The merger between two health care systems Research Paper

The merger between two health care systems - Research Paper Example management overlooked potential distrust from local care providers, it also did not focus on the overall inefficiencies as well as the market forces that come about during a merger. Furthermore, the new entity did not have cost-saving skills needed to keep the company a float after the merger; they combined this with poor cultural knowledge and team leadership needed to deal with losers and winners in the arrangement. Pennsylvania witnessed what could potentially be their largest health system yet in the 7th month of 1997 through the creation of Penn State Geisinger Health System. At first, the new unit now had 1342 beds, 1000 physicians, 77 outpatient clinics, 3 hospitals, 1 drug treatment facility as well as patients from about 40 counties in central Pennsylvania (Sidorov, 2003). During the formation process, the two former organizations needed to decide upon executive leadership, so they came up with a methodology for creation of a new board. They took a 50-50 split between board members from both health systems; however, Geisinger got the upper hand in this regard because its representative was the chairperson. He had the power to break ties during votes and he contributed towards a higher ratio of members from his own company; this implies that executive decisions were now skewed towards the chairperson’s former organization. Not all the aspects of the two companies were dissolved as Pen State Hershey would be retaining control of the college of Medicine that was under Hershey Medical Center. Several changes took place throughout the organization; for instance, the Health Plan under Geisinger now became a joint plan whose name accommodated the new change. This had the advantage of increasing the customer base to about a million for the HMO and expanded the geographic regions from which consumers came. The merged unit still maintained the regional demarcations that had been used by Geisinger, and only added Penn state HMC as a forth region which would

New technolgy work and the economy Essay Example | Topics and Well Written Essays - 2000 words

New technolgy work and the economy - Essay Example It complements other organizational management indicatives in providing a focus on the sustenance of competitive advantage. Every company has its own unique knowledge management strategy. To understand how knowledge management affects work and the economy, it is important to understand what it is in all aspects (Christensen, 2003). There is no universal definition of knowledge management, but a few experts have tried to put to words what this kind of management entails. Knowledge management is the term used to refer to the â€Å"collection of processes that govern the creation, dissemination, and utilization of knowledge† (Newman, 2002). It can also be said to be the systematic process by which information is found, selected, organized, distilled and presented. This systematic process is carried out in a way that serves to improve the employees’ understanding of a particular area of interest. In other words knowledge management is a process that should be used to enhance the objectives and goals of the organization (Nonaka, 2002). Knowledge management allows an organization to achieve its goals and objectives. This means that knowledge management is an important factor that contributes to the organization’s long term success without putting too much strain on the existing resources. All the different definitions are similar in that they emphasize the importance of the organization as a whole in the process of knowledge management. Most of the definitions point out that knowledge emanates from individuals and that not a single one of them knows everything. It is therefore important to manage all this knowledge so that everyone on the organization can gain something from one another (Christensen, 2003). The aim of any organization is to ensure that it is as profitable as possible. Mnprofitability can be achieved through many ways, including proper knowledge management. Effective knowledge management makes it possible for a company to serve customers to

United States Declaration of Independence Essay Example for Free

United States Declaration of Independence Essay In contemplating the relation of freedom and identity, the Latin maxim libertas non datur sine veritate aptly reminds us that there can be no freedom without truth. While certain aspects of who we are, such as nationality or ethnic ancestry, may be cul? turally or serendipitously determined, there is a truth to hu? man nature which, if not observed, corrupts or destroys life and any exercise of freedom dependent upon it. Human nature and the natural law it reflects are inescapable, and, insofar as the Constitution of the United States was consciously fashioned with an outline of human nature in mind, natural law is an in? dispensable aid to proper constitutional interpretation. This essay explores the founding conception of liberty and its interrelationship with human nature. It then addresses how the Constitution reflects these aspects of human nature. Finally, it contains some concluding perspectives on aspects of human nature understated in the constitutional design and what ought to be done when there are disputing conceptions of human na? ture. I. LIBERTY The founding view of liberty was taken up directly by Ham? ilton. In Federalist 15, Hamilton asks â€Å"why,† if man1 is naturally * Caruso Family Chair and Professor of Constitutional Law, Pepperdine Uni? versity; Dean and St. Thomas More Professor, The Catholic University of America Columbus School of Law, 2001–2003; Professor and Director of the Center on Law Government at the University of Notre Dame, 1980–1999; Assistant Attorney General and Head of the Office of Legal Counsel, Department of Justice, 1985– 1989. 1. The use of the masculine in this essay is intended to include the feminine; the masculine usage is continued in the essay so as not to raise in the mind of the reader any inference that the thoughts expressed are somehow at odds with the quoted material from the founding period, which reflected a different custom in 34 Harvard Journal of Law Public Policy [Vol. 29 free,2 â€Å"has government been instituted at all? †3 Hamilton’s an? swer is blunt and rests squarely on a claim about human na? ture. Government is instituted, Hamilton asserts, â€Å"[b]ecause the passions of men will not conform to the dictates of reason and justice without constraint. †4 Liberty without restraint will not lead to private or public good. How does Hamilton know this? Well, he says, just look around; and further, if the evidence of our own eyes does not convince us and we seek something beyond this empirical claim, he urges us to draw yet another inference about human nature: It is to be expected that men in a collective or group will act badly because the â€Å"[r]egard to reputation has a less ac? tive influence. †5 Think about it, Hamilton admonishes: Liberty will be badly used if joining together obscures accountability. Moreover, â€Å"a spirit of faction† will aggravate these intrinsic human aspects, thereby magnifying the resulting harms. 6 In a group, we will ally with others of like mind in a shameless way to disadvantage or harm others. We will be inclined to use our liberty to pursue â€Å"improprieties and excesses, for which [we] would blush in a private capacity. †7 The desire for liberty to be well used, once â€Å"we the people† were united in political society, greatly motivated the Foun? ders. It will be argued below that this founding conception of liberty informed by human nature accounts for much of the constitutional structure and the express limitations upon gov? ernment power within and appended to it. The justification for the new Constitution is forthrightly anchored in the mainte? nance of human nature as the â€Å"great principle of self? preservation. †8 As such, the precondition for liberty to be used well is honoring the core principle of preserving the truth of oneself—a proposition traceable, as Federalist 43 expressly af? using the masculine pronoun alone, but which this author believes is applicable to all persons without gender distinction. 2. Note that any other presupposition is counterfactual, except to extreme be? haviorists. See, e. g. , Thomas Szasz, Against Behaviorism: A Review of B. F. Skinner’s About Behaviorism, 5 PSYCHOL. NOTES (1991), available at http://www.libertarian. co. uk/lapubs/psycn/psycn005. pdf. 3. THE FEDERALIST NO. 15, at 110 (Alexander Hamilton) (Clinton Rossiter ed. , 1961). 4. Id. 5. Id. at 111. 6. Id. 7. Id. 8. THE FEDERALIST NO. 43 (James Madison), supra note 3, at 279. No. 1] The Human Nature of Freedom and Identity 35 firms, to â€Å"the transcendent law of Nature and of Nature’s God† upon which the nation is founded and all human action de? pends. 9 The question whether identity is a limitation or starting point for freedom may be a puzzler for twenty?first century man, but it is an easier question when tossed the way of Pub? lius. The authors of The Federalist Papers knew human nature or identity to be the starting point for human freedom or liberty. II. HUMAN NATURE What is the law of nature? An early twentieth century lec? turer put matters nicely: Every living creature is the embodiment of some form of natural law. Its duration of life depends upon its obedience to the law of its nature, as embodied in its organism. It lives by being itself, by persisting in being itself, and when it vio?lates the law of the kind of being it is, it renounces life and perishes . . . . All animated beings are subject to the laws of cause and effect, as Nature has prescribed them for each species . . . . [I]n any complex organization, like human soci? ety, something must be freely granted to the individual. This is what we mean politically by â€Å"liberty. † On the other hand, something must be insisted upon for the benefit of the group. This is what we mean by â€Å"law,† in its social sense . . .. Without liberty, there is no initiative, and hence no progress. Without law, there is no survival of the group. 10 It is within the will of man to have positive law either ad? vance human nature or undermine it. It would be a mistake, however, to suppose that the constructed, positive law of soci? ety can disregard the law of nature without consequence. We can construct governments and other social structures beyond our individual natures, but these perform well only if nature’s truths are observed. â€Å"What we must never forget is that Nature never ceases to govern; and that, if men wish to govern, they must govern under Nature’s Laws, or they will be doomed to failure. †11 9. Id. 10. DAVID JAYNE HILL, HUMAN NATURE IN THE CONSTITUTION 24–25 (1926). 11. Id. at 29. 36 A. Harvard Journal of Law Public Policy [Vol. 29 Human Liberty or â€Å"Right† Derived from Assumed Duty The founding generation was studied in the dismal history of societies that sought the false freedom of governing against human nature. If one begins the history of human government with the patriarchal clan, one sees force, but little acknowl? edgment of human liberty or freedom. 12 As the clan gave way to various forms of warrior chiefs and kingships, there was a natural mindfulness of the well? being of one’s group. Several thousand years before Christ, Hammurabi’s famous legal code would describe the clan leader as a shepherd chosen â€Å"to care for the people [and cause them] to dwell in peace and security, that the great should not oppress the weak. †13 The Greeks would give a name to these assumed natural duties of care, and these in turn would later become encapsulated into the notion of rights or liberties. Rights, therefore, arose as correlatives from the reasoned objection of man’s intellect when leaders defaulted on their expected duty of care and irrationally de? prived man of the necessary goods or sustenance to survive. Stoic philosophers like Cicero would bring this conception of human right or liberty derived from duty to Rome, but, with Rome’s fall, barbarian kings once again obscured the concept of natural rights. It would not re? emerge until the American Founders decided to build a government upon human nature and its associated rights. B. Affirmation of Creation as Source of Natural Right or Liberty â€Å"When . . . the Laws of Nature and of Nature’s God entitle them, [and] a decent respect to the opinions of mankind re? quires . . . .†:14 With these words, the Founders gave explana? tion not only for the formation of a new sovereignty, but also the human liberty the newly established United States sought to advance. It was an explanation premised upon the pro? claimed truth that man is not self? creation, but created. That the handiwork of the Creator came with a conscious endow? ment of unalienable rights—life, liberty, and the pursuit of happiness—led to the conclusion that any governmental form 12. This is not to say that force within the clan was always contrary to human nature. 13. HILL, supra note 10, at 37 (quoting Hammurabi’s legal code from approximately 2250 B. C. ). 14. THE DECLARATION OF INDEPENDENCE para. 1 (U. S. 1776). No. 1] The Human Nature of Freedom and Identity 37 that followed would need to have one overriding end: to secure human nature and the rights associated with it. There is much speculation as to why America in the late Eighteenth Century was the locus of natural law rediscovery. Possibly, it was the wide sweep of land, and nature, itself, that the colonists daily inhabited and sought to harness. Perhaps it was the extraordinary discoveries of the era in natural science. Or it may simply have been that no people so distant from their country of origin could rationally continue to think of them? selves as â€Å"subjects. † American colonists were persons enjoying natural liberty. However it was, â€Å"[t]he American colonists came upon this idea in their own way . . . . It was the result of their own experience in self? government, coupled with their faith that their human nature had a Divine origin and involved a moral responsibility of which freedom was a necessary corre? late. †15 If freedom, and the new government that aspired to it, were to be guided by human nature, then that nature would need to be understood. At a very basic level, giving proper attribution to a Creator put human nature off? limits to human redefini? tion16 and secured unalienable rights against the government,17 but a workable government would require some greater identi? 15. HILL, supra note 10, at 51–52. 16. Such attempted human redefinition of truth, unfortunately, is all too common. For instance, disputes abound over what legal protection to extend to an unborn child ever since Roe v. Wade, 410 U. S. 113 (1973), but the legal dispute has absolutely no effect on the truth of the child’s humanity. So too, any association of persons can be legally called a marriage, but such domination has no effect on the truth of what marriage is in terms of conjugal unity and procreative potential. Moreover, because legal assertions have no discernible power to redefine the natural essence of these matters, man ought not to seek to have positive law and nature work toward different ends. Justice James Wilson, who signed both the Declaration of Independence and the Constitution, sagely counseled that â€Å"law can never attain either the extent or the elevation of a science, unless it be raised upon the science of man. † JAMES WILSON, Man as an Individual—Abstractly Treated, in 1 THE WORKS OF JAMES WILSON 206, 207 (James DeWitt Andrews ed. , 1896). It was obvious in the 1850s that black men and women were human. Nonetheless, the law pointedly chose to treat them inhumanly. The bloody consequences of the law’s impertinence in ignoring human nature are etched in history. 17. See Thomas L. Pangle, The Philosophic Understandings of Human Nature Informing the Constitution, in CONFRONTING THE CONSTITUTION 9, 74 (Allan Bloom ed. , 1990) (â€Å"This means . . . while the majority retains supreme political power, it does not retain and never had unlimited power. The supreme (irresistible) power governing every rational person’s behavior is the desire for self? preservation and every individual retains the inalienable right to resist perceived threats to his property and existence, no matter what the source of those threats. †). 38 Harvard Journal of Law Public Policy [Vol. 29 fication of the particulars of human nature. A few of these par? ticulars are explored below. III. MAN IS FREE, BUT NOT APART FROM OR ABOVE, SOCIETY In the Seventeenth and Eighteenth Centuries, it was under? stood that man was not intended to live alone, but in society. Of course, part of this sociability was a product of pure neces? sity. â€Å"From his beginning [man] was born into [society], and without it he could never have been. Helpless in his isolation, he could be exterminated even by swarms of insects. †18 But the yearning for community was more than a utilitarian means of defense against predatory animals or other threats to physical existence. The Founders read Aristotle and accepted his propo? sition that â€Å"man is by nature a political animal . . . . There is . . . a natural impulse in all men towards an association [with others]. †19 This natural desire, according to Aristotle, arose from two sources: reasoned reflection on right and wrong (which is only a comprehensible exercise in relation to others) and our love of others. 20 A. Jefferson: Man Has a Moral Sense Developed Out of Service to Others Thomas Jefferson most notably made reference to man’s so? cial side, observing in correspondence to John Adams that man is â€Å"an animal destined to live in society. †21 For this reason, Jef? ferson would deliberately criticize the anti? social, atomistic conceptions of Hobbes as a â€Å"humiliation to human nature. †22 Thomas Pangle records that Jefferson had derived from the Enlightenment philosopher Helvetius that we experience pleasure â€Å"when we aid or even when we seem to sacrifice for others. †23 Jefferson was not fully satisfied that Helvetius had explained the origin of the pleasure derived from the service to 18. HILL, supra note 10, at 17. 19. ARISTOTLE, THE POLITICS 10–11 (Ernest Barker trans. , 1995). 20. Id. at 106. 21. Letter from Thomas Jefferson to John Adams (Oct. 14, 1816), in 2 THE ADAMS? JEFFERSON LETTERS 492 (Lester J. Cappon ed. , 1959). 22. Letter from Thomas Jefferson to Frances Gilmer (June 7, 1816), in THE WRITINGS OF THOMAS JEFFERSON 24 (Albert Ellery Bergh ed., 1905). 23. THOMAS L. PANGLE, THE SPIRIT OF MODERN REPUBLICANISM: THE MORAL VISION OF THE AMERICAN FOUNDERS AND THE PHILOSOPHY OF LOCKE 120 (1988). No. 1] The Human Nature of Freedom and Identity 39 others and was unprepared to ascribe the origin of man’s moral sense solely to God since that would leave unaccounted for the moral sense or like sensation in a disbeliever. Therefore, on a philosophical level, Jefferson would conclude that, like other aspects of the moral sense in man, nature simply reveals the pleasure of service. 24 As he grew older, Jefferson would come to value tranquility over continued public service,25 but he would continue to lean upon the theorem that the pursuit of happi? ness was dependent upon the virtue of knowing oneself and being useful to others. The â€Å"moral instinct† that inclines us to do good out of a love of others is, Jefferson would conclude, â€Å"the brightest gem with which the human character is studded, and the want of it as more degrading than the most hideous of bodily deformities. †26 B. Wilson: Man Has Moral Sense Because He Has an Innate Conscience James Wilson would question Jefferson’s reliance upon the pleasure or utility of serving others as a sufficiently reliable ba? sis for the development of a moral sense. Unlike Jefferson, Wil? son would insist that human nature intrinsically includes not only a desire to be social and socially useful, but also a con? science. 27 Relying upon Thomas Aquinas by way of Richard Hooker, Wilson would insist that it is conscience that guides reason. 28 The first principles of virtue are self? evident to man, and, were it otherwise, most men would find the pursuit of vir? tue to be impossible and beyond their capacity. Wilson’s attachment to innate conscience contrasts with John Locke, who, in his Essay Concerning Human Understanding, opines that not even the Golden Rule is innately known. Locke is often quoted in a way that makes his writing seem highly relativistic, and certainly the statement, â€Å"[c]onscience . . . is noth? ing else, but our own Opinion,† seems to be just that. 29 Locke was obviously a stronger influence on Jefferson than on Wil? 24. See id. 25. Pangle quotes Jefferson as advising a young James Monroe that â€Å"public service and private misery [are] inseparably linked together. † Id. at 121. 26. Id. at 120. 27. Id. at 121–22. 28. JAMES WILSON, Of the General Principles of Law and Obligation, in SELECTED POLITICAL ESSAYS OF JAMES WILSON 215, 222–24 (Randolph G. Adams ed. , 1930). 29. JOHN LOCKE, AN ESSAY CONCERNING HUMAN UNDERSTANDING 70 (Peter H. Nidditch ed., 1975) (1689). 40 Harvard Journal of Law Public Policy [Vol. 29 son, as Locke’s denial of conscience as innate fits nicely with Jefferson’s proposition that men always inquire further to seek an underlying reason for a moral rule. 30 For Jefferson again, it was the utility of service that brought happiness, not following an inner voice guided by an objective, knowable virtue. Locke would similarly write that â€Å"[p]ower and riches, nay Vertue [sic] it self, are valued only as Conducing to our Happiness. †31 C. Man’s Created Nature Bridges Jefferson and Wilson But Jefferson (and Locke) may not be as far from Wilson as it first would seem. What unifies them is reference to the tran? scendent. All three concede that acknowledgment of a Creator influences man’s moral sense. Locke makes repeated reference to man’s creation, and Jefferson’s â€Å"endowed by their Creator† reference in the Declaration is well known. Nevertheless, Jef? ferson is sometimes described as a â€Å"materialist,† a term he bor?rowed from Locke, or often as a â€Å"deist. † These terms obscure more than they clarify because it was Jefferson’s concession of a Creator God that had real consequence for filling out his con? ception of human nature. As Father John Hardon, S. J. , wrote in apprising the so? called Jefferson Bible, the Life and Morals of Je? sus of Nazareth: That Jefferson believed in God is evident first from his ready acceptance of the teachings of Christ on the subject, the Lord’s Prayer, the Eight Beatitudes, the Parables of the Un?just Steward and the Ten Talents, the Sermon on the Mount—all of which presuppose a belief in the existence of God, the Creator of heaven and earth. Correlative with this goes the belief in prayer and some kind of Providence, and to that extent, at least, an acceptance of some kind of grace, requested for example in the petition, â€Å"Deliver us from evil,† in the Pater Noster. Also the Morals of Jesus allows us to conclude that Jeffer? son believed in some sort of future life, where the good are rewarded and the wicked punished. Besides the Parables of Lazarus and Dives, of the Pharisee and Publican, and the Wedding Feast, Jefferson accepted and extracted the whole discourse of Christ about the Day of Judgment, in the twenty? fifth chapter of Matthew, not excluding the classic 30. See id. at 65. 31. John Locke, Some Thoughts Concerning Education, in THE EDUCATIONAL WRITINGS OF JOHN LOCKE 109, 249 (James Axtell ed. , 1968). No. 1] The Human Nature of Freedom and Identity 41 verse 46, in which Christ foretells: â€Å"These will go into ever?lasting punishment, but the just into everlasting life. †32 What, then, of Jefferson’s self? description as a materialist in the Lockean sense? Hardon writes that it was not a denial of the spirituality of the human soul, but merely the humble con? fession that there is no human proof anchored solely in reason of the soul’s spiritual nature. 33 Hardon’s explanation is persua? sive. Even though Locke (and by extension Jefferson) was un? able to prove the imprint of a moral sense in man and questioned whether reason is naturally inclined toward seek?ing the good, as Aquinas taught, Locke nevertheless insisted on the existence of natural law, knowable only by means of the Divine creator and legislator. 34 By this, Locke meant that hu? man beings are the creation or â€Å"workmanship† of God; there? fore, they belong to God and are His property. From this declared status as created beings, a set of prescrip? tions under the natural law can be deduced. For example, the presupposition of creation allows man to deduce moral pre? cepts in support of â€Å"unalienable rights† derived out of his rela? tionship with a Creator? Owner and other created human beings. These moral precepts themselves then encourage habits of virtue, especially including Jefferson’s insight of service to others. Habits of virtue yield happiness. Disregard the presup? position of man as a created being, however, and think of man as his own self? creation living outside or above society, and the process would work in reverse: unhappiness resulting from practices of vice and self? interest unchecked by any moral sense derived from human nature. Without the public ac?knowledgment of man’s created nature, the derivation of moral sense would be impossible, because there would then be no 32. Fr. John A. Hardon, S. J. , The Jefferson Bible, AM. ECCLESIASTICAL REV. , June 1954, available at http://www. catholicculture. org/docs/doc_view. cfm? recnum? 6040. 33. See id. John Locke writes, â€Å"we do not owe our origin to ourselves . . . .† JOHN LOCKE, QUESTIONS CONCERNING THE LAW OF NATURE 161 (Robert Horowitz et al. trans. , Cornell Univ. Press 1990) (1664). Locke was sure that this is not a religious doctrine, even as such doctrines may confirm â€Å"the truth of our argument that man can, by making use of sense and reason together, arrive at knowledge of some su? preme power . . . .† Id. at 165. Locke admitted that reason may prompt some to doubt God’s existence, but he said â€Å"there exists nowhere a race so barbarous, so far removed from all humanity† that is not suited to â€Å"infer from sensible things that there exists some powerful and wise being who has jurisdiction and power over men themselves. † Id. at 165, 167. 34. See Michael P. Zuckert, Do Natural Rights Derive from Natural Law? , 20 HARV. J. L. PUB. POL’Y 695, 721 (1997). 42 Harvard Journal of Law Public Policy [Vol. 29 stable conception of human nature. Human nature would, of course, be factually constant, but insofar as it would be subject to legal redefinition by those in the possession of force, it would not yield moral clarity for public or private decision. Of course, man is not assured of happiness merely by public acknowledgment of his created nature. When man enacts laws or undertakes personal action in defiance of that created na?ture, he is acting in a way that is contrary to a state of happi? ness. For this reason, if a government of law is to be successful, it must be formed to meet the reality of man’s nature: a reality which recognizes both man’s created nobility and rebelling imperfection. Hence, Wilson insightfully comments: [G]overnment is the scaffolding of society: and if society could be built and kept entire without government, the scaf? folding might be thrown down, without the least inconven? ience or cause of regret. Government is, indeed, highly necessary .. . to a fallen state. Had man continued innocent, society, without the aids of government, would have shed its benign influence even over the bowers of Paradise. 35 he Founders believed man had not â€Å"continued innocent† T and so shaped American government to meet his shortcom? ings. IV. MAN’S IMPERFECT NOBILITY The seventeenth? to? eighteenth? century period out of which the Constitution emerged was, as Arthur O. Lovejoy records, a period of transition between the denigration of man and the celebration of his potential. 36 Theologians and religious writers reminded the Founders of man’s creation in the image and like? ness of God and man’s supernatural destiny, but one satire writer after another demonstrated that man, in action, failed regularly to live up to this nobility. These satires of the Seven? teenth Century were but the flowering of earlier writing. Father James Gillis writes: Shakespeare—the myriad? minded Shakespeare—probably knew man better than any other poet or dramatist or phi? losopher. Certainly he made a life study of man; he tracked 35. JAMES WILSON, Of the Study of Law in the United States, in SELECTED POLITICAL ESSAYS OF JAMES WILSON, supra note 28, at 210. 36. See ARTHUR O. LOVEJOY, REFLECTIONS ON HUMAN NATURE 20 (1961). No. 1] The Human Nature of Freedom and Identity 43 every emotion and mood and thought and passion of man to its secret lair in the human heart, dragged it out, incarnated it in man or woman, king, peasant, soldier, student, lover, clown, clothed it in ermine or fustian or in mourner’s weeds, and made it â€Å"strut and fret its hour upon the stage. † If ever a man revealed ourselves to ourselves, it was that all? But? omniscient Shakespeare. But even he was compelled in the end to confess that he couldn’t solve the riddle of man. Wit? ness the famous monologue, â€Å"[w]hat a piece of work is man! † continuing â€Å"how like an angel! † but concluding, â€Å"this quintessence of dust! †37 A. Man Rationalizes Himself as an Exception: The Self? Interest Problem Thirty years before the Declaration, the French writer Mar? quis de Vauvenargues noted how much we enjoy pointing out human defect, thinking we can somehow exempt ourselves from the same criticism. Vauvenargues lamented, â€Å"We are so presumptuous that we imagine we can separate our personal interest from that of humanity in general, and malign the hu? man race without implicating ourselves. †38 n response to this criticism, man would assert as a defense I his commitment to reason. However, one would have to cau? tiously wonder if â€Å"reason† was itself rationalization and self? deception. Man reaches a conclusion favoring passion over rea? son, then finds reasons to justify the passion and deceives him? self into thinking the reasons discovered were the cause for the initial decision. Again, satirists of the Seventeenth Century regularly pointed out that â€Å"[t]he passions always seek to justify themselves and persuade us insensibly that we have reason for following them. The gratification and pleasure to which they give rise in the mind which should be judging them, corrupt its judgment in their favor. †39 hese insights were best represented in the founding genera? T tion by John Adams. He observed that men tend to act first and think after. Men have a tendency to flatter themselves, and Ad? ams thought this self? deception was responsible for many ca? 37. JAMES M. GILLIS, THIS MYSTERIOUS HUMAN NATURE 5 (1956) (quoting WILLIAM SHAKESPEARE, HAMLET act 2, sc. 2). 38. LOVEJOY, supra note 36, at 20 (citation omitted). 39. Id. at 26. 44 Harvard Journal of Law Public Policy [Vol. 29 lamities. 40 Caught up in the various political controversies of his day, Adams wondered why those against him sought to â€Å"blacken and discredit† his motives, rather than address under? lying issues. 41 This trait of human nature has not changed. 42 B. A Government to Bring Perfection from Imperfect Human Nature Richard Hooker had faithfully recorded the noble, but imper? fect, aspects of human nature: Laws politic, ordained for external order . . . are never framed as they should be, unless presuming the will of man to be inwardly obstinate, rebellious, and averse from all obedience unto the sacred laws of nature; in a word, unless presuming man to be in regard of his depraved mind little better than a wild beast, they do accordingly provide not? Withstanding so to frame his outward actions, that they be no hindrance unto the common good for which societies are instituted: unless they do this, they are not perfect. 43 et all was not lost. God had created a universe by counter? Y balancing the forces of physical science, as Newton explained, and man could likewise construct a successful polity by follow? ing His model. So the Constitution came to be, following this instruction of counterpoise or balance, reflected in the planets as well as literature. The Founders, already having declared their fidelity to â€Å"the Laws of Nature and Nature’s God,† pro? 40. See generally JOHN ADAMS, ON SELF? DELUSION, in 3 THE WORKS OF JOHN ADAMS, SECOND PRESIDENT OF THE UNITED STATES 432, 433–36 (Charles C. Little James Brown eds. 1851). 41. Id. at 436. 42. Why, for instance, did environmental groups seek to demonize then? Judge John Roberts as anti? environment because of his dissent in Rancho Viejo v. Norton, 334 F. 3d 1158 (D. C. Cir. 2003), rather than take up the jurisprudential difficulty that animated the Supreme Court decisions upon which preced.

The Issue Of Elder Abuse And Neglect Social Work Essay

The Issue Of Elder Abuse And Neglect Social Work Essay Elder abuse and neglect is a critical health care issue that must be brought to the attention of health care providers and older adults family members. Adults older than 65 who live at home or in long-term care facilities may be at risk for abuse. Nurses should be aware of the causes, screening questions, symptoms of abuse, and resources in the community. Armed with information and a better understanding about the issue, nurses can minimize the devastating effects of abuse on older adults and their families. Every man, woman, and child deserves to be treated with respect and caring. Individuals of all ages deserve to be protected from harm by caregivers (American Psychological Association, 2006). Significant policy developments during the past 20 years have focused on eliminating abuse. However, a deficit in health care providers knowledge and clinical skill application remains. The purpose of this article is to define and describe the kinds of abuse, their potential clinical presentations, and theoretical explanations for abuse to enhance nurses knowledge and understanding of their role in its assessment and management in older adults. BACKGROUND Abuse is defined as the infliction of injury, unreasonable confinement, intimidation, or punishment, with resulting physical harm, pain, or mental anguish (Table 1). It can also be the willful deprivation by a caregiver of goods or services that are necessary to maintain physical or mental health (American Psychological Association, 2006). Elder abuse and neglect has plagued society for centuries but only recently has the issue come to the attention of health care providers, law enforcement agencies, and protective services. Fewer research studies exist about the maltreatment of older adults than about other forms of family violence, including child abuse, rape, and intimate partner violence. The earliest reports of elder abuse and neglect in the United Kingdom in the 1970s dramatized case reports of the phenomenon, termed Granny battering. The health care community and the public were shocked and appalled. A decade later, studies confirmed that the problem was common in the United S tates as well. In the late 1970s, the U.S. Senate Special Committee on Aging issued a series of reports on abuse and neglect occurring in nursing homes. In 1981, the U.S. House of Representatives Select Committee on Aging conducted hearings in which victimized older adults gave firsthand testimony of their experiences with abuse. In 1986, the Institute of Medicine published recommendations for preventing the maltreatment of older adults in institutions, and several years later, the Elder Abuse Task Force was created by the Secretary of the U.S. Department of Health and Human Services. The task force developed an action plan for the identification and prevention of maltreatment of older adults in their own homes, health care facilities, and communities. The action plan included data collection, research, technical assistance, training, and public education. The National Center on Elder Abuse was established as part of the Administration on Agings Elder Care Campaign. Adult Protective Services progra ms now exist in every state to serve vulnerable adults, particularly older adults, who may be at risk for abuse and neglect. Many law enforcement agencies and Offices of the District Attorney have investigative staff specifically trained to address abuse of older adults and other vulnerable populations, in collaboration with health care and protective service professionals. Such actions have led to increased public and health care provider awareness about elder abuse and neglect. Researchers have also sought to grasp the full scope and causes of maltreatment among older adults. Laws that require health care providers to report suspected cases have been instituted in nearly every state. The Joint Commission on Accreditation of Healthcare Organizations (2006) standards for emergency departments and ambulatory care centers call for improved identification and management of elder abuse, in addition to intimate partner violence and child abuse. As the U.S. population ages, demands placed on health care systems to care for older adults are increasing. More than 36 million people who live in the United States are older than age 65, and 600,000 older adults will require assisted living (U.S. Department of Health and Human Services, Administration on Aging, 2006). Currently, there are approximately 17,000 nursing homes in the United States, with 1.6 million residents (U.S. Department of Health and Human Services, Administration on Aging, 2004). Unfortunately, older adults are becoming victims of intentional abuse and neglect within their own homes, as well as in assisted living and long-term care facilities. Each year in the United States, 1 to 2 million adults older than age 65 are injured, exploited, or mistreated by their caregivers (National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect, 2003). One community-based, cross-sectional survey reported that 32 of every 1,000 older adults reported that they had experienced some form of maltreatment at least once since reaching age 65 (Pillemer Finkelhor, 1988). Underreporting is typical with all kinds of abuse, and it is estimated that only 1 in 14 elder maltreatment cases are reported. Health care providers can expect to see a steady increase in the number of cases of elder maltreatment as the older adult population rapidly increases. THEORIES OF ELDER ABUSE Elder abuse is a complex problem with multiple risks and causes. Dysfunctional family lives, cultural issues, and caregiver inadequacies have been implicated as contributing factors. Awareness of such factors may help nurses understand and anticipate situations where maltreatment may be preventable. Several theories attempt to explain the existence and increasing occurrence of elder abuse. The transgenerational, or social learning, theory asserts that violence is a learned behavior. Individuals who have witnessed or been victims of family violence are more likely to try to resolve challenging and difficult life situations with violent tactics they learned in their formative growth. Although 90% of perpetrators of elder abuse are reported to be family members, this cannot account for all cases (Fulmer, Guadagno, Bitondo, Dyer, Connolly, 2004). Situational theory supports the idea that the greater the burden on caregivers, the more likely caregivers are to abuse. Exchange theory addresses the dependence of older adults on their caregivers as a risk of abuse, along with inadequate methods of problem solving as an established pattern of family behavior. Political economic theory addresses the changing roles of older adults. Their loss of independence and income may cause them to look to others for care and support (Fulmer et al., 2004). Psychopathology of the caregiver theory studies caregivers with severe emotional or mental health problems or addictions that put the older adults for whom they care at risk of being abused. For example, a caregiver with a mental health problem who cares for a frail older adult with cognitive impairment is a dangerous combination and may lead to resistant behavior and maltreatment. Although theoretical frameworks cannot explain all cases of elder maltreatment, they can provide a foundation for nurses to begin to understand the combination of factors responsible for the occurrence of elder abuse and initiate a holistic plan of care. NURSING ASSESSMENT INTERVENTIONS Nurses are in an ideal position to play a significant role in the detection, management, and prevention of elder maltreatment and may be the only individuals outside of the family who have regular contact with an older adult. Nurses are uniquely qualified to perform physical and psychological assessments, order confirmatory diagnostic tests (e.g., blood tests, x-rays), and collaborate with physicians and protective services. They may authorize services, such as home health care, or recommend hospital admission as they initiate further investigation by the appropriate local agencies. Opportunities for abuse detection and intervention occur daily in health care settings. In institutional settings, nurses may monitor patient health and perform health history interviews and physical, psychological, sexual, and financial abuse assessments that may be crucial to elicit reports, expose or prevent abuse, and intervene for patients safety (Wieland, 2000). Nurses and other health care providers are part of an interprofessional team collaborating to ensure appropriate, sensitive, and safe outcomes for older adult patients. Institutional maltreatment occurs in long-term care facilities, board-and-care homes, and other assisted-living facilities. Institutional medical directors, private practitioners, nurses, and all health care workers in daily contact with older adults have a responsibility to identify, treat, and prevent abuse. Abuse may be perpetrated by a staff member, another patient, an intruder or a visitor, or a family caregiver. Abuse may include failure to implement a plan of care or provide treatment, unauthorized use of physical or chemical restraints, and use of medication or isolation for punishment or staff convenience. Nurses must be aware of patient diagnoses, medical orders for care, and medications and their side effects to recognize what is suspicious and needs further evaluation or warrants a report to supervisors. However, most elder maltreatment does not occur in institutions but in the home at the hands of a caregiver, often a family member. Unless nurses are educated about abuse and how to observe suspicious injuries, elder abuse may be difficult to detect. Definitions of the kinds of abuse and their signs and symptoms should be included in the training and education of family members and health care workers who care for older adults. Older adults experiencing abuse may be unable to communicate clearly, their bruises may be attributed to the aging process, or they may be fearful and hesitant to report abuse (Wieland, 2000). Indications of physical abuse should signal health care providers to evaluate for other kinds of abuse, such as sexual abuse. In addition to inadequate information, training, and the caregivers experience of caring for older adults, older adults are at risk for maltreatment due to other vulnerabilities. Older adult residents in institutions are typically dependent and chronically ill and may have cognitive, visual, and auditory impairments. They are usually more frail than are younger patients and may not have regular visitors who monitor their mental status, physical condition, or health care. In older adults, each vulnerability increases their mortality risk (Fulmer et al., 2004). Co-existing conditions and medical diagnoses may lead to worse outcomes for older adults who are abused. They may have a decreased ability to heal after injury and may experience greater trauma from physical injuries than do younger people. Their bones are more brittle and tissue more easily bruised, abraded, and lacerated with minimal trauma. Injured older adults differ from the younger population in terms of cause of injury, physical and psychological responses to abuse and injury, and outcomes. Dementia is common in 50% of residents of long-term care facilities (National Center for Health Statistics, 1985), and cognitive impairments often cause older adults to behave in a more resistant manner toward caregivers. Impaired cognition, along with insufficient resources, staff shortages, high staff turnover, and inadequate supervision and training, may increase the risk of elder maltreatment. In addition, societal ignorance about required standards for quality care and victimized older adults acceptance of abusive or neglectful behavior can lead to exacerbation of elder abuse in institutions. Routine questions related to elder abuse and neglect can be incorporated into daily nursing practice. Diminished cognitive capacity does not necessarily negate older adults ability to describe maltreatment. It is always reasonable for nurses to ask about abuse or neglect. A brief mental status examination can be helpful in evaluating patients cognitive status. Assessment for elder abuse should include caregiver, as well as victim, evaluation. Nurses should conduct interviews and examinations with the patient first, in a private setting separate from the caregiver. Clinical settings should have a protocol for the detection and assessment of elder maltreatment. Protocols should consist of a narrative, checklist, or standardized forms that enable rapid screening for elder abuse and provide guidelines for sound documentation that may help disclose patterns of abuse over time and will withstand scrutiny in court. Basic demographic questions should be included and should allow the interviewer to determine the family composition and socioeconomic status. Interviews should proceed from general questions that assess the patients sense of well-being to those focusing on specific kinds of abuse. Common signs and symptoms of maltreatment should be evaluated (Table 2). Elder abuse screening instruments are summarized by Fulmer et al. (2004). Questions recommended by Wieland (2000) for general abuse screening and assessment include: * Do you feel safe where you are living? * Who is responsible for your care? * Do you often disagree with your caregiver(s)? If so, what happens? * Does anyone scold or shout at you, slap or hit you, or leave you alone and make you wait for care or food? After general screening questions, more specific questions about kinds of abuse may follow: * Has anyone ever touched you without your consent? * Has anyone ever made you do things you did not want to do? * Has anyone ever taken something that was yours without asking? * Have you ever signed any documents that you did not understand? Health care providers do not have to prove that elder maltreatment has occurred. They need to screen and document suspicious verbal and physical findings, which may be as simple as stating that the patient seems to have health or personal problems and needs assistance. Sound documentation may include drawings of injuries on body diagrams or photographs to support written reports. Suspicious claims for abuse and neglect may be difficult to quantify. Diagnosis of elder maltreatment depends on education about abuse and application of that knowledge by the multidisciplinary team of health care providers, law enforcement agencies, advocates, and patients. Protocols for elder abuse screening, assessment of risk factors, and documentation should be posted in all health care facilities. ABUSE AND THE LAW National standards for care in nursing homes are based on the Nursing Home Reform Act of 1987. The law is part of the Consolidated Omnibus Budget Reconciliation Act of 1987, often referred to as OBRA 87. The intent of the law is to promote high-quality care and prevent substandard care. The law also seeks to ensure that the rights of nursing home residents are respected. These include: * The right of protection against Medicaid discrimination. * The right to participate in health care decisions and to give or withhold informed consent for particular interventions. * The right to safeguards to reduce inappropriate use of physical and chemical restraints. * The right for provisions to ensure proper transfers or discharges. * The right to full access to a personal physician, long-term care ombudsman, and other advocates. * The right to be free from verbal, sexual, physical, or mental abuse, corporal punishment, and involuntary seclusion. * The right to be free from physical restraints or psychoactive drugs administered for the purpose of discipline or convenience. Nearly all states have mandatory reporting laws that require health care professionals and paraprofessionals to report suspected elder abuse and neglect to a designated authority. Some state laws specify that after authorities have been alerted to suspected elder abuse or neglect, an agent of the state must make an onsite investigation in an attempt to corroborate the report. Uniform reporting systems are established, and cases are assigned and investigated by protective services in a timely fashion. Cases are assigned and investigated by protective services in a timely fashion. Nurses may play an important role in preventing and identifying elder abuse, as well as in the subsequent investigation. CONCLUSION Elder abuse is a significant problem in the United States and often goes unreported and unrecognized. Elder abuse may be physical, emotional, psychological, sexual, or financial. Immediate care, overnight housing, and care in a safe location, in addition to long-term care and home-delivered food, may be necessary. Elder abuse may be a minor issue that can be easily resolved or it can result in severe and life-threatening debilitation. The more knowledge health care providers have, the more likely they are to institute strategies for abuse prevention and management. No matter how minor or severe the abuse, nurses have a duty to assess elderly patients according to recommended protocols and report suspected abuse to designated authorities. The multidisciplinary team then works together to help resolve the issue. The application of knowledge about elder abuse includes screening, assessment, and sound documentation in an attempt to enhance the quality of life and maximize the functional ability of older adults. [Sidebar]

Comparing the Ghost Stories: The Old Nurses Story versus The Ostler Ess

Ghost stories have been popular throughout the ages. During the nineteenth century, there was a sudden boom and ghost stories were made popular. Storytelling was the main source of entertainment as there weren't any films, TV's or computer games. People would gather around in groups telling or reading each other stories. The stories were made more real by the superstitions people kept and as the rooms were lit by dim candle light, it built a sense of atmosphere. Most ghost stories were written in the nineteenth century period, so people could imagine such things happening to them, in the places they lived. As storytelling was the main form of entertainment, people had nothing to compare it to, so it built tension, suspense and fear. In the nineteenth century there weren't many scientific advances. Everything was blamed on higher or supernatural forces, therefore, people believed the explanations given in ghost stories. I will be comparing and contrasting four ghost stories which were all written in the nineteenth century. They are ?The Old Nurse?s Story? by Elizabeth Gaskell, 1855 and ?The Ostler? by Wilkie Collins, 1855. ?The Old Nurse?s Story? by Elizabeth Gaskell is about a young girl (Miss Rosamund) and her nanny (Hester) going to live with her great aunt (Miss Grace Furnivall) at her aunt?s stately house called Furnivall Hall. Strange events take place at Furnivall Hall and family secrets are revealed. The past comes back to haunt Miss Furnivall and unfinished business is resolved. ?The Ostler? by Wilkie Collins is about an unlucky man (Isaac Scratchard) who has a premonition of his death, being killed by a woman. His luck begins to improve when he meets a woman (Rebecca Murdock). He falls in love and decides to marry to he... ...house in order to claim it to the deep unknown. In ?The Ostler?, Isaac Scratchard found a ?lonely, road-side inn? to stay at as he was lost, he was in an area ?which he was entirely unacquainted with?. Surrounding the inn was a ?thick, dark forest? which adds mystery to the lonely inn and creates an ideal scene for the strange event. A reader in 1855 would find ?The Old Nurse?s Story? to be extremely frightening as the setting is located in a typical 1855 town, so people could imagine such events occurring in places they lived. The location is typically ghostly as the story it is in an isolated, large house during bad weather. However, this gives the reader comfort as not few would live in stately houses. A contemporary reader would not find these as scary as they?re used to the special effects being used and in comparison, the ghost stories don?t seem scary. Comparing the Ghost Stories: The Old Nurses Story versus The Ostler Ess Ghost stories have been popular throughout the ages. During the nineteenth century, there was a sudden boom and ghost stories were made popular. Storytelling was the main source of entertainment as there weren't any films, TV's or computer games. People would gather around in groups telling or reading each other stories. The stories were made more real by the superstitions people kept and as the rooms were lit by dim candle light, it built a sense of atmosphere. Most ghost stories were written in the nineteenth century period, so people could imagine such things happening to them, in the places they lived. As storytelling was the main form of entertainment, people had nothing to compare it to, so it built tension, suspense and fear. In the nineteenth century there weren't many scientific advances. Everything was blamed on higher or supernatural forces, therefore, people believed the explanations given in ghost stories. I will be comparing and contrasting four ghost stories which were all written in the nineteenth century. They are ?The Old Nurse?s Story? by Elizabeth Gaskell, 1855 and ?The Ostler? by Wilkie Collins, 1855. ?The Old Nurse?s Story? by Elizabeth Gaskell is about a young girl (Miss Rosamund) and her nanny (Hester) going to live with her great aunt (Miss Grace Furnivall) at her aunt?s stately house called Furnivall Hall. Strange events take place at Furnivall Hall and family secrets are revealed. The past comes back to haunt Miss Furnivall and unfinished business is resolved. ?The Ostler? by Wilkie Collins is about an unlucky man (Isaac Scratchard) who has a premonition of his death, being killed by a woman. His luck begins to improve when he meets a woman (Rebecca Murdock). He falls in love and decides to marry to he... ...house in order to claim it to the deep unknown. In ?The Ostler?, Isaac Scratchard found a ?lonely, road-side inn? to stay at as he was lost, he was in an area ?which he was entirely unacquainted with?. Surrounding the inn was a ?thick, dark forest? which adds mystery to the lonely inn and creates an ideal scene for the strange event. A reader in 1855 would find ?The Old Nurse?s Story? to be extremely frightening as the setting is located in a typical 1855 town, so people could imagine such events occurring in places they lived. The location is typically ghostly as the story it is in an isolated, large house during bad weather. However, this gives the reader comfort as not few would live in stately houses. A contemporary reader would not find these as scary as they?re used to the special effects being used and in comparison, the ghost stories don?t seem scary.

Herald :: Essays Papers

Herald The early Middle Ages were when Heraldry began. Knights needed a way to identify each other. The noble families developed different patterns and symbols that they would paint on their shields. These symbols served the purpose of representing their families and also, establishing who the enemy was and who the allies was in a battle. They termed these shields, coats of arms. Any family could have a coat of arms but for them to be considered official, they had to be recognized by The College of Arms. The College was where heralds trained to read and write and memorize the existing coats of arms. Therefore they were able to identify the enemies and the allies if needed to do so. A coat of arms, or blazon of arms, as they were sometimes called consisted of several parts. These components were the shield, the crest, the helm, the wreath and the mantle. The shield contained the symbols and their colors. The crest is what goes on top of the helmet. The helm or helmet varied in accordance with the rank of the knight, the time period, or the herald's preference. The wreath consisted of the metal and the primary color. And the design of the mantle also varied with the herald's preference. The herald's used a variety of colors like gold, silver, red, blue, green and black on the shields. But the colors were not there for decoration. They symbolized specific meanings. For example, silver stood for peace and sincerity, whereas black stood for consistency and grief. Red was considered to be the martyr's color and blue meant truth and loyalty. But along with the colors were objects or actual symbols that represented certain meanings. There were many more symbols than there were colors. There was a symbol starting with most of the letters of the alphabet. The meanings of the different symbols were even more specific than those of the colors. For example, a hawk stood for one who does not rest until he achieves his objective. Another symbol was a battle-axe, which stood for the execution of military duty. There were probably almost a hundred, if not more, of these symbols used.

Ethical Dilemma with the End of Life Decisions Essay

In the advent of technology and biomedical advancements in the twentieth century, modern medicine is able to prolong the life of a patient. This dramatic improvement has raised appreciation as well as criticisms in and outside of the medical community. This is because of the important questions that come in about the end-of-life decisions. This is about who really is empowered to make the decisions regarding life, and which quality of life factors should really be considered with these end of life decisions. With technology, the medical world is come up with life support systems which literally â€Å"supports† life even those who are already dying. Because of this, ethical issues regarding when and who will decide on who pulls the plug came up. There are debates on who really has a say to stop the life from these patients. Some say the decision lies on the hands of the doctors, as they are the ones who can perceive whether or not a person still has a chance to survive. Some say the decision depends on the family members and loved ones of the patients, since it is up to them if they want to lessen the patient’s suffering. This goes in line with the concept of Euthanasia or â€Å"mercy killing† which aims to lessen the suffering of the dying patient. There are however several ethical questions which euthanasia has to answer, as it diverts from what the medical community stands for: to prolong and improve the quality of life of a patient. However, we still lack of the comprehensive bioethical rules and laws regarding these end of life decisions, that’s why doctors, as well as relatives and loved ones doesn’t know when it is the time to let go of the patient and literally â€Å"pull the plug†. If the patient however understands the situation he or she is in, he can aid the decision making process of ending his life by creating a will that appoints a relative or friend to carry out what he wishes.