It is argued that a number of important, and seemingly disparate, types of representation are species of a single relation, here called structural representation, that can be described in detail and studied in a way that is of considerable philosophical interest. A structural representation depends on the existence of a common structure between a representation and that which it represents, and it is important because it allows us to reason directly about the representation in order to draw conclusions about the (...) phenomenon that it depicts. The present goal is to give a general and precise account of structural representation, then to use that account to illuminate several problems of current philosophical interest — including some that do not initially seem to involve representation at all. In particular, it is argued that ontological reductions (like that of the natural numbers to sets), compositional accounts of semantics, several important sorts of mental representation, and (perhaps) possible worlds semantics for intensional logics are all species of structural representation and are fruitfully studied in the framework developed here. (shrink)

In this paper, I develop Mauricio Suárez’s distinction between denotation, epistemic representation, and faithful epistemic representation. I then outline an interpretational account of epistemic representation, according to which a vehicle represents a target for a certain user if and only if the user adopts an interpretation of the vehicle in terms of the target, which would allow them to perform valid (but not necessarily sound) surrogative inferences from the model to the system. The main difference between the interpretational conception I (...) defend here and Suárez’s inferential conception is that the interpretational account is a substantial account—interpretation is not just a “symptom” of representation; it is what makes something an epistemic representation of a something else. (shrink)

Computer simulations are widely used for surrogative reasoning in scientific research. They also play a crucial role in engineering, more specifically in the design of new robotic systems, yet the nature of this role has been little discussed so far in the philosophy of technology literature. The main claim made in this article is that the notion of surrogative reasoning is central to understanding how computer simulations can serve the purpose of designing new robots. More specifically, it is (...) argued that computer simulations can support two forms of surrogative reasoning, which are called model-oriented and prediction-oriented, whose inferential structure is reconstructed to some extent. And it is argued that, when computer simulations are used to design new robots, they are distinctively used in the model-oriented way. By unravelling the structure of the computer simulation-supported methods adopted in robotic design, this article may contribute to a finer-grained understanding of the epistemic processes involved in technological research. (shrink)

This article aims to present a Free Dialogic Logic [FDL] as a general framework for hypothesis generation in the practice of modelling in science. Our proposal is based on the idea that the inferential function that models fulfil during the modelling process (surrogate reasoning) should be carried out without ontological commitments. The starting point to achieve our objective is that the scientific consideration of models without a target is a symptom that, on the one hand, the Applicability of (...) Logic should be considered among the conditions of adequacy that should take into account all modeling process and, on the other, that the inferential apparatus at the base of the surrogate reasoning process must be rid of realistic assumptions that lead to erroneous conclusions. In this sense, we propose as an alternative an ontologically neutral inferential system in the perspective of dialogical pragmatism. (shrink)

El objetivo de este artículo es proponer una justificación lógica del proceso de razonamiento sustitutivo en la práctica del modelado en ciencia. Para ello, definimos la generación de hipótesis como la creación de un diálogo interactivo y formal entre el modelo y el sistema objetivo. Para describir esta idea desde un punto de vista lógico, nos basaremos en el enfoque pragmático de la Dialógica como marco ideal para ilustrar las interacciones lógicas.

Incompetent patients need to have someone else make decisions on their behalf. According to the Substituted Judgment Standard the surrogate decision maker ought to make the decision that the patient would have made, had he or she been competent. Objections have been raised against this traditional construal of the standard on the grounds that it involves flawed counterfactual reasoning, and amendments have been suggested within the framework of possible worlds semantics. The paper shows that while this approach may (...) circumvent the alleged problem, the way it has so far been elaborated reflects insufficient understanding of the moral underpinnings of the idea of substituted judgment. Proper recognition of these moral underpinnings has potentially far-reaching implications for our normative assumptions about accuracy and objectivity in surrogate decision making. (shrink)

ABSTRACT In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision‐making competence and 2) the practice of surrogate decision‐making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. Because of (...) ‘structural arbitrariness’ in the whole process of how we assess decision‐making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision‐ making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision‐making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non‐competent others. (shrink)

In this paper, I address some of the shortcomings of established clinical ethics centring on personal autonomy and consent and what I label the Doctrine of Respecting Personal Autonomy in Healthcare. I discuss two implications of this doctrine: 1) the practice for treating patients who are considered to have borderline decision-making competence and 2) the practice of surrogate decision-making in general. I argue that none of these practices are currently aligned with respectful treatment of vulnerable individuals. Because of ‘structural (...) arbitrariness’ in the whole process of how we assess decision-making competence, this area is open to disrespectful treatment of people. The practice of surrogate decision- making on the basis of a single person's judgment is arguably not consistent with ethical and political requirements derived from the doctrine itself. In response to the inadequacies of the doctrine, I suggest a framework for reasonableness in surrogate decision-making which might allow practice to avoid the problems above. I conclude by suggesting an extended concept of Patient Autonomy which integrates both personal autonomy and the regulative idea of morality that is required by reasonableness in deciding for non-competent others. (shrink)

As medical technology continues to improve, more people will live longer lives with multiple chronic illnesses with increasing cumulative debilitation, including cognitive dysfunction. Combined with the aging of society in most developed countries, an ever-growing number of patients will require surrogate decision-makers. While advance care planning by patients still capable of expressing their preferences about medical interventions and end-of-life care can improve the quality and accuracy of surrogate decisions, this is often not the case, not infrequently leading to (...) demands for ineffective, inappropriate and prolonged interventions. In 1980 LaFollette called for the licensing of prospective parents, basing his argument on the harm they can do to vulnerable people. In this paper, I apply his arguments to surrogate decision-makers for cognitively incapacitated patients, rhetorically suggesting that we require potential surrogates to qualify for this position by demonstrating their ability to make reasonable and rational decisions for others. I employ this theoretical approach to argue that the loose criteria by which we authorize surrogates’ generally unchallenged power should be reconsidered. (shrink)

A general view in philosophy of science says that the appropriateness of an object to act as a surrogate depends on the user’s decision to utilize it as such. This paper challenges this claim by examining the role of surrogative reasoning in high-throughput sequencing technologies as they are used in contemporary microbiome science. Drawing on this, we argue that, in technology-driven surrogates, knowledge about the type of inference practically permitted and epistemically justified by the surrogate constrains their (...) use and thus puts a limit to the user’s intentions to use any object as a surrogate for what they please. Ignoring this leads to a serious epistemic misalignment, which ultimately prevents surrogative reasoning. Thus, we conclude that knowledge about the type of surrogate reasoning that the technologies being used allow is fundamental to avoid misinterpreting the consequences of the data obtained with them, the hypothesis this data supports, and what these technologies are surrogates of. (shrink)

This paper accomplishes two tasks. First, I examine in detail Edmund Husserl’s earliest philosophy of surrogates, as it is found in his 1890 “On the Logic of Signs ”. I analyze his psychological and logical investigations of surrogates, where the former is concerned with explaining how these signs function and the latter with how they do so reliably. His differentiation of surrogates on the basis of their genetic origins and degrees of necessity is discussed. Second, the historical importance of this (...) text is disclosed by showing how Semiotic serves as both the inspiration for, and the foil to, Husserl’s 1901 First Logical Investigation. Husserl not only adopts the idea that linguistic signs can function via association, but also maintains that such signs can motivate me to execute one of two experiences. The key difference between the texts is that Husserl abandons his theory of surrogates in 1901, instead holding that I can experience absent objects by means of empty intentions. The reasons why Husserl found it necessary to transform this tenet of his philosophy are discussed at length. (shrink)

It is usually taken for granted, in discussions about fiction, that real things or events can occur as referents of fictional names . In this paper, I take issue with this view, and provide several arguments to the effect that it is better to take the names in fiction to refer to fictional surrogates of real objects. Doing so allows us to solve a series of problems that arise on the reference-continuity view. I also show that the arguments philosophers usually (...) rely on in order to ban surrogates are not as serious as they have been taken to be. In the first part of the paper, I describe the two conflicting views. In the second part, I discuss several specific arguments in favor of surrogates. In the third part I take up the kind of reasons ordinarily offered against them. (shrink)

Patients can be harmed by a religiously motivated surrogate decision maker whose decisions are contrary to the standard of care; therefore, surrogate decision making should be held to a high standard. Stewart Eskew and Christopher Meyers proposed a two-part rule for deciding which religiously based decisions to honor: (1) a secular reason condition and (2) a rationality condition. The second condition is based on a coherence theory of rationality, which they claim is accessible, generous, and culturally sensitive. In (...) this article, I will propose strengthening the rationality condition by grounding it in a theory of intellectual virtue, which is both rigorous and culturally sensitive. (shrink)

Conservative ethical systems, particularly organized religions, are frequently at odds with the means, if not the goals of the new reproductive technologies. Among the most problematic measures adopted in recent years to allow childless women to raise genetically related offspring is surrogate motherhood. Traditional Jewish law, or Halakha, notwithstanding this reluctance, is, nevertheless, more likely than many others to find reasons to justify the practice, given its well-known stance viz procreation and its leniency regarding the new reproductive technologies. In (...) the following article, we ask whether Halakha, which allows abortion to save the life of a mother, would sanction the employment of a surrogacy arrangement in the case where pregnancy threats her life, in order to save the fetus as well. (shrink)

ABSTRACT In the first part of this article I discuss some objections which assert that surrogacy is primarily—but not exclusively—harmful in a moral sense. After examination of mainly but not exclusively morality‐dependent harms (objections from similarity with prostitution, exploitation, etc.) and after the discussion of possible non‐morality‐dependent harms (baby, couple, surrogate mother, agency, etc.), I argue, in the second part, that no one reason supports the possible prohibition of surrogacy. In the last part I try to show why moral (...) reasons alone could not be sufficient to criminalize any kind of activity—including surrogacy—in a liberal order. (shrink)

This paper will explore some moral and conceptual aspects of the practice of surrogate motherhood. Although I put forward a number of criticisms of existing ideas about this subject, I do not claim to offer a fully developed position. Instead what I have tried to do is to call into question what seem to be some generally accepted assumptions about surrogate motherhood, and to lend plausibility to my view that surrogate motherhood may be morally troubling for reasons (...) not always fully recognized by other writers on this issue. These reasons go beyond the fairly obvious consequentialist concerns about its effects on the persons - particularly the child — involved. A concern for the well being of a child produced by a surrogate is, I believe, entirely justified, but my focus in this paper will be upon the surrogate mother herself. (shrink)

Standard views on surrogate decision making present alternative ideal models of what ideal surrogates should consider in rendering a decision. They do not, however, explain the physician''s responsibility to a patient who lacks decisional capacity or how a physician should regard surrogates and surrogate decisions. The authors argue that it is critical to recognize the moral difference between a patient''s decisions and a surrogate''s and the professional responsibilities implied by that distinction. In every case involving a patient (...) who lacks decisional capacity, physicians and the treatment team have to make judgments about the appropriateness of both the surrogate and the surrogate''s decision. They have to assess the surrogate''s decisional capacity and attitude toward the patient as well as the reasons that support the surrogate''s decision. This paper provides a model for acceptable surrogate decisions and a standard for blocking inappropriate surrogates. Only decisions based on widely shared reasons are allowable for surrogate refusal of highly beneficial treatment. (shrink)

A first principle in ethics consultation is that reasoning is essential. A second principle is that the religious and cultural views of patients and their surrogates are usually respected. What can be done when these principles collide—when patients or surrogates have religious or cultural views and beliefs that clinicians find unreasonable or even offensive? Mediation may provide some approaches to assist us in providing the most ethically appropriate assistance.

The capacity to designate a surrogate (CDS) is not simply another kind of medical decision-making capacity (DMC). A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients (...) who lack DMC for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases (eg, Alzheimer’s disease). That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions. (shrink)

Can Rawlsian public reason sufficiently justify public policies that regulate or restrain controversial medical and technological interventions in bioethics (and the broader social world), such as abortion, physician aid-in-dying, CRISPER-cas9 gene editing of embryos, surrogate mothers, pre-implantation genetic diagnosis of eight-cell embryos, and so on? The first part of this essay briefly explicates the central concepts that define Rawlsian political liberalism. The latter half of this essay then demonstrates how a commitment to Rawlsian public reason can ameliorate (not completely (...) resolve) many of the policy disagreements related to bioethically controversial medical interventions today. The goal of public reason is to reduce the size of the disagreement by eliminating features of the disagreement that violate the norms of public reason. The norms of public reason are those norms that are politically necessary to preserve the liberal, pluralistic, democratic character of this society. What remains is reasonable disagreement to be addressed through normal democratic deliberative processes. Specific issues addressed from a public reason perspective include personal responsibility for excessive health costs, the utility of a metaphysical definition of death for organ transplantation, and the moral status of excess embryos generated through IVF and/or their use in medical research. (shrink)

My topic is a problem with our practice of surrogate decision-making in health care, namely, the problem of the surrogate who is not doing her job—the surrogate who cannot be reached or the surrogate who seems to refuse to understand or to be unable to understand the clinical situation. The analysis raises a question about the surrogate who simply disagrees with the medical team. One might think that such a surrogate is doing her job—the (...) team just doesn't like how she is doing it. My analysis raises the question of whether she should be overridden. In approaching this problem, I focus not on the range of difficulties in practice but on the underlying moral conceptual issue. My concern will be to show that the moral values that underpin patient decision-making are fundamentally different from those that underpin surrogate decision-making. Identifying the distinctions will set parameters for any successful solution to the “Who should decide?” question. A patient has a specific kind of moral right to make her own medical decisions. A surrogate has no analogous moral right to decide for someone else. We want the surrogate to make the decision because we believe that she has a relevant epistemological advantage over anyone else on the scene. If and when she has no such advantage or if she refuses or is unable to use it, then there might not be sufficient reason to let her be the decision-maker. (shrink)

Our ethics committee is revising the organization's policy on forgoing life-sustaining treatment. The current policy now includes the statement, “When life-sustaining treatment is forgone, supportive care will be provided to relieve pain and ensure the patient's comfort, unless the patient or surrogate refuses those measures.” Is it reasonable, however, for the surrogate to have the authority to refuse consent for pain medication and/or other supportive care?

When patients are not able to speak for themselves, surrogate decision makers are asked to guide treatment decisions and formulate a plan of care in accordance with what the patients would have wanted. This necessitates an exploration into the patients’ views about life and how it should be lived, how the patients constructed their identity or life story, and their attitudes towards sickness and suffering. When an individual appoints a surrogate, such as a healthcare power of attorney, a (...) common presumption is that this designation evinces merit. This obscures the possibility of multiple other considerations that influence individual choice. This article presents a clinical case in which the claim to know someone best created a controversy that brought treatment decisions to a standstill. Further, it illuminates how the question, “Given the current medical condition, what would this person want?” risks presuming that a singular, unambiguous preference exists and that one person can provide the answer. Clinical ethicists can play a vital role in situations when there is a dispute among a designated surrogate and family members over a patient’s preference. By embracing the complexity of the desire to synthesize seemingly irreconcilable perspectives about identity, uncovering the reasons that underlie disagreement, and guiding inquiry in such a way that allows stakeholders to move beyond the conflict, clinical ethicists can facilitate decision making that honors the patient and may mitigate moral distress. (shrink)

Existing state surrogate decision-maker laws are fragmented and inconsistent and fail to ensure that all eligible decision makers of the same surrogate priority class are included in the healthcare decisions made for an incapacitated loved one. In this article, we explore three categories of harm that result from failing to include all surrogates of equal priority in a patient’s healthcare decision, namely harms to the patient, harms to the excluded surrogate, and harms to the family. Given these (...) harms, we argue that clinical ethicists have a moral obligation to take reasonable steps to include all surrogate decision makers of equal priority in the healthcare decision-making process for patients without a designated healthcare proxy. (shrink)

This issue’s “Legal Briefing” column covers recent legal developments involving medical decision making for unbefriended patients. These patients have neither decision-making capacity nor a reasonably available surrogate to make healthcare decisions on their behalf. This topic has been the subject of recent articles in JCE. It has been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the “single greatest category of problems” encountered in bioethics consultation. Moreover, the scope of the problem (...) continues to expand, especially with rapid growth in the elderly population and with an increased prevalence of dementia.Unfortunately, most U.S. jurisdictions have failed to adopt effective healthcare decision-making systems or procedures for the unbefriended. “Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform.” Most providers are “muddling through on an ad hoc basis.” Still, over the past several months, a number of state legislatures have finally addressed the issue. These developments and a survey of the current landscape are grouped into the following 14 categories. The first two define the problem of medical decision making for the unbefriended. The remaining 12 categories describe different solutions to the problem. The first six of these solutions are discussed in this article (Part 1). The last eight solutions will be covered in the Summer 2012 issue of JCE (Part 2). 1. Who are the unbefriended?2. Risks and problems of the unbefriended3. Prevention: advance care planning, diligent searching, and careful capacity assessment4. Decision-making mechanisms and standards5. Emergency exception to informed consent6. Expanded default surrogate lists: close friends7. Private guardians8. Volunteer guardians9. Public guardians10. Temporary and emergency guardians11. Attending physicians12. Other clinicians, individuals, and entities13. Institutional committees14. External committees. (shrink)

Surrogate selection can be extremely consequential for patients. Most surrogates are selected by default, so we should care about whether legal provisions for default surrogate selections are ethically justified. Most U.S. states use an inflexible, prioritized list of relationships, that is, a hierarchical list where eligible classes of higher-ranked individuals must be selected before lower-ranked individuals. I argue that while some inflexible, prioritized lists may roughly reflect the order that many patients would select, there is a significant minority (...) that inflexible lists systematically disempower. This is morally unacceptable given the availability of less morally problematic alternatives. One alternative is a flexible, prioritized list, which provides conditions for lower-ranked individuals to be selected ahead of higher-ranked ones. I argue that since all the U.S. states that currently have an inflexible, prioritized list systematically disempower a significant proportion of their residents, they have good reason to adopt a flexible, prioritized list instead. Furthermore, the Universal Law Commission currently recommends that states adopt an inflexible, prioritized list, so they have good reason to change their recommendation. (shrink)

Next SectionOne of the major concerns about surrogacy is the potential harm that may be inflicted upon the surrogate mother and the child after relinquishment. Even if one were to take the liberal view that surrogacy should be presumptively allowed on the basis of autonomy and/or compassion, evidence of harm must be taken seriously. In this paper I review the evidence from psychological studies on the effect that relinquishing a child has on the surrogate mother and while it (...) appears that many surrogates are able to cope with relinquishment, I argue that there are good reasons, grounded in empirical evidence, to support the view that the subsequent management of the relinquishment necessarily objectifies the surrogate mother. (shrink)

This issue’s “Legal Briefing” column continues coverage of recent legal developments involving medical decision making for unbefriended patients. These patients have neither decision-making capacity nor a reasonably available surrogate to make healthcare decisions on their behalf. This topic has been the subject of recent articles in JCE. It has been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the “single greatest category of problems” encountered in bioethics consultation. Moreover, the scope of (...) the problem continues to expand, especially with rapid growth in the elderly population and with an increased prevalence of dementia.Unfortunately, most U.S. jurisdictions have failed to adopt effective healthcare decision-making systems or procedures for the unbefriended. “Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform.” Most providers are “muddling through on an ad hoc basis.” Still, over the past several months, a number of state legislatures have finally addressed the issue. These developments and a survey of the current landscape are grouped into the following 14 categories. The first two categories define the problem of medical decision making for the unbefriended. The remaining 12 describe different solutions to the problem. The first six categories were covered in Part 1 of this article; the last eight categories are covered in this issue (Part 2). 1. Who are the unbefriended?2. Risks and problems of the unbefriended3. Prevention: advance care planning, diligent searching, and careful capacity assessment4. Decision-making mechanisms and standards5. Emergency exception to informed consent6. Expanded default surrogate lists: close friends7. Private guardians8. Volunteer guardians9. Public guardians10. Temporary and emergency guardians11. Attending physicians12. Other clinicians, individuals, and entities13. Institutional committees14. External committees. (shrink)

The law ordinarily recognises the woman who gives birth as the mother of a child, but in certain jurisdictions, it will recognise the commissioning couple as the legal parents of a child born to a commercial surrogate. Some commissioning parents have, however, effectively abandoned the children they commission, and in such cases, commercial surrogates may find themselves facing unexpected maternal responsibility for children they had fully intended to give up. Any assumption that commercial surrogates ought to assume maternal responsibility (...) for abandoned children runs contrary to the moral suppositions that typically govern contract surrogacy, in particular, assumptions that gestational carriers are not ‘mothers’ in any morally significant sense. In general, commercial gestational surrogates are almost entirely conceptualised as ‘vessels’. In a moral sense, it is deeply inconsistent to expect commercial surrogates to assume maternal responsibility simply because commissioning parents abandon children for one reason or another. We identify several instances of child abandonment and discuss their implications with regard to the moral conceptualisation of commercial gestational surrogates. We conclude that if gestational surrogates are to remain conceptualised as mere vessels, they should not be expected to assume responsibility for children abandoned by commissioning parents, not even the limited responsibility of giving them up for adoption or surrendering them to the state. (shrink)

Patients who are incompetent need a surrogate decision maker to make treatment decisons on their behalf. One of the main ethical questions that arise in this context is what standard ought to govern such decision making. According to the Substituted Judgment Standard, a surrogate ought to make the decision that the patient would have made, had he or she been competent. Although this standard has sometimes been criticized on the grounds of being difficult to apply, it has found (...) wide appeal, since it it is alleged to protect incompetent patients? right to autonomy. The main purpose of the thesis is to evaluate SJS, from a conceptual and ethical perspective. It argues that the traditional formulation of SJS is seriously incomplete, and discusses alternative ways of completing it. Moreover, it questions the received view on how SJS should be morally justified, by offering arguments against the view that decision making in accordance with this standard extends the patient's opportunities for self-determination. Instead it suggests a virtue-ethical approach according to which the moral point of SJS-based decision making is not to protect the patient's interests, but to express respect for person. The thesis also critically assesses empirical studies according to which surrogates often fail to correctly predict patients? actual treatment preferences. It is shown that such results cannot, for a number of reasons, support the conclusion drawn that surrogates are ill-equipped to make decisions that comply with SJS. (shrink)

In today’s science, the output of measurement processes are often visual representations of the data detected. Moreover, we find such visual data as parts of scientific reasoning in different contexts. In this article, we will take a look at two of them. On the one hand, visual representations are used as a kind of surrogate for the real object to ask questions about it – we will call this the exploratory use of visual data. On the other hand, (...) visualisations are often used to communicate research results to scientific peers or to laymen. Instances of the latter case we will subsequently call the explanatory use of visual data. However, in both contexts the question arises what might justify these epistemic practices. Believing without reasons is epistemically irresponsible, it leads to gullibility. Thus, we will try to answer the question whether there are any reasons to support our epistemic practices concerning scientific visualisations in the above-mentioned senses and whether these are good reasons to rely on. (shrink)

During an outbreak or pandemic involving a novel disease such as COVID-19, infected persons may need to undergo strict medical isolation and be separated from their families for public health reasons. Such a practice raises various ethical questions, the characteristics of which are heightened by uncertainties such as mode of transmission and increasingly scarce healthcare resources. For example, under what circumstances should non-infected parents be allowed to stay with their infected children in an isolation facility? This paper will examine ethical (...) issues with three modes of “family presence” or “being there or with” a separated family member during the current COVID-19 pandemic: physical, virtual, and surrogate. Physical visits, stays, or care by family members in isolation facilities are usually prohibited, discouraged, or limited to exceptional circumstances. Virtual presence for isolated patients is often recommended and used to enable communication. When visits are disallowed, frontline workers sometimes act as surrogate family for patients, such as performing bedside vigils for dying patients. Drawing on lessons from past outbreaks such as the 2002-2003 SARS epidemic and the recent Ebola epidemic in West Africa, we consider the ethical management of these modes of family presence and argue for the promotion of physical presence under some conditions. (shrink)

Background Health care professionals have to judge the appropriateness of treatment in critical care on a daily basis. There is general consensus that critical care interventions should not be performed when they are inappropriate. It is not yet clear which chances of survival are considered necessary or which risk for serious disabilities is acceptable in quantitative terms for different stakeholders to start intensive care treatment. Methods We performed an anonymous online survey in a random sample of 1,052 participants recruited via (...) email invitation and social media. Age, sex, nationality, education, professional involvement in health care, critical care medicine and treatment decisions in critical care medicine as well as personal experience with critical illness were assessed as potential influencing variables. Participants provided their opinion on the necessary chances of survival and the acceptable risk for serious disabilities to start a high-risk or uncomfortable therapy for themselves, relatives or for their patients on a scale of 0–100%. Results Answers ranged from 0 to 100% for all questions. A three-peak pattern with different distributions of the peaks was observed. Sex, education, being a health care professional, being involved in treatment decisions and religiosity influence these opinions. Male respondents and those with a university education would agree that a risky and uncomfortable treatment should be started even with a low chance of survival for themselves, relatives and patients. More respondents would choose a lower necessary chance of survival when deciding for patients compared to themselves or relatives to start a risky and uncomfortable treatment. On the other hand, the majority of respondents would accept only a low risk of severe disability for both themselves and their patients. Conclusion No cut-off can be identified for the necessary chances of survival or the acceptable risk of disability to help quantify the “inappropriateness” of critical care treatment. Sex and education are the strongest influencing factors on this opinion. The large variation in personal opinions, depending on demographic and personality variables and education needs to be considered in the communication between health care professionals and patients or surrogates. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 39.3 (2001) 454-456 [Access article in PDF] Michael Potter. Reason's Nearest Kin: Philosophies of Arithmetic from Kant to Carnap.New York: Oxford University Press, 2000. Pp. x + 305. Cloth, $45.00. This book tells the story of a remarkable series of answers to two related questions:(1) How can arithmetic be necessary and knowable a priori? [End Page 454](2) What accounts for the applicability of (...) arithmetic to matters of empirical fact?These are philosophical questions, part of a "wider puzzle of explaining the link between experience, language, thought, and the world" (18). But answers to them are heavily constrained by technical results in logic and mathematics, and most of Potter's protagonists are either mathematicians (Frege, Dedekind, Ramsey, Hilbert, Gödel) or mathematically trained philosophers (Kant, Russell, Carnap). (Only Wittgenstein fits neither category.) Potter, whose doctorate was in pure mathematics, is an able guide.It is not hard to think of answers to these questions taken singly; what is hard is answering both at the same time. Formalists can easily explain why arithmetic does not depend for its justification on empirical fact—it is just a game with symbols, not responsible to anything beyond its own rules—but they then have trouble explaining why the world of empirical fact is constrained by this game. Empiricists can explain the applicability of arithmetic in just the same way they explain the applicability of physics, but they then must then explain away the apparent a prioricity and necessity of arithmetic. Kant was the first to propose a plausible answer to both questions: arithmetic is both necessary and empirically applicable because it is grounded in the spatio-temporal form of any possible experience.What unites Frege, Dedekind, Russell, Ramsey, Hilbert, and Carnap is that they reject Kant's answer while continuing to seek an answer to his question: how can arithmetic's necessity be reconciled with its applicability? Potter helpfully classifies their projects by the surrogates they substitute for Kant's appeal to the form of spatio-temporal intuition: Frege and Dedekind appeal to thought, Russell to necessary features of the world, Wittgenstein, Ramsey, and Carnap to language, and Hilbert to the necessary structure of our experience of finitary combinations of objects. (Revealingly, the logicists are not grouped together in Potter's taxonomy.) A chapter (or two) is devoted to each of these thinkers, plus Kant and Gödel.This breadth of coverage does not come at the price of superficiality: Potter's chapters are (by and large) accurate, penetrating, and full of interesting insights. I cannot think of another book that offers such clear explanations of the many mathematical concepts and distinctions one must grasp in order to follow debates in the philosophy of arithmetic. The Russell chapters are enhanced by numerous quotations from archival material. The exposition of Hilbert's programme and the implications for it of Gödel's theorems is the best I have seen. The discussions of Wittgenstein's views on arithmetic and of Carnap's syntactical approach also shine. The chapters on Kant and Frege are somewhat weaker; the discussion of Kant, in particular, would have benefited from some engagement with Michael Friedman's views.But the real contribution of Potter's book is its integration of these nine thinkers into a single coherent story. No one will be surprised that Russell's motivations can only be understood in light of Frege's failures, or that many features of Wittgenstein's cryptic work become clearer when seen in light of the specific problems with Russell's system. But there are also some less obvious payoffs: for example, Hilbert's programme is usefully compared with Russell's regressive method (227-8), and Carnap and Russell are shown to face a common dilemma (269, 286).If there is a central theme to Potter's story, it is "how often we have had to reject an [End Page 455] account not for philosophical reasons but for technical ones" (278). Frege's program founders on Russell's paradox, Russell's... (shrink)

Advance directives (ADs) offer the opportunity for patients to express their desires regarding medical care in advance of any form of incapacitation. However, the efficacy of ADs in achieving care that aligns with patients’ preferences is the subject of intense ethical debate. Current instructional AD formats may not allow for expression of the reasoning or values behind a patient’s care preferences, limiting their utility and efficacy. Here, we review written AD formats and their limitations, and discuss video messages, as (...) a supplement to written ADs, as a potential improvement. While video messages have limitations of their own, their potential use as a tool for better understanding patients’ wishes and values suggests a need for further research and consideration of their application and integration into standard clinical practice. (shrink)

BackgroundHealthcare providers have to make ethically complex clinical decisions which may be a source of stress. Researchers have recently introduced Artificial Intelligence (AI)-based applications to assist in clinical ethical decision-making. However, the use of such tools is controversial. This review aims to provide a comprehensive overview of the reasons given in the academic literature for and against their use.MethodsPubMed, Web of Science, Philpapers.org and Google Scholar were searched for all relevant publications. The resulting set of publications was title and abstract (...) screened according to defined inclusion and exclusion criteria, resulting in 44 papers whose full texts were analysed using the Kuckartz method of qualitative text analysis.ResultsArtificial Intelligence might increase patient autonomy by improving the accuracy of predictions and allowing patients to receive their preferred treatment. It is thought to increase beneficence by providing reliable information, thereby, supporting surrogate decision-making. Some authors fear that reducing ethical decision-making to statistical correlations may limit autonomy. Others argue that AI may not be able to replicate the process of ethical deliberation because it lacks human characteristics. Concerns have been raised about issues of justice, as AI may replicate existing biases in the decision-making process.ConclusionsThe prospective benefits of using AI in clinical ethical decision-making are manifold, but its development and use should be undertaken carefully to avoid ethical pitfalls. Several issues that are central to the discussion of Clinical Decision Support Systems, such as justice, explicability or human–machine interaction, have been neglected in the debate on AI for clinical ethics so far.Trial registrationThis review is registered at Open Science Framework (https://osf.io/wvcs9). (shrink)

Critical notice of Paul Feyerabend's Farewell to Reason. The basic difficulty with Feyerabend's argument is not that he goes too far in rejecting traditional philosophical views but that he does not go far enough. We should indeed dismiss philosophical attempts to forge a "direct line to heaven" and forswear introducing "caricatures" of the rationalist's conception of reason to accommodate the complexities of history. But we should also shun the temptation to regard tradition as a surrogate for reason and to (...) elevate freedom and democracy to the status of explanatory philosophical principles. It is no less a mistake to follow the relativist and fetishize cultural diversity than it is to follow the rationalist and fetishize reason. To recognise that we are on our own is not to repudiate rationalism in favour of relativism, but to bid farewell as firmly and as finally to both. (shrink)

To evaluate how study characteristics and methodological aspects compare based on presence or absence of industry funding, Hughes et al. conducted a systematic survey of randomized controlled trials (RCTs) published in three major medical journals. The authors found industry-funded RCTs were more likely to be blinded, post results on a clinical trials registration database (ClinicalTrials.gov), and accrue high citation counts.1 Conversely, industry-funded trials had smaller sample sizes and more frequently used placebo as the comparator, used a surrogate as their (...) primary outcome, and had positive results. (shrink)

What is perception doing in mathematical reasoning? To address this question, I discuss the role of perception in geometric reasoning. Perception of the shape properties of concrete diagrams provides, I argue, a surrogate consciousness of the shape properties of the abstract geometric objects depicted in the diagrams. Some of what perception is not doing in mathematical reasoning is also discussed. I take issue with both Parsons and Maddy. Parsons claims that we perceive a certain type of (...) abstract object. Maddy claims (at least at one time claimed) that perception provides the basis for intuition of mathematical sets. 1 Mathematical reasoning with diagrams 2 Do we perceive abstract objects? 3 Do we perceive mathematical sets? (shrink)

In February 1999, I received a call from a lawyer at Hill Abra Dewar stating that she had instructions to retain my services as an expert witness in the case of Sawatzky v. Riverview Health Centre. She was representing the Manitoba League of Persons with Disabilities which had intervenor status.In Canada the admission of expert testimony depends upon the application of four criteria outlined in R. v. Mohan by Justice Sopinka. These criteria are: relevance; necessity in assisting the trier of (...) fact, the absence of any exclusionary rule; and a properly qualified expert. The lawyer believed that I could provide the court with relevant, reliable ethics testimony about surrogate decision-making and about medical futility-information that likely would be outside the experience and knowledge of the trier of fact. (shrink)

In this article we defend the inferential view of scientific models and idealisation. Models are seen as “inferential prostheses” (instruments for surrogative reasoning) construed by means of an idealisation-concretisation process, which we essentially understand as a kind of counterfactual deformation procedure (also analysed in inferential terms). The value of scientific representation is understood in terms not only of the success of the inferential outcomes arrived at with its help, but also of the heuristic power of representation and their capacity (...) to correct and improve our models. This provides us with an argument against Sugden’s account of credible models: the likelihood or realisticness (their “credibility”) is not always a good measure of their acceptability. As opposed to “credibility” we propose the notion of “enlightening”, which is the capacity of giving us understanding in the sense of an inferential ability. (shrink)

In this article we defend the inferential view of scientific models and idealisation. Models are seen as “inferential prostheses” (instruments for surrogative reasoning) construed by means of an idealisation-concretisation process, which we essentially understand as a kind of counterfactual deformation procedure (also analysed in inferential terms). The value of scientific representation is understood in terms not only of the success of the inferential outcomes arrived at with its help, but also of the heuristic power of representation and their capacity (...) to correct and improve our models. This provides us with an argument against Sugden’s account of credible models: the likelihood or realisticness (their “credibility”) is not always a good measure of their acceptability. As opposed to “credibility” we propose the notion of “enlightening”, which is the capacity of giving us understanding in the sense of an inferential ability. (shrink)

This paper offers a modeling account of episodic representation. I argue that the episodic system constructsmental models: representations that preserve the spatiotemporal structure of represented domains. In prototypical cases, these domains are events: occurrences taken by subjects to have characteristic structures, dynamics and relatively determinate beginnings and ends. Due to their simplicity and manipulability, mental event models can be used in a variety of cognitive contexts: in remembering the personal past, but also in future-oriented and counterfactual imagination. As structural representations, (...) they allow surrogative reasoning, supporting inferences about their constituents which can be used in reasoning about the represented events. (shrink)

This paper defends an inferential conception of scientific representation. It approaches the notion of representation in a deflationary spirit, and minimally characterizes the concept as it appears in science by means of two necessary conditions: its essential directionality and its capacity to allow surrogate reasoning and inference. The conception is defended by showing that it successfully meets the objections that make its competitors, such as isomorphism and similarity, untenable. In addition the inferential conception captures the objectivity of the (...) cognitive representations used by science, it sheds light on their truth and completeness, and it explains the source of the analogy between scientific and artistic modes of representation. (shrink)

Simulation and Similarity: Using Models to Understand the World is an account of modeling in contemporary science. Modeling is a form of surrogate reasoning where target systems in the natural world are studied using models, which are similar to these targets. My book develops an account of the nature of models, the practice of modeling, and the similarity relation that holds between models and their targets. I also analyze the conceptual tools that allow theorists to identify the trustworthy (...) aspects of models. Taken as a whole, I try to account for the ways that modeling is actually practiced by theorists, while abstracting sufficiently to understand the similarities and differences among examples of concrete, mathematical, and computational modeling.I am grateful to Wendy Parker, Jay Odenbaugh, and Bill Wimsatt for their careful and interesting reading of my book, as well as their constructive criticisms. Although I naturally disagree with some of their critiques, I have learned much .. (shrink)

This paper is divided in two parts. In part I, I argue against two attempts to naturalise the notion of scientific representation, by reducing it to isomorphism and similarity. I distinguish between the means and the constituents of representation, and I argue that isomorphism and similarity are common means of representation; but that they are not constituents of scientific representation. I look at the prospects for weakened versions of these theories, and I argue that only those that abandon the aim (...) to naturalise scientific representation are likely to be successful. In part II of the paper, I present a deflationary conception of scientific representation, which minimally characterises it by means of two necessary conditions: representation is essentially intentional and it has the capacity to allow surrogate reasoning and inference. I then defend this conception by showing that it successfully meets the objections and difficulties that make its competitors, such as isomorphism and similarity, untenable. In addition the inferential conception explains the success of various means of representation in their appropriate domains, and it sheds light on the truth and accuracy of scientific representations. (shrink)

This paper presents an artifactual approach to models that also addresses their fictional features. It discusses first the imaginary accounts of models and fiction that set model descriptions apart from imagined-objects, concentrating on the latter :251–268, 2010; Frigg and Nguyen in The Monist 99:225–242, 2016; Godfrey-Smith in Biol Philos 21:725–740, 2006; Philos Stud 143:101–116, 2009). While the imaginary approaches accommodate surrogative reasoning as an important characteristic of scientific modeling, they simultaneously raise difficult questions concerning how the imagined entities are (...) related to actual representational tools, and coordinated among different scientists, and with real-world phenomena. The artifactual account focuses, in contrast, on the culturally established external representational tools that enable, embody, and extend scientific imagination and reasoning. While there are commonalities between models and fictions, it is argued that the focus should be on the fictional uses of models rather than considering models as fictions. (shrink)