A conservatorship — often called a guardianship — puts a court-mandated guardian in charge of making decisions for people who have been found to be incapable of acting in their own best interests. Depending on the type of guardianship, that might be limited to just certain kinds of decisions, such as financial matters, or it could extend to every aspect of someone’s life, including medical care.

It’s most well-known as a system that elderly people are placed under — especially those who have dementia — but actually, conservatorships can be used for anyone who has a disability and is seen as unable to take care of themselves.

Because this standard can be interpreted in a variety of ways, and because there’s poor oversight of guardianships in general, it’s a system that can take advantage of the very people it’s supposed to protect — and, ultimately, violate a person’s fundamental right to self-determination.

There’s a universe of difference between helping someone live the life they want, and deciding the kind of life you think they should want. A kind guardian might deign to take into account the desires of the person they’re purporting to guard — but the danger is that they don’t have to.

A large part of the “cultural change” Crane mentions is in how we frame stories of disability. Self-determination should not be conditional on public opinion or institutional authority. “We need to recognize that everyone needs support, especially for complicated decisions,” Crane says. If you don’t have a disability, asking for support doesn’t usually lead to the verdict that you’re incapable of self-determination wholesale — yet this is what the guardianship system essentially says about people with disabilities.

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