Advance Care Planning and Other Care Plans

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We all share a desire to live life on our own terms, regardless of age. That includes being able to make our own lifestyle and healthcare choices. But what happens if we lose the mental capacity to make decisions for ourselves?

If you have a care plan in place, you’re more likely to get the future care you want.¹ With Advance Care Planning (ACP), Advance Medical Directive (AMD) and Lasting Power of Attorney (LPA), you can actively plan ahead to ensure you receive care that is aligned with your preferences and beliefs, especially in the event of mental incapacitation. In this article, we’ll break down the process into easy-to-follow steps, and share some essential resources to help you get started.

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What is Advance Care Planning (ACP)?

ACP refers to the process in which you plan for your future medical and personal care arrangements.

It involves two important parts:

Initiating ACP conversations with your loved ones or healthcare providers, where you communicate your personal beliefs and values, and explore how these may influence your care preferences and treatment decisions under different medical scenarios.
Nominating someone you trust to be your Nominated Healthcare Spokesperson (NHS). The NHS will have the ACP conversations with you and will make decisions on your behalf, in the event that you are in a medical crisis and unable to communicate your thoughts.

The ACP conversations are documented to provide guidance for your caregivers and medical team in delivering care options that are consistent with your wishes. It is activated upon the loss of your mental capacity.

Who Is ACP for?

ACP is for everyone. Unforeseen events like sudden illness and injury can happen to anyone, so it’s always a good idea to be prepared, regardless of age or health status.

For those living with chronic health conditions or degenerative diseases such as early-stage dementia, ACP can offer peace of mind by ensuring that their preferences and wishes for future medical treatment and care are known and respected.

Why is ACP Important?

If you lose mental capacity, ACP empowers you by allowing you to participate directly in decisions about your future health and personal care. It also serves as a guide for your healthcare team in better decision-making when it comes to future healthcare preferences. For example, how aggressive or comfort-oriented your medical treatment should be.

Furthermore, ACP helps to relieve your loved ones from the burdens of decision-making, freeing up more time for them to support and spend with you.

The ACP Process

There are five simple steps involved in creating your ACP successfully.

1. Think About What Matters Most to You

Consider what values and beliefs are important to you, and explore how they may shape your healthcare preferences.

If you need some help with the thought process, we recommend using the ACP Workbook. Inside, you’ll find useful prompts to guide you in the right direction. The workbook can also double up as a document to record your reflections and healthcare wishes.

2. Choose Your Nominated Healthcare Spokesperson (NHS)

Your NHS has the crucial role of representing your views and preferences for scenarios that were unplanned for. Pick someone you trust to act in your best interests. He/She should also ideally be:

At least 21 years old
Willing to speak on your behalf
Able to hold honest and open conversations with you
Someone who understands you well. Usually a kin or close friend
Respectful of your concerns, wishes and care preferences

You may nominate up to two NHS, as long as both parties agree on what your preferences are.

3. Speak with Your NHS

Discussing sensitive topics such as end-of-life care with someone can be a daunting experience. However, it's important to remember that planning for the future is a natural part of life and you shouldn't hesitate to have that conversation.

Here are a couple of gentle conversation starters you can consider using:

Plan ahead for the future

“Right now, I’m healthy, but I want to be prepared for a sudden decline in my health. Let's talk about how we might handle that situation.”

Share a personal experience

“I was thinking about what happened to Auntie Theresa. Can I tell you how I want to be taken care of if I get really sick like her? Will you be willing to make decisions for me based on what I want?

4. Document Your ACP

This step is vital as it allows your healthcare team and loved ones to gain access to your ACP. There are several ways to complete your ACP documentation.

If you are a patient at a polyclinic or hospital, you may request a session with an in-house ACP facilitator. Alternatively, you may choose to book a session with a community ACP facilitator near you. Individuals with limited mobility who prefer to do via an online session can inquire about Tele-ACP services here.

The ACP facilitator will take you through their version of the ACP Workbook, and submit your ACP to the National Electronic Health Record system, as well as make a copy available to you.

You can proceed to print copies, or email it to share the document with your kin.

The process of ACP is free, although some providers may charge a nominal fee for facilitating an ACP, so do ask about any fees in advance.

5. Review The ACP

The ACP is an ongoing process and should be regularly reviewed and documented to stay relevant, especially when there are changes to your medical condition or your life goals and decisions. You may continue to edit it as long as you have mental capacity.

Additional Resources to Help You Plan Ahead

While important for future care planning, the ACP is not a legally binding contract so it does not require a lawyer. Its primary purpose is to promote conversation, and guide your caregivers in making decisions that align with your best interests.

If you wish to explore legally binding ways to plan ahead, you may consider the following legal documents.

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Advance Medical Directive (AMD)

AMD is a legal document that you can sign to indicate that you do not want extraordinary life-sustaining treatment, in the event you become terminally ill. It is activated under the triple conditions of a terminal diagnosis, the loss of your mental capacity, and the need for life-sustaining treatment.

Who is AMD for?

Individuals who are 21 years old and above, and have decision-making mental capacity can make an AMD.

How Do I Make an AMD?

You will need to:

Obtain and complete the AMD form, which is available at clinics, polyclinics, hospitals or for download here.
Consult a doctor, and bring along a witness who is at least 21 years old. Both the doctor and witness need to be present for the signing of the AMD form. The doctor will check and certify that you have mental capacity, and are willing and able to understand what it means to sign the AMD form.
Mail or submit the completed form by hand to the Registrar of Advance Medical Directives at Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854.

Making an AMD is a voluntary decision. If you wish to, you can get your AMD witnessed and certified by doctors from NTUC Health Family Medicine Clinic, at a fee of $45.00. Make an appointment here to see a qualified doctor who will guide you through the AMD process, and ensure that you understand the implications before signing it.

What to do if I change my mind after making the AMD?

An AMD can be revoked at any time in the presence of at least one witness. This can be done by either completing a standard form for revocation of an AMD or by writing to the Registrar of AMD.

Lasting Power of Attorney (LPA)

The LPA is a legal document which enables you ( known as the "Donor") to appoint one or more persons (known as "Donees") to make decisions and act on your behalf if you lose mental capacity. Both the Donor and Donee must be aged 21 or above.

What Can the Donee Do?

The Donee is granted the legal right to act in two areas - personal welfare, and property and affairs. Examples of personal welfare matters include decisions about your living arrangements, daily activities, social interaction and healthcare treatment; whereas property and affairs matters include your taxes, investments, central provident fund (CPF), property and bank account management.

We recommend designating the same person as your Donee and your Nominated Healthcare Spokesperson, as both roles require a deep understanding of your personal values, beliefs, and preferences. Having one person making decisions on your behalf, will make the process conflict-free and less complicated.

Why Is the LPA important?

Without an LPA in place, a court order must be obtained to manage your affairs if you become mentally incapable. This can be a long-drawn and costly process.

In addition, you won’t have a say in who your court-appointed representative will be. With an LPA, this hassle is avoided, and you can choose a trusted person to act in your best interests.

How Do I Make an LPA?