Supported Decision-Making Service

Supported Decision-Making Service for Persons with Disabilities | Service Model

The Human Rights Center for People with Disabilitis

logic. So, for instance, well known and recognized cognitive tests such as MMSE or MoCA are

vastly used as "proof" of senior citizens' incompetency in guardianship procedures. However, a

thorough examination of the nature of said cognitive tests reveals that these are, at most, initial

"screening" tests whose "score" is only an initial indication that a "problem" exists, but they

cannot in and of themselves determine the level of competency and functional and decision-

making abilities in different and diverse contexts. Indeed, there are cases in Israeli jurisprudence

in which senior citizens were "defined" as incompetent based on a low "score" in tests such

as MMSE; but when they underwent a thorough and comprehensive competence evaluation, it

became evident that they were still competent in many and diverse contexts, had comprehension

ability and the ability to make decisions independently. Therefore, it is acknowledged with good

reason that "competency evaluation" of senior citizens requires time and a multi-dimensional,

inter-disciplinary examination to gain a reliable picture in the field, and in most cases the picture

is complex, relative and not one-dimensional or unambiguous.

A.3.3. "Alzheimerism"

The importance of ageism (the social structuring of old age) has already been noted as an

explanation for the relative ease with which guardians are appointed for senior citizens and with

which their liberties and rights are revoked. Nevertheless, beyond the general stigma of old age, the

stigma and prejudice commonly held by the public at large and by professionals toward dementia

– in general, and Alzheimer's dementia, in particular (hereinafter: "Alzheimerism") should also be

emphasized in this context. The prevalent stigma in this context sweepingly attributes to persons

with dementia the inability to comprehend what happens around them and/or inability to exercise

"their self-determination" in the sense of making choices and decisions. Dementia is still regarded

as "senility", the absolute and total loss of self-identity and a need for a "responsible person" who

will "look after their best interests". A combination of empathy, pity and concern for the wellbeing

of the "poor elderly" clearly leads to the stigma and stereotypes underlying the lack of criticism

in which guardianship is applied to senior citizens.

A.4. Summary of the current situation and the opportunities following the amendment to

the law

There is no dispute that there are situations in which applying the guardianship "tool" to senior

citizens is not only appropriate but also required and necessary. For instance, in situations of

substantive loss of cognitive ability (for instance, in very advanced stages of Alzheimer's disease)

or where human rights are clearly at risk (for instance, in circumstances of severe abuse and

exploitation by family members on whom the senior citizen depends), it seems that there would be

justification to use it. However, as described above, in many cases the institution of guardianship

may be altogether avoided by using alternative planning tools, or may be used in a moderate,

tailored and much more proportionate manner which would maintain the rules of natural justice.

It is no coincidence that in recent years, senior citizens' rights organizations have increasingly

criticized the institution of guardianship and called for a comprehensive reform in the current law

in the area.

Following the criticisms described previously and the call for a statutory reform, indeed, a far-

reaching reform has recently been made in this area. At the time of writing, it is still unknown

whether and to what extent the reform will succeed to truly change reality, and what its full

consequences will be. It is also understood that significant change is a long process that requires