10 things to know about pre-planning

Dr Cheah: Anyone with family and assets can consider pre-planning in case of untimely illness or demise. Young people who have experienced near death events frequently feel the need to discuss end-of-life plans.

Dr Ong: Anyone with a sound mind and who has clear ideas of how EOL should be for himself or herself should consider doing this. Planning ahead can provide peace of mind to your loved ones and help them to better carry out your wishes. At the same time it reduces the administrative work and legal costs for them during that difficult time.

Dr Ong: It is still taboo to discuss end of life here in Singapore, especially when one seems hale and healthy. In my prior capacity as a doctor, I generally gave patients who were not too comfortable with the notion time and space to think about it before broaching the topic again.

Dr Cheah: Some people would rather be oblivious than to face reality. Some elderly who are diagnosed with cancer still have their children requesting for the truth to be hidden from them. Being in the hospital is actually a wakeup call for you to start your EOL planning if you haven’t already done so.

Dr Cheah: Pre-planning is not just important for you, but for your loved ones as well. Planning how you want to live and how you want to die helps your loved ones make the difficult decisions for you when you no longer have the capacity to decide.

Dr Ong: It is most relevant to anyone who has been diagnosed with a terminal or life limiting illness, and where all forms of treatment have failed. However, it is also relevant for healthy individuals, as there are many possible causes of sudden unexpected mortality, or loss of mental capacity.

Dr Cheah: The biggest hurdle is to face the fact that we are all mortals. We are all fearful of dying and we are also fearful of being left alone when our loved one dies. We have to accept that our time will come, and that it is prudent to make appropriate plans for the benefit of our loved ones.

Dr Ong: In my prior capacity as a doctor, I felt the hardest part of this was being able to make informed decisions about medical treatment options. Advancements in medicine make this very technical, and there are often no clear cut decisions.

Dr Ong: You can facilitate the process, but it’s important that the person participates. This is because pre-planning plans should reflect his or her beliefs and intent. If they are not familiar with the areas to make decisions for, efforts should be made to explain in a medium /language that suits them, so that they can make informed choices.

Dr Cheah: A person who has no mental capacity, for example a person with advanced dementia or one with severe intellectual disability, will not be able to sign the legal documents. A person with special needs will be assessed for his/her mental capacity to make decisions. Otherwise a deputy has to be legally appointed.

Dr Cheah: There are ways to revoke your documents and revise your documents when circumstances change. You can revoke your LPA by informing the Office of Public Guardian (OPG), and pay a cancellation fee. You need to complete the revocation form, inform your donee in writing, and reapply for a new LPA.

Dr Cheah: Patients are worried that they will be denied proper medical care if they sign their AMD. Some are afraid that they will trouble their children when they no longer have mental capacity, and lose their independence. Similarly, some worry that they may pick the wrong person to decide on their behalf.

Dr Ong: Whether they have ensured that their loved ones, especially dependents, are taken care of, mostly financially. Sometimes they also worry about milestone events, for instance their children’s graduation, wedding ceremony, and so on. In addition they may also be concerned about the actual end-of-life moment, whether there will be suffering, such as breathlessness and pain. They also worry about whether their continued treatment will affect their family and be a burden to loved ones.

Dr Cheah: As of 31 May 2023, the Office of the Public Guardian has received more than 220,000 LPA applications, with 77% made by donors aged 50 years old and above. Since the launch of the Office of the Public Guardian Online (OPGO) system in November 2022, more than 57,000 LPA applications have been submitted online. As of 31 May 2023 too, more than 36,000 unique individuals have completed their ACP.

Dr Cheah: I truly appreciate it when a family comes together and tells me exactly what the patient wishes for. For example I had a patient who did not want to have an artificial feeding tube or breathing tube. We worked together with his family to allow a gradual and natural process of death with dignity in his own home. I also fulfilled a patient’s wish to die at home at the ripe old age of 99 years old, with a fully supportive family. There were no arguments at the final stages, and it was very peaceful.

Dr Ong: In my prior capacity as a doctor, I had a patient who was brought in unconscious after a heart attack. Upon admission, it was revealed that an LPA had been done. This made the treatment process more efficient as there was only one nominated person making all the medical decisions.

There was another case where the patient developed relatively early onset dementia. With an LPA done, the patient’s spouse was able to quickly identify the bank accounts, insurance policies and investment plans as he had also had an asset list done up. Hence she was able to administer his financial affairs for him. The family was thankful that they did not have to spend months applying for deputyship while having immediate bills to pay for.