A Lasting Power of Attorney (LPA) gives people (called donees) power to make important decisions for you when you lose mental capacity. But having too many donees may put a strain on everyone and create unnecessary suffering for you, according to Moses Loh, a family medicine doctor at Loh & Loh Clinic & Surgery. We discuss with Loh on challenges that people face when it comes to signing elderhood-related legal documents and how family disagreements can escalate into physical fights when there’s no proper planning.
Name: Moses Loh
Company: Loh & Loh Clinic & Surgery
Medical Specialization: Surgery, Internal Medicine and Family Medicine
Base Country: Singapore
Service Style: Friendly, comprehensive, sincere
Languages: English, Mandarin, Cantonese, French, Hokkien, Bahasa Melayu, Bahasa Indonesia, Tamil
Anything Interesting: Former chef turned doctor
Clinic Location: 501 West Coast Drive, #01-284, Singapore 120501 (South West CDC)
Q: Can you tell us about yourself? How did you become a doctor and eventually set up your own clinic?
Loh: I was overseas for a long time and lived in places such as Hong Kong, Beijing and Paris because of my mother’s job. I came back to Singapore and decided to become a doctor because I wanted to choose a career that will have a positive impact on other people. To me, being a doctor is what allows me to have the most direct and immediate ability to make a positive impact on others.
I got my qualifications as a doctor at the National University of Singapore. Since I wanted to be able to treat all aspects of my patients’ health and healthcare and not just focus on one medical specialty, I went on to set up my own clinic about a year and a half ago
Q: What does your clinic do? Are there any differences between your clinic and other clinics?
Loh: Yes, we are somewhat different from other clinics. We’re like a mixture of a polyclinic, an urgent care center and a physiotherapy department.
We want to be a one-stop community clinic for everyone, where patients can settle most of their medical issues in one place without having the need to visit many different doctors.
Besides doing what a typical clinic does, we also perform minor surgeries, do preventive healthcare, deal with complex chronic diseases, and handle minor emergencies such as severe diarrhea or pain, and even bone fractures. We have an in-house X-ray that we can examine patients’ bones and joints instantly.
Another differentiating factor is that we work closely with hospitals.
We are a part of the GPFirst programme, an initiative to encourage patients to visit a participating clinic for non-life threatening urgent conditions first rather than going to a hospital’s emergency department directly. If any patient needs more specialized and emergency care, they will be referred to a hospital’s emergency department for further diagnosis and treatment, and the patient can receive a $50 subsidy.
Q: What is your typical patient?
Loh: Our clinic is surrounded by HDB flats, landed properties, schools and playgrounds, so we have a good mix of people in our area.
Our patients are generally children, middle-aged people who require care for chronic illnesses such as high cholesterol and diabetes, and working-class people such as industrial workers who have higher risks of getting injured. Having a diverse crowd of people puts our skills to good use.
Q: Any memorable cases from you being able to do more than what a regular clinic can?
Loh: Yes. I remember a time when the coffee shop auntie whom I regularly buy coffee from suddenly collapsed. A nearby hawker saw what happened. Knowing that we are just around the corner and that we can deal with such emergencies, he immediately carried her to our clinic.
We did an assessment and realized she had a stroke, so we gave her some IV fluids and blood thinners, which are crucial substances to prevent her from developing an even bigger stroke that can cause her to lose her life.
Even though we managed to save her life and stabilize her, we referred her to the hospital for further treatment as it is important to extract the blood clot from her brain within 4 hours to prevent permanent brain damage, and this can only be done at the hospitals.
Q: Does your clinic provide any elderhood-related services?
Loh: Yes, we provide Advanced Medical Directive (AMD), Lasting Power of Attorney (LPA), Advance Care Planning (ACP) and death certification.
[LPA is a legal document that allows you to appoint one or more persons (donees) to make decisions on your behalf if you lose mental capacity one day.
AMD is a legal document that allows you to inform medical professionals in advance that you do not want any extraordinary life-sustaining treatment to be used to prolong your life when you become terminally ill and unconscious.
ACP is the process of planning for your future healthcare options. It is a non-legally binding document that allows you to have a say in your healthcare when you no longer have mental capacity.]
Generally, when I see people who are frail or have children, I tend to raise the topic of LPA or AMD and explain to them what these are and why they should consider doing them.
Most people have never heard of ACP before. When we detect any serious medical conditions, such as when a patient keeps falling ill, has end-stage heart disease or has badly injured his hip that requires a big surgery, we will inform and educate the patients about ACP. In these cases, they can lose their mental capacity anytime due to their illness and ACP will allow the patient to state their healthcare preferences in the event that they are unable to.
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Q: What are the common issues that your patients face when they do their LPA and/or AMD?
Loh: When it comes to LPA, one of the issues that my patients face is that they often choose too many donees (people who will make decisions on your behalf when you lose mental capacity).
Choosing too many donees defeats the purpose of an LPA because there are too many people making decisions for you and they very often have different opinions on things. When it’s hard for your donees to reach consensus, it delays matters, such as healthcare and medical treatment decisions, for you.
It is best to choose one donee and tell him/her exactly what you want and trust that they will stick to your wishes.
Second, people often think that LPA is only concerned about their assets.
They don’t realize that donees are supposed to make decisions for things involving the way they live as well, such as what to eat and wear, where to stay and with who. These are important discussions that they need to have with their donees so that their wishes can be fulfilled if they lose their mental capacity.
When it comes to AMD, many people don’t quite understand what the document means, and often family members don't realize their loved ones have already signed the document.
There was a time when one of my patient's daughters started crying midway through the patient’s AMD discussion because she was shocked to find out that once her father signed the document, it means he officially declared that he won’t be receiving advance life saving measures such as ventilator support and CPR when he becomes terminally ill and unconscious. This breaks her heart to know that what she wants is not what her father wants.
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Q: Are there any challenges that caregivers or family members face when patients didn’t do their LPA and/or AMD, but lose their mental capacity?
Loh: When patients did not do their LPA and/or AMD, it causes a lot of arguments between family members. Family members often have different opinions on what is best for the patient, so it’s usually difficult for them to come to agreements.
Back in the day when I was still working in the hospital, I’ve seen many occasions where family members were upset with one another for making particular decisions without consulting each other. I had an encounter with a patient’s family members, where a verbal argument escalated into a physical fight because they couldn't come to an agreement.
Most of the time, arguments don’t become this violent, but that doesn’t mean it’s any less suffering for the family members as they often debate on what their sick loved ones might actually want. These discussions normally stretch on for a long time, which put a strain on the mental health of everyone who is involved and subsequently put the patient through unnecessary suffering, such as not being medically cared for the way they wanted.
Q: Do you see any triggers that may cause more people to want to do their AMD, LPA, or ACP?
Loh: We are actually seeing an increasing number of patients enquiring about LPA.
Primarily, people would consider doing or actually do their LPAs or AMDs because they reached a certain age. When we first started our clinic, people who did their LPAs or AMDs were also the more educated and well-informed ones.
After these people have done theirs, they have been sharing information and recommending LPA and AMD to their neighbors and friends, which resulted in a lot more people from different educational backgrounds coming to do their LPAs with us.
For ACP, we don’t really see a difference in the number of people so far. Whether people do it or not is more or less determined by whether they have any serious illnesses. People who would likely do their ACP are the ones who expect to develop certain diseases, such as cancer or organ failures.
Q: What are your interests or hobbies?
Loh: I like to cook. Before I went to the army, I worked at a restaurant as a chef for a while. Even though I didn’t have any cooking experience before, the restaurant took a chance on me because I know how to speak French.
This interview has been edited for length.
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FAQs
Can I have more than one Lasting Power of Attorney (LPA) donee?
Yes, an LPA allows you to choose up to 2 donees and 1 replacement donee. However, one of the issues that some people face is that they often choose too many donees. When there are too many donees, it’s hard for them to reach consensus, which could delay matters, such as healthcare and medical treatment decisions, for you.
What happens if I lose mental capacity without a Lasting Power of Attorney (LPA)?
Your family would have to go to court and apply to become your deputy in order to make decisions for you. Without an LPA and you designating powers to specific people to make decisions for you, it can potentially cause a lot of arguments between family members, as they often have different opinions on what is best for you.
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