What if you have difficulty making decisions?

We all make decisions in life—like where we live, how we spend money, and our healthcare. Sometimes, an accident, disability, illness, or older age can make it harder for you to make decisions.

If you or someone close to you is worried about your ability to make decisions, you can ask for an assessment. The assessment will help you to find out what support you may need.

Signs you might need support with decision-making

What is decision-making ability?

To have decision-making ability (capacity in a legal context), you must be able to:

1. understand the decision you're making: know what the decision is about, the options you have, and what could happen with each choice
2. make the decision freely: decide without pressure from others, including family, friends, professionals or carers
3. communicate your decision: share your decision by speaking, writing, using sign language, an interpreter, a symbol board, or other methods.

If you can’t do all three of these things, you may need someone to support you to make some or all of your decisions.

What can affect your ability to make decisions?

Your ability to make decisions can depend on:

• the type of decision: you might have the ability to make simple decisions (like what to eat) but find complex ones harder (like selling a house)
• timing: your ability may change over time or during illness
• support: with the right help, you may still be able to make decisions.

Why is decision-making ability important?

If you can make your own decisions, you have the legal right to make decisions about your life, such as:

• where you live
• how you spend your money
• your health care and support services.

If you don’t have the ability to make some or all of your decisions, this is called impaired decision-making ability (or impaired decision-making capacity in a legal context).

For help with bigger decisions like moving into an aged care facility or selling a house, you may need a more formal arrangement where a substitute decision-maker is legally appointed for you.

What causes impaired decision-making ability?

Impaired decision-making ability can be caused by:

• dementia or other degenerative conditions
• psychiatric disabilities or mental illness (e.g., schizophrenia)
• intellectual disabilities
• acquired brain injuries or cognitive disabilities
• medical treatments (e.g., induced coma)
• drugs or alcohol
• any other condition that affects your ability to make decisions.

How do I know if I’m having trouble making decisions?

If you or someone close to you notices any of these signs, you may need extra help:

• sudden changes in mood or behaviour (such as depression, aggression, mood swings, or paranoia)
• trouble finding words or changes in the way you speak or write
• forgetting where you are or where you have put things
• making choices that are unusual or out of character
• forgetting important information, especially in the short term
• difficulty focusing or paying attention
• losing things often or getting lost
• being taken advantage of by others.

What support is available?

How can I get my decision-making ability checked?

If you or someone close to you is worried about your ability to make decisions, you can have an assessment done by:

• your GP (doctor)
• a geriatrician (specialist in older people’s health)
• a psychiatrist (specialist in mental health)
• a psychologist
• a lawyer.

The assessment will focus on the decision you need to make at that time.

What are the Capacity Assessment Guidelines in Queensland?

Queensland uses the Capacity Assessment Guidelines to help professionals assess decision-making ability.

They include:

• General Test of Capacity – for personal, health, or financial decisions.
• Test for Enduring Documents – for making or cancelling an Enduring Power of Attorney (EPOA) or Advance Health Directive (AHD).

What if someone questions my ability to make decisions?

In Queensland, the law says everyone is presumed to have decision-making ability unless there is proof otherwise:

• if someone challenges your ability, they must prove it with an assessment
• assessments are opinions and they can be reviewed or challenged.

Only the Queensland Civil and Administrative Tribunal (QCAT) or the Supreme Court can make a formal decision about your ability to make decisions.

What does a legal assessment mean?

A capacity assessment is a professional opinion:

• it’s not a final legal decision
• you can ask for the results to be reviewed or challenged
• only QCAT or the Supreme Court can make a formal legal finding about someone’s decision-making ability
• if you or a person concerned about you is unsure about your ability to make decisions, you can get legal advice.

What happens if the assessment says I need help?

If you need help making decisions, there are a few different ways to get support. The most appropriate support option for you may depend on your circumstances.

Can I make my own decisions with support?

Yes. You can get help from someone you trust, such as a family member, friend, or professional to make your own decisions. This is an informal arrangement that respects your right to decide, and you stay in control. This is called supported decision-making.

Queensland law says you can’t be treated as having impaired decision-making ability until all reasonable steps have been taken to give you the support and the information you need.

Can someone I trust make decisions for me without being formally appointed?

Yes, a trusted person such as a family member or friend can step in to make decisions for you if a supported decision-making approach isn't suited to your circumstances. This is an informal arrangement, and they don’t need legal paperwork or formal authority to do so. These people are called informal decision-makers.

Can I have someone formally appointed to make decisions for me?

If you can’t make a decision with support and you don't have an informal decision-making arrangement in place, someone may need to be formally appointed to make decisions for you.

This is called a substitute decision-maker.

A substitute decision-maker can be:

• Attorney: you can choose someone in advance. This is called appointing an attorney under an Enduring Power of Attorney (EPOA) or Advance Health Directive (AHD)
• Guardian or Administrator:  formally appointed by the Queensland Civil and Administrative Tribunal (QCAT). They can formally appoint a Guardian to make personal and health decisions, or an Administrator to make financial decisions
• Statutory Health Attorney (SHA): who automatically has the authority to make healthcare decisions for you. The law allows a SHA (such as a family member, friend or carer) to make healthcare decisions for you.