Advance Medical Directive Regulations 1997

Advance Medical Directive Act 1996

(Section 22)

Advance Medical Directive
Regulations 1997

2024 REVISED EDITION

(18 December 2024)

[1 July 1997]

Citation

1. These Regulations are the Advance Medical Directive Regulations 1997.

Advance medical directive

2. For the purposes of section 3 of the Act, an advance medical directive (called in these Regulations a directive) must be in Form 1 set out in the Schedule.

Acknowledgment of registration

3. For the purposes of section 5 of the Act, an acknowledgment of registration of a directive must be in Form 2 set out in the Schedule.

Revocation of directive

4. A written revocation of a directive and a notice of revocation (whether the revocation was in writing or by any other way of communication) under section 7 of the Act may be in Form 3 set out in the Schedule.

Acknowledgment of notice of revocation

5. For the purposes of section 7(5) of the Act, an acknowledgment of receipt of a notice of revocation must be in Form 4 set out in the Schedule.

Certification of terminal illness

6.—(1) A certification by a medical practitioner that a person is suffering from a terminal illness and a request for a search of the register under section 9(1) of the Act must be in Form 5 set out in the Schedule.

(2) The Registrar must inform the medical practitioner of the result of his or her search of the register under section 9(2) of the Act in Form 6 set out in the Schedule.

(3) The medical practitioner responsible for the treatment of the patient must obtain the opinions of the 2 medical practitioners required under section 9(3) of the Act in Form 7 set out in the Schedule.

(4) Where a committee of 3 specialists is appointed under section 9(5) of the Act, the Registrar must notify each specialist and obtain his or her opinion as to whether the patient is suffering from a terminal illness in Form 8 set out in the Schedule.

(5) For the purposes of section 9(8) of the Act, the determination by a committee of 3 specialists as to whether a patient is suffering from a terminal illness must be recorded in Form 9 set out in the Schedule.

(6) For the purposes of section 10(3) of the Act, the medical practitioner must certify whether the patient is pregnant, on page 3 of Form 7 set out in the Schedule or, where the committee of 3 specialists is unanimously in agreement that the patient is suffering from a terminal illness, on page 2 of Form 9 set out in the Schedule.

Conscientious objector

7.—(1) For the purposes of section 10(1) of the Act, a medical practitioner or any person who acts under the instructions of a medical practitioner who objects to acting on a directive must register his or her objection in Part 1 of Form 10 set out in the Schedule.

(2) Revocation of an objection under section 10(1) of the Act must be notified to the Registrar by retrieving the form on which the objection was registered from the Registry and completing Part 2 of the form at the Registry.

THE SCHEDULE

FORM 1

MAKING OF ADVANCE MEDICAL DIRECTIVE

ADVANCE MEDICAL DIRECTIVE ACT 1996 [SECTION 3]

ADVANCE MEDICAL DIRECTIVE REGULATIONS 1997

PERSON MAKING THE ADVANCE MEDICAL DIRECTIVE

Name: ________________________________________________________________________

NRIC No.: ________________

Sex: □ Male □ Female (please tick)

Date of Birth: _________________ (must be at least 21 years of age)

Day/ Month/ Year

Address: ______________________________________________________________________

___________________________________________

Singapore _______________

Home Telephone: _______________

Office Telephone: _______________

THE DIRECTIVE

I make this advance medical directive that if I should suffer from a terminal illness and if I should become unconscious or incapable of exercising rational judgment so that I am unable to communicate my wishes to my doctor, no extraordinary life‑sustaining treatment should be applied or given to me.

2.	I understand that “terminal illness” in the Advance Medical Directive Act 1996 means an incurable condition caused by injury or disease from which there is no reasonable prospect of a temporary or permanent recovery where —

(a)	death would, within reasonable medical judgment, be imminent regardless of the application of extraordinary life‑sustaining treatment; and

(b)	the application of extraordinary life‑sustaining treatment would only serve to postpone the moment of death.

3.	I understand that “extraordinary life‑sustaining treatment” in the Advance Medical Directive Act 1996 means any medical procedure or measure which, when administered to a terminally ill patient, will only prolong the process of dying when death is imminent, but excludes palliative care.

4.	This directive shall not affect any right, power or duty which a medical practitioner or any other person has in giving me palliative care, including the provision of reasonable medical procedures to relieve pain, suffering or discomfort, and the reasonable provision of food and water.

5.	I make this directive in the presence of the 2 witnesses named on page 2.

__________________________

_________________

Signature/Thumb Print

Date

INSTRUCTIONS ON THE REGISTRATION OF THE ADVANCE MEDICAL DIRECTIVE

1.	The person making the advance medical directive should complete this form and send it in a sealed envelope by mail or by hand to the Registrar of Advance Medical Directives at the address given below. Faxed copies will not be accepted.

2.	The advance medical directive is only valid when it is registered with the Registrar of Advance Medical Directives. The Registrar will send the maker of the directive an acknowledgement when the directive has been registered.

The Registry of Advance Medical Directives
Ministry of Health, College of Medicine Building,
16 College Road, Singapore 169854
Tel: 63259136 Fax: 63259212

(Please direct all enquiries to this address)

(Both witnesses please read the NOTES FOR THE WITNESS below before signing)

NOTES FOR THE WITNESS

A witness must be a person who to the best of his or her knowledge —

(a)	is not a beneficiary under the patient’s will or any policy of insurance;

(b)	has no interest under any instrument under which the patient is the donor, settlor or grantor;

(c)	would not be entitled to an interest in the estate of the patient on the patient’s death intestate;

(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; and

(e)	has not registered an objection under section 10(1) of the Advance Medical Directive Act 1996.

FIRST WITNESS (This witness must be a registered medical practitioner)

Name: ________________________________________________________________________

NRIC No.: ________________

Office Address: ________________________________________________________________

____________________________________________

Singapore _______________

Office Telephone: _____________

Handphone/Pager: ________________

1.	I have taken reasonable steps in the circumstances to ensure that the maker of this directive —

(a)	is not mentally disordered;

(b)	has attained 21 years of age;

(c)	has made the directive voluntarily and without inducement or compulsion; and

(d)	has been informed of the nature and consequences of making the directive.

2.	I declare that this directive is made and signed in my presence together with the witness named below.

_______________________

______________

Signature of the
Medical Practitioner

Name/Clinic Stamp of the
Medical Practitioner

Date

Note:

As a guide for the purposes of ensuring that the maker of the directive is not mentally disordered, the medical practitioner should ascertain whether the maker —

(a)	understands the nature and implications of the directive;

(b)	is oriented to time and space; and

(c)	is able to name himself or herself and his or her immediate family members.

SECOND WITNESS (This witness must be at least 21 years of age)

Name: ________________________________________________________________________

NRIC No.: ________________

Home Address: _________________________________________________________________

____________________________________________

Singapore _______________

Home Telephone: _____________

Office Telephone: ________________

I declare that this directive is made and signed in my presence together with the witness named above.

_____________________

_____________

Signature

Date

FORM 2

ACKNOWLEDGMENT OF REGISTRATION OF ADVANCE MEDICAL DIRECTIVE

ADVANCE MEDICAL DIRECTIVE ACT 1996 [SECTION 5(2)]

ADVANCE MEDICAL DIRECTIVE REGULATIONS 1997

TO THE MAKER OF THE ADVANCE MEDICAL DIRECTIVE (named below)

Name: ______________________________________

NRIC No.: ____________________

Address: ______________________________________________________________________

____________________________________________

Singapore ____________________

1.	This is to acknowledge that the advance medical directive made by you on _____________ has been registered with the Registrar of Advance Medical Directives.

2.	Your directive is valid with effect from the date stated below.

______________________

___________________

__________

       Signature of the
    Registrar of Advance
     Medical Directives

Official Stamp of the
Registrar of Advance
Medical Directives

Date

NOTES

1.	You may revoke your advance medical directive at any time in the presence of at least one witness, in writing, orally, or in any other way in which you can communicate.

2.	Attached to this acknowledgement is a copy of FORM 3 which may be used as a written revocation of the directive and a notice of revocation (whether the revocation was in writing or by any other way of communication).

The Registry of Advance Medical Directives
Ministry of Health, College of Medicine Building,
16 College Road, Singapore 169854
Tel: 63259136 Fax: 63259212

(Please direct all enquiries to this address)

FORM 3

NOTICE OF REVOCATION OF ADVANCE MEDICAL DIRECTIVE

ADVANCE MEDICAL DIRECTIVE ACT 1996 [SECTION 7(1) AND (3)]

ADVANCE MEDICAL DIRECTIVE REGULATIONS 1997

INSTRUCTIONS

1.	Any person who has made an advance medical directive under the Advance Medical Directive Act 1996 may in the presence of at least one witness revoke the directive in writing, orally, or in any other way in which the person can communicate.

It is the duty of the person revoking the directive (if practicable) and each witness of such a revocation to notify the Registrar of Advance Medical Directives of the revocation. The notice of revocation may be made in this form, or other ways of writing provided that the particulars of the name, address and telephone number of the person revoking the directive and of the witness, and the date, time and place where the revocation was made, are included. The Registrar will send an acknowledgment to the person revoking the directive when the notice of revocation is received.

3.	Please send this form by fax or other means immediately after it is completed to the address given below. If the form is faxed, the original copy should also be forwarded to the Registry.

The Registry of Advance Medical Directives
Ministry of Health, College of Medicine Building,
16 College Road, Singapore 169854
Tel: 63259136 Fax: 63259212

(Please direct all enquiries to this address)

REVOCATION OF ADVANCE MEDICAL DIRECTIVE

1.	This notice indicates the revocation made by the person named below of his or her advance medical directive registered under the Advance Medical Directive Act 1996, in the presence of the witness named below.

Revocation Details:

Date: _______

Time: _______

Place:_________

2.	The revocation was made by the person (please tick one of the following boxes) —

□	in writing in the presence of the witness named below.

•	This form can serve as the written revocation as well as the notice of revocation.

•	If the revocation is written on a separate sheet of paper and this form is used as the notice of revocation, please append that sheet of paper to this form.

□	by non-written way of communication in the presence of the witness named below.

•	This form will serve as the notice of revocation.

•	Please specify the way of communication (e.g. orally, sign language, etc.)

__________________________________________________________

PERSON REVOKING ADVANCE MEDICAL DIRECTIVE

Name: ______________________________________

NRIC No.: ____________________

Address: ______________________________________________________________________

____________________________________________

Singapore ____________________

Home Telephone: _______________

Office Telephone: _______________

__________________________

______________

Signature (if practicable)

Date

WITNESS

Name: ______________________________________

NRIC No.: ____________________

Address: ______________________________________________________________________

____________________________________________

Singapore ____________________

Home Telephone: _______________

Office Telephone: _______________

________________

______________

Signature

Date

FORM 4

ACKNOWLEDGMENT OF REVOCATION OF ADVANCE MEDICAL DIRECTIVE

ADVANCE MEDICAL DIRECTIVE ACT 1996 [SECTION 7(5)]

ADVANCE MEDICAL DIRECTIVE REGULATIONS 1997

TO THE PERSON REVOKING ADVANCE MEDICAL DIRECTIVE (named below)

Name: _______________________________________

NRIC No.: ____________________

Address: ______________________________________________________________________

_____________________________________________

Singapore ____________________

1.	This is to acknowledge that the revocation of your advance medical directive made on ___________ has been registered with the Registrar of Advance Medical Directives.

2.	The revocation was made by you —

□	in writing in the presence of the witness named below.

□	by non-written way of communication in the presence of the witness named below.

3.	The revocation of your advance medical directive was witnessed by —

Name: __________________________

NRIC No.: ______________

______________________

___________________

__________

       Signature of the
    Registrar of Advance
     Medical Directives

Official Stamp of the
Registrar of Advance
Medical Directives

Date

NOTES

If you wish to make an advance medical directive again, you need to fill in FORM 1 and send it to the Registrar of Advance Medical Directives at the address given below.

The Registry of Advance Medical Directives
Ministry of Health, College of Medicine Building,
16 College Road, Singapore 169854
Tel: 63259136 Fax: 63259212

(Please direct all enquiries to this address)

FORM 5

CERTIFICATION OF TERMINAL ILLNESS AND
REQUEST FOR SEARCH OF THE ADVANCE MEDICAL DIRECTIVE REGISTER

ADVANCE MEDICAL DIRECTIVE ACT 1996 [SECTION 9(1)]

ADVANCE MEDICAL DIRECTIVE REGULATIONS 1997

INSTRUCTIONS TO THE MEDICAL PRACTITIONER RESPONSIBLE FOR THE TREATMENT OF A PATIENT SUFFERING FROM A TERMINAL ILLNESS

1.	It is the duty of the medical practitioner responsible for the treatment of a patient (who has attained 21 years of age) to request for a search of the Advance Medical Directive Register if he or she has reason to believe that the patient —

(a)	is suffering from a terminal illness;

(b)	requires extraordinary life-sustaining treatment; and

(c)	is unconscious or incapable of exercising rational judgment.

The medical practitioner responsible for the treatment of the patient should complete Page 2 of this form and send it to the Registrar of Advance Medical Directives by fax or other means at the address given on page 2. If the form is faxed, the original copy should also be forwarded to the Registry.

3.	The Registrar of Advance Medical Directives will then inform the medical practitioner in writing whether the patient has an advance medical directive which is in force.

4.	Please read the NOTES FOR MEDICAL PRACTITIONER below before completing this form.

NOTES FOR MEDICAL PRACTIONER

1.	No medical practitioner shall certify or participate in the determination or certification that a patient is terminally ill if the medical practitioner —

(a)	is a beneficiary under the patient’s will or any policy of insurance;

(b)	has an interest under any instrument under which the patient is the donor, settlor or grantor;

(c)	would 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; or

(d)	has registered an objection under section 10(1) of the Advance Medical Directive Act 1996.

2.	“Terminal illness” means an incurable condition caused by injury or disease from which there is no reasonable prospect of a temporary or permanent recovery where —

(a)	death would within reasonable medical judgment be imminent regardless of the application of extraordinary life‑sustaining treatment; and

(b)	the application of extraordinary life‑sustaining treatment would only serve to postpone the moment of death.

“Specialist” is a medical practitioner who has completed advance specialty training administered by the Joint Committee of Advanced Specialty Training, or possesses any other postgraduate medical qualification which the Director‑General of Health deems equivalent thereto for the purposes of the Advance Medical Directive Act 1996.

The Registry of Advance Medical Directives
Ministry of Health, College of Medicine Building,
16 College Road, Singapore 169854
Tel: 63259136 Fax: 63259212

(Please direct all enquiries to this address)

TO THE REGISTRAR OF ADVANCE MEDICAL DIRECTIVES

Please fax this page to the Registrar of Advance Medical Directives at the following
8‑digit number that is to be used only for FORM 5:

Fax: 63259212

THE PATIENT

Name: _______________________________________

NRIC No.: ____________________

Address: ______________________________________________________________________

_____________________________________________

Singapore ____________________

Hospital (if the patient is currently warded): ___________________________________________

Principal Diagnosis for the Patient: _________________________________________________

Other Significant Medical Conditions: _______________________________________________

MEDICAL PRACTITIONER RESPONSIBLE FOR THE TREATMENT OF THE PATIENT

Name: _______________________________________

NRIC No.: ____________________

Office Address: ________________________________________________________________

_____________________________________________

Singapore ____________________

Office Telephone: _____________

Fax: __________

Handphone/Pager: ___________

Qualification (please tick one of the following boxes):

□	Specialist (specify specialty): _______________

□	Non-specialist

1.	I have examined the patient named above and determined that the patient is suffering from a terminal illness, requires extraordinary life‑sustaining treatment, and is unconscious or incapable of exercising rational judgment.

2.	I request that a search of the Advance Medical Directive Register be conducted to ascertain whether the patient has made a directive which is in force, and that I be informed accordingly.

____________________

_______________________

__________

Signature of the
Medical Practitioner

Name/Clinic Stamp of the
Medical Practitioner

Date

FORM 6

RESULT OF SEARCH OF THE ADVANCE MEDICAL DIRECTIVE REGISTER

ADVANCE MEDICAL DIRECTIVE ACT 1996 [SECTION 9(2)]

ADVANCE MEDICAL DIRECTIVE REGULATIONS 1997

TO THE MEDICAL PRACTITIONER (named below)

Name: _______________________________________

NRIC No.: ____________________

Office Address: ________________________________________________________________

_____________________________________________

Singapore ____________________

A search of the Advance Medical Directive Register has been made at your request as the medical practitioner responsible for the treatment of the patient named below. You have determined that the patient is suffering from a terminal illness, requires extraordinary life‑sustaining treatment, and is unconscious or incapable of exercising rational judgment.

THE PATIENT

Name: _______________________________________

NRIC No.: ____________________

Address: ______________________________________________________________________

_____________________________________________

Singapore ____________________

RESULT OF SEARCH OF THE ADVANCE MEDICAL DIRECTIVE REGISTER

The patient named above DOES NOT HAVE AN ADVANCE MEDICAL DIRECTIVE registered under the Advance Medical Directive Act 1996.

1.	The patient named above HAS AN ADVANCE MEDICAL DIRECTIVE registered under the Advance Medical Directive Act 1996 which is in force.

2.	You must proceed to obtain the opinions of 2 other medical practitioners as to whether the patient is suffering from a terminal illness using FORM 7 and follow the instructions given there.

If you have registered an objection to acting on an advance medical directive under section 10(1) of the Advance Medical Directive Act 1996, you should take all reasonable steps as soon as practicable for the care of the patient to be transferred to another medical practitioner who has not registered such an objection.

(delete one of the above boxes as appropriate)

____________________

_____________________

__________

       Signature of the
    Registrar of Advance
     Medical Directives

Official Stamp of the
Registrar of Advance
Medical Directives

Date

The Registry of Advance Medical Directives
Ministry of Health, College of Medicine Building,
16 College Road, Singapore 169854
Tel: 63259136 Fax: 63259212

(Please direct all enquiries to this address)

FORM 7

CERTIFICATION OF TERMINAL ILLNESS
BY 2 OTHER MEDICAL PRACTITIONERS

ADVANCE MEDICAL DIRECTIVE ACT 1996 [SECTION 9(3)]

ADVANCE MEDICAL DIRECTIVE REGULATIONS 1997

TO THE MEDICAL PRACTITIONER RESPONSIBLE FOR THE TREATMENT OF THE PATIENT

1.	Please complete your particulars below and the patient’s particulars on page 2.

Name: _______________________________________

NRIC No.: ____________________

Office Address: ________________________________________________________________

_____________________________________________

Singapore ____________________

Office Telephone: ______________

Pager: ____________

It is your responsibility to obtain the opinions of 2 other medical practitioners as to whether the patient is suffering from a terminal illness. If you are a specialist, at least one of the 2 other medical practitioners must be a specialist. If you are not a specialist, both of the 2 other medical practitioners must be specialists. The specialist(s) should be practising in a specialty related to the patient’s illness.

(The definition of “specialist” is given below)

3.	Please ensure that all medical records of the patient are made available to the 2 other medical practitioners and arrange for them to see and examine the patient.

4.	After the 2 other medical practitioners have completed page 2, please complete page 3 and follow the instructions given there.

The Registry of Advance Medical Directives
Ministry of Health, College of Medicine Building,
16 College Road, Singapore 169854
Tel: 63259136 Fax: 63259212

(Please direct all enquiries to this address)

TO THE 2 OTHER MEDICAL PRACTITIONERS WHOSE OPINIONS ARE BEING SOUGHT

1.	The medical practitioner named above who is responsible for the treatment of the patient named on page 2 has determined that the patient is suffering from a terminal illness, requires extraordinary life‑sustaining treatment, and is unconscious or incapable of exercising rational judgment.

2.	The patient has an advance medical directive registered under the Advance Medical Directive Act 1996 which is in force.

3.	Your opinions are sought as to whether you agree that the patient is suffering from a terminal illness.

4.	Please complete page 2 of this form and return this form to the medical practitioner who is responsible for the treatment of the patient. Please read the NOTES FOR MEDICAL PRACTITIONER below before completing this form.

NOTES FOR MEDICAL PRACTITIONER

1.	No medical practitioner shall certify or participate in the determination or certification that a patient is terminally ill if the medical practitioner —

(a)	is a beneficiary under the patient’s will or any policy of insurance;

(b)	has an interest under any instrument under which the patient is the donor, settlor or grantor;

(c)	would 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; or

(d)	has registered an objection under section 10(1) of the Advance Medical Directive Act 1996.

2.	“Terminal illness” means an incurable condition caused by injury or disease from which there is no reasonable prospect of a temporary or permanent recovery where —

(a)	death would within reasonable medical judgment be imminent regardless of the application of extraordinary life‑sustaining treatment; and

(b)	the application of extraordinary life‑sustaining treatment would only serve to postpone the moment of death.

“Specialist” is a medical practitioner who has completed advanced specialty training administered by the Joint Committee on Advanced Specialty Training, or possesses any other postgraduate medical qualification which the Director‑General of Health deems equivalent thereto for the purposes of the Advance Medical Directive Act 1996.

THE PATIENT

Name: _______________________________________

NRIC No.: ____________________

Hospital (if the patient is currently warded): ___________________________________________

Principal Diagnosis for the Patient: _________________________________________________

Other Significant Medical Conditions: _______________________________________________

FIRST OTHER MEDICAL PRACTITIONER WHOSE OPINION IS BEING SOUGHT

Name: _______________________________________

NRIC No.: ____________________

Office Address: ________________________________________________________________

_____________________________________________

Singapore ____________________

Office Telephone: ______________

Pager: ____________

Qualification (please tick one of the following boxes):

□	Specialist (specify specialty): _______________

□	Non-specialist

1.	I have read the medical records of the patient named above, and have independently examined this patient who is unconscious or incapable of exercising rational judgment.

2.	My opinion is that —

□	THE PATIENT IS SUFFERING FROM A TERMINAL ILLNESS.

(please tick one of the boxes)

□	THE PATIENT IS NOT SUFFERING FROM A TERMINAL ILLNESS.

____________________

_______________________

__________

Signature of the
Medical Practitioner

Name/Clinic Stamp of the
Medical Practitioner

Date

SECOND OTHER MEDICAL PRACTITIONER WHOSE OPINION IS BEING SOUGHT

Name: _______________________________________

NRIC No.: ___________________

Office Address: ________________________________________________________________

_____________________________________________

Singapore ____________________

Office Telephone: ______________

Pager: ____________

Qualification (please tick one of the following boxes):

□	Specialist (specify specialty): _______________

□	Non-specialist

1.	I have read the medical records of the patient named above, and have independently examined this patient who is unconscious or incapable of exercising rational judgment.

2.	My opinion is that —

□	THE PATIENT IS SUFFERING FROM A TERMINAL ILLNESS.

(please tick one of the boxes)

□	THE PATIENT IS NOT SUFFERING FROM A TERMINAL ILLNESS.

____________________

_______________________

__________

Signature of the
Medical Practitioner

Name/Clinic Stamp of the
Medical Practitioner

Date

THIS SECTION TO BE COMPLETED BY:

THE MEDICAL PRACTITIONER RESPONSIBLE FOR THE TREATMENT OF THE PATIENT

(Please complete this section after the 2 other medical practitioners have completed page 2 of this form and return the entire form to the Registrar of Advance Medical Directives at the address given on page 1)

1.	I have determined that the patient, __________________________ _______________ ,

Name NRIC No.

(a)	is suffering from a terminal illness;

(b)	requires extraordinary life-sustaining treatment; and

(c)	is unconscious or incapable of exercising rational judgment.

2.	The Registrar of Advance Medical Directives has confirmed that the patient has an advance medical directive registered under the Advance Medical Directive Act 1996 which is in force.

3.	I have determined that the patient is not pregnant with a foetus which will probably develop to the point of live birth with continued application of extraordinary life‑sustaining treatment. My determination is based on the following fact (please tick one of the following boxes):

□	There is reasonable ground to believe that the patient is unable to become pregnant.

□	The patient’s blood has been tested negative for β-HCG (human chorionic gonadotrophin) using microparticle enzyme immunoassay. The test was done within the past 2 weeks.

□	The patient’s blood has been tested positive for β-HCG (human chorionic gonadotrophin) using microparticle enzyme immunoassay but other evidence shows that the foetus will probably not develop to the point of live birth with continued application of extraordinary life‑sustaining treatment.

(give details of the other evidence) _____________________________________________

4.	I have sought the opinions of the 2 other medical practitioners named on page 2: (please tick one of the following boxes)

□	They are in agreement that the patient is suffering from a terminal illness.

I will give effect to the patient’s advance medical directive.

(Note: You may give effect to the patient’s directive as soon as you have signed this section. Upon the death of the patient, please obtain a duplicate copy of the patient’s certificate of cause of death issued by you or the coroner under the Registration of Births and Deaths Act 2021 and forward it to the Registrar of Advance Medical Directives.)

□	They are not in unanimous agreement that the patient is suffering from a terminal illness.

I will not give effect to the patient’s advance medical directive at present.

I request that this case be referred to a committee of 3 specialists to be appointed by the Director‑General of Health.

____________________

_______________________

__________

Signature of the
Medical Practitioner

Name/Clinic Stamp of the
Medical Practitioner

Date

NOTES

1.	No medical practitioner shall act in accordance with an advance medical directive if the medical practitioner has reasonable ground to believe —

(a)	that a notice of revocation of the directive has been received by the Registry of Advance Medical Directives or such revocation has been sent to the Registry;

(b)	that the patient has, whether in writing, orally or in any other way, communicated to any medical practitioner his or her intention to revoke the directive; or

(c)	that the patient was not, at the time of making the directive, capable of understanding the nature and consequences of the directive.

2.	No medical practitioner shall act in accordance with an advance medical directive if the medical practitioner —

(a)	is a beneficiary under the patient’s will or any policy of insurance;

(b)	has an interest under any instrument under which the patient is the donor, settlor or grantor;

(c)	would 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; or

(d)	has registered an objection under section 10(1) of the Advance Medical Directive Act 1996.

If you are disqualified from acting in accordance with an advance medical directive, please take all reasonable steps as soon as practicable for the care of the patient to be transferred to another medical practitioner who has not registered an objection under section 10(1) of the Advance Medical Directive Act 1996. Please hand this form over to the medical practitioner to whom the patient is transferred.

If you change your mind at any time and believe that the patient is not suffering from a terminal illness, please return all forms prescribed under the Advance Medical Directive Regulations 1997 relating to the case which are in your possession to the Registrar of Advance Medical Directives, with a covering letter confirming your decision.

5.	The advance medical directive does not —

(a)	affect any right, power or duty which a medical practitioner or any other person has in relation to palliative care;

(b)

derogate from any duty of a medical practitioner to inform a patient who is conscious and capable of exercising a rational judgment of all the various forms of treatment that may be available in his or her particular case so that the patient may make an informed judgment as to whether a particular form of treatment should, or should not, be undertaken; or

(c)	affect the right of a patient to make a decision in relation to the use of extraordinary life‑sustaining treatment, so long as he or she is able to do so.

FORM 8

CERTIFICATION OF TERMINAL ILLNESS BY A COMMITTEE OF
3 SPECIALISTS APPOINTED BY THE DIRECTOR‑GENERAL OF HEALTH

ADVANCE MEDICAL DIRECTIVE ACT 1996 [SECTION 9(5)]

ADVANCE MEDICAL DIRECTIVE REGULATIONS 1997

TO MEMBERS OF THE COMMITTEE OF 3 SPECIALISTS

1.	The medical practitioner responsible for the treatment of the patient named on page 2 has determined that the patient is suffering from a terminal illness, requires extraordinary life‑sustaining treatment, and is unconscious or incapable of exercising rational judgment.

As the opinions of the 2 other medical practitioners were not unanimously in agreement that the patient is suffering from a terminal illness, this case is referred to a committee of 3 specialists under the Advance Medical Directive Act 1996 to decide whether the patient is suffering from a terminal illness. The Director‑General of Health has appointed you as a member of this committee.

3.	Please make arrangements with the medical practitioner named below for all medical records of the patient to be available to you, and for you to see and examine the patient.

Please complete this form and return it by fax or other means to the Registrar of Advance Medical Directives at the address given below within 24 hours from the time you receive it. If the form is faxed, the original copy should also be forwarded to the Registry. Please read the NOTES FOR MEDICAL PRACTITIONER below before you complete this form.

____________________

_____________________

__________

       Signature of the
    Registrar of Advance
     Medical Directives

Official Stamp of the
Registrar of Advance
Medical Directives

Date

The Registry of Advance Medical Directives
Ministry of Health, College of Medicine Building,
16 College Road, Singapore 169854
Tel: 63259136 Fax: 63259212

(Please direct all enquiries to this address)

NOTES FOR MEDICAL PRACTITIONER

1.	No medical practitioner shall certify or participate in the determination or certification that a patient is terminally ill if the medical practitioner —

(a)	is a beneficiary under the patient’s will or any policy of insurance;

(b)	has an interest under any instrument under which the patient is the donor, settlor or grantor;

(c)	would 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; or

(d)	has registered an objection under section 10(1) of the Advance Medical Directive Act 1996.

2.	“Terminal illness” means an incurable condition caused by injury or disease from which there is no reasonable prospect of a temporary or permanent recovery where —

(a)	death would within reasonable medical judgment be imminent regardless of the application of extraordinary life‑sustaining treatment; and

(b)	the application of extraordinary life‑sustaining treatment would only serve to postpone the moment of death.

MEDICAL PRACTITIONER RESPONSIBLE FOR THE TREATMENT OF THE PATIENT

Name: _______________________________________

NRIC No.: ___________________

Office Address: ________________________________________________________________

_____________________________________________

Singapore ____________________

Office Telephone: ______________

Pager: ____________

THE PATIENT

Name: _______________________________________

NRIC No.: ____________________

Address: ______________________________________________________________________

_____________________________________________

Singapore ____________________

Hospital (if the patient is currently warded): ___________________________________________

Principal Diagnosis for the Patient: _________________________________________________

Other Significant Medical Conditions: _______________________________________________

MEMBER OF THE COMMITTEE OF 3 SPECIALISTS

Name: _______________________________________

NRIC No.: ___________________

Office Address: ________________________________________________________________

_____________________________________________

Singapore ____________________

Office Telephone: ______________

Pager: ____________

Specialty: _____________________________________________________________________

1.	I have read the medical records of the patient named above, and have independently examined this patient who is unconscious or incapable of exercising rational judgment.

2.	My opinion is that —

□	THE PATIENT IS SUFFERING FROM A TERMINAL ILLNESS.

(please tick one of the boxes)

□	THE PATIENT IS NOT SUFFERING FROM A TERMINAL ILLNESS.

____________________

_______________________

__________

Signature of
the Specialist

Name/Clinic Stamp of
the Specialist

Date

FORM 9

RECORD OF DECISION OF THE COMMITTEE OF 3 SPECIALISTS
APPOINTED BY THE DIRECTOR‑GENERAL OF HEALTH

ADVANCE MEDICAL DIRECTIVE ACT 1996 [SECTION 9(8)]

ADVANCE MEDICAL DIRECTIVE REGULATIONS 1997

TO THE MEDICAL PRACTITIONER (named below)

Name: _______________________________________

NRIC No.: ____________________

Office Address: ________________________________________________________________

_____________________________________________

Singapore ____________________

1.	As the medical practitioner responsible for the treatment of the patient named below, you have determined that this patient is suffering from a terminal illness, requires extraordinary life‑sustaining treatment, and is unconscious or incapable of exercising rational judgment.

2.	This case has been referred to a committee of 3 specialists appointed by the Director‑General of Health to determine whether the patient is suffering from a terminal illness.

3.	The decision of the committee is stated below. Please take note of the decision of the committee and follow the instructions given there.

THE PATIENT

Name: _______________________________________

NRIC No.: ____________________

DECISION OF THE COMMITTEE OF 3 SPECIALISTS

1.	The committee of 3 specialists IS UNANIMOUSLY in agreement that the patient named above is suffering from a terminal illness.

2.	The patient’s advance medical directive registered under the Advance Medical Directive Act 1996 is in force and SHOULD BE EFFECTED. No extraordinary life‑sustaining treatment is to be applied or given to the patient. You may act on the directive after completing page 2 of this form.

1.	The Committee of 3 specialists IS NOT UNANIMOUSLY in agreement that the patient named above is suffering from a terminal illness.

2.	The patient should be treated as not suffering from a terminal illness and the patient’s advance medical directive registered under the Advance Medical Directive Act 1996 MUST NOT BE EFFECTED.

(Delete one of the above boxes as appropriate)

____________________

_____________________

__________

     Signature of the
  Registrar of Advance
   Medical Directives

Official Stamp of the
Registrar of Advance
Medical Directives

Date

The Registry of Advance Medical Directives
Ministry of Health, College of Medicine Building,
16 College Road, Singapore 169854
Tel: 63259136 Fax: 63259212

(Please direct all enquiries to this address)

THIS SECTION TO BE COMPLETED BY:

THE MEDICAL PRACTITIONER RESPONSIBLE FOR THE TREATMENT OF THE PATIENT

(Please complete this section and return the entire form to the Registrar of Advance Medical Directives at the address given on page 1)

1.	I have determined that the patient, __________________________ _______________ ,

Name NRIC No.

(a)	is suffering from a terminal illness;

(b)	requires extraordinary life-sustaining treatment; and

(c)	is unconscious or incapable of exercising rational judgment.

2.	The Registrar of Advance Medical Directives has confirmed that the patient has an advance medical directive registered under the Advance Medical Directive Act 1996 which is in force.

3.	I have determined that the patient is not pregnant with a foetus which will probably develop to the point of live birth with continued application of extraordinary life‑sustaining treatment. My determination is based on the following fact (please tick one of the following boxes):

□	There is reasonable ground to believe that the patient is unable to become pregnant.

□	The patient’s blood has been tested negative for β-HCG (human chorionic gonadotrophin) using microparticle enzyme immunoassay. The test was done within the past 2 weeks.

□	The patient’s blood has been tested positive for β-HCG (human chorionic gonadotrophin) using microparticle enzyme immunoassay but other evidence shows that the foetus will probably not develop to the point of live birth with continued application of extraordinary life‑sustaining treatment.

(give details of the other evidence) ______________________________________________

4.	I have received confirmation from the Registrar of Advance Medical Directives that the committee of 3 specialists appointed by the Director‑General of Health is unanimously in agreement that the patient is suffering from a terminal illness.

I will give effect to the patient’s advance medical directive.

____________________

_______________________

__________

Signature of the
Medical Practitioner

Name/Clinic Stamp of the
Medical Practitioner

Date

NOTES

1.	No medical practitioner shall act in accordance with an advance medical directive if the medical practitioner has reasonable ground to believe —

(a)	that a notice of revocation of the directive has been received by the Registry of Advance Medical Directives or such revocation has been sent to the Registry;

(b)	that the patient has, whether in writing, orally or in any other way, communicated to any medical practitioner his or her intention to revoke the directive; or

(c)	that the patient was not, at the time of making the directive, capable of understanding the nature and consequences of the directive.

2.	No medical practitioner shall act in accordance with an advance medical directive if the medical practitioner —

(a)	is a beneficiary under the patient’s will or any policy of insurance;

(b)	has an interest under any instrument under which the patient is the donor, settlor or grantor;

(c)	would 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; or

(d)	has registered an objection under section 10(1) of the Advance Medical Directive Act 1996.

5.	The advance medical directive does not —

(a)	affect any right, power or duty which a medical practitioner or any other person has in relation to palliative care;

(b)

(c)	affect the right of a patient to make a decision in relation to the use of extraordinary life‑sustaining treatment, so long as he or she is able to do so.

FORM 10

OBJECTION TO ACTING ON AN ADVANCE MEDICAL DIRECTIVE

ADVANCE MEDICAL DIRECTIVE ACT 1996 [SECTION 10(1)]

ADVANCE MEDICAL DIRECTIVE REGULATIONS 1997

INSTRUCTIONS FOR REGISTRATION OF OBJECTION TO ACTING ON AN ADVANCE MEDICAL DIRECTIVE

A medical practitioner or any person who acts under the instructions of a medical practitioner, who for any reason objects to acting on an advance medical directive made under the Advance Medical Directive Act 1996, shall register his or her objection by completing PART 1 of this form. The objection can be revoked by retrieving this form from the Registry of Advance Medical Directives and signing the declaration in PART 2.

2.	The person making this objection should send this form in a sealed envelope by mail or by hand after it is completed to the Registrar of Advance Medical Directives at the address given below. The objection is only valid when it is registered with the Registrar of Advance Medical Directives.

The Registry of Advance Medical Directives
Ministry of Health, College of Medicine Building,
16 College Road, Singapore 169854
Tel: 63259136 Fax: 63259212

(Please direct all enquiries to this address)

PART 1: PERSON WHO OBJECTS TO ACTING ON AN ADVANCE MEDICAL DIRECTIVE

Name: _______________________________________

NRIC No.: ___________________

Office Address: ________________________________________________________________

_____________________________________________

Singapore ____________________

Office Telephone: _____________

Profession/Occupation: ____________

1.	I object to acting in accordance with any advanced medical directive made under the Advance Medical Directive Act 1996.

2.	I will not act as a witness in the making of any advance medical directive, or certify or participate in the determination or certification of terminal illness for any patient whom I have been informed to have an advance medical directive which is in force.

If a patient for whose treatment I am responsible, in my opinion, is suffering from a terminal illness, requires extraordinary life‑sustaining treatment, and is unconscious or incapable of exercising rational judgment, and I have been informed that the patient has an advance medical directive which is in force, I will take all reasonable steps as soon as practicable for the care of the patient to be transferred to another medical practitioner who has not registered such an objection.

_______________

__________

Signature

Date

PART 2: REVOCATION OF THE ABOVE OBJECTION

I revoke my objection to acting on an advance medical directive stated in PART 1 of this form.

___________________

__________________

_____________

__________

Signature

Name

NRIC No.

Date