# Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward of a provincial hospital. The ward follows the Mental Health Act (Republic Act [RA] 11036). On day three the psychiatrist documents that her decision-making capacity is impaired. She has not designated a legal representative and has no advance directive. Her relatives are: • Husband, 41 — permanently separated from her by a court decree three years ago • Daughter, 22 — lives with her • Son, 16 — lives with her • Mother, 64 — lives in another town Under RA 11036, who acts as her legal representative?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629968  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 38-year-old woman with bipolar I disorder is admitted to the psychiatric ward of a provincial hospital. The ward follows the Mental Health Act (Republic Act [RA] 11036).

On day three the psychiatrist documents that her decision-making capacity is impaired. She has not designated a legal representative and has no advance directive. Her relatives are:
• Husband, 41 — permanently separated from her by a court decree three years ago
• Daughter, 22 — lives with her
• Son, 16 — lives with her
• Mother, 64 — lives in another town
Under RA 11036, who acts as her legal representative?

## 보기

1. The medical director of the hospital
2. Her 22-year-old daughter **✔ 정답**
3. Her 64-year-old mother
4. Her 41-year-old husband

**정답: 2**

## 해설

When a service user has not designated a legal representative, RA 11036 sets an order: the spouse (unless permanently separated by a court decree or in a state of abandonment), then non-minor children, then either parent by mutual consent only if the service user is a minor, then the chief or medical director of the facility, and finally a person appointed by a court. The court decree excludes the husband, so the 22-year-old daughter, a non-minor child, is next.

## 심화 해설

Legal representative under RA 11036

When a service user with impaired decision-making capacity has not personally designated a legal representative and has no advance directive, the Mental Health Act provides a statutory hierarchy for substitute decision-making. The sequence is not based on emotional closeness or who lives with the patient; it follows a fixed legal order that prioritizes the spouse, then adult children, and only in specific circumstances moves to parents or facility personnel.

In this case, the husband is permanently separated by a court decree, which removes him from the first position under the law. The next category is non-minor children. The daughter is 22 years old, making her a non-minor child, while the son is 16 and therefore still a minor. The mother would only be considered if the service user were a minor, which does not apply here. The medical director of the facility is a fallback option that comes later in the hierarchy, not before an available adult child.

The court decree excluding the husband means the 22-year-old daughter is the first eligible person in the statutory order. This reflects the law's intent to prioritize family members with legal standing over institutional representatives, while still respecting the legal reality that a permanently separated spouse no longer holds that role.

Key point! The order under RA 11036 is: spouse (unless permanently separated or in a state of abandonment) → non-minor children → either parent by mutual consent only if the service user is a minor → chief or medical director of the facility → person appointed by a court.

Watch out! Do not confuse "lives with the patient" with legal priority. The mother lives in another town and the daughter lives with the patient, but residence is not the deciding factor; the statutory category is.

| Candidate | Legal status under RA 11036 | Eligible? |
| --- | --- | --- |
| Husband, 41 | Spouse, but permanently separated by court decree | No — excluded by decree |
| Daughter, 22 | Non-minor child | Yes — next in order |
| Son, 16 | Minor child | No — not a non-minor child |
| Mother, 64 | Parent | No — parent only if service user is a minor |
| Medical director | Facility chief | No — lower in hierarchy than adult child |

The concept of a nominated representative in mental health law parallels the broader principle of advance directives and supported decision-making. When a person has not exercised that right while capable, the law supplies a default order to ensure that treatment decisions can still be made lawfully and in the person's best interest. The absence of an advance directive in this scenario means the statutory default applies, and the daughter's position as a non-minor child places her first among the available relatives.

The psychiatric nurse's role is not to decide who the representative is, but to understand the legal framework so that consent processes, information sharing, and family involvement are handled correctly. In closed ward settings, where decision-making capacity can fluctuate, knowing which family member holds legal authority prevents unauthorized disclosure and ensures that the treatment team engages the correct person for decisions the patient cannot currently make.

## 임상 시나리오

RA 11036 Legal Representative OrderWho decides when the patient cannot?
When a service user has impaired decision-making capacity and no designated representative or advance directive, follow the statutory hierarchy under RA 11036. The order is: spouse (unless permanently separated by court decree or abandoned) → non-minor children → parent (only if the service user is a minor) → facility medical director → court-appointed person.

A court decree of permanent separation removes the spouse from the first position. In this scenario, the husband is excluded, so the 22-year-old daughter is the first eligible legal representative as a non-minor child. The 16-year-old son is a minor and cannot serve in this role.

CautionDo not prioritize based on who lives with the patient or emotional closeness. The medical director is only a fallback when no eligible family member is available; do not skip an available adult child.

## 핵심 개념

- **Legal representative** — A person authorized under RA 11036 to make decisions for a service user with impaired decision-making capacity when no advance directive exists.
- **Non-minor child** — A child who is 18 years or older; in this case, the 22-year-old daughter qualifies while the 16-year-old son does not.
- **Permanent separation by court decree** — A legal status that removes a spouse from the priority order for substitute decision-making under RA 11036.
- **Advance directive** — A written statement made by a person with capacity, specifying preferences for treatment and/or a representative in case of future incapacity.
- **Substitute decision-making** — A process where another person makes decisions on behalf of a service user who lacks decision-making capacity.

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