Patients with end-stage renal disease experience significant mortality and morbidity, including cognitive decline. Advance care planning has been emphasized as a responsibility and priority of physicians caring for patients with chronic kidney disease in order to align with patient values before decision-making capacity is lost and to avoid suffering. This emphasis has proven ineffective, as illustrated in the case of a patient treated in our hospital. Is this ineffectiveness a consequence of failure in the courtroom or the clinic? Through our (...) own experience we affirm what has been written before: that legal precedent favors intensive treatment in virtually all cases without ‘clear and convincing evidence’ of a patient’s previously declared wishes to the contrary. Equally clear is that more than 20 years of support in the clinical literature suggesting advance care planning early in the course of disease can address challenges in the legal system for those lacking capacity. However, many physicians fail t... (shrink)

Part of the accepted scholarly lore about Kierkegaard is that he holds that “existence”—human existence—and “the System” are mutually incompatible. For Kierkegaard, human being cannot be understood in terms of a nice, neat, complete systematic package; he shows, on this view, that the Hegelian attempt to grasp all of reality in terms of a philosophical system will always fail to grasp the reality of at least one thing: the concrete, living, existing individual human being.

One vigorous line of thought in contemporary moral philosophy, which I shall call ‘Neo-Aristotelianism,’ centers on three things: a rejection of traditional enlightenment moral theories like Kantianism and utilitarianism; a claim that another look at the ethical concerns and projects of ancient Greek thought might help us past the impasse into which enlightenment moral theories have left us; more particularly, an attempt to reinterpret Aristotle’s ethical work for the late twentieth-century so as to transcend this impasse.