Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Best-interests decision-making and least restriction
Essential points for quick revision.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Immediate treatment before full consultation
Serious deterioration may make delay unsafe, but emergency best-interests action must remain necessary, proportionate and compatible with any known valid refusal or court decision.
Action: Search rapidly for advance decisions and authorised proxies, involve the person as far as possible and provide only treatment needed to prevent serious harm while wider evidence is gathered. Document urgency, alternatives, restraint and review, and seek immediate senior or legal advice for disputed life-sustaining treatment or uncertain authority.
Synopsis
Make transparent, lawful decisions when a person cannot decide, first respecting valid prior authority, then centring wishes, values, clinical options, consultation and the least restrictive effective course under the correct UK jurisdiction.
Confirm that capacity is absent for the specific decision after practicable support and consider whether the choice can wait for recovery.
Check first for a valid applicable advance refusal, health-and-welfare attorney, deputy, guardian or court order and verify the exact scope of authority.
In England and Wales, encourage participation and consider all relevant circumstances, present and past wishes, values, beliefs and the views of appropriate people.
Key red flags
A valid and applicable advance decision refusing treatment in England and Wales is binding and cannot be replaced by a clinician's or family's view of best interests.
Investigation priorities
01
Capacity and timing confirmationFirst step
Verify inability for this decision and whether safe delay could restore personal decision making.
Management branches
Best-interests processAuthority first, then person-centred balance
The patient cannot make the specified decision and safe delay will not restore capacity in time.
Check binding refusals, proxy or court authority and involve the person using the best available communication and support.
Gather wishes, values, professional evidence and appropriate consultation, then compare all clinically available options and no action.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Mental Capacity Act 2005England-and-Wales advance decisions, best interests, restraint, LPAs and court powers.