatment.
4. Pain Management and Comfort:
For conditions like cancer, patients can experience tremendous pain and discomfort. With AMD, this can be prevented and patients can have a natural death.
5. Financial Considerations:
Extraordinary life-sustaining treatment can be financially draining. An AMD can help limit unnecessary medical expenses during a terminal illness.
Creating an AMD often prompts open conversations about end-of-life wishes with loved ones, fostering understanding and reducing potential family conflicts during a difficult time. By considering an AMD, you can take control of your end-of-life care, ensuring your wishes are respected with dignity and compassion.
Situations that May Happen When Using Your AMD
This section outlines important situations to consider when using an Advance Medical Directive.
Revoking Your AMD
You retain the right to revoke your AMD at any time. There are three ways to achieve this:
Completion of Revocation Form: A revocation form will be provided with your AMD acknowledgement. Complete it in the presence of a witness and submit it as instructed.
Written Letter: Alternatively, you may write a letter to the Registrar of AMDs expressing your desire to revoke the directive.
Verbal or Sign Language Communication: If writing is not possible, you may communicate your wish to revoke the AMD verbally or using sign language. Your witness will then submit a notice on your behalf, explaining your inability to submit a written revocation.
Activation of Your AMD
An AMD only comes into effect when a terminal illness is diagnosed and a certificate of terminal illness is issued. This requires the following:
Unanimous Agreement by Three Doctors: Three doctors, including your attending physician, must unanimously certify your terminal illness. Two of these doctors must be specialists in their respective fields.
Dispute Resolution: If the doctors disagree, the doctor in-charge will review the diagnosis. If they maintain the patient is terminally ill, the case goes to a second panel of three Ministry of Health-appointed specialists. Their unanimous agreement is required for the AMD to take effect.
Treatment in Absence of Unanimous Agreement: Disagreement among doctors regarding your terminal illness renders the AMD ineffective. In this case, all available medical treatment will be administered to attempt your recovery.
While family objections cannot invalidate an AMD, open communication with loved ones about your decisions is highly recommended. This fosters understanding, support, and respect for your wishes at the end of life.
Ready to Draft Your Advance Medical Directive? Let The Life Legacy Help You
We understand that navigating end-of-life decisions can be complex. The Life Legacy is here to guide you through the process. We'll first provide a clear explanation of AMDs. If you decide to proceed, we'll assist you in completing the form, obtaining doctor certification, and mailing it to the registrar on your behalf.
Take control of your healthcare journey. Contact The Life Legacy today to discuss your AMD and ensure your wishes are heard.
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