FORENSIC PSYCHIATRY

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No one with any fiduciary relationship to the patient should sign any order under the Act. Discharge from the hospital can take place once the patient is considered fit by the psychiatrist. B. Consent to Treatment For medical (psychopharmacological) treatment of psychiatric patients, no formal consent is obtained and is implied if no objections are made. If the treatment is necessary but there is refusal because of impaired judgement arising from illness, the patient can be made an involuntary patient and treated. For electroconvulsive therapy (ECT), permission should be sought from all patients who are able to understand and give consent after explanation. If the patient is not competent to give consent, this can be obtained from the next of kin or an immediate family member. If none is available then a second opinion and concordance should be sought from another consultant psychiatrist. Sometimes, the psychiatrist is consulted regarding whether a mentally ill individual is able to give consent for a surgical procedure. Provisions governing consent to medical treatment in Singapore is found in sections 87-92 of the Penal Code. In essence, it requires that a person giving consent is able to understand the nature and consequence of the procedure. As far as possible the patient should give his own consent. Some mental conditions fluctuate in severity and consent may be obtained during a lucid period, as long as he is, at the time able to understand the nature of the operation, the risks involved and consequences. If the patient is unable to give consent, the next-of-kin can give consent on his /her behalf. In the event of emergencies, a procedure done in good faith for a person who is unable to give consent, is not considered an offence provided it is for the purpose of treatment. C. Civil Laws Civils laws concern the rights and obligations of individuals to one another and deal with matters like property and inheritance or contracts. Psychiatric input is sought at times concerning fitness to make a will, validity of marriage contracts or guardianship, or capacity to manage one’s own affairs. 1. Testamentary Capacity This refers to an individual’s capacity to make a will. A will made by someone with mental illness may be challenged by potential beneficiaries who query its validity. Psychiatric opinion about whether a person is of “sound disposing mind” would entail assessing if the person knows: a) What a will is and what the consequences of it are. b) The nature and extent of his property. c) Who the potential beneficiaries are. 2
Most importantly, the psychiatrist determines whether the existence of a mental illness has affected judgement pertaining to the above factors. The presence of a mental illness in and of itself need not necessarily affect the patient’s ability to make a will. 2. Capacity to Manage own Property and Affairs Relatives of patients who are in possession of valuable estates e.g. property, money, shares etc. may be concerned about the effect of mental illness on their capability to manage their affairs. A patient may give written authorization, i.e. power of attorney, to someone else to act on his behalf. However if the person is alleged to be mentally disordered, is of unsound mind and incapable of managing himself and his affairs then the Court may appoint a committee or committees of the person and his estate and the management thereof. 3. The Marriage Contract A marriage can be considered invalid if one party was mentally unwell such that he/she was unable to understand the nature of the contract. Alternatively, one partner may have been ignorant that the other was having a mental illness. “Mental cruelty” has also been cited as grounds for divorce, in that one party feels he/she has become mentally ill as a result of ill treatment by the spouse. Mental illness is also grounds for divorce if a spouse has been mentally ill for more than five years despite continuous treatment or causes exceptional hardship or irretrievable breakdown of marriage. D. The Mentally Disordered Offender Persons may be admitted and detained for assessment in Woodbridge Hospital on a Warrant of Remand from the Court, if they are charged with a criminal offence and are suspected to be of unsound mind. The psychiatrist is called upon to give his opinion to the Court as to the individual’s: 1) Fitness to plead. 2) Criminal responsibility. 3) Treatment and disposal. a. Fitness to Plead A basic right of a person accused of a crime is the right to defend himself/herself. In determining fitness to plead, the psychiatrist is interested in whether the defendant: i. Understands the nature of the offence. ii. Knows the difference between pleading guilty and not guilty. iii. Can follow court proceedings. iv. Is able to take instructions from and advise counsel. 3
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Page 5: c. Treatment and Disposal Psychiatr

FORENSIC PSYCHIATRY

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