A special factor in the Best Interests Checklist applies to decisions about treatment which is necessary to keep the person alive (otherwise known as life sustaining treatment). The fundamental rule is that anyone who is deciding whether or not life sustaining treatment is in the best interests of someone who lacks capacity to consent to or refuse such treatment, must not be motivated by a desire to bring about the person’s death.
Whether a treatment is life sustaining depends on the type of treatment and on the particular circumstances in which it may be prescribed. For example, in some situations giving antibiotics may be life sustaining, whereas in other circumstances antibiotics are used to treat a non-life threatening condition. It is up to the doctor or healthcare professional giving the treatment to assess whether the treatment is life sustaining in each situation.
All reasonable steps which are in the person’s best interests should be taken to prolong their life. There are some cases – for example where someone has a terminal illness and is nearing the end of their life – where treatment would not be appropriate, as side effects may be too much to bear or where there is no prospect of recovery.
In such circumstances, it may be that an assessment of the person’s best interests concludes that it would be in their best interests to stop or not give life sustaining treatment, even if this may result in their death.
The decision maker’s decision must be based on the person’s best interests. They must not be motivated by wanting the person to die for whatever reason, even if this is because they do not want them to suffer any longer.
As with all decisions, before deciding to withdraw or withhold life sustaining treatment, the decision maker must consider the range of treatment options available to work out what would be in the person’s best interests. All the factors in the Best Interests Checklist should be considered, and the decision maker should consider any statements that the person previously made about their wishes and feelings about life sustaining treatment.
This does not mean that doctors must provide, or to continue to provide, life sustaining treatment where that treatment is not in the person’s best interests, even if they may die as a result.
Where a person who does not have mental capacity previously made a written statement in advance about particular medical treatments when they did have mental capacity, such as being fed by a tube, these should be taken into account by the doctor in the same way as those made by a patient who has the mental capacity to make such decisions.
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