Reflecting on values and bias in mental capacity decision-making

Defensive Practice

Defensive practice can be seen when a health or social care professional sets their own professional needs/concerns above the interests of their patient/service user. Professionals may practice in a defensive way for a number of reasons including:

  • When they are anxious about making mistakes – might result in rigid procedurally driven practice  
  • Where they fear of blame for getting it wrong
  • Focusing on task completion/getting it done rather than on empowering the patient/service user. This principle of self-determination requires that practitioners respect the wishes of the patient/service user even where they do not consider it to be in the patient’s best interests to do so.

Defensive practice may occur where professionals wish to avoid risk decisions. For example, within Best Interest assessments the rights and preferences of service users might be undermined by subjective aspects of professional decision-making which avoid risk at the expense of choice and Autonomy. The impact of risk averse practice within best interest decisions can compromise the rights and interests of service users with the result ‘that ‘best interests’ may be conflated with the clinician’s evaluation of ‘best medical interests’. When an assessor disagrees with a person’s choice, they are prone to suggest that a person lacks capacity in their decision, rather than accepting it as an unwise choice.