Abstract
Clinicians sometimes disagree about how much to honor surrogates’ deeply held cultural values or traditions when they differ from those of the host country. Such a controversy arose when parents requested a cultural accommodation to let their infant die by withdrawing life saving care. While both the parents and clinicians claimed to be using the Best Interests Standard to decide what to do, they were at an impasse. This standard is analyzed into three necessary and jointly sufficient conditions and used to resolve the question of how much to accommodate cultural preferences and how to treat this infant. The extreme versions of absolutism and relativism are rejected. Properly understood, the Best Interests Standard can serve as a powerful tool in settling disputes about how to make good decisions for those who cannot decide for themselves.
Article PDF
Similar content being viewed by others
References
American Academy of Pediatrics, Committee on Bioethics. Guidelines on Foregoing Life-sustaining Medical Treatment. Pediatrics 93 (1994): 532–536.
American Academy of Pediatrics, Committee on Fetus and Newborn. The Initiation or Withdrawal of Treatment for High-risk Newborns. Pediatrics 96 (1995): 362–364.
American Academy of Pediatrics, Committee on Bioethics. Ethics and the Care of Critically Ill Infants and Children. Pediatrics 98, no. 1 (1996):149–153.
Buchanan A. E., D. W. Brock. Deciding for Others: The Ethics of Surrogate Decision-making. New York: Cambridge University Press, 1989.
Ginsberg F., What Do Women Want? Feminist Anthropology Confronts Clitoridectomy. Medical Anthropology Quarterly 5, no.1 (1991): 17–19.
Hafemeister T. L., P. L. Hannaford. Resolving Disputes for Life-Sustaining Treatment. (Williamsburg: National Center for State Courts, 1996), pp. 15–20.
Institute of Medicine of the National Academics, Ethical Conduct of Clinical Research Involving Children. Washington D.C.: The National Academies Press, 2004.
Kopelman L. M. The Punishment Concept of Disease. In AIDS: Ethics and Public Policy. Edited by C. C. Pierce, D. Van De Veer. (Belmont, California: Wadsworth Publishing Co., 1988), pp. 49–55.
Kopelman L. M. Female Circumcision/Genital Mutilation and Ethical Relativism. Second Opinion 20, no. 2 (1994): 55–71.
Kopelman L. M. The Best Interests Standard as Threshold, Ideal, and Standard of Reasonableness. Journal of Medicine and Philosophy 22, no. 3 (1997): 271–289.
Kopelman L. M. “Female Circumcision and Genital Mutilation.” Encyclopedia of␣Applied Ethics, Vol 2. (Boston: Academic Press 1998), pp. 249–259.
Kopelman L. M. If HIV/AIDS Is Punishment, Who Is Bad? The Journal of Medicine and Philosophy 27, no. 2 (2002): 231–243.
Kopelman L. M. “Circumcision, Female Update.” Encyclopedia of Bioethics, 3rd Edition. (New York: MacMillan, 2004), pp. 417–420.
Kopelman L. M. Are the 21-Year-Old Baby Doe Rules Misunderstood or Mistaken. Pediatrics 115, no. 3 (2005): 797–802.
Kopelman L. M. Rejecting the ‹Baby Doe’ Regulations and Defending a ‹Negative’ Analysis of the Best Interests Standard. Journal of Medicine and Philosophy 30 (2005): 331–352.
Kopelman L. M. The Best Interests Standard for Incompetent or Incapacitated Persons of All Ages. The Journal of Law, Medicine and Ethics 35, no. 1 (2007):187–196.
Kopelman L. M. “Using the Best Interests Standard to Decide Whether toTest Children For Untreatable, Late-Onset Diseases.” Journal of Medicine and Philosophy 32, no. 4 (2007): 375–394.
Krause H. D. Family Law in a Nutshell, second edition , St. Paul: West Publishing Co., 1986.
Macklin R. Against Relativism: Cultural Diversity and the Search for Ethical Universals in Medicine. New York: Oxford University Press, 1999.
President’s Council on Bioethics. Taking Care: Ethical Caregiving in Our Aging Society, Washington D.C.: NBAC HHS 2005.
Scheper-Hughes N. Virginity Territory: The Male Discovery of the Clitoris. Medical Anthropology Quarterly 5, no. 1 (1991): 25–28.
Sigerist H. E. History of Medicine. New York: Oxford University Press 1955, Vol. 1, pp. 180ff, 442ff; and Vol. II: pp. 298ff.
Shweder R. Ethical Relativism: Is There a Defensible Version? Ethos 18 (1990): 205–218.
Sober E. Core Questions in Philosophy. New York: Macmillan Publishing Co. 1990.
United Nations, International Bioethics Committee, United Nations Education, Scientific and Cultural Organization. “Universal Declaration on Bioethics and Human Rights.” 2005. http://portal.unesco.org/en/ev.php-URL_ID= 31058&URL_DO=DO_TOPIC&URL_SECTION=201.html.
United Nations: The Office of the High Commission for Human Rights. Convention on the Rights of the Child. Adopted and opened for signature, ratification and accession by General Assembly resolution 44/25 of 20 November 1989 entry into force 2 September 1990, in accordance with article 49. http://www.unhchr.ch/html/menu3/b/k2crc.htm.
Acknowledgments
We would like to acknowledge that this discussion was based on an actual case where the attending physician was Dr. William Meetze. He initiated discussions about the ethical questions involved.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kopelman, L.M., Kopelman, A.E. Using a new analysis of the best interests standard to address cultural disputes: Whose data, which values?. Theor Med Bioeth 28, 373–391 (2007). https://doi.org/10.1007/s11017-007-9050-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11017-007-9050-0