Making our own choices is good for us:

Making our own choices is good for us, not only because of the obvious fact that if we have made our own choices we are more likely to get what we want, but also because it helps to increase our confidence and learn new skills. Supporting people to make personal choices is therefore an important part of supported self-care.

Whatever our age, personal circumstances or disabilities, we have the presumed right to make our own decisions, even if the choices we make might sometimes seem unwise to other people. However, we are also expected to take personal responsibility for the individual choices that we make.

Risk-taking is part of everyday life:

Very often our decisions and choices involve some element of risk. Our daily lives are full of hazards; things that have the potential to cause harm to either us or to others. The likelihood that this potential harm will actually occur is called the risk. The process of risk assessment identifies hazards associated with any given situation or set of circumstances, assesses the risk that harm might actually occur, and assesses the seriousness of the potential harm. Importantly, the process of risk assessment also puts plans and actions in place to reduce that risk.

Although we all usually want to make our own choices, sometimes we might need, and welcome, advice or support from other people to help us reach those decisions. We may also require help to carry out the actions arising from our decisions. Supporting individuals to make their own choices is an important part of supporting self-care. This includes encouraging people to make safer choices whenever possible, but also means accepting that a person might sometimes make what we consider to be unwise choices. Whatever we think of a person’s choices, our role is to evaluate and communicate the risks associated with them, and work with individuals, families and carers to reduce those risks as far as we possibly can. We should do things together with the person rather than for them, supporting their own choices even if we regard this as risky.

Understanding capacity to make decisions:

There can however be an exception to this right to make our own decisions. Somebody may have been judged, under the Mental Capacity Act, to lack capacity to be able to make the specific decision under consideration. In order to be judged to lack the capacity to make the decision, the person must have a disturbance or impairment of their mind or brain that affects their ability to understand, retain and process the information needed to make the decision.

The inability to communicate a decision should not be confused with a lack of capacity to make one. Importantly, capacity must be assessed for each decision that a person is required to make, and may vary depending upon the nature of the decision to be made. For example, a person with a brain impairment might be able to understand, retain and process the information necessary to make a simple decision, such as whether they would like to be taken for a walk in the garden or what they would like to eat or drink, but might not be able to do the same for the more complex information required to plan their own future care needs.

In the case of somebody who lacks the capacity to make a decision for themselves, there is a formal process to ensure that decisions made by others on their behalf are in the best interests of the individual concerned. Decisions taken in the best interests of somebody who lacks capacity must take what is known as the ‘least restrictive option’ in the management of their care. Sometimes a person who lacks mental capacity to make a decision, or give consent regarding their own treatment or care, can be deprived of their liberty for their own safety and wellbeing. In such cases, a process known as the ‘Deprivation of Liberty Safeguards’ is used to protect the best interests of the person who lacks capacity.

Further information

Mental Capacity Act

Self Care Training Manual Module 9: supporting people’s choices

Office of the Public Guardian: Making decisions…about your health, welfare or finances. Who decides when you can’t?

Age UK Deprivation of Liberty Safeguards Factsheet

Department of Health’s guidance: ‘Nothing Ventured,Nothing Gained: Risk Guidance for People with Dementia’

Self Care Training Manual Module 6: self care
- effective communication

Health & Safety Executive (HSE): Sensible risk assessment in care settings