Appendix D: Notation and Conventions

Consistent with the Geometric Series. Where domain-specific notation extends the parent conventions, the extension is marked with (GM).


Manifolds and Spaces

Symbol Meaning Introduced
$\mathcal{C}$ Clinical decision complex (weighted simplicial complex) (GM) Ch. 4
$M$ General manifold Ch. 3, App. A
$\mathbb{R}^9$ Nine-dimensional clinical-moral attribute space Ch. 4
$T_pM$ Tangent space at $p \in M$ App. A
$G$ Goal region (acceptable clinical-moral outcomes) (GM) Ch. 6

Metrics, Distances, and Costs

Symbol Meaning Introduced
$g$ Riemannian metric on $M$ Ch. 3, App. A
$g_{ij}$ Metric components in local coordinates App. A
$d(p, q)$ Geodesic distance between $p$ and $q$ App. A
$d_\Sigma(\mathbf{a}, \mathbf{b})$ Mahalanobis distance with covariance $\Sigma$ (GM) Ch. 4, App. A
$\Sigma$ $9 \times 9$ clinical-moral covariance matrix (GM) Ch. 4
$\Sigma_{ij}$ Cross-dimensional covariance between $d_i$ and $d_j$ (GM) Ch. 4
$w(v_i, v_j)$ Clinical edge weight (Mahalanobis + boundary penalties) (GM) Ch. 4
$\text{CF}(\gamma)$ Clinical friction: total path cost of $\gamma$ on $\mathcal{C}$ (GM) Ch. 10

The Nine Clinical-Moral Dimensions (GM)

Symbol Meaning Introduced
$d_1$ Clinical outcomes (survival, morbidity, function, symptom burden) Ch. 4
$d_2$ Rights and obligations (right to treatment, duty of care, non-maleficence) Ch. 4
$d_3$ Justice and fairness (equitable access, distributive justice) Ch. 4
$d_4$ Autonomy (self-determination, voluntariness, freedom from coercion) Ch. 4
$d_5$ Trust (therapeutic relationship, fiduciary duty, confidentiality) Ch. 4
$d_6$ Social and relational impact (family, caregivers, community) Ch. 4
$d_7$ Dignity and identity (sense of self, bodily integrity, personal values) Ch. 4
$d_8$ Institutional legitimacy (standard of care, guidelines, regulatory compliance) Ch. 4
$d_9$ Epistemic status (diagnostic certainty, prognostic accuracy, patient understanding) Ch. 4

Search and Pathfinding (GM)

Symbol Meaning Introduced
$f(n)$ Total evaluation function: $f(n) = g(n) + h(n)$ Ch. 6
$g(n)$ Accumulated clinical cost from start to $n$ (evidence-based medicine) Ch. 6
$h(n)$ Moral-heuristic estimate of remaining cost (clinical wisdom) Ch. 6
$h^*(n)$ True minimum cost from $n$ to goal (unknown; $h$ approximates) Ch. 7
$\varepsilon$ Admissibility tolerance: $h(n) \leq (1+\varepsilon) h^*(n)$ Ch. 7
$v_0$ Start node (patient’s presenting condition) Ch. 6
$\gamma$ Path on $\mathcal{C}$ (sequence of clinical actions) Ch. 6
$\gamma^*$ Clinical geodesic (minimum-cost path on the full manifold) Ch. 6
$\gamma_P^*$ Policy-mandated path (path required by institutional policy $P$) Ch. 12
$\gamma_U^*$ Utilitarian-optimal path (minimizes $d_1$ cost only) Ch. 10

Boundary Penalties (GM)

Symbol Meaning Introduced
$\beta_k$ Penalty for crossing clinical-moral boundary $k$ Ch. 4
$\beta_k^*$ True cost of crossing boundary $k$ (including all consequences) Ch. 7
$\beta_k^{(\text{clin})}$ Clinician’s personal boundary penalty for boundary $k$ Ch. 13
$\beta_{\text{harm}}$ Harm boundary (“first, do no harm”) Ch. 4
$\beta_{\text{consent}}$ Consent boundary (treating without valid consent) Ch. 4
$\beta_{\text{futile}}$ Futility boundary (treating beyond clinical benefit) Ch. 4
$\beta_{\text{abandon}}$ Abandonment boundary (withdrawing care from dependent patient) Ch. 4
$\beta_{\text{sacred}}$ Sacred-value boundary ($= \infty$; absolute prohibition) Ch. 4
$\tau$ Clinician’s tolerance threshold for boundary crossing cost Ch. 13

Moral Injury (GM)

Symbol Meaning Introduced
$\Delta \text{MI}(t)$ Moral injury increment at time $t$ Ch. 13
$\text{MI}(T)$ Cumulative moral injury at time $T$ Ch. 13
$\text{MI}_{\text{crit}}$ Critical threshold for irreversible heuristic damage Ch. 13
$\text{MI}(P)$ Moral Injury Index of policy $P$ Ch. 13

Structural Justice (GM)

Symbol Meaning Introduced
$\text{BI}(P, S)$ Clinical Bond Index of policy $P$ for population $S$ Ch. 12
$S$ Patient population (demographic subgroup) Ch. 12
$P$ Institutional policy Ch. 12

Gauge Invariance

Symbol Meaning Introduced
$\tau$ Meaning-preserving re-description (gauge transformation) Ch. 8
BIP Bond Invariance Principle Ch. 8
$D_4$ Dihedral group of order 8 (Hohfeldian symmetry on $d_2$) Ch. 4

Triage (GM)

Symbol Meaning Introduced
$N$ Set of patients in a triage problem Ch. 10
$R$ Resource constraint (ventilators, beds, hours) Ch. 10
$r(\gamma_i)$ Resource cost of patient $i$’s path Ch. 10

Conventions