When the Guardian Relinquishes Decision Making: Limited Capacity in the Legally Incompetent Patient

• Published in: The journal of hospital ethics Vol. 8; no. 3; pp. 84 - 87
• Main Authors: Salupo, Nicholas, Merryman, Sharon, Kaufhold, Jeffrey
• Format: Journal Article
• Language: English
• Published: Washington MedStar Washington Hospital Center 01.10.2022
• Subjects: Adult abuse & neglect; Bioethics; Cardiovascular disease; Consent; Consultants; Coronary vessels; Decision making; Ethics; Failure to thrive; Guardians; Hospitals; Palliative care; Primary care; Psychiatry; Rehabilitation; Vein & artery diseases; United States > US; Colorado
• ISSN: 1938-4955; 1938-4920

Prior to this hospitalization, Mrs. L's primary care physician filed a report with the local Adult Protective Services (APS) agency. Upon review of the case, APS determined that Mrs. L had been a victim of elder abuse and neglect. Despite the emergently obtained guardianship order due to what APS reported of the patient's circumstances at home, and regardless of whether or not the patient actually did have the capacity to make a fully autonomous decision to go home, the primary medical team's assessment was that she did not, and they felt duty bound to discharge the patient somewhere they felt was going to constitute a safe discharge. This case presents several ethical considerations that were further complicated by the unusual legal situation of having a court appointed guardian wish to relinquish his court appointment so quickly. First, can a medically frail and socially vulnerable patient, in this case a victim of elder abuse and self-neglect, with at best questionable decisional capacity, make a seemingly unsafe decision to go back into a neglectful environment? Second, does the hospital staff have an obligation to refuse to agree with decisions of a questionably autonomous patient? Finally, who should be ultimately granted decision-making authority if a court-appointed guardian believes his ward has decisional capacity?