Monday, September 30, 2019

Washington Square (Henry James)

Washington Square  is a short novel by  Henry James. Originally published in 1880 as a serial in Cornhill Magazine  and  Harper's New Monthly Magazine, it is a structurally simple  tragicomedy  that recounts the conflict between a dull but sweet daughter and her brilliant, domineering father. The plot of the novel is based upon a true story told to James by his close friend, British actress  Fanny Kemble. [1]  The book is often compared to  Jane Austen's work for the clarity and grace of its  prose and its intense focus on family relationships.James was hardly a great admirer of Jane Austen, so he might not have regarded the comparison as flattering. In fact, James was not a great fan of Washington Square  itself. He tried to read it over for inclusion in the  New York Edition  of his fiction (1907–1909) but found that he couldn't, and the novel was not included. Other readers, though, have sufficiently enjoyed the book to make it one of the more popu lar works of the Jamesian canon. ————————————————- Structure The novel is told from a  third-person omniscient  point of view, although we don't know anything about the narrator.The narrator often offers his comments directly to the reader. The novella begins at a distance from the characters, describing the background of the Sloper family. It then recounts in detail the story of Catherine's romance with Morris Townsend. When Morris jilts her, the focus shifts back to a long view. As James puts it: â€Å"Our story has hitherto moved with very short steps, but as it approaches its termination it must take a long stride. † The final few chapters are taken once more in short steps, ending with the striking vignette of Catherine's refusal of Morris. ——————————————â€⠀Ã¢â‚¬â€ Major themes The bitterest irony in the story is that Dr Sloper, a brilliant and successful physician, is exactly right about Morris Townsend, and yet he shows cruelty to his defenseless and loving daughter. If the doctor had been incorrect in his appraisal of the worthless Townsend, he would only be a stock villain. As it is, the doctor's head works perfectly but his heart has grown cold after the death of his beautiful and gifted wife. Catherine gradually grows throughout the story into right judgment of her situation.As James puts it: â€Å"From her point of view the great facts of her career were that Morris Townsend had trifled with her affection, and that her father had broken its spring. Nothing could ever alter these facts; they were always there, like her name, her age, her plain face. Nothing could ever undo the wrong or cure the pain that Morris had inflicted on her, and nothing could ever make her feel towards her father as she felt in her younger years. â₠¬  Catherine will never be brilliant, but she learns to be clear-sighted. ————————————————-Literary significance ; criticism â€Å"Everybody likes  Washington Square, even the denigrators of Henry James†, wrote  critic  Donald Hall, and most other commentators have echoed the sentiment. Although James himself regarded the novel with near contempt, readers have enjoyed its linear  narrative  technique, its straightforward prose (far removed from the convoluted language of James's later career), and the sharply etched portraits of the four main characters. Even the rusty plot revolving around â€Å"the will† has charmed many critics with its old-fashioned simplicity.Catherine's slow but unmistakable development into independence and wisdom is a notable success for James and has been much appreciated by critics and readers in general. Henry James,   OM  (15 April 1843  Ã¢â‚¬â€œ 28 February 1916) was an American-born writer, regarded as one of the key figures of 19th-century  literary realism. James alternated between America and Europe for the first 20 years of his life, after which he settled in England, becoming a  British subject  in 1915, one year before his death.He is primarily known for the series of novels in which he portrays the encounter of Americans with Europe and Europeans. His method of writing from the point of view of a character within a tale allows him to explore issues related to  consciousness  and  perception, and his style in later works has been compared to  impressionist painting. James contributed significantly to  literary criticism, particularly in his insistence that writers be allowed the greatest possible freedom in presenting their view of the world.James was born in New York City into a wealthy family. His father, Henry James Sr. , was one of the best-known intellectuals in m id-19th-century America. In his youth James travelled back and forth between Europe and America. He studied with tutors in Geneva, London, Paris, Bologna, and Bonn. At the age of 19 he briefly attended  Harvard Law School, but preferred reading literature to studying law. James published his first short story,  A Tragedy of Error, at age 21, and devoted himself to literature.James is one of the major figures of  trans-Atlantic  literature. His works frequently juxtapose characters from the  Old World  (Europe), embodying a feudal civilization that is beautiful, often corrupt, and alluring, and from the  New World  (United States), where people are often brash, open, and  assertive  and embody the virtues—freedom and a more highly evolved moral character—of the new American society. James explores this clash of personalities and cultures, in stories of personal relationships in which power is exercised well or badly.His protagonists were often young American women facing oppression or abuse. Novels * Watch and Ward  (1871) * Roderick Hudson  (1875) * The American  (1877) * The Europeans  (1878) * Confidence  (1879) * Washington Square  (1880) * The Portrait of a Lady(1881) * The Bostonians  (1886)| * The Princess Casamassima(1886) * The Reverberator  (1888) * The Tragic Muse  (1890) * The Other House  (1896) * The Spoils of Poynton  (1897) * What Maisie Knew  (1897) * The Awkward Age  (1899) * The Sacred Fount  (1901)|Short stories and novellas * A Tragedy of Error  (1864) My Friend Bingham * Poor Richard A Day of Days * The Story of a Masterpiece The Story of a Year * A Most Extraordinary Case A Landscape Painter

Sunday, September 29, 2019

Psychology: Nervous System and William James

1. Professor Lewis studies the history of psychology. She would most likely agree with which of the following statements about psychology's early history? 2. In thinking about psychology and consciousness, the idea that the mind and the body are separate entities that interact makes a lot of sense to you. This view that you hold is most like the view of: 3. Interactive dualism is the idea that: Mind and body were separate entities that interact to produce sensations, emotions, and other conscious experiences. 4. Psychology is formally defined as:The scientific study of unconscious mental processes. 5. Wilhelm Wundt investigated which of the following phenomena? Wundt investigated basic sensory and perceptual processes. 6. Which of the following events do most historians consider to mark the formal beginning of psychology as a scientific discipline? In 1879 Wundt opened the first psychology research laboratory which marked psychology as an independent field of study. 7. Which early ap proach or â€Å"school† of psychology is associated with Wilhelm Wundt's student Edward Titchener? Structuralism 8.You are a subject in an experiment who is told: â€Å"Look at this apple very carefully and tell me your exact sensations and feelings as you experience them. † The experimenter in this study probably believes in what school of psychology? Structuralism 9. Which of the following people played a key role in establishing psychology as a scientific discipline in the United States? William James 10. Which school of psychology would agree that â€Å"psychology should stress the study of how behavior and mental processes allow people and animals to adapt to their environments†?Functionalism 11. Which of the following is a TRUE statement about Mary Whiton Calkins? 12. Who would have been most likely to say: â€Å"Why you behave the way you do is because of unconscious reasons, not reasons in your consciousness†? Sigmund Freud 13. Your therapist is v ery interested in your dreams, blocked memories, and slips of the tongue. On which approach to psychology is your therapist probably basing his psychotherapy? Psychoanalysis 14. Behaviorism was characterized by: observable behaviors that could be objectively measured and verified. 15. My goal is to discover how behavior is acquired and modified in response to environmental influences. † Such a statement would most likely be made by: William James 16. Who conditioned dogs to reflexively salivate to the sound of a bell rather than food? Ivan Pavlov 17. Two key figures in the development of humanistic psychology include: Carl Rogers and Abraham Maslow 18. Which of the following people developed a theory of motivation that emphasized psychological growth? Carl Rogers 19. Humanistic psychology emphasized: In self-determination, free-will, and the importance of choice in human behavior. 0. The development of drugs that helped control the symptoms of severe psychological disorders an d development of techniques to study the human brain contributed to the importance of _____ psychology in recent decades. 21. Dr. Barongon is a psychotherapist who helps people develop choices and self-direction in striving to reach their fullest potential. Dr. Barongon probably subscribes to the Humanistic perspective of psychology. 22. The cognitive perspective of psychology focuses on: mental processes, including reasoning and thinking, problem soving, memory, perception, mental imagery, and language. 3. As a psychology researcher, you have found that the public expression of emotions differs among people from the United States, Japan, Switzerland, and Israel. This type of research fits best with which perspective in psychology? 24. Which of the following is NOT a characteristic of collectivistic cultures? 25. In collectivistic cultures, a person's sense of identity: is interdependent with others 26. Ethnocentrism refers to the tendency to: judge other cultures by the standards o f our own culture. 27. Which of the following statements best characterizes the principle of natural selection? 28.Cognitive psychology focuses on the study of: studies how our brains perceive, process, interpret, and respond to internal and external stimuli. 29. Mrs. Brunberg works with children who have special needs, helping them to develop their intellectual and social skills. Mrs. Brunberg is most likely a _____ psychologist. 30. Lynn has just received a research grant to study the effect of downsizing on morale at a large computer company. Lynn is most likely a(n) _____ psychologist. 31. Which of the following is a FALSE statement about clinical psychologists? 32. Which of the following best represents psychology's basic goals? escribe, explain, predict, and influence behavior 33. Empirical evidence refers to evidence that is the result of: verifiable evidence based on objective observation, measurement and experimentation 34. A hypothesis is: A tentative statement about the r elationship between variables. 35. An operational definition is: A precise description of how the variables will be measured. 36. Which type of research method is used to show that one variable causes change in another variable? Independent variable 37. In contrast to the experimental method, the basic goal of the descriptive methods is to:observe and describe behavior. 8. Meta-analysis is: Used to analyze the results of several studies into a single analysis in order to identify overall trends. 39. The word replicate refers to: To repeat or duplicate a scientific study in order to increase confidence in the validity of the original findings. 40. When psychologists systematically observe and record behaviors as they occur in their natural settings, they are using a descriptive method called: they are using the descriptive method called naturalisticobservation. 41. A pseudoscience is a: A fake or false science that makes claims based on little or no scientific evidence. 2. A case stu dy is a(n): Highly detailed description of a single individual. 43. One potential problem with surveys and questionnaires is that: people may not report accurate information 44. A correlation coefficient is: Used to measure how an independent variable relates to dependent variable 45. The research method that is used to demonstrate a cause-and-effect relationship between changes in one variable and the effects on another variable is called: Independent Variable 46. In an experiment, the independent variable is the variable that is: The controlled factor in an experiment.It is hypothesized to cause an effect on another variable. 47. In an experiment, the dependent variable is: The measured facts. It is hypothesized to be affected. 48. Random assignment refers to a procedure that: Every subject in the study should have an equal chance of being placed in either the experimental or control group. 49. The purpose of the control group in an experiment is to: To have a group of stable and unchanged variables to compare and analyze results to. 50. The purpose of using a double-blind research design is to: help prevent the influence of inadvertent demand chatacterisitcs. 1. The ethical requirement of informed consent means that: purpose procedures risks confidentiality alternatives to participation costs compensation questions consent statement participation is voluntary 52. The branch of psychology that is focused on understanding the internal physical events and processes that correspond with our experiences and behavior is called: biological psychology 53. The branch of science that is concerned with the study of the nervous system is called: neuroscience 54. Which of the following is TRUE of glial cells? functions like glue Forms the myelin sheathAssist neurons in communicating with each other Removes waste products from neurons Nourishes neurons Besides the neuron, it also the other main type of cell in nervous system 55. The three basic types of neurons are: Sens ory Neurons, Motor Neurons, and Interneurons 56. Which part of the neuron receives messages from other neurons? Interneurons 57. The primary function of the myelin sheath is to: The primary function is to insulate the neuron cells so that it can conduct quickly. 58. The presynaptic neuron and the postsynaptic neuron are separated by a tiny, fluid-filled space called the: Synaptic Gap 9. Which of the following best defines a neurotransmitter? They are special chemical messengers manufactured by the neuron. 60. What happens to the neurotransmitters that fail to attach to a receptor site? They are reabsorbed by the presynaptic neuron so that they can be recycled and used again. 61. Like a key in a lock, the shape of the Neurotransmitters must fit the Receptor site to affect the postsynaptic neuron. 62. The neurotransmitter called acetylcholine: Is found in all motor neurons. It stimulates muscles to contract, including the heart and stomach muscles. 63.Parkinson's disease is caused by the degeneration of neurons that produce: Dopamine 64. Miguel jogs about five miles a day. At roughly the three-mile point, Miguel usually experiences a rush of positive feelings due to heavy levels of Endorphins. 65. The two main divisions of the nervous system are the Central nervous system and the Peripheral Nervous System. 66. In combination, the brain and spinal cord make up the: Motor neurons 67. The autonomic nervous system is composed of two different branches called the Sympathetic and Parasympathetic nervous systems. 68. Which of the following best defines neurogenesis?The development of new neurons. 69. Which represents the largest region of the brain? Cerebrum 70. The primary communication link between the left and right cerebral hemispheres is called: Corpus Callosum 71. The hippocampus plays a key role in: The ability to form new memories. 72. Of the following brain structures, which is associated with the emotional responses of fear, disgust, and anger? Amygdala 73. W hy was the split-brain operation first performed? It was performed to stop the patient’s seizures. 74. Functional plasticity: Refers to the brains ability to shift functions from damaged to undamaged brain. 75.The notion of structural plasticity: Refers to the brain’s ability to physically change its structure in response to learning, active practice, or environment stimulation. 76. In psychology, the term sensation formally refers to: The process of detecting a physical stimulus such as light, sound, heat, or pressure. 77. In contrast to sensation, the term perception is formally defined as the: Process of integrating, organizing, and interpreting sensory. 78. The process by which physical energy, such as light, is converted into a coded neural signal that can be transmitted to and interpreted by the brain is called: Transduction 9. The smallest possible stimulus that can be detected half the time, or the minimum level of stimuli that we can detect is called: The abso lute threshold 80. The smallest possible difference between two stimuli that can be detected is called the: absolute threshold 81. According to Weber’s Law, whether we can detect a change in the strength of a stimulus depends upon the intensity of the original stimulus. 82. Perception that is below the threshold of conscious perception is called: Subliminal Perception 83. John puts one toe into the swimming pool and shivers because the water is so cold.He grits his teeth and dives in anyway. After about ten minutes, the temperature of the water seems quite comfortable to him. This example illustrates the principle of: Sensory Adaption 84. Rods are used for vision in Dark light, and cones are used for vision in Bright light. 85. Which theory best explains color vision in humans? The trichromatic theory and opponent process theory. 86. The sense of hearing is also known as: Audition 87. As you walk into your office, you are almost overwhelmed by the strong smell of the cologne with which the copier repairman has doused himself.Because you have studied this chapter, however, you reassure yourself that sensory adaptation will occur and you will become much less aware of the odor in approximately: 88. The best candidates for hypnosis are people who: Approach the experience with positive, receptive attitudes. 89. A group of techniques that induce an altered state of focused attention and heightened awareness is a definition of: Meditation 90. Chemical substances that can alter arousal, mood, thinking, sensation, and perception are called: Psychoactive drugs 91. Taste is to gustation as smell is to olfaction. 92.According to your textbook, factors that can INCREASE the perception of pain include: Anxiety and a sense of helplessness. 93. You are able to maintain your equilibrium and balance because of the: Vestibular Sense 94. The term gestalt means: meaningful whole perceptions 95. The ability to accurately gauge the distance of the coffee cup on your desk as you reach for it is called: depth perception 96. As you walk on the beach, every detail of the rocks, shells, and sand beneath your feet seem crisp and distinct. As you look further down the beach, however, the details of the ground in the distance seem fuzzy and blurred.Because of the depth perception cue of texture gradient, you perceive the ground beneath your feet to be much closer than the ground that extends into the distance. 97. Distance cues that involve both eyes are called _____ cues. binocular 98. Distance cues that require the use of only one eye are called _____ cues. vestibular 99. It was the famous American psychologist named _____ who described consciousness as being like a river or a stream. William James 100. The term circadian rhythm refers to: any rhythmic change that continues at close to a 24 hour cycle in the absence of 24 hour cues. 01. Circadian rhythms that are drastically out of synchronization with daylight and darkness cues can produce: jet lag 102. If you are like most people, you experience a daily slump in your mental alertness around 3 o'clock each afternoon. This daily fluctuation in mental alertness is an example of: delta brain wave activity. 103. According to the activation-synthesis model of dreaming: dreams are a byproduct of physiological processes in the brain. 104. As you are reading this question, you are awake and alert. This means that your brain is generating beta brain waves. 105.Shortly after going to bed and as you are falling asleep, you experience the vividly realistic sensation that you are falling or tripping forward, which jolts you awake. This vivid sensation is a common example of: hypnologic hallucinations 106. As you are being monitored by sleep researchers, almost all of your brain activity comprises delta brain waves. This is a clear sign that you are in: stage 4 NREM sleep 107. According to the adaptive theory of sleep: sleep emerged in evolution 108. The most common sleep complaint among adults is: Insomnia 109. Somnambulism is also called: Sleep walking 110.The term nocturnal enuresis is: bedwetting 111. The parasomnias are: undesirable physical arousal, behaviors, or events during sleep or sleep transitions. 112. What is sexsomnia? abnormal sexual behaviors and experiences during sleep 113. In a study described in your text, research participants learned a new task before going to sleep. During the night, some participants were repeatedly awakened during NREM sleep, other participants during REM sleep. What did the researchers find when they tested the participants on the new skill the next day? 114. What is a lucid dream? When you can control your dreams 15. Who said, â€Å"In every dream an instinctual wish has to represented as fulfilled. † Sigmund Freud 116. Which of the following best defines hypnosis? A cooperative social interaction in which the hypnotized person responds to the hypnotists suggestions. 117. Pseudomemories: are false memories that can be inadve rtently created when under hypnosis 118. The most widely used psychoactive drug in the world is: Caffeine 119. Alcohol is classified as a: Depressant 120. Prolonged use of cocaine can: cause withdrawal symptoms. 121. Brandy is fond of attending all-night raves at a dance club near her home.Some of the raves are drug-free, but at one rave she saw a friend who was sweating profusely, chewing ice and a plastic pacifier, drinking large quantities of water, and hugging everyone in reach as he proclaimed his love for all humanity. Brandy suspected that her friend was probably high on _____. 122. Methamphetamine is a type of amphetamine that can be easily manufactured, provides an intense high, and causes a reduction in the brain's dopamine transporters and receptors. 123. _____ are highly addictive drugs that suppress appetite, produce euphoria, and reduce fatigue. Ecstacy 124. Which of the following is NOT classified as a stimulant?

Saturday, September 28, 2019

Private Security Industry Essay Example | Topics and Well Written Essays - 1500 words

Private Security Industry - Essay Example Their job description is private in nature, that is, they serve only under the benefit of their employees. Police officers, on the other hand, have limitless task that range from patrolling in the streets to the prosecution of case of arrested violators. They play a vital role in the administration of the Criminal Justice System as the first pillar of the system. They help enforce the fundamental duty of every state to serve and protect the lives and properties of its people. Police officers are far better trained than security officers. They are even receiving better salaries and benefits since. They received their salaries directly from the treasure box of the government they serve. Despite of these differences with the police service, security services are a booming industry nowadays. Because of the spiraling crime rate in the society, many people now are security conscious. Businessmen, politicians, and other high profile individuals are those that usually engage the services of security agencies. There is a limit as to what police agencies can do. One of these limitations is that police agencies cannot serve at the pleasure of private persons since they serve the public in general. Security agencies, on the other hand, capitalize much on these limitations. ... Since said activities is usually conducted in a business matter, operators and owners recruit and employ only to obtain high profit with fewer expenses. This is because of the absence of strict laws that regulate the business. Operators and owners have the freedom to select and employ their security guards. That is why they often end up with security guards who are unlicensed, less educated, inexperienced, untrained, and incapable of performing security task. With the concept of self-regulation of these industries, security guards also received meager salaries and less benefits which to not equate to the long hours that they render service. The Private Security Industry Act of 2001 In the recent developments, many states had already adapted means and measures within which to improve the status of their security industry. One of these means is the passage of laws or acts which are primarily aimed in enhancing and regulating this booming industry. The United Kingdom, for instance, passed a regulatory act entitled "Private Security Act of 2001" that received Royal Assent on 11 May 2001. As explained in the Explanatory Notes (2001), The Act sets out a system for the statutory regulation of the security industry. It aimed to raise standards, ensure greater consistency, and introduce arrangements that vet people working in the industry to exclude criminal elements who tarnished the image of the industry. It also aimed to provide recognition to companies who can provide a satisfactory service measured against relevant agreed standards and who are able to demonstrate such recognition to costumers through voluntary scheme. To achieve realized these objectives, the Act created the Security Industry Authority, referred through

Friday, September 27, 2019

Should the Ruler Always Keep His Word Essay Example | Topics and Well Written Essays - 2250 words

Should the Ruler Always Keep His Word - Essay Example It is possible to present power from an unusual perspective. This task was the most relevant to Machiavelli and he managed to open the eyes of his fans and follower and the coming generations on the real essence of power, and on power of the words. In the majority of cases Princes are focused on their own interests. They are selfish and prudent; they do not care about their people at all. Machiavelli has been focused on the relevance of the ruler and the meaning of his word. Further on this paper considers controversial and challenging moments of the statement that a ruler should not keep his word. A word of a ruler Machiavelli inspires readers. They love him for sincerity, unexpected expressions, feelings and emotions. Machiavelli claims: â€Å"One ought not, of course, to call it  virtu  to massacre one’s fellow citizens, to betray one’s friends, to break one’s word, to be without mercy and without religion. By such means one can acquire power but not glor y† (Prince online). Nowadays, the majority of politicians are focused on power. They consider it as an enormous blessing and there is no doubt that even the modern politicians cannot look further than their nose. Machiavelli and his feeling of patriotism, multiplied by a possibility to exist among other politicians and clerk were the main triggers for further developments of his political ideas. Actually, Machiavelli described people as masters and slaves. A former group of people is more powerful and it is appropriate for them to take care about themselves only. Slaves, or common people, in accordance with Machiavelli, are narrow-minded and follow the laws of the ruler, like an obedient herd of ships (Bagley, 1989). Therefore, it is possible to suggest, that Machiavelli wants to describe a dual nature of a human being. There are two origins in the nature of every man: on the one hand, we choose: "What [classical writers] intended to convey, with this story of rulers’ b eing educated by someone who was half beast and half man, was that it is necessary for a ruler to know when to act like an animal and when like a man; and if he relies on just one or the other mode of behavior he cannot hope to survive" (Prince online). This explanation can be correlated with a developed system of people, i.e. Masters and Slaves (Alter, 1999). Masters know how to behave with their slaves; they impose perverted laws on them and they have no doubts that their Slaves would follow all their needs and wants. When it goes about Masters’ words or the ways of behavior, they have sharp minds and can easily choose appropriate strategies and the ways of behavior. A Master uses beasty features, turns into a lion and can easily conquer his enemies. A Master turns into a fox, when he wants to conduct his cunning laws and create traps for his Slaves. On the one hand, it is appropriate for a ruler to choose different strategies of behavior. Otherwise it is impossible to reig n. On the other hand, what can be said about a ruler if he does not keep his word? He can lose respect and trust of his people. Only a feeling of fear can prevent people from real protesting. In this case, the Prince can behave in whatever he wants, because he will get no resistance from people around him. There are many things, which are permitted for the king, but these deeds are forbidden for a slave. Machiavelli claims that there are many sins and every man

Thursday, September 26, 2019

Text analysis Article Example | Topics and Well Written Essays - 500 words

Text analysis - Article Example Even though the writer knows that balancing the job requirements and family attention can be challenging, she instinctively insists upon going on with the dream of making a positive impact on the society as a whole. She even vows to be role model to her daughter and that explains how dedicated and passionate she is towards dream of making positive impact on people’s life. Although the writer is the central character in the story and we can learn more about her, the introduction of Lana (the patient) seems to gives much in depth information about the whole scenario (Ehrenhaft and George, 56). The writer gives a brief description about herself and that is critical in giving insight into her inspirations to become a nurse. The writer seems to be motivated more by the events that happen in her life. She quotes â€Å"That statement solidified my purpose of positively contributing to society, positively influencing people’s life, and being the best nurse I can be. I know that I need to take my career to the next level†.This essay is so appealing to the audience. The setting is such that it is easy to understand the main theme of the essay (Ehrenhaft and George, 78). From the essay, a person can be easily convinced that social responsibility is something that needs to be implemented for the wellbeing of the society. The transition from one point of argument to the other in the essay is splendid. The writer offers her argument in a more open and detailed manner. She first, describes herself then she talks about the family and finally she talks about her job and he r relationship with the patients. She also talks about how that relationship has helped her make a positive impact in somebody’s life. The most interesting part of the essay is the fact that the writer acknowledges that you can make an impact on somebody’s life despite your economic,

Wednesday, September 25, 2019

W6D Teams Essay Example | Topics and Well Written Essays - 250 words

W6D Teams - Essay Example ganizations have preferred this kind of team apparently because of its cost effectiveness in terms of reduced cost of technology, greater use of outsourced and temporary workers, shift towards globalization and many others. Moreover, functional teams are compost of individuals from different departments but with the same task to perform. For example, an individual performing an accounting task in one department team up with another individual performing accounting task in another department. In functional team, the team members try to specialize in their roles as they try to stick to their roles (Jurgen A. (2011). Finally, self-managing teams are teams that are accountable for all the tasks they perform (Manz & Sims 1993). The team members share the work force and the supportive tasks. It is a group that is composed of individuals with a common purpose and the tasks are defined by the members (Stewart & Manz 1995). Team processes are those step-by-step actions that are taken or perform in order to produce a favorite outcome. These team processes sometimes have positive influence or negative influence on the team performance. They include transition, action and interpersonal processes (Garvin2009). All these process can have positive influence on performance. For example, a transition process like creating an action plan can help in prior achievement and organizing for future wants. Action process like assisting other team members performs their task can help promote positive cohesion and timely goal achievement. Also interpersonal process like conflict management can also help in developing some rules that can finally encourage cooperation. On the other hand, an interpersonal process like storming can have negative influence on performance. The questioning of the team’s ability to perform a given task can lead to discouragement of the team members hence not giving their best (Garvin2009 ). In conclusion, teams are important to an organization as they help in

Tuesday, September 24, 2019

Contemporary management Essay Example | Topics and Well Written Essays - 1000 words

Contemporary management - Essay Example So, the level of preference for social media enhanced to a significant extent thereby amplifying its prospects, in the entire world. The similar technique is used by a reputed organization of United States of America named Starbucks so as to increase the level of awareness of its customers and shareholders regarding its strategies and policies (Beall, 2010, pp. 131-133). Starbucks is one of the popular and leading coffee retailers, operating its functions significantly from Seattle of United States of America. After its introduction, very easily it expanded in almost 55 countries that enhanced its brand value and market share to a certain extent. Along with this, it owned almost 17,000 stores in the entire world so as to present world best coffee to its customers at a competitive cost. The prime desire behind such a strategy is to enhance its range of customers thereby amplifying its profitability and sustainability in future era (Hansen, 2012). Apart from this, Starbucks also desired to enhance its reputation and identity by offering high attention over the concept of corporate social responsibility (CSR). This proved extremely effective for the organization in both current and future aspects. In order to enhance the competitive advantage of the organization of Starbucks, its management decided to present the best coffee to its customers. However, to do so, it presented varying types of flavours that enhanced the level of preference of the customers. This became possible only due to the promotion of the flavours of Starbucks through the online sites and social media partners such as face-book, Twitter, linkedIn and many others. As a result of which, the level of awareness of the customers enhanced that improved the profitability of the organization by a significant extent. Thus, this strategy acted positively over

Monday, September 23, 2019

Ethic Challenges Essay Example | Topics and Well Written Essays - 250 words

Ethic Challenges - Essay Example The current elderly population is as a result of the boom in births between the year 1946 and 1964. The medical services at that time were excellent and consequently many children born survived. A requirement for more healthcare providers and services emerges for rationing health care services to serve the sick population (Raingruber, 2014). The legislature must embrace rationing soon to ensure maximum utilization of the available resources. Otherwise, the federal government must spend more in employing more providers and procurement of more equipment that may consequently suppress other sectors in the state. The American healthcare services should be available for all its citizens. The American population comprises mostly Judaism and Christians who value life as a precious gift (Kelly, Magill, & Have, 2013). The medical ethics state that the nurses should offer the best healthcare services to the patients in their hour of need (Eileen, 2013). The nurses and the patients who already have insurance covers, however, may get the universal health care slogan challenging since it will compromise on the quality of the services. The increased population that requires medical services will stress on the limited available nurses and medical equipment. However, the government can implement the universal medicare by budgeting more on the equipment and

Sunday, September 22, 2019

Muhamad Abdel Wahab Essay Example for Free

Muhamad Abdel Wahab Essay Mohammad Abdel Wahab was born in 1907 and died in May 3, 1991. He was a prominent 20th century Egyptian singer and composer born in Bab El Shriyah area of Cairo Egypt. He composed 10 songs for Omm Katherm, the greatest Arab songstress in history. Mohammad Abdel is a legend to the vast majority of Arabic speaking people. Mohammad was a renown singer, composer and actor and who lasted in musical career for spanning seventy four (74) years. He had a captivating voice and his melodies were of the classical poetry from the Arab’s golden age and that of their modern struggle against Western colonialism. Through this composition he instilled in his listener a feeling of pride in their Arabic’s rich culture and heritage. Though Abdul Wahab is known for his music, he composed more that he sang. Exploring the life of Abdul Wahab as a composer without referring to his songs or music and acting is inadequate for all of were a part of him and his many released songs and movies that later became `hits` were as a result of his creativity and talented mind. His enjoyed musical voice and the melodies were no doubt a product of his great composition. His songs were his own compositions and it is said that from his teens Mohammad had composed for himself and other leading Arab singers over 1800 romantic and patriotic songs (Salloum. Habeeb). His composition had the Western taste due to his innovative nature of always thinking of new and better ways to enrich the traditional songs. This is a factor that has contributed to a great extent to the popularity and influence of his compositions among the youth, a reason that has made his compositions to maintain the lead in music industry up to date. In the 1920s Mohammad is said to have become a close friend of a well known poet, Ahmad Shawky who helped him excel well in compositions and boost his talent as a composer. In the following years the world watched Muhammad Abdul Waham climb the ladder to later become a star and earned himself the title ‘singer of princes’ When the Egyptian monarchy was overthrown in 1952 by young nationalist army officers his perception of life changed drastically and radically. His songs which were purely his own compositions became more inspiring and more patriotic. He produced some of his finest works which included ‘The Eternal Nile’, ‘Damascus’, Palestine the musical scores for Egypt’s national anthem and the national anthems of Oman and the United Arab Republic. He composed political, national and Arab national songs; Muhammad also composed more songs after 1933. His compositions underwent different stages of development due to the environment in which he lived. Muhammad as a person accepted the changes and that is why his music in great deals synthesized the two worlds (both Western world and Arab world). (Levinson. M. L, 1995) His music was at first traditional a thing that later changed to westernization after he underwent formal training in both Arabic and Western music. Among his early composition of song was the Goose Consul Operetta, based on a theme of Naguib El Rehani which became a great success. Later his movie composition introduced female artist such as Leila Murad a thing that may have been found awkward during the time. Muhamad Abdul Wahab in his own way was a revolutionary leader in some sort of special way. His compositions featured large orchestras with a Western blend of instruments such as the guitar bass, accordion and later the organ and synthesizer. He also added new rhythmic formulas, including the tango, the mambo, samba and rumba, as well as the Arabic oriental rhythms, maqsoum and baladi in his compositions. (The story behind the stomp) In the 1960s Abdul Wahab composed songs for other singers such Om Koulthom. He released Omri a recording that later became Egypt’s all time best seller. In the 1970s he started fading from the public though his music from his own compositions continued with the same energy and vigor but in 1988 when he was (81), he emerged again to the surprise of many with new composition of his own. Age to him was nothing, infact it gave him more reason to write and consequently more reason to live. In his life time Abdul Wahab was recognized for his work in his great compositions, music and movie industries and hence received a lot of awards. Suprisingly enough his work is still rated as one of the best to have ever come from an Arab world. (Levinson. M. L) He died at the age of ninety and Egypt country honored him with a huge military funeral at the Rabia-al-Aldawiya Mosque in Cairo. After his death, his work was covered in newspapers, radio and television ranging from his compositions of songs and movies. He was accorded the title `The father of modern Arabic songs`. He died in 1991 of heart failure; he left a legacy nobody can afford to forget especially in the world of modern Arabic music and melody. Up to until his death Mohammad sorts peace in his writings, writings that appealed to both the old and the young. He stole many hearts with his music and compositions and became a beloved figure. Although he is gone he speaks to us through his work Works Ci

Saturday, September 21, 2019

Origins of Quinceanera Essay Example for Free

Origins of Quinceanera Essay Quinceanera cerebrations history is mainly found in the Aztec and Mayan cultures of the Latin American people with the roots in the ancient Mexican society. A girl approaching her fifteenth birthday would be taken from her home to be prepared on how to transcend from girlhood to womanhood and marriage. During this time, she would be taught about her traditions and history as well as being given instructions and guidelines through which she would learn to be a responsible adult and a good wife in her community. By the time she was returning to her family, a great celebration was launched that marked her womanhood (sexual maturity) status. The celebration is still held to this date in Latin and Hispanic families all over the world. However, the girls are no longer taken from their families but they rather get involved in group discussions and classes where they learn issues such as family, adulthood, and religion. In many cases, this goes on for a period of six months or even more as adopted by different communities around the world. Preparations for the major quinceanera celebrations often begin about two years before the actual date of the wonderful occasion. The major purpose for the quinceanera is to act as a right of passage or social initiation that is intended to teach as well as reinforce the important and valuable cultural values of the community. These days, the ceremony is conducted to acknowledge the young girl’s rite of passage to womanhood. Since many societies that practice this ceremony have turned it into a religiously oriented activity, the ceremony acts as reaffirmation of the baptismal vows the parents made on behalf of their daughter(s). The ancient Mexican quinceanera is equivalent to the sweet sixteen in many United States societies. At the age of fifteen, boys traditionally became warriors. This therefore necessitated the need for girls to be presented to their communities as a vital force of community’s future in the sense that their power to become mothers would ensure continued provision of more warriors for the tribe (http://kufflynx. com/historyofquinceanera. aspx) The history of quinceanera, unlike the sweet sixteen, has many religious components that make it more or less the same as the Bar Mitzvah which is held in the Jewish culture when their youth turn thirteen (Lankford, 1994, pp. 18). Before the celebrations commence, family members and guests accompany the quinceanera to a church service. The delivered sermon by the clergy is usually one whose main theme is the importance of growing up to be a responsible woman in the society. In the process, the young lady is given an opportunity to share her future hopes. Other family members and guests may also be allowed to speak too. After the service is over, people proceed to the party where under normal circumstances plenty of food, games, dance, and music take the order of the day. Quinceanera parties usually require a lot of preparation and planning. It is as thus a very big occasion for the young woman and sometimes it takes many years of saving to make the girl’s fifteenth birthday dream a reality. Due to the value attached to this event, it is very common to have live bands, catered food, superb location reservations, and photo sessions. The quinceanera girl will often have a lavish gown and the guest of honor will sometimes have one as well. This makes the birthday as elaborate as a wedding. The most crucial aspect of the quinceanera is invariably a thanksgiving Mass (Karen, 1996, pp. 76). Traditionally, the King conducted the girl’s exhortation, giving the relevant instructions related to the duties of the woman. In the Aztec tradition for example, if a woman died during child birth, she received funeral honors equivalent to the ones accorded a warrior who died in battle. During the whole session of the Mass, the girl remains specially seated at the altar’s foot. When the Mass ends, bolos or commemorative favors are passed out by cousins, younger sisters and close friends to those who have attended, while the quinceanera girl deposits her bouquet in a niche or on the altar honoring the Virgin Mary (http://kufflynx. com/historyofquinceanera. aspx) There is a traditional provision that the quinceanera, depending on the economic strength of the parents and the godparents, can further the celebration opulence by opting between a journey to a fancy city and a party with live band music. Today there is a general tendency of women from all social strata to opt for the later. Regardless of the magnitude of the opulence involved in the quinceanera celebrations, the highest goal of the event is to strengthen the social fabric and bonds that should remain firmly cemented not only among families but also at the societal level. This postulates the spirit of communal cohabitation, togetherness, and cohesiveness that must be maintained at all times. One uncertain thing is how far this norm is maintained in our â€Å"electronic† global community (Lankford, 1994, pp. 40). Learning from the importance that was, and to some extent is still associated to quinceanera or the sweet sixteen in most parts of the United States, we need to realize the significance of the social bonds that persist in our societies from ancient times to date. Beyond any reasonable doubts, there are certain stages and rights of passage that each one of us passes in life and which are given some form of communal responsibility, however little it may be compared to earlier times. These include similarly shared social functions such as child birth, the first marriage, parental responsibility, and lastly the final stage which is death. These are considered in different perspectives in different cultural backgrounds but the truth of the matter is that they are present in all communities in the world. Furthermore, the quinceanera topic is significant in the sense that it portrays the gender differentials were and are still seen in our societies today. Not many years have passed since women stated involving themselves in the disciplines which were traditionally regarded as masculine oriented. Examples of this can be found in cases where women were considered as child bearers and home keepers who were expected to be submissive to their husbands. In academic arenas, mathematics and science oriented subjects were gender-roles meant for men (Karen, 1996, pp. 45). The trend has fundamentally changed from women being submissive child-bearers, cookers, and weavers to equally productive citizens in the world. The political climate has also significantly changed since women engaged in politics. Further lessons from the quinceanera topic advocate for personal growth and development. The major reason I postulate this is because by learning of our cultural heritage and social institutions we find ourselves in, one is able to critically reflect on what needs to be reinforced and what should be abolished from our systems. On example is the fact that in many Mexican communities, women are still regarded as second-class citizens, even with the known fact that they are the best family maintainers as compared to their male counterparts (Karen, 1996, pp. 64). Some of these outdated opinions should be addressed with the most appropriate urgency if we are to claim of freedom from social segregations and inequalities. References: Karen Mary (1996). La Quinceanera: Making Gender and Ethnic Identities. Frontiers: A Journal of Women’s Studies, Vol. 16, pp. 45, 64, 76 Lankford, Mary D. (1994). Quinceanera: a Latina’s Journey into Womanhood. Brookfield, Connecticut: Millbrook Press, pp. 18, 40 The History and Meaning of Quinceanera.

Friday, September 20, 2019

A Comparison Between Pakistani And British Consumers On Buying Moblies Marketing Essay

A Comparison Between Pakistani And British Consumers On Buying Moblies Marketing Essay Mobile phone has become an important part of human life .With the invention of new technology, along with computers, this technology has ease the work of human being in communicating with each others. Before the invention of mobile phones, there were land line telephones which also help human being to communicate with each others but at a limited scale. To use land line, person should be at one place where that phone is installed. But mobile phones remove this barrier by allowing customers to communicate with each others from any place where it has signals. AS this system is connected with the satellite, person can communicate without any hurdle. This is the only technology on the globe which is sold at highest numbers than any other technology. Out of 6.8 billion people on the earth, 5 billion use mobile phones (international telecommunication union, 2010).Two countries Pakistan and UK have been chosen for this dissertation because these two countries are very much different in many prospective. Pakistan telecommunication authority (PTA, 2010) shows that mobile phone in Pakistan enjoy a tremendous annual growth of 119% during 2000 to 2007. It is also being observed that between fiscal year 2006-07, mobile phone penetration increased by 15.5%. Whereas between years 2007-08, it was 55.6% which is 34.9% higher than Indias for the same period. Pakistans telecommunications industry maintains its growth trend in the coming years as well with the penetration rate in 2009 was 61.8% and in September this penetration rate reaches to 70%.On the other hand UK mobile phone market is different than Pakistani market. According to report presented by Ofcom (2007), the mobile phone market in UK grew by 41.3% between 2003 to 2007.In 2010, the penetration rate in UK was 84% which stay same till 2011.Mobile phone market is very competitive these days as there are number of companies who are trying to compete in this market to become the best in the business. It is very essential for the companies to better understand the buying behaviour of the customers.It gives them an edge on the competitors in targeting the right segment and getting market share. The purchasing decisions of consumers are mostly affected by factors that have direct or indirect impact on how we live and what we consume. Culture is one of the factors that impact on buying behaviour of consumers. Culture represents the behaviour, beliefs and, in many cases, the way we act learned by interacting or observing other members of society. In this way much of what we do is shared behaviour, passed along from one member of society to another. Culture play an important role in breaking target market into different segments and then targets the right segment. Blackwell et al., (2001) demonstrated that culture has a profound influence on how and why consumers purchase a range of products and services. The selection of products by consumer affect by the culture and it can help companies to design their marketing plan. Culture shapes the lifestyle of the consumer which affect directly on the buying pattern of the consumer. The cultural comparison between Pakistan and UK about mobile phone purchasing behaviour will provide a complete picture which will help understand these two countries mobile phone market. Culture defines the lifestyle of the people so it is very important for the manager to understand this factor and design a marketing plan by considering culture as a back bone of marketing. Companies these days are operating globally, marketing manager should divide the targeting segment into small sub segments on the basis of culture to market their product efficiently. Pakistani culture represent the most part of Asias culture and British culture represent the most of European culture. This purpose of this study to find the cultural impact on consumer buying behaviour of these two countries so that marketers of telecommunication industry use it to generalise it for the whole Asia and Europe. Literature Review Culture is defined in many different ways that can be used here for the sake of this paper. Culture is defined as ways of life like language, arts science, thoughts, spirituality, social activity and interaction (Roshan).By Hofstede (1991, 2001), culture is an identity that is used to distinguish one group from another.Keegan and schlegemilch (2001) state that culture is formed by people those are living in a community for many years and has a life that pass on from one generation to another. This mean that culture has a starting point and finish point. So its all about the life style of a group of people whom code of life is represented by culture.Doney etal(1998) defined culture as a system of values and norms that are shared among a group of people and that when taken together constitute a design for living. So by Doney culture is the design of life. There are many different cultures exist and these cultures represents particular group of people who actually adapted that design. It also depend on the individuals whose life style effect on the culture.Doney Lowe (2008, 73) believe that culture is made up of three essentials components. Those are (1) Beliefs: refers to the mental and verbal processes that reflect peoples knowledge and assessments of things. (2) Values: used by people as guide for what is appropriate behaviour. (3) Customs: Overt modes of behaviour that constitute culturally approved or acceptable way of behaving in specific situations. To be very precise as far as this project is concerned, above definitions of culture are generalised. Actually theme of culture that is more suitable to this dissertation is that culture defined way of living, behaving, acting in a particular situation, dealing with others and organising oneself. That is way it is very important for the marketers who are dealing international business particularly should understand the importance of this phenomena. If they understand this concept and then target particularly segment on the basis of culture then it will be easy for them to launch the product in the right segment. So culture is the medium for communication for marketers that transmit these beliefs, values, behaviour and norms into shaping the attitude and behaviour of human. It help the members of such group in deciding what, why, where, how and when to do different things and how to act in a particular situation. So it means that culture is not a static concept. Its dynamic and it can change with the passage of time and influence ones own behaviour although they also contribute to the culture. Customer buying behaviour is another factor that affects consumer choices and trends. Recognizing consumer behaviours importance to business, marketers attempt to develop means on assessing or measuring how a customer behaves (Bailey and Schultz, 2000). Consumer buying behaviour is said to be different from one business to another in a way that consumer buying behaviour tends to have different attitudes about the needs and purpose of buying while the business-to-business approach is one which is more on supplier-company relationship. So consumer buying behaviour is the procedure which shows what, how, when and where people buy the product as they do. Thus this is an attempt to understand the decision making process in buying the products. The first thing is trying to understand the buying behaviour of the individual from the same group. Then generalise it to the whole group because all the individuals in the group have same characteristics. But decision making process is not easy. Th ere are different levels of decision making forms. Some are low-involvement decision making process , some are high involvement decision making process. So it all depends on the product itself as well. Mobile phones are not high involvement decisions making products. But these decisions are also depend on consumer perception, attitudes and understanding of the given product based on the educational background, societal background, financial situation and more importantly social and cultural environment. Culture here play an important role on the consumer buying pattern as individuals can not live alone. They are part on culture and the way they behave all depend on the cultural environment in which they live. So it is very important that to understand the cultural to study the buying behaviour of consumer and this dissertation is all about this. Pakistan and UK are two different cultures. Both these cultures have strong influence on the buying behaviour of its consumers. Hofstede (1991, 2001) divide culture into two different types. One is called individualistic and other one is collectivist. According to this dissertation UK is highly individualistic country in which people mostly decide individually about the buying of products. On the other hand, Pakistan scores highly as a collectivists country where family, friends or group influence the buying behaviour. Individualist and collectivist are two out of five cultural dimensions which Hofstede find out when he was trying to find an explanation for the motivation of IBM employees around the world. Hall (1960, 1981, 1990) presented culture as high and low context cultures. He explains that culture can be divided into two groups. One is called high context culture and other one is called low context culture. The theme of difference between these two cultures according to Hall is the individual relationship. He stated that high context culture is based on the close tie between individuals personals relationships such as family, friends and colleagues etc. and in this group information and knowledge is share exclusively. People in this group are social and they care each other, listen to each others, sometime depend each others and discuss information between each others. Hall (1960. 1981, 1990) stated that high context culture is more common in East. And as far as this project is concerned, it represents Pakistan. On the other hand, low context culture is belonging to outer group. In this culture, people live their individual life. They belong to their personal network. Family, f riends and colleagues are all separate to each others. All of them live their individual life. Things are share less exclusively. People are more independent and make their own decisions.UK is the one in this dissertation which represents low context culture. Here society in not social enough to influence the decisions of others. People live their own life and they rarely involve in the decisions making process of others. Industry Background Telecommunication industry is the fastest growing industry in the world. This is because of the fast growth in technology sector and increasingly becoming part of human lifestyle. With 73% of the world population is using mobile phones , the network covers the 90% of the world area (mob thinking, Oct2010).Mobile phone industry started way back in 1970s when first mobile phone launched in Japan.After that this industry never look back and continuously grow with different transition period. During the last 40 years it have undergone a transition from technology focused for professional business to a mass consumer market and become an integral part of lifestyle. With the passage of time, it is not only used as a communication tool but also it is helping consumers in other businesses like of internet , financial transaction , tracking device , video conferencing and many more. Pakistan and UK mobile phone market is very strong in the sense that Pakistani market is still growing and it need to know more about consumer buying behaviour.UK mobile phone market is also growing but more effort is needed to do business with the existing customers. Culture of an important role in consumer buying behaviour in both these market which is why this research is being done to let marketers understand the depth in the market. The comparison between these two segments will help marketers understand that how to target the existing segment and how to create new segments within the existing segment. Research Aim Literature Review

Thursday, September 19, 2019

Disparity and Discrimination Essay example -- Race Racism Prejudice

Disparity and Discrimination According to Webster’s Dictionary, the proper definition for discrimination is: 1 a : the act of discriminating b : the process by which two stimuli differing in some aspect are responded to differently 2 : the quality or power of finely distinguishing 3 a : the act, practice, or an instance of discriminating categorically rather than individually b : prejudiced or prejudicial outlook, action, or treatment (Webster’s dictionary). Discrimination has been around for centuries and even though there have been improvements in the way society deals with discrimination, we still have a long way to go. One of the biggest problems in America today is racial discrimination. We see it happening all over the world and also we see how it affects our criminal justice system. For example, there have been many problems with police officers using racial profiling with mostly people of African American and Mexican decent. Police officers do pull over minorities more than they would if the person was white. Even though the minority races have a higher criminal rate compared to the white community, we should not be labeled automatically without reason or just cause. And we should not be treated any differently when you are comparing the two.   Ã‚  Ã‚  Ã‚  Ã‚  Another example of discrimination is what can happen in our court systems. For example, minorities may not be able to provide for a good lawyer, which leaves them to a public defender and in most cases, they e...

Wednesday, September 18, 2019

Crime in America Essay -- essays research papers

Parole (early release from prison) is often referred to as the back door to the US corrections system. The concept of parole dates back to the establishment of the Elmira Reformatory. The goal of the Elmira Reformatory was to rehabilitate and reform the criminal instead of following the traditional method of silence, obedience, and labor. Parole was originally set up to encourage prisoners to do well, keep their noses clean, and become model prisoners. Once a prisoner had shown rehabilitation and reform they were released prior to the execution of their full sentence. Before a prisoner can be released on parole he/she must meet before a parole board. Each prison with a parole system is set up with one of two types of parole services. Service one is the independent model. Like its name says it is independent, independent from any other state agency. Meaning that it’s parole officers do not work for the corrections system. This enables them to be more bias and fair with their decisions. Service two is the consolidated model. This model is ran by the corrections system and is under the direction of the commissioner of corrections. The consolidated model does not give its members the ability to be bias. They have to bite their tongues in some instances as to not ruffle the feathers of those appointed over them. No matter which model is in place if not used correctly it is a failure. In most states the members of the parole board are appointed by the governor and serve a term of...

Tuesday, September 17, 2019

Night World : Spellbinder Chapter 13

You know, he probably only loved you because of the yemonja,† Blaise said. Thea looked up from her seat in the empty chemistry lab. It was morning break, and this was the most private place they could find at school. â€Å"Thanks, Blaise. I needed that.† But maybe it was true. She'd almost forgotten that she'd used a spell to get him in the first place. That should make a difference, she told herself. If it was all artificial, I shouldn't even miss it. She still felt as if she were encased in ice. â€Å"Did you get it?† â€Å"Sure.† Blaise tossed a ring on the high table. â€Å"I asked her if I could look at it, then pretended I dropped it in the bushes. She's still out there searching.† Thea pulled the binding spell out of her backpack. Two anatomically correct dolls, both made with the blue wax Blaise used for her jewelry. Beautiful little creatures-Blaise was an artist. The male one contained the Kleenex with Eric's blood and a single sandy hair Thea had found clinging to her shoulder. Thea put Pilar's turquoise ring around the feet of the female doll and tied it with a red thread to keep it on. She held out a hand. From her backpack, Blaise produced a corked hexagonal bottle. The liquid inside was made up of all sorts of disgusting things, including ground bezoar stone. Thea held her breath as she poured it over the two figures, which immediately began to smoke. â€Å"Now bind them together,† Blaise said, coughing and waving a hand to clear a space to breathe. â€Å"I know.† Thea took a thin scarlet ribbon seven feet long and patiently began winding it around the two figures. It wrapped them like mummies. She tucked the loose end into a loop. â€Å"And there they are,† Blaise said. â€Å"Bound till death. Congratulations. Let's see, it's ten fifteen now, so he should have forgotten your existence by about†¦ say, ten sixteen.† She reached up and her hair ran like black water through her hands as she stretched. Thea tried to smile. The pain was bad. It was as if some part of Thea's physical body had been cut off. She felt raw and bleeding and not at all able to deal with things like French or trigonometry. There must be more to life. I'll go somewhere and do something for other people; I'll work in third world countries or try to save an endangered species. But thinking about future good works didn't help the raw ache. Or the feeling that if the ache stopped she would just be numb and never be happy again. And all this for a human†¦ It didn't work anymore. She couldn't go back to her old way of thinking. Humans might be alien, but they were still people. They were as good as witches. Just different. She managed to get through the schoolday without running into Eric-which mainly meant scuttling around corridors after bells rang and being tardy for classes. She was scuttling after the last bell toward Dani's U.S. government class when she almost collided with Pilar. â€Å"Thea!† The voice was surprised. Thea looked up. Deep amber-brown eyes, framed by spiky black lashes. Pilar was looking at her very strangely. Wondering at your good luck? Thea thought. Has Eric proposed to you yet? â€Å"What?† she said. Pilar hesitated, then just shook her head and walked off. Thea ducked into the history classroom. Dani said, â€Å"Thea!† Everybody sounds the same. â€Å"Where've you been? Eric's looking all over for you.† Of course, I should have realized. Blaise was wrong-he's not just going to forget about me and walk away. He's a gentleman; he's going to tell me he's walking away. â€Å"Can I go home with you?† she asked Dani wretchedly. â€Å"I need some space.† â€Å"Thea†¦Ã¢â‚¬  Dani dragged her to a corner and looked her over with anxious eyes. â€Å"Eric really wants to find you†¦ but what's wrong?† she whispered. â€Å"Is it something about Suzanne? The old gym's still closed, isn't it?† â€Å"It's nothing to do with that.† She was about to suggest they get moving when a tall figure walked in the door. Eric. He walked straight to Thea. The kids hanging around the teacher's desk were looking. The teacher was looking. Thea felt like a freak show. â€Å"We have to talk,† Eric said flatly. She'd never seen him look quite like this before. He was pale, glassy-eyed, hollow-cheeked. He somehow managed to look as if he'd missed a week's worth of sleep since that morning. And he was right. They had to talk to end it. She had to explain that it was okay, or he'd never be able to go. I can do that. â€Å"Somewhere private,† Thea said. They left Dani and walked through the campus, past the old gym with its yellow ribbon of police tape hanging limp and still. Through the football field. Thea didn't know where they were going, and suspected Eric didn't either-they just kept moving until they were out of sight of people. The green of the tended grass gave way to yellow-green, and then brown, and then desert. Thea wrapped her arms around herself, thinking about how cold it had gotten in just a week and a half. The last trace of summer was gone. And now we're going to talk about it, she thought as Eric stopped. Okay. I don't have to think, just say the right words. She forced herself to look at him. He turned the haggard, haunted face on her and said, â€Å"I want you to stop it.† Funny choice of words. You mean end it, break it off, put it quietly out of its misery. She couldn't get all that out, so she just said, â€Å"What?† â€Å"I don't know what you're doing,† he said, â€Å"but I want it stopped. Now.† His green eyes were level. Not apologetic, more like demanding. His voice was flat. Thea had a sudden sense of shifting realities. All the hairs on her arms were standing up. Caught without a working brain, she said, â€Å"I- what are you talking about?† â€Å"You know what I'm talking about.† He was still looking at her steadily. Thea shook her head no. He shrugged. It was a you-asked-for-it shrug. â€Å"Whatever you're doing,† he said with terrible distinctness, â€Å"to try and make me like Pilar, it has got to stop. Because it's not fair to her. She's upset right now because I'm acting crazy. But I don't want to be with her. It's you I love. And if you want to get rid of me, then tell me, but don't try and foist me off on somebody else.† Thea listened to the whole speech feeling as if she were floating several feet above the ground. The sky and desert seemed too bright, not warm, just very shiny. While her brain ran around frantically like Madame Curie in a new cage, she managed to get out, â€Å"What could I possibly have to do-with you liking Pilar?† Eric looked around, found a rock, and sat on it. He stared down at his hands for a minute or so. Finally he looked up, his expression helpless. â€Å"Give me a break, Thea,† he said. â€Å"How stupid do you think I am?† Oh. â€Å"Oh.† Then she thought, don't just stand there. You bluffed him before. You talked him out of knowing he'd been bitten by a snake. For Earth's sake, you can talk him out of whatever he's thinking now. â€Å"Eric-I guess we've all been under a lot of stress†¦.† â€Å"Oh, please don't give me that.† He seemed to be talking to a clump of silver cholla, eyeing the halos of awful spines as if he might jump into them. â€Å"Please don't give me that.† He took a deep breath and spoke deliberately. â€Å"You charm snakes and read guinea pigs' minds. You cure rattler bites with a touch. You tap into people's brains. You make up magical potpourri bags and your insane cousin is the goddess Aphrodite.† He looked at her. â€Å"Did I miss anything?† Thea found another rock and backed up to it blindly. She sat. Of everything in the universe, right then what she was most aware of was her own breathing. â€Å"I have this feeling,† Eric said, watching her with his green eyes, â€Å"that you guys are in fact the descendants of good old Hecate Witch-Queen. Am I dose?† â€Å"You think you win a prize?† Thea still couldn't think, couldn't put a meaningful remark together. Could only gabble. He paused and grinned, a wry and painful grin, but the first one she'd seen today. Then the smile faded. â€Å"It's true, isn't it?† he said simply. Thea looked out over the desert, toward the huge, bare cliffs of rock in the distance. She let her eyes unfocus, soaking in the expanse of brown-green. Then she put her ringers to the bridge of her nose. She was going to do something that all her ancestors would condemn her for, something that nobody she'd grown up with would understand. â€Å"It's true,† she whispered. He breathed out, a lonely human figure in that vastness of the desert. â€Å"How long have you known?† she asked. â€Å"I†¦ don't know. I mean, I think I always sort of knew. But it wasn't possible-and you didn't want me to know. So I didn't know.† A kind of excitement was creeping into his haggardness. â€Å"It's really true, then. You can do magic.† Say it, Thea told herself. You've done everything else. Say the words to a human. â€Å"I'm a witch.† â€Å"A Hearth-Woman, I thought you called it. That's what Roz was telling me.† At that, Thea was horrified out of her daze of horror. Stricken. â€Å"Eric-you can't talk about this with Roz. You don't understand. They'll kill her.† He didn't look as shocked as she might have expected. â€Å"I knew you were scared of something. I thought it was just that people might hurt you-and your grandma.† â€Å"They will; they'll kill me. But they'll kill you and Roz, too-and your mom and any other human they think may have learned about them-â€Å" â€Å"Who will?† She looked at him, floundered a moment, and then made the ultimate betrayal of her upbringing. â€Å"It's called the Night World.† â€Å"Okay,† he said slowly, half an hour later. They were sitting side by side on his rock. Thea wasn't touching him, although her whole side was aware of his presence. â€Å"Okay, so basically, the descendants of Maya are lamia and the descendants of Hellewise are witches. And together they're all this big secret organization, the Night World.† â€Å"Yes.† Thea had to fight the instinct to whisper. â€Å"It's not just lamia and witches, though. It's shape-shifters and made vampires and werewolves and other things. All the races that the human race couldn't deal with.† â€Å"Vampires,† Eric muttered to the cholla, his eyes going glassy again. â€Å"That's what really gets me, real vampires. I don't know why, it follows logically†¦.† He looked at Thea, his gaze sharpening. â€Å"Look, if all you people have supernatural powers, why don't you just take over?† â€Å"Not enough of us,† Thea said. â€Å"And too many of you. It doesn't matter how supernatural we are.† â€Å"But, look-â€Å" â€Å"You breed much faster, have more children-and you kill us whenever you find us. The witches were on the verge of extinction before they got together with the other races and formed the Night World. And that's why Night World law is so strict about keeping our secrets from humans.† â€Å"And that's why you tried to hand me over to Pilar,† Eric said. Thea could feel his eyes on her like a physical sensation. She stared at a patch of rock nettle between her feet. â€Å"I didn't want you dead. I didn't want me dead, either.† â€Å"And they'd really kill us for being in love.† â€Å"In a minute.† He touched her shoulder. Thea could feel warmth spread from his hand and she had to work to make sure she didn't tremble. â€Å"Then we'll keep it a secret,† he said. â€Å"Eric, it's not like that. You don't understand. There's nowhere we could go, no place we could hide. The Night People are everywhere.† â€Å"And they all follow these same rules.† â€Å"Yes. It's what allows them to survive.† He breathed for a moment, then said in a voice that had gone husky, â€Å"There's got to be a way.† â€Å"That's what I let myself think-for a while.† Her own voice sounded shaky. â€Å"But we have to face reality. The only chance we have of even living through this is for us to just go our separate ways. And for you to try as hard as you can to forget me and everything I've told you.† She was trembling now, and her eyes had filled. But her hands were balled into fists and she wouldn't look at him. â€Å"Thea-â€Å" The tears spilled. â€Å"I won't be your death!† â€Å"And I can't forget you! I can't stop loving you.† â€Å"Well, and maybe that was just a spell, too,† she said, sniffling. Tears were falling straight off her face and onto the rock. Eric looked around for something to give her, then tried to wipe her wet cheeks with his thumb. She whacked his hand away. â€Å"Listen to me. You did miss something when you were adding up what I did. I also make love spells for me. I put one on you, and that's why you fell in love in the first place.† Eric didn't look impressed. â€Å"When?† â€Å"When did I put the spell on you? The day I asked you to the dance.† Eric laughed. â€Å"You-â€Å" â€Å"Thea.† He shook his head. â€Å"Look,† he said gently, â€Å"I fell in love with you before that. It was when we were out here with that snake. When we just looked at each other and†¦ and†¦ I saw you surrounded by mist and you were the most beautiful thing in the world.† He shook his head again. â€Å"And maybe that was magic, but I don't think it was any spell you were putting on me.† Thea wiped her eyes on her sleeve. Okay, so the yemonja had nothing to do with it. Anyway, love spells just seemed to bounce off Eric-even the dolls hadn't worked†¦. She bent suddenly and picked up her backpack. â€Å"And I don't know why this didn't work,† she muttered. She took out a quilted makeup bag, unzipped it, and reached inside. The dolls came out as a bundle. At first glance they looked all right. Then Thea saw it. The male doll had turned around. Instead of being face-to-face with the female doll, it had its back to her. The scarlet ribbon was still wound tightly around them. There was no way that it could have slipped, that this could have happened by accident. But the dolls had been inside the case, and the case had been inside her backpack all day. Eric was watching. â€Å"That's Pilar's ring. Hey, is that the spell on me and Pilar? Can I see it?† â€Å"Oh, why not?† Thea whispered. She felt dazed again. So it couldn't have been an accident, and no human could have done it. And no witch could have done it either. Maybe†¦ Maybe there was a magic stronger than spells. Maybe the soulmate principle was responsible, and if two people were meant to be together, nothing could keep them apart. Eric was gingerly unwinding the scarlet ribbon. â€Å"I'll give the ring back to Pilar,† he said. He reduced the binding spell to its constituent parts, put them gently back in the makeup bag. Then he looked at her. â€Å"I've always loved you,† he said. â€Å"The only question is†¦Ã¢â‚¬  He broke off and looked like the shy Eric she knew again. â€Å"Is, do you love me?† he finished at last. His voice was soft, but he was looking at her steadily. Maybe there are some things you just can't fight†¦. She made herself look at him. The image wobbled and split. â€Å"I love you,† she whispered. â€Å"I don't know what's going to happen, but I do.† They fell-slow as a dream, but still falling-into each other's arms. â€Å"There's a problem,† Thea said some time later. â€Å"Besides all the other problems. I'm going to be doing something next week, and I just need you to give me some time.† â€Å"What kind of something?† â€Å"I can't tell you.† â€Å"You have to tell me,† he said calmly, his breath against her hair. â€Å"You have to tell me everything now.† â€Å"It's magic stuff and it's dangerous-† A second too late she realized her mistake. â€Å"What do you mean, dangerous?† He straightened up. His voice told her the peaceful interlude was over. â€Å"If you think I'm going to let you do something dangerous by yourself†¦Ã¢â‚¬  He wore her down. He was good at that-even better than his sister-and Thea was no good at refusing him. In the end she told him about Suzanne Blanchet. â€Å"A dead witch,† he said. â€Å"A spirit. And a very angry one.† â€Å"And you think she's coming back,† he said. â€Å"I think she's been here all along. Maybe hanging around the old gym, which hasn't done her any good since nobody's been there assaulting dummies. But if they open it to have the Halloween party†¦Ã¢â‚¬  â€Å"It'll be full of humans, all visiting those booths, all reminding her of what she hates. She can pick them off like ticks off a dog.† â€Å"Something like that. I think it could be bad. So what I've got to do is quietly lure her somewhere else and then send her back where she came from.† â€Å"And how are you going to do that?† â€Å"I don't know.† Thea rubbed her forehead. The sun was dipping toward the cliffs and long afternoon shadows had fallen across the desert. â€Å"You've got a plan,† Eric said matter-of-factly. Not you, Thea thought. I promised myself I wouldn't use you. Not even to save lives. â€Å"You've got a plan you think is dangerous for humans. For me, since I'm going to be helping you.† I will not use you†¦. â€Å"Let's make this easy on everybody. You know I'm not going to let you do it alone. We might as well take that as given and go on from there.† This is the crazy guy who ignores snakebites and attacks people with punch, she reminded herself. Do you really expect to talk him out of helping you? But if something were to happen to him†¦ The voice came back again, and Thea didn't understand it and she didn't like it at all. Would you give up everything?

Monday, September 16, 2019

Ethical Challenges in the Era If Health Care Reform

Ethics, Law, and Policy Vicki D. Lachman Ethical Challenges in the Era Of Health Care Reform n truth, the United States is at the beginning of a long overdue and a much needed health care reform. We have seen the dismal statistics about our high cost health care system and some of the less than stellar outcomes (e. g. , infant mortality) (Callahan, 2011; World Health Organization [WHO], 2011)). The purpose of this article is not to complain about the current health care system, but instead to focus on existing reform efforts — The Patient Protection and he Affordable Care Act (ACA), the ethical justifications for its creation, and ethical challenges it brings. I Key Features of the Law ACA offers new ways for consumers and providers to hold insurance companies accountable. The most important parts of the law are features described in the following discussion. Because of space limitation, I will highlight some elements of the law that are enacted through 2014 and clearly impact nursing. These selected features include insurance choices, insurance costs, rights and protection, and people age 65 and older. Insurance ChoicesThe intention of the law is to expand health care coverage to most U. S. citizens and permanent residents by requiring most people to have or purchase health insurance (HealthCare. gov, 2012a). Citizens will have a choice of private insurance, employer-paid insurance, Medicaid, Medicare, or state-based insurance exchanges. Affordable Insurance Exchanges. Individuals and small businesses can purchase coverage through these exchanges, with premium and cost-sharing credits available to individuals and families with income between 133%-400% of the federal poverty guideline (in 2011, the overty guideline was $18,530 for a family of three) (Werhane & Tieman, 2011). Businesses with 50 or more employees need to make coverage available, and businesses with less than 25 employees will qualify for tax credits to offset their cost (Kaiser Family Foun dation, 2011). Consumer Operated and Oriented Plan (CO-OP). The ACA produces a new kind of non-profit health insurer, called a Consumer Operated and Oriented Plan (CO-OP). CO-OPs are meant to offer consumer-friendly, affordable health insurance options to individuals and small businesses. By January 1, 2014, individuals will be able to buy a CO-OPVicki D. Lachman, PhD, APRN, MBE, FAAN, is Clinical Professor, and Director, Innovation and Intra/Entrepreneurship in Advanced Practice Nursing, Drexel University, College of Nursing and Health Professions, Philadelphia, PA. 248 health plan through the Affordable Insurance Exchanges. Pre-existing condition insurance plan. All covered benefits are available to individuals, even to treat a pre-existing condition. This program offers temporary protection for people with pre-existing conditions until 2014, when insurance companies can no longer deny individuals coverage based on their health status.Young adult coverage. Individuals can add or k eep their children on their health insurance policy until they reach age 26. The law makes it easier and more affordable for young adults to get health insurance coverage. Insurance Costs ACA holds insurance companies accountable. It also helps individuals keep their costs down. Value for individual’s premium dollar. ACA requires insurers selling policies to individuals or small groups to spend at least 80% of premiums on direct medical care and efforts to improve the quality of care. Unfortunately, this does not apply to self-insured plans.Lifetime and annual limits. ACA restricts and phases out the annual dollar limits a health plan can place on most of its benefits. Furthermore, ACA eliminates these limits completely in 2014. Rate review. Insurance companies must now justify proposed rate increases for health insurance. Insurance companies cannot raise rates by 10% or more without first explaining the reasons to the state or federal rate review program. Rights and Protecti ons The ACA puts consumers in charge of their health care, not insurance companies. The following rights and consumer protections are available. Preventive care.Individuals may not have to pay a copayment, co-insurance, or deductible to receive recommended preventive health services, such as screenings (e. g. , mammograms and colonoscopies), vaccinations (e. g. measles, polio, or meningitis), and counseling (e. g. , smoking cessation, weight loss, healthy eating). Doctor choice and ER access. Individuals can choose any available participating primary care provider and they can access out-of-network emergency rooms without prior approval. ACA prohibits health plans from requiring a referral from a primary care provider before women can seek coverage for obstetrical or ynecological (OBGYN) care. People 65 and older. ACA offers eligible elders a range of preventive services with no cost-sharing. ACA also provides discounts on drugs when older adults are in the coverage gap known as the â€Å"donut hole. † July-August 2012 †¢ Vol. 21/No. 4 Ethical Challenges in the Era of Health Care Reform TABLE 1. Views of Liberal Egalitarians vs. Libertarians and Free-Market Advocates Liberal Egalitarians Libertarians and Free-Market Advocates Health care is a fundamental good and access to this good Role of government is confined to protecting the freedom of all allows us to become full members of society. ersons to choose their own goals and means to pursue them. This right to health care must be exercised by removing all People have a right to non-interference. barriers to access. Justice, equality, and community are values. Freedom and personal responsibility are values. Health care is a right. Health care is a commodity. Single-payer system is the solution. Decentralized market mechanisms with personal payment are the solution. Preventive services. The list is significant and begins with an annual wellness visit. Other important preventive services include bone mass measurement; cervical cancer creening, including Pap smear tests and pelvic exams; colorectal, prostate, and diabetes screening; influenza, pneumonia, and hepatitis B immunizations; and many other services. There are other services and features in the ACA that could be discussed, but we will now move to discuss the ethical justifications for the ACA. The controversy it has created in the eyes of individuals with a free-market or libertarian view will be compared to those with a liberalegalitarian outlook. Ethical Justifications for the ACA Since 1986, the Emergency Treatment and Labor Act has prohibited hospitals from refusing acute care to any ndividual who could not afford to pay (CMS. gov, 2012). â€Å"Consequently, $100 billion of care annually is ‘costshifted’ onto patients who can pay, almost all whom are insured. This shift raises the average annual health insurance premium roughly $1,000 for every insured family† (Crowley, 2009, p. 10). This lack of distributive justice for the insured is one reason why insurance is being mandated in ACA. It is equally unfair to mandate that all citizens have insurance if insurance is not affordable, as this could cause significant harm to individuals and families already struggling financially.Therefore, the ethical principles of beneficence and nonmaleficence are supported by the features of Affordable Insurance Exchanges and the development of Consumer Operated and Oriented Plans. Ethical reasoning for health care reform has relied primarily on distributive justice as justification for change, specifically due to lack of access to care for the underinsured and uninsured (Lachman, 2009). According to the U. S. Census Bureau, 46. 3 million people in the United States were uninsured in 2008 (ProCon. org, 2012). The United States is the only developed nation in the world hat does not guarantee health coverage. Table 1 offers a comparison of views of persons who support distributive justice, see health care as a right, and therefore want a single-payer system with those individuals who want to continue the free-market system. â€Å"To single-payer advocates, the primary goal of health policy is ensuring that everyone can obtain some minimal level July-August 2012 †¢ Vol. 21/No. 4 of health care† (Sade, 2007, p. 1429). Making access to health care widely available permits individuals to be fully functioning members of society and the moral ommunity (a group of people drawn together by a common interest in living according to a particular moral philosophy). On the other hand, Americans who are libertarians and free-market advocates mostly look beyond the natural (genetic) and social (upbringing) lottery that places some at a disadvantage and instead look to the individual’s free will and personal responsibility for actions (Callahan, 2011; Pariser, 2012; Trotter, 2011). They believe health care is one of the many options from which to choose to improve the ir lot in life. Their belief in personal responsibility can make them unsympathetic o people with unhealthy lifestyles for whom they would ultimately have to spend their insurance dollars. They also resent having to fund treatments they personally would not choose (e. g. , transplants, mechanical ventilation for person in persistent vegetative state). Though many wealthy individuals support health care reform out of benevolence, they do fear the loss of freedom which is central to their value system. However, two additional factors drive change for health care reform — significant cost and quality problems. In 2007, health care expenditures totaled $2. 2 trillion, 16. 2% of the U.S. economy. Health care employs more than 14 million people and is the largest industry in the United States. Of the 193 WHO member states, the United States is ranked first in per capita health care expenditures ($6,719) (ProCon. org, 2012). The present health care system is not giving the utility f or the dollars spent. This cost problem is a reason that ACA has a focus on physicians counseling individuals on end-of-life options. It found that about 30 percent of Medicare dollars are spent during the last year of life, and half of that is spent during the last 60 days. In 2009 dollars, Dr.Gordon calculated, that amounts to $70 billion a year, much of it spent on futile care that prolongs suffering (Brody, 2009, para 20). Unfortunately, politics initially got in the way in 2009 with the â€Å"death panel† jargon and this counseling was dropped from ACA; however, this end-of-life options counseling was incorporated into 2011 Medicare reimbursement for health care providers (HealthCare. gov, 2012b). 249 Ethics, Law, and Policy WHO (2011) statistics also indicate the money spent is not putting us at the top of the list in quality outcomes. The infant mortality rate for the United States in 2009 was even deaths per 1,000 live births, ranking the United States 43rd among WHO nations. Rates for Sweden, Spain, Italy, Germany, France, Czech Republic, Slovenia, and Iceland are all half of the United States rate. Quality is a focus of ACA in the preventive realm and with quality measurement. Two essential principles of the ACA are that: 1. Provider reimbursement for health services is based, in part, on the relative quality and patient experience of the care provided. 2. Information about that comparative quality and patient experience will be publicly accessible. Quality and patient satisfaction will be rewarded by ata from hospital comparison required by the Hospital Consumer Assessment of Healthcare Providers and Systems for Medicare patients. â€Å"The implications of Value-Based Purchasing (VBP) regulations for hospitals are clear — FY2013 implementation at 1% of base DRG payments, rising to 2% by FY2017† (Acton, 2012, para 2). Hospitals will have to earn it back by achieving and maintaining high quality and positive patient experiences. T his consequential focus in the patient care experience supports the autonomous choice of the patient for hospitals and physicians. Ethical Challenges of ACA Legal ChallengeBefore discussing three key ethical challenges health care providers will face, the legal challenge before the Supreme Court needs to be addressed. This challenge determined if the ACA requirement to purchase health insurance violates Article 1, Section 8, Clause 3 of the U. S. Constitution: Congress shall have the Power To lay and collect Taxes, Duties, Imposts, and Excises, to pay the Debts and provide for the common Defence and the general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States†¦ (Werhane & Tieman, 2011, p. 83)The argument against this mandate is that the government has never required people to buy any good or service as a condition of lawful residence in the United States. However, every working person is required to pay into Social Security and Medicare. The counter argument is that these are government-mandated and governmentrun programs. This argument ultimately could support a Supreme Court decision of only a government-run singlepayer system, an action libertarians and free-market advocates oppose. Second, there are requirements for car insurance for drivers, and flood insurance for persons ho live within authorized distance from a possible flood plain. Because all people will need health care at some point in their lives, the argument could be made that insurance should be a requirement so as not to burden the moral community with the costs of those who do pay for insurance (Hamel & Nairn, 2011). 250 On June 28, 2012, the U. S. Supreme Court endorsed most of the Patient Protection and Affordable Care Act, including the contentious individual mandate that requires most Americans to obtain health insurance. In a 5-4 decision, the court said the federal government has he power to fine Americans who do not ac quire insurance because it is considered a tax (Jaslow, 2012). Electronic Medical Records The requirement for electronic records could generate a significant ethical challenge for privacy and confidentiality. Unfortunately, the $20 billion for health information technology from the American Recovery and Reinvestment Act (ARRA) did little to change the current HIPPA privacy paradigm (Crowley, 2009). Furthermore, it is likely patients will carry their personal health records in their own electronic devices or retrieve them through the Internet.A transformation in rural health care is likely through telehealth and telehomecare. These innovations will bring expertise to patients to facilitate the best choice in their treatment decisions. The challenge will be to assure informed consent and confidentiality in this expanded digital age. Chronic Disease Management Individuals with chronic illness benefit significantly from palliative care services, not just at end-of-life care but througho ut the disease progression. The ACA focus on chronic disease management is best exemplified by this phrase: â€Å"An integrated care approach to managing illness hich includes screenings, check-ups, monitoring and coordinating treatment, and patient education† (HealthCare. gov, 2012b, para 1). Feministic ethics, with its focus on managing the particulars of any person’s situation, celebrates this personalized service to individuals who must manage illnesses often for many years. In her book, Caring: A Feminine Approach to Ethics and Moral Education, Nell Noddings (2003) argued that a morality based on rules is inadequate. She contended this approach loses the richness of the moral dilemmas people face, and nly situational and contextual knowledge of the individual can help resolve the moral quandaries of life. Shaping Health Care Policy According to the Code of Ethics for Nurses, provision 9 (American Nurses Association [ANA], 2001), nurses have an obligation to  "work individually as citizens or collectively through political action to bring about social change† (p. 25). This responsibility to shape social (health care) policy calls for nurses to voice concerns about the meaning of the rejection of the individual mandate for society. The libertarians and free-market advocates reinforce a caricature of American individualism and weaken a sense of responsibility for oneself and fellow citizens†¦It neglects one side of the equation, forgetting that we are not only individuals with the freedom to choose, but also members of society called to uphold a common good. (Hamel & Nairn, 2011, p. 94) continued on page 245 July-August 2012 †¢ Vol. 21/No. 4 Ethics, Law, and Policy REFERENCES continued from page 250 Therefore, nurses and nursing associations have the ethical challenge to stand firm for patients and ensure the long-term sustainability of our health care system.Nurses need to advocate for the people without a voice — t hose discriminated against because of health status and lack of insurance. Conclusion ACA has provided a forum for debate about not only health care insurance, mechanisms to maintain financial stability of its systems, and strategies to ensure access to millions of people, but also has contributed to defining American society’s values. It is easy to argue against the individual mandate impingement on choice and freedom. 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(2012). Medical groups laud Supreme Court’s decision on Affordable Care Act. Retrieved from http://www. cbsnews. com/8301504763_162-57462837-10391704/medical-groups-laud-supremecourts-decision-on-affordable-care-act/ Kaiser Family Foundation. (2011). Summary of new health reform law. Retrieved from www. kff. org/healthreform/8061. cfm Lachman, V. D. (2009). Ethical challenges in healthcare: Developing your moral compass. New York, NY: Springer. Noddings, N. (2003). Caring: A feminine approach to ethics and moral education.Berkeley, CA: Universit y of California Press. Pariser, D. M. (2012). Ethical considerations in health care reform: Pros and cons of the affordable care act. Clinics in Dermatology, 30(2), 151-155. ProCon. org. (2012). Right to healthcare: Did you know? Retrieved from http://healthcare. procon. org/ Sade, R. M. (2007). Ethical foundations of health care system reform. Annuals of Thoracic Surgery, 84(5), 1429-1431. Trotter, G. (2011). The moral basis for healthcare reform in the United States. Cambridge Quarterly of Healthcare Ethics, 20(1), 102-107. Werhane, P. , & Tieman, J. 2011). Clearing the brush: Myths surround the Affordable Care Act. Health Progress, 92(4), 82-84, 86-87. World Health Organization (WHO). (2011). World health statistics 2011. Retrieved from http://www. who. int/whosis/indicators/WHS2011_ IndicatorCompendium_20110530. pdf 245 Copyright of MEDSURG Nursing is the property of Jannetti Publications, Inc. and its content may not be copied or emailed to multiple sites or posted to a listser v without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.