Best interest decisions often come into play when an individual lacks the capacity to make decisions related to their health and wellbeing, as governed by the Mental Capacity Act 2005 in the UK. In these situations, the responsibility of decision-making may fall on healthcare professionals or appointed decision-makers like a legally appointed welfare attorney or a court-appointed deputy

The concept of ‘best interest’ as per the Mental Capacity Act 2005 isn’t specifically defined but, in making best interest decisions, the decision-maker must consider the person’s past and present wishes and feelings, the beliefs and values that the person would likely consider, and the views of other people close to them such as family and caregivers.

Next of kin or family members do not have automatic legal rights to make decisions for a person who lacks capacity unless they have been legally appointed to do so. They can, however, offer valuable insights into the person’s past and present wishes and feelings which can guide healthcare professionals in making the most appropriate decisions while considering the best interests of the individual.

For example, if a person is in a coma and unable to make decisions about their treatment, while their partner (being the next of kin) cannot directly take the decisions, their views about what the patient would have wanted will carry weight in discussions with the healthcare team about the course of treatment.

An Advance Decision to Refuse Treatment (ADRT) can provide further clarity in these situations. An ADRT is a decision you can make now to refuse a specific type of treatment at some time in the future. It is a useful document to have as it makes your wishes clear to anyone who might be involved in your care or treatment, particularly when you are unable to express them yourself. The myADRT service offers people an opportunity to prepare an ADRT form swiftly and effortlessly and is a valuable asset for such scenarios.

Following on from the discussion on whether next of kin can make best interest decisions, few questions may arise. These could include “Who usually makes best interest decisions when a person can’t?”, “What are the steps involved in making a best interest decision?”, and “How can an Advance Decision to Refuse Treatment (ADRT) affect best interest decisions?”.

1. Who usually makes best interest decisions when a person can’t?

Best interest decisions are typically made by health and social care professionals providing care for a person who lacks capacity to make these decisions themselves. This is firmly established in the UK’s Mental Capacity Act (MCA) of 2005. The professional might be a GP, a hospital doctor, a nurse, a social worker, or any other healthcare provider. The key point is that the decision is made by someone with appropriate professional expertise, guided by the principle of acting in the person’s best interests.

It’s also worth noting that in decisions of long-term care or significant treatment changes, a formal best interest meeting is often held. Attendees may include professionals from different disciplines, the patient if possible, and usually close family members or friends who know the patient well.

2. What are the steps involved in making a best interest decision?

Normally, making a best interest decision involves five key steps. These include assessing if the person lacks capacity, not treating the person’s lack of capacity as a justification for decisions, all consideration must be in the best interest of the person, any existing advance decisions must be taken into account, and all decisions should least restrict the person’s rights and freedoms.

The decision-maker must also consult other people close to the person, where practical and appropriate, to better understand the person’s needs, wishes, and values.

3. How can an ADRT affect best interest decisions?

An ADRT is made when a person has the capacity to make decisions about their future medical treatment and wishes to refuse a specific type of treatment in certain circumstances in the future. It is legally binding, meaning that healthcare providers must adhere to it, even if it goes against what they believe is in your best interest.

Importantly, when accurately completed, an ADRT specifies the treatments a person would refuse if they were unable to make or express decisions themselves. Therefore, it can have a significant impact on best interest decisions, as it provides a legally binding declaration of the person’s wishes. This means that the healthcare professionals would be legally obliged to follow it, as long as the ADRT applies to the current circumstances.

For example, if a person had filled ADRT on the myADRT website specifying they wished to refuse resuscitation in the event of cardiac arrest, healthcare professionals caring for that person would be bound to respect this decision if the situation arose.

In summary, an ADRT offers a way for people to assert their treatment wishes for the future and can significantly influence best interest decisions if they become unable to communicate or make decisions. Therefore, it’s crucial to provide clear, accurate information when completing one.

If you are considering creating an ADRT or updating an existing one, we encourage you to register your ADRT form with myADRT by visiting https://myadrt.com/register/  By registering with myADRT, you can ensure that your document is created, stored, and shared more efficiently with healthcare professionals and trusted individuals involved in your care.

Additionally, please consider sharing the myADRT service with your friends, family, or loved ones who may also benefit from having an ADRT in place. By spreading the word about this valuable service, you can help others take control of their future medical care and ensure their wishes are respected even when they are unable to communicate them personally. Registering an ADRT with myADRT is a proactive step towards peace of mind for both you and the people who care about you.