3A. Making Decisions

When you are making decisions for your ward, you have “substitute judgment” responsibilities.  “Substitute judgment” means you make decisions based on the ward’s values and preferences. 

You must base your mental health treatment decisions on the ward’s known preferences. You must put aside your personal beliefs to preserve the rights and values of your ward. 

You keep your decision-making responsibilities until the court restores the ward to competency, amends or terminates your decision-making authority, or the Court order expires. 

How do you exercise your “substitute judgment” responsibilities?

Before You Make a Decision

North Dakota law requires that you safeguard the ward’s rights by involving them as much as possible in decision-making.  So when you need to decide about the ward’s living arrangements, health care or other care, you must include the ward in the decision making process. Your job is to use the least restrictive forms of intervention with the ward. Remember,  restrictions may only be imposed when necessary for the safety of the ward or others. 

Before You Provide Consent

The law also requires that before you give consent to medical treatment, you must first determine if the treatment is something that the ward would have consented to on their own. If you are unsure what the ward would want, the decision to allow treatment comes down to whether it’s in your ward’s best interest.

When You Authorize Treatment

You must decide whether to authorize any treatment. If you refuse to allow non-emergency treatment, an interested party or lawyer acting on behalf of the ward may file a legal petition challenging your decision.  The petition may also request the appointment of a different guardian.

When the Treatment Plan Isn’t Working

You need to be proactive and regularly review the ward’s treatment progress. If the treatment is not helping or is causing negative side effects, you need to immediately talk with the ward’s doctor. 

When the Ward Needs an Alternative Treatment

If the medical staff is reluctant to make a treatment change, and the current program does not seem to be working, you should look for a different provider or alternative programs.  When in doubt, ask for a second opinion.