Demystifying Advance Care Planning (Singapore Edition)
Updated: Jul 18
Advance Care Planning (ACP) is an important part of preparing for one's Last Mile of Life. But what exactly is it, how much does it cost and what's the difference between ACP, Lasting Power of Attorney, Advance Medical Directive and other Last Mile of Life-related documents?
In this article, we explain the differences and give you a big picture overview of why ACP is important and how to get it done.
What is Advance Care Planning?
Advance Care Planning (ACP) is the process of planning for your future healthcare options. It is non-legally binding and completely voluntarily. The objective of an ACP is to allow you to have a say in your healthcare when you no longer have mental capacity.
In essence, ACP consists of having a conversation with your family and doctors on your goals, values and beliefs, to help them understand your preference towards future healthcare treatments. Your preferences will be documented and stored on the National Electronic Healthcare Record.
For example, if you are severely mentally impaired with a low chance of recovery, your individual goals and values may influence decisions regarding comfort care (types of medication given to keep you comfortable) or life-sustaining care (types of treatment to keep you alive).
In the event that you are unable to make decisions for yourself, your ACP will guide your representative, also known as your Nominated Healthcare Spokesperson (NHS), on how to act in your best interest.
Who is Advance Care Planning for?
While ACP can be done by anyone at anytime, regardless of age or healthcare conditions, ACP can be particularly important if you are frail, have a chronic illness, an early cognitive impairment, or are approaching the end of life.
Why is Advance Care Planning important?
Planning for your future healthcare options gives you the opportunity to have a say in what you want done to yourself and gives your loved ones better clarity on how to decide for you in the event that you are unable to express your own wishes.
Who should I choose as my Nominated Healthcare Spokesperson (NHS)?
At least 21 year-old;
Someone who knows you well;
Willing to speak up for your goals and values on your behalf;
Someone you trust and will act in your best interests to tell your doctors about the care you would like to receive should you lose mental capacity; and
Someone who can handle stressful situations well.
You can appoint up to two NHS. If you do appoint two NHS, make sure that they both agree on your preferences.
What's the difference between ACP and LPA?
The key difference between Lasting Power of Attorney (LPA), Advance Care Planning (ACP) and other last mile of life planning-related documents such as Advance Medical Directive (AMD) and Will is the function of the documents and whether the document is legally binding.
In the following section, we explain the differences.
LPA vs ACP
Lasting Power of Attorney (LPA) allows you to give legally binding rights to one or more persons (called donee) to make decisions for you if you lose mental capacity. The key focus here is on assigning official powers and LPA generally doesn't tell your representative what specific decisions to make with that power.
While you can include your healthcare preferences in your LPA, anything specific will need to be drafted by a lawyer, who may not be the best person to give medical advice, and it can be costly. This is where ACP comes in.
ACP helps you communicate your wishes to your loved one, who may also be your LPA donee, about the healthcare decisions you would like to make if you lose mental capacity. The key here is about communicating your preferences and the ACP document is not legally binding.
*NOTE: If you are considering or have already made an LPA, you should include your donee in your ACP discussions to ensure that your donee is aware of your wishes.
AMD & Will
An Advance Medical Directive (AMD) tells the doctor that you do not want extraordinary life-sustaining treatments used to prolong your life in the event that you become terminally ill and unconscious.
You can think of it as a legally binding document that transfers the power to decide whether to put you on extraordinary life-sustaining treatments to the doctors. The key here is that the doctors get to decide and even if your family, LPA donee or nominated healthcare spokesperson objects, the doctors are legally obligated to respect your wishes.
LPA, ACP and AMD takes effect when you are alive and can't decide for yourself. Will, on the other hand, is a legally binding document that takes care of your affairs after you pass away.
Where do I go to get my ACP done?
You can do your ACP at certain government hospitals, polyclinics, clinics and social care providers. Which provider is more suitable for you depends on your circumstances.
For example, if you are a patient at the hospital or polyclinic, you may ask your doctor for a referral.
For a list of ACP providers, click here.
How much does it cost to do an ACP?
How much it costs depends on factors such as the type of provider, whether you have a decision or require frequent consultations, etc.
For example, going to a clinic with three sessions to draft up the documentation can cost ~$300.
For a list of ACP providers on Immortalize marketplace and their estimated cost, check here.
Need help on getting your ACP, LPA, AMD or Will done?
Speak to the Immortalize Customer Service Team and we'll explain what you need to do, how much it costs to get them done and which provider is most suitable for you.
What should I do to get started on my ACP?
The Agency for Integrated Care (AIC) has provided some steps to help you get started on your ACP.
1. Think about what is important
This involves reflecting on your values and wishes so that you have a clearer and better understanding of yourself to aid you in your choices.
Using the ACP workbook can help you reflect on your views and learn about the types of care decisions involved in ACP.
2. Talk with the Nominated Healthcare Spokesperson
One of the main points of ACP is about having a conversation with the people acting as your voice in the event you cannot speak for yourself. After picking your NHS, remember to speak to them so that you hear their concerns and they understand your wishes.
3. Document your ACP
To ensure that your wishes are available to the healthcare team when needed, make sure that your ACP is documented and submitted to the National Electronic Healthcare Record. This allows your healthcare team to easily access and refer to your Advance Care Plan.
For more information on the National Electronic Healthcare Record, who has access and others, check here.
What should I do after I make an ACP?
You should take care to review and revise your plans periodically to ensure that they are up-to-date with your current wishes.
As long as you have mental capacity, you can contact your ACP provider to make any changes. It is recommended that you share any updates with your loved ones, healthcare team, and any other persons you deem relevant.
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Disclaimer: Nothing in this article or site should be construed as providing legal advice, financial advice or advice of any sort. The information provided are general in nature and may become inaccurate over time. Please consult a professional for advice.
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