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Background Best interests is a ubiquitous principle in medical policy and practice, informing the treatment of both children and adults. Yet theory underlying the concept of best interests is unclear and rarely articulated. This paper examines bioethical literature for theoretical accounts of best interests to gain a better sense of the meanings and underlying philosophy that structure understandings. Methods A scoping review of was undertaken. Following a literature search, 57 sources were selected and analysed using the thematic method. Results Three themes emerged. The first placed best interests within the structure of wider theory, noting relationships with consequentialism, deontology, prudential value theory, rights and political philosophy. The second mapped a typology of processes of decision-making, among which best interests was ambiguously positioned. It further indicated factors that informed best interests decision-making, primarily preferences, dignity and quality of life. The final theme considered best interests from a relational perspective. Conclusions Characterisation of best interests as strictly paternalist and consequentialist is questionable: while accounts often suggested a consequentialist basis for best interests, arguments appeared philosophically weak. Deontological accounts, found in law and Kantianism, and theories of political liberalism influenced accounts of best interests, with accounts often associating best interests with negative patient preferences (i.e. individual refusals). There was much more emphasis on negative interests than positive interests. Besides preference, factors like dignity and quality of life were held to inform best interests decisions, but generally were weakly defined. To the extent that preferences were unable to inform decision making, decisions were either made by proxy authority or by an intersubjective process of diffuse authority. Differing approaches reflect bifurcations in liberal philosophy between new liberalism and neo-liberalism. Although neither account of authority appears dominant, bias to negative interests suggests that bioethical debate tends to reflect the widespread ascendancy of neo-liberalism. This attitude was underscored by the way relational accounts converged on private familial authority. The visible connections to theory suggest that best interests is underpinned by socio-political trends that may set up frictions with practice. How practice negotiates these frictions remains a key question.

The article investigates the Estonian government's response to the fiscal crisis by looking at the dynamics of the decision-making processes during cutback management from 2008 to 2013 from the dichotomy of centralization–decentralization. The study explores the cutback decision-making by pinpointing the main actors and contextual variables shedding light on the management of fiscal crisis. It is demonstrated that, in general, the fiscal crisis contributed to increasing levels of centralization in governmental decision-making. The crisis decision-making was dominated by centralized political decisions and non-inclusion of the opposition and interest groups. Still, achieving urgent solutions was facilitated by decentralized decisions at the ministerial level, the empowerment of budgetary institutions and the intensive engagement of the civil servants. It has been indicated that the initially short-term procedures to enable cuts and resultant changes in decision-making processes are mostly in effect still in 2014 and thereby influence public administration practices in the long run.Points for practitionersThe study shows that cutback management may lead to urgency in governmental decision-making, where centralization facilitates quick decisions. It is also demonstrated that a minority government is able to achieve fiscal adjustment even in a context of high political conflict. The crisis context sets new requirements to the competencies of public servants, as cutback management obliges them to cope with new and very complicated tasks. The article indicates that short-term cuts and changes in decision-making processes intended to alleviate the acute phase of crisis may remain in effect considerably longer than initially planned and thereby influence public administration practices in the long run.

The decision of a committee is determined jointly by the voting process it adopts & the composition of its membership. The paper analyzes the process through which committee members emerge from the eligible population, & traces the consequences of this for the decisions of the committee. It is shown that the equilibrium committee will be composed of representatives from the extremes of the taste distribution. These extremes balance each other, & the committee reaches a moderate decision. However, this mutual negation by the extremes is a socially wasteful use of time. Data from the UK House of Lords are used to illustrate these results. 2 Tables, 1 Appendix, 7 References. Adapted from the source document.

Political control is not the only potential source of interference with judicial independence and impartiality. As the stakeholders in cases, litigants have perhaps the most significant incentive to influence the outcome of judges' decision-making. Based on introducing the concept in Chinese society of interpersonal relationships known as guanxi into a discussion of the nature of judicial power, this article examines a report released by the Caijing magazine about 200 corrupt judges convicted between 1995 and 2013 and argues that in China's society with guanxi embedded as its cultural roots, social pressure from relatives, friends and acquaintances of judges is a major source of external interference in judicial decision-making. (China/GIGA)

Enthält außerdem: Improving the financial operations of DFIs