Advance Directives

Making an advance directive

Since making an advance directive is a matter of grave importance, the Government encourages those who wish to make advance directives to seek legal advice and to discuss the matter with their families first. Family members are also encouraged to be present when the individual makes the advance directive. Once a patient (or person) decides to make a directive, the steps listed below should be followed:

1. The first thing to be done is that the attending doctor must ensure that you are mentally competent when you make the directive. Roughly put, a mentally competent adult is defined as one with decision making capacity, which consists of the elements of:
(a) the ability to understand the medical information presented;
(b) the ability to reason and consider this information in relation his or her own personal values and goals; and
(c) the ability to communicate meaningfully.

2. When making an advance directive, you should be given sufficient and accurate information so that you may make an informed decision free from inappropriate pressure. You should be informed clearly what the effect of an advance directive will be and how you could alter or revoke that directive, should you ever want to do so.

3. Whenever possible, an advance directive should be made in writing. Whilst you have the right to make your own advance directive in the way you like, for the sake of preventing uncertainty and disputes, the government recommends that the public use the model form that it proposes (click here to download the form).

4. Advance directives should be made in the presence of two witnesses. Among the witnesses, one of them should be a medical doctor, and none of them should have any interest in your estate (stand to gain anything from your estate).

5. If you cannot make the advance directive in writing, you may make the directive verbally in the presence of a doctor, lawyer or any other independent person who does not have an interest in your estate. Such a directive should be properly documented, that is, it should be written down by one of the people present who hear it, if possible.

6. The government recommends that as the person making an advance directive, you may specify in the directive that when you are in any of the three conditions stated below:
(a) terminally ill;
(b) in a state of irreversible coma; or
(c)in a persistent vegetative state,

you do not agree to receive any life-sustaining treatment or any treatment that you specify except for basic and pain-relieving care (The advance directive will be carried out only when you are in one of those three conditions, unfortunately)

In the absence of any evidence to the contrary, advance directives that follow the above procedures will generally be considered as having been duly made and valid. To ensure the smooth carrying-out of the directive, you should provide a copy of your directive to your family members, lawyer and attorney/trustee, if any, in addition to your healthcare professionals.