How Is Decision-Making Capacity Assessed?
In Queensland, every adult is presumed to have the capacity to make their own decisions, unless there is clear evidence showing otherwise.
Sometimes, people close to someone—such as family members, health professionals, or support workers may be unsure whether that person can make a specific decision on their own. In these cases, a capacity assessment might be requested or required.
It’s important to remember: capacity is about whether a person can make a specific decision at a particular time—not whether they make a decision that others agree with.
A capacity assessment may be carried out:
- When a significant or complex decision needs to be made (e.g. legal, medical, financial),
- When there’s concern about undue influence or exploitation,
- When different people disagree about the person’s ability to decide,
- When someone is applying to QCAT (Queensland Civil and Administrative Tribunal) for guardianship or administration.
In the QCAT process, the application must show that the person lacks capacity for particular decisions, even with support. That’s why QCAT often requires a formal capacity assessment report as part of the application.
Capacity assessments must be done ethically, respectfully, and with the least restrictive approach. Poor or rushed assessments can disempower people or lead to unnecessary substitute decision-making.
A well-conducted, rights-based assessment will:
- Be specific to the decision in question (e.g. "Can the person manage their money?" not "Are they capable in general?"),
- Focus on the person’s functional abilities, not their diagnosis,
- Explore and document what support was provided to assist decision-making,
- Be done with the person’s informed consent, where possible,
- Respect the person’s communication preferences and cultural needs.
Informal Assessments:
For everyday or lower-risk decisions, trusted people like carers, family members, or advocates might help determine whether the person can decide with support.
Formal Assessments:
For high-stakes decisions—especially when applying to QCAT—a qualified professional is usually needed, such as a:
- General Practitioner (GP)
- Psychologist or neuropsychologist
- Psychiatrist
- Occupational Therapist
- Speech Pathologist (especially for communication support)
The professional will usually write a formal report that outlines:
- What decision is being assessed (e.g. accommodation, finances, health care),
- Whether the person has capacity for that decision,
- What support was given to assist decision-making.
A capacity assessment should only be done when:
- There’s a real decision to be made, and
- There is genuine uncertainty about whether the person can make that decision, even with support.
Assessments should not be done:
- Simply because a person has a disability or mental illness,
- Just because someone is older,
- Or because others disagree with their choice.
In a respectful, rights-based assessment, the professional will:
- Clearly define the decision being assessed,
- Talk with the person to explore how they understand the decision,
- Use accessible communication tools or support people,
- Determine whether the person can:
- Understand the information relevant to the decision,
- Weigh up the risks and benefits,
- Remember the information long enough to decide,
- Communicate their choice.
They may also seek input (with consent) from support workers, family members, or advocates to gain a fuller understanding of the person’s abilities and preferences.
- The outcome should be explained to the person in plain, accessible language.
- A written report may be used to inform future support, services, or legal processes.
If the person has capacity, they must be supported to make their decision and act on it.
If the person lacks capacity, all less restrictive alternatives should be considered before applying to QCAT or appointing a substitute decision-maker.
Additional Resources
Relevant Laws and Rights:
Guardianship and Administration Act 2000 (QLD) – outlines how capacity is defined and assessed, and presumes adults have capacity.
Human Rights Act 2019 (QLD) – protects the right to autonomy, privacy, and freedom.
UN Convention on the Rights of Persons with Disabilities (UNCRPD), Article 12 – recognises the equal right of people with disabilities to make decisions and receive the support they need to do so.
Guidelines for assessing decision-making capacity (Queensland Government Website) HERE
Queensland Capacity Assessment Guidelines (PDF from QLD Gov publications portal) HERE
Decision-making for Adults with impaired capacity (QCAT website) HERE