It is important to remember that capacity is decision specific, so at any time a patient may have capacity for some decisions but not for other more complex ones. It is also important to remember that capacity is time specific and may fluctuate due to the clinical condition of the patient. In circumstances when a patient lacks capacity, the medical team must make a treatment decision in the
made in the past, any advance statements or advanced decisions, and involving the patient as much as possible, and seeking information and views from family members, friends and staff that may aid the decision making. The MCA Code of Practice contains a Best Interests checklist for guidance, to ensure a broad approach considering all aspects of a patient’s life is taken when making a Best Interests decision.
Some people may have made written advanced statements before becoming unwell, giving the medical team an idea of what would and wouldn’t be acceptable to the patient in the event of losing capacity. These are not legally binding but contribute to the Best Interests decision making process. Some patients also make a formal advanced decision to refuse a specific treatment in certain circumstances. These decisions are legally binding, and must be written and signed as witnessed by an independent person to apply to refusing lifesaving
best interests of the patient. This should include not only
considering what is medically the best treatment option, but also consideration must be given to what the patient would likely want to be done in the given situation. This will include considering treatment decisions they may have
treatment; for example invasive ventilation or cardiopulmonary resuscitation.
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