Supported Decision-Making Service

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Supported Decision-Making Service for Persons with Disabilities | Service Model
The Human Rights Center for People with Disabilitis
(3) End-of-life issues: one of the most important issues preoccupying senior citizens is the
end-of-life issue: how to die; where to die; in what manner to die; the scope and type
of medical treatment to receive before death; burial arrangements; and more. Specific
issues may arise regarding the role of the decision-making supporter in providing
assistance for the realization of the person's wills and preferences regarding the end of
their life (for instance, by not taking drugs). These issues in their entirety are neither
included nor discussed under "Health Issues" in Bizchut's model, and taking into
consideration the provisions of the Dying Patient's Law, 5766-2005, the issue becomes
even more complex.
(4) Issues of support and inter-generational money transfer: another issue of crucial
importance for senior citizens concerns economic inter-generational transfer. Senior
citizens choose, to whatever degree, to support their family members, children
and grandchildren. The support is provided in different ways, including by diverse
monetary and property transfers. Here too, these issues are not sufficiently discussed in
the "Financial Issues" section.
(5) Issues of training and exposure to the array of services and rights of senior citizens:
the section which discusses supporter training should provide specific information
regarding the practical and daily challenges faced by the population of senior citizens
(which is different from that of the population of persons with disabilities). There
is room to equip supporters with specific knowledge regarding the diverse array of
services, support systems and knowledge available to this population.
(6) The issue of support in the preparation of additional alternatives to guardianship:
one of the features of the need for guardianship for senior citizens is that it usually
involves a continuing and progressive process which entails changing, declining
abilities, and requires increasing levels of support to the point in which the support
model may not adequately provide a solution to the formal legal needs. For instance,
in states of advanced stage dementia, cognitive or mental decline may reach a state
in which even the highest level of support will not enable a person to make decisions
that express and reflect their preferences at that specific point in time. To avoid the
need to "move" to the level of guardianship at that stage, it is advisable that at the time
supported decision-making is obtained, at the person's choice and in a proactive and
planned manner, the person be presented with the additional legal planning options
(such as preparing powers of attorney and/or advance medical instructions), as a tool
which would obviate the need for guardianship if and to the extent the support model
does not enable decision-making.
(7) The legal status of decision-making supporters: for diverse reasons, different service
providers in the area of gerontology are reluctant to respect the status and role played
by decision-making supporters of senior citizens – particularly when the decision runs
contrary to their position. The above pertains mainly to professionals who are of the
opinion that the decision of the senior citizen is erroneous (namely, is contrary to their
recommendation), and that it is "influenced" by their supporters (family members).
Precisely to prevent circumstances in which decision-making supporters of senior
citizens are excluded, and to prevent the redundant use by professionals of the argument
that "guardianship is necessary" – it seems that entrenching the status of decision-
making supporters on a statutory level is justified.