Advance Medical Directive as Opt-out Scheme for Older and Terminally Ill Persons

Dr Chia Shi-Lu asked the Minister for Health whether the Ministry will consider implementing the Advance Medical Directive as an opt-out scheme for (i) those aged 85 and above and (ii) those aged above 80 who are terminally ill and have been unconscious for more than a year.

Mr Gan Kim Yong: The Advance Medical Directive (AMD) is a legal document that a person signs in advance, to direct the doctor treating him, not to employ extraordinary life-sustaining treatment to prolong his life, in the event that he suffers a terminal illness and is unable to exercise rational judgement at that time. Making an AMD is a personal, voluntary and optional decision. It represents a person’s considered and rational decision in advance.

It is critical to maintain the principle that the decision on whether to accept or reject treatment should be considered carefully and made personally. Hence we do not support an opt-out scheme for AMD.

Where a person is unable to communicate his preference and has not made an AMD, decisions relating to the care should be made by the attending doctor, in close consultation with family members and care givers, taking into consideration the best interest of the person, and any documented personal preferences.