Dr Anson Fehross1
1University Of New South Wales; University Of Sydney; Macquarie University, , Australia
Biography:
Anson Fehross is a bioethicist and philosopher with a focus on autonomy, substitute decision-making, axiology, and metaphysics within the bioethical context.
He earned his PhD from Sydney Health Ethics (USYD) in 2022. His thesis advances an argument in favour of rethinking proxy decision-making, advancing a novel model where proxies are selected based on shared values rather than knowledge of the patient's wishes.
Currently, Anson is a sessional academic at the University of New South Wales, Macquarie University, and the University of Sydney. He looks forward to completing the set by working for UTS some day.
Abstract:
Intuitively, a proxy cannot transfer their decision-making authority; they can resign but not appoint another, as their role is to make treatment decisions, not to choose who makes these decisions. Anthony Wrigley, however, notes that articulating a clear rationale against such transference is challenging. He presents a scenario where Patient A appoints Proxy B, who then transfers authority to Proxy C. Wrigley justifies this transfer through substituted judgement, arguing that if Proxy B believes Patient A would have chosen Proxy C under the circumstances, the transfer aligns with the patient’s autonomy, and is a justified exercise of proxy authority.
I argue against Wrigley’s position in this paper, noting that there is a difference between transferring decision-making authority and making decisions on behalf of the patient. To this end, I differentiate between agent-sensitive and agent-insensitive values. Agent-sensitive values, such as a patient’s wish to be cared for by specific individuals, cannot be transferred without losing their essence. These values are inherently linked to particular relationships and cannot be represented by a third party. Meanwhile, agent-insensitive values, which aim at certain outcomes irrespective of who enacts them, do not face the same limitations but are less pertinent in the context of personal care decisions. As I will show, the issue is that some decisions simply aim at certain states-of-affairs (e.g. the cessation of life support) while many others actually factor in who brings these states of affairs about.