Medical decision-making during the guardianship process for incapacitated, hospitalized adults: A descriptive cohort study

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

Research output: Contribution to journalArticle

24 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1003-1008
Number of pages6
JournalJournal of General Internal Medicine
Volume25
Issue number10
DOIs
StatePublished - Oct 2010

Fingerprint

Cohort Studies
Medical Records
Appointments and Schedules
Clinical Decision-Making
Public Hospitals
Urban Hospitals
Documentation
African Americans
Hospitalization
Emergencies
Referral and Consultation
Communication
Demography
Physicians

Keywords

  • court-appointed guardian
  • health care consent
  • health care decisions
  • incapacitated patients
  • proxy decision-making
  • surrogate decision-making

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Medical decision-making during the guardianship process for incapacitated, hospitalized adults : A descriptive cohort study. / Bandy, Robin J.; Helft, Paul; Bandy, Robert W.; Torke, Alexia.

In: Journal of General Internal Medicine, Vol. 25, No. 10, 10.2010, p. 1003-1008.

Research output: Contribution to journalArticle

@article{ec43291ee6dd44b9b10bf9ca3357939b,
title = "Medical decision-making during the guardianship process for incapacitated, hospitalized adults: A descriptive cohort study",
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.",
keywords = "court-appointed guardian, health care consent, health care decisions, incapacitated patients, proxy decision-making, surrogate decision-making",
author = "Bandy, {Robin J.} and Paul Helft and Bandy, {Robert W.} and Alexia Torke",
year = "2010",
month = "10",
doi = "10.1007/s11606-010-1351-8",
language = "English",
volume = "25",
pages = "1003--1008",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "10",

}

TY - JOUR

T1 - Medical decision-making during the guardianship process for incapacitated, hospitalized adults

T2 - A descriptive cohort study

AU - Bandy, Robin J.

AU - Helft, Paul

AU - Bandy, Robert W.

AU - Torke, Alexia

PY - 2010/10

Y1 - 2010/10

N2 - 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.

AB - 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.

KW - court-appointed guardian

KW - health care consent

KW - health care decisions

KW - incapacitated patients

KW - proxy decision-making

KW - surrogate decision-making

UR - http://www.scopus.com/inward/record.url?scp=77957195888&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77957195888&partnerID=8YFLogxK

U2 - 10.1007/s11606-010-1351-8

DO - 10.1007/s11606-010-1351-8

M3 - Article

C2 - 20422304

AN - SCOPUS:77957195888

VL - 25

SP - 1003

EP - 1008

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 10

ER -