American Journal of Bioethics 20 (2):59-61 (2020)

Parker Crutchfield
Western Michigan University School Of Medicine
Scott Scheall
Arizona State University
Berger (forthcoming) states that moral intimacy is important in applying the best interests standard. But what he calls moral intimacy requires that someone has overcome epistemic burdens needed to represent the patient. We argue elsewhere that good surrogate decision-making is first and foremost a matter of overcoming epistemic burdens, or those obstacles that stand in the way of a surrogate decision-maker knowing what a patient wants and how to satisfy those preferences. Berger’s notion of moral intimacy depends on epistemic intimacy: the fact that a surrogate's epistemic burdens with respect to the best interests of the incapacitated patient have been adequately surmounted, plus some other feature. Thus, where a particular patient-surrogate relationship fails to be morally intimate, what is lacking is either epistemic intimacy or this second feature. Furthermore, Berger uses the notion of moral intimacy as an explanans for the application of the best interests standard. We argue that the notions of epistemic intimacy and epistemic burdens not only help to explain the notion of moral intimacy, but also better explain the application of the best interests standard. Given the role of epistemic burdens and the epistemic intimacy that overcoming them enables, bioethicists and physicians should consider a surrogate’s epistemic standing relative to the patient’s best interests before pronouncing on the former’s ethical probity.
Keywords Surrogate decision-making  Biomedical ethics  Best interests  Substituted judgment
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DOI 10.1080/15265161.2019.1701737
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Epistemic Burdens and the Incentives of Surrogate Decision-Makers.Parker Crutchfield & Scott Scheall - 2019 - Medicine, Health Care and Philosophy 22 (4):613-621.

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