Safety vs. Autonomy: When is Guardianship Legally and Ethically Acceptable?

The tension between the values of autonomy and safety have been a major debate topic in the field of medical ethics. This tension applies to debates about guardianship, which is when a court appoints a person to make and supervise personal, day-to-day decisions, including medical decisions, for another person [1]. Guardianship is granted when the supervisee is deemed unable to independently manage their own lives [2]. 

Addiction can greatly impact a person’s ability to make sound, well-informed decisions about their health, finances, and everyday responsibilities [3]. Although substance use by itself does not necessarily mean someone lacks legal capacity, long-term or severe addiction can weaken judgment, memory, impulse control, and risk awareness [3]. When these effects begin to hinder a person’s ability to care for themselves or handle essential obligations, courts may consider whether legal measures, such as guardianship, are appropriate [3]. 

Guardianship is a controversial power because on one hand it helps protect people from themselves, but on the other hand it reduces their autonomy and has a risk for abuse. Courts try to navigate the line between this tension by trying to choose the least restrictive measures that can effectively protect someone, which means they typically will not order absolute guardianship lightly [3]. 

One of the most controversial aspects of guardianship is that it allows one to make medical decisions for another person [1]. Since addiction tends to have a high co-occurrence with psychiatric illnesses, this means that in a scenario of guardianship the guardian can force another person into receiving antipsychotic medications and electroconvulsive therapy [4-5]. Some argue that these restrictive measures can further the stigma around mental illness and addiction, and additionally weaken their ability to develop the competencies needed to re-integrate back into broader society after a mental health crisis [5]. 

But if we got rid of guardianship, what should society do if an addict is a clear danger to themselves? One alternative is involuntary commitment, where an addict is forced into a treatment facility, either short term or long term [6]. This could help protect the addict during a crisis, without needing a guardian to make their decisions long term. However, a problem with this is that once the rehab is completed the patient has a high risk of relapse, with 40–60% of individuals treated for a substance use disorder relapsing at some point [7]. This means that involuntary commitment alone is not effective for everyone long term, meaning further interventions like guardianship might be necessary for some. 

Overall, guardianship in the case of addiction is a contested issue that does not have a clear solution. Our government needs to find a healthy balance between protecting individual liberties while also protecting individual and societal safety. As a last resort, guardianship in some capacity seems to be necessary, but with strong safeguards against abuse and with the goal to make it temporary. 

Designed by: Vedant Patel

Reviewed by: Vedant Patel

References

[1] Moye, J. (2005). Guardianship and Conservatorship. In Evaluating Competencies (Vol. 16, pp. 309–389). Kluwer Academic Publishers. https://doi.org/10.1007/0-306-47922-2_8

[2] Nwakasi, C., & Restorick Roberts, A. (2018). CHALLENGES OF ADULT GUARDIANSHIP. Innovation in Aging, 2(suppl_1), 525–525. https://doi.org/10.1093/geroni/igy023.1940

[3] Casey, R. (2026, March 11). Guardianship and Addiction: What the Courts Consider. Robinson & Casey, PLLC. https://robinsoncasey.com/guardianship-and-addiction-what-the-courts-consider/

[4] Avramut, M. (2024). Mental illness and addiction . EBSCO Information Services, Inc. https://www.ebsco.com/research-starters/health-and-medicine/mental-illness-and-addiction

[5] Salzman, Leslie. (2011). Guardianship for persons with mental illness a legal and appropriate alternative. Saint Louis University Journal of Health Law & Policy, 4(2), 279-330.

[6] NC DHHS: Involuntary Commitments. (n.d.). Www.ncdhhs.gov. https://www.ncdhhs.gov/ivc

[7] Estrellado, N. (2024, July 24). National Statistics on Relapse Rates for Various Addictions - Addiction Group. Addiction Group. https://www.addictiongroup.org/resources/relapse-rates-statistics/