Who should have a right to participate in a polity’s decision-making? Although the answers to this ‘boundary problem’ in democratic theory remain controversial, it is widely believed that the enfranchisement of tourists and children is unacceptable. Yet, the two most prominent inclusion principles in the literature – Robert Goodin’s ‘all (possibly) affected interests’-principle and the ‘all subjected to law’-principle – both enfranchise those groups. Unsurprisingly, democratic theorists have therefore offered several reasons for nonetheless exempting tourists and children from the franchise. (...) In this paper, I argue that their attempts fail. None of the proposed rationales can do the job without having unacceptable implications for the voting rights of other groups. I then develop a new specification of the affected interests-view, one that avoids such problems. According to my life plan-principle, a person is entitled to participate in a polity’s decision-making if and only if its decisions will actually affect her autonomously chosen life plans, or prevent her from developing or revising plans of that kind. I show that this principle straightforwardly avoids enfranchising tourists and children, and thus improves upon its two prominent rivals. The paper ends by considering and rejecting two objections to my new principle. (shrink)

Ageing has become a central topic of medical ethical debates, e.g. regarding autonomy and care in geriatric practice, the just distribution of healthcare or the implications of anti-ageing medicine. In all these debates, however, particular conceptions of ageing are tacitly presupposed. The aim of my research is to develop an explicit understanding of the relevance of ageing for ethical reasoning, providing a conceptual framework for discussing concrete medical ethical problems in a more comprehensive and reflected manner. I proceed from the (...) life course approach, assuming that our life is shaped by a time regime defined and implemented by social institutions and structures, reflected in cultural images, and internalized as an “inner clock” directing individual decisions. From the ethical viewpoint, two concepts appear particularly significant: In a deontological perspective, the idea of “age norms”, social standards of age-appropriate behavior, becomes relevant. In a teleological perspective focusing on individual flourishing and good life, the concept of life plans, comprising age-related self-images and expectations, is important. I will briefly sketch the current medical ethical debates around ageing, then delineate the life course perspective and its implications for ethical reasoning, and finally exemplify its theoretical potential regarding medical ethical controversies about long time care, resource allocation and life extension. (shrink)

Even though the phenomenon of gentrification is ever-growing in contemporary urban contexts, especially in high income countries, it has been mostly overlooked by normative political theorists and philosophers. In this paper we examine the normative dimensions of gentrification through the lens of food. By drawing on Huber and Wolkenstein’s (Huber and Wolkenstein, Politics, Philosophy & Economics 17:378–397, 2018) work, we use food as an example to illustrate the multiple ways in which life plans can be located and to argue (...) that both existing residents and newcomers have an interest in occupancy rights. More specifically, while newcomers have an interest in moving freely to new neighbourhoods in order to purse their preferred life plans, they also have an interest in being able to continue to pursue those life plans once they have acquired them, and this requires occupancy rights and the implementation of measures aimed at regulating and slowing down gentrification. Moreover, when residents belong to already disadvantaged groups, more significant anti-gentrification measures can be implemented in order to prevent injustices from being compounded. (shrink)

When philosophers undertake to say what it is that makes life worth living, they generally display a procrustean habit of thought which the practice of philosophy itself does much to encourage. As a result, they arrive at an image of the human good that is far more controversial than they suspect. The canonical view among philosophers ancient and modern has been, in essence, that the life lived well is the life lived in accord with a rational (...) class='Hi'>plan. To me this conception of the human good seems manifestly wrong. The idea that life should be the object of a plan is false to the human condition. It misses the important truth which Proust, by contrast, discerned and made into one of the organizing themes of his great meditation on disappointment and revelation, A la recherche du temps perdu : The happiness that life affords is less often the good we have reason to pursue than the good that befalls us unexpectedly. (shrink)

Background: Despite the growing body of knowledge about surrogate decision making, we know very little about the use of ethical frameworks (including ethical theories, principles, and concepts) to understand surrogates’ day-to-day experiences in end-of-life care planning for incapacitated adults. Objectives and Methods: This qualitative systematic review was conducted to identify the types of ethical frameworks used to address surrogates’ experiences in end-of-life care planning for incapacitated adults as well as the most common themes or patterns found in surrogate (...) decision-making research. Findings: Seven research papers explicitly identified ethical theories, principles, or concepts, such as autonomy, substituted judgment, and best interest standards as guidelines for the research. Surrogate decision making themes included the responsibilities and goals of being a surrogate, factors influencing surrogates’ decision making, outcomes for surrogates, and an overarching theme of “wanting to do the right thing” for their loved one and/or themselves. Discussion: Understanding the complexity of surrogates’ experiences of end-of-life care planning is beyond the scope of conventional ethical frameworks. Conclusion: Ethical frameworks that address individuality and contextual variations related to decision making may more appropriately guide surrogate decision-making research that explores surrogates’ end-of-life care planning experiences. (shrink)

Aristotle claims at Eudemian Ethics 1.2 that everyone who can live according to his own choice should adopt some goal for the good life, which he will keep in view in all his actions, for not to have done so is a sign of folly. This is an opinion shared by other ancients as well as some moderns. Others believe, however, that this view is false to the human condition, and provide a number of objections: (1) you can’t (...) class='Hi'>plan love; (2) nor life’s surprises; (3) planning a whole life is of no use since the world changes too much; (4) as do our values; and (5) planning a life is something only dreary people would do. The aim of this paper is to examine these objections, as part of a broader attempt to defend the relevance of a eudaimonistic approach to the question of how to live well. (shrink)

How we live our lives depends on how we relate to our past, present and future. The article focusses on the relation to our future. The target of my critique is a “planning conception” that imagines the future as a realm that we can rationally plan and form in light of our ends. In the first section I present an outline of the planning conception, building on Bratman’s planning theory and Rawls’ idea of a life plan. The (...) second section highlights the attractions of the planning conception. I argue that this conception offers a prima facie intriguing view of the temporality of human life. It promises a life in which we can control the passage of time. The third section reveals severe limitations of the planning conception. I question the claim that plans are central to our self-understanding and to a good life. The planning conception tends to distort the temporality of human life with respect to past, present and future. Given this diagnosis, I sketch an alternative in the last section of the paper. I explore the temporal specifics of ways of understanding oneself as a person and argue that both the formation and the very form of these ‘ways of being’ do not follow the logic of planning. (shrink)

Es bien conocido el aprecio que desde hace tiempo tiene la Iglesia por el método ver-juzgar-actuar, sin embargo, las reflexiones de la filosofía y la sociología hacen considerar hoy la necesidad de enriquecer el momento del ver, con unos elementos fenomenológicos y hermenéuticos que lo hagan más histórico y menos objetivista y de lograr además una mayor interacción entre los tres momentos. En este sentido, la investigación propone la inserción de las historias de vida de las personas y las comunidades (...) como un camino nuevo de conocimiento de la realidad. En efecto, la realidad no sólo consiste en el hecho desnudo, sino también en el hecho tal y como lo percibe el sujeto; no sólo es suceso, sino también narración. Así, las historias de vida, y el consecuente método autobiográfico constituyen, según la investigación, un recurso vital en la planificación pastoral; no simplemente un apéndice secundario o un recurso simplemente aplicativo, sino, un momento intrínseco de la reflexión y de la experiencia teológica y pastoral. It is well-known the log lasting appreciation of the church for the method see-judge-act, however the current philosophical and sociological considerations are considering the need for an enrichment of the moment of seeing with some phenomenological and hermeneutical elements which could make it more historical and less objective and to achieve, moreover, a major interaction among the three moments. In this sense, the research proposes also the introduction of the stories of people’s lives and of the communities as a new way of awareness of reality. Indeed, reality is not only in the naked event, but also in the event as it is seen by the subject; not only the happened event, but also its narration. For this reason, the life stories and the autobiographical method are, according to the research a vital resource in the pastoral planning; not simply a secondary appendix or a applicative type, but as an intrinsic moment of the theological and pastoral reflection and experience. (shrink)

Predictive medicine presents opportunities to consider later life under conditions of illness, such as dementia. This paper examines how family caregivers (N = 27) assess the opportunity of prediction and early diagnosis of dementia for oneself based on their particular experience. Furthermore, it compares their attitudes with laypersons’ attitudes (N = 43) towards genetic testing of APOE. By this, we elaborate how much personal experience impacts anticipation and affects, but also moral attitudes towards predictive medicine. Differences in our settings (...) do not allow for direct comparison, so our analysis focuses on multiple similarities in the assessments of predictive (non-genetic vs. genetic) testing. Groups’ reasoning showed also differences influenced mainly by personal experience. Family caregivers addressed more responsibility towards family and had more hopes into medical treatments. To cope with the disease, they expressed expectations to start with medicine and care decisions as early as possible. Laypersons, however, stressed self-determination more and expressed worries about the influence of the pharmaceutical industry by referring to unnecessary medication and, implicitly, the medicalization of aging. (shrink)

This book examines the relevance of modern medicine and healthcare in shaping the lives of elderly persons and ageing societies. Combining individual and social dimensions, Planning Later Life discusses the ethical, social, and political consequences of increasing life expectancies and demographic change in the context of biomedicine and public health. By focusing on the field of biomedicine and healthcare, the authors engage readers in a dialogue on the ethical and social implications of recent trends in dementia research and (...) care, advance healthcare planning, or the rise of anti-ageing medicine and prevention. Bringing together the largely separated debates of individualist bioethics on the one hand, and public health ethics on the other, the volume deliberately considers the entanglements of envisioning, evaluating, and controlling individual and societal futures. The process of devising and exploring the various positive and negative visions and strategies related to later life is rarely reflected systematically from a philosophical, sociological, and ethical point of view. As such, this book will be crucial to those working and studying in the life sciences, the humanities, and the social sciences, particularly in the areas of bioethics, social work, gerontology and aging studies, healthcare and social service, sociology, social policy, and geography and population studies. (shrink)

A number of influential reports on influenza pandemic preparedness include recommendations for extra-autonomous decisions to withdraw mechanical ventilation from some patients, who might still benefit from this technology, when demand for ventilators exceeds supply. An unintended implication of recommendations for nonvoluntary and involuntary termination of life support is that it make pandemic preparedness plans vulnerable to patients’ claims for assisted suicide and active euthanasia. Supporters of nonvoluntary passive euthanasia need to articulate why it is both morally different and morally (...) superior to voluntary active euthanasia if they do not wish to invite expansion of end-of-life options during health system catastrophe. (shrink)

An emerging ethical philosophy in marketing is developing. This philosophy is based on quality-of-life studies which are becoming an important topic of research in behavioral and social sciences (basic and applied research). This paper addresses the QOL orientation in marketing from a decision-making perspective. Specifically, this paper shows how marketers can engage in strategic marketing planning guided by the QOL concept.

Physicians and families need to interact more meaningfully to clarify the values and preferences at stake in advance care planning. The current use of advance directives fails to respect patient autonomy. This paper proposes using the family covenant as a preventive ethics process designed to improve end-of-life planning by incorporating other family members—as agreed to by the patient and those family members—into the medical care dialogue. The family covenant formulates advance directives in conversation with family members and with the (...) assistance of a physician, thereby making advance directives more acceptable to the family, and more intelligible to other physicians. It adds the moral force of a promise to the obligation of respecting a patient’s preferences about end-of-life care. These negotiations between patient, family, and physician, from early planning phases through implementation, should greatly reduce the incidence of family disagreements on what the patient would have wanted. The family covenant ensures advance directive discussions within the family, promotes and respects the autonomy of other family members, and might even spur others in the family to complete advance directives through additional covenants. The family covenant holds the potential to transform moral quagmires into meaningful moral conversation. J Am Geriatr Soc 51:1155–1158, 2003. (shrink)

Simonet, Emanuel Nicolas Cortes Advance care planning is a significant and important process of end-of-life care. It provides the opportunity for persons to express their medical treatment preferences prior to losing the capacity to decide for themselves. It also allows for the appointment of substituted decision maker to make medical decisions for persons who have lost capacity. Whilst advance care planning can be beneficial when it is used effectively, the legislative framework surrounding advance care planning is complex and confusing. (...) This brief article will summarise advance care planning, its current legislative framework in Victoria and how proposed recommendations offered by the Inquiry into end of life choices may simplify advance care planning. (shrink)

PurposeAdvance directives have been criticized for failing to help physicians make decisions consistent with patients’ wishes. This pilot study sought to determine if an interactive, computer-based decision aid that generates an advance directive can help physicians accurately translate patients’ wishes into treatment decisions.MethodsWe recruited 19 patient-participants who had each previously created an advance directive using a computer-based decision aid, and 14 physicians who had no prior knowledge of the patient-participants. For each advance directive, three physicians were randomly assigned to review (...) the advance directive and make five to six treatment decisions for each of six (potentially) end-of-life clinical scenarios.From the three individual physicians’ responses, a “consensus physician response” was generated for each treatment decision (total decisions = 32). This consensus response was shared with the patient whose advance directive had been reviewed, and she/he was then asked to indicate how well the physician translated his/her wishes into clinical decisions.ResultsPatient-participants agreed with the consensus physician responses 84 percent (508/608) of the time, including 82 percent agreement on whether to provide mechanical ventilation, and 75 percent on decisions about cardiopulmonary resuscitation (CPR).Across the six vignettes, patient-participants’ rating of how well physicians translated their advance directive into medical decisions was 8.4 (range = 6.5-10, where 1 = extremely poorly, and 10 = extremely well). Physicians’ overall rating of their confidence at accurately translating patients’ wishes into clinical decisions was 7.8 (range = 6.1-9.3, 1 = not at all confident, 10 = extremely confident).ConclusionFor simulated cases, a computer-based decision aid for advance care planning can help physicians more confidently make end-of-life decisions that patients will endorse. (shrink)

Planning is a significant process function and counterpoises a very complex,dynamic and specific activity, which means that its subject consists of all forms of socialactivity, activities and life. Planning and programming are equally important to allentities regardless of their size and goals, as they all have experienced painful problemswith their planning efforts. Some emerge from the planning process itself, and somefrom the implementing procedure. Therefore the question arises: „How to help overcomefailures in planning from failures in implementation?” Hence, the (...) management teamhas no choice regarding the question: “Do they want to plan or not?” The sole alternativeis to carry out the planning completely, pragmatically and systematically. Onthe other hand, programming connects planning with budgeting and execution, andcounterpoises a sort of rational assumption to “turn” plans from adopted plans into programs,that is, projects and activities across main accounting categories, in accordancewith the desired capabilities and priorities. The analysis of the entire matter processedin this paper is carried out in a very specific way through the prism of identifying notonly the problems related to planning, programming and budgeting, but also makinga scientific contribution to the foundation of this rather significant conditionality andinterdependence. (shrink)

The great urbanist Jane Jacobs details how urban planning impacts the social interactions and social networks responsible for the economic death or life of a city. How might urban planning impinge on the moral values that underlie that development? I draw on Jacobs’s work on the moral foundations of commercial society to identify two “urban values” (tolerance and innovation). I then examine how these values support the social networks and processes that facilitate urban-based innovation and how urban planning can (...) strengthen or undermine those values. I use the examples of urban planning in the 15th Ward of Syracuse, New York and of city building in the private development of Cayalá in Guatemala City to illustrate these points. (shrink)

Defending Life is arguably the most comprehensive defense of the pro-life position on abortion - morally, legally, and politically - that has ever been published in an academic monograph. It offers a detailed and critical analysis of Roe v. Wade and Planned Parenthood v. Casey as well as arguments by those who defend a Rawlsian case for abortion-choice, such as J. J. Thomson. The author defends the substance view of persons as the view with the most explanatory power. (...) The substance view entails that the unborn is a subject of moral rights from conception. While defending this view, the author responds to the arguments of thinkers such as Boonin, Dworkin, Stretton, Ford and Brody. He also critiques Thomson's famous violinist argument and its revisions by Boonin and McDonagh. Defending Life includes chapters critiquing arguments found in popular politics and the controversy over cloning and stem cell research. (shrink)

A new public centered long-range corporate planning orientation is proposed. Underlying this orientation is the rationale that the main purpose of business activity is the satisfaction of socially desirable needs, i.e. needs that are compatible with long run public welfare. Such need satisfaction will tend to bring about improvements in the quality of private and public life. Corporate planning should thus facilitate the performance of business activities designed to achieve the satisfaction of socially desirable needs.The determination of what are (...) socially desirable needs will be based on public consensus, which corporations can periodically assess, and incorporate into their long range plans. A long-range planning procedure, incorporating social welfare considerations is developed. It is suggested that a planning procedure such as this is essential for the existence of firms in the long run. (shrink)

Advance care planning is a process that encourages people to identify their values, to reflect upon the meanings and consequences of serious illness, to define goals and preferences for future medical treatment and care, and to discuss these goals with family and health-care providers. Advance care planning is especially important for those who are chronically ill, as patients and their families face a variety of complex healthcare decisions. Participating in advance care planning has been associated with improved outcomes; yet, despite (...) over 25 years of public awareness campaigns, research, and interventions developed to increase participation, advance care planning completion rates for people with chronic illnesses are no different than those in the general public (approximately 25%). Advance care planning has traditionally used an individualistic approach to autonomy, which puts forward an understanding of agents as independent, rational and self-interested persons. Because this individualistic approach has been largely unsuccessful in improving advance care planning uptake, a re-examination of the philosophical underpinnings of this practice and an exploration of alternative frameworks is warranted. In offering this exploration, we briefly outline two current perspectives on autonomy: the individualistic view and the relational view as articulated by feminist philosophers. Using a critical examination of the theoretical and empirical work on this topic, we argue that the individualistic view of autonomy does not sufficiently capture the relational and social complexities of the decision-making process of advance care planning. To offer a counterpoint, we examine the relational view of autonomy and suggest that this perspective is better aligned with the process of advance care planning. Specifically, we demonstrate that a relational model of autonomy is well suited to exploring advance care planning for four main reasons: (1) it recognizes the importance of relationships, (2) it reflects the fluctuating nature of autonomy in chronic illness, (3) it recognizes vulnerability, and (4) it is consonant with empirical work examining the advance care planning process. (shrink)

TWO OBJECTIONS are often levelled against Aristotle's theory of practical inference. The first is that he fails to discuss adequately the nature of reasoning about the ends of good living. Thus, while there is no shortage of examples of technical deliberation, such as how a doctor deliberates to bring about healing, we have no comparable examples of how a person of determinate character deliberates to promote the ends of that character. The second is that while Aristotle has an account of (...) how we reason to a decision to act now, he lacks a more general account of intention that can accommodate both present intention and future intention--that is, intending now to act later. The two challenges, I want to argue, are related, though often not by the objectors. Deliberation about how best to live over the course of a life requires a continuing interest in one's future self and a capacity to decide upon future ends that constrain the present and are constrained by it. An Aristotelian conception of the good life, with its intrinsic sense of completeness and unity, requires this close knit of present and future. But if this is so, then the capacity to deliberate about the future and to regulate the present in light of future plans will be particularly urgent in the case of living such a life. Deliberation about future intentions should, if anywhere, play a prominent role here. It will be a severe limitation on Aristotle's view if his account of deliberation precludes such a role for practical reason. (shrink)

The concept of “Time” seems to play out differently at various phases of our lives: In our teens and twenties, we experience the luxury of youth; we may feel invincible or even indomitable. Generally, we feel our whole lives are ahead of us, and we “take” time to enjoy, explore and experience our world. Concurrently, our physiology also goes through the phases of childhood, adolescence, puberty and into adulthood, or the “reproductive years”; and ultimately (for women) through menopause and “ageing”, (...) or, the “non- reproductive years”. In this paper I will submit, on what I believe, is the obligation of the health care community to disseminate information early to their patients. This might ensure that the choices that people make in specific phases of their lives are educated and informed choices. Early education would be invaluable if backed up by the benefit of research that already exists, some of it presented in this paper. If this research was to be made available, say, on a patient’s first visit to a gynaecologist, (presumably in their late teens, early twenties), to start the education process, I believe many patients could benefit from it. (shrink)

In an Israeli qualitative study with adolescent cancer survivors and parents who had considered fertility preservation, practically all participants could not recall any discussions with healthcare providers about plans for cryopreserved biological materials in the case of death. This finding is surprising given recent court struggles in Israel over the posthumous use of cryopreserved sperm. In interviews with these adolescent survivors and their parents, intended future use of cryopreserved biological materials is directed for affected individuals’ reproductive purposes later in (...) class='Hi'>life, with hardly any consideration of others' use of these materials for posthumous reproduction. To avoid future ethical and legal quagmires, healthcare professionals should have frank discussions with adolescents and their parents about what to do with such materials in the case of death. This paper discusses the socio-cultural and legal Israeli context and considers the ethical implications of using minors’ biological materials for posthumous assisted reproduction in Israel. (shrink)

As workforce aging continues through the next decade, the number of persons who will retire from long-held jobs and careers will increase. In recent years, researchers across disciplines of psychology have focused attention on the impact of the retirement process on post-retirement adjustment and well-being. One area that has received attention from investigators in both psychology and economics pertains to the impact of retirement planning on the retirement decision and post-retirement adjustment. The objective of the current review is twohreefold. The (...) first goal is to review the literature on retirement planning with attention to past conceptualizations and current theoretical specifications. Second, empirical work investigating the psychological antecedents of retirement planning is reviewed. The primary conclusion reached from this review is that, conceptually, retirement planning continues to be poorly delineated and, thereby, narrowly investigated. Empirically, cognitive antecedents of retirement planning continue to figure prominently in both workplace and retirement researches. The boundary conditions of retirement planning, as well as alternative mechanisms for adult wellbeing, are discussed. Specifically, retirement planning’s meaning amidst increasing job mobility and longer life expectancies are identified as two complementary areas for future empirical integration of work - retirement research domains. (shrink)

Life Takes Place argues that, even in our mobile, hypermodern world, human life is impossible without place. Seamon asks the question: why does life take place? He draws on examples of specific places and place experiences to understand place more broadly. Advocating for a holistic way of understanding that he calls "synergistic relationality," Seamon defines places as spatial fields that gather, activate, sustain, identify, and interconnect things, human beings, experiences, meanings, and events. Throughout his phenomenological explication, Seamon (...) recognizes that places are multivalent in their constitution and sophisticated in their dynamics. Drawing on British philosopher J. G. Bennett's method of progressive approximation, he considers place and place experience in terms of their holistic, dialectical, and processual dimensions. Recognizing that places always change over time, Seamon examines their processual dimension by identifying six generative processes that he labels interaction, identity, release, realization, intensification, and creation. Drawing on practical examples from architecture, planning, and urban design, he argues that an understanding of these six place processes might contribute to a more rigorous place making that produces robust places and propels vibrant environmental experiences. This book is a significant contribution to the growing research literature in "place and place making studies.". (shrink)

In this article I review the principal arguments in favour of and against the UK government’s recent proposals to allow access to NHS patient records to life sciences companies as part of the NHS–Life Sciences partnership scheme.

While I, as may be said, “groaned” and “puffed” over the last chapter of the third book of the second series of my writings, in the process of my “subconscious mentation,” that is to say, in my automatically flowing thoughts, the center of gravity of interest was concentrated by itself on the question: how should I begin the third series of books predetermined by me for writing, namely, that series of books which according to my conviction was destined to become (...) in a short time so to say “edifyingly instructive” for all the creatures of Our Common Father similar to myself; but here I must sincerely confess that soon after I had chosen for myself the profession of a writer, as the most corresponding to my unexpectedly arisen physical state, and when, parallel to the improvement in my physical state, I clearly understood that, thanks to my personal written explanations, a great benefit will arise for the majority of contemporary people as well as for future generations, I determined by this very series of books consciously to acquit myself with Great Nature for my arising and existence, chiefly for an existence not merely as an “ordinary life,” automatically fulfilling some purpose necessary for the general realizations of Great Nature, but rather as an existence determinate and conscious, impartially evaluating itself and, in addition, gifted with the capacity of all-round perfecting and independent unity. The outcome of these recent reflections, combined with my conscious thoughts of today upon finishing this last-mentioned book, brought me to the categorical decision to begin this “edifyingly instructive” series of books with the description of the events connected with my last two visits to some of the cities of North America, and to cite in concise form the talks delivered by me there to a certain group of the followers of my ideas which had already been organized ten years before during my first visit in New York. I wish to begin with this description chiefly because upon these talks, as I planned them in my thoughts, a corresponding foundation may be built for everything which I have decided to introduce into the conscious life of people by means of this third and last series of my writings; furthermore, because the publication of these lectures, combined with the description of the events and causes which provoked them, to which events and causes I reacted by means of these very talks of definite form and sequence, will, I have almost no doubt, create in their totality a so to say “automatically acting factor” for the possible saving from their total ruination of many thousand people of both sexes from various countries in Europe, Asia and America. In this introductory book of the third series, I shall expose the “quintessence” of five talks, four of which were delivered by me at the end of 1930 and the beginning of 1931, and one other at the end of 1931 or the beginning of 1932. For the readers of this series of my expositions, no matter in which degree of consciousness they may rank themselves, it would not in my opinion be superfluous to know, among other things, from which of my conceptions and instinctive suppositions was derived the phrase I used: “consciously to acquit myself with Great Nature.” This phrase burst forth from me almost involuntarily and took a shape which derived from the totality of my instinctive and conscious conviction that by this act of making known this last series of my writings, I could rely on fulfilling what is in my opinion the most important duty of a man who has reached responsible age, which consists in preparing without fail for the benefit of posterity, according to one’s own individuality, certain profitable instructions; furthermore, I could by this same act, albeit quite subjectively, justify the sense of all my past intentional labors and conscious renunciations of all kinds of benefits which are generally crystallized in the life of contemporary people, and which have always been very easy for me to obtain; and finally, I hope, in the moment of my last breathing, to experience with no possible mental, sensitive or instinctive doubt the impulse, sacred for a man, which was called by the ancient Essenes “impartial self-satisfaction.” In order that there should arise in the mentation of the readers of this book, for a better orientation and an easier logical confrontation with what will follow, a “something” which existed on Earth before the Babylonian civilization in a branch of science named “Theomathos” and was called “a vivifying factor for objective assuming”—I refer, of course, to the mentation of those readers who, as soon as they became acquainted with my expositions, were guided by and closely followed my advice—I wish first of all to try, for their inner sight, to depict by a verbal description various information, the totality of which might help them to represent in true perspective and clearly understand two situations which occurred in the process of my ordinary life during the time of my writing activity. (shrink)

Eight principles to take responsibility for your life"--Provided by publisher.

In this discussion paper we consider the influence of ethnicity, religiosity, spirituality and health literacy on Advance Care Planning for older people. Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of advance care planning by this group across a number of countries where advance care planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. Health literacy (...) issues have been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote advance care planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape advance care planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples’ ability to enact moral agency in making such decisions. (shrink)

Advance care planning (ACP) is considered a pivotal aid in the decision‐making process, especially for many people living with dementia, who inevitably will lose the capacity to make decisions at the end of life. In Italy, ACP has been recently regulated by law 219/2017, leading to the investigation of how physicians deal with ACP in dementia. In order to comprehend the perception of physicians who provide care for patients with dementia regarding ACP and to describe their difficulties and needs, (...) this study presents the results of a qualitative research study performed within a local health authority in northern Italy. Data were collected by semi‐structured interviews with 11 physicians dealing with patients with dementia and were analysed using interpretative phenomenological analysis. Four superordinate themes were identified, describing both the difficulties and challenges perceived by physicians in performing shared ACP in their daily activities. This study demonstrates that physicians experience troubles synchronizing the time of shared ACP with the more rapid development of dementia. Results also suggest that further training about communication on ACP is urgently required to ease the implementation of shared ACP. A broader involvement of institutions and other professionals is also important in spreading ACP among healthcare institutions. (shrink)