Using a new analysis of the best interests standard to address cultural disputes: Whose data, which values?
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.
Keywordsethics best interests law neonatal intensive care unit culture resource allocation incompetent premature infant
Unable to display preview. Download preview PDF.
- American Academy of Pediatrics, Committee on Bioethics. Guidelines on Foregoing Life-sustaining Medical Treatment. Pediatrics 93 (1994): 532–536.Google Scholar
- American Academy of Pediatrics, Committee on Fetus and Newborn. The Initiation or Withdrawal of Treatment for High-risk Newborns. Pediatrics 96 (1995): 362–364.Google Scholar
- American Academy of Pediatrics, Committee on Bioethics. Ethics and the Care of Critically Ill Infants and Children. Pediatrics 98, no. 1 (1996):149–153.Google Scholar
- Buchanan A. E., D. W. Brock. Deciding for Others: The Ethics of Surrogate Decision-making. New York: Cambridge University Press, 1989.Google Scholar
- Hafemeister T. L., P. L. Hannaford. Resolving Disputes for Life-Sustaining Treatment. (Williamsburg: National Center for State Courts, 1996), pp. 15–20.Google Scholar
- Institute of Medicine of the National Academics, Ethical Conduct of Clinical Research Involving Children. Washington D.C.: The National Academies Press, 2004.Google Scholar
- 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.Google Scholar
- Kopelman L. M. Female Circumcision/Genital Mutilation and Ethical Relativism. Second Opinion 20, no. 2 (1994): 55–71.Google Scholar
- 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.Google Scholar
- Kopelman L. M. “Female Circumcision and Genital Mutilation.” Encyclopedia of␣Applied Ethics, Vol 2. (Boston: Academic Press 1998), pp. 249–259.Google Scholar
- Kopelman L. M. “Circumcision, Female Update.” Encyclopedia of Bioethics, 3rd Edition. (New York: MacMillan, 2004), pp. 417–420.Google Scholar
- 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.Google Scholar
- Krause H. D. Family Law in a Nutshell, second edition , St. Paul: West Publishing Co., 1986.Google Scholar
- Macklin R. Against Relativism: Cultural Diversity and the Search for Ethical Universals in Medicine. New York: Oxford University Press, 1999.Google Scholar
- President’s Council on Bioethics. Taking Care: Ethical Caregiving in Our Aging Society, Washington D.C.: NBAC HHS 2005.Google Scholar
- Sigerist H. E. History of Medicine. New York: Oxford University Press 1955, Vol. 1, pp. 180ff, 442ff; and Vol. II: pp. 298ff.Google Scholar
- Sober E. Core Questions in Philosophy. New York: Macmillan Publishing Co. 1990.Google Scholar
- 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.