Rotten medical compromise and the instrumentalisation of P: findings from a qualitative study of best interests decision making in adult kidney care in England

Abstract According to the Mental Capacity Act 2005, P’s family are to be afforded a consultee role in a best interests decision. That is, they are to be involved in decisions but are not empowered to act as a substitute decision maker. However, in practice, healthcare professionals can struggle to set clear boundaries where families are insistent on more active treatment. The Best Interests in Renal Dialysis Study explored the making of best interests decisions in the context of adult kidney care in England. Interviewing healthcare professionals – both doctors and nurses – we found that it is not uncommon for the ‘path of least resistance’ to be pursued in best interests decisions where the family takes a strong position. Out of a fear of legal action and a desire to maintain a working relationship, healthcare professionals will sometimes compromise in providing care that they do not consider to be in P’s best interests to appease the family. This is seemingly at odds with the requirements of the Mental Capacity Act 2005, particularly where it goes as far as to prove harmful to P. Drawing on Margalit’s conception of rotten compromise, we argue that this form of rotten medical compromise undermines the law’s recognised P-centricity.