Best Interests Meeting
These meetings need to take place when there is no Health and Welfare Lasting Power of Attorney in place, when the person under discussion has lost mental capacity to make decisions for themselves and there is a difference of opinion between the various parties involved. Often the difference is between the family and the healthcare professionals looking after the person.
So who is involved? What happens? And how to they work?
The people involved are the person themselves, to the extent that they can participate, which may be not at all, but they may be very involved. The person’s family, since it is usually the family that have the disagreement, but it may be that the disagreement emanates from the person themselves. There is usually a chair of the meeting and someone to take minutes. The other people there are those that are relevant to that person’s care. So it might include a general nurse, a mental health nurse and doctor or consultant, a social worker or a physio. It all depends on the needs of the individual. There may also be an IMCA, who is an advocate for the person, they should have met and spoken with them prior to the best interests meeting and their role is to put forward that person’s view.
The purpose is to consider the options that are available and consider their advantages and disadvantages. The chair of the meeting should also consider the Principles of the Mental Capacity Act 2005, which are:
- a) A person must be assumed to have capacity unless it is established that they do not have capacity.
- b) A person is not to be treated as unable to make a decision unless all practicable steps to help him make a decision have been taken without success.
- c) A person is not treated as unable to make a decision merely because it is an unwise decision.
- d) An act done or decision made under this Act for or on behalf of a person who lacks capacity must be done or made in his best interests.
- e) Before the act is done or decision is made, regard must be had to whether the purpose for which it is needed can be effectively achieved in a way that is less restrictive of the person’s rights and freedoms of action.
The key ones for this purpose, since the lack of capacity will have been established is the principle around best interests and that the option should be the less restrictive. It is not the least restrictive option, since the least restrictive would be to do nothing and that is not always an option!
The meeting will then look at each of the proposed options one by one and each party will get a chance to say their views about the advantages and disadvantages. Then having discussed the first option, they move onto the next one and then the third, if there is one. Once there has been a discussion of the advantages, it is hoped that an answer will emerge after discussion.
Although the options are discussed, sometimes they are discussed is to “go through the process”, as someone will bring up a disadvantage that is unsurmountable, so it is never a realistic option and should have been dismissed before it was ever proposed at the best interests meeting.
These meetings can take 1-2 hours and seem laborious and stressful for families, the discussions seem prolonged and the process cumbersome.
For any family member going through this, if you feel overwhelmed at the prospect, let me know, I can attend and support you, which will take away some of the stress of the situation. You will still have a poorly relative, I can’t change that, but I can sort out some of the situation for you.