Skip to main content Accessibility help
×
Home

Best interests and the raison d’être of health care

  • V. Riordan (a1)

Abstract

The report of the expert group on the review of the Mental Health Act has recommended that the requirement to consider the best interests of the person be replaced by a list of guiding principles, which focus on the autonomy of the individual. The implied rationale for this is that acting in our patients’ best interests may be a violation of their human rights. Dignity is being proposed as an alternative way of capturing ‘the positive aspects associated with best interests’, but it is not clear how dignity is preferable to best interests. Both approaches may help protect the most vulnerable from exploitation. However, unlike best interests, dignity can be used as a synonym for autonomy. Valuing autonomy as a means to an end (instrumental value) should be distinguished from valuing autonomy as an end in itself (intrinsic value). As the ultimate end of instrumental autonomy is invariably the person’s best interests, abandoning that principle renders instrumental autonomy obsolete, leaving intrinsic autonomy as the supreme value. As best interest, dignity and autonomy rarely conflict, the proposed changes may appear minor, but they are not. When such values do conflict, acting against our patients’ interests may become inevitable.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Best interests and the raison d’être of health care
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Best interests and the raison d’être of health care
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Best interests and the raison d’être of health care
      Available formats
      ×

Copyright

Corresponding author

*Address for correspondence: Dr V. Riordan, MRCPsych, Consultant Psychiatrist, West Cork Mental Health Services, Bantry Hospital, Bantry, Co Cork 027 52970, Ireland. (Email: Vincent.riordan@hse.ie)

References

Hide All
Andorno, R (2009). Human dignity and human rights as a common ground for a global bioethics. Journal of Medicine and Philosophy 34, 223240.
Beauchamp, TL, Childress, JF (2001). Principles of Biomedical Ethics. Oxford University Press: Oxford.
Beyeveld, D, Brownsword, R (2001). Human Dignity in Bioethics and Biolaw. Oxford University Press: Oxford.
Caulfield, T, Chapman, A (2005). Human dignity as a criterion for science policy. PLoS Med 2, 736738.
Department of Health (2015). Report of the Expert Group on the Review of the Mental Health Act 2001. Department of Health: Dublin.
Dignitas (1998). Who is Dignitas? http://dignitas.ch/index.php?option=com_content&view=article& id=4&Itemid=44&lang=en. Accessed 26 September 2014.
Fulford, KWM (2004). Ten principles of values based medicine (VBM). In Philosophy and Psychiatry (ed. T. Schramme and J. Thone), pp. 5083. De Gruyter GmBH: Berlin.
Gillon, R (2003). Ethics needs principles – four can encompass the rest – and respect for autonomy should be ‘first among equals’. Journal of Medical Ethics 29, 307312.
Horton, R (2004). Rediscovering human dignity. Lancet 364, 10811085.
John Paul II (1995). Evangelicum Vitae, Papal Encyclical Letter. 25 March.
Kelly, BD (2014). Dignity, human rights and the limits of mental health legislation. Irish Journal of Psychological Medicine 31, 7581.
Kennedy, H (2012). ‘Libertarian’ Groupthink not helping mentally ill. Irish Times 12 September, p. 14.
Lepping, P, Raveeesh, BN (2014). Overvaluing autonomous decision making. British Journal of Psychiatry 204, 12.
Macklin, R (2003). Dignity is a useless concept. British Medical Journal 327, 14191420.
Matthews, E (2007). Is autonomy relevant to psychiatric ethics?. In Autonomy and Paternalism: Reflections on the Theory and Practice of Health Care (ed. T. Nys, Y. Denier and T. Vandevelde), pp. 129146. Peeters: Leuven.
Medical Council (2009). Guide to Professional Conduct and Ethics for Registered Medical Practitioners, p. 7. Medical Council: Dublin.
Mill, JS (1869). On Liberty. Longman, Roberts & Green, London.
Orwell, G (1945). Animal Farm. Chapter IX, para 6. First published by Martin Secker and Warberg, London.
Rosen, M (2012). Dignity; Its History and Meaning. Harvard University Press: Cambridge, MA.
Slade, M (2009). Personal Recovery and Mental Illness. Compulsion Justification 2: Best Interests, pp. 5860. Cambridge University Press: Cambridge.
United Nations (2006). Convention on the Rights of Persons with Disabilities. United Nations: Geneva.
Varelius, J (2006). The value of autonomy in medical ethics. Medicine, Health Care and Philosophy 9, 377388.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed