PERSONAL DECISION-MAKING Making decisions, communicating decisions, or carrying out decisions
Observations and Notes
Options Ensuring supports and accommodations Supported decision-making
Ensuring supports and accommodations. Patients have the right to make informed decisions about their care, even if you don’t agree with those decisions. Be mindful of your obligations under the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, and Maryland laws barring discrimination on the basis of disability. If you are presented with signs that a patient appears to be struggling with the ability to receive, understand, or process information, screen for any supports and accommodations they may need. Those may alleviate or eliminate any concerns about their ability to make, communicate, or effectuate the relevant decision(s). Appendix A provides additional guidance. Supported decision-making (SDM). Supported decision-making is an arrangement in which an individual chooses a ‘supporter’ or a network of ‘supporters’ to help them make, communicate, or effectuate important life decisions. A supporter must be someone the individual chooses. It can be a family member, friend, or someone else the individual trusts.4 The individual also chooses how supporters will assist in their decision-making process. Supporters cannot make decisions for or on behalf of the individual; the ultimate power to make decisions is with the individual. Supporters may ask questions, give the individual advice, explain things in a way that they understand, or serve as an effective communication accommodation. While SDM can be used by anyone, it can serve as an important accommodation for people with disabilities and older adults. SDM arrangements can be informal or a formal written agreements. There is no required format for written agreements, but Disability Rights Maryland offers a template. If a patient has a written SDM agreement, include a copy in their medical records . Md. Code, Estates & Trusts Art., § 18-101 et seq.
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There are many ways an individual can use SDM. Examples of how SDM can be used in healthcare settings include having a supporter: • Be with the patient during appointments or any discussions about their care (as an accommodation) • Take notes for or help the patient come up with questions to ask the care team • Help to ensure the patient understands information and options • Advocate for extra time, breaks, or other accommodations to ensure the patient has a meaningful opportunity to digest information or make an informed decision • Help the patient in weighing the benefits and risks of any treatment or procedure • Assist the patient in communicating their decisions • Help the patient complete paperwork or access relevant records
ˆ A supporter cannot be a minor; someone the individual has a protective order, peace order, or other order prohibiting contact against; or someone who has been convicted of ÿnancial exploitation.
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