ACP Frequently Asked Questions

1. Is the Advance Care Planning form legally binding?

The Advance Care Planning form is not a legal document, it can be regarded as a statement of the patient’s wishes and preferences. It is not to be blindly followed, but serves to guide decision making in the event that the patient cannot communicate his wishes, so that the treatment is aligned with patient’s values and goals.

2. What is the difference between Advance Care Planning (ACP) and the Advance Medical Directive (AMD)?

Advance Care Planning (ACP) is not a legal document. It is an on-going communication process to help patients make informed decisions regarding future healthcare wishes.

An Advance Medical Directive or AMD (made in accordance with the Advance Medical Directive Act) is a legal document that one completes stating that one does not wish to receive extraordinary life-sustaining treatment in the event of terminal illness (impending death). One can make an AMD and also undergo the advance care planning process. The existence of an Advance Medical Directive should be documented during ACP discussions. To find out more about an Advance Medical Directive, go to https://www.moh.gov.sg/policies-and-legislation/advance-medical-directive.

3. What is the relationship between an Advance Care Planning (ACP) and Lasting Power of Attorney (LPA)?

Both are important pre-planning instruments. The Lasting Power of Attorney (LPA) is a legal document which allows a person to appoint a proxy called a donee to make decisions on the patient’s behalf should the patient lose mental capacity. The powers granted via a Lasting Power of Attorney covers two broad areas: personal welfare matters (which includes healthcare decisions) as well as property and affairs matters.

Advance Care Planning (ACP) complements the LPA by allowing patients to express their values and preferences in relation to future healthcare needs. This will help the appointed donee(s) to make decisions in their best interests.

4. Why should patients document their care preferences?

The patient’s documented care preferences will be used to guide their legally appointed proxy decision-maker(s) or donee(s), next-of-kin and healthcare professionals in making care and treatment decisions when the patient has lost decision-making capacity. Having something in writing helps serve as a reminder, support and guide for their loved ones during times of crisis, on what matters to the patient, and what had been previously discussed with the patient and the healthcare team. This can reduce the stress and uncertainty around decision-making.

5. Who is present during Advance Care Planning facilitation and how long does each session last?

The Advance Care Planning facilitator, the patient as well as the patient’s loved one or Nominated Healthcare Spokesperson (if possible). ACP sessions are important opportunities for facilitators to bring patients, their loved ones and the healthcare team “onto the same page” with regards to patients’ care preferences and goals. If the patient has lost decision making capacity, Advance Care Planning can be conducted with the patient’s loved ones.

The patient’s physician may be involved to address queries regarding the patient’s medical condition. Each ACP session may last between 30 minutes to 1.5 hours, and more than one may be needed. The ACP document can also be changed over time as the patient changes his/her preferences or his/her medical condition changes.

6. When will my doctors act on the decisions in my Advance Care Plan?

Your preferences may be used to guide your healthcare team if you are no longer able to make decisions for yourself. As long as you have the mental capacity to make decisions, you will be consulted upon for your consent on receiving or ending treatment.

7. Why is there a need for training and certification for facilitators? Besides the facilitator, can the Advance Care Planning form be filled by other healthcare workers e.g. nurses and Doctors?

An Advance Care Planning facilitator can be any suitably trained healthcare professional such as a doctor, nurse, social worker, case manager or care coordinator. ACP can be complex and resource intensive and there is a need to equip facilitators with requisite understanding and skills to conduct a structured discussion in a consistent manner. This ensures that the ACP documents can be trusted as accurate reflections of patients’ wishes and preferences.

8. What if relatives of patients disagree with the contents of the Advance Care Planning form when the patient is incapacitated from making decisions?

As far as possible, such a scenario should be avoided by involving the patient’s loved ones in the ACP discussions. Should such a situation arise, it is the ethical imperative of the medical team in-attendance to honour the patient’s wishes unless there are reasons to believe the patient’s wishes have changed. At all times, communication channels should be kept open and the medical team in-attendance should act in the patient’s best interests. Where need be, the ethics committee of the hospital should be consulted.