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A new analysis of the Best Interests Standard is given and applied to the controversy about testing children for untreatable, severe law-onset genetic diseases, such as Huntington's disease or Alzbeimer's disease. A professional consensus recommends against such predictive testing, because it is not in children's best interest. Critics disagree. The Best Interests Standard can be a powerful way to resolve such disputes. This paper begins by analyzing its meaning into three necessary and jointly sufficient conditions showing it: 1. is an 'umbrella' standard, used differently in different contexts, 2. has objective and subjective features, 3. is more than people's intuitions about how to rank potential benefits and risks in deciding for others but also includes evidence, established rights, duties and thresholds of acceptable care, and 4. can have different professional, medical moral and legal uses, as in this dispute. Using this standard, support is given for the professional consensus based on concerns about discrimination, analogies to adult choices, consistency with clinical judgments for adults, and desires to preserve of an open future for children. Support is also given for parents' legal authority to decide what genetic tests to do. Keywords: Alzheimer's disease, best interest, children, ethics, genetics, Huntington's disease, law, pediatrics, rights

A dispute exists about whether bioethics should become a new discipline with its own methods, competency standards, duties, honored texts, and core curriculum. Unique expertise is a necessary condition for disciplines. Using the current literature, different views about the sort of expertise that might be unique to bioethicists are critically examined to determine if there is an expertise that might meet this requirement. Candidates include analyses of expertise based in 'philosophical ethics,' 'casuistry,' 'atheoretical or situation ethics,' 'conventionalist relativism,' 'institutional guidance,' 'regulatory guidance and compliance,' 'political advocacy,' 'functionalism,' and 'principlism.' None succeed in identifying a unique area of expertise for successful bioethicists that could serve as a basis for making it a new discipline. Rather expertise in bioethics is rooted in many professions, disciplines and fields and best understood as a second-order discipline. Keywords: bioethics, codes, ethics, professionalism, interdisciplinary, multidisciplinary

Two incompatible policies exist for guiding medical decisions for extremely premature, sick, or terminally ill infants, the Best Interests Standard and the newer, 20-year old 'Baby Doe' Rules. The background, including why there were two sets of Baby Doe Rules, and their differences with the Best Interests Standard, are illustrated. Two defenses of the Baby Doe Rules are considered and rejected. The first, held by Reagan, Koop, and others, is a 'right-to-life' defense. The second, held by some leaders of the American Academy of Pediatrics, is that the Baby Doe Rules are benign and misunderstood. The Baby Doe Rules should be rejected since they can thwart compassionate and individualized decision-making, undercut duties to minimize unnecessary suffering, and single out one group for treatment adults would not want for themselves. In these ways, they are inferior to the older Best Interests Standard. A 'negative' analysis of the Best Interests Standard is articulated and defended for decision-making for all incompetent individuals. Keywords: American Academy of Pediatrics, Baby Doe, Best Interests Standard, end of life treatment, ethics, infants, Koop, law, neonatal, right-to-life, Reagan, sanctity of life

Classifying research proposals by risk of harm is fundamental to the approval process and the most pivotal risk category in most regulations is that of 'minimal risk.' If studies have no more than a minimal risk, for example, a nearly worldwide consensus exists that review boards may sometimes: (1) expedite review, (2) waive or modify some or all elements of informed consent, or (3) enroll vulnerable subjects including healthy children, incapacitated persons and prisoners even if studies do not hold out direct benefits to them. The moral and social purposes behind this threshold are discussed along with relevant views from the National Commission, NBAC, NHRPAC. Grimes v. Kennedy Krieger Institute, The Nuremberg Code, and The WMA's Declaration of Helsinki. Representative policies from Australia, Canada, South Africa, the U.S., and CIOMS are reviewed revealing different understandings of this sorting threshold. Six of nine frequently cited interpretations of 'minimal risk' are untenable. The 'absolute' interpretation of the 'routine examination' standard is defended as best. Keywords: ethics, minimal risk, precautionary principle, research, regulations, review boards, minors