I touch on the difficult topic of end-of-life care.
It’s important to plan this well so that when we lose our mental capacity to make decisions, someone who knows our wishes can execute them.
There are two important documents to get done – Lasting Power of Attorney (LPA) and Advanced Medical Directive (AMD).
The first is the Lasting Power of Attorney, or LPA for short. With the LPA, you (donor), appoint one or more donees (executors) to make decision on two critical areas:
- Personal welfare: such as where you should live, medical treatment
- Property and affairs: such as operating bank accounts, paying household expenses
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Possible complications:
- Whether the Executor (s) know what you want?
- A family member is not automatically given the right to make legal decisions should you lose mental capability. This can hinder their ability to care for you.
- If there are 2 executors, you have to decide whether they act jointly or severally
- Make sure the LPA is certified by any one of these:
- Medical practitioner, or
- Lawyer, or
- Psychiatrist
- Ensure that the doc is submitted to the Office of the Public Guardian (OPG), and note that the LPA is only registered after three weeks when there are no objections
- The LPA must be submitted within six mths of the donor signing.
Here’s the form: LPA_Form_1_2020.pdf (msf.gov.sg).
The second document is the Advanced Medical Directive or AMD. This directs the doctor (if you are terminally ill or unconscious) on how to treat you, medically.
Why’s this important?
In an unconscious state, the doctor may put you on a respirator which prolongs life unnecessarily.
I’ve seen this first-hand, the difficult the decision that must be made, not just by the doctor but also your children and closest family who would want the best treatment in the hope that medicine catches up with the disease.
What to do with the AMD:
- The form must be submitted through a doctor
- There has to be two people to witness : whilst one can the doctor, the second can be the nurse (it’s to ensure that you are not being forced into making the AMD)
- Only valid if it’s registered with the Registrar of Advance Medical Directives at Ministry of Health.
This is to allow doctors not familiar with you to check your wishes at an official Registry.
Possible complications
It’s important to understand that the AMD is just a directive and lacking in many aspects.
Here are two examples:
- Should a patient that is unconscious, say from a stroke, continue to be kept alive through a nasogastric (nose to stomach) feeding tube when their brain cells have died?
- Family discord and break-up when patients who suffer mental illnesses such as Alzheimer’s present long-term symptoms, not to mention financial burden.
In these cases, and outside the AMD, it is important to make your wishes clear. For me after the experiences that my parents went through, I would not want to be ‘kept alive’ when I no longer have my mental capabilities. In this respect, it is a pity that euthanasia or mercy-killing is not legal in Singapore. In my opinion, it is time for the parameters of the AMD to be relooked at.
The form can be downloaded here: form1amd(270905).pdf (moh.gov.sg).
