[PDF] - Guardianship and Trusteeship Guardianship and Trusteeship Conceptual PDF Document

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3/3/2010 1 Conceptual & Conceptual & Ethical Ethical I i I i Issues in Issues in Guardianship Guardianship

Dick Sobsey & Brendan Leier Dick Sobsey & Brendan Leier

John Dossetor Health Ethics Centre John Dossetor Health Ethics Centre

Guardianship and Trusteeship Guardianship and Trusteeship

Both address decision making.

Both are intended to protect the individual.

Both are intended to protect the individual. hi d l i h fi i l d i i hi d l i h fi i l d i i

Trusteeship deals with financial 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.

Agree or Disagree? Agree or Disagree?

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.

Once a guardian has been appointed to make decisions for an Once a guardian has been appointed to make decisions for an 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

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 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

Less education

Older

Federal Conservative

Most Disagreement Most Disagreement

More education

Younger

Federal Liberal

Federal Conservative

Federal Liberal

Protection from Who? Protection from Who?

Protection from others?

Might a vulnerable individual be taken advantage of by

thers?
thers?

P

t ti f lf? P t ti f lf?

Protection from self?

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?

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Finding the Balance….. Finding the Balance…..

Autonomy Autonomy

The right to make one’s

The right to make one’s d i i d i i

Nonmaleficence Nonmaleficence & Beneficence & Beneficence

Protection from harm

wn decisions
wn decisions

Do we have a right to

Do we have a right to make our own bad make our own bad decisions? decisions?

Right to benefit

Is there always a right

Is there always a right and a wrong decision? and a wrong decision?

Varieties of Decisions Varieties of Decisions

Individual does not indicate preference Individual assents to guardian’s decision Individual indicates clear preference Guardian makes decision within normal framework Guardian assists individual in making decision within Guardian supports individual within normal framework in making decision within normal framework individual Guardian makes decision

utside normal framework

Guardian assists individual in making decision outside normal framework Guardian overrules decision Guardian makes decision that is challenged Guardian assists individual in making decision that is challenged Guardian attempts to influence but not control individual

Decision Decision‐Making Making and and and and Best Interest 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 for Patient Autonomy for Patient Autonomy

Decision Decision‐Making and Best Interest Making and Best Interest

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?

Decision Decision‐Making and Best Interest Making and Best Interest

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 interest

Does it question the perspective from which best interest is determined? Yes. is determined? Yes.

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Decision Decision‐Making and Best Interest Making and Best Interest

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 Why is surrogate decision‐ ‐making so hard? making so hard? Why is surrogate decision Why is surrogate decision‐making so hard? 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 I i Issues in Issues in Guardianship Guardianship

Brendan Leier & Dick Sobsey Brendan Leier & Dick Sobsey

John Dossetor Health Ethics Centre John Dossetor Health Ethics Centre