Why conversations about Advance Care Planning are a boon
With lifespans getting longer in Singapore, it is becoming increasingly important to think ahead
AS MY parents aged and developed health conditions, the conversation on their care preferences became inevitable. Such situations are where Advance Care Planning (ACP) comes in handy.
It is no wonder, then, that the Monetary Authority of Singapore included ACP as one of the estate planning tools – which include wills, lasting power of attorney and Central Provident Fund nomination – in its Basic Financial Planning Guide.
Launched in 2023, the guide helps Singaporeans take steps to enhance financial well-being.
The importance of planning ahead with ACP is now greater than before, as Singapore residents are enjoying longer lifespans. This year, Singapore moved from an aged to a super-aged nation, which is when 21 per cent or more of its population is aged 65 and above.
But a longer life does not automatically translate to longer healthspans for everyone.
No one knows what the future holds. You can try to stay in the pink of health, but cannot predict what may unfold in the future. However, you can plan ahead to make your wishes known.
What ACP is and why it matters
ACP is about putting your values and preferences for your future health and personal care into words.
In the event that you cannot make decisions or speak for yourself, ACP will help your loved ones, caregivers and healthcare team act in your best interests, based on your personal values, beliefs and wishes.
It explores how your values affect your healthcare preferences in difficult medical situations. For example, would you prefer more aggressive treatment to prolong life, or comfort-focused care, especially if further aggressive treatment will not reverse the medical condition?
ACP allows you to choose up to two nominated healthcare spokespersons (NHS). In the event of a serious medical emergency where you are not able to speak for yourself, your NHS can do so.
The ACP conversation therefore gives you the chance to think ahead, and lets your loved ones know your wishes. It is a care plan that you make in advance, exploring what you want or might not want in your medical care.
Doing so reduces the stress faced by family members and caregivers in deciding on your care if you cannot do so.
In addition, ACP reduces the possibility of high medical bills that would be incurred from life-sustaining treatment that you might not want.
My parents’ case
My father, aged 89, died in December 2024 of renal failure. Six months before he died, his doctor advised that he should have an ACP conversation with a trained facilitator. My brother and I were appointed by my father as his NHS.
During the 45-minute session, the facilitator explored what living well meant to my father, his care preferences and how he would like to spend his last days. My father opted for palliative care and indicated his preference to die at home.
Looking back, it was an emotional exercise, albeit a necessary one. No one wants to talk about the end. But it really helped, as I didn’t feel the burden that I might be doing something wrong. I could care for my father in the way he wanted.
A year later, we had another ACP conversation; this time, it was for my mother.
From the conversations, my brother and I had a better understanding of what our parents prefer in terms of healthcare treatment, particularly in life-threatening situations. Doing so gives us more confidence that we would get to fulfil their wishes with peace of mind.
ACP versus AMD
Both ACP and Advanced Medical Directives (AMDs) are made on a voluntary basis.
ACP covers a broader range of decisions related to your personal care and healthcare, while an AMD is a legal document that you sign in advance to inform your doctor (in the event you become terminally ill and unconscious) that you do not want any extraordinary life-sustaining treatment to be used to prolong your life.
ACP involves a NHS, whereas an AMD can be used only when you are terminally ill, require life-sustaining treatment, and are unconscious or unable to exercise rational judgement.
How to complete an ACP
There is no charge for completing ACP. Start by reflecting on what you want in terms of quality of life and the medical treatment you are comfortable with.
When choosing your NHS, be mindful that the individual should be:
- at least 21 years old;
- respectful of your wishes;
- able to make decisions under stress;
- contactable during emergencies; and
- able to communicate effectively with healthcare teams.
You can record your digital ACP by logging in to My Legacy portal via Singpass. If you prefer face-to-face support, you may book an appointment with an ACP facilitator from government-appointed providers across Singapore.
You may visit the Agency for Integrated Care’s website for ACP partners. Your ACP will then be registered in National Electronic Health Record post-discussion with your facilitator.
Review your ACP at significant life stages to reflect your most current preferences. You may make changes to your ACP as long as you have mental capacity. Do update your NHS of any changes.
ACP is a gift for our loved ones, enhancing individual and family satisfaction by reducing stress, as well as helping us and our loved ones prepare for future decisions.
The writer is head of financial planning literacy at DBS
