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Providing all practicable supports to enable a person to participate in decision-making is one of the five key principles of the English and Welsh Mental Capacity Act 2005. This article (set in the Canadian legal framework, which has many similarities to our own) provides a detailed description of strategies to support a person with aphasia to access the language around decision-making. The authors emphasise that people with aphasia do not necessarily have difficulties in the internal processes required to make a decision, but may not be able to access the language to understand or express a decision or demonstrate the components of weighing up and retention as part of a functional test. The list of strategies to support participation in decision-making for people with aphasia includes pausing before and after important information is given, repeating and rephrasing said information, providing written key words and drawings/diagrams, giving time, and using yes/no questions to enable a person to respond. The authors provide two examples where not following this due process has resulted in an ethical violation of the rights of people with disabilities. Speech and language therapists are often best placed to support a person with aphasia and the professionals around them to ensure a person’s rights and our clinical ethics are maintained.

Assumptions about Decision-Making Capacity and Aphasia: Ethical Implications and Impact.
Kagan A, Shumway E, MacDonald S.
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Anna Volkmer

UCL, London, UK.

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