An 86-year-old patient attends with her son, who holds legal guardianship. How should treatment be discussed and consented?

Correct answer: A. Discuss the treatment plan with the son as the legal decision maker, while still including the patient in the conversation

• A. CORRECT. A guardianship order transfers legal decision-making authority to the guardian, so consent must come from the SON. But legal capacity and human dignity are separate things: the patient is still the person being treated, is still spoken to directly, and her preferences and assent still inform the plan wherever she can express them.
• B. Talking past a patient as though she were absent is a failure of respect, and it forfeits information only she can give — where it hurts, what she can tolerate, what she wants.
• C. Once a guardian has been appointed the patient no longer holds legal capacity to consent, and her signature would not be valid.
• D. Guardianship documentation should be verified and recorded, but there is no basis for restricting her to emergency care while that happens.

Note: Verify and file a copy of the guardianship order — 'he says he's the guardian' is not documentation. Note also that guardianship can be partial: some orders cover finances only and leave healthcare decisions with the patient. Read what the order actually authorises.