Medicine, Health Care and Philosophy

, Volume 22, Issue 4, pp 613–621 | Cite as

Epistemic burdens and the incentives of surrogate decision-makers

  • Parker CrutchfieldEmail author
  • Scott Scheall
Scientific Contribution


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.


Surrogate decision-making Epistemology Ignorance 



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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Medial Ethics, Humanities, and LawWestern Michigan University Homer Stryker M.D. School of MedicineKalamazooUSA
  2. 2.Faculty of Social Science, College of Integrative Sciences and ArtsArizona State University Polytechnic CampusMesaUSA

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