Guardians can only do so much if client refuses care

More and more accounts of controversial guardianship decisions have come up in recent years. They can be fraught with life or death decisions when a patient is mentally incapable of taking care of herself. At issue in this Pennsylvania case is whether a guardian was justified in allowing a mentally ill patient to refuse to continue her life-sustaining dialysis treatment.

A guardian’s hands may be tied when a client refuses a prescribed treatment. When one 47-year-old patient refused to continue her dialysis, the staff in her personal care home tried to dissuade her. Due to her mental illness, the woman refused, claiming the dialysis was a trick. Upon her death, questions arose regarding this decision. The woman not only refused to continue her kidney treatment, she exhibited erratic behavior in the dialysis treatment facility and frightened other patients.

The patient, diagnosed with psychosis, was taking psychotropic drugs along with a prescribed course of treatment for renal failure. She repeatedly refused both, leaving her caregivers no other options but to make decisions for her. One staff member stated the woman had no idea she would die if she stopped her treatments. Although staff might convince her to go back to treatments when she got sick, one administrator called the woman’s life at the care facility a “roller-coaster.”

Final reports indicated that after consulting with her guardian, the decision was made to stop dialysis.

Now the issue remains if the guardian and health care agency could have done more to save her life. One spokesperson for the National Disability Rights Network said this case underscores the need to implement a better health care system designed to help mentally ill patients with more effective support systems to manage their quality of care.

In other cultures around the world, families and relatives step up to take care of ailing members. Here in the United States, some families are not willing to take on this responsibility, so a public health agency appoints a legal guardian, who makes decisions for the incapacitated person. Some experts say the issue is an ethical one that places a great deal of responsibility on the shoulders of a stranger. A guardian may struggle with the final decision of when to allow a patient the right to forgo treatment that will ultimately result in her death.

Source:Pittsburgh Post-Gazette, “When a guardian decides on life or death” Joe Smydo, Jan. 18, 2014