Standards for Health Care Decision-Making: Legal and Practical Considerations

Abstract

In contemporary guardianship systems, it is likely that most court-appointed guardians will eventually be called upon either to make or to assist the ward to make health care decisions of many sorts. These decisions may involve matters as simple as scheduling physician or dental appointments for the ward, helping her to complete medical history forms, and authorizing nonemergency treatment for minor illnesses or injuries. They may also involve such critical decisions as whether to permit risky surgical procedures, to switch from curative care that is unlikely to cure in favor of palliative care and aggressive pain management, or to direct health care providers to terminate ongoing, life-sustaining treatments including artificial respiration, nutrition, or hydration. Often, these health care decisions must be made in circumstances where time is of the essence or stress levels are high due to the seriousness of the ward’s medical situation and the possible deleterious, irreversible consequences of a “wrong” decision. Persons other than the guardian—a family member or care giver, for example—may wish to, or feel entitled to, have a role in the decision-making process. Persons interested in the ward’s welfare, but who do not have legal authority to make decisions in her behalf, may seek to involve themselves in health care decision-making, although not always in ways that would best serve the preferences, interests, and needs of the person under guardianship.