Background: Current practice frequently fails to provide care consistent with the preferences of decisionally-incapacitated patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a possible way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. The present study thus assessed the views of experienced surrogates regarding the possible use of PPPs as a means to help make (...) treatment decisions for decisionally-incapacitated patients. -/- Methods: This qualitative study used semi-structured interviews to determine the views of experienced surrogates [n=26] who were identified from two academic medical centers and two community hospitals. The primary outcomes were respondents’ overall level of support for the idea of using PPPs and the themes related to their views on how a PPP should be used, if at all, in practice. -/- Results: Overall, 21 participants supported the idea of using PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on substituted judgment. Major themes which emerged were that surrogates, not the patient’s preferences, should determine how treatment decisions are made, and concern that PPPs might be used to deny expensive care or be biased against minority groups. -/- Conclusions: Surrogates, like patients, strongly support the idea of using PPPs to help make treatment decisions for decisionally-incapacitated patients. These findings provide support for developing a PPP and assessing it in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions are made, including whether to use a PPP. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making. Future research is needed to assess this disagreement and consider ways to address it. (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)

This article challenges a widespread assumption, arguing that Wittgenstein and the Austrian composer Arnold Schoenberg had little in common beyond their shared cultural heritage, overlapping social circles in fin-de-ciecle Vienna. The article explores Wittgenstein's aesthetic inclinations and the intellectual and philosophical influences that may have reinforced them. The article culminates in an attempt to form a Wittgensteinian response to Schoenberg's dodecaphonic language and to answer the question as to why Wittgenstein and Schoenberg arrived at very different ideas about contemporary music (...) and the music of the future. (shrink)

This article shows how the MISS account of models—as isolations and surrogate systems—accommodates and elaborates Sugden’s account of models as credible worlds and Hausman’s account of models as explorations. Theoretical models typically isolate by means of idealization, and they are representatives of some target system, which prompts issues of resemblance between the two to arise. Models as representations are constrained both ontologically (by their targets) and pragmatically (by the purposes and audiences of the modeller), and these relations are coordinated (...) by a model commentary. Surrogate models are often about single mechanisms. They are distinguishable from substitute models, which are examined without any concern about their connections with the target. Models as credible worlds are surrogate models that are believed to provide access to their targets on account of their credibility (of which a few senses are distinguished). (shrink)

Mackenzie Graham has made an important contribution to the literature on decisionmaking for patients with disorders of consciousness. He argues, and I agree, that decisions for unresponsive patients who are known to retain some degree of covert awareness ought to focus on current interests, since such patients likely retain the kinds of mental capacities that in ordinary life command our current respect and attention. If he is right, then it is not appropriate to make decisions for such patients by appealing (...) to the values they had in the past, either the values expressed in an advance directive or the values recalled by a surrogate. There are two things I wish to add to the discussion. My first point is somewhat critical, for although I agree with his general conclusion about how, ideally, such decisions should be approached, I remain skeptical about whether his conclusion offers decisionmakers real practical help. The problem with these cases is that the evidence we have about the nature of the patient’s current interests is minimal or nonexistent. However—and this is important—Graham’s conclusion will be extremely relevant if in the future, our ability to communicate with such patients improves, as I hope it will. This leads to my second point. Graham’s conclusion illustrates a more general problem with our standard framework for decisionmaking for previously competent patients, a problem that has not been adequately recognized. So, in what follows, I explain the problem I see and offer some brief thoughts about solutions. (shrink)

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. (shrink)

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. (shrink)

My paper builds on the conceptual tools from three interrelated philosophical debates that—as I believe—may help structure important if chaotic discussions about surrogates for living human brains and resolve some practical issues related to regulatory matters. In particular, I refer to the discussions about the “moral precautionary principle” in research ethics (Koplin and Wilkinson 2019); about normative uncertainty in ethics (MacAskill, Bykvist, and Ord 2020), and about the inductive risk problem for animal welfare scientists (Birch 2018). I elucidate upon the (...) possible meanings of the phrase “a too good human brain surrogate” used by Henry T. Greely (2021), and I demonstrate that the evaluation of the practical and regulatory implications of the “goodness” of such surrogates created for research purposes should be sensitive to the possible consequences of two types of errors: the under-attribution and over-attribution of moral status to such beings. Many authors writing about this topic (including Greely 2021, but see also, e.g., Koplin and Savulescu 2019) concentrate only on the first type of error, neglecting the negative consequences of the second type, i.e., over-attribution. (shrink)

Although neurological disease and mental illness can cause terrible human suffering, strategies for researching their causes and cures are not obvious. Invasive brain research on actual human being...

Because an increasing number of patients have medical conditions that render them incompetent at making their own medical choices, more and more medical choices are now made by surrogates, often patient family members. However, many studies indicate that surrogates often do not discharge their responsibilities adequately, and in particular, do not choose in accordance with what those patients would have chosen for themselves, especially when it comes to end-of-life medical choices. This chapter argues that a significant part of the explanation (...) of such surrogate failure is that family surrogates are likely to undergo anticipatory grief when making end-of-life decisions. After clarifying both the emotional structure and object of grief, I propose that the pending death of a loved one induces an emotional conflict in surrogates between the care demanded by their responsibility as surrogates and the attachment surrogates feel toward their dying loved one, an attachment surrogates "resolve" in the direction of attachment rather than care. This hypothesis helps to explain both surrogates' general inability to exercise "substituted judgment" on behalf of their loved ones and a wide swath of the particular data regarding this inability (e.g., that surrogates more often err by choosing overtreatment). I conclude by considering possible clinical and philosophical responses to this hypothesis. (shrink)

The Substituted Judgment Standard for surrogate decision-making dictates that a surrogate, when making medical decisions on behalf of an incapacitated patient, ought to make the decision that the patient would have made if the patient had decisional capacity. Despite its intuitive appeal, however, SJS has been the target of a variety of criticisms. Most objections to SJS appeal to epistemic difficulties involved in determining what a patient would have decided in a given case. In this article, I offer (...) an alternative standard for surrogate decision-making that avoids these difficulties. I then offer an account of its theoretical underpinnings which shows that it preserves the central moral justification for SJS, namely, respect for patient autonomy. (shrink)

Upon Brexit & Trade War, the research took a supply-side analysis in macroeconomic paradigm for the purpose and cause of the actions. In the geopolitical competitions on crude oil resources between the allied powers & the Russian hegemony, the latter of which has effective control over P. R. China’s multilateral behaviors, the external research induced that trade war, either by complete information in intelligence or an unintended result, was a supply chain attack in prohibiting the antisatellite weapon supplies in the (...) Northern regions of mainland China in relation to Russia. Although no substantive change to international relations, the Trade War’s prohibitive effect on the high frequency trading in the monetary domain of CNY was observed, which had been the source of economic bubbles in the import-export control regime with centralized banking. The paper argues that by realism in economy & military strategy, trade war was ineffective in deterring the covert operations of the People’s Liberation Army by their territorial strategies and raises questions in humanitarianism in conflict situations. Moreover, with gross privacy breaches by mass surveillance in domain politics, totalitarianism with coercions, and counterfeit of drone strikes, traditional methods of threat elimination are rendered less pragmatic apart from the adversaries’ cyber security breaches. With the scientific approach, I offer an ecological paradigm with historic analysis of the Chinese military’s conducts in terms economics. The territorial methods of the PLA are contextualized into the ecological paradigm in regionalism & public administration. Electronic combats of the Chinese regime with the Great Firewall and Denial-of-Service attacks not only contribute to the diminishing natural freedoms of the population, but also transgress the fundamental right to health along with non-traditional nuclear threats to P.R.C. itself. (shrink)

Based on a critical interpretative review of existing qualitative research investigating accounts of ‘lived experience’ of surrogates and intended parents from a relational perspective, this article proposes a typology of surrogacy arrangements. The review is based on the analysis of 39 articles, which belong to a range of different disciplines (mostly sociology, social psychology, anthropology, ethnology, and gender studies). The number of interviews in each study range from as few as seven to over one hundred. Countries covered include Australia, Canada, (...) Greece, India, Iran, Israel, Italy, Mexico, Norway, Russia, Sweden, UK, Ukraine, and the USA. Most studies focus only on surrogacy practices in one country (although often with intended parents from other countries), and some include several countries (e.g. interviewees from several countries or fieldwork in different field-sites). The proposed typology goes beyond the division between altruistic versus commercial, and traditional versus gestational surrogacy, in order to inform further research and to contribute to bioethical and policy debates on surrogacy in a transnational context. Four types of relations are identifiable: open, restricted, structured, and enmeshed. The criteria which influence these relationships are: the frequency and character of contact pre- and post-birth; expectations of both parties; the type of exchange involved in surrogacy arrangements; and cultural, legal, and economic contexts. The theoretical contribution of the article is to further the development of a relational justice approach to surrogacy. (shrink)

It has been argued by disability advocates that supported decision-making must replace surrogate, or substituted, decision-making for people with cognitive disabilities. From a moral perspective surrogate decision-making it is said to be an indefensible form of paternalism. At the heart of this argument against surrogate decision-making is the belief that such paternalistic action expresses something fundamentally disrespectful about those upon whom it is imposed: that they are inferior, deficient or child-like in some way. Contrary to this widespread (...) belief, I will argue that surrogate decision-making sometimes expresses more respect for people with life-long, ‘severe’ or ‘profound’ cognitive disabilities than does the adoption of supported decision-making.. Specifically, I argue that in some cases supported decision-making can arguably express that people with severe or profound cognitive disabilities lack equal moral value. I also argue that supported decision-making for people with profound cognitive disabilities can arguably express that they lack complex and rich inner lives. If our aim is to ensure our behaviour and practices express respect for people with life-long ‘severe’ or ‘profound’ cognitive disabilities, then sometimes surrogate rather than supportive decision-making will be a better option. (shrink)

What process ought to guide decision making for pediatric patients? The prevailing view is that decision making should be informed and guided by the best interest of the child. A widely discussed structural model proposed by Buchanan and Brock focuses on parents as surrogate decision makers and examines best interests as guiding and/or intervention principles. Working from two recent articles by Ross on “constrained parental autonomy” in pediatric decision making (which is grounded in the Buchanan and Brock model), I (...) discuss (supportively) features of Ross’s effort visa-vis the best interest standard. I argue that any pediatric decision-making model that brackets or formally limits an engagement with the child patient assumes too much. Further, any model that under appreciates the place of parents and their autonomy, and the dynamic parent-child relationship, misses an opportunity to broaden the clinical encounter by considering questions of justice for the child (Rawls) and within a family (Ross). In this context, I focus on the child’s emerging and ongoing emotional and intellectual development and autonomy—their capabilities and identifying primary goods. (shrink)

Childcare robots are being manufactured and developed with the long term aim of creating surrogate carers. While total childcare is not yet being promoted, there are indications that it is 'on the cards'. We examine recent research and developments in childcare robots and speculate on progress over the coming years by extrapolating from other ongoing robotics work. Our main aim is to raise ethical questions about the part or full-time replacement of primary carers. The questions are about human rights, (...) privacy, robot use of restraint, deception of children and accountability. But the most pressing ethical issues throughout the paper concern the consequences for the psychological and emotional wellbeing of children. We set these in the context of the child development literature on the pathology and causes of attachment disorders. We then consider the adequacy of current legislation and international ethical guidelines on the protection of children from the overuse of robot care. (shrink)

Epistemic burdens – the nature and extent of our ignorance (that and how) with respect to various courses of action – serve to determine our incentive structures. Courses of action that seem to bear impossibly heavy epistemic burdens are typically not counted as options in an actor’s menu, while courses of action that seem to bear comparatively heavy epistemic burdens are systematically discounted in an actor’s menu relative to options that appear less epistemically burdensome. That ignorance serves to determine what (...) counts as an option means that epistemic considerations are logically prior to moral, prudential, and economic considerations: in order to have moral, prudential, or economic obligations, one must have options, and epistemic burdens serve to determine our options. One cannot have obligations without doing some epistemic work. We defend this claim on introspective grounds. We also consider how epistemic burdens distort surrogate decision-making. The unique epistemology of surrogate cases makes the priority of the epistemic readily apparent. We then argue that anyone who accepts a principle similar to ought implies can is committed to the logical priority of the epistemic. We also consider and reject several possible counterarguments. -/- . (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)

Janet Malek (91–102, 2019) argues that a “clinical ethics consultant’s religious worldview has no place in developing ethical recommendations or communicating about them with patients, surrogates, and clinicians.” She offers five types of arguments in support of this thesis: arguments from consensus, clarity, availability, consistency, and autonomy. This essay shows that there are serious problems for each of Malek’s arguments. None of them is sufficient to motivate her thesis. Thus, if it is true that the religious worldview of clinical ethics (...) consultants should play no role whatsoever in their work as consultants, this claim will need to be defended on some other ground. (shrink)

Many authors in ethics, economics, and political science endorse the Lottery Requirement, that is, the following thesis: where different parties have equal moral claims to one indivisible good, it is morally obligatory to let a fair lottery decide which party is to receive the good. This article defends skepticism about the Lottery Requirement. It distinguishes three broad strategies of defending such a requirement: the surrogate satisfaction account, the procedural account, and the ideal consent account, and argues that none of (...) these strategies succeed. The article then discusses and discharges some remaining grounds for resistance to these skeptical conclusions, as well as the possibility of defending a weaker version of a normative lottery principle. The conclusion is that we have no reason to believe that where equal claims conflict, we are morally required to hold a lottery, as opposed to simply picking one of the parties on more subjective grounds or out of pure whim. In addition to the practical consequences of this skeptical view, the article sketches some theoretical implications for debates about saving the greater number and about axiomatic utilitarianism. (shrink)

Sometimes, scientific models are either intended to or plausibly interpreted as representing nonactual but possible targets. Call this “hypothetical modeling”. This paper raises two epistemological challenges concerning hypothetical modeling. To begin with, I observe that given common philosophical assumptions about the scope of objective possibility, hypothetical models are fallible with respect to what is objectively possible. There is thus a need to distinguish between accurate and inaccurate hypothetical modeling. The first epistemological challenge is that no account of the epistemology of (...) hypothetical models seems to cohere with the most characteristic function of scientific modeling in general, i.e., surrogative representation. The second epistemological challenge is a version of “reliability challenges” familiar from other areas. There is a challenge to explain how hypothetical models could be a reliable guide to what is possible, given that they are not and cannot be compared against their nonactual targets and updated accordingly. I close with some brief remarks on possible solutions to these challenges. (shrink)

Access to surrogacy is often cast in the language of rights. Here, I examine what form such a right could take. I distinguish between surrogacy as a right to assisted procreation, and surrogacy as a contractual right. I find the first interpretation implausible: it would give rise to claims against the state that no state can fulfil, namely the provision of sufficient surrogates to satisfy the need. Instead, I argue that the right to surrogacy can only be plausibly understood as (...) a contractual right. I then investigate two different sets of harms that are often employed to argue against such a contractual interpretation of the right to surrogacy: harm to women's interests in a gendered society, and harm to the sense of self of the surrogate. I assess both of these through the analytical lens of vulnerability. I find neither of them to be convincing arguments against surrogacy contracts. In conclusion, I agree that surrogacy contracts should be carefully regulated, but I disagree with those who call for prohibition of the right to surrogacy as a contractual right. (shrink)

This paper brings new work to bear on the perennial question about Hobbes's atheism to show that as a debate about scepticism it is falsely framed. Hobbes, like fellow members of the Mersenne circle, Descartes and Gassendi, was no sceptic, but rather concerned to rescue physics and metaphysics from radical scepticism by exploring corporealism. In his early letter of November 1640, Hobbes had issued a provocative challenge to Descartes to abandon metaphysical dualism and subscribe to a ?corporeal God?; a provocation (...) to which the Frenchman angrily responded, but was perhaps importantly influenced. Hobbes's minimal realism was consonant with atheism, to which Descartes felt he was being forced. Moreover, Hobbes was unrelenting in his battle against Cartesian dualism, for which he saw Robert Boyle's experimental science as a surrogate. (shrink)

Eliminativists sometimes invoke evolutionary debunking arguments against ordinary object beliefs, either to help them establish object skepticism or to soften the appeal of commonsense ontology. I argue that object debunkers face a self-defeat problem: their conclusion undermines the scientific support for one of their premises, because evolutionary biology depends on our object beliefs. Using work on reductionism and multiple realizability from the philosophy of science, I argue that it will not suffice for an eliminativist debunker to simply appeal to some (...) object-free surrogate theory of evolution that results from converting any scientific proposition about some object K into a proposition about simples arranged K-wise. In the process, I examine some hazards peculiar to eliminative reductions of scientific theories, and propose a trilemma for eliminativists who attempt to recoup generality for ontologically sparse reducing theories by appealing to pluralities of simples arranged K-wise. The paper is intended to define and develop the object debunker’s self-defeat problem for further study, and to clarify some of the ways sparse and abundant ontologies interact with scientific theory. (shrink)

This essay presents a fully inferentialist-expressivist account of scientific representation. In general, inferentialist approaches to scientific representation argue that the capacity of a model to represent a target system depends on inferences from models to target systems. Inferentialism is attractive because it makes the epistemic function of models central to their representational capacity. Prior inferentialist approaches to scientific representation, however, have depended on some representational element, such as denotation or representational force. Brandom’s Making It Explicit provides a model of how (...) to fully discharge such representational vocabulary, but it cannot be applied directly to scientific representations. Pursuing a strategy parallel to Brandom’s, this essay begins with an account of how surrogative inference is justified. Scientific representation and the denotation of model elements are then explained in terms of surrogative inference by treating scientific representation and denotation as expressive, analogous to Brandom’s account of truth. The result is a thoroughgoing inferentialism: M is a scientific representation of T if and only if M has scientifically justified surrogative consequences that are answers to questions about T. (shrink)

Inferentialists about scientific representation hold that an apparatus’s representing a target system consists in the apparatus allowing “surrogative inferences” about the target. I argue that a serious problem for inferentialism arises from the fact that many scientific theories and models contain internal inconsistencies. Inferentialism, left unamended, implies that inconsistent scientific models have unlimited representational power, since an inconsistency permits any conclusion to be inferred. I consider a number of ways that inferentialists can respond to this challenge before suggesting my own (...) solution. I develop an analogy to exploitable glitches in a game. Even though inconsistent representational apparatuses may in some sense allow for contradictions to be generated within them, doing so violates the intended function of the apparatus’s parts and hence violates representational “gameplay.”. (shrink)

One way of understanding Kant’s views about moral emotions is the cultivation view. On this view, emotions play a role in Kantian morality provided they are properly cultivated. I evince a sceptical position about the cultivation view. First, I show that the textual evidence in support of cultivation is ambiguous. I then provide an account of emotions in Kant’s theory that explains both his positive and negative views about them. Emotions capture our attention such that they both disrupt the mind’s (...) composure and serve as a surrogate for reason. As such, Kant cannot recommend that we cultivate our emotions. (shrink)

Decision-making capacity (DMC) plays an important role in clinical practice—determining, on the basis of a patient’s decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it’s critical that we get things right—that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers correct verdicts (...) about who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine tuning—variations of the standard approach cannot adequately address them. Instead, we should ditch DMC. (shrink)

Families play an essential role in deceased organ procurement. As the person cannot directly communicate his or her wishes regarding donation, the family is often the only source of information regarding consent or refusal. We provide a systematic description and analysis of the different roles the family can play, and actions the family can take, in the organ procurement process across different jurisdictions and consent systems. First, families can inform or update healthcare professionals about a person’s donation wishes. Second, families (...) can authorize organ procurement in the absence of deceased’s preferences and the default is not to remove organs, and oppose donation where there is no evidence of preference but the default is to presume consent; in both cases, the decision could be based on their own wishes or what they think the deceased would have wanted. Finally, families can overrule the known wishes of the deceased, which can mean preventing donation, or permitting donation when the deceased refused it. We propose a schema of 4 levels on which to map these possible family roles: no role, witness, surrogate, and full decisional authority. We conclude by mapping different jurisdictions onto this schema to provide a more comprehensive understanding of the consent system for organ donation and some important nuances about the role of families. This classificatory model aims to account for the majority of the world’s consent systems. It provides conceptual and methodological guidance that can be useful to researchers, professionals, and policymakers involved in organ procurement. (shrink)

In this paper, I will claim that fictional works apparently about utterly immigrant objects, i.e., real individuals imported in fiction from reality, are instead about fictional individuals that intentionally resemble those real individuals in a significant manner: fictional surrogates of such individuals. Since I also share the realists’ conviction that the remaining fictional works concern native characters, i.e., full-fledged fictional individuals that originate in fiction itself, I will here defend a hyperrealist position according to which fictional works only concern fictional (...) individuals. (shrink)

John Broome has proposed a theory of fairness according to which fairness requires that agents’ claims to goods be satisfied in proportion to the relative strength of those claims. In the case of competing claims for a single indivisible good, Broome argues that what fairness requires is the use of a weighted lottery as a surrogate to satisfying the competing claims: the relative chance of each claimant's winning the lottery should be set to the relative strength of each claimant's (...) claim. In this journal, James Kirkpatrick and Nick Eastwood have objected that the use of weighted lotteries in the case of indivisible goods is unacceptable. In this article, I explain why Kirkpatrick and Eastwood's objection misses its mark. (shrink)

Human vision briefly retains a trace of a stimulus after it disappears. This trace—iconic memory—is often believed to be a surrogate for the original stimulus, a representational structure that can be used as if the original stimulus were still present. To investigate its nature, a flicker-search paradigm was developed that relied upon a full scan (rather than partial report) of its contents. Results show that for visual search it can indeed act as a surrogate, with little cost for (...) alternating between visible and iconic representations. However, the duration over which it can be used depends on the type of task: some tasks can use iconic memory for at least 240 ms, others for only about 190 ms, while others for no more than about 120 ms. The existence of these different limits suggests that iconic memory may have multiple layers, each corresponding to a particular level of the visual hierarchy. In this view, the inability to use a layer of iconic memory may reflect an inability to maintain feedback connections to the corresponding representation. (shrink)

In this paper I provide an exposition and critique of Johnson and Noorman’s (2014) three conceptualizations of the agential roles artificial systems can play. I argue that two of these conceptions are unproblematic: that of causally efficacious agency and “acting for” or surrogate agency. Their third conception, that of “autonomous agency,” however, is one I have reservations about. The authors point out that there are two ways in which the term “autonomy” can be used: there is, firstly, the engineering (...) sense of the term, which simply refers to the ability of some system to act independently of substantive human control. Secondly, there is the moral sense of the term, which has traditionally grounded many notions of human mor-al responsibility. I argue that the continued usage of “autonomy” in discussions of artificial agency complicates matters unnecessarily. This occurs in two ways: firstly, the condition of autonomy, even in its engineering sense, fails to accurately describe the way “autonomous” systems are developed in practice. Secondly, the continued usage of autonomy in the moral sense introduces unnecessary meta-physical baggage form the free will debate into discussions about moral agency. In order to understand the debate surrounding autonomy, we would therefore first need to settle many seemingly intractable metaphysical questions regarding the existence of free will in human beings. (shrink)

This essay challenges some assumptions of prevalent theories of empathy. The empathizer, according to these theories, must have an emotion or a representation that matches the recipient’s emotion or representation. I argue that these conditions fail to account for important cases, namely surrogate and out-group empathy. In the course of this argument, I isolate some conceptual difficulties in extant models of cognitive empathy. In place of the matching theories,I propose an indexical model that (1) distinguishes virtual from real self-reference (...) and (2) replaces self–other distinctions with an epistemic condition. According to this account, empathy occurs when we index an intention to another person about whom we have the relevant knowledge or understanding. (shrink)

Typical philosophical discussions of physician-assisted death have focused on whether the practice can be permissible. We address a different question: assuming that pad can be morally permissible, how far does that permission extend? We will argue that granting requests for pad may be permissible even when the pad recipient can no longer speak for themselves. In particular, we argue against the ‘competency requirement’ that constrains pad-eligibility to presently-competent patients in most countries that have legalized pad. We think pad on terminally (...) ill, incapacitated patients can be morally permissible in cases where advance directives or suitable surrogate decision-makers are available, and should be legally permissible in such cases as well. We argue that this view should be accepted on pain of inconsistency: by allowing surrogate decision-makers to request withdrawal of life-sustaining care on behalf of patients and by allowing patients to request pad, we rule out any plausible justification for imposing a competency requirement on pad. (shrink)

In this paper we investigate with a case study from chemistry under what conditions a simulation can serve as a surrogate for an experiment. The case-study concerns a simulation of H2-formation in outer space. We find that in this case the simulation can act as a surrogate for an experiment, because there exists comprehensive theoretical background knowledge in form of quantum mechanics about the range of phenomena to which the investigated process belongs and because any particular modelling assumptions (...) as can be justified. If these requirements are met then direct empirical validation may even be dispensable. We conjecture that this is not the case in the absence of comprehensive theoretical background knowledge. (shrink)

Representing unborn generations to more suitably include future interests in today's climate policymaking has sparked much interest in recent years. In this review we survey the main proposed instruments to achieve this effect, some of which have been attempted in polities such as Israel, Philippines, Wales, Finland, and Chile. We first review recent normative work on the idea of representing future people in climate governance: The grounds on which it has been advocated, and the main difficulties that traditional forms of (...) representation have encountered when applied to this particular case. We then survey existing institutional means to represent generations to come. We separate out representation in courts, in parliament, and by independent bodies, and review specific instruments including climate litigation, parliamentary commissions, future representatives, youth quotas, and independent offices for future generations. We examine the particular forms whereby each of these may suitably represent future people, including audience representation, surrogate representation, and indicative representation, and discuss the main challenges they encounter in so doing. (shrink)

Cases of non-traditional family-making offer a rich seam for thinking about normative parenthood. Gamete donors are genetically related to the resulting offspring but are not thought to be normative parents. Gestational surrogates are also typically not thought to be normative parents, despite having gestated a child. Adoptive parents are typically thought to be normative parents even though they are neither genetically nor gestationally related to their child. Philosophers have paid attention to these kinds of cases. But they have not paid (...) attention to what the people who have engaged in these forms of family-making have to say about what they’re doing and, more specifically, how they answer the questions: “Who is the normative parent? And why?” Paying attention to their answers reveals two things. First, accounts of parenthood from people involved in two forms of non-traditional family-making – reproduction with gestational surrogacy and reproduction with donated eggs – are mutually inconsistent. This is not surprising. What is surprising is that the contradictory aspects of the views evince a common commitment to, as I shall put it, naturalizing parenthood. The central goal of this paper is to explain what that means, but rough idea is that in naturalizing parenthood, prospective parents aim to put the features that make someone a normative parent beyond the reach of human agency. I conclude by briefly suggesting that we should think of the grounds of normative parenthood – and the very task of theorizing about the grounds of normative parenthood – in a way that avoids the need to naturalize altogether. (shrink)

South African law currently forbids those seeking to arrange a surrogate motherhood agreement from creating a child that will not be genetically related to at least one of them. For a surrogacy contract to be legally valid, there must be a ‘genetic link’ between the child created through a surrogate and the parents who will raise it. Currently, this law is being challenged in the High Court of South Africa, and in this article I critically explore salient ethical (...) facets of the dispute. I argue that the law is unjust and should be revised. (shrink)

Without doubt, there is a great diversity of scientific images both with regard to their appearances and their functions. Diagrams, photographs, drawings, etc. serve as evidence in publications, as eye-catchers in presentations, as surrogates for the research object in scientific reasoning. This fact has been highlighted by Stephen M. Downes who takes this diversity as a reason to argue against a unifying representation-based account of how visualisations play their epistemic role in science. In the following paper, I will suggest an (...) alternative explanation of the diversity of scientific images. This account refers to processes which are caused by the social setting of science. What exactly is meant by this, I will spell out with the aid of Ludwik Fleck’s theory of the social mechanisms of scientific communication. (shrink)

Philosophers concerned with what would be good for a person sometimes consider a person’s past desires. Indeed, some theorists have argued by appeal to past desires that it is in the best interests of certain dementia patients to die. I reject this conclusion. I consider three different ways one might appeal to a person’s past desires in arguing for conclusions about the good of such patients, finding flaws with each. Of the views I reject, the most interesting one is the (...) view that prudential value is, at least partly, concerned with the shape of a life as a whole. (shrink)

Goal: To assess public knowledge and attitudes towards the family’s role in deceased organ donation in Europe. -/- Methods: A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data collection (...) were performed by two or more independent reviewers for each record. -/- Results: Of the 1482 results, 467 studies were assessed in full-text form, and 33 were included in this synthesis. When the deceased has not expressed any preference, a majority of the public support the family's role as a surrogate decision-maker. When the deceased expressly consented, the respondents' answers depend on whether they see themselves as potential donors or as a deceased's next-of-kin. Answers also depend on the relationship between the deceased and the decision-maker(s) within the family, and on their ethnic or cultural background. -/- Conclusions: Public views on the authority of the family in organ donation decision-making require further research. A common conceptual framework and validated well-designed questionnaires are needed for future studies. The findings should be considered in the development of Government policy and guidance regarding the role of families in deceased organ donation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 43.1 (2005) 55-81 [Access article in PDF] Self-Knowledge in Descartes and Malebranche Lawrence Nolan John Whipple 1. Introduction Descartes's notorious claim that mind is better known than body has been the target of repeated criticisms, but none appears more challenging than that of his intellectual heir Nicolas Malebranche.1 Whereas other critics—especially twentieth-century philosophers eager to use Descartes as their whipping boy—have often been (...) uncharitable, Malebranche accepts many of the fundamental Cartesian doctrines, including mind-body dualism. But he argues that Descartes's position on knowledge of the mind is internally inconsistent. Malebranche agrees with Descartes that the existence of the mind is better known than that of body, but he vehemently denies that the nature of the mind is better known. This denial is based on his view that we lack a clear idea of the mind.2 [End Page 55]Malebranche's polemic has attracted much attention in recent scholarship.3 The growing consensus among commentators is that Malebranche develops a devastating internal critique of Descartes's theory of the mind. For example, Nicholas Jolley writes: "In his case for his negative thesis [concerning knowledge of the mind] Malebranche mounted a powerful, even annihilating, critique of Descartes. This critique embodies the remarkable insight that there is a serious muddle at the heart of Descartes's whole theory of knowledge."4 In a book-length defense of Malebranche's critique, Tad Schmaltz also emphasizes its internal character: "the interpretation here of Malebranche's theory presents it as fundamentally Cartesian, and thereby serves to reinforce his own view that he has provided an authoritative interpretation of the account of mind in the writings of Descartes and other Cartesians."5 Schmaltz also asserts: "Malebranche took his negative thesis concerning our knowledge of the soul to involve not so much a rejection of Cartesianism as an internal correction of it."6We think such remarks misstate the case. Indeed, we argue in this paper that Malebranche's polemic fails as an internal critique of Descartes's theory of the mind. Although we do not here aspire to defend Descartes's strong thesis—that mind is better known than body—we do think he can consistently maintain that we have a clear and distinct idea of the mind, and thus that our knowledge of the mind's nature is at least on a par with our knowledge of corporeal nature.7 While Malebranche's rhetoric would encourage us to think that the debate between him and his predecessor is being fought on common or neutral ground, the fact is that Malebranche often appeals to assumptions and aspects of his own theory of "Vision in God" that Descartes would reject. Once more, he interprets Descartes's theory of knowledge in ways that are misguided and sometimes even uncharitable. If Malebranche's critique succeeds at all, it succeeds only against a straw man—Malebranche's Descartes and not the historical figure.Ours is not the first effort to defend Descartes against this particular attack. When Malebranche first published his critique in Book Three of his first great work, The Search After Truth (1674),8 Descartes had been dead for over two decades, [End Page 56] but he was ably defended by the famous Cartesian Antoine Arnauld in On True and False Ideas (1683). In the ensuing debate Arnauld was clearly the superior dialectician, but while winning several tactical points, he appears not to fully appreciate the crux of Malebranche's argument, or at least that is the view of Jolley and Schmaltz.9 We have a somewhat higher opinion of Arnauld's side of the debate. Granted, some of his defenses are facile and can be easily dismissed; others however are quite compelling when properly developed. In at least one instance, we attempt to provide that development. At the same time we think it is a mistake to treat Arnauld as Descartes's surrogate or as if he had issued the final salvo from the camp of the orthodox Cartesians. Arnauld was a... (shrink)

Biomarkers are widely used not only as prognostic or diagnostic indicators, or as surrogate markers of disease in clinical trials, but also to formulate theories of pathogenesis. We identify two problems in the use of biomarkers in mechanistic studies. The first problem arises in the case of multifactorial diseases, where different combinations of multiple causes result in patient heterogeneity. The second problem arises when a pathogenic mediator is difficult to measure. This is the case of the oxidative stress (OS) (...) theory of disease, where the causal components are reactive oxygen species (ROS) that have very short half-lives. In this case, it is usual to measure the traces left by the reaction of ROS with biological molecules, rather than the ROS themselves. Borrowing from the philosophical theories of signs, we look at the different facets of biomarkers and discuss their different value and meaning in multifactorial diseases and system medicine to inform their use in patient stratification in personalized medicine. (shrink)

In the philosophy of perception, representationalism is the view that all phenomenological differences among mental states are representational differences, in other words, differences in content. In this paper I defend an alternative view which I call external sortalism, inspired by traditional adverbialism, and according to which experiences are not essentially representational. The central idea is that the external world serves as a model for sorting, conceptualizing, and reasoning surrogatively about perceptual experience. On external sortalism, contents are construed as a kind (...) of gloss on experiences themselves. We can retain what is attractive about representationalism, namely, that perceptual experiences can be evaluated for accuracy, without problematic commitment to the idea that they bear a substantive, representational relation to external objects and properties and that this relation determines the phenomenal character of experience. (shrink)

2020 is the year of the first pandemic lived through the Internet. More than half of the world population is now online and because of self-isolation, our moral and social lives unfold almost exclusively online. Two pressing questions arise in this context: how much can we rely on the Internet, as a set of technologies, and how much should we trust online platforms and applications? In order to answer these two questions, I develop an argument based on two fundamental assumptions: (...) the development stage of today’s Internet is a contingent and not a necessary one and technologies are never neutral. My argument is that today’s pandemic produced an acceleration of the change which started almost 30 years ago, one of online migration, datafication and algorithmization of day to day life, a change in which digital technologies take on the classic role of institutions, both formal and informal. My thesis is a descriptive one, although it has some normative implications: this take over is not just a translation, but a modification or mutation which demands a creative collective answer, although users don’t have direct power over it. When they play the role of institutions, these technologies are surrogates or simulacra. I offer the paradigmatic case of online education, an experiment we were forced into because of the pandemic, in order to show that the institutional matrix of education cannot be reproduced online, due to the limitations of the medium and of the applications, especially those concerning physical presence. In the end I will critically address the question of the role played by Artificial Intelligence in the pandemic, and then I will show that the open source ethics was more useful in approaching scientifically and technologically the problems generated by the epidemic. (shrink)

Recently, some have challenged the idea that there are genuine norms of diachronic rationality. Part of this challenge has involved offering replacements for diachronic principles. Skeptics about diachronic rationality believe that we can provide an error theory for it by appealing to synchronic updating rules that, over time, mimic the behavior of diachronic norms. In this paper, I argue that the most promising attempts to develop this position within the Bayesian framework are unsuccessful. I sketch a new synchronic surrogate (...) that draws upon some of the features of each of these earlier attempts. At the heart of this discussion is the question of what exactly it means to say that one norm is a surrogate for another. I argue that surrogacy, in the given context, can be taken as a proxy for the degree to which formal and traditional epistemology can be made compatible. (shrink)

In this ethnography of transnational commercial surrogacy In a small clinic In India, the narratives of two sets of womenInvolved In this new form of reproductive travel - the transnational clients and the surrogates themselves - are evaluated. How do these women negotiate the culturally anomalous nature of transnational surrogacy within the unusual setting of India? It Is demonstrated that while both sets of women downplay the economic aspect of surrogacy by drawing on predictable cultural tools like 'gift', 'sisterhood' and (...) 'mission', they use these tools In completely unexpected ways. Previous ethnographies of surrogacy In other parts of the world have revealed that women Involved In surrogacy use these narratives to downplay the contractual nature of their relationship with each other. Ironically, when used In the context of transnational surrogacy 1n India, these narratives further highlight and often reify the Inequalities based on class, race and nationality between the clients and suppliers of reproductive tourism In India. (shrink)

‘Visualisations play an important role in science’, this seems to be an uncontroversial statement today. Scientists not only use visual representations as means to communicate their research results in publications or talks, but also often as surrogates for their objects of interest during the process of research. Thus, we can make a distinction between two contexts of usage here, namely the explanatory and the exploratory context. The focus of this paper is on the latter one. Obviously, using visualisations as surrogates (...) for their objects of depiction presupposes the assumption that the former can tell us something relevant about the latter. Thus, a particular referential relation between object and image has to be assumed that can transfer the relevant information. Furthermore, as science is a collaborative enterprise – a social activity – this information has to be intersubjectively accessible and stable. Nonetheless, philosophers of science still quarrel about the epistemic and ontological status of such visualisations. After all, they are means to visualise theoretical entities, such as the Higgs Boson, i.e. entities that are principally not observable with the unaided eye. Especially the significant reliance on information technology devices to access this world of the unobservable provokes a lot of suspicion with regard to the referential status of such visualisations. In this sense, quite a few philosophers adopt social constructivism as an explanatory hypothesis. A particular image is constructed with the aid of instruments and theoretical assumptions; hence it does not refer to an entity outside this system. In this paper, I will critically analyse this assumption and try to argue for an alternative point of view. (shrink)

We apply the analysis that we have developed over the course of several publications on the significance of ignorance for decision-making, especially in surrogate (and, thus, in political) contexts, to political decision-making, such as it has been, during the COVID-19 pandemic (see Scheall 2019; Crutchfield and Scheall 2019; Scheall and Crutchfield 2020; Scheall 2020). Policy responses to the coronavirus constitute a case study of the problem of policymaker ignorance. We argue that political responses to the virus cannot be explained (...) by assuming that the interests of policymakers were at loggerheads with those of their constituents at the beginning of the crisis. In order to explain the responses of policymakers, it is necessary to recognize the effects of relevant ignorance on their incentives to pursue different policy objectives. We discuss the knowledge that policymakers required at the start of the pandemic in order to deliberately realize the goal of limiting overall human suffering and the spontaneous forces that could have facilitated the realization of this goal. The problem of policymaker ignorance implies that policymakers have not earnestly pursued the goal of limiting overall suffering due to the novel coronavirus, but have repeatedly resorted to the pursuit of relatively less epistemically burdensome goals. The problem of policymaker ignorance explains why policymakers have focused primarily on limiting one kind of suffering – physical suffering due to the virus – and have mostly ignored related kinds of suffering, i.e., the economic, sociological, psychological, and physical suffering caused by policies to limit physical suffering from the virus. The problem of policymaker ignorance also helps to explain why policymakers relied on the relatively blunt instrument of economic lockdown rather than more focused protection policies, and why they continue to resort to lockdowns, despite the emerging scientific evidence of their ineffectiveness at mitigating physical suffering due to the virus. (shrink)