Your partner is involved in an accident. He was hit by a car while crossing the zebra crossing. He checked and was so sure before he crossed the road but it was because of a speeding drunk who came out of nowhere that he is in the hospital now. The drunk is absolutely apologetic, but your lifetime partner is now in the ICU, comatose, and you are sobbing your eyes out.
Your partner’s parents are too old. You don’t want to let them know of this incident because knowing this may also mean shocking them to the end of their lives. The doctor comes to you knowing you are somewhat related. Yet, you have no legal relation to your partner. The doctor will not be able to reveal crucial information of your partner’s medical condition. You are stuck. You have no way to resolve this. You do not know your partner’s wishes in this situation. The doctor can only continue to prolong your partner’s life, with you second guessing if that is painful or not. Your pain and dilemma continues …. not knowing the desired path.
Today we will be highlighting the importance of the Advance Medical Directive (AMD).
Our key point today is to have you think about what you want to do in a dire situation and discuss it with your loved ones.
The procedures to make or revoke an AMD are very straightforward, so we have put them in the Annex below with key notes for the LGBTQ+ community of Singapore. In this article, we will discuss more on how this is important to the LGBTQ+ community.
What is an AMD?
It is a 2 page, estimated 5 minutes, legal document that you sign in advance to inform the doctor treating you (in the event you become terminally ill and unconscious) that you do not want any extraordinary life-sustaining treatment to be used to prolong your life.
The keyword here is AND. You need to be terminally ill (a doctor declaring you have no prospect of recovering and death is only postponed even with extraordinary life sustaining treatment) AND unconscious (not like when you are completely drunk and asleep, but when you are not awake and not aware of and not responding to your surrounding environment, where even pouring water all over your face doesn’t wake you up. This will also be declared by the doctor.)
Making an AMD is a voluntary decision. It is entirely up to you whether you wish to make one. In fact, it is a criminal offence for any person to force you to make one against your will.
What should the LGBTQ+ community take note of when making an AMD?
The AMD form can be completed by anyone who is 21 years of age or older.
Those below 21 years old, unfortunately have no way to make this AMD. The decision to continue treatment will lie in the wishes of your parents/guardians. This does not mean you shouldn’t discuss this with them. Estranged or not, you can still let them know.
For the adults aged 21 and above, once you have made this declaration, you may inform your partners or very close friends of it. They can then inform the doctor and the family when the time comes.
Now you may ask, why not continue treatment? Assume this scenario:
Doctor declares you are terminally ill AND unconscious. Life sustaining treatment is possible and there is no say of when you will recover and even if you do, what vegetative state you will be. The doctor locates and asks your family what to do – to continue life support or not. You did not make an AMD declaration. Someone has to still pay for the medical bills and your family pays in hope you will make a full recovery some day. They are unwilling to let you go without trying. Your partner joins in the financial support and is also at wits end financially at some point. Finally, after a 2 year fight, you depart this world because your body just gave up trying for so long. Your partner and family are now left financially challenged and eventually physically apart from you.
The very fact that you have a hospital insurance even with a cash rider, does not necessarily mean that all costs will be covered. There is usually a time or expense limit to how long or how much the hospital treatment can be covered for (you may hit the 90-, 180- or 365-day post-hospitalisation or even the annual limit for the plans).
Hospital staff, including doctors and nurses, do not know who has made an AMD as it is confidential and they are NOT allowed to ask you if you have made an AMD. However, if your attending doctor has reasons to believe that you are terminally ill and unable to make your wishes known to him, he can check with the Registrar of Advance Medical Directives on whether you have made an AMD.
Is there a difference between euthanasia and the AMD?
Euthanasia/mercy killing is the deliberate ending of the life of a person suffering from an incurable and painful disease by unnatural means, such as the administration of lethal chemicals. An AMD acts as advance instruction for your doctor not to prolong your life with extraordinary life-sustaining treatment, and to let the dying process take its natural course when you become terminally ill and unconscious. The AMD Act does NOT encourage euthanasia. On the contrary, the AMD Act is explicitly and categorically against euthanasia.
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.
Three doctors, including the patient’s hospital doctor, must unanimously certify a patient’s terminal illness. Two of the doctors must be specialists.
If the first panel of three doctors cannot agree unanimously that the patient is terminally ill, the doctor-in-charge will review his diagnosis. If he is still of the opinion that the patient is terminally ill, the matter will be referred to a second panel of three specialists, to be appointed by the Ministry of Health.
If the second panel of doctors also cannot agree unanimously that the patient is terminally ill, the AMD CANNOT take effect. The patient’s life will continue to be sustained and he will receive medical treatment as normal.
If you still need more clarity, or just need to speak to someone on this, you can call MOH hotline at 1800-333-9999 or drop me a message and I will help you get the resources you need regarding this topic.
Once again, speak to your loved ones on this matter and let them know your decision and action (or inaction)on the AMD. Coming to any decision is better than not knowing what the decision is.
To recap the past Estate Planning topics:
- Wills – To decide who to give what you have and by what methods.
- Lasting Power of Attorney – Appointing individuals to act and make decisions for you should you lose your mental capacity, especially important in dealing with your finance and real estate matters.
Seeking professionals to guide you on the decision process and ensure that your individual rights are respected is important. Do seek a well trained professional in the legal, medical, real estate and financial services field to guide you in these estate planning steps. Do not let hearsay or other’s own experience cloud your decisions. You have the right to make your own decisions after understanding what needs to be known.
About the Author
Kelvyn Choo is a financial consultant since 2013. His interest to serve the LGBTQ+ community is because he understands that many in the circle are wary of people who just in it for the Pink Dollar. Hence, proper advice is hard to get. He focuses a lot on getting the basic insurance done for the LGBTQ+ community, thereafter focusing on estate and retirement planning, an aspect which requires heart and not just buying a product off the shelves.
You can reach out to him on his Facebook page.
Disclaimer: The views expressed belong solely to the individual contributors in their individual capacities and do not necessarily reflect those of their respective employers, organisation or other group. Any information provided does not constitute legal, financial or any kind of advice. You should obtain specific advice suitable for your circumstances from an appropriate professional before taking any action. Although we try our best to ensure the accuracy of the information on this website, you rely on it at your own risk. We welcome feedback relating to factual accuracy via email at email@example.com.
Annex – Procedures to make or revoke an AMD.
How do you make an AMD?
Anyone who is aged 21 years old and above, and is not mentally disordered can make an AMD.
Simply follow these steps:
- Obtain an AMD form
The forms are available from medical clinics, polyclinics and hospitals. You may also ask your doctor for the form if you have decided to make an AMD. Alternatively, you can also download the AMD form online (print both sheets on a single sheet of paper front and back).
- Consult a doctor with a witness
The AMD must be made through a doctor (you do not need either a lawyer or legal advice to make an AMD). The doctor has the responsibility to ensure that:
- You are not being forced into making the AMD.
- You are not mentally disordered.
- You understand the nature and implications of making an AMD.
You need to have two people witness you sign the AMD and they must sign the form as witnesses in your presence. One witness must be the doctor. The second witness must be 21 years or above and can be the doctor’s nurse, or any other suitable person.
Witnesses can be anyone. So long as they have no vested interests in your demise, they would be allowed to act as witness.
A witness shall be a person who to the best of his knowledge –
(a) is not a beneficiary under the patient’s will or any policy of insurance (so if you named your partner to receive death benefits on your life, they cannot be a witness);
(b) has no interest under any instrument under which the patient is the donor, settlor or grantor (so your donees under your Lasting Power of Attorney, beneficiaries of any trust or any persons to whom you have granted powers to in a written instrument or document cannot be a witness);
(c) would not be entitled to an interest in the estate of the patient on the patient’s death intestate (so if you have no Will, your family members cannot be a witness);
(d) would not be entitled to an interest in the moneys of the patient held in the Central Provident Fund or other provident fund on the death of that patient (similarly note the highlight of point a and c); and
(e) has not registered an objection under section 10(1) of the Advance Medical Directive Act (so a doctor who has officially registered their objection to act on your AMD and has not removed this objection cannot be your witness to your fresh AMD).
If you have made an AMD regardless of objections from members of your family, the doctors will have to respect your AMD (or if such doctor is unable or unwilling to respect your AMD even if the procedures have been followed, they will have to transfer you to a doctor who is able to). We encourage you to discuss it with your family members and loved ones. This will help them to understand and respect your wishes should you become terminally ill.
A doctor who for any reason objects to the AMD and registers his objection with the Registrar can refuse to witness the signing of an AMD. You can then approach another doctor to witness your AMD.
Return the form to the Registrar of AMD
The completed form should be sent in a sealed envelope by mail or by hand to the Registrar of Advance Medical Directives at Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854
Your AMD is only valid when it is registered with the Registrar of Advance Medical Directives. The Registrar will send you an acknowledgement when the directive has been registered. Any mistake in the form, it may be rejected and you have to do it all over again. Hence, our advice is to do it with a doctor. Polyclinics also offer this service and they charge the usual consultation fees at most.
The AMD form is free.
If you are overseas, as long as the first witness is a doctor currently registered with the Singapore Medical Council (SMC), and the AMD is filed with the AMD Registry in Singapore, the AMD is considered valid.
Revoking an AMD
An AMD can be revoked at any time in the presence of at least one witness. You should do so by completing AMD Form 3, which is the standard form for revocation of an AMD. (Those who have made an AMD will receive Form 3 together with Form 2, which confirms that their AMD has been registered by the Registry of AMDs)
Alternatively, you or your witness could write a simple letter to the Registrar of AMDs.
The letter should contain the following information:
- The name and NRIC of both the person revoking the AMD and the witness, along with their addresses and home and office telephone numbers.
- Time, date and place where the revocation was made.
- If the letter is written by the witness, the method of communication which the person used to communicate his intention to revoke the AMD (e.g. orally, sign language, etc.)
Revocations should be sent to the Registry of AMDs as soon as possible.
You can read more at https://www.moh.gov.sg/policies-and-legislation/advance-medical-directive