“Best interests” decision-making should always be collaborative. Whoever is the best interests decision-maker, there is an obligation in the MCA to consult “others engaged in caring for [the patient] or interested in their welfare” about best interests, and in particular, to make sure that the decision-maker is as fully informed as possible about the patient’s wishes, values, beliefs, and what they want for themselves (MCA s4(6) and 4(7)).
For decisions about medical treatment, “best interests” is to be interpreted much more broadly than simply medical risk/benefit — it includes social, emotional, and all other relevant aspects.
In any case, wherever possible, all individuals should be involved in decisions about their care and treatment. Every reasonable effort should be made to ensure that their views are sought and shared.
It is not mandatory that a best interests decision involves a formal meeting. However, for serious decisions, it may be appropriate to hold one or more meetings to discuss the matter with professionals and others such as family, friends, or anyone else engaged in caring for the patient or interested in their welfare.
Disputes about best interests can be resolved by the Court of Protection. The onus should be on the public body proposing the treatment to bring the case to court, so there should be no costs to the family.
