Group items tagged

>"...Offering a default option of opting in, rather than opting out (as many have suggested with organ donations as well) doesn't take away choice but guides us to make better ones, according to Richard H. Thaler, an economics professor at the University of Chicago, and Cass R. Sunstein, a professor at Chicago's law school, authors of "Nudge: Improving Decisions About Health, Wealth and Happiness". Making choices can be most difficult in the area of health. While we don't want to go back to the days when doctors unilaterally determined what was best, there may be ways of changing policy so that families are not forced to make unbearable choices. >Professor Iyengar and some colleagues compared how American and French families coped after making the heart-wrenching decision to withdraw life-sustaining treatment from an infant. In the United States, parents must make the decision to end the treatment, while in France, the doctors decide, unless explicitly challenged by the parents. >French families weren't as angry or confused about what had happened, and focused much less on how things might have been or should have been than the American parents.

Dostoevsky's great virtue as a writer is to be so utterly convincing in outlining what he doesn't believe and so deeply unconvincing in defending what he wants to believe. As Blake said of "Paradise Lost," Satan gets all the best lines. The story of the Grand Inquisitor places a stark choice in front of us: demonic happiness or unbearable freedom? And this choice conceals another, deeper one: truth or falsehood? The truth that sets free is not, as we saw, the freedom of inclination and passing desire. It is the freedom of faith. It is the acceptance - submission, even - to a demand that both places a perhaps intolerable burden on the self, but which also energizes a movement of subjective conversion, to begin again. In disobeying ourselves and obeying this hard command, we may put on new selves. Faith hopes for grace.

Autonomy has limits - pts want docs to exercise expertise.

'"Contamination" ... is an evocative term. When people speak for an ideal of cultural purity, sustaining the authentic culture of the Asante or the American family farm, I find myself drawn to contamination as the name for a counterideal. [The Roman playwright] Terence [whose plays acquired that label to describe his conflation of Greek plays into a single Roman comedy] had a notably firm grasp on the range of human variety: "So many men, so many opinions" was a line of his. And it's in his comedy "The Self-Tormentor" that you'll find what may be the golden rule of cosmopolitanism - Homo sum: humani nil a me alienum puto; "I am human: nothing human is alien to me." The context is illuminating. A busybody farmer named Chremes is told by his neighbor to mind his own affairs; the homo sum credo is Chremes's breezy rejoinder. It isn't meant to be an ordinance from on high; it's just the case for gossip. Then again, gossip - the fascination people have for the small doings of other people - has been a powerful force for conversation among cultures. 'The ideal of contamination has few exponents more eloquent than Salman Rushdie, who has insisted that the novel that occasioned his fatwa "celebrates hybridity, impurity, intermingling, the transformation that comes of new and unexpected combinations of human beings, cultures, ideas, politics, movies, songs. It rejoices in mongrelisation and fears the absolutism of the Pure. Mélange, hotch-potch, a bit of this and a bit of that is how newness enters the world." No doubt there can be an easy and spurious utopianism of "mixture," as there is of "purity" or "authenticity." And yet the larger human truth is on the side of contamination - that endless process of imitation and revision. 'A tenable global ethics has to temper a respect for difference with a respect for the freedom of actual human beings to make their own choices. That's why cosmopolitans don't insist that everyone become cosmopolitan. They know they don't hav

But the "last chance" for a 4-year-old to quit his screeching, lest he get a timeout? There are usually another seven or eight chances still to go, in a string of flaccid ultimatums: "Now this is your last chance." "This is really your last chance." "I'm giving you just one more chance. I'm not kidding." Of course you are, and your kids know it. They're not idiots. But they're also not adults, so why this whole school of thought that they should be treated as if they are, long before they can perform such basic tasks of civilization as driving, say, or decanting? Why all the choices - "What would you like to wear?"- and all the negotiating and the painstakingly calibrated diplomacy? They're toddlers, not Pakistan. I understand that you want them to adore you. But having them fear you is surely the saner strategy, not just for you and for them but for the rest of us and the future of the republic. Above all I'm confounded by the boundless fretting, as if ushering kids into adulthood were some newfangled sorcery dependent on a slew of child-rearing books and a bevy of child-rearing blogs.

"[I]f our brain's chemistry does affect our moral behavior, the question of whether that balance is set in a natural way or by medical intervention will make no difference in how freely we act. If there are already biochemical differences between us that can be used to predict how ethically we will act, then either such differences are compatible with free will, or they are evidence that at least as far as some of our ethical actions are concerned, none of us have ever had free will anyway. In any case, whether or not we have free will, we may soon face new choices about the ways in which we are willing to influence behavior for the better.

"New York's newest basketball sensation spends most nights on a couch in a one-bedroom apartment on the Lower East Side. The housing choice is understandable once you get to know Jeremy Lin. He is a Harvard graduate playing in the National Basketball Association. He is an Asian-American in a league devoid of them, which makes him doubly anomalous. No team drafted Lin in 2010. Two teams cut him in December, before the Knicks picked him up. His contract, potentially worth nearly $800,000, was not even guaranteed until Tuesday afternoon. So for the past six weeks, Lin, 23, has been sleeping in his brother Josh's living room, waiting for clarity and career security."

'...the Cochrane Collaboration reported last year that patients who used tools to guide their decisions had a better grasp of their choices and risks. They were also more likely to select less intense or invasive treatment when considering major elective surgery, though results were mixed for other decisions. The influence of decision aids on adherence to medication or overall costs was "inconclusive," according to the report. 'But that uncertainty does not reduce the ethical obligation to better inform patients, or lessen the promise of tools that help patients understand their options and identify their values, some doctors say. "It is the right thing to do," said Dr. Victor Montori, associate director of the Health Care Delivery Research Program at the Mayo Clinic Center for the Science of Health Care Delivery....'

Most readers favor palliative sedation if its primary intent is to allay intolerable suffering even if it may accelerate dying - as opposed to allowing the suffering because its treatment may lead to an earlier death.

Discussion of palliative sedation at end of life (Franklin Hospital Hospice Unit, NSLIJHealth System & Hospice Care Network of L.I.)