According to government statistics, the population of Singapore in 2011 was 5,183.700 million inhabitants, of whom 3.2 million were Singaporean citizens and permanent residents. It is the second most densely populated independent country in the world.

· Only persons aged 21 or over may take this option.

· A doctor must first evaluate the patient and declare him capable.

· A lawyer is not required to make an AD

· No one can made an AD on behalf of another person, whether a child or an adult

· ADs are fulfilled in cases where the patient is suffering terminal illness, requires vital support measures or when they are incapacitated.

· AD forms are available in medical clinics, polyclinics and hospitals. They can also be requested from GPs or the appropriate doctor or downloaded directly from the Ministry of Health Website.

· The form must be signed in the presence of two witnesses at least 1 of whom must be a doctor. The other witness must be at least 21 years old. Both witnesses must not have any vested interests in the patient’s demise.

· The doctor acting as a witness must assess the patient's capacity and be sure that said person is not being forced to sign an AD and that they understand the implications that its enactment will have.

· The AD should be sent to the AD Register which will send confirmation when the it is officially registered.

· Doctors may state their opposition to an AD by registering their objection with the AD Register, meaning that the refuse to act as the patient’s witness.

· Doctors are not permitted to know or ask if a patient has registered an AD. The doctor responsible for a case may consult the Register if they have reason to believe that the terminal patient in question in incapable of expressing their wishes.

· Doctors will continue to provide palliative care for the relief of pain, suffering and discomfort, and the provision of food and water.

· The AD may be revoked at any time. This requires a witness to be present.

· For those unable to write, AD can be revoked orally or in any other forms of communication.

· It is the duty of the witness to state the reason why the person revoking the AD, whether made in writing, orally or in any other form of communication, to inform the registrar of the revocation as soon as possible.

· A terminally ill patient cannot use the AD to commit suicide, nor does it permit doctors to assist in any suicide attempt, which is punishable by law.

“The Advance Medical Directive Act” was approved by the parliament of Singapore in May 1996 and came into force in July 1997.

An Advance Directives Register has been set up in Singapore, however, it was not possible to obtain actual data on the number of ADs registered in Singapore.

Changes in the recent Mental Capacity Act (2010) which allows the appointment of Last Power of Attorney, will not affect the AD that a patient has already made. In other words, the donee cannot change the AD.

The Register of Advance Medical Directives is kept confidential and will only be disclosed to persons authorised by the owner of the AD in writing and/or the doctor when he has reason to believe that the patient is terminally ill and is unable to make his wishes known to the doctor.

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.AD forms are available in clinics, general hospitals and hospitals. They can also be requested from GPs or the appropriate doctor.

More information about Advance Directives in Singapore can be found in the following organizations:

· The Ministry of Health www.moh.gov.sg

· The Law Society of Singapore www.lawsociety.org.sg. This Society is a non-profit organization established in 1967. The Law Society is dedicated to serving its members and the community, sustaining a competent and independent Bar, upholding the rule of law and ensuring access to justice for all. It is possible to find information about ADs in the link  http://www.lawsociety.org.sg/awareness/adv_medical_directive.htm