Oral Presentation Australasian Association of Bioethics & Health Law and New Zealand Bioethics Conference

From substitute decision making to supported decision making in psychiatry (913)

Giles Newton-Howes 1 , Sarah Gordon 1
  1. University of Otago, Wellington, WELLINGTON, New Zealand

Recognizing the rights of all people to make their own decisions in health is an increasingly important cornerstone upon which western medicine is based.  For most people, most of the time this fundamental tenet of any healthcare interaction is unchallenged, in large part because decision making capacity is assumed. However, this is not always the case in psychiatric practice. Mental Health legislation can deny people the right to make their own decisions (even irrespective of decision-making capacity) and enable others to make decisions about an individual’s treatment that are then enforceable, compulsorily (substitute decision-making).

Since coming into force, the Committee of the Convention on the Rights of Persons with Disabilities (CRPD) has clarified the interpretation of the CRPD. This includes that substitute decision-making regimes are prohibited by the CRPD and that States parties’ are obliged to replace substitute decision-making regimes with supported decision-making regimes.  This is a radical step away from current psychiatric practice. Much of the response of academia has been critical of the Committee’s interpretation.  Recognising the need for change to occur at all levels, the University of Otago ‘World of Difference’ teaching and research team has implemented a programme* to support psychiatric trainees to identify personal and organisational strategies to reduce substitute decision-making and promote supported decision-making. Through the paper we will present progress made and barriers faced with implementing this significant shift in practice.  

* Funded through the Like Minds, Like Mine programme, which is led by the Health Promotion Agency.