Can Guardians Make Medical Decisions

I recently had a call with Emily, absolutely distraught. Her brother, David, had a severe stroke, and she’d been appointed his temporary guardian by the court. But the hospital was refusing to let her authorize a necessary surgery. They claimed they needed more documentation, and they were questioning whether the surgery aligned with David’s “best interests.” Emily was facing a $30,000 medical bill ticking up every day, plus the anguish of potentially losing her brother, all because of a bureaucratic impasse. This situation, unfortunately, is more common than you might think.

The short answer is yes, a guardian can make medical decisions, but it’s rarely that simple. California law vests broad authority in guardians to consent to, or refuse to consent to, medical care for their wards. However, that authority isn’t automatic, and it’s subject to numerous limitations and judicial oversight. The level of authority granted – and the required procedures – depend heavily on whether the guardianship is limited or full, and whether the ward had previously executed advance healthcare directives.

What Types of Guardianship Authority Exist?

California law recognizes different types of guardianships tailored to the specific needs of the ward. A General Guardianship grants the guardian broad powers over both the person and the estate of the ward. A Limited Guardianship, however, confines the guardian’s authority to specific tasks, such as managing finances or consenting to a particular type of treatment. Crucially, the scope of authority is defined by the court order establishing the guardianship. If David’s guardianship was limited to financial matters, Emily would likely lack the legal authority to make medical decisions, even if she believes she knows what David would want.

Furthermore, if David had a valid Durable Power of Attorney for Healthcare, or an Advance Healthcare Directive like a living will, those documents take precedence. The guardian’s authority is subordinate to the instructions contained in those pre-existing directives. The hospital was right to question the surgery – they were obligated to seek evidence of those documents.

What About “Best Interests”?

Even with broad authority, a guardian isn’t free to make arbitrary decisions. They must act in the “best interests” of the ward. This standard, while seemingly straightforward, is often open to interpretation. California courts will consider several factors when evaluating whether a guardian’s decisions are appropriate. These include the ward’s wishes (if known), their medical condition, the potential benefits and risks of treatment, and the ward’s values and beliefs.

• Prior Expressed Wishes: If David previously discussed his preferences regarding medical treatment with family or friends, Emily should document those statements.
• Current Medical Condition: The guardian should obtain a thorough assessment of David’s condition from his physicians.
• Quality of Life: Courts consider the likely impact of treatment on the ward’s overall quality of life.

In Emily’s case, the hospital’s concern about “best interests” likely stemmed from a lack of clarity regarding David’s wishes and potentially a disagreement among family members about the appropriate course of treatment. That’s where a strong understanding of probate law and the ability to present a compelling case to the court becomes essential.

Digital Assets and Healthcare Information

Modern healthcare increasingly relies on digital records and online portals. A guardian’s ability to access David’s electronic health information, communicate with his doctors through secure messaging, and manage his online medical accounts is vital. However, access isn’t guaranteed. Codified in California Probate Code §§ 870–884, the RUFADAA (Revised Uniform Fiduciary Access to Digital Assets Act) requires the decedent to have given explicit “written direction” in their Will, Trust, or via an online tool (like Google’s Inactive Account Manager) to allow access. Without this, Emily may need to petition the court for special orders granting her authority to access David’s digital assets.

The Importance of a Comprehensive Estate Plan

As an estate planning attorney and CPA with 35+ years of experience, I always emphasize the importance of proactive planning. A well-drafted estate plan, including a Durable Power of Attorney for Healthcare, Advance Healthcare Directive, and a thoughtfully constructed Will or Trust, can prevent precisely these kinds of crises. The CPA advantage here is crucial; we can ensure that all assets are properly valued for tax purposes, helping to minimize potential capital gains and maximize the step-up in basis – a critical benefit often overlooked. In Emily’s situation, a clear Advance Healthcare Directive would have immediately resolved the hospital’s concerns and allowed her to focus on supporting her brother.

Furthermore, California law requires that estates with a gross value exceeding $208,850 (California Probate Threshold under Probate Code Section 13100, updated effective April 1, 2025) generally undergo formal probate. While the OBBBA (One Big Beautiful Bill Act), signed July 2025, made the higher Federal Estate Tax Exemption of $15 million per person permanent effective January 1, 2026, it doesn’t diminish the need for careful estate planning to avoid the complexities of probate.

How do probate courts in California evaluate intent when a will is challenged?

In California, a last will and testament operates within a probate system that emphasizes intent, clarity, and procedural compliance. When properly drafted, a will does more than distribute property—it creates legally enforceable instructions that guide courts, fiduciaries, and beneficiaries through administration with fewer disputes and less uncertainty.

• Leadership: Define executor responsibilities clearly.
• Guardians: Establish guardianship for minors.
• Location: Confirm domicile requirements.

When a will is drafted with California probate review in mind, it becomes a stabilizing roadmap rather than a source of conflict. Clear intent, proper authority, and compliant execution protect both families and estates.

Official Legal Mandates and Resources for California Guardianship

• Mandatory Judicial Forms:
  Judicial Council of California – Guardianship Forms (GC Series)
  Access the complete library of “GC” (Guardianship and Conservatorship) forms required for filing a petition in California. In 2026, this remains the official source for mandatory background screening forms and the specific notices required for relatives under the Probate Code.
• Self-Help Procedural Guide:
  California Courts – Guardianship Self-Help
  An official judicial resource providing step-by-step instructions for families seeking legal custody. This guide explains the critical 2026 distinctions between Guardianship of the Person (physical care and health) and Guardianship of the Estate (financial management of the minor’s assets).
• Acknowledgment of Fiduciary Duties:
  Duties of Guardian (Form GC-248)
  The mandatory Judicial Council document that every prospective guardian must sign. It acknowledges your legal obligations regarding the minor’s education, health, and welfare, and establishes your ongoing accountability to the California Probate Court.
• Statutory Authority:
  California Probate Code § 1500 (Guardianship)
  The definitive statutory authority governing the appointment of guardians. This code stipulates that a parent or third party can only be appointed if it is proven—under the “Clear and Convincing” evidence standard—that parental custody would be detrimental to the child’s best interests.