• Vol. 39 No. 6, 424–428
  • 15 June 2010

Knowledge, Attitudes and Practices of the Advance Medical Directive in a Residential Estate in Singapore



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Introduction: This study investigates the knowledge, attitudes and practices of residents in a residential estate in Singapore on the Advance Medical Directive (AMD).

Materials and Methods: A community-based cross-sectional study was conducted with residents in the residential estate of Toa Payoh Lorong 6, Singapore. A stratified random sampling was conducted to obtain a representative sample of the estate. Only residents aged 21 years and older were included. An interviewer-administered questionnaire was conducted, and only those who understood the AMD sufficiently were further evaluated on their knowledge, attitudes and practices.

Results: A total of 414 residents were enrolled (50.1% response rate). Only 37.9% of the participants knew about the AMD prior to this study. Participants who had a higher knowledge level of AMD, did not wish “for an artificially prolonged life”, “to be kept alive indefinitely on a life-support machine”, wished to “lessen the financial burden of loved ones”, “avoid prolonged suffering” and accepted the “imminence of death” were more willing to sign an AMD. However, “religious beliefs”, “personal ethical views”, “dissuasion by family members” and “unclear terminology in the AMD” discouraged the participants from signing an AMD. After adjusting for significant factors, participants who did not wish “to be kept alive indefinitely on a life-support machine” and accepted the “imminence of death” were found to correlate significantly with the willingness to sign an AMD [Prevalence Rate Ratio (PRR) = 2.050 [1.140-3.685], P = 0.016; PRR = 2.669 [1.449-4.917], P = 0.02, respectively].

Conclusion: There is a need to increase awareness on the AMD. Public education methods can be improved to inform residents on the implications of the AMD.

The Advance Medical Directive (AMD) Act was passed in Parliament in May 1996. The AMD is a legal document that an individual can sign in advance to inform his or her attending doctor that he or she does not want any extraordinary life-sustaining treatment to be used to prolong life in the event that he or she becomes terminally ill or unconscious.

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