1. Section Editor(s): Risser, Nancy MN, RN, C, ANP
  2. Murphy, Mary CPNP, PhD, Literature Review Editors

Article Content

Dreher GK: Curbside consultation: Is this patient really incompetent? Am Fam Phys 2005;71(1):191-4.

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The author uses a case scenario to illustrate key principles regarding the role of a clinician with a patient and his legal guardian. Although every state has its own statutes, there is general guidance from the Uniform Guardianship and Protective Proceedings Act of 1997. Guardianship should be reserved for cases where less restrictive means will not meet needs. It should only remove those rights that the incapacitated person can no longer exercise or manage. Incapacity in one area, such as money management, does not mean the individual cannot receive and evaluate medical information or make medical decisions. Incapacity proven in the past cannot be assumed to continue to exist. A patient should be given the chance to demonstrate capacity because the burden of proof is always on those who wish to remove a person's rights. When the patient does lack capacity to make medical decisions, the guardian is still required to take into account the views and values of the patient. The guardian is expected to maintain enough contact with the patient to know his capabilities, limitations, needs, and opportunities. When the patient does not have the capability of making medical decisions, the provider should approach the guardian just as he would a patient. Although not expected to discuss every decision with patients, providers are expected to inform patients adequately of the general course of treatment and advise them of any new problems or risks that would require changing the course of care.