Start thinking of that chat you should have with your loved ones: Planning for your future health and personal care when you’re unable to do so for yourself. Knowing what you want, and have that set in place, will take the burden off them, who might otherwise be left with having to decide on life-and-death issues on your behalf. After all, you know yourself best.

Adj Asst Prof David Sim, Senior Consultant from the Department of Cardiology at Singapore General Hospital and Ms Sumytra Menon, Senior Assistant Director fro​m the Centr​​e for Biomedical Ethics,​​ give detailed answers​​​ to your questions.

Question by healthblur

What safeguard and guarantees do I get that my advanced care directive is interpreted correctly and applied properly ? How complicated is it to understand properly?

Answered by Adj Asst Prof David Sim, Senior Consultant, Department of Cardiology, Director, Heart Failure Programme, National Heart Centre Singapore

The advance care plan (acp) is drawn up after a series of conversations between yourself and the acp facilitator. The person (family or friend), who can represent you when your unable to speak for yourself, would also be invited to these conversations. Besides the acp document, your substitute decision maker would be aware of your treatment preferences and ensure that your plan is interpreted correctly. We also encourage our participants to discuss their plans with their doctors so that he/she is well informed.

Question by hui2ng

Is it correct to say that be it ACP, AMD, or LPA, the doctor still have the final say/decision, acting in the best interest of the patient ? Eg, if the ACP states that patient does not want CPR, intervention, but doctor goes ahead, is this ok ? What if vice versa ? patient wants full treatment, but doctor recommends no intervention ...Thanks

Answered by Adj Asst Prof David Sim, Senior Consultant, Department of Cardiology, Director, Heart Failure Programme, National Heart Centre Singapore & Ms Sumytra Menon, Senior Assistant Director, Centre for Biomedical Ethics, NUS YLL School of Medicine

Yes, we should ​get the doctors and other healthcare professions involved in helping your parents to start sharing their preferences. There are likely to be forms in other languages. If there are none available, yes, you can help them complete the forms. It is valid as long as the patient agrees to what is written on the form and signs it. It may be a good idea to complete these forms in the presence of your healthcare professional.

Here are the details to:

Make a ​LPA​

Make an Advance Medical Directive under the Advance Medical Directive Act​

Reposted by administrator

Hello! My parents do not seem to understand the importance of sharing with my brother and me, on the kind of medical (or home care even) they’d want for themselves – just in case they are ever in a situation that they are not able to decide or care for themselves.

  1. What is a good way to start them thinking and should I get help from their respective physicians?
  2. Also they are not fluent in English and cannot fill up forms by themselves – my brother and I are the ones who usually help with those sort of things. If there are forms to fill, and we do it for them, will they be valid? Do we need a witness?

Thank you.

ATan

Answered by Ms Sumytra Menon, Senior Assistant Director, Centre for Biomedical Ethics, NUS YLL School of Medicine

Maybe, sorry I can’t give a clear answer because it depends on the circumstances. Doctors would prefer to honour a patient’s wishes but the doctor in Australia is unlikely to have a pre-existing doctor-patient relationship with your mother. Therefore, he/she will act cautiously before deciding whether to follow the ACP. Depending on which jurisdiction you’re in Australia, one option is to explore the options for making an ACP in Australia. It may also be prudent for your mother to have a regular doctor in Australia, so you can set up an ACP there also.

Reposted by administrator

Dear Ms Menon

I recently had a lasting power of attorney drawn up. Will this not cover everything I need my son to do for me in the event I cannot make any health-related decisions on my own? It seems that there are just too many forms to fill up.

Thank you!

db_mosen54

Answered by Ms Sumytra Menon, Senior Assistant Director, Centre for Biomedical Ethics, NUS YLL School of Medicine

First, it depends on what type of LPA you made. It has to be an LPA for personal welfare where the donor (you) specifically authorised the donee (your son) to make healthcare decisions on your behalf. If you have such an LPA, it does not allow your son to make decisions relating to life-sustaining treatment or treatment to prevent a serious deterioration in your health. For those serious medical decisions, the final decision-maker is the doctor. However, the doctor must consider the views of your son when making a decision in your best interests. Making an ACP is helpful because it allows you to express your values and preferences for healthcare. This will help those making decisions that are aligned with your values and preferences when you lack capacity in the future to make those decisions yourself. This will help alleviate the burden on your loved ones at a critical and difficult time.

Reposted by administrator

Hi doctor! Is organ donation part of an advanced medical directive (AMD)? And can I change my mind after I apply for an AMD? If I happen to be unconscious and a medical decision needs to be made, who has the final say please – my family or the doctor?

Thanks & regards.

vesper_ak

Answered by Adj Asst Prof David Sim, Senior Consultant, Department of Cardiology, Director, Heart Failure Programme, National Heart Centre Singapore & Ms Sumytra Menon, Senior Assistant Director, Centre for Biomedical Ethics, NUS YLL School of Medicine

The AMD made under the AMD Act has to do with withdrawing extraordinary life-sustaining treatment when someone is terminally ill and at imminent death. Yes, you can change your mind after you have made one. Read here about how to revoke your AMD. The Human Organ Transplant Act covers organ donation. Singaporeans and PRs, who do not wish their organs to be harvested when they eventually die may opt-out by completing the appropriate form. On who has the final say if you do not have capacity to make your own healthcare decisions, if you have an AMD made under the AMD Act, then if all the conditions are fulfilled, the doctor will carry out your AMD and no one can interfere with that decision. If you have an LPA, and have appointed a personal welfare donee (authorised to make healthcare decisions), then this person decides for non-serious medical decisions but the doctor makes the final decision on serious medical decisions but after having considered your past and present wishes, those of your loved ones and any other relevant information to make a decision in your best interests. The doctor would usually honour a patient’s preferences expressed in an ACP unless there is a very strong reason not too (see answer above).

Reposted by administrator

Dear specialists

My aunt’s kidney condition recently got worse. She also has diabetes and she has been in and out of hospital because she fainted a few times and has become breathless too. We would like to help my cousin manage this situation but she sa​ys her mother sometimes doesn’t seem very clear-headed. My cousin is worried that whatever her mother tells her now may not really be what she (the mother) wants. Is it too late to put a care plan in place? What is required? Thanks!

Zacmeister

Answered by Adj Asst Prof David Sim, Senior Consultant, Department of Cardiology, Director, Heart Failure Programme, National Heart Centre Singa​​pore

Advance care planning is a series of conversations to discuss the patient’s treatment preferences and wishes. The plans can be revised as the condition progresses. In this case, as you are worried about your aunt’s mental capacity and her understanding of her condition and treatment/care options, it would be ideal to have your cousin discuss with her mother’s renal physician and advance care planning facilitator to address these concerns. An advance care plan could be drafted after those issues are established.

Question by alasquera

What is the true relevance of advance care planning given that it is non-legal and decisions made can be changed any time in accordance to different situations?

​Answered by Ms Sumytra Menon, Senior Assistant Director, Centre for Biomedical Ethics, NUS YLL School of Medicine

It allows patient’s, their chosen loved ones and the healthcare practitioner to discuss the patient’s values and preferences for health care. This is a broader and more holistic discussion that will help guide the individuals making decisions on your behalf when you no longer have the capacity to do so.

Ref: Q15