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Best Interest Decision

Patient asleep on a hospital bed.

In accordance with the Mental Capacity Act’s (2005) fourth principle: any decision made on the behalf of an individual who has been assessed as lacking capacity for that decision shall be done in their Best Interest.

This should be done while respecting the third and fifth principles of the Act that states a person has the right to do what others may determine to be an unwise decision, and that any decision made in an individual’s Best Interest must be the least restrictive option.

Who makes a Best Interest decision? 

For complex decisions that have significant implications for an individual’s health and wellbeing (such as placement, treatment and safeguarding), these decisions should be made through the process of a Best Interest Meeting. This meeting is chaired by an appropriate healthcare professional with a clearly assigned decision maker.   

Meanwhile, for general everyday decisions that are included within a care plan, such as an individual’s meals, personal care support (etc.), these decisions can be completed informally by appropriate care team members, with appropriate consultation of the individual and family. 

Note: When forming and reviewing a care plan, if an individual lacks capacity or finds it difficult to engage with the process of Care Plan Reviews, these should be referred to an Independent Care Act Advocate (ICCA) if an appropriate friend or family member is not available or cannot represent. There are also further specific circumstances where an advocate can support. For further information, please contact your local provider.  

How is a Best Interest Decision determined? 

Pages 64-88 of the MCA’s code of practice (2007) provide a non-exhaustive checklist to both direct and focus Best Interest decisions to represent the individual’s rights, wishes and needs as impartially as possible. 

By stating that they are non-exhaustive, it emphasises the responsibility of the decision maker to professionally reflect upon the decision in question, considering any additional factors that should be accounted for, thus recognising the diversity of decisions that the MCA covers. These include:  

  • Encouraging the individual to participate, making all appropriate adjustments to support this. 
  • Identify all relevant circumstances. 
  • Find out the person’s views. 
  • Avoid discrimination. 
  • Assess whether the person might regain capacity at some point in the future. 
  • If the decision concerns life-sustaining treatment then these decisions should not be motivated to bring about the individual’s death or make assumptions as to their quality of life. 
  • Consult all relevant others. 
  • Refer to an appropriate Advocate.
  • Least restrictive practices should always be adhered to. 
  • Any other factors to consider or assess? 
  • Weigh up all these factors to conclude what would be in the individual’s Best Interests. 

Best practice

To protect the individual and staff, all MCAs and Best Interest decisions should be appropriately documented, including the justification and who has been consulted. This should be reviewed regularly, being assessed immediately if there are significant changes for the individual. 

For further details, please see the UK Government’s Mental Capacity Code of Practice.

Finally, please remember the upcoming renewal of the Mental Capacity Act (2005) which is due for release with associated updates surrounding this topic.