JCPSLP Vol 21 No 1 2019

decision-making practice. Communication and interaction is increasingly being recognised as central to supported decision-making processes, particularly for people with severe intellectual or cognitive disability (Watson, 2016a; Watson, Wilson, & Hagiliassis, 2017). Considering their clear expertise and knowledge of human interaction and communication, there can be little argument that the facilitation of supported decision-making processes fall easily into the scope of practice for speech-language pathologists. However, there is a dearth of empirical research available to guide practitioners in this area. Much of the research that does exist is not focused on enhancing legal capacity through supported decision-making, but rather on the speech-language pathologists’ role in determining decision-making competence (and therefore legal capacity) (Ferguson, Duffield, & Worrall, 2010; McCormick, Bose, & Marinis, 2017; Suleman & Hopper, 2016). As previously discussed, proponents of universal legal capacity are of the view that such assessments are not in the spirit of the convention. This characterisation of supported decision-making clearly acknowledges the crucial role of communicative responsiveness within a supporters’ role, highlighting the importance of a speech-language pathologists clinical input in this emerging area of practice. Watson’s research not only characterises the role of supporters within supported decision-making, but identifies a range of communication and interactional factors that underpin the success of the process. A discussion of these factors is beyond the scope of this paper: however, they have been reported elsewhere (Watson, 2016a, b; Watson et al., 2017). Conclusion In a time when most people, including many with disability, are discovering and celebrating freedom and self- determination like never before, people with the most severe intellectual or cognitive disability are not necessarily enjoying these same entitlements (Watson, 2016a; Wehmeyer, 2005). There is little doubt that challenges in terms of their ability to lead self-determined lives are closely related to their difficulties with communication (Johnson, Watson, Iacono, Bloomberg, & West, 2012; Watson et al., 2017; Wehmeyer, 2005; Zuscak, Peisah, & Ferguson, 2016). The UNCRPD (2008), specifically Article 12, has instigated a paradigm shift in the way people with intellectual and cognitive disability are viewed in terms of their self-determination. However, despite the legislative strength of this paradigm shift, many people with severe intellectual and cognitive disability routinely have their human right to legal capacity and personhood removed via guardianship. Supported decision-making is emerging as a viable alternative to guardianship for many people with cognitive disability; however, there remains a lack of focus on the practice for people with the most severe intellectual or cognitive disability. Speech-language pathologists have specialised skills and knowledge in communication and human interaction, both central elements of supported decision-making practice, making them ideally placed to facilitate practice in this area. With Australia being a signatory nation to the UNCRPD, Australian speech- language pathologists have a clear obligation to contribute their unique skills in promoting legal capacity and personhood for those they service through supported decision-making.

all the time and that this communication will include preferences. Preferences can be built up into expressions of choice and these into formal decisions. From this perspective, where someone lands on a continuum of capacity is not half as important as the amount and type of support they get to build preferences into choices. Supported decision-making is a system that recognises that a person’s ability to make decisions does not rest on their individual cognitive capability but on the quality of support available to help them to make decisions. In response to Article 12 of the convention, supported decision-making has emerged as an alternative paradigm to be employed in lieu of substitute decision-making in many parts of the world. It is being heralded as the vehicle by which many people who would otherwise be denied their legal capacity and personhood may be able to live autonomous lives that reflect their will and preference (Arstein-Kerslake, Watson, Browning, Martinis, & Blanck, 2017; Watson, 2016b). In so doing, supported decision- making refrains from basing definitions of legal personhood and legal capacity on a person’s cognitive ability. Watson’s (2016a) action research study analysing supported decision-making practice for people with severe or profound intellectual disability provides a detailed characterisation of supported decision-making. This description of supported decision-making is heavily focused on communication. Rather than placing emphasis on individual communicative capability, it highlights the collaborative nature of communication. Supported decision-making for people with severe to profound intellectual disability is an interdependent and complex process shared between people with severe to profound intellectual disability and their supporters. Within this dynamic, both parties contribute differently. The person faced with the decision contributes by expressing their will and preference through a range of means, including facial expression, body language, gesture, physiological reactions, and sometimes behaviours of concern. Supporters’ contribution to the process is to respond to these expressions of will and preference, by acknowledging, interpreting and acting on these expressions. Within this process, it is a supporters’ role of responding that is amenable to change and therefore, the onus of enhancing decision-making capability (therefore legal capacity) should not rest with the person with the disability, but with those who support them. Supporters’ role of responding to a person’s expression of will and preference needs to be acknowledged (i.e., noticed and not ignored), then interpreted, and finally acted upon. By attending to all three of these tasks, supporters of people with severe to profound intellectual disability can effectively support their decision-making (Watson, 2016a). The role of speech-language pathology in supported decision- making practice Considering Australia’s clear obligation as a signatory nation to the UNCRPD to move from models of substituted decision-making to supported decision-making, there is a practical need to understand how the communication expertise of speech-language pathologists can be mined to support legal capacity and personhood through supported

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JCPSLP Volume 21, Number 1 2019

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