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- Title
Contention of Two Perspectives About Substitute Decision Maker (SDM) - SDM versus Clients Working with SDM.
- Authors
Law, Samuel; Shao Hua Lu; Shinsuke Kondo; Takashi Inoue
- Abstract
The United Nations' Convention on the Rights of Persons with Disabilities (CRPD) is a major achievement in promoting the rights of those with disabilities. Launched in 2008, there are 164 signatories and 186 parties as of 2023, including most countries in the Pacific Rim (e.g., Canada, Japan, but not the USA). For people with serious mental illness (SMI), implementation of the CRPD has been more controversial, as Article 12 of the CRPD promotes a rightsbased approach in treatment decision-making, and the Committee overseeing the implementation of the CRPD and other advocacy groups have mandated the abolishment of current capacity-based practices. Symposium presentation and discussion on a specific example of the CRPD proposed replacement of the substitute decision-maker (SDM) model for a person who is found incapable of treatment decision, with supported decision making. Using two Pacific Rim perspectives, we will 1) introduce the concept and controversy related to the CRPD, provide data on two Canadian perspectives (family and patient) on SDM; 2) overview the current Canadian Mental Health Act in terms of level of compatibility with the CRPD; 3) review the current state of SDM practices in Japan and challenges to meet the CRPD mandate; and 4) contrast current practices in medical decision making in children and youth in Canada and Japan in the context of CRPD. While the principles of the CRPD are inspirational, there are active concerns that people with SMI often may not have the insight and judgement to make the best treatment decisions even with supported decision-making, often rejecting timely and necessary treatment, placing them in a further vulnerable state if without treatment. We aim to increase awareness and familiarity of the CRPD and discuss with the diverse attendants to generate possible ideas that may reconcile and bridge the described controversies.
- Subjects
PACIFIC Area; JAPAN; CONVENTION on the Rights of Persons with Disabilities; DISABILITY laws; DECISION making in children; PEOPLE with mental illness
- Publication
Malaysian Journal of Medicine & Health Sciences, 2023, Vol 19, p9
- ISSN
1675-8544
- Publication type
Article