Britney Spears’ conservatorship shined a spotlight on the problems of guardianship systems and their damaging impact on people’s lives. The world saw that Britney’s mental health challenges did not impede her ability to make decisions such as selecting attorneys and engaging health care professionals. What the California system lacked was an appreciation for the concept of supported decision-making, involving the individual in their life choices even when they are challenged by some level of mental health or cognitive limitation.
Supported decision-making is a factor in everyone’s lives. Do you bring a friend or relative to your doctor appointments? Medical advice can be confusing. Emotions run high when the news is disappointing. Support can be the factor that guarantees great health care.
Many of us have elderly parents or family members with disabilities. In order to achieve the best health care, our family might need support without substituting our judgment for theirs. A key element is empowering the patient, even if they have some cognitive challenges. Also, guaranteeing a patient’s role in their own health care is a matter of human dignity.
States and the District of Columbia have passed laws to further “supported decision-making.” Simply put, everyone should have a role in their health care and life choices to the extent they can. Our choices are often best made when we are supported by caring and skilled advisors. Such advisors can be family, social workers, medical professionals, and lawyers. Unless and until someone has a very limited cognitive function, supported decision-making involves each individual in decision-making as possible.
One example is the District of Columbia’s approach to students with disabilities. Until recently, DC schools routinely advised parents that a guardianship appointment was required for each child turning 18 who had some cognitive limitations. Educational records were withheld from parents even when the children requested their parents’ help. DC Schools presumed that children with disabilities were uniformly dependent on parents or family for educational and healthcare decisions. Due to a recent change, DC Public School Guidelines allow an 18-year-old student to choose supported decision-making rather than forcing the family to turn to the courts to appoint a guardian.
Elderly parents or family members with disabilities deserve the dignity of making decisions about their lives. The supported decision-making approach freed Brittney. Perhaps the best practice is that we all should consider ourselves as needing support when vital healthcare decisions are made.
Evan J. Krame