By Invitation

The psychiatrist's dilemma over patient autonomy

For psychiatric patients with no insight into their own illness, where does the concept of patient consent end and when do doctors take over the care, with the family's agreement?

Mr L. was referred to me after his attending psychiatrist at the Institute of Mental Health went into private practice.

He was a slight, trim man with greying hair and was in his mid-50s when I saw him. He had had schizophrenia for the past 20 years. Going through his voluminous medical records, a pattern emerged. He would become acutely unwell and had to be hospitalised, and then would get better after the reinstatement of his medication. After discharge, he would turn up at the outpatient clinic for a follow-up session, but these visits would soon taper off.

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A version of this article appeared in the print edition of The Straits Times on April 23, 2019, with the headline 'The psychiatrist's dilemma over patient autonomy'. Print Edition | Subscribe