CPG Healthcare Decisions 3 â Questions and Answers
Question 1: A ward is hospitalized and a surgeon requests consent for an elective, non-emergency procedure. The guardian is unreachable for 12 hours. What should the hospital do?
- Proceed with surgery immediately without consent
- Postpone the elective procedure until the guardian can be reached (Correct answer)
- Ask the ward's neighbor to consent
- Contact the court for emergency authorization
Correct answer: Postpone the elective procedure until the guardian can be reached
For elective (non-emergency) procedures, healthcare providers must wait for the legally authorized decision-maker; the guardian should be located before proceeding.
Question 2: A professional guardian oversees a ward with schizophrenia who refuses antipsychotic medication. The treatment team wants to medicate forcibly. What must generally occur first?
- The guardian alone can authorize forced medication without further process
- A court hearing is typically required to authorize involuntary administration of psychotropic medication (Correct answer)
- The ward's insurer must approve the medication
- The facility administrator's written approval is sufficient
Correct answer: A court hearing is typically required to authorize involuntary administration of psychotropic medication
Forced administration of psychotropic medication typically requires a separate court order due to heightened constitutional protections around the right to refuse psychiatric treatment.
Question 3: When a guardian consents to a Do-Not-Resuscitate (DNR) order for a ward, what should the guardian ensure is documented?
- Only the physician's signature is needed; guardian documentation is optional
- The basis for the decisionâincluding the ward's prior expressed wishes or best interest analysisâshould be documented in the guardian's records (Correct answer)
- The DNR must be approved by the ward's employer
- No documentation is required beyond the standard medical form
Correct answer: The basis for the decisionâincluding the ward's prior expressed wishes or best interest analysisâshould be documented in the guardian's records
Guardians should document the ethical and factual basis for DNR consent, including any advance directives or substituted judgment analysis, to demonstrate the decision was properly made.
Question 4: A ward requires surgery and has a blood type that makes transfusions critical. The ward's prior statements indicated they were a Jehovah's Witness who refused blood transfusions. How should the guardian approach this?
- Ignore the religious preference and consent to transfusions as the medically optimal choice
- Honor the ward's deeply held religious beliefs and refuse transfusion consent in line with substituted judgment (Correct answer)
- Consent to transfusions only if the surgeon insists
- Ask the ward's former employer to decide
Correct answer: Honor the ward's deeply held religious beliefs and refuse transfusion consent in line with substituted judgment
Under the substituted judgment standard, the guardian should honor the ward's previously expressed, deeply held religious beliefs about refusing blood transfusions.
Question 5: What role does an ethics committee at a healthcare facility play when a guardian faces a difficult medical decision?
- Ethics committees have binding legal authority over the guardian's decisions
- Ethics committees provide consultation and recommendations but cannot override the guardian's legal authority (Correct answer)
- Ethics committees replace the need for court involvement in all cases
- Ethics committees only handle billing disputes
Correct answer: Ethics committees provide consultation and recommendations but cannot override the guardian's legal authority
Hospital ethics committees offer valuable consultation and moral guidance for difficult cases, but their recommendations are advisory; the guardian retains legal decision-making authority.
Question 6: A professional guardian learns that a ward's physician has a financial interest in a surgical center where the recommended procedure would be performed. What should the guardian do?
- Automatically consent because the physician's recommendation is legally binding
- Seek a second opinion and evaluate whether the recommendation is truly in the ward's best interest given the conflict (Correct answer)
- Report the physician to the police immediately
- Do nothing, as financial conflicts are common and irrelevant
Correct answer: Seek a second opinion and evaluate whether the recommendation is truly in the ward's best interest given the conflict
A financial conflict of interest by a treating physician is a red flag that requires the guardian to seek independent verification that the recommended treatment genuinely serves the ward's best interest.
Question 7: Which of the following best describes 'informed consent' as it applies to a professional guardian authorizing medical treatment?
- The guardian signs any consent form the hospital provides without reviewing it
- The guardian must receive adequate information about the procedure, risks, benefits, and alternatives before agreeing (Correct answer)
- Informed consent only applies to surgical procedures, not medication changes
- The guardian's consent is only valid if co-signed by a family member
Correct answer: The guardian must receive adequate information about the procedure, risks, benefits, and alternatives before agreeing
Informed consent requires that the decision-makerâhere, the guardianâreceive sufficient information about the proposed treatment, its risks, benefits, and alternatives to make a meaningful decision.
CPG Healthcare Decisions 3
A ward is hospitalized and a surgeon requests consent for an elective, non-emergency procedure.
The guardian is unreachable for 12 hours.
What should the hospital do?