Journal of Medical Ethics 42 (8):542-549 (2016)
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Abstract |
One recurring criticism of the best interests standard concerns its vagueness, and thus the inadequate guidance it offers to care providers. The lack of an agreed definition of ‘best interests’, together with the fact that several suggested considerations adopted in legislation or professional guidelines for doctors do not obviously apply across different groups of persons, result in decisions being made in murky waters. In response, bioethicists have attempted to specify the best interests standard, to reduce the indeterminacy surrounding medical decisions. In this paper, we discuss the bioethicists’ response in relation to the state's possible role in clarifying the best interests standard. We identify and characterise two clarificatory strategies employed by bioethicists —elaborative and enumerative—and argue that the state should adopt the latter. Beyond the practical difficulties of the former strategy, a state adoption of it would inevitably be prejudicial in a pluralistic society. Given the gravity of best interests decisions, and the delicate task of respecting citizens with different understandings of best interests, only the enumerative strategy is viable. We argue that this does not commit the state to silence in providing guidance to and supporting healthcare providers, nor does it facilitate the abuse of the vulnerable. Finally, we address two methodological worries about adopting this approach at the state level. The adoption of the enumerative strategy is not defeatist in attitude, nor does it eventually collapse into (a form of) the elaborative strategy.
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Keywords | best interests political philosophy legitimacy |
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DOI | 10.1136/medethics-2016-103454 |
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References found in this work BETA
Balancing Legitimate Critical-Care Interests: Setting Defensible Care Limits Through Policy Development.Jeffrey Kirby - 2016 - American Journal of Bioethics 16 (1):38-47.
Reasoning About Well-Being: Nussbaum's Methods of Justifying the Capabilities.Alison M. Jaggar - 2006 - Journal of Political Philosophy 14 (3):301–322.
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Citations of this work BETA
An Incomplete Inclusion of Non-Cooperators Into a Rawlsian Theory of Justice.Chong-Ming Lim - 2016 - Res Philosophica 93 (4):893-920.
Clinic, Courtroom or (Specialist) Committee: In the Best Interests of the Critically Ill Child?Richard Huxtable - 2018 - Journal of Medical Ethics 44 (7):471-475.
Mental Capacity Act Application: Social Care Settings.Michael Dunn & Anthony Holland - 2019 - In Rebecca Jacob, Michael Gunn & Anthony Holland (eds.), Mental Capacity Legislation: Principles and Practice. pp. 82-90.
Forgoing Life-Sustaining Treatment – a Comparative Analysis of Regulations in Japan, Korea, Taiwan, and England.Miho Tanaka, Satoshi Kodama, Ilhak Lee, Richard Huxtable & Yicheng Chung - 2020 - BMC Medical Ethics 21 (1):1-15.
Dialysis Decisions Concerning Cognitively Impaired Adults: A Scoping Literature Review.Jonathan Ives & Jordan A. Parsons - 2021 - BMC Medical Ethics 22 (1):1-17.
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