Guardianship and Trusteeship Guardianship and Trusteeship Conceptual - PDF document

3/3/2010 Guardianship and Trusteeship Guardianship and Trusteeship Conceptual & Conceptual & � Both address decision making. Both address decision making. Ethical Ethical � Both are intended to protect the individual. Both are intended to protect the individual. Issues in I I Issues in i i � Trusteeship deals with financial decisions. Trusteeship deals with financial decisions. hi d hi d l l i h fi i h fi i l d i l d i i i i Guardianship Guardianship � Guardianship deals with other decisions. Guardianship deals with other decisions. � Today’s focus is on guardianship, but most of the same Today’s focus is on guardianship, but most of the same principles apply. principles apply. Dick Sobsey & Brendan Leier Dick Sobsey & Brendan Leier John Dossetor Health Ethics Centre John Dossetor Health Ethics Centre Once a guardian has been appointed to make decisions for an Once a guardian has been appointed to make decisions for an Agree or Disagree? Agree or Disagree? individual determined to be incompetent, the guardian individual determined to be incompetent, the guardian should make all decisions for the individual should make all decisions for the individual � Once a guardian has been appointed to Once a guardian has been appointed to make decisions for an individual make decisions for an individual determined to be incompetent the determined to be incompetent, the determined to be incompetent the determined to be incompetent, the guardian should make all decisions for guardian should make all decisions for the individual. the individual. Survey of 1200 randomly sampled Albertans, Summer, 2009 Once a guardian has been appointed to make decisions for an Once a guardian has been appointed to make decisions for an Protection from Who? Protection from Who? individual determined to be incompetent, the guardian individual determined to be incompetent, the guardian should make all decisions for the individual should make all decisions for the individual Most agreement Most agreement Most Disagreement Most Disagreement � Protection from others? Protection from others? � Might a vulnerable individual be taken advantage of by Might a vulnerable individual be taken advantage of by � Less education � More education Less education More education others? others? � Older � Younger Older Younger � Federal Conservative � Federal Conservative � Federal Liberal � Federal Liberal Federal Conservative Federal Conservative Federal Liberal Federal Liberal � P � Protection from self? Protection from self? P t t ti ti f f lf? lf? � Might an individual with limited understanding of the Might an individual with limited understanding of the consequences make a decision that causes harm or denies consequences make a decision that causes harm or denies benefit? benefit? � Protection from Guardian? Protection from Guardian? � Might a guardian make a decision for an individual that is not Might a guardian make a decision for an individual that is not in the individual’s best interest? in the individual’s best interest? 1

3/3/2010 Finding the Balance….. Finding the Balance….. Varieties of Decisions Varieties of Decisions Nonmaleficence Nonmaleficence Autonomy Autonomy Individual does not Individual assents to Individual indicates clear & Beneficence & Beneficence indicate preference guardian’s decision preference � The right to make one’s � Protection from harm The right to make one’s Protection from harm Guardian makes decision Guardian assists individual Guardian supports within normal framework within normal framework in making decision within in making decision within individual individual own decisions own decisions d d i i i i � Right to benefit Right to benefit normal framework Guardian makes decision Guardian assists individual Guardian overrules outside normal framework in making decision outside decision � Do we have a right to Do we have a right to � Is there always a right Is there always a right normal framework make our own bad make our own bad and a wrong decision? and a wrong decision? Guardian makes decision Guardian assists individual Guardian attempts to decisions? decisions? that is challenged in making decision that is influence but not control challenged individual Decision Decision ‐ Making and Best Interest Making and Best Interest Decision ‐ Making Decision Making � Paradigm shift from Physician Paternalism to Respect Paradigm shift from Physician Paternalism to Respect for Patient Autonomy for Patient Autonomy and and and and Best Interest Best Interest Decision ‐ Making and Best Interest Decision Making and Best Interest Decision Decision ‐ Making and Best Interest Making and Best Interest � Paradigm shift from Physician Paternalism to Respect � Paradigm shift from Physician Paternalism to Respect Paradigm shift from Physician Paternalism to Respect Paradigm shift from Physician Paternalism to Respect for Patient Autonomy for Patient Autonomy for Patient Autonomy for Patient Autonomy � Question: Realistically, what does this paradigm shift Question: Realistically, what does this paradigm shift � Question: Realistically, what does this paradigm shift Question: Realistically, what does this paradigm shift accomplish? accomplish? accomplish? accomplish? � Does it question the perspective from which best interest Does it question the perspective from which best interest is determined? Yes. is determined? Yes. 2

3/3/2010 Decision Decision ‐ Making and Best Interest Making and Best Interest Why is surrogate decision ‐ Why is surrogate decision ‐ making so hard? making so hard? � Paradigm shift from Physician Paternalism to Respect Paradigm shift from Physician Paternalism to Respect for Patient Autonomy for Patient Autonomy � Question: Realistically, what does this paradigm shift Question: Realistically, what does this paradigm shift accomplish? accomplish? � Does it question the perspective from which best Does it question the perspective from which best ‐ interest interest is determined? Yes. is determined? Yes. � Does it question the legitimacy of the best Does it question the legitimacy of the best ‐ interest interest standard? No. standard? No. Why is surrogate decision ‐ making so hard? Why is surrogate decision making so hard? My Thesis: We fail to recognize the deep (questionable) My Thesis: We fail to recognize the deep (questionable) philosophical assumptions that drive our current philosophical assumptions that drive our current legal/ethical conceptions of agency and freedom (both legal/ethical conceptions of agency and freedom (both individual and surrogate). individual and surrogate). g Conceptual & Conceptual & Ethical Ethical I I Issues in Issues in i i Guardianship Guardianship Brendan Leier & Dick Sobsey Brendan Leier & Dick Sobsey John Dossetor Health Ethics Centre John Dossetor Health Ethics Centre 3