'Best interests' is a panacea within medico-legal decisions for incapacitated patients.
Its scope is extensive and its range of application situationally diverse, yet the
meaning of best interests remains relatively obscure. To clarify its character this
thesis deconstructs best interests by critically examining current law regarding
treatment decisions for incompetent patients (Chapters 1 and 2). The conceptual
implications of using 'interests' are then considered through exploration of
philosophical approaches to sources of interests (Chapter 3). Certain important
distinctions are raised and the notion of an 'interest network' is mooted. The
possibilities for reconstruction of best interests are considered in Chapters 4 and 5.
The importance of autonomy, including competence construction and patient
perspective in alternative decision-making mechanisms, is considered. The meaning
of welfare, together with quality of life and personhood are also explored in the
context of incapacitated persons. Reconstruction then begins in earnest. 'Respect' is
proffered as the most suitable ethic for governing 'best interests'. A new synthesis of
respect is developed through Chapters 6,7 and 8. It is argued (Chapter 6) that we
should admit a wider range of interests, recognise the importance of relationship, and
differentiate between input and decision-making authority. A 'whole life, over time'
approach is proffered in Chapter 7, including a reclassification of incompetence, and
a process for ascertaining interests outlined. The final chapter embraces ethical
issues, conflict resolution and criteria for justified decision-making. Discussion
concludes by developing a normative framework to legally represent the improved
respect synthesis within 'best interests'.