Observations Ethics Man

Clarifying best interests

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a994 (Published 30 July 2008) Cite this as: BMJ 2008;337:a994
  1. Daniel K Sokol, lecturer in medical ethics and law
  1. 1St George’s, University of London
  1. daniel.sokol{at}talk21.com

    Whether patients have full autonomy or are incapable of indicating their values, how should we determine what is best for them?

    If from the lamp emerged a bioethics genie who granted me only one wish, I would ask for the ability to determine what is in the best interests of a particular individual. Armed with such insight I would resolve many of the thorniest dilemmas in clinical ethics, discerning in an instant what is best for the patient. Should we withhold treatment from this severely disabled neonate? Should we repeatedly inform this woman with Alzheimer’s disease that her husband died 10 years ago? Should we respect the confidentiality of this sexually active 14 year old girl? I can already picture the headline: “Ethicist wins Nobel prize for medicine.”

    Nowadays it is almost trite to say that “best interests” is a broader term than “medical best interests.” While important, health is one value among others that may, on occasion, be offset by those others. Hence a bon vivant might accept the life shortening effects of eating a daily chunk of full fat brie in exchange for the gustatory pleasure he …

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