Oral Presentations Abstracts: A CONCEPTUAL FRAMEWORK FOR THE ETHICAL EVALUATION OF SUPPORTED DECISION-MAKING

Matthé SCHOLTEN; Jakov GATHER; Jochen VOLLMANN

doi:10.24193/subbbioethica.2021.spiss.107

Authors

Matthé SCHOLTEN Postdoc, Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Germany. E-mail: matthe.scholten@rub.de
Jakov GATHER Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital and Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Germany
Jochen VOLLMANN Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Germany

DOI:

https://doi.org/10.24193/subbbioethica.2021.spiss.107

Abstract

View of Volume 66, Special Issue, September 2021

Background: Supported decision-making (SDM) refers to all types of interventions support persons with impaired decision-making capacity (DMC) in making informed treatment decisions. It encompasses a wide range of interventions, such as enhanced consent procedures, elaborated plain language and involvement of family, friends or peers in the informed consent process. Empirical research showed that SDM can enhance DMC. The UN Convention on the Rights of Persons with Disabilities, which has been ratified by 180 states parties to date, pronounces in article 12(3) that “states parties shall take appropriate measures to provide access by persons with disabilities to the support they may require in exercising their legal capacity.” At the same time, medical ethicists and legal scholars have raised the concern that persons with impaired DMC are more likely to become subject to undue influence under SDM arrangements.

Objectives: The aim of this presentation is to provide a conceptual framework to facilitate an ethical evaluation of various forms of supported decision-making.

Methods: Empirically informed conceptual analysis. Various SDM interventions are analyzed.

Findings: It is necessary to distinguish between input, process and output support. Input support involves influencing factors that are negatively correlated with DMC; process support involves interpreting a person’s preferences and carrying out intellectual processing; and output support involves enabling a person to communicate decisions to others.

Conclusion: Most forms of input and output support are promising, but ethical issues in relation to framing and interpersonal leverage must be addressed. Forms of process support that involve “outsourcing” decision-making capacities are ethically problematic.