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A Protocol for Medical Decision Making

Alicia A. Chapman, NCG has eighteen years of experience in protective intervention and surrogacy. She has assisted in the training of family guardians and professional guardians since 1990. She established Alicianna LLC in 2005. The Mission of the company is to “Restore dignity to the vulnerable, one person at a time.” Ms. Chapman believes that all conscious life has a right to dignity, autonomy and safety.

This module has been adapted from a presentation made at the National Guardianship Association’s 2006 Conference on Guardianship.

Course Level: Intermediate
Written by: Alicia A. Chapman NCG, Executive Director of Alicianna LLC, Eastpointe, MI.
Course Material: Download
  • Read the course material and take the 21-question test below.
  • You will need to enter your payment information before you can submit your test for grading.
  • A passing score is 75%. There are 100 possible points.
  • You will be notified of your test score within two weeks by email. If you receive a passing score, a certificate will also be emailed.

The following scenarios are used to answer the test questions:

Scenario One

Linda McKenzie is a fifty year old woman. She has suffered from Bi-Polar Disorder since the age of sixteen. Ms. McKenzie has been cycling through the symptoms of the disease more slowly in the past twelve years. During periods of mania she displays all the symptoms of a person with grandiose ideas experiencing mania. The manic slope of the cycle can last from two to six months and usually culminates in a mixed episode. During mixed episodes Ms. McKenzie is combative, rude, provocative, and extravagant. She has been arrested several times during her mixed episodes. Her mixed episodes usually end with a suicide attempt. Her severe depression with suicidal ideations often continues for four to five months. Her periods of balanced thought processes and stable mood have been lasting for five to six months.

Over the past forty years Ms. McKenzie’s physicians have tried a wide range of pharmaceutical interventions. Several of the drugs have relieved her symptoms for two to seven months at a time. However, she has become inured to most of the drugs that are traditionally used for treating Bi-Polar Disorder. The depression that she is currently experiencing has been particularly deep and has now persisted for over seven months. During that time period she has made two suicide attempts and experienced four psychiatric hospitalizations. Her physicians have approached you with the possibility of treating Ms. McKenzie with ECT. You have had a good relationship with Ms. McKenzie and her family over the seven years that you have been guardian for her.

Scenario Two

Jack Hudson was involved in an automobile accident 15 years ago at age 38. Mr. Hudson has not awakened from the closed head trauma injuries that he sustained in the accident. Mr. Hudson has lived in a specialized long term care facility since that time. Although he is not on a respirator, his life is maintained by artificial hydration and nutrition. Eleven years ago his wife, Tracy divorced him and took their two children, Emily age eight and Christian aged five, to live in another state. She remarried three years later.

Mr. Hudson had an independent third party as his guardian until three weeks ago. At that time the independent third party guardian was asked to execute a Do Not Resuscitate Order and a Palliative Care Only order on Mr. Hudson’s behalf. The independent third party guardian asked the court to remove her as guardian because she is “just too soft hearted” to “let Jack Hudson Die”. The court has appointed you as the successor guardian.

Scenario Three

Sarah Albright has been your ward for three years. Initially, Mrs. Albright came to you because her infarction dementia had caused her to be delusional and unable to retain information for a long enough period of time to make an informed consent, manage her income and assets, provide for her own safety, etc. Mrs. Albright also came to you with a diagnosis of hypertension, artheriosclerptic heart disease, and chronic obstructive pulmonary disease. Mrs. Albright was very ambulatory, social, and conscious of her forgetfulness. As guardian you placed Mrs. Albright into an assisted living environment. Mrs. Albright’s improved nutrition, regular medical attention, compliance to her medication regimen, and daily contact with her peers has improved her mental status. Mrs. Albright is now able to retain information that is important to her. However, she continues to experience serious sundown symptoms.

Recently, Mrs. Albright’s mammogram revealed a small mass in her left breast. Needle biopsy revealed that tumor is malignant and this type of cancer is very aggressive.

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