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Best Interest: A Philosophical Critique

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Abstract

On one conception of “best interest” there can only be one course of action in a given situation that is in a person’s best interest. In this paper we will first consider what theories of “best interest” and rational decision-making that can lead to this conclusion and explore some of the less commonly appreciated implications of these theories. We will then move on to consider what ethical theories that are compatible with such a view and explore their implications. In the second part of the paper we will explore a range of possible criticisms of these views. And in the third part we will criticise the view that a court is always or even often in a good position to decide what the patient’s best interest is. In the fourth and final part we will put forward a reconstructive proposal aimed at saving whatever is sound in the “best interest” conception.

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Notes

  1. All our analysis in this paper should be read as philosophical analysis, even in those instances where we quote legal material.

  2. In Re s (Adult Patient: Sterilisation) [2001] Fam 15.

  3. The acceptance of the precautionary principle in many areas of policy making indicates that even fairly radical degrees of risk aversivity are seen as rational.

  4. If the von Neumann–Morgenstern approach is directly transformed into an ethical position it turns out to be the position usually called “Ethical egoism”.

  5. The quote from Dame Butler-Sloss at the beginning of this paper furthermore seems to imply that what the court does is deciding on best interest in the widest possible sense.

  6. In Re A (Children) (Conjoined Twins: Surgical Separation) [2001] Fam 147, at 155.

References

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  4. von Neumann, J., & Morgenstern, O. (1953). Theory of games and economic behavior (3rd ed.). Princeton: Princeton University Press.

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Authors and Affiliations

  1. Cardiff Law School, Museum Avenue, Cardiff, CF10 3AX, UK

    Søren Holm

  2. Section for Medical Ethics, University of Oslo, P.O. Box 1130, Blindern, 0318, Oslo, Norway

    Søren Holm

  3. Centre for Applied Ethics, Cardiff University, Humanities Building, Colum Drive, Cardiff, CF10 3EU, UK

    Andrew Edgar

Authors
  1. Søren Holm
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  2. Andrew Edgar
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Correspondence to Søren Holm.

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Holm, S., Edgar, A. Best Interest: A Philosophical Critique. Health Care Anal 16, 197–207 (2008). https://doi.org/10.1007/s10728-008-0092-x

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  • DOI: https://doi.org/10.1007/s10728-008-0092-x

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