Best Interest, Harm, God’s Will, Parental Discretion, or Utility

Best Interest Standard in School Health: A Concept Analysis

“…There are several other pediatric decisionmaking frameworks, such as constrained parental autonomy (CPA), the zone of parental discretion (ZPD), satisficing versus optimizing parentalism, BIS bc (for "best choice"), and the harm principle (HP). Of these, the most recognized alternative concept for BIS is the HP (Blustein, 2012;Diekema, 2011Diekema, , 2019Jacobs, 2018;Lantos, 2018;Paquette, 2019;Winters, 2018). Proponents of the HP assert that the BIS is appropriate as a guiding standard but is too vague to be an intervening or limiting principle (Diekema, 2019;Ross, 2019a;Shah et al, 2018;Truog, 2020).…”

Who Are “Unrepresented” Patients and What Count as “Important” Medical Decisions for Them?

“…Absent such legislative action, hospitals or systems could enact policies that would enable such a committee (or individual) at least informally to partner with an unrepresented patient's attending physician(s) in determining the patient's best interest when important medical decisions need to be made for the patient and throughout his or her hospital stay (even as attendings rotate on and off). 6,7 Definition of unrepresented. UPPI currently defines an unrepresented patient as meeting 5 conditions:…”

“…Hence it is ethically problematic that whoever happens to be an unrepresented patient's attending physician may have to make important medical decisions alone-perhaps with personally chosen assistance-because there is no one to represent the patient. How best interest judgments ought to be made-which is widely debated in the bioethics literature 6 -is thus an important ethical consideration in caring for unrepresented patients, although rarely discussed in connection with this population. 7 Definition of important medical decisions.…”

Should Physicians Offer a Ventricular Assist Device to a Pediatric Oncology Patient With a Poor Prognosis?

“…[11][12][13][14] Pediatric ethical principles and guiding frameworks, though sometimes conflicting, can be applied to various clinical scenarios with young patients of various ages. 15,16 These include various formulations of the best interest standard, avoiding harm, constrained parental autonomy, shared family-centered decision making, clinically reasonable alternatives, responsible thinking, and rational decision making. [17][18][19][20][21][22] While these principles and frameworks have historically served as a guide for parental refusals of therapy, as technology advances and parental requests for therapies arise that a clinical team might consider inappropriate, these models will need to repurposed to address parental requests.…”

“…In cases such as this, several principles and frameworks, as mentioned above, can be helpful for guiding decision making. 15 One approach entails constraining or limiting parental decisional autonomy. While acknowledging that parents are almost always acting in their child's best interest, as in BJ's case, physicians must occasionally weigh whether harms outweigh potential benefits of an emerging technology when considering whether to present that technology as an option.…”