Last month, energy was high at the United Nations as an intergovernmental working group began the formal process of drafting a convention on the rights of older persons. The momentum is welcome. Older people have long received limited attention in international human rights law, and ageism remains embedded in legal and social systems.
But as the global community moves toward a treaty, the challenge is not simply to expand autonomy but also to ensure that rights are practical and responsive to the realities of isolated lives. Many older adults face social disconnection, whether due to lost family ties, outliving friends, institutionalization, mental health conditions, or loneliness that can lead them to push others away.
Over the past two decades, the U.N. Convention on the Rights of Persons with Disabilities (CRPD) has influenced how the world thinks about capacity and autonomy. Article 12 encourages moving away from substitute decision-making, where decisions are made on a person’s behalf, and calls for countries to let individuals make their own choices with support from someone they trust.
In New Brunswick, this international movement found concrete expression in law when legislation formalizing supported decision-making came into force in January 2024, placing the province alongside jurisdictions such as British Columbia, where similar legislation was enacted in 2000.
Yet this shift raises an accessibility question: how can a model built on chosen support work for those who have no trusted network? Consider an 82-year-old woman with dementia sitting in a hospital room. She has no spouse, no children, no close friends. The neighbours who once checked in have moved away. A social worker is trying to arrange her discharge, but there is no one to call, no one authorized to help her navigate housing, finances, or medical care. For so-called “unbefriended” older adults, the promise of supported decision-making can ring hollow. The framework assumes trusted relationships. For some older people, those relationships simply do not exist.
We should also avoid assuming that everyone wants friends or family to assist them. Some may prefer to delegate decisions to state authorities rather than rely on personal contacts.
As convention drafters move forward, it is important to bear in mind the limits of supported decision-making. Indeed, Canada’s long-standing interpretation of the CRPD recognizes that substitute decision-making should continue in appropriate circumstances.
Attention must also be paid to the risk that coercion can occur behind the veneer of a “supported decision,” giving the appearance of genuine choice when the individual’s autonomy has in fact been compromised. In such cases, carefully structured substitute decision-making by state authorities may better protect the person’s safety and rights, relieving an older adult from the dominating tactics of an abusive adult child, for example.
As international and domestic systems advance decisional support, autonomy must be paired with accessible rights so that no older adult is left invisible. Legal frameworks must address the structural and personal barriers that make it difficult for some older adults to access trusted support networks, and progress may require innovative approaches to ensure support is available where informal networks are absent. The experiences of isolated seniors illustrate the limits of well-intentioned legal reforms: rights cannot fulfil their promise if they fail to reach the most isolated among us.
Heather Campbell Pope is founder of Dementia Justice Canada and writes on legal issues affecting older adults.
