Medicine, Health Care and Philosophy 22 (4):613-621 (2019)

Parker Crutchfield
Western Michigan University School Of Medicine
Scott Scheall
Arizona State University
We aim to establish the following claim: other factors held constant, the relative weights of the epistemic burdens of competing treatment options serve to determine the options that patient surrogates pursue. Simply put, surrogates confront an incentive, ceteris paribus, to pursue treatment options with respect to which their knowledge is most adequate to the requirements of the case. Regardless of what the patient would choose, options that require more knowledge than the surrogate possesses (or is likely to learn) will either be neglected altogether or deeply discounted in the surrogate’s incentive structure. We establish this claim by arguing that the relation between epistemic burdens and incentives in decision-making is a general feature of surrogate decision-making. After establishing the claim, we draw out some of the implications for surrogate decision-making in medicine and offer philosophical and psychological explanations of the phenomenon.
Keywords Surrogate decision-maker, proxy decision-maker, epistemology, medical ethics, end of life
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DOI 10.1007/s11019-019-09899-2
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