Reviewing Requirement for Advance Medical Directives to be Signed in Doctor's Presence

75 Ms Kuah Boon Theng asked the Coordinating Minister for Social Policies and Minister for Health (a) how many Advance Medical Directives (AMDs) have been registered to date; and (b) to make it easier to sign an AMD, whether the Ministry will consider removing the requirement that AMDs must always be signed before a doctor, even when there are no concerns that the individual may lack mental capacity.

76 Ms Kuah Boon Theng asked the Coordinating Minister for Social Policies and Minister for Health whether the Ministry will reassess the need to continue prohibiting doctors from asking their patients if they have an AMD, especially as the Registrar of AMDs is contactable during office or clinic hours, and doctors may otherwise experience difficulties ascertaining their patient's AMD status if the certification of terminal illness occurs after the Registrar's regular office hours.

The Minister of State for Health (Ms Rahayu Mahzam) (for the Coordinating Minister for Social Policies and Minister for Health): Mr Speaker, may I have your permission to answer Question Nos 75 and 76 together?

Mr Speaker: Please go ahead.

Ms Rahayu Mahzam: Thank you. As of February 2026, more than 84,500 individuals have signed the Advance Medical Directive (AMD). The decision to make an AMD must be taken seriously as it is a legal document stating that an individual 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. Hence, safeguards are in place to protect the interests of individuals. For example, a witnessing doctor ensures that the individual understands the medical implications of making an AMD, is not being coerced and is of sound mind.

Strict confidentiality of AMDs are maintained to ensure that the knowledge of an AMD does not inappropriately influence treatment decisions before a patient is certified terminally ill. We have established operational processes to ensure that AMD search requests made by doctors receive prompt attention, including after regular office hours.

Mr Speaker: Ms Kuah.

Ms Kuah Boon Theng (Nominated Member): I thank the Minister of State for the information she has provided. By way of supplementary question, I would like to ask if the Minister of State will agree that, in general, the take-up rate for AMDs has been quite slow compared to Lasting Power of Attorney (LPAs). I am glad to see that the numbers have now been boosted to 84,000, but I know it is had a very, very long roll-out, bearing in mind that this legislation is now 30 years old.

I accept that what the Minister of State has said, that it is good for those who want to sign an AMD to get advice from their doctors on the implications. But I will make the argument that lawyers, too, are able to give the same advice, of course, provided that the individual has mental capacity and there is no issue of their lack of understanding.

The advantage of being able to remove this requirement that one of the witnesses must be a doctor will mean that those who are interested to make end-of-life decision-making will have a one-stop shop, they will be able to see the lawyers, and have both their LPAs and their AMDs signed at the same time and have access to the advice to make informed decisions.

So, I hope this is something that the Ministry is open to doing – to remove the requirement that one of the witnesses must be a doctor, so long as there is no issue of lack of mental capacity.

And I believe that for Question No 76, which I have raised, it is about the fact that doctors are not allowed to ask their patient, "Have you signed the AMD?". I hope to receive the Minister of State's reply to that.

Ms Rahayu Mahzam: I thank the Member for the questions. In relation to the first matter, as I have explained, and I think the Member is fully aware, the reason we require that a doctor be present for the purposes of this is, because there are clinical implications, there are clinical treatments that may require some explanation from the medical perspective, as well as the fact that you need to also ensure the soundness of mind of the individual.

I note the points raised, and actually, we are reviewing the whole AMD process to increase uptake and awareness on this; and also to streamline the processes to make it a lot simpler and accessible to the public.

On the second point, actually, I did mention it. It is really a function of confidentiality. It is an important safeguard. You would appreciate the seriousness of the implications of an AMD. Firstly, because with an AMD, you want to make sure that it is only triggered at the point where the patient is certified to be terminally ill. We want to ensure that this does not get raised inappropriately. This is governed by the AMD Act and within the Act, there are exceptions, safeguards that say that the doctor can talk about this as a concept, to describe and explain the process, with a view to protect against the inappropriate use of this matter.

Also, in our assessment, in terms of how the protocols are put in place, we are very conscious that this is a very time-sensitive process in a directive. And from our records, it does appear that it has been properly exercised. But if there is any further feedback in specific circumstances, feel free to raise it to us and we can look at how we can continue to improve the process as we are reviewing this.

Mr Speaker: Ms Kuah.

Ms Kuah Boon Theng: I thank the Minister of State. I just want to assure you that I fully agree that there is a time and place to ask that question, whether an AMD has been executed and it should not be done at insensitive junctures where the circumstances have not arisen for an AMD to be relied upon.

But to the question of confidentiality, I do think that when you are in a position to ask the patient himself or herself, there should not be a concern that there is an issue of confidentiality, because you are asking that information from the patient. But currently, the doctors are not even allowed to do that.

And in my question, the scenario I painted is that, very often, those conditions where an AMD may be triggered often arrives in very inconvenient moments, like in the middle of the night. And the feedback I have obtained from doctors is that they literally have to wait because they are not allowed to ask the patient, they are not allowed to ask family members who have that information, and they have to wait until they have the opportunity to call the Registrar to obtain the information.

So, I hope there would be some interest in trying to remove that requirement, but of course, re-affirm that it must still be information that is sought at the appropriate time and place.

Ms Rahayu Mahzam: I will just reiterate the point I mentioned earlier. From our assessment, there have been very prompt responses, even outside office hours, in terms of following through with a request for the search. So, in terms of the process, it is something that we have been monitoring and it is something that is done very promptly. So, it is not something that causes any inordinate delay. But like I said, if there are some specific circumstances, please let us know.

I would also highlight that in discussions with patient, when the patient is still very conscious and lucid, clearly nothing stops the doctor from having conversations. And in fact, as I highlighted, the exception in section 15(2), I believe, of the AMD Act allows for the doctor to have a conversation about AMD broadly, to explain the concept, to explain the directive.

So, this is something that I think does not stop the doctor from having that robust discussion, especially as they also discuss things, like Advanced Care Planning and LPA. They can, indeed, talk about the concept, so that the patient is aware of it and may want to choose it. But I think there are some concerns about it.

I note the point, however, and this is feedback that I will take back to my colleagues to see if there are some other areas for which we can sharpen this further.