Guardianship and Mental Illness: Retaining a Ward’s Right to Self-Determination

Even after a guardian is appointed for an incapacitated person, our courts will seek to preserve the incapacitated person’s right to self-determination, to the extent possible. This challenging task was addressed by the New Jersey Supreme Court in M.R., 135 N.J. 155 (1994):

Unless they endanger themselves or others, competent people ordinarily can choose what they want, even if their choices are irrational or dangerous. Traditionally, however, courts have tempered the right of self-determination of incompetent people with concerns for their best interests. The paradox with incompetent people is to preserve as much as possible their right of self-determination while discharging the judicial responsibility to protect their best interests.

Difficult situations may arise when a mentally incapacitated person expresses wishes or preferences that are based upon illness-driven delusions. One such delusion-based expression may be an objection to, or rejection of, a spouse serving in the role of guardian.

Certainly, if an incapacitated person were under the delusion that he or she required surgery for a non-existent ailment, that opinion would not be given effect by a court. But what is the outcome when a ward’s delusion-based expression is not so clearly contrary to his or her best interests? What if, based upon that delusion, the ward objects to having a long-term spouse act as guardian?

Our courts have held that a ward’s antagonism toward a guardian shall not be the basis for the guardian’s removal, where the hostility between the guardian and ward is caused be the ward’s misbehavior. Heath v. Maddock, 81 N.J. Eq. 469 (Prerog. Ct. 1913), aff’d, 82 N.J. Eq. 366 (E. & A. 1913). Although New Jersey courts have not addressed a case in which the ward’s antagonism is based on a delusion, courts of other jurisdictions have held that such delusions should not be given credence.

In Guardianship of Flaherty, a son was denied appointment as his incapacitated mother’s guardian, based on the mother’s opposition to that appointment. The Court of Appeals affirmed that decision after finding that, although the ward was psychotic and delusional at times, “her decision/choice to not have her son serve as guardian does not appear to be based on or driven by any psychiatric or organic process.” 2009 Mass. App. Unpub. LEXIS 655 (May 1, 2009) (emphasis supplied). As set forth in In re Diurno for Conticchio, 696 N.Y.S.2d 769, 1999 N.Y. Misc. LEXIS 395 (N.Y. Sup. Ct. 1999),

The basic purpose of [the guardianship statutes] is to provide guardians for persons who are likely to suffer harm because they are not capable of taking care of themselves or their property….  The powers are to be tailored to the individual needs of the incapacitated person, taking into account said person’s wishes, preferences and desires, and afford[ing] him or her the greatest amount of independence, self-determination and participation in all decisions affecting him or her. However, all these factors are to be considered in light of the incapacitated person’s understanding and appreciation of his or her functional limitations…. A schizophrenic may be under the delusion that he or she is cured or is being medicated as part of a plot to take over the universe, but obviously wishes arising from such delusions should not be followed if harmful to his or her treatment since they are part of the functional limitations and incapacity which necessitated the guardian’s appointment and powers in the first place…. such [treatment decisions] should accord with the incapacitated person’s wishes… but the Law Revision Commission Comments thereto clarify that the relevant wishes are prior competent  ones and the relevant beliefs are ones based on past values and preferences. Obviously, the Legislature did not intend a guardian to be bound by the delusional wishes of an incapacitated person in the throes of his or her mental disability.

(Emphasis supplied).

A ward’s opposition to his or her spouse acting as guardian is an exceedingly difficult issue to address. However, when that opposition is based upon a delusion experienced while in the throes of a mental illness, disregarding that opinion can promote the ward’s best interests, while at the same time promoting the public policy of this state to protect the sanctity, stability and tranquility of marriage. See J.S.v. R.T.H., 155 N.J. 330 (1998); State v. Mauti, 208 N.J. 519 (2012).

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