MCA: Best interests principle

It is important for the application of the MCA to have a fundamental understanding of the best interests principle.

If a person has been assessed as lacking capacity then any action taken, or any decision made for, or on behalf of that person, must be made in his or her best interests (principle 4). The person who has to make the decision is known as the ‘decision-maker’ and normally will be the carer responsible for the day-to-day care, or a professional such as a doctor, nurse or social worker where decisions about treatment, care arrangements or accommodation need to be made.

The video looks at the five key principles of the Mental Capacity Act (MCA), and how these can be applied to the care planning process.  It shows, through interviews with self-advocates, and health, legal and social care professionals, how the proper application of the MCA is needed to ensure that care planning is person-centred and empowering. The film stresses the importance of planning for the least restrictive option in any situation, and always acting in the best interests of people who lack capacity, and not in organisational interests. It talks about how advance decisions about future treatment can be really helpful.

What is ‘best interests’?

The MCA provides a non-exhaustive checklist of factors that decision-makers must work through in deciding what is in a person’s best interests.

Some of the factors to take into consideration are:

  • Do not discriminate. Do not make assumptions about someone’s best interests merely on the basis of the person’s age or appearance, condition or any aspect their behaviour. 
  • Take into account all relevant circumstances
  • If faced with a particularly difficult or contentious decision,  it is recommended that practitioners adopt a ‘balance sheet’ approach
  • Will the person regain capacity? If so, can the decision wait?
  • Involve the individual as fully as possible
  • Take into account the individual’s past and present wishes and feelings, and any beliefs and values likely to have a bearing on the decision
  • Consult as far and as widely as possible.

Again, it is vital that you record your best interests decision. Not only is this good professional practice, but given the evidence-based approach required by the MCA, you will have an objective record should your decision or decision-making processes later be challenged.

For more detailed information you should refer to the Mental Capacity Act Code of Practice.