Supported Decision-Making: Emerging Paradigm in Research, Law, and Policy

Blanck, Peter

doi:10.1177/10442073211023168

Cited by 12 publications

(38 citation statements)

References 20 publications

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“…Supported decision-making is used to empower individuals to make their own decisions to the maximum extent possible. This approach increases self-determination and should be implemented before resorting to substitute decision-making ( 25 ). More research is needed in this field, but there are important arguments such as human rights, effectiveness and pragmatism that support this approach in mental health care ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Ageism, human rights and ethical aspects of end-of-life care for older people with serious mental illness

Kotzé

Roos

2022

Front. Psychiatry

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There are many complex concepts to consider during end-of-life discussions and advance care planning, especially when vulnerable populations such as older individuals with serious mental illness are involved. This article aims to summarize some of these important concepts, such as the effects of ageism, preservation of human rights and dignity, supported or shared decision making and palliative approaches. It emerged from a study that found two thirds of 100 participants 60 years of age and older with serious mental illness had end-of-life decision-making capacity. This finding highlighted the individual and contextual nature of decision-making capacity, the importance of consideration of individual values and protection of human dignity during end-of-life care. Healthcare providers have a duty to initiate end-of-life and advance care discussions, to optimize decision-making capacity, and to protect autonomous decision-making. Chronological age or diagnostic categories should never be used as reasons for discrimination and all patients should receive end-of-life care in keeping with their preferences and values.

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Section: Discussionmentioning

confidence: 99%

Ageism, human rights and ethical aspects of end-of-life care for older people with serious mental illness

Kotzé

Roos

2022

Front. Psychiatry

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“…Supported decision-making is an emerging paradigm in which people get help from others to understand and address choices they encounter in everyday life. The aim is to increase selfdetermination, to empower individuals to make their own decisions as far as possible and to prevent the need for substitute decision-making (40,41).…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

2021

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Background: The study's main aim was to assess the end-of-life decision-making capacity and health-related values of older people with serious mental illness.Methods: A cross-sectional, observational study, was done at Weskoppies Psychiatric Hospital, Gauteng Province, South Africa that included 100 adults older than 60 years of age and diagnosed with serious mental illness. The Mini-Cog and a semi-structured clinical assessment of end-of-life decision-making capacity was done before a standardized interview, Assessment of Capacity to Consent to Treatment, was administered. This standardized instrument uses a hypothetical vignette to assess decision-making capacity and explores healthcare-related values.Results: The Assessment of Capacity to Consent to Treatment scores correlated (p < 0.001) with the outcomes of the semi-structured decision-making capacity evaluation. Significant correlations with impaired decision-making capacity included: lower scores on the Mini-Cog (p < 0.001); a duration of serious mental illness of 30–39 years (p = 0025); having a diagnosis of schizophrenia spectrum disorders (p = 0.0007); and being admitted involuntarily (p < 0.0001). A main finding was that 65% of participants had decision-making capacity for end-of-life decisions, were able to express their values and engage in advance care discussions.Discussion and Conclusion: Healthcare providers have a duty to initiate advance care discussions, optimize decision-making capacity, and protect autonomous decision-making. Many older patients with serious mental illness can engage in end-of-life discussions and can make autonomous decisions about preferred end-of-life care. Chronological age or diagnostic categories should never be used as reasons for discrimination, and older people with serious mental illness should receive end-of-life care in keeping with their preferences and values.

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“…Increasing SDM research and practice is important in its own right because, as mentioned, SDM is associated with self-determination (Blanck & Martinis, 2015). People exercise self-determination when they make life choices and act as causal agents in their lives (e.g., Blanck, this issue; Wehmeyer et al, 2000). Researchers have found that people with disabilities who exercise greater self-determination experience enhanced quality of life, including increased independence, employment, community integration, and safety (Khemka et al, 2005; McDougall et al, 2010; Powers et al, 2012; Shogren et al, 2015; Wehmeyer & Schwartz, 1997).…”

Section: Discussionmentioning

confidence: 99%

“…The high rate of guardianship among young adults with disabilities once again suggests that laws on the books requiring the use of alternatives to guardianship like SDM may not be enough to ensure that such approaches are used. The school to guardianship pipeline suggests that the same trend is true of laws requiring schools to provide students receiving special education with supports and services to prepare them for independent living (Blanck, 2020; Individuals with Disabilities Education Improvement Act [IDEA], 20 U.S.C. §1400(d)(1)(A), 2004) and transition services to ambitiously facilitate the child’s movement from school to postschool activities, including independent living and the acquisition of daily living skills (Blanck, 2020; IDEA, 20 U.S.C.…”

Section: Discussionmentioning

confidence: 99%

State Guardianship Laws and Supported Decision-Making in the United States After Ross and Ross v. Hatch: Analysis and Implications for Research, Policy, Education, and Advocacy

Martinis

Harris

Fox

et al. 2021

Journal of Disability Policy Studies

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In the last decade, and especially after the 2013 Virginia court case of Ross and Ross v. Hatch, there has been a dramatic increase in knowledge, use, and legal recognition of supported decision-making (SDM) in the United States. SDM is a methodology in which people work with trusted friends, family members, and professionals who help them understand their situations and choices so they may make their own decisions and direct their lives. After the Hatch case, in which a young woman with Down syndrome defeated a petition for permanent guardianship by demonstrating that she uses SDM, this methodology has increasingly been considered and used as an alternative to guardianship to enable people to retain their legal rights and make life choices to the maximum extent possible. This article reviews the guardianship laws of the 50 U.S. states and the District of Columbia. Using criteria we developed, in light of the findings and values expressed in Hatch, we assessed the extent to which those laws recognize or encourage the use of SDM as an alternative to guardianship and as a means to enhance self-determination for people in guardianship. We then offer recommendations for future SDM research, policy, education, and advocacy efforts.

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Supported Decision-Making: Emerging Paradigm in Research, Law, and Policy

Cited by 12 publications

References 20 publications

Ageism, human rights and ethical aspects of end-of-life care for older people with serious mental illness

Ageism, human rights and ethical aspects of end-of-life care for older people with serious mental illness

End-of-Life Decision-Making Capacity in Older People With Serious Mental Illness

State Guardianship Laws and Supported Decision-Making in the United States After Ross and Ross v. Hatch: Analysis and Implications for Research, Policy, Education, and Advocacy

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