In health and social care, “best interests” refer to decisions made on behalf of individuals who cannot make those decisions themselves.
This guide helps professionals ensure that they act in the most appropriate way for the person’s welfare.
What is Mental Capacity?
Mental capacity refers to a person’s ability to make their own decisions. To have mental capacity, one must understand information, retain it, use or weigh it, and communicate their decision.
What Happens When Someone Lacks Mental Capacity?
When a person lacks mental capacity, they cannot make certain decisions for themselves. This scenario can happen due to various conditions like dementia, learning disabilities, or mental health issues. In such cases, decisions about their health and social care need to be made in their best interests.
Legal Framework
The Mental Capacity Act 2005
The Mental Capacity Act 2005 in the UK provides a legal framework to protect and empower individuals who may lack mental capacity. It ensures decisions are made in the person’s best interests.
Five Key Principles of the Act
- Assume Capacity: Always start by assuming the person has mental capacity, unless proven otherwise.
- Support to Decide: Provide all necessary support to the person to help them make their own decisions.
- Right to Make Unwise Decisions: Understand that people have the right to make decisions others may consider unwise or eccentric.
- Best Interests: Any decision made on behalf of someone who lacks mental capacity must be in their best interests.
- Least Restrictive Option: Choose actions that interfere the least with the person’s rights and freedoms.
Determining Best Interests
Factors to Consider
To decide someone’s best interests, various factors need attention. These include the person’s past and present wishes, feelings, beliefs, and values.
- Past and Present Wishes: Consider any expressed wishes whether verbally, written, or through an advance decision.
- Feelings: Take into account the person’s feelings about their situation.
- Beliefs and Values: Reflect on anything they would consider important. This includes cultural or religious beliefs.
- Other Factors: Address other factors the person would think relevant. This can include the views of close family members and friends.
Consultation
In making a best interests decision, consult with others involved in the person’s care. This may include family members, friends, carers, and professionals to gain a rounded perspective.
Use of Best Interests Checklist
The Mental Capacity Act provides a checklist to ensure the decision-maker covers all aspects when determining best interests. This ensures thorough and consistent decision-making.
Best Interests Meetings
What is a Best Interests Meeting?
A best interests meeting is a formal meeting to discuss and decide what is best for the person who lacks capacity. It’s a collaborative effort, where all key people involved come together.
Who Attends?
Attendees can include health professionals, social workers, family members, friends, and sometimes legal representatives. The person themselves should also attend if possible, to provide their perspective.
Process of the Meeting
During the meeting, attendees discuss all relevant information. They consider risks, benefits, and alternative options before arriving at a decision. Notes are taken to document the process and conclusions reached.
Making Decisions
Health Care Decisions
For healthcare, best interests can cover a wide range of issues. These include treatments, surgeries, and end-of-life care.
- Medical Treatments: Consider the necessity, benefits, and potential risks of a treatment.
- Surgical Procedures: Weigh the need for surgery against its risks and the expected quality of life post-operation.
- End-of-Life Care: Ensure decisions respect the person’s dignity and previously expressed wishes regarding end-of-life care.
Social Care Decisions
In social care, best interests might involve decisions about living arrangements, care services, and everyday activities.
- Living Arrangements: Evaluate if moving to a different living situation, such as a care home, would be beneficial.
- Care Services: Determine which care services best meet the person’s needs.
- Everyday Activities: Facilitate the person’s involvement in social and recreational activities they enjoy.
Protecting Rights
Advocacy
Sometimes an independent advocate, like an IMCA (Independent Mental Capacity Advocate), can help represent the person’s interests. They ensure the person’s voice is heard and their rights protected.
Legal Protections
If there are disputes or concerns about the best interests decision-making process, the Court of Protection may be involved. This court has the authority to make decisions and appoint legal guardians.
Examples of Best Interests in Health and Social Care
To better understand how best interests work in real-world scenarios, let’s explore some examples. These situations highlight how professionals make decisions to benefit individuals who cannot decide for themselves. Each example will demonstrate how various factors influence best interests decision-making.
Example 1: Medical Treatment
Situation
Mr. Thompson, aged 75, has advanced dementia and is hospitalised due to pneumonia. He is unable to understand the nature and purpose of treatment options.
Factors Considered
- Past Wishes: Mr. Thompson had previously expressed a preference to avoid aggressive medical treatments.
- Current Condition: His condition is serious, but antibiotics have a high chance of recovery.
- Family Input: His daughter believes he would have wanted the treatment as it offers a good chance of recovery without excessive suffering.
- Medical Advice: Doctors recommend antibiotics, highlighting their effectiveness.
Best Interests Decision
After consulting with his daughter, considering Mr. Thompson’s previous wishes, and evaluating medical advice, the healthcare team decides it’s in Mr. Thompson’s best interests to administer antibiotics. They explain the decision to his daughter and ensure that his comfort and dignity are maintained throughout the treatment.
Example 2: Living Arrangements
Situation
Ms. Patel, a 60-year-old woman with severe learning disabilities, can no longer stay at her family home due to safety concerns and inadequate care support.
Factors Considered
- Current Wishes: Ms. Patel enjoys living with her family but cannot express her understanding of safety concerns.
- Risks: The family home lacks necessary safety adaptations and the required level of care.
- Alternative Options: A nearby specialised residential care home offers 24-hour support and tailored activities.
- Family Input: Her family prefers she remains home but understands their limitations in providing adequate care.
Best Interests Decision
In a best interests meeting, social workers, Ms. Patel’s family, and healthcare providers discuss her needs and preferences. The team decides that moving to the specialised residential care home is in her best interests. This decision ensures she receives appropriate care and safety. Her family is encouraged to visit frequently.
Example 3: End-of-Life Care
Situation
Mr. Roberts, an 80-year-old with terminal cancer, has lost the capacity to make decisions due to his declining health.
Factors Considered
- Past Wishes: Mr. Roberts had made an advance decision to refuse life-sustaining treatments, including being put on a ventilator.
- Medical Condition: His condition is deteriorating rapidly, and life-sustaining treatment may only prolong suffering.
- Family Input: His family supports his advance decision and wants him to be comfortable during his final days.
- Palliative Care Options: The healthcare team can provide palliative care to manage pain and ensure comfort.
Best Interests Decision
Respecting Mr. Roberts’ advance decision, the healthcare team focuses on palliative care. They manage his pain and provide comfort measures, involving his family in the process to support him emotionally. This approach respects his wishes and ensures dignity in his final days.
Example 4: Daily Activities and Social Interaction
Situation
Mrs. Green, a 55-year-old with severe mental health issues, struggles to engage in social activities due to anxiety and depression.
Factors Considered
- Current Condition: Mrs. Green is isolated and shows signs of depression worsened by lack of social interaction.
- Past Hobbies: She previously enjoyed gardening and attending community events.
- Input from Carers: Her carers suggest introducing activities gradually to avoid overwhelming her.
- Support Services: Local community centres offer therapeutic gardening and social groups for mental health support.
Best Interests Decision
A holistic care plan is developed to reintroduce Mrs. Green to social activities she enjoys. The plan includes small, manageable steps like brief gardening sessions and gradually increasing participation in community events. This approach aims to improve her mental health and overall wellbeing, respecting her preferences and providing the necessary support.
Example 5: Financial Decisions
Situation
Mr. Williams, a 70-year-old with Alzheimer’s, can no longer manage his finances and is at risk of financial abuse.
Factors Considered
- Past Financial Management: Mr. Williams was always meticulous about his finances.
- Current Capacity: His cognitive decline has significantly impaired his ability to handle money.
- Financial Risks: Without proper management, Mr. Williams is susceptible to financial scams and exploitation.
- Family Input: His son is willing to help manage his finances and protect his assets, but a formal arrangement is needed.
Best Interests Decision
To safeguard Mr. Williams’ financial wellbeing, a deputyship is arranged through the Court of Protection. His son is appointed as a deputy to manage his finances legally. This decision protects Mr. Williams from exploitation and ensures his financial needs are met responsibly.
Through these examples, it’s clear that best interests decisions are multifaceted and tailored to each individual’s unique situation. Professionals must carefully consider all relevant factors, involve the person whenever possible, and consult those close to them. This thorough approach ensures that decisions made are respectful, fair, and truly in the person’s best interests.
Conclusion
In summary, best interests in health and social care are about ensuring decisions made for those who cannot decide for themselves are fair, respectful, and considerate of the individual’s overall wellbeing. This involves a structured process rooted in the legal framework of the Mental Capacity Act 2005, considering all relevant factors, and involving those close to the person. Professionals must always aim to respect the rights, beliefs, and preferences of the individuals they support.