Mediation Essay Example | Topics and Well Written Essays - 500 words - 1

Mediation - Essay Example The mediator listens to the different versions of all the parties and calms or reassures them accordingly. The mediator should have active listening skills for this stage to be successful. During this stage, the mediator clarifies statements and questions so that the parties involved understand each other. He or she may also paraphrase the stories given by the parties. The third stage is the agenda setting stage. In this stage, the mediator outlines the issues that require a solution. He or she sets the agenda for the process by summarizing the disagreements or agreements between the parties. The purpose of mediation is to resolve these disagreements in an unbiased way (Drews 44). The fourth stage is the generation of alternatives stage. The mediator employs his or her skills to generate a series of possible options for the parties (Drews 44). He or she may also guide the parties in generating alternatives. In the fifth stage, the mediator asks the parties to choose among the generated alternatives. He or she guides the parties in selecting alternatives that are satisfactory and feasible to them all. The sixth stage is ending stage. In this stage, the mediator writes the agreement as agreed by all parties. A mediation process normally involves three people. The first person is the mediator. The second and third persons are the two warring parties. However, the process may also have â€Å"support people† who assist in signing the agreements. Concluding a mediation process is the last stage of a mediation process. In case a solution is reached, the mediator concludes the process by writing an agreement that is signed by all the parties. However, if the process is not fruitful to come up with a solution, the mediator summarizes the issues raised and thanks the parties for their contributions and making progress. He then ends the session. The first advantage of

Voluntary Active Euthanasia Research Paper Example | Topics and Well Written Essays - 1500 words

Voluntary Active Euthanasia - Research Paper Example 2). Which elements would proposed legislation need to possess in order to safely permit and suitably regulate VAE? It is clear to observe that the reluctance to legalize VAE is based primarily on fears of abuse (Keown, 2002, p. 74) combined with fears that terminally ill patients would â€Å"feel under pressure to agree to an assisted death† (Smartt, 2009, p. 100). However, such apprehensions can be eased and overcome by properly drafted and implemented legislation which would precisely prevent abuse and strike an appropriate balance between the right to life and the right to die. The public perception of VAE is clear: studies suggest that a huge majority of the public stands in favor of legalizing VAE, and those who were against it expressed the very aforementioned fears of abuse (Chapple et al, 2006). The legalization of euthanasia would have a difficult task ahead of it, but such legalization would not be impossible, and would also be beneficial to society as a whole. The l aw generally protects the autonomy of individuals in several areas of life, yet the ability to choose between autonomy and life when the two conflict is an issue that the law has been rather reluctant to delve into (Callahan and Keown, 1995, p. 208). Some question the point of the assessment of whether some have a more ‘worthy’ life than others, thus rendering them with a greater right to life: the issues rather turns on the fact that â€Å"doctors have never been under a duty to preserve life at all costs† (Keown, 2002, p. 58). There is an obvious stigma which is closely linked to allowing others to enact VAE, however. It is arguable that there can safely exist a social duty to end the pain of a person who expressly declares a wish to end their life, and that this duty can override the fears and apprehensions of society as a whole (Hooker, 2002, p. 26). Very little evidence exists to provide foundations for the argument that legalization of VAE would gradually b e interpreted as a positive duty to end the life of suffering individuals in all cases; its very restriction to ‘voluntariness’ would overcome such fears. Some argue that the value of human life cannot be overridden by any conflicting theory, thus rendering VAE morally incorrect because the sanctity of life should never be actively legislated against (Keown, 1997, pp. 482-484). Such arguments approach the issue of VAE on simplistic notions of good versus bad, and this is not a realistic approach; it is suggested that ethics should be approached as a science allowing notions of good and bad to be balanced against one another in specific situations. This would enable the argument surrounding VAE to escape irrelevant and frustratingly complex analyses of morality and enable legal drafters to approach the issue on an objective level. The most potent arguments against VAE are based on the assumption that such a law would be applied equally to all individuals, resulting in th e requirement that terminally ill individuals have their life prematurely taken. This is described by Laing as a situation in which â€Å"disability may be ruthlessly eliminated and some perceived form of perfection imposed’ (1997, p. 4). This argument is however unrealistic. It would be extremely easy to draft the law in a manner that would expressly forbid the extension of VAE to involuntary euthanasia. Careful drafting could safely ensure that it would not be mandatory for every terminally

Common Causes for Emergency Geriatric Treatment

Common Causes for Emergency Geriatric Treatment Introduction Chronological age of 65 years or above is accepted as the defining criteria for Geriatric patients in most developed countries 1 .This large heterogeneous group is further classified into three subpopulations commonly referred as ‘Young-Old’ [65-74 Years], ‘Old’ [75-84 Years] and ‘Old-Old’ [85 years and older]. Worldwide, the number of Elderly persons is expected to more than double from 841 million people in 2013 to more than 2 billion in 2050 2.In United States, patients over the age of 64 years account for 15-18% of ED visits 3 .Of these, about 35% requires admission as inpatient and a significant proportion of this gets admitted to Intensive care units 3.. The common geriatric syndromes in the Emergency Department include altered mental status, functional decline, fall, trauma, acute abdomen, infections, acute coronary syndromes, cerbrovascular accidents and exacerbations of chronic respiratory disorders. There are unique characteristics and special needs which have to be kept in mind while addressing elderly patients in the emergency department. The clinical presentation of geriatric patients is usually complex with more of atypical manifestations; confounding effects of co-morbid diseases, super added cognitive dysfunction, polypharmacy and associated adverse drug reactions, psychosocial issues and lack of adequate social support etc 4. Assessment of these issues usually demands a comprehensive approach with detailed clinical and liberal laboratory and imaging evaluations. This is justified in the context that a brief focused evaluation can overlook many life-threatening conditions in these patient group. More over the attending physician should also try to understand the baseline functional status of the patient prior to the presentation as it has got important prognostic implications. Thus it requires great skill, knowledge and patience from the part of the attending physician and the health care team as such to effectively and safely manage this vulnerable patient population. Approach to Unstable Elderly patient in Emergency Department In general, the principles of resuscitation in elderly patients are same as the standard guidelines followed for adult patients. But it is desirable for the emergency physician to speak to the immediate relatives or to the patient himself if possible to see whether there is any advance directive or patient’s wishes for end of life care decisions. If present, it has to be respected before taking treatment decisions. The special characteristics in elderly while assessing Airway, Breathing and Circulation are summarized in figure 1.Nasal airway or Nasogastric tube has to be inserted gently with care as the nasal mucosa is very friable and has a tendency to bleed in elderly patients. Always examine the oral cavity in unconscious patients for loose fitting dentures or partly chewed food as they can cause potential airway obstruction and if present, has to be removed. Edentulous airway can result in ineffective bag-mask ventilation. Hence well fitting dentures can be kept insitu while bag mask ventilation but always has to be removed before attempts of intubation. Difficulty in extending neck or in opening mouth has to be anticipated while attempting intubation due to degenerative diseases of spine and temperomandibular joints. Arterial Blood gases are an important adjunct to the clinician as the clinical response to hypoxia, hypercapnea and acidosis can be blunted in elderly. Arterial hypotension (systolic BP 5. Serial assessment of Blood pressures and Arterial Blood gas examination to see trends in lactate, base excess and acidosis can identify such potential high risk candidates early 6. Fluid resuscitation should follow in the standard fashion with fluids or blood in an elderly patient who is hemodynamically unstable in the Emergency department. But it should be careful with constant monitoring to avoid pulmonary edema. Early blood transfusion should be considered in elderly unstable trauma patient. Common Geriatric syndromes in Emergency department Altered Mental status At least 25% of elderly patients in the ED have altered mental status 7, 8. Delirium is an acute confusional state and dementia is a chronic confusional state. Etiology of delirium is often mutltifactorial but often represents an underlying medical emergency. Diagnosis of delirium is clinical and is based on assessment of the level of consciousness and cognition. The confusion assessment method (CAM) is a useful tool for diagnosing delirium at ED 9.The important management steps in the Emergency department are illustrated in Figure 2.The first priority is to address predisposing and precipitating factors like hypovolemia, hypotension, hypoxia, hypoglycemia, hyponatremia, Acidosis etc. Often inpatient admission is needed for the management of the underlying illness. Drugs like haloperidol or lorazepam may be used in cases of extreme agitation but with caution and at titrating doses. Decline in Functional status Functional status reflects how well a person is able to meet his or her own daily needs-like feeding oneself, dressing up, getting out of bed, bathing, toileting etc. The attending physician should not misinterpret a decline in functional status as a part of normal ageing process. Functional status of an elderly patient can be formally assessed with use of standard scales for basic activities of daily living. Activity of Daily living –ADL is one such tool and is shown in figure 4. New onset Functional decline is often precipitated by medical, psychological or social reasons. Patients with unexplained functional decline need admission for evaluation and management. Functional decline is an important predictor of further functional decline, repeat ED visits, hospitalization, need for home care or institutionalization and death10, 11. The general approach to a patient with decline in functional status is illustrated in figure 5. Falls Falls account for approximately 10% of emergency visits in Elderly 12, 13.Falls are the most common cause of fatal as well as non fatal injuries in geriatric population. A fall should be treated as a symptom and the physician should evaluate the causes and consequences of fall. The most common reasons for injurious fall-related ED visits among the elderly were fractures (41.0 percent), followed by superficial/contusion injuries (22.6 percent) and open wounds (21.4 percent) 13. Serious injuries associated with fall include hip fracture, rib fracture, subdural hematoma, other serious soft tissue injury or head trauma. It is important to remember that a fall can signal a sentinel event in an elder person’s life triggering a downwards spiral of complicating events, finally leading to death. Acute abdomen in elderly Acute abdominal pain in elderly usually poses a challenge to the clinician as the symptoms are often non-specific, abdominal findings are often subtle and the presence of co-morbid conditions which can complicate the definitive surgical procedures. Common causes of acute abdomen in elderly include acute cholecystitis, acute appendicitis, peptic –ulcer perforation, mesenteric ischemia, acute pancreatitis, ruptured abdominal aortic aneurysm, bowel obstruction and diverticular diseases. Elderly usually presents with atypical symptoms, often significantly late in the course of the illness. It is essential to consider serious medical conditions like inferior myocardial infarction, pneumonia, pleurisy, diabetic ketoacidosis and pulmonary embolism in all cases of suspected acute abdomen. Abdominal tenderness may not be present or poorly localized. Guarding or rebound tenderness might be difficult to appreciate. Serial abdominal examination is important as new signs tend to appear with time. High risk features include acute onset of pain, severe pain, pain followed by vomiting, worsening or persistent pain, signs of peritonitis, hemoperitoneum and hemodynamic disturbances. Liberal imaging is the usual protocol with Plain x-ray abdomen, abdominal ultrasound and CT abdomen as necessary. Patients with continuing symptoms but with unremarkable laboratory and imaging studies should be observed and serially evaluated as necessary. An approach to elderly with abdominal pain is illustrated in figure 6. Infections in elderly Elderly are significantly more prone to infections and its life threatening complications. Presentation of infection can be atypical with lack of fever or localizing features. Sepsis can present with subtle clinical features like lethargy, decline in functional status or confusion. Usual site of infections include lung, urinary tract, skin and abdomen. High index of suspicion is necessary to early identify the patients with sepsis. Management of Severe Sepsis and Septic shock in elderly should follow the standard guidelines used for adults like international surviving sepsis guidelines 14. Early initiation of antibiotics and other sepsis resuscitation bundles is found to improve mortality and functional recovery 15, 16, 17 .The salient points in the clinical approach to an elderly with suspected sepsis are summarized in figure 7. Medication related problems Adverse events related to drugs are common in elderly population and is a common cause for ED visits. Elderly are more susceptible to serious and fatal adverse drug effects due to polypharmacy, lack of monitoring , non-adherence, use of multiple medications, use of over the counter medications, wrong dosage , altered drug metabolism and propensity for drug interactions. The risk factors for serious adverse drug reaction in elderly include ‘old-old’ patient, lean body mass, more than 6 chronic medical illnesses, 9 or more drugs, more than 12 doses per day and a previous history of adverse drug reaction 18. Most commonly encountered problematic drugs include diuretics, NSAIDs, Warfarin, Digoxin, antidiabetic agents, antiepileptic agents, chemotherapeutic agents, antibiotics and psychotropic drugs 19. Detailed drug history, reviewing prescriptions and direct verification of current medications may prove to be very helpful strategies while evaluating geriatric patients in th e ED. Elder Abuse and Neglect Elder abuse is defined a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person 20. It can result either from an act of commission or of omission and may present as physical abuse, psychological abuse, sexual abuse, care giver neglect, self neglect and financial exploitation. It should be suspected in patients who present with unexplained or multiple injuries in various stages of evolution. Key points: The characteristics and needs of elderly in the Emergency department are quite different than the younger patient. Clinical presentation of life threatening diseases can be atypical, subtle or misleading with absence of classic symptoms and signs. Presence of multiple co- morbid conditions and cognitive impairment usually complicates the picture. A comprehensive work up-including detailed history, physical examination and liberal investigations and imaging is recommended than a brief goal directed or symptom based work up. Altered mental status, falls, functional decline, acute coronary syndromes, stroke, infections with or without sepsis, acute abdomen and trauma are the common geriatric syndromes in the emergency department. Social and non medical issues are important and need multidisciplinary input to ensure safe and effective disposition of these population.

The Nearly Fatal Snow Caving Trip Essay -- Reflection Memoir Essays

The Nearly Fatal Snow Caving Trip Sharp pains shooting through muscles, trying to avoid sleep, hypothermia set in on an Antarctic ice crevasse researcher. I had the opportunity to go snow caving with my brother, Josh. I was confident in my winter backcountry skills and anticipated a memorable trip. I did not know what I was getting into. Growing colder day-by-day, winter became more dominant. Deep snow made travel difficult. To navigate through this terrain, I would have to wear special equipment. There are a few ways to travel over snow: snowmobiles, cross-country skis, and snowshoes. The uneven terrain and fresh powder called for snowshoes. Along with shoes, winter camping requires many other types of gear. To cope with the cold, I had to pack bulky warm clothing, and sleeping gear. The Campin' Gaz lantern and stove, both blue and oddly shaped, were necessary for a cold night without a fire. Large, stiff, blue tarps were needed to repel the wet snow while heavy, green foldable shovels comprised the majority of the weight in my pack. The down filled, sleeping bag received much of the attention of my pack's available space. A Kelty 5400 cubic inch Red Cloud swelled with these items, impatient to be worn. With our gear ready, we boarded our transportation, a brown, earth-colored Subaru wagon, was the car of choice. The packs filled the little space of the hatchback. Through the neighboring towns, we made our way to the top of the mesa. After we reached our chosen parking area, we stepped out of the brown machine quickly realizing that we needed to put the rest of our clothes on. After only a moment to acclimate, we prepared our gear. Hurling Kelty over my back, I balanced to put on my orange, plastic, snowshoes. Al... ... to be inside this precarious place, I was careful with every movement. As we both lay in our bags, the cave's darkness soon soothed our eyes and sleep came to our tired bodies. Striking camp early in the morning we traversed over the white, moon lit landscape. We arrived at the car for a late lunch, which ended our camping trip. Thanks to my knowledge of winter backcountry, and my brother, I made it back alive. Now I realize more possibilities and consequences before I am doing dangerous things. Even with all the knowledge and experience, nature can still prevail. Luckily, this was not the case this time. I am extremely thankful for my brother, and he is thankful to still have a brother. I am continually learning new knowledge and skills and am still humbled by this experience. I hoped that this would be a memorable trip, but it turned out to be life changing.

5.04 Sinclair: Snoop for Scoop

5. 04 Sinclair: Snoop for Scoop! Part I: 1. Sinclair â€Å"muckrake† for social reform, by uncovering the terrible working conditions people in the meat industries were experiencing. After uncovering these terrible conditions Sinclair then wrote â€Å"The Jungle† which made the public aware of the terrible & unsanitary working conditions in the meat industry. Soon after, Americans demanded better regulations for the meat industry. 2.The Pure Food and Drug Act was established as a direct result of the public outcry from Sinclair novel â€Å"The Jungle†. 3. As a result of his novel Sinclair wanted to opened the public eyes to the terrible working conditions people were experiencing and how the meat products were being produced. In this he hoped to see changes in meat productions such as healthier productions and working conditions. Sinclair also wanted to help promote socialism. 4.Majority of the public was mortified that their meat was filled with contaminations & wanted this problem to be fixed immediately. Some on the other hand saw Sinclair's book as an exaggeration of what was really going on. Many people began to stop eating meat. 5. ABC News found that the conditions at Food Lion was mortifing. Food Lion was selling food that was rotten & washed them with bleach to get rid of the ordor. They also found cheese that was being gnawed at by rats. . Food Lion could not prove the findings were false. 7. The basis of Food Lion's lawsuit against ABC-News was that they were charged with fraud ,trespassing, and breach of duty. 8. In the jury's verdict they ruled against ABC News 9. The jurors' rationale for the verdict was that Food Lion Lion food recieved twice the amount as compensation for wages paid to producers because the jurors' believed ABC didn't have to lie to get the information about Food Lion Part II:I do believe journalists have a duty to be â€Å"watchdogs† for the public, but to a certain instinct. I say this because altho ugh it is apart of their profession if being a so called â€Å"watchdog† for the public means breaking morals & laws then it shouldn't be done. But then again I feel that we have to be our own â€Å"watchdogs† inorder to know what's really going on. I'm not sure of the name of the person who post I responded to, but the date of the post I replied to was on Thu Oct 11 09:36:35 2012 5.04 Sinclair: Snoop for Scoop 5. 04 Sinclair: Snoop for Scoop! Part I: 1. Sinclair â€Å"muckrake† for social reform, by uncovering the terrible working conditions people in the meat industries were experiencing. After uncovering these terrible conditions Sinclair then wrote â€Å"The Jungle† which made the public aware of the terrible & unsanitary working conditions in the meat industry. Soon after, Americans demanded better regulations for the meat industry. 2.The Pure Food and Drug Act was established as a direct result of the public outcry from Sinclair novel â€Å"The Jungle†. 3. As a result of his novel Sinclair wanted to opened the public eyes to the terrible working conditions people were experiencing and how the meat products were being produced. In this he hoped to see changes in meat productions such as healthier productions and working conditions. Sinclair also wanted to help promote socialism. 4.Majority of the public was mortified that their meat was filled with contaminations & wanted this problem to be fixed immediately. Some on the other hand saw Sinclair's book as an exaggeration of what was really going on. Many people began to stop eating meat. 5. ABC News found that the conditions at Food Lion was mortifing. Food Lion was selling food that was rotten & washed them with bleach to get rid of the ordor. They also found cheese that was being gnawed at by rats. . Food Lion could not prove the findings were false. 7. The basis of Food Lion's lawsuit against ABC-News was that they were charged with fraud ,trespassing, and breach of duty. 8. In the jury's verdict they ruled against ABC News 9. The jurors' rationale for the verdict was that Food Lion Lion food recieved twice the amount as compensation for wages paid to producers because the jurors' believed ABC didn't have to lie to get the information about Food Lion Part II:I do believe journalists have a duty to be â€Å"watchdogs† for the public, but to a certain instinct. I say this because altho ugh it is apart of their profession if being a so called â€Å"watchdog† for the public means breaking morals & laws then it shouldn't be done. But then again I feel that we have to be our own â€Å"watchdogs† inorder to know what's really going on. I'm not sure of the name of the person who post I responded to, but the date of the post I replied to was on Thu Oct 11 09:36:35 2012

Mockingbird Characters in “To Kill a Mockingbird” Essay

There are many different â€Å"mockingbird† characters in Harper Lee’s classic novel To Kill a Mockingbird. Early on in the novel, Atticus tells his children to â€Å"shoot all the blue jays that you want, but remember it’s a sin to kill a mockingbird† (Lee 103). He says this because mockingbirds are known to be harmless creatures that do nothing but sing joyously. Lee cleverly uses this mockingbird imagery to title her classic novel and to describe characters that are kind, innocent people and have done nothing wrong, but are destroyed by the society around them. The first â€Å"mockingbird† in this novel is Boo Radley. At the beginning of the story, Boo is a strange and mysterious person to both Jem and Scout. Because he is unknown and not very well understood, they suppose that he is a monster, along with most of the people in Maycomb. They make up unfair, gruesome stories and accusations about him because he is never seen or heard. As the story progresses, one learns that Boo is a kind man who acts as a type of father figure to the children leaving them gifts in a knothole outside his home and repairing Jem’s pants after he is shot at by Nathan Radley. He does not voluntarily stay locked up in his house, but is kept there almost as a prisoner by Nathan. At the end of the novel, Boo shows that he is very brave by saving the children’s lives by killing their attacker Bob Ewell. It is decided by Maycomb’s sheriff, Mr. Heck Tate, that nobody would tell about this murder because if they did it would be â€Å"like ki lling a mockingbird† because Boo is so shy and reclusive, never harming a soul until it is necessary (Lee 317) The character of Tom Robinson is that of yet another cruelly treated â€Å"mockingbird†. The title of the novel refers most specifically to his character in the fact that Tom is an innocent man, who is â€Å"killed† only because he is black. He is accused of raping a young white girl in a town full of prejudice and hatred towards Negroes. In his testimony he states that he feels compelled to help the young girl with her chores, and when she approaches him, he decides to run instead of pushing her away. This shows his gentile, sympathetic nature and that he is a true â€Å"mockingbird† character. The all white jury, though, cannot look past the color of his skin, and when he is accused of the offense and sent to a prison camp, he  attempts to escape, but fails because of his crippled left arm and is shot. Mr. Underwood compares his death to â€Å"the senseless slaughter of songbirds by hunters and children† (Lee 275). This again relates to the mockingbird title by showing Tom’s good natured character and willingness to provide pleasure for others being destroyed by the narrow minded citizens of Maycomb. Boo and Tom Robinson are both misunderstood by the people of Maycomb. They are both innocent songbirds who have different lifestyles than the others in their community, and since others don’t know them for who they truly are, they are unjustly treated. These characters were not punished for wrong doings, but for being different from the normal. Had the people of Maycomb taken the time to get to know and understand these citizens better, they might not have had to â€Å"kill† any â€Å"mockingbirds†, thus showing the significance of Lee’s properly placed title.