Families often contact our office in a state of crisis. A mother is showing clear signs of dementia but insists nothing is wrong. A father is forgetting medications, falling behind on bills, or making irrational financial decisions, yet refuses to see a doctor. Adult children understandably ask:

“Can’t we get a court order requiring my parent to be evaluated?”

The unfortunate answer under current Maryland law is generally no.

In a significant recent decision, the Appellate Court of Maryland reaffirmed that Maryland courts do not have authority to compel an allegedly disabled adult to undergo a medical or mental health evaluation simply so that a guardianship case can proceed. In the Matter of Anita Rani Mishra, No. 1068, September Term, 2024 (App. Ct. Md. Aug. 27, 2026).

For families facing a loved one’s cognitive decline, the opinion provides important guidance. Unfortunately, it also highlights a gap in Maryland law that likely can be addressed only through legislative action.

Why Families Can Feel Stuck

To obtain guardianship of an adult in Maryland, a petitioner generally must file medical certificates completed by qualified healthcare professionals establishing that the person is unable to manage their personal affairs or property. Maryland Estates and Trusts § 13-705 and Maryland Rule 10-202 require this evidence before the case can move forward.

But what happens when the person who may need a guardian refuses to see a doctor?

This situation is common in dementia cases. Individuals experiencing cognitive decline often lack insight into their condition. They may reject family concerns, decline medical care, and refuse evaluations.

As a result, families can find themselves trapped in a frustrating cycle:

1. They need medical evidence to pursue guardianship.
2. The parent refuses to be examined.
3. Without the examination, the required medical evidence may be unavailable.
4. Without the evidence, the guardianship petition may not proceed.

What the Mishra Case Means for Families

The petitioner sought guardianship of his sister, who allegedly suffered from severe mental illness and was refusing treatment and proper self-care. He filed a petition for guardianship but encountered a problem: one of the required medical certificates did not satisfy the statutory requirements because it was not signed by one of the healthcare professionals identified in Maryland law.

To cure that defect, the petitioner asked the Circuit Court to order his sister to undergo a mental examination so that a compliant certificate could be obtained. Through her court-appointed counsel, his sister opposed the request, asserting her right to refuse medical examination and treatment.

The Circuit Court denied the motion and ultimately dismissed the guardianship petition. The petitioner appealed.

The Appellate Court affirmed.

What the Court Decided

The court held that neither Maryland’s guardianship statutes nor the Maryland Rules authorize a court to compel an unwilling alleged disabled person to undergo a medical or mental health examination for purposes of obtaining the certificates required to initiate a guardianship proceeding.

The court also rejected the argument that Maryland Rule 2-423, which permits courts to order physical or mental examinations of parties in certain circumstances (such as when another person is preventing the alleged disabled person from being evaluated), could be used in this context. According to the court, the alleged disabled person in that case was not yet a “party” within the meaning of the rule, and therefore Rule 2-423 did not provide authority for the requested examination.

Finally, the court undertook an extensive historical review of guardianship law and concluded that the traditional equitable powers of courts do not supply authority that is absent from the statutes and rules governing guardianship proceedings.

In short, the court concluded that if authority to compel an evaluation exists, it must come from the legislature rather than the judiciary.

Why This Decision Matters for Your Family

For practitioners who regularly handle guardianship matters, the result is not entirely surprising. The decision reflects Maryland’s strong commitment to personal autonomy and bodily integrity.

At the same time, it exposes a very real problem.

The individuals most in need of protection are often the very people least likely to voluntarily seek evaluation or treatment. Dementia, Alzheimer’s disease, and certain psychiatric conditions can impair awareness of one’s own limitations. Family members may observe obvious warning signs while still being unable to obtain the medical evidence necessary to pursue legal intervention.

Consequently, families must often wait until another event creates an opportunity for evaluation, such as:

• Hospitalization following an illness or injury;
• Involvement of Adult Protective Services;
• Emergency medical intervention;
• Placement in a rehabilitation facility; or
• A voluntary examination by a treating physician.

Each situation is different, and there are sometimes alternative legal tools available, but the Mishra decision makes clear that a guardianship petitioner cannot simply ask the court to force an unwilling adult to undergo an evaluation.

Why Maryland Law May Need to Change

The most important takeaway from Mishra may be what the opinion says about the limits of judicial authority.

The court did not suggest that the concerns raised by families are unimportant. Rather, the court concluded that current Maryland law does not provide a mechanism for compelling the examination sought in that case.

If Maryland policymakers determine that courts should have limited authority to order evaluations when credible evidence exists that an individual lacks capacity and is refusing assessment, that authority will likely need to be created through legislation.

Until then, families and practitioners must operate within the framework established by existing statutes and rules.

Why It Still Makes Sense to Speak With an Attorney

Although the Mishra decision limits one specific remedy—asking a court to force an unwilling adult to undergo an evaluation—it does not mean families are out of options. In many cases, early legal guidance can help a family avoid delay, preserve evidence, and identify practical next steps before a crisis becomes worse.

An attorney can help determine whether the available facts support a guardianship petition, whether existing medical records or prior evaluations may satisfy the legal requirements, and whether there are less restrictive alternatives that should be considered first. Counsel can also help families communicate with physicians, hospitals, care facilities, Adult Protective Services, and other involved parties in a way that protects the loved one while respecting the limits of Maryland law.

Legal advice is also important because timing matters. A hospitalization, rehabilitation stay, emergency intervention, or voluntary doctor visit may create an opportunity to obtain the evaluations or records needed to move forward. Families who have already spoken with counsel are often better prepared to act quickly when those opportunities arise.

Finally, an attorney can help family members understand what guardianship can—and cannot—accomplish, reduce the risk of filing a petition that is procedurally defective, and develop a strategy tailored to the loved one’s medical condition, finances, safety concerns, and family dynamics.

Talk With Us About Your Options

If your parent or loved one appears to have declining cognitive abilities, is refusing medical care, and you are concerned about their safety, it is important to understand both the possibilities and limitations of Maryland guardianship law.

Every situation is unique. While guardianship may ultimately be appropriate in some cases, there may be other planning or protective measures worth exploring.

Our attorneys regularly advise families on guardianship proceedings, incapacity issues, and strategies for protecting vulnerable adults. If you are facing these challenges, we can help you assess your options under current Maryland law.