Making one's own choices is an important part of leading a fulfilling life within society. However, people with IDs often face significant obstacles when making their own decisions. Article 12 (Equal recognition before the law) of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) aims to ensure firstly that people with IDs and others with compromised capacity are nonetheless recognized as legal individuals, and secondly that assistance is provided in the form of supported decision-making in order to exercise this resulting legal capacity. It is unclear whether current national legislation in any country satisfies these requirements in practice. This study utilizes institutional ethnography to reveal how decision-making is coordinated in practice for people with mild to moderate IDs living in supported residential environments in England, and to determine whether these processes are compliant with Article 12 of the CRPD. Data collection was based on observations, semi-structured interviews, and documentary analysis, involving 29 participants including people with mild to moderate IDs. The results point to the complexity of supported decision-making and identify three main categories of decision-making: spontaneous decisions, mid-term decisions, and strategic decisions. The data also show that people with mild to moderate IDs are able to exercise their legal capacity through support decision-making in their everyday life. Immediate and informal supported decision-making exists in daily practice for people with mild to moderate IDs living in supported residential environments. Although there are structures in place for implementing supported decision-making, various barriers persist that limit the overall efficacy and consistency of the realization of supported decision-making, for example, multiple use of mental capacity assessments. Such practices move away from the supported decision-making model toward substituted decision-making.

Making decisions is an important component of everyday living, and issues surrounding autonomy and self-determination are crucial for persons with intellectual disabilities. Article 12 (Equal Recognition before the Law) of the UN Convention on the Rights of Persons with Disabilities addresses this issue of decision-making for persons with disabilities: the recognition of legal capacity. Legal capacity means recognizing the right to make decisions for oneself. Article 12 is also moving in the direction of supported decision-making, as an alternative to substituted decision-making. The objective of this paper is to show conceptually the connection between supported decisionmaking and the preservation of personal autonomy for persons with intellectual disabilities. This paper discusses supported decision-making based on Bach and Kerzner's model: (a) legally independent status, (b) supported decision- making status, and (c) facilitated decision-making status. Arguments will be made based on John Stuart Mill's concept of autonomy and arguments against it using Sarah Conly's argument for paternalism.

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) entered into force in May 2008. It is the first legally binding international treaty aimed specifically at protecting the rights of persons with disabilities. Ratifying State Parties have to either incorporate new laws or change existing laws, to meet their obligations of implementing the CRPD. Article 12 (Equal Recognition before the Law) of the CRPD supports legal capacity (recognition of a person's right to make decisions). It has been claimed that 'it challenges literally centuries of legal practice which may now be directly contrary to Article 12 and therefore requires examination by States to ensure that legislation complies with the Convention...' (McLay, 2008). In relation to the interpretation of Article 12, most jurisdictions have incorporated substitute decision- making (e.g., guardianship) rather than supported decision-making in their legislation. The best interpretation of Article 12 requires a supported decision-making model. This paper will illustrate this point by (a) examining different approaches to legal capacity, (b) clarifying the distinction between substituted and supported decision-making, (c) examining the history of Article 12 in light of substituted and supported decisionmaking, and (d) arguing on the basis of history and the deliberation process of the CRPD, that Article 12 requires state parties to implement supported decision-making. (C) 2011 Association ALTER. Published by Elsevier Masson SAS. All rights reserved.