The Mental Capacity Act: 'Best interests'-a review of the literature

The Mental Capacity Act (MCA) is statutory legislation introduced in 2007 in order to provide a consistent, robust framework with the aim to protect and empower people to make decisions themselves. However, an assessment as per the MCA may demonstrate that a person is lacking mental capacity and therefore unable to make an autonomous decision at the time it needs to be made. In this case, a 'best interests' decision may be made on their behalf, ensuring their wishes and beliefs are at the centre of the decision-making process. When making a best interests decision, a health practitioner must follow the guidance as set out in the MCA legislation to ensure fair and consistent approaches to safeguard and provide assurance that the outcome is truly the best decision for the individual. This review of the literature supports the findings of a 2014 post-legislative review by the House of Lords, which concluded the principles of the MCA are not sufficiently embedded into the practice of all health practitioners, due to a lack of knowledge, awareness and understanding. However, the evidence base also appreciates making a decision on behalf of another person can be a stressful, complex and intricate process when further support may be required from the wider multidisciplinary team, including potentially seeking legal advice.