Access to AMD register balanced with safeguards on patient confidentiality

15 September 2012, Straits Times

Ensure better record-keeping for AMDs

IN 2008, I made an Advance Medical Directive (AMD). In October 2010, I was diagnosed with pancreatic cancer.

However, at Singapore General Hospital, there were no records that I had made an AMD, and the doctors were not aware of it.

Does the Ministry of Health (MOH) merely acknowledge the making of an AMD by an individual but not inform the hospitals?

When I heard that I was diagnosed with pancreatic cancer, the last thing on my mind at that moment was I had made an AMD. But I recalled it just when I was being wheeled into the operation theatre and mentioned it to the doctors.

Can MOH ensure that all hospitals have a computer record of patients who have made an AMD? This can be called up the moment one is admitted, when one's NRIC number is keyed in.

Kamala Krishnan (Ms)

Reply from MOH

21 September 2012, Straits Times

WE ARE sorry to learn of Ms Kamala Krishnan's illness and her experience with the Advance Medical Directive (AMD) ("Ensure better record-keeping for AMDs"; last Saturday). We hope she is keeping in good health.

Ms Krishnan is right that in the event of a terminal illness and/or incapacitation, it is important that a patient's wish, as stated in the AMD, be known and respected.

To recap, the AMD Act provides a legal framework for Singaporeans and permanent residents in expressing their medical care preference of not having extraordinary life-sustaining treatment, in the event that they become terminally ill and unconscious or incapable of exercising rational judgment.

The AMD Act seeks to strike a balance between patient confidentiality and enabling the patient's preferred mode of care to be carried out.

In this regard, the AMD system is designed such that the AMD register should not be disclosed to any person except:

• the patient, or individuals authorised by the patient in writing;

• the patient's doctors, with reasons to believe that their patient is terminally ill but unable to make his wishes known; and/or

• the registrar and persons appointed to maintain and administer the register
   

Hence, individuals' AMD information is not made

known automatically to hospitals.

To protect patients' interests and well-being, doctors can search for their patients' AMD registration only under strict conditions, when the patients are:

• suffering from terminal illnesses;

• in need of extraordinary life-sustaining treatment; and

• unconscious or incapable of exercising rational judgment.
   

As these three conditions were not present in Ms Krishnan's case, her attending doctor could not conduct a search for her AMD record.

However, we recognise that there are limitations in the current system.

We also agree with Ms Krishnan on the importance of patients' peace of mind that their wishes will be respected, in the event they are unable to make their wishes known.

Currently, doctors ascertain whether a patient has made an AMD through manual checks with the AMD Registry.

We are currently working to improve this through the ongoing implementation of the National Electronic Health Record, which will enable such checks with the AMD Registry to be done electronically, while still ensuring that the necessary safeguards are in place.

We thank Ms Krishnan for her letter and wish her good health.

Bey Mui Leng (Ms)

Director, Corporate Communications

Ministry of Health