The UN Challenge to Guardianship and Surrogate Decision-Making

In 2006, the United Nations issued the Convention on the Rights of Persons with Disabilities. The Convention, together with an accompanying commentary, urges governments to abandon laws authorizing guardianship and substitute decision-making for people with intellectual disabilities and to replace them with supportive decision-making laws that give all individuals the freedom to make choices reflecting their "will and preferences." Although critics point to ethical and legal problems with this approach, the Convention and commentary offer guidance to clinicians, ethicists, and others involved in evaluating medical decision-making. Whether or not it leads to formal legal action, the Convention rightly urges us to give people with cognitive impairments a greater role in decisions about their lives.