Advance Care Planning

Advance Care Planning (ACP) is an on-going communication process between the advance care planning facilitator, the patient, health professionals involved in the patient’s care and the patient’s next-of-kin to help the patient reflect, plan and make decisions for their future healthcare options. It is a non-legal binding document. 

Advance care planning is for everyone, regardless of age or state of health.

Advance care planning is beneficial because it helps patients to:

• Explore their values, beliefs, healthcare experience,
• Understand their options regarding healthcare, and
• Communicate their future healthcare preferences to their next-of-kin and healthcare professionals

The patient’s documented care preferences will be used to guide their nominated healthcare spokesperson, next-of-kin and healthcare professionals in making care and treatment decisions when the patient has lost capacity to make those decisions.

The ACP facilitator, the patient as well as the patient’s loved one or nominated healthcare spokesperson should be present during the ACP facilitation.

Patients can review their ACP when they want to make changes to their plan, or when there are changes to their social or health status. Patients would have to inform their primary physician/ facilitator and schedule an appointment to review it. 

There is no validity date for ACP.

Patients can seek assistance from a certified advance care planning facilitator, who may be a doctor or nurse who is providing treatment to him/her, medical social worker, or other allied health professional. Alternatively, patients can request for his/her current medical team to refer him/her to the ACP team.

Advance Care Planning

On-going discussion to make informed decisions regarding future healthcare preferences based on patient’s goals, values and beliefs.

Advance Medical Directive

Legal document to allow the doctor to suspend extraordinary life sustaining treatment when the individual is terminally ill, death is imminent and no mental capacity.

Lasting Power of Attorney

Legal document that you (Donor) can make to appoint one or more persons (Donee(s)) to act on your behalf should you lose the capacity to make your own decisions. You have to be at least 21 years old. 

Will

Legal document stating what you want to happen to your estate (property and assets) after you die.

Should such a scenario 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. 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.

Doctors can still recommend alternative treatment options as long as the decision is based on their clinical judgment and in the best interests of the patient.

Some possible reasons could be:

• Patients verbally express changes in their wishes to doctors or to their nominated healthcare spokesperson(s)
• Patient’s decision-making capacity was in doubt at the time of ACP facilitation
• Contextual factors change the scenario which is common in most medical situations such as when the seriously ill patient is judged to have an acutely reversible deterioration that was not discussed before.

No, the ACP form is meant to guide, but not to restrict or dictate, treatment doctors in rendering care for the patient. The instructions laid out in the form should be taken into consideration in influencing care upon deterioration and near the end-of-life.

A nominated healthcare spokesperson must be at least 21 years old. A patient may choose a relative, best friend or anyone who can fulfill the following criteria:

• Willingness to be a nominated healthcare spokesperson
• Ability to discuss patient’s preferences, values and goals
• Willingness to follow patient’s preferences
• Ability to make decisions under stressful situations