The key issue about best interests, is that it does not become relevant if the person can make decisions for themselves.  It is only when they are unable to make that decision does the issue of what is in their best interests become relevant.

There are lots of statutory criteria about what should and should not be taken into account and these are discriminatory factors, people’s decision making should not be based on how other people view that “category / type / kind” of person, so not based on age or gender for example.

There is some case law about a balance sheet, so the positive things and the negatives things should be weighed up against each other.  Sometimes, there are lots of things in one side of the balance sheet and not many on the other side, but what is on the side with not many points has very important key points that are of “magnetic importance”, so can outweigh the other side.

I have been involved with decision making about someone living in their own home, that it is risky and they are safer in a care home.  But crucially, they want to go home, this is very important to them.  So what might be of magnetic importance is not whether it is safe, but whether it is impossible!

Best interests decision making is not substitute decision making, which is what would the person decide if they could choose?  That is part of the balance sheet, but it may not be the final decision, but it should be an important factor to consider.

Best interests is also about what is best for this particular person, not a generic person, so not a generic disabled person or a generic old person, but this person.  What are the circumstances of their life that are relevant to the decision making process, what choices are available and what choices are not possible?  Whilst the theory of some lovely choice that is not achievable might be nice, if it is never going to happen, then it is should not be part of the consideration.

The decision maker might be an attorney, it might be a judge or it might be a healthcare professional.  The final decision needs to be made carefully, so that the best possible outcome for this person can be achieved.

The decision may need to be revisited in the future and then with hindsight, the decision made might not have such a good outcome, but hindsight is never available at the time of the decision.

All decision makers can ever do is weigh up the choice and hope it’s the right on