Substituted Decision Making: Elder Guardianship

Abstract

The goal of this column is to help experienced clinicians navigate the judicial system when they are confronted with requests for capacity evaluations that involve guardianship (conservatorship). The interface between the growing elderly medical population and increasing requests for substituted decision making is becoming more complex. This column will help practicing psychiatrists understand the medical, legal, and societal factors involved in adult guardianship. Such understanding is necessary in order to effectively perform guardianship evaluations and adequately inform courts, patients, and families about the psychiatric diagnoses central to substituted decision making.

Decision-making capacity evaluation in adult guardianship: a systematic review

“…Applications are made to guardianship (also known as conservatorship) courts and tribunals seeking legal orders to appoint a substitute decisionmaker, also known as a guardian or conservator (Leatherman and Goethe, 2009). However, when informal solutions cannot be found or issues of conflict are raised, the law may have a role.…”

“…However, when informal solutions cannot be found or issues of conflict are raised, the law may have a role. Applications are made to guardianship (also known as conservatorship) courts and tribunals seeking legal orders to appoint a substitute decision-maker, also known as a guardian or conservator (Leatherman and Goethe, 2009). A critical piece of evidence in the legal proceedings is the clinical report of decision-making capacity written by a health professional (Moye et al , 2005).…”

Ethical Challenges in the Treatment of Individuals With Intellectual Disabilities

“…In general, we propose that the treatment of mental illness in clients with ID is consistent with treatment of mental illness in intellectually typical clients but requires special attention to areas of potential ethical tension to provide the highest quality of care possible. Some of the issues discussed here may be germane to other populations; for example, elderly people with dementia and mental illness may present with the complications of guardianship (Leatherman & Goethe, 2009) and impaired ability to consent to treatment (Okonkwo et al, 2007). Our discussion of these considerations focuses on five unique areas of concern: promoting access to services, identifying the client, obtaining informed consent, carrying out sound assessment evaluations, and providing competent clinical services.…”