Table 1 Factors in best interests decisions
From: The theorisation of ‘best interests’ in bioethical accounts of decision-making
Factor | Sources and notes |
|---|---|
Conscious experience | Conscious experience is defined as sentience [55] which manifests (at minimum) in short-term recall [63]. It is suggested as a factor by a number of sources [50, 57, 61, 63, 92] |
Dignity | Identified without definition by [49, 60, 62, 86, 92]. Defined as inalienable rights to equal treatment and respect [61, 87] and a recognition of common humanity linked to human rights [55, 77] |
Medical interests | Clinical needs/medical interests are identified as factors in best interest [75, 76]. Identified as a potential narrative of best interests offered by the courts [75]. No specific definition of what counts as a medical interest |
Benefits and burdens | Many sources identify benefits and burdens [44, 46,47,48,49,50,51,52,53,54,55, 58,59,60,61,62], with a variety of examples given |
Pleasure and pain | Pleasure exclusively identified as an interest of children [34, 56]. Pain Identified as pain [83] or harm [86]. Some [57] argue pain is only against interests to the extent a person is aware of it |
Quality of life | Frequently identified [49, 50, 52, 54, 55, 57, 60, 62, 85, 88, 98]. Defined as either subjective or objective value of life [49, 54, 73, 75] Authors argue that quality of life is an implicit factor guiding legal [49, 62, 98] and clinical [44, 50] best interests decisions or used as explicit cover for arbitrary and prejudiced decisions [44, 52,53,54] |
Futility | Identified by [49, 53, 61, 76, 88, 98, 99]. Sometimes [44, 62, 75] identified with a medical judgment |
Effective treatment possibilities and prognosis | |
Developmental potential | |
Medical progress | Identified by [51] in context of research |
Sanctity of life | Noted in the context of law [44, 54, 55, 59, 95]. Defined as the inviolability of life [44] |