A time to step in: Legal mechanisms for protecting those with declining capacity

American Journal of Law and Medicine

Volumn 39, Issue 1, 2013, Pages 134-159

  Arias, Jalayne J ^a  

^a LERNER RESEARCH INSTITUTE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CUSTODY; DECISION MAKING; DEMENTIA; HUMAN; LEGAL ASPECT; MENTAL CAPACITY; NEUROPSYCHOLOGICAL TEST; PSYCHOLOGICAL ASPECT; UNITED STATES;

DECISION MAKING; DEMENTIA; HUMANS; LEGAL GUARDIANS; MENTAL COMPETENCY; NEUROPSYCHOLOGICAL TESTS; UNITED STATES;

MLCS; MLOWN;

EID: 84880163335     PISSN: 00988588     EISSN: None     Source Type: Journal    
DOI: 10.1177/009885881303900103     Document Type: Article

References (56)

1. U.S. DEP'T OF HEALTH & HUMAN SERVS., NATIONAL PLAN TO ADDRESS ALZHEIMER'S DISEASE 5 (2012), available at http://aspe.hhs.gov/daltcp/napa/ NatlPlan.pdf.
2. See Rebecca C. Brown et al., Neurodegenerative Diseases: An Overview of Environmental Risk Factors, 113 ENVTL. HEALTH PERSP. 1250, 1250 (2005).
3. * See id. at 1824.
4. See Cruzan v. Dir., Mo. Dept. of Health, 497 U.S. 261, 270 (1990).
5. Jennifer L. Wright, Protecting Who from What, and Why, and How?: A Proposal for an Integrative Approach to Adult Protective Proceedings, 12 ELDER L.J. 53, 71 (2004).
6. Guardianship proceedings for children follow a different structure because children are presumed to be incompetent due to age. Scott J. Shackelford & Lawrence M. Friedman, Legally Incompetent: A Research Note, 49 AM. J. LEGAL HIST. 321, 322 (2007).
7. Jessica Wilen Berg et al., Constructing Competence: Formulating Standards of Legal Competence to Make Medical Decisions, 48 RUTGERS L. REV. 345, 348-49 (1996).
8. See Jason Karlawish, Measuring Decision-Making Capacity in Cognitively Impaired Individuals, 16 NEUROSIGNALS 91, 93 (2008).
9. Marshall B. Kapp & Douglas Mossman, Measuring Decisional Capacity: Cautions on the Construction of a "Capacimeter," 2 PSYCHOL. PUB. POL'Y & L. 73, 76-77 (1996).
10. Melanie Gavisk & Edith Greene, Guardianship Determinations by Judges, Attorneys, and Guardians, 25 BEHAV. SCI. & L. 339, 339-40 (2007).
11. Paul S. Appelbaum, Assessment of Patients' Competence to Consent to Treatment, 357 NEW ENG. J. MED 1834, 1838 (2007).
12. ABA COMM'N ON LAW & AGING, AM. PSYCHOLOGICAL ASS'N & NAT'L COLL. OF PROBATE JUDGES, JUDICIAL DETERMINATION OF CAPACITY OF OLDER ADULTS IN GUARDIANSHIP PROCEEDINGS: A HANDBOOK FOR JUDGES 4 (2006) [hereinafter JUDICIAL DETERMINATION OF CAPACITY], available at http://www.apa.org/pi/aging/resources/ guides/judges-diminished.pdf.
13. See Olivier Godefroy et al., Is the Montreal Cognitive Assessment Superior to the Mini-Mental State Examination to Detect Poststroke Cognitive Impairment?: A Study with Neuropsychological Evaluation, 42 STROKE 1712, 1712 (2011).
14. See SCOTT Y.H. KIM, EVALUATION OF CAPACITY TO CONSENT TO TREATMENT AND RESEARCH 55 (2010);
15. Laura L. Sessums et al., Does This Patient Have Medical Decision-Making Capacity?, 306 JAMA 420, 422 (2011) (stating that while these tests can provide valuable information regarding an individual's cognitive deficits, they alone are not determinants of an individual's decision-making capacity).
16. Monica Franklin, Senior Moments: Is Conservatorship What Is Needed? Here's Help in Figuring It Out, TENN. BAR J., Feb. 2011, at 27, 28.
17. 34See Scott Y.H. Kim et al., Preservation of the Capacity to Appoint a Proxy Decision Maker: Implications for Dementia Research, 68 ARCHIVES GEN. PSYCHIATRY 214, 214-15 (2011).
18. Stella Karantzoulis & James E. Galvin, Distinguishing Alzheimer's Disease from Other Forms of Dementia, 11 EXPERT REV. NEUROTHERAPEUTICS 1579, 1585 (2011).
19. 39 Id. at 101.
20. nId.
21. Paul S. Appelbaum, Consent in Impaired Populations, 10 CURRENT NEUROLOGY & NEUROSCIENCE REP. 367, 368 (2010).
22. Jennifer Moye & Daniel C. Marson, Assessment of Decision Making Capacity in Older Adults: An Emerging Area of Practice and Research, 62B J. GERONTOLOGY: PSYCHOL. Sci. P3, P3-P4 (2007).
23. Paul J. Mober & Jacqueline H. Rick, Decision-Making Capacity and Competency in the Elderly: A Clinical and Neuropsychological Perspective, 23 NEUROREHABILITATION 403, 409 (2008).
24. See Brown et al., supra note 3, at 1250; What is Dementia?, ALZHEIMER'S ASS'N, http://www.alz.org/what-is-dementia.asp (last visited Aug. 18, 2012).
25. See ALZHEIMER'S ASS'N, KNOW THE 10 SIGNS: EARLY DETECTION MATTERS 1 (2009), available at http://www.alz.org/national/documents/checklist-10signs. pdf.
26. Denise Grady, When Illness Makes a Spouse a Stranger, N.Y. TIMES, May 6, 2012, at Al.
27. Paul S. Appelbaum & Thomas Grisso, Assessing Patients Capacities to Consent to Treatment, 319 NEW ENG. J.MED. 1635, 1635-36 (1988).
28. Michel J. Karel et al., Reasoning in the Capacity to Make Medical Decisions: The Consideration of Values, 21 J. CLINICAL ETHICS 58, 60 (2010).
29. See Amtul Q. Farhat, Organ Donation: "Should One Be Buried Whole?," MUSLIM TIMES (Oct. 6, 2011), http://www.themuslimtimes.org/2011/ 10/science-and-technology/alternative-medicine/organ-donarion-%E2%80%9Cshould- one-be-buried-whole%E2%80%9D.
30. Id.at 28-32; Daniel Brudney & John Lantos, Agency and Authenticity: Which Value Grounds Patient Choice?, 32 THEORETICAL MED. BIOETHICS 217, 217-27 (2011).
31. Various clinicians may be qualified to conduct capacity evaluations, including neurologists, psychologists, and psychiatrists. Some clinicians may have received additional experience related to capacity evaluations. Experience in capacity evaluations, however, is a critical component to determining whether a clinician is qualified to conduct the evaluation. ABA COMM'N ON LAW & AGING & AM. PSYCHOLOGICAL ASS'N, ASSESSMENT OF OLDER ADULTS WITH DIMINISHED CAPACITY: A HANDBOOK FOR LAWYERS 32-33 (2005).
32. See James M. Lai et al., Everyday Decision-Making Ability in Older Persons with Cognitive Impairment, 16 AM. J. GERIATRIC PSYCHIATRY 693 (2008);
33. Daniel C. Marson et al., Assessing Financial Capacity in Patients with Alzheimer Disease: A Conceptual Model and Prototype Instrument, 57 ARCHIVES NEUROLOGY 877 (2000); Sessums et al., supra note 28, at 422.
34. Daniel C. Marson et al., Assessing the Competency of Patients with Alzheimer's Disease Under Different Legal Standards: A Prototype Instrument, 52 ARCHIVES NEUROLOGY 949 (1995).
35. Lawrence A. Frolik, Promoting Judicial Acceptance and Use of Limited Guardianship, 31 STETSON L. REV. 735, 745 (2002).
36. Kathleen H. Wilber & Sandra L. Reynolds, Rethinking Alternatives to Guardianship, 35 GERONTOLOGIST 248, 251 (1995).
37. Following the petition, the court will conduct an initial screening to determine whether the case is appropriate for further review. Gavisk & Greene, supra note 20, at 341; Jennifer Moye et al., Clinical Evidence in Guardianship of Older Adults Is Inadequate: Findings from a Tri-State Study, 47 GERONTOLOGIST 604, 608 (2007).
38. Pamela B. Teaster et al., Wards of the State: A National Study of Public Guardianship, 37 STETSON L. REV. 193, 196 (2007).
39. See GN 00502.300: Digest of State Guardianship Laws, SOC. SECURITY ONLINE (Aug. 3, 2012), http://policy.ssa.gov/poms.nsf/lnx/0200502300.
40. See generally Patricia C. McManus, A Therapudential Approach to Guardianship of Persons with Mild Cognitive Impairment, 36 SETON HALL L. REV. 591 (2006) (discussing therapeutic jurisprudence and its impact in court proceedings for people who possess mental impairments).
41. Leslie Salzman, Rethinking Guardianship (Again): Substituted Decision Making as a Violation of the Integration Mandate of Title II of the Americans with Disabilities Act, 81 U. COLO. L. REV. 156, 174 (2010).
42. See CAL. PROB. CODE § 811(d) (2012) ("The mere diagnosis of a mental or physical disorder shall not be sufficient in and of itself to support a determination that a person is of unsound mind⋯."); UNIF. GUARDIANSHIP & PROTECTIVE PROCEEDINGS ACT § 102(5) (1997)
43. 5 Teaster et al., supra note 118, at 196-98.
44. UNIF. PROBATE CODE § 5-102(4).
45. See Uniform Probale Code Locator, LEGAL INFO. INST., http://www.law. cornell.edu/uniform/probate.html (last visited Dec. 2, 2012).
46. UNIF. GUARDIANSHIP & PROTECTIVE PROCEEDINGS ACT § 102(5) ("'Incapacitated person' means an individual who, for reasons other than being a minor, is unable to receive and evaluate information or make or communicate decisions to such an extent that the individual lacks the ability to meet essential requirements for physical health, safety, or self-care, even with appropriate technological assistance.").
47. Probale Code Summary, UNIF. LAW COMM'N, http://www.uniformlaws.org/ ActSummary.aspx?title=ProbateCode (last visited Aug. 16, 2012).
48. ARIZ. REV. STAT. ANN. § 14-5101(1) (2011).
49. See, e.g., NEV. REV. STAT. § 159. 022 (2011).
50. Laura Gibson, Giving Courts the Information Necessary to Implement Limited Guardianships: Are We There Yet?, 54 J. GERONTOLOGICAL Soc. WORK 803, 806 (2011).
51. See, e.g., Pankaj Prasun & Vinod K. Misra, Declining School Performance as a Harbinger of a Treatable Neurodegenerative Condition, 260 J. PEDIATRICS 1062 (2012).
52. See Alaya B. Meyers, Rejecting the Clear and Convincing Evidence Standard for Proof of Incompetence, 87 J. CRIM. L. & CRIMINOLOGY 1016, 1039 (1997).
53. Jennifer L. Rhein, No One in Charge: Durable Powers of Attorney and the Failure to Protect Incapacitated Principals, 17 ELDER L.J. 165, 170-71 (2009). For example, a healthcare power of attorney may or may not be authorized to refuse life-sustaining treatment for a patient who lacks capacity.
54. See generally Richard T. Vanderheiden, Guardianship: Consider the Alternatives, LIFE & TIMES (Nat'l Coll. of Probate Judges, Williamsburg, Va.), Fall 2003, available at http://www.maricopa.gov/pubfid/Documents/Misc/ alternate.pdf.
55. Id.; see also UNIF. PROBATE CODE § 5-501 (1969) (amended 2010) (A durable power of attorney designates another person to serve as the legal decision-maker upon losing decision-making capacity).
56. Representative Payee Home, Soc. SECURITY, http://www.ssa.gov/payee/ (lastupdated Oct. 2, 2012).