Saturday, May 23, 2020
In particular, LewisÃ¢â¬â¢s book discussed Ã¢â¬Å"The CrisisÃ¢â¬ newspaper that DuBois in which he used as a vehicle to discuss his views. Throughout his book, Lewis describes DuBois Christian beliefs as an influence on his perspectives. That is what makes his account of him different from other historians that written about him. While, they focused heavily on the man, the intellectual in his activism, they do not examine his background much. Lewis writes of DuBois, Ã¢â¬Å"he catechized readers with the pursuit of Democracy, Justice, and ProgressÃ¢â¬ ¦ achievable only by following a straight path.Ã¢â¬ In other words, by connecting his vision with religion, DuBois can draw Christians to advocate for African-American rights because it is morally right to do so. What is interesting about Lewis account is that he highlighted a key point in the American Civil Rights movement: the connection to religion. By doing so, he contrasted himself from other historians who shied from maki ng that declaration. Lewis was able to reach that conclusion, only after, an extensive look into DuBois personal life. The evidence he uses to support his position takes cues from Ã¢â¬Å"The CrisisÃ¢â¬ pages. Again, Lewis uses DuBois own words in his editorials as he tried to educate his readers on issues that may have been previously unaware of. Lewis interpretation of the paper leads readers to believe that he shared that similar sentiment with other historians in the significance of an African-American man having a voice during thisShow MoreRelatedExploring Racial Conflict Of America Essay1535 Words Ã |Ã 7 PagesExploring Racial Conflict in America The United States of America is comprised of citizens who have rights afforded to them that are explicitly written in the United States Constitution and Bill of Rights. All of these individuals exhibit diversity. Some came by choice, others by slavery. 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During the time of Martin Luther King JrÃ¢â¬â¢s speech, the country was in a great state of distress regarding equal rights and equal opportunity for people of color. Riots, protests, and chaos seemed to be taking over the country as African Americans began to demand their deserved equality. Martin Luther King Jr stepped up through all the madness going on andRead MoreThe Civil Rights Movement Essay1624 Words Ã |Ã 7 Pages The Civil Rights Movement lead nonviolently by Martin Luther King in the 1960s is an important era to examine when analyzing the extent to which the ideology of Carl Schmitt remains relevant to domestic conflict outside of the interwar period. SchmittÃ¢â¬ â¢s theory assists in understanding the racial segregation in the United States as political. However, while King identified similar critiques of liberalism as Schmitt, he believed that nonviolent direct action was an effective, politically engaged methodRead MoreRhetorical Analysis Of Martin Luther King Jr847 Words Ã |Ã 4 PagesMartin Luther King Jr and The Civil Rights Movement Martin Luther King Jr was a protestor who became the most important spokesperson and leader in the Civil Rights Movement.Ã He was a member of the National Association for the Advancement of Colored People(NAACP) and in 1954, he decided to take a position as a preacher at Dexter Avenue Church in Montgomery, Alabama. King felt as though it was his moral duty to help the civil rights movement which is why he planned many activities that will helpRead More`` Blood Done Sign My Name `` By Timothy B. Tyson1409 Words Ã |Ã 6 PagesEvery American history class addresses the civil rights movement. Yet, author Timothy B. Tyson, in his novel Blood Done Sign My Name, specifically discusses the use of violence in this well-known movement. As a way to draw attention, many groups turn to acts of violence to attempt to rectify social injustice. Although violence may not directly change a negative situation, it indirectly helped the civil rights movement by drawing attention to the rising racial conflicts in Oxford, North Carolina,
Tuesday, May 12, 2020
Sample details Pages: 24 Words: 7096 Downloads: 6 Date added: 2017/06/26 Category Health Essay Type Analytical essay Did you like this example? Chapter 1-Introduction 1.1 In modern society, everyone has the basic right to consent to medical treatment. However, this is a recent development as consent was not always considered a critical issue in medical treatment. Hippocrates himself, advised doctors that they should conceal the effects of medical treatment from their patients, his reasoning being he believed that when patients were given relevant information they would take a turn for the worse. DonÃ¢â¬â¢t waste time! Our writers will create an original "Consent Treatment Patients Health Dissertations" essay for you Create order It was not standard practice for patients to question a doctors decision or authority. Recent changes have contributed to this change in attitude and as such altered the method of practice of a doctors obligation. The final years of the twentieth century as witnessed the most dramatic shift in the reputation of the medical profession within the United Kingdom, due to scandal after scandal plaguing doctors. Major news headlines left the doctor-patient relationship in a state of concern, for example, Doctors who steal organs face jail.This headline refers to the Bristol and Liverpool Hospital where it was discovered that they were retaining childrens organs, without consent or knowledge of the parents. It became apparent in the Bristol and Liverpool reports that organ retention, of both children and adults was widespread practice. Another significant humiliation for the medical profession was the case of Harold Shipman, a general practitioner who was convicted of murdering fiftee n of his patients. Whether these circumstances are due to the actions of individualist or media influence makes little difference to the effect they had on societys viewpoint. There was need for change and this brought about the introduction of regulations and guidelines that protected both the patient and the doctor. 1.2 Informed consent was seen to break the doctor knows best concept and established a liberated choice for the patient. The locus classicus for informed consent is contained within the case Schloendroff v Society of New York Hospital, where it was held, Ã¢â¬Å"Every person being of adult years and sound mind has a right to determine what shall be done with his own body.Ã¢â¬ There are many examples within the UK system which confirms this principle of law, one being the case Re A (Minors) in which Robert Walker L.J stated, Ã¢â¬Å"Every human beings right to life carries with it, as an intrinsic part of it, rights of bodily integrity and autonomy The principle und erpins the common law concerning consent to treatment within the UK. The consent that a patient has the right to choose is a fundamental part of receiving medical treatment. No considerations need to be examined whether the choice is rational or irrational, as the patient has an absolute right. 1.3 The Department of Health 1993 stated, Ã¢â¬Å"Consent is the voluntary and continuing permission of the patient to receive a particular treatment based on an adequate knowledge of the purpose, nature and likely risks of the treatment including the likelihood of its success and any alternatives to it.Ã¢â¬ Meaning any permission given under any unfair or undue pressure is not consent. Consent may be expressed or implied, however the validity of informed consent does not depend upon the form in which it is given 1.4 This dissertation will firstly consider the development of informed consent, as the English courts initially had reservations of its establishment and for this reason was gradually introduced in stages, until the case of Chester v Afshar which saw the full acceptance of the doctrine. It needs to be considered how the medical profession dealt with this change and in addition how patients themselves are exercising such powers. The effect in which the Human Acts 1998 has had on the courts decision making process will also be analysed to observe the relevance this may have had on informed consent. Another factor of informed consent includes giving sufficient information and the patients understanding of this. For informed consent to exist, the patient must have all the relevant information and capability to make an informed choice as to the treatment they decide to receive. This was made apparent in the case Reibiu v Hughes, where Laskin J stated, Ã¢â¬Å"the genuineness of consent to medical treatment depends on proper disclosure of the risks it entailsÃ¢â¬ For informed consent to exist within the UK; provisions need to be made for those who are s imply unable to give an informed choice. The capacity of a patient needs to be considered and if they lack this then a doctor must make a decision as to what is in the patients best interest. This can be seen to restrict informed consent as it goes against its true principle, however if a patient can not make an informed choice for themselves then it is only passable that someone has to act on their behalf. This dissertation will examine the procedure for this and how the law enables decisions to be made fairly and respectably. Chapter 2-The Development of Informed Consent 2.1 The area of law that needs to be established is the nature and scope of the duty to inform and the extent to which this has been incorporated into the English legal system. The existence of a duty to warn came about when the relationship between a doctor and the patient, which was based solely on trust, began to erode. There was a need for scrutiny and examination within the medical profession and thi s was achieved through the development of the law. The scope of the doctors duty of care is determined by a reference to the Bolam case. Mr Bolam agreed to electroconvulsive therapy to help improve his depression. He suffered fractures in the course of the treatment. The risk was known to his doctor, but he had not informed Mr Bolam of such. Mr Bolam alleged that the failure to warn him of the risk was negligent. The judge found that the amount of information harmonized with accepted medical practice and dismissed his claim. The judge, McNair J, directed the jury to the principle that, Ã¢â¬Å"A doctor is not guilty of negligence if he has acted in accordance with the practice accepted as proper by a responsible body of medical men skilled in that particular artÃ¢â¬ Therefore, the defendant doctor had conformed with a practice which was approved by a responsible body of medical opinion. This test was known as the Bolam test and it determines whether the doctor fell below Ã¢â¬Å "the standard of the ordinary skilled man exercising and professing to have that special skillÃ¢â¬ 2.2 Where there is a difference of judgment between two differing medical opinions, the defendant will be given the benefit of the doubt. As a result a doctor would not be found negligent if the court is satisfied that there is a responsible body of medical opinion that considers the doctor had acted appropriately. This responsible body need not be the majority of the profession. It appears that the courts allowed the medical profession to set their own standard. A doctor simply needed to provide an expert testimony and the courts assumed that it must be responsible. In exceptional cases, the courts perceived some established practice to be substandard, however it appears that only one reported case has materialized where such a judgement has occurred. The case, Hucks v Cole, where a woman contracted puerperal fever due to her doctor failing to treat her with penicillin for he r septic toe and finger. Although a number of distinguished doctors gave evidence that they would not have administrated penicillin, the Court of Appeal found the defendant to have been negligent. The Judge, Sachs LJ, commented that the courts have to be in a position to verify that the medical opinion stood up to logical analysis and that they are not merely tailored to fit the requirements of the respective parties cases. This judgement was one of rarity, as Judges would not ordinarily cross examine a doctors opinion on a logical basis. 2.3 Often cases were even more favourable to the doctor, as is witnessed in the case Hatcher v Black. In this case Lord Denning stated, Ã¢â¬Å"As a matter of law it might be justifiable for a doctor to tell a lie, when he only does that which many a wise and good doctor would do.Ã¢â¬ It can be concluded from this that it is entirely for the individual doctor to determine what to inform his patient, even if the doctor went so far as to opt for what his lordship termed a therapeutic lie. Professor Michael Jones expressed the state of play as a football score, Ã¢â¬Å"In six medical negligence claims before the House of Lords between 1980-1999 the score stood at Plaintiffs 0, Defendants 6Ã¢â¬ . 2.4 The Bolam test which was adopted by English law focused on accepted practice and responsible profession opinion. The story was very different in America, as the American Courts rejected the professional medical standard and instead emphasised the patients right to know what the risks are inherent in the treatment. In Canterbury v. Spence a US Court stated that the prudent patient should prevail and its the doctors duty to disclose to their patient any material risk in a proposed line of treatment. The prudent patient principle emphasises what the doctor needs to inform the patient, according to what the average reasonable patient would want to know about potential risks and treatment options. This is made evident when the Judge commented, Ã¢â¬Å"A risk is material when a reasonable personÃ¢â¬ ¦.is likely to attach significance to the riskÃ¢â¬ Contrary to the English Courts, the USA placed more importance on the patients rights and exigencies than those of the doctors. However, soon after the Bolam decision the English law was making changes towards incorporating this American style of law, to incorporating the doctrine of informed consent. 2.5 The question that needs to be examined is to what extent the Bolam test does or should apply to the duty to inform. Sidaway v Board of Governors of the Bethlem Royal Hospital was the subsequent, leading case to appear before the House of Lords that approached such a matter. While the majority of Lordships legitimatised the traditional test expressed in the case of Mr Bolam, the individual judgements were small steps towards informed consent. Four out of the five Law Lords rejected the transatlantic test that a duty to inform a patient should be based on the reasonable or prudent patient and Lord Scarman alone favoured this manner of law. 2.6 Lord Scarman made it apparent that he considered the patient to have the right to choose what happens to his body, which signified the patient needs to know the risks so can exercise an informed choice. He went on to express what he held to be the suitable relationship between a doctor and his patient, Ã¢â¬Å"There is room in our law for a legal duty to warn a patient of the risk inherent in the treatment proposedÃ¢â¬ . He went on to consider the doctrine of informed consent and its relevance in the Canterbury case, Ã¢â¬Å"I think the Canterbury propositions reflect a legal truth which too much judicial reliance on medical judgment tends to obscureÃ¢â¬ Lord Scarman acknowledged the patients rights and that the prudent patient principle made the doctors much more accountable for their actions. As such he rejected the current medical practice that a patient will be informed if he need s to be, as opposed to if he wants to be. Doctors, in Lord Scarmans view, should be liable where the risk is such that in the courts view a prudent person in the patients situation would have regarded it significant. He appears to suggest that the onus proof rests on the doctor to satisfy the court as to the reasonableness of any non-disclosure and therefore suggesting a support for informed consent. However, it must be noted that he did not find in favour of Miss Sidaway, on the basis that she failed to establish that the less than one per cent risk was such that a reasonable patient would consider significant. 2.7 In spite of this the speech of Lord Scarman has stood as a symbol of hope to those who argue for informed consent to be introduced into English law. Lord Diplock rejects Lord Scarmans scrutiny, as he maintains that the Bolam test covers all aspects of the doctors duty to care to his patient. However, he distinguished from the position where a patient asks a question a bout treatment, by stating Ã¢â¬Å"if the patient in fact manifested this attitude by means of questions the doctor would tell him whatever it was the patient wanted to know.Ã¢â¬ This illustrates that while Lord Diplock believed doctors were not be required to inform the patient of risks, he does not fully discount the patients rights. Lord Bridge also rejected the notion that a patient should be warned of all risks, yet Ã¢â¬Å"when questioned specially by a patient of apparently sound mind about risks involved in a particular treatment proposed, the doctors duty must, in my opinion, be to answer both truthfully and as fully as the question requires.Ã¢â¬ This gives the patient the option of asking for information from the doctor and if the doctor failed to do so then his duty of care could be in breach. However, Lord Templeman, expressed that this is not clear cut, as Ã¢â¬Å"the court will be slow to conclude that the doctor has been guilty of a breach of duty owed to the pa tient merely because the doctor omits some specific item of information.Ã¢â¬ It was important that Lord Scarman recognised the doctrine of informed consent and that the remaining four judges recognised the meaning of a patients ability to enquire and the doctor responsibility to notify. 2.8 It seemed that English legal system was initially hesitant to adopt informed consent into medical law. However, the approach taken in the case Gold v Haringey Health Authority contradicts that expressed by their Lordships in Sidaway. The claimant, in this case, indicated that she did not wish to have any more children and was advised to undergo a sterilisation operation after the birth of her third child. The operation was carried out but the claimant later became pregnant and gave birth to her fourth child. The Judge at first instances applied his own analysis as to what information the doctor should have given and found the defendant negligent. Upon appeal, Lloyd L.J held that the Bola m test should be strictly applied and he dismissed the view of the judge prior to him. He asserted that for the purposes of establishing the test as to the duty of care owed by a doctor to a patient no distinction needed to be made between advice given in a therapeutic and non-therapeutic context. In reference to Sidaway he stated, Ã¢â¬Å"the House of Lords could have adopted the doctrine of informed consent favoured in United States of America and Canada, but the House of Lords decided not to follow that path.Ã¢â¬ It seems clear from the Sidaway judgement that the nature to inform is more extensive than that of the Bolam test where no information is required. The decision in Gold repealed any progress been made towards informed consent and the judgement seemed to convey patient autonomy to be rather trivial 2.9 The view of Diplock in Sidaway has been regarded as the authoritative statement regarding the extent of the doctors duty. There has been a move away from the Diploc k approach as seen in the case Pearce v. United Bristol Health Care NHS Trust which altered the analysis of a doctors obligation. Mrs Pearce, who was expecting her sixth child, was two weeks past her due date of delivery. She discussed the possibility of induction with her obstetrician who warned her of the risks of induction and caesarean surgery, but did not tell her that there was a 0.1 to 0.2 per cent risk of stillbirth associated with non-intervention. Mrs Pearces child was stillborn and she alleged that failure to warn her of the full risks was negligent. Lord Woolf, in this case, held that the patient had the right to know and stated the doctor should normally inform a patient of Ã¢â¬Å"a significant risk which would affect the judgment of a reasonable patient.Ã¢â¬ It was decided, however, that while a doctor is under an obligation to warn, the 0.1 to 0.2 per cent risk of stillbirth was not classed a significant risk. While the Pearce judgment did not go so far as to fu lly accept the doctrine of informed consent, it adopted elements of the reasonable test. The judgement goes a certain distance to reconcile the approaches of Lord Scarman, Lord Bridge and Lord Templeman in Sidaway. It isolated Bolam, which by Professor Margaret Brazier,who has wrote many publications on issues of medical law, was considered good as Bolam was Ã¢â¬Å"out of control and out of context, it came close to acquiring democratic status in some quarters.Ã¢â¬ The test for duty to warn was now suggested to be that the reasonable doctor must tell the patient what a reasonable patient wanted to know. The judgement signified a more patient-friendly approach and made greater demands on the level of disclosure. Chapter 3: Further development towards the doctrine of informed consent 3.1 The medical professional has taken steps to further achieve the full introduction of informed consent into the medical world. The General Medical Council (GMC) produced comprehensive guidance to, doctors on seeking the patients consent in Seeking Patient Consent: The Ethical Considerations February 1999 (appendix I). These guidelines make particular reference to the requirement on doctors to attain informed consent, a doctrine which a few years earlier was alien to English law. Since 1992 Professor Sir Ian Kennedy LLD, a former member of the GMC, has been arguing that doctors need specific guidelines on what constitutes good practice. At that time he was the voice of the minority, however due to dramatic change in the doctor-patient relationship the GMC recognised guidelines needed to be established. The standard adopted in these guidelines resembles elements of the prudent patient test specifically that of the judgment made by Lord Scarman in Sidaway. Guidance from the GMC directs doctors toÃ¢â¬ ¦take appropriate steps to find what patients want to know and ought to know about their condition and its treatment. Andrew Hockton believed that the guidelines, Ã¢â¬Å "should now be considered to amount to more an ethical obligation: they provide at least, a starting-point for measuring the extent of a doctors duty of care to patientsÃ¢â¬ It appears that the guidelines are considered to be a benchmark for doctors to monitor their legal duty of care, to which the Bolam test fails to create. This dissertation professes that perhaps this is the responsible body of medical opinion and it seems the medical profession are setting a higher standard for both themselves and the patient. 3.2 It must be noted the development of the Human Rights Act 1998, has extended the doctrine of informed consent in medical treatment. Incorporation of the European Convention of Human Rights under the Human Rights Act encourages the courts to focus more on the patients rights. This area of law includes Article 2 (the right to life), Article 3 (prohibition on inhuman or degrading treatment) and Article 8 (the right to respect for private and family life which include s the right to bodily integrity). The case R(on the application of Wilkinson) v Broadmoor Hospital illustrates how the introduction of the rights affected certain aspects of medical law. A mental patient appealed concerning a decision to administer treatment without his consent and under restraint. He claimed it infringed his rights under the European Convention of Human Rights 1950, Art.2, Art.3 and Art.8. The judge allowed the appeal stating that under the 1998 Act, it was no longer appropriate to forcible treat detained patients without a court judgement granting so. While the decision in this case would not have been so without the introduction of the Human Rights Act, it had little effect on the majority of medical consent cases. The Act was expected to have a great impact upon issues of medical consent, however it does not seem to have made a dramatic difference on the Courts decision making. 3.3 The most recent case that has dealt with the issue of informed consent is C hester v Afshar, where the claimant underwent surgery and suffered nerve damage leading to paralysis. The surgeon failed to warn Miss Chester of the inherent risk in surgery and the House of Lords decided that the risk was of sufficient quantity to determine the defendant had inadequately warned. The case is considered to show the importance the courts attached to the principle of autonomy, as Lord Hope reiterates when he states, Ã¢â¬Å"the duty to warn has at its heart the right of the patient to make an informed choice as to whether and if so when and by whom to be operated on.Ã¢â¬ The claimants evidence verified had she been warned of the risk she would not have agreed to surgery without at least seeking a second opinion on the necessity and risks of surgery. Therefore, a causation link was adopted by the courts to further prove negligence by the doctor. 3.4 In this case it was sufficient for her to prove that, if properly warned, she would not have consented to the oper ation. Dr Afshar was found to violate her right to choose, which meant she was unable to seek further advice or alternatives. Therefore, a claimant pursuing a claim in this area must prove if the information had been given, their decision as to the treatment would have caused extra consideration. Lord Steyn asserted that individuals have a right to make important decisions affecting their lives for themselvesÃ¢â¬ ¦in modern law paternalism no longer rules. This case was a ground breaking decision by the House of Lords, as it introduced fully informed consent and it addressed the purpose and rationale behind a doctors duty to warn. 3.5 Historically the law as taken the view that doctors are honourable and true, essentially allowing the medical profession themselves to dictate the duty to disclose. As a result of the decision made in Chester v Afshar this outlook has changed somewhat and it appears to provide a new dawn for patients rights. It has created a remedy for patients who have received insufficient information, where previously the majority of case had failed to provide such a remedy. The days of Lord Denning are long gone, meaning the doctor-friendly Bolam principle has practically been condemned worthless. While the judgement can be seen to address the reality of responsible expectations of society, it seems the judgment leaves the court with a difficult job determining who, between the patient and the doctor, is effectively legitimate when it comes to what information is disclosed. More specifically the outcome is likely to be met with distaste from doctors and there is already evidence of growing concern from within the profession. Despite the doctors concern the law of informed consent has moved on considerably from the reality where the majority of cases would fail to offer a remedy for those who had not been completely informed. As was stated by Sarah Devaney in a Medical Law Review, that back then, Ã¢â¬Å"It did not matter whether or n ot doctors were wearing the flak jackets of consent, as patients wishing to make claims about lack of information were in any event carrying unloaded guns. However, after cases, time and the materialization of certain events the doctrine of informed consent began to take effect in English law. Chapter 4: The Degree of Sufficient Information 4.1 Informed consent is based on the requirements of appropriate information to allow patients to make an informed choice. The law fails to formulate a standardize figure which can be consider significant and therefore it can only be gauged on previous cases and what the accepted amount has or has not been within these circumstances. More specifically, as no clear indication has been articulated, the judgement will be dependant on the individual facts of the case, as long as this coincides with the authoritative case law. What is clear is that failure to advise sufficiently as to the nature and purpose of the procedure may give rise to a n action against the doctor. If the patient is given inadequate information, then how they able to make an informed decision and therefore be said to have given real consent? 4.2 The leading case Chester v Afshar (as discussed above) contradicted any previous beliefs of the court and that of the medical profession. The case prior to Chester was Pearce v United Bristol Health Care (as discussed above) where Lord Woolf stated that the doctor should normally inform a patient of a significant risk which would affect the judgement of a reasonable patient. It considered the balance of percentages and whether this balance would have effected the patients decision to have the treatment. The risk of 1-2 per cent in this case was not considered to be sufficient to represent a significant risk. The decision in Chester made it clear that a 1-2 per cent risk was an adequate percentage for the doctor to warn the patient. Even though, the doctor appropriately informed according to the Pearce decision and the GMC standards, Chester v Afshar brought a new way of thinking to the table. 4.3 Chester disregarded the concept of what a reasonable patient would want to know and instead looked at what each individual patient wanted to know for themselves. This meant it was more plausible for the doctor to consider the patients personality, concerns and wants and information given must be relevant to the patients decision. The involvement of the causation link enabled patients to assert their rights over decision not only on the surgery itself, but in addition on the circumstances in which it was under, for example the time, place and in whose hands the operation should be performed. The causation link made it easier for patients to receive a remedy at law, as long as they could prove that had they been sufficiently warned of the risks they wouldnt have undergone the treatment. This does not mean they need to prove that they would not have had the operation at any time, jus t not at that moment in time in which they did. The doctor needs to make acknowledgment to both warn of a significant risk and risks which a patient would consider relevant, even if not below significance. It left the doctors with the delicate job of determining what information individual patients wanted to know. This contemporary approach sent shock waves through the medical profession and the GMC had to amend their guidelines, as they now failed to reach a high enough standard. The new guidelines can be found In Good Medical Practice 2006. (see Appendix II) 4.4 Professional guidelines now go further and state the doctor must do his best to discover the patients individual needs and priorities to analysis what information that individual may require. When consenting to treatment patients should be aware of certain factors such as, diagnosis, prognosis, various treatment options, probabilities of success and possible side effects. This was the situation in the case Smith v Tunbridge Wells Health Authority, where a claim was brought against a 28 year old man who was not warned of the risk of impotence inherent in rectal surgery. His claim succeeded despite the risk being considered significantly low, as the judge found failure to warn such a patient of a risk of such importance to him was neither reasonable nor responsible. The doctor needed to have balanced the small risk of importance against the importance it possessed on his life. 4.5 The most effective way of obtaining consent that is currently in the English medical system is consent forms. Consent forms place emphasis on the patients rights; it gives them a sense of control and perhaps recaptures some of the faith that is said to have disappeared between doctors and patients. There is no requirement in English law that consent forms should be in writing, however the Department of Health have recommended the use model consent forms (see appendix III). The most prominent aspect is the fact it does not shy away from informed consent and instead seems to embrace it. It attempts to ensure that patients are aware that they are entitled to ask questions and expect explanations do with the medical treatment they receive. Unfortunately this way of operating is time consuming and is limited to operations and major procedures. It would not be viable for such things as checking a patients throat or examining a patients stomach, as these everyday occurrences are too frequent and considered to be too minor. Some see the consent form as purely evidential yet other believes them to signify fairness to both the patient and the doctor. It creates patient awareness of the fact that they have the right to know and for this right to be attained the patient needs to make it aware what they specifically want to know. This does not extinguish the doctors duties, he must still follow the guidelines set out in obtaining informed consent, for example, explaining the treatment and its implicat ions. In the case Abbas v Kenny the judge stated the obligation is not placed upon the patient and it simply reaffirms their rights, yet it is still the doctors responsibility to Ã¢â¬Å"take into account the personality of the patient and the likelihood of misfortune.Ã¢â¬ 4.6 Even if a warning is given, it can not be consider a suitable warning if it is insufficiently clear to the patient and affects their ability to make a decision on information they fail to comprehend. The doctor must take responsible steps to ensure that advice is understood by the patient. To what extent is it the doctors duty to make sure the patient understands? Chapter 5: A Patients Capability to Understand 5.1 There is a rebuttable presumption that adults have capacity to consent to or refuse treatment. Therefore to make consent valid they must possess the capacity to understanding the method, consequences and benefits. If one fails to understand the information given and the inherent risks of t reatment then it can not be regarded as informed consent. Care must be taken to not automatically presume those with learning difficulties are incapable; it is important for doctors to not underestimate a person from their faÃ §ade. Capacity is not a question of decree of intelligence or maturity of the person concerned, it incorporates elements of ability and belief. 5.2 There are different functions of what must be understood. The must frequently cited case in this context is Re C (Adult: Refusal of Medical Treatment) in which, Thorpe J, held that the person must understand the nature, purpose and effect of the procedure. In other words, sufficient knowledge constitutes the general functions of treatment. Another function that capacity can occupy is that held in Re T (Adult: Refusal of Traetment) where Lord Donaldson referred to knowledge in broad terms of the nature and effect of the procedure to which consent was given. The level of understanding was made important in thi s case and that this will differ according to the gravity of the decision. More specifically, the more serious a decision the greater capacity required and accordingly patients may have capacity to make some decisions but not others. 5.3 Assessment of a patients capacity is determined by reference to the Thorpe. Js three stage test in Re C it states the courts will assess the patients ability: to take in and retain treatment information; to believe it; to weigh that information, balancing risks and needs. In this case, a sixty-eight-year old patient was being detained in a special hospital, as he survived from schizophrenia. Despite this, the Judge ruled that the patient remained capable of understanding what he was told about the proposed treatment and the proposed risks involved. By satisfying the three points, a patient can verify that information can be given by the doctor, thought through and decided on and therefore the doctrine of informed consent is followed through. Others that would normally have capacity may be deprived of it by temporary factors such as unconsciousness, confusion, pain or drugs used in treatment. Even a persons phobia can effect they ability, as seen in the case Re MB (Medical Treatment) The patient, MB, suffered acute needle phobia and refused to agree to any form of anaesthetic during a necessary Caesarian section. The Court of Appeal held that she lacked the required capacity to refuse treatment, as her phobia disabled her from making an informed decision. Although she suffered from no mental illness or impairment, temporary factors erode the patients capability. The judge stated that hercapacity was inadequate, Ã¢â¬Å"at the moment the needle or mask dominated her thinking and made her quite unable to consider anything else.Ã¢â¬ Her fear masked her ability to fully understand the risks of the treatment and as such the decision had to be made for her. 5.5 Similar decisions are made when dealing with patients in emergency situations as they too can often lack the ability to give informed consent. When a patient is unconscious, appropriate treatment must be given in an emergency where consent cannot be obtained. As long as there is no available evidence of a patients own wishes, then under these circumstances the law authorises doctor to perform treatment that is necessary to perceive the patients life. Examining the case Murray v McMurchy explains the courts perception of necessity. Whilst the doctor was performing an agreed caesarean section, he sterilised the patient without prior agreement. The courts held that the sterilisation was not necessity and could have been postponed. More specifically as Lord Goff stated in Re F, treatment is to be confined to Ã¢â¬Å"action taken to preserve the life, health or well-being of another who is unable to consent. Such treatment is justified under the doctrine of necessity. The case Re F made it clear that the basic requirement for necessity, was that a doctors duty at that hospital was to utilise their best endeavours, by way of operation or other treatment, that which is in the best interest of such patients. The principle of best interest will be covered more extensively in the next chapter. 5.6 It is important to look at the effect religion may have on ones understanding to consent fully to treatment. Article 9 of the Human Rights Act provides that everyone has the right to freedom of thought, conscience and religion. In the context of treatment, Article 9 reinforces the approach already adopted by the English Courts. Under the principle of autonomy the religious beliefs and values of a competent patient must be upheld, however illogical from the perspective of the observer. An adult can make a decision which others would regard as being wholly irrational or against his or her best interest so long as he has the requisite capacity to understand the na ture, purpose and effect of treatment. A good example of this situation arising within the law is cases involving Jehovah Witnesses. The wishes of competent Jehovah Witness must be respected, irrespective of a reasonable patients rationale or beliefs. The case Malette v Shulman illustrates such an issue, where a blood transfusion was given to an unconscious card-carrying Jehovah Witness. The judge, Robins J.A. stated, Ã¢â¬Å"Competent adultsÃ¢â¬ ¦are generally at liberty to refuse medical treatment even at the risk of death. The right to determine what shall be done with ones own body is a fundamental right in our society.Ã¢â¬ 5.7 Ian Kennedy and Andrew Grubb, two of Englands most influential experts, declare the three stage test makes capacity dependent on the information the patient receives. The doctor must take this factor into consideration and it is their duty to make the information as comprehension and uncomplicated according to patients ability. Most patients w ould not readily understand a complex explanation whereas the same information delivered in a more basic manner may be followed more simply. So the doctor must take into account the patient in which he is informing and the level of understanding they might have. So what is the procedure for incompetent adults and how can treatment be lawfully authorized on their behalf? Chapter 6: Incompetent Adults Under English law, no one is able to make an informed choice for treatment on behalf of an incompetent adult. However, this poses a problem as the patient himself may not be capable of authorizing his own treatment, and no one has the legal authority to act for him. Before 1983, section 34(1) of the Mental Health Act 1959 allowed a guardian, appointed to care for a mentally disabled adult, to consent to treatment on behalf of that patient. This was replaced by section 8 of the Mental Health Act 1983, which restricted the powers of the guardian and placed ownership of power onto the courts. The law in this area has long been unsatisfactory and has since been subjected to extensive review. The most recent amendment is the Mental Health Act 2007, which sets out the procedures that must adhere to the safeguards for patients. The Mental Health Acts, however are subject to persons detained under the Act and is not applicable to the majority of mentally disabled or ill patients living in the community. For them there are no treatment guidelines or legislation set out in UK on how to appropriately acquire consent or to act on their behalf. The clarity on this issue came in a series of cases, which set out the legality of treatment. The Department of Health advised that, It should never be assumed that people can take no decisions for themselves,Ã¢â¬ and that the doctor Ã¢â¬Å"must never coerce the person into changing their decision. Seeking consent is about helping the person to make their own informed choiceÃ¢â¬ Care must be taken not to make presump tions that individuals with mental disabilities are incapable of consenting, they are too subjected to the competence test set out by Re C, which was looked at in the above chapter. If they possess the ability to retain information, believe it and make an informed choice then they can make an informed decision. However, if they fail to satisfy the criteria then doctors are under the legal duty to treat incompetent patients in accordance with the best interest principle. This principle can be found within the application of the Bolam test, which asserts that a professional person will not be found negligent if he can demonstrate that he acted in accordance with practices accepted by a senior body of people skilled in his field. This objective test is employed to determine the suitability of treatment for that individual patient. As in the case T v T where the Courts authorized an abortion and sterilisation on a mental disabled woman, as the parents and doctors agreed it was in her best interest. The decision empowered the doctors to decided what treatment the patient should receive as long as taken Ã¢â¬Å"such steps as good medical practice demands.Ã¢â¬ This has changed slightly and it can now be seen that Bolam is simply just a starting point for the best interest principle. The best interest test does not fully coincide with the Bolam test; it encompasses the broad concept yet makes its own assessment of the patients welfare. As Dame Elizabeth Bulter-Sloss P, stated in the case Re S, Ã¢â¬Å"the principle of best interest, as applied by the courts extends beyond the considerations set out in Bolam.Ã¢â¬ The Bolam test needs the recognition of a responsible body of professional medical opinion which supports the proposed decision to be in the patients best interest. However it fails to take into account ethical, social, moral and welfare issues. Therefore while it is important to consider the objective element, a subjective viewpoint needs to b e included in the decision. The subjective approach is based on the presumed wishes of the patient and the courts consider what the incompetent would do if she or he could make the choice. This subjective element is patient specific and focuses on what is thought to be the patients wishes and beliefs, but of course this is mostly a matter of speculation. The combination of these two fundamental features acts as a balanced approach to the best interest principle, with the medical profession deciding what is the best treatment for the patient, and the courts making the patients welfare the paramount consideration. It is important to note that the thoughts of immediate relatives or carer will be taken into account, as Lord Donaldson ascertained his view when he stated, Ã¢â¬Å"consultation with the next of kin has a further advantage in that it may reveal information as to the personal circumstances of the patient and as to the choice the patient might have made.Ã¢â¬ The closet to the incompetent adult can give light on the personality and nature of that person which may assist the courts come to a decision that may reflect the patients wishes. Standard practice is that doctors will decide what the best treatment is for the patient and unless the immediate family or carer disagrees, this treatment will be performed. The guidance of the court must be sought where there is doubt about a patients best interest and special category cases; these include non-therapeutic sterilisation and Persistent Vegetative State In Re S, Thorpe L.J made it clear that Ã¢â¬Å"if a particular case lies anywhere near to the boundary line it should be referred to the courts.Ã¢â¬ Much improvement has been made on the position of consent for incompetent adults, more regulations and guidance are in place to assure the best possible outcome. Chapter Seven-Conclusion This dissertation analyses the aspects of informed consent within the United Kingdom. When looking at the d evelopment of the doctrine of informed consent it seems that initially the courts were reluctant to incorporate it into the legal system. At first the courts left the power in the hand of to the doctor, much to the dissatisfaction of the patients. It seemed to leave them struggling to assert their right of an informed choice and perhaps confused on exactly what this right actually entailed. When informed consent was fully accepted through he case Chester v Afshar it seemed to clear these clouds of confusion and hand the reigns over to the patient. It enabled the patient to exercise a choice and placed regulations on the doctors to make sure patients had all the tools to do so. This is where perhaps doctors became discontented, as it now seemed there job to provide the patient with sufficient information and make sure they understood it. It was a dramatic transition for health professionals as it required more time, which was already considered to lack.
Wednesday, May 6, 2020
Realism, the Portray of Women Mistreatment In the 19th century a new trend of writing appeared in the American literature called, realism and it is defined as the Ã¢â¬Å"faithful representation of realityÃ¢â¬â¢. Writers attempt to document life as it Ã¢â¬Å"without romantic idealization or dramatizationÃ¢â¬ and Ã¢â¬Å"character is more important than action and plotÃ¢â¬ . Two short stories are representative of realism Ã¢â¬Å"The Yellow WallpaperÃ¢â¬ and Ã¢â¬Å"The Story of An Hour. We will write a custom essay sample on Realism, the Portray of Women Mistreatment or any similar topic only for you Order Now Ã¢â¬ In these stories Charlotte Gilman and Kate Chopin characterize women who are being dominated by a manly society nd who do not see women more than a simply spouses or mothers. However, they are faithful believers that women in reality are beings that should be allowed to express themselves because they are strong enough to stand for themselves; and should not be subordinate in any marriage. Likewise, in these two stories the realism portrays the maltreatment of women in their marriage, which clearly can be seen develop in the plot, characterization, setting, and theme of the stories. The works of realism are present in the plot of both stories. Throughout the story of Ã¢â¬Å"The Yellow WallpaperÃ¢â¬ her husband John treats the protagonist with a lot of authority and demand. Ã¢â¬Å"John says if I donÃ¢â¬â¢t pick up faster he shall send me to Weir Mitchell in the fallÃ¢â¬ ¦ But John says the very worst thing I can do is to think about my condition, and I confess it always makes me feel bad. (Gilman, 86-90. ). And this overwhelming treatment carried the poor woman to a deep insanity, making her hallucinate about the paper design of her room. Ã¢â¬Å"It is the strangest yellow, that wall-paper! It makes me think of all the yellow things I ever sawÃ¢â¬ not beautiful ones like buttercups, but old oul, bad yellow thingsÃ¢â¬ ¦ Through watching so much at night, when it changes so, I have finally found out. The front pattern does moveÃ¢â¬ and no wonder! The woman behind shakes it! Sometimes I think there are a great many women behind, and sometimes only one, and she crawls around fast, and her crawling shakes it all over. Ã¢â¬ (Gilman, 95, 96. ). The husbandÃ¢â¬â¢s controlling attitude and low ignorance against her destroyed this woman mental stability. At the same time in Ã¢â¬Å"The Story of An Hour,Ã¢â¬ Mrs. Mallard thought that the death of Mr. Mallard would be the opportunity or her to get out from an oppressed marriage that didnÃ¢â¬â¢t let her live the life that she ever dreamed. For the first time in her life, she could visualize herself without the control and pressure that her marriage gave her. Ã¢â¬Å"There was something coming to her and she was waiting for it, fearfullyÃ¢â¬ ¦ But she saw beyond that bitter moment a long procession of years to come that would belong to her absolutely. And she opened and spread her arms out to them in welcome. Ã¢â¬ (Chopin, 66-67. ). In these two stories we can see the great desire of these women to be treated with respect; a ense of dignity for what they are, something that would make them feel like their voice counted rather than having a meaning to their life because of who theyre married to. Moreover, the women of these stories are truthful realistic characters. The narrator of Ã¢â¬Å"The Yellow WallpaperÃ¢â¬ it is a docile, Ã¢â¬Å"ordinaryÃ¢â¬â¢ (Gilman, 85. middle class woman who suffered from a Ã¢â¬Å"temporary nervous depressionÃ¢â¬ (Gilman, 85). She is forbidden to work and writes in her Journal, which she enjoys very much. She is also torbi dden to take care ot ner newborn baby and visit any triends, making ner eel like no control over her life. Ã¢â¬Å"Am absolutely forbidden to Ã¢â¬Å"workÃ¢â¬ until I am well againÃ¢â¬ ¦ Ã¢â¬Å"There comes John, and I must put this away, Ã¢â¬ he hates to have me write a wordÃ¢â¬ ¦ And yet I cannot be with him (baby), it makes me so nervousÃ¢â¬ Ã¢â¬ ¦ (Gilman, 85-87-88. ). The main character of this story is an oppressed woman, who could not escape from her reality and in real life a vast of women around the world go through this kind of situation. For instance, my mother is one of them, for many years she undergoes from a temporary nervous depression, caused by my little brotherÃ¢â¬â¢s birth. My father labeled himself a very wise man, but never looked for the help she needed to. As well, he prohibited her to work and the only thing that she could do was to take care of houseÃ¢â¬â¢s chores. Couple times in my life I saw my own mother in the edge of the madness that her monotony life and my father little comprehension about her illness carried her. I remembered, myself scare at her and crying because I did not understand why she behaved in those manner and why my father was so authoritarian with all of us; and with so low emotion about my mother situation. One day my mother woke up from her dream and decides that she had to take control of her life and run away from him, leaving my little brother and me in his cares. I strongly believed that many women around the world, most of the time married the wrong man, because they cannot understand them and do not make them feel valuable as their marital partner. On the other hand, in Ã¢â¬Å"The Story of An Hour,Ã¢â¬ Mrs. Mallard is another typical middle class woman that has Ã¢â¬Å"loved her husband sometimesÃ¢â¬ (Chopin, 67. ), but with a Ã¢â¬Å"certain strengthÃ¢â¬ (Chopin, 67. ) that all she anted is to Ã¢â¬Å"drink a very elixir of lifeÃ¢â¬ , (Chopin, 68. ). And who suffers from heart problem, that probably her outrage marriage had left her with Ã¢â¬Å"Knowing that Mrs. Mallard was afflicted with a heart troubleÃ¢â¬ ¦ Ã¢â¬ (Chopin, 66. ). In fact, Mrs. Mallard is an intelligence woman with a great desire of living her life without any attachments and a visionary woman that proved that she did not need any man to stand up for her. As an illustration, Mrs. Mallard story is similar to my cousin BirmaniaÃ¢â¬â¢s story. She is also a very intelligent woman, who married her boyfriend whom she was for a long time. After the wedding, they got a beautiful house, equipped with a lot nice furniture. Her boyfriend (now her husband), as soon they got married prohibited her to work. At first, she was happy with the idea because she used to love him and she wanted to play a wifeÃ¢â¬â¢s roles. Times passed and her monotonic life started hit her and her husbandÃ¢â¬â¢s behavior was not what she dreamed about, she felt she wanted to escape from him and divorced him. He, otherwise did not accept her idea, he thought that could not be possible because he had always give her all the material thing that she ad wanted; house, money and car. But, in reality she needed more than that. Birmania needed more emotional attention; she wanted to work, to be herself, once for all. Eventually, how many women nowadays are yet bowed in the oppression of their marriages? As well as the plot and characterization, these two stories share realistic settings. Both take place in the United States during the 19th century and fully described the surrounding of their main characters. For example, in the Ã¢â¬Å"The Yellow WallpaperÃ¢â¬ the story take place in a summerÃ¢â¬â¢s house, specifically in the narratorÃ¢â¬â¢s room. She does not have lot furniture on it, except for a bed, the barred around the window and the Ã¢â¬Å"queerÃ¢â¬ (Gilman, 85. ) yellow wallpaper. IÃ¢â¬â¢m really getting quite tond ot the big room, all but that horrid paperÃ¢â¬ ¦ It is a big, airy room, the whole floor nearly, with windows that look all ways, and air and sunshine galore. It was nursery first and then playroom and gymnasium, I should Judge; for the windows are barred for little children, and there are rings and things in the walls. Ã¢â¬Å"(Gilman, 87-88. ). Consequently, Ã¢â¬Å "The Story of An HourÃ¢â¬ happened in the Mrs. MallardÃ¢â¬â¢s house mostly in er room, where she sat in a chair to contemplate the outside windows landscape and dreamed about her future. She sat with her head thrown back upon the cushion of the chairÃ¢â¬ ¦ A dull stare in her eyes, whose gaze was fixed away off yonder on one of those patches of blue sky. It was not a glance of reflection. Ã¢â¬Å"(Chopin, 66-67. ). The ironic reality in the settings of theses stories is that even though the environment illustrated for these women were a comfortable life, nice houses and neighborhood, deep inside of themselves, their hearts were screaming to be understood as well as heir need of a sense of freedom. Above all, the themes in these stories are the reflection of real struggle of women in their marriage. Even though it is not explain in the story, Mrs. Mallard perhaps had to encounter a lot discouragement and affliction in her marriage in order to feel that only with Mr. Mallard death, she would be free. A sense of freedom that was stronger than the sadness she felt from this news. Ã¢â¬Å"Free! Body and soul free! Ã¢â¬ She kept whisperingÃ¢â¬ (Chopin, 68. ). Today, despite of a lot of women, they donÃ¢â¬â¢t feel treated, as they wanted by their spouses; they continue in ilence, struggling in their marriage enduring maltreatment and restrained themselves from the pleasure of doing what they dreamed one day for their life. However, in Ã¢â¬Å"The Yellow WallpaperÃ¢â¬ the woman did not have a voice, she loved her husband too and appreciated all what he did for her, she suffered to know that whatever she said or did was never enough for him. Ã¢â¬Å"John does not know how much I really suffer. He knows there is no reason to suffer, and that satisfies himÃ¢â¬ ¦ I donÃ¢â¬â¢t like our room a bit. I wanted one downstairs that opened on the piazza and had roses all ver the window, and such pretty old-fashioned chintz hangings! But John would not hear of it. (Gilman, 86- 87. ). For this woman to feel underappreciated by her husband, may have been more depressing than her own nervous condition. It is fair to say that the themes of this story it is also relate to the fact that many women in all cultures of our society, become victims of their circumstance, and they lose the control of their life when their husbands do not look at them as human beings that are capable of going beyond of their gendersÃ¢â¬â¢ identity. For the most part, the characters in both of tories go along in the theme of discouragement in their marriage. To conclude, Ã¢â¬Å"The Yellow Wallpaper and The Story of an HourÃ¢â¬ we now agree that the realism is shown in the plot, characterization, setting, and the theme of both stories. Also, we can see that both characters share the same concerned to their reader, they want women around the world to have self-expression, freedom to be themselves. They believed that women, not only deserve a good house and furniture, but they do also deserve respects. Gilman and Chopin with these work portray themselves as faithful believer n women Ã¢â¬Ëcapacities and do not support any physical or mental mistreatment to them. How to cite Realism, the Portray of Women Mistreatment, Papers
Saturday, May 2, 2020
Question: Discuss about theBusiness Communication for Audit Process. Answer: Objectives and background Description of the audit process An audit was conducted in the data management company named Data Solutions that is located in Brisbane. The company has many other branches in other parts of the country like Melbourne and Sydney. The company laid the focus on the communication process. The company had poor system of external as well as internal communication. The company focused on the significance of the communication in terms of cost effectiveness and efficiency of the employees. The internal communication includes the training of the employees, the designing of the programs that can improve the communication of the management with their employees. This further includes the feedback session of the employees and valuing the feedbacks of the employees. The specific purpose The purpose of the audit process is making a better system of communication between the management and the employees. This would build a strong infrastructure within the organization. The aspects that were included in the external communication were the marketing, promotion of the software products. Both the internal and the external process of communication have been focused on the process of audit. General purpose The general purpose of the audit process is to achieve the goals of the organization as well as the goals of the individuals. Problems Before conducting the audit it was noticed that there were several issues: Problem one The method of communication was not well defined and the employees found difficulty in selecting an appropriate forum to convey their issues to the management. The problem was witnessed not while communicating with the management but also with the target audience. The employees had confusion between the traditional form of communication and the digital form of communication. They wanted a platform to communicate with their audience. Problem two The other issue that was serious was the poor system of internal communication. The network was poor and it was a serious problem. The employees ignored some groups and some important audiences and all this happened because of the poor system of network. They were not able to concentrate on some serious issue and deal with the issues of the audiences. The poor communication system was due to the poor system of network. Problem three There were many meetings that were held in the organizations and those were useless. The meetings turned out to be absolute waste of time and they had no significance in the organization. The meetings failed to reach out to the audiences and to the employees of the organizations. There was no effort on the part of the organization to make it reach to the employees and the audiences who are attached to the organization. The problem analysed the difficulties that were faced on the importance of holding an effective form of communication within the organization. The audit has been conducted for this particular reason. The communication is aimed towards making the employees realize about their goals and their actions that would make them achieve their personal as well as the goal of the organization. The improvement of the employees has a direct influence on the development of the organization. This is the reason the individual goal should be high. A good and well structured communication process would make the individuals achieve their goal and would lead the organization towards a better position. Three major problems have been highlighted in the communication audit process. The primary problem faced by the employees is the problem of selection of a proper form of communication. This includes the confusion between the digital form of communication and traditional form of communication. The qualitative significance of the problem would include making the communication effective by using a different means of communication. The company can head towards the increase of 10 percent sell of the data management software per month. This would lead to the positive impact of the company in terms of both quantity and quality. The second issue was the poor network. The poor network made dir difficult for the employees to reach the audience and communicate with the audience. The company faced negative impact for the poor internal communication system. The failure in the management of the internal communication within the system makes the company experience a setback. The qualitative significance of the issue would include making the system of communication effective by using the different medium of communication. In terms of the quantity issue it can be solved by increasing the sale 30 percent more. The third problem includes the meetings that have no worth. The company was not a huge-sized company and this is the reason the communication between the employees and the dignitaries could be in a closed circle. In order to make it huge the company should improve their communication system. The communication system should be a two-way communication system, this is the qualitative significance. The quantitative significance would include the growth of 100 percent within a year. Actions steps to solve the problem a) In order to overcome the problems the company is required to circulate the google forms that would included the feedback from the employees that should be taken into consideration by the management. The identity of the employees should be kept a secret and it should not be revealed in front of all. b) They should be trained to use all methods of interaction, the traditional method as well as the digital method. The training that will be delivered to the employees must include the practical understanding of the methods of communication. finally the employees should be encouraged to do their job and they should be motivated by the management. They should indulge in direct conversation with the authority and any issue should be directly communicated to them. This would make the employees feel comfortable. A proper agenda of work should be created before performing these actions. Closing The memo was intended to plan an effective process of internal as well as external communication that can be helpful for the employees. This would benefit the employees as well as the organization. This would create a good reputation of the company and they would be able to experience a huge amount of revenue. This would also make the working environment better. It is extremely important to have a good working environment as it beneficial for the organization as well as for the employees. We will be happy to address any of your queries. For further assistance, the details are provided below. Call-9038008023 Mail- firstname.lastname@example.org
Sunday, March 22, 2020
IÃ¢â¬â¢m exceptionally good at focusing on insignificant things in life, like the shoes I wear. I have that pair of shoes I had to buy for Winter Ball freshman year, with the one-inch heel, because I absolutely could not be taller than my date. I have four-year-old cheerleading sneakers that have been through endless practices and four state championship games with me. I have a pair of heels that make me six feet tall and I feel like IÃ¢â¬â¢m on top of the world when I have them on. I have a pair of white Converse that Alison spilled a blue slushy all over, but I couldnÃ¢â¬â¢t be mad because her and her boyfriend just broke up the day before. I have flip-flops that have walked the sands of many beaches, but my point is, is that every pair of shoes I own hold their own memories to me, and the list of things IÃ¢â¬â¢ve done while wearing certain pairs of shoes is endless. We will write a custom essay sample on Shoes or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page There is one pair of shoes that are extremely important to me and they are my moccasins. IÃ¢â¬â¢m not even sure why IÃ¢â¬â¢m so obsessed with them, they are plain old gray moccasins that I bought for no particular reason in the NordstromÃ¢â¬â¢s shoe department at the Providence Place Mall. As I bought them I just figured theyÃ¢â¬â¢d be a pair of shoes I was going to wear to school occasionally, not knowing that I would wear them every single day to school for almost 2 straight years. I have many pairs of shoes, IÃ¢â¬â¢d say too many but the limit for how many shoes I own is non-existent, but for some reason I always pick these moccasins to wear to school. Recently I was let down by my foot doctor that I should wear shoes that lace up for the next month because of a bump on my toe, but IÃ¢â¬â¢m fearless so that wont stop me from wearing my moccasins because I never think twice about wearing them, even with my newfound instructions from my foot doctor. I have an attachment to a pair of shoes is what IÃ¢â¬â¢ve realized. ItÃ¢â¬â¢s not that these are the only shoes I ever wear its just that these shoes hold some of my favorite memories. I think itÃ¢â¬â¢s important to focus on the small details in life because everything can go by like a whirlwind, I take things to the extreme and remember right down to the underwear I have on when something important happens to me. But a way of keeping memories in my life alive is to remember the shoes, or underwear, that IÃ¢â¬â¢m wearing when I do something. Every time I put on a pair of shoes I remember the last thing I did in them, who I was with or where I was going. I like that IÃ¢â¬â¢m capable of remembering things in my life just by putting on a pair of shoes, its almost like going through a photo album, and having all the Ã¢â¬Å"remember whenÃ¢â¬ moments. Things in life tend to go by fast, sometimes we experience no changes at all in our lives or way too many. IÃ¢â¬â¢m not a person that likes change. Certain things change very easily in our lives like relationships, maybe our grades, or even our surroundings. Since I donÃ¢â¬â¢t like changes at all I tend to hold onto things that are concrete and I know they cannot change. People can leave your life when they want to, shoes cannot, and neither can the memories we have made with these people while wearing certain shoes. My moccasins have done so many things with me, especially within the halls of my school. Junior year is when they started here. They didnÃ¢â¬â¢t get to experience awkward or overly dramatic moments freshman year or dull, boring moments sophomore year but they have been through two years of high school, and sometimes I think that may just be enough. My moccasins have maybe attended more than 10 liturgies in the auditorium, two Christmas concerts, one cabaret, over 200 school lunches, and have easily sat through over 700 classes with me. Next year when they enter an unknown classroom instead of one here itÃ¢â¬â¢s going to be tough. It wont be with the teachers IÃ¢â¬â¢m so comfortable with, or in the chairs IÃ¢â¬â¢ve sat in for four years. It will all be new, but I have something that will always remind me where I came from. IÃ¢â¬â¢ve learned some of the most valuable lessons I will ever learn in life while wearing my moccasins. These lessons will travel to college with me and I will never forget the values instilled in them. Sometimes I find it hard to appreciate the education IÃ¢â¬â¢ve been given because of all the stress it puts on me, as much as I say I cant wait to leave my old school I know that once IÃ¢â¬â¢m gone IÃ¢â¬â¢ll be holding onto any memory I can of it. Walking out of the cathedral will be hard because it signifies the end of my high school career. I wont have on my moccasins while I graduate because I never want to end their high school career. I want to hold my memories of my old school with me forever and I will do that through my moccasins. I am already on the search for white shoes for graduation, another pair of shoes that will hold more memories. They will go through class day with me, our pinning ceremony, and graduation and every time I see my white shoes I will remember my ending at this school. IÃ¢â¬â¢m happy that IÃ¢â¬â¢ll be able to say I donÃ¢â¬â¢t just have shoes that remind me of leaving but, I have my moccasins that remind me of my typical days at school, the days I want to remember the most. The other day I saw a photo that said, Ã¢â¬Å"Shoes make me happy. IÃ¢â¬â¢m superficial. Whatever.Ã¢â¬ I laughed because shoes do make me happy but in the least superficial way possible, and this picture reminded me of why I always look deeper into things. Now I challenge you to try to remember a few memories youÃ¢â¬â¢ve made in the shoes youÃ¢â¬â¢re wearing right now, the shoes might end up meaning more to you than you think. IÃ¢â¬â¢m sure some of the memories do make you happy, and not in a superficial way, in a way that people would never realize why shoes could make a person so happy.
Thursday, March 5, 2020
Lee Valley Segmentation Essay Example Lee Valley Segmentation Essay Lee Valley Segmentation Essay Background Lee Valley- - a family-owned concern which has been supplying clients of woodworking and horticulture tools since 1978. Their repute is based on three rules: 1. Customer satisfaction: Any merchandise may be returned within 3 months and no cost to the client ( for cargos within North America. they will return your return package station costs ) . 2. Integrity: Merchandise descriptions are matched with the product- - even if the merchandise is approximately made. they will give you accurate descriptions. 3. Treat the client like a friend. About one tierce of their entire gross revenues volume is in merchandises of their ain design. The huge bulk of these are VeritasÃ ® trade name merchandises made by Veritas Tools Inc. . their fabrication arm. They have a research and development squad of 11 people and 130 more in fabrication. And. to reenforce the portion about listening to clients. they have a figure of clients gaining royalties on merchandises that they manufacture based on designs received from them ( Lee Valley ) . Aim Both woodworking and horticulture must hold a 2. 5 % addition in entire gross revenues in the following financial twelvemonth. To accomplish this end. direction has allocated a budget of $ 500. 000- exclusive of the cost of printing and get offing the catalogues. This budget is intended to fund the prospecting activities of both merchandise lines. Current Situation Analysis Since Lee Valley launched its e-Commerce site in 2000. cyberspace gross revenues have been an increasing per centum of entire gross revenues. When launched. the sitegenerated about 20 % of entire gross revenues. with phone gross revenues being 70 % and gross revenues from mail at 10 % . By 2010. Internet gross revenues have reached 70 % of entire gross revenues. which phone gross revenues at 25 % and mail at 5 % . [ movie ] Fig. 1. Percentage of entire orders generated by e-commerce from Lee Valley Tools Ltd. [ movie ] Fig. 2. Percentage of entire orders generated by e-commerce from Lee Valley Tools Ltd. Harmonizing to the pie charts illustrate above. Internet gross revenues have already dominated the entire gross revenues of Lee Valley since its e-Commerce site launched in 2000. About 70 % of the entire clients obtain their merchandises online in 2010 which means that new market cleavage and publicity which focal point on on-line shopping must be generated to suit the demands of bing clients every bit good as new clients. Customer Segmentation- - who the house will function Geographic Variables In positions of the database surveyed by Euromonitor International in 2012. Home and Garden reveals emerging markets and are turning in popularity. developed states remain. by far. the highest Spenders on horticulture merchandises. Higher degrees of urbanisation and incomes. combined with greater entree to a wider scope of goods and services in metropoliss. are cardinal factors underpinning demand. -All states with per family outgo higher than US $ 1. 000 have more than three quarters of their population. -Economic growing and urbanisation are the chief forces behind the growing in place and garden in developing states. Demographic Variables Harmonizing to the Gardening Market Research. the most popular lawn and garden activities included lawn attention ( 48 % of families ) . turning indoor houseplants ( 31 % of families ) . flower horticulture ( 30 % of families ) . and landscape gardening ( 27 % of families ) . The client profile indicated from Lee Valley shows that the norm gardening purchaser features are as follows: -Age: mean 47 -Gender: 65 % female -Income: mean household income $ 72. 017 -Education: 60 % have a college instruction -68 % are married -82 % are householders Psychographic Variables In general. horticulture partisans besides have their distinguishing life styles and personality traits. such as: -Environmental friendly -Family-oriented -Seeking freedom and relaxation -Living a simple and peaceable life -Retired. bask DIY and private clip -Focus on landscaping Behavioral Variables 1. User position Regular users are those who have their regular agenda for purchase in gardening. most of whom have their ain undertakings. Potential users are people who are meaning to entree to the market but still with different grounds of vacillation or lacking of stimulation. Ex-users are those who used to buy horticulture tools in the yesteryear or 2. Intensity of usage In the ParetoÃ¢â¬â¢s Law . 20 % of the clients are heavy users but the staying 80 % are merely light users. That indicates companies should emphasis on the most valuable group of clients who are come from the 20 % . It dosenÃ¢â¬â¢t intend the remainder parts are non-essential. Frenquency of order in footings of the clime where the clients live every bit good as the intent of purchase. 3. Innovativeness Since 2000. there has been a double-digit growing in the e-commerce sector ; statistics have shown that more than 80 % of regular online shoppers have used Internet to buy merchandises or services. while 50 % of the on-line population recorded to hold shopped online more than one time. Harmonizing to statistics from Invesp Blog. shoppers by age group is as follows: 18-30 old ages ( 54 % ) . 31-44 old ages ( 68 % ) . 45-54 old ages ( 64 % ) . 55-65 old ages ( 68 % ) . 66 old ages and up ( 48 % ) . Teenss and the immature coevals happen amusement and societal webs online. whereas older coevalss use the cyberspace as a tool for research. shopping and banking. Harmonizing to statistics researched in 2009. Generation X ( internet users ages 33-44 ) continues to take in on-line shopping. Fully 80 % of Generation X cyberspace users buy merchandises online. compared to teenage on-line users between ages of 18-32. the following second best. which constitute 71 % of online shopping sum. However. there is a diminution of cyberspace shopping between the ages 64-72. accounting to 56 % . and 47 % of online users between the age 73 and older. Global E-commerce gross revenues are turning by more than 19 % a twelvemonth and will be of about $ 1. 4 trillion by 2015. Lee Valley has a big Numberss of clients ( 70 % ) telling online. which illustrates that clients with these certain features are the cardinal portion of gardening market. Most people between 35 and 55 old ages have their ain house and garden. 68 % of them are married and they are more willing to populate a high quality of life with their households. They prefer to online shopping because it is more convenient and can salvage most of their clip every bit good as money. Equally far as I am concerned. I suggest Lee Valley to construct up collaborative relationships with transnational cyberspace corporations like eBay to widen their market size. At the same clip. cut the budget on publishing the catalogues and set it to societal media so as to pull more new clients. Meanwhile. trueness plan to go outing clients is besides indispensable. For case. garnering different suggestions from trueness clients and run into their particular demands will non merely increase the order frequence but besides better the client satisfaction. Plants Cited Datagraphics. Home and Garden. Urban Countries Spend the Most in Home and Garden. Euromonitor International. N. d. Web. 21 Sept. 2012. Khalid. How Big is E-commerce Industry. invesp Blog. Web. 21 Sept. 2012. Lee Valley. About Us. Lee Valley A ; Veritas. N. d. Web. 21 Sept. 2012. National Gardening Association. Garden Market Research. National Gardening Association. N. d. Web. 21 Sept. 2012. Pew Research Center. Generations Online in 2009. PewResearchCenter Publications. Pew Research Center. 2009. Web. 21 Sept. 2012.
Tuesday, February 18, 2020
1965 Selma to Montgomery march - Essay Example History 1). The civil war that had taken place previously had failed to eradicate the social barriers created by some institutions (U.S. History 1). In the south, after the war, there was the creation of laws that only highlighted issues of whites at the expense of African American (U.S. History 1). The situation remained until the beginning of the second part of 20th century. At this period various institutions begun to be sensitive to African American demands. The greatest progress was the school integration ruling of 1954 by the Supreme Court (U.S. History 1). Later, there was a development of peaceful protest by Dr. Martin Luther King Junior. Consequently, this led to increased marches, boycotts, sit-ins, and freedom rides in both the American south and parts of north (U.S. History 1). Moreover, public opinions changed and showed a significant deal of sympathy towards the African Americans. However, there remained obstacles to complete racial equality. Although legal equality had made progress for African Americans, there was reduced economic equality and social acceptance (U.S. History 1). Consequently, this led to increased activism in the 1960s. Malcolm X, the Black Power Movement leader, advocated for the policy of non-violence, and he inspired most of the movements in this period (U.S. History 1). A reflection on the civil rights movements helps in highlighting the role of Selma to Montgomery marches. ... History 1). Consequently, there was reduced hopes for achievements of equal rights among African Americans. Moreover, there was increased discrimination in various states, in the north and south. For example, there was approval of laws creating schools and public facilities for each race (U.S. History 2). One of such laws was the Jim Craw laws that reinforced the white supremacy that had diminished during the reconstruction era. The discrimination was seen as whites, and blacks carried activities in different areas such as in school and restaurants (U.S. History 2). In addition, there was also discrimination in public spending. For example, teachers in white schools were paid better wages, and white schools were well maintained while in black school teachers were paid poorly, and the situation was poor (U.S. History 2). Additionally, there was a failure of implementation of Brown decision on segregation in the south. In fact, one decade after the decision, fewer than ten percent in s outhern public schools had integrated (U.S. History 2). This is because the ruling failed to address the issue that led to segregation such as separate restrooms, bus seats, or hotel rooms (U.S. History 1). There are various reasons for the inspiration to revolution. One of the people that inspired revolution was Rosa Parks. She boarded a Montgomery bus and refused to pave the way for the white passengers (U.S. History 3). This was followed by her arrest, and she was fined $10 (U.S. History 3). Consequently, revolutions began in various parts of the country. One of the instrumental persons for the revolution was Martin Luther King Junior (U.S. History 3). After the Rosa Park development, he organized the boycott of MontgomeryÃ¢â¬â¢s buses (U.S. History 3). They wanted for equal