Balancing Best Interests in Health Care, Ethics and Law (BABEL)

Every year, judges, doctors, and family members must decide what is in the “best interests” of patients who cannot decide for themselves—young children, people with dementia, or those in a coma—but there is no clear agreement on what that standard actually means or how it should be applied. This matters because the best interests standard is the legal and ethical bedrock for some of the most fraught decisions in medicine: whether to sterilise a person with learning disabilities, vaccinate a child against a parent’s wishes, withdraw life support from an incapacitated adult, or change the care plan for someone with advanced dementia. Currently, different judges, clinicians, and advocates interpret the same phrase in inconsistent ways, creating uncertainty for families and legal risk for healthcare providers. The BABEL project will map how the best interests standard is currently used across these settings, analyse why it is applied inconsistently, and develop a clearer framework for how it *should* operate going forward. If successful, the research will produce practical guidance for judges, lawyers, and healthcare professionals, and empower patients’ families and carers to participate more effectively in decisions that profoundly affect their lives. The project will also create a national network linking medical law and bioethics researchers, ensuring that future policy and case law are grounded in rigorous, shared understanding rather than ad hoc interpretation.