Angry Doctor

Wednesday, August 15, 2007

Mental Capacity Act 4

Just keeping the news on the MCA logged.

When you can't make the call
Proposed Mental Capacity Bill lets you pick who you want to make decisions for you
Jasmine Yin

OFTEN disoriented, the 80-year-old woman with dementia would complain of "neighbours who wanted to kill her".

Her five children took it in turns to care for her. But as the burden grew, two of the siblings suggested an old folks' home. The other three argued against "dumping" their mum — and a bitter split ensued.

"Had she stated clearly her wishes when she was mentally capable of doing so, this disagreement among her children would unlikely have arisen," said psychiatrist Ang Yong Guan, who recounted this story to Today.

But a proposed law could soon help avert such family feuds — and give Singaporeans a crucial say in who should make the decisions for them, when they themselves are no longer of fit mind to do so.

If passed, it means you will get to appoint the person or people you trust — called a donee — to act on your behalf, in areas as wide-ranging as managing your household budget for buying groceries, to deciding where you would live, to certain healthcare decisions.

You can also spell out your wishes on such issues in advance, to be taken into consideration when the time comes.

The draft Mental Capacity Bill — in similar vein to legislation such as the Advanced Medical Directive (AMD) — gives individuals the power to make such choices before they become unable to do so because of dementia or brain damage, for example. This will not be mandatory.

The proposed law is "much more flexible and ... allows people to tailor-make plans for their requirements," said Minister for Community Development, Youth and Sports Vivian Balakrishnan at a press conference yesterday.

Currently, under the Mental Disorders and Treatment Act, the court appoints a committee for someone who has lost his or her mental capacity.

The Bill spells out a checklist of how decisions must be made in the person's best interests: Such as, taking into account the person's "past and present wishes and feelings" and consulting other caregivers.

Decisions the donee cannot make include consenting to marriage or sexual relations on the person's behalf or making a Central Provident Fund nomination.

Also — since the situation presents opportunity for abuse or exploitation — tough action has also been mooted against donees who flout their responsibilities.

A jail term of up to 12 months or a fine not exceeding $7,000, or both, will be levied on those found guilty of ill-treatment or wilful neglect of their mentally incapacitated charges. This is a new criminal offence created under the draft Bill.

A new Office of Public Guardian would investigate complaints and supervise court-appointed guardians, among other functions. Anyone wishing to challenge the decisions made by a donee would find it easier to do so, instead of having to go to court.

"If we are creating the framework which confers responsibility and power in the hands of the donee or the (court-appointed) deputy, it also makes sense that the person be made accountable," said Dr Balakrishnan.

Welcoming this was Mr Navin Lobo, a lawyer with Harry Elias, who said the safeguards would give family and friends who aren't donees of the mentally-incapacitated person a "certain measure of comfort".

He has seen cases in which court-appointed kin have pilfered the bank accounts of their charges, leaving little for their day-to-day expenses.

The Ministry of Community Development, Youth and Sports had studied similar laws in Britain and Hong Kong. The draft Bill is now up for public consultation and because of the issues involved, Dr Balakrishnan said, "this is not a Bill that we need to rush through Parliament".

But there is some degree of urgency. In five years, there will be an estimated 20,000 people with dementia in Singapore. The number of court cases involving decisions made for the personal well-being and finances of the mentally incapacitated has gone up, too — from 188 in 2000 to 228 last year.

Getting Singaporeans to sign up once the law is passed, however, is another challenge. Since the AMD Act was passed in 1996, only 3,840 people have signed up as of last October.

Acknowledging that there are "many end-of-life issues that we would rather avoid", Dr Balakrishnan nevertheless urged Singaporeans not to "wait till disaster has befallen you".

The authorities, on their part, plan to make the process of appointing a donee "affordable" and easy, such as simply filling up a standard form.

Retiree Tan Siew Kheng, 67, for one, is interested in this, having had to care for a parent who had dementia. He even suggested that this new legislative framework may even help reduce cases of elderly abandonment in the future.



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