Stretching beyond our perceived boundaries: The role of speech-language pathology in realising autonomy through supported decision-making

Purpose: Based on a 2022 Speech Pathology Australia National Conference keynote address, the author explores the concept of autonomy and how it can be reconceptualised for people with profound intellectual and multiple disability through supported decision-making. Method: A collection of participatory action research studies with people with profound intellectual and multiple disability and their supporters are presented. Qualitative action research methodologies, including participatory observation, co-design workshops, and interviews, were used to explore supported decision-making for people with profound intellectual and multiple disability. Result: The insights have been used to co-design (with supporters) a definition and practice framework to enhance the autonomy of people with profound intellectual and multiple disability. Conclusion: Drawing on the construct of relational autonomy, readers are asked to reflect on their role as speech-language pathologists in enhancing autonomy of those they service, particularly people with profound intellectual and multiple disabilities. A definition of supported decision-making for people with profound intellectual and multiple disability along with a practice framework are offered. This body of work adds to a growing evidence base in supported decision-making, providing much needed practice guidance specifically relating to people with profound intellectual and multiple disability.