Abstract
The best interest standard (BIS) is the predominant ethical and legal principle in decision-making about children and in pediatrics. Over the past 25 years there has been a debate in the academic literature about the continued use of the BIS. Critiques of the BIS have been published, and alternative principles to replace or augment the BIS have been suggested. This chapter provides a review of the BIS, the functions it fulfills in pediatrics, the debate about the BIS, and alternative principles that have been suggested. The BIS is a robust ethical principle that fulfills many indispensable functions in pediatrics and is well able to overcome the objections of its critics. The BIS remains the best ethical standard to form the ethical basis of pediatrics.
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Further Reading
Bester, J.C. 2019a. The best interest standard and children: Clarifying a concept and responding to its critics. Journal of Medical Ethics 45 (2): 117–124.
Bester, J.C. 2019b. The best interest standard is the best we have: Why the harm principle and constrained parental autonomy cannot replace the best interest standard in pediatric ethics. The Journal of Clinical Ethics 30 (3): 223–231.
Diekema, D.S. 2004. Parental refusals of medical treatment: The harm principle as threshold for state intervention. Theoretical Medicine and Bioethics 25: 243–264.
Kopelman, L.M. 1997. The best interests standard as threshold, ideal, and standard of reasonableness. The Journal of Medicine and Philosophy 22: 271–289.
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Bester, J.C. (2022). The Best Interest Standard and Its Rivals: The Debate About Ethical Decision-Making Standards in Pediatrics. In: Nortjé, N., Bester, J.C. (eds) Pediatric Ethics: Theory and Practice . The International Library of Bioethics, vol 89. Springer, Cham. https://doi.org/10.1007/978-3-030-86182-7_4
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