Making healthcare decisions in a person's best interests when they lack capacity: clinical guidance based on a review of evidence.
Derick T Wade, Celia Kitzinger
PMID 31169031WHAT IT FOUND
In England and Wales, guidance says healthcare teams should build a long-term best-interests policy for adults lacking capacity, not treat each decision as a separate meeting.
Key findings
01The guidance says the healthcare team should set out a strategic best-interests policy for an adult who lacks capacity, rather than treating each decision as a separate meeting.
02Family and friends are asked to provide information about the patient's wishes, values and beliefs; they do not make the decision.
03The guidance suggests reviewing a stable person's best-interests policy every 6 to 12 months, and holding a new meeting within 7 to 14 days when the person moves to a new setting.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
It is guidance, not a study with patient outcomes, so it cannot show that the proposed process improves care. It is written for England and Wales law, so its legal requirements may not apply elsewhere. It assumes the team can find family, friends or prior information about the patient's wishes, which may be difficult. It recommends meetings, documentation and reviews but gives no tested way to make them practical in busy services.
Declared interests
No financial support was received. Dr Wade is paid for assessing some people in a prolonged state of unconsciousness. Professor Celia Kitzinger has a sister who was in a prolonged disorder of consciousness.
The easy way to misread this
Do not read this as evidence that best-interests meetings improve outcomes. It is clinical guidance based on a review, not a trial of the process.