Psychologists' perspectives on supported decision making in Ireland.
Irish psychologists say culture, not law, keeps adults with ID locked out of decisions.
01Research in Context
What this study did
Granieri et al. (2020) talked with 15 Irish psychologists about supported decision-making.
The 2015 Irish law says every adult can decide for themselves unless proved otherwise.
The researchers asked what stops this law from working for adults with intellectual disabilities.
What they found
Psychologists said adults with ID still get left out of choices big and small.
Culture moves slower than law: staff fear risk, lack time, and default to ‘he can’t decide.’
Paperwork, training, and scared families add more walls between people and their rights.
How this fits with other research
Fahmie et al. (2013) saw the same empty ritual in the Netherlands. Adults sat in their own support-plan meetings while staff ticked boxes.
English et al. (2020) scoped end-of-life studies and found only 2 of 10 let the patient speak. The Irish psychologists explain why: risk fear and no tools.
van der Miesen et al. (2024) counted UK health research and locked out 78 % of adults with ID. E et al. show the same lock happens every day in clinics and homes.
Kruithof et al. (2022) add Irish parents who feel they must decide everything for adults with profound ID. The psychologists agree—everyone assumes incapacity.
Why it matters
If you write plans, run meetings, or train staff, start by presuming the person can decide.
Offer picture choices, extra time, and plain-language forms. Record their real words, not ‘unable to respond.’
One small shift: ask the adult first, then ask the family. The law already does—our practice should too.
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02At a glance
03Original abstract
BACKGROUND: A new legal capacity act was introduced in Ireland in 2015. This study aimed to identify and critically examine key issues in the area of decision-making capacity from the perspective of psychologists working with adults with an intellectual disability. METHODS: A qualitative exploratory approach was employed, and the study was positioned in a social constructionist framework. Purposive and snowballing sampling methods were used to recruit 15 clinical psychologists working with adults with an intellectual disability. Data were collected with the use of individual semistructured interviews. Interview transcripts were analysed using a model of thematic analysis. RESULTS: Six themes were identified: (1) a presumption of capacity but a culture of incapacity, (2) supporting decision making as a process, (3) authenticity of decision making, (4) need for support and training, (5) contributions of psychology and (6) the way forward. CONCLUSIONS: Participants described that people with intellectual disabilities were often excluded from decision-making processes. They welcomed the functional approach to decision making, considered substituted decision making to be necessary within a support framework and described supporting decision making as a process. Systemic, resource and attitudinal challenges were identified.
Journal of intellectual disability research : JIDR, 2020 · doi:10.1111/jir.12712