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denied there was any ethical component to this decision. Instead, the decision was
described as a ‘clinically based’ and relied heavily on set guidelines and medical
evidence. These denials epitomise the problems with best interest determinations made
in medical and legal contexts – entrenched perceptions that they can be made without
recourse to values.
To challenge this perception, it is necessary to strip away centuries of positivist legal
process and medical, fact centred approaches, and start with a basic understanding of
how an ethically complex decision like withdrawing life sustaining treatment is made.
Seedhouse’s rational fields theory offers a comprehensive and realistic theory of
decision making. I use it as the basic theoretical framework with which to advance my
argument.
I start by considering perceptions about value-free decision making. I then set out the
main points of the rational fields theory, following which I apply the model to best
interest determinations. I finish by considering how the additional understanding and
clarity provided resolves important philosophical questions and offers practical
solutions to enhance decision making.
Existing foundations
Obviously evidence and values are intertwined. Obviously all decisions
are a balance of evidence and values. Obviously we should regard our
values as at least equally important as evidence. And yet we don’t.
It isn’t particularly easy to understand why. We know we value. We
know we are passionate creatures. And yet we want more and more
evidence and less and less values in our decision-making.
Seedhouse, 2005, p 23
Best interest determinations take place within legal and medical contexts which are
underpinned by philosophical frameworks which aim to achieve neutrality and
eliminate the individual values of decision makers. The medical model is traditionally
based on scientific method and essentially ‘fact-centred’. For example, the current push
for evidence based medicine places perspective-free information such as ‘meta-analyses
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