Best Interests and Least Restrictive Care

If a patient lacks capacity for a necessary decision, the question is, "What is in this person's best interests, using the least restrictive option that meets the need?" The person should be involved as fully as possible in decisions about their care.

Best-interests thinking includes

• The patient's past and present wishes, feelings, beliefs and values.
• Whether the decision can safely wait until the patient may regain capacity.
• Views from carers, family, attorneys, deputies, advocates or others involved in their care.
• The clinical benefits, burdens, risks and reasonable alternatives.
• The option that interferes least with the person's rights and freedoms while achieving the clinical aim.

Dental examples include deciding whether to adjust a denture, extract a painful tooth, provide preventive care, use sedation or defer treatment. Dental nurses often know practical details such as the patient's preferred time of day, which carer calms them, or whether they need a clear stop signal to avoid distress.

The least restrictive option is not always the smallest intervention. Doing nothing may allow avoidable pain or infection. A staged appointment, an acclimatisation visit, a local adjustment or extra communication support can sometimes avoid a more restrictive approach.

Dental nurses help keep best-interests discussions grounded in the patient's everyday reality. They may observe that a loose denture stops the person eating, that lying flat causes distress, or that a particular carer can reliably help the person communicate pain.

IMCA and deprivation of liberty

Best interests are not the same as convenience. Least restrictive care asks whether the same clinical aim can be achieved with less interference in the person's rights and dignity.