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More training needed for judges around dementia and legal guardianship, study says
A new study has found that when it comes to appointing a legal guardian for those with dementia, judges and physicians have very different views.
Lauren Croft
A new interdisciplinary study, published in the European Journal of Neurology, has found weaknesses in guardianship assessment for people with dementia.
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Dementia often leads to the appointment of a legal guardian for the individual affected, as their legal capacity diminishes as the disease progresses and causes symptoms such as memory impairment, language deficits, impulsivity and sensitivity.
According to the study, which was conducted in Finland and surveyed both physicians and legal experts, the significance attributed to different symptoms varied greatly when assessing the need for legal guardianship. The study revealed significant differences of opinion both within and between the professional groups.
Similar dementia symptoms could even lead to entirely opposing conclusions from physicians and judges, University of Eastern Finland (UEF) doctoral researcher Kaisa Näkki said.
“The significance attributed to various symptoms is largely based on each professional’s personal views rather than on research evidence,” she said.
“In particular, subjective opinions were prominent in the interview responses of legal experts, which can undermine equality before the law of those who may need legal guardianship.”
According to the study, those in the legal sphere regarded memory impairment and dyscalculia as the most evident symptoms necessitating legal guardianship. However, opinions were divided regarding other symptoms.
Physicians, on the other hand, regarded neuropsychiatric symptoms, and especially impulsivity, as the most evident symptom necessitating legal guardianship. Often, neuropsychiatric symptoms were found to necessitate legal guardianship already in the early or mild stages of dementia. Physicians were also consistent in their views of memory impairment being a factor that leads to the need for legal guardianship in the moderate stage of dementia.
These findings show a need for a change on an international scale, said Eino Solje, UEF associate professor of clinical research and director of brain research unit.
“Our findings, combined with a lack of previous international research on this topic, indicate that there is an urgent need, both here in Finland and internationally, for a consensus definition of how various symptoms affect legal capacity in dementia,” he said.
“Decisions should not be based on the personal experiences of physicians or judges but on research evidence, which requires systematic data collection. Additionally, there is a need for training for both physicians and legal experts.”
The findings of the study can, therefore, be used to improve the consistency of medical and legal assessments and to ensure equal treatment of those who may need legal guardianship across the globe.
“This study provides deeper insight into the weaknesses of guardianship assessment. The study is also the first step towards the development of relevant medico-legal criteria as well as towards broader collection of data internationally,” Näkki said.
“Based on international data, it is possible to formulate uniform guidelines on the impact of cognitive and neuropsychiatric symptoms on legal capacity and on the need for legal guardianship.”
