Debated in Parliament on 5 Feb 2025.
Ms He Ting Ru asked the Minister for Health (a) whether the Government has identified key barriers preventing Singaporeans from signing advance medical directives; (b) what specific strategies are being implemented to increase participation rates beyond existing public education campaigns; and (c) whether the Ministry is considering simplifying the certification process to encourage uptake.
The process to make an Advance Medical Directive (AMD) can be a barrier. This is because an AMD is a legal document for a patient to inform the doctor that he does not want to use any life-sustaining treatment to prolong his life in the event that he is terminally ill, unconscious or requires life-sustaining treatment. It must, therefore, be taken very seriously. Hence, individuals need to complete a form in the presence of two witnesses, one of whom must be a doctor. These are necessary safeguards that may have contributed to the complexity of the AMD process but are designed to protect the interests of individuals who make an AMD.
In the absence of AMD, doctors may also recommend the withdrawal of life-sustaining treatment to family members if this is deemed to be in the patient's best interest. In arriving at this recommendation, the doctor would have taken into account the patient's clinical conditions, possible care pathways and healthcare preferences, if any. The family's decision to accept or reject the doctor's recommendation will be greatly facilitated if the patient has made an Advance Care Plan (ACP) and/or has appointed a donee to make medical care decisions under a Lasting Power of Attorney (LPA). Both ACP and LPA are much easier to set up than an AMD.
With growing public awareness and discourse on end-of-life planning, the annual uptake of AMD has increased, from 3,000 in 2015 to over 8,000 in 2024.
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