Medical-Legal Topics

Medical-psychiatric-legal issues are often inescapable in the treatment of geriatric patients. An elderly patient’s capacity to make decisions about a work-up ranges in risk, for example, from whether to pursue a X-ray with radio-opaque, contrast medium with adverse impact on kidney function, to a brain biopsy. Treatment decisions can range, for example, from capacity to give informed consent to an antidepressant that can interfere with libido, to open heart surgery to repair an expanding aortic aneurysm. Although some of these tasks fall within the purview of social workers or other specialists, early recognition by the clinicians who diagnose and direct medical treatment can help avoid more complicated medical-legal problems later and can facilitate smooth delivery of necessary medical and psychiatric care. The specific statutes that control medical practice, standard of care, definitions of capacity, guardianship, informed consent, involuntary psychiatric treatment, mandatory reporting, and other issues differ between jurisdictions; this chapter offers an overview of the basic concepts behind these topics and principles common to the majority of jurisdictions across the USA and other countries that strive to adhere to an individual’s right to make decisions over one’s own body. Topics discussed here also include decision-making capacity over financial matters and estates (testamentary capacity), surrogate decision-making such as conservatorships and guardianships, identification of elder abuse, recognition of vulnerability to undue influence, and mandatory reporting requirements.