Step 3: Planning for Future Care (ACP, LPA and AMD)
When we are well and alive, financial planning is important, especially when we have young dependents. When we are dead, estate and legacy planning takes the stress off our loved ones, more about that in my upcoming posts. But what about the in-between, when we’re not dead but also not functionally alive, like being in a coma?
This is where this post steps in with three important tools to communicate our wishes and ease the burden on our loved ones:
- Advance Care Planning (ACP) – indicate your healthcare and lifestyle preferences.
- Lasting Power of Attorney (LPA) – grants authority in personal welfare and property matters.
- Advance Medical Directive (AMD) – sets legally binding end‑of‑life instructions.
All three will help reduce the stress on your loved ones when an unfortunate event happens to you. Here’s an overview of ACP, LPA and AMD:
| Tool | Purpose | When It Applies | Legal Status | Priority |
|---|---|---|---|---|
| Advance Care Planning (ACP) | Records your values, care preferences, and personal welfare wishes (e.g., living arrangements, lifestyle). | When you lose mental capacity to make decisions or speak for yourself. | Not legally binding. | First Step: Lays the foundation by clarifying your wishes. |
| Lasting Power of Attorney (LPA) | Appoints a trusted Donee to make decisions on your behalf (personal welfare or property/affairs). | When you lose mental capacity to make decisions or speak for yourself. | Legal document under the Mental Capacity Act. | Second Step: Ensures someone has the legal authority to act on your wishes. |
| Advance Medical Directive (AMD) | States refusal of life‑sustaining treatments to prolong life. | When you become terminally ill, near death, unconscious or lose your mental capacity. | Legal document under the Advance Medical Directive Act. | Third Step: applies only in specific end‑of‑life scenarios. |
Jump to the relevant section:
Jump to the related posts:
- Step 1: Financial Planning (Insurance) / Financial Planning as Parents
- Step 2: Financial Planning (Investments)
- CPF and Insurance Nominations and Legacy Planning
- Estate Planning: Writing a Will
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Advance Care Planning
“If you fall into a coma one day, does your family know how you like to be cared for?”
Advance Care Planning (ACP) helps your loved ones, appointed Donee (under an LPA), or healthcare team make decisions aligned with your wishes during emergencies or critical moments when you lose the capacity to decide or speak for yourself. While ACP is not legally binding, it is guided by the principles of the Mental Capacity Act (MCA), which provides the legal framework for decision‑making when a person lacks mental capacity.
On the Agency for Integrated Care’s website (aic.sg), you can find many resources for ACP, such as a three-part video about ACP and an overview of the steps you can take towards ACP (including conversation starters with your loved ones!).
Step 1: Advance Care Planning Workbook
Think about the quality of life and the medical treatment you want. Aic.sg offers a helpful ACP workbook in English, Chinese, Malay, and Tamil) to guide you to explore your preferences. Documenting your ACP makes for easy reference in the future and ensures the attending healthcare team can readily access it whenever needed. ACP can be done for all ages.
Step 2: Appoint a Nominated Healthcare Spokesperson (NHS)
After documenting your ACP, appoint up to two Nominated Healthcare Spokespersons (“NHS”) to communicate your concerns and wishes to your doctors. Make sure they agree to it before you appoint them.
Your NHS would ideally be:
- At least 21 years old.
- Someone you are comfortable sharing with, such as family and trusted friends.
- Someone you trust to act in your best interests and who is willing to speak up for you on your behalf.
- Someone who can handle stressful situations well.
- Your LPA Donee. Although it is not necessary, having the same person reduces conflict in healthcare decisions made on your behalf.
If you have no one suitable around you, you can appoint a Professional Deputy as your NHS and/or Donee in your Lasting Power of Attorney (“LPA”). Alternatively, you may consult an ACP facilitator as mentioned in the next section or engage service providers who may charge a nominal fee for doing an ACP.
Step 3: Document and Submit your ACP
You can document and submit your ACP to the National Electronic Healthcare Record (“NEHR”) via myACP online service (available to those aged 21 and above without serious illness) or an ACP facilitator through this directory. If you are receiving medical care at a public healthcare institution, ask your care team to arrange an ACP session for you.
Once your ACP is completed and accepted by your NHS, it will be registered in the National ACP IT system and linked to the NEHR for viewing by ACP facilitators and your healthcare team.
Review your ACP every few years and especially after these events:
- Every new decade of life (20, 30, 40, etc)
- Significant medical diagnosis
- Significant change in daily functioning (i.e. activities of daily living)
If you made any changes to the ACP, remember to update your NHS. You can continue to make changes to your ACP as long as you have mental capacity.
More resources:
Lasting Power of Attorney (LPA)
Lasting Power of Attorney (“LPA”) is a legal document that allows you to appoint one or more trusted individuals (Donee(s)) to make decisions on your behalf if you become incapacitated or lose the mental capacity to do so. Such loss of capacity may arise from conditions like dementia, mental illness, coma, or unconsciousness due to illness or medical treatment.
An LPA ensures that someone you trust is legally empowered to act for you and manage your affairs according to your wishes when you are unable to make decisions yourself.
If you lose mental capacity without an LPA in place, your family or a trusted person must apply to the court for permission to access your assets, manage your finances, and make decisions for you. This process can be lengthy and costly, and there is no guarantee that the court will appoint the person you would have chosen.
Step 1: Knowing the Power of LPA
The general powers granted in an LPA are:
- Personal welfare decisions (e.g., medical care, living arrangements)
- Property and financial matters (if you choose), such as paying bills, checking that bank accounts are in order, looking after investments, etc.
Your Donee can only act after a registered medical practitioner certifies that you have lost mental capacity.
Step 2: Choose Your Donee(s)
Your Donee should be someone you trust and who is reliable. It is important to speak with your potential Donee beforehand to discuss your expectations, any concerns, and the scope of authority you intend to give them.
You may appoint:
- One or two Donees, and
- One Replacement Donee (optional)
If you wish to appoint more than two Donees or require customised powers, you must use LPA Form 2 with the assistance of a lawyer.
To make an LPA, you must:
- Be at least 21 years old
- Have mental capacity
- Not be an undischarged bankrupt (if appointing Donee for property & affairs)
Step 3: Draft Your LPA (Form 1) online
Create and submit the Lasting Power of Attorney (LPA) Form 1 online via the Office of the Public Guardian Online (OPGO) using Singpass. You will need to use a laptop/tablet for the form and a smartphone with the Singpass app for digital signing.
After you fill in your personal details and the details of your Donee(s) (name, NRIC/FIN, mobile, email), wait for your appointed Donee(s) to log in to OPGO to accept their appointment.
The application fee for LPA Form 1 is permanently waived for Singapore Citizens (that is, free!), effective 1 April 2026. For non-citizens, the application fee is S$90 for permanent residents and S$230 for foreigners.
Step 4: Visit an LPA Certificate Issuer
Book an appointment with a Certificate Issuer (“CI”) via the Health Appointment System (HAS) to certify the LPA. Accredited doctors, lawyers and registered psychiatrists can act as CIs. They verify that you understand what you’re signing and are not being forced.
There’s a separate certification fee paid to the CI. MSF said that as of June 2025, the 10 most visited accredited doctors charged fees ranging from $24 to $60, lawyers from $50 to $300, and psychiatrists from $24 to $1,500.
After your LPA is certified, you may still amend it at any time, as long as you have mental capacity. Certain events will automatically invalidate an LPA—for example, if your Donee becomes bankrupt for property matters.
For further assistance:
Advance Medical Directive (AMD)
An Advance Medical Directive (AMD) is a legal document that tells your doctors to stop extraordinary life‑sustaining treatment if you become terminally ill, unconscious, mentally incompetent, or are near death.
It only applies when you are unable to make decisions for yourself or have no reasonable hope of recovery. An AMD also allows you to specify the medical situations in which you do not wish to receive life‑sustaining measures such as artificial ventilation, tube feeding, or cardiopulmonary resuscitation (CPR).
AMD is not the same as euthanasia. Euthanasia is the deliberate ending of a person’s life to relieve suffering from an incurable and painful disease. AMD allows you to die naturally without artificial prolongation, to minimise suffering through palliative care and medication.
Step 1: Obtain an AMD Form
Anyone who is 21 years old and above and is mentally sound can make an AMD.
You can get the form from clinics, polyclinics, and hospitals. Alternatively, you can also download the AMD form online (ensure both sides are printed on a single sheet, front and back).
Step 2: Make the AMD
An AMD must be made through a doctor, although you do not need a lawyer or legal advice. The doctor ensures that you are not pressurised into making the AMD, you are not mentally disordered, and you know what the AMD is and its implications.
You will need two witnesses present at the same time when you sign the AMD. One witness must be the doctor, and the second witness can be a nurse or another suitable person. Both must fulfil these conditions:
- Be above 21 years old
- Not be beneficiaries of your will or insurance policies
- Not be immediate family members
- Have no interest in any instrument where you are the donor, settler or grantor
- Have no financial interest in your CPF or other provident funds
- Not have registered an objection under the Advance Medical Directive Act
If a doctor objects to the AMD and registers that objection with the Registrar, they may refuse to serve as a witness to your AMD. You can approach another doctor.
Step 3: Return the form to the Registrar of AMD
Send the completed form in a sealed envelope by mail or by hand to:
Registrar of Advance Medical Directives
Ministry of Health, Singapore
College of Medicine Building
16 College Road
Singapore 169854
Your AMD becomes valid only after it is registered. You will receive an acknowledgement once registration is complete.
Other Important Notes
Making an Advance Medical Directive (AMD) is entirely optional. You can revoke or terminate an AMD at any time. This is done by signing a revocation form in the presence of at least one witness.
If you have made an AMD, doctors must honour it even if family members disagree. This is why it is best to discuss your decision with your loved ones, so they understand and can respect your wishes should you become terminally ill.
For more information, please refer to the AMD Booklet by MOH.
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