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AdvanceMedicalDirectiveAct
(CHAPTER4A)
LongTitle
1Shorttitle
2Interpretation
3Powertomakeadvancemedicaldirective
4Dutyofwitness
5Registrationofdirectives
6Registryofdirectivesandobjections
7Revocationofdirective
8Panelofspecialists
9Certificationofterminalillness
10Dutyofmedicalpractitioner
11Advancedirectivenottoaffectpalliativecare
12Patientsrightstomakeinformeddecisionsonhistreatmentnotaffected
13Actnottoaffectotherrights
14Penaltyforobtainingdirectivebyfraud,forgingdirectiveorconcealingrevocation
15Offencetoenquirewhetherdirectivemade
16Offencetorequiredirectiveasconditionforinsuranceormedicalcare
17Actpermitsonlynaturaldeathandnoteuthanasiaorabetmentofsuicide
18Actnottoaffectinsurancepolicies
19Protectionofmedicalpractitionersandotherpersonsactingingoodfaithandwithoutnegligence
20Certainaspectsofcausationofdeath
21Compositionofoffences
22Regulations

LegislativeHistory

ADVANCEMEDICALDIRECTIVEACT
(CHAPTER4A)
(OriginalEnactment:Act16of1996)
REVISEDEDITION1997

(20thDecember1997)

AnActtoprovidefor,andgivelegaleffectto,advancedirectivestomedicalpractitioners
againstartificialprolongationofthedyingprocessandformattersconnectedtherewith.
[1stJuly1997]
Shorttitle
1.(1)ThisActmaybecitedastheAdvanceMedicalDirectiveAct.
(2)ThisActshallnotapplytoanyactdoneoranydirectiveorinstrumentmadeorexecuted
before1stJuly1997.
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Interpretation
2.InthisAct,unlessthecontextotherwiserequires
directivemeansanadvancemedicaldirectivemadeundersection3
DirectormeanstheDirectorofMedicalServices
extraordinarylifesustainingtreatmentmeansanymedicalprocedureormeasurewhich,
whenadministeredtoaterminallyillpatient,willonlyprolongtheprocessofdying
whendeathisimminent,butexcludespalliativecare
medicalpractitionermeansapersonwhoisregistered,ordeemedtoberegistered,asa
medicalpractitionerundertheMedicalRegistrationAct(Cap.174)
palliativecareincludes
(a) theprovisionofreasonablemedicalproceduresforthereliefofpain,suffering
ordiscomfortand
(b) thereasonableprovisionoffoodandwater
patientmeansanyperson(whetherornotheisundergoinganymedicaltreatment,care
ortherapy)whoisnotmentallydisordered,whohasattainedtheageof21yearsand
whohasmadeordesirestomakeadirectiveinaccordancewiththisAct
[21/2008wef01/03/2010]

recovery,inrelationtoaterminalillness,includesaremissionofsymptomsoreffects
oftheillness
registermeanstheregisterofadvancemedicaldirectivesestablishedundersection6
Registrar means the Registrar of Advance Medical Directives appointed under
section6andshallincludeaDeputyRegistrarandanAssistantRegistrar
specialist means a medical practitioner who possesses such postgraduate medical
qualificationsastheDirectormayrecogniseforthepurposesofthisAct
terminalillnessmeansanincurableconditioncausedbyinjuryordiseasefromwhich
thereisnoreasonableprospectofatemporaryorpermanentrecoverywhere
(a) death would, within reasonable medical judgment, be imminent regardless of
theapplicationofextraordinarylifesustainingtreatmentand
(b) the application of extraordinary lifesustaining treatment would only serve to
postponethemomentofdeathofthepatient.
Powertomakeadvancemedicaldirective
3.(1)Apersonwhoisnotmentallydisordered,whohasattainedtheageof21yearsand
who desires not to be subjected to extraordinary lifesustaining treatment in the event of his
suffering from a terminal illness, may at any time make an advance medical directive in the
prescribedform.
[21/2008wef01/03/2010]

(2)Subjecttosubsection(3),thedirectivemustbewitnessedby2witnessespresentatthe
same time one of whom shall be the patients family medical practitioner or any other
practitionerofhischoiceandtheothershallbeapersonwhohasattainedtheageof21years.
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(3)Awitnessshallbeapersonwhotothebestofhisknowledge
(a) isnotabeneficiaryunderthepatientswilloranypolicyofinsurance
(b) hasnointerestunderanyinstrumentunderwhichthepatientisthedonor,settloror
grantor
(c) wouldnotbeentitledtoaninterestintheestateofthepatientonthepatientsdeath
intestate
(d) wouldnotbeentitledtoaninterestinthemoneysofthepatientheldintheCentral
ProvidentFundorotherprovidentfundonthedeathofthatpatientand
(e) hasnotregisteredanobjectionundersection10(1).
Dutyofwitness
4.Beforewitnessingtheexecutionofthedirectiveontheprescribedform,awitnesswhois
a medical practitioner shall take reasonable steps in the circumstances to ensure that the
patient
(a) isnotmentallydisordered
[21/2008wef01/03/2010]

(b) hasattainedtheageof21years
(c) hasmadethedirectivevoluntarilyandwithoutinducementorcompulsionand
(d) hasbeeninformedofthenatureandconsequencesofmakingthedirective.
Registrationofdirectives
5.(1)Anypersonwhohasmadeadirectiveinaccordancewithsection3shallregisterhis
directivewiththeRegistrar.
(2)Uponreceiptofthedirectiveregisteredundersubsection(1),theRegistrarshallissueto
thepersonwhomadethedirectiveanacknowledgmentintheprescribedform.
(3)Nopersonshallactonadirectiveifithasnotbeenregisteredinaccordancewiththis
section.
Registryofdirectivesandobjections
6.(1)TheDirectorshallcausearegisterofadvancemedicaldirectivestobeestablished
andmaintainedforthepurposesofthisActandwhichshallcomprise
(a) alldirectivesregisteredundersection5
(b) allrevocationsofdirectivesregisteredundersection7
(c) allobjectionsofmedicalpractitionersregisteredundersection10(1).
(2)TheMinistershallappointaRegistrar,aDeputyRegistrarandanAssistantRegistrarof
Advance Medical Directives and such other officers and employees as he may consider
necessaryforthepurposesofthisAct.
(3)Theregistershallbekeptconfidentialandshallnotbedisclosedtoanypersonexceptto
thefollowing:
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(a) the person who made the directive or such other person as he may in writing
authorise
(b) theRegistrarandotherpersonsappointedtomaintainandadministertheregister
(c) the medical practitioner responsible for the treatment of the person who made the
directive only if a certificate in respect of that person has been forwarded to the
Registrarinaccordancewithsection9(1).
(4) Any person who wilfully destroys, mutilates or makes any unauthorised alteration or
manipulationintheregistershallbeguiltyofanoffenceandshallbeliableonconvictiontoa
finenotexceeding$10,000ortoimprisonmentforatermnotexceeding3yearsortoboth.
Revocationofdirective
7.(1)Anypatientwhohasmadeadirectivemay,inthepresenceofatleastonewitness,
revokethedirective
(a) inwriting
(b) orallyor
(c) inanyotherwayinwhichthepatientcancommunicate.
(2)Asfarasmaybepracticable,therevocationshallberegisteredwiththeRegistrar.
(3)Wherearevocationismadeinaccordancewithsubsection(1),thepatient(ifpracticable)
andeachwitnessshallnotifytheRegistrarinwritingoftherevocationwithfullparticularsof
thename,addressandtelephonenumberofthepatientandofthewitnessandthetime,dateand
placewheretherevocationwasmade.
(4)Itshallbethedutyofanyotherpersonwhohaswitnessedarevocation,whethermadein
writing, orally or in any other way in which the patient can communicate, to inform the
Registrarofthatfact.
(5) Upon receipt of the notice of revocation (if there is more than one notice, the first
notice),theRegistrarshallissuetothatpersonanacknowledgmentintheprescribedformand
shallmarkthedirectiveasarevokeddirectiveintheregister.
Panelofspecialists
8.(1)TheMinistershallappointapanelofnotlessthan20specialistswhohaveeachnot
lessthan10yearsexperienceinmedicalpractice.
(2)TheMinistershall,inappointingthemembersofthepanel,haveregardtotheneedto
appointspecialistswhopossesstherequisiteskills,knowledgeandqualificationsindiagnosing
terminalillness.
(3) Every member of the panel shall, except where his appointment is revoked by the
Ministerundersubsection(4)orheresignsduringtheperiodofhisappointment,beappointed
foraperiodof3yearsorforsuchshorterperiodastheMinistermay,inanycase,determine
andshallbeeligibleforreappointment.
(4)TheMinistermayatanytimerevoketheappointmentofamemberofthepanelonthe
groundofhisunfitnesstocontinueinofficeorincapacitytoperformthedutiesthereof.

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Certificationofterminalillness
9.(1)Whereamedicalpractitioner,whoisresponsibleforthetreatmentofanyperson,has
reasontobelievethattheperson
(a) issufferingfromaterminalillness
(b) requiresextraordinarylifesustainingtreatmentand
(c) isunconsciousorincapableofexercisingrationaljudgment,
themedicalpractitionershall
(i) determine and certify in the prescribed form that the person is suffering from a
terminalillnessandthereasonsforthedeterminationand
(ii) forwardthecertificatetotheRegistrarwitharequestthatasearchoftheregisterbe
conductedinordertoascertainwhetherthepersonhasmadeadirectivewhichisin
force.
(2)Uponreceiptofarequestmadeundersubsection(1),theRegistrarshallcauseasearchof
theregistertobeconductedinordertoascertainwhetherthepersonhasmadeadirectivewhich
isinforceandshallthereafterinformthemedicalpractitioneraccordingly.
(3)WheretheRegistrarinformsthemedicalpractitionerresponsibleforthetreatmentofthe
personwhohasbeencertifiedtobeterminallyillthatthepatienthasmadeadirectivewhichis
in force, that medical practitioner shall obtain, in the prescribed form, the opinion of 2 other
medical practitioners as to whether they agree with the determination that the patient is
terminallyill.
(4)Wherethemedicalpractitionerresponsibleforthetreatmentofthepatient
(a) isnotaspecialist,the2othermedicalpractitionersreferredtoinsubsection(3)shall
bothbespecialists
(b) is a specialist, at least one of the 2 other medical practitioners referred to in
subsection(3)shallbeaspecialist.
(5) Where the opinions of the 2 medical practitioners referred to in subsection (3) are not
unanimously in agreement that the patient is terminally ill, the issue shall be referred for
determination to a committee of 3 specialists (referred to in this section as the committee)
appointedbytheDirectorfromamongthepanelofspecialistsreferredtoinsection8.
(6)Apatientshall,onareferencetothecommittee,bedeterminedtobeterminallyillonly
ontheunanimousdecisionofthecommittee.
(7)Ifthecommitteeisunabletoreachaunanimousdecision,thepatientshallbepresumed
nottobeterminallyill.
(8)Thecommitteesdeterminationshallberecordedintheprescribedformandsenttothe
medicalpractitionerresponsibleforthetreatmentofthepatient.
(9)Nomedicalpractitionershallcertifyorparticipateinthedeterminationorcertification
thatthepatientisterminallyillifthemedicalpractitioner
(a) isabeneficiaryunderthepatientswilloranypolicyofinsurance
(b) hasaninterestunderanyinstrumentunderwhichthepatientisthedonor,settloror
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grantor
(c) would be entitled to an interest in the moneys of the patient held in the Central
ProvidentFundorotherprovidentfundonthedeathofthatpatientor
(d) hasregisteredanobjectionundersection10(1).
Dutyofmedicalpractitioner
10.(1)Amedicalpractitioneroranypersonwhoactsundertheinstructionsofamedical
practitioner,whoforanyreasonobjectstoactingonadirectiveshallregisterhisobjectionin
theprescribedformtothiseffectandregisteritwiththeRegistrarandsuchobjectionmaybe
revokedbynotifyingtheRegistrarintheprescribedform.
(2) Where a person who has made a directive in accordance with section 3 has been
determinedinaccordancewithsection9tobesufferingfromaterminalillness,itshallbethe
duty of the medical practitioner responsible for his treatment (unless he has registered his
objectionundersubsection(1))toactinaccordancewiththedirectiveunlessthereisreasonable
groundtobelieve
(a) thatanoticeofrevocationundersection7hasbeenreceivedbytheregistryorsuch
revocationhasbeensenttotheregistry
(b) thatthepersonhas,whetherinwriting,orallyorinanyotherway,communicatedto
anymedicalpractitionerhisintentiontorevokethedirectiveor
(c) thatthepersonwasnot,atthetimeofmakingthedirective,capableofunderstanding
thenatureandconsequencesofthedirective.
(3)Beforeamedicalpractitioneractsinaccordancewithadirective,heshall
(a) ascertainfromtheRegistrarthatthedirectivehasbeenregisteredundersection5and
isinforce
(b) ensure that the patient has been certified to be terminally ill in accordance with
section9and
(c) as far as may be practicable determine and certify in writing whether the patient is
pregnantwithafoetuswhichwillprobablydeveloptothepointoflivebirth.
(4) No medical practitioner shall act in accordance with a directive if the medical
practitioner
(a) isabeneficiaryunderthepatientswilloranypolicyofinsurance
(b) hasaninterestunderanyinstrumentunderwhichthepatientisthedonor,settloror
grantoror
(c) would be entitled to an interest in the moneys of the patient held in the Central
ProvidentFundorotherprovidentfundonthedeathofthatpatient.
(5) Where a medical practitioner has registered his objection under subsection (1) or is
disqualified under subsection (4), he shall, in the circumstances referred to in subsection (2),
take all reasonable steps as soon as practicable for the care of the patient to be transferred to
anothermedicalpractitionerwhohasnotregisteredsuchanobjection.
(6) Extraordinary lifesustaining treatment shall not be withheld or withdrawn pursuant to
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this section from a patient known to the medical practitioner to be pregnant so long as it is
probable that the foetus will develop to the point of live birth with continued application of
extraordinarylifesustainingtreatment.
Advancedirectivenottoaffectpalliativecare
11.ThisActshallnotapplytopalliativecareanddoesnotaffectanyright,powerorduty
whichamedicalpractitioneroranyotherpersonhasinrelationtopalliativecare.
Patientsrightstomakeinformeddecisionsonhistreatmentnotaffected
12.(1)Section3or10shallnotderogatefromanydutyofamedicalpractitionertoinform
apatientwhoisconsciousandcapableofexercisingarationaljudgmentofallthevariousforms
of treatment that may be available in his 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.
(2)ThisActshallnotaffecttherightofapatienttomakedecisionsinrelationtotheuseof
extraordinarylifesustainingtreatment,solongasheisabletodoso.
Actnottoaffectotherrights
13.(1) This Act shall not affect the right of any person to refuse medical or surgical
treatment.
(2)ThisAct(otherthansection20)shallnotaffectthelegalconsequences(ifany)of
(a) taking, or refraining from taking, therapeutic or palliative measures (not being
extraordinarylifesustainingtreatment)inthecaseofapatientwhoissufferingfrom
aterminalillness(whetherornothehasmadeadirective)or
(b) taking, or refraining from taking, extraordinary lifesustaining treatment in the case
ofapatientwhohasnotmadeadirectiveorhasrevokedadirectivemadebyhim.
Penaltyforobtainingdirectivebyfraud,forgingdirectiveorconcealingrevocation
14.(1)Anypersonwho
(a) byanydeception,fraud,misstatement,unconscionableconductorundueinfluence,
procures or obtains, directly or indirectly, the execution by another person of a
directive
(b) falsifiesorforgesthedirectiveofanotherpersonor
(c) wilfullyconcealsorwithholdspersonalknowledgeofarevocationofadirective,
shallbeguiltyofanoffenceandshallbeliableonconvictiontoafinenotexceeding$10,000or
toimprisonmentforatermnotexceeding3yearsortoboth.
(2)Anypersonwho
(a) isabeneficiaryunderthewilloranypolicyofinsuranceofanotherperson
(b) hasaninterestunderanyinstrumentunderwhichanotherpersonisthedonor,settlor
orgrantor
(c) wouldbeentitledtoaninterestintheestateofanotherpersononthedeathintestate
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ofthatpersonor
(d) wouldbeentitledtoaninterestinthemoneysofanotherpersonheldintheCentral
ProvidentFundorotherprovidentfundonthedeathofthatperson,
andwhoisguiltyofanoffenceundersubsection(1)(whetherornothehasbeenconvictedof
such an offence) shall forfeit any interest under the will, policy, instrument, intestacy or
memorandumexecutedundertheCentralProvidentFundAct(Cap.36),asthecasemaybe.
(3)Whereapersonischargedforanoffenceundersubsection(1),nopersonshallactona
directive unless it is ascertained that the directive has been validly and voluntarily made in
accordancewiththeprovisionsofthisAct.
(4) Where a person is convicted of an offence under subsection (1), the directive shall be
deemedtoberevokedandshallhavenoeffect.
Offencetoenquirewhetherdirectivemade
15.(1)Exceptinthecircumstancesspecifiedinsubsection(2),nopersonwhohasorwho
willbelikelytohavethemedicalcareofanypatient(whetherornothehasmadeorintendsto
makeadirective)shallaskorotherwiseenquireofthepatientastowhetherornotthepatient
hasmadeorintendstomakeadirective.
(2) Nothing in subsection (1) shall affect the duty or right of a medical practitioner
responsible for the care of a patient to discuss and explore with his patient the concept of
directivesandtheobjectsandprovisionsofthisActandanyregulationsmadethereunderwhere
suchdiscussionsare
(a) consistentwithgoodmedicalpractice
(b) heldinthecontextoftherelationshipbetweenamedicalpractitionerandhispatient
and
(c) infurtheranceofthepurposesofpubliceducation.
(3)Exceptwhereapatienthasbeendeterminedinaccordancewithsection9tobesuffering
fromaterminalillness,allinformationrelatingtothepatientsmakingofadirective,orofthe
patientsintentiontomakeadirectivecommunicatedbythepatienttothemedicalpractitioner
orothermedicalworkerhavingthecareofthepatientshallbekeptconfidentialbythemedical
practitionerorothermedicalworker.
(4)Anypersonwhocontravenessubsection(1)or(3)shallbeguiltyofanoffenceandshall
be liable on conviction to a fine not exceeding $5,000 or to imprisonment for a term not
exceeding12monthsortoboth.
Offencetorequiredirectiveasconditionforinsuranceormedicalcare
16.(1)Anypersonwhorequiresorprohibitsthemakingofadirectiveasaconditionfor
beinginsuredfor,orreceivingmedicalorhealthcareservicesshallbeguiltyofanoffenceand
shallbeliableonconvictiontoafinenotexceeding$5,000ortoimprisonmentforatermnot
exceeding12monthsortoboth.
(2)Anyconditionofapolicyofinsurancereferredtoinsubsection(1)shallbevoidtothe
extentthatitrequiresorprohibitsthemakingofadirective.

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Actpermitsonlynaturaldeathandnoteuthanasiaorabetmentofsuicide
17.(1)NothinginthisActshallauthoriseanactthatcausesoracceleratesdeathasdistinct
fromanactthatpermitsthedyingprocesstotakeitsnaturalcourse.
(2)Fortheavoidanceofdoubt,itisherebydeclaredthatnothinginthisActshallcondone,
authoriseorapproveabetmentofsuicide,mercykillingoreuthanasia.
Actnottoaffectinsurancepolicies
18.(1) The making of a directive shall not affect the sale, procurement or issuance of a
policyofinsuranceoranyofthetermsthereof.
(2)Exceptinthecircumstancesasprovidedinsection14(2),apolicyofinsuranceshallnot
beavoided,invalidatedorotherwiseaffectedbythewithholdingorwithdrawalofextraordinary
lifesustainingtreatmentfromaninsuredpersoninaccordancewiththisAct.
Protectionofmedicalpractitionersandotherpersonsactingingoodfaithandwithout
negligence
19.(1)Amedicalpractitionershallnotbesubjecttocivilorcriminalliabilityordiscipline
forprofessionalmisconductforadecisionmadebyhimingoodfaithandwithoutnegligenceas
towhether
(a) apatientis,orisnot,sufferingfromaterminalillness
(b) apatienthasrevoked,orintendedtorevoke,adirective
(c) apatientwas,orwasnot,atthetimeofmakingadirective,capableofunderstanding
thenatureandconsequencesofthedirectiveor
(d) adirectivewasvalid.
(2)Apersonactingundertheinstructionsofamedicalpractitionershallnotbesubjectto
civil or criminal liability or discipline for professional misconduct for giving effect to a
directiveintheabsenceofknowledgeofrevocationorintendedrevocationofthedirective.
Certainaspectsofcausationofdeath
20.(1) For the purposes of the laws of Singapore, the nonapplication of extraordinary
lifesustainingtreatmentto,orthewithdrawalofextraordinarylifesustainingtreatmentfrom,a
person suffering from a terminal illness shall not constitute a cause of death where the non
applicationorwithdrawalwasasaresultofandincompliancewithadirectivevalidlymadein
accordancewiththisActbytheperson.
(2)Thissectionshallnotrelieveamedicalpractitionerfromtheconsequencesofanegligent
decisionastowhetherornotapatientissufferingfromaterminalillness.
Compositionofoffences
21.(1) The Director or any person authorised by him may, in his discretion, compound
any offence under this Act or any regulations made thereunder which is prescribed to be a
compoundableoffencebyacceptingfromthepersonreasonablysuspectedofhavingcommitted
theoffenceasumnotexceeding$1,000.
(2)Onpaymentofsuchsumofmoney,nofurtherproceedingsshallbetakenagainstthat
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personinrespectofsuchoffence.
(3) The Minister may make regulations to prescribe the offences which may be
compounded.
Regulations
22. The Minister may make regulations to prescribe anything which is required to be
prescribedbythisActandgenerallytogiveeffecttotheprovisionsofthisAct.
LEGISLATIVEHISTORY
ADVANCEMEDICALDIRECTIVEACT
(CHAPTER4A)
This Legislative History is provided for the convenience of users of the Advance Medical Directive
Act.ItisnotpartoftheAct.
1.Act16of1996AdvanceMedicalDirectiveAct1996
DateofFirstReading

: 1November1995
(Bill No. 40/1995 published on 2
November1995)

DateofSecondReading

: 5December1995

ReferredtoSelectCommittee

: Parl 1 of 1996 presented to


Parliamenton11March1996

DateofThirdReading

: 2May1996

Dateofcommencement

: 1July1997

2.1997RevisedEditionAdvanceMedicalDirectiveAct
Dateofoperation

: 20December1997

3.Act21of2008MentalHealth(CareandTreatment)Act2008
(ConsequentialamendmentsmadetoActby)
DateofFirstReading
: 21July2008
(Bill No. 11/2008 published on 22
July2008)
DateofSecondandThirdReadings

: 15September2008

Dateofcommencement

: 1March2010

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