What is a best interests meeting?

A best interest decision is a formal process used to make choices on behalf of someone who lacks the mental capacity to make a specific decision for themselves. This concept is central to the Mental Capacity Act 2005 in England and Wales, which provides a legal framework for supporting individuals who may be unable to make decisions due to conditions such as dementia, learning disabilities, brain injuries, or mental health issues. There is no single definition of best interests. The Mental Capacity Act sets out a checklist of factors to be considered when making a decision.

A best interest decision is a formal process used to make choices on behalf of someone who lacks the mental capacity to make a specific decision for themselves. The concept is key to the Mental Capacity Act of 2005 which governs capacity law in England and Wales. There is no one definition of bests interests. Instead this piece of legislation sets out a checklist of factors which need to be considered when making a best interest decision.

This process will be used when someone is assessed as lacking capacity to make a decision for themselves and has no advanced decision, lasting power of attorney or deputyship order in place, and the decision cannot be delayed (if there is a possibility of capacity returning). Best interest decisions are not just medical decisions. They can be related to financial matters but also more general life decisions. If you are faced with making a best interest decision you need to consider the individual's needs and welfare in the widest sense and take into consideration their wishes and feelings, values and beliefs.

When Is a Best Interest Meeting Needed?

A formal best interest meeting may be convened when:

• The decision is complex or life-changing (e.g., surgery, moving to a care home)

• There is disagreement among those involved

• The person has no close family or friends to consult

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How Is a Best Interest Decision Made?

The process involves:

• Gathering Information: Understanding the person’s medical, emotional, social, and cultural needs.

• Consulting Others: Involving family members, carers, healthcare professionals, and anyone else who knows the person well.

• Considering the Person’s Wishes: Taking into account past and present wishes, beliefs, and values.

• Balancing Risks and Benefits: Weighing the potential outcomes of each option.

• Documenting the Decision: Clearly recording the rationale, who was involved, and how the decision was reached.

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Consulting others is a really important part of this process. In the absence of the person making a decision for themselves you, as family or friend are the next person who is most likely to be able to advise what the individual who lacks capacity wanted. This means they must talk to you! We have seen too many situations where professionals have chosen to ignore or not even invite family and those involved in a person's care to a best interest decision making meeting. If you are heavily involved in a person's life it does not matter whether the decision being made is financial or welfare you should be spoken to.

The decision about the individual and what they would want not what is best for those around them or what the reasonable person would want.

There is a formal meeting process which must be followed for a best interest meeting. There is a chair of the meeting, a decision maker, minutes are taken and conclusions are reached. Discussions, whether heated or not, are had, suggestions are debated and argued through. Pros and cons of situations are considered until an agreement is reached. I Decisions could be about medical treatment for someone living with dementia, choosing a care home or managing finances.

Who Makes the Decision?

Depending on the context, the decision-maker could be:

• A healthcare professional (e.g., doctor, nurse)

• A social worker

• A legal guardian or attorney under a Lasting Power of Attorney (LPA)

• A Court of Protection-appointed deputy

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In the absence of agreement or if there are concerns about a decision the Court of Protection will be asked to exercise its decision making authority.

Best Interest Decisions are about more than just safety. They are about dignity, respect, and person-centred care. By following a clear, inclusive, and transparent process, professionals can ensure that decisions made on behalf of others are both lawful and compassionate. However, these are not always carried out as they should be.

If you have an upcoming best interest decision meeting or have attended one and did not feel you were heard give us a call for some support and advice.