Theoretical Medicine and Bioethics

, Volume 33, Issue 3, pp 179–198 | Cite as

Deciding for a child: a comprehensive analysis of the best interest standard

  • Erica K. SalterEmail author


This article critically examines, and ultimately rejects, the best interest standard as the predominant, go-to ethical and legal standard of decision making for children. After an introduction to the presumption of parental authority, it characterizes and distinguishes six versions of the best interest standard according to two key dimensions related to the types of interests emphasized. Then the article brings three main criticisms against the best interest standard: (1) that it is ill-defined and inconsistently appealed to and applied, (2) that it is unreasonably demanding and narrow, and (3) that it fails to respect the family. Finally, it argues that despite the best interest standard’s potent rhetorical power, it is irreparably encumbered by too much inconsistency and confusion and should be rejected.


Pediatric decision making Best interest standard Surrogate decision making 



I would like to thank Ana Iltis for her guidance and help in the preparation of this manuscript, as well as the reviewers at Theoretical Medicine and Bioethics for their helpful suggestions in the refinement of my arguments.


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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Center for Health Care EthicsSaint Louis UniversitySt. LouisUSA

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