Supported Decision-Making

Key concerns and policy questions for families in Nova Scotia

What is Supported Decision-Making?

• Supported Decision Making allows adults with reduced capacity to make their own choices with help from trusted supporters.
• It’s mostly been applied in narrow cases (e.g., intellectual disabilities where some decision-making ability exists).
• Each situation is unique; applying Supported Decision Making broadly without safeguards risks harm.

Government Initiative in Nova Scotia

• The province is exploring how to implement Supported Decision Making, but the process is unclear and not transparent, and does not allow the time required for those potentially impacted to have their say in an informed way.
• Engagement sessions are being run by Research Power Inc., with reports going only to the government, not the public.
• The discussion paper frames Supported Decision-Making as helping adults make decisions with support, but it could affect many laws beyond the Adult Capacity and Decision-Making Act — including the Hospitals Act, Involuntary Psychiatric Treatment Act, Personal Directives Act, Personal Health Information Act, and many more.

Where Supported Decision Making Works Well

• Healthcare decisions where information needs to be simplified.
• Financial management for everyday spending.
• Education, employment, housing, and daily life choices where values can be expressed.

Where Supported Decision Making Does Not Work Well

• Severe cognitive impairment with no communication.
• Acute medical emergencies.
• Situations where there is a risk of serious harm, or coercion.
• Complex legal and financial transactions requiring full capacity.

Concerns for Serious Mental Illness

• Many experience anosognosia (lack of insight). Supported Decision Making assumes insight that may not exist.
• Risks include suicide, violence, neglect, and delayed treatment.
• There is weak evidence that Supported Decision Making improves outcomes in severe illness.
• There is vulnerability to exploitation if unsafe supporters are chosen.
• Clinicians face liability if unable to intervene.

International Context – UN CRPD

• The Committee on the UN Convention on the Rights of Persons with Disabilities (CRPD) recognizes equal legal capacity and calls for Supported Decision Making in all situations.
• Canada ratified the treaty with a reservation (Article 12), allowing substitute decision-making to remain.
• The UN CRPD Committee opposes substitute decision-making, despite the fact that Canada’s reservation (Article 12) protects current Substitute Decision Making laws.

Bottom Line

• Families and clinicians support autonomy, but abolishing substitute decision-making and involuntary treatment is unsafe, unrealistic, and unsupported by evidence.
• Policy must balance autonomy with safety, clinical realities, and family involvement.

Policy Ask

• Transparent consultation with families, clinicians, and advocacy groups.
• Retention of substitute decision-making as a safeguard.
• Evidence-based reforms with proper resources.
• Strong protections against coercion and exploitation.

Closing Message

This is a pivotal moment. Expanding Supported Decision Making without safeguards risks sidelining families, exposing vulnerable people to harm, and leaving clinicians at risk. We must advocate for a balanced, humane, evidence-informed approach that respects autonomy while protecting safety and dignity.

The current “engagement process” is unclear and not transparent, and does not allow the time required for those potentially impacted to be included and to be able to provide informed and comprehensive responses.