Three decades after Baby Doe: how neonatologists and bioethicists conceptualize the Best Interests Standard

J Perinatol. 2016 Oct;36(10):906-11. doi: 10.1038/jp.2016.87. Epub 2016 Jun 2.


Objective: The objective of this study is to determine how neonatologists and bioethicists conceptualize and apply the Best Interests Standard (BIS).

Study design: Members of the American Society for Bioethics and Humanities and the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine were surveyed to determine how they conceptualized the BIS and ranked the appropriateness of forgoing life-sustaining therapy (LST).

Results: Neonatologists' median response supported an infant-specific BIS conceptualization that linked the infant's and family's interests. They did not support allowing limitations on the family's obligations. Ethicists' supported a conceptualization that linked the infant's and family's interests and limitations on the family's obligations, a less infant-specific conceptualization. Ethicists were less or equally likely to agree with forgoing LST in seven of eight cases.

Conclusions: Ethicists endorsed a conceptualization of the BIS that includes the effects on the family and rejected an infant-specific one. Neonatologists split between these two and rejected limiting the family's obligations. Critical appraisal of the BIS is needed in neonatal ethics.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abnormalities, Multiple / therapy
  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude of Health Personnel*
  • Bioethical Issues
  • Decision Making / ethics*
  • Ethicists*
  • Euthanasia, Passive / ethics*
  • Family / psychology
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Neonatologists*
  • Practice Patterns, Physicians'
  • Statistics, Nonparametric
  • Surveys and Questionnaires
  • United States