Living Will, Living Won't

Interesting letter in the ST Forum today on the subject of Advanced Medical Directive (AMD):


May 15, 2006
Doc won't witness medical directive

MY WIFE and I, aged 73 and 80 respectively, read in The Sunday Times that one can make a legal directive stating that if one is terminally ill and in a coma with no hope of recovery, no life sustaining treatment should be given ('When death strikes'; ST, April 16).

So my wife, who is a stroke victim, and I went to the nearest doctor, each with a prepared advance medical directive, with our daughter who was to be a witness, with a request for the doctor to be the second witness. It was stated in the article that two witnesses are required, one of whom must be a registered medical practitioner.

Imagine my surprise when the doctor declined to be a witness, saying it is not clear she is empowered to do that. She also said that as we had no medical records at her clinic, she could not witness our signatures. In my wife's case, she suggested she go to Tan Tock Seng Hospital where she was admitted for her stroke and ask a hospital doctor to be her witness as her records are there. She suggested I go to Ang Mo Kio Polyclinic as I was treated there for asthma.

From my observations, I believe ours was the first such request this doctor has had, as the advance medical directive is new, and I suspect she decided to play safe and not get involved.

There must be many elderly poor who want to make an advance medical directive, but are either unaware that such a scheme is available or don't know how to do it.

Can the authorities kindly enlighten us what one has to do to get an advance medical directive validated?

Trevor Reginald


Mr Reginald's letter contains a couple of inaccuracies:

1. The AMD is not something new, but has been around for 10 years.

2. The doctor is the first witness, and his daughter, being someone who may stand to gain from his death, cannot be a witness.

Of course he cannot be faulted for the misconceptions; in fact this proves his point about the general ignorance about the existence of such a law. You can find out more about the AMD (or 'Living Will') from the MOH website.

I won't be surprised if the doctor had, as Mr Reginald suspected, never witnessed an AMD previously. I don't think I have witnessed more than two or three AMDs in the ten years that the law has been passed. In any case, a doctor can actually refuse to witness an AMD if he registers his objection with the Registrar, or if he does not believe that the patient fulfills the criteria for an AMD.

If I were the doctor, I too would have been reluctant to witness an AMD for someone who had just read about it in the newspaper and decided to go to the nearest clinic to have one signed. A doctor has the duty to make sure that the patient understands the nature and consequences of an AMD, and also that he or she is not under any compulsion to sign one - hardly something you can be certain of for someone you see for the first time.


I have actually been thinking about the topic over the weekend because I have just witnessed an AMD for a patient last week. I am not his family doctor (like many Singaporeans he did not have a 'family doctor'), but he had seen me a few times previously for his chronic medical condition, and at the age of 73, had decided that he would plan for his eventual death. He did not want to burden his family in the event that he would require "extraordinary life-sustaining treatment" when death is imminent. He understood the nature and consequences of the AMD, and had thought the matter over.

But there was a slight problem - he had not discussed the matter with his family. I told him his family would most likely feel hurt that he had not discussed the issue with them, but he was determined to keep the AMD from his family. One does not require a family's consent to sign an AMD. I witnessed his AMD.

That same afternoon his son actually came back to see me, hoping to find out why his father had asked him not to accompany him into the consultation room like he had always done before. I told him he had to ask his father himself.

"But he wouldn't tell me!"

I knew that was going to happen - people often underestimate their family members' ability to tell that something is 'wrong' with them. I told him that as an adult of sound mind his father was entitled to privacy of his medical status and I could not reveal any information without his consent. I encouraged him to continue to talk to his father. The poor man probably went home thinking his father has cancer or something.


Curiously, I have never seen an AMD 'in action', as it were. Most of the ICU patients whose treatment I was involved in either got well, or died before the issue of an AMD was even brought up. Still, it would be interesting to see what further discussion Mr Reginald's letter would generate.