Preparing for the Unknown: Why Do Advance Care Planning?
An accident or stroke could result in a loss of mental capacity. Should this happen, you will be glad you started the ACP conversation with your loved ones.
As you age, it is important to plan for future decisions about your medical care and to discuss those decisions with your loved ones. Having an Advance Care Plan (ACP) ensures that your healthcare wishes are met and avoid disagreements among family members when decisions need to be made regarding your care.
ACP is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care.
So, if a crisis or sudden serious illness strikes, the ACP is helpful in ensuring people receive medical care that is consistent with their values and preferences, says Ms Chin Shih Yuin, ACP Programme Coordinator, Division of Medicine and Inpatient Care at Sengkang General Hospital.
Ms Chin shares a case where a family with a Buddhist background whose daughter had converted to Christianity insisted her mother was a Christian believer as she had accompanied her to church. This gave rise to friction with her siblings.
“As an ACP facilitator, I encouraged the patient to share her views on religion to avoid confusion and conflict among her children. I also highlighted the fact that the patient has the right to make her own decision, and as children, they should respect their mother’s preference. The patient eventually revealed she considers herself a Buddhist as her late husband had been one, and she wanted to share his beliefs,” discloses Ms Chin.
The daughter finally accepted this, and the patient appreciated the ACP session as this had been a longstanding issue. Ms Chin is gratified that with the ACP discussion, the patient was given a chance to state her preferences and share her thoughts with her family.
Unfortunately, the topic can be sensitive as many view death and illness as taboo subjects. This makes it difficult for them to broach it with loved ones. On top of that, many are not clear as to what is involved in drawing up an ACP.
The first thing you need to do before going for an ACP discussion is to think about what you want. The following questions should get you thinking:
Do you have a firm decision for yourself in the event that you are in a critical condition?
What is the treatment option you would prefer for yourself?
Next, select a nominated healthcare spokesperson (NHS), advises Ms Chin. This person can be a family member or a friend. “This should be someone who knows you best and is able to honour and respect your decision,” recommends Ms Chin.
You may choose an ACP facilitator located near you from the My Legacy website and make an appointment with them directly.
The ACP facilitator, the patient, his or her loved ones, as well as the NHS will be present. If the patient has lost all decision-making capacity, ACP can be carried out with his or her loved ones. The patient's doctor could also be brought in to address queries regarding his or her medical condition.
Each ACP session may last between 45 minutes to one-and-a-half hours. Sometimes, more than one session may be needed.
The ACP document can also be revised over time as the patient changes his or her preferences or his or her medical condition changes.
You can do an ACP even if you have an AMD. Unlike AMD, ACP is not a legal document.
"ACP is an ongoing communication process to help patients make informed decisions regarding future healthcare wishes," emphasises Ms Chin.
ACP is easily accessible by your healthcare team, and it helps your doctor to be better acquainted with your preference. "It is not to be blindly followed but serves as a guide for decision making in the event the patient is unable to communicate his wishes, so that the treatment is aligned with the patient's values and goals," explains Ms Chin.
On the other hand, an 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 undergo the advance care planning process. The existence of an AMD can be documented during ACP discussions.
The LPA is a legal document which allows a person to appoint a proxy, called a donee, to make decisions on the patient's behalf if the patient should lose his or her mental capacity. It involves two broad areas: personal welfare matters (which includes healthcare decisions) as well as property and affairs matters.
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.
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