Ryan Hubbard

The increasing accuracy of algorithms to predict values and preferences raises the possibility that artificial intelligence technology will be able to serve as a surrogate decision-maker for incapacitated patients. Following Camillo Lamanna and Lauren Byrne, we call this technology the autonomy algorithm. Such an algorithm would mine medical research, health records, and social media data to predict patient treatment preferences. The possibility of developing the AA raises the ethical question of whether the AA or a relative ought to serve as surrogate decision-maker in cases where the patient has not issued a medical power of attorney. We argue that in such cases, and against the standard practice of vesting familial surrogates with decision making authority, the AA should have sole decision-making authority. This is because the AA will likely be better at predicting what treatment option the patient would have chosen. It would also be better at avoiding bias and, therefore, choosing in a more patient-centered manner. Furthermore, we argue that these considerations override any moral weight of the patient’s special relationship with their relatives.

We recently argued that—contrary to what we call the dominant view— physicians ought to avoid engaging patients on religious grounds.1 The six responses to our article present an array of concerns and have provided us with the opportunity to consider further aspects of our view. While we cannot reply to all the relevant issues, our aim here is to reply to the most significant concerns. Against our Public Reason Argument, Nick Colgrove maintains that physicians are not relevantly akin to public officials and should therefore not be constrained by public reasons. Colgrove does not take issue with the idea that it may be reasonable for public officials to justify their policymaking according to public reasons because their policies affect a diverse population. But since ‘the [medical] decision being made is not binding for other patients,’ physicians need not be constrained by public reasons.2 Colgrove’s criticism hinges on the claim that deliberation ought to be constrained by public reason only if the outcome of such deliberation is a policy or a rule that a diverse group of people must follow. We disagree with this claim. We do not believe, nor did we argue, that this is a necessary condition for when we are morally required to cite public reasons. Instead we believe that three facts together provide sufficient reason for why physicians should generally be constrained by public reasons: physicians are directly and indirectly paid by the state via Medicare and Medicaid; physicians allocate public resources; and physicians are regulated by the state. Colgrove takes particular issue with our ‘Dr Chatterjee case’, which is meant to illustrate why citing religious reasons is inappropriate. And our explanation for why we find this case jarring …

On what basis should we judge whether a parent’s medical decision for their child is morally acceptable? In a recent article, Johan Bester attempts to answer this question by defending a version of the Best Interest Standard for parental decision making. The purpose of this paper is to identify a number of problems faced by Bester’s version of BIS and to suggest ways to redress these problems. Accordingly, we intend to advance the project of formulating a method for guiding parents’ medical decision making for their children. We argue that Bester’s standard fails to accommodate the autonomy of the child and that his criteria for assessing the reasonableness of the parents’ argument for their decision is too weak. We conclude that properly addressing these worries renders his test otiose and that it ought to be replaced with the three commonly held principles of bioethics—the principles of autonomy, beneficence, non-maleficence—and a standard of reasonableness.

A survey of the recent literature suggests that physicians should engage religious patients on religious grounds when the patient cites religious considerations for a medical decision. We offer two arguments that physicians ought to avoid engaging patients in this manner. The first is the Public Reason Argument. We explain why physicians are relevantly akin to public officials. This suggests that it is not the physician’s proper role to engage in religious deliberation. This is because the public character of a physician’s role binds him/her to public reason, which precludes the use of religious considerations. The second argument is the Fiduciary Argument. We show that the patient-physician relationship is a fiduciary relationship, which suggests that the patient has the clinical expectation that physicians limit themselves to medical considerations. Since engaging in religious deliberations lies outside this set of considerations, such engagement undermines trust and therefore damages the patient-physician relationship.

Laura Odwazny and Benjamin Berkman have raised several challenges regarding the new reasonable person standard in the revised Common Rule, which states that in‐ formed consent requires potential research subjects be provided with information a reasonable person would want to know to make an informed decision on whether to participate in a study. Our aim is to offer a response to the challenges Odwazny and Berkman raise, which include the need for a reasonable person standard that can be applied consistently across institutional review boards and that does not stigmatize marginal groups. In response, we argue that the standard ought to be based in an ordinary rather than ideal person conception of reasonable person and that the standard ought to employ what we call a liberal constraint: the reasonability standard must be malleable enough such that a wide variety of individuals with different, unique value systems would endorse it. We conclude by suggesting some of the likely consequences our view would have, if adopted.