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The best interest standard and children: clarifying a concept and responding to its critics
  1. Johan Christiaan Bester
  1. Correspondence to Dr Johan Christiaan Bester, UNLV School of Medicine, University of Nevada, Las Vegas, Nevada 89102, USA; jcbester{at}


This work clarifies the role of the best interest standard (BIS) as ethical principle in the medical care of children. It relates the BIS to the ethical framework of medical practice. The BIS is shown to be a general principle in medical ethics, providing grounding to prima facie obligations. The foundational BIS of Kopelman and Buchanan and Brock are reviewed and shown to be in agreement with the BIS here defended. Critics describe the BIS as being too demanding, narrow, opaque, not taking the family into account and not suitable as limiting principle. This work responds to these criticisms, showing that they do not stand up to scrutiny. They either do not apply to the BIS, only apply to misuses of the BIS or criticise a BIS that is not seriously defended in the literature.

  • children
  • decision-making
  • family
  • minors/parental consent
  • paediatrics

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  • Contributors JCB conceived of, wrote and edited this article in its entirety.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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