Consent Treatment Patients - Health Dissertations - Free Essay Example

Chapter 1-Introduction 1.1 In modern society, everyone has the basic right to consent to medical treatment. However, this is a recent development as consent was not always considered a critical issue in medical treatment. Hippocrates himself, advised doctors that they should conceal the effects of medical treatment from their patients, his reasoning being he believed that when patients were given relevant information they would take a turn for the worse. It was not standard practice for patients to question a doctors decision or authority. Recent changes have contributed to this change in attitude and as such altered the method of practice of a doctors obligation. The final years of the twentieth century as witnessed the most dramatic shift in the reputation of the medical profession within the United Kingdom, due to scandal after scandal plaguing doctors. Major news headlines left the doctor-patient relationship in a state of concern, for example, Doctors who steal organs face jail.This headline refers to the Bristol and Liverpool Hospital where it was discovered that they were retaining childrens organs, without consent or knowledge of the parents. It became apparent in the Bristol and Liverpool reports that organ retention, of both children and adults was widespread practice. Another significant humiliation for the medical profession was the case of Harold Shipman, a general practitioner who was convicted of murdering fiftee n of his patients. Whether these circumstances are due to the actions of individualist or media influence makes little difference to the effect they had on societys viewpoint. There was need for change and this brought about the introduction of regulations and guidelines that protected both the patient and the doctor. 1.2 Informed consent was seen to break the doctor knows best concept and established a liberated choice for the patient. The locus classicus for informed consent is contained within the case Schloendroff v Society of New York Hospital, where it was held, â€Å"Every person being of adult years and sound mind has a right to determine what shall be done with his own body.† There are many examples within the UK system which confirms this principle of law, one being the case Re A (Minors) in which Robert Walker L.J stated, â€Å"Every human beings right to life carries with it, as an intrinsic part of it, rights of bodily integrity and autonomy The principle und erpins the common law concerning consent to treatment within the UK. The consent that a patient has the right to choose is a fundamental part of receiving medical treatment. No considerations need to be examined whether the choice is rational or irrational, as the patient has an absolute right. 1.3 The Department of Health 1993 stated, â€Å"Consent is the voluntary and continuing permission of the patient to receive a particular treatment based on an adequate knowledge of the purpose, nature and likely risks of the treatment including the likelihood of its success and any alternatives to it.† Meaning any permission given under any unfair or undue pressure is not consent. Consent may be expressed or implied, however the validity of informed consent does not depend upon the form in which it is given 1.4 This dissertation will firstly consider the development of informed consent, as the English courts initially had reservations of its establishment and for this reason was gradually introduced in stages, until the case of Chester v Afshar which saw the full acceptance of the doctrine. It needs to be considered how the medical profession dealt with this change and in addition how patients themselves are exercising such powers. The effect in which the Human Acts 1998 has had on the courts decision making process will also be analysed to observe the relevance this may have had on informed consent. Another factor of informed consent includes giving sufficient information and the patients understanding of this. For informed consent to exist, the patient must have all the relevant information and capability to make an informed choice as to the treatment they decide to receive. This was made apparent in the case Reibiu v Hughes, where Laskin J stated, â€Å"the genuineness of consent to medical treatment depends on proper disclosure of the risks it entails† For informed consent to exist within the UK; provisions need to be made for those who are s imply unable to give an informed choice. The capacity of a patient needs to be considered and if they lack this then a doctor must make a decision as to what is in the patients best interest. This can be seen to restrict informed consent as it goes against its true principle, however if a patient can not make an informed choice for themselves then it is only passable that someone has to act on their behalf. This dissertation will examine the procedure for this and how the law enables decisions to be made fairly and respectably. Chapter 2-The Development of Informed Consent 2.1 The area of law that needs to be established is the nature and scope of the duty to inform and the extent to which this has been incorporated into the English legal system. The existence of a duty to warn came about when the relationship between a doctor and the patient, which was based solely on trust, began to erode. There was a need for scrutiny and examination within the medical profession and thi s was achieved through the development of the law. The scope of the doctors duty of care is determined by a reference to the Bolam case. Mr Bolam agreed to electroconvulsive therapy to help improve his depression. He suffered fractures in the course of the treatment. The risk was known to his doctor, but he had not informed Mr Bolam of such. Mr Bolam alleged that the failure to warn him of the risk was negligent. The judge found that the amount of information harmonized with accepted medical practice and dismissed his claim. The judge, McNair J, directed the jury to the principle that, â€Å"A doctor is not guilty of negligence if he has acted in accordance with the practice accepted as proper by a responsible body of medical men skilled in that particular art† Therefore, the defendant doctor had conformed with a practice which was approved by a responsible body of medical opinion. This test was known as the Bolam test and it determines whether the doctor fell below  "the standard of the ordinary skilled man exercising and professing to have that special skill† 2.2 Where there is a difference of judgment between two differing medical opinions, the defendant will be given the benefit of the doubt. As a result a doctor would not be found negligent if the court is satisfied that there is a responsible body of medical opinion that considers the doctor had acted appropriately. This responsible body need not be the majority of the profession. It appears that the courts allowed the medical profession to set their own standard. A doctor simply needed to provide an expert testimony and the courts assumed that it must be responsible. In exceptional cases, the courts perceived some established practice to be substandard, however it appears that only one reported case has materialized where such a judgement has occurred. The case, Hucks v Cole, where a woman contracted puerperal fever due to her doctor failing to treat her with penicillin for he r septic toe and finger. Although a number of distinguished doctors gave evidence that they would not have administrated penicillin, the Court of Appeal found the defendant to have been negligent. The Judge, Sachs LJ, commented that the courts have to be in a position to verify that the medical opinion stood up to logical analysis and that they are not merely tailored to fit the requirements of the respective parties cases. This judgement was one of rarity, as Judges would not ordinarily cross examine a doctors opinion on a logical basis. 2.3 Often cases were even more favourable to the doctor, as is witnessed in the case Hatcher v Black. In this case Lord Denning stated, â€Å"As a matter of law it might be justifiable for a doctor to tell a lie, when he only does that which many a wise and good doctor would do.† It can be concluded from this that it is entirely for the individual doctor to determine what to inform his patient, even if the doctor went so far as to opt for what his lordship termed a therapeutic lie. Professor Michael Jones expressed the state of play as a football score, â€Å"In six medical negligence claims before the House of Lords between 1980-1999 the score stood at Plaintiffs 0, Defendants 6†. 2.4 The Bolam test which was adopted by English law focused on accepted practice and responsible profession opinion. The story was very different in America, as the American Courts rejected the professional medical standard and instead emphasised the patients right to know what the risks are inherent in the treatment. In Canterbury v. Spence a US Court stated that the prudent patient should prevail and its the doctors duty to disclose to their patient any material risk in a proposed line of treatment. The prudent patient principle emphasises what the doctor needs to inform the patient, according to what the average reasonable patient would want to know about potential risks and treatment options. This is made evident when the Judge commented, â€Å"A risk is material when a reasonable person†¦.is likely to attach significance to the risk† Contrary to the English Courts, the USA placed more importance on the patients rights and exigencies than those of the doctors. However, soon after the Bolam decision the English law was making changes towards incorporating this American style of law, to incorporating the doctrine of informed consent. 2.5 The question that needs to be examined is to what extent the Bolam test does or should apply to the duty to inform. Sidaway v Board of Governors of the Bethlem Royal Hospital was the subsequent, leading case to appear before the House of Lords that approached such a matter. While the majority of Lordships legitimatised the traditional test expressed in the case of Mr Bolam, the individual judgements were small steps towards informed consent. Four out of the five Law Lords rejected the transatlantic test that a duty to inform a patient should be based on the reasonable or prudent patient and Lord Scarman alone favoured this manner of law. 2.6 Lord Scarman made it apparent that he considered the patient to have the right to choose what happens to his body, which signified the patient needs to know the risks so can exercise an informed choice. He went on to express what he held to be the suitable relationship between a doctor and his patient, â€Å"There is room in our law for a legal duty to warn a patient of the risk inherent in the treatment proposed†. He went on to consider the doctrine of informed consent and its relevance in the Canterbury case, â€Å"I think the Canterbury propositions reflect a legal truth which too much judicial reliance on medical judgment tends to obscure† Lord Scarman acknowledged the patients rights and that the prudent patient principle made the doctors much more accountable for their actions. As such he rejected the current medical practice that a patient will be informed if he need s to be, as opposed to if he wants to be. Doctors, in Lord Scarmans view, should be liable where the risk is such that in the courts view a prudent person in the patients situation would have regarded it significant. He appears to suggest that the onus proof rests on the doctor to satisfy the court as to the reasonableness of any non-disclosure and therefore suggesting a support for informed consent. However, it must be noted that he did not find in favour of Miss Sidaway, on the basis that she failed to establish that the less than one per cent risk was such that a reasonable patient would consider significant. 2.7 In spite of this the speech of Lord Scarman has stood as a symbol of hope to those who argue for informed consent to be introduced into English law. Lord Diplock rejects Lord Scarmans scrutiny, as he maintains that the Bolam test covers all aspects of the doctors duty to care to his patient. However, he distinguished from the position where a patient asks a question a bout treatment, by stating â€Å"if the patient in fact manifested this attitude by means of questions the doctor would tell him whatever it was the patient wanted to know.† This illustrates that while Lord Diplock believed doctors were not be required to inform the patient of risks, he does not fully discount the patients rights. Lord Bridge also rejected the notion that a patient should be warned of all risks, yet â€Å"when questioned specially by a patient of apparently sound mind about risks involved in a particular treatment proposed, the doctors duty must, in my opinion, be to answer both truthfully and as fully as the question requires.† This gives the patient the option of asking for information from the doctor and if the doctor failed to do so then his duty of care could be in breach. However, Lord Templeman, expressed that this is not clear cut, as â€Å"the court will be slow to conclude that the doctor has been guilty of a breach of duty owed to the pa tient merely because the doctor omits some specific item of information.† It was important that Lord Scarman recognised the doctrine of informed consent and that the remaining four judges recognised the meaning of a patients ability to enquire and the doctor responsibility to notify. 2.8 It seemed that English legal system was initially hesitant to adopt informed consent into medical law. However, the approach taken in the case Gold v Haringey Health Authority contradicts that expressed by their Lordships in Sidaway. The claimant, in this case, indicated that she did not wish to have any more children and was advised to undergo a sterilisation operation after the birth of her third child. The operation was carried out but the claimant later became pregnant and gave birth to her fourth child. The Judge at first instances applied his own analysis as to what information the doctor should have given and found the defendant negligent. Upon appeal, Lloyd L.J held that the Bola m test should be strictly applied and he dismissed the view of the judge prior to him. He asserted that for the purposes of establishing the test as to the duty of care owed by a doctor to a patient no distinction needed to be made between advice given in a therapeutic and non-therapeutic context. In reference to Sidaway he stated, â€Å"the House of Lords could have adopted the doctrine of informed consent favoured in United States of America and Canada, but the House of Lords decided not to follow that path.† It seems clear from the Sidaway judgement that the nature to inform is more extensive than that of the Bolam test where no information is required. The decision in Gold repealed any progress been made towards informed consent and the judgement seemed to convey patient autonomy to be rather trivial 2.9 The view of Diplock in Sidaway has been regarded as the authoritative statement regarding the extent of the doctors duty. There has been a move away from the Diploc k approach as seen in the case Pearce v. United Bristol Health Care NHS Trust which altered the analysis of a doctors obligation. Mrs Pearce, who was expecting her sixth child, was two weeks past her due date of delivery. She discussed the possibility of induction with her obstetrician who warned her of the risks of induction and caesarean surgery, but did not tell her that there was a 0.1 to 0.2 per cent risk of stillbirth associated with non-intervention. Mrs Pearces child was stillborn and she alleged that failure to warn her of the full risks was negligent. Lord Woolf, in this case, held that the patient had the right to know and stated the doctor should normally inform a patient of â€Å"a significant risk which would affect the judgment of a reasonable patient.† It was decided, however, that while a doctor is under an obligation to warn, the 0.1 to 0.2 per cent risk of stillbirth was not classed a significant risk. While the Pearce judgment did not go so far as to fu lly accept the doctrine of informed consent, it adopted elements of the reasonable test. The judgement goes a certain distance to reconcile the approaches of Lord Scarman, Lord Bridge and Lord Templeman in Sidaway. It isolated Bolam, which by Professor Margaret Brazier,who has wrote many publications on issues of medical law, was considered good as Bolam was â€Å"out of control and out of context, it came close to acquiring democratic status in some quarters.† The test for duty to warn was now suggested to be that the reasonable doctor must tell the patient what a reasonable patient wanted to know. The judgement signified a more patient-friendly approach and made greater demands on the level of disclosure. Chapter 3: Further development towards the doctrine of informed consent 3.1 The medical professional has taken steps to further achieve the full introduction of informed consent into the medical world. The General Medical Council (GMC) produced comprehensive guidance to, doctors on seeking the patients consent in Seeking Patient Consent: The Ethical Considerations February 1999 (appendix I). These guidelines make particular reference to the requirement on doctors to attain informed consent, a doctrine which a few years earlier was alien to English law. Since 1992 Professor Sir Ian Kennedy LLD, a former member of the GMC, has been arguing that doctors need specific guidelines on what constitutes good practice. At that time he was the voice of the minority, however due to dramatic change in the doctor-patient relationship the GMC recognised guidelines needed to be established. The standard adopted in these guidelines resembles elements of the prudent patient test specifically that of the judgment made by Lord Scarman in Sidaway. Guidance from the GMC directs doctors to†¦take appropriate steps to find what patients want to know and ought to know about their condition and its treatment. Andrew Hockton believed that the guidelines,  "should now be considered to amount to more an ethical obligation: they provide at least, a starting-point for measuring the extent of a doctors duty of care to patients† It appears that the guidelines are considered to be a benchmark for doctors to monitor their legal duty of care, to which the Bolam test fails to create. This dissertation professes that perhaps this is the responsible body of medical opinion and it seems the medical profession are setting a higher standard for both themselves and the patient. 3.2 It must be noted the development of the Human Rights Act 1998, has extended the doctrine of informed consent in medical treatment. Incorporation of the European Convention of Human Rights under the Human Rights Act encourages the courts to focus more on the patients rights. This area of law includes Article 2 (the right to life), Article 3 (prohibition on inhuman or degrading treatment) and Article 8 (the right to respect for private and family life which include s the right to bodily integrity). The case R(on the application of Wilkinson) v Broadmoor Hospital illustrates how the introduction of the rights affected certain aspects of medical law. A mental patient appealed concerning a decision to administer treatment without his consent and under restraint. He claimed it infringed his rights under the European Convention of Human Rights 1950, Art.2, Art.3 and Art.8. The judge allowed the appeal stating that under the 1998 Act, it was no longer appropriate to forcible treat detained patients without a court judgement granting so. While the decision in this case would not have been so without the introduction of the Human Rights Act, it had little effect on the majority of medical consent cases. The Act was expected to have a great impact upon issues of medical consent, however it does not seem to have made a dramatic difference on the Courts decision making. 3.3 The most recent case that has dealt with the issue of informed consent is C hester v Afshar, where the claimant underwent surgery and suffered nerve damage leading to paralysis. The surgeon failed to warn Miss Chester of the inherent risk in surgery and the House of Lords decided that the risk was of sufficient quantity to determine the defendant had inadequately warned. The case is considered to show the importance the courts attached to the principle of autonomy, as Lord Hope reiterates when he states, â€Å"the duty to warn has at its heart the right of the patient to make an informed choice as to whether and if so when and by whom to be operated on.† The claimants evidence verified had she been warned of the risk she would not have agreed to surgery without at least seeking a second opinion on the necessity and risks of surgery. Therefore, a causation link was adopted by the courts to further prove negligence by the doctor. 3.4 In this case it was sufficient for her to prove that, if properly warned, she would not have consented to the oper ation. Dr Afshar was found to violate her right to choose, which meant she was unable to seek further advice or alternatives. Therefore, a claimant pursuing a claim in this area must prove if the information had been given, their decision as to the treatment would have caused extra consideration. Lord Steyn asserted that individuals have a right to make important decisions affecting their lives for themselves†¦in modern law paternalism no longer rules. This case was a ground breaking decision by the House of Lords, as it introduced fully informed consent and it addressed the purpose and rationale behind a doctors duty to warn. 3.5 Historically the law as taken the view that doctors are honourable and true, essentially allowing the medical profession themselves to dictate the duty to disclose. As a result of the decision made in Chester v Afshar this outlook has changed somewhat and it appears to provide a new dawn for patients rights. It has created a remedy for patients who have received insufficient information, where previously the majority of case had failed to provide such a remedy. The days of Lord Denning are long gone, meaning the doctor-friendly Bolam principle has practically been condemned worthless. While the judgement can be seen to address the reality of responsible expectations of society, it seems the judgment leaves the court with a difficult job determining who, between the patient and the doctor, is effectively legitimate when it comes to what information is disclosed. More specifically the outcome is likely to be met with distaste from doctors and there is already evidence of growing concern from within the profession. Despite the doctors concern the law of informed consent has moved on considerably from the reality where the majority of cases would fail to offer a remedy for those who had not been completely informed. As was stated by Sarah Devaney in a Medical Law Review, that back then, â€Å"It did not matter whether or n ot doctors were wearing the flak jackets of consent, as patients wishing to make claims about lack of information were in any event carrying unloaded guns. However, after cases, time and the materialization of certain events the doctrine of informed consent began to take effect in English law. Chapter 4: The Degree of Sufficient Information 4.1 Informed consent is based on the requirements of appropriate information to allow patients to make an informed choice. The law fails to formulate a standardize figure which can be consider significant and therefore it can only be gauged on previous cases and what the accepted amount has or has not been within these circumstances. More specifically, as no clear indication has been articulated, the judgement will be dependant on the individual facts of the case, as long as this coincides with the authoritative case law. What is clear is that failure to advise sufficiently as to the nature and purpose of the procedure may give rise to a n action against the doctor. If the patient is given inadequate information, then how they able to make an informed decision and therefore be said to have given real consent? 4.2 The leading case Chester v Afshar (as discussed above) contradicted any previous beliefs of the court and that of the medical profession. The case prior to Chester was Pearce v United Bristol Health Care (as discussed above) where Lord Woolf stated that the doctor should normally inform a patient of a significant risk which would affect the judgement of a reasonable patient. It considered the balance of percentages and whether this balance would have effected the patients decision to have the treatment. The risk of 1-2 per cent in this case was not considered to be sufficient to represent a significant risk. The decision in Chester made it clear that a 1-2 per cent risk was an adequate percentage for the doctor to warn the patient. Even though, the doctor appropriately informed according to the Pearce decision and the GMC standards, Chester v Afshar brought a new way of thinking to the table. 4.3 Chester disregarded the concept of what a reasonable patient would want to know and instead looked at what each individual patient wanted to know for themselves. This meant it was more plausible for the doctor to consider the patients personality, concerns and wants and information given must be relevant to the patients decision. The involvement of the causation link enabled patients to assert their rights over decision not only on the surgery itself, but in addition on the circumstances in which it was under, for example the time, place and in whose hands the operation should be performed. The causation link made it easier for patients to receive a remedy at law, as long as they could prove that had they been sufficiently warned of the risks they wouldnt have undergone the treatment. This does not mean they need to prove that they would not have had the operation at any time, jus t not at that moment in time in which they did. The doctor needs to make acknowledgment to both warn of a significant risk and risks which a patient would consider relevant, even if not below significance. It left the doctors with the delicate job of determining what information individual patients wanted to know. This contemporary approach sent shock waves through the medical profession and the GMC had to amend their guidelines, as they now failed to reach a high enough standard. The new guidelines can be found In Good Medical Practice 2006. (see Appendix II) 4.4 Professional guidelines now go further and state the doctor must do his best to discover the patients individual needs and priorities to analysis what information that individual may require. When consenting to treatment patients should be aware of certain factors such as, diagnosis, prognosis, various treatment options, probabilities of success and possible side effects. This was the situation in the case Smith v Tunbridge Wells Health Authority, where a claim was brought against a 28 year old man who was not warned of the risk of impotence inherent in rectal surgery. His claim succeeded despite the risk being considered significantly low, as the judge found failure to warn such a patient of a risk of such importance to him was neither reasonable nor responsible. The doctor needed to have balanced the small risk of importance against the importance it possessed on his life. 4.5 The most effective way of obtaining consent that is currently in the English medical system is consent forms. Consent forms place emphasis on the patients rights; it gives them a sense of control and perhaps recaptures some of the faith that is said to have disappeared between doctors and patients. There is no requirement in English law that consent forms should be in writing, however the Department of Health have recommended the use model consent forms (see appendix III). The most prominent aspect is the fact it does not shy away from informed consent and instead seems to embrace it. It attempts to ensure that patients are aware that they are entitled to ask questions and expect explanations do with the medical treatment they receive. Unfortunately this way of operating is time consuming and is limited to operations and major procedures. It would not be viable for such things as checking a patients throat or examining a patients stomach, as these everyday occurrences are too frequent and considered to be too minor. Some see the consent form as purely evidential yet other believes them to signify fairness to both the patient and the doctor. It creates patient awareness of the fact that they have the right to know and for this right to be attained the patient needs to make it aware what they specifically want to know. This does not extinguish the doctors duties, he must still follow the guidelines set out in obtaining informed consent, for example, explaining the treatment and its implicat ions. In the case Abbas v Kenny the judge stated the obligation is not placed upon the patient and it simply reaffirms their rights, yet it is still the doctors responsibility to â€Å"take into account the personality of the patient and the likelihood of misfortune.† 4.6 Even if a warning is given, it can not be consider a suitable warning if it is insufficiently clear to the patient and affects their ability to make a decision on information they fail to comprehend. The doctor must take responsible steps to ensure that advice is understood by the patient. To what extent is it the doctors duty to make sure the patient understands? Chapter 5: A Patients Capability to Understand 5.1 There is a rebuttable presumption that adults have capacity to consent to or refuse treatment. Therefore to make consent valid they must possess the capacity to understanding the method, consequences and benefits. If one fails to understand the information given and the inherent risks of t reatment then it can not be regarded as informed consent. Care must be taken to not automatically presume those with learning difficulties are incapable; it is important for doctors to not underestimate a person from their faà §ade. Capacity is not a question of decree of intelligence or maturity of the person concerned, it incorporates elements of ability and belief. 5.2 There are different functions of what must be understood. The must frequently cited case in this context is Re C (Adult: Refusal of Medical Treatment) in which, Thorpe J, held that the person must understand the nature, purpose and effect of the procedure. In other words, sufficient knowledge constitutes the general functions of treatment. Another function that capacity can occupy is that held in Re T (Adult: Refusal of Traetment) where Lord Donaldson referred to knowledge in broad terms of the nature and effect of the procedure to which consent was given. The level of understanding was made important in thi s case and that this will differ according to the gravity of the decision. More specifically, the more serious a decision the greater capacity required and accordingly patients may have capacity to make some decisions but not others. 5.3 Assessment of a patients capacity is determined by reference to the Thorpe. Js three stage test in Re C it states the courts will assess the patients ability: to take in and retain treatment information; to believe it; to weigh that information, balancing risks and needs. In this case, a sixty-eight-year old patient was being detained in a special hospital, as he survived from schizophrenia. Despite this, the Judge ruled that the patient remained capable of understanding what he was told about the proposed treatment and the proposed risks involved. By satisfying the three points, a patient can verify that information can be given by the doctor, thought through and decided on and therefore the doctrine of informed consent is followed through. Others that would normally have capacity may be deprived of it by temporary factors such as unconsciousness, confusion, pain or drugs used in treatment. Even a persons phobia can effect they ability, as seen in the case Re MB (Medical Treatment) The patient, MB, suffered acute needle phobia and refused to agree to any form of anaesthetic during a necessary Caesarian section. The Court of Appeal held that she lacked the required capacity to refuse treatment, as her phobia disabled her from making an informed decision. Although she suffered from no mental illness or impairment, temporary factors erode the patients capability. The judge stated that hercapacity was inadequate, â€Å"at the moment the needle or mask dominated her thinking and made her quite unable to consider anything else.† Her fear masked her ability to fully understand the risks of the treatment and as such the decision had to be made for her. 5.5 Similar decisions are made when dealing with patients in emergency situations as they too can often lack the ability to give informed consent. When a patient is unconscious, appropriate treatment must be given in an emergency where consent cannot be obtained. As long as there is no available evidence of a patients own wishes, then under these circumstances the law authorises doctor to perform treatment that is necessary to perceive the patients life. Examining the case Murray v McMurchy explains the courts perception of necessity. Whilst the doctor was performing an agreed caesarean section, he sterilised the patient without prior agreement. The courts held that the sterilisation was not necessity and could have been postponed. More specifically as Lord Goff stated in Re F, treatment is to be confined to â€Å"action taken to preserve the life, health or well-being of another who is unable to consent. Such treatment is justified under the doctrine of necessity. The case Re F made it clear that the basic requirement for necessity, was that a doctors duty at that hospital was to utilise their best endeavours, by way of operation or other treatment, that which is in the best interest of such patients. The principle of best interest will be covered more extensively in the next chapter. 5.6 It is important to look at the effect religion may have on ones understanding to consent fully to treatment. Article 9 of the Human Rights Act provides that everyone has the right to freedom of thought, conscience and religion. In the context of treatment, Article 9 reinforces the approach already adopted by the English Courts. Under the principle of autonomy the religious beliefs and values of a competent patient must be upheld, however illogical from the perspective of the observer. An adult can make a decision which others would regard as being wholly irrational or against his or her best interest so long as he has the requisite capacity to understand the na ture, purpose and effect of treatment. A good example of this situation arising within the law is cases involving Jehovah Witnesses. The wishes of competent Jehovah Witness must be respected, irrespective of a reasonable patients rationale or beliefs. The case Malette v Shulman illustrates such an issue, where a blood transfusion was given to an unconscious card-carrying Jehovah Witness. The judge, Robins J.A. stated, â€Å"Competent adults†¦are generally at liberty to refuse medical treatment even at the risk of death. The right to determine what shall be done with ones own body is a fundamental right in our society.† 5.7 Ian Kennedy and Andrew Grubb, two of Englands most influential experts, declare the three stage test makes capacity dependent on the information the patient receives. The doctor must take this factor into consideration and it is their duty to make the information as comprehension and uncomplicated according to patients ability. Most patients w ould not readily understand a complex explanation whereas the same information delivered in a more basic manner may be followed more simply. So the doctor must take into account the patient in which he is informing and the level of understanding they might have. So what is the procedure for incompetent adults and how can treatment be lawfully authorized on their behalf? Chapter 6: Incompetent Adults Under English law, no one is able to make an informed choice for treatment on behalf of an incompetent adult. However, this poses a problem as the patient himself may not be capable of authorizing his own treatment, and no one has the legal authority to act for him. Before 1983, section 34(1) of the Mental Health Act 1959 allowed a guardian, appointed to care for a mentally disabled adult, to consent to treatment on behalf of that patient. This was replaced by section 8 of the Mental Health Act 1983, which restricted the powers of the guardian and placed ownership of power onto the courts. The law in this area has long been unsatisfactory and has since been subjected to extensive review. The most recent amendment is the Mental Health Act 2007, which sets out the procedures that must adhere to the safeguards for patients. The Mental Health Acts, however are subject to persons detained under the Act and is not applicable to the majority of mentally disabled or ill patients living in the community. For them there are no treatment guidelines or legislation set out in UK on how to appropriately acquire consent or to act on their behalf. The clarity on this issue came in a series of cases, which set out the legality of treatment. The Department of Health advised that, It should never be assumed that people can take no decisions for themselves,† and that the doctor â€Å"must never coerce the person into changing their decision. Seeking consent is about helping the person to make their own informed choice† Care must be taken not to make presump tions that individuals with mental disabilities are incapable of consenting, they are too subjected to the competence test set out by Re C, which was looked at in the above chapter. If they possess the ability to retain information, believe it and make an informed choice then they can make an informed decision. However, if they fail to satisfy the criteria then doctors are under the legal duty to treat incompetent patients in accordance with the best interest principle. This principle can be found within the application of the Bolam test, which asserts that a professional person will not be found negligent if he can demonstrate that he acted in accordance with practices accepted by a senior body of people skilled in his field. This objective test is employed to determine the suitability of treatment for that individual patient. As in the case T v T where the Courts authorized an abortion and sterilisation on a mental disabled woman, as the parents and doctors agreed it was in her best interest. The decision empowered the doctors to decided what treatment the patient should receive as long as taken â€Å"such steps as good medical practice demands.† This has changed slightly and it can now be seen that Bolam is simply just a starting point for the best interest principle. The best interest test does not fully coincide with the Bolam test; it encompasses the broad concept yet makes its own assessment of the patients welfare. As Dame Elizabeth Bulter-Sloss P, stated in the case Re S, â€Å"the principle of best interest, as applied by the courts extends beyond the considerations set out in Bolam.† The Bolam test needs the recognition of a responsible body of professional medical opinion which supports the proposed decision to be in the patients best interest. However it fails to take into account ethical, social, moral and welfare issues. Therefore while it is important to consider the objective element, a subjective viewpoint needs to b e included in the decision. The subjective approach is based on the presumed wishes of the patient and the courts consider what the incompetent would do if she or he could make the choice. This subjective element is patient specific and focuses on what is thought to be the patients wishes and beliefs, but of course this is mostly a matter of speculation. The combination of these two fundamental features acts as a balanced approach to the best interest principle, with the medical profession deciding what is the best treatment for the patient, and the courts making the patients welfare the paramount consideration. It is important to note that the thoughts of immediate relatives or carer will be taken into account, as Lord Donaldson ascertained his view when he stated, â€Å"consultation with the next of kin has a further advantage in that it may reveal information as to the personal circumstances of the patient and as to the choice the patient might have made.† The closet to the incompetent adult can give light on the personality and nature of that person which may assist the courts come to a decision that may reflect the patients wishes. Standard practice is that doctors will decide what the best treatment is for the patient and unless the immediate family or carer disagrees, this treatment will be performed. The guidance of the court must be sought where there is doubt about a patients best interest and special category cases; these include non-therapeutic sterilisation and Persistent Vegetative State In Re S, Thorpe L.J made it clear that â€Å"if a particular case lies anywhere near to the boundary line it should be referred to the courts.† Much improvement has been made on the position of consent for incompetent adults, more regulations and guidance are in place to assure the best possible outcome. Chapter Seven-Conclusion This dissertation analyses the aspects of informed consent within the United Kingdom. When looking at the d evelopment of the doctrine of informed consent it seems that initially the courts were reluctant to incorporate it into the legal system. At first the courts left the power in the hand of to the doctor, much to the dissatisfaction of the patients. It seemed to leave them struggling to assert their right of an informed choice and perhaps confused on exactly what this right actually entailed. When informed consent was fully accepted through he case Chester v Afshar it seemed to clear these clouds of confusion and hand the reigns over to the patient. It enabled the patient to exercise a choice and placed regulations on the doctors to make sure patients had all the tools to do so. This is where perhaps doctors became discontented, as it now seemed there job to provide the patient with sufficient information and make sure they understood it. It was a dramatic transition for health professionals as it required more time, which was already considered to lack.

New Questions About Accepted 50 Successful College Admission Essays 25 Essay Mistakes to Avoid Answered and Why You Must Read Every Word of This Report

New Questions About Accepted 50 Successful College Admission Essays 25 Essay Mistakes to Avoid Answered and Why You Must Read Every Word of This Report The best in reusing is to mail a similar article in exactly the same words to all of the schools to which you're applying. Valid, the paper is an extra work, yet it's your chance to publicize yourself to your fantasy college. Because you've just composed a school exposition for a solitary college doesn't imply that it might likewise apply on your next applications. Building up a great school exposition can lose its motivation in the occasion the substance of what you've composed isn't what the college is requesting. By Mari, IvyWise Master Admissions Counselor Just since there isn't any 1 way to getting admitted to a particular school, there's no one explanation that candidates become dismissed. It's extremely useful to see how the specific top understudies approach the school paper, inasmuch as their absolute best exertion neither scares nor hinders you. It's very critical to exhibit your ability to be an exhaustive onlooker of the Earth, since that will be one of your essential employments as an understudy. Moreover, there are some who think they are fit competitors and are ensured to have a spot for enlistment. The Basic Facts of Accepted 50 Successful College Admission Essays 25 Essay Mistakes to Avoid Additionally, it's smarter to focus on new articles (not more established than 10-15 years), and that implies you are perusing what has worked in the most recent past, instead of seeing obsolete musings and recorded viewpoints. In this occurrence, you're endeavoring to make yourself important to an affirmations official that has been perusing a large number of various articles. Some bothersome themes show affirmations officials which you don't have a prevalent consciousness of judgment or development, which is an issue as they are building a classification of understudies who have so as to oversee autonomous life nearby. Overall quite productive composing as a rule implies that you must check your excitement for self-articulation and be careful about things that have the ability to crush your paper. The Tried and True Method for Accepted 50 Successful College Admission Essays 25 Essay Mistakes to Avoid in Step by Step Detail Bridget's paper is very solid, yet there keep on being a couple easily overlooked details that could be improved. Through long and careful critique on each exposition, Robinson shows why story is only the kind of structure that works best for individual articles. Therefore, you ought to dispense with any themes that wouldn't yield a unique article. In the event that you are scanning for top paper composing organizations, give a shot the referenced previously. Along these lines, you may utilize various individuals' expositions to consider different opportunities for expounding on your own theme. On the off chance that you form an exposition or task with a huge focus, at that point you won't get off the subject. Shockingly, bumbling in the TMI zone of article points is more common than you accept. On the off chance that you have this device close by, it is easy to improve certain segments of the paper before at last composing the school exposition you will submit. The most fundamental piece of your entire paper is discovering this 1 subject. There are a few exposition composing administrations that believe they're the absolute best, and along these lines don't be cheated and check the valid rundown of the absolute best. Other than the things you ought to consistently recall, what's more, there are a few things which you shouldn't do while making the substance of your school article. Thusly, choosing a subject can be the hardest aspects of the total affirmations process. When you own a rundown of thoughts, you have to limit your decisions. Applying on the web is certainly advantageous. You additionally need to continually audit your paper, to ensure your point drives with what it is that you are expounding on. You should search for a theme you can expound on most enthusiastically and adequately. So as of now you understand that the subject probably won't be unique. In the event that a subject bombs the thumb test, see whether you're ready to go over a unique technique. It's an issue of need. Inside this profoundly, propelled time, there are a lot of supportive applications that help you to keep on keeping your exposition liberated from a wide scope of spelling botches. Rehearsing majority rule government isn't hypothesis in respects from the mass brain and formless society we call the people of Mzantsi. There's possibly some proof to suggest that the creator was shaken to some degree from an agreeable, materialistic presence. The History of Accepted 50 Successful College Admission Essays 25 Essay Mistakes to Avoid Refuted Despite its person on foot look, the applic ation structure is a pivotal piece of being acknowledged. With your deficient composing abilities, it will in like manner be difficult for you to get by in your expert profession. The application is some place to praise the opposite side, your absolute best self. Be careful about mix-ups and spend the chance to look at your work.

How to Choose Nursing Essay Topics

<h1>How to Choose Nursing Essay Topics</h1><p>Writing a nursing article has numerous styles and composing difficulties, however not all are anything but difficult to finish. These papers can take a great deal of time, vitality and persistence in arranging, research and composing. However, composing a nursing paper can be perhaps the most ideal approaches to become familiar with the nursing field. It is imperative to discover approaches to find out about various subjects so as to make a progressively adjusted, balanced and enlightening essay.</p><p></p><p>One of the primary interesting points when picking nursing article themes is whether you are right now an enlisted nurture or will be sometime in the not so distant future. There are many nursing themes that you can browse and have a ton of fun. Most people will need to pick a point that identifies with what they are at present doing in their profession, for example, what territories of intri gue they have. A vocation in social insurance has a ton of chances to climb to a more significant level of demonstrable skill, however it requires a lot of difficult work and commitment. In the event that you are as of now in your vocation, at that point this is an incredible theme to consider.</p><p></p><p>If you are at present not in a profession, however might want to one day be, at that point you have to realize how to plan for this projection. A vocation in nursing is a remunerating experience, yet in addition extremely testing. You should take courses when all is said in done instruction, starting nursing, emergency clinic organization, and clinical field preparing so as to meet all requirements for nursing professions. Since there are a wide range of ways you can take to turning into a medical attendant, you should choose which way will be the most useful for you, in view of your vocation objectives and interests.</p><p></p><p>O ne of the best decisions you will make while making a nursing article subject is to choose a topic that you feel is applicable to your profession objectives. This can help with the advancement of your exposition, in such a case that you pick a particular subject, you will have the option to use your composing abilities and information on the branch of knowledge to fabricate a viable article. For instance, in the event that you picked the name of a town in Florida, you can expound on the historical backdrop of the town, the emergency clinic it is situated in, or the ventures that have discovered an enormous following in the town.</p><p></p><p>The subject can likewise enable you to figure out what kind of nursing vocation you need to seek after. On the off chance that you have interests in research and insights, for instance, you can think about a point regarding this in your exposition. Or then again, on the off chance that you appreciate working with others t o achieve an objective, you can expound on that point in your article. Whatever you are keen on, you can discover a subject to accommodate your inclinations. Subjects are not restricted to human services, yet are an incredible method to change up your essay.</p><p></p><p>Many individuals additionally pick a nursing theme that they are especially keen on, for example, their preferred food. This allows them to develop their inclinations while they are composing their paper. For whatever length of time that you make a point to give your primary concerns in your paper, this can give you a decent degree of parity in your article. Ensuring that you center around the primary concern of your exposition, while as yet leaving space for different thoughts and conclusions, is a decent method to keep away from data overload.</p><p></p><p>Nursing paper subjects are extraordinary for understudies who need to improve their composing aptitudes or need some additional training. The more set you up are for composing an article, the more set you up will be to assembled an amazing and compelling essay.</p>

How Do You Find the Best Essays?

<h1>How Do You Find the Best Essays?</h1><p>To become a superior author, the best papers are basic. Be that as it may, how would you locate the best expositions that have the privilege content?</p><p></p><p>Some state that an author is a conceived essayist. It is a long lasting calling that never stops. Others state that the individual in question shows signs of improvement at composing expositions as they get more seasoned. All things considered, you have a decision to be the best.</p><p></p><p>But what truly characterizes a decent paper? I might want to disclose to you that a decent article has quality substance and arranging. These are significant and will give your exposition its extraordinary stamp.</p><p></p><p>The substance of a paper is likewise significant. There are a wide range of sorts of articles out there. The substance of an article is dictated by the reason for the paper. What is the target of the exposition? Is it to instruct or to educate?</p><p></p><p>So in the event that you need to compose an elegantly composed paper, attempt to comprehend the motivation behind the article. It may not be the best article that can breeze through the assessment however it is significant in deciding its quality. On the off chance that it has clear goals and plainly characterized content, you will have a phenomenal essay.</p><p></p><p>To think of a decent article, attempt to concoct an intriguing subject. Expounding regarding any matter is troublesome however expounding on something that intrigues you will keep your advantage high. By making the subject of the paper regarding a matter that intrigues you, you will make the exposition more interesting!</p><p></p><p>Formatting is the last advance recorded as a hard copy an article. In the event that the substance is acceptable, the organization will assum e a tremendous job in forming the substance of the paper. How would you improve the substance of your essay?</p>

Capital Punishment Should Be Abolished Essay - 1161 Words

More than 18,000 Americans have been executed since the creation of the death penalty in colonial times (University of Alabama). The sentence of death for the punishment of a murder in the United States has declined in recent years. In 2014, the number of new death sentences was 72, the lowest level in many decades. Unfortunately, the U.S. fails to recognize capital punishment as a profound human rights violation and as a frightening abuse of government power. There are both pros and cons to capital punishment, but many people are against it. The innocent people put on death row, the cost, the lack of proven deterrence and discrimination within the system are all reasons capital punishment should be abolished. The death penalty can†¦show more content†¦U.S Attorney General Janet Reno stated on January 21, 2000 that â€Å"I have inquired for most of my adult life about studies that might show that the death penalty is a deterrent. And I have not seen any research that would substantiate that point (Reno).† Studies in Oklahoma and California failed to find that capital punishment had a deterrent effect on violent crime and, in fact, found a significant increase in stranger killings and homicide rates after the death penalty had been reinstated (Bailey). According to a survey conducted by Radelet and Lacock in 2009 of the former and present presidents of the country’s top academic criminological societies, 88% of these experts rejected the notion that the death penalty acts as a deterrent to murder (DPIC).We are unable to tell if the death penalty truly has a deterrent effect because once someone is killed they can go back out into society and commit another crime; they are dead. In its Apr. 9, 2007 website presentation titled The Death Penalty: Questions and Answers, the American Civil Liberties Union offered the following statement: â€Å"There is no credible evidence that the death penalty deters crime more effectively than long terms of imprisonment. States that have death penalty laws do not have lower crime rates or murder rates than states without such lawsShow MoreRelatedCapital Punishment Should Be Abolished965 Words   |  4 PagesHaesemeyer Advanced Studies English 9 7 April 2017 Capital Punishment Over the centuries, capital punishment has fallen in and out of public support. In several countries, the practice has been overruled by law. In others, it is simply not exercised. More than half of U.S. states still practice capital punishment for capital crimes. Often, innocent people are sentenced to death because of circumstantial evidence. Capital punishment should be abolished in all fifty U.S. states because of the severalRead MoreCapital Punishment Should Not Be Abolished1541 Words   |  7 Pagestime, if a person committed a severe crime, like murder or rape, they were executed to maintain peace in the community and to bring comfort to those who knew the victim. Capital punishment has been used in almost every part of the world, but in the last few decades many countries have abolished it. The issue of capital punishment has been a sensitive topic for nations attempting a careful balancing act between prisoner’s rights and legal defense teams and society’s la ws on cases of extreme gravityRead MoreCapital Punishment Should Not Be Abolished901 Words   |  4 Pagesgovernment (â€Å"Capital Punishment in the United States†). Capital punishment is being debated all over the world whether it is murder or justice for the crime they have committed. Statistics show that murderers often kill again after releasement from prison. The Bureau of Justice gives relevant statistics pertaining to murderers who were released from prison: in 1994 40.7% of murderers were arrested for a new crime within three years of release (United States Department of Justice). Capital punishment shouldRead MoreCapital Punishment Should Be Abolished1115 Words   |  5 Pagesjail time, house arrest, and/or having to pay fines. Crimes that are severe can lead to greater punishment, like spending life in prison. The most severe crimes can lead one to an equally severe punishment known as capital punishment. Capital punishment is the authorization to kill someone fo r the crime he or she has committed. Capital punishment, commonly referred to as the death penalty, should be abolished in all states because it can put innocent lives at risk, it costs millions of dollars each yearRead MoreCapital Punishment Should Not Be Abolished750 Words   |  3 PagesCapital Punishment Should Not be Abolished There are many reasons why the United States of America keeps capital punishment. These reasons include the deterrence theory, the idea of retribution, cost of prisons, and general safety of the public. First of all, I’m sure that you have heard of the deterrence theory. Deterrence is basically the fear of punishment; and even though it doesn’t prevent all crimes, the results are still undeniable. The deterrence theory is when criminals thinkRead MoreCapital Punishment Should be Abolished883 Words   |  4 Pages Capital punishment is the punishment of death for a crime given by the state. It is used for a variety of crimes such as murder, drug trafficking and treason. Many countries also have the death penalty for sexual crimes such as rape, incest and adultery. The lethal injection, the electric chair, hanging and stoning are all methods of execution used throughout the world. Capital punishment has been around since ancient times; it was used in ancient Rome, and one of the most famous people to be crucifiedRead MoreCapital Punishment Should Be Abolished1137 Words   |  5 PagesThe case for capital punishment Topic: why capital punishment should continue General purpose: To argue Specific purpose: my main aim is to convince the audience that capital punishment should be upheld. In other, the advantages of capital punishment outweigh its disadvantages. Introduction Capital punishment is also known as death penalty and it has been in existence since time immemorial. Throughout history, the death penalty has been used to punish a number of crimes that include murderRead MoreCapital Punishment Should Be Abolished1955 Words   |  8 Pagesit has become apparent that capital punishment should be abolished worldwide. Around the world, various countries continue to practice this brash, inhumane punishment. The legal system is intended to regulate citizen’s behaviour which aims to provide a smooth functioning society. When someone is sentenced to death, the legal system loses the â€Å"fair† aspect of the proceedings, as under no circumstances is the death penalty â€Å"fair†. Capital punishment should be abolished because it violates Section 12Read MoreCapital Punishment Should Be Abolished1135 Words   |  5 Pagesname -unknown. Nobody should ever have to hear these words. Especially coming from their own state the one that is supposed to protect their rights no matter what. Capital punishment should be abolished from the United States. The number one goal of the constitution is to protect the life of an individual and the death penalty passes by this. The death penalty is an easy way out of the crime, it is expensive, philosophers and even psychologists disagree with capital punishment and most important itRead MoreCapital Punishment Should Be Abolished Essay1293 Words   |  6 PagesApproaching the topic of capital punishment is difficult when looking at society as a whole. In the opinion stated by my class group, capital punishment should be entirely abolished due to the possibility of mistakes while sentencing. This idea relies on the basis that capital punishment has absolutely no purpose or benefit. Members of my group mistakenly used a utilitarianist point of view to argue their case, even though this view can be stretched to fit almost any argument. This paper will explore

Ideas, Formulas and Shortcuts for Cause Effect Essay Topics

<h1> Ideas, Formulas and Shortcuts for Cause Effect Essay Topics </h1> <p>You may need to think about engaging the peruser. The gathering of qualified article journalists is constantly arranged to help you with that in no second! The author put forth no attempt to make the peruser care about the subject. He endeavors to make the peruser care about the subject, however isn't generally effective. </p> <p>Cause and Effect articles are simple instruments to check whether somebody can really bolster a particular case. Since you may see, composing a circumstances and logical results article includes much something other than choosing a point. Causes are presented as contentious themes which present the primary subjects of contemporary society in a succinct introduction where inventiveness is essential. Subjects for a circumstances and logical results article can be found on the web, or you may conceptualize with a companion and see what you could turn out yet plainly, it is likewise conceivable to discover online methodologies on composing papers for school. </p> <h2> Ok, I Think I Understand Cause Effect Essay Topics, Now Tell Me About Cause Effect Essay Topics! </h2> <p>Before you start taking a shot at your absolute first draft, make a rundown of causes and comparing results. In spite of the fact that a reason is what gets thing going, an outcome is th e thing that the outcomes are because of a reason. At whatever point you have the circumstances and end results, you must produce a rundown of all them relying upon their classifications. While portraying a medical issue, for example, some sort of infection, it's conceivable to incorporate various impacts. </p> <p>There's now a breathtaking extent of joblessness which obliges the underemployment. When there are absolutely loads of wellbeing related reasons for a sleeping disorder, you may likewise examine how pressures at school, at work or in your public activity may let you dispose of rest. The understudy may have solid convictions which don't line up with some restorative medications, and may be not ready to locate a local Chinese expert who can flexibly them with the herbs or other Eastern therapeutic medicines favored like measuring. </p> <p>When you wish to make a decent motivation and impact exposition for school, acquiring a drawing in theme you have to comprehend that you could have a fabulous time as well! For example, on the off chance that you are keen on being firmly related to the point, at that point it is conceivable to expand the measure of your contentions about the results of a functioning occasion. The point might be progressively hard to deliver. All t he more regularly you'll need to choose your own circumstances and logical results article theme. </p> <h2>The Battle Over Cause Effect Essay Topics and How to Win It </h2> <p>Academic papers can't contain any signs of unoriginality. Understudies regularly make some troublesome memories recorded as a hard copy their paper since they aren't sure about their capacities or composing. Subsequently, numerous understudies and workers choose to buy modest paper as opposed to composing it themselves. </p> <p>Kibin editors are substance to help survey your paper. When you are in control of a solid subject and important information against it, it is less difficult to make your paper. At the point when you educate us pretty much all regarding the paper data, we'll start scanning for a satisfactory author for your paper. </p> <h2> What You Need to Do About Cause Effect Essay Topics</h2> <p>There are a few assortments of papers there on the planet you can simply lose your head. Normally, it may be any assortment of clarifications. After the country populace arrives at its most noteworthy level conceivable, a ton of issues quickly show up. Normally, the level of precision of the basic certainty you will present will depend on the stock information you gangs. </p> <h2>Cause Effect Essay Topics Secrets </h2> <p>There's, unmistakably, a breaking point on the assortment of pages even our absolute best scholars can deliver with a squeezing cu toff time, yet normally, we can fulfill all the customers looking for dire help. Fortunately there are heaps of exposition composing administrations, which give help and help. You may likewise connect with your essayist to gracefully some overabundance proposals or solicitation data in regards to the request's advancement. On the off chance that you've just moved on from school or college and are searching for an extraordinary activity, you should get an influential resume to dazzle your future business. </p> <p>An expanding number of expert essayists are enrolling for sites to give their ability at very lower rates. All things considered, immense quantities of individuals love the kind of shoddy nourishment and its reasonable rates. Gain from each upsetHigh entertainers understand a steamed is an opportunity to learn. </p> <h2>The Argument About Cause Effect Essay Topics </h2> <p>New understudies who come to America either for a whole grant or ma ybe an incomplete report abroad program face numerous sorts of segregation in the study hall and away from the homeroom. There are different forms of the GI Bill, yet all license you to go to school without waiting be stressed over educational cost costs. Understudies should be considered legitimately responsible for tormenting in schools. They have occupied existences and frequently disregard an up and coming cutoff time. </p>

The Case Organisations Towards Sustainability - 2077 Words

Introduction This case study critically examines Nike, the case organisations journey towards sustainability over a period of 15 years after facing intense criticism in 1998 for unsafe working conditions, excessive overtime, restrictions on organising and environmental impact. The meaning of sustainability, its motivation and application to the case organisation has been explored further. The authenticity of these initiatives has been assessed through the lenses of stakeholder theory. The implications of the initiatives undertaken by the case organisation on the three pillars of sustainability positive and negative have been discussed further to understand the level of balance and drift specially impacting the economic and societal cause.†¦show more content†¦(Colbert and Kurucz 2007). As for the case organisation, the reason for the sustainability awakening was strong criticism from NGO’s for their business practises and media attention i.e. non-market factors. These non-market f actors resulted in dropping sales and reputation for an organisation of their size. The case organisation undertook several approached and initiatives along the course of its sustainability journey, it is important to note that when formulating a â€Å"business case† for sustainability, it is more important on how the sustainability management is organised rather than focussing on the number of initiatives (Schalttegger 2010). Initiatives taken: †¢ Initial focus was on engagement with the critics, formulating a body to help improve workers conditions and monitoring as a means of creating awareness. †¢ Publicising corporate responsibility reports added the dimension of transparency. †¢ Further steps included moving the corporate responsibility team in corporate decision making and formulating indexes to rate its sustainability practices. †¢ Focus on utilising environmental friendly raw materials and minimising waste. ARGUMENTS Authenticity of what drove the sustainability for the case organisation over the 15 years is arguable given that the drivers of success have changed from time to time.

Information Systems

Question: ExplainInformation Systems. Answer: With the evolution of technology, the human life has become much easier than ever. One of the greatest gifts of technology to the humans has been the information systems. Information systems are the combination of hardware and software that support data-intensive applications. It aids business organizations in collecting, filtering, processing, creating and distribution of data. Information systems are the talk of the day and are greatly helping the organisations in managing the information that they collect related to their business. Information systems not just help in managing data but also help the management in making better and planned decisions (Journals.elsevier.com, 2016). As business units are running giant databases, it is important to have them managed in the best possible manner so that the data that is there can be used in a proper format as and when required. With development of time, there have been different variants of tools and applications available which is giving companies an edge to manage their database in the best possible manner. Database management system is now being used largely in all the organizations, as it is better than manual storing and noting of data. With implementation of database management system, companies can now easily compile all the essential information in form of data at one single place, which can be utilized whenever required. With database management system, it has now become easy to access the files with just a few clicks. (Balasubramanian and Bhattacharyya, 1986) Database management system is helping big organizations on a positive note as maintaining of all the records related to the business and its transactions can now be done with ease. With introduction of DBMS, paper free environment is the biggest advantage that has been attained. As working style and pattern of organizations are changing, DBMS is also introducing new formats and application, which is helping in a smoother working process. Some predefined software programs are there that needs to be installed into your server systems when you decide to function on DBMS. Once this process is completed, you can add links to the database server and share the details to the employees. When it comes to DBMS, it is helping companies who are into ecommerce to cataloguing of books. (Balasubramanian and Bhattacharyya, 1986) ADVANTAGES OF DATABASE MANAGEMENT SYSTEM As database management system is a collection of programs, its implications makes a better control over the data that you are storing. One can even term it as an electronic file cabinet with unlimited storage and powerful working system making the process of an organization perform in a smoother way. Over the years, there have been different advantages that have been attained with DBMS. As the organization of my choice is Barclays Bank, below listed are some of the advantages and sources of business intelligence along with analytical tool that have been attained by the bank with use of DBMS. (Cohen, 1982) Control over Data Redundancy With employing of DBMS, Barclays removed any chance of double entry into their database. As there was always a chance of data duplication, implication of DBMS eliminated this issue. In addition to this, management of storage space is also possible. As there were issues in manual entry system, using DBMS helped in generating of errors which can be rectified with ease. Data Sharing With use of DBMS, the process of data sharing has now become easy and simple. As Barclays is having several branches, DBMS helps in having a connection with all the branches in one single go. This makes end users work in an efficient manner (beginnersbook.com, 2015). Security of Data With use of DBMS, Barclays has developed a security framework that assures better security to the data and policies of security. Data Integration The management of the working in Barclays has become easy with use of DBMS. With DBMS into the role, it is easy to see the plan of action and its effects on the other segments (Tutorialcup.com, 2016). Better Services With use of DBMS, a wide array of services is offered to the users. As banking functions requires a lot of time, use of DBMS has reduced the time gap making it better in providing customer services. Enhanced Data Access Solutions to ad hoc queries is possible with use of DBMS. As there are no chanced of data manipulation, accurate data is provided to the users. In addition to this, sales data can easily be accessed and queries related to the up and down of the dollar rate along with figures of sales can be known with ease. Enhancement in decision-making When Barclays is having better access to the data and it is managed in the best possible manner, it helps in generating better information on which the decisions are based. With use of database management system, a framework for better data quality is being initiated. Better standards of data As all the working process will be through database management system, Barclays can fix a standard format for saving all the data. As standardization would be possible, the productivity of the business would be more (Computer-dbms.blogspot.in, 2011). Recognition of requirements As banking is a complex process and holds several departments, database management system helps in identifying of urgent requirements of the departments so that better working is assured. Report Writers As banking requires numerous forms of reports to be written, it is possible with database management system. Barclays can now easily generate reports based on the transactions performed in a monthly, quarterly, and half-yearly and annual basis. Better options of recovery For a smoother function of the bank, Barclays has introduced database management system into their working process. With DBMS, the recovery options are higher in case there is a system failure. As all the information is stored at a centralized space, data recovery is easy and simple (User, 2011). CHALLENGES FACED BY DATABASE MANAGEMENT SYSTEM As it has been rightly stated that every coin has two sides, there are some challenges standing in the way of database management system. Below listed are some of the challenges that are being faced of database management system. (Felician, 1987) Costing With economic slowdown being the current situation, the budget for IT is reducing or has become static. This has resulted in working to the maximum at minimum capabilities. Even though the costing of the software and other hardware required for database management system is low, the cost involved with the people in making them function is getting higher and higher. Moreover, if you employee an experienced database administrator, you ought to pay them good (User, 2011). Finding the right talent As database management system involves various functionalities along with storing data; it has become a hard task to find the right talent for the job. It is hard to find a DBA expert with required knowledge and experience. Updating the system With increase in complexities of database software, it is becoming hard for the companies to update their system every time there is a new update available. As mastering over database management system takes years, new software updates means overall training which will require cost and time from the database managers out of the office time (Computer-dbms.blogspot.in, 2011). Reactive Vs Proactive As there are different processes of working for database administrators, they are unable to keep a check on the main work of management of the database, they are unable to proactively keep a check on the database management system and have a look into them only if there is a reactive situation. Cover for DBAs Having a fully functional database management system means that there would be a requirement of at least three DBAs who will manage the working process of the DBMS functioning 24*7. However, holidays along with sickness and other forms of leaves stand as a challenge for better functionality of the database management system. Version of the database Even though there are new software updates and versions available for database management system, companies are unable to have them installed into their systems because of complexities and risks involved of data erase. Issues of structured and unstructured data With years of usage increasing, the issues of structured and unstructured data are increasing day by day. People involved in the analysis of the data that is stored find it difficult in assorting the data as the bases and platforms of database management system is increasing day by day. It is becoming hard for the DBAs to monitor and manage the data in the best possible manner (beginnersbook.com, 2015). Integration of data from unrelated sources As more of Smartphone users are increasing day by day, business units are integrating their process of data collection accordingly. Along with getting genuine data, some useless data is also integrated into the system that is of no use. Database and cloud computing With cloud computing getting popular, companies are now willing to have their database systems into the same. However, getting a space into the cloud is a big issue as maximum companies are now opting for the same. It would only be possible if you were ready to shell out hefty amounts for attaining a space in the cloud system (Tutorialcup.com, 2016). Securing public and private data As the age of digital era is increasing, the threats to database system are growing rapidly. It is the duty of the IT administrators to keep a vigil over the systems so that they do not stay vulnerable to hackers and other forms of security breech. Data Recovery Even though data recovery is not a major challenge, it still stands as a threat to the DBMS. It is easier to recover the data when only a single part of the same has crashed. However, if there is a failure experienced with the entire system, then getting the data back on track and that also in its original state is a hard task. Auditability Associations are under expanded weight to review each activity that a client performs inside a database. This is because of expanded spotlight on security, danger, responsibility, and evasion of misrepresentation and defilement. While security aversion measures (logins, firewalls, tokens and so forth) are essential to counteract unapproved access to the information in any case, as this review appears, most ruptures happen by clients who are approved however are either careless or pernicious. ISSUES FACED BY DATABASE SYSTEM MANAGERS With development of technology, DBMS has grown. However, the database administrators are facing several issues and hassles in the way, which is making them helpless in the working environment. Listed below are some of the issues that DBAs have to face: Lack of information is one of the main concerns that DBAs have to face while working on the DBMS. As new and updated technologies in DBMS are being introduced, the companies want them to work over these new updates without proper knowledge and information. In addition to this, excessive load of data given by the companies over the DBAs is also an issue that they have to face. The administrators are finding it difficult in managing the complete set of data as it is increasing day by day (Academia.edu, 2016). Legal issues are also a concern for the DBAs while working with DBMS. If there is any form of security breech, then the DBA is the first person who will be grilled related to the hacking (Academia.edu, 2016). Proper sources of backup are not provided to the DBAs because of which they have to work overtime at limited pay scale. (ADMINISTRATORS, 2008) ghly skilled professionals. It is obvious that the management receives some benefits out of it because of which it invests such heavy resources in it. The benefit of database to companies is in business intelligence. Business intelligence, in simple words, can be defined as the process of converting raw data and information into useful information that can help a management in making important decisions related to the business (SearchDataManagement, n.d.). ABC Retailers Pvt. Ltd. is one of the top retailing stores in the country. It has around 189 retail shops throughout the country and deals in all kinds of grocery and household products. The company has a workforce of around 10,000 employees and has been giving a stiff competition to some of the bigger brands in the country. One of the main reasons behind the success of the company is its ability to use its database as a source of business intelligence. The company has a separate department for management of information systems where professional and highly skilled employees work hard every day to convert raw data and information into useful business information, which is used by the managers to make important decision related to the business. The company uses ERP business suite along with cloud storage to manage all its business operations. The combination of ERP and cloud storage allows the company to keep a track of the inventory in all the stores. The central headquarters keeps a check on the items that are running out and dispatches fresh stock for the stores before they run out of stock. In this way, the company is able to reduce a lot of its operational costs by managing the inventory using database systems. The company has been using non-relational databases, which helps it in storing all kinds of data, such as pictures, videos, animations, clips, etc. because such information can help in obtaining more useful information as compared to relational databases (MongoDB, n.d.). Further, the information system branch also collects information about the products that the customers buy. The information collected is combination of products purchased, time of purchases, seasonal demands, frequency of purchases, quantity of purchases, etc. The department then uses this raw data and information for the purpose of business intelligence. It checks the combination of products that people buy the most so that it can introduce an offer on the combination in the next month to maximize the sales. Further, the sales data of the products helps in forecasting the demand in the future and the inventory can be subsequently maintained. In this way, ABC Retailers Pvt. Ltd. has been using its database for the purpose of business intelligence and has been shaping its success as a result of the information obtained. CONCLUSION Database management system has become a crucial aspect of working for organizations. However, one has to keep a check on the challenges and give out proper solutions so that working of the organization can be carried out in a proper manner. 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