Who are the decision makers?

The “Decision Maker” will vary according to an individual’s circumstances and the decision that needs to be made.

A decision maker is the person who makes a decision for, or carries out an act on behalf of a person who lacks capacity at the time the act or decision has to be made. It is the decision maker’s responsibility to work out what would be in the best interests of the person who lacks capacity to make a decision.

Examples of decision makers:

• Health staff will be decision makers for matters relating to medical and other treatment such as dentistry, physiotherapy, the prescription of medication, surgeon or consultants who carry out medical procedures.
• Social workers will be decision makers regarding making plans for welfare and financial matters or  where to live, the need for support services, management of risk.

Key considerations for decision makers:

• What about environment?
  Find the best possible circumstances for the person to be interviewed or assessed.
• Is there a particular time of day when the adult is more capable than other times?
  Medication or illness may affect this. Does this decision have to be made now? If not, how long can it wait?
• Unfamiliarity/lack of relationship with decision maker
  Can you identify someone known to the person who may help put the person at ease?
• The impact of environmental factors
  Distractions, the presence of certain people, unfamiliar surroundings, environments where a person doesn’t feel safe.
• Remember complex matters may in fact involve several decisions
  Can these be broken into component parts? The adult may have capacity to make decisions on some elements of a multiple decision but not others.
• Language & communication
  Who has skills/knowledge to convey information to the person in a way that is understandable? Can they understand what the adult might be trying to communicate?
• Decision Makers need to involve family/friends/advocates
  As well as considering the use of other professionals with expertise /knowledge of the person or the condition that affects their communication abilities.
• Don’t put pressure on the person when capacity is lowest
  Can the information be broken down into smaller pieces? Can the information be given in the format most appropriate for the relevant person?
• Don’t rush
  Is it really necessary that the decision is made at this particular time? How long can the decision be delayed?

This page was last updated on 4 October 2009