Importance of mental capacity: time for greater attention and action.

Abstract

The dramatic case of a wealthy widow suffering from dementia who previously handed over control of her significant assets to a tour guide has put the spotlight on the Lasting Power of Attorney (LPA) scheme.(1) Given the legal implications of the case, it has also unnerved fellow medical colleagues who are LPA certificate issuers. The crux of the issue is the determination of mental capacity. This matter is all the more pressing, given Singapore’s ageing population with its increasing life expectancy,(2) and the associated increasing prevalence of dementia and psychiatric, medical and neurological comorbidities. All these conditions are intimately linked to the loss of decision-making capability. From a broader perspective, the issue of determining mental capacity is the concern of not only the accredited LPA certificate issuer, but also the medical practitioner, who needs to obtain valid informed consent from the patient. This article discusses some of the challenges, concerns and misconceptions concerning the assessment of mental capacity, and serves to provide guidance to the busy clinician.