Kapp M B
Office of Geriatric Medicine & Gerontology, Wright State University School of Medicine, Dayton, OH 45401-0927, USA.
Aging Ment Health. 2002 Nov;6(4):413-7. doi: 10.1080/1360786021000007054.
The reform of guardianship law and practice remains an active topic of interest for service providers, policy makers, and advocates involved with older persons. Guardianship is a legal device designed to protect persons who lack the cognitive and emotional capacity to make their own life decisions. However, for most 'grey zone' individuals and even for many who are rather clearly and severely mentally disabled, the capacity issue never gets formally raised and the legal process of guardianship (or placement in a formal guardianship diversion program) never gets invoked. Instead, the various parties generally 'bumble through' extra-legally as best they can. When the capacity issue does get raised formally, it often is done so as a matter of legal self-protection for a health care provider or financial institution, rather than primarily for the ward's benefit. The central policy issue to be debated is whether we ought to be encouraging or discouraging extralegal, bumbling through-type handling of persons with questionable capacity rather than initiation of formal judicial involvement or a formalized guardianship diversion program. A closely related issue is what we ought to be teaching health care providers, financial officers, and other third parties who in reality are usually the ones who initially decide whether the formal guardianship system should be initiated for a particular person.
监护法及其实践的改革仍是服务提供者、政策制定者以及关注老年人事务的倡导者们感兴趣的热门话题。监护是一种法律手段，旨在保护那些缺乏做出自身生活决策的认知和情感能力的人。然而，对于大多数处于“灰色地带”的人，甚至对于许多明显存在严重精神残疾的人来说，能力问题从未被正式提出，监护的法律程序（或安置到正式的监护替代项目中）也从未启动。相反，各方通常尽可能在法律之外自行摸索解决。当能力问题确实被正式提出时，往往是医疗服务提供者或金融机构出于法律自我保护的目的，而并非主要为了受监护人的利益。有待辩论的核心政策问题是，我们究竟应该鼓励还是不鼓励对能力存疑的人进行法律之外、自行摸索式的处理，而不是启动正式的司法介入或正式的监护替代项目。一个密切相关的问题是，我们应该向医疗服务提供者、财务人员以及其他第三方传授什么内容，而实际上通常正是这些人最初决定是否应为特定个人启动正式的监护系统。
