If there is serious doubt about the patient's capacity to give consent, it should be assessed as a matter of priority. The patient's general practitioner or other responsible doctor may be sufficiently qualified to make the assessment, but in serious or complex cases involving difficult issues about the future health and well-being, or even the life of the patient, the issue of capacity to consent should be assessed by an independent psychiatrist (in England, ideally, but not necessarily, one approved under section 12 of the Mental Health Act of 1983) (9). If after assessment serious doubts still remain about the patient's competence (e.g., the patient is incapable by reason of mental disorder of managing his or her property or affairs), it may be necessary to seek the involvement of the courts.
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