Political Disputes by 1860 Essay Example for Free

Political Disputes by 1860 Essay During the 1800s, Americans in the North and South often had conflict but could no longer resolve their political disputes through compromise by the year 1860. In this time period, compromise was not an option because slavery and states rights caused political disputes between the north and south.The two political parties in the north and south lost their ability to cooperate and by the mid 1800s increased the issue of the division of the states. The political view on slavery and states rights grew as compromise between the north and south political parties began to collapse during the mid 19th century. Henry Clay stated that it is impossible for South Carolina to become an independent state. (Doc A) A report of the American Anti-Slavery Society was opposed to slavery naming slave owners as man stealers and believed that slaves should be free. (Doc B) Political compromise was not greatly effected by their belief but the Compromise of 1850 resulted in the Fugitive Slave Law being passed which caused the collapse in the political parties. The issue of slavery continued to increase as compromise slowly disintegrated. Abolitionism increased by the encouragement of Frederick Douglass, a leader, who promoted freedom for all slaves. Also, Uncle Toms Cabin published by Harriet Beecher started up abolitionism in the North while the South to oppose against abolitinists. Senator Daniel Webster who is opposed to secession stated that the North is not complied with the Fugitive Slave Law. (Doc D) In addition, a New York Tribune comparing working class men in the north to southern gentlemen (Doc F) caused more conflict between the states over the issue of slavery. The division of the states over the issue of slavery enhanced the collapse of compromise between the North and South political parties.

Myth and Thomas Jefferson Essay Example for Free

Myth and Thomas Jefferson Essay Essay: Topic: Compare and Contrast â€Å"Thomas Jefferson’s first inaugural address† (Chapter 15 in Readings in United States History) and â€Å"Hope and Heritage: Myth and Thomas Jefferson†, (Chapter 14 in Readings in United States History) â€Å"Do you want to know who you are? Dont ask. Act! Action will delineate and define you.† (By Thomas Jefferson). Thomas Jefferson, who was born on April 13 1743 and died on July 4 1826, was the son of a wealthy uneducated planter from Western Virginia. He was the first to go to College in his family and he attended the College of William and Mary. He was dreaming about a society where men would be judged by what they have accomplished and by their taste .He was the third president of the United States of America (From 1801 to 1809) and also the first United States Secretary of State (From 1790 to 1793 ).He was much more: founder of the University of Virginia. Philosopher, cofounder of the oldest political party in the nation, coauthor of the Declaration of Independence. In this essay, we are going to compare and contrast â€Å"Thomas Jefferson’s first inaugural address† (Chapter 15 in Readings in United States History) and â€Å"Hope and Heritage: Myth and Thomas Jefferson†, (Chapter 14 in Readings in United States History). In his book â€Å"The Jefferson image in the American Mind (1960), the writer Merrill Peterson is basically showing how American’s people see Thomas Jefferson. They have always seen him as a particular man, a symbol for the United States of America .Therefore, many people took their time to find out something wrong about that man. The man who started criticizing him as probably the writer Leonard Levy’s in his Book â€Å"Jefferson and Civil Liberties: The Darker Side†. In Chapter 14 â€Å"Hope and Heritage: Myth and Thomas Jefferson†, Gordon Wood really talks about Jefferson’s personal life. Thomas Jefferson is described as someone who had passion for partisan persecution, someone who didn’t care about the civil liberties,  someone who thought he was morally perfect and used to judge people around him. In the chapter, they are comparing him to his friend James Madison. Thomas Jefferson wasn’t thinking about the country like Madison when he was taking decisions. While taking his decisions, he was mostly concerned about what his French friends would think of it than the needs of the American population. The main portion of Jefferson’s life, was his fight to abolish slavery. As it is written in this chapter, Thomas Jefferson hated slavery. He worked really hard to eradicate it in New Western territories. But apparently, he was never able to set all his slaves free. Many recent historians claimed that Jefferson’s acting toward Black people was very disgusting, revolting. Especially for someone who claimed that he wanted to eradicate slavery. During his life, he wanted to make sure that the eradication of slavery will be accompanied by the deportation of Back people of the country. For him, Black people living in a white’s man America was totally unbearable. He was â€Å"Racist†. In his mind, Black men were extremely inferior to White Not only in Body but also in mind. People were surprised to see hear him talk about freedom and control Black slaves at the same time. Most people started to think that he was a hypocrite. In 1802, James Callender, a political pamphleteer and journalist pointed the fat that Tomas Jefferson maintained Sally Hemings a Black Slave as a mistress and fathered her with various children. This was barely believable because everybody knew him as a man who always suppressed his passions. In addition to that, Thomas Jefferson was a man of the eighteenth century, an intelligent man, conventional, and enlightened. But he also had his own weaknesses. Jefferson was fully part of the Enlightenment in the United States of America. His desire to know everything and his open-minded character put him on the top of the American Enlightenment. Unlike in Chapter 14 (Hope and Heritage: Myth and Thomas Jefferson), Chapter 15 (First Inaugural Address, 1801) is basically Thomas Jefferson’s speech which marks the abolition of one of the worst period in the United States of America. The First Inaugural Address of Thomas Jefferson is lionizing the most important election in the history as Thomas Jefferson was succeeding to John Adams as president. During 1790s, some divisions were created between the Federalists (Hamilton and Adams) and the Republicans (Jefferson and Madison) due to the opposition to Hamilton’s financial policies and polemics over foreign policy. Thomas Jefferson was  the first President to take office in the new capital city of Washington. In his speech, Thomas Jefferson says â€Å"Every difference of opinion is not a difference of principle. We have called by different names brethren of the same principle. We are all Republicans, we are all Federalists.† He is basically telling his Fellow-Citizens that even though there are some differences, both Federalists and Republicans are serving the same constitution and following the same principles. What is different is the way each of them interprets and apply it. He is calling for Union. Jefferson wants a government when no one will injure another; where each citizen will work. In his partisanship, the First Inaugural of Jefferson mingles the American past of Washington and some heroes into his different principles .By making his party’s victory a victory for all the country, the speech sets the standard for inaugural addresses. In Conclusion, we were ask to compare and contrast â€Å"Thomas Jefferson’s Inaugural Address† (Chapter 15 in Readings of the United States History) and â€Å"Hope and Heritage: Myth and Thomas Jefferson† (Chapter 14 in Readings of the United States History).We can undoubtedly say that Thomas Jefferson was a great Leader. It is therefore all the more important to see and distinguish where he had success and also where he failed. Whenever something is great, people will always try to find out the Bad in it and that’s what happened to Thomas Jefferson. But it doesn’t change anything to what he has accomplished for the United States of America. Till today, no other figure in the American history as reached that standard.

The Marketing Audits Lo1 Marketing Essay

The Marketing Audits Lo1 Marketing Essay a. There are two components of marketing environment micro and macro components some of these are uncontrollable and some of them are controllable. Political, economic, Social, Technological, Legal forces, and indirect competitors are macro components of this environment. These are also uncontrollable forces. Customers, direct competitors, distributors, suppliers, sources of finance and the public are the micro components of the environment. The audit is the means by which a company can understand how it is related and integrated to the environment in which it operates. Audit divided into two parts, which are external and internal audit. Market is subject to continuous change so marketing techniques adopted by a company needs to be dynamic and open to changes. If a company is not ready to embrace the new challenges and opportunities that a changing, developing market has to offer it is doom to diminish its activities. Therefore, like financial auditing marketing auditing is essential before introducing a new marketing plan. For instance, McDonalds did not pay attention to the changing needs of customers and altering market. McDonalds eventually changed its longer-term strategic marketing plan after gaining a dull understanding of the market. There are number of techniques and tools to assess organizational capabilities such as Value chain analysis, SWOT Analysis, TOWS Analysis, Porters Five Forces, and BCG Matrix. Lets assume that Starbucks is using Value Chain Analysis. It will go through these points to fully analyze it. Inbound Logistics: To acquire one of the highest quality beans available Starbucks collaborated with a little town to buy the entire stock of beans available. Operations: the beans that are bought are roasted in Starbucks own roaster and if the sample is not in the same quality with the other samples it is being discarded. Therefore, it is a pretty complex operations system. Marketing and Sales: TV advertisements are not Starbucks priority. Instead, it is using the most powerful tool; word of mouth marketing and conduct some promotions. Because, it claims to offer more than coffee, which is Starbucks experience, company are not offering so many promotions and advertisement. Human Resource Management: Training of all employees is extremely important. Employees are valued and there is a really low turnover rate. Administration: Starbucks is avoiding becoming a traditional organization. Therefore, it doesnt have a formal organizational chart. Macintosh HD:Users:sara:Desktop:Screen Shot 2012-06-25 at 5.04.08 PM.png As the above example shows, it is inevitable to say that even a quick analysis (internal/external) is a must when considering forming a marketing plan in this volatile market environment. b. For auditing the organization, we should look at the capabilities of a firm. Our goal is to identify the firms strengths as compared to requirements of the market. Following capabilities can be examined while auditing the organization. Corporate capabilities, Resource audit, Utilization of resources, financial measures, Comparative analysis There are number of techniques and tools to assess organizational capabilities such as Value chain analysis, SWOT Analysis and BCG Matrix. For Starbucks Ive chose to conduct SWOT Analysis. SWOT Analysis SWOT ANALYSIS is used for measuring the organizations internal assessment. Strengths: Starbucks offer quality coffee and an experience for customers, which increase brand loyalty and customer satisfaction. Starbucks has high brand equity. Starbucks is operating in 40 countries worldwide with offering same quality. Product diversification is high Very recognized logo and brand High visibility locations is a good way of attracting customers and staling share from the competitors Good relationship with suppliers Good working environment, happy employees lead to satisfied customers Weaknesses: Prices are higher compared to competitors. Operating costs are high. Profit of the business depends on coffee prices. Starbucks is so much focusing on expansion, internal focus is ignored Threats: Increasing number of competitors. Health conscious people decreasing the coffee consumption. US market saturation and increasing unemployment rate Coffee price extremely dependent on developing countries Opportunities: Entering India, Pakistan and other countries with high population Whole bean sales in supermarkets Adding new products Technological advances New distribution channels PEST Analysis PEST ANALYSIS is used for measuring the organizations goals against influences and demands of environment. It is a very efficient tool to assess external (uncontrollable) factors in the market. Political: Relationship between US and countries producing coffee beans The political stability of the countries in potential destinations The political stability of the countries, which provides raw materials to Starbucks Environmental regulations Industry-specific regulations Economic: Demand for food and beverages Customers purchasing power Exchange rate taxation Tariffs quotes Unemployment rates in potential destinations Social: Current trends in coffee shops around world Consumer Preferences Changes in lifestyle and occupation Education of employees and customers Technology: RD in manufacturing RD in biotech and agriculture RD in IT Following social media strategies Macintosh HD:Users:sara:Desktop:Screen Shot 2012-06-25 at 12.37.59 AM.png Task 2- Barriers to Marketing Planning LO2: a. McDonald defines 5 areas in marketing planning that may have problems, which are cultural, behavioral, cognitive, systems procedures and resources. Cultural- lack of belief in planning or need for change Behavioral- lack of top management support, lack of team coherence Cognitive- lack of knowledge and skill Systems procedures- lack of data Resources- lack of time, people and money More in depth the barriers are, 1. Confusion between marketing tactics and strategy, 2. Isolating the marketing function from operations, 3. Confusion between the marketing function and the marketing concept. 4. Organizational barriers -the tribal mentality, for example the failure to define strategic business units (SBUs) correctly. 5. Lack of in-depth analysis, 6. Confusion between process and output. 7. Lack of knowledge and skills. 8. Lack of a systematic approach to marketing planning, 9. Failure to prioritize objectives, 10. Hostile corporate cultures b. Ten S Framework In order to overcome the above barriers McDonalds Ten S Framework can be used. If they follow this circle strategically Macintosh HD:Users:sara:Desktop:Screen Shot 2012-06-25 at 2.43.09 AM.png According to Mc Donald, Principle I: Developing the strategic marketing plan. In this plan, the period should be between three and five years. Principle 2: Marketing function should be as close as possible to the consumers. Principle 3: Define clearly what is marketing. Principle 4: Company activities should be organized around customer groups and market segments. Principle 5: Scan the environment thoroughly (PEST analysis etc.) Principle 6: Scanning the internal environment (SWOT Analysis) Principle 7: Marketing personnel must have skills and technical knowledge for the job. Principle 8: Prepare written procedures, as it is a common and systematic format for marketing planning. Principle 9: Objectives should be prioritized according to allocation of resources, their urgency. Principle 10: Organization should make sure to have the active support and participation of culture leaders. Task 3- The Marketing Plan LO3: Starbucks needs to be innovative as the market is so harsh and it has lots of competitors. In addition to that, profit margins of Starbucks are low so it has to offer the same good quality. Also in order to keep and increase brand loyalty, Starbucks has to offer different ideas all the time. As people get bored easily of products and services offered. Starbucks is trying to find and embrace new ideas all the time, they have a website called My Starbucks Idea for people. Community shares their ideas in this platform and maybe Starbucks would apply some of them  [1]  . Developing meaningful products and services for long-term success. Innovative solutions are developed to improve peoples lives and to increase demand to the firm. Also, innovation makes businesses to think about why it wants to do something. It makes businesses to look ahead and think about the possible problems that could be solved. This can be achieved through thinking outside the box. New product development is an essential section of any company marketing strategy. There are some ways for new product development. For instance developing/creating products that are totally new to the world (Tablet computers), Product improvements (Panthene Shampoos with conditioner), product modifications (mobile phones), new brands. Starbucks can use these 4 ways to develop products. When we apply these techniques to Starbucks and its products; Products new to the world: Frozen Starbucks coffee cubes. Product improvements: Coffee mocha that makes you sleep better and tastes stronger. Product modifications: Coffee without any fat. Cappuccino with more skimming. New brands: Starbucks for juniors-Starkids. Pricing: There are several ways for pricing such as price making, price taking, niche marketing, cost-based pricing, market-oriented pricing, price skimming, and price penetration etc. Among these pricing techniques Starbucks can use price making for new products. Since, Starbucks is the market leader. It has the opportunity to dictate the market prices. Price makers can also manipulate the prices more easily to adjust market conditions. Therefore, the autonomy of control is much higher. Distribution: Manufacturers can sell directly to customers. Manufacturers can sell to retailers and then to customers or manufacturer can sell to wholesaler, wholesaler can sell to retailer and retailer can sell to customer. In this case, Starbucks is the manufacturer, wholesaler (selling to other retailers such as Krogers etc.) and the retailer. In addition to that, instead of traditional ways of distribution a company can use vertical marketing channel too. In this model, all three functions are integrated. Manufacturer is also in contact with the wholesaler and with the retailer. This includes sharing information, and know-how to ensure that the requirements of customers are always treated as the priority. This is an effective model for Starbucks as it is modern and suitable for Starbucks. In addition to distribution method, company also needs to decide on the distribution intensity of its products such as exclusive, selective and intensive distribution. When it comes to distribution intensity, intensive distribution method is appropriate for Starbucks. Macintosh HD:Users:sara:Desktop:Screen Shot 2012-06-25 at 9.20.43 PM.png Communicating: The communication tools are advertising, radio, magazines, television channels, direct marketing, personal selling, promotions, exhibitions, telemarketing, events, public relations, sponsorship, and merchandising. Marketing communications (promotion) mix for Starbucks. Advertising: If Starbucks opens new location reminder advertising should be done. If Starbucks wants to inform and emphasize the guaranteed satisfaction for consumers persuasive advertising should be done. If Starbucks creates a new flavor for a beverage informative advertising should be done. Public relations: This is an important strategy for Starbucks as it is an essential strategy for community relationship. In addition to that, celebrity endorsement can be a vital strategy to target younger consumers. Social Media Marketing: In todays world consumers are very connected and social. Therefore, it is extremely important for companies to stay connected with potential consumers. d. The new product for Starbucks is create your own Frappuccino. Firstly, we need a review of the environment (PEST and SWOT). Then we need to conduct 7P Analysis then we need a review of the marketing system. The next thing to do is clarifying goals and objectives. If our objectives and strategies are feasible in terms of the market share, sales, costs and profits we can continue with our plan, if not we should revise our company goals. Finally, we can establish targets and standards. Analysis stage Marketing audit, environmental and organizational analysis (see task 1 for SWOT and PEST) Planning stage Setting objectives is in this part. Customize your Frappuccino will earn 20% of the market share within 2 years is our new goal for the new product. Implementation stage Promotion mix: Informative TV and magazine advertisings for the new product should be done. Also, through Facebook and Twitter social media campaigns will be started. Pricing: As the leader of the market, we make the price. For a limited time Customized Frappuccinos are for 4 $ (additional fees may occur due to seasonal changes and excessive amount of selections). Distribution: Same strategy vertical marketing channel applies here too. In addition to these, we target people around 15- 45 who enjoy trying new things and have an independent personality. Monitoring stage The last stage in the marketing planning process is where we monitor the plans performance. This diagram can be used in order to assess and monitor the achievement of the plan. One of our short-term goals might be increasing the awareness of this product 30% by the end of two months in Berlin. What is happening? Are we close to achieve it? Why or why not? Macintosh HD:Users:sara:Desktop:Screen Shot 2012-06-26 at 1.19.05 AM.png Task 4- Ethical Issues LO4 : a. Some ethical issues in marketing are product recalls, product issues, product market research, pricing issues (price fixing, predatory pricing etc.). Considering these headings, Starbucks have couple of ethical issues, which are also taken into account by social media too. First of all, for years Starbucks claimed their cups are disposable/ green but consumers learnt that it wasnt recyclable. This is a product issue  [2]  . There is also another issue that Starbucks is making every other small coffee shops close their doors. Therefore, it is decreasing the competition by acquiring more and more places (to be more convenient), which can also be discussed whether it is ethical or not. Since, Starbucks is a very big company and has good relationship with the coffee beans suppliers, it is buying all of the premium coffee beans in a very small town, which is unfair to other competitors. b. Marketing Mix Ethical Issues: Because, Starbucks advertised its coffee cups as green it is false or misleading advertising. This may damage the reputation of the company and decrease brand loyalty. One of the major ethical problem and its implication on the distribution is the restrictions of supply. There is a small town, which produces high quality, premium coffee beans and their product is bought buy Starbucks only. Starbucks buy large quantities of coffee beans compared to its competitors throughout the world therefore it is inevitable to state that Starbucks both will have negative and positive image among consumers, competitors and media. Ethical issues will arise, the main success is diminishing and eliminating this ethical issues with sponsorship or good corporate relationships. Personal selling and counterfeiting (other ethical issues) dont apply to Starbucks case. c. Starbucks is the only coffee shop (comparing to Costa or Coffee Nero) that sells fair trade coffee. Fairtrade guarantees a minimum price that tracks slightly above market rates, the Rainforest Alliance label only guarantees that 30% of coffee beans in a product have been certified  [3]  . In my point of view, the main ethical issue Starbucks is their strategy of expanding. It ignores other smaller shops and other locally owned coffee shops go out of business and face bankruptcy. The Fairtrade Mark guarantees that Third World producers get a superior arrangement for the goods that they develop.

Ethics - Virtue of Patience Essay -- essays research papers

Virtue and Patience In order to survive these days, there need to be at least some standards and goals of morality in a person's life. Moral excellence is definitely hard to achieve, but is something worth while to attempt. Personally, there are many distractions and obstructions the present day provides, creating a difficulty of direction in my own life. I need to overcome obstacles such as peer pressure in order to become a confident, successful person. The present day provides impediments which I believe I can overcome by way of morality and virtue. I have chosen to work on more patience in my life. According to Aristotle, for every virtue there are two vices. One is in excess and the other being deficit. Patience is a deficiency in my life. In having barely any patience, I am often stressed out and make more of simple situations. Aristotle would call this vice impatience. On the other end of the spectrum, the excess of patience is being passive. Aristotle and Plato, it was all about having balance in your life. I believe this theory is still in tact today. What I am striving for is not passivity, it is a moderate amount of patience, not too much and not too little, but just enough to make me more of a moral individual. The hard part about being virtuous is not practicing virtue sometimes but mastering it and doing it consistently. I have always been impatient and it would be extremely difficult for me to master being patient. One of Aristotle’s points about being a virtuous person is not doing everything well but doing what you do well and doing it consistently. Patience is defined as â€Å"good natured tolerance of delay or incompetence.† (www.dictionary.com) for me, this definition does the word a world of just... ...s outside and we ended up waiting for and hour for him to come back. I was going to flip out and tell my mom I wasn’t going to do this and that we should just leave and come back tomorrow but I remembered this essay and my goal of becoming more patient. So I put on my headphones and I went for a walk to find my cat, when I finally found him I was so excited for myself, I really felt like I accomplished something. For me this was a gratifying process and I actually enjoyed the journaling and paper. I think I could have put a little more effort into the specific instances. But over all it was alright for me. Before this I would have never noticed what lack of patience I had and how annoying it must be for the people around me. I’m excited to continue being a more virtuous person and improving my character through practicing more patience.

Daisy in The Great Gatsby by Fitzgerald Essay -- Great Gatsby Fitzgera

Daisy in The Great Gatsby by Fitzgerald Throughout the novel The Great Gatsby, by F. Scott Fitzgerald, the character of Daisy Buchanan undergoes many noticeable changes. Daisy is a symbol of wealth and of promises broken. She is a character we grow to feel sorry for but probably should not. Born Daisy Fay in Louisville, Kentucky, Daisy was always the princess in the tower, the golden girl that every man dreamed of possessing. ?She dressed in white, and had a little white roadster, and all the day long the telephone rang in her house and excited young officers from Camp Taylor demanded the privilege of monopolizing her that night,? (79). Daisy is beautiful, rich, and appears very innocent as a young woman, although it is later suggested that she was quite promiscuous. While she was the object of every man?s desire, Daisy was madly in love with Jay Gatsby. Daisy tried to escape to New York to see Gatsby off to war but was prevented by her parents because Jay did not meet their standards. They disapproved of him because he did not have as much money or come from a family in the same social class as their own. Though Daisy wrote letters to Gatsby and promised to remain faithful she married Tom Buchanan from Chicago the very next year. Tom was incredibly wealthy and ?the day before the wedding he gave her a string of pearls valued at three hundred and fifty thousand dollars,? (80). Daisy seemed to be madly in love with her new husband and looked to be very happy. Daisy has been married to Tom for quite a considerable amount of time and they have already had a daughter by the time Daisy?s cousin, Nick, reappears in Daisy?s life. Mrs. Buchanan is extremely friendly with her cousin and always seems glad to see h... ...nted everyone to feel sorry for Daisy. However, one finds it hard to feel sorry for someone as well off as herself. She is a symbol of money and the corruption it brings. One must be careful not to identify Daisy with the green light at the end of her dock. The green light is the promise, the dream. Daisy herself is much less than that. Even Gatsby must realize that having Daisy in the flesh is much, much less than what he imagined it would be when he fell in love with the idea of her. While Daisy Buchanan undergoes numerous changes throughout the novel The Great Gatsby, by F. Scott Fitzgerald, she remains a symbol of wealth, broken promises, and dreams corrupted. While one finds it easy to feel sorry for her, she is in no means the victim of the novel. Work Cited F. Scott Fitzgerald. The Great Gatsby. New York: Macmillan Publishing Company, 1992

Home Rule :: Essays Papers

Home Rule It all took place between the 1870's and 1920's. Home rule was a huge part of the political life in Ireland, which meant that the Irish Parliament would be restored for most issues, but the British government would still cover many important areas (Conflict 3). The term Government Association started to be used very frequently; Isaac Butt was the gentleman who founded this association. In 1873 this became known as the Home Rule League and in 1874 a general election was held where fifty home rulers were elected to the Home Rule party also known as the Irish Parliamentary Party (Irish 29). Butts' goal was to get both Protestants and Catholics to support Home Rule as a movement targeted towards giving Ireland a federal government within the United Kingdom. Butt was not an aggressive leader and the people of Ireland did not feel he was fulfilling his job completely. A man by the name of Charles Stewart Parnell challenged Butt and became the leader in 1880 (Charles17). The British people began to think that the Home Rule would lead to the separation of Ireland and Britain. Parnell realized that the people did not like the British Rule and this is what caused them to support Irish nationalism. In 1880 Parnell won the support of the Fenians and the Irish Republican brotherhood that wanted total separation but were willing to compromise and accept Home Rule. In 1881 the second Land Act gave the "Three F's" which the Land League had demanded. Fair rents would be fixed by judges appointed by the government, fixed tenancies would have to be agreed between tenants and landowners (avoiding evictions), and free sale of his lease would be permitted to a tenant who wished to give up farming. Gladstone and most of the Liberal Party conversed to the Home Rule cause in 1885, and this is when the conservative party opposed Home Rule and threatened some kind of defense on the United Kingdom (Gladstone 6).

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.