Angry Doctor

Friday, March 09, 2007

Mental Capacity Act

News to keep an eye on:

Law may let you pick guardian before dementia strikes
Jasmine Yin

YOUR mind is still sharp and you have friends and relatives that you can trust. But what if dementia strikes, the thinking gets muddled and you are left helpless in the care of someone who doesn't particularly care for you?

The Government is exploring a new law that would enable individuals to appoint, in advance, someone to take charge of their personal well-being and financial affairs, should they be incapacitated by dementia or some other mental illness.

Broaching this tentative Mental Capacity Act (MCA), the Minister for Community Development, Youth and Sports Dr Vivian Balakrishnan told Parliament that it was better for Singapore to prepare for an ageing population.

"Our seniors, especially those with dementia, deserve better legal protection," he said.

This is a truth that lawyer Navin Lobo has seen underscored all too frequently.

He has seen enough tears and dirty linen aired when family members go to court to fight over who should be appointed to care for a mentally disordered person and manage his or her affairs.

"It gets messy and people end up getting hurt," the lawyer from Harry Elias told Today.

The tussle gets worse if there is money involved.

A family member appointed by the court to look after a mentally-ill man emptied his bank account and did away with his property. There wasn't even enough money to take care of his day-to-day expenses and she told other relatives to chip in.

In some cases, persons appointed by the court may not always have take decisions the best interest of the patient, said Mr Lobo. In other cases, the level of care provided could be indifferent.

Such situations can be averted if individuals, themselves, can decide what happens to them and their affairs before they lose their mental capacity.

Currently, under the Mental Disorders and Treatment Act, the High Court can appoint someone only after the person has lost his or her mental capacity.

The Ministry is studying similar laws enacted overseas in Britain, Germany and Hong Kong.

For instance, Britain's version of the MCA provides for a lasting power of attorney, which gives someone the right to make decisions on your behalf about things like your personal welfare and healthcare, as well as property and money. Financial decisions can be taken even before the illness strikes, but this person can take decisions about personal matters only after you lose your mental capacity.

Giving the thumbs-up to this proposal was Ms Cho Peilin, who works in public relations. She said that having something like the MCA could avert the bind she faces as caregiver to her aunt, who is in her 80s, unmarried and suffers from dementia.

Relatives were worried about inviting allegations of fraud after Ms Cho suggested that the family to go through her aunt's finances to work out a financial and healthcare plan for the elderly woman.

Vice-president of the Autism Resource Centre Loh Wai Mooi, who also welcomed such an Act, also hoped for a Code of Practices to be drawn up as minimum standards that MCA appointees have to abide by.

Dr Balakrishnan said that the Ministry will conduct "extensive" consultation with the public and related organisations to ensure that "we have a system that protects and safeguards the interests of the mentally incapacitated".

The draft Bill is expected to be ready by May and consultation will start after that.

angry doc wonders how we've managed to muddle through this issue without such a law all these years.

Anyone who has had to care for a 'mentally incapacitated' patient with a complex family dynamics can tell you it can be a nightmare; oftentimes the patient becomes more of a battleground fought over by the relatives than a person to be cared for. How should the doctors decide which party's decision over the patient's management to respect?

While this proposed bill may not end fighting amongst family members, it will make things easier for the healthcare and social service workers managing the patient's case.

You can find out more about UK's Mental Capacity Act here.

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