When making a best interest decision, it is important to gather as much information as possible in order to make an appropriate and informed choice. This is Ben’s story: Should Ben have the flu vaccine? Who makes that decision?
Ben
Ben attends day care and sometimes has short breaks away from home. He can make some decisions for himself about day-to-day things and wishes that staff, family, and friends would listen to him more. He finds it difficult to understand the long-term consequences of his treatment. Last year, he was seriously ill and did not enjoy being in hospital—where he felt he wasn’t listened to. Ben communicates verbally but can be hard to understand if people don’t give him enough time. His behaviour can sometimes be challenging, usually due to frustration when he’s not listened to or when people make assumptions about his abilities.
Ben is scared of needles.
Ben’s Parent
Ben is one of four children and has always taken up much of his parent’s time and energy. He is dearly loved. Ben’s parents do not believe in the flu vaccine, as his grandmother died the same year she had it. Ben has been offered the vaccine. While his parents do not want him to go to hospital again, the thought of getting him ready for the vaccine is exhausting. They know he may become angry or distressed and could be difficult to live with for the next week.
Ben’s GP
Ben’s GP has cared for him and his family for many years and is well aware of the complexity of his condition and behaviour. The GP believes the flu vaccine would be helpful and is encouraging the family to bring Ben to the clinic.
Day Care Worker
Ben’s keyworker knows him well and supports him in expressing his thoughts and feelings using his preferred communication methods—Makaton and speech. She has a close working relationship with him, understands his needs and his family’s concerns, and would be happy to facilitate any interventions that are in his best interests. She believes she is a good advocate for Ben.
Consultant Neurologist
Ben has been known to his neurologist since transitioning into adult services. His clinic attendance has sometimes been inconsistent. The consultant is aware that Ben’s last hospital admission was traumatic and believes the flu vaccine is a good option to help avoid another admission. He has encouraged Ben’s GP to follow up the vaccine offer and has recommended a clinic he thinks would be suitable.
District Nurse
The lead district nurse at the clinic has experience working with patients with similar needs to Ben. She is happy to support the referral and would be the person administering the injection.
Who Makes the Decision?
The person administering the procedure—in this case, the district nurse—would be responsible for making the best interest decision. She must take into account the views of everyone involved: Ben, his parents, keyworker, GP, and specialists. She must also assess whether Ben has the capacity to make the decision himself. On the day, she would need to determine whether it is the right time to proceed—particularly if Ben is highly distressed. Preparation work with Ben could help support a positive outcome.
