Theoretical Medicine and Bioethics

, Volume 28, Issue 5, pp 373-391

First online:

Using a new analysis of the best interests standard to address cultural disputes: Whose data, which values?

  • Loretta M. KopelmanAffiliated withBrody School of Medicine Email author 
  • , Arthur E. KopelmanAffiliated withBrody School of Medicine

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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.


ethics best interests law neonatal intensive care unit culture resource allocation incompetent premature infant