| Medical decision-making during the guardianship process for incapacitated, hospitalized adults: a descriptive cohort study. | |
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MedLine Citation:
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PMID: 20422304 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Robin J Bandy; Paul R Helft; Robert W Bandy; Alexia M Torke |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2010-04-27 |
Journal Detail:
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Title: Journal of general internal medicine Volume: 25 ISSN: 1525-1497 ISO Abbreviation: J Gen Intern Med Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-21 Completed Date: 2011-08-16 Revised Date: 2012-04-27 |
Medline Journal Info:
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Nlm Unique ID: 8605834 Medline TA: J Gen Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 1003-8 Citation Subset: IM |
Affiliation:
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Wishard Health Services, Indianapolis, IN 46202, USA. Robin.Bandy@Wishard.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Cohort Studies Decision Making* Female Hospitalization / legislation & jurisprudence* Humans Informed Consent / legislation & jurisprudence* Legal Guardians / legislation & jurisprudence* Male Medical Records / legislation & jurisprudence* Mental Competency / legislation & jurisprudence* Middle Aged Retrospective Studies |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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