Serious complaint

PUBLISHED : Monday, 24 April, 2000, 12:00am
UPDATED : Monday, 24 April, 2000, 12:00am

The Mental Health Ordinance provides that doctors and dentists may treat a mental patient without his or his guardian's consent if it is done in his best interest.

The merit of the provision is unquestionable. While a normal person's right to refuse medical treatment must be respected because he can only be assumed to know what is best for himself, the same cannot be said of a mental patient who lacks the capacity to make critical decisions about his own medical condition. Sometimes, even the patient's guardian cannot be trusted to make the best decision for him because the guardian may be wrong and may have ulterior motives in facilitating his demise.

The provision also aims to allow doctors to provide treatment to a mental patient expeditiously without having to go through a laborious process to obtain approval to over-rule him or his guardian.

So it is disappointing to find that some doctors are not making good use of the provision for fear their judgment may be challenged. One even refused to accept consent given by a mental patient's mother for a surgery to her son's broken leg. Social workers were forced to apply to the Guardianship Board to appoint the mother as guardian of her son. This was absurd.

Doctors complain that they are forced to practise 'defensive medicine' because they have to protect themselves against unreasonable lawsuits in an increasingly litigious society. But in trying to protect themselves, doctors risk abdicating their responsibility towards patients. In the case of mental patients, doctors who insist on getting unnecessary approvals may be accused of depriving these patients of their right to receive medical treatment.

Doctors demoralised by what they consider to be unreasonable complaints from dissatisfied patients should know that most people do accept that doctors know what is good for them. But they want their doctors to have the patience to explain to them the pros and cons of the treatment they are asked to receive before giving consent.

'Doctors know best' is the implicit assumption behind the Mental Health Ordinance. The last thing that doctors should do is to undermine this assumption by not exercising the power to do what is medically best for mental patients.