Louis Riel Essay -- essays research papers

On October 23, 1844, in Red River Manitoba, Louis Riel Sr and Julie Lagimodiere, devout Christians, brought a young Mà ©tis boy into the world. Little did they know, Louis Riel Jr. would grow up to become known to many as â€Å"the founder of Manitoba.† His life was filled with excitement, both political and personal. The question is, were his actions against the government acts of honor and truth, or deception and lies?   Ã‚  Ã‚  Ã‚  Ã‚  Riel Jr.’s political adventures did not begin until he was 25. On November 23, 1869, Riel proposed the formation of a provincial government to replace the Council of Assiniboia because he did not believe that they were not doing their jobs well enough to improve the dull life in Red River. On December 10th his flag flew on the pole at Fort Gary. Riel held a convention of twenty French and twenty English Canadians to draw up a new list of rights. The convention sat a week and finished on February 10th. Riel soon formed another provincial government that was more represented than the last. Three delegates were chosen from the provincial government to present the list of formed rights to the Canadian government: Father Noà «l Ritchot, Judge Black and Alfred Scott . On March 24th, the three delegates left for Ottawa to negotiate entry into Confederation and discuss the list of rights. Finally on May 12th, 1870, the list of rights, now known as the â€Å"Manit oba Act† , was passed by Canadian parliament. One section protected Mà ©tis lands, guaranteed the right to their religion, and the use of their language in the legislature and courts, but it seemed not enough. December 16th 1884, Riel dispatched a petition to Ottawa demanding that settlers be given title to the lands they occupied, that the districts of Saskatchewan, Alberta and Assiniboia be granted provincial status, that laws be passed to encourage nomadic Indians and Mà ©tis to settle on the lands and that they be better treated. On February 11th, 1885, the government answered the petition by promising to appoint a commissioner to investigate the Mà ©tis claims and titles. First, a lengthy census would be taken of the Mà ©tis. Riel, since little had been accomplished, questioned his own leadership qualities. The Mà ©tis reaffirmed their vision of Riel as a leader and asked him to continue as their leader.   Ã‚  Ã‚  Ã‚  Ã‚  Not long after these issues were tabled, a ... ...nment feared him? Whatever the reason, it was wrong. No man can be exiled without a clear, good reason , says the Charter of Rights and Freedoms. This Charter was established in 1872. Long before the trial. Riel’s exile is one of the main reason Riel was viewed as a traitor: not good enough for Canada. It appears that Riel’s treacherous deeds were merely a myth, brought upon by the government to stir fear in the heart of Riel followers.   Ã‚  Ã‚  Ã‚  Ã‚  So to answer the question of â€Å"truth or treason?† I say truth. Riel began his own provincial government, improving it as time went on; even in a weak moment of question, his people supported him. When battle and political issues drove him from his home, he did it with grace; yet, when he returned he spoke eloquently on the subject. Even during his trial, he spoke with all the dignity and honor of a gentleman and a hero. His death was for his people. If that does not prove his honor, I do not know what does. Riel’s life and troubles have taught us much. In the future, we must not allow the government to control whom we believe in. We cannot allow another honorable person to die because he or she are seen as a threat.

All The King’s Men :: essays research papers

The title of the book is All The King’s Men and the Publication date for this book is 1996. The author Robert Penn Warren was a very famous author. His life was full of many achievements that helped him become recognized. He even won the Pulitzer Prize for this book All The King’s Men. Warren was inspired to write this book because when he was younger he lived in the state of Louisiana and around this time Huey P. Long was already an established politician. Warren started out writing poetry but then turned to writing novels. His works are loved and cherished by many and even used in today’s schools. It is safe to say that Robert Penn Warren was one of America’s most brilliant writers. This book takes place in the southern part of the United States in the 1930s. Although Warren never reveals the true setting of this book, one can conclude that this took place in Louisiana seeing how Warren became inspired in that state by a person who is mirrored in this very book. Part of this novel is in Mason City. Another place in this novel is Burden’s Landing Jack , the main character, goes there many times because this is his hometown. This novel is mainly about the rise and fall of the political figure Willie Stark told through the eyes of his business associate and friend Jack Burden. Willie stark in his early political career is all for helping the people and trying to do what is best for them. As he gains power and the trust of his people he soon becomes corrupt by the evils of success. Characters Jack Burden- He is the narrator of this story and he is the companion of Willie Stark. He works at a newspaper company before getting a job from Willie after they become acquainted . Readers will learn his story while they are learning about the life of Willie. Willie Stark-He becomes a treasurer of Mason City and from there his political career takes flight. After becoming a treasurer Stark decides to study law and become a lawyer. After he receives some success he runs for governor and becomes a power-hungry politician. Sadie Burke-She was an employee and mistress of Willie Stark. She has a crude behavior and has an outspoken personality. Later she becomes very intolerant in all the women Stark is with. Two reoccurring motifs and symbols are The Great Sleep and the Hospital.

Civil engineering (outline) :: essays research papers

Civil Engineer I.  Ã‚  Ã‚  Ã‚  Ã‚  A construction engineer can plan, design, and build any thing from roads, buildings, airports, tunnels, bridges, dams, and water systems all over the world. II.  Ã‚  Ã‚  Ã‚  Ã‚  Job Information A. Pay 1. In Idaho they get paid $17.50 to $41.88 2. Nationally they get paid $19.65 to $44.24 B. Special requirements 1. Bachelor’s degree in civil engineering 2. Engineering license a. 4 years as an engineer in training b. Pass the professional engineer exam C. Employment 1. About 228,000 work as civil engineers in Nationally 2. About 1,180 civil engineers work III. Preparations A. Complete a bachelor’s degree in civil engineering 1. A lot get a master’s degree B. Have strong observational skills C. Be creative IV. Specific Activities A. Plan, design, and build 1. Roads 2. Buildings 3. Airports, 4. Tunnels 5. Bridges 6. Dams 7. Water systems B. Test for strength 1. Soil 2. Materials C. Conduct studies 1. Traffic patterns 2. Environmental conditions V. Work conditions A. Physical 1. Work both indoors and outdoors 2. Exposed to contaminants 3. Exposed to very hot or cold weather 4. Exposed to hazardous equipment A.  Ã‚  Ã‚  Ã‚  Ã‚  Hours/ travel 1. Usually work standard 40-hour weeks 2. May work longer to meet deadlines 3. Travel a lot to get to work sites B.  Ã‚  Ã‚  Ã‚  Ã‚  Interpersonal relationships 1. Deal with external costumers or associates 2. Sometimes placed in a conflict situation VI. Common Activities A. Think creatively B. Use computers C. Provide information 1. Devices 2. Equipment 3. Structures D. Estimate 1. Size 2. Time 3. Cost 4. Quantities 5. Materials needed VII. Skills and abilities A. Use math and science 1. Choose a mathematical method 2. Use math skills to solve problems

Discrimination of Micronesians in Hawaii Essay

Since the COFA (Compact of Free Association) Act was formalized between the Pacific Island nations of Micronesia and the United States in 1986, there have been rising influxes of Micronesian citizens that have the privilege of entering the U. S. without the need for a visa or time limit. These FAS (Freely Associated States) include the Republic of Palau, the Republic of the Marshall Islands and the Federated States of Micronesia. While there is no obligation to immigrate to a specific state within the U. S. , many choose to settle on Hawai’i. Due to its proximity to their home islands and tropical environment, the Micronesian population in Hawai’i has been steadily increasing during recent years. It is estimated that around 15,000 COFA migrants are currently residing in Hawai’i, where they subsequently face many barriers as new immigrants, including language, social and cultural barriers. Specifically, there is an ever-growing presence of Micronesian stereotyping and marginalization that is frequently exhibited by other ethnic populations in Hawai’i. Because they are seen as the â€Å"newest† population to arrive on the islands and the fastest growing, Micronesians are subject to many forms of discrimination. In recent years, our local community has been ill-equipped and misinformed about the Micronesian population. Consequently, our unfamiliarity has contributed to their isolation and discrimination within the Hawai’ian Islands. It is important for us as residents of Hawai’i to bridge the gap that exists between Micronesians and what we perceive as our own â€Å"local society†. Due to our society being misinformed and social control factors at work, we perceive Micronesians as being inept, destitute and imprudent. There are several barriers that hinder Micronesian assimilation within the islands. One such barrier is within the health care system. In Dr. Yamada’s article titled, â€Å"Discrimination in Hawaii and the Health of Micronesians†, he says Micronesians are often victims of â€Å"inferior care or denial of services†. There are instances of Micronesian patients that are denied services and being referred to another clinic, or being discriminated against due to their perceived lack of adherence to treatment plans. Personally, I believe that there is a kind of â€Å"ignorance† that health care providers bestow upon Micronesian patients. In 2006, I began working as a volunteer for the Kaka’ako homeless shelter and clinic started by Dr. Jill Omori that included inhabitants comprised mostly of Micronesian ethnicity. Many of them were unable to find a job and help themselves financially. Those individuals who lacked the means to support their family also sought refuge at the shelter. I observed that a lot of the older Micronesian shelter inhabitants could not speak English, and those who did only had limited basic knowledge and phrases that they used. What was surprising, however, was that most of the doctors and medical students who treated these patients did not having a working knowledge of the Chuukese language, which is spoken by the majority of the Micronesians. Many of these patients used the help of their children who were fortunate to attend public schools. Thus, a language barrier had existed, and still to this day, is continually a major factor in the fair treatment of health care delivery among Micronesians. In the health care system, it can be challenging to relay medical information from English into Chuukese. Pobutsky et. al. uggests having health education materials translated and readily available for Micronesian patients. Pobutsky also notes that having interpreters fluent in Chuukese is essential. Regarding denial of health services, Yamada talks about how COFA migrants were denied MED-QUEST (a Medicaid program) benefits in July 2010 by the Hawai’i State Administration. It was reinstated 4 months later because the denial was in direct violation of the Equal Protection clause of the 14th Amendment of the U. S. Constitution. Such discrimination is not only seen in our health care system, but also within the confines of social and economic settings. Yamada suggests that examining and countering â€Å"prevailing social forces† will help eliminate discrimination. By my personal interpretation, he is saying we must realize that social forces – such as the criminal justice system and the government – are shared by all of us as one single community in Hawai’i. By being responsible and looking out for one another regardless of race or ethnicity, we can close the social bridge that divide us. In other words, we must be proactive and bring to light the issues that face Micronesian immigrants who are treated unfairly. Another brief policy report from the Hawai’i Appleseed Center for Law and Economic Justice (HACLEJ) provides accounts of stigmatization by governmental leaders towards COFA migrants. The report further goes on to explain how there is an absence of interpreters available to help COFA migrants within labor, housing and court disputes. Within the context of the court system, it can be a challenge for someone convicted who does not have a working knowledge of the English language. HACLEJ emphasizes the need to â€Å"stimulate awareness, advocacy and action† in order to better address Micronesians living in Hawai’i. Several paths can be taken to address discrimination issues against Micronesians. Already, there are many advocates and groups that support Micronesians and other at-risk migrants. Some of these groups do not receive funding from the state of Hawai’i, and must rely on private funds to continue their work. There are also few research projects that involve Micronesians living in Hawai’i and thus there is little information in regards to ethnographic and qualitative studies. Additionally, surveys measuring Micronesians’ health needs and risk factors should be included within the context of how to better deliver health care. Within the political system, our lawmakers should be better informed and take more consideration into immigration affairs. Pobutsky et. al. gives several examples of health service programs that are currently in the process of addressing the language barriers and health concerns of Micronesians, but there is much more work to be done in order to achieve long-term success. Allocation of state and government funds should be directed towards creating more educational and social programs that can help better address disparities quite often seen with newly arrived immigrants. Based in part by my own personal experiences and also through research, many Micronesians are illiterate and lack a good work ethic to succeed in future endeavors. Because Micronesians are discriminated both in the job market and in school, they may perceive themselves as being unable to achieve success that is often seen with other ethnicities. Consequently many of them, especially Micronesian youths, engage in criminal behavior and illicit activities. My worry is that this cycle will manifest itself unchecked among these youths well into adulthood and create more harm than good within the criminal justice system of Hawai’i. As citizens of a diverse society in Hawai’i, we need to be more proactive and open-minded on issues that deal with the Micronesian population as a whole. Local perspectives that Micronesians are a kind of â€Å"deviance† on the islands and a â€Å"burden† to our society are obstructive to our continuous theme of the â€Å"Aloha spirit†. We must come together as a society and be more considerate and helpful to those who we might think less highly of. As long as institutions of power continue to ignore the problem of discrimination and disparity, then recent immigrants who include Micronesians will continue to face hardship. In our study of social control theory, there is the idea of â€Å"strain† that is frequently seen in societies that stress hard work and having a good education. More research efforts and studies must be done in order to better assess disparities present within the Micronesian population in Hawai’i, as well as having adequate funding by the state to support programs that meet the needs of the Micronesian community.

The Aging Special Senses

Vanessa McClain Anatomy and Physiology GE 258 Unit 9. Assignment 2. The Aging Special Senses Thursday, November 17, 2011 1. ) Age-related Macular Disease – Is a disease associated with aging that gradually destroys sharp, central vision. Central vision is needed for seeing objects clearly and for common daily tasks such as reading and driving. AMD affects the macula, the part of the eye that allows you to see fine detail. There are two forms of age-related macular degeneration: Dry form and Wet form. The dry form is characterized by the presence of yellow deposits, called drusen, in the macula. A few drusen may not cause change in vision; however, as they grow in size and increase in number, they may lead to a dimming or distortion of vision that people find most noticeable when they read. In more advanced stages, there is also a thinning of the light-sensitive layer of cells in the macula leading to atrophy, or tissue death. In the atrophic form, patients may have blind spots in the center of their vision. The wet form is characterized by the growth of abnormal blood vessels from the choroid underneath the macula. These blood vessels leak blood and fluid into the retina, causing distortion of vision that makes straight lines look wavy, as well as blind spots and loss of central vision. They eventually scar, leading to permanent loss of central vision. They affect daily life in that there is struggle to do housework, studying, shopping, enjoying leisure activities and interests such as reading. 2. ) Glaucoma – Is a disease in which damage to the optic nerve leads to progressive, irreversible vision loss because the aqueous humor does not flow out of the eye properly and fluid pressure builds up over time causing damage to the optic nerve. It is the second leading cause of blindness. It affects one’s daily life such as driving or playing certain sports . It causes contrast sensitivity, problems with glare, and light sensitivity which interfere with daily activities. 3. ) Cataracts – Are cloudy areas in the lens inside the eye which is normally clear. There are two types: Age related cataracts which appear later in life and congenital cataracts, that may be present when a baby is born or shortly after birth. Cataracts cause an individual to see halos around lights. In some, the glare from car ights become bothersome and driving at night may be dangerous. Although far sight is affected more than near vision. If the cataracts are bad enough, it can make reading more difficult as well. 4. ) Detached Retina – Is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, l eading to vision loss and blindness. It affects daily activities because of the sudden appearance of â€Å"floaters†, (dark, semi-transparent, floating shapes) in the field of vision or a shower of black dots. These are actually red blood cells because all retinal tears bleed a little when they occur. ) It causes a loss of central vision, a loss of peripheral vision called the â€Å"curtain effect† and brief, bright flashes of light which may be most noticeable when you move your eyes in the dark. 5. ) Deafness (sensorineural and conductive) – Sensorineural hearing loss is due to damage to the pathway that sound impulses take from the hair cells of the inner ear to the auditory nerve and the brain. Conductive hearing loss is caused by anything that interferes with the transmission of sound from the outer to the inner ear. Both of these hearing losses affect daily life because you may experience difficulty localizing sounds or understanding speech in busy environments and participating in everyday normal conversations which can lead to social isolation, frustration, tension, anger, stress and depression. 6. ) Meniere’s Disease – Is a disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of vertigo and tinnitus and progressive hearing loss, though usually in one ear. It affects daily life because for some, sounds appear tiny or distorted and may experience unusual sensitivity to noises. In addition, you may experience a sensation of fullness or pressure in one or both ears and unilateral or bilateral tinnitus. Some may have parasitic symptoms, which aren’t necessarily symptoms of Meniere’s, but rather side effects from other symptoms. Typically these are nausea, vomiting and sweating. 7. ) Ataxia – Is an inability to coordinate muscle activity during voluntary movement, most often results from disorders of the cerebellum or the posterior columns of the spinal cord; may involve the limbs, head or trunk. Affects one’s daily life because it can alter a person’s walking pattern. For e. . wide based unsteady gain with difficulty stopping, turning and problem walking in poorly lit areas. It can cause falls due to postural instability, difficulty with tasks requiring fine control and coordination, tremors during voluntary movement, slurred speech and altered handwriting. 8. ) Hyposomnia – literally means â€Å"less† sleep. I t is a condition whereby a person does not need as much sleep as a normal individual. Specifically, they sleep less than 6 hours per night, but are adequately rested. It may occur at the onset, during or at the termination of sleep, and is common among the elderly. It affects daily life because the person that sleeps less but feels they need more experience the same problems as the person with insomnia that cannot sleep more than a few hours but feel they need more. It affects everyday life and activities because it is usually accompanied by general emotional upset, depression, or anxiety. References Conductive and Sensorineural hearing loss | Hearing Aid Know. (n. d. ). Hearing aids – hearing loss – help, information and blog – hear aids | Hearing Aid Know. Retrieved November 13, 2011, from http://www. hearingaidknow. om/2007/10/25/conductive-and-sensorineural-hearing-loss/ Detached Retina (or Retinal Detachment): Eye Conditions: Patient Care: U-M Kellogg Eye Center. (n. d. ). University of Michigan Kellogg Eye Center in Ann Arbor, Michigan. Retrieved November 13, 2011, from http://www. kellogg. umich. edu/patientcare/conditions/detached. retina. html Manan Hearing Care | Types of Hearing Loss. (n. d. ). Manan Hearing Care | #1 Midwest On-Site Hearing Care. Retrieved November 13, 2011, from http://mananhearing. com/types_of_hearing_loss. html Meniere's disease – MayoClinic. com. (n. d. ). Mayo Clinic. Retrieved November 13, 2011, from http://www. mayoclinic. com/health/menieres-disease/DS00535 What is Cataracts?. (n. d. ). Consumer Reports: Expert product reviews and product Ratings from our test labs. Retrieved November 13, 2011, from http://www. consumerreports. org/health/conditions-and-treatments/cataracts/what-is-it. htm What is Glaucoma? | Glaucoma Research Foundation. (n. d. ). Glaucoma Research Foundation. Retrieved November 13, 2011, from http://www. glaucoma. org/glaucoma/what-is-glaucoma. php? gclid=CO2f2Jvns6wCFY3KKgodyH2rIQ hyposomnia (thing)@Everything2. com. (n. d. ). Everything2. Retrieved November 13, 2011, from

Explain the Strengths and Weaknesses of Aquinas’ Cosmological Argument

a) Explain the strengths and weaknesses of Aquinas’ cosmological arguments. The cosmological argument is an a posteriori argument based on the question of the relation of the universe’s existence and God’s existence. This argument focuses on the theory that if the universe exists then something must have caused it to existence, ie. A God or Creator. Supporters of this argument claim that to fully comprehend the existence of the universe, one must rely on a theory of a God however critics would say that due to the inability to prove God’s existence means that the universe cannot be fully explained.Many who don’t support the cosmological believe there doesn’t necessarily need to be an explanation for the universe’s existence as it simply exists. Some strengths of the cosmological argument is that it gives an explanation and reason for the universe as oppose to thinking everything just exists because it does. People may find comfort in th e cosmological argument and believing that a God created the universe as it gives the impression that everything in the universe has a specific purpose instead of just being random.Another strength is due to the argument being an a posteriori argument and it being from everyday experience of the universe. In other words, our experience of the universe aids our understanding that certain aspects of the universe have specific purposes and exist for specific reasons which gives strong support for this argument. The fact that the argument also helps develop an understanding of popular questions helps it to be a strong theory. A question such as ‘Why is there a universe? can be answered with the cosmological argument as believing that God created the universe provides an answer. The ideas on cause and effect, motion and change and contingency are clear and easy to follow making it comprehendible and easy to support. For many people, the idea that God is the cause of the universe is straightforward and no more explanation is required. Aquinas put forward three questions to answer the inquires about God’s existence whilst forming the cosmological argument.There were five proofs which he came up with but his three ways are commonly used as the cosmological argument for the existence of God. The first way is motion, the second is causation and the third way is the idea that God as a necessary being. The first way which Aquinas provided was very focused on the fact that the universe constantly changes and experiences motion which he went on the relate to the change being caused by an original Creator or God. He believed that we can observe that things in the world are always in motion or changing and is changing from a potential state to an actual state.A chain of events causes things to change from one state to another through the process of motion but the chain of movers cannot continue the process of change and motion forever as then there would be no fi rst mover (I. e. God) and then there would be no other movers. Aquinas emphasised that the first mover was not put into motion by anyone else and is essentially God. This makes the cosmological argument a strong argument to support as helps explain the reason why the universe is constantly changing. Aquinas produced the second way of causation also known as the First Cause Argument.This argument concentrated on the fact that cause and effect existed in the world. Aquinas stressed that all events that happened had a cause and must either be infinite or have its starting point in a first cause. Aquinas couldn’t believe in an endless chain of causes and effects and therefore assumed there had to be some first cause, which was God. Aquinas continued this argument to say that nothing can be a cause of itself. This is a large strength of Aquinas’ cosmological argument as things cannot simply bring themselves into existence so the explanation of a first cause is extremely log ical.Aquinas theory of a first cause gives way for God being called the first uncaused cause as he came to existence unlike anything else. The third way of Aquinas’ cosmological argument is about the idea that God is a necessary being. This argument states that because everything in the universe is contingent and dependant on something else for its existence, the universes explanation leads back to something non-contingent. Everything in the universe is dependant on something else which means that once there was a time when nothing existed. This means that the being which created the niverse must have been external to it and also must be a necessary being, aka, must have always existed. Aquinas continued to argue that this necessary being is God and that if God didn’t exist, nothing else would. This logically explains the existence of the universe without it being contradictory of God’s existence, making the argument strong. However, Aquinas’ cosmological argument did receive some criticisms from David Hume. Hume put forward several responses to the cosmological idea, provided an alternative argument to Aquinas’ beliefs.Hume believed that the idea of the necessary being was incoherent and illogical. Also, he questioned the relation between causes and effects and that every event has a cause. His response to this is that the argument provided no proof for events having causes and as humans, we never actually experience causation therefore providing an argument against the first and second way which Aquinas produced. Hume also criticised the idea of the first cause as he implied it was too confusing to follow.The word ‘cause’ itself creates confusion as the first cause doesn’t have anything to do with the actual cause which we understand. There is a contradiction as the world ‘cause’ implies a finite thing whereas a God would be infinite. Hume pointed out that calling God a cause made him seem l ike he belonged with all the other finite beings. Another one of Hume’s arguments against Aquinas’ idea of a first cause was his criticism that there is no proof saying there should be only one first cause or that that first cause was the Christian God.The ‘uncaused cause’ that Aquinas described is a largely different character to the Christian God and Aquinas doesn’t specify of any qualities which God is supposed to behold. Hume labelled this idea illogical as the God Aquinas described was a being out of touch and indifferent to the universe he apparently caused. Hume questioned the necessity of claiming the whole universe has a cause just because it can be explained by a chain of causes. Hume argued that you cannot claim the universe has a cause just because all things in the universe supposedly has a cause.He also claimed that since the universe is beyond our experience, how can we know that the universe has a first cause? Aquinas believed that t he universe could not have just come into existence yet Hume’s argument implied that there is nothing saying that this is not correct and now science can efficiently explain that the universe may have just come into existence randomly. This argument successfully defeats Aquinas’ view about a first cause causing the universe to exist.

Ethical Legal Dilemma Advanced Practice Nursing Case Study II Essay

Ethical Legal Dilemma Advanced Practice Nursing Case Study II Health insurance policies have set limits on what services will be paid for with a terminally ill person in the home and these limitations may conflict with the nurse’s obligation to provide care for the terminally ill patient (Fry, Veatch & Taylor, 2011). Speaking with the family of a 59 year old male with his only history being terminal lung cancer that has metastasized to the brain, they express concern that they are beginning to have increase difficulty managing this condition. The patient is receiving hospice currently in the home, but the insurance company will not cover both hospice and respite services to assist the family. Community nurses working in the homes of dying patients often encounter many forms of ethical dilemma and they need support in this demanding situation that arises during the end of a patient’s life in the home (Karlsson et al. , 2010). The community nurse is a professional to whom the patient and family turn when they have questions or want to discuss plan of care and treatment options at a critical time in the patient’s life when personal assistance is required (Erlen, 2005). Speaking with the family (son and daughter), it is now found that the patient is now incontinent of both stool and urine and they are now limiting his intake of food and fluid in the afternoon and evening, so that their father doesn’t â€Å"lay in his own wastes throughout the night†. The patient has now developed an excoriated perineum and it appears that further skin breakdown is imminent. The patient has become increasingly weak, and has fallen several times over the last few days. He requires total care with all ADL’s and IADL’s and the family verbalizes being overwhelmed with what their father requires. The patient is receiving hospice for medication administration for agitation and pain as well. Both son and daughter are at risk of losing their jobs related to missing work in order to take care of their father. The son works day shift and the sister works afternoon shift. They have each decided to return to work and this will cause their father to be left alone for almost two hours each day. This could be a case of negligence, where there is a failure to exercise a standard of care and it can be alleged when a person fails to act when a duty exists. There are five elements required to establish a case of negligence: the existence of a legal duty to exercise reasonable care; a failure to exercise reasonable care; cause in fact of physical harm by the negligent conduct; physical harm in the form of actual damages; and proximate cause, a showing that the harm is within the scope of liability (Cornell University Law School, n. d). Negligence falls under tort law and could be criminal. According to Collins English Dictionary (2009) negligence or mal-practice is defined as any immoral, unethical misconduct or neglect of a health care professional. The patient is receiving care at home from Hospice for pain and agitation medication management, which is not sufficient. There is no absolute method to avoid lawsuits; however, prevention of this case could have occurred prior to discharge with proper education of the family of their options for care regarding their father. Detailed explanation of what care their father may need as the end of life is near, may have steered the family to make alternative arrangements for their father. Hospice will have a duty to educate the family of the possible act of negligence and it will be the duty of the hospice workers to report this act made by the family, by following their policies and procedures, which will be their best defense (Grant & Ballard, 2011). Further discussion has shed light on the possibility of Human Rights being violated, under the Affordable Car Act. This is due to the patient’s insurance declining to pay for needs at home. This law alleviates according to Gable (2011) some of the hardships forced on the public’s health for those with insufficient availability of health insurance or access to health care. The Affordable Care Act bans insurance companies from placing lifetime dollar limits on health benefits, which will prevent individuals suffering from chronic diseases from having to worry about going without treatment because of their lifetime limits and it restricts the use of annual limits and bans them completely in 2014 (U. S. Department of Health and Human Services, n. d. ). The ethical principle that will be violated here is the respect for person and the concept of deontology. Deontology means that some behaviors are our duty, whether there is benefit or not (Fry, Veatch & Taylor, 2011). The Stanford Encyclopedia of Philosophy (2012), says that deontology is within the moral theories that guide and assess our choices of what we ought to do and what type of person we should be. Again, proper education to the family, prior to discharge of this patient and by the nurses within the hospice agency could have avoided this occurring. Respect for person involves autonomy, but not all individuals are able to acting autonomously. This requires the ability to set goals and make choices, and this may be compromised at times in a person’s life. Defined by the Belmont Report, respect for persons requires that these vulnerable individuals be offered special protections during periods when they cannot act autonomously. This is also a major emphasis of the principle of justice which requires that the vulnerable be extended special protections with regard to the distribution of the benefits and burdens of research (Yale Human Subject Research Resource & Education Program, 2006). Legal reasoning is evident in two forms, legislative drafting and application of rules to cases and it involves an acceptance and spirit of working within law, which gives it some bias towards maintaining existing rules (Peterson, n. d. ). This does not always mean that law is always just and practical, and judges avoid applying rules that would result in less than desired outcomes. According to Peterson (n. d. ), legal reasoning contains many examples of efforts to changing the legal system and returning to the law making process. Coherence in legal reasoning is where law makes sense as a whole, and is a form of supportive rationality (Bertea, 2009). The coherence part of legal reasoning may be weaker than the logical part. Coherence of a set of legal norms is made by there being a realization of some common value or some common principle (Dickson, 2010). Logic in legal reasoning is the reasoning involved in interpreting constitutions, statutes, regulations, balancing fundamental principles, adopting and modifying legal rules, while applying those rules to cases and evaluating evidence, prior to making decisions (Walker, 2007). Case law is the legal principles embodied in judicial decisions that are derived from applying areas of law to the facts of individual cases. Case law is a dynamic and constantly developing body of law, where each case contains part of the facts of the controversy and an explanation of how the judge arrived at a conclusion (The Free Dictionary by Farlex). Lastly is legal analysis, which requires proving each element of a rule to be true or false and it refers to a statement by a court, judicial officer, or legal expert as to the legality or illegality of an action, condition, or intent (Connelly, n. d. ). The function of ethical reasoning revolved around the fact that much of human behavior has consequences for the welfare of others. People can act toward others in such a way as to increase or decrease the quality of their lives and we are capable of helping or harming. We are empathetic and therefore can recognize when we are doing one or the other. The role of ethical reasoning is to decipher acts that either enhances the well-being of others and those that harm or diminish the well-being of others. Developing one’s ethical reasoning abilities is crucial because there is in human nature a strong tendency toward egotism, prejudice, self-justification, and self-deception which has sociocentric influences (Elder & Paul, 2011). The problem of pseudo-ethics is that one cannot develop as ethical persons if we cannot face the fact that everyone is prone to egotism and prejudice. Flaws in human thinking are the cause of much human suffering and only developing fair-mindedness, honesty, integrity, self-knowledge, and deep concern for the welfare of others can provide foundations for sound ethical reasoning (Paul & Elder, 2009). According to Paul and Elder (2009), ethical reasoning involves doing what is right while avoiding selfish desires and to live an ethical life, is to develop command over our native egocentric tendencies. The elements of ethical reasoning include awareness, independent problem solving, supported problem solving, and decision and outcome evaluation, while effective ethical reasoning requires sensitivity, problem solving skills, and the motivation and determination to act on decisions (Kenny et al. , 2007). The logic of ethical reasoning involves moral theory derived from meta-ethics and evolutionary ethics. The fundamental problem is that evolutionary ethics is a scientifically based theory while meta-ethics is a philosophically based and logic related to human behavior is cannot convey the complexity of human experience, so moral terminology such as good and moral have evolved from billions of social issues over centuries of time that are related to human behavior (Bromberg, 2011). The advantages and disadvantages of ethical reasoning start with the fact that ethical reasoning assumes that everyone will make choices that will cause no harm. This would mean that an ethical society will prohibit unethical actions, but ethical reasoning excludes actions that are based on spiritual or social customs and does not persecute any specific group for their beliefs. Ethical reasoning is meant to determine actions that are in the best interest of everyone, but the course of action is not always clear-cut. Ethical reasoning is simple, all things are not equal, and determining the true ethical route can be difficult and subjective (Mayers, n. d. ). Summary Some cultures continue to practice rituals that are illegal in other counties. Those things that are ethically acceptable in one culture, many times aren’t with other cultures. Laws are based on rules within cultures. Rules are things that citizens must obey in order to prevent persecution by governing authority. Ethical reasoning is based on what people believe is morally right or wrong, whereas legal reasoning is based rules made within cultures. Many times things that are illegal coincide with things that are believed to be unethical within a culture; however, an illegal act by a health care practitioner is always unethical, but an unethical act is not necessarily illegal. Ethics involves standards of behavior and the concept of right and wrong, over that which is legal in a given situation. Moral values are formed through the influence of the family, culture, and society and form one’s ethical reasoning basis (Judson & Harrison, 2012). I feel any ethical decision model must involve individual employees, as well as their supervisors in order to be effective. Shared decision making, between health care professionals, is vital to arrive at what best meets the employee’s needs. I think an ethical reasoning tool needs to involve the employee and the supervisor so the problem can be addressed. The use of an integrative model can develop confidence and justification in making ethical decisions. Preferences and values come into effect during the process of an integrated ethical decision making model and principles of patient-centeredness and shared-decision making must be integrated (Sestini, 2010). An integrated model of ethical reasoning highlights the integration between ethics and decision making, where ethics is a tool that brings positive aspects of the reasoning process. The model is composed of three major elements: the ethical component; the decision making component; and the contextual component (Grundstein-Amado, 1991). Park (2012), reviewed available structured ethical reasoning and decision-making models and developed an integrated model consisting of six steps: 1. the identification of an ethical problem 2. the collection of additional information to identify the problem and develop solutions 3. the development of alternatives for analysis and comparison 4. the selection of the best alternatives and justification 5. the development of diverse, practical ways to implement ethical decisions and actions 6. the evaluation of effects and development of strategies to prevent a similar occurrence. The best ethical reasoning should be determined by putting efforts from all health care professionals involved and although it will not guarantee ethically right or good decisions, it will likely improve a process and outcomes of clinical ethical decisions (Park, 2012). Applying this model to the situation of 59 year old male with his only history being terminal lung cancer that has metastasized to the brain. Applying the chosen model: 1. the identification of an ethical problem: They have each decided to return to work and this will cause their father to be left alone for almost two hours each day. 2. the collection of additional information to identify the problem and develop solutions: families concerns: Increased difficulty managing this condition Patient is receiving hospice but the insurance company will not cover both hospice and respite services to assist the family. patient is now incontinent of both stool and urine and they are now limiting his intake of food and fluid in the afternoon and evening patient has now developed an excoriated perineum The patient has become increasingly weak, and has fallen several times over the last few days. requires total care with all ADL’s and IADL’s and the family verbalizes being overwhelmed 7. Both son and daughter are at risk of losing their jobs related to missing work in order to take care of their father. 3. the development of alternatives for analysis and comparison: this would involve the family’s input into the situation. Possible another family member could be available for the two hours. There could be a possibility to withdrawal from hospice and pursuing home health care to be used for respite services. 4. the selection of the best alternatives and justification: Again this would have to involve the family’s input to see what best meets their needs, as well as their father’s needs. Justification to the family regarding their father being left alone for two hours at a time, as well as withholding fluids and food from him can be done through education. 5. the development of diverse, practical ways to implement ethical decisions and actions: Deontology means that some behaviors are our duty, whether there is benefit or not (Fry, Veatch & Taylor, 2011). This is also a major emphasis of the principle of justice which requires that the vulnerable be extended special protections with regard to the distribution of the benefits and burdens of research (Yale Human Subject Research Resource & Education Program, 2006). As a case manager, I need to work with family on awareness, independent problem solving, supported problem solving, and decision and outcome evaluation. 6. the evaluation of effects and development of strategies to prevent a similar occurrence: this would be done post intervention, and then determination could be made of whether the end result was effective. Evaluating the effects of the interventions will allow the health care professional to adapt future encounters with similar situations. Recommendations Further research revealed the U. S. Department of Health & Human Services said federal hospice investigations have increased drastically over the last few years. A Medicare oversight report in 2009, found nearly a third of hospice patients were not getting services of treatment in care plans, nor were they getting visits providers had promised to provide (Bloomberg News, 2011). This would lead to the first recommendation to the family. It can be recommended that they ask the visiting hospice to review the overall care plan with them. The case manager needs to ask for a copy of the care plan, so it can be reviewed with the family. Once the care plan is reviewed, services being received can be reviewed to match what is promised to take place. A second recommendation to the given situation includes involvement of the case manager. The case manager needs to ask the family to discuss options with the patient and consider his preferences as well as special physical, emotional and psychosocial needs. A final recommendation is that the case manager assist the family to evaluate how much support can be provided by other family members and friends. For help determining the best option, they may need to talk with the health care team. Caring for their father, according to research, may have left them no time for self-care; drained them of energy and enthusiasm; and affected interactions with other family and friends (Joad et. al, 2011). References Bertea, S. (2009). The argument from coherence. Available at http://ivr-enc. info/index. php? title=The_Argument_from_Coherence Bloomberg News. (2011). Hospice care grows as do patient negligence concerns. Retrieved from http://www. ltlmagazine. com/news-item/hospice-care-grows-do-patient-negligence-concerns Bromberg, S. E. (2011). The evolution of ethics: An introduction to cybernetic ethics. Retrieved from http://www. evolutionaryethics. com Collins English Dictionary (2009). Negligence. Retrieved from http://dictionary. reference. com/browse/malpractice. Connelly, A. (n. d. ). Legal analysis and reasoning from precedent. 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