Best interests and involving the person and others

If a person lacks capacity for a particular decision and the decision cannot safely wait, it must be made in their best interests. Best interests is not about what is quickest for staff, cheapest for the provider, or preferred by the loudest relative.

What best interests involves

• Involve the person as far as possible: even if they cannot make the final decision, their views, preferences and responses should inform the process.
• Consider past and present wishes: review values, beliefs, routines, relationships, culture and any prior statements or decisions.
• Consult relevant others: family, friends, attorneys, deputies, advocates and professionals may hold important information for the decision.
• Avoid discriminatory assumptions: do not base decisions on age, diagnosis, appearance or behaviour, or on what staff find most convenient.
• Consider whether capacity may return: if the decision can safely wait, delaying it may be preferable.
• Choose the least restrictive option: meet the need in the way that interferes least with the person’s rights and freedom.

Who is the decision-maker?

The decision-maker is the person or team with responsibility for that specific decision. For day-to-day care this may be the care team or nurse in charge. For significant medical or accommodation decisions it may be a clinician, a local authority professional, or the court. Frontline staff frequently provide essential evidence but are not always the final legal decision-maker.

Best interests means keeping the person at the centre when they cannot make the decision alone. It is a structured process, not a shortcut for staff convenience.