No abstract available.
Accreditation/*legislation & jurisprudence ; Education, Medical/*legislation & jurisprudence ; Humans ; *Legislation, Medical ; Physicians/*legislation & jurisprudence ; Republic of Korea

Medical reports are required to support court applications to appoint a deputy to make decisions on behalf of a person who has lost mental capacity. The doctor writing such a medical report needs to be able to systematically assess the mental capacity of the person in question, in order to gather the necessary evidence for the court to make a decision. If the medical report is not adequate, the application will be rejected and the appointment of the deputy delayed. This article sets out best practices for performing the assessment and writing the medical report, common errors, and issues of concern.
Documentation ; Humans ; Mental Competency ; legislation & jurisprudence ; Patient Advocacy ; legislation & jurisprudence ; Physicians ; legislation & jurisprudence ; Proxy ; legislation & jurisprudence ; Singapore ; Third-Party Consent ; legislation & jurisprudence ; Vulnerable Populations ; legislation & jurisprudence ; Writing

INTRODUCTIONEarlier treatment with intravenous stroke thrombolysis improves outcomes and lowers risk of bleeding complications. The decision-making and consent process is one of the rate-limiting steps in the duration between hospital arrival and treatment initiation. We aim to describe the attitudes and practices of neurologists in Singapore on the consent and decision-making processes for stroke thrombolysis.

MATERIALS AND METHODSA survey of neurologists and neurologists-in-training in 2 large tertiary public hospitals in Singapore was conducted.

RESULTSAmong 46 respondents, 94% of them considered stroke thrombolysis an emergency treatment and 67% of them indicated there is a need for written informed consent. The majority (87%) knew that from a legal perspective, the doctor should be the decision-maker in an emergency treatment for a mentally incapacitated patient. However, 63% of respondents reported that it is the next-of-kin who usually makes the decision in actual practice. If confronted with a mentally incapacitated stroke patient, 57% of them were willing to be the proxy decision-maker and 13% of them were not. In 3 commonly encountered vignettes when a mentally incapacitated patient was being considered for stroke thrombolysis, there was no clear consensus on the respondents' practices.

CONCLUSIONThe next-of-kin is usually the decision-maker for stroke thrombolysis in practice for a mentally incapacitated patient despite most doctors considering thrombolysis an emergency treatment. This, together with the lack of consensus and variance in decision-making and consent practice amongst neurologists for stroke thrombolysis, demonstrates the need to develop best practice guidelines to standardise healthcare practices for greater consistency in health service delivery.

Attitude ; Decision Making ; Humans ; Informed Consent ; legislation & jurisprudence ; Physicians ; Stroke

The Mental Capacity Act (MCA) came into effect in March 2010 but the impact of this groundbreaking 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.
Advance Directives ; legislation & jurisprudence ; Decision Making ; Delivery of Health Care ; legislation & jurisprudence ; Humans ; Informed Consent ; legislation & jurisprudence ; Mental Competency ; legislation & jurisprudence ; Physician-Patient Relations ; Physicians ; legislation & jurisprudence ; Singapore ; Third-Party Consent ; legislation & jurisprudence

Clinical Competence ; Health Personnel ; Humans ; Informed Consent ; Physicians ; legislation & jurisprudence ; Professional Misconduct ; Professional Practice ; legislation & jurisprudence ; Singapore

Cognition Disorders ; diagnosis ; Decision Making ; Humans ; Mental Competency ; legislation & jurisprudence ; Physicians ; Singapore