Medical Decision-making During the Guardianship Process for Incapacitated, Hospitalized Adults: A Descriptive Cohort Study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2010-10

AUTHORS

Robin J. Bandy, Paul R. Helft, Robert W. Bandy, Alexia M. Torke

ABSTRACT

BACKGROUND: It is sometimes necessary for courts to appoint guardians for adult, incapacitated patients. There are few data describing how medical decisions are made for such patients before and during the guardianship process. OBJECTIVE: To describe the process of medical decision-making for incapacitated, hospitalized adults for whom court-appointed guardians are requested. DESIGN: Retrospective, descriptive cohort study. MEASUREMENTS: Patients were identified from the legal files of a public, urban hospital. Medical and legal records were reviewed for demographic data, code status, diagnoses, code status orders and invasive procedures and person authorizing the order or procedure, dates of incapacitation and appointment of temporary guardian, reason for guardianship, and documentation of communication with a guardian. RESULTS: A total of 79 patients met inclusion criteria; 68.4% were male and 56.2% African-American. The median age was 65 years. Of the 71 patients with medical records available 89% of patients had a temporary guardianship petitioned because of the need for placement only. Seventeen patients had a new DNR order written during hospitalization, eight of which were ordered by physicians without consultation with a surrogate decision maker. Overall, 32 patients underwent a total of 81 documented invasive procedures, 16 of which were authorized by the patient, 15 by family or friend, and 11 by a guardian; consent was not required for 39 of the procedures because of emergency conditions or because a procedure was medically necessary and no surrogate decision maker was available. CONCLUSIONS: Although most of the guardianships were requested for placement purposes, important medical decisions were made while patients were awaiting appointment of a guardian. Hospitalized, incapacitated adults awaiting guardianship may lack a surrogate decision maker when serious decisions must be made about their medical care. More... »

PAGES

1003-1008

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11606-010-1351-8

DOI

http://dx.doi.org/10.1007/s11606-010-1351-8

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1000358391

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/20422304


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