Abstract

This article argues that supported decision making is ideal for people with dynamic cognitive and functional impairments that place them at the margins of autonomy. First, we argue that guardianship and similar surrogate decision-making frameworks may be inappropriate for people with dynamic impairments. Second, we provide a conceptual foundation for supported decision making for individuals with dynamic impairments, which integrates the social model of disability with relational accounts of autonomy. Third, we propose a three-step model that specifies the necessary conditions of supported decision making: identifying domains for support; identifying kinds of supports; and reaching a mutually acceptable and formal agreement. Finally, we identify a series of challenges for supported decision making, provide preliminary responses, and highlight avenues for future bioethics research.

摘要

本文认为，支持决策对于那些处于自主边缘的动态认知和功能障碍的人来说是理想的选择。首先，我们认为监护权和类似的代理决策框架可能不适合有动态障碍的人。其次，我们为动态障碍个体的支持性决策提供了概念基础，它将残疾的社会模型与自主性的关系描述相结合。第三，我们提出了一个三步模型，指定了支持决策的必要条件：确定支持领域；识别支持的种类；并达成双方都能接受的正式协议。最后，我们确定了支持决策的一系列挑战，提供了初步应对措施，并强调了未来生物伦理学研究的途径。