Supported Decision-Making and Legal Capacity for Persons with Disabilities

Supported decision-making is an approach that enables individuals with cognitive, intellectual or psychosocial disabilities to make and communicate their own choices with the assistance of trusted supporters. Rooted in the principle of equal recognition before the law, it shifts the paradigm from substituted decision-making—where a guardian or proxy makes decisions on behalf of an individual—to one in which will and preference guide outcomes. The United Nations Convention on the Rights of Persons with Disabilities enshrines legal capacity as a fundamental right, obliging States parties to provide access to support measures that respect autonomy and personhood. Practical models vary from informal arrangements within families and communities to formal schemes such as legal agreements, councils of supporters or peer networks. Key challenges include ensuring consistency in the presumption of capacity, safeguarding against undue influence, securing adequate resourcing and training professionals. Evidence suggests that successful implementation combines legislative reform, multidisciplinary collaboration and capacity-building programmes for supporters, thereby promoting social inclusion and reducing reliance on coercive measures.

Research from Nature Portfolio

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Supported Decision-Making and Legal Capacity for Persons with Disabilities publication trend

The graph below shows the total number of articles in supported decision-making and legal capacity for persons with disabilities across all publications each year (not limited to Nature Index journals).

Technical terms

Supported decision-making: A framework in which individuals retain legal capacity and receive tailored assistance to understand, deliberate and communicate choices without surrendering decision-making authority.

Legal capacity: The recognition that a person has the right to hold and exercise civil and political rights on an equal basis with others.

Substituted decision-making: A legal mechanism whereby decisions are made by another party on behalf of an individual judged to lack capacity.

Presumption of capacity: The principle that all adults are presumed to have decision-making ability unless proven otherwise through a fair assessment process.

Will and preference: The authentic desires and choices of an individual, which should direct decision-making processes and outcomes.

References

1. The United Nations Convention on the Rights of Persons with Disabilities and Social Work: Evidence for Impact?. International Journal of Environmental Research and Public Health (2023).
2. Supported Decision-Making from Theory to Practice: Implementing the Right to Enjoy Legal Capacity. Societies (2018).
3. Assumptions of Decision-Making Capacity: The Role Supporter Attitudes Play in the Realisation of Article 12 for People with Severe or Profound Intellectual Disability. Laws (2016).
4. Supporting Choice and Control—An Analysis of the Approach Taken to Legal Capacity in Australia’s National Disability Insurance Scheme. Laws (2019).
5. Prioritising Supported Decision-Making: Running on Empty or a Basis for Glacial-To-Steady Progress?. Laws (2017).
6. Experiences and perceptions of everyday decision-making in the lives of adults with intellectual disabilities, their care partners and direct care support workers.. Journal of Intellectual Disabilities (2023).