Nursing And Diabetes Essay Example for Free

Nursing And Diabetes Essay Patients with diabetes need to understand what diabetes is. Patients who understand what diabetes is and the complicated process associated with the disease are more likely to comply with the prescribed regimen. Diabetes Mellitus is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or to a combination of insulin resistance and inadequate insulin secretion to compensate (Davis, 2001). Diabetes is a chronic progressive disease that requires lifestyle changes, especially in the areas of nutrition and physical activity. The overall goal of medical and nutritional therapy is to assist persons with diabetes in making self-directed behavioral changes that will improve their overall health (Franz, 2012). Blood glucose monitoring and goals of blood glucose monitoring Testing blood glucose levels pre-meal and post-meal can help the patient with diabetes make better food choices, based on how their bodies are responding to specific foods. Patients should be taught specific directions for obtaining an adequate blood sample and what to do with the numbers that they receive. Research has found that patients who have had education on the use of their meters and how to interpret the data are more likely to perform self-blood glucose monitoring on a regular basis (Franz, 2012). There are many different glucose monitors available for patients. The patient needs to have a device that is easy for them to use and convenient. A patient’s visual acuity and dexterity skills should be assessed prior to selecting a blood glucose monitoring device. A device is usually selected to meet the patient’s needs in collaboration with a diabetic educator at a health care facility. The patient needs to be reminded to record the blood glucose values on a log sheet with the date and time and any associated signs and symptoms that he/she is experiencing at the time the specimen was obtained. This log should be shared with his/her primary care practitioner. A discussion of glycosylated hemoglobin (HbA1c) should include the reasons for doing the test, how it is performed and how the health care practitioner will interpret the data. These laboratory tests are ordered on a routine basis along with other laboratory tests that are being monitored for the patient. A simple method to describe the HbA1c is to tell the patient that the test measures the amount of sugar that attaches to the protein in the red blood cell. The test shows the average blood sugar during the last three months. The higher the blood sugar the higher the HbA1c. The high blood sugar over a long period of time causes damage to the large and small blood vessels therefore increasing the risk of complications from diabetes. Medications and Insulin The patient with diabetes needs to be reminded that the addition of medications to help manage his/her diabetes is not because they are failing at diet management. Many patients with diabetes become depressed or despondent when they have to begin taking oral hyperglycemic medications and/or insulin. The teaching session should include a review of the different types of oral diabetic agents. A review of the different types of insulins and how to mix insulins should also be discussed. Teach the patient about self-administration of insulin or oral agents as prescribed, and the importance of taking medications exactly as prescribed, in the appropriate dose (Davis, 2001). Patients should be provided with a list of signs and symptoms of hypoglycemia and hyperglycemia and actions to take in each situation. Complications from Diabetes The teaching regarding the complications encountered from diabetes should stress the effect of blood glucose control on long-term health (McGovern, 2002). The patient should be taught how to manage their diabetes when he/she has a minor illness, such as a cold, flu or gastrointestinal virus. The patient should also be taught how to watch for diabetic effects on the cardiovascular system, such as cerebrovascular incidents/stroke, coronary artery disease, and peripheral vascular disease. Patients should be taught how to be alert for signs of urinary tract, respiratory tract infections and signs of renal disease. Assessment for signs of diabetic neuropathy should also be included in the teaching plan. Diabetes is the leading cause of death by disease in the United States, it also is a contributing factor in about 50% of myocardial infarctions and about 75% of strokes as well as renal failure and peripheral vascular disease. Diabetes is also the leading cause of new blindness (McGovern, 2002). Patients with diabetes should also receive education on the importance of smoking cessation, cholesterol and lipid management, blood pressure monitoring and management and management of other disease processes. Skin and Foot Care Teach the patient to care for his feet by washing them daily, drying them carefully particularly between the toes, and inspecting for corns, calluses, redness, swelling, bruises, blisters, and breaks in the skin. The patient should be encouraged to report any changes to his/her health care provider as soon as possible. Advise the patient to wear non-constricting shoes and to avoid walking barefoot. The patient may use over-the-counter athlete’s foot remedies to cure foot fungal infections and should be encouraged to call their health care provider if the athlete’s foot doesn’t improve (McGovern, 2002). The patient should be reminded that he/she needs to treat all injuries, cuts and blisters particularly on the legs or feet carefully. Patients should be aware that foot problems are a common problem for patients with diabetes. Informing them of what to look for is an important teaching concern. The signs and symptoms of foot problems to emphasize are: feet that are cold, blue or black in color, feet that are warm and red in color, foot swelling, foot pain when resting or with activity, weak pulses in the feet, not feeling pain although there is a cut or sore on the foot, shiny smooth skin on the feet and lower legs Exercise and Diabetes A moderate weight loss of ten to twenty pounds has been known to improve hyperglycemia, dyslipidemia, and hypertension. The target goal for body weight for patients with diabetes is based on a reasonable or healthy body weight. â€Å"Reasonable body weight is the weight an individual and health care professional acknowledge as achievable and maintainable, both short-term and long-term (Franz, 2012, p.8).† More emphasis is now placed on waist circumference, rather than on actual weight. A waist circumference greater than 40 inches in men and greater than 35 inches in women indicates a risk for metabolic disease. This is now part of what is referred to as metabolic syndrome. Reducing abdominal fat improves insulin sensitivity as well as lipid profiles. The benefits from exercise result from regular, long term, and aerobic exercise. Exercise used to increase muscle strength is an important means of preserving and increasing muscular strength and endurance and is useful in helping to prevent falls and increase mobility among the elderly (Franz, 2012). Regular exercise can improve the functioning of the cardiovascular system, improve strength and flexibility, improve lipid levels, improve glycemic control, help decrease weight, and improve quality of life and self-esteem. Exercise increases the cellular glucose uptake by increasing the number of cell receptors. The following points should be considered in educating patients regarding beginning an exercise program. Exercise program must be individualized and built up slowly. Insulin is more rapidly absorbed when injected into a limb that is exercised, therefore can result in hypoglycemia (Ferri, 1999). Patients need to be informed that exercise of a high intensity can also cause blood glucose levels to be higher after exercise than before, even though blood glucose levels are in the normal range before beginning exercise. This hyperglycemia can also extend into the post-exercise state and is mediated by the counter-regulatory hormones (Franz, 2012, p. 62). The exercise program should include a five to ten minute warm-up and cool-down session. The warm-up increases core body temperature and prevents muscle injury and the cool-down session prevents blood pooling in the extremities and facilitates removal of metabolic by-products. Research studies show there are similar cardiorespiratory benefits that occur when activity is done in shorter sessions, (approximately 10 minutes) accumulated throughout the day than in activity sessions of prolonged sessions (greater than 30 minutes) (Franz, 2012). This is an important factor to emphasize with patients who don’t think they have the time and energy for exercise. Diet and Diabetes The American Diabetes Association (ADA) has established nutritional guidelines for patients with diabetes. Their focus is on achieving optimal metabolic outcomes related to glycemia, lipid profiles, and blood pressure levels. Patients with diabetes need to maintain a healthy diet consisting of multiple servings of fruits, vegetables, whole grains, low-fat dairy products, fish, lean meats, and poultry (Franz, 2012). The exchange diet of the ADA includes protein, bread, fruit, milk, and low and intermediate carbohydrate vegetables (Ferri, 1999). The food/meal plan is based on the individual’s appetite, preferred foods, and usual schedule of food intake and activities, and cultural preferences. Determination of caloric needs varies considerably among individuals, and is based on present weight and current level of energy. Required calories are about 40 kcal/kg or 20 kcal/lb per day for adults with normal activity patterns (Davis, 2001). Emphasis should also be placed on maintaining a consistent day-to-day carbohydrate intake at meals and snacks. It is the carbohydrates that have the greatest impact on glycemia. â€Å"A number of factors influence glycemic responses to foods, including the amount of carbohydrate, nature of the monosaccharide components, nature of the starch, cooking and food processing, and other food components (Franz, 2012, p.13).† Maintaining a food diary can help identify areas of weaknesses and how to prepare better menu plans. Recommendations for fiber intake are the same for patients with diabetes as for the general population. It is recommended that they increase the amount of fiber to approximately 50 grams per day in their diet. Insoluble and soluble globular fiber delay glucose absorption and attenuate the postprandial serum glucose peak, they also help to lower the elevated triglyceride levels often present in uncontrolled diabetes (Ferri, 1999). The discussion of diet management should also include a discussion of alcohol intake. Precautions regarding the use of alcohol that apply to the general public also apply to people with diabetes. Abstaining from alcohol should be advised for people with a history of alcohol abuse, during pregnancy, and for people with other medical conditions such as pancreatitis, advanced neuropathy, and elevated triglycerides. The effects of alcohol on blood glucose levels is dependent on the amount of alcohol ingested as well as the relationship to food intake. Because alcohol cannot be used as a source of glucose, hypoglycemia can result when alcohol is ingested without food. The hypoglycemia can persist from eight to twelve hours after the last drink of alcohol. When alcohol is ingested in moderation and with food, blood glucose levels are not affected by the ingestion of moderate amounts of alcohol. If the patient plans to consume alcoholic beverages they are to be included in the meal plan. The patient should be reminded that no food should be omitted because of the possibility of alcohol induced hypoglycemia (Franz, 2012). Coping with Diabetes The patient needs to understand that the diagnosis of diabetes mellitus as with any chronic illness can be unexpected and potentially devastating. Grief is the most common reaction of an individual diagnosed with diabetes. Resolution of the grief is dependent on variables such as education, economics, geography, and religious and cultural factors. The support of family and friends affects the long-term acceptance of the disease progression. Patients need to be aware that depression is common with chronic diseases such as diabetes. The depression should be recognized and treated as soon as possible since depression can affect glycemic control and complicate the management of the diabetes (Buttaro, 2008). The patient needs to understand that diabetes is a lifelong disease process that requires a lifetime commitment and lifestyle changes. The patient should be educated about empowerment – having the resources and knowing how and when to use them. The skills of empowerment that help the patient reflect on life satisfaction in the following areas: physical, mental, spiritual, family related, social, work related, financial, personal. The patient should be encouraged to establish goals which emphasize at least two of these areas in which he/she has control. In the session of coping with diabetes the patient should be assisted to develop better problem solving skills, which are necessary to manage a life-long disease such as diabetes. Coping with diabetes should also include stress management concepts. Stress management concepts should include: a definition of stress, the body’s reaction to stress, the effects of stress on diabetes management, identifying stressors, identifying methods of coping, relaxation exercises and identifying support systems to tap into. Management of the disease process should include eliminating or minimizing other cardiovascular risk factors for example blood pressure control, lipid control, and smoking cessation. Patients with diabetes should also be instructed on what to do when they become sick with a cold, flu, gastrointestinal virus, or other minor illness. They need to be aware that these minor illnesses can affect their diabetes and blood glucose levels (McGovern, 2002). Instruction on what to do when they become ill and the importance of continuing to take their diabetes medications and/or insulin and other general care should be discussed. Some basic guidelines for management during an illness or sick-day include maintain adequate hydration because of the risk of dehydration from decreased fluid intake, polyuria, vomiting, diarrhea, and evaporative losses from fever. Patient should be instructed to drink at least eight ounces of calorie free liquids every hour while they are awake. The beverages should be caffeine-free, since caffeine acts as a diuretic and can actually increase the chances of hypovolemia. If the patient is unable to tolerate fluids by mouth, antiemetic suppositories or intravenous fluids may be required. Vomiting that is persistent and intractable may require emergency room care. The patient should be encouraged to perform blood glucose monitoring more frequently while he/she is ill and to initiate urine ketone monitoring with urine dipsticks, during the illness (Franz, 2012). The patient should be instructed to continue taking his/her insulin and/or oral antidiabetic agents while ill and even when unable to eat. The omission of insulin is a common cause of ketosis and can result in a serious condition called diabetic ketoacidosis. The patient should be given a list of foods that contain fast acting carbohydrates that they can consume when they experience signs and symptoms of hypoglycemia. Patients should be encouraged to seek regular ophthalmologic examinations to detect for diabetic retinopathy. Regular dental examinations should also be encouraged to evaluate to potential areas that can become infected and possible oral lesions. Summary The teaching program for the patients with diabetes is designed to be held for six sessions. However, the sessions can be lengthened or shortened to meet the needs of the intended audience. These two to three hour sessions allow the patient to absorb the material that is being taught and to be able to ask questions. The learning needs are focused on managing their glucose levels and preventing complications of diabetes. The patient needs to be educated on the multiple disease processes associated with diabetes and the factors affecting each of these areas. The patient also needs to have the knowledge of how to manage their diabetes when they are ill and warning signs that they are hypo/hyperglycemic. Diabetic patients should be advised to contact their health care provider any time they are unsure what to do or have questions on how to manage their disease. There are many teaching handouts and pamphlets that are available free of charge from the various agencies. These handouts are available on a wide variety of subjects that can be used with the teaching plan. The evaluation criteria for the teaching plan would include an evaluation tool in which the patients could complete anonymously at the end of the program. References Buttaro, T.M., Trybulski, J., Bailey, P.P., Sandberg-Cook, J. (2008). Primary Care: A Collaborative Practice, 3rd. Edition. Philadelphia, PA: Mosby, Inc. NO Davis, A. (2001). Adult Nurse Practitioner: Certification Review. Philadelphia, PA; Mosby, Inc. Ferri, F. (2012). Clinical Advisor: Instant Diagnosis and Treatment. Philadelphia, PA: Mosby, Inc. NO Franz, M. (Ed.) (2001). Diabetes Management Therapies: A Core Curriculum for Diabetes Education. 4th Edition. Chicago, IL: American Association of Diabetes Educators. Franz, M. (2012). American Diabetes Association Guide to Nutrition Therapy for Diabetes, 2nd Edition. Alexandria, VA: American Diabetes Association. Herfindal, E. and Gourley D. (2000). Textbook of Therapeutics: Drug and Disease Management. Seventh Edition. Philadelphia, PA: Lippincott Williams and Wilkins. NO McGovern, K., Devlin, M., Lange, E., and Mann, N. (Eds.) (2002). Disease Management for Nurse Practitioners. Springhouse, PA: Springhouse Corporation.

The Values And Ethics Social Work Essay

The Values And Ethics Social Work Essay Social workers are faced with making decisions about risks whilst managing the pressures of limited resources such as a lack of social workers and societys view of social work (11). This can cause a social worker to be risk averse and become more concerned with avoiding risk to protect themselves instead of taking action that may be right for the service user. 88% of social workers have expressed a concern that cuts in services can put peoples lives at risk and 77% stated that they were unable to manage their caseloads (1). Wales has the second highest vacancy rate of social workers in the UK at 9% with England at 11% (Lombard, 2010). There are 3 different types of risk (Adams, Dominelli Payne). These are the risk to service users from others, the risk to service users from themselves and the risk to others from service users. In the statutory sector risk assessment is a mandatory part of casework as it is within law and agency policy to assess risk to an individual (Healy,2012). S17 and S47 of the Children Act 1989 places a duty on a social worker to investigate when it is believed that a child is at risk of harm. The difference between S17 and s47 is the urgency and seriousness of risks (Beckett, 2010). Risk to the child includes some form of harm and the probability of that harm occurring. 2. Factors of Risk There are certain factors in a childs life that may be linked to poor outcomes (Parton, ) These include low family income, homelessness, parenting capacity, post natal depression in the mother, low birth weight, substance misuse and community factors such as residing in a disadvantaged neighbourhood. Protective factors may include a strong relationship with parents and other significant adults, parental interest and involvement in the childs education and positive role models. There are also other protective factors if the child is outgoing, has self motivation, has intelligence and plays an active role in family and community life. The more risk factors present the more likely it is that they would experience abuse or poor outcomes (5). Early intervention to identify risks can help to reduce problems. Identifying the risk and protective factors can give a prognosis on the childs future development (8). Assessing their needs and risks will help to identify the services that should be in place to prevent further impairment to their health and development (BASW, 2012, 3.2). In assessment we must recognise the factors that could have harmful consequences and the severity and the likelihood of harm (Beckett, ). The difficulty in assessing risks is that we may see a high risk factor that may be unlikely to materialise but dismiss low risk factors which may cause more harm long term. There is the potential to reinforce social inequalities as many factors are strongly associated with socioeconomic disadvantage such as single parents, low income and previous institutional care (CCW, 2002, 1.5). 3. Assessment In social work the assessment of children involves analysing the childs development needs, parenting capacity and family and environment factors (Welsh Government, 2001). Using the assessment triangle gives a holistic view of the child and the influences upon them. Once all the information is gathered it can be easier to identify the areas in which a child is most at risk and how those risks maybe addressed (BASW, 2012, 3.2). Risk is an aspect of all assessments (Whittington, 2007). The aim of a risk assessment is to consider the situation, decide on the likelihood of the risk happening and aim to reduce the identified risk having a negative impact. There are different types of risk assessment (Coulshed Orme, ). These are preventative, investigative and continuation. Preventative is undertaken before intervention to decide on whether or not to intervene. It involves looking at the situation and assessing the risk factors along with balancing the rights of service users and the responsibilities of the social worker. Investigative is carried out during an initial assessment to identify the current and potential risks. Continuation assessment is balancing the risks of intervention against no intervention. A social worker should evaluate the original situation then acknowledge changes and what effect these changes will have if any at all. In social work the actuarial and clinical methods of risk assessing are used (Cree Myers, ). The actuarial method uses statistical calculations of probability and how an individuals behaviour is judged on the basis of behaviours in other people in a similar situation. The clinical method uses personality factors and situational factors relevant to risky behaviour and the interaction between the two. Adhering to legislation, policy and procedures and the rights of the service user should ensure good practice in relation to assessment and managing risk and protection (Adams, Dominelli and Payne, ). Legislation and policy shapes and determines the actions, duties and powers of a social worker (CCW, 2002, 6.1). Failure to follow set policies and procedures can result in things going wrong. 4. Skills and Judgements in Assessment Management of risk is often judged by the outcome and not the process of the assessment (7). When examining a case that has had negative outcomes it is easy to see the presence of heightened risk. This can reinforce the view that the outcome could have been avoided had the risks been realised. Conducting an initial assessment requires interview skills to get the information and reasoning skills to analyse the information and identify risks (CCW, 2002, 4.2). Assessment is an essential skill in itself (9). It requires effective communication skills to gather the necessary information and critical analytical skills to interpret that information. A social worker will need the appropriate skills to be able to negotiate with a service user or an agency in order to provide appropriate services (BASW, 2012, 2.2.3). Serious case reviews often highlight the importance of assessment and analysis (Good practice in assessment book). An effective assessment looks at the overall situation to explain what has happened to a child and provides a framework for analysing the needs of the child and the dangers that individuals pose to children. Particular care must be taken so that the assessment does not become over optimistic and minimise the risk to the child. The focus should be on gathering evidence to make professional judgements about whether a child is safe from harm, neglect, and abuse. Other skills in assessing risk is the ability to predict what may happen in the future in areas of uncertainty (Trevithick, ). If the information gathered is accurate and up to date and the social worker has a sound knowledge and skill base there is less chance of over or underestimating the risks involved. In order to gain accurate information a social worker should use effective communication and listening skills to pick up on the risks presented. Communication between professionals and agencies may be difficult as there may be issues of power, different priorities and professional values (10). For example a doctor will be more concerned with discharging a service user once their medical issue has been addressed. A social worker will be concerned that services are put in place to ensure that the service user is safe to return home. Skills and knowledge are frequently criticised in serious case reviews into child protection services and can adversely affect risk management. 5. Risk Management In a review of child protection services it was identified that mistakes in assessment of risk have been either over or under estimating the risk posed to the child (2). Risk management cannot completely eliminate risks only reduce them. An assessment may decide that the risk of harm to a child will be low but low risk events can still happen. A social worker should use their professional judgement when deciding on actions to take as all options will involve a certain amount of risk (CCW, 2002, 4.1). For example when a child is removed from their family and placed in local authority care they may face other risks such as being unable to settle with a new family. The principles of working in child protection are to maintain the safety, security and well being of individuals. A social worker should use their judgement to balance the possible benefits of a decision against the likelihood of possible harm. They should work with other professionals to make decisions on risk involved so th at errors can potentially be reduced (BASW, 2012, 3.1). Lessons can be learnt to improve decision making from the successes as well as the failures. Positive risk taking relies on quality information. Agencies should share appropriate information on those individuals who pose a risk to others or those that are at risk from harm. A serious case review identified several failings in the protection of Baby P (6). Two of the children in the family were already subject to child protection plans which may be seen as a risk factor. The adults involved had refused to explain Ps injuries. It would have been reasonable to believe that Baby P was at risk if the adults were not willing to provide an explanation if they had nothing to hide. It was recommended that interagency working and communication must improve to ensure that children have a greater level of protection from different professionals. Professionals should recognise and respect each other roles and be trained appropriately together (BASW, 2012, 3.14). Supervision for the social worker in the case of Baby P was inconsistent and often cancelled. When carrying out S47 enquiries a social worker should be supported by their manager and have periods of supervision to review their caseload. This provides the opportunity to view the actions of the social worker f rom another perspective so that other options can be explored. A criticism of social workers in child protection is over familiarity with a family (10). The social worker may have long term involvement with the family and are unable to take an unbiased view of the situation. Therefore it is important that supervision takes place to gain another perspective (BASW, 2012, 3.13). Child protection conferences should involve the parents (AWCCP). Professionals should determine how information about the case will be shared with them to ensure that a child is not put at further risk. Unless the criteria for exclusion are met parents should always be encouraged and supported to attend the conference. By attending the conference parents will be clear on what the concerns are, understand the risk to their children and the reason for the involvement of the different agencies. This will ensure that they are aware of the changes that need to be made to protect their children from harm. During the conference professionals involved must consider the risks of harm if the child were to remain at home and how those risks can be managed. A plan will be created which will detail the arrangements for managing the risks identified and how it will be monitored. The child protection plan must consider the wishes of the child and the parents (CCW, 2002, 1.2). A solution focussed approach can be utilised by the social worker to plan the necessary services required to manage the risk (Creer and Myers). This approach is used when finding solutions to the current situation. A social worker may consider services such as family counselling to explore and understand the issues the family have. 6 Values and Ethics etc There are times when taking a risk is a positive move (Beckett, ). It provides an opportunity to learn to manage risk. If a child is over protected they cannot be expected to understand how and when to take risks. If risks are unavoidable then the positives and negatives of the outcome should be analysed. In child protection the dilemma may arise when deciding on whether to remove a child and place them in foster care or remain with the family. As previously identified there are risks in placing a child in foster care. If they are unable to settle they may experience multiple moves. When there are risks of harm to children there will be pressure on the social worker to act quickly but this may be difficult as exploring the risks and benefits effectively may take time. There are also risks to social workers from aggressive parents when working in child protection (Lindon, ). The social worker should acknowledge the parents feelings and refrain from arguing back. As the social worker has a responsibility towards the children they should attempt to diffuse the situation to prevent upsetting the children (CCW, 2002, 5.7). The anger from the parents could present a risk to the children and should be acknowledged as such. A child has the right under Article 19 of the United Nations Convention on the Rights of the Child to protection from abuse and neglect (WAG, 2008). The parents could also argue that they have the right to a private family life under Article 8 of the Human Rights Act 1998 but if they are subjecting their child to abuse or neglect then this right is over ridden. There are many uncertainties regarding risk in child protection (Adams, Dominelli and Payne). There may be no right or wrong decisions if it is approached correctly. However, there is always the possibility of a negative outcome which can be difficult for all involved and have serious implications for a child. It is difficult to make decisions where there is incomplete knowledge and uncertainty of a situation. The social worker must use their professional judgement to ensure they have taken as much care as possible to address risks with the information available (BASW, 2012, 2.3.4) In conclusion risk can be difficult to manage as it contains many areas of uncertainty. The negative factors should be identified early to prevent further risks occurring. The assessment must take into account all areas in a childs life to ensure a complete picture is gained and all risks are acknowledged. If the social worker has good communication skills then the quality of the information gained should be high and will enable them to make a more informed assessment. If the relevant information is not gathered then appropriate decisions may not be made. Several recommendations were made in the serious case review of Baby P. Supervision is important as it can ensure the quality of a social workers practice, provide other perspectives on relevant cases and potentially can improve outcomes for service users. Multi agency working is a requirement in social work. It must be utilised to gain a holistic view of the child and identify various services that can be put in place to manage ris ks. A service user still may not experience a positive outcome even though the most appropriate services are utilised to reduce and manage risks. If the social worker has carried out their duties correctly in accordance with legislation and policies, identified the risks and worked with others to manage those risks then they can be satisfied that they have done all they can and accept that not all outcomes will be positive.

Should We Establish A Market For Human Organs?

Should We Establish A Market For Human Organs? There are a number of arguments with regards to organ commodification, which is the subject of hot debate. I will purposefully be limiting the scope of the argument to kidneys, as kidneys are paired organs that can be safely removed with minimal impact to the health of the donor. Although this topic is heavily related to philosophical and ethical issues, I would first like to discuss certain relevant aspects of background information with regards to a few simple and basic economic concepts, specifically related to supply and demand as it relates to the buying and selling of organs in an economic forum. The fact is that there are sick people who will die without transplants, and the number of organs available through donation, whether live donations from friends, relatives, or anonymous persons or donations through the harvest of organs from people who die, fall far short of the required number. This raises the question whether it is justifiable to provide financial incentives for org an donors to donate their kidneys in order to help narrow the gap between excess demand and shortage in supply. A variety of concerns and arguments have been raised regarding whether a legal market permitting the commodification of kidneys should exist. Many countries, including Singapore, still prohibit the sale of human organs. In the United States, the National Organ Transplant Act officially bans the selling of human organs. Would such a legal market encourage an increase in black market activities, as some individuals in dire need of organs might not be able to afford the price on the legal market? I will discuss the reasons why a legal market permitting the commodification of kidneys should exist. Some contend that allowing kidneys to be commodified would cheapen our humanity. I believe, however, that the intrinsic value of our humanity would not be cheapened even if we were to put a price tag on our organs, as such a price would only signify that we are trading kidneys at a s pecific rate. Finally, I will address some of the concerns that have been raised regarding commodifying other human organs and body parts, such as the heart, hair, and blood. I will conclude with the assertion that a legal market could mitigate the large number of black market activities that already exist, and that commodification would in no way devalue our humanity or our culture of liberty, but would rather place a greater value on freedom by demonstrating a respect for individuals rational choices regarding kidney donation. Introduction Before getting into the heart of the argument about whether there should be a legal system established for allowing commodification of organs, I would first like to draw on literature from Gill and Sade in order to address a few preliminary points. The pro-market argument we will be considering is a prima facie argument which, unless rebutted, would be sufficient to support the permissibility of the practice. On the other hand, the reason Im purposefully limiting the scope of the argument to kidneys is because the kidney is paired organ that can be safely removed with the minimal impact of the health of the donor. Here is a quick background behind the argument: It is that there are sick people who will die without a transplant and that the number that becomes available through donation either live or cadaveric fall far short of the numbers that are required. In many countries, thousands of candidates on organ transplant waiting lists die each year due to the lack of donor availability. According to the U.S. Department of Health Human Services, there are currently 86,445 people waiting for kidney transplantation, while only 7,000 people are available as kidney donors. This huge shortage of organs has led to a thriving black market trade in human organs, especially kidneys. People who advocate legalization believe that selling their organs might create a solution to the shortage; additionally, sellers make generous financial gains from the sale of organs. Therefore, a market solution, one where people are given a financial incentive to part with their organs, would procure more of them than a d onation-only scheme and narrow the gap between supply and demand. Because black market trade has become so widespread, some concerns and hot debates have been raised regarding whether there should be a legal market permitting the commodification of kidneys. Many countries, including Singapore, still prohibit the sale of human organs. In United States, the National Organ Transplant Act officially bans the selling of human organs. This essay will discuss why there should be a legal market permitting the commodification of kidneys. A legal market could mitigate the black market activities that already exist, and commodification would not devalue our humanity or our culture of liberty; rather, it would place a greater value on freedom by respecting individuals rational choices regarding kidney donation. According to Gill and Sade, the prima facie pro-market argument addresses two points: first, donation is permissible. It is, and ought to be legal for a living person to donate a kidney to someone else who needs one in order to survive. From its point of view, we actually dont just allow people to do this. However, we praise and encourage this. In Singapore, the government makes it harder than other countries not to donate. Citizens are presumed to be organ donors and have to opt out, rather than the reverse. In either case, though, donation is typically taken to be a case of saving a human life and morally unproblematic. It implies that it should be legal for a living person to decide to transfer one of his or her kidneys to someone else. Second, commodification of tissue is permissible, according to Gill and Sade. It is, and ought to be, legal for a living person to buy and/ or sell certain body tissues such as hair, sperm, eggs, blood products, etc. For instance, the Singapore Cord Blood Bank (SCBB) has facilitated over 40 cord blood transplants according to Cord Blood Bank of Singapore (for the SCBB, cord blood is donated but then sold to recipients, unless the recipient was also a donor). In other countries, though, people who give blood are financially compensated. Of course we would not typically praise people who sell their body tissue as we do people who donate it to save a life, but, at the same time, most people do not brand commercial blood banks as moral abominations, rather than an acceptable means of procuring a resource that is needed to save lives. It implies that it should be legal for a living person to decide to transfer part of his or her body to someone else for money. As a result, it thus seems i nitially plausible to hold that the two claims together imply that it should be legal for a living person to decide to transfer one of his or her kidneys to someone else for money. There are some responses, according to Gill and Sades literature, to the prima facie argument. First of all, the argument attempts to establish a moral difference between selling and donating. One thinks that commodification of body parts is wrong in itself because if one commodify oneself by selling oneself or part of oneself as a mere means which is as an object to be used, bought and sold for a price. It is thus disrespectful of ones humanity to treat oneself as a mere means as it cheapens us and takes away from the meaning and significance of humanity. Therefore, commodifying oneself violates a duty one has to oneself to respect what makes us morally significant creatures. Secondly, commodification of body parts leads to undesirable social consequences, according to Julia Mahoney. We would view others as commodities rather than as persons, according to Kass. We dont have to say that this is intrinsically wrong, but it would definitely affect the quality of social life. One may ar gue that legalizing kidney sales would promote an everything-is-for-sale mentality that will lead to the degeneration of civil society. It may make it more likely that we would legalize live-donor heart sales in the future, or it may promote a mindset where people are more commercial minded, and less generous, loving or friendly to each other. Thirdly, commodification of body parts unjustifiably infringes upon the freedom of certain people. As a result, some suggest that prohibiting commodification is necessary to protect certain liberties, according to Wolf. Criminalizing kidney sales infringes upon the freedom of potential buyers and sellers, but it protects the freedom of donors who have an interest in making pure gifts which to give something that cannot be bought (Lomasky, p. 252-255). The latter freedom is the more important one and infringing upon the freedom to buy and sell is necessary to protect it. However, according to Lomasky on sex, his argument is a reduction ad absur dum of the Titmuss-inspired argument against kidney sales. If prohibiting kidney [human tissue] sales is necessary to protect the freedom of someone who wants to make her kidney a pure gift, then prohibiting marriage is necessary to protect the freedom of someone who wants to engage in sex outside the context of any contractual format. However, this is a terrible reason to prohibit marriage obviously, so it must also be a terrible reason to prohibit a market in kidneys or even human tissues. Therefore, it evokes my deeper curiosity to take somewhat in-depth analysis about what justifies legalization for commodifying body parts, especially kidneys in this essay. Many people claim that the growth of black market activity is induced by financial incentives of kidney transplantation, but I would argue that an equal force driving the expansion of the black market is the lack of a legitimate market. Clearly, the current donation system is unable to meet overall demand. The countries with a huge shortage of kidneys that have outlawed commodification have inadvertently stimulated the growth of black market activities because there are always wealthy people who will strive to preserve their own lives even if it means exploiting the poor. For example, one recent headlined article from Singapore reads, Two Indonesian men who agreed to sell their kidneys for more than S$20,000 ($14,814 U.S. dollars) each were given light prison terms and fines after a judge blamed syndicates for exploiting them (Earth Times News). If a legal market were to be established, law enforcement would be better able to protect the poor from such exploitation. Kidney transplant ation would also be formally and properly regulated within a legitimate market, thereby protecting the sellers and guaranteeing the quality of the organs for the recipients. On the other hand, one of the most prominent concerns about legalizing the commodification of kidneys is that it would, in effect, evoke financial incentives. Thus there are some anti-market rebuttals that try to address why commodification of organs is not allowed. First of all, people argue that with the differences between the motive of the individual in selling a kidney and donating one. Sellers are motivated by financial incentives, self-interest, or the interests of their families if they sell in order to provide for their families. Donors are motivated by benevolence or altruism. However, I would argue that if self-interest was so bad then the commodification of, for instance, blood products would be ruled out. As a result, the self-interested motive does not rule commodification of other body parts. On the other hand, parting with a kidney is different than parting with blood. The latter is simple and quick while the former requires the risks of major surgery and living the r est of ones life with just one kidney. However, if kidney transplant was so dangerous because of its invasiveness, then donating them would be ruled out. Thus, these risks are not judged great enough to justify prohibiting donating kidneys. So, there are arguments about these differences which dont suggest the market for commodification of organs. However, these differences do not make any moral difference. If we oppose the sale of kidneys because we think it is too dangerous, then we should also oppose live kidney donations. On the contrary, we do not oppose live kidney donations because we realize that the risks are acceptably low and worth taking in order to save lives. So, it is inconsistent to oppose selling kidneys because of the possible dangers while at the same time endorsing donating kidneys is permissible. Similarly, if we oppose kidney sales because we think people should not commodify body parts, then we should also oppose commercial blood banks which I mentioned before. However, most people would not oppose the existence of commercial blood banks because they realize that these blood banks play an extraordinary role in saving lives. Therefore, it is also inconsistent to oppose selling kidneys since it involves payment while at the same time endorsing commodification of tissue is a permissible act. It seems that if people would ban the market for commodification of organs, they should also oppose the ideas either the donation of kidneys isnt permissible due to the risk attached to the surgery or commodification of other tissues isnt permissible. I think both of them are neither plausible nor have very wide support. Indeed, most nations are trying to encourage more donation as well as more supply in order to save more people. The failure to generate adequate supply is why market solutions are beginning to get more traction in certain countries including Singapore. In addition, it might still be fine to sell hair. One might argue that there is a moral difference to be made between hair on one hand and kidneys are blood products on the other hand. Obviously, people need blood and kidneys in order to live due to physical necessities, so one might say that it is only impermissible to sell human tissue that arent physical necessities. I, however, think that theres something wrong wit h the claim about commodifying stuff like that. In fact, legalizing commodification could itself convince people to participate in kidney transplantation. Because communitarians emphasize that individual rights and interests should be compatible with those of the community as a whole, they believe this could change societys moral sense. Thus, setting up a law to allow the commodification of kidney transplantation could lead people to believe that giving a kidney to others is not only moral but expected. Setting aside the communitarian perspective, poor people risk their own lives by giving up their kidneys in order to save anothers life, which is justified by their altruism, according to our class discussion. They are all rational people who are self-governed and able to weigh the risks of kidney donation against their own propensity toward altruism. Some poor people may attempt to receive compensation for their organ donation, thus blaming their decision on the financial incentives. However, they still had the option to make money in other ways. Even the current system of organ donation may contain a form of coercion in that a prospective donor may feel extremely uncomfortable refusing to donate his or her kidney to someone who is in such desperate need due to the vast shortage of donors. In the end, we should respect the decisions of individuals who make rational choices about kidney donation regardless of whether these choices are made with consideration of the financial incentiv es. Also, anti-commodification about kidneys cant be just a knee-jerk antipathy towards markets. We shouldnt spurn markets without stopping to think of how much markets in goods do for our general welfare. In other words, it would be improper to be anti-commodification about everything. Moreover, we should not spurn markets in the name of the poor and oppressed without stopping to think of how getting rid of these markets would affect the poor and oppressed. People do not sell spare kidneys or turn to prostitution for fun. They make such choices only when their alternatives are even worse. Therefore, it seems to me that rejecting commodification may be a luxury that not everyone can afford. There are also some arguments that claim that the commodification of kidneys would cheapen our humanity. I, however, think that the intrinsic value of our humanity would not be cheapened even if we put a price tag on our organs, for the price only signifies that we are trading kidneys at a specific rate. A price tag does not indicate the total value of a commodity. Rather, a price tag should be seen as an attempt to quantify some aspects of [the] usage (de Castro, 2003, p. 145) of somethings infinite value à ¢Ã¢â€š ¬Ã‚ ¦ No one would ever say that this method capture[s] the full value that we ascribe to human life (de Castro, 2003, p. 145). Such a method never aims to capture that infinite value (Julia Joseph). Thus, creating financial incentives to encourage people to sell their organs to the needy does not devalue humanity. Moreover, as I mentioned in the class discussion, we accept donors giving up their kidneys on the basis of altruistic motivations, so we should likewise not rule out the possibility that donors would like to give up their kidneys for financial incentives, especially when we strongly believe that such motivations could save a significantly greater number of lives. Thus, commodification should be permissible, as it would neither devalue the intrinsic worth of humanity nor be limited by the boundary of altruism. Even in a commodified system, each individual can give his or her kidney on the basis of pure altruism; the financial reward would merely be a secondary benefit to altruists. A legal commodified system would ultimately save more lives, as people would be donating for altruistic as well as financial reasons, and the system would be stringently regulated by law. This essay focused on arguments regarding a legitimate market for the commodification of kidneys as well as misconceptions about the consequences of permitting this commodification. Above, I discussed three rebuttals to anti-market arguments, all of which demonstrate that black market activities are thriving due to the lack of legitimate market regulation of human organ procurement. Fortunately, our culture of liberty places great value on individuals rational decisions; in this sense, people should be allowed to weigh the potential risks against their own propensity toward altruism. Commodification encourages such deliberation by respecting peoples decisions to seek money for their available organs, in addition to seeking spiritual reward, on the basis of rationality. Moreover, a legal financial incentive would encourage more people to donate. Saving more lives through allowing the selling of kidneys does not devalue a humans dignity any more than does our current practice of sellin g other medical services. The key to the safe and effective commodification of kidneys may ultimately depend on proper regulation of the system by law enforcement. In order to more quickly start saving more lives, we should prioritize the creation of a legal market of properly regulated commodification of kidneys instead of arguing over the possible undesirable consequences of such a market.

An Inspector Calls By J.B Priestley :: English Literature:

An Inspector Calls By J.B Priestley An Inspector calls beings with the Birling family celebrating Shelia's engagement to Gerald Croft, Mr Birlings friends son. In the beginning of the play the light is 'pink and intimate' until the unexpected arrival of the Inspector we find the light change symbolises start of an investigation put under the spotlight, being brought out of their own world into reality. The inspectors arrival is unexpected to the family 'some trouble about a warrant' Mr Birlings first thought to what the arrival of the inspector might be and shrugs it as if their could be no greater concern. The inspector explains his reason of why he is here. The inspector starts to question Mr Birling the head of the family. The inspector asks how Eva Smith was apart of Mr Birlings work. Mr Birling explains his involvement with Eva Smith of how she worked for him and asked for a pay rise and was fired from her job by Mr Birling. After the questioning of Mr Birling the inspector questions Shelia who is shown to an innocent girl, we out find after the questioning that it was Shelia who had Eva Smith fired from her second job because of her jealousy over Eva Smith. After revealing her involvement she starts to blame herself. But the inspector tells her that it wasn't her who made her commit suicide. At the end of act one we find Gerald in a sign of recognition when he hears the name Daisy Renton (Eva Smith's second name when she changed it to find herself a second job). Before the closing of the first act we see Shelia question Gerald where had he known Eva Smith. Gerald explains that he had known her from last summer. We see the irony when Shelia says 'I don't believe I will. (Half playful, half serious, to Gerald.) So you be careful.' She laughs at the fact that the 'important work' Gerald was at last summer was probably knows that Gerald was having an affair. After act one we find the irony of what was said by Gerald 'You seem to be a nice well-behaved family-' and Mr Birlings reply 'Well we think we are'. The exit of Eric shows us that there is more to Eric's involvement than the others which is hidden in Act one until the end because of his drunkenness the inspector leaves him last to be questioned. At the end of act one the audience is left at suspense when Gerald is approached by the inspector we find a great intensity

A Worn Path Essay -- essays research papers

â€Å"A Worn Path†   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"A Worn Path† is, in my opinion, a very good story. It tells of an old black woman and the struggles she’s had to deal with throughout her life. The author names the woman Phoenix after a mythological bird that died and then came back to life through its ashes which makes it immortal. The author makes the woman â€Å"immortal† because she continues to have something to live for, her grandson, whom she apparently considers her biggest gift.   Ã‚  Ã‚  Ã‚  Ã‚  The author never says exactly how often the woman makes the journey, but we know she’s made it before because the attendants knew who she was when she came in the building. It is a very long trip because the hunter even said that he only goes into town when he is sick, and tells Ph...

My Career Goal

When I was a child and people would ask me what I wanted to be when I grew up, I always had an answer. That answer changed significantly as time went on, and right now it would be IT programmer if somebody asks me again. That’s my main goal right now and I know I still have a long way ahead of me. But I realized that in order to achieve that long term goal I should have few small and short term goals each year and accomplish them one by one like small ladder steps toward my main goal. So I came up with this year’s goal that is getting me a new laptop and enrolling to new advance classes in my career. My first goal this year is getting a new laptop. Like I said my main goal is to be IT programmer, so of course I need a better laptop like the one I have right now and good laptop aren’t cheap. The one I like is nearly 2500 dollars. Even though I’ve been cutting all other interests like going out, shopping and been working on weekends and my day offs on my half time right now, I’m still haven’t come up with enough money for my laptop yet. So I have to look for a full time job in summer to come up with that money. Luckily, I have a friend who promised to take me in her store as a fulltime technician for the whole summer. So hopefully by the end of summer I will have enough money to afford my new laptop, or even have some money left so I won’t be completely broke after that. So after I reach my first goal then I can be able to move forward to my second one this year that is enrolling to new advanced classes for my career. Although some programmers may qualify for certain jobs with 2-year degrees or certificates, but like we all know the economy is going bad right now so employers will be more picky as they choose for applicants. So I think it would be more advantage for me if I have more advance and wider programming knowledge required for my career. So this semester I’ll try to get the best grades I can then coming next semester I’ll be able to enroll in IT programming classes such as C++, Java or may be even code writing classes. That will give me more time to learn and master those required skills for my future career. Planning for our futures is very important even if those plans may change. But I think we should stick to those plans we have in order to achieve the main goal. Set the times to achieve your goal, but you should be beginning now. So, I will keep my goal in my mind and built it up in this year.

Macbeth: A Tragic Hero

There is much debate to whether Macbeth is a villain or hero, but it truly is clear that Macbeth is a tragic hero based on that he has the fatal flaw of having too much ambition, he was doomed to make a serious error in judgment which was killing Duncan, and that he suffered greatly in order to accomplish what he believed was right. Macbeth’s flaw of his extreme ambition is demonstrated by how he kills Duncan, how he kills Banquo, and how he kills MacDuff’s family.He was doomed to make the serious judgment error that was killing Duncan, and he was condemned to do this because the witches prophesized it, his wife wanted him to, and he was unnaturally guided by a dagger to kill Duncan. Also he went through the death of his friends at his own hand and the death of his wife to achieve what he wanted to, and was willing to suffer for it. Macbeth showed that he had a fatal flaw, which was that his ambition was what mainly factored his decisions.This is shown when he killed th e King in his quest for power, when he killed his friend Banquo, and when he killed the wife and child of MacDuff. Early in the play Macbeth was told that he would become King of Scotland, and that really put the gears in motion for the terrible decisions he would make throughout the play. His first one was to kill Duncan, who was not only the King whom he had loyally served for a long time, but also his own cousin. He killed his own flesh and blood in order to get the opportunity to gain power.He figured that if he killed Duncan he would have a chance at being king, and he acted upon that thought. This thought process is shown in the quote, â€Å"If good, why do I yield to that suggestion whose horrid image doth unfix my hair and make my seated heart knock at my ribs, against the use of nature? Present fears are less than horrible imaginings: My thought, whose murder yet is but fantastical, shakes so my single state of man that function is smother'd in surmise, and nothing is but what is not. † (Act1, Scene3).This showed that he knew what a terrible deed he would be doing, but that couldn’t stop his need to become king. Also, Macbeth killed his dear friend Banquo and even attempted to kill Fleance, Banquo’s son, in order to keep the throne. The witches prophesized that Fleance would become king, and Macbeth decided that he had already done so much to become king that there was no point in letting the throne leave him so soon, and that is shown in the quote, â€Å"I am in blood, stepped in so far that should I wade no more, Returning were as tedious as go'oer† (Act3, Scene4).He decided that he had already hit the point of no return and acted accordingly. Finally, the fact that he killed the wife and child of his enemy MacDuff, proved that Macbeth was willing to cross any line to keep his spot as king, and would let nothing stand in the way of his ambition. The quote, â€Å"The castle of Macduff I will surprise; Seize upon Fife; giv e to the edge o' the sword his wife, his babes, and all unfortunate souls that trace him in his line. † (Act4, Scene1), shows that Macbeth was willing to kill an innocent family to prove that he was not ready to be defeated.Basically Macbeth showed that his fatal flaw was too much ambition, and that was demonstrated through him killing Duncan, killing Banquo, and killing the family of MacDuff. Macbeth appeared to be destined to make the serious judgment error that was killing Duncan because when you take his ambition as talked about above, and that he was told by witches that it was his future to be king, that his wife thought it was the right thing to do, and that he even had hallucinations pointing towards killing him, it seemed like he had no other choice.First off, Macbeth was approached by witches who told him that he would become king of Scotland and that intrigued him very much, especially with his crazy ambition. He took this to heart and because he wanted to become ki ng and he now thought it was in the realm of possibility, yet he knew it would not happen legally, he was really left with just one option. This was despite that at the time he knew it wasn’t the right thing to do. This is shown by the quote, â€Å"All hail, Macbeth, thou shalt be king hereafter! † (Act1, Scene3).This was just the beginning of the seed that would grow in Macbeth that eventually culminated into a plant of terrible things. Next, Lady Macbeth also influenced Macbeth, and that was presented in the quote, â€Å"Glamis thou art, and Cawdor; and shalt be what thou art promised: yet do I fear thy nature; It is too full o' the milk of human kindness to catch the nearest way: thou wouldst be great; Art not without ambition, but without the illness should attend it. † (Act1, Scene5). This just showed how Lady Macbeth reacted to the situation as though killing Duncan was the right thing to do and that Macbeth would be greatly benefited from it.Lastly, Macbe th was influenced by a hallucination of a blood stained dagger that was meant to be stained by the blood of Duncan. One night Macbeth saw the dagger and didn’t know whether it was real or fake, and what to do with it, but then it became clear in the quote, â€Å"Is this a dagger which I see before me, the handle toward my hand? Come, let me clutch thee†¦ †¦ I go, and it is done; the bell invites me. Hear it not, Duncan; for it is a knell hat summons thee to heaven or to hell. † (Act2, Scene2) This showed how Macbeth was basically shown the way to murdering Duncan by the dagger.And from being influenced by the witches, his wife, and the dagger, it was obviously meant to be that Macbeth was going to make a serious judgment of error in killing Duncan. A tragic hero must have a capacity for suffering, and suffer because he believes in what he is doing, and because he feels both guilt and guiltlessness. Macbeth in my mind does fit into this category through all th e pain and suffering he experiences throughout the play after he murders Duncan. A quote that shows he is suffering is â€Å"Will all great Neptune’s ocean wash this blood clean from my hand?No, this my hand will rather turn the multitudinous seas incarnadine, making the green one red. † (Act 2, Scene2). Macbeth is just realizing that what he has done is irreversible and he will never be able to get it off of his conscious. He therefore must have the capacity for suffering, and though there are many moments when he is unsure, I believe that he truly believes in what he is doing. There are also times when Macbeth feels guilt over the act he has committed and he is never really able to shake these feelings off, but he still gladly takes over as king and moves on in life, therefore showing he feels both guilt and guiltlessness.Again, the point is now raised that yes, he believes in what he is doing, but what he is doing is a terrible thing, and how does this make him a he ro? I believe that while Macbeth isn’t your typical hero, whether his actions were right or wrong he still meets the criteria, and it is on that that I’m basing the decision. Overall, it was clear in the story that Macbeth was definitely a tragic hero. He displayed his fatal flaw that was his insane ambition, he was destined to make the disastrous make of killing Duncan, and that he is  willing so suffer to achieve what he believes is right.Macbeth showed his ambition through killing Duncan, killing Banquo, and killing Macduff’s wife and child. His serious error in judgment of killing the king was always meant to happen because three witches gave him the thought, his wife wanted him to do it, and his hallucination even pointed him towards it. To sum it up, the debate over whether Macbeth is a hero or villain should be put to rest because it is quite evident that Macbeth is a tragic, tragic hero.