Advance Care Planning (ACP) and Advance Medical Directive (AMD) are two tools that you can use to indicate your preferences for medical care for future contingencies, when you are not able to make decisions for yourself. These directives guide healthcare professionals and your loved ones when making decisions on your behalf, and more importantly, it relieves loved ones of the burden of not knowing what you would have wanted.

“By indicating your preferences in advance, you can ensure that you will get the medical care you desire during a future medical crisis,” says Ms Sumytra Menon, Senior Assistant Director, Centre for Biomedical Ethics (CBmE), Yong Loo Lin School of Medicine, National University of Singapore (NUS).

Advance Care Planning and Advance M​​edical Directive in Singapore

Advance Care Planning (ACP)

The ACP process consists of a series of wide-ranging discussions with loved ones you have selected and doctors, and facilitated by a trained ACP facilitator on your future health and personal care preferences. At the end of the discussion, this discussion is summarized in an ACP document. The advance care plan is a document that states how you want to be cared for in the event that you are seriously ill and unable to express yourself, or make your own decisions. This is not a legal document and can be as detailed as you would like it to be.

Who is it for: Advance care planning is for everyone, regardless of age or health condition.

What you could consider:

  • Ask a healthcare professional about an ACP.
  • Have an ACP conversation with a trained ACP facilitator. ACP facilitators can be found at Singapore General Hospital (SGH), the National Heart Centre Singapore (NHCS) and other hospitals.
  • Share the ACP document with your doctor and family members.
  • You can change, review and update your advance care plan at any time throughout your life.
  • Appoint a person you trust to make decisions for you if you are mentally incapacitated in the future. The person you appoint to speak on your behalf is typically a trusted friend or family member who is at least 21 years old. This person can be formally appointed using a Lasting Power of Attorney (LPA).

What is the cost: There is no payment for advance care planning.

Advance medical directive (AMD)

This is a legal document made in accordance with the Advance Medical Directive Act in Singapore. It states that you do not want extraordinary life-sustaining treatment to artificially prolong your life in the event of terminal illness, where death is inevitable and impending. An AMD is also called a living will in some other countries.

Who is it for: Anyone who is 21 years old and above, and has the mental capacity to make the AMD.

What you have to do:

  • Download the AMD form from the Ministry of Health website or get the form from a medical clinic, polyclinic or hospital.
  • Fill out the form and sign it in the presence of two witnesses, one of them being your doctor. The second witness must be at least 21 years old. Both witnesses should not have any vested interests in your death.
  • Send the form to the Registrar of AMDs in Singapore.

What is the cost: There is no payment for an advance medic​​al directive.

“The AMD only takes effect when the patient loses the capacity to make decisions, is terminally ill and is at impending death. This document is irrelevant otherwise,” says Ms Menon.

Read on to learn about Lasting Power of Attorney for healthcare.

Ref: Q15