Decision-Making Supports and Cognitive Decline

For persons with a range of cognitive disabilities, supported decision-making, rooted in a human rights approach to disability, has emerged as a tool that permits them to make legally binding decisions and avoid guardianship. As supported decision-making policy has evolved in the United States, state statutes have primarily focused on formal agreements through which individuals can designate trusted supporters to assist in obtaining information, processing that information, and communicating a decision. This Article argues that supported decision-making has promise for preserving the autonomy of persons living with dementia, but that the model of a supported decisionmaking agreement embodied in the state statutes does not fully address the circumstances of those experiencing cognitive decline. The different context requires a different and broader range of supports for decisionmaking.

The Article proposes supplemental policy interventions to be more responsive to the needs of people experiencing cognitive decline. These include developing a values-based planning process that combines supported decision-making with advance directives, promoting enhanced guardianship diversion services, and more explicitly requiring decisionmaking