Best interests and the MCA - a damning judgment

Mr Justice Hayden has published a damning judgment on the failure to apply the Mental Capacity Act in the case of man with a brain injury cared for at the Royal Hospital for Neuro-disability. It is a wide ranging judgment and covers lots of elements including Best Interests, the duty to consult others and the role of ICBs. The judge was highly critical of the failure to act in the man's best interests over many years and stated:

"It requires to be stated that, from the very early stages of his admission, there was powerful and strong evidence that JP would have hated to have been in the circumstances in which he found himself. Notwithstanding this, he has languished in this condition, as I have indicated, for nine years. His identifiable wishes and feelings, eloquently and movingly articulated by his son, daughter, brother and his partner (now deceased), either found insufficient expression or were not heard by those charged with the responsibility for his medical care."

Best interests and dignity: "I am driven to conclude that the failure properly to address his best interests, in a timely way, has compromised his dignity....The inherent dignity of a human being imposes an obligation on those treating him, actively to promote his dignity. I very much regret to say that the RHN has failed to meet this most fundamental of obligations."

Repeated failures: "...this is now the third case, from the same hospital, in a period of fewer than eighteen months, where similar failures have emerged."

The role/duty of ICBs: "For the best interests reviews to be effective, the ICB is required to be vigilant and proactive in the process. Notwithstanding Theis J’s clear signal that they should not be “passive bystanders”, that appears to be what has happened again here."

The duty to consult others: "...the family are not making the best interests decision, nor are they being consulted as to what they think is best. Their observations are solicited to illuminate what JP’s past and present wishes and feelings have been (where ascertainable), and on the beliefs and values that would be likely to influence his decision if he had retained capacity.”

Download the judgment from: https://www.bailii.org/ew/cases/EWCOP/2025/8.html

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