Informed consent for major medical treatment of mentally disabled people. A new approach.

When an incompetent mentally disabled person has no family member or guardian available, obtaining informed consent for major medical treatment usually requires a court order--an often time-consuming, formal, and expensive process that does not provide for much substantive review of the decision about treatment. Consequently, there is a temptation to circumvent the requirement that informed consent be obtained for treatment of the residents of institutions as well as of those in community mental-health and mental-retardation programs. Under a new pilot program established by the New York State legislature, volunteer committees are empowered to make decisions about medical care in such cases. The law protects physicians from liability when they rely on the committees' decisions. The results of the program after one year indicate that this is an effective approach, which provides quick yet careful individualized decisions, in an informal and accessible forum. Advocates for the mentally disabled and health care providers agree that this approach is preferable to the judicial process for making decisions about medical care for incompetent mentally disabled persons. This type of program may prove workable for other groups of incompetent people who lack family members or guardians to act as surrogate decision makers.