Diekema Douglas S
Professor at the University of Washington-Seattle and is Director of Education at the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Hospital in Seattle, Washington USA.
J Clin Ethics. 2019 Fall;30(3):207-212.
Thirty years ago, Buchanan and Brock distinguished between guidance principles and interference principles in the setting of surrogate decision making on behalf of children and incompetent adult patients. They suggested that the best interest standard could serve as a guidance principle, but was insufficient as an interference principle. In this issue of The Journal of Clinical Ethics, Ross argues that the best interest standard can serve as neither a guidance or interference principle for decision making on behalf of children, but that her model of constrained parental autonomy can serve as both. I will argue that Buchanan and Brock were correct that a single model or standard cannot serve as both a guidance and interference principle in pediatrics and that the best interest standard is a sufficient guidance principle. The harm principle fulfills the conditions necessary for an interference principle, at least insofar as deciding when state intervention to interfere with parental decision making is justified.
三十年前，布坎南和布罗克在代表儿童和无行为能力成年患者进行替代决策的背景下，区分了指导原则和干预原则。他们认为，最佳利益标准可以作为一项指导原则，但作为干预原则则不够充分。在本期《临床伦理学杂志》中，罗斯认为，最佳利益标准既不能作为代表儿童进行决策的指导原则，也不能作为干预原则，而她的受限父母自主权模型却可以同时充当这两种角色。我将论证，布坎南和布罗克是正确的，即在儿科领域，单一的模型或标准不能同时作为指导原则和干预原则，且最佳利益标准是一项充分的指导原则。伤害原则满足了作为干预原则所需的条件，至少在确定何时国家干预父母决策是合理的这方面是如此。
