This article belongs to a three-part series on the documents that you can make to record your healthcare decisions and preferences to be used in the event that there is a difficult medical decision to be made and you are not able to speak for yourself. Do check out the other articles:
Content
What is an LPA?
An LPA is a legal document that empowers a person who is at least 21 years old (known as the 'donor') to appoint one or more persons (known as 'donee(s)') to make certain decisions on behalf of the donor in the event the donor loses his/her mental capacity.
A donor can choose to give the donee(s) powers to decide matters relating to:
Personal welfare (including healthcare decisions)
Property and affairs
Mental Capacity
Mental capacity is the ability of a person to make a specific decision at a particular time.
Under the Mental Capacity Act (Chapter 177A), a person is unable to make a decision for himself if he is unable to:
Understand the information relevant to the decision
Retain that information
Use or weigh that information as part of the process of making the decision
Communicate his decision (whether by talking, using sign language, or any other means)
Do note that in medical conditions such as Dementia, if the person is able to retain the information relevant to a decision for a short period, that person may still be deemed as having mental capacity to make decisions if he/she fulfils the rest of the criteria stated above.
Personal Welfare
A personal welfare donee helps to make decisions on behalf of the donor with regards to the donor's living arrangements and daily activities. Examples of this are (but not limited to):
Where the donor should live
Who the donor should live with
Day-to-day care decisions (e.g. what to wear, what to eat)
What social activities to take part in
Handling the donor's personal correspondence
Who the donor may have contact with
With regards to healthcare decisions, a personal welfare donee can only give consent or refuse the carrying out or continuing of medical treatment if the donor has granted that right in the LPA. This includes participating and withdrawing from clinical trials.
A personal welfare donee does not have the ability to refuse life-sustaining treatment on behalf of the donor. This decision is made by the healthcare team in charge of the care of the donor or in accordance with the donor's advance medical directive (if applicable).
Other healthcare-related matters you may want to discuss with your potential donee(s) before making an LPA includes (but is not limited to):
Feeding and administration of medications via nasogastric tube if you are unable/unwilling to take in food orally
Undergoing scans
Undergoing invasive investigations e.g. endoscopy
Undergoing procedures (e.g. chest tube insertion to drain water or air in the space beside the lungs) and/or surgery (e.g. cancer)
Use of restraints in the event your actions cause harm to yourself (e.g. attempting to climb out of bed despite being too weak to stand leading to a high risk of fall)
A personal welfare donee does not have the power to refuse life-sustaining treatment or any other treatment that is necessary to prevent a serious deterioration in the condition of the donor. Such decisions are usually made by the healthcare team. If you wish to refuse life-sustaining treatment in the event where death is imminent, do make an Advance Medical Directive.
Example of LPA Form 1, Personal Welfare section (source: Ministry of Social and Family Development (MSF))
Property and Affairs
A property and affairs donee helps to make decisions on behalf of the donor with regards to the donor's finances and assets.
Examples of this are (but not limited to):
Purchasing equipment that the donor needs
Opening, closing and operating bank accounts
Handling tax matters
Handing Central Provident Fund (CPF) savings
Handling Dependants' Protection Scheme (DPS) payouts
Handling insurance payouts
Paying the rent, mortgage repayments and household expenses
Dealing with property - buying, swelling, renting and mortgaging property
Investing the donor's monies
Receiving dividends, income, inheritance benefits or other financial entitlements on behalf of the donor
A property and affairs donee is not allowed to make or revoke a nomination for the donor's CPF account and insurance policies. The donee is also not allowed to make gift's from the donor's property unless the donor in the LPA has specifically authorised the donee to do so.
Example of LPA Form 1, Property and Affairs section (source: MSF)
Why should you make an LPA?
Despite our best efforts to remain healthy, we can never really know when we will be inflicted with a debilitating illness that takes away our mental capacity.
In the event that you lose your mental capacity and you do not have an LPA, there are several challenges you will face:
The court will usually appoint a family member or a close friend to be your deputy (someone that makes decisions pertaining to personal welfare and finances on your behalf). However, if there are significant disputes present, the court may appoint an independent third party instead (e.g. professional deputy). This means that you and your next-of-kin have no control over who will be appointed as deputy.
The application fee is $40 for deputyship court orders involving use of monies of up to $60,000 (simplified filing track) or $150-200 for orders involving use of monies more than $60,000 (regular filing track).
The process of appointing a deputy can take 4-6 months. During this period of time, there may be funds belonging to you that cannot be utilised for your care as you do not have the mental capacity to authorise someone to utilise it on your behalf.
Having an LPA helps you to avoid this situation. You will be in control of who you wish to appoint as a donee and you can discuss with your donee how you wish for your personal welfare and finances to be managed in the event you lose your mental capacity.
If you are aware that you have a terminal illness that is likely to affect your mental capacity in the future, making an LPA could be useful for you.
Making an LPA is different from a will, whereby you appoint an executor to manage your estate for you upon your death.
Who can make an LPA?
To make an LPA, you will need to be:
At least 21 years old
Possess mental capacity to make your own LPA
Not be bankrupt if you are appointing a property and affairs donee
How do I make an LPA?
Obtain the LPA Form
Download and print the appropriate form required:
LPA Form 1: For donors who wish to grant donee(s) general powers with basic restrictions. Donors may appoint up to 2 donees and 1 replacement donee in LPA Form 1.
LPA Form 2: For donors who wish to appoint either more than 2 donees, more than 1 replacement donee, or grant specific and customised powers to their donee(s) which cannot be addressed in LPA Form 1. Form 2 must be drafted by a lawyer.
According to the Office of Public Guardian, 98% of Singapore citizens who have made an LPA used LPA Form 1.
Choose your donee(s)
Donee(s) are required to:
Be at least 21 years old
Not be bankrupt if you are appointing the donee for property and affairs matters
Choose someone whom you trust has your best interest's at heart and is capable of making sound decisions.
If you appoint more than one donee, you can appoint them to act
Jointly: donees have to make decisions together, or
Jointly and severally: donees can either make decisions together or separately.
You can also appoint a replacement donee to replace your existing donee if any of the following events occur if:
Your donee renounces his/her appointment as donee
Your donee becomes bankrupt (this will only terminate his power to be a property affairs donee, but he/she can still be a personal welfare donee)
Your donee loses mental capacity
Your donee passes on
You and your donee divorce or have your marriage annulled
Choose what decision powers you wish to grant your donee(s)
Choose which powers you would like to grant your donee(s):
Personal welfare only
Property and affairs only
Both
Example of LPA Form 1, Powers Granted to Donor (source: MSF)
Find an LPA Certificate Issuers
An LPA certificate issuer's role is to certify that the donor:
Has the mental capacity to make an LPA
Understands the purpose of making an LPA
Understands the scope of authority granted to donees
Is not coerced into making an LPA
There are three groups of people who can act as an LPA certificate issuer: medical practitioners accredited by the Public Guardian, practising lawyers qualified to practice Singapore law in a Singapore law practice, and registered psychiatrists.
The list of professionals who can be LPA certificate issuers can be found here:
Lawyers (select 'Singapore Practising Certificate' under Registration Type and 'Singapore Law Practice' under Type of Law Practice )
The donee(s) do not need to be present when the certificate issuer witnesses and certifies the LPA. However, some certificate issuers may prefer that the donees are present. Hence, check with the certificate issuer on their requirements before booking an appointment with them.
Register your LPA with the Office of Public Guardian (OPG)
Send the required documents to OPG by post within 6 months from the date the donor signs the LPA Form:
LPA Form 1 or 2
Clear photocopies of donor's and all donee's/replacement donees' identification documents (For Singaporeans and PRs: front and back of NRIC; for non-citizens: passport)
Clear photocopy of Director's Resolution of the Licensed Trust Company (only applicable for Form 2 applicants who wish to appoint at least 1 Licensed Trust Company as a donee/replacement donee)
OPG will verify documents and accept your complete application for registration if there are no valid objections raised within the 3 weeks mandatory waiting period.
For LPAs received by OPA from 1 August 2019, donors and donees are able to access a softcopy PDF of the registered LPA. Donors can share the softcopy LPA with anyone via OPG's e-services portal using Singpass.
You are encouraged to inform your loved ones the relevant parties (e.g. healthcare providers) that you have made an LPA. You can also update your Legacy Vault to reflect that your LPA has been made.
How much does an LPA cost?
There is no cost to making an LPA. However, there will be a fee charged by the Certificate Issuer for their services depending on the complexity of the case. According to MSF, accredited medical practitioners charged between $25-80 for their certificate issuer services.
When can an LPA be used?
An LPA takes effect when the donor loses his/her mental capacity. The donee should obtain a medical report establishing that the donor lacks the mental capacity to manage personal welfare and/or property and affairs.
The donee should have the LPA and medical report on hand when carrying out transactions with institutions on behalf of the donor. The institution will need to check with OPG on whether the LPA is valid in order to allow the donee to carry out the transaction on behalf of the donor.
How to revoke an LPA?
The donor can revoke the LPA at any time as long as he/she has the mental capacity to do so. The donor would need to fill up the revocation form (and obtain the signature(s) of the donee(s) and a witness) and submit it to the OPG together with the original LPA. The fee for cancellation of an LPA is $25.
Conclusion
An LPA gives you the ability to appoint trusted individuals to manage your personal welfare and property and affairs in the event you lose your mental capacity.
Making an LPA helps to avoid the added costs, time, and uncertainty involved in the alternate scenario of a court appointed deputy.
If you are aware that you have a terminal illness that is likely to affect your mental capacity in the future, making an LPA will allow you the ability to grant power to trusted individuals to manage your future affairs.
Do check out the other related articles at these links:
References