Autonomy and Substitute Decision-Making with People with Intellectual Disabilities. Ethical Perspective

The text deals with the existing ethical tension between decision-making on behalf of people with intellectual disabilities and substitute decision-making, and the duty-bound respect for the person’s autonomy. The work begins by distinguishing decision- making on behalf of someone and substitute decision-making, consequently favoring the latter, as well as relating autonomy to interdependence. This first clarification leads to the construction of a basic and general criterion for substitute decision-making practice. The reflection continues analyzing three main issues implied in the criteria: the definition of the insuperable limitation of decision-making capacity, the content of substitute decision-making and the subjects who exercise decision-making. The selected methodology for this second part is mainly based on a conceptual definition aimed to enable practice. Specific criteria and orientation may be withdrawn from this analysis in order to practice substitute decision-making ethically, specifically considering the will of the person with intellectual disability.