CPG Healthcare Decisions 2 — Questions and Answers
Question 1: When applying the substituted judgment standard, what must a professional guardian primarily attempt to determine?
- What the guardian believes is medically best for the ward
- What decision the ward would have made if still capable (Correct answer)
- What the ward's family prefers regarding treatment
- What the attending physician recommends
Correct answer: What decision the ward would have made if still capable
The substituted judgment standard requires the guardian to make the decision the incapacitated person would have made based on their known values, beliefs, and preferences.
Question 2: A professional guardian discovers that their ward has a valid healthcare proxy naming a family member as healthcare agent. How should the guardian proceed?
- Override the proxy because guardianship supersedes all advance directives
- Defer to the healthcare agent named in the proxy for medical decisions (Correct answer)
- File a court motion to invalidate the proxy
- Consult only with the attending physician, ignoring both the proxy and family
Correct answer: Defer to the healthcare agent named in the proxy for medical decisions
A valid healthcare proxy generally designates a healthcare agent whose authority for medical decisions is respected even when a guardian has been appointed, unless the court order specifies otherwise.
Question 3: Under HIPAA, what is a professional guardian's status with respect to accessing a ward's protected health information?
- Guardians have no HIPAA rights and must obtain a court order each time
- Guardians are considered personal representatives and generally have the same access rights as the patient (Correct answer)
- Guardians may only access billing records, not clinical notes
- HIPAA does not apply to guardianship situations
Correct answer: Guardians are considered personal representatives and generally have the same access rights as the patient
HIPAA treats a legally appointed guardian as the patient's personal representative, granting the same rights to access protected health information as the patient would have.
Question 4: A ward's adult children strongly oppose a guardian's decision to discontinue aggressive cancer treatment in favor of palliative care. What should the guardian do?
- Always defer to the family to avoid conflict
- Continue aggressive treatment regardless of the ward's prior expressed wishes
- Proceed based on the ward's known wishes and best interest, documenting reasoning thoroughly (Correct answer)
- Resign from the guardianship immediately
Correct answer: Proceed based on the ward's known wishes and best interest, documenting reasoning thoroughly
The guardian's duty is to the ward, not the family; the guardian should act on the ward's best interest and known wishes while documenting the decision-making process carefully.
Question 5: Which document provides the most direct evidence of a ward's prior healthcare wishes when the guardian must make an end-of-life decision?
- A life insurance policy
- A living will or advance healthcare directive executed while the ward had capacity (Correct answer)
- A letter from the ward's employer
- A guardianship inventory form
Correct answer: A living will or advance healthcare directive executed while the ward had capacity
A living will or advance directive executed while the person had decisional capacity is the most direct evidence of their personal healthcare preferences for end-of-life situations.
Question 6: What is the 'best interest' standard, and when is it typically applied in guardian healthcare decisions?
- It applies when the ward's prior wishes are fully known and documented
- It is used when the ward's prior preferences cannot be determined and the guardian must objectively evaluate benefits vs. burdens (Correct answer)
- It means always choosing the most expensive treatment available
- It requires the guardian to follow only the physician's recommendation
Correct answer: It is used when the ward's prior preferences cannot be determined and the guardian must objectively evaluate benefits vs. burdens
The best interest standard is applied when the ward's prior wishes are unknown; it requires the guardian to weigh the benefits and burdens of treatment options objectively.
Question 7: A professional guardian is asked to consent to an experimental clinical trial for their ward. What is the most important initial consideration?
- Whether the trial is funded by a reputable organization
- Whether court approval is required and whether the ward's prior wishes about research participation are known (Correct answer)
- Whether other wards of the same guardian have participated in trials
- Whether the trial offers financial compensation
Correct answer: Whether court approval is required and whether the ward's prior wishes about research participation are known
Consenting to experimental treatment or research for an incapacitated ward is a heightened-scrutiny decision that may require court authorization and must reflect the ward's known values.
CPG Healthcare Decisions 2
When applying the substituted judgment standard, what must a professional guardian primarily attempt to determine?