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04. Advanced Medical Directives
Advanced Medical Directives (AMD)
New advances in medical knowledge and technology create new choices for both patients and healthcare 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.
Anyone who is 21 years old and above, and who is not mentally disordered can make an AMD.
Why Make An AMD?
If you have an opinion regarding your end-of-life care and wish to state it while you’re of sound mind, an AMD is a legally recognised way to ensure your wishes will be honoured, even if you’re incapacitated.
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When faced with a terminal illness, some people would rather die naturally and in peace, rather than continue to have their lives prolonged artificially with no real possibility of recovery and at immense pain and financial costs.
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Patients with conditions like cancer can experience tremendous discomfort and pain. An AMD prevents their suffering from being prolonged, and allows them to have a natural death with dignity.
Why Make An AMD?
You can revoke your AMD any time. You can do this by completing the revocation form in the presence of a witness. This form will be sent to you along with the acknowledgement from the Registrar of AMD. Alternatively, you can write a letter to the Registrar of AMDs.
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If you are unable to write, you can communicate your wishes to cancel your AMD verbally or using sign language. Your witness will submit the notice on your behalf and explain why you cannot submit it yourself.
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The AMD will only come into force once you have been determined to have a terminal illness and a certificate of terminal illness has been issued. For this to happen, three doctors, including the patient's attending doctor, must unanimously certify a patient's terminal illness. Two of the doctors must be specialists.
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If the doctors are not unanimous, then the doctor-in-charge will review his diagnosis. If he is still of the opinion that the patient is terminally ill, then the matter will be referred to another panel of three specialists appointed by the Ministry of Health. If this second panel of doctors cannot agree unanimously that the patient is terminally ill, the AMD will not take effect. All medical treatment will be administered in an attempt to heal the patient.
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While family objection to an AMD does not invalidate it, it is recommended that you explain the rationale for your decision with your loved ones, so that they would support and respect your wishes at the end of your days.
