Making healthcare decisions in a person's best interests when they lack capacity: clinical guidance based on a review of evidence.

Making healthcare decisions in a person's best interests when they lack capacity: clinical guidance based on a review of evidence.
Clin Rehabil. 2019 Jun 06;:269215519852987
Authors: Wade DT, Kitzinger C
Abstract
OBJECTIVE: To clarify the concept of best interests, setting out how they should be ascertained and used to make healthcare decisions for patients who lack the mental capacity to make decisions.
CONTEXT: The legal framework is the Mental Capacity Act (MCA) 2005, which applies to England and Wales.
THEORY: Unless there is a valid and applicable Advance Decision, an appointed decision-maker needs to decide for those without capacity. This may be someone appointed by the patient through a Lasting Power of Attorney, or a Deputy appointed by the court. Otherwise the decision-maker is usually the responsible clinician. Different approaches exist to surrogate decision-making cross-nationally. In England and Wales, decision-making is governed by the MCA 2005, which uses a person-centred, flexible best interests (substituted interests) approach.
OBSERVATIONS: The MCA is often not followed in healthcare settings, despite widespread mandatory training. The possible reasons include its focus on single decisions, when multiple decisions are made daily, the potential time involved and lack of clarity about who is the responsible decision-maker.
SOLUTION: One solution is to decide a strategic policy to cover...

Source: Clinical Rehabilitation - June 5, 2019 Category: Rehabilitation Authors: Wade DT, Kitzinger C Tags: Clin Rehabil Source Type: research