Understanding Rogers Guardianships in Massachusetts: Key Insights and Considerations
- Attorney Gonsalves
- Mar 19
- 4 min read
Updated: Mar 23
In Massachusetts, a Rogers guardianship authorizes the appointee to make medical decisions on behalf of an incapacitated person with respect to extraordinary medical treatment or medical procedures. This post explains what Rogers guardianships are, how they work, and what you should consider if you or a loved one might need one.
What Is a Rogers Guardianship?
A Rogers guardianship confers authority on the appointee to make decisions involving extraordinary medical treatment or procedures on behalf of an incapacitated person.
The best explanation of a Rogers guardianship may be found by examining its historical roots and the case that changed the legal landscape surrounding forcible treatment of involuntarily committed patients with antipsychotic medication. This case is discussed below:
On November 29, 1983, the Massachusetts Supreme Judicial Court rendered a decision regarding forcible treatment with antipsychotic medication, without consent, in the landmark case Rogers v. Commissioner of the Department of Medical Health, 390 Mass. 489, 458 N.E.2d 308 (1983).
The Court grappled with the legal question of whether patients involuntarily admitted to psychiatric institutions could be subjected to forced treatment with antipsychotic medication absent consent.
Seven plaintiffs previously committed to hospitalization filed a lawsuit against the Commissioner of the Department of Mental Health and numerous doctors and administrative staff members of the May and Austin Units of Boston State Hospital.
The plaintiffs argued that the Boston State Hospital's practice of forced treatment with antipsychotic medication violated acceptable medical standards and amounted to a violation of their rights under the United States Constitution.
The Rogers court agreed and found that "[n]o State interest justifies the use of antipsychotic drugs in a nonemergency situation without a patient's consent." Rogers at 491.
The Rogers court concluded that ". . . a committed mental patient is competent and has the right to make treatment decisions until the patient is adjudicated incompetent by a judge." Id.
Lastly, the Rogers court imposed a procedural safeguard - that is: "If a patient is adjudicated incompetent, a judge, using a substituted judgment standard, shall decide whether the patient would have consented to the administration of antipsychotic drugs." Rogers at 491. (Emphasis supplied).
The Rogers v. Commissioner case established the substituted judgment standard used today for Rogers determinations. Specifically, the court will consider the following factors to determine whether the subject would consent to treatment if competent: (1) Expressed preference of the subject; (2) His/her Religious Convictions; (3) Impact on Family; (4) Probability of Adverse Side Effects; (5) Prognosis with Treatment; and (6) Prognosis without Treatment.
A substituted judgment analysis typically depends upon the invasiveness of the particular proposed procedure or advancements which reduce side effects. see In Matter of Spring, 380 Mass. 629, 405 N.E.2d 115 (1980).
Examples of Treatment Requiring Authorization:
The following examples are of some situations that require authorization:
Administration of Antipsychotic Medication
Sterilization
Abortion
Electro-convulsive Therapy
Psychosurgery and Removal of Artificial Maintenance of Nutrition or Hydration
This list is not all-inclusive and could include other treatments or procedures depending on its invasiveness.
Other Protections Afforded:
The guardian must act in the best interest of the individual while respecting their preferences and rights. The court regularly reviews the guardianship to ensure it remains appropriate and that the individual’s autonomy is preserved as much as possible.
An individual known as a "Monitor" is appointed to monitor compliance with the approved treatment plan. The Monitor is required to submit a court report and subject to annual review to ". . . determine whether the. . . incapacitated person's condition and circumstances have substantially changed such that, if competent, the minor or incapacitated person would no longer consent to the treatment authorized therein." M.G.L. c. 190B § 5-306A(b)-(c).
Steps to Establish a Rogers Guardianship in Massachusetts
Establishing a Rogers guardianship involves several steps:
Filing a Petition
A family member, friend, or agency files a petition with the probate court explaining why the guardianship is needed.
Evaluation
The court orders a clinical evaluation by a qualified professional to assess the person’s capacity and needs.
Hearing
A judge holds a hearing where evidence is presented. The person subject to guardianship has the right to attend, be represented by an attorney, and express their views.
Court Decision
If the court finds that a Rogers guardianship is appropriate, it issues an order defining the guardian’s powers and limitations.
Ongoing Oversight
The guardian must report regularly to the court, and the guardianship can be modified or ended if circumstances change.
Challenges and Considerations
While Rogers guardianships provide a balanced approach, there are important considerations:
Complex Process
The legal steps can be time-consuming and require professional guidance.
Emotional Impact
Guardianship can affect family dynamics and the person’s sense of independence.
Cost
Legal fees and court costs may be significant.
Ongoing Responsibility
Guardians must act responsibly and comply with court requirements.
Alternatives to Rogers Guardianships
In some cases, less restrictive options may work better, such as:
Health Care Proxy
A legally enforceable document that designates an agent to make health care decision on behalf of an adult.
Supported Decision-Making Agreements
The individual retains decision-making power but receives help from a trusted team.
Medical Order for Life Sustaining Treatment ("MOLST") or Portable Medical Orders ("POLST")
A document containing an adult's decisions about life-sustaining treatment that is voluntarily created, modifiable, and revocable.
Choosing the right option depends on the person’s abilities, needs, and preferences.
Final Thoughts
Rogers guardianships in Massachusetts offer a thoughtful way to support adults who need help while respecting their autonomy. Understanding how these guardianships work can help families make informed decisions that protect loved ones and honor their rights. If you are considering a Rogers guardianship, you should consult with an experienced attorney that can guide you through the process and ensure the best outcome.
