Intended for healthcare professionals


An unblinkered view of best interests

BMJ 2012; 345 doi: (Published 05 December 2012) Cite this as: BMJ 2012;345:e8007
  1. Wayne Martin, professor of philosophy,
  2. Fabian Freyenhagen, reader in philosophy,
  3. Elizabeth Hall, consultant in palliative medicine (retired),
  4. Tom O’Shea, senior research officer,
  5. Antal Szerletics, senior research officer,
  6. Vivienne Ashley, postgraduate research assistant
  1. 1Essex Autonomy Project, School of Philosophy and Art History, University of Essex, Colchester CO4 3SQ, UK
  1. Correspondence to: V Ashley vlashl{at}
  • Accepted 13 November 2012

Wayne Martin and colleagues argue that decisions about patients’ best interests must sometimes take into account the interests of others

Doctors often find themselves in circumstances where they must make decisions on behalf of an incapacitated patient. As a matter of both ethics and law, such decisions must be taken in the best interests of the patient, but uncertainty remains about what is meant by best interests, especially in relation to the interests of others. Should the interests of others enter into a determination of the patient’s best interests? We believe that they should and argue against a recent trend to focus solely on the patient.

Interests of patients are not confined to self

It only takes a moment’s reflection to appreciate that the interests of one person are often wrapped up with the interests of others. A patient has an interest in recovering from her illness, but so do her family, employer, care providers, etc. Sometimes these various interests can be independently specified, but in other cases they are inextricably intertwined. Suppose that I am a single parent whose overriding interest is to ensure the wellbeing of my children. In that case the proper specification of my best interest is a function of theirs; I simply cannot determine the one without considering the other. This can create an ethical problem in medical decision making. In circumstances where medical staff must make a decision in the best interests of an incapacitated patient, to what extent can or should they take account of the interests of other people whose lives are affected by the outcome?

These ethical issues have taken on a concrete legal shape in the UK with the implementation of the Mental Capacity Act 2005, which specifies that, “An act done, or decision made, under this Act for or on behalf of a person who lacks capacity …

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