Autonomy and safeguards in people with impaired decision-making abilities

Abstract

In everyday life we all make choices and decisions with regard to ourselves and our environment. Such decisions may be quite trivial, for example which pair of trousers we should wear, or major, for example to move home. The freedom to make such decisions may be called the right to self-determination or autonomy. For adults, such a right is recognised by the law, either explicitly as in USA or more implicitly as here in the United Kingdom. Such a right is also partially acknowledged in children although if the child or young person is not capable of making a reasoned decision then the parent or guardian may make the decision on their behalf. Some adults through mental disability (mental illness, mental handicap) have a diminished ability to make reasoned decisions. However, it is important to recognise that in any given situation there should be an assessment of the person's ability to make a reasoned decision and assumptions not made for convenience's sake. Even people with substantial intellectual impairment are capable of making some decisions.