Capacity & Consent

ABOUT MENTAL CAPACITY ACT

Sometimes people have difficulty making decisions for themselves. The ability to make decision yourself is termed “Mental Capacity” or “Capacity” for short. Therefore, someone with advanced dementia is said to have lost “Capacity”. More details are highlighted in the Mental Capacity Act (MCA).

There are various degree that someone can lose “Capacity”. For example, an adult with learning disability may consent to you doing a dental cleaning, but object to you extracting a molar affecting his diet. Simple medical (or dental) procedures can be carried out by the clinician in the patient’s “Best Interest”, of which the Pros of such a treatment obviously outweigh another. It is also good practice that two clinicians access the case together and concur on the same treatment.

For patients who lack “Capacity”, their Next-of-Kin can apply to the Court to officially become an authorised legal representative for the patient. Such a person is known as “Court Appointed Deputy“. The Court or legal bodies, can also appoint a representative to the patient. Court Appointed Deputies can represent the patient’s decision for welfare (health care) or also finance (and property).

If a person above 18 has “Capacity” and he/she is afraid of losing “Capacity” in the future (e.g. in a coma or having advanced dementia), he/she can authorise the power of decision making to another person. This deed is called the “Lasting Power of Attorney“, and the person named is called the “Attorney”. Theses are usually the children of elderly patients. You will still be responsible for your own decisions, until when you are medically deemed to have lost your “Mental Capacity”. That is when the Attorney’s power takes over.

When the MCA came into effect, the Office of Public Guardian (OPG) is established in March 2010 to set up and register LPAs and CAD, and also to supervise and prevent abuse.

Generally, it is easier to appoint some as your own Attorney than for the Courts to appoint someone for you as a Deputy. This is because (legally) no one else other than yourself knows better who is in the best place to decide for you. If the Court has to appoint someone, there are legal procedures to ensure the Deputy is suitable. Hence this can take up to S$7000+ in cost and a duration of 3-6 months to process. Some bodies may be able to process Deputyship at a faster rate and lower cost.

The below consent forms are for patients undergoing generic medical or dental procedures. These are obtained from NHS UK are rather comprehensive.

Consent Form 4 are for people who lack capacity to make decisions on investigations or treatment.

Consent Form 3 are for people who have capacity and agree to investigations or treatment in procedures that do not impair consciousness.

Consent Form 2 are for parental (or persons with parental responsibilities) to consent to investigations or treatment for a child or young adult. Children and young adults are sometimes unsuitable to make informed decisions for themselves.

Consent Form 1 are for people who have capacity and agree to investigation or treatment, whether or not consciousness will be impaired during the process (such as under dental sedation or general anaesthesia).