Death Essay Example | Topics and Well Written Essays - 500 words

Death - Essay Example The hospitals and health care systems have become such an all-encompassing establishment that â€Å"personally witnessed death has become an uncommon event in many Western countries† (Aiken, 2001, p.6). This phenomenon has been viewed as an attempt to â€Å"deny the reality of death† (Aiken, 2001, p.6). All the same, media, especially visual media have been showing vivid pictures and scenes of death so enthusiastically that death has become a daily affair for the viewers (Aiken, 2001, p.6). In this way, death has become a fearsome taboo as well as an enjoyable spectacle, on two extremes of our modern times. In medical terms, it can be said that: When the body dies, cells in the higher brain centers, which are very susceptible to oxygen deprivation, die first. This usually occurs between 5 to 10 min after the supply of oxygen is cut off. Next to die are the cells in the lower brain centers, including those in the medulla oblongata, which is the regulator of respiration, heartbeat and other vital reflexes (Aiken, 2001, p.7). There are other perspectives on death as described by different branches of human thought.

The effective usage of HRM principles Essay Example | Topics and Well Written Essays - 2000 words

The effective usage of HRM principles - Essay Example The importance of HRM has already been recognised by virtually any company which follows western standards of business. It is clear that its performance depends not only on hard and attenuating work of its personnel, but also on the "human side" of the employees, their competence, motivation, attitudes, communication and other variables: "HRM is the core of company's general efficiency and the basis for effective management" (Gunnigle et al, 2002: 12). In a similar vein Beardwell (2003: 15) believes that despite the visible simplicity, the area of HRM is exceptionally complex due to potentially unpredictable nature of human resources. If a company fails to properly and effectively manage its human resources in the right areas of the business, at the right time and at the right cost, serious inefficiencies are likely to arise creating considerable operational difficulties and likely business failure (Beardwell, 2003). Originally emerged in 1960s, the paradigm of HRM relied, however, on previous researches and findings of organizational scientists. As Alan Price (2000: 62) states the concept of HRM "...hasn't come out of nowhere" as there is a long history of attempts to achieve an understanding of human behaviour in the workplace. Throughout the whole XX century and even earlier both practitioners and scholars attempted to design the theories explaining human behaviour at work and the ways to raise its effectiveness. A number of organizational theories brought to life the principles of HRM in 1960s-1970s. Though many of modern HRM principles have been already developed by this time, the year of HRM "official birth" is 1981 when Harvard Business School introduced a course that served a blueprint for global spread of human resource planning and management (Price, 2000: 64). A good insight into the value of HR related programs is provided by Schuler (1990: 52-54). He emphasizes that the HR function had an opportunity to shift from being an "employee advocate" (associated with personnel management) to a "member of the management team". Schuler's (1990) view was that this required HR professionals to be concerned with the bottom line, profits, organizational effectiveness and business survival. In other words, human resource issues should be addressed as business issues. It is noteworthy that emergence of HRM chimed with decay of heavy industry and development of sophisticated IT business. Storey (2001: 18-34) believes that emergence of HRM contributed greatly to an ever-greatest since industrial revolution shift in the principles of management. HRM encouraged both managers and employees to get rid of traditional patterns of interaction, outdated ideas of motivation, stereotypes, assessment and appraisal. Managers as well stop being the mentors and executioners and turned to be the members of business teams. Introduction of HRM principle has made modern companies more competitive, dynamic and people-friendly that consequently influenced their efficiency and marketability. Storey (2001: 18) argues that HRM caused what was later called "a new managerialism" - a new look on organization, the ways it functions and succeeds and the way its employees work. Regardless of global recognition of HRM, many managers are still

In the country of men Essay Example for Free

In the country of men Essay Hisham Matar presents In the Country of Men as a national allegory. This is done through metaphors, personification, and characters’ relationships. His purposes for writing this novel were political. A national allegory is any attribution of human characteristics to other animals, non-living things, material states, objects or abstract concepts, such as organizations or governments1 of a nation or its people. 2 Fredric Jameson, with ideas more suitable for the novel than Aijaz Ahmad, was first to think of national allegory. 3 Jameson states that third-world literature must be a national allegory because of the state of its embattled culture and society. A political dimension is always present from the nature of the third-world as opposed to capitalism in the first-world, which enables their public and government to focus on luxuries rather than survival. Ahmed argues that Jameson fails to recognize other third-world novels with different forms of literature because he only considers English written novels. 4 In times of war when the government controls the public’s lives, third-world writers can only search to write in a national allegory, otherwise, torture would be eminent. Political dimensions are always present from the nature of the third-world. National allegory writing emphasizes the political situation of the government. 5 Hisham Matar wrote In the Country of Men for a political purpose. The book may be fiction, but it seems to be drawn upon by real-life events. Writers then were tortured by the revolutionary committee and imprisoned, similar to Ustath Rashid. An interview with Matar reads â€Å"Because of the fear Gadhafi inspired in the intellectual community, many Libyan writers turned to allegory to make their work opaque to the regime. But Matars own writing is more forthright about political experiences — he says that when he decided to set his novel in Libya in the late 1970s, it seemed inauthentic and insincere to not include the extraordinary details of the time†. 6 Writers created allegories so that their ideas on the Libyan regime would not be transparent. Those who were caught were imprisoned. Books were gathered from bookshops and burned like Baba’s were, therefore representing a national allegory. The fact that Matar grew up in Cairo influences the ending of the novel and other aspects of the storyline. His father was kidnapped from his home in Cairo and taken back to Libya where he was tortured and imprisoned, corresponding with Baba’s capture. His uncle and two cousins were imprisoned as well. When they were finally released, his uncle would ask him if he remembered things they used to do together. 7 The child memories recounted inspired the innocence of having a child narrator to be an allegory of the younger generation of the nation, therefore representing a national allegory for a political purpose. The mother and son represent two generations of the country. Their intimate relationship and care for one another is a metaphor for how the country should care for their people and their people towards it. Both are inferior in society, Mama a woman and Suleiman a child. It seems that the title of the novel demonstrates that they are controlled by the men of society. They rely on one another to survive when Baba, the superior figure, is gone. Mama and Suleiman are the only functioning relationship from start to end. The mother cares for her son and compensates him if she does something wrong. Suleiman cares for her and watches after her while Baba is away. They can represent hope for a new and better government in Libya to come. Metaphors and imagery of water compare people and society to actions of the sea, exposing the novel as a national allegory. When Ustath Rashid was hung the crowd responded; â€Å"Like a wave rising, cheering became louder†. 8 The crowd flowed together in a solid movement, influenced by the revolutionary committee’s actions. Those who associated with writers against the revolution were suspected of treason. If the crowd of the hanging did not cheer, they may be hung next. Suleiman and Mama were not allowed to talk to Kareem’s family when his father was accused. The revolution moved as one and like a wave, gathering others as it moved forward. Suleiman finds a calming peace with the soft waves of the sea. It was the only hope he could find in the revolution. â€Å"I held the sea as my target, my paradise.. Low wavelets curled their white foamy edges across the turquoise face of the water†. 9 He uses the sea to escape from the heat of the day and the pressures of society. The edges are more subtle than the centre. He stays on the edge of society so he can escape the movement of the revolution. The motions of the sea can be unknown and dangerous, similar to the movement of the revolution. Matar uses personification to dehumanize characters. This shows that this novel is a national allegory. Baba becomes an object once the revolutionary committee release him. His eyes were described as â€Å"tomatoes†10 and his movements as â€Å"mechanical†. 11 He was nothing but a â€Å"figure†12 and a â€Å"monster†. 13 Suleiman did not believe the man was his father. This eliminates any human aspects he once had, being consumed by the revolution. The revolutionary committee controls the public by turning their lives into objects. Therefore, personification shows how Matar wrote this as a national allegory. By analyzing metaphors, personification, and characters’ relationships, it is evident that Matar wrote In the Country of Men as a national allegory. The interview with Matar provides evidence that his intentions behind the novel, personal and political, were to write it as a national allegory. Jameson’s ideas on the nature of third-world text hold for this novel. The objectifying and dehumanization of characters through metaphors and personification develop a meaning for the novel beyond a struggling family, but a national allegory. Bibliography Ahmad, Aijaz, ‘Jameson’s Rhtoric of Otherness and the â€Å"National Allegory†Ã¢â‚¬â„¢, Social Text, 17 (1987), 3-25. ‘Anthropomorphism’, Wikipedia (13 November 2012) [25 November 2012]. Jameson, Fredric, ‘Third World Literature in the Era of Multinational Capitalism’, Social Text, 15 (1986), 65-88. Krishnan, Madhu. ‘Contemporary Fiction: Booker Prize,’ (Lecture 1 Given on 13 November 2012). Matar, Hisham, In the Country of Men (80 Strand, London WC2R ORL, England: Penguin Books Ltd. , 2006). Montagne, Renee, ‘Hisham Matar On The Power Of Libyan Fiction’, NPR (April 28, 2011) , 23 November 2012. ‘National Personification’, Wikipedia (16 November 2012) [25 November 2012].

Environmental Issues For The Countries Of Asia Environmental Sciences Essay

Environmental Issues For The Countries Of Asia Environmental Sciences Essay Asia and its various countries have considerable environmental issues which are cause for concern if not managed effectively. Most of these issues stem from the introduction of capitalism, which has meant rapid industrialisation at a pace difficult to keep up with. Environmental issues arising from capitalism are exploitation of land and natural resources, with devastating effects. Rapid population growth has seen an increase in air pollution and has also been a major issue in developing countries. This paper will look at some of the important environmental issues in Japan, China and Indonesia. It will also look at what governments and transnational organisations have done to address them. Currently, environmental issues are population, water eutrophication, air pollution, waste management, nature conservation, chemical management and international co-operation for environmental conservation  [1]  . Japan currently has one of the worlds highest life expectancies at 81.25 and ranked at the 10th most populated country with 127 million in 2006  [2]  . It has been anticipated that due to falling birth-rates the population will be lower in the long term, yet the current ageing population will rise from 6% to 15% by 2025  [3]  . One issue is how the smaller, younger working generations will support the larger ageing generations  [4]  and what plans the government has in store to address these issues. From an environmental viewpoint, on one hand the workforce and younger generations contribute to the economy, and so balance out their own greater energy consumption. However it is thought that the older generation will ultimately consume more energy via the residential sector  [5]  . Another issue is how to keep Japans modest natural resources for e.g. land, air and water healthy for future generations  [6]  to enjoy. Lake Biwa provides a good example of water eutrophication. Post Second World War economic activities led to economic growth of Japan  [7]  . Due to no knowledge of water quality management, contamination from local industry and agricultural runoff led to rapid and intense pollution and deterioration of many water systems e.g. Lake Biwas plankton biomass, red and bluegreen algae blooms and eventual high rate of eutrophication  [8]  .The introduction of wastewater treatment, banning of certain detergents containing polyphosphates and construction of wetlands to support drainage by local government and community efforts led to a halt in degradation  [9]  . At the same time as Lake Biwa, Minamata Bay was being poisoned. Minamata Disease was not discovered until it was realised that approximately 4000 victims  [10]  had in common the fact they had all eaten fish from the Minamata Bay. After years of testing, along with protests from the Nippon Chisso Company who had a defective production process for acetaldehyde, it was finally determined that massive amounts of mercury had been dumped into the bay by the same company, and had caused much suffering and death  [11]  . Industrialisation has caused air pollution to be a major issue in Japan. In the 1950s and 60s it experienced levels of pollution 3-5 times higher than current national ambient air quality standards  [12]  hence very high rates of asthma and other respiratory illnesses  [13]   Japans population, limited resources and past environmental experiences have meant moving toward more sustainable development. The government has recognised the need to address these problems. The Millennium Project is one strategy whereby the government is committed to achieving set Millennium Development Goals to help reverse international problems of poverty and sustainable development  [14]  . Concurrently, ESRI (Economic and Social Research Institute) began a study called A study on Economic Social Structure in the 21st Century, which manages issues of ageing impact on the environment. Strict regulations; strong monitoring abilities; overhauling of relevant legislative framework; setting new standards and monetary assistance for research on sustainable technologies have been effective in the implementation of environmental policy  [15]  . Family policy was implemented in the shape of pension reform; the introduction of the LTCI (Long Term Care Insurance) and its reform in 2005  [16]  and Health Policy  [17]  . All are all ways in which the government and transnational organisations have attempted to address the environmental problems. China According to Thavasi and Ramakrishna, China represents 20% of the global population with 1.3 billion people. There is no doubt that the urbanisation of the Chinese population and environmental issues are directly connected. The link between population growth, the need for economic growth and energy consumption unfortunately overlaps with agriculture, natural resources and industrial activities. This overlap is has a negative impact upon human health and the immediate environment, and according to Bannister is irreparable in the medium term  [18]  . Many would agree that air pollution is one of Chinas major environmental issues and is determined by some to be one of the leading causes of death. It is caused mainly by burning of fossil fuels for electricity production and transport  [19]  . The transport sector has grown in conjunction with the population over recent decades. The consumption of petroleum for transport increased on an average 6.7% a year between 1990 and 2002. Although China was a primary producer of petroleum, they began importing in 1996 as consumption outweighed produce. By 2007 Chinas net oil imports including crude and refined petroleum products had increased rapidly at an astonishing rate of 22 percent annually, reaching 197 million tonnes in 2007  [20]  . About 90% of the fuel used to generate electricity from consists of coal, making thermal power stations a major source of concentrated pollution. This pollution consists of primary particles and S0à ¢Ã¢â‚¬Å¡Ã¢â‚¬Å¡ emissions, of which China is classified as 99 in the world based on its C0à ¢Ã¢â‚¬Å¡Ã¢â‚¬Å¡ emissions per capita  [21]  . Larger power plants are more efficient in terms of coal use than smaller plants because they have higher combustion efficiency, so less coal is needed to create the same amount of power. Also, the taller smoke stacks of the larger power plants disperse pollution over a much larger area making them appear less damaging per ton than the smaller plants, whose pollution is spread over a more concentrated area  [22]  . Government strategies have been to close down the smaller plants, limit mining of high -sulphur coal and encourage encourage high stacks on power plants. These strategies were not enough to keep emissions below the emission standards. In 2004 the government implemented a decree to raise fees for sulphur emissions. All new plants will install desulphurisation and older plants will install over time  [23]  . Most recently, the government plan to reduce sulphur emissions is to install (FGD) flue gas desulphurisation so that by2010, emissions will be reduced by 6 000 million tons  [24]  . With the exception of cement manufacturing which is spread throughout urban and rural areas, heavy industry such as chemical manufacturing plants and large iron and steel mills were a major part of Chinas economy in the past. By means of government policy of the time, these plants and mills were built close to cities to create employment and increase economy  [25]  . Human exposure to these and other air pollutants can cause health issues such as respiratory illnesses, chronic bronchitis, skin and eye irritation, chronic and obstructive pulmonary disease, pulmonary heart disease, asthma and lung cancer  [26]   Water quality has also been affected by industry. Population growth led to expansion of cities and industry. This resulted in a large increase of freshwater aqua cultural fishing, more dumped industrial waste, agricultural runoff, and sewerage which has caused rapid decline of Chinas water supply and similar to Japan, the worsening eutrophication of lakes  [27]  . Between 2000 and 2005, an increase from 30% to 45% in wastewater treatment should have seen a slowing down of eutrophication. However, due to the mentioned expansion, the amount of wastewater entering the lakes continues to increase accordingly. The four trophic states of a lake are ogliotrophic being most pure, mesotrophic, eutrophic and hypereutrophic being virtually dead. To reach the hypereutrophic state could take thousands of years if at all. However the waste continually enters the lakes at such a rate that it has caused some like Dianche Lake, to change from eutrophic to hypereutrophic in less than 20 years  [28]  . Measures implemented by the government to reduce water pollution include building more wastewater plants and sewer collection systems, promoting clean production in factories, control of types and quantities of pesticides used, and more environmentally friendly methods of irrigation. Research on economical technologies into prevention of damage from fertilisers is also being conducted by the government in conjunction with local communities  [29]  . South-east Asia The most important pressures on Japans environment today originate from transport, agriculture, industry and, particularly, the growth of energy demand and private final consumption. Priority environmental issues include urban air pollution (NOx, suspended particulate matter, toxics), waste management, water eutrophication, nature conservation, climate change, chemical management and international co-operation for environmental conservation. The Ministry of the Environment was established in 2001, 30 years after the Japan Environment Agency (which it replaced), with extended or strengthened environmental responsibilities such as waste management, international environmental co-operation. http://www.oecd.org/dataoecd/0/16/2110703.pdf Environmental performance review of Japan:summary and conclusions

Wuthering Heights and Northanger Abbey as Gothic Novels Essay -- Emily

While on the vigorous journey through a novel, a reader can be faced with many questions, put forth intentionally by the author, as well as ones they might conjure up for themselves. Roland Barthes says â€Å"Literature is the question minus the answer.† For the most part this is true, however when one is reading for leisure or the author does not portray as well as they could this statement is invalid. Two novels that have been broken down recently are Emily Bronte’s Wuthering Heights and Jane Austen’s Northanger Abbey. Neither book has a common central question, but they both have their pros and cons. Wuthering Heights is a book containing an intricate plot, and a labyrinth of relationships and emotions. The characterization in this book is extravagant, this is done primarily to draw attention to Bronte’s central question, â€Å"how good is humanity?† Most of Bronte’s focus goes into her characters, her most distinct character is Heathcliff, followed by the older Catherine then to Nelly. As we look back at the text, there were many moments of pain when Heathcliff is described. As a child he was abandoned by his biological family, then Earnshaw died and left him, then the rest of the family treated him poorly and he grew up a villain dragging Catherine with him. He is depicted as manipulative, cruel and heartless, and the classic outsider in Gothic novels. Most can agree that he was put through vast hardships and unfair circumstances and undoubtedly, his personality was altered negatively by this. Could he have changed to a good person? Did he want to? Maybe, but the death of his saviour and the hindrances of his new family all prevented him from becoming anything better. Yet we are all faced with hard circumstances and bitter hat... ...son for writing the novel. Even though the book was written over one hundred and fifty years ago, she still had a grasp on the ways of humanity. Austen on the other hand was not quite there. She did try to make the reader see beyond the plot and characters, and most of the readers pick up on the satire, but it seemed as if there was no more to the book aside from this and critic of the Gothic. Bronte wants us to look at our lives and see what wrongs we are doing and change them, but she still leaves the unanswered questions: ‘How?’ and ‘Why are humans like this?’ Austen may have intended to have more to her novel than just critic, but it was not obvious enough to be usable. All-in-all, both novels gave the reader a sense of being there with the characters, and both used precision in their narration to keep the readers in suspension or rolling on the floor laughing.

Comparing the Daily Lives of African American Women in the 1940s and To

Comparing the Daily Lives of African American Women in the 1940s and Today For much of the nineteenth and twentieth centuries in America, Black women were an after-thought in our nation's history. They were the mammies and maids, the cooks and caregivers, the universal shoulder to cry on in times of trouble. Often overlooked and undervalued, Black women were just ... there. African American women have come a long way. In the 1940s, women were treated as second-class citizens and Blacks faced discrimination everywhere they looked. They were not taught to be proud of being Black (Dressier, 1985). They had a hard time going to school. Black children were not taught Black history. African Americans were not able to have a sense of pride about themselves or their culture (Farley & Allen, 1987). In this paper, I will try to describe and compare the lives of African American women around the time of World War II, a period of great change in the U.S., with their lives today. Due to the enormity of this subject, I am limiting my scope to the discrimination and the resulting economic hardships African American women in particular have endured. Discrimination in Daily Life In 1940, it was very difficult for Blacks to get a job due to discrimination. Naomi Craig, an African American and former World War II defense plant worker, describes that when she graduated from high school, she could not get a job. ?I went to the offices of the different insurance companies. I was a crackerjack stenographer, and I was smart, but I was colored. When I would go down for a job, the girl in the office would look at me and then call for the employer. He?d come out; he?d say, ?Uh, uh Miss Jennings, um, yes, well the job is filled.? I?d go hom... ...own.edu/projects/WWII_Women/ McLoyd, V. C., & Wilson, L. (1992). Telling them like it is: The role of economic and environmental factors in single mothers? discussions with their children. American Journal of Community Psychology, 20, 419-444. Mitchell, L., (November 5, 2000). Personal interview via telephone. Schaefer, R.T. (2000). Racial and ethnic groups, New Jersey: Prentice Hall. Sokoloff, N. J. (1999). Black women and white women in the professions. New York: Routledge. Taylor, R. D., & Roberts, D. (1995). Kinship support and maternal adolescent well being in economically disadvantaged African American Families. Child Development, 66, 15851597. Ulbrich, P. M., Warheit, G. J., & Zimmerman, R. S. (1989). Race, socioeconomic status, and psychological distress: An examination of differential vulnerability. Journal of Health and Social Behavior, 30, 131-146.

Do Resuscitate Status: a Legal and Ethical Challenge for Nursing

Do Resuscitate Status: A Legal and Ethical Challenge for Nursing Shawn Wolkart Senior Integrative Seminar Spring A semester, 2010 University of Saint Mary Abstract A status of do resuscitate in those critically ill patients may result in a slow code. A slow code is a situation where the nursing staff decides to do less than the standard set forth by advanced life support algorithms and the nurse practice act and allow the patient to die instead of possibly sustaining life. The legal implications include falsification of documents and breaching the standard of care set forth by the nurse practice act. The ethical issues include malfeasance, dishonesty, and taking on the role of deciding who has a chance to live during a life threatening situation, demonstrating medical paternalism. When I was in nursing school, I did my rotations in a couple of intensive care units (ICU). Often I cared for patients who were very ill and possibly dying. I took very seriously the task of discussing do not resuscitate (DNR) status with the patient and family, even as a student. Many times, death was anticipated and those involved were ready to make a decision toward do not resuscitate status. The legal and ethical dilemma arose when the patient or family was against DNR status and wanted everything done. Some of the intensive care units that I have worked in had an unwritten status of â€Å"slow code† that the nursing staff would assign to patients that, according to consensus, would not survive. This slow code meant that the staff would call the code after the patient was too far-gone for successful resuscitation or that advanced cardiac life support (ACLS) protocol drugs would not be given. It may have been less than adequate CPR or decreasing the concentration of oxygen used. I had the understanding that life saving resources was not to be wasted on these patients. I heard nurses talk about squirting the drugs into a garbage can or into the mattress of the bed. In one small hospital in a small town, I rotated through a 7-bed intensive care unit. When the manager of the unit would receive a synopsis of the patients and their statuses she would ask about code status. She would tell me that ICU did not need to waste its resources on patients with a do not resuscitate (DNR) status. I, however, believed that â€Å"no code† did not mean â€Å"no care†. This manager would push the nurses to talk to the family and physicians about making the patient a DNR so they could be moved out to another level of care. For those patients with a dismal prognosis that did not become DNR, the staff would then decide if they should be a â€Å"slow code†. As a new upcoming nurse, this appalled me. How could nurses decide when we gave our all and when we held back? I never participated in these slow codes but I never reported what I heard. At that time I was certain the manager would have supported or even taught the nursing staff the techniques of slow codes. Performing these slow codes was a breach in legal and ethical conduct. Legally, the charting would include the drugs given that were actually being wasted, constituting falsification of documents. If these nurses were turned over to the legal system, they could have been charged with harm to the patient by with holding treatment. The nurse’s participation also breached the nurse practice act by not following the standard of care. Ethically, there are issues of malfeasance, dishonesty, and â€Å"playing God† by making decisions about life and death. There were many times that I felt that our efforts were wasted on ninety year old patients with radiation markings for cancer treatment but I always tried to do my best and follow the patients and family’s wishes. I spent time explaining to families the condition of their loved one and what resuscitation did to a body. I wanted the family to understand what resuscitation efforts looked like and the damage they may cause. My instructor often thought I got too involved. I too did not want to resuscitate a patient dying of pancreatic cancer or from severe head trauma but never felt that I had the authority to make those decisions. Although it has been many years since I rotated through an intensive care, I am sure these issues still arise. As a nurse I worked in the pediatric and neonatal ICU’s and thankfully was not exposed to this type of ethical dilemma. In those instances we did everything we could for those little lives. Today, I would report this to the manager and follow the hain of command. The staff needs education and training on end of life care and issues, legal and ethical dilemmas in relation to code status, and review of the nurse practice act. Reviewing legal cases and outcomes with the staff may also increase awareness of the dangers of practices such as slow codes. Nurses are to be healing, caring, empathetic and supportive of patients and families during critical illness, death and dying. At that time, I was just a student nurse and had yet to realize the consequences of this unethical practice. However, as a manager equipped with the knowledge of the ethical and legal dilemmas of a slow code, my actions today would be different. Involving the ethics committee in these cases would be encouraged. According to Pozgar (2007), â€Å"An ethics committee in the health care setting is a multidisciplinary committee that serves as a hospital resource to patients, families, and staff, offering an objective counsel when facing difficult health care issues and decisions. † As a manager, I have a duty to care and having staff breach this duty to care would also be my responsibility. Falsification of medical records is grounds for criminal indictment, as well as civil liability even if the intent was not malicious. Punitive damages may be awarded even if the falsification did not cause compensable harm (Pozgar 2007). Negligence must also be considered in these slow codes. It could be shown that the patient was not given an opportunity to survive. As a manager aware of these slow codes, I would be prepared to bring disciplinary action against those participating and to report their actions to the state board of nursing as necessary. This type of behavior violates patient autonomy and is similar to medical paternalism, which involves the health care professional making decisions for those capable of making their own. These actions in slow codes can constitute passive euthanasia, involving the withholding of life-saving treatment. (Pozgar 2007) These types of situations and the legal and ethical dilemmas surrounding them will continue in the future. With machines that can sustain cardiopulmonary function, the medical and lay communities will continue to question what constitutes death and the realities of dying. We will also continue to encounter situational ethics, where one’s values and moral character can changes with difficult decisions (Pozgar 2007). What I would not change is that staff continues to receive education and support in these difficult situations. After reviewing the material and reflecting on the various legal and ethical issues presented during the course work, my thinking about these events has not changed concerning the legal aspects. Legally, withholding treatment and falsifying documentation is negligence on the nurse’s part, punishable by tort law. The ethics considerations in these events and others studied presented a plethora of considerations including paternalism, euthanasia, and dishonesty. I would involve administration and the ethics committee to conduct a review of the case and appropriate investigation. If an investigation reveals wrongdoing, the issues encompass the legal, clinical, and public relations perspectives. If the practice is disclosed to the family, civil suits may result. If the practice is disclosed to the community, trust may be affected and the hospital’s reputation damaged. The administration and medical staff are legally bound and ethically obligated to report information affecting the licensure of professionals involved, including nurses and other physicians. If the facility chooses the course of saving the family the emotional pain of knowing that more could have been done by not disclosing the slow code, are they really only protecting themselves from further damage? The ethical decisions to be made over known slow codes are not easy, but it remains important that the thought process is a clear as possible. Any course of action will have practical and moral implications. (Boyle, 2001) The ethics committee is a valuable resource to be utilized when these difficult situations occur. In the past, I viewed the ethics committee as a shadow of administration that was only to be used in the most difficult life and death cases involving comatose mothers and unborn children. However, now the ethics committee can be utilized as a powerful resource for supporting and educating staff, patients, and families. As expansive as the legal issues are in a slow code, the ethical issues are doubled. The education I have received by participating in this course leaves me confused as to why these practices were allowed and ashamed that I did not do more to properly report this practice. However, I can now take a stance in educating others on the moral, legal, and ethical standards concerning the practice of slow codes. This will remain a challenge, as I recently had the nurse manager of a critical care unit say that slow codes were the best thing that physicians and nurses could do for a patient at times. Dying with dignity, when patients and families are informed and supported, is a better path than one filled with negligence and dishonesty. References Pozgar, G. D. , (2007). Legal aspects of health care administration (10th ed. ). Sudbury, MA. Jones and Bartlett Publishers, Inc. Boyle, P. J. , Dubois, E. R. , Ellingson, S. J. , Guinn, D. E. , & McCurdy, D. B. (2001). Organizational ethics in health care: Principles, cases, and practical solutions. San Francisco: Jossey-Bass.