The Surrogation of Surrogacy: The Perils and Pitfalls of Epistemic Authority

Abstract

While philosophers have long noted that having knowledge alone is not sufficient reason to act, in bioethics, we take epistemic authority to be sufficient justification for decisional authority. A bit of disambiguation focuses this concern; surrogation is a psychological phenomenon found in business practices whereby a measure of something of interest evolves to replace the thing itself. In an everyday example of surrogation, a manager tasked with increasing customer satisfaction begins to believe that the customer satisfaction survey score is in fact customer satisfaction. In the clinical setting, an equivalent would involve the belief that a surrogate decision-maker's wishes for the patient are the patient's own wishes. Recounting a father's unexpected life-or-death decision about treatment for an adult son, this essay explores the perils and pitfalls of taking epistemic authority to be sufficient justification for decisional authority.

Keywords: authority; clinical ethics; critical care; decisional; epistemic; surrogate decision-making.