4 Best interests Introduction Decision making The best interests checklist Life sustaining treatment Recording the decision Key Learning Points 4f References and further reading Reflective Exercise Quiz Reflective Exercise Topic: Best Interests Michael, a retired Classics teacher, is 85 and has lived alone since the death of his wife. He has no other family. He has just returned home following admission to hospital after having a stroke. His neighbours in the village keep a watchful eye on him but he has always been fiercely independent and is reluctant to receive any help around the home. He still insists on riding his trusty bicycle to the nearby town to get shopping, something he has done for over thirty years, but he is becoming increasingly unsteady on it. He has some heart failure, increasing signs of dementia and memory loss and there have been concerning episodes of risky behaviour associated with his increasing forgetfulness. A recent fall from his bicycle has escalated concern to a point whereby his GP has asked him to consider more home support and someone to do his shopping for him. Michael refuses to accept that he is not coping and is now rejecting all approaches to offer help and or support from any avenue. He has, however, stopped riding his bicycle as it was damaged in his fall and is now not eating because he is “making supplies last” until he can get out and about again. What do you need to know more about with regards to this situation? What specific elements of the MCA might apply? How might your preconceptions/assumptions about this person influence you? How would you ensure your approach is ethical and unbiased? How do you ensure you are communicating in a way to involve the individual in the decisions made about them? Email me a copy of my answers Next:Quiz 0 Introduction 1 Reflecting on values and bias within mental capacity decision-making 2 The history and current context of mental capacity legislation and policy 3 The concept of mental capacity 4 Best interests 5 Supported decision making 6 Deprivation of liberty: human rights 7 MCA in clinical decisions for care and treatment 8 MCA and the Office of the Public Guardian (OPG) role 9 Conclusion