Parental authority, patient's best interest and refusal of resuscitation at borderline gestational age

Mercurio, Mark R.

doi:10.1038/sj.jp.7211547

Cited by 24 publications

(12 citation statements)

References 14 publications

(13 reference statements)

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“…More commonly, commentators suggest (explicitly or implicitly) that best interests involves similar considerations to utilitarianism, such as calculating welfare [ 46 ] by balancing benefits and burdens [ 44 , 47 – 62 ] and/or maximisation of the good [ 46 , 50 , 51 , 58 , 60 , 63 – 68 ]. The convergence on ‘maximisation’ masks some disagreement over whether maximisation implies ‘strict’ pursuit of a single good [ 47 , 56 , 59 , 67 , 69 , 70 ] or a more pragmatic, all-things-considered, interpretation of good [ 42 , 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…Despite such scepticism of children’s rights [ 83 ] a number of commentators focus on parental rights. Some [ 13 , 44 , 84 ] consider parental rights in relation to custody and an unencumbered relationship with their child, while others focused on medical decision-making [ 44 , 56 , 59 , 85 ]. Often the latter identify parental rights as rights of authoritative decision-making on behalf of their child, to which best interests are believed antagonistic [ 44 , 56 , 59 ].…”

Section: Resultsmentioning

confidence: 99%

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The theorisation of ‘best interests’ in bioethical accounts of decision-making

Birchley

2021

BMC Med Ethics

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Background Best interests is a ubiquitous principle in medical policy and practice, informing the treatment of both children and adults. Yet theory underlying the concept of best interests is unclear and rarely articulated. This paper examines bioethical literature for theoretical accounts of best interests to gain a better sense of the meanings and underlying philosophy that structure understandings. Methods A scoping review of was undertaken. Following a literature search, 57 sources were selected and analysed using the thematic method. Results Three themes emerged. The first placed best interests within the structure of wider theory, noting relationships with consequentialism, deontology, prudential value theory, rights and political philosophy. The second mapped a typology of processes of decision-making, among which best interests was ambiguously positioned. It further indicated factors that informed best interests decision-making, primarily preferences, dignity and quality of life. The final theme considered best interests from a relational perspective. Conclusions Characterisation of best interests as strictly paternalist and consequentialist is questionable: while accounts often suggested a consequentialist basis for best interests, arguments appeared philosophically weak. Deontological accounts, found in law and Kantianism, and theories of political liberalism influenced accounts of best interests, with accounts often associating best interests with negative patient preferences (i.e. individual refusals). There was much more emphasis on negative interests than positive interests. Besides preference, factors like dignity and quality of life were held to inform best interests decisions, but generally were weakly defined. To the extent that preferences were unable to inform decision making, decisions were either made by proxy authority or by an intersubjective process of diffuse authority. Differing approaches reflect bifurcations in liberal philosophy between new liberalism and neo-liberalism. Although neither account of authority appears dominant, bias to negative interests suggests that bioethical debate tends to reflect the widespread ascendancy of neo-liberalism. This attitude was underscored by the way relational accounts converged on private familial authority. The visible connections to theory suggest that best interests is underpinned by socio-political trends that may set up frictions with practice. How practice negotiates these frictions remains a key question.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The theorisation of ‘best interests’ in bioethical accounts of decision-making

Birchley

2021

BMC Med Ethics

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“…Some ethicists have suggested that those limits might be better found by utilizing a threshold of harm, rather than seeking the maximal best interest of the patient. 11,[16][17][18][19][20] In a harm threshold, some range of parental discretion to make decisions that are different than those advised by the medical team is allowed. A model utilizing a threshold of harm would limit parental decisions if, on balance, the child was harmed by their decision.…”

Section: Decisional Authoritymentioning

confidence: 99%

“…A model utilizing a threshold of harm would limit parental decisions if, on balance, the child was harmed by their decision. 11,[16][17][18][19][20] This does not remove subjectivity in decision-making. It also does not solve the potential value clash of death being a lesser or greater harm than high-risk intervention or therapy.…”

Section: Decisional Authoritymentioning

confidence: 99%

The Burdens of Offering: Ethical and Practical Considerations

Kirsch

Coronado

Roeleveld

et al. 2017

World J Pediatr Congenit Heart Surg

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We reflect upon highlights of a facilitated panel discussion from the 2016 Pediatric Cardiac Intensive Care Society Meeting. The session was designed to explore challenges, share practical clinical experiences, and review ethical underpinnings surrounding decisions to offer intensive, invasive therapies to patients who have a poor prognosis for survival or are likely to be burdened with multiple residual comorbidities if survival is achieved. The discussion panel was representative of a variety of disciplines including pediatric cardiology, cardiac intensive care, nursing, and cardiovascular surgery as well as different health-care delivery systems. Key issues discussed included patient's best interests, physician obligations, moral distress, and communication in the context of decisions about providing therapy for patients with a poor prognosis.

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“…Leben geopfert wird zugunsten des Wohles Dritter. Nimmt man andererseits den Grundsatz, nicht zu schaden ernst, kann man nicht übersehen, dass man durch Tun oder durch Unterlassen sehr wohl auch Eltern und Geschwister eines Patienten schädigen kann [13]. Manche Paare oder Familien ertragen und meistern Leiden oder schwerste Beeinträchti-gungen eines Kindes in bewundernswerter Weise, aber andere zerbrechen daran, worüber es genug Berichte gibt [2, 3,10,14,17].…”

Section: Wohl Des Patientenunclassified

Positionspapier zur Begrenzung lebenserhaltender Therapie im Kindes- und Jugendalter

2009

Monatsschr Kinderheilkd

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Parental authority, patient's best interest and refusal of resuscitation at borderline gestational age

Cited by 24 publications

References 14 publications

The theorisation of ‘best interests’ in bioethical accounts of decision-making

The theorisation of ‘best interests’ in bioethical accounts of decision-making

The Burdens of Offering: Ethical and Practical Considerations

Positionspapier zur Begrenzung lebenserhaltender Therapie im Kindes- und Jugendalter

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