In theory, at least, we might achieve a certain sort of invulnerability right at the end of life. Suppose that under favorable circumstances we can live a certain number of years, say 125, but no longer, and also that we can make life as a whole better and better over time. Under these assumptions we might hope to disarm death by spending 125 years making life as good as it can be. If we were lucky (...) enough to accomplish that, afterwards we would be immune to mortal harm. Especially for those who are closer to the beginning of life than to the end, however, this strategy leaves much to be desired. It is like devouring an entire banquet so as to eliminate the danger of someone stealing it from us. Like a feast, a good life is safely ours after it is over, but then safety comes too late to be of any use to us. To be of practical value, we need protection from mortal harm much earlier in life. (shrink)

Hastings Center Report, Volume 51, Issue 5, Page 18-29, September‐October 2021.

In quantifying the global burden of disease in terms of Disability-Adjusted Life Years (DALYs), we must determine both Years of Life Lost (YLLs) and Years Lost to Disability (YLDs). In setting priorities for global health, many have felt that YLLs should not always simply equal life expectancy at death. To this end, Dean Jamison and colleagues recommend the use of a DALY metric that incorporates Acquisition of Life Potential (ALP). When an individual dies, (...) the YLLs that we would otherwise count are multiplied by the value of the ALP function, which rises gradually from 0 to 1 during the first stages of an individual’s life. Jamison et al. do not provide a detailed philosophical justification for the use of gradual ALP. In this chapter I explain why I believe the Time-Relative Interest Account represents the most plausible ethical basis for the ALP approach and describe how we might model ALP in light of this account. (shrink)

When considering the social valuation of a life-year, there is a conflict between two basic intuitions: on the one hand, the intuition of universality, according to which the value of an additional life-year should be universal, and, as such, should be invariant to the context considered; on the other hand, the intuition of complementarity, according to which the value of a life-year should depend on what this extra-life-year allows for, and, hence, on the quality of that (...) life-year, because the quantity of life and the quality of life are complement to each other. This paper proposes three distinct accounts of the intuition of universality, and shows that those accounts either conflict with a basic monotonicity property, or lead to indifference with respect to how life-years are distributed within the population. Those results support the abandon of the intuition of universality. But abandoning the intuition of universality does not prevent a social evaluator from giving priority, when allocating life-years, to individuals with the lowest quality of life. (shrink)

Medical resource allocation is a controversial topic, because in the end it prioritises some peoples’ medical problems over those of others. This is less controversial when there is a clear clinical reason for such a prioritisation, but when such a reason is not available people might perceive it as deeming certain individuals more important than others. This article looks at the role of social utility in medical resource allocation, in a situation where the clinical outcome would be identical if either (...) person received the treatment. This situation is explored with a focus on the United Kingdom, but its conclusions have wider applications to any system where healthcare is tax-payer funded. The article proposes an experience adjusted life years system, and discusses its strengths and weaknesses. (shrink)

Whose values should count – those of patients or the general public – when adopting the quality-adjusted life year framework for healthcare decision making is a long-standing debate. Specific disciplines, such as economics, are not wedded to a particular side of the debate, and arguments for and against the use of patient values have been discussed at length in the literature. In 2012, Sinclair proposed an approach, grounded within patient preference theory, which sought to avoid a perceived unfair discrimination (...) against people with disabilities when using values from the general public. Key assumptions about general public values that beget this line of thinking were that ‘disabled states always tally with lower quality of life’, and the use of standardised instruments means that ‘you are forced into a fixed view of disability as a lower value state’. Drawing on recent contributions to the health economics literature, we contend that such assumptions are not inherent to the incorporation of general public values for the estimation of QALYs. In practice, whether health states of people with disabilities are of ‘lower value’ is, to some extent, a reflection of the health state descriptions that members of the public are asked to value. (shrink)

It is widely accepted that one of the main objectives of government expenditure on health care is to generate health. Since health is a function of both length of life and quality of life, the quality-adjusted life-year (QALY) has been developed in an attempt to combine the value of these attributes into a single index number. The QALY approach - and particularly the decision rule that healthcare resources should be allocated so as to maximise the number of (...) QALYs generated - has often been equated with the utilitarian philosophy of maximising `the greatest happiness of the greatest number'. This paper considers the extent to which the measurement and aggregation of QALYs really is utilitarian by developing a new taxonomy in order to classify utilitarianism and the different aspects of the QALY approach. It is shown that the measurement of QALYs is consistent with a number of different moral positions and that QALYs do not have to be aggregated according to the maximisation rule. Therefore it is inappropriate to necessarily equate QALYs with utilitarianism. It is shown that much turns on what in principle the QALY represents and how in practice it can be operationalised. The paper highlights the category confusion that is often present here and suggests possible avenues for future theoretical and empirical research. (shrink)

A lot of medical procedures can be justified in terms of the number of quality-adjusted life-years (QALYs) they can be expected to generate; that is, the number of extra years that the procedure will provide, with the quality of life during those extra years factored in. QALYs are a crude tool, but good enough for many decisions. Notoriously, however, they cannot justify spending any money on terminal care (and indeed on older people in general). In (...) this paper I suggest a different way of construing ‘quality’ (as meaningfulness rather than physical comfort) and ‘life’ (as both backward-looking and forward-looking), so that the terminal patient's efforts to find meaning in his life could in principle generate plenty of ‘retrospective QALYs’ to justify funding. (shrink)

Health policymakers employ utility measures to inform resource allocation decisions. They often rely on a conceptual tool called the quality-adjusted life year that discounts the value of years lived in a state of disability relative to years lived in full health. A representative sample of the general public is asked to place values on hypothetical health states as part of a standard gamble or time trade-off task. Policymakers use the resulting values to calculate the number of QALYs (...) gained through particular interventions. Utilitarian reasoning mandates that policymakers maximize QALYs gained per unit cost.Although many scholars have explored the problems of distributive justice that arise from this system... (shrink)

The moral philosopher Dan Brock has argued that equality of health outcomes “even if achievable” is problematic as a goal in its own right—because it is open to the levelling down objection. The levelling down objection to egalitarianism has received surprisingly little attention in the bioethics literature on distribution of health and healthcare and deserves more attention. This paper discusses and accepts an example given by Brock showing that prioritarianism and egalitarianism may judge distributions of health outcomes differently. We should (...) accept that levelling down is never a good thing, all things considered, but that equality often is. By discussing variants of Brock’s example, it is demonstrated that if equality, prioritarianism and aggregation are combined, as in a population-wide summary measure of health, such as the health achievement index, this combined set of principles is not open to levelling down. The paper suggests—although a more thorough investigation of the properties of the achievement index is needed—that this measure is always sensitive to inequality in health, is always sensitive to average health, can assign priority to those with lowest health outcomes and is not sensitive to levelling down. Levelling down is not an embarrassment for egalitarians if they adopt a pluralist theory that integrates fairness with goodness. Equality is not the only value egalitarians promote. But equality is so important that we should not reject it. (shrink)

Objective: Quality of Life is an important predictor of patient's recovery and survival in lung cancer patients. The aim of the present study is to identify 1-year trends of lung cancer patients' QoL after robot-assisted or traditional lobectomy and investigate whether clinical and sociodemographic variables may predict these trends.Methods: An Italian sample of 176 lung cancer patients undergoing lobectomy completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire—Core 30 at the pre-hospitalization, 30 days, (...) 4 months, 8 months, and 12 months after surgery. Sociodemographic and clinical characteristics were also collected. The individual change over time of the 15 dimensions of the EORTC QLQ-C30 and the effects of pre-surgery scores of QoL dimensions, type of surgery, perioperative complications, and age on patients' QoL after surgery were studied with the individual growth curve models.Results: Patients had a good recovery after lobectomy: functioning subscales improved over time, while most of the symptoms became less severe over the care process. Perioperative complications, type of surgery, pre-surgery status, and age significantly affected these trends, thus becoming predictors of patients' QoL.Conclusion: This study highlights different 1-year trends of lung cancer patients' QoL. The measurement of pre- and post-surgery QoL and its clinical and sociodemographic covariables would be necessary to better investigate patients' care process and implement personalized medicine in lung cancer hospital divisions. (shrink)

Time is perceived very differently from different vantage points. A year in the life of a primary-school student, for instance, is a very long time—somewhere between 1/5 and 1/ 12 of a primary-school child’s life. When you tlirow in the massive amount a child learns in any one year, compared with the diminishing returns that conspire against us later in life, a child’s year is more like a decade in adult years. But for a primary-school teacher, (...) a school year is just another ten or so months spent trying to remember names, delivering lessons, writing report cards, and endeavoring to shepherd students through the educational system. And, of course, the classroom is just one part of a teacher’s life. Teachers are juggling other serious and timeconsuming matters such as relationships, mortgages, further study, family and so forth. The best teachers, however, don’t let on about these asymmetries between the child’s world and their own; they conceal the differences in temporal perception and they give no clue that each student is just a small part of their life. Such sleight of hand can’t be easy, yet all my primary school teachers pulled it off to perfection. One, however, deserves special mention: Mr. Williams. In 1969 I turned 11 and was in 6th class at the Armidale Demonstration.. (shrink)

A simply written and beautifully illustrated collection of meditations, this book explores each year and phase of life. Hans Korteweg, a well-respected Jungian scholar, offers simple yet profound insights into the qualities, challenges, and possibilities each cycle of life brings to one's lifelong journey toward happiness and fulfillment. Full-color illustrations.

The article examines the subjective attitudes towards life chances of the Lithuanian youth (aged 18–35). Following the concept of life chances introduced by M. Weber (1920) (cited by Grusky 2001), the theoretical aspects of life chances are analysed. The empirical part of the paper is to survey the research results on the life chances of young people in Lithuania in 2023. Based on the analysis of scientific literature and survey research data, we can state that the (...) subjective attitudes of young people to life chances vary depending on age, gender, employment, and parents’ socio-economic status when the respondent is 14–15 years old. The survey research revealed that young people, who are currently not working or studying, or who identify themselves and their family with the lowest social class, most unfavourably evaluate their life chances. The scientific research is funded by the Lithuanian Science Council researchers group’s Project ‘Socio-economic Factors of Youth Life Chances Differentiation in Lithuania’ (Reg. No. S-MIP-22-42, contract date 18.03.2022). (shrink)

There is an ongoing and robust tradition of science and technology studies scholars conducting ethnographic laboratory studies. These laboratory studies—like all ethnographies—are each conducted at a particular time, are situated in a particular place, and are about a particular culture. Presumably, this contextual specificity means that such ethnographies have limited applicability beyond the narrow slice of time, place, and culture that they each subject to examination. But we do not always or even often treat them that way. It is beyond (...) common for us to speak about what one or another laboratory study reveals about the laboratory, or “science” much more broadly. Given the contextual specificity of our ethnographic laboratory studies, what justifies this presumed generalizability? Initially, this manuscript surveys typical responses to this question, but then it pursues an unusual one: the potential replicability of ethnographic results. This potential is hereby explored, via an ethnographic replication attempt—one designed and conducted in order to test the generalizability of a particular laboratory study, that of Latour and Woolgar’s classic Laboratory Life. The results of the ethnographic replication attempt are reported, and a remarkable degree of replicability is established. (shrink)

The movement repertoire that develops in the first year of life is a language in itself and conveys desires, intentions, and emotions. This early life in motion serves as the roots of ongoing nonverbal interaction and later verbal expression – in short, this language remains a key element in communication throughout life. In their path-breaking book, gestalt therapist Ruella Frank and psychoanalyst Frances La Barre give readers the tools to see and understand the logic of this nonverbal (...) realm. They demonstrate how observations of fundamental movement interactions between babies and parents cue us to coconstructed experiences that underlie psychological development. Numerous clinical vignettes and detailed case studies show how movement observation opens the door to understanding problems that develop in infancy and also those that appear in the continuing nonverbal dimension of adult communication. Their user-friendly nonverbal lexicon – foundational movement analysis – enhances perception of emerging interactive patterns of parents and their babies, couples, and individual adults within psychotherapy. Clinicians in any setting will find this book to be a masterful application of infant research and movement theory that significantly augments clinical acumen and promotes greater understanding of the nonverbal basis of all relationships. (shrink)

Excerpt from Martin Buber: The Life of Dialogue This book is the product of a dialogue, a dialogue first with the works of Martin Buber and later with Martin Buber himself. The influence of Buber's thought has steadily spread throughout the last fifty years until today Buber is recognized throughout the world as occupying a position in the foremost ranks of contemporary philosophers, theologians, and scholars. What has made such men as Hermann Hesse and Reinhold Niebuhr speak of (...) Martin Buber as one of the few wise men living on the earth today, however, is not only his eminence as a thinker but also his concern with the 'lived concrete, ' the everyday reality which he takes up into his imagining and bears as his responsibility. Buber's eightieth birthday, on February 8, 1958, was celebrated all over the world, for Martin Buber is one of the truly universal men of our time. 'More than any other person in the modern world, ' said the Protestant theologian H. Richard Niebuhr at one such celebration, 'more even than Kierkegaard, Martin Buber has been for me, and for many of my companions, the prophet of the soul and the witness to that truth which is required of the soul not as solitary, but as companionable being.' In a time in which we are in danger of losing our birthright as human beings, Martin Buber has shown us what it means to live as men. When in 1944 Dr. Simon Greenberg gave me the first book of Buber's that I ever read - The Legend of the Baal-Shem - Buber himself was practically unknown in America and only two of his books were in English, both published in England. Even when I wrote my doctoral dissertation on Buber in 1950, few had heard of him and few of his books were published here. Today more than twenty of Buber's books have been published in English, most of them in both England and America, several more translations are underway, five of his books have been reissued in paperback editions, four anthologies of his writings have appeared, and several books in English have been written on his thought, including the forthcoming Philosophy of Martin Buber volume of The Library of Living Philosophers, which I have had the honor of editing. In 1951-1952 Buber spent almost a year in America under the auspices of the Jewish Theological Seminary; in 1957 he was brought here by the Washington School of Psychiatry to deliver the fourth William Alanson White Memorial Lectures; and in 1958 he was brought to this country by Princeton University. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works. (shrink)

A biography of the noted philosopher and Jewish theologian focuses on the years in which Buber became internationally acclaimed for his work as an author, philosopher, and peacemaker.

The current study examines changes in the economic, social, and well-being life events that women and men reported during the first 7 months of the COVID-19 pandemic. Analyses compared monthly averages in cross-sectional national probability data from two annual waves of the New Zealand Attitudes and Values Study collected between October 2018–September 2019, and October 2019–September 2020, which included the first 7 months of the pandemic. Results indicated that people reported increased job loss in the months following an initial (...) COVID-19 lockdown relative to the same months the year earlier. Women also experienced an increase in family troubles when restrictions eased and reported increased negative lifestyle changes that persisted throughout the first 7 months of the pandemic. The proportion of people experiencing many other life events in New Zealand did not differ reliably from the pre-pandemic monthly baseline. These results highlight resilience to many potential negative life events within the first 7 months of the COVID-19 pandemic. However, the pandemic did not affect everyone equally, and the burden of increased negative events appears more heavily borne by women. As the pandemic continues more than 18 months from initial community transmission of COVID-19, our findings provide important insight into the impact of the pandemic on potential negative life events, especially among women, that may have critical consequences for mental health, gender equality, and social well-being over time. (shrink)

Satisfaction with life is a core dimension of well-being that can be of great importance in the workplace, in light of the close link between worker health and organizational success highlighted by the perspective of healthy organizations. This study aimed at analyzing the factors associated with satisfaction with life, focusing on the role of resilience, career adaptability, self-efficacy, and years of education. A sample of 315 workers filled out the Satisfaction with Life Scale, General Self-Efficacy Scale, (...) Career Adapt-Abilities Scale, the 10-item Connor-Davidson Resilience Scale, and a demographic questionnaire. Data were analyzed by implementing a chained mediation model. Results showed a significant and positive relationship between resilience and satisfaction with life, partially moderated by the chained effect of career adaptability and self-efficacy, controlling for education. When inserted as a covariate, education showed a significant and negative association with satisfaction with life. Such findings contribute to enriching the field of research on the factors that contribute to the well-being of workers and may have important practical implications for interventions in organizations. (shrink)

Soon after the book's publication in 1982, artist David Hockney read Lawrence Weschler's _Seeing Is Forgetting the Name of the Thing One Sees: A Life of Contemporary Artist Robert Irwin _and invited Weschler to his studio to discuss it, initiating a series of engrossing dialogues, gathered here for the first time. Weschler chronicles Hockney's protean production and speculations, including his scenic designs for opera, his homemade xerographic prints, his exploration of physics in relation to Chinese landscape painting, his investigations (...) into optical devices, his taking up of watercolor—and then his spectacular return to oil painting, around 2005, with a series of landscapes of the East Yorkshire countryside of his youth. These conversations provide an astonishing record of what has been Hockney's grand endeavor, nothing less than an exploration of "the structure of seeing" itself. (shrink)

Soon after the book's publication in 1982, artist David Hockney read Lawrence Weschler's _Seeing Is Forgetting the Name of the Thing One Sees: A Life of Contemporary Artist Robert Irwin _and invited Weschler to his studio to discuss it, initiating a series of engrossing dialogues, gathered here for the first time. Weschler chronicles Hockney's protean production and speculations, including his scenic designs for opera, his homemade xerographic prints, his exploration of physics in relation to Chinese landscape painting, his investigations (...) into optical devices, his taking up of watercolor—and then his spectacular return to oil painting, around 2005, with a series of landscapes of the East Yorkshire countryside of his youth. These conversations provide an astonishing record of what has been Hockney's grand endeavor, nothing less than an exploration of "the structure of seeing" itself. (shrink)

Traces the development of the famous theologian's philosophy as he faced the challenges of the Weimar Republic, Nazi Germany, and prewar Palestine.