Taking control of an adult&#39;s healthcare John Smith is over 18 but under 26. He lives with his parents in California. He has been diagnosed with bipolar disorder with possible comorbid psychological disorders. John has been hospitalized several times for psychotic episodes but more recently has been reasonably stable on medication. He receives health insurance under his parents' plan, but his parents refuse to pay for his co-pays, hospital bills, and other out-of-pocket costs. He currently receives disability money which allows him to pay for his co-pays. John is only marginally able to take responsibility for his own healthcare. He often does not schedule psychiatrist appointments until he has run out of medication (due to the nature of his medications, he must see the psychiatrist before every refill). He frequently misses scheduled appointments and spends more money on missed-appointment fees than on co-pays. He will discontinue new medications in as little as a week, without consulting with a doctor, if he believes he is experiencing any negative side effects. He refuses to take his medications at consistent times every day, and forgets to take his morning or evening meds at least once a week. John's parents do not take responsibility for his healthcare. They do nothing to make sure that he keeps his medications filled or takes his medications on time, nor make any effort to help him schedule or attend appointments. If John is unable to take care of his own medical needs, and his parents do not assist him in managing his medical needs, is it possible for a third party (e.g. a friend or parent of a friend) to assume responsibility for his medical care (e.g. scheduling appointments, picking up medications, administering medications)? Would this be termed Healthcare Power of Attorney (which is commonly associated with the elderly) or something else? If a non-family-member assumes responsibility for John's medical care, does the law still require that he (as an adult under the age of 26) be covered under his parents' healthcare plan?
As a preface, while the best course of action isn't always clear and the reality of implementing some solution is often rocky, the bipolar diagnosis situation you describe is probably the single most common situation in which legal arrangements must be made for an adult child, and is almost as common as the need for children to make legal arrangements for the care of their declining parents. You aren't the only one going through situations like these. Probably 0.5%-2% of people in any given area experience bipolar, usually starting in adolescence or young adulthood, and difficulties managing it of the kind that you describe are the rule and not the exception. Also, just ignoring the problems you describe is a very bad idea. Premature death either from suicide or bad judgment related to the bipolar diagnosis is all too common in these situations. It is serious business, not something that should be thought of as bad character, or futile to do anything about, or blameworthy. It just is, and if someone doesn't do something when the plan gets off course, serious consequences often follow. There are really several intertwined issues present here. Realistically, given the nature of the concerns expressed, a limited guardianship may be necessary to accomplish the goals expressed. What Are Medical Powers Of Attorney? A healthcare or medical power of attorney gives the person who holds it (who is called an "agent" or "proxy") the authority to make medical decisions for someone called the principal (i.e. John Smith) when the principal lacks the capacity to give informed consent at that very moment to do so. This is because a power of attorney is an inherently revocable document expressing the wishes of the person writing it. You generally can't bind yourself in the future without court approval or a contractual relationship with a third party which a power of attorney is not. It isn't uncommon for medical personnel to decide on the spot when to and not to listen to someone with a medical power of attorney based upon how mentally competent the patient seems at the time on a decision-by-decision basis. For example, they might defer to the medical power of attorney agent when the patient is unconscious or heavily drugged, and listen to the patient when the patient is conscious, not drugged, and not acting erratically. Parents, incidentally, do not automatically have this authority, nor do spouses. A medical POA is a document that allows the agent to say "yes" when the patient (i.e. John Smith) cannot. Another name for a document that is very similar and sometimes used is a "health care proxy." It would typically cost a few hundred dollars to $1,000 to have a medical power of attorney drawn up after discussing the situation and the principal's needs in a meeting with a lawyer and might take an initial meeting and then a second one at which the document is signed after it is prepared following the initial meeting. Other lawyers might manage this in a single meeting and draft it while you wait. If all you need is a power of attorney, don't be penny wise and pound foolish by doing it yourself, unless the form is provided to you by the health care provider you will spend most of your time dealing with and they prefer their own form. Otherwise, the likelihood that you will have to pay more to a lawyer later cleaning up your own mistakes probably exceeds any money that you will save. Other Kinds Of Authorizations Many medical providers will allow someone to act on behalf of a patient in matters other than matters that call for the kind of medical decision that would normally require the informed consent of the patient, even when the patient is not manifestly incapable of making medical decisions at that very moment. This could simply be a note in the file that the patient has given that person authority to do so, it could be a written authorization to access HIPAA protected personal health information of the patient, and it could be a variety of other things (e.g., authority to make financial arrangements). Some of this is often incorporated in the same document as a medical POA. Picking Up Controlled Substances A Medical POA may, or may not, necessarily be sufficient to authorize someone to pick up a controlled substance on behalf of a patient if the patient is physically able to do so, without the presence of the patient. I don't know what the true rule of law under the controlled substances acts and pharmacy regulation is, but I do know that practice in real life varies quite a bit. The best practical solution to the issue of picking up controlled substances would be to ask the usual pharmacist what they require and to comply. (A legal guardian would generally have the power to pick up controlled substances for a ward.) Guardianships and Limited Guardianships What Is a Guardianship? A guardian of the person is someone appointed by a court who has the authority to make medical decisions and other personal life decisions for their ward (i.e. John Smith), even contrary to their apparent stated wishes. A guardian has the authority to say "yes" and also to say "no" to the expressed wishes of the ward, overruling the ward. A guardianship of an adult can be general, or can be limited on a customized basis. A guardian must be appointed by a court with jurisdiction over these cases, usually in the county where the ward resides. But, a guardianship can be requested by the ward as opposed to contested. Realistically, a court would be unlikely to grant a full guardianship or a contested guardianship in these circumstances, but might grant a limited guardianship with the consent of the ward in these circumstances. The parents and possibly any siblings, would have a right to notice of the proceedings and to object or to seek to be appointed instead. What Process Is Involved In Having a Guardian Appointed? This would realistically be a proceeding that should ideally involve a specialist lawyer (with experience in mental health or elder law and guardianships) and at least one medical professional's statement (probably a treating psychiatrist or psychologist). There would also probably be a court investigator or guardian ad litem appointed at the ward's expense, to confirm that the facts represented in the petition to have a guardian appointed really reflect the ward's intent. Usually, a proposed guardian selected by the adult ward during a lucid interval would have priority for appointment. The medical professional and lawyer should be able to provide good suggestions regarding what the scope of the limited guardianship needs to be, although don't ignore or fail to give full credit to your own layperson's practical understanding of the situation either. The guardian would have to provide information to the court in connection with the petition showing eligibility to serve (e.g. criminal record check, credit check, CV, nomination by ward). Often the guardian would have to demonstrate good intentions towards the ward in some way, especially if the guardian is a third party and not someone who serves as a guardian as a livelihood. Some courts would require the guardian to have insurance for liability in connection with the task or a surety bond up to some dollar amount. The final decision would usually be made in an in-person hearing at which the ward, the proposed guardian, the proposed guardian's lawyer, the medical professional, the guardian ad litem or investigator, the judge, a court clerk, a court reporter, and any family members who chose to appear (with their lawyers, if any), were present. If the guardianship was granted, perhaps with modifications requested by the judge to the terms of the guardianship, then the Court would issue what are called "Letters" that formally appoint the guardian to the post. Once appointed, the guardian would have to file periodic status reports with the court and would also be subject to the court's jurisdiction in the event of any future dispute regarding the guardianship, or any allegations of misconduct by the guardian, or any circumstance that requires court approval such as a change in the terms of the guardianship or in the person serving as guardian. The procedural details I am describing are approximate and aren't necessarily up-to-the minute correct, and might vary somewhat even from court to court within California under local rules and customs of practice; but they give you a gist of what the process would be like if it is working properly and with best practices. Typically, this might cost $3,000 to $10,000 all in for an uncontested proceeding, and many times that much in the event of a contested attempt to have a guardian appointed. Health Insurance Eligibility I'll defer to someone else's answer regarding health insurance eligibility, as I don't have time to look into that at the moment. My instinct is that this wouldn't be a problem in any case except a guardianship and probably wouldn't be a problem even in a case with a third party guardian, but I can't confirm that without doing research.
The WHO regulations (according to that page; I haven't seen them) &quot;provide an overarching legal framework that defines countries’ rights and obligations in handling public health events and emergencies that have the potential to cross borders.&quot; They don't dictate the conditions for practicing medicine. it does not make that much sense that an American living in Germany could not get telemedicine from America with the same level of convenience - for example, German insurance covering it, and the American prescription being somewhat valid. This would result in a geometric increase in the administrative burden. You need a system for the American prescriber to know what medicines are approved in both countries (and in every other covered country). You need some way for the German health authorities and the insurers to trust that prescribers in the United States are not endangering the health of people in Germany, which means that they need to evaluate the education and certification systems in place in the US (and every other covered country). You need to consider the legal recourse in cases of malpractice: if the prescriber makes a mistake, does the case go to the US courts or German? If German, will the US state that licensed the prescriber honor a judgment revoking the prescriber's medical license? And more. There are simply too many elements that need to be coordinated. With two countries, you have to reconcile one pair of systems. With three countries, three pairs. With four countries, six pairs. With N countries, it's N(N-1)/2, so even with a modest number of countries such as 20, you have 190 pairs of systems to consider. With 196, the number is 19,110.
OK, I talked to a lawyer (in Massachusetts) and these are the answers I got. One can draft a confidential exclusion letter to state wishes regarding excluding certain people from being guardians. In the letter you can explain in detail why you think somebody is unfit to be a guardian. Execute this document as you do for your will and tell your family that it exists so that they can access it if you die (or give them a copy). The advantage of a stand-alone document is that it is not public, differently from the will which is public. The lawyer also suggested to also have a separate stand-alone guardianship document (and so to not include the guardian section in the will). The reason is that a will can be executed only if somebody is dead. But if somebody is e.g. in a coma (or missing), he won't be able to take care of his children and yet his will would not be able to executed. A separate guardianship document would instead apply also in these situations thereby minimizing the chances that somebody, whom you do not consider fit, becomes a guardian of your children.
It is legal for a dentist to bill you for services rendered. You have an obligation to pay the dentist (in exchange for services); the insurance company has an obligation to cover certain expenses of yours (in exchange for money); the dentist has an obligation to the insurance company to accept certain terms specified by the insurance company (in exchange for being listed as 'in-network'). Your recourse is to object to the insurance company, since they are the ones who have an obligation to you. The brute force approach would be to sue the insurance company for failing to cover something that they are (ostensibly) obligated to pay on your behalf, under the terms of your insurance contract. However, the chances are virtually non-existent that they are actually obligated to pay the dentist. You can call the insurance company in advance of the procedure and get a definite decision as to whether the service in question is covered, and if they say "Yes", then you are covered, otherwise you will know you are not, and can plan accordingly. The insurance company has some (minor) leverage over the dentist, if the dentist has breached his contract with the company. If a service provider egregiously breaks the terms of an agreement with the insurance company, the provider could be sued or at least dropped from the in-network list. This is, however, fairly theoretical. The insurance company statement "You should not be billed for this service" has no legal force, but it does weakly suggest that they blame the dentist somewhat (the alternative is to simply say "This service is not covered"). Your obligation to the dentist arises from the service provided plus the rarely-read clause in the financial agreement document that you signed at some point which says something like "We will submit claims to your insurance company, but you are ultimately responsible for any unpaid charges". It is highly unlikely that the dentist actually lied to you about the cost, especially it is unlikely that he said anything that could be construed as a promise that the insurance company would provide a particular level of coverage. For future reference, you either need to get a clear written statement from the service provider that they will accept whatever the insurance company allows you (i.e. their seat of the pants estimates are legally binding), or you need to get a clear written statement from the insurance company regarding what is and is not covered.
north-carolina A parent is responsible for supporting their minor child, therefore they cannot &quot;kick out&quot; their child (they can arrange for someone else to take care of the child but they are financially responsible for this arrangement). This is true even if the parent is a minor. In that case, the grandparents and the parent (who is herself a minor child) are both responsible for the grandchild. We can turn to NCGS § 50-13.4(b) which states the hierarchy of responsibilities: In the absence of pleading and proof that the circumstances otherwise warrant, parents of a minor, unemancipated child who is the custodial or noncustodial parent of a child shall share this primary liability for their grandchild's support with the minor parent, the court determining the proper share, until the minor parent reaches the age of 18 or becomes emancipated. If both the parents of the child requiring support were unemancipated minors at the time of the child's conception, the parents of both minor parents share primary liability for their grandchild's support until both minor parents reach the age of 18 or become emancipated. The details could be different in another jurisdiction.
You seem to have put a lot of thought into this - which is good. However, the short answer is: There is no legal solution. To address your points: And legally, my future wife has the right to divorce me even if I did nothing wrong (no-fault). Yes (at least in most jurisdictions). And then, according to the US Census Bureau [1], mothers usually get primary custody (unless she is on drugs or abusive, which she isn't). And according to the Indiana Parenting Guidelines [2], babies only get one night per week with the non-custodial parent. And even as a teenager, only alternating weekends. Here, it depends. What you describe is indeed what happens often, but not always. Rules vary a lot, and change, but there is an increasing trend to have joint custody in case of a divorce. The details vary, but joint custody can extend to joint physical custody or shared parenting, where both parents take turns looking after the child. This is possible in the United States. In practice, in case of separation the parents will have to work out a parenting plan - ideally together, or in court if needs be. What the result is will depend on circumstances, and on the opinion of the court what is in the children's best interest. This may or may not mean joint physical custody. Child support payments are based on custody, so I would need to pay her child support. And since she always planned on her husband financially supporting her, then I would need to pay her alimony too. And because of imputed income, I couldn't afford to take a lower-paying job with more flexibility. Again, this depends. For example, with joint physical custody, there may be only small or no child support payments if both parents care for the children about equal time. And even if child support is due, there may be no alimony payments if the mother can work (even if she chooses not to). Again, a lot depends on the specific case and jurisdiction. Also, while it is not possible to reduce child support in a pre-nup (because theses payments belong to the child), you can (to some extent) limit alimony payments in a pre-nup. Is there any way out of this situation? How can I ensure, starting now before my children are born, that their primary caregiver is me? Here we are leaving legal territory. The short answer is: There is no way to ensure this, certainly not using legal means. The only good approach is to get to know your partner first, and make sure you have similar views on how to approach parenting. If she wants to be a stay-at-home mom, and you want to share both work and parenting (such as in a shared earning/shared parenting marriage) then you need to think (and speak) about how to reconcile these views. You may find that you are just not compatible on that point. Then take appropriate consequences. To put it plainly: In my opinion, if you do not trust your partner to respect your wishes on parenting together, she is probably not the right person for you to have children with.
Children/youths are allowed to make some decisions themselves even before becoming adults. In the US, COPPA has privacy protections for children under the age of 13. This means that many US-based or US-oriented online services refuse to provide services to people younger than 13. The terms of service often include language to the effect that no part of the service is intended to children under 13. In the EU, the GDPR lets member states pick a cutoff age between 13 and 16 years. Children below this age cannot give consent themselves. However, this is a very narrow condition as consent isn't generally needed to use a website (cookie consent banners are extremely common though). For example, Stack Exchange bans under 13 year olds, and under 16 year olds in the EU: 3. Age Eligibility You must be at least 13 years old to access or use the Network or Services, including without limitation to complete a Stack Overflow account registration. By accessing or using the Services or the Network in any manner, you represent and warrant that you are at least 13 years of age. If you are under 13 years old, you may not, under any circumstances or for any reason, access or use the Services or Network in any manner, and may not provide any personal information to or on the Services or Network (including, for example, a name, address, telephone number or email address). If you are located within the European Union, you must be at least 16 years old to access or use the Network or Services, including without limitation to complete a Stack Overflow Account Registration. By accessing or using the Services or the Network in any manner, you represent and warrant that you are at least 16 years of age. If you are under 16 years old, you may not, under any circumstances or for any reason, access or use the Services or Network in any manner, and may not provide any personal information to or on the Services or Network (including, for example, a name, address, telephone number or email address). Source: Public Network Terms of Service These age limits are solely related to privacy laws. This is not about whether the child has legal competency to enter into contracts, or about your rights as a parent to supervise the development of your children. As a matter of internal policy, but in respect of this legal landscape, many parental control/surveillance software tools limit the available degree of control/surveillance as the children become older. While this may not be required in your particular jurisdiction, software providers are often interested in applying uniform policies across multiple jurisdictions.
1) Bob could disclose the PTSD condition and seek accommodation for it (in reality, controlled narcotics aren't actually used to treat PTSD but it isn't hard to imagine a situation where another controlled substance, e.g. ketamine, was used to treat this or some other Americans with Disabilities Act recognized disability and the absence of that disability was not a bona fide qualification of the job). The legal analysis in the case of the FBI (a federal government civilian civil service employer subject to special rules applicable to governmental employers), and a private employer, is not exactly the same, but it ends up in the same place. 2) Medical marijuana is, as a matter of federal law an oxymoron, because it is a Class I controlled substance that as a matter of law (contrary to reasonable facts) has no medical applications, and the FBI is charged with enforcing this law (among other agencies), so medical marijuana would legally disqualify someone from FBI employment. In Colorado which has legal under state law medical marijuana, employers have been allowed to discriminate based upon medical marijuana use because an employer is at a minimum allowed to treat federal law as enforceable. It is conceivable that some U.S. state other than Colorado which allows medical marijuana at the state level might reach a different conclusion as a matter of state law on the employment discrimination point, but potentially, the employer could appeal to the U.S. Supreme Court on a pre-emption argument so it would be a tenuous legal position to take.