With Advance Care Planning, Your Loved Ones’ Care Wishes Matter
Imagine a time when your senior loved ones are unable to make care decisions on their own. As their caregiver, you will be in a difficult situation as you have to second-guess what care options they would have preferred, and you must make tough decisions with little time to spare.
Such scenarios are all too common, especially when caregivers and their loved ones have not planned ahead and discussed their care preferences while they are still able to. In the event that the loved ones need care help and are unable to communicate, the caregivers may find it challenging to make a care decision for them.
This is why advance care planning is so important.
In “You Ask, We Answer”, Tan Shen Kiat, a Succession, Trusts, Estate and Mental Capacity (STEM) lawyer, gives insights into advance care planning and how to begin the process.
Mr. Tan Shen Kiat
Director - Kith & Kin Law Corporation
Specialist Solicitor in Succession, Trusts, Estate and Mental Capacity practice (“STEM Law”).
Shen Kiat is a Volunteer Lawyer with Law Society Pro Bono Services . His areas of specialty are advance care and estate planning issues. He advises and assists clients on the preparation of lasting powers of attorney under the Mental Capacity Act, including those for seniors. His work occasionally involves house-calls or hospital visits, where he is sensitive and empathetic to clients’ needs.
1. What is Advance Care Planning (ACP), Lasting Power of Attorney (LPA), and Advance Medical Directive (AMD)? What are the differences between them?
Answer:
Here is a look at the three documents:
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| An ongoing conversation that helps your loved one decide on future care options. He/she can nominate someone, such as his/her current or future caregiver, appointed in the LPA, to make any medical decisions on his/her behalf. Your loved one's wishes will be documented in an ACP document, which can be updated anytime. |
The appointment of one or more decision-makers (known as donees) on your loved one's behalf if he/she loses mental capacity. The donee will act on your loved one's behalf in matters relating to personal welfare and/or property and affairs. | A legal document that your loved one signs in advance, stating his/her preference not to have extraordinary life-sustaining treatment in the event that he/she becomes terminally ill and unconscious. It is a confidential document; hospital staff are not allowed to ask the patient if they have made an AMD. Such info can only be released by the Registrar of Advance Medical Directives upon request. |
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 Takes effect when your loved one loses the capacity to make decisions. |
 Takes effect when your loved one loses the capacity to make decisions or is terminally ill. |
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| A roadmap to guide the appointed decision-maker on making care decisions on your loved one's behalf based on his/her preferences. | The appointed donee can make lifestyle-related decisions for your loved one such as where to live, what social activities to engage in, who to socialise with, as well as health matters. Donees can also help to make decisions on property and financial matters. |
If your loved one faces the possibility of extraordinary life-sustaining treatment, an active AMD will override the decision-making powers of any appointed personal welfare donee. |
While each serves a different purpose, they all seek to communicate how your loved ones wish to be cared for. If your loved ones have an LPA and/or AMD, do include them in the ACP discussion. Ideally, your loved ones should appoint the same person or persons in the ACP and LPA, to avoid potential disagreements when they make care decisions on his/her behalf.
How do I or my loved ones start Advance Care Planning?
Answer:
You or your loved ones can start the process by downloading the ACP workbook from the AIC website. Alternatively, you can visit any of the ACP centres around Singapore.
3. Can two people be appointed through the Lasting Power of Attorney (LPA)?
Answer:
Yes, your loved ones can appoint up to two donees and one replacement donee in the most basic LPA (also known as “LPA form 1”). Each donee can be authorised to make decisions about personal welfare and/or property matters.
The more complex LPA (also known as “LPA form 2”) gives you room for further customisation based on specific needs. Your loved ones are legally required to appoint a lawyer specialising in mental capacity law when making an LPA (form 2).
If your loved ones have more than one donee, they have to indicate whether the donees are to act:
- Jointly (donees have to act together, cannot act separately); OR
- Jointly and Severally (donees can make decisions together or independently)
How can an LPA or AMD be terminated?
Answer:
Your loved ones can terminate or revoke an LPA at any time by signing a revocation form and notifying the Office of the Public Guardian (OPG) and the donee.
If your loved ones wish to terminate or revoke an AMD, they need to complete the AMD Form 3 and it must be witnessed by at least one person.
Alternatively, your loved ones or the witness could write to the Registrar of AMD with the following information:
- The names and NRICs of the person revoking the AMD and the witness, along with their addresses, and home and office telephone numbers.
- Time, date, and place where the revocation was made.
- If the letter is written by the witness, the method of communication (in writing, orally, or using sign language) used to communicate your loved ones' intention to revoke the AMD.
Caregiver Forum 2020 (Postponed until further notice)
Shen Kiat will be sharing more at the Caregiver Forum 2020 on later care planning. His session covers advance care, and financial and legal matters, for persons entering the later stages of their lives.
The Caregiver Public Forum 2020 is co-organised by Agency for Integrated Care (AIC) and National Council of Social Service (NCSS), to provide caregivers with more insights into family roles in caregiving, and how to handle family dynamics.
