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Support for decision-making guidance in England: a pragmatic review
Jillian Craigie1, Antonia Alley2, Maria Teresa Cotrufo1
1Centre of Medical Law and Ethics, Dickson Poon School of Law, King's College London, London, WC2R 2LS, United Kingdom.
Medical Law Review
|July 31, 2025
Summary
Support for decision making (SFDM) law in England and Wales, under the Mental Capacity Act 2005, diverges from international standards like the UN Convention on the Rights of Persons with Disabilities. Guidance needs to be more multifaceted to address practical implementation challenges.
Area of Science:
- Law and social sciences
- Disability studies
- Healthcare policy
Background:
- Legal frameworks increasingly support autonomy for adults with limited decision-making capacity.
- Support for Decision Making (SFDM) is legislated in England and Wales via the Mental Capacity Act 2005 (MCA).
- International recognition of SFDM is growing through the UN Convention on the Rights of Persons with Disabilities (CRPD).
Purpose of the Study:
- To analyze the conceptualization and implementation of SFDM in England.
- To identify gaps and needs in current SFDM guidance.
- To explore the divergence between domestic (MCA) and international (CRPD) approaches to SFDM.
Main Methods:
- A pragmatic review methodology was employed.
- Analysis of 40 resources containing SFDM guidance.
- Examination of legal and policy documents related to SFDM.
Main Results:
- Current SFDM guidance in England primarily conceptualizes it as a means to enable mental capacity.
- A divergence exists between the MCA's understanding of SFDM and a CRPD-aligned approach, which includes substituted decision-making.
- Identified needs for more multifaceted guidance addressing decision nature, difficulty sources, and supporter relationships, alongside gaps for specific contexts and stakeholders.
Conclusions:
- There is a need for authoritative, comprehensive SFDM guidance in England.
- The dualistic model of SFDM, arising from differing legal interpretations, presents practical challenges.
- Further research is required to reconcile domestic and international approaches to SFDM.
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