Lasting Power of Attorney (LPA) and the ways to plan ahead for your future care, as explained by the Centre for Biomedical Ethics at Yong Loo Lin School of Medicine, National University of Singapore (NUS).
What is a Lasting Power of Attorney (LPA)?
A lasting power of attorney (LPA) is a type of advance directive that allows you to legally appoint one or more individuals to make decisions and act on your behalf if you are mentally incapacitated. This legal document is made under the Mental Capacity Act in Singapore.
Anyone who is 21 years old and above, and has the mental capacity to make an LPA, is eligible to make one. The legal term for the person who makes the LPA is a donor and the person who is appointed is known as the donee. A donor can appoint one or more donees to act in one or both of the following areas:
- Personal welfare and healthcare
- Property and affairs
Your donee should be at least 21 years old and someone who you believe is trustworthy, reliable and competent to make decisions for you.
“The LPA only kicks in when the donor loses capacity to make a decision,” says Ms Sumytra Menon, Senior Assistant Director, Centre for Biomedical Ethics (CBmE),
Yong Loo Lin School of Medicine, National University of Singapore (NUS).
In the case of patients who have fluctuating mental capacity, for example, patients with mild dementia, an effort is made to allow them to make their own decisions during their periods of lucidity.
“We have an obligation to try and enhance the person’s ability to take decisions,” says Ms Menon. “For example, there are patients who are lucid in the morning but hazy in the afternoon and evening. The effort should be to get them to make a decision in the morning when they are lucid,” she adds.
While a donee is empowered to make basic healthcare decisions on behalf of the donor, a donee cannot make decisions on life-sustaining treatment or treatment to prevent a serious deterioration in the donor’s health. The doctor is the final decision-maker in this case, and has to make this decision based on the patient’s best interests. If the patient made an ACP earlier, the doctor will refer to the ACP, and where possible consult with the patient’s loved ones, when making this decision.
Step-by-step method to create a lasting power of attorney
- Select the donee(s) and the powers you want to give to them.
- Download the relevant LPA forms – LPA 1 or LPA 2 and application form – from the website of the Office of the Public Guardian (OPG) in Singapore. Fill the forms out carefully.
- Get the forms signed by an LPA certificate issuer and submit them to the OPG via post. A list of LPA certificate issuers is available on the OPG website.
- Once your form has been received and verified, you will be advised about the payment. The LPA is free for Singaporeans but PRs and non-Singaporeans have to pay S$50.
- The LPA is registered after a six-week mandatory waiting period
“For a personal welfare LPA, you have to select the healthcare option if you want someone to be responsible for your healthcare decisions,” says Ms Menon. You can revoke or terminate an LPA at any time by signing a revocation form and notifying OPG and your donee.
Differences between ACP, AMD and LPA
Advance Care Planning (ACP) is an ongoing communication process to help patients indicate their healthcare preferences for future medical care and treatment. The advance care plan that is the outcome of this communication, is not legally binding.
An Advance Medical Directive (AMD) and Lasting Power of Attorney (LPA), on the other hand,
are legal documents, which can operate together and be part of the ACP process. If you have an AMD and LPA, they should be recorded during ACP discussions. You can choose to have one or two of these advance directives or all three – it’s a personal choice. Each directive fulfils a different purpose. It is advisable to appoint the same individual in your ACP and LPA to make healthcare decisions on your behalf. If there is more than one proxy decision-maker, they may disagree and struggle to come to a decision on your behalf.
“Ideally, you should have one person for both,” says Ms Menon, “If there is more than one, they should be in agreement about what your preferences are.”
Ref: Q15
