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    Guide for healthcare professionals and disability service providers

    Access practical guidance, explore key legislation, and find valuable resources to help you prioritise supported decision-making as a rights-based alternative to substitute decision-making in your professional practice.

    Supported decision-making

    Supported decision-making is a person-centred approach that ensures every adult, including those with impaired decision-making abilities, has the right to make their own decisions with appropriate support. Unlike substitute decision-making, which involves making decisions on behalf of someone, supported decision-making empowers individuals to:

    • understand their options
    • consider their choices
    • express their decisions.

    Why supported decision-making matters

    Supported decision-making is a rights-based approach embedded in Queensland and Australian legislation, which upholds the rights and self-determination of individuals including those with impaired decision-making abilities.

    Key legislative frameworks include:

    • Human Rights Act 2019 (QLD): Protects the right to equality and self-determination.
    • Guardianship and Administration Act 2000 and Powers of Attorney Act 1998: Provides frameworks for supported and substitute decision-making.
    • NDIS, Aged Care Act 1997, and Advance Care Planning: Together with Australia’s commitment to the UN Convention on the Rights of Persons with Disabilities (UNCRPD) these establish the legal foundation for supported decision-making.
    • Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability: Highlights the importance of empowering people with disability to make their own decisions and ensuring their rights and dignity are upheld in all aspects of life.

    These laws and legal frameworks require professionals to prioritise supported decision-making before considering substitute decision-making, to ensure that individuals’ rights, values, and preferences are respected.

    Supported decision-maker versus substitute decision-maker

    The role of the supported decision-maker is not to make decisions for someone with impaired capacity, but to assist them in understanding information, exploring options and expressing their choices. The supporter provides tailored support that respects the individual’s autonomy and promotes their right to self-determination.

    A substitute decision-maker is legally appointed to make decisions on behalf of a person who is unable to make decisions independently. Their role is to act in the individual’s best interests while also taking into account any known wishes or preferences the person may have previously expressed.

    Core Principles

    Health and disability support professionals can adopt the following principles to support individuals in making their own decisions:

    • Capacity must be assumed: Always assume individuals can make decisions and focus on empowering them to make informed choices.
    • Support don’t substitute: Guide them to understand their options, consider their choices, and express their decisions —don’t decide for them.
    • Focus on their values: Centre the decision-making process on what matters most to them — their values, preferences, and wishes.
    • Balance dignity with safety: Help them understand risks and consequences but respecting their right to make their own choices. A risky decision is not necessarily a wrong decision.
    • Be flexible: Adapt your support to the patient’s unique needs and the health care decision they are making.
    • Involve support networks: Recognise and include trusted family members, friends, or carers in the decision-making process.

    A 7-step approach to supported decision-making

    Health and disability support professionals can use a 7-step process to help individuals with impaired capacity in making their own decisions about their healthcare, medical treatments or other important matters.

    Step 1: Understand the person

    Take time to understand the person’s values, priorities, and preferences for communication and support.

    • Ask questions like:
      • What matters most to you when it comes to your health or care?
      • How do you prefer to communicate about your needs?
      • Who do you trust to be involved in this decision?

    Step 2: Recognise

    Recognise the individual’s capacity to make decisions and identify any barriers they may face.

    • Assume the person has capacity unless proven otherwise.
    • Identify if they need support, such as interpreters, cultural liaisons, or communication aids.

    Step 3: Identify the decision

    Be clear about the decision that needs to be made and why it matters.

    • Clearly explain the decision and its implications.
    • Ask questions to clarify their understanding, such as:
      • How do you feel about this decision?
      • What happens if no decision is made?

    Step 4: Communicate clearly

    Present information and treatment options in a way that works best for the individual.

    • Use tools like Easy English, visuals, symbols, or repetition.
    • Offer to involve a trusted support person or cultural liaison if needed.
    • Give the person time to process the information and ask questions.

    Step 5: Explore options

    Help the person consider the pros and cons of each option and how each option aligns with their goals and preferences.

    • Ask questions like:
      • Which option feels right to you?
      • Would you like me to explain anything again or in a simpler way?

    Step 6: Support and act

    Assist with practical steps to implement the decision to ensure the patient feels supported throughout the process.

    • Help with tasks such as organising appointments, arranging transport, or booking follow-ups.
    • Ask:
      • Is there anything else I can do to make this easier for you?
      • Do you need help setting things up?

    Step 7: Review and adjust

    Follow up to ensure the decision meets the patient’s needs and adjust if necessary.

    • Check in with the person to see how they feel about the decision and its outcomes.
    • Be prepared to revisit the decision if circumstances or preferences change.

    For practical guidance, our  8-step supported decision-making checklists (PDF, 884.4 KB) provide advice for decisions about living arrangements, healthcare, aged care or NDIS matters.

    Other considerations

    • Cultural sensitivity: Involve cultural liaisons or interpreters as needed, such as a First Nations Liaison Officer, to ensure culturally appropriate support.
    • Empowerment: Focus on enabling individuals to make their own decisions rather than substituting their judgment.
    • Flexibility: Tailor your approach to the person’s unique needs, communication style, and decision-making process.

    Resources to help you get started

    Use our resources to support individuals with impaired capacity to make decisions about healthcare their, medical treatments or other important matters.

    Webinar recordings

    Resources for family families, friends and carers

    Last updated: 23 June 2026