Charlie Gard and the Limits of the Harm Principle

To the Editor An article by Shah et al¹ published in JAMA Pediatrics argues that the best interest standard is too vague and indeterminate to be the appropriate decision-making standard in cases such as that of Charlie Gard.¹ The authors favor the harm principle advanced by Diekema² as a clearer, more understandable standard. Indeed, the best interest standard requires the complex work of identifying and weighing interests and values. However, the harm principle does not avoid this, nor is it less vague and indeterminate.