A reminder this week of applying the five principles of the Mental Capacity Act, especially when key decisions need to be made, as they must be in the patient's best interests.

Our learning comes after a patient with learning disabilities with kidney disease was admitted acutely unwell and at end of life and there were issues with the family over DNACPR decision making and the end-of-life care.  

The Act is underpinned by these five principles:

• a presumption of capacity - every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise
• the right for individuals to be supported to make their own decisions - people must be given all appropriate help before anyone concludes that they cannot make their own decisions
• that individuals must retain the right to make what might be seen as eccentric or unwise decisions
• best interests - anything done for or on behalf of people without capacity must be in their best interests
• least restrictive intervention - anything done for or on behalf of people without capacity should be an option that is less restrictive of their basic - as long as it is still in their best interests.