Supported Decision-Making Service

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Supported Decision-Making Service for Persons with Disabilities | Service Model
The Human Rights Center for People with Disabilitis
Objectives, goals, values and guiding principles, and decision-making processes
The description of the objectives, goals, values and guiding principles of the project with persons
with disabilities in its entirety is and/or can be suitable for the population of senior citizens.
Naturally, the model's values and guiding principles could have been conceptualized through
different configurations and forms using alternative terms (dignity, autonomy etc.), but with
respect to its suitability and applicability to senior citizens it seems that the proposed model can
be suitable without issue.
An important point which should, nevertheless, be emphasized in this context pertains to the
importance and role played by family members and additional significant persons in connection
with decision-making processes of senior citizens. As aforesaid, a large part of the senior citizen
population has a significant family support system created throughout the years based on long
term choices and design (for instance, long term spousal relations). Studies show that these family
members play a significant and substantial role in decision-making processes in advanced ages,
and that these family members also play a central and substantial role in providing solutions
to care and nursing needs. Therefore, the a-priori role and status of family members forming
a substantial and integral part of decision-making processes of senior citizens is a point which
should be emphasized when building a supported decision-making model for this population.
"Decision supporters" service model
Here, again, the entire model established for persons with disabilities seems to be suitable and
appropriate for senior citizens, but I shall try to highlight a few important points:
(1) The "dynamic" nature of the support in decision-making: senior citizens are
exposed to chronic and progressive disease processes characterized by changes over
time which are not always linear or uniform. Therefore, the process and content of the
"support" in decision-making provided to them should be "dynamic" and "flexible" in
two unique respects: firstly – there is a continuing obligation to re-evaluate the changes
in the abilities and preferences of senior citizens; secondly – there is an obligation to
accommodate and change the pattern, scope, extent and content of the support in view
of the changes arising from the periodic evaluation of abilities.
(2) The dilemma of the "authenticity" of the will of dementia patients: although
the dilemma is not "unique" to senior citizens suffering from dementia, it should be
emphasized that a specific dilemma arises around the issue of "respecting" the latter's
will, particularly when they express will, choices or preferences which "contradict"
their past values or the values of their families or culture (for instance: an observant
woman from a religious background who suddenly manifests a will and preference
to act in a manner which ostensibly contradicts her past values). While some argue
that such will manifestations should be disregarded since they do not reflect the real
person but rather the expression of their "disease", others contend that there is a moral
obligation to respect this "new" will, which reflect the "new"/renewed self of the person
in their current state. In this unique context – and without resolving the debate on its
merits – the role of "support in decision-making" has a special importance, as it can
echo the past choices and preferences of the senior citizens, and try to ascertain that
the "new" choices and decisions of the senior citizens do indeed reflect a conscious
and clear choice of a will to adopt a new and different form of identity and personality.