I Mind My Own Business and Expect Others to Do the Same: Conversations About Declining Financial Capacity

Introduction One of the smartest ways to prepare for declines in financial decision making capacity is to appoint an agent under power of attorney for finances and to share important financial information and preferences with trusted family or friends. Yet only 12% of older Americans with children think that they’ll need help with their finances as they age, and more than half are uncomfortable talking about their finances with children. Method: We conducted four in-depth interviews with older adults and four focus groups with Black, Latino, low income, and low-middle income adults aged 65 and older. An average of 9 participants were in each 2-hour focus group. Results Barriers included lack of awareness, denial of future changes in capacity, lack of trustworthy surrogate decision-makers, shame about one’s financial situation, desire for privacy, fear of being a burden, and resistance to overtures by children. Barriers differed by ethnicity and socioeconomic status, with lower income older adults having less knowledge of advance planning and Powers of Attorney. Implications: Significant education is needed around Powers of Attorney and how to begin the advance planning process. Study findings informed the Thinking Ahead Roadmap, a guide to facilitate planning and communication around future money management. The Roadmap uses an empowerment framework to motivate individuals to appoint trusted financial advocates and prepare them for a smooth transition in money management, thereby reducing risk of exploitation, costly mistakes, and family conflict.

Parents’ experiences of initiation of paediatric advance care planning discussions: a qualitative study

Advance care planning enables parents to discuss their goal and wishes for the future treatment and care of their life-limited or life-threatened child. Whilst research has identified the barriers clinicians face to initiate such discussions, the views of the parents have received scant attention. This qualitative study, using reflexive thematic analysis, aimed to explore parents’ experience of the initiation of their child’s advance care planning discussions, to help provide an understanding to inform future practice. Single interviews were undertaken with 17 non-bereaved and bereaved parents. Parents reported they had engaged with future thinking but needed time before initiating this with clinicians. They identified the need for a trusted professional and time for private, thorough, non-judgemental discussion without feeling clinicians were ‘giving up’. Parents reported that advance care planning discussions were not always aligned to the dynamics of family life. They felt that health professionals were responsible for initiating advance planning conversations according to the families’ individual requirements. There was an apparent lack of standardised protocols to assist paediatric advance care planning discussion initiation.Conclusion: Initiating advance care planning is a complicated process that needs to be tailored to the specific parent and child situation. Health professionals need to appreciate that parents are key contributors to initiate engagement with advance care planning discussions but that they also require support and care, recognising this may facilitate the building of trust, identified as a key corner stone, of paediatric advance care planning initiation and engagement. What is Known:• In paediatric palliative care, parents are challenged with wanting to sustain hope whilst thinking and planning for their child’s end of life. Paediatric advance care planning discussions are often delayed or avoided and triggered by physical deterioration. What is New:• Previous relationship with HCP not essential but parental trust of the HCP is fundamental to Paediatric advance care planning initiation engagement. To build mutual trust health professionals’ approach needs to be professional, respectful and empathetic to the parent and child’s situation.• Subtle paediatric advance care planning parent initiation preparation by HCP is often unnoticed by parents but may be the crux of empowering parents to initiate advance care planning conversations themselves as they need to feel a sense of regaining control before planning ahead.

Palliative Care For Patients with Advanced COPD in Primary Care

Patients with advanced COPD have a high symptom burden that is often multidimensional. Identification of patients who might benefit from palliative care through validated identification tools, multidimensional symptom management, and timely discussion of advance planning are elements of a palliative care approach for these patients and their families. Coordination among stakeholders providing care and support to these patients is central to ensuring high-quality care and meeting all of their needs.

Sharing the World with Digital Minds

The minds of biological creatures occupy a small corner of a much larger space of possible minds that could be created once we master the technology of artificial intelligence. Yet many of our moral intuitions and practices are based on assumptions about human nature that need not hold for digital minds. This points to the need for moral reflection as we approach the era of advanced machine intelligence. This chapter focuses on one set of issues, which arise from the prospect of digital minds with superhumanly strong claims to resources and influence. These could arise from the vast collective benefits that mass-produced digital minds could derive from relatively small amounts of resources. Alternatively, they could arise from individual digital minds with superhuman moral status or ability to benefit from resources. Such beings could contribute immense value to the world, and failing to respect their interests could produce a moral catastrophe, while a naive way of respecting them could be disastrous for humanity. A sensible approach requires reforms of our moral norms and institutions along with advance planning regarding what kinds of digital minds we bring into existence.