Best interests decision-making for adults who lack capacity A toolkit for doctors working in England and Wales by British Medical Association.
The BMA would like to thank the many individuals and organisations who provided advice and guidance on earlier drafts of the report. Special thanks are due to the Ministry of Justice’s Mental Capacity Act Forum, and the BABEL team at the University of Bristol.
About this toolkit Decisions for adults who lack the capacity to consent to medical treatment in England and Wales are governed by the Mental Capacity Act 2005 (MCA). The MCA specifies that, any act done, or decision made, for a person who lacks capacity must be made in their best interests.
The MCA does not define best interests. Instead, it sets out a process to be followed when making a decision. In most circumstances it will be clear where the individual’s best interests lie, and a decision as to care or treatment will not be challenging or time-consuming – but this is not always the case. Whether to provide analgesics for someone in pain is likely to be a straightforward question; a decision about whether to continue providing life-sustaining treatment is less so.
This toolkit provides practical guidance to help doctors make decisions in the best interests of adults who lack capacity. It sets out the decision-making process that should be followed, the different factors to consider, and how these should be balanced. It also signposts to further reading and sources of support. Although aimed primarily at doctors, much of the information here will be useful to other members of the healthcare team involved in treating and caring for patients who lack capacity. As members of the multi-disciplinary team (MDT), they will have a crucial role in best interests assessments and decisions.
This toolkit applies to England and Wales only. In Scotland, decision-making in this area is covered by the Adults with Incapacity (Scotland) Act 2000. In Northern Ireland, it is governed by the common law (although at the time of writing, change is anticipated). Although many of the basic principles outlined in this guidance will be applicable, doctors working in Scotland and Northern Ireland should not rely on this toolkit without also referring to country-specific guidance.
The document can be downloaded here (Best interests decision making for adults who lack capacity) or can be viewed below