COUNTERFACTUAL REASONING IN SURROGATE DECISION MAKING – ANOTHER LOOK
Article first published online: 28 OCT 2009
© 2009 Blackwell Publishing Ltd.
Volume 25, Issue 5, pages 244–249, June 2011
How to Cite
JOHANSSON, M. and BROSTRÖM, L. (2011), COUNTERFACTUAL REASONING IN SURROGATE DECISION MAKING – ANOTHER LOOK. Bioethics, 25: 244–249. doi: 10.1111/j.1467-8519.2009.01768.x
- Issue published online: 28 OCT 2009
- Article first published online: 28 OCT 2009
- proxy consent;
- substituted judgment;
- possible worlds semantics;
- surrogate decision making;
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.