The focus is always on what the person wants

What a person wants includes their will and preferences.

• Will: Long-term goals and what the person values in life. Some examples might be wanting to be independent, stay healthy, or stay connected to family.
• Preferences: What a person likes right now. Everyone has preferences. People communicate their preferences in different ways such as words, expressions, or gestures.

Sometimes, preferences and will don’t match. For example, we might prefer to skip our exercise and stay in bed, but we also want to be healthy. It can be hard to decide on our own when we have to balance short-term and long-term wants.

Sasi’s story

Sasi needs to decide whether to have an operation on her leg.

The operation will help Sasi's goal to live independently. (Sasi's will)

Sasi doesn’t like the hospital because it might be scary. (Sasi's preferences)

Sasi's decision-supporter helps Sasi

• • Visit the hospital and talk with staff
  • Understand what will happen if she has the operation.
  • Talk about her options

Sasi finds out that she can have a support person with her in the hospital. This information makes Sasi feel happier about the option of having the operation. She decides to go ahead.

Sometimes, people can't easily say what they want and what is important to them. Supporters need to:

• Listen carefully
• Watch how the person acts
• Notice small signs.

The supporters may need to interpret what the person wants.

Wiri’s story

Wiri has a learning disability. He doesn’t use many words. 

Wiri loves visiting Aroha. Wiri and Aroha live in group homes next door to each other. Wiri’s face lights up when he sees Aroha. 

Wiri’s parents suggest he shift to a new home close to them. Wiri shows he's upset:

• • Rocking
  • Flapping his hands
  • Not wanting to go to usual activities
  • Wanting to see Aroha.

His supporters understand that Wiri wants to stay close to Aroha.

Supported decision-making is always led by what the person wants, no matter how much support they need. A person shouldn’t be left out of decision-making because they have trouble saying what they want.

The supporter tries to understand what the person wants. Usually, the decision can be based on what the decision-maker says or does. Even if that’s not an option, the supporter bases the decision on what they believe the person wants. This is called a principled approach.

Sometimes, people can set what they want to happen if they become unwell in the future. This can help supporters to understand the person’s will and preferences.

This can include

• Our wishes for treatment and care, especially at the end of life. An Advance Care Plan sets out our wishes generally. A Shared Goals of Care conversation sets out our wishes when we are receiving care.
• Our wishes for who we would like to step up when needed for decisions by setting up an Enduring Power of Attorney.
• Our wishes for treatment when mentally distressed in a Mental Health Advance Preferences Statement.

Courtney's story

Courtney experienced times of mental distress over many years. Sometimes, she was admitted to the inpatient mental health unit. Courtney made a Mental Health Advance Preferences Statement with the support of her whanau, community mental health team, and psychiatrist. 

Courtney stated that if she was admitted, she wanted to be promptly given a medicine to help her rest. Courtney had been given this medication before. She found it helped her recovery. 

Courtney felt better. She knew that she would receive the care and treatment that worked best for her. She knew that her wishes would be listened to. 

Find out more about the principled approach to decision-making

• A research report: external Researchers from Queens College Belfast asked how people have or have not been, supported to make their own decisions.

• An Australian Royal Commission report: external This report explains the idea of a principled approach to decision-making. The Commission provides an easy-read summary of the report.

Find out more about planning for the future.

• Advance Care Plans external
• Shared Goals of Care conversations external
• Enduring Power of Attorney external
• Mental Health Advance Preferences Statement external