12 minutes
Supported decision-making Learn the difference between helping a person decide and deciding for them, and how to tell which one is happening.
What you’ll be able to do Explain how supported decision-making differs from substituted decision-making and identify signs that support has become substitution. Compare the responses to this question and explain your choice: What is the most useful contribution? Document a next step for Supported decision-making: Ask one person you support who helps them make big decisions, and how; then compare it to what the file says. Two questions that get confused Who makes the decision and who helps with it are different questions, and a great deal of practice blurs them. Supported decision-making answers the first with the person, always, and the second with whomever the person chooses: a family member, a friend, a worker, a peer. Support can be extensive. It can mean explaining options several times, in several ways, over several weeks. It can mean help communicating the choice to others. What it cannot mean is that the supporter's view becomes the decision.
Substituted decision-making answers the first question with someone other than the person. Guardianship is its most formal version, and it is sometimes necessary. The problem is not that it exists. The problem is how often it is reached for first, on the basis of a diagnosis rather than a demonstrated inability to decide with support, and how rarely it is revisited once granted.
Support or substitution? What supported decision-making looks like What substitution looks like The signs support has slipped
The person chooses their supporters. Options are explained in ways the person can use, with time. Consequences are talked through. The person's choice is communicated, in their words, to whoever needs to hear it. The record shows the person decided and who helped.
Someone else decides, sometimes after consulting the person. The record shows the substitute's decision. The person may or may not have been present. The reason is often a diagnosis or a general statement about capacity rather than a specific decision the person could not make with support.
The supporter's preference is what gets recorded. The person is asked to agree rather than to choose. Options the supporter disfavors are not mentioned. The person stops being asked because the answer is assumed.
The question is never whether a person can decide. It is what support it would take for them to.
Match the intervention to the concern What you can change You control whether a worry about one decision area becomes a proposal about all of them. Naming the specific area is what keeps the response proportionate.
What to watch for Do not let a diagnosis stand in for a demonstrated inability to decide with support. The two are routinely confused and the confusion costs people their authority over their own lives.
Your next step The next time guardianship comes up, ask which decisions specifically, and what support has been tried for each.
Carry this forward Supported decision-making keeps the decision with the person and adds help: explaining options, weighing consequences, communicating the choice.
Substituted decision-making transfers the decision to someone else, and guardianship is its most formal form; it should be the last resort, not the default.
Support has become substitution when the supporter's preference is what gets recorded, however gently it was reached.
A tabs comparison, a quote, a scenario decision and a knowledge check.
Ask one person you support who helps them make big decisions, and how; then compare it to what the file says.
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Previous lesson Next lesson Carry this into practice What it means for a person to direct their own supports, where the independent living movement came from and what it asks of a service system, and how to support a decision without taking it over.
Return to the experience: What did you notice or try, whose perspective informed it, and what would you keep or adjust?
Participation and course completion in this program do not count toward DHS-required training credits unless management, a director, or DHS leadership expressly approves an exception.
