Supported decision-making in Canada: principles, policy, and practice

Realising economic and social rights for children with communication and swallowing disability: Sustainable Development Goals 1, 8 and 10

PURPOSE

This commentary describes the economic disempowerment of children with communication and/or swallowing disability and outlines why attending to their economic and social needs is essential for the realisation of the United Nations' Agenda 2030.

RESULT

Children with communication and/or swallowing disability encounter intersectional disempowerment on account of both their disability, and their status as children. In particular, they experience unique barriers to the realisation of their economic and social rights. This presents a number of challenges to the realisation of Agenda 2030, and its Sustainable Development Goals (SDGs). Drawing on the broader disability rights and child rights literature, we outline these issues, and describe four empowering solutions, within the scope of this special issue commentary.

CONCLUSION

We describe that speech-language pathologists must interpret the discussion of these issues as a call to action for our profession. This commentary focusses on the Agenda 2030 Sustainable Development Goals of, No Poverty (SDG 1), Decent Work and Economic Growth (SDG 8), and Reduced Inequalities (SDG 10), and also addresses the goals of Zero Hunger (SDG 2), Good Health and Well-Being (SDG 3), Quality Education (SDG 4), Gender Equality (SDG 5) and Partnerships for the Goals (SDG 17).

Supported decision-making for persons with intellectual disabilities in Japan and Taiwan: a survey of social workers' and adult guardians' awareness of supported decision-making

Background: Priority given to supported decision-making has increased internationally since the United Nations General Assembly adopted the Convention on the Rights of Persons with Disabilities (CRPDs). Nations worldwide have moved to ratify and enact the CRPD. Methods: A questionnaire survey on the supported decision-making status was conducted in Japan and Taiwan (60 and 73 people, respectively; N = 133, 82 women and 51 men). Survey items were objective indicators based on the CRPD. Results: In both countries, people who are older (vs younger) or those having more (vs less) experience supporting persons with intellectual disabilities were more likely to practice supported decision-making. Relationships between persons with intellectual disabilities and family members are vital. Conclusions: It is necessary to establish appropriate supported decision-making methods, that do not depend on aspects such as support experience, for persons with intellectual disabilities in Japan and Taiwan. Additionally, it is necessary to clarify the relationship with the family in supported decision-making for persons with intellectual disabilities and to work together appropriately.

Supported decision making for people with mental health disorders in clinical practice: a systematic review

Objectives: The Convention on the Rights of Persons with Disabilities (CRPD) was adopted at the United Nations Assembly in 2006. The main aim of the convention is to ensure equal rights for people with disabilities including the expression of people's own "will and preferences" concerning health treatment. Article 12 demands the respect of a person's "rights, will and preferences" (CRPD) and suggests supported decision making (SDM) when possible. The aim of this review was to gather information regarding the SDM implementation from a clinical perspective for people with mental health disorders.Methods: A systematic literature search was performed on electronic databases MEDLINE, PsycARTICLES, and PsycINFO using the keywords "supported decision making" and "UN convention on the rights of persons with disabilities" in March 2018.Results: Eleven articles were included in the final review, which focussed on three themes: (1) different models of SDM, (2) stakeholder views, and (3) challenges for implementation. A limited number of papers described clinical models that had good theoretical consistency with SDM. The main challenges of implementation related to critical situations when "will and preferences" are poorly understood or appear contradictory. Future studies should assess specific models of SDM implementation, including related outcomes and process measures.

Sexual Expression in Alberta's Continuing Care Homes: Capacity, Consent, and Co-decision-making

In this article, we explore the role of substitute decision-makers (SDMs) in matters of sexual expression for continuing care residents with diminished cognitive capacity. We examine how Alberta's current use of SDMs can enable an "all-or-none" approach to competence, wherein a person either has capacity to make all decisions or is incapable of making any. Three factors facilitate an environment in which this approach can influence residents' sexual expression. These include the wording of current legislation, lack of resources for SDMs, and relational dynamics between SDMs and care staff. We provide a critical review of existing legislation and empirical evidence of its challenges in practice. Though we focus on the Alberta context, there is reason to believe that similar issues persist in other Western jurisdictions. We offer several recommendations for how we can better support residents' sexual autonomy in continuing care and avoid pitfalls of the "all-or-none" approach to competence.