Services and supports for people with ID are most effective when choices include input from the person who requires them. First, the FNP should determine whether or not Mr. Cruz has a guardian or if he receives support in making decisions from trusted allies. Many people with ID can make their own decisions. Even if someone with ID needs help making decisions, if trusted family members, friends, and providers are there to assist it may not be necessary to take legal rights away from an individual through the guardianship process. Supported decision-making is a recognized alternative to guardianship where people with disabilities use trusted friends, family members and professionals to help them understand situations and choices so that they may make their own decisions without needing a guardian1.
Individuals under guardianship may lose many rights, including the right to vote, the right to marry, and the right to make decisions on where and how to live. In fact, guardianship should only be considered when all of the people in the individual’s life agree that the person with ID is incapable of making informed decisions with appropriate guidance and information. Health care powers of attorney or appointing a representative payee or designated representative can offer less restrictive methods to provide assistance in decision making. Some states have limited guardianship which allows for the retention of some rights.
The Minnesota Board on Aging and the Volunteers of America’s Estate and Elder Law Services and the Center for Excellence in Supported Decision-Making offer a number of resources on supported decision making at https://www.voamnwi.org/center-excellence-supported-decision-making. This includes a series of videos from the Minnesota Department of Human Services: “What’s Your Favorite Right?” “Uncovering the History of Guardianship,” “Understanding the Benefits of Self-Determination,” “Meet Jenny Hatch,” “Justice for Jenny,” “Capacity to Make Decisions,” “From Theory into Practice: Special Education,” “From Theory into Practice: Medical and Financial Decisions,” “From Theory into Practice: Restoring Rights,” and “A Vision for Integration and Equal Rights.”
Additional Resources:
- Supported Decision Making and Health Care-help for people with disabilities to make decisions about their own health care. The National Disability Rights Network, April 2019. https://www.ndrn.org/resource/supported-decision-making-and-health-care/
- PRACTICAL Tool for Healthcare Providers: putting supported decision making in action for medical professionals. The South Carolina Supported Decision Making Project. https://www.aucd.org/docs/phe/supported-decision-making-manual-for-medical-professionals.pdf
References:
- Blanck, P., & Martinis, J. G. (2015). “The right to make choices”: The national resource center for supported decision-making. Inclusion, 3(1), 24-33. Retrieved from http://supportmydecision.org/assets/tools/Supported-Decision-Making-Overview.pdf.
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Additional Cases:
Case 1: Mr. Herman Cruz, a 57 year old man who has diabetes and is obese, visiting a new primary care provider
Case 2: Ms. Terry Schaeffer, a 35 year old woman, on a visit with a new primary care provider.
Case 3: Mr. James Foster, a 22 year old man visiting the emergency department because of a severe cough
Case 4: Ms. Grace Tester, a 63 year old woman with dementia and breast cancer.