guardianship for Jack

| PART 3 |

Temporary guardianship for Jack

A guardianship application is required before proceeding with Jack’s treatment

All parties agree that Jack requires treatment despite his objection and physical resistance. You discuss a guardianship application with Coral and suggest that Coral should be appointed as a temporary guardian with a ‘restrictive practices function’ to consent to restraint. You download the guardianship application form, fill it in and attach a medical report from the geriatrician.

Before moving on to the outcome of the guardianship application, let’s explore some common guardianship myths which arise in clinical practice.
Mouseover each of the myths below to reveal a response.

The process takes too long and unnecessary delays can cause suffering

Urgent guardianship orders for consent to treatment can in fact be given over the phone, with documentation subsequently faxed at earliest convenience. Awaiting any subsequent hearing does not delay treatment if provided in a patient’s ‘best interests’, although like any treatment, this claim may be contested and must be justifiable.

Only the treating doctor can make an application

Although an application is generally requested by a member of the treating medical team, any person with an interest in the welfare of the patient can make an application for a guardianship order. This includes any member of the multi-disciplinary team.

Guardianship is only for long term options in patients with dementia

Temporary guardianship orders for consent to medical or dental treatment can be given for periods up to as little as one week.

The NCAT is only open during business hours

The NCAT Guardianship Division is available over the phone 24/7 to discuss urgent issues.
(02) 9556 7600 or 1300 006 228.

If the NCAT appoints a Public Guardian, it will take days or weeks to get a decision

Urgent decisions regarding consent to medical or dental treatment are expedited.

A patient can’t be detained under the Mental Health Act and have a guardianship order at the same time

Both these statutes legislate for different aspects of a person’s care and wellbeing, therefore the application of one does not preclude application of the other.

Guardianship orders are not required if you use duty of care

Duty of care is NOT a coercive framework and it does NOT provide an excuse to do anything to a patient that would otherwise be unlawful, such as unwanted touching or detaining against a patient’s will. Thus, duty of care is not an alternative to guardianship.

Guardians have a legal right to demand treatment

Guardians with a ‘health care’ function may request treatment on behalf of the person, but they have no more right than anyone else to demand healthcare treatment.

Jack’s discharge

Find out how Jack’s story finishes up.

The following day the NCAT hold a teleconference guardianship hearing, with Jack, Coral, the geriatrician, and the nurse unit manager in attendance. Coral is appointed as Jack’s guardian for one week, with a function of providing substitute consent for medical treatment and authorising restraint when necessary. Jack re-commences IV fluids with consent from Coral. Consequently, his cognitive status improves as does his cooperation with treatment, only once requiring further restraint when reassurance is not sufficient. He is discharged after 3 days following rehydration and improved nutritional intake.