by Growing Needs | Mar 20, 2023 | A Better Tomorrow, Financial Services/Grants, Will & LPA
“The fact of death is unsettling. Yet there is no other way to live.” – Paul Kalanithi, When Breath Becomes Air
Brain surgeon Paul Kalanithi’s book is a remarkably honest assessment of life in the face of a diagnosis of terminal cancer. His writing is both raw and insightful, as he lays bare his thinking in the latter days of his life.
In one sense, the book could be seen as a form of preparation for death, and a record for the loved ones who would survive him.
Most of us may not have the literary gifts to write a poignant book for our loved ones before we leave them, but there are several simple steps we can take in preparation for what everyone of us must face.
When we are in the pink of health, we often take for granted that our current condition will continue. We ignore the reality of our mortality, and the frailty of our bodies.
Some deliberately choose to avoid the thought of death altogether, believing that dwelling on it is “bad luck”.
We would suggest a different approach, and a different attitude – namely, to proactively take steps in preparation for the time when we are no longer around which should be motivated by a deep-seated love for those whom we leave behind.
If you are seeking to encourage a loved one along in this journey, it might be useful to broach the topic indirectly for a start. You might also find some ideas from watching this video:
There are a variety of things we can do for our loved ones, from recordings and writings that will serve to preserve memories, down to the minutiae of preparing the details of the wake.
But perhaps the most basic would be working through the following 4 steps:
There is a common misconception that only the wealthy need to make a will.
This is inaccurate, because the primary purpose of making a will is to record how the will-maker (the legal term is “testator”) wants to distribute his/ her money and other assets amongst his friends, loved ones and/or charities.
In the absence of a will, there is a pre-determined formula for the distribution of the deceased’s assets, which is spelt out in the Intestate Succession Act (for non-Muslims) or Inheritance Certificate (for Muslims). This pre-determined formula may not coincide with the deceased’s desires.
A well-drafted will may also serve to minimize disagreements between surviving family members, who may otherwise quarrel about oral expressions of desire and intent made by the deceased during his/ her lifetime. Crystallizing the intentions in the form of a will signed in accordance with the Wills Act can help to mitigate such disagreements and reduce the chance of ugly family disputes which dredge up old grievances and wounds and spill over into the courts and are captured in the newspapers.
For some, death is preceded by a loss of mobility, mental capacity, or quality of life – either through a health condition, or an accident.
The loss of mental capacity brings with it a whole host of issues for family members and care-givers. As loved ones grapple with understanding the instructions of the mentally incapacitated individual (sometimes called the patient), legal issues may also arise concerning the use of the patient’s monies and assets for medical bills and daily expenses. Much-needed funds may be frozen or inaccessible unless the patient had signed a Lasting Power of Attorney or the family applies to appoint a Deputy under the Mental Capacity Act.
If the patient has properly signed and lodged a Lasting Power of Attorney (LPA) with the Office of the Public Guardian, the LPA spells out who is authorized to act on behalf of the patient. Such authorized person(s) are called Donees, and their powers would be circumscribed by the terms of the LPA and the Mental Capacity Act.
Since a LPA identifies the person(s) who will act on behalf of the patient, this avoids arguments between family members and loved ones about who would be the more appropriate person to care for the patient.
On the other hand, if the patient did not sign a LPA, the family members would need to obtain a court order before they can access the patient’s assets – a process which is both time-consuming and costly.
Modern medical advances make it possible to prolong life even in the final stages of a terminal illness.
However, not everyone desires to have their lives technically prolonged, particularly when it is not coupled with a certain quality of life.
An Advance Medical Directive (AMD) is an option to consider. An AMD is signed when the AMD-maker wants to record that he/ she has made an informed decision, that he/ she would not want extraordinary life-sustaining treatment to be used to prolong the patient’s life. It will apply when the patient becomes terminally ill and is unconscious or incapable of expressing his/ her own judgment.
Signing an AMD relieves the burden placed on loved ones to make the difficult decision on behalf of a terminally ill patient. Since the patient’s intentions are made known, it also avoids the unfortunate situation that sometimes occurs in such circumstances, when family members have differing views over what the patient would have wanted for himself/ herself.
Another step that is worth taking is to engage in Advance Care Planning. This is a structured discussion between patients and loved ones, to help loved ones understand the values and preferences that the patient has for his/ her future medical care and treatment. Unlike the other three steps, this is not a legal document, but is ideally intended to be an ongoing discussion process as the patient’s health status evolves.
Nonetheless, it helps loved ones and healthcare professionals to understand the appropriate forms of treatment which accord with the patient’s values and wishes when the patient is unable to make his/ her own decision.
Advocates of ACP report that families who have done ACP experience less anxiety and stress when the time comes, because they have a better understanding of what decisions to make.
Several hospitals and agencies have ACP workbooks (e.g. AIC’s workbook which can be easily downloaded and used to guide conversations about ACP is available here.
The following video produced by Tan Tock Seng Hospital also provides useful guidance on ACP:
Joni Mitchell wrote a song, titled Both Sides Now, which include these lines:
“I’ve looked at life from both sides now
From win and lose and still somehow
It’s life’s illusions I recall
I really don’t know life at all.”
Whichever way we look at life – from win or lose, from up or down, the beginning or the end – and regardless of whether we conclude that we “know life” or not, we can all be sure there will be an end for each one of us.
But while we still have breath in our bodies, and a mind able to reflect on these matters, we have the opportunity to take these 4 steps outlined above, to ease the pain and issues that we leave behind for our loved ones when our time is up.
Growing Needs grew out of our own encounters with caring for our aging parents and reflecting on the Growing Needs that we ourselves would face as we advance in years. We hope to build a community that will learn, share and contribute towards caring for the growing needs of our loved ones.