Offering choices to people with intellectual disabilities: an interactional study.

BACKGROUND: At the level of policy recommendation, it is agreed that people with intellectual impairments ought to be given opportunities to make choices in their lives; indeed, in the UK, the Mental Capacity Act of 2005 enshrines such a right in law. However, at the level of practice, there is a dearth of evidence as to how choices are actually offered in everyday situations, which must hinder recommendations to change.
METHOD: This qualitative interactional study, based on video recordings in British residential homes, combines ethnography with the fine-grained methods of Conversation Analysis.
RESULTS: We identify six conversational practices that staff use to offer choices to residents with intellectual disabilities.
CONCLUSIONS: We describe the unwanted consequences of some of these practices, and how the institutional imperative to solicit clear and decisive choice may sometimes succeed only in producing the opposite.