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Neurofibrillary and ethico-legal tangles: in search of surrogates for dementia patients lacking decision-making capacity and relatives.
Chin, J J; Sahadevan, S.
Afiliação
  • Chin JJ; Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. jing_jih_chin@ttsh.com.sg
Ann Acad Med Singap ; 32(6): 756-63, 2003 Nov.
Article em En | MEDLINE | ID: mdl-14716943
Singapore's greying population has led to an alarming increase in the prevalence of dementia, and inevitably to a rising number of dementia patients who lack competence and relatives. Although legislative provisions exist in the current Mental Disorders and Treatment Act (MDTA) for the appointment of committees of person and estate for incompetent patients, healthcare professionals continue to face challenging obstacles in their attempts to search for appropriate surrogate decision-makers for such patients. We illustrate, with 2 cases from our clinical experience, the ethical, legal and administrative tangles faced in our search for appropriate surrogate decision-makers. Specific problems, such as administrative ambiguities in applying the MDTA and the impracticalities of a rigorous judicial process in appointing surrogates, are discussed. We propose possible solutions how these obstacles can be effectively tackled, in particular adopting a radical shift from the present judiciary model to a clinical-based model of appointing surrogates for healthcare decisions. This clinical model is based on best interests considerations and emphasies peer review and a multidisciplinary consultative approach in determining the clinical merits of proposed treatment and its impact on quality of life. The ultimate aim of such a change is to facilitate timely medical care while ensuring ethical practices that respect the patient's dignity.
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Procurador / Ética Clínica Tipo de estudo: Prognostic_studies / Risk_factors_studies Aspecto: Ethics / Patient_preference Limite: Aged / Female / Humans / Male País/Região como assunto: Asia Idioma: En Revista: Ann Acad Med Singap Ano de publicação: 2003 Tipo de documento: Article
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Procurador / Ética Clínica Tipo de estudo: Prognostic_studies / Risk_factors_studies Aspecto: Ethics / Patient_preference Limite: Aged / Female / Humans / Male País/Região como assunto: Asia Idioma: En Revista: Ann Acad Med Singap Ano de publicação: 2003 Tipo de documento: Article