Best interests decisions

What does best interests mean? It is a well-established principle that when a person lacks capacity to make any decision, the decision which is made by others, be it professionals or the court, should be made in the person’s best interests. While the Mental Capacity Act 2005 does not expressly define the term ‘best interests’, Section 4 of the act does provide a checklist of factors to be taken into account when making a best interests decision.

What factors should be considered when making a best interests decision?

The checklist of factors to be taken into account when making a best interests decision, are as follows:

  1. The past and present wishes and feelings of the client and in particular any written statements which may have been made when he/she had capacity

  2. The client’s values and beliefs that would have been likely to influence his/her decision if he/she still had capacity

  3. Any other factors that the client would have considered if he/she were able to do so

 

What forms past and present wishes and feelings?

There is often confusion in respect of what factors would contribute towards a person’s wishes and feelings, below is a list of examples of factors which would form a person’s wishes and feelings:

  • A written statements that provide information about an individual’s wishes of how they would like to be cared for
  • The beliefs and values that would be likely to influence their decision if they had the capacity – evidence of this can be found by looking at an individual’s cultural background, religious beliefs, political and moral convictions or past behaviour or habits

It is also paramount that the decision maker considers whether it is likely that the person will regain capacity in relation to the matter in question, and if so when that is likely to be. If this is in the near future, and the decision does not need to made imminently, steps should be taken to delay the decision. Furthermore, the decision maker must, so far as reasonably practicable, encourage the person to participate, as fully as possible in any act done for him/her and any decision which will affect him/her.

What factors shouldn't be considered?

In considering what is in a person’s best interests it is important for the decision maker to ensure that their decision isn’t solely based on a person’s age, appearance, gender, sexuality, race, ethnic background or religion. Furthermore, Section 4 of the act also states that a decision should not merely be based on a person’s condition or an aspect of their behaviour, as these factors might lead to an unjustified assumptions about what might be in a person’s best interests.

Who should be consulted when making a best interests decision?

During the best interests decision process, the following people should be consulted for their views:

  • Anyone engaged in caring for the person
  • Close relatives, friends or others who take an interest in the persons welfare
  • Any attorney appointed under a Lasting Power of Attorney made by the person
  • For decisions where there is no one who fits into any of the above categories, an independent mental capacity advocate must be consulted

It is essential that the decision maker makes the appropriate enquiries to ascertain the views of those listed above.

Are there any exceptions to the rule?

If a person has made an advance decision to refuse certain medical treatment whilst they had capacity and there is no reason to believe they subsequently changed their mind, the best interests process should not be followed as it is unlawful to override a person’s decision made during the time they had capacity. Furthermore, Section 27 of the Mental Capacity Act 2005 provides an express list of decisions which cannot be made in a person’s best interests without applying to the court, these are as follows:

  • Consenting to marriage
  • Consenting to sexual relations
  • Consenting to a decree of divorce
  • Consenting to a child being placed for adoption by an adoption agency
  • Consenting to the making of an adoption order
  • Discharging parental responsibilities in matters not relating to a child's property

What next?

Once a decision maker has taken all of the necessary steps set out in the checklist within Section 4 of the act, they must employ what the court has described as a ‘balance sheet’ approach, which means weighing the likely advantages for the person against the likely disadvantages. Only if the ‘account’ is ‘relatively significantly in credit’, will the intervention be in the person’s best interests – this approach was set out in the case of Re A (Medical Treatment: Male Sterilisation) (2000).

What if there is a best interest dispute?

In the event that a unanimous decision cannot be reached either amongst professionals or with the involvement of family members, the appropriate responsible body, be that the local authority or the Clinical Commissioning Group (CCG) should make an application to the Court of Protection.

Should you find yourself in a dispute in respect of a decision which is made in a loved one’s best interests, please do not hesitate to contact us on 0175 321 5096 for assistance.

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