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Janice Tai
Wednesday, Sep 3, 2014

Singapore

More Singaporeans making end-of-life preparations

The Straits Times | Janice Tai | Wednesday, Sep 3, 2014

Mr and Mrs Hey Bong Koi with their Lasting Power of Attorney and Advance Medical Directive documents. Mr Hey saw the urgency of making an LPA after a stressful experience dealing with his parents' assets.

Whether it be instructing medics to turn off life support or relatives to make decisions if mental ability deteriorates, more Singaporeans are taking active steps to get their end-of-life papers in order.

More than 2,500 people applied for the Lasting Power of Attorney (LPA) from April last year to March this year.

Only 655 people did so in the same timeframe three years ago.

An LPA is a legal document that allows one's next of kin to make key decisions on their behalf should they lose the mental ability to do so.

Figures obtained from the Ministry of Health (MOH) also show that 1,800 people signed an Advance Medical Directive (AMD) - a form of "living will" - last year, up from 500 a decade ago.

An AMD aims to minimise suffering by indicating that people do not want their lives artificially prolonged should they become unconscious while terminally ill.

Figures from MOH show that as of the end of last year, over 18,700 people had made an AMD.

About 6,500 have made an LPA to date, according to the Office of the Public Guardian which maintains the LPA registry.

Those who work with the elderly or terminally ill attributed the rise to greater awareness of these documents, and increasing ease and affordability of applying for them.

More people are aware that they have these end-of-life options as a growing number of doctors are trained to administer them and are also encouraging their patients to plan early.

Professor Kua Ee Heok, senior consultant at National University Hospital, said he makes it a point to discuss the LPA with patients who are 65 and older.

Dr R. Akhileswaran, chief executive of HCA Hospice Care, said all its doctors, nurses and medical social workers are trained in advance care planning, with some doctors authorised to issue LPA certificates.

"This makes it easier for patients to discuss the AMD, LPA or other ways of advance care planning whenever they wish to and take the next steps," he said.

It is also cheaper and easier to apply for an LPA now.

From today, the $50 registration fee for the basic form for the LPA will be waived for two years.

Used by more than 97 per cent of applicants, this has also been simplified and cut from 15 pages to eight.

Health-care workers say it is a good sign that more are willing to make end-of-life preparations now because people are losing their mental faculties earlier.

In 2011, 44 per cent of those who lost their mental capacity and needed the court to step in to appoint deputies to make decisions on their behalf - as they did not make an LPA - were 71 years old and above.

This year, the percentage for those above 70 shrank to 36 per cent.

Meanwhile, those between 35 and 70 years old who suffered mental deterioration increased to 59 per cent, up from 49 per cent in 2011.

"It could be due to diseases such as stroke or vascular dementia of which studies have shown are increasingly striking younger people," said Prof Kua.

Retiree Hey Bong Koi, 66, saw the urgency of making an LPA after a stressful experience dealing with his parents' assets.

When his dad died in 2010, his mum was meant to be the executor of his will. She was, however, certified as unable to do so because she had dementia.

The lawyer suggested that Mr Hey replace his mum as executor, but he needed to be appointed as her deputy by the court first.

It took him two years to get that done, due to legal procedures and having to get the consent of relatives based overseas. During this time, many decisions - such as on bank accounts and insurance - came to a standstill.

He and his wife have since applied for an LPA and AMD.

"I am relieved that we have done it," he said.

"Though it requires you to think carefully about who to appoint, it will save one a lot of hassle and anxiety down the road."

jantai@sph.com.sg

This article was published on Sept 1 in The Straits Times.

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