Assessing capacity of a person with developmental disability to make decisions

Capacity assessments for people with developmental disability usually relate to health care, but general practitioners may also be approached to facilitate decisions about activities, accommodation, who the person has contact with, service provision under the National Disability Insurance Scheme (NDIS) and financial or testamentary matters.

Whether or not a person with developmental disability is considered to have capacity will depend on the nature and timing of the decision. A person’s capacity for specific decisions can fluctuate and may improve with appropriate information and support.

Note: Health practitioners need to assess each person’s situation individually.

No universally accepted standard or tool exists for assessing capacity to make decisions about health care. Health practitioners need to assess each person’s situation individually. Considerations when assessing capacity for decision making in a person with developmental disability are outlined in Considerations when assessing capacity for decision making in a person with developmental disability.

Figure 1. Considerations when assessing capacity for decision making in a person with developmental disability

A person’s capacity can be expressed in terms of their ability to:

  • receive, comprehend, retain and recall relevant information
  • integrate the information received and relate it to their situation
  • evaluate benefits and harms in terms of personal values
  • select an option and give convincing reasons for the choice
  • communicate their choice to others
  • persevere with that choice, at least until the decision is acted upon.

For strategies to optimise communication, see Establishing successful communication with people with developmental disability and Reasonable adjustments.

Capacity assessment should take into account advice from multiple sources (eg carers, support people, other healthcare providers). Assessment of capacity by a practitioner who has not had a longitudinal relationship with a person can be unreliable. If there is uncertainty about a person’s capacity, referral to a neuropsychologist or other healthcare professional with experience in assessing the decision-making capacity of people with developmental disability is recommended.

Note: If there is uncertainty about a person’s capacity, refer to a neuropsychologist or other healthcare professional with experience in assessing the decision-making capacity of people with developmental disability.

Record key issues considered, others consulted and any assessments undertaken in the person’s medical history.

In most jurisdictions and circumstances, only a tribunal can declare an adult’s incapacity or otherwise to make a decision (with the practitioner’s advice as a key input); evidence requirements vary by state and territory.

It is important to be aware of family dynamics (including domestic and family violence) when a person with developmental disability presents as lacking decision-making capacity or the ability to provide their views and wishes when accompanied by another. For example, the power imbalance between a carer and person with developmental disability may be a factor. For advice, see carer and family dynamics.