A focus on the principle of beneficence directs us to look at what does the most good. This focus is often framed in terms of looking at what a specific course of action does to promote an individual’s best interests.
Respect for autonomy means that an individual patient can (and often does) make choices that are not aligned with what might seem to be their best interests, but in the absence of such direction from a patient it is generally assumed that health care decisions should promote best interests (which are generally presumed to be, at minimum, continued life, having basic needs met, and functioning in society).
Beneficence is especially relevant in decision making with individuals who for whatever reason lack capacity; for example, parents are held to a best interest standard when their decision making on behalf of their children is being assessed.
Individuals with capacity are seen as the best judges of what is in fact in their best interest, although if an individual’s assessment of their best interest is not available the prevailing assumption described above regarding basic interests in continued life, needs satisfied, and functioning would apply. Challenges can arise when different individuals who are close to the patient have differing understandings of what that patient would construe as being in their best interest.
In making decisions on behalf of patients, substitute decision makers are instructed to follow explicit wishes, if known, and if not turn to the patient’s expressed values and preferences. Consideration of best interests should only play a role in decision making if the previous two sources of information are unavailable.