Admission of Alzheimer’s Disease Patients to Locked Special Care Facilities Against Their Will

To the Editor: We read with interest that Ruth Dukoff, M.D., and Trey Sunderland, M.D., use the durable power of attorney in drug studies involving Alzheimer’s disease patients so that continued participation is not threatened by the inability to give informal consent (1). We would add the caveat that a durable power of attorney is not sufficient to override the expressed wishes of a patient in cases of medical and psychiatric procedures, hospitalizations, and nursing home placement. Overall, it is surprising that geriatric psychiatrists have not been more concerned about the risk of violating patients’ right to due process, given the current medical/legal environment. Vulnerability to lawsuits brought by third parties on behalf of unwilling residents of locked Alzheimer’s units who are not under guardianship seems a potential, largely unaddressed risk.

In Texas, guardianship is a cumbersome and expensive process that families and nursing homes may wish to avoid. Little published information is available regarding Alzheimer’s disease locked units and the legal status of residents. Information about legal status is sometimes not even part of the medical chart. But the psychiatrist needs to consider the role of due process, for it is not up to us to sidestep the letter of the law, especially since we are often the ones held most accountable.