Who Protects the Vulnerable?

Written by: Dr. Kathy Gennuso

When patients are unable to give informed consent and make autonomous decisions because they are incompetent, a court may appoint a guardian to make decisions on their behalf. A patient may be found to be incompetent when she or he is incapable of caring for personal interests because of infancy, incapacity, or disability. When a court finds a person to be incompetent to make decisions, it will appoint a legal guardian to make those decisions on his or her behalf. The guardian is responsible for making all legal and medical decisions on the patient’s behalf, including courses of treatment and when it is appropriate to withdraw care, in the best interests of the patient and in keeping with the patient’s previously stated preferences and values.

The assignment of guardianship is a life and death decision and must be made with appropriate care and attention. One case in the news concerns a patient in a nursing home who has been placed under the guardianship of Distinctive Human Services, Inc. This gives the agency authority over her care and financial affairs. A dispute has arisen from their decision to remove treatment, thus allowing the patient to die. Interesting that it is the same organization that the Social Security Administration is investigating for alleged embezzlement of funds from the same individuals they were appointed to protect. Maybe these two incidents have nothing in common, but how do we know? Who is watching those appointed to protect the vulnerable?