Supported decision-making for people living with dementia in NSW
This paper examines how legal frameworks in NSW shape decision-making for people living with dementia, given the challenges posed by progressive cognitive decline. It considers traditional surrogate decision-making models and the supported decision-making approach, which aligns with Australia's obligations under the Convention on the Rights of Persons with Disabilities. The paper highlights legal reforms and experiences from other Australian jurisdictions, in particular Victoria, and explores the implications of the new Aged Care Act 2024 (Cth).
Cameron Stewart, BEc, LLB (Hons), Grad Dip Jur, Grad Dip Legal Prac, PhD
Professor of Health, Law and Ethics
Research Paper 6, 2025
Cameron Stewart is professor of Health, Law and Ethics at Sydney University. He is a member of Sydney Health Law and an associate of the Centre for Values, Ethics and the Law in Medicine, Sydney Medical School.
Key points
- Dementia affects hundreds of thousands of Australians and is a leading cause of disability and death.
- Dementia leads to a progressive decline in a person's ability to make decisions about their personal lives, their finances and their healthcare. People living with dementia will need help making those decisions and, as dementia progresses, they may no longer be able to be involved in decision-making at all when they have permanently lost mental capacity.
- Supported decision-making is an approach to decision-making that requires support to be given to a person living with a disability (like dementia) to enable them to make decisions. It requires that the will and preferences of a person living with dementia remain at the centre of decision-making.
- Supported decision-making is mandated by Australia's ratification of the United Nations Convention on the Rights of Persons with Disabilities. The Australian Government and some state and territory jurisdictions have made changes to their laws to enact supported decision-making.
- NSW has implemented supported decision-making into its policy frameworks but has not updated its laws on decision-making to include supported decision-making. In the future this may lead to difficulties arising as NSW law conflicts with Commonwealth laws that are concerned with decision-making for people living with dementia.
Published 16 October 2025