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News In Brief 4/13/18

When Adults Have Guardians

Many psychologists who work with children and adolescents are familiar with the role of parents and guardians. Yet, when adult clients have guardians, psychologists are often less familiar with the implications.

To proceed ethically, psychologists must understand the differences between three common substitute decision making processes – Guardianship, Power of Attorney, and Representative Payee – and the authority, or lack thereof, that each has regarding consent to treatment and access to personal health information.

  • Guardianship is the only of these that is a court involved process.
  • Both guardianship and power of attorney include different categories which can limit the aspects of a person’s life that the guardian or power of attorney has substitute decision-making over. Thus, it is important that psychologists confirm that court paperwork gives a guardian the ability to arrange health care and establishes guardianship “over person” (verses only “over estate”) prior to allowing a guardian to consent to treatment or have access to personal health information.
  • Because a client can revoke power of attorney at any time, even when there is a healthcare power of attorney, psychologists are advised to include clients in decision making about treatment and release of information and records.
  • A Representative Payee is someone approved by the Social Security Administration (SSA) to manage another person’s benefits through Social Security. Sometimes, a Representative Payee is also a guardian or power of attorney. When there is no guardianship or power of attorney, the Representative Payee has no authority to consent to treatment or to information or records about the client’s treatment. It is recommended that a release of information be obtained to send bills to Representative Payees if requested by the client.

The General Principles of APA’s Ethical Principles of Psychologists and Code of Conduct include that “Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination” (Principle E). One way to uphold this principle is to be sure to request documentation of any legal guardianship and understand where rights have and have not been limited.

Click here for a table that outlines the above information.

Respectfully submitted by NHPA Ethics Committee