Value theory and the best interests standard

Bioethics. 1995 Jan;9(1):50-61. doi: 10.1111/j.1467-8519.1995.tb00300.x.


The idea of a patient's best interests raises issues in prudential value theory -- the study of what makes up an individual's ultimate (nonmoral) good or well-being. While this connection may strike a philosopher as obvious, the literature on the best interests standard reveals almost no engagement of recent work in value theory. There seems to be a growing sentiment among bioethicists that their work is independent of philosophical theorizing. Is this sentiment wrong in the present case? Does value theory make a significant difference in interpreting best interests? In pursuing this question, I begin with a quick sketch of broad kinds of value theories, identifying representatives that are plausible enough to count as contenders. I then explore what each account suggests in (1) neonatal treatment decisions, and (2) decisions for patients in persistent vegetative states. I conclude that while these accounts converge somewhat in their interpretations of best interests, they also have importantly different implications.

MeSH terms

  • Adult
  • Congenital, Hereditary, and Neonatal Diseases and Abnormalities
  • Decision Making*
  • Ethical Theory*
  • Ethics*
  • Euthanasia, Passive*
  • Humans
  • Infant, Newborn
  • Life Support Care*
  • Persistent Vegetative State
  • Philosophy*
  • Reference Standards*
  • Risk
  • Risk Assessment
  • Social Values
  • Stress, Psychological
  • Third-Party Consent*
  • Wounds and Injuries