Question: In Singapore, there is the option to opt in the Advanced Medical Directive (AMD). ‘Opting in means to refuse in advance any life-sustaining treatment to be used to prolong your life should you become terminally ill and unconscious, and where death is imminent.’ Should Pure Land practitioners opt in?
Answer: This question has no clear universal answer, with the points in section  of https://purelanders.com/2015/12/30/important-guidelines-1-before-dying-pure-land-passport-section-4a to be considered.
‘The key consideration is whether such life-sustaining treatment will help or hamper ability to Niànfó well, such as by causing great pain or discomfort (e.g. from CPR by defibrillators or hand, cardiotonic injections). When uncertain, it is best to swiftly and sincerely pray to Āmítuófó for inspired advice, on what best to do. Those who practise Niànfó well in everyday life are likelier to not have prolonged or painful dying processes, which will instead be swifter and less painful or painless. They are even able to depart before any need for life-sustaining treatment.‘
 Having reasonable life support that offers more time to Niànfó well can be helpful, while an earlier death that forces unprepared entry into the bardo state can be more dangerous. This is so as the person might quickly follow karmic inclinations then, to be reborn elsewhere. (See  below too.)
 Having unreasonable life support that causes much pain and discomfort can hamper Niànfó, which can be more dangerous. This is so as strong negative emotions provoked might lead to a negative rebirth. (See  above too.)
 It is difficult to know in advance what emergency one might have, and thus what kind of life support will be offered then, be it  or , reasonable or unreasonable. If uncertain on deciding in advance now, on whether to have life support or not later, it is best to follow the advice in bold above, for focusing on preventive measures.
Should There Be Plugging In To Life Support?
How Long Should One Be On Life Support (With Ventilator & Tube Feeding)?
Should Those ‘Brain Dead’ Be Unplugged?
Section : Considerations On Life Support & AMD
How To Urge Family Of Those On Life Support To Offer Guidance And Support-Chanting?