Vivisurgeon's Insight

three generic mana one blue mana Sorcery

Draw three cards. Proliferate. (Choose any number of permanents and/or players, then give each another counter of each kind already there.)

"Experimental Log 290: Leaving the subject's pain receptors active appears to yield an unprecedented combination of incoherence and hyperawareness."

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Showing Phyrexia: All Will Be One#77

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Vivisurgeon's Insight rulings

2023-02-04
To proliferate, you can choose any permanent that has a counter, including ones controlled by opponents. You can choose any player who has a counter, including opponents. You can't choose cards in any zone other than the battlefield, even if they have counters on them.
2023-02-04
You don't have to choose every permanent or player that has a counter, only the ones you want to add another counter to. Since "any number" includes zero, you don't have to choose any permanents at all, and you don't have to choose any players at all.
2023-02-04
If a player or permanent has more than one kind of counter on it, and you choose for it to get additional counters, it must get one of each kind of counter it already has. You can't have it get just one kind of counter it already has and not the others.
2023-02-04
An ability that triggers "Whenever you proliferate" triggers even if you chose no permanents or players while doing so.
2023-02-04
Players can respond to a spell or ability whose effect includes proliferating. Once that spell or ability starts to resolve, however, and its controller chooses which permanents and players will get new counters, it's too late for anyone to respond.
2023-02-04
If a permanent ever has both +1/+1 counters and -1/-1 counters on it at the same time, they're removed in pairs as a state-based action so that the permanent has only one of those kinds of counters on it.

Vivisurgeon's Insight keyword rules

Proliferate Rule 701.27

To proliferate means to choose any number of permanents and/or players that have a counter, then give each one additional counter of each kind that permanent or player already has.

In a Two-Headed Giant game, poison counters are shared by the team. If more than one player on a team is chosen this way, only one of those players can be given an additional poison counter. The player who proliferates chooses which player that is. See rule , “Two-Headed Giant Variant.”