Hardships of End-of-Life Care With Court-Appointed Guardians

Abstract

In the United States, the court-appointed guardians do not have the ability to make decisions regarding end-of-life (EOL) care for their clients. Additionally, the process of initiating EOL care measures can be slow and cumbersome, despite an existing process of getting approval for such care. This process has the potential to prolong suffering and delay imperative decisions. This article reviews the hardships that patients, court-appointed guardians, and health care staff endure while moving through the oppressive process of obtaining EOL care orders through the court. This article also proposes ways of tuning up the laws, regulations, and communications to make it easier and faster to obtain orders regarding EOL care to preserve the dignity of our patients and loved ones. "A guardianship is a legal relationship created when a person or institution named in a will or assigned by the court to take care of minor children or incompetent adults."

Guardianship and End-of-Life Decision Making

“…Reports have long suggested that they choose instead the “safer” path of aggressive care by default or defer to a cumbersome judicial process. 12–17 Physicians are in a unique position to assist guardians with these difficult decisions and to collaborate with them to protect the rights and dignity of the vulnerable persons they represent. Doing so, however, requires knowledge of the laws governing guardians, particularly those concerning what decisions a guardian is allowed to make and when judicial review is required.…”

End‐of‐Life Decision Making and Treatment for Patients with Professional Guardians

“…When pivotal choices arise near the end of life, case studies and clinical experience have led experts to suggest that professional guardians respond in two potentially problematic ways. One is by selecting high‐intensity treatment regardless of the likely benefit because the guardian perceives this to be the “safer” course . The other is by avoiding complex decisions and leaving them to the court, whether or not the law requires the guardian to do so .…”

“…One is by selecting high-intensity treatment regardless of the likely benefit because the guardian perceives this to be the "safer" course. [2][3][4] The other is by avoiding complex decisions and leaving them to the court, whether or not the law requires the guardian to do so. 5 The result is that highintensity treatment is delivered by default while health professionals wait for a judge to make a decision.…”

End-of-Life Care for Patients with Schizophrenia #332

“…Depending on state laws, guardians may be limited in their capacity to withdraw lifeextending treatment such as artificial feedings. 9,11 In such cases, involvement of social work and bioethics may be necessary.…”