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The article discusses the use of advance directives (ADs) in the context of dementia and argues against the strategy of broadening the concept of suffering to respect patients' wishes. While the authors acknowledge the importance of considering patients' judgments about suffering and the need for clear ADs, they argue that focusing solely on suffering overlooks the desire of many patients to avoid unacceptable deterioration. They emphasize the importance of recognizing and respecting patients' preferences regarding cognitive and physical deterioration. The article suggests that advance care planning should include discussions about both suffering and deterioration to address the "then-self versus now-self" problem and ensure that ADs reflect patients' values and desires. [Extracted from the article]

To the Editor: Last year I sent a vial of my spit to a prominent direct-to-consumer genetic testing company. The company's Web site promised that, in return, I would get [...]

In their normative role in shaping the basic structure of a health care system, liberty and equality are often thought to conflict so sharply that health policy is condemned to remain an ideological battleground. In this paper, I will articulate my own view of why much of the apparently fundamental conflict between individual liberty and responsibility, on the one hand, and equality and equality's related concern for cost-efficiency, on the other hand, is less intractable than it is usually assumed to be. The result will be to break the rigid and stereotypical association of liberty-emphasizing social philosophies with the pluralistic market paradigm for a health care system and egalitarian, equity-emphasizing social philosophies with the unitary public system paradigm. Understanding better the moral ingredients of liberty and equitable distribution as well as the complexity of how liberty and equality actually intersect in a health care system opens the door to seeing the possibility of significant reconciliation. I will conclude, among other things, that even semi-libertarian views of distributive justice should strongly embrace compulsory, universal coverage of health care for some significant level of care, and that egalitarian views ought not to regard different levels of coverage for people of different income levels as necessarily unjust. Keywords: distributive justice, equality, free-riding, liberty, universal access