A/HRC/30/43 Convention does not legitimatize the denial of legal capacity based on perceived or actual deficits in mental capacity. 49. The Independent Expert noted the positive trend in recent years to reform legal capacity and guardianship laws. General comment No.1 also provides guidance to States parties on reforming their current laws and legislation—in particular mental-health legislation that deprives persons with disabilities of their legal capacity—and encourages States to replace regimes that provide for substitute decision-making by supported decisionmaking. 50. Effective safeguards for ensuring the autonomy of older persons should be developed and implemented to ensure the respect of the rights, wishes and preferences of older persons and to avoid undue interference. The Committee on the Rights of Persons with Disabilities provides guidance on supportive measures, stressing that if, after significant efforts have been made, it is still not practicable to determine the will and preferences of an individual, the “best interpretation of will and preferences” must replace the “best interests” determinations.9 In addition, articles 11 and 30 of the Inter-American Convention on Protecting the Human Rights of Older Persons could also guide States on this issue. 51. Legal capacity has particular relevance for older persons regarding making fundamental decisions regarding their social and health care, in particular medical treatment. The respect for and the strengthening of older persons’ autonomy in care settings means that they must be able to give consent to, refuse or choose an alternative medical intervention. 52. In his report on the fundamental role played by informed consent in respecting, protecting and fulfilling the right to health, the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health highlighted that informed consent is not a mere acceptance of a medical intervention, but a voluntary and sufficiently informed decision, safeguarding the right of the patient to be involved in medical decision-making, and assigning associated duties and obligations to health-care providers.10 Its ethical and legal normative justifications stem from its promotion of patient autonomy, self-determination, bodily integrity and well-being.11 Older persons should therefore be encouraged to plan in advance any decisions regarding their care. Advance planning allows them to prevent abuses that often occur in older age. 3. Adequate standard of living and social protection 53. Living with autonomy is closely linked to the right to an adequate standard of living, social security, income security and an adequate public pension. The important role of social protection is recognized in several international and regional instruments and should be fully implemented and enforced in order to promote the autonomy of older persons. 54. Poverty contributes to the decline of older persons’ autonomy and is an impediment to accessing adequate nutrition, water and sanitation, and social and health care. Not receiving a pension or not having insurance often inhibits older persons from seeking medical attention, putting them at a higher risk of social isolation and of being denied access to health care. Even for those who have insurance, there are delays in seeking public health care or obtaining prescription drugs because of the financial burden. Financial services, such as loans or mortgages, or insurance are often not available to older persons or are prohibitively expensive because of the inappropriate use of age as a criterion, including for determining risk. 9 10 11 10 General comment No. 1, para. 21. See A/64/272. Ibid., para. 9.