Capacity and Relationship

In the lead article in the May-June 2019 issue of the Hastings Center Report, Aaron Wightman and coauthors consider the guiding principles for making decisions about life-sustaining treatment for children who have profound cognitive impairments. They argue that the usual standard, which asks decision-makers to consider what will be in the child's best interests, cannot provide sufficient guidance. Discussing this problem in HCR thirty-five years ago, the philosopher John Arras proposed addressing it by means of a "relational potential standard," according to which decisions about providing life-sustaining treatment to a child should depend in part on whether the child has the capacity to form human relationships. Wightman et al. build on Arras's work, but where Arras had suggested that the capacity to form relationships could be gauged by examining the child's cognitive capabilities, the authors suggest that the medical team should lean heavily on the parents' views.