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Objective: Current practice frequently fails to provide care consistent with the preferences and values of decisionally-incapacitated, critically ill patients. It also imposes significant emotional burden on their surrogates. Algorithmic-based patient preference predictors (PPPs) have been proposed as a way to address these two concerns. While previous research found that patients strongly support the use of PPPs, the views of surrogates are unknown. This study assesses the views of experienced surrogates regarding the use of PPPs as a means to improve treatment decision making for incapacitated patients.Setting: Two academic medical centers and two community hospitals.Subjects: Experienced Surrogates [n=26].Interventions: An initial quantitative survey followed by an in-depth interview and a final quantitative survey.Measurements: Overall level of support for PPPs and views on how a PPP should be used, if at all, in practice.Main Results: Overall, 21 participants supported the use of PPPs. The remaining five indicated that they would not use a PPP because they made decisions based on the patient’s best interests, not based on which treatments the patient would choose for themselves. Some respondents expressed concern that PPPs might be used to deny expensive care or be biased against minority groups. Finally, 24 respondents indicated that surrogates, not patients, should decide how treatment decisions are made, including whether and how to use PPPs.Conclusions: Surrogates, like patients, strongly support the use of PPPs as a means to improving decision-making for incapacitated patients. These findings provide support for developing a PPP and assessing its use in practice. At the same time, patients and surrogates disagree over whose preferences should determine how treatment decisions, including whether to use a PPP, are made. These findings reveal a fundamental disagreement regarding the guiding principles for surrogate decision-making that need to be addressed by attempts to improve current critical care practice.

WHO recently issued new guidance on the prevention of sexual transmission of Zika virus. The updated guidance states that '[c]ountry health programmes should ensure that… [i]n order to prevent adverse pregnancy and fetal outcomes, men and women of reproductive age, living in areas where local transmission of Zika virus is known to occur, be correctly informed and oriented to consider delaying pregnancy'. While the media has reported this advice as WHO telling couples in Zika-affected regions to avoid pregnancy, WHO states that they are not doing that. In an interview with the New York Times, a spokesperson from WHO stated, 'it's important to understand that this is not WHO saying, "Hey everybody, don't get pregnant." It's that they should be advised about this, so they themselves can make the final decision'. In this statement, the WHO's spokesperson distinguishes between actively directing individuals to delay pregnancy and advising them, which is portrayed as a merely informative act that facilitates but does not direct an individual's final decision. This paper proposes that advising should not be understood as a purely informational and non-directive act. The choices that agencies make in what advice to offer and to whom to offer the advice are ethical choices with practical implications. We will thus lay out a framework for considering the ethical issues that arise in the context of advising and demonstrate how it can be used to evaluate the WHO guidance.

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The‘Thick Sandwich’ (1–3–1) course is growing in popularity. More and more men are going to university to read engineering with a year of practical training behind them, and this has several obvious virtues. There are, of course, various attendant drawbacks differing in their magnitude from one type of industry to another. In the heavy electrical industry the problem is that the man who has academic qualifications only as far as GCE ‘A’ level or university entrance standards is a difficult man to employ usefully in research, design or development departments and is possibly a liability when it comes to testing equipment where there is anything but the lowest of voltages.