Tell us whether you plan to have your children immunized and what factors led to your decision.A child receives a second dose of the Pfizer coronavirus vaccine during a clinical trial earlier this year.Shawn Rocco/Duke Health/Via ReutersWith the Food and Drug Administration likely to authorize a Covid vaccine for children ages 5 to 11, the Biden administration announced that it would distribute millions of doses for young patients. But recent surveys show that many parents are wrestling with whether to allow the shots for their children.If you have children who will be eligible, Times journalists would like to know your thoughts. Your name and comments may be published, but your contact information will not. A reporter or editor from The Times may follow up with you directly.Will you permit your children ages 5 to 11 to have a Covid vaccine?

The number of eligible people still weighing whether to get a Covid vaccine has sharply dwindled, leaving an unvaccinated population that is mostly hard-core refusers.Vaccinated people have been burning up the phone lines at the community health center in rural Franklin, La., clamoring for the newly authorized Covid booster shot.But only a trickle of people have been coming in for their initial doses, even though the rate of full vaccination in the area is still scarcely 39 percent.The dichotomy illustrates one of the most frustrating problems facing public health officials at this stage of the pandemic: Almost all the eligible adults who remain unvaccinated in the United States are hard-core refusers, and the arrival of boosters is making efforts to coax them as well as those who are still hesitating even more difficult. In the September vaccine monitor survey from the Kaiser Family Foundation, 71 percent of unvaccinated respondents said the need for boosters indicated that the vaccines were not working.“This vaccine has tested me like nothing before and I’ve been doing this for 40 years,” said Dr. Gary Wiltz, director of the Franklin health center. “I can’t tell you how many people we’ve tried to cajole into taking it.”In some ways the Covid vaccine landscape reflects great progress: Millions of holdouts have decided to get vaccinated over the past couple months, many prodded at the last minute by mandates or anxiety over the highly transmissible Delta variant. (Three unvaccinated people who showed up for shots in Franklin the other morning came because each knew someone who had recently died from Covid.) The decline of new cases recently in many states is another marker of the success of the vaccine campaigns, public health officials say.But millions of adults are not covered by mandates. Experts in vaccine behavior fear that the country is bumping up against the ceiling of persuadable people, one that is significantly lower than the threshold needed for broad immunity from Delta and, possibly, future variants.“One day we just hit a wall,” said Dr. Steven Furr, who practices family medicine in rural Jackson, Ala., where he has even made house calls to give patients their Covid shots. “We had vaccinated everybody who wanted to be vaccinated and there was nobody left.”Dr. Steven Furr practices family medicine in Jackson, Ala. He said he expected some vaccine hesitancy in his area, but not this much. “One day we just hit a wall,” he said.Charity Rachelle for The New York TimesAbout 56 percent of the U.S. population is fully vaccinated, a level that exceeds some early estimates about what it could take to achieve so-called herd immunity against the coronavirus. That percentage will surely rise once the shots are authorized for children under 12. But Delta is so contagious that experts have revised their optimum coverage estimates to 90 percent or higher.According to the Kaiser Family Foundation’s vaccine surveys, those who say they will never get the vaccine — the “definitely nots” — have held steady for months between 15 and 12 percent of respondents. The rising vaccination rates of late reflect the steady shrinking of a different group — those who say they had been waiting to decide and could be convinced. They now total just 7 percent, down from 39 percent in December.(An additional 4 percent of respondents say they would get vaccinated only if their workplace or school mandates it.)But even as boosters are providing added protection for vulnerable populations, they are raising further doubts among people like Christopher Poe, 47, who works in a manufacturing plant in Lima, Ohio. He hasn’t gotten the shot, despite haranguing and wheedling from worried relatives. He said the need for a booster had deepened his skepticism.“It seems like such a short time and people are already having to get boosters,” Mr. Poe said. “And the fact that they didn’t realize that earlier in the rollout shows me that there could be other questions that could be out there, like the long-term effects.”And when shots are approved for children ages 5 through 11, as is soon expected, health officials fear that the need for boosters will make parents of those younger children, whom surveys show are very skittish about the vaccines, that much harder to persuade.Faced with these accruing obstacles, doctors and others admit to bouts of “outreach fatigue,” exasperation and despair.“I just don’t know what else I can do,” Dr. Wiltz said. “Some people you just can’t convince and you have to accept that’s the way it’s going to be.”Some outreach campaigns are turning their focus to getting boosters to the homebound and nursing home patients, hoping that older vaccinated people, among the most in danger from the virus, are readily amenable to an additional shot.“We’ve got to revisit the places that we prioritized first, which were our senior centers in neighborhoods with folks that maybe had access challenges and who weren’t going to get that initial vaccination easily,” said Dr. Jennifer Avegno, director of the New Orleans health department.In Franklin, La., Dr. Wiltz, who serves a predominantly Black community, said that initial tireless discussions about the vaccine by doctors and ministers with older, reluctant patients were paying off in their enthusiasm for the boosters. “They don’t have to be convinced,” he said. “They’re already there.”But while doctors try to encourage eligible vaccinated people to come in for boosters, they struggle to defend the need for the third shot to those who have yet to get their first. “Between boosters and the unvaccinated, it’s now really two different types of campaigns,” Dr. Avegno said.Of late, many who are wary of the vaccine say they have become more confused by what they see as mixed messages from federal health agencies and the White House. To get them straightforward information, Yamhill County, Ore., will soon be offering discreet phone appointments. People who want to learn more about the shots will be able to sign up online and get a call from a local physician..css-1kpebx{margin:0 auto;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1kpebx{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-1kpebx{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-1kpebx{font-size:1.25rem;line-height:1.4375rem;}}.css-1gtxqqv{margin-bottom:0;}.css-k59gj9{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;width:100%;}.css-1e2usoh{font-family:inherit;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;border-top:1px solid #ccc;padding:10px 0px 10px 0px;background-color:#fff;}.css-1jz6h6z{font-family:inherit;font-weight:bold;font-size:1rem;line-height:1.5rem;text-align:left;}.css-1t412wb{box-sizing:border-box;margin:8px 15px 0px 15px;cursor:pointer;}.css-hhzar2{-webkit-transition:-webkit-transform ease 0.5s;-webkit-transition:transform ease 0.5s;transition:transform ease 0.5s;}.css-t54hv4{-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-1r2j9qz{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-e1ipqs{font-size:1rem;line-height:1.5rem;padding:0px 30px 0px 0px;}.css-e1ipqs a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;}.css-e1ipqs a:hover{-webkit-text-decoration:none;text-decoration:none;}.css-1o76pdf{visibility:show;height:100%;padding-bottom:20px;}.css-1sw9s96{visibility:hidden;height:0px;}.css-1in8jot{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;font-family:’nyt-franklin’,arial,helvetica,sans-serif;text-align:left;}@media (min-width:740px){.css-1in8jot{padding:20px;width:100%;}}.css-1in8jot:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1in8jot{border:none;padding:10px 0 0;border-top:2px solid #121212;}What to Know About Covid-19 Booster ShotsThe F.D.A. authorized booster shots for a select group of people who received their second doses of the Pfizer-BioNTech vaccine at least six months ago. That group includes: Pfizer recipients who are 65 or older or who live in long-term care facilities; adults who are at high risk of severe Covid-19 because of an underlying medical condition; health care workers and others whose jobs put them at risk. People with weakened immune systems are eligible for a third dose of either Pfizer or Moderna four weeks after the second shot.Regulators have not authorized booster shots for recipients of the Moderna and Johnson & Johnson vaccines yet, but an F.D.A. panel is scheduled to meet to weigh booster shots for adult recipients of the Moderna and Johnson & Johnson vaccines.The C.D.C. has said the conditions that qualify a person for a booster shot include: hypertension and heart disease; diabetes or obesity; cancer or blood disorders; weakened immune system; chronic lung, kidney or liver disease; dementia and certain disabilities. Pregnant women and current and former smokers are also eligible.The F.D.A. authorized boosters for workers whose jobs put them at high risk of exposure to potentially infectious people. The C.D.C. says that group includes: emergency medical workers; education workers; food and agriculture workers; manufacturing workers; corrections workers; U.S. Postal Service workers; public transit workers; grocery store workers.It is not recommended. For now, Pfizer vaccine recipients are advised to get a Pfizer booster shot, and Moderna and Johnson & Johnson recipients should wait until booster doses from those manufacturers are approved.Yes. The C.D.C. says the Covid vaccine may be administered without regard to the timing of other vaccines, and many pharmacy sites are allowing people to schedule a flu shot at the same time as a booster dose.“People have lots of questions and they want a confidential way to have that conversation,” said Lindsey Manfrin, director of the county’s health and human services office. “Unfortunately, there’s stigma here around getting vaccinated and there’s stigma around not getting vaccinated.”Health officials like Ms. Manfrin are reaching down deep to come up with creative solutions, and redoubling efforts to engage primary care providers and faith and business leaders to help them win over the holdouts, one by one.Lindsey Manfrin, the director of health and human services in Yamhill County, Ore. “Unfortunately, there’s stigma here around getting vaccinated and there’s stigma around not getting vaccinated.” she said.Alisha Jucevic for The New York TimesDan Mehan, president of the Missouri Chamber of Commerce and Industry, a pro-business group in a state where vaccination rates lag nationally, is providing companies a “vaccination encouragement” tip sheet and awarding them bronze, silver or gold-level certificates, based on percentage of vaccinated employees. Employers can then flaunt their status to encourage customer traffic. “We think vaccination is essential for the recovery from the pandemic,” Mr. Mehan said.Grief-stricken relatives of children and unvaccinated adults who succumbed to the Delta variant have even been taking it upon themselves to sponsor vaccine drives. This summer, some held vaccine events at funerals.But with mass vaccine sites largely shuttered, the burden of persuasion has fallen increasingly to primary care providers. Dr. David Priest, an infectious disease specialist with Novant Health, which has many clinics in North Carolina, has had repeated discussions with hesitant patients around the Covid vaccines.“You have to overcommunicate to an incredible degree,” Dr. Priest said, “because we still get questions on things that I think, ‘This was well-known 18 months ago.’ But that’s where people are, so you just have to keep answering that question and answering it and answering it.”It is critical, he added, that doctors have vaccines on hand. “So when the patient finally says, ‘I think I’ll do it,’ we can seal the deal. Because if you don’t have the shots in your clinic right then, people get in their car, get busy with other errands, forget or change their mind.”Alison Buttenheim, a behavioral health expert at the University of Pennsylvania, noted that although primary care doctors, as trusted sources for patients, had been playing a crucial role in this phase of vaccine uptake, “it definitely raises the question of what happens to people who don’t have a usual source of care.”But at this point, many doctors and nurses say they are exhausted by putting in so much persuasive effort, for so many months, with relatively little return, even as they are treating very ill patients who had refused to get vaccinated.“It is an uphill battle,” said Dr. Uzma Syed, an infectious disease specialist in Jericho, N.Y., on Long Island, who for months has been giving vaccine education talks to national and international groups. “I can’t say that these conversations don’t come with tremendous burnout. But you keep going in hopes that you reach even one person to change their mind, because that’s a life saved.”Nell Outlaw, a 95-year-old who finally received her first dose in Dr. Furr’s clinic.Charity Rachelle for The New York Times

Lockdowns helped keep last year’s flu season historically mild in both the United States and around the world, but U.S. officials fear a more serious season this fall and winter, with unmasked people out and about far more, and nearly half of adults in a new survey saying they are unlikely to get a flu shot.At a news briefing to release the survey data on Thursday morning, top health experts said they were particularly concerned that, with the coronavirus still coursing around the country, nearly one in four people at higher risk for flu-related complications indicated they did not intend to get the flu vaccine.Dr. Rochelle P. Walensky, head of the Centers for Disease Control and Prevention, noted that while experts did not yet know how severely the flu would hit the United States this fall, other respiratory infections had already returned, including RSV, a common cause of pneumonia and bronchitis in babies and a serious threat to older adults. The C.D.C.’s latest weekly flu report shows that only one state, Wyoming, had reached a “moderate” level of flu cases.Because the flu was almost nonexistent last year, Dr. Walensky noted, people do not have the protective immunity they might have acquired if they had gotten sick, and she urged that everyone age 6 months and older be vaccinated. “The Covid-19 pandemic is not over, and the risk of both flu and Covid-19 circulating could put additional strain on hospitals and frontline health care professionals,” she said.The survey was commissioned by the National Foundation for Infectious Diseases, a nonprofit organization. Its medical director, Dr. William Schaffner, said that overall vulnerability to flu could be higher this year, “with relaxed Covid-19 mitigation strategies, increased travel and the reopening of schools.”For the survey, more than 1,110 respondents 18 and older from all 50 states and the District of Columbia answered questions in mid-August that explored attitudes about the flu; Covid-19; pneumococcal disease, which can cause pneumonia, sepsis and meningitis; and vaccination intentions.The answers revealed a tension between beliefs about the value of the flu vaccination and the intention to get one: 61 percent of respondents agreed that a shot was the best protection against the flu, but 44 percent said they were either unsure whether they would get one or did not intend to do so.The coronavirus pandemic, however, has had a positive effect on behaviors that could help lessen the impact of the flu. Nearly half of those surveyed said that because of the pandemic, they were more likely to stay home from work or school if they were sick, and 54 percent said they would wear a mask at least sometimes during the flu season.But there were racial disparities: 73 percent of Black respondents and 62 percent of Latinos said they would wear a mask during flu season, compared with only 46 percent of white respondents. Black and Latino respondents were also more likely to be worried about being infected with Covid and the flu simultaneously than white respondents.Dr. Walensky said that the flu vaccination rate nationally had held steady over the year before, at about 52 percent, but criticized what she called a “disparity gap” in flu vaccination: 56 percent for white people versus 43 percent among Black people. Patsy Stinchfield, a nurse practitioner at Children’s Minnesota, a pediatric health care system, and the president-elect of the infectious disease foundation, said that it was safe for people to get flu and Covid shots — including boosters — at the same time. Dr. Walensky also raised alarms about a decline in the flu vaccination rates among young children, to 59 percent from 64 percent the year before. In the 2019-2020 season, she said, 199 children died from the flu, about 80 percent of whom were not vaccinated.

About one in four U.S. parents report that a child of theirs had to quarantine at home because of a possible exposure to Covid-19 since the beginning of the school year, according to the latest findings of a monthly survey about vaccine attitudes by the Kaiser Family Foundation.That is even as two-thirds of parents say they feel that their school is taking appropriate measures to contain the spread of the coronavirus. The report suggests that many parents are conflicted about which courses of action will keep their children both healthy and educated.Even among parents who have received at least one vaccine dose, 18 percent do not think schools should require all staff and students to wear masks, a view held by 63 percent of unvaccinated parents. Overall, 58 percent of parents say that schools should have comprehensive mask requirements, 35 percent say there should be no mask mandates at all, and 4 percent believe that only unvaccinated students and staff should be compelled to wear masks, according to the report.Over the summer, the Centers for Disease Control and Prevention recommended that all students, teachers and staff members in elementary and secondary schools wear masks, regardless of their vaccination status, to allow as many students as possible to return to in-person instruction.Kaiser conducted a nationally representative survey of 1,519 people from Sept. 13 to Sept. 22 — a time of surging Covid deaths — and was mostly completed before Pfizer and BioNTech announced that their coronavirus vaccine was safe and effective for children aged 5 to 11. No vaccine is currently authorized in the United States for children under 12. Of all the people who were polled, 414 identified themselves as parents of children 17 or younger, and were included in the analysis of parents’ responses.The Pfizer vaccine, already in use for older children and adults, was authorized in mid-May for children aged 12 to 15, and the report suggests that over time, parents of children in that age group and older are slowly becoming more comfortable with it. By the time of the September interviews, 48 percent said that their children between the ages 12 to 17 had gotten at least one dose, up from 41 percent in July. According to federal data, 57 percent of that age group has received at least one dose.And perhaps prompted by a constellation of factors, including rising numbers of children hospitalized because of the Delta variant as well as seeing older vaccinated children remain healthy, parents of children aged 5 to 11 increasingly report favoring the vaccine as well..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-1kpebx{margin:0 auto;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1kpebx{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-1kpebx{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-1kpebx{font-size:1.25rem;line-height:1.4375rem;}}.css-1gtxqqv{margin-bottom:0;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-19zsuqr{display:block;margin-bottom:0.9375rem;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}Thirty-four percent of those parents say now that they will have their children vaccinated as soon as they can, up from 26 percent in July. Commensurately, parental hesitation is beginning to melt: In September, with school open, 32 percent of parents of those younger children said they preferred to “wait and see” before making a decision about vaccinating them, down from 40 percent in July.Of note, the share of parents of children aged 5 to 17 who insist that they will “definitely not” vaccinate their children has scarcely budged in months, suggesting that they will be the most difficult to persuade. In April, 22 percent of parents of the older cohort, ages 12 to 17, said they would definitely not have their children get shots; in September, 21 percent reported holding the same view. Parents of younger children are similarly adamant: in July, 25 percent said “definitely not” position, and in September, 24 percent did.

The Delta variant was the main reason that people decided to get vaccinated against Covid-19 this summer and why most say they will get boosters when eligible, according to the latest monthly survey on vaccine attitudes by the Kaiser Family Foundation, released on Tuesday morning. But the survey indicated that nearly three-quarters of unvaccinated Americans view boosters very differently, saying that the need for them shows that the vaccines are not working.That divide suggests that while it may be relatively easy to persuade vaccinated people to line up for an additional shot, the need for boosters may complicate public health officials’ efforts to persuade the remaining unvaccinated people to get their initial one.Another takeaway from the Kaiser Family Foundation survey: For all the carrots dangled to induce hesitant people to get Covid shots — cash, doughnuts, racetrack privileges — more credit for the recent rise in vaccination goes to the stick. Almost 40 percent of newly inoculated people said that they had sought the vaccines because of the increase in Covid cases, with more than a third saying that they had become alarmed by overcrowding in local hospitals and rising death rates.“When a theoretical threat becomes a clear and present danger, people are more likely to act to protect themselves and their loved ones,” said Drew Altman, the Kaiser Family Foundation’s chief executive.The nationally representative survey of 1,519 people was conducted from Sept. 13-22 — during a time of surging Covid deaths, but before the government authorized boosters for millions of high-risk people who had received the Pfizer-BioNTech shot, including those 65 and over and adults of any age whose job puts them at high risk of infection.Sweeteners did have some role in getting shots in arms. One-third of respondents said that they had gotten vaccinated to travel or attend events where the shots were required.Two reasons often cited as important for motivating those hesitant to get a vaccine — employer mandates (about 20 percent) and full federal approval for the Pfizer-BioNTech vaccine (15 percent) — carried less sway.Seventy-two percent of adults in the survey said that they were at least partly vaccinated, up from 67 percent in late July. The latest numbers from the Centers for Disease Control and Prevention are even higher, reporting 77 percent of the adult population in the United States with at least one shot. The sharpest change in this month was in vaccination rates for Latinos: a jump of 12 percentage points since late July, to 73 percent, in the number of Latino adults who had received at least one shot.With the vaccination racial gap narrowing, the political divide has, by far, become the widest, with 90 percent of Democrats saying that they have gotten at least one dose, compared with 58 percent of Republicans.Perhaps reflecting pandemic fatigue, about eight in 10 adults said that they believed Covid was now a permanent fixture of the health landscape. Just 14 percent said that they thought “it will be largely eliminated in the U.S., like polio.”

What to Know: Purdue Pharma SettlementJan HoffmanReporting on the opioid epidemicAbout 130,485 people who can prove they were harmed by OxyContin will each get between $3,500 and $48,000. Guardians of 6,550 children born with symptoms of opioid withdrawal will receive about $7,000. Over the past 20 years, more than 500,000 people in the U.S. died from prescription and illicit opioids. Federal economists said that the true cost of the epidemic — including law enforcement, healthcare and treatment — could run into trillions of dollars. During the pandemic, overdose deaths soared.

The ruling in bankruptcy court caps a long legal battle over the fate of a company accused of fueling the opioid epidemic and the family that owns it.Purdue Pharma, the maker of the highly addictive painkiller OxyContin, was dissolved on Wednesday in a wide-ranging bankruptcy settlement that will require the company’s owners, members of the Sackler family, to turn over billions of dollars of their fortune to address the deadly opioid epidemic.But the agreement includes a much-disputed condition: It largely absolves the Sacklers of Purdue’s opioid-related liability. And as such, they will remain among the richest families in the country.Judge Robert Drain of the U.S. Bankruptcy Court in White Plains, N.Y., approved the settlement, saying he wanted modest adjustments. The painstakingly negotiated plan will end thousands of lawsuits brought by state and local governments, tribes, hospitals and individuals to address a public health crisis that led to the deaths of more than 500,000 people nationwide.The settlement terms have been harshly criticized for shielding the Sacklers. They are receiving protections that are typically given to companies that emerge from bankruptcy, but not necessarily to owners who, like the Sacklers, do not themselves file for bankruptcy.Several states, including Connecticut and Washington State, have already said they intend to appeal the judge’s ruling.In exchange for the protections, the Sacklers agreed to turn over $4.5 billion, including federal settlement fees, paid in installments over roughly nine years. Those payments, and the profits of a new drug company rising from Purdue’s ashes with no ties to the Sackler family, will mainly go to addiction treatment and prevention programs across the country.Judge Drain delivered his ruling orally from the bench in a marathon session that ran to six hours, meticulously working through his reasoning in a case he called the most complex he had ever faced. “This is a bitter result,” he said. “B-I-T-T-E-R,” he spelled out, explaining that he was frustrated that so much Sackler money was parked in offshore accounts. He said he had expected and wished for a higher settlement.But the costs of further delay, he said, and the benefits of an agreement he described as “remarkable” in its ability to help abate the epidemic, tilted toward approval.While the settlement serves as a benchmark in the nationwide opioid litigation aimed at covering governments’ costs and compensating families, it also means that a full accounting of Purdue’s role in the epidemic will never unfold in open court. Purdue pleaded guilty to federal criminal charges for drastically downplaying OxyContin’s addictive properties and, years later, for soliciting high-volume prescribers.But in a concession that made the bankruptcy plan more palatable to many plaintiffs, the company and the Sacklers agreed to make public more than 30 million documents, including confidential emails, that may reveal comprehensive marketing strategies.Just last month, Dr. Richard Sackler, a former president and co-chairman of the board, testified that neither the family, the company nor its products bore any responsibility for the opioid epidemic. Other Sacklers struck a more conciliatory note, saying they were horrified that a medication intended to alleviate pain had, in fact, caused pain to so many. But no one apologized or took personal responsibility.“I don’t think anybody would say that justice has been done because there’s just so much harm that was caused, and so much money that has been retained by the company and by the family,” said Dr. Joshua Sharfstein, a professor at the Johns Hopkins Bloomberg School of Public Health who developed a set of priorities for opioid settlement funds. “But this is what the legal system is going to produce. So at this point, the question becomes, how can those resources be used as effectively as possible?”A majority of states and other plaintiffs support the plan, reasoning that it is the best to help pay for a problem that has only grown worse during the pandemic, with a record number of opioid overdose deaths last year.Steve Miller, the chairman of Purdue’s board, said in a statement that the plan “ensures that billions of dollars will be devoted to helping people and communities who have been hurt by the opioid crisis.”The Mortimer Sackler branch and the Raymond Sackler branch each issued statements calling the resolution an important step in providing funds to address the public health crisis.Makeshift gravestones in protest against Purdue Pharma placed outside the White Plains courthouse during the bankruptcy proceedings. Seth Wenig/Associated PressThe Purdue settlement aligns with what some experts predicted from the outset: The money extracted through litigation will not be sufficient to cover the costs of the epidemic — including for law enforcement, treatment and social services — which some economists put in the trillions.Nor will the money gush forth. A recent deal with pharmaceutical distributors and Johnson & Johnson for $26 billion could take a year to be approved, and even then, payments would be doled out over 18 years.The Sacklers’ payments will come from their investments and from the sale of their international pharmaceutical companies, which they have seven years to complete. Purdue will make initial payments of roughly $500 million. Additional funds will come from anticipated profits from the new company’s drugs, including addiction-reversal medications as well as OxyContin.States will get money from a national opioid abatement trust, which they will distribute to their local governments. Native American tribes have their own fund.Another fund will compensate 130,485 individuals and families of those who suffered from addiction or died from an overdose, in amounts ranging from $3,500 to $48,000. Guardians of about 6,550 children with a history of neonatal abstinence syndrome may each receive about $7,000.“It was take it or leave it,” said Ryan Hampton, who resigned on Tuesday as co-chairman of a watchdog committee of plaintiffs, appointed by the federal government.OxyContin came on the market in 1996, at a time when doctors were being exhorted to recognize and treat pain, a symptom that the medical profession had tended to disregard as psychological or fleeting.Purdue’s sales troops fanned across the country, preaching the new pain relief gospel to thousands of doctors, who began prescribing OxyContin for both acute and chronic pain. By 2000, sales of the new drug had grown to almost $1.1 billion.But soon afterward, reports began surfacing of OxyContin pills being stolen from pharmacies and crushed and snorted. In 2007, the company and three executives pleaded guilty to federal criminal charges, paying a combined $634.5 million for minimizing the drug’s risk of addiction to doctors, regulators and patients.The nation was pounded by a spiraling epidemic of opioid abuse and overdose deaths. By 2014, local governments began filing lawsuits against Purdue. More plaintiffs followed, eventually suing other companies across the pharmaceutical supply chain. Members of the Sackler family became the personification of the epidemic’s villains. The Sacklers withdrew $10.4 billion from Purdue between 2008 and 2017. About half was paid to taxes.In September 2019, Purdue, facing 2,900 lawsuits, 628 of which named the Sacklers, filed for bankruptcy restructuring, which paused all claims.The most ferocious battle was fought over the extent to which the Sacklers would be released from Purdue-related lawsuits.Companies that emerge from bankruptcy restructuring are granted considerable legal protections. But federal appeals courts disagree over whether that shield can be accorded to owners, like the Sacklers. The prospect of Sacklers left relatively unscathed has led some members of Congress to introduce a bill that would prevent protections for owners in similar situations.Dr. Richard Sackler, a former president and co-chairman of Purdue’s board of directors, said that neither the family, the company nor its products bore responsibility for the opioid epidemic. via ProPublicaThe settlement does not preclude criminal prosecution. But realistically, say prosecutors, those cases are difficult to prove; no government entity has pressed a Purdue-related criminal charge against a Sackler. The Sacklers can still be held liable for some non-opioid related claims against Purdue, such as an environmental hazard or other Purdue drugs, if their conduct occurred before the bankruptcy plan takes effect.And opioid claims could be brought against the as-yet unnamed new company, which is independent of Purdue, if it breaches strict controls intended to closely monitor sales and distribution.During hearings last month, four Sacklers tried to put an arm’s length between their role as board members and that of Purdue’s executives, whom they said oversaw marketing and sales.But Dr. Kathe Sackler also testified, “I wouldn’t describe the board as passive listeners.” Rather, she said, they were “attentive listeners. Asked good questions, thoughtful questions, engaged in some debate over some questions from time to time.”Nine states objected to the plan, arguing that the shields would prevent them from exercising their police powers to prosecute the Sacklers for violating civil laws like consumer protection statutes.Washington State’s attorney general, Bob Ferguson, called the plan “morally and legally bankrupt,” because, he said, “it allows the Sacklers to walk away as billionaires with a lifetime legal shield.”Another objector was the U.S. Trustee, a program under the Department of Justice that monitors bankruptcy cases. Immediately after Judge Drain’s ruling, its lawyer said he would be requesting a stay of the order, pending an appeal.But Marshall Huebner, a bankruptcy lawyer who has shepherded Purdue through proceedings, had contended earlier that such objections would topple the Jenga tower-like deal and delay desperately needed funds.He characterized the governments’ terms as punitive toward the Sacklers and their company. “We will rip it out of your hands,” he said. “We will stomp it out of existence. We will transfer its assets to a trust for the benefit of the American people. It will have a monitor. We will pick the board. You will be barred. And you will have to sell all your overseas companies and give us over $4 billion.”A Congressional committee investigating the Sacklers last spring estimated the family fortune at about $11 billion.U.S District Court in White Plains in 2019, where Purdue Pharma’s bankruptcy case was argued. Seth Wenig/Associated PressDoses of OxyContin in a Massachusetts pharmacy in 2001.Darren McCollester/Getty ImagesJudge Drain had largely excluded the voices of victims during the two years. But at the conclusion of testimony in August, he pointedly acknowledged the families whose tragedies were entwined with Purdue’s drug.He spoke haltingly, his voice choking up. “I am very aware of the impact that this company’s products have had on hundreds of thousands of people,” he said.The letters families placed on the docket were eloquent and brave, he said. “If anyone doubts that impact, you should read them, not as advocates’ pieces but as evidence of the effect of this company’s products.”Judge Drain broke off in midsentence, overcome, and abruptly left the bench, ending the hearing.One letter he noted was from a Minneapolis widow with Stage 4 cancer. Years earlier, her firefighter husband was prescribed OxyContin for a back injury. He became addicted. Eventually he lost his job. Then the family lost its home. In September, he committed suicide.“I believe the Sackler family should know what their greed has caused,” the widow, Stephanie Lubinski, wrote. “They should know the name Troy Lubinski and the many, many others that have lost their lives to OxyContin.”

In a rare court appearance, David Sackler said he and his family would withdraw their pledge to pay $4.5 billion, unless they are granted broad legal immunity.A scion of the Sackler family, the billionaire owners of Purdue Pharma, vowed in court on Tuesday that the family would walk away from a $4.5 billion pledge to help communities nationwide that have been devastated by the opioid epidemic, unless a judge grants it immunity from all current and future civil claims associated with the company.Absent that broad release from liability, said David Sackler, 41, a former board member and grandson of one of the founders, the family would no longer support the deal that the parties have painstakingly negotiated over two years to settle thousands of opioids lawsuits brought by states, cities, tribes and other plaintiffs.“We need a release that is sufficient to get our goals accomplished, and if the release fails to do that, then we will not support it,” Mr. Sackler declared during the fourth day of fractious testimony in the confirmation hearing for the bankruptcy plan of Purdue Pharma, whose misleading marketing of the prescription painkiller OxyContin is widely seen as igniting the opioid epidemic.Instead, he said he believed the Sacklers would resume fighting all the cases “to their final outcomes” — a process that would be inordinately costly and protracted for everyone involved.The Sackler’s $4.5 billion pledge is the centerpiece of the settlement plan and, without it, the deal will almost certainly collapse. The money is to be paid over nine or ten years, to begin to cover the extraordinary costs of an addiction crisis that has contributed to the deaths of more than a half-million Americans since the late 1990s. Under the plan’s other major terms, Purdue would be remade into a new public benefit company, whose profits would almost all go to the settlement, and the Sacklers would renounce all involvement.They will, however, be allowed to remain involved in their considerable international pharmaceutical companies, through which they can continue to produce and market opioids for up to seven years, until the companies are sold, to seed the litigation payments.Another signature feature would be a public repository for more than 30 million documents from Purdue and the Sacklers “so that academics and scholars and families of victims and everyone can look at those documents and understand what can happen when there is a fraud and how intense and how long that fraud can go on,” said Jayne Conroy, a lawyer who began pursuing Purdue in 2002, and who testified on Monday in favor of the plan.A federal bankruptcy judge had been expected to confirm the plan at the end of these hearings, particularly after a majority of states that had earlier opposed the deal expressed support for it last month. But objections to the legal shield for the Sacklers have become the sharp focus of much of the testimony. The details of the Sacklers’ liability releases are so far-reaching that last week Judge Robert Drain himself said he had “some concerns about the breadth.”Mr. Sackler testified by video before Judge Drain, who sits in White Plains, N.Y. It is believed to be the first time that a member of the family has appeared in open court on a matter related to OxyContin, though some Sacklers have given depositions in cases over the years.He said the family anticipated that the liability shield would cover him, other members of his extensive family, and about 1,000 other individuals, including contractors and consultants, and protect them from lawsuits that had nothing to do with opioids. That means they would be forever immunized from any current and future lawsuits worldwide related not only directly to Purdue’s opioids but to other drugs the company makes, including drugs for addiction reversal, high cholesterol and even constipation as a result of taking prescription opioids.Purdue and the actions of Sackler family members, who as hands-on board members took a keen interest in the marketing of the company’s prescription opioids as nonaddictive, have been widely implicated in the opioid epidemic.The company has pleaded guilty to federal criminal charges twice, most recently in 2021, during which the Sacklers themselves paid related civil penalties.In his court appearance, Mr. Sackler refused to be pinned down by lawyers who sought to elicit an acknowledgment of family responsibility in the continuing tragedy, which saw a record-breaking number of overdose deaths last year during the pandemic. He continued to stoutly defend the company’s opioid medications as federally approved drugs to alleviate pain.The balance between “risk and societal benefit is, I think, beyond question,” Mr. Sackler said. “So I bristle at the notion that people are dying as the only barometer of these medications.”But at another moment during cross-examination, Mr. Sackler said, “I think because of the product we produced that has helped millions of people has also been associated with the opioid epidemic, we bear moral responsibility to try and help, and that’s what this settlement is designed to do.”At least 2,700 lawsuits and hundreds of thousands of claims have been registered against Purdue, beginning in 2014, when the opioid epidemic began to crest. The plaintiffs span a vast array including 48 states, local governments, tribes, hospitals, individuals and monitors of infants born with symptoms of withdrawal to opioids, all of whom have been ravaged and financially depleted by opioids.In more recent years, individual Sacklers themselves have been named in a growing number of the cases.Nearly two years ago, Purdue filed for bankruptcy restructuring, which put an automatic stay on those lawsuits. But the Sacklers themselves did not file for bankruptcy, although they insisted that they, too, benefit from the liability releases expected to be given to their company.The issue of releases for the Sacklers and other third parties is at the heart of the resistance to the bankruptcy plan now pursued by nine states, including Maryland, Washington and Connecticut. The District of Columbia, the federal Justice Department and U.S. Trustee, a program in the Justice Department that monitors bankruptcy cases, as well as some Canadian local governments and First Nations, have joined in the objections.According to current law in the First Circuit Court of Appeals, in which Judge Drain’s court is located, the judge can grant releases to the Sacklers and other third-party individuals who have not filed for bankruptcy. But, broadly speaking, the issue is unsettled.Other federal circuits prohibit it. The question has been taken up by members of Congress, and may well drive an appeal by the objectors, should Judge Drain confirm the plan. The hammering questions by objecting lawyers have so far been intended not only to raise questions about the plan, but to lay a foundation for such appeals.Alain Delaqueriere contributed research.

If approved by a judge next month, the plan would resolve thousands of lawsuits and set in motion the release of $4.5 billion to help cover costs from the opioid epidemic.A huge majority of more than 120,000 creditors of Purdue Pharma have voted to approve the company’s bankruptcy plan, a key step toward the eventual release of more than $4.5 billion dollars to help pay for the costs of the opioid epidemic and the resolution of thousands of lawsuits against the company and its owners, members of the billionaire Sackler family.Preliminary tabulation of voting by cities, states, tribes, insurers, families and caregivers of babies born with symptoms of withdrawal from being exposed to opioids in utero show that 95 percent favor the plan, the company said.Under the plan, the Sacklers would relinquish control of Purdue. The restructured company would re-emerge with a new name, and be run by an independently appointed board. Profits from sales of its signature prescription painkiller, OxyContin, and addiction-reversal drugs would flow into creditors’ trusts that would fund addiction prevention and treatment programs.The Sacklers, who have not filed for personal bankruptcy, would pay at least $4.5 billion of their personal funds over nine years (in addition to $225 million from a separate civil settlement with the Justice Department).Neither the company, nor the Sacklers, would admit to wrongdoing in connection with these lawsuits.Over the past two decades, more than 500,000 people in the United States have died from overdoses of prescription and illegal opioids, including a record annual number in 2020. Purdue, widely believed to have helped ignite the problem by downplaying the addictive potential of OxyContin and aggressively marketing the drug with misleading campaigns, pleaded guilty to two separate investigations by the Justice Department.For the complex plan to take effect, Judge Robert Drain of the U.S. Bankruptcy Court for the Southern District of New York, must sign off, a move long expected and now made even more likely by the full-throated results of the creditor vote. Purdue said it would release final voting tallies on Aug. 2, a week before a court hearing at which final objections will be aired, but the company does not anticipate that these results will change materially. The judge is expected to rule shortly after.Although a handful of states filed objections to the plan, as did the Department of Justice, those efforts seem unlikely to derail proceedings. Earlier this month, attorneys general for 15 states that had been among the most vociferous objectors, including Massachusetts and New York, said they had negotiated fresh terms that made the plan more palatable and now supported the plan.Among the new elements the states and Purdue reached during mediation was an agreement by the company to release more than 30 million documents to a public repository, including private communications with lawyers. Those documents are expected to unfurl the full story of the company’s and the Sacklers’ involvement in the selling of OxyContin.The Sacklers, long known for their philanthropy in the arts, would relinquish future naming rights to any institutions to which they donate until their contributions to the opioids settlement are paid in full.For nearly two years, the objecting states argued that they should be able to reach directly into the pockets of individual Sacklers, because they did not themselves file for bankruptcy protection. Under the terms of the Purdue plan, however, the Sacklers as well as their company have been released from all civil liability.Some members of Congress have introduced legislation to close a loophole in the bankruptcy code. It would permit states and possibly individuals to sue third-party owners of a company in bankruptcy who, like the Sacklers, have not themselves filed for bankruptcy. But if the legislation is passed, the Purdue plan and the status of the Sacklers will almost certainly have been long since resolved.

To get out of conservatorship, the pop star will likely have to undergo a psychiatric evaluation, an uneasy melding of legal standards and mental health criteria.Her voice quaking with anger and despair, the pop star Britney Spears has asked repeatedly in court to be freed from the conservatorship that has controlled her money and personal life for 13 years. What’s more, she asked the judge to sever the arrangement without making her undergo a psychological evaluation.It’s a demand that legal experts say is unlikely to be granted. The mental health assessment is usually the pole star in a constellation of evidence that a judge considers in deciding whether to restore independence.Its underlying purpose is to determine whether the conditions that led to the imposition of the conservatorship have stabilized or been resolved.The evaluation process, which uneasily melds mental health criteria with legal standards, illustrates why the exit from strict oversight is difficult and rare. State laws are often ambiguous. And their application can vary from county to county, judge to judge, case to case.Isn’t Ms. Spears’s artistic and financial success proof she is self-sufficient?Yes and no. A judge looks for what, in law, is called “capacity.” The term generally refers to benchmarks in a person’s functional and cognitive ability as well as their vulnerability to harm or coercion.Under California law, which governs Ms. Spears’s case, a person deemed to have capacity can articulate risks and benefits in making decisions about medical care, wills, marriage and contracts (such as hiring a lawyer), and can feed, clothe and shelter themselves.Annette Swain, a Los Angeles psychologist who does neuropsychological assessments, said that because someone doesn’t always show good judgment, it doesn’t mean they lack capacity. “We all can make bad decisions at many points in our lives,” she said. “But that doesn’t mean that we should have our rights taken away.”Even so, Ms. Spears’s professional and financial successes do not directly speak to whether she has regained “legal mental capacity,” which she was found to lack in 2008, after a series of public breakdowns, breathlessly captured by the media. At that time, a judge ruled that Ms. Spears, who did not appear in court, was so fragile that a conservatorship was warranted.Judges authorize conservatorships usually for one of three broad categories: a severe psychiatric breakdown; a chronic, worsening condition like dementia; or an intellectual or physical disability that critically impairs function.Markers indicating a person has regained capacity appear to set a low bar. But in practice, the bar can be quite high.“‘Restored to capacity’ before the psychotic break? Or the age the person is now? That expression is fraught with importing value judgment,” said Robert Dinerstein, a disability rights law professor at American University.Records detailing grounds for the petition from Ms. Spears’s father, Jamie Spears, to become his daughter’s conservator are sealed. A few factors suggest the judge at the outset regarded the situation as serious. She appointed conservators to oversee Ms. Spears’s personal life as well as finances. She also ruled that Ms. Spears could not hire her own lawyer, though a lawyer the singer consulted at the time said he thought she was capable of that.Earlier this month, Los Angeles Superior Court Judge Brenda Penny said Ms. Spears could retain her own counsel.Does “capacity” differ among states?Yes. Some states, like California, detail basic functional abilities. Others do not. Colorado acknowledges modern advances like “appropriate and reasonably available technological assistance.” Illinois looks for “mental deterioration, physical incapacity, mental illness, developmental disability, gambling, idleness, debauchery, excessive use of intoxicants or drugs.”Sally Hurme of the National Guardianship Association noted: “You could be found to be incapacitated in one state but not in another.”Who performs the psychological assessment?Ideally, a forensic psychiatrist or a psychologist with expertise in neuropsychological assessments. But some states just specify “physician.” Psychiatrists tend to place greater weight on diagnoses; psychologists emphasize tests that measure cognitive abilities. Each reviews medical records and interview family, friends and others.Assessments can extend over several days. They range widely in depth and duration.Eric Freitag, who conducts neuropsychological assessments in the Bay Area, said he prefers interviewing people at home where they are often more at ease, and where he can evaluate the environment. He asks about financial literacy: bill-paying, health insurance, even counting out change.Assessing safety is key. Dr. Freitag will ask what the person would do if a fire broke out. “I’d call my daughter,” one of his subjects replied.Who chooses the evaluator?Ms. Spears has not been able to choose her evaluators in the past because the conservator has the power to make those decisions. However, if she moves to dissolve the conservatorship, she can select the evaluator, to help build her case. If the conservator, her father, opposes her petition and objects to her selection, he could nominate a candidate to perform an additional assessment. Ms. Spears would likely pick up both tabs as costs of the conservatorship.To avoid a bitter battle of experts and the appearance that an assessor hired by either camp would be inherently biased — plus the strain of two evaluations on Ms. Spears — the judge could try to get both sides to agree to an independent, court-appointed doctor.What impact does a mental health diagnosis have on an evaluation?Many states explicitly say that a diagnosis of a severe mental health disorder is not, on its own, evidence that a person should remain in conservatorship.Stuart Zimring, an attorney in Los Angeles County who specializes in elderlaw and special needs trusts, noted that he once represented a physician with schizophrenia and bipolar disorder who was under a conservatorship. The doctor’s rights were eventually restored after he proved he was attending counseling sessions and taking medication.“It was a joyous day when the conservatorship was terminated,” said Mr. Zimring. “He got to practice medicine again, under supervision.”The association between the diagnosis of a severe mental disorder and a determination of incapacity troubles Dr. Swain, the Los Angeles psychologist.“Whatever they ended up diagnosing Britney Spears with, was it of such severity that she did not understand the decisions that she had to make, that she could not provide adequate self-care?” she asked. “Where do you draw that line? It’s a moving target.”Does the judge have to accept an evaluator’s findings?No, but judges usually do.What standard does a probate judge apply to reach a decision?In most states, when a judge approves a conservatorship, which constrains a person’s autonomy, the evidence has to be “clear and convincing,” a rigorous standard just below the standard of “beyond a reasonable doubt.”But when a conservatee wants those rights restored, many experts believe the standard should be more lenient.Some states indeed apply a lower standard to end a conservatorship. In California, a judge can do so by finding it is more likely than not (“preponderance of evidence”) that the conservatee has capacity. But some states say that the evidence to earn a ticket out still has to be “clear and convincing.”Most states do not even set a standard.“There’s an underlying assumption that if you can get the process right, everything would be fine and we wouldn’t be depriving people of rights,” said Jennifer Mathis, deputy director of the Bazelon Center for Mental Health Law. “Our take is that the process is fundamentally broken and that we shouldn’t be using guardianship in so many cases.”If someone is doing well, isn’t the conservatorship no longer necessary?Yes and no. “Judges are haunted by people they have had in front of them who have been released and disaster happens,” said Victoria Haneman, a trusts and estates law professor at Creighton University. “So they take a conservative approach to freedom.”Describing the Kafkaesque conundrum of conservatorship, Zoe Brennan-Krohn, a disabilities rights lawyer with the American Civil Liberties Union, said: “If she’s doing great, the system is working and should continue. If she is making choices others disagree with, then she’s unreliable and she needs the system.”Or, as Kristin Booth Glen, a former New York State judge who oversaw such cases and now works to reform the system, put it, “Conservatorship and guardianship are like roach motels: you can check in but you can’t check out.”Can an evaluator recommend a less restrictive approach than a conservatorship?At times. Judge Glen once approved the termination of a guardianship of a young woman originally deemed to have the mental acuity of a 7-year-old. After three years of thoughtful interventions, the woman, since married and raising two children, had become able to participate fully in her life. She relied on a team for “supported decision making,” which Judge Glen called “a less restrictive alternate to the Draconian loss of liberty” of guardianship.A supported decision-making approach has been hailed by the Uniform Law Commission, which drafts model statutes. It has said judges should seek “the least restrictive alternative” to conservatorship.To date, only Washington and Maine have fully adopted the commission’s recommended model.Samantha Stark contributed reporting.