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Lying to a client is fundamentally wrong. But are there rare occasions when 'benevolent deceit' may be considered appropriate, if it is in the best interests of someone with a learning disability who lacks capacity? By describing some forms of benevolent deception, Gary Watt hopes to prompt reflection, rather than to undermine choice and control for people who lack capacity
Keywords
* learning disabilities: rights
* patients: empowerment
* law
* ethics
These keywords are based on the subject headings from the British Nursing Index. This article has been subject to a doubleblind review.
The Mental Capacity Act (2005) provides a statutory framework underpinned by a desire to protect and empower people who are not able to make their own decisions, and who therefore rely on others to help with decision-making on their behalf. Practitioners in the field of learning disabilities are therefore under a duty to have regard for the workings of the Act and its associated code of practice.
The Act enshrines five key principles:
* a presumption of capacity
* the right for individuals to be supported in making their own decisions
* the right to make decisions that may be considered unwise
* best interests
* least restrictive intervention(s).
The current focus on the Act and its implications encourages practitioners to reflect on past and present practice, and although the five key principles are equally important, it is 'best interests' that has particular relevance to day-to-day practice.
The term 'best interests' is not defined in the Mental Capacity Act and a succinct definition is perhaps impossible because there are many types of decisions, circumstances and actions that affect people. However, acting in someone's best interests essentially involves considering and responding to what is best for someone who lacks capacity. This responsibility falls on all those concerned with an individual's welfare, whether a court-appointed deputy, a paid care worker or a family member.
People with learning disabilities who lack capacity may need assistance with all sorts of important decisions; financial, medical and social care options may all need to be addressed. But everyday decisions in an individual's life can prove to be just as, if not more, important. Daily or even hourly decisions such as what a person should wear, eat...