What to Do If Your Loved One Refuses Medical Care in Maryland

Facing a situation where a loved one refuses medical care can be deeply distressing. Whether it's due to fear, denial, or other reasons, it's crucial to approach the issue with sensitivity and knowledge of your options. In Maryland, there are specific steps you can take to navigate this challenging scenario while respecting your loved one’s rights and ensuring their well-being.

Understanding the Reasons Behind Refusal 

Before taking any action, it’s important to understand why your loved one is refusing care. Common reasons include:

- Fear or Anxiety: Medical procedures and hospitals can be intimidating.

- Denial of Illness: Some people may not accept that they need medical attention.

- Cultural or Religious Beliefs: Beliefs may influence their decision to refuse certain types of care.

- Mental Health Issues: Conditions such as dementia, depression, addition/substance abuse or mental health disorders can affect decision-making.

Having an open and empathetic conversation can sometimes uncover the root cause and help you address their concerns. 

Steps You Can Take

1. Communicate and Educate

Start by having an honest discussion with your loved one about the importance of the medical care they are refusing. Provide clear, understandable information about the potential consequences of not receiving treatment and try to address their fears or misconceptions. Sometimes, involving a trusted healthcare professional in the conversation can make a difference.

2. Involve a Trusted Third Party

If direct communication doesn’t work, consider involving a neutral third party, such as a family friend, a religious leader, or an elder care social worker. A different perspective might help your loved one feel more comfortable and open to the idea of receiving care.

3. Seek a Second Opinion

Sometimes, a second medical opinion can help alleviate fears. If your loved one is unsure about the diagnosis or treatment plan, another doctor’s perspective might provide reassurance and lead to acceptance of the necessary care.

4. Leverage Support Systems

Involve other family members and close friends to form a support system. Collective encouragement can sometimes persuade a loved one to seek treatment. Additionally, support groups for patients and families facing similar issues can provide valuable advice and emotional support.

5. Understand Legal Options

If your loved one’s refusal of care poses a serious risk to their health and they are not capable of making informed decisions, you may need to explore legal options. In Maryland, you can consider the following:

- Guardianship: If the person is unable to make sound decisions due to mental incapacity, you might be able to petition the court for guardianship. This legal process allows you to make healthcare decisions on their behalf. However, it is important to note that guardianship will not grant the authority to involuntarily commit someone.

- Emergency Petition: In extreme cases where your loved one is in immediate danger and refuses care, you may file an emergency petition with the court.

- Advance Directives and Powers of Attorney: If your loved one has previously executed an advance directive or healthcare power of attorney, these documents can guide medical decisions according to their wishes and designate a healthcare agent to make decisions on their behalf.

Working with Healthcare Providers 

Engage with healthcare providers to develop a collaborative approach. Doctors, nurses, and social workers are experienced in dealing with patients who refuse care and can offer practical advice and support. They may also recommend palliative care or hospice services if the refusal is due to end-of-life issues. 

Respecting Autonomy

It’s essential to balance respect for your loved one’s autonomy with the need to ensure their health and safety. Understanding their wishes and striving to honor them as much as possible is crucial, even when you disagree. Building trust and maintaining a compassionate approach can make a significant difference.

Conclusion

Dealing with a loved one who refuses medical care in Maryland is a complex and emotionally charged situation. By communicating effectively, involving support systems, understanding legal options, and working closely with healthcare providers, you can navigate this challenging terrain. Always aim to respect your loved one’s autonomy while ensuring their safety and well-being. If you find yourself overwhelmed, consulting with an attorney at Markham Law Firm may help you see a path forward.

Understanding Guardianship in Maryland: Powers and Limitations

Guardianship in Maryland is a legal arrangement that grants one person (the guardian) the authority to make decisions on behalf of another person (the ward) who is unable to manage their own affairs. This arrangement is typically sought for minors, elderly adults, or individuals with disabilities. While guardianship provides the guardian with significant responsibilities, it also comes with specific limitations. Here’s an overview of what guardianship in Maryland allows and what powers it does not entail.

 What Guardianship Allows

1. Personal and Medical Decisions

A guardian of the person has the authority to make decisions about the ward’s personal care and medical treatment. This includes:

- Healthcare: Making medical decisions, including consenting to or refusing medical treatments and surgeries.

- Living Arrangements: Deciding where the ward will live, whether it’s at home, in a nursing facility, or another type of care arrangement.

- Daily Needs: Overseeing the ward’s daily personal needs, such as food, clothing, hygiene, and recreational activities.

2. Financial Management

A guardian of the property is responsible for managing the ward’s financial affairs. This includes:

- Asset Management: Handling bank accounts, investments, real estate, and other assets.

- Bill Payments: Ensuring all bills and financial obligations are paid on time.

- Financial Planning: Budgeting and planning for the ward’s future financial needs.

- Legal Transactions: Entering into contracts, filing taxes, and managing other legal and financial matters on behalf of the ward.

3. Educational Decisions

For minors or individuals with specific educational needs, the guardian can make decisions about their education, including selecting schools, approving educational plans, and arranging for special education services if necessary.

4. Legal Representation

The guardian has the authority to act on behalf of the ward in legal matters, which can include filing lawsuits, defending against legal actions, and making decisions in legal disputes.

What Guardianship Does Not Allow 

Despite the extensive powers granted to guardians, there are important limitations designed to protect the rights and autonomy of the ward:

1. Personal Autonomy and Rights 

Guardianship does not give the guardian unlimited control over the ward’s life. The guardian must always act in the ward’s best interests and respect their personal rights and dignity. This includes:

- Respecting the Ward’s Preferences: Whenever possible, the guardian should consider the ward’s preferences and wishes, especially in personal and healthcare decisions.

- Limitation on Restrictive Measures: The guardian cannot unduly restrict the ward’s freedom or impose excessive limitations on their lifestyle without just cause.

2. No Absolute Control Over Property

While a guardian of the property manages the ward’s finances, they must do so prudently and with accountability. They cannot:

- Misuse Funds: Use the ward’s funds for personal benefit or any purpose other than the ward’s needs.

- Sell Property Without Court Approval: Significant financial decisions, such as selling real estate, often require court approval to ensure the transaction is in the ward’s best interests.

3. Healthcare Decisions with Ethical Implications

Certain healthcare decisions, especially those involving ethical or end-of-life considerations, may require additional oversight or court approval:

- Withholding Life-Sustaining Treatment: Decisions to withhold or withdraw life-sustaining treatment typically require court approval or must align with the ward’s advance directives.

- Consent to Experimental Treatments: Guardians may face limitations on consenting to experimental or high-risk medical treatments without additional legal or medical consultation.

Conclusion

Guardianship in Maryland provides a framework for protecting individuals who cannot manage their own affairs, granting guardians significant authority to make personal, medical, and financial decisions. However, this authority comes with important limitations designed to protect the rights and autonomy of the ward. Understanding these powers and limitations is crucial for anyone considering or currently serving as a guardian. Always act in the ward’s best interests, seek court approval when necessary, and consult with legal professionals to navigate the complexities of guardianship effectively. If you find yourself in a situation where guardianship might be necessary, consulting with an attorney at Markham Law Firm can help you navigate this important process.

Understanding Guardianship in Maryland: Person vs. Property

Navigating the legal landscape of guardianship can be complex, especially when it involves the well-being and assets of a loved one. In Maryland, guardianship is divided into two distinct types: guardianship of the person and guardianship of the property. Each type serves a unique purpose and involves different responsibilities. Let’s explore the differences between these two forms of guardianship and what they entail. 

Guardianship of the Person

Guardianship of the person is focused on the personal and medical care of an individual who is unable to make decisions for themselves. This type of guardianship is typically sought for minors, elderly adults, or individuals with disabilities who cannot make or communicate responsible decisions for their own needs.

Responsibilities of a Guardian of the Person:

1. Healthcare Decisions The guardian is responsible for making medical decisions on behalf of the ward (the person under guardianship). This includes consenting to or refusing medical treatments and ensuring the ward receives appropriate medical care.

2. Living Arrangements: The guardian decides where the ward will live, ensuring that the living conditions are safe and appropriate. This could involve arranging for in-home care, assisted living, or a nursing facility.

3. Personal Care: The guardian oversees the ward's daily needs, such as food, clothing, hygiene, and general well-being. This might include coordinating with caregivers or service providers.

4. Education and Social Activities: For minors or individuals with specific educational needs, the guardian ensures that educational and social activities are arranged and that the ward has opportunities for engagement and development.

Guardianship of the Property

Guardianship of the property, on the other hand, pertains to managing the financial affairs and assets of an individual who cannot do so themselves. This is often necessary when the ward has substantial assets that need to be protected and managed prudently.

Responsibilities of a Guardian of the Property: 

1. Asset Management: The guardian is tasked with managing the ward’s assets, including bank accounts, investments, real estate, and personal property. This involves making decisions to preserve and potentially grow these assets.

2. Bill Payments: The guardian ensures that all bills are paid on time, including utility bills, mortgage payments, taxes, and any other financial obligations.

3. Financial Planning: The guardian may need to create a budget, manage income, and plan for future financial needs to ensure the ward's long-term financial stability.

4. Legal and Financial Transactions: The guardian can enter into legal agreements and financial transactions on behalf of the ward. This includes filing taxes, dealing with insurance, and making any necessary legal claims.

Key Differences

 While both types of guardianship aim to protect and support individuals who cannot care for themselves, the key difference lies in their focus:

- Guardianship of the Person: Centers on personal, medical, and day-to-day care.

- Guardianship of the Property: Focuses on financial management and asset protection.

Seeking Guardianship in Maryland

In Maryland, the process for establishing either type of guardianship involves petitioning the court. The petitioner must provide evidence that the prospective ward is incapable of managing their personal or financial affairs. An attorney will be appointed to represent the ward's interests in the guardianship matter. If after a hearing the court finds that a guardianship is appropriate under the law, the court will appoint a guardian based on a statutory priority and in consideration of the ward's best interests. 

It’s important to note that the same individual can be appointed as both the guardian of the person and the guardian of the property, or these roles can be filled by different people depending on the circumstances and capabilities of the guardians.

Conclusion 

Understanding the distinction between guardianship of the person and guardianship of the property is crucial for anyone involved in the care of a vulnerable individual in Maryland. Each type of guardianship comes with its own set of responsibilities and challenges, but both are aimed at ensuring the well-being and security of those who cannot care for themselves without imposing unnecessary restrictions on a person's liberties. If you find yourself in a situation where guardianship might be necessary, consulting with an attorney at Markham Law Firm can help you navigate this important process.

Understanding Guardianship in Maryland: When Is It Appropriate?

In Maryland, guardianship is a legal arrangement where a court appoints a person (the guardian) to make decisions for another person (the ward) who is unable to make decisions for themselves due to reasons such as age, incapacity, or disability. This blog aims to provide a clear understanding of when guardianship is appropriate and the process involved in Maryland.

What Is Guardianship? 

Guardianship is a legal relationship established by a court order. It involves:

1. Guardian: The person appointed to make decisions on behalf of the ward.

2. Ward: The individual who needs assistance with decision-making. In Maryland, until a guardianship is established by the Court, the ward is often referred to as an "Alleged Disabled Person."

Guardianship can be of the person, of the property, or both:

- Guardianship of the Person: The guardian makes personal decisions for the ward, such as those related to healthcare and living arrangements.

- Guardianship of the Property: The guardian manages the ward's financial matters, including assets and income.

When Is Guardianship Appropriate? 

Guardianship is generally considered a last resort because it removes a person’s rights to make their own decisions. Maryland law provides for less restrictive alternatives to guardianship and requires that guardianship only be imposed when there is no less restrictive alternative available which protects the ward. Guardianship is appropriate in the following situations:

1. Minor Children

Guardianship may be necessary for minor children (under 18 years old) when:

- The parents are deceased.

- The parents are unfit or unable to care for the child.

- There is no other parent, family member, or adult willing or able to take responsibility.

2. Adults with Disabilities

For adults with disabilities, guardianship might be necessary if:

- The individual has a significant intellectual or developmental disability.

- The individual is unable to make or communicate responsible decisions about personal care, finances, or health due to mental disability, disease, habitual drunkenness or addiction to drugs.

- There are no less restrictive alternatives, like a power of attorney, that can meet the person’s needs.

3. Elderly Individuals

Elderly individuals may need a guardian if they:

- Have dementia, Alzheimer's, or another condition that significantly impairs their cognitive functions.

- Cannot manage their personal or financial affairs.

- Are at risk of abuse, neglect, or exploitation and need protection.

4. Emergency Situations

In emergency situations where an individual is in immediate danger or is unable to care for themselves due to a sudden illness or accident, temporary guardianship can be established by the court to ensure the person's safety and well-being.

The Guardianship Process in Maryland

The process to establish guardianship in Maryland involves several steps: 

1. Filing a Petition

A person seeking that a guardian be appointed must file a petition with the Circuit Court in the county where the ward lives. The petition should include:

- Detailed reasons why guardianship is necessary.

- Information about the proposed ward’s condition and incapacity including medical certificates.

-Reasons why less restrictive alternatives would be ineffective or have been attempted and failed

- The proposed guardian’s qualifications and willingness to serve.

2. Evidence and Right to Counsel

Two certificates of incapacity must be provided, from at least one doctor and either a second doctor or a psychologist, social worker or psychiatrist, attesting to the proposed ward’s inability to manage their personal or financial affairs. An attorney will be appointed on behalf of the alleged disabled person to ensure their right to due process is protected.

3. Court Hearing 

The court will schedule a hearing where: 

- Evidence is presented regarding the Alleged Disabled Person's condition and need for guardianship.

- Interested parties can express their views.

- The proposed guardian’s suitability is evaluated.

-If finances are involved, bond is either ordered or waived.

 4. Court Order

If the court finds guardianship is necessary and that the proposed guardian is suitable, it will issue a guardianship order specifying the scope of the guardian’s powers and responsibilities.

Alternatives to Guardianship 

Before pursuing guardianship, it’s important to consider less restrictive alternatives that might be sufficient, such as:

- Power of Attorney: If the person has capacity, it allows a person to appoint someone to make decisions on their behalf.

- Health Care Agent/Proxy: If the person has capacity, they can appoint someone to make healthcare decisions in the event they become incapacitated.

Conclusion

Guardianship is a significant legal step that should only be taken when necessary to protect a person who cannot protect themselves. In Maryland, it is used to ensure the safety and well-being of minors, adults with disabilities, and elderly individuals who are unable to make decisions due to incapacity. By understanding the process and exploring all alternatives, guardianship can be effectively utilized to support those in need while respecting their rights and autonomy.

Further Resources

By understanding when and how guardianship is appropriate, we can better ensure that vulnerable individuals receive the care and protection they need. If you feel that guardianship is an option for your family, call Markham Law Firm to learn more.

Navigating Family Disagreements: What to Do When Siblings Can't Agree on Elderly Parent Care in Maryland

 Caring for an elderly parent is a significant responsibility that often requires cooperation and coordination among siblings. However, disagreements can arise, making it challenging to determine the best course of action. In Maryland, there are several steps you can take if you and your siblings cannot agree on who will care for your elderly parent or the care they will receive.

 Understanding the Challenges

Disagreements among siblings can stem from various factors, including:

• Different Opinions on Care Needs: Siblings may have differing views on the level of care required for an elderly parent, such as in-home care versus nursing home placement.

• Geographical Distance: Siblings living far away may have different perspectives compared to those living nearby. Conflicts may arise between siblings when geographic distance or other factors lead to an uneven allocation of responsibility when caring for an elderly parent.

• Financial Concerns: Disputes may arise over how to finance care for an elderly parent and who will bear the financial responsibility.

• Emotional Factors: Old family dynamics, unresolved conflicts, and emotional stress can exacerbate disagreements.

Steps to Resolve Disagreements

1. Open Communication

Start with open and honest communication. Schedule a family meeting to discuss your concerns and preferences. Ensure everyone has an opportunity to express their views and listen to each other without interruption. Sometimes, understanding each other’s perspectives can help find common ground.

2. Seek Help from Neutral Third Parties

If discussions among siblings reach an impasse, consider involving a neutral third party to help. A trusted third party such as another family member or a clergy member could help resolve the dispute. Or, you can engage a mediator. A mediator can facilitate productive conversations and help the family reach a consensus. Mediation services are available through community organizations, legal aid societies, and private mediators specializing in family disputes.

3. Consult a Geriatric Care Manager

A geriatric care manager is a professional who specializes in elder care. They can assess your parent's needs and provide recommendations for care options. Having an expert opinion can sometimes help siblings agree on the best course of action.

4. Involve a Family Therapist

Family therapists or counselors can help address underlying emotional issues and improve communication among siblings. Therapy can be particularly beneficial if long-standing conflicts are contributing to the disagreement.

Legal Options 

If informal attempts to resolve the disagreement fail, legal intervention may be necessary. There are a number of legal options that may be available to allocate decision-making responsibilities and to ensure proper care for an elderly parent:

1. Power of Attorney

If your parent still has the mental capacity to enter into a legal document, they can execute a power of attorney (POA) document and Advanced Healthcare Directive (AHD), designating one or more individuals to make decisions on their behalf. Having your parent designate others to make such decisions while they are still able to do so can prevent sibling disputes in the future and can ensure that your parent's wishes are honored.  

2. Guardianship

If your parent is no longer capable of making decisions and does not have a POA or AHD, you may need to seek guardianship through the court. Guardianship grants one or more individuals the legal authority to make decisions about their parent's care and/or management of property and finances. A guardian can be appointed for the person, property, or both. The court will evaluate the situation and if no less restrictive alternative is available, will appoint a guardian or guardians to serve in the best interest of the parent.

Here’s what to expect in such a scenario: 

1. Petition for Guardianship: One or more siblings can file a petition for guardianship with the court. The petition should outline why guardianship is necessary and who is best suited to serve as guardian. In most cases, a petition must be accompanied by certifications regarding your parent's mental capacity.

2. Appointment of Attorney for the Alleged Disabled Person. The court will appoint an attorney to represent your parent's interests. Such attorney will ensure your parent receives due process and that their preferences are stated.

3. Notice to Interested Parties. Notice of guardianship proceedings will be served on individuals and institutions designated under the law to be "interested persons." All interested persons will be given the opportunity to assert their position regarding the appropriateness of the guardianship and/or the fitness of the proposed guardian(s).  

4. Hearing: The court will hold a hearing where all interested parties can present their case. The judge will then make a decision based on the evidence and testimony provided.

5. Appointment: The court may appoint a guardian, who will have legal authority to make decisions about your parent's care, property, or both. In some cases, the court may appoint co-guardians if it believes that shared responsibility is in the best interest of your parent. Guardianship of the person and guardianship of the property can also be awarded to separate parties.

6. Ongoing Oversight of the Court. The court has ultimate oversight over guardianship matters. Certain training and filings may be required of guardians to ensure that guardians are acting in the parent’s best interests.

Conclusion

Remember, the primary goal is to ensure your parent receives the best possible care while respecting their wishes and needs. Seeking legal advice and involving professionals can help navigate this complex and sensitive process. Please contact our office to speak with a dedicated family law attorney. Our group of highly experienced attorneys are ready to help answer your questions and guide you through this process.

Do I need to pursue Guardianship over my loved one?

Sometimes the answer to this question is simple, however, more often than not the answer to this question is much more complicated.  The unfortunate truth is that many older adults have long periods towards the end of life where they cannot make decisions for themselves.  

A guardian is a person appointed by the Court to make healthcare or monetary decisions for someone who cannot make these types of decisions because of illness, injury, or disability. A guardianship is a crucial legal tool that allows person(s) to make decisions for the disabled adult.  If the person has an advanced health care directive, medical decision making is already being provided for and a Guardianship of Person would most likely not be necessary. Similarly, if the person has a durable power of attorney for finances a Guardianship of the Property would most likely not be necessary.

An illness, injury or disability can make it impossible for someone to make their own decisions.  Admitting this about your loved one can be difficult.  It helps to think of Guardianships as a way to facilitate the independence of the disabled adult and can often help allow the person to maintain as much self-reliance as possible.  

When becoming a Guardian, you may be tasked with deciding where and how your loved will live, what medical treatment they will receive, whether they should buy or sell their property, and what end of life measures should be taken (to name a few).  The Court is considered the “actual” Guardian with the person appointed as a Guardian acting as mere arm or “agent” for the Court.  A loved one is, in most cases, appointed as Guardian because it is presumed they have the disabled adults’ best interest and personal wishes in mind.  The Court will set the parameters for a Guardianship allowing for certain actions to be taken without Court’s approval whereas major life changes such as changes in level of care from at home to an assisted living facility can only be made by the Court.

When deciding if it’s time to obtain a guardianship, hopefully you’ve had a chance to talk about this with your loved one.  He or she may or may not be capable of providing constructive input.  Once you decide to file for a Guardianship, the Court may appoint an independent attorney to represent the alleged disabled adult in the proceeding. This attorney will meet with your loved and determine if a Guardian is necessary and if you are the best choice to become Guardian.  In addition to this, in Maryland, you must provide the Court with two Certifications from a doctor and/or mental health professional certifying that the alleged disabled is incapacitated.  

Again, we understand how difficult this decision can be.  To further discuss your options and learn more, contact our office at 240-396-4373.