The Concept of Best Interests in Clinical Practice

Abstract

The Best Interests Standard is a difficult and controversial concept, and its implementation in clinical practice faces substantial concerns from conceptual and linguistic points of view. By analyzing the underlying premises I conclude in a first step that the often criticized inconsistencies is not as much a problem of the concept of best interests itself but rather an inevitable consequence of coherent tensions between different values and perspectives in clinical practice. Nevertheless by pretending normative statements without the argumentative groundwork the term of “best interests” is prone to become empty or rhetorical. For using “best interests” as a meaningful concept and to respect and to consider the sometimes conflicting needs, values and perspectives in clinical practice I propose a constitutional matrix with three different discourses and four stakeholders. Arguing with the concept of “best interests” therefore implies to understand underlying ideologies (1), to delineate a particular area of optimum care and choice (2), and to learn about established or needed thresholds (3). Furthermore these three discourses are informed, each in a particular manner, by the views of expert (1), parents (2), the child (3) and the knowledge of a prospective future person (4). If only one of these considerations is missing we either should conceive the concept of “best interests” as a mandate to complete these considerations or refrain from using it in our argumentation. As a consequence the best interests is not perceived as a particular principle or philosophical argument but as a complex claim to assess and to implement multifaceted needs, aims, conditions and arguments concerning a child.