• Vol. 42 No. 4, 200–202
  • 15 April 2013

The Mental Capacity Act: Implications for Patients and Doctors Faced with Difficult Choices



The Mental Capacity Act (MCA) came into effect in March 2010 but the impact of this ground-breaking legislation on the doctor-patient relationship has not yet been studied in Singapore. It is evident that communication between healthcare professionals, patients and their loved ones has never been so critical. Translating this into practice, healthcare professionals must identify the decision-maker to obtain consent from the correct person. Consent for healthcare and treatment must be obtained from the patient with capacity or the patient’s legally appointed proxy decision-maker under a Lasting Power of Attorney (LPA) where the patient lacks capacity. However, the doctor is the decision-maker for patients lacking capacity in matters of life-sustaining treatment or treatment to prevent a serious deterioration of the patient’s health. All decisions made on behalf of persons lacking capacity must be made in their best interests. Capacity assessments must be properly conducted and if a patient has the capacity to make the decision then healthcare professionals must take practicable steps to help them make a decision.

The way doctors engage with patients who may lack capacity, family members and others connected with the patient’s care must be modified in light of the recent enactment of the Mental Capacity Act (MCA). It is a common misconception that the patient’s relatives have the right to make decisions on behalf of the patient who may lack mental capacity. They have no such legal right. However, as a matter of good practice and common sense, doctors should involve the patient’s relatives in the treatment decision-making process if the patient is agreeable. Furthermore, if the patient has lost the capacity to make treatment decisions, the patient’s relatives should be consulted as part of the best interests decision-making process under the MCA.

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