If you watched Season 2 of The Pitt, you may have noticed something that doesn’t get talked about nearly enough:

Supported decision-making.

And if you are the parent of an adult with a disability, this is one of those things I wish someone had explained to me much earlier.

Because when your child turns 18, there is suddenly a whole new vocabulary.

Guardianship.

Power of attorney.

Healthcare representative.

Supported decision-making.

Person-centered planning.

And approximately 700 new acronyms that nobody bothered to explain.

Then you get to the really hard part:

How do I keep helping my adult child without accidentally taking over their life?

That is exactly the tension we see with Mel and her sister Becca in The Pitt.

A quick note about Becca

In Season 2, Becca is an adult with an intellectual disability who lives in a supported living environment.

Her sister Mel is extremely involved in her life.

Mel is her sister, her caregiver, her advocate, and someone who clearly loves her enormously.

She also has a durable power of attorney.

But Mel and Becca have made another agreement:

Supported decision-making.

That distinction becomes incredibly important when Mel discovers that Becca has been in a relationship for approximately six months.

And they are sexually active.

Mel is shocked.

She’s worried about Becca.

She’s worried about whether Becca is being taken advantage of.

And, honestly, she’s also hurt.

Because Mel has spent so much of her life taking care of Becca that finding out Becca has an entire part of her life that Mel doesn’t know about feels enormous.

But then comes the uncomfortable question:

Does being Becca’s sister and supporter mean Mel gets to make the decision for Becca?

No.

And that is where supported decision-making becomes so important.

What is supported decision-making?

Supported decision-making, or SDM, means that the person remains the decision-maker.

They can choose trusted people to help them understand information, consider choices, communicate decisions, or work through complicated situations.

But the supporter does not become the person who makes the decision simply because they are helping.

Michigan’s Department of Health and Human Services describes SDM as an approach that allows people with intellectual and developmental disabilities to receive the support they need and want while maintaining their rights and control over their own lives.

And here’s the part I really want parents to hear:

Needing help making a decision does not automatically mean someone needs someone else to make the decision for them.

Those are two very different things.

Think about it this way

Imagine I have to make a complicated medical decision.

I might ask:

• My husband
• My sister
• My doctor
• A friend who works in healthcare
• Someone who understands insurance
• Someone who knows me really well

They might explain things to me.

They might tell me what questions I should ask.

They might help me make a list of pros and cons.

They might even say:

“Kathryn, I really think you should think about option B because of X, Y and Z.”

But ultimately:

I make the decision.

Supported decision-making applies that same basic concept to people with disabilities.

Michigan describes it as something that mirrors how adults generally make decisions—with advice, information, support, and trusted people—while the individual maintains control.

So what is the difference between SDM and guardianship?

This is where the distinction becomes really important.

Supported Decision-Making

The adult makes the decision.

A supporter may:

• Explain information
• Help the person understand choices
• Help communicate with doctors or agencies
• Help compare options
• Help identify consequences
• Help organize information
• Help communicate the person’s decision
• Provide reminders or practical assistance

But the person remains the decision-maker.

Guardianship

Guardianship is fundamentally different.

A guardian is appointed through a legal process and receives authority to make decisions for another adult within the scope of the guardianship.

Michigan describes guardianship as a court order allowing one person to make decisions for another person. Michigan also identifies supported decision-making as an alternative that can allow a person with a developmental disability to maintain decision-making rights.

And guardianship can involve significant restrictions on a person’s legal rights.

That’s why it shouldn’t simply be:

“My child has a disability, so I guess I need guardianship.”

The question should be:

What kind of help does this person actually need?

And then there’s the power of attorney issue

This is another place where The Pitt gives us something interesting to talk about.

Mel tells Langdon that she has durable power of attorney and that she and Becca have also established supported decision-making.

Those are not the same thing.

A power of attorney can authorize another person to act on someone’s behalf in specific areas.

For example, depending on the document and applicable law, someone might authorize another person to help handle:

• Financial matters
• Legal matters
• Healthcare matters
• Communication with organizations
• Other specifically identified responsibilities

But having a power of attorney does not automatically mean the adult has lost the right to make their own decisions.

That’s one reason the conversation between Mel and Langdon is so important.

Langdon asks:

“Are you Becca’s legal guardian?”

Mel says no.

And suddenly the situation looks very different.

Because Mel’s role is not:

“I make Becca’s decisions.”

It’s:

“I support Becca.”

That distinction is enormous.

Why Becca’s relationship matters so much

This is the part of the episode that I think parents of adults with disabilities really need to sit with.

Mel is worried about Becca’s boyfriend.

And she has legitimate reasons to be concerned.

Becca has a disability.

She’s living in a supported environment.

She’s having sex.

Mel doesn’t know the boyfriend.

Mel doesn’t know his family.

Mel doesn’t know what is happening.

And Mel’s protective instincts kick in.

That doesn’t make Mel a bad sister.

It makes her a human being who loves someone and is scared something could happen to her.

But here’s the problem:

Being worried about someone’s decision does not automatically give you the right to make the decision for them.

Becca is allowed to make a decision that Mel doesn’t like.

She’s allowed to make a decision that Mel wouldn’t make.

She’s even allowed to make a decision that turns out badly.

That’s part of being an adult.

Michigan’s supported decision-making guidance specifically recognizes that people with disabilities have the right to make their own choices, learn from those choices, and experience their consequences.

That does not mean we throw someone into the deep end and say:

“Good luck!”

It means we figure out what support they need to participate in the decision.

What Mel eventually has to understand

Mel has spent so much of her life being Becca’s protector that she has trouble separating:

“I need to protect Becca.”

from

“I need to control what happens to Becca.”

Those aren’t the same thing.

And this is where the episode gets really good.

Langdon doesn’t simply tell Mel:

“You’re wrong.”

Instead, he gets her to recognize the agreement she already made with Becca.

Becca is allowed to make her own decisions.

Mel agreed to support that.

And now Mel has to actually live with what that means.

Because supported decision-making is easy when the person makes the decision you agree with.

It’s much harder when they don’t.

Why SDM makes sense for Becca based on what we see

Again, this is a fictional character, so we’re working with what the show gives us rather than a real clinical or legal assessment.

But based on the episode, Becca appears able to:

• Communicate what she wants
• Tell Mel what information she does and doesn’t want to share
• Understand that she has choices
• Make relationship decisions
• Set boundaries with her sister
• Ask for medical assistance
• Express when she does not want Mel involved in a particular conversation

Those are important pieces of information.

Becca doesn’t appear to need someone to be her.

She needs people who can support her.

And that is exactly the space supported decision-making is designed to occupy.

What about guardianship?

Guardianship isn’t automatically wrong.

There are adults who have significant impairments in decision-making and may need a guardian.

Michigan’s guidance recognizes that guardianship can sometimes be necessary, while also identifying less restrictive alternatives. Michigan’s materials emphasize considering alternatives and tailoring restrictions to the individual’s actual needs.

The important question isn’t:

“Does this person have a disability?”

The important questions are:

What decisions can this person make independently?

What decisions can they make with support?

What specific areas require additional legal authority?

And:

Is there a less restrictive way to provide that support?

Those questions are much more useful than simply asking whether someone has a disability.

What other options exist?

Supported decision-making is not the only alternative to guardianship.

Depending on the person and their circumstances, families may use combinations of:

Natural supports

Family members, friends, trusted people, or other members of a person’s circle of support.

The person remains in control.

Person-centered planning

A process that focuses on what the person wants for their own life and what supports they need to make that happen.

Releases and authorizations

These can allow a person to give specific people permission to receive information or participate in certain situations.

Power of attorney

A person can authorize someone else to act on their behalf in specified areas.

Healthcare decision-making documents

Depending on state law, there may be documents that allow someone to designate another person to participate in healthcare decision-making under particular circumstances.

Representative payee

For some government benefits, another person may be appointed to manage benefit payments.

Limited guardianship

If guardianship is actually necessary, it doesn’t always have to mean handing over every decision.

A limited guardianship can address specific areas rather than every aspect of someone’s life.

Michigan’s resources describe a range of decision-making supports and alternatives, from informal supports and supported decision-making through more restrictive legal arrangements.

Here’s the question I wish more families were asked

Instead of:

“Do you want guardianship?”

I’d love to hear:

“What decisions does your adult child need help with?”

Then break it down.

Healthcare?

Money?

Housing?

Transportation?

Employment?

Relationships?

Communication?

Contracts?

Benefits?

Daily living?

And then ask:

“What can they do independently?”

“What can they do with support?”

“What actually requires someone else to have legal authority?”

That is a much more individualized conversation.

And this is why Becca’s story matters

The most important part of Becca’s story isn’t whether Mel is a good sister.

She obviously loves Becca.

It’s not whether Becca will always make perfect decisions.

She won’t.

None of us do.

It’s not whether Mel should worry about her.

Of course she should.

The bigger question is:

Can we love someone, protect someone, and support someone without taking away their right to be the person living their life?

That’s the heart of supported decision-making.

And sometimes supporting someone means helping them make a decision.

Sometimes it means explaining the consequences.

Sometimes it means saying:

“I don’t think this is a good idea, but it is your decision.”

And sometimes—this is the really hard part—it means letting an adult you love make a choice you wouldn’t make yourself.

For parents raising a child with disabilities

This is something to start thinking about before your child turns 18.

Don’t wait until the birthday arrives and someone hands you a stack of paperwork and says:

“So…guardianship?”

Start practicing decision-making now.

Let your child choose whenever possible.

Give information in a way they understand.

Talk through consequences.

Let them ask questions.

Let them make mistakes when the consequences are manageable.

Help them learn what questions to ask.

Build a circle of trusted people.

And pay attention to what your child can actually do—not just what they struggle with.

Michigan’s supported decision-making resources specifically encourage families to begin developing these skills before adulthood and emphasize that SDM can support autonomy without creating a legal relationship that takes away the person’s rights.

Because eventually, our kids become adults.

And our job changes.

We don’t necessarily stop being their advocates.

We don’t stop loving them.

We don’t stop worrying.

We don’t stop helping.

But sometimes the most important thing we can do is move from:

“I will make sure you are okay.”

to:

“I will help you figure out what you want, and I’ll be here while you figure it out.”

That is a very different kind of parenting.

And honestly?

It’s hard as hell.

But maybe that’s the point.

We aren’t raising people so we can make every decision for them forever.

We’re helping them become the most self-directed adults they can be—with whatever support they need along the way.

And The Pitt gave us a surprisingly good conversation starter for exactly that.