#6 Companion Who Gets To Decide When Minds Are Unsteady

Tonight's Episode

Client choice can feel like a clean principle right up until the moment symptoms surge, risk rises, and everyone around the person feels responsible for the outcome. I walk through why that moment becomes an ethical tightrope for legal advocates, clinicians, providers, peers, and family members and how quickly “help” can turn into control when we confuse disagreement with incapacity. If you care about mental health advocacy, disability rights, informed consent, and ethical crisis response, this conversation is built for you.

We dig into the practical work of preserving someone’s autonomy when psychosis or impairment is part of the picture. That starts with protecting the person’s voice: their values, their words, their fears, and their goals, captured clearly instead of overwritten by other people’s opinions. We also talk about the power of documentation and why observable facts and timing beat vague labels like “noncompliant” or “difficult.” When you focus on what happened and when it happened, you create clarity across systems and reduce the chances of a rushed, assumption-driven decision.

I also explain why disagreement across family members, lawyers, clinicians, providers, and even courts does not automatically mean bad faith. Often it means people are doing their jobs, with different duties pulling in different directions. As a lawyer, that conflict is especially sharp because my role is to do what my client wants, not what everyone else thinks they need.

Grab the Cloak of Client Choice listener action guide at michaelmachniac.org, then subscribe, share this with someone who navigates tough calls, and leave a review so more people can find the show.

DOWNLOAD THE FREE LISTENER ACTION GUIDE

https://drive.google.com/file/d/1HrHl6opiJAKbvBoBvD4clhV92Q-6g1hi/view?usp=drive_link

LISTEN TO HOLDING IT TOGETHER (KINDA)

Spotify:
https://open.spotify.com/show/2nobQzuuYVGKY9NYYWgcvO

YouTube:
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ADDITIONAL FAMILY AND CAREGIVER RESOURCES

Care Coalition Journal:
https://guardian-academy.thinkific.com/courses/CareKeeperJournal

Mental Health Resource Network:
https://www.facebook.com/groups/1296747162391859

Care Coalition:
https://carecoalition.org/

ABOUT MICHAEL MACKNIAK

Michael Mackniak is an attorney, author, speaker and creator of the Guardian Model. For more than 30 years, his work has focused on mental illness, caregiving, care coordination and what happens when real families collide with systems that don't always work the way they're supposed to.

Welcome And The Midweek Unpack

Hi folks, Michael Maknaak here. Welcome to the midweek unpack for Holding It Together kinda, the podcast.

The Ethical Tightrope Of Client Choice

I tackled with my crew here a real toughie when we talk about client choice. This is a real ethical tight rope that legal advocates, providers, uh family members have to walk. And it's really addresses that tension between respecting a person's autonomy and responding when psychosis or impairment or severe symptoms are really the uh at the forefront of what's happening in an acute moment or even overall in a prolonged moment.

Why A Listener Action Guide Matters

So I obviously put this together just recently for you all so you can go back to listen to the episode called The Cloak of Client Choice with this uh action companion uh available with you. And you know, you could if something resonated with you as you were listening to the episode, you can go back and and use the companion to to get into action uh and and and to help you sort out in your own mind some of the issues that we discussed.

Preserve Voice Without Assumptions

Because this was this is a really big, big topic. So, for instance, we talk about how we preserve one's voice, how we we record our our our own values, our words, our our fears, our goals, instead of assuming that because we disagree with somebody else that they must be incapacitated. Um we want to describe what happens when we use observable facts and timing instead of subjective labels like incompliant or difficult. You know, kind of like discuss a full decision pictures.

Use Facts And Timing Not Labels

We put all the duties and viewpoints onto one page from the clinician to the attorney to the individual to family members to peers. So things along this line are what these action companions are really about. You know, guys, disagreement among family lawyers, clinicians, providers, even the courts, it does not mean bad faith.

Putting Every Duty On One Page

It means that people are doing their job. You know, I mean, very often my role as as a lawyer comes into direct conflict with what a family member may think is in the best interest of their loved one. And that's spot on. That happens when I represent a client. I do what the client wants, not what everybody thinks they need. So those kinds of things, those kinds of uh high pressure questions and ethical dilemmas are discussed in this episode.

When Professionals Disagree In Good Faith

A Lawyer’s Job Is The Client’s Wishes

There's a lot more to it. So please grab the cloak of client choice listener action guide. The the PDF can be found certainly at michaelmachniac.org.

Download The Guide And Closing

And um, until next time, just keep on holding it together, folks, even if it's just kinda.

Chapters

Key Takeaways

Preserving autonomy during psychosis or impairment starts with clearly recording the person’s values, words, fears, and goals.

Documentation focused on observable facts and timing can create clarity across systems; the episode contrasts this with vague labels such as “noncompliant” or “difficult.”

Disagreement among family members, lawyers, clinicians, providers, and courts does not automatically indicate bad faith; people may have different duties.

The speaker says a lawyer’s role is to do what the client wants, not what others think the client needs.

Frequently Asked Questions

What does the episode recommend documenting?

The person’s values, words, fears, and goals, along with observable facts and when events happened.

Does disagreement among people involved in a case mean bad faith?

Not necessarily. The episode says people may have different duties pulling them in different directions.

What does the speaker say a lawyer’s role is?

To do what the client wants, not what everyone else thinks the client needs.