Managing your care if you have not planned ahead

If you have not planned ahead and become unable to make decisions, your family and carers will usually be involved in making everyday decisions about your care.

But sometimes a decision may need to be made about your medical care or treatment. This is done by a senior healthcare professional. They will discuss any decision with your family and anyone else involved in your care. They are known as best interests decisions.

The Mental Capacity Act 2005 ensures that when making a best interests decision:

  • those who make decisions think about all the relevant circumstances about your care
  • the motives of the person making the decision are proper and in your best interests.

If a best interests decision is about life-sustaining treatment, the views of family members and friends will be considered. But the final responsibility for the decision remains with the senior healthcare professional.

Sometimes, healthcare staff may need to appoint someone as an Independent Mental Capacity Advocate (IMCA). An IMCA represents your interests, if you cannot do so yourself or have no family or friends to represent you.

Best interests decisions

You may worry about who will make decisions about your care if you have not planned ahead and you become seriously ill and unable to make decisions for yourself.

Usually your carers and family will be involved in making everyday decisions about your care. However, sometimes a decision may need to be made about your medical care or treatment.

If this is the case, a senior healthcare professional will make the decision about giving you a treatment. They will base this decision on their experience and understanding of your circumstances. They will discuss the decision with your family, friends and anyone else who might be involved in your care. These decisions are known as best interests decisions.

The Mental Capacity Act 2005 sets out several factors that should be considered when making a best interests decision. These include:

  • all the relevant circumstances
  • your past and present wishes, and values and beliefs
  • the views of anyone caring for you, such as a family member, friend or carer.

The Act states that a best interests decision should not be based on your age, condition, appearance or any aspect of your behaviour.

The Act ensures that those who make decisions, think about all the relevant circumstances about your care. It also makes sure that the motives of the person making the decision are proper and in your best interests.


Decisions made by healthcare professionals

If a best interests decision is about life-sustaining treatment, a health professional cannot be motivated by a desire to bring about someone’s death. They should look at the appropriate treatment options available to make sure that the best interests of a person are met.

The views of family members and friends will be considered in any best interests decision. But the final responsibility for the decision remains with the decision maker. This is usually a senior healthcare professional. Occasionally, this will mean that the views of family members are not followed. In this situation, the healthcare professional should explain the law regarding best interest decisions and the reason for the decision to the family.


Independent Mental Capacity Advocates

In some situations, medical staff may need to appoint someone as an Independent Mental Capacity Advocate (IMCA). This person acts as your advocate and represents your interests, if you cannot do so yourself. This will usually only happen if you do not have a Health and Welfare Lasting Power of Attorney and have no family or friends able or willing to represent you.

IMCAs are usually appointed if a non-urgent decision needs to be made on your behalf that involves serious medical treatment, such as:

  • giving new treatment
  • stopping treatment that has already started
  • withholding treatment that could be offered.

In this situation, the IMCA will consider how giving, stopping or withholding treatment will affect you and whether your life is likely to be made better or worse. For example, giving you a new treatment may cause side effects such as sickness or pain and may give you a longer life by only a few weeks. The IMCA will work with your medical team to make sure that your civil, human and welfare rights are respected and all options are considered before a decision is made.

IMCAs may also be appointed if an NHS body or local authority is proposing to arrange accommodation or a change of accommodation in hospital or a care home, and:

  • the person will stay in hospital longer than 28 days, or
  • they will stay in the care home for more than eight weeks.

IMCAs may also be appointed to input into decisions in relation to care reviews and adult protection cases.

You can find out more information about the IMCA service from gov.uk

Back to Advance care planning in England and Wales

Planning ahead

Planning ahead can help people know what care you would like if you become unable to make choices yourself.

Making a will

Having an up-to-date will ensures that your wishes for who you would like to leave your estate to are guaranteed.

Your wishes for your care

When planning ahead, it is important to think about how and where you would like to be cared for.

Funeral planning

Planning your funeral in advance means your family and friends can arrange the type of funeral you would like.