'People are my landscape', Isaiah Berlin liked to say, and nowhere is the truth of this observation more evident than in his letters. He is a fascinated watcher of human beings in all their variety, and revels in describing them to his many correspondents. His letters combine ironic social comedy and a passionate concern for individual freedom. His interpretation of political events, historical and contemporary, and his views on how life should be lived, are always grounded in the personal, and (...) his fiercest condemnation is reserved for purveyors of grand abstract theories that ignore what people are really like. This second volume of Berlin's letters takes up the story when, after war service in the United States, he returns to life as an Oxford don. Against the background of post-war austerity, the letters chart years of academic frustration and self-doubt, the intellectual explosion when he moves from philosophy to the history of ideas, his growing national fame as broadcaster and lecturer, the publication of some of his best-known works, his election to a professorship, and his reaction to knighthood. Berlin's visits to American universities, where he sees McCarthyism at work, and his journeys eastward - to Europe, Palestine (and later Israel) and the Soviet Union - inspire acute and often very funny pen-pictures. His political contacts yield an inside view of major world events - the creation of Israel, the Suez Crisis, the Cold War. Many letters provide illuminating, accessible commentary on his ideas. These are the years, too, of momentous developments in his private life: the bachelor don's loss of sexual innocence, the emotional turmoil of his father's death, his courtship of a married woman and transformation into husband and stepfather. Above all, these revealing letters vividly display Berlin's effervescent personality - often infuriating, but always irresistible. (shrink)

A breathtaking look at the new science that can track consciousness deep in the brain How does our brain generate a conscious thought? And why does so much of our knowledge remain unconscious? Thanks to clever psychological and brain-imaging experiments, scientists are closer to cracking this mystery than ever before. In this lively book, Stanislas Dehaene describes the pioneering work his lab and the labs of other cognitive neuroscientists worldwide have accomplished in defining, testing, and explaining the brain events behind (...) a conscious state. We can now pin down the neurons that fire when a person reports becoming aware of a piece of information and understand the crucial role unconscious computations play in how we make decisions. The emerging theory enables a test of consciousness in animals, babies, and those with severe brain injuries. A joyous exploration of the mind and its thrilling complexities, Consciousness and the Brain will excite anyone interested in cutting-edge science and technology and the vast philosophical, personal, and ethical implications of finally quantifying consciousness. (shrink)

The Making of British Bioethics provides the first in-depth study of how philosophers, lawyers and other 'outsiders' came to play a major role in discussing and helping to regulate issues that used to be left to doctors and scientists. It details how British bioethics emerged thanks to a dynamic interplay between sociopolitical concerns and the aims of specific professional groups and individuals who helped create the demand for outside involvement and transformed themselves into influential 'ethics experts'. Highlighting this interplay helps (...) us appreciate how issues such as embryo research and assisted dying became high-profile 'bioethical' concerns in the late twentieth century, and why different groups now play a critical role in developing regulatory standards and leading public debates. The book draws on a wide range of original sources and will be of interest to historians of medicine and science, general historians and bioethicists. (shrink)

Rhetoric -- Paradox -- Space -- Time -- Utopia -- Progress -- Art -- Ethics.

Challenging, with several powerful arguments, some of our deepest beliefs about rationality, morality, and personal identity, Parfit claims that we have a false view about our own nature. It is often rational to act against our own best interersts, he argues, and most of us have moral views that are self-defeating. We often act wrongly, although we know there will be no one with serious grounds for complaint, and when we consider future generations it is very hard to avoid conclusions (...) that most of us will find very disturbing. (shrink)

This is the first publication of these ideas in book form. 'It is a rare treat--important, original philosophy that is also a pleasure to read.

Moral intuitions are strong, stable, immediate moral beliefs. Moral philosophers ask when they are justified. This question cannot be answered separately from a psychological question: How do moral intuitions arise? Their reliability depends upon their source. This chapter develops and argues for a new theory of how moral intuitions arise—that they arise through heuristic processes best understood as unconscious attribute substitutions. That is, when asked whether something has the attribute of moral wrongness, people unconsciously substitute a different question about a (...) separate but related heuristic attribute (such as emotional impact). Evidence for this view is drawn from psychology and neuroscience, and competing views of moral heuristics are contrasted. It is argued that moral intuitions are not direct perceptions and, in many cases, are unreliable sources of evidence for moral claims. (shrink)

Whether it is to be maximized or promoted as the object of a duty of beneficence, well-being is a vitally important notion in ethical theory. Well-being is a value, but to play the role it has often been assigned by ethical theory it must also be something we can measure and compare. It is a normative concept, then, but it also seems to have empirical content. Historically, philosophical conceptions of well-being have been responsive to the paired demands for normative and (...) empirical adequacy. However, recent work has yet to pay serious attention to the burgeoning field of well-being research in empirical psychology. This might be because the research is new and unknown, or it might be due to uncertainty about how a philosophical investigation would take such research into account. This chapter offers solutions to both of these problems. It provides an overview of well-being research in empirical psychology. It then uses this overview as part of an argument for an empirical informed account of well-being that we call the Value-Based Life Satisfaction Account. (shrink)

What is moral reasoning? For that matter, what is any sort of reasoning? Let me begin by making a few distinctions. First, there is a distinction between reasoning as something that that people do and the abstract structures of proof or “argument” that are the subject matter of formal logic. I will be mainly concerned with reasoning in the first sense, reasoning that people do. Second, there is a distinction between moral reasoning with other people and moral reasoning by and (...) for yourself . Moral reasoning with others may involve discussion with them, bargaining with them, and possibly arguing with them. (shrink)

Previous edition, 1st, published in 1971.

In _Nonsense upon Stilts¸_ first published in 1987, Waldron includes and discusses extracts from three classic critiques of the idea of natural rights embodied in the 1789 Declaration of the Rights of Man and the Citizen. Each text is prefaced by an historical introduction and an analysis of its main themes. The collection as a whole in introduced with an essay tracing the philosophical background to the three critiques as well as the eighteenth-century idea of natural rights which they attacked. (...) But the point of reproducing these works is not merely historical. Modern attacks on ‘rights-based’ political philosophy mirror the concerns of Bentham, Burke and Marx. Jeremy Waldron has therefore added an extensive concluding essay which relates these classic texts to the modern discussion of rights and re-examines the idea of rights in the light of contemporary critiques. This text provides an invaluable teaching tool for courses in politics and philosophy. (shrink)

This book will challenge the orthodox view that children cannot have the same rights as adults because they are particularly vulnerable. It will argue that we should treat adults and children in the same way as the child liberationists claim. However, the basis of that claim is not that children are more competent than we traditionally given them credit for, but rather that adults are far less competent than we give them credit for. It is commonly assumed that children are (...) more vulnerable. That is why we need to have a special legal regime for children. Children cannot have all the same rights as adults and need especial protect from harms. While in the 1970s “child liberationists” mounted a sustained challenge to this image, arguing that childhood was a form of slavery and that the assumption that children lacked capacity was unsustainable. This movement has significantly fallen out of favour, particularly given increasing awareness of child abuse and the multiple ways that children can be harmed at the hands of adults. This book will explore the concept of vulnerability, the way it used to undermine the interests of children and our assumptions that adults are not vulnerable in the same way that children are. It will argue that a law based around mutual vulnerability can provide an approach which avoids the need to distinguish adults and children. (shrink)

The family is hotly contested ideological terrain. Some defend the traditional two-parent heterosexual family while others welcome its demise. Opinions vary about how much control parents should have over their children's upbringing. Family Values provides a major new theoretical account of the morality and politics of the family, telling us why the family is valuable, who has the right to parent, and what rights parents should—and should not—have over their children. Harry Brighouse and Adam Swift argue that parent-child relationships produce (...) the "familial relationship goods" that people need to flourish. Children's healthy development depends on intimate relationships with authoritative adults, while the distinctive joys and challenges of parenting are part of a fulfilling life for adults. Yet the relationships that make these goods possible have little to do with biology, and do not require the extensive rights that parents currently enjoy. Challenging some of our most commonly held beliefs about the family, Brighouse and Swift explain why a child's interest in autonomy severely limits parents' right to shape their children's values, and why parents have no fundamental right to confer wealth or advantage on their children. Family Values reaffirms the vital importance of the family as a social institution while challenging its role in the reproduction of social inequality and carefully balancing the interests of parents and children. (shrink)

Should we treat other people according to what they want (their own values), or according to what we take their best interests to be? If they have given us no mandate to decide for them, their values should prevail. This applies not only to allowing but also to assisting them to get what they want. Taking this seriously in medical practice involves a lot of communication between doctor and patient, and a lot of research to establish a typology of patients (...) in respect of their wants. The results would seriously affect doctor-patient relationships and the organisation of general practice and hospital care. It is with this, rather than dramatic 'moral problems', that medical ethics should be chiefly concerned. (shrink)

The principle that physicians should always act in the best interests of the present patient is widely endorsed. At the same time, and often within the same document, it is recognised that there are appropriate exceptions to this principle. Unfortunately, little, if any, guidance is provided regarding which exceptions are appropriate and how they should be handled. These circumstances might be tenable if the appropriate exceptions were rare. Yet, evaluation of the literature reveals that there are numerous exceptions, several of (...) which pervade clinical medicine. This situation leaves physicians without adequate guidance on when to allow exceptions and how to address them, increasing the chances for unfairness in practice. The present article considers the range of exceptions, illustrates how the lack of guidance poses ethical concern and describes an alternative account of physician obligations to address this concern. (shrink)

In _Nonsense upon Stilts¸_ first published in 1987, Waldron includes and discusses extracts from three classic critiques of the idea of natural rights embodied in the 1789 Declaration of the Rights of Man and the Citizen. Each text is prefaced by an historical introduction and an analysis of its main themes. The collection as a whole in introduced with an essay tracing the philosophical background to the three critiques as well as the eighteenth-century idea of natural rights which they attacked. (...) But the point of reproducing these works is not merely historical. Modern attacks on ‘rights-based’ political philosophy mirror the concerns of Bentham, Burke and Marx. Jeremy Waldron has therefore added an extensive concluding essay which relates these classic texts to the modern discussion of rights and re-examines the idea of rights in the light of contemporary critiques. This text provides an invaluable teaching tool for courses in politics and philosophy. (shrink)

Children are presumptively regarded as incompetent to make their own medical decisions, and the responsibility for making such decisions typically falls to parents. Parental authority is not unlimited, however, and ethical guidelines identifying appropriate bounds on this authority are needed. One proposal currently gaining support is the Harm Threshold (HT), which asserts that the state may only legitimately intervene in parental decision-making when serious and preventable harm to children is likely. This paper considers two questions: in virtue of what underlying (...) principle or property does the HT gain its purported justification?; and does this underlying principle or property ground the HT as its proponents conceive of it? I identify two separate grounds represented in the literature: (i) J.S. Mill’s Harm Principle; and (ii) the liberty interests of parents. I find that the HT is not sufficiently grounded in either of these, revealing a substantial conceptual difficulty for its advocates. (shrink)

:Use of the best-interests test as the legal standard to justify medical treatment in respect to legally incompetent adults or minors has come under sustained critique over the years. “Best interests” has variously been alleged to be indeterminate as well as susceptible to majoritarian ideology and inherent bias. It has also been alleged to be inferior to rights-based approaches. Against the background of several particularly hard cases involving minors discussed by Gillett in a prior article in this journal, this article (...) considers some of these critiques. It concludes that these critical accounts make significant contributions to enabling a more procedurally and substantively robust consideration of what might be in a child’s best interests. However, it is argued that none of these accounts alone provide a superior framework that would justify jettisoning the concept of best interests. Further, it is suggested that best interests still has an important role in achieving patient-centered decisionmaking in this context. It concludes by suggesting a taxonomy of considerations when determining best interests. (shrink)

Kant's concept of autonomy and the Kantian notion of autonomy are often conflated in bioethics. However, the contemporary Kantian notion has very little at all to do with Kant's original. In order to further bioethics discourse on autonomy, I critically distinguish the contemporary Kantian notion from Kant's original concept of moral autonomy. I then evaluate the practical relevance of both concepts of autonomy for use in bioethics. I argue that it is not appropriate to appeal to either concept toward assessing (...) which patients we ought to respect as autonomous. Finally, I sketch criteria for what I take to be a more promising concept of autonomy for patients. (shrink)

It is widely accepted among medical ethicists that competence is a necessary condition for informed consent. In this view, if a patient is incompetent to make a particular treatment decision, the decision must be based on an advance directive or made by a substitute decision-maker on behalf of the patient. We call this the competence model. According to a recent report of the United Nations (UN) High Commissioner for Human Rights, article 12 of the UN Convention on the Rights of (...) Persons with Disabilities (CRPD) presents a wholesale rejection of the competence model. The High Commissioner here adopts the interpretation of article 12 proposed by the Committee on the Rights of Persons with Disabilities. On this interpretation, CRPD article 12 renders it impermissible to deny persons with mental disabilities the right to make treatment decisions on the basis of impaired decision-making capacity and demands the replacement of all regimes of substitute decision-making by supported decision-making. In this paper, we explicate six adverse consequences of CRPD article 12 for persons with mental disabilities and propose an alternative way forward. The proposed model combines the strengths of the competence model and supported decision-making. (shrink)

The purpose of this paper is to analyse the concept of 'best interest' in order to give nurses, who use it to justify their actions, a clear picture of what this means, and to identify the skills needed for doing so. The process for concept analysis developed by Walker and Avant was used in the analysis of data generated from the literature. Themes were identified from which the defining attributes, antecedents and consequences emerged. The congruence of the findings with current (...) values in nursing, such as promotion of patient autonomy, and the nurse as advocate, are discussed, together with the underpinning ethics theory. The skills needed for nursing practice are identified and recommendations for nurse education are made. (shrink)

This book originated as lectures for a course on political philosophy that Rawls taught regularly at Harvard in the 1980s.

Clinicians are required to act in the best interest of neonates.However, it is not obvious that entry into a randomised controlled trial (RCT) is in a neonate’s best interest because such trials often involve additional onerous procedures (such as intramuscular injections) in return for which the neonate receives unproven treatment or a placebo.On the other hand, neonatology needs to develop its evidence base, and RCTs are central to this task. The solution posited here is based on two points. First, “best (...) interest” is not equivalent to “the best possible interest” only to “best interest within a certain realm”. The realm of deliberation when asking the title question is the neonate’s health. Deliberating in this realm may involve the exclusion from consideration of some factors that might be thought relevant (such as parental wealth). Furthermore, circumstances may dictate the need to deliberate on other factors that might be thought irrelevant (such as health care resources). Second, deciding on a neonate’s best interest does not involve “putting oneself in its shoes”. Rather, it involves asking in what it has an interest, or stake. These will include some things in which we all, as human beings, have a stake, such as medical progress. Putting these two points together, in the realm of health the answer to whether RCT entry is in a neonate’s best interest is usually very finely balanced. Where this is the case, it is reasonable to invoke a broader notion of best interest and include a broader range of elements in which the neonate has a stake, including medical progress. In this way RCT entry can, usually, be said to be in a neonate’s best interest. (Journal of Medical Ethics 2001;27:110–113) Keywords: Neonates; randomised controlled trials; best interest; ethics. (shrink)

United Stated federal regulations allow participation of children in greater than minimal risk research with no potential for direct benefit under narrowly defined circumstances. This type of research is controversial, as it runs contrary to the best interest standard, on which we base most decisions made on behalf of children. I argue that such research is ethically defensible if a fully informed, scrupulous, and virtuous parent would choose to enroll his or her child in the study. Further, I defend the (...) current regulations, which allow local Institutional Review Boards to approve more than minimal risk, nontherapeutic research when the research involves children with the medical condition being studied, but requires federal review for similarly risky studies that involve healthy children. Because families of children with medical diseases tend to be more familiar with the health care system and with medical procedures, they are more able to make informed decisions about the burdens of research participation. Further, parents of children with medical conditions have a morally significant interest in advancing medical knowledge about their child's condition. It is appropriate to take this interest into account when evaluating the ethical status of a research study. (shrink)

Pediatric participation in non-therapeutic research that poses greater than minimal risk has been the subject of considerable thought-provoking debate in the research ethics literature. While the need for more pediatric research has been called morally imperative, and concerted efforts have been made to increase pediatric medical research, the importance of protecting children from undue research risks remains paramount.United States research regulations are derived largely from the deliberations and report of the National Commission for the Protection of Human Subjects of Biomedical (...) and Behavioral Research. The authors of this report specifically designated children as a vulnerable population and suggested additional protections, most of which became U.S. law. One of the more contested sets of regulations surrounds non-therapeutic research, e.g., research that does not offer the potential for direct benefit to participants. Federal regulations allow local Institutional Review Boards to approve non-therapeutic research posing a minor increase above minimal risk when it involves children who have the disease or medical condition that the research addresses. (shrink)

In this paper, we examine the lawfulness of a proposal to provide elective ventilation to incompetent patients who are potential organ donors. Under the current legal framework, this depends on whether the best interests test could be satisfied. It might be argued that, because the Mental Capacity Act 2005 (UK) (and the common law) makes it clear that the best interests test is not confined to the patient's clinical interests, but extends to include the individual's own values, wishes and beliefs, (...) the proposal will be in the patient's best interests. We reject this claim. We argue that, as things currently stand, the proposal could not lawfully be justified as a blanket proposition by reference to the best interests test. Accordingly, a modification of the law would be necessary to render the proposal lawful. We conclude with a suggestion about how that could be achieved. (shrink)

In this article I will show that ‘best interests’ is a concept that fits nicely with many of the features of pragmatism—Holm and Edgar’s rejection of the principle in favour of pragmatism it will be suggested is misplaced. ‘Best interests’ as a principle may be considered an embodiment of the ideals of pragmatic adjudication. The paper starts by briefly introducing the concept of ‘best interests’ and theories of judicial and legal ‘pragmatism’. This article will examine the role of the rational (...) decision-maker in medical law and argue that this role is limited. The paper concludes by suggesting how we view the relationship between ‘best interests’ and ‘pragmatism’. (shrink)

This paper reviews the ethical literature on conflicts between health professionals and parents about medical decision-making for children. We present the results of a systematic review which addressed the question ‘when health professionals and parents disagree about the appropriate course of medical treatment for a child, under what circumstances is the health professional ethically justified in overriding the parents’ wishes?’ We identified nine different ethical frameworks that were put forward by their authors as applicable across various ages and clinical scenarios. (...) Each of these frameworks centred on a different key moral concept including harm, constrained parental autonomy, best interests, medically reasonable alternatives, responsible thinking and rationality. (shrink)

One recurring criticism of the best interests standard concerns its vagueness, and thus the inadequate guidance it offers to care providers. The lack of an agreed definition of ‘best interests’, together with the fact that several suggested considerations adopted in legislation or professional guidelines for doctors do not obviously apply across different groups of persons, result in decisions being made in murky waters. In response, bioethicists have attempted to specify the best interests standard, to reduce the indeterminacy surrounding medical decisions. (...) In this paper, we discuss the bioethicists’ response in relation to the state's possible role in clarifying the best interests standard. We identify and characterise two clarificatory strategies employed by bioethicists —elaborative and enumerative—and argue that the state should adopt the latter. Beyond the practical difficulties of the former strategy, a state adoption of it would inevitably be prejudicial in a pluralistic society. Given the gravity of best interests decisions, and the delicate task of respecting citizens with different understandings of best interests, only the enumerative strategy is viable. We argue that this does not commit the state to silence in providing guidance to and supporting healthcare providers, nor does it facilitate the abuse of the vulnerable. Finally, we address two methodological worries about adopting this approach at the state level. The adoption of the enumerative strategy is not defeatist in attitude, nor does it eventually collapse into (a form of) the elaborative strategy. (shrink)

A new analysis of the Best Interests Standard is given and applied to the controversy about testing children for untreatable, severe late-onset genetic diseases, such as Huntington's disease or Alzheimer's disease. A professional consensus recommends against such predictive testing, because it is not in children's best interest. Critics disagree. The Best Interests Standard can be a powerful way to resolve such disputes. This paper begins by analyzing its meaning into three necessary and jointly sufficient conditions showing it: is an "umbrella" (...) standard, used differently in different contexts, has objective and subjective features, is more than people's intuitions about how to rank potential benefits and risks in deciding for others but also includes evidence, established rights, duties and thresholds of acceptable care, and can have different professional, medical, moral and legal uses, as in this dispute. Using this standard, support is given for the professional consensus based on concerns about discrimination, analogies to adult choices, consistency with clinical judgments for adults, and desires to preserve of an open future for children. Support is also given for parents' legal authority to decide what genetic tests to do. (shrink)

In this classic text, Kant sets out to articulate and defend the Categorical Imperative - the fundamental principle that underlies moral reasoning - and to lay the foundation for a comprehensive account of justice and human virtues. This new edition and translation of Kant's work is designed especially for students. An extensive and comprehensive introduction explains the central concepts of Groundwork and looks at Kant's main lines of argument. Detailed notes aim to clarify Kant's thoughts and to correct some common (...) misunderstandings of his doctrines. (shrink)

In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate (who may or may not hold the power of attorney ), and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The evermore common aversion of (...) best interest judgments entails a risk that health care providers withdraw from the decision-making process, abandoning patients (or their family members) to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit. (shrink)

In 2017 and 2018, the English courts were asked to decide whether continued life‐sustaining treatment was in the best interests of three infants: Charlie Gard, Alfie Evans and Isaiah Haastrup. Each infant had sustained catastrophic, irrecoverable brain damage. Dignity played an important role in the best interests assessments reached by the Family division of the High Court in each case. Multiple conceptions of dignity circulate, with potentially conflicting implications for infants such as Charlie, Alfie and Isaiah. The judgements do not (...) explicate the conceptions of dignity upon which they rely. This article reconstructs the conceptions of dignity invoked in these judgements, finding that a broadly Kantian, agential conception dominates, under which human dignity requires the prospect of agency. This conception is situated within the broader body of thought on dignity, and the potentially adverse implications of applying the reconstructed conception in best interests assessments for infants with severely restricted consciousness are discussed. (shrink)

History's judgment on the success of bioethics will not depend solely on the conceptual creativity and innovation in the field at the level of ethical and political theory, but this intellectual work is not insignificant. One important new development is what I shall refer to as the relational turn in bioethics. This development represents a renewed emphasis on the ideographic approach, which interprets the meaning of right and wrong in human actions as they are inscribed in social and cultural practices (...) and in structures of lived meaning and interdependence; in an ideographic approach, the task of bioethics is to bring practice into theory, not the other way around. The relational turn in bioethics may profoundly affect the critical questions that the field asks and the ethical guidance it offers society, politics, and policy. The relational turn provides a way of correcting the excessive atomism of many individualistic perspectives that have been, and continue to be, influential in bioethics. Nonetheless, I would argue that most of the work reflecting the relational turn remains distinctively liberal in its respect for the ethical significance of the human individual. It moves away from individualism, but not from the value of individuality.In this review essay, I shall focus on how the relational turn has manifested itself in work on core concepts in bioethics, especially liberty and autonomy. Following a general review, I conclude with a brief consideration of two important recent books in this area: Jennifer Nedelsky's Law's Relations and Rachel Haliburton's Autonomy and the Situated Self. (shrink)

The Mental Capacity Act is an impressive piece of legislation that deserves serious ethical attention, but much of the commentary on the Act has focussed on its legal and practical implications rather than the underlying ethical concepts. This paper examines the approach that the Act takes to best interests. The Act does not provide an account of the underlying concept of best interests. Instead it lists factors that must be considered in determining best interests, and the Code of Practice to (...) the Act states that this list is incomplete. This paper argues that this general approach is correct, contrary to some accounts of best interests. The checklist includes items that are unhelpful. Furthermore, neither the Act nor its Code of Practice provides sufficient guidance to carers faced with difficult decisions concerning best interests. This paper suggests ways in which the checklist can be developed and discusses cases that could be used in an updated Code of Practice. (shrink)

Children like Baby G, born with complex chronic medical conditions that compromise function in the long term, are an increasing presence in tertiary-level neonatal intensive care units. The parents and health-care providers of these children are faced with profoundly difficult decisions. Whether severe congenital anomalies with poor prognosis are diagnosed antenatally or are discovered at the time of birth, the issues are vexing, and the impact decisions will have on everyone in the family is profound. What should such decisions be (...) based upon? What values and principles might guide the decision-making process? What moral justifications allow for pursuing.. (shrink)

Although there are many different moral arguments concerning the use of Best Interests in neonatal decision-making, there seems in practice a firm commitment to application of the concept. And yet, there is still little reflection given by practitioners about what employing a Best Interest determination means in infant care. The following lays out a comprehensive taxonomy of interest-sources in order to provide for more robust considerations of what constitutes best interests of/for neonates.

Should advance directives (ADs) such as living wills be employed to direct the care of the severely demented? In considering this question, I focus primarily on the claims of Rebecca Dresser who objects in principle to the use of ADs in this context. Dresser has persuasively argued that ADs are both theoretically incoherent and ethically dangerous. She proceeds to advocate a Best Interest Standard as the best way for deciding when and how the demented ought to be treated. I put (...) forth a compromise position: both ADs and the Best Interest Standard have roles to play in guiding the care of the severely demented. (shrink)

The principle of beneficence directs healthcare practitioners to promote patients’ well-being, ensuring that the patients’ best interests guide treatment decisions. Because there are a number of distinct theories of well-being that could lead to different conclusions about the patient’s good, a careful consideration of which account is best suited for use in the medical context is needed. While there has been some discussion of the differences between subjective and objective theories of well-being within the bioethics literature, less attention has been (...) given to the questions of what work a theory of well-being needs to do in bioethics and which standards of success ought to be used in selecting a theory of well-being for use in medicine. In this article, I argue that traditional theories of well-being developed in philosophy are not well suited to meet the needs of the medical context. For the principle of beneficence to be most useful, the underlying account of well-being should satisfy two conditions: first, it needs to lead to a concrete, action-guiding determination of the patient’s good; and, second, any recommendations it offers need to be justifiable to patients. Standard accounts of well-being have difficulty satisfying both conditions. Exploring the limitations of these theories when applied to treatment dilemmas helps point the way toward the development of an account of well-being better suited to healthcare. (shrink)