title: [How do physicians actually write guardianship certificates for elderly patients?].
abstract: Physicians participate in the legal process of appointing guardianship by writing medical certificates concerning guardianship. There are no instructions or clear-cut methods to examine how to determine a person's ability to handle his own affairs (estate and body), or to evaluate his ability to express his opinion concerning guardianship. There are, however, a number of ways to examine and analyze the subject. Our paper presents findings from 16 randomly collected medical certificates from diverse sources (13 different institutions, physicians from various specialties), for which the courts decision is known. We checked to see if the medical certificates relate to and fulfill basic medico-legal and clinical points referred to in the professional literature.
  
  
  RESULTS
  We found that full demographic details were recorded in only one certificate (6.2%), the identity of the solicitor of the certificate was mentioned in 3 cases (18.7%) and the source/s of information in 6 cases (37.5%). Results of complete cognitive/mental examination (mental status) were mentioned in 4 cases (25%), psychiatric diagnoses in 12 cases (75%), level of severity in 9 cases (56.2%), reference to a temporary phenomenon in one case, and evaluation of basic daily functioning in 2 cases (12.5%). None of the cases included more complex daily functioning evaluations (instrumental). Similarly, none of the certificates mentioned whether or not legal criteria were used to evaluate the subjects ability to handle his estate or body or his ability to express his opinion concerning guardianship. On the other hand, formal reference to the ability to handle affairs (in 7 cases [43.7%] distinction between estate and body) and to express an opinion concerning guardianship was noted in 15 cases (93.75%). The length of the medical certificate averaged 13.8 lines (standard deviation 10.1, range 4-41); 13 of the certificates were written in public forums with an average length of 9.9 lines (standard deviation 4.6, range 4-20 lines), as opposed to 31 lines (standard deviation 9.5, range 22-41) for the private sector. Our findings suggest that the medical certificates were lacking in clinical facets examined, especially the medico-legal aspects. Despite these shortcomings, the courts accepted the overwhelming majority of the documents (15/16, 93.7%), perhaps because most of the certificates included formal reference to specific legal questions raised in the court (ability to handle affairs, ability to express opinion concerning guardianship). In our opinion, these findings, if validated in larger groups and in more courts, require multi-system re-evaluation of the subject of writing medical certificates for legal guardianship of the elderly.
authors.affiliation: Margoletz Psychogeriatric Center, Ichilov Hospital, Tel-Aviv Sackler Faculty of Medicine, Tel-Aviv University.
authors.forename: J
authors.initials: J
authors.lastname: Heinik
authors.forename: A
authors.initials: A
authors.lastname: Solomesh
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002568:Certification / Q000331:legislation & jurisprudence; D003071:Cognition; D003710:Demography; D006801:Humans; D007557:Israel; D007872:Legal Guardians / Q000331:legislation & jurisprudence*; D007883:Legislation, Medical; D008609:Mental Status Schedule; D008875:Middle Aged; D012720:Severity of Illness Index