If you have difficulty making decisions

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

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

What decision-making ability means

Decision-making ability (called capacity in a legal context) means you can:

• understand the decision – know what the decision is about, the options you have and what could happen with each choice
• make the decision freely – decide without pressure or influence from others, including family, friends, professionals or carers
• communicate your decision – share your decision by speaking, writing, using sign language, an interpreter, a symbol board or another method.

If you cannot do all three of these things, you may need support to make some or all of your decisions.

Your ability to make decisions can depend on:

• the type of decision – simple decisions may be easier than complex ones
• timing – your ability may change over time or during illness
• support – with the right help and information, you may still be able to make your own decisions.

Signs you may need support

Signs that you may need help making decisions include:

• 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.

These signs do not always mean your decision-making ability is impaired, but they may suggest that getting support or an assessment could be helpful.

What can affect decision-making ability

Impaired decision-making ability can be caused by conditions that affect how the brain works, including:

• dementia or other degenerative conditions
• psychiatric disability or mental illness (for example, schizophrenia)
• intellectual disability
• acquired brain injury or cognitive disability
• medical treatments such as an induced coma
• drugs or alcohol
• other conditions that affect your ability to make decisions.

Getting your decision-making ability assessed

If you are concerned about your ability to make decisions, you can ask for an assessment.

Assessments can be done by a:

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

The assessment focuses on the specific decision that needs to be made at the time.

In Queensland, professionals use the Capacity Assessment Guidelines, which include:

• the general test of capacity for personal, health or financial decisions
• the test for enduring documents, used when making or cancelling an Enduring Power of Attorney (EPOA) or Advance Health Directive (AHD).

If someone questions your decision-making ability

Queensland law says that every adult is presumed to have decision-making ability unless there is evidence to show otherwise.

This means:

• a person who challenges your ability must provide evidence through an assessment
• assessments are professional opinions and can be reviewed or challenged.

Only the Queensland Civil and Administrative Tribunal (QCAT) or the Supreme Court can make a formal legal decision about a person’s decision-making ability.

Support if you need help making decisions

If you need help making decisions, there are several ways you can receive support.

Supported decision-making

You may be able to make your own decisions with help from someone you trust, such as a family member, friend or professional.

This is called supported decision-making. It allows you to stay in control and make your own choices, with help from others when needed. Making decisions in this way should always be the first option before considering other alternatives.

Queensland law says a person cannot be treated as having impaired decision-making ability until all reasonable steps have been taken to provide the support and information they need.

Informal decision-makers

Sometimes a trusted person, such as a family member or friend, may step in to make decisions for you without a formal appointment.

These arrangements are informal and do not require legal paperwork.

Substitute decision-makers

If you cannot make decisions even with support and you do not have an informal 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 – someone you appoint under an Enduring Power of Attorney (EPOA) or Advance Health Directive (AHD)
• Guardian or Administrator – 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) – someone who automatically has authority under law to make health care decisions for you.