18 December 2012

Supporting doctors with the ethical challenges of determining ‘best interests’

Doctors taking decisions on the ‘best interests’ of incapacitated patients also need to take into account the interests of others when making their assessments according to researchers on the Essex Autonomy Project at the University of Essex.

Their analysis An unblinkered view of best interests was published this month in the British Medical Journal and argues against a recent trend to focus solely on the patient, while also offering advice on interpreting the Mental Capacity Act 2005

The article looks at the ethical dilemmas faced by medical professionals and others involved in the care of a patient and how they should interpret ‘best interest’ in the context of the Mental Capacity Act. The Act says doctors must act in the ‘best interest’ of the patient, but does not clearly define what this means. This lack of clarity has led to confusion about how to assess best interest.

The Essex Autonomy Project team argues in the article: “Doctors often find themselves in circumstances where they must make decisions on behalf of an incapacitated patient. As a matter of both ethics and law, such decisions must be taken in the best interests of the patient, but uncertainty remains about what is meant by best interests, especially in relation to the interests of others. Should the interests of others enter into a determination of the patient’s best interests? We believe that they should and argue against a recent trend to focus solely on the patient.”

The article is written by members of the Essex Autonomy Project team including Professor Wayne Martin, Dr Fabian Freyenhagen, Dr Tom O'Shea, Dr Antal Szerletics and Postgraduate Research Assistant Vivienne Ashley, as well as Dr Elizabeth Hall, a retired consultant in palliative medicine.

The authors use four fictional case studies to investigate the complex decisions doctors are facing everyday on how to assess the best interests of patients who may be incapacitated due to illness, dementia or physical injury. They also draw on case law to offer support on interpreting the legal situation.

The article concludes: “The Mental Capacity Act provides that treatment undertaken on behalf of an incapacitated patient must be undertaken in the patient’s best interests. But provided that a benefit to a third party can be shown to advance the best interests of the patient, it is both ethical and legal to take it into account. In assessing the best interests of patients clinicians should therefore be ready and willing to “take the blinkers off,” recognising that the best interests of the patient may in some cases be decisively shaped by the best interests of someone else.”

The Essex Autonomy Project is an interdisciplinary research and knowledge exchange initiative, which investigates the ideal of self determination in human affairs, particularly in the vocations of care. The project is funded by the Arts and Humanities Research Council (AHRC).

For more information contact the University of Essex Communications Office on 01206 874377.

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