Psych · intellectual-disability
Capacity and supported decision-making in ID
Also known as Supported decision-making · Decision-making capacity intellectual disability · Legal capacity UNCRPD · Guardianship intellectual disability · Substitute decision-making ID · Mental capacity learning disability · Article 12 CRPD · Easy Read consent
Exam-exhaustive fellowship reference on decision-specific capacity and supported decision-making in intellectual disability — four functional abilities after accessible supports, UNCRPD Article 12 legal capacity vs mental capacity, guardianship least-restrictive principles, substitute pathways when supports fail, and CASC communication. Statutes are jurisdiction-specific; no invented section numbers. FRANZCP-primary, globally tagged.
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10 MCQs with explanations
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Meet the patient
A 24-year-old man with moderate intellectual disability is admitted for an elective cholecystectomy. His mother has signed the consent form and tells the surgical team, "He can't decide anything, I always decide for him." When you sit with him alone, with pictures, he tells you clearly that he does not want an operation because "they cut me last time and it hurt a lot."[2][13]
The referral asks for a "global incapacity letter." Note what that request has already assumed. Two questions are now live. Has anyone actually explained the operation to him in a way he can hold? And who, lawfully, is the decision-maker here — the man, the mother, or the court?[2][5][13]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
References18Show ledgerHide ledger
- [1]Appelbaum PS, Grisso T Assessing patients' capacities to consent to treatment N Engl J Med, 1988.PMID 3200278
- [2]Appelbaum PS Clinical practice. Assessment of patients' competence to consent to treatment N Engl J Med, 2007.PMID 17978292
- [3]Grisso T, Appelbaum PS, Hill-Fotouhi C The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions Psychiatr Serv, 1997.PMID 9355168
- [4]Sessums LL, Zembrzuska H, Jackson JL Does this patient have medical decision-making capacity? JAMA, 2011.PMID 21791691
- [5]Buchanan A Mental capacity, legal competence and consent to treatment J R Soc Med, 2004.PMID 15340019
- [6]Palmer BW, Harmell AL Assessment of Healthcare Decision-making Capacity Arch Clin Neuropsychol, 2016.PMID 27551024
- [7]Cea CD, Fisher CB Health care decision-making by adults with mental retardation Ment Retard, 2003.PMID 12622524
- [8]Fisher CB, Cea CD, Davidson PW, Fried AL Capacity of persons with mental retardation to consent to participate in randomized clinical trials Am J Psychiatry, 2006.PMID 17012694
- [9]Fisher CB Goodness-of-fit ethic for informed consent to research involving adults with mental retardation and developmental disabilities Ment Retard Dev Disabil Res Rev, 2003.PMID 12587135
- [10]Devi N Supported decision-making and personal autonomy for persons with intellectual disabilities: article 12 of the UN convention on the rights of persons with disabilities J Law Med Ethics, 2013.PMID 24446938
- [11]Kohn NA, Blumenthal JA A critical assessment of supported decision-making for persons aging with intellectual disabilities Disabil Health J, 2014.PMID 24456684
- [12]Szmukler G "Capacity", "best interests", "will and preferences" and the UN Convention on the Rights of Persons with Disabilities World Psychiatry, 2019.PMID 30600630
- [13]Sullivan WF, Heng J Supporting adults with intellectual and developmental disabilities to participate in health care decision making Can Fam Physician, 2018.PMID 29650742
- [14]Sullivan WF, Diepstra H, Heng J, et al. Primary care of adults with intellectual and developmental disabilities: 2018 Canadian consensus guidelines Can Fam Physician, 2018.PMID 29650602
- [15]Watson J, Wilson E, Hagiliassis N Supporting end of life decision making: Case studies of relational closeness in supported decision making for people with severe or profound intellectual disability J Appl Res Intellect Disabil, 2017.PMID 28815814
- [16]Bigby C, Douglas J, Smith E, et al. "I used to call him a non-decision-maker - I never do that anymore": parental reflections about training to support decision-making of their adult offspring with intellectual disabilities Res Dev Disabil, 2022.PMID 34477481
- [17]Parker M Getting the Balance Right: Conceptual Considerations Concerning Legal Capacity and Supported Decision-Making Int J Law Psychiatry, 2016.PMID 27329177
- [18]Shogren KA, Wehmeyer ML, Uyanik H, Heidrich M Development of the Supported Decision Making Inventory System Intellect Dev Disabil, 2017.PMID 29194029