Supported Decision-Making in the Japanese Context

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Abstract

In Japan, we face a seriously aging society. The population of older adults with dementia is sharply increasing as adults live longer. We thus need effective laws and policies to protect older adults with dementia from the risk of abuse. Respect for human rights and the right to self-determination in an aged society requires that older adults be presented with multiple options in making their choices. One such option is supported decision-making (SDM). SDM is a legal concept derived from a combination of the vulnerability approach and a rights-based approach. In Japan, SDM guidelines ensure that necessary measures are taken up by nursing home managers, social workers, and adult guardians when dealing with adults with disabilities and/or dementia, without disregard for these adults’ will and preferences. The SDM guidelines can be applied with flexibility by users, but when a problem arises, the legal basis is ambiguous, and the responsibility is unclear. The definitions, standardization of methods, legal examination, safeguards for risk of abuse, and human resources development for SDM are still under development. Practices in the SDM model projects are important, where potential issues of SDM for property management and personal protection are systematically clarified. After the examination of developments in and challenges of SDM in this article, it will be understood that the Japanese model has room for legislative improvements, particularly considering that the SDM guidelines are largely not enforced and there are no judicial norms for dispute resolutions. A step-by-step approach is important to improve the practice of SDM and analyze effective SDM methods. This would gradually formulate the social norms that may encourage the use of SDM through guidelines and legislation, with the adult guardianship option to be used as a last resort. In such a situation, SDM may coexist with and complement the adult guardianship system, and both devices may prevent vulnerable adults from abuse. By reviewing the SDM guidelines as a soft law, it will be possible for Japan to legislate SDM to match advanced SDM models in other countries.