Supported Decisions as the Patient's Own?

Abstract

This brief commentary addresses what I regard as the thorniest challenge to supported decision making: how to determine if a supported decision really is the decision of the supported person, rather than an insidious form of concealed paternalism or conflicts of interest. The risk that apparent supported decision-making really becomes the decision of the supporter looms as capacities wane. Peterson, Karlawash and Largent (PK&L), who offer a defense of supported decision making in health care for people with dynamic and diminishing capacity, are alert to these problems but skirt their implications. The authors’ model for supported decisionmaking is incomplete; at a minimum, it should be supplemented by substantive guidance for supporters given by persons who anticipate diminishing capacity.

Note:
Funding Information: None to declare.

Declaration of Interests: None to declare.