In the United States, an adult deemed "incompetent" because of medical conditions, mental health issues or intellectual or developmental disabilities is placed under the care of a guardian appointed by a state court. In NC, clerks or assistant clerks of the court serve as the judge for matters relating to guardianship. The guardian serves as a surrogate decision-maker in all areas of a person’s life (full guardianship) or only in certain areas (limited guardianship) where the court deemed the individual competent to make decisions in certain areas. Guardians can serve temporarily or indefinitely depending on the nature of the incapacity.

Guardianship is most restrictive when it removes an adult’s right to manage his or her life decisions and places those decision-making responsibilities with a court appointed guardian. On the national level, the Olmstead decision (1999) and Department of Justice settlements call for individuals with disabilities to be placed in less restrictive living and work environments to give an individual as much control over their life as possible. However, in practice courts make decisions without a uniform interpretation of guardianship, or an understanding of less restrictive alternatives to guardianship. Similarly, loved ones petitioning for guardianship of a family member may not be well informed of less restrictive alternatives which would allow them to help their family member without stripping the person of rights and personal autonomy.

• Presentation on Guardianship, Disability Rights North Carolina
• Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act (UAGAPJA) - Uniform Guardianship Summary
• Rethinking Guardianship: Building a Case for Less Restrictive Alternatives - First Year Report