The moral economy of care: weaving fiduciary trust and national obligation

“ Of all fiduciary institutions, life insurance should be the most sacred. Its chief function is to care for the widow, the orphan, and the helpless. The millions of revenue paid annually into the life-insurance companies of this country represent the blood and tears and sweat of millions of Americans who thus provide for the care of their dear ones for the time when death shall have put an end to their own income-earning abilities. The administrator of a trust so solemn and exalted should devote himself to its safeguarding as a priest dedicates himself to the service of his [472] Maker. ”

“ By helping control pain and minimize other symptoms, these men and women bring relief to those who are terminally ill and show them the utmost respect. Hospice care enables many of our citizens to spend their final days in comfort and dignity surrounded by loved ones. This palliative care plays a vital role in our Nation's health care system, and the dedicated work of hospice caregivers helps ensure that our citizens receive the services and support they need. Hospice caregivers also reach out to families and friends to provide guidance and counseling after the loss of a loved one. ”

“ When we help those who hurt and those in pain, we become part of our Nation's armies of compassion. Hospice programs provide an option for individuals with terminal illnesses to be cared for as they choose in their final days, often in their own homes and surrounded by the love of their families. The doctors, nurses, counselors, volunteers, and others who provide hospice care throughout our country bring comfort to those most in need every day, treating terminally ill patients with the dignity and respect they deserve. ”

“ The provision of reproductive health care, information and supplies giving priority to poor beneficiaries as identified through the NHTS-PR and other government measures of identifying marginalization must be the primary responsibility of the national government consistent with its obligation to respect, protect and promote the right to health and the right to life ”

“ That a moral obligation rests upon the National Government to employ its constitutional power and influence to establish the rights of the people it has emancipated, and to protect them in the enjoyment of those rights when they are infringed or assailed, is also generally admitted. ”

“ Aristotle, for instance, declares that no one must suppose he belongs to himself, but rather that all alike belong to the state; and Plato, in the construction of his ideal republic, is thinking much less of the happiness of the individual citizens, than of the symmetry and beauty of the whole as it might appear to a disinterested observer from without. Certainly it would have been tedious and irksome to any but his own ideal philosopher to live under the rule of that perfect polity. Individual enterprise, bent, and choice is rigorously excluded. ”

“ For we are lovers of the beautiful, yet simple in our tastes, and we cultivate the mind without loss of manliness.
"Wealth we employ, not for talk and ostentation, but when there is a real use for it. To avow poverty with us is no disgrace; the true disgrace is in doing nothing to avoid it. An Athenian citizen does not neglect the state because he takes care of his own household; and even those of us who are engaged in business have a very fair idea of politics. We alone regard a man who takes no interest in public affairs, not as a harmless, but as a useless character ”

“ The state in his view is not merely the convenient machinery that raises a man above his animal wants and sets him free to follow his own devices; it is itself his end, or at least a part of it. And from this it follows that the regulations of the state were not regarded by the Greeks—as they are apt to be by modern men—as so many vexatious, if necessary, restraints on individual liberty; but rather as the expression of the best and highest nature of the citizen, as the formula of the conduct which the good man would naturally prescribe to himself. ”

“ All modern societies aim, to this extent at least, at equality, that their tendency, so far as it is conscious and avowed, is not to separate off a privileged class of citizens, set free by the labour of others to live the perfect life, but rather to distribute impartially to all the burdens and advantages of the state, so that every one shall be at once a labourer for himself and a citizen of the state. But this ideal is clearly incompatible with the Greek conception of the citizen. ”

“ Every interest is compelled to recognize other interests, on the one hand as parts of its environment, and on the other hand as partners in the general enterprise of life. Thus there is evolved the moral idea, or principle of action, according to which interest allies itself with interest in order to be free-handed and powerful against the common hereditary enemy, the heavy inertia and the incessant wear of the cosmos. Through morality a plurality of interests becomes an economy, or community of interests. ”

“ Morality is that procedure in which several interests, whether they involve one or more physical organisms, are so adjusted as to function as one interest, more massive in its support, and more coherent and united in the common task of fulfilment. Interests morally combined are not destroyed or superseded, as are mechanical forces, by their resultant. The power of the higher interest is due to a summing of incentives emanating from the contributing interests; it can perpetuate itself only through keeping these interests alive. ”

“ Morality is only the method of carrying on the affair of life beyond a certain point of complexity. It is the method of concerted, cumulative living, through which interests are brought from a doubtful condition of being tolerated by the cosmos, to a condition of security and confidence. The spring and motive of morality are therefore absolutely one with those of life. The self-preservative impulse of the simplest organism is the initial bias from which, by a continuous progression in the direction of first intent, have sprung the service of mankind and the love of God. ”

“ To be righteously indignant is to protest passionately in behalf of the whole good, and against the clumsy and inadvertent evil. To this morality owes its universal support, its invincible finality. It need never be apologetic, because it holds no brief; it advocates no measure except the carrying through to the end of what is virtually undertaken by all parties to the adventure of life.
It follows that no man can exempt himself from moral liability. He is irrevocably committed to life, and can neglect the laws of life only at his absolute or ultimate peril. ”

“ Hospice organizations provide people who are near the end of their lives with family-centered, quality care, that emphasizes compassion, independence, respect, and dignity. During National Hospice Month, our Nation pays tribute to hospice care and the persons and organizations involved with it, by recognizing and honoring its value and importance for people who are dying, for their families and friends, and for our communities. ”

“ Americans believe that every person has matchless value throughout all of life's stages. Hospice physicians, nurses, counselors, and volunteers put this belief into action by using their talents and energy to care for those who are terminally ill and by providing support and comfort to their loved ones. As an alternative to traditional services, hospice care frequently provides assistance in the home so that patients can be surrounded by family and friends. ”

“ Each year, approximately 700,000 terminally ill patients and their families rely on the invaluable end-of-life care provided by the 3,100 hospice programs located in the United States. Hospice care allows a terminally ill individual to receive professional medical services, pain management therapy, and emotional and spiritual support, without having to enter a hospital. This focus on the patient's quality of life during his or her last illness can make the best of the most challenging of situations. ”

“ Each one, then, should love his life, even though it be not Very attractive, for it is the only life. It is a boon that will never return and that each person should tend and enjoy with care; it is one's capital, large or small, and can not be treated as an investment like those whose dividends are payable through eternity. Life is an annuity; nothing is more certain than that. So that all efforts are to be respected that tend to ameliorate the tenure of this perishable possession which, at the end of every day, has already lost a little of its value. ”

“ It is essential, then, to life, not only to assert and reproduce itself, but to increase itself through allying itself with life. Where the motive of life thus freely expresses itself, there are no natural enemies.
I count it to be important thus to trace morality back to the original love of life, since only so is it possible to understand its urgency, and its continuity with every organic impulse. It is because morality is without warrant dislocated from the natural life, that it is accused of being barren and formal. ”

“ Morality in its springs is absolutely one with that clinging to life which is the most deep-lying of all interests, and with that relish for life in which its goodness needs no philosopher's approval. ”

“ An interest, or unit of life, is essentially an organization which consistently acts for its own preservation. It deals with its environment in such wise as to keep itself intact and bring itself to maturity; appropriating what it needs, and avoiding or destroying what threatens it with injury. The interest so functions as to supply itself with the means whereby it may continue to exist and function. This is the principle of action which may be generalized from its behavior, and through which it may be distinguished within the context of nature. ”

“ The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965) . `` (E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title. ”

“ Through and through, the Greek ideal is Unity. To make the individual at one with the State, the real with the ideal, the inner with the outer, art with morals, finally to bring all phases of life under the empire of a single idea, which, with Goethe, we may call, as we will, the good, the beautiful, or the whole—this was the aim, and, to a great extent, the achievement of their genius. ”

“ My Administration has acted to strengthen and modernize Medicare for our seniors, and we remain committed to providing a health care system that meets the needs of every patient. Hospice services are covered by Medicare, and many States offer hospice care under their Medicaid programs. The Medicare legislation that I signed into law last December provides that Medicare will, for the first time, cover hospice consultation services so that terminally ill patients and their families will better understand end-of-life issues and care options. ”

“ A guardian who fails to perform his duties or infringes upon the lawful rights or interests of the ward shall bear legal liability. Where a guardian is temporarily unable to perform his duties owing to an emergency such as an unexpected incident, thus leaving the ward in an unattended situation, the residents’ committee, the villagers’ committee, or the civil affairs department in the place where the ward’s domicile is located shall make arrangement as a temporary measure to provide necessary life care for the ward. ”

“ He can never be impertinent because, contrary to the formula of the day, there is no such thing as virtue for virtue's sake. Morality is the one interest that virtually represents all interests. It is the interest of every man in the general tests of success and failure, and in the maintenance of the field or medium of all interests. There is no enterprise which, if conducted efficiently, is not a verification of moral rules; there is no enterprise which does not receive and transmit the now of life that circulates through the moral system at large. ”

“ The primal determination to be and to sell one's self dearly, is not different, except in its limits, from the moral determination to be and to attain to the uttermost. The whole force of life is behind every moral scruple, and guarantees the sanity even of a universal good-will.
But the identification of morality with the organization of life, serves also to demonstrate life in its unity and larger auspices. Morality harmonizes life and eliminates its wanton {28} self-destruction; but life is not therefore left without an object of conquest. ”

“ Morality is only life where life is organized and confident, the struggle for mere existence being replaced with the prospect of a progressive and limitless attainment. The good is fulfilled desire; the moral good the fulfilment of a universal economy, embracing all desires, actual and possible, and providing for them as liberally as their mutual relations permit. The moral good is simply the greatest possible good, where good in the broad generic sense means any object of interest whatsoever, anything proved worth the seeking from the fact that some unit of life actually seeks it. ”

“ Government, education, science, and religion are fixed moral necessities. They arise out of those conditions of life which are general and constant. Hence each has a history coextensive with the history of society itself. And since the function of each remains identical throughout, the adequacy with which at any given time it fulfils that function may be taken as a measure of civilization. Government being the most prominent of institutions, and its improvement being the deepest concern of society, I shall select it for special consideration. ”

“ The original and always the fundamental values of government are order and power. But these must be obtained with the minimum of personal exploitation on the part of the ruler; the function of government must be clearly understood and vigilantly guarded by a body of citizens who identify their interests with it. And secondly, order and power must be made compatible with individual initiative, with playfulness and leisure, and with the free development of all worthy interests. This pressure has been steadily operative in the evolution of modern political institutions. ”

“ And I saw just the other day, in Mentor, Ohio, where a father told the story of his eight-year-old daughter, whose long battle with leukemia nearly cost their family everything had it not been for health care reform passing just a few months before the insurance company was about to stop paying for her care. [1]
I had an opportunity to not just talk to the father, but meet this incredible daughter of his. And when he spoke to the crowd listening to that father’s story, every parent in that room had tears in their eyes, because we knew that little girl could be our own. ”

“ There are as many varieties of goodness as there are varieties of interest; and to the variety of interest there is no end.
Strictly speaking, goodness belongs to an interest's actual state of fulfilment. This will consist in an activity, exercised by the interest, but employing the environment. With a slight shift of emphasis, goodness in this absolute sense will attach either to interest in so far as nourished by objects, as in the case of hunger appeased, or to objects in so far as assimilated to interest, as in the case of food consumed. ”

“ A particular action is invariably connected with a particular interest; and in so far as it is successful it will thus be directly fruitful of fulfilment. And it matters not how broad a purpose constitutes its ultimate motive; for purposes can be served only through a variety of activities, each of which will have its proximate interest and its own continuous yield of satisfaction. Life pays as it goes, even though it goes to the length of serving humanity at large, and the larger enterprises owe their very justification to this additive and cumulative principle. ”

“ For every step in the organization of life is attended with the growth of new interests, and especially of interests fostered or directly evoked by principles that have proved their moral virtue. Thus the forms of prudence and justice are supported by the immediate love of these things. And a growing rationality involves an increasing subtlety and delicacy in desires, the enrichment of life through the multiplication of such sources of satisfaction as are consistent with order and liberality. ”