‘I lost yesterday’: Dementia, Mediation and Decision-making

Ageing populations and dementia rates raise many questions and challenges for mediators. 

Margaret Doyle
Independent Mediator and is a Visiting Research Fellow at the University of Essex School of Law and University of Reading School of Law.

Key Words: dementia, decision-making, mediation, elder mediation, ageing, rights, human rights, mental capacity

Abstract
An estimated one million people in the UK will be living with dementia by 2025. This stark statistic makes it urgent to address our institutional and personal responses and our design of support for decision-making for those living with dementia. We could draw on the social model developed by the disability rights movement, whose slogan is ‘Nothing about us without us’. Mediation has a role in this, as a process for collaborative
problem-solving and decision-making that puts voice and supported participation at its heart. This article explores how specialist elder mediators can facilitate the involvement of people living with dementia in decision-making that affects their lives. It refers to what people living with dementia say they value and draws on philosophical perspectives on selfhood and on people’s decision-making capacity. Using principles
drawn from human rights and social work, mediators can help prevent and resolve disagreements about care in a way that prioritises human flourishing and facilitates participation by the person at the centre of the dispute. To do so, mediators must challenge prevalent and paternalistic assumptions about vulnerability and protection.