Essence of Assisted Decision Making: Analytical Essay

Assisted decision making is a hugely misused and misunderstood concept in medical practice, mistakes in or lack of providing assisted decision making became very common and are on the rise. In this essay I shall discuss the legal issues concerning assisted decision making, its use in the health care systems and the ethical issues related to this vital aspect of life and medical practice. Assisted decision making is circled around the idea of providing an individual with assessment in the process of making a decision concerning either a medical, legal, social or any other aspect of their life. It is provided to people with reduced/altered capacity. There is more than one way in which assisted decision making can be provided governed by the degree of the relevant person’s current/future capacity. For instance, if the person is at the lower end of the capacity support spectrum, they may appoint a decision-making assistant that helps by explaining, providing relevant information and the overall correlation of the issues at hand. However, people at the high end of capacity support may appoint a co-decision maker who does almost the same job as a decision-making assistant, but with more involvement in the final decision made by the relevant person. As for people with a diminished or very low capacity, a decision-making representative can be assigned by the circuit court which is usually someone close to the relevant person. (Kelly, 2020) Other forms of supported decision making exist, like forming an advanced healthcare directive or assigning a designated health care representative prior to an individual’s loss of capacity.

Assisted decision making has been recently recognized in Ireland in the health care of disabled patients, patients with reduced capacity, or in the general healthcare of any patient. When assisted decision making is applied correctly, it can greatly affect the relevant person experience within their decision-making process. The Assisted Decision-Making (Capacity) Act 2015, has various provisions that promote the recognition of a person with altered capacity as having the right of supported decision making in relation to their healthcare choices and providing them with the needed assistance to achieve that. It has begun to change the law relating to capacity in Ireland since its establishment as it has been signed into the law on the 30th of December 2015, it applies to everyone and is relevant to all health and social care environments.(HSE.ie, 2020) Since the addition of the act in 2015, huge awareness started to rise in relation to assisted decision making and the vitality of its application in the different aspects of caring for individuals with altered capacity. The legalization of the act involves a multi-step process, including the support of advanced care planning, discussion and reflection about goals, values and the relevant persons preferences regarding the future and the end of life care, which includes a doctor or a nurse. (Hospicefoundation.ie, 2020) This process is provided to individuals that are assessed and found to require it. Moreover, the act includes various vital provisions that promote the use of assisted decision making in the health care system and to put an end to the lunacy regulations underlining the ward of court system, such as imposing a legal requirement upon medical and service care providers to enable a person to make a decision through the supplement of a range of support and information appropriate to their condition.(HSE.ie, 2020) All of this is done with an aim to improve the process of decision making and the experiences of relevant persons within the healthcare system. However, even though the legislation of this act was authorized in 2015 and registered in the laws of Ireland it is yet to be commenced, which means that the lunacy act (1871) is still applicable in Ireland. Regardless, it is recommended that the guidelines in the legislation are used “along with existing case law and other national guidelines/policies” (Hospicefoundation.ie, 2020) to ensure competent medical practice and the reservation of people’s rights.

Providing assisted decision making depends on the assessment of an individual’s capacity. Decision making capacity, which is also known as mental capacity can often be confused with legal capacity which is “A recognition that all persons have a right to make decisions and have those decisions recognised regardless of disability.” before the law. (Inclusionireland.ie, 2020) With regards to legal capacity, the 12th article of the Convention on the Rights of Persons with DisabilitiesCRPD states that countries should ‘recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life” (Un.org, 2020), which promotes the equal recognition of persons with disability before the law. Furthermore, assessing a person’s capacity is never a onetime process. Capacity is known to be a flexible thing that can vary from a day to day basis and it should be assessed carefully to prevent any injustice to the relevant persons. It is established that to assess a person’s capacity, many factors shall be put into consideration. Such as time, location of the assessment, whether the relevant person needs special communication services and the general environment and nature of the meeting. All of these factors can affect the current capacity of the relevant person in many ways. The Assisted Decision-Making Capacity Act introduced a new definition of capacity, which illustrates the assumption of decision-making capacity to all unless fairly proven otherwise. It also provides a functional test along with a specific principle-based framework for the assessment of capacity. (Mhc.ie, 2020) So assessing capacity should not be inclusive, rather only exclusive to the issue in place.

Ethically, it is believed that all disabled people have the right of legal capacity and assisted decision making no matter the amount of assistance required. Discrimination based on disability is considered morally horrific as it’s argued that people with disabilities might not be able to respond to the discrimination they face or if they do so, they might not be taken seriously. The act of abusing a disabled person’s right of legal capacity on the notion that it’s in their best interest is widely seen, especially, -coming from a personal experience- in countries that lack the awareness of the right of legal capacity and assisted decision making for people with disability. The most common issue that people with reduced decision-making capacity face is the paternalistic “best interest” attitude expressed by those who deem themselves capable of making a decision for another individual without prioritizing what the relevant persons wishes are. This issue is common, it can even be present and happening without the knowledge of its wrongdoing by the person practicing it. Furthermore, this paternalistic attitude can be expressed by individuals within the healthcare system and other social care environments where disabled people are viewed as incompetent andor not able to take ahold of their own decision making. All of That underlies why it is strongly argued that further awareness should be raised regarding assisted decision making, especially in societies where disabled people are still not treated as active members capable of making everyday decisions regardless of assistance required. More effort shall be made in assessing capacity properly as to assign the correct degree of assistance required for decision making and to prevent any form of injustice toward people with disability.

Finally, the general aim of most disabled people’s right advocates and committees is to replace substituted decision making with assisted decision making, to involve the relevant persons as much as possible in their decision making process and their life choices, to treat disabled people as active members of society capable of making everyday life decisions, to always assume that a person is capable of their own decision making until a fair effort is put to prove otherwise.