The Problem of Counterfactuals in Substituted Judgement Decision-Making

Journal of Applied Philosophy 28 (2):169-187 (2011)
The standard by which we apply decision-making for those unable to do so for themselves is an important practical ethical issue with substantial implications for the treatment and welfare of such individuals. The approach to proxy or surrogate decision-making based upon substituted judgement is often seen as the ideal standard to aim for but suffers from a need to provide a clear account of how to determine the validity of the proxy's judgements. Proponents have responded to this demand by providing the truth-conditions for the substituted judgement in terms of counterfactual reasoning using a possible worlds semantics. In this paper, I show how these underpinnings fail to support the substituted judgement approach as a reasonable standard for decision-making. Firstly, I show how this counterfactual element has been poorly interpreted. I then explain how various accounts have failed to reflect problems and limitations associated with providing an interpretation of their truth-conditions using counterfactuals. Finally, I argue that, even when we attend to the initial problems of providing a counterfactual analysis, it still deeply problematic as a means of determining the validity of substituted judgements for two main reasons. Firstly, making determinate judgements as to the truth-value of these judgements will often not be possible and, secondly, there is a strong requirement when interpreting many counterfactual claims to charitably accede to their being true. I conclude that substituted judgements, as interpreted through counterfactual reasoning and possible worlds semantics, do not therefore provide an adequate standard for surrogate decision-making.
Keywords Proxy Decision-Making  Counterfactuals  Substituted Judgements
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DOI 10.1111/j.1468-5930.2011.00516.x
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Anthony Wrigley (2015). Moral Authority and Proxy Decision-Making. Ethical Theory and Moral Practice 18 (3):631-647.

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S. Barker (2003). A Dilemma for the Counterfactual Analysis of Causation. Australasian Journal of Philosophy 81 (1):62 – 77.

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