Throughout its proceedings and in its Final Report, the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability gave considerable prominence to supported decision-making as a means for achieving the human rights of people with disabilities. It sought input on supported decision-making from people with lived experience, roundtables, public hearings, and commissioned independent research on supported decision-making and proposals for reform. Practical challenges raised at the roundtables and by witnesses included the resources needed for education, training, and capacity building, and the challenge of finding supporters for people who were isolated. Evidence was given that legal reform was only one aspect of what was needed to embed supported decision-making into sectors and services to improve the lives of people with cognitive disabilities. The Commission’s Final Report endorsed a set of national supported decision-making principles, with many of these principles underpinned by the evidence received and commissioned research. However, overall, the Commission’s recommendations were overly focused on reform of guardianship and administration systems, and implementation guidance was lacking. The Commission also missed an opportunity to recommend legislative and practice reform beyond guardianship systems, into multiple services and sectors including the National Disability Insurance Scheme, the health system, and the public sector more widely.