We advocate for a change in the way individuals with cognitive impairment are enrolled in minimal risk clinical research. We do so in the hope that such a change will lead to more cognitively impaired individuals being enrolled in research. Our proposal applies only to cases where would-be participants retain some interest in decision-making as well as the ability to express a decision. In these cases, we argue that the common practice whereby researchers either obtain consent from the individual or consent from a surrogate and assent from the individual, is ethically unnecessary. Instead, a process of facilitated decision-making based on SDM (supported decision-making) should be employed. Although it is possible that this process of facilitation will enable some individuals to make a capacitated choice who would not otherwise have done so, this should not be a requirement of getting to choose. In those cases where a would-be participant, despite support, fails to make a capacitated choice, the individual should still have the final say about participation. In this respect, our proposal deviates from standard practice. However, we argue that our proposal offers participants as much ethical protection as the more common procedures involving surrogates.

This memorial essay introduces the Journal of Law, Medicine, and Ethics special issue on supported decision-making in research by honoring David T. Wasserman (1953–2025), a major organizer of the NIH workshop from which the issue emerged and a coauthor of two papers in the volume. It situates supported decision-making in research as an emerging approach that aims to make participation by people with cognitive disabilities possible without displacing their agency through default reliance on legally authorized representatives. The essay highlights Wasserman’s distinctive contribution to this developing area. He sought a position that is respectful while remaining clear eyed about exploitation risks and about well-intentioned practices that can undermine a participant’s interests, especially in hard cases where meaningful authorization is fragile. Drawing on the two coauthored papers in the issue and on colleagues’ recollections, the essay emphasizes Wasserman’s commitment to conceptual clarity, workable institutional design, and mentorship through collaboration. It closes by reflecting on his intellectual virtues, humor, and lasting influence on disability bioethics and research ethics.