Directives in Singapore, Australia and US
The 1998 Advanced Medical Directive Act allows citizens aged 21 or over to sign a legal document indicating that, should they become terminally ill, 'extraordinary life-sustaining treatment' will not be used. This is defined as medical intervention which does not cure the illness but only prolongs the process of dying. It is a criminal offence to force someone to make a directive against their will. There have been 1,692 directives registered so far.
In Queensland, South Australia and the Northern Territory, advance directives are legally binding. In New South Wales, they are not a legal document but are seen as strongly persuasive to health-care providers and the Guardianship Board. The 1987 Guardianship Act provides that if someone is in a prolonged comatose state, responsibility for making medical decisions lies first with a spouse or partner, then a carer (such as an adult child for an elderly person) and finally a close relative or friend.
Advanced directives were originally devised by American lawyer Louis Kutner, who first proposed the idea in 1969. Many states have legislation governing advanced directives. Without a directive, the mechanism for withdrawing treatment for comatose patients comes either with a declaration of death if there is no brain function or through a guardian if there is clear evidence of delegation of decision-making authority previously given by the individual. However, even if a persistently vegetative patient's family insists he be kept alive on artificial respiration, a doctor can stop treatment if he is declared brain dead. Relatives often then move the patient to another hospital, a situation that has resulted in thousands of individuals in the US in permanent vegetative states receiving medical care.