Decision-making Ability in Aged Care: Understanding Capacity and Autonomy
The term "decision-making ability" refers to a person's capability to make an informed choice. In the context of aged care, this concept is central to respecting an older person’s autonomy and dignity, guiding everything from daily routines to complex medical treatments and legal matters. When a person has decision-making ability, they are considered capable of making choices for themselves.
Understanding a person's ability to make decisions involves looking at a specific process, not just the outcome of a choice. A person is generally considered capable if they can:
- Understand information relevant to the decision and what might happen as a result.
- Keep that information long enough to make the decision.
- Use or weigh that information thoughtfully as part of the decision process.
In aged care, maintaining an older person's self-determination is paramount. Care providers and family members must always assume the person is capable unless a formal assessment proves otherwise. Even when ability is diminished, care should focus on supporting the person to participate in decisions to the greatest extent possible.
Decision-making Capacity is Decision-Specific
It is important to recognize that decision-making capacity is not an all-or-nothing state. It is decision-specific, meaning a person might be capable of making some choices but incapable of making others. For example, an individual may be capable of deciding what clothing to wear each day, but may lack the capacity to make complex financial choices or consent to a major medical procedure.
Capacity is also time-specific and can change. Factors like illness, pain, medication, or confusion can temporarily affect a person's ability to make choices. Because capacity can fluctuate, it must be assessed at the time the specific decision needs to be made.
Assessment in Aged Care
In aged care settings, assessments of decision-making capacity are generally carried out by the relevant health care professional proposing the treatment or decision. These assessments look at the process the person uses to reach a choice, rather than judging the choice itself.
If concerns arise about a resident's ability to make a specific choice, a formal assessment may be necessary. This assessment helps determine if substitute decision-making arrangements need to be put in place, such as appointing a guardian or activated power of attorney, to act in the person’s best interests. This is done to uphold the person's rights while keeping them safe.
Supporting Autonomy and Independence
Regardless of capacity, aged care providers must involve the older adult in discussions about their care. This means acting in the spirit of least restrictive practice, which requires restricting a person's rights or freedoms only when absolutely necessary and to the minimum degree required.
Tips for supporting decision-making:
- Simplify information: Present facts clearly and concisely, avoiding confusing technical terms.
- Allow time: Give the person sufficient time to process information and express their preference without pressure.
- Focus on values: Understand what the individual values in their quality of life, independence, and dignity. Use these values as a compass for discussions.
- Graduated support: Start by offering choices and involving them in conversations. Only introduce substitute decision-makers if participation is truly not possible for a given choice.
The goal is always to treat the older person as an active participant in their life and care plan, upholding their dignity even when their ability to make choices changes. This respectful approach forms the foundation of ethical and quality aged care provision.
FAQs about Decision-making Ability in Aged Care
What is the difference between decision-making ability and capacity?
The terms "ability" and "capacity" are often used interchangeably in general conversation. However, in legal and medical contexts, "capacity" often refers to the legal determination of whether a person can make a specific decision, typically assessed against specific criteria. Decision-making ability is the underlying skill set that capacity assessments measure.
Can an older adult lose and regain decision-making ability?
Yes. Capacity is time-specific. It can temporarily diminish due to factors like acute illness, pain, or temporary confusion, and then return once the underlying issue is addressed. This is why capacity is assessed for the specific decision at the time it needs to be made.
Who assesses decision-making capacity in aged care?
For treatment decisions, the health care professional proposing the treatment is usually responsible for assessing the patient's capacity to consent to that specific decision. Other legal or financial decisions may require assessment by specific legal professionals or tribunals, depending on local laws.
What happens if an older person is found to lack capacity for a specific decision?
If a formal assessment determines that a person lacks capacity for a specific choice, a previously appointed substitute decision-maker (like a guardian or power of attorney) will step in to make that choice on their behalf, always acting in the best interests of the older person.
