BMA guidance

Best interests decision-making for adults who lack capacity toolkit

This toolkit provides practical guidance to assist doctors in making decisions in the best interests of adults who lack capacity in England and Wales.

Location: England Wales
Audience: All doctors
Updated: Tuesday 5 September 2023
Topics: Ethics
Justice scales article illustration

This toolkit will provide you with practical guidance when faced with making decisions for adults who lack capacity.

It sets out an overview of the law in England and Wales; outlines a clear decision-making process to follow and provides detailed practical advice as to who you should consult and the information you need in reaching a decision.


What you'll get from this guide

  • An overview of the law in England and Wales as it relates to medical decision-making for people who lack capacity.
  • A clear framework for your decision-making process. 
  • Detailed practical guidance about who should be consulted as part of a best interests decision; what factors you should consider in reaching a decision and how competing factors can be balanced.


How to use this guide

This guidance will provide you with the legal and ethical considerations you need to take into account when making a decision and signposts to other sources of support and information.

It is not a set of rules or instructions, or a substitute for careful reflection and discussion. You can seek additional advice on specific dilemmas from the BMA’s medical ethics and human rights department, the GMC, or your medical defence organisation.

Need help? For questions about any aspect of your working life, our advisers are here to help you. Opening times: 8am - 6pm Monday to Friday (excluding UK bank holidays)
  • The Mental Capacity Act 2005: a refresher
  • Key principles of best interests decision-making
  • Who is the decision-maker?
  • Who should be consulted?
  • What should be considered as part of a best interests decision?
  • How do I use the information I gather?
  • Best interests meetings
  • Recording best interests decisions and keeping them under review
  • Disputes
  • Best interests and life-sustaining treatment