Toward a Pure Best Interests Model of Proxy Decision Making for Incompetent Psychiatric Patients

Discharge‐planning for long‐term care needs: the values and priorities of older people, their younger relatives and health professionals

“…Another limitation of the current study was that identical interview questions had differing levels of personal relevance for the different stakeholders. Future researchers could consider asking all participants directly about their hypothetical future selves, as well as about others, because people considering proxy decisions may make more conservative suggestions (56).…”

Capacity as a Determinant of Non-consensual Treatment of the Mentally Ill in Australia

“…The application of non-consensual treatment to PLWMI should rest on a finding that a person lacks capacity, and in such cases treatment decisions should be based upon an estimate of what the person 254 C. J. Ryan might have wanted had they retained capacity. 59 Capacity assessments are a day-to-day part of the work of mental health clinicians and, as revealed above, capacity assessments are already legally required in five of Australia's jurisdictions. In these jurisdictions particularly, legislative reform that introduced a capacity test would not involve any new task.…”

Best interests, dementia and the Mental Capacity Act (2005)

“…McCubbin and Weisstub5 argue that the concept of best interests necessarily has an underlying meaning or objective. According to their position the MCA should provide an account of what is being aimed at in determining best interests.…”

“…According to this view (see box 1) we ask the hypothetical question: what decision would the person make now, if he or she were “magically” able to regain capacity long enough to make a decision, but that apart from regaining capacity, he or she would remain in exactly the same situation as he or she is in currently? (see for example Buchanan and Brock;14 Berghmans;6 Savulescu and Dickenson15) McCubbin and Weisstub5 argue essentially in favour of the position that this type of substituted judgement (which they call pure best interests) should be the core meaning (or objective) of best interests on the grounds that it is derived from the right of an adult with capacity to have a contemporaneous decision respected.…”

“…Basing best interests exclusively on the idea of desire-fulfilment, whether current desires or on a dispositional account seems inadequate, although desire-fulfilment might be one component of best interests. For these reasons we believe that McCubbin and Weisstub5 are wrong in insisting that the concept of best interests necessarily has an underlying meaning or objective? We agree with writers such as Kopelman23 and Holm,19 who not only see judgements about best interests as properly based on several types of evidence, but also see the concepts themselves as being made from a mixture of components.…”