Health and Social Care †Service User Needs Essay

Individual service users have a range of needs, which must be met, including physical, intellectual, emotional ad social needs. In my case study, a care worker, a nurse and a doctor who in turn identified Sophie’s range of needs carried out Sophie’s care assessment. They then developed a plan to meet Sophie’s needs. This next section covers a range of approaches used in Health and Social Care to help services and practitioners meet the needs of individuals. An analysis of how practitioners meet the needs of Sophie and her family Physical Health Firstly, Sophie’s strengths and needs were considered. Her general health was discussed in relation to Sophie’s condition and impairments; access to and use of dentist, GP, optician; immunisations, development checks, hospital admissions, accidents, health advice and information. Next, Sophie’s physical development was assessed in relation to her nourishment, activity, relation, vision and hearing, fine motor skills (e.g. drawing), gross motor skills (e.g. mobility, playing games and sport). In addition, her speech language and communication skills were assessed. These included her preferred communication language, listening, responding and understanding. The care workers needed to ensure that Sophie had basic care, ensuring her safety and protection. Finally, it was important to confirm that Sophie was provided with food, drink, warmth, shelter, appropriate clothing and that her personal needs were assessed within a safe and healthy environment. Social Health Next, Sophie’s behavioural development including her lifestyle, self-control, behavior with peers, attention span and concentration were looked at. Then Sophie was assessed for her perceptions of self knowledge of personal and family history, sense of belonging, experiences of discrimination due to race, religion, age, gender, sexuality and disability. The multidisciplinary team of workers then focused on Sophie’s family and social relationships Sophie had with her friends. Intellectual Health The workers focused on her aspirations and ambitions in her confidence and progress was monitored and measured. Also Sophie’s understanding of reasoning and problem solving and her progress and achievement in learning was assessed and recorded. Emotional Health It was also important for Sophie to be raised in an emotionally warm and stable environment ensuring that the family was stable, affectionate, stimulating, where praise and encouragement and secure attachments were made. It was also necessary to make sure that Sophie had guidance, boundaries and stimulation and that self-control was encouraged and that she showed positive behavior. Finally, it was checked to see is Sophie’s family provided effective and appropriate discipline, avoiding over-protection and support for positive activities. Approached Used to Support Sophie’s Health and Well-being Treating diseases and illnesses at an early stage can improve outcomes. In the case of Sophie’s, Health and Social Care workers were aware that service users have social, intellectual and emotional needs and Sophie was supported at an early stage to make an informed choice about the treatment that was offered. In addition, a holistic approach was used which took into account of the whole needs of Sophie. By assessing all areas of Sophie’s physical, intellectual, emotional and social personal health, the practitioners involved helped to reduce the effects of her initial problem. By targeting the stress through the holistic approach, practitioners prevented the trauma of Sophie’s abuse from getting worse. Sophie was also given the opportunity to make decisions and not be treated as passive receivers of Health and Social Care services; this is called empowerment of patients. As a result, Sophie and her family become active participants in the support and care planning process.

Lack Of Interested In Sports Essay

Many of my schoolmates are not interested in sports. I had carried out a survey on the reasons for their lack of interest. The reasons that causes students not to be interested in sports comes from themselves, parents and facilities. Firstly, the attitude of students for sports was wasting their time. They feel that time is money, so they use their time to study. They think that studying is important than sports and study ensures their future. This causes them to have lack of time for sports. Parents are also the reason why students lack of interest in sports. Parents emphasize on their child’s academic performance only. So, they sign up tuition classes such as English tuition class, Chemistry tuition class and so on for their children to improve their children’s academic performance. The last reason that I learnt from survey is facilities. Some students are interested in sports but there are insufficient sports equipment for them. The sport equipments like basketball, football, and so on are not enough for those students. Besides, the poor condition of field and courts in schools cause students to dislike sports because the field will become muddy when it is raining. These are a few suggestions which can be adopt to overcome the above issues. First and foremost, the school authorities should emphasize the importance of sports in school. The students must know that sports keep their bodies as fit as a fiddle. Besides, dialogue sessions should be conducted with parents to inform them the vital role of sport in helping to create a well-rounded student. As we know, sport is essential for health. As the saying goes, â€Å"Prevention is better than cure†. Therefore, we should always exercise to prevent us from diseases. Moreover, the sport facilities in school must be improved too. Nowadays, our school lack of sports equipments for students to use during physical  education. This causes them to lose interest in sports but put all their effort in their academic performances. School authorities should employ qualified trainers to improve the students’ skills in sports. A good trainer may further increase the students’ curiosity in sports. Students can learn many essential values through sports. Furthermore, more competitions in sports should be organized in our school too. For example, badminton and basketball matches can be held in schools for those who are interested in the games. Plus, those who excel in competitions should be rewarded with attractive prizes to encourage them. I hope the authorities can consider the suggestions that I had stated. I believe that the above ways can help the school attain their goal of creating interest and encouraging student participation in sports. Reported by, Joanne

Service Assignment Example | Topics and Well Written Essays - 500 words

Service - Assignment Example In fact, the company had no policy on how to deal with chronically complaining clients versus this critical case of a one-time customer. According to Churchman, a system is defined as a distinct set of parts that are designed in a coordinated manner to deliver some set objectives (churchman, 1968). In the case of Presto cleaners, the entire business operations formed the core system, and the newly installed computer system was just an additional component to the system. The additional component was expected to streamline business operations and improve efficiency, but it ended up creating inconveniencies. A critical analysis of the vents reveals that the computer system installed was alright, but the root cause of the problem resulted from poor reception of the components into the system. The newly introduced computerized environment was responsible for a change in the system. It is plausible that the general manager at Presto had only one week to familiarize the personnel with the workings of the new computer system. However, the employees took longer than expected to acquaint themselves with the workings of the new system. Ion adequate training resulted in incompetent personnel, who ended up making grave mistakes leading to customer complaints. The system was designed and expected to reduce customer waiting time and improve service delivery. The system was expected to increase the rate of picking and dropping laundry items, hence increase the total bulk of clothes processed daily. It is apparent that there was nothing wrong with the whole system in the first place. It only required the management to create an enabling environment that will make it possible to introduce new components into the system in a smooth transition. The considerations of systems thinking as elucidated by Churchman can serve as vital ingredients in an organization

Small bussines Essay Example | Topics and Well Written Essays - 500 words

Small bussines - Essay Example As can be seen from Appendix A, the business will have losses for the first two years but beginning in the third year profitability will become positive and the following years thereafter. However this paper will report only the first three years. The higher expenses than revenues in the first two years are understandable as the business is just starting. Sales revenues will expand over time with higher sales volume into new locations as the branded products of the business become known. The decreasing expenses starting after two years would come as the business take less expensive locations. This would result to increasing gross monthly margin overtime as can be seen in Appendix B. Increasing sales is observable for the next three year period and such behavior should indicate growth of the business for the next three years. The greater the revenues the higher would be the changes for better profitability after deducting the expense (Bernstein, 1993; Droms, 1990). The profitability of the business is obvious the third year and as reflected in the positive net profit margin of 16.7% after having negative rates for the past two years because of the losses. See Appendix C. Profitability essentially means higher revenues than expenses which would mean that the business would naturally incur cost or expenses in running the business but the same should generate higher revenues in exchange of the expenses to indicate profitability of the business. The profit generated by the business is not enough to assure that business will prosper. The business must be able to pay its maturing obligations on time like the salaries of employees, payment for goods and services to supplies, regular bills for electricity, telephone and other utilities. In other words, it must have sufficient working capital or excess of current assets over its current liabilities at one point in time which can be measure also by liquidity ratios

Innovating Essay Example | Topics and Well Written Essays - 2500 words

Innovating - Essay Example Some of these factors include the cost of research, the nature of research and the potential for resistance by the various agencies. Both the normative and the constructivist have their own way of meeting these different needs and it is necessary to know exactly what an organisation is looking for. For an organisation that is looking to manage the risk and the cost of research, it might be necessary to use the normative process. On the other hand, those organisations, such as the military which are not concerned with the risk of failure or the costs can use the constructivist approach. This paper tries to compare the two approaches with regard to various factors of innovation. Normative approach has its advantages in the light of the creation, distribution and sharing of knowledge. In the academic world, and especially at the tertiary level, the normative approach to knowledge and innovation can be very useful due to several reasons. First, it is indispensable to understand that one of the most imperative things about modern knowledge management is the shared learning which means that knowledge is shared equally across the world. While innovation is something that should be free from the rigid standards, it is definite that it is dependent on the normative knowledge. Most innovators are people who have acquired the shared knowledge in a specific field of knowledge. To keep up with the demand of innovation that is necessary in the modern world, there is a need to have a well thought-out way of innovation. The modern world cannot depend on erratic and unexpected innovations for its development. In this regard, normative approach to innovation is very necessary to help in a guided innovation. Despite this, there are those who believe that normative approach to innovation is not the best way to go, but that a constructivist model should be used. Most of innovations done in the past were done in a constructivist

Why is College So Expensive Research Paper Example | Topics and Well Written Essays - 1000 words

Why is College So Expensive - Research Paper Example Tuition, books and housing are enormously expensive and take the biggest bite out of the higher education budget but it doesn’t end there. It never ends. There are lab fees, dorm needs including computer, clothes and stereo, commuting costs, parking fees, tutoring and food. Forget entertainment expenses, no money left for that. College is expensive, very much so but just how expensive and why? According to experts, the cost to attend a four-year public university is about $16,000. That includes tuition, housing and general fees but not books. A private university is more than double that amount. Add to that other expenses such as dorm room accessories, electronics and clothing. Then there’s commuting which includes gas, maintenance and parking fess which can total up to $500 per semester. Tickets for outdated stickers handed out by the campus police push the cost higher. Getting a little tutoring help for that physics test will run about $30 per hour. The â€Å"luxuryà ¢â‚¬  of living on campus costs more than anyone can possibly anticipate. â€Å"The main reason why people who go to public universities end up in debt, is not the tuition, but the living away from home expenses, which at a public university, are three or four times more than tuition.† (Hacker, 2010) The price of books is another expense that is always higher than anticipated, shockingly so. The cost of books sometimes determines a student’s major. The difference in price of books can total $1200 depending on the field of study. (Beeman, 2011). There is a legitimate justification for why college textbooks cost more than paperbacks at discount book stores. Producing a new textbook is often very expensive. The market for these books is limited and has become increasingly so. In days past there were more buyers for new textbooks. Publishers could, therefore, distribute production expenses over a larger number of buyers. The relatively recent expansion of the rental and u sed textbook market has diminished the number of new books sold which has kept the price of new editions inflated. Publishers now generate updated editions. In this way they sell more books which acts to spread the production costs over more buyers. The total cost of college textbooks has actually fallen recently even as the price for new books has risen. (Weston, 2011). â€Å"Student spending on textbooks has been decreasing since 2006 because of the rise of electronic books, rentals and the used book market† (â€Å"Why,† 2011). During the 2010-11 scholastic year the average amount spent on books at a four-year college was $534. During the 2005-06 year that amount was $644. Students spend more on gasoline and going to the movies during the academic year and twice the amount on cell-phone use as they do on book expenditures. (Weston, 2011). Tuition costs are high for many reasons. Colleges have expenses which may or may not be obvious to the casual observer. The high-e nd salaries paid to employees have risen. The expense of employing well educated people began to increase substantially about 30 years ago for every industry. Colleges are an industry that cannot readily cut back on labor and much of its work force is well educated by necessity. (Goldstein, 2010). Salaries of faculty and supportive staff account for the largest piece of the college expense pie. The second highest expense can be classified as building maintenance which includes paying the electric bill, ongoing construction, cleaning and furnishing classrooms, libraries, gyms, labs, dorms, student centers and supplying computers, software, IT needs and books. (Trachtenberg, 2011) Colleges have been allocating more for support

Left side right side Essay Example | Topics and Well Written Essays - 1500 words

Left side right side - Essay Example I discovered that the political system was an important party of society. Because of the multi-party system, the average person on the street can fight for and protect their basic human rights. On the other hand, living under a political system where one party dominates can be tough. The people’s rights are not respected because the party controls everything. The Internet has become a vital part of the younger generation. Nowadays, corruption cases can be exposed by the Internet and sent around the world. The Internet is the gateway for the proclamation of truth. One great example is the story commonly known as â€Å"My father is Li Gang.† Li Ai is the son of Li Gang. One day, when Li Ai was driving his flash car, he crashed into a small girl and killed her. There were some people who knew what he had done. However, Li Ai said â€Å"my father is Li Gang, the head of the police. I will be fine.† I believed what he said because no one would find out about it. But, the Internet is the perfect tool to help publicize issues like this. If we did not have the Internet, would we have even found out about this story? A scarier thought is how many people get away with actions like this because they are protected by powerful people? The root of all our social problems is our political system. A one party state often contains many weak points. As I have lived in a one party state for 19 years, I really doubt if this system is the right way to go. I have spent the last two years studying in America and now really support a multi-party system. A multi-party system allows freedom of expression and considers human rights. Greater party representation means more competition, and more competition satisfies the people’s needs and wants. The people can freely choose to support the party that they think will benefit them the most. In the opposite way, a one party state can make decisions all by themselves. In

The Fortune 100 Best COmpanies Coursework Example | Topics and Well Written Essays - 2000 words

The Fortune 100 Best COmpanies - Coursework Example When executed accurately, this relationship will benefit all the parties involved. It will ensure the company that only the ones who possess the specific skills are directed to the company. In addition, it means reduced expenditure and reduced wastage of time. For the agency, there is more profit, and for the candidate, the most suitable job in the shortest period of time. However, for the relationship, to work properly, there should be a clear understanding between the employer and the recruitment agency as to what are the specific requirements for various positions in the company.This work intends to look into the Fortune 100 Best Companies to Work for List and tries to identify the best performing companies in terms of percentage of job growth, top salary and perks. Thereafter, the companies that are suitable for people with less work experience are identified and listed. Also, the companies that suit the fresh graduates of St. Leo University are identified and listed. ... The more the working relationships are, the easier the work will be, and the higher the placement will be. By having working relationships with the companies, it will be easy to identify exactly what qualities the companies are looking for in the potential candidates. That way, it will be easy to meet the expectations of the employer and the employee in a better way. When such a relationship is developed, it benefits all the concerned parties. For the company, this ensures easy availability of the most suitable candidates in the shortest possible time, and that too at a considerably lower cost. When the relationship works out as the candidates are successful, the agency gains more credibility, and thus, more business. Thirdly, for the candidate, there is the most suitable job with less effort as there is no need to search for vacancies in various companies. This work attempts to look into the Fortune 100 Best Companies to Work for List, and tries to find out which are some important companies in the list with which a recruitment agency has to develop working relationships. In addition, efforts are made to identify the ones which best suit candidates with less experience, and the ones which best suit the fresh graduates from Saint Leo University. Here, the candidates are adults with some work experience and fresh graduates of St. Leo University. To analyze the situation, the Fortune 100 Best Companies to Work for List is used. 1. Benefits of establishing a working relationship with the Fortune 100 Best Companies to Work For Undoubtedly, establishing a working relationship with companies makes the role of employment agency much easier. This is especially so when the companies have not provided a clear idea about the skills they are looking

Personal reflective journal examining key positive psychological Essay

Personal reflective journal examining key positive psychological constructs - Essay Example Everyone wants to have the freedom to do the things they want to do, this is because everyone abides in the principle of pursuit of happiness. In happiness, humans find glory, peace and freedom. What does it need to be happy? Does a person need to be rich? Strong? Influential? I believe it is more than that. There are those who have everything in life, yet they are not happy. And there are those who could not eat three times a day but are pretty satisfied with their lives. Take for example the people in Middle East, they are being threatened by wars every day. Death, starvation and fear are common elements of their day to day lives, but they could still manage to dream of a bright future for them and for their families (Burke, 1993). Whenever I hear success stories of people from Middle East in television, I realize that life’s problems could be overcome by aspiration and willingness to succeed. It’s Tuesday already, prior to my critical point of realization: I was less of an ordinary person. There was nothing exciting in my life. I worked to eat, I ate to live and I lived because I had to. While it is true that humans mature as they grow, I thought that I was just going to stay psychologically and socially stunted for the rest of my life. I always wonder why soldiers sent to the most dangerous parts of the world still manage to laugh, play cards and drinks with their friends while on battle. Perhaps this is one of the tangible proofs that life is about psychological mindset and perception towards the world (Harris, 1992, p.185). I write for a major newspaper in one of the most progressive cities in the world. My editor once said that I was one of the best writers she ever met, and that I would be a very successful author someday. I really could not tell whether she was lying or not. Well, I don’t have the capability to tell other people’s emotions, feelings and sentiments. I do not have that much friends. While my readers keep on

Herman Miller and Local Produce Essay Example | Topics and Well Written Essays - 500 words

Herman Miller and Local Produce - Essay Example Local produce good for everyone: This is a fact that Herman Miller considers very strongly. For instance Miller and a team of experts have looked beyond their immediate markets to other local but promising markets i. e the Chinese markets. They have noticed that the Chinese do not patronize global goods but are in love with their local produce like many other Asian countries. Thus Miller is creating some designs which are very specific to that marketplace and in other to achieve this; they will have to hire a few local people to guide the company towards achieving a perfect local design/produce that suits the need of the local market. Analysis According to (Google books, 2010) Herman Miller uses outside resources to drive innovations. They outsource their creative work to a network of award winning independent designers. Miller states boldly that when talents are drawn from a variety of sources, innovation thrives faster. This is what walker refers to as â€Å" a fresh perspective o n existing or emerging problems† In expanding into Malaysia, the company will require the flexibility of working alongside other designers in Malaysia and sharing profits with them. This will help them conquer the indigenous Malaysian market.

Adrenaline rush Essay Example for Free

Adrenaline rush Essay This week was so stressful. For the entire whole week, I was assigned to track the advertising history of the company’s sports drink client. I ran through hundreds of video tapes of the sport drink’s advertisement in the span of 5 years, noting each and every aspect in the ideals in their communication style. I was assessing the visual, the content and the semiotics of the whole thing. What’s worse about it is that I have to review the entire set of tapes in the office. I would have liked it watching at home but I have to be confined in the workplace. But knowing it was a job; I accepted the challenge and readied myself for hours and hours of video tapes. But I learned another valuable idea in the media industry concerning contents of the advertising. In a way, it does imply that advertisements do manipulate the consumer behavior. Watching the advertisements of the sport drink, I observed how it evolved into describing the product itself into touching the health issues of the health-conscious and athletes. Like what the sport drink company wants to advertise their latest sports drink product that addresses the more health-conscious consumer, I realized that they now are conscious of the fact that people today likes to know more of the content of their product, and that is their aim in their new advertising venture. Other things I was exposed this week: learning semiotics of the print ads of the sports drink company details on how STG Media Corp. analyzes these given semiotics establishing more communication with the sports drink company developing more personal and professional relationship with the Creative Team (they invited me to one of their deliberations and I get to witness how they brain-storm ideas for the project) Week 4 (provide date) It was a week of adrenaline rush. The Creative Team finalized their output and was presented to the sport drink company. They liked it! With this the whole team was pressed for time. Everybody seemed to be really anticipating the results. I was assigned to track the statistics of how the product is doing in the market after the release of the advertisement. The company has a great way to promote the product and was successfully able to deliver the results for the company. Other thing I learned is that the media industry has many issues to deal with. Like for example, the Creative Team was perfectionists in the sense that after releasing the output in form of the print ad, they wanted to be sure that the effects of the print ad will be evident and reflected through sales. They were still anxious and worried of the end result when in fact; they already did their job by producing a print ad. I realized that many of them really are dedicated in providing the client with their money’s worth. Another thing I realized is that companies take advertisements seriously. I thought that business management theories and ideals only entails that they give importance to advertisements, but through this experience I learned that they are really committed in selling the idea to the consumer. And this generates the influence of media to the consumers. Week 5 (provide date) This week was a mix of tasks. One of the most interesting things exposed to me was the process of reviewing the Creative Team and the advertising project in general. I thought that the evaluation of the employees was done by the executives of the company alone, but at STG Media Corp. , they provide real life processes in dealing with performance issues. The company has an interesting way to evaluate its employees. There is the concept of a performance improvement plan that is drawn between the Human Resource department of the company and from the employee’s manager, in this case the Creative Team head. These reports are then presented to the employees. This draw my attention as I realize that the method of evaluating employees in this company is a non-punitive method that demonstrates how the company recognizes the issues in the Team but are willing to work with the employee and give them opportunity to improve. It was interesting to me because of notice that one particular person was not able to contribute that much in the Creative Team and was not able to contribute much ideas in the process (I was present in almost all their meetings so this is an observation that is true). The evaluation was not very good to him and as a result, the whole Creative Team talked it through the management. The executives of the company then addressed a letter to the employee and showed his performance evaluation. After which, the whole Creative Team approached and talked to him and encouraged him to be open and present his ideas. Turns out, the team member was intimidated with the other professionals he is working with and needs to feel he is welcomed in the team along with his ideas.

Measuring Cytotoxicity in HepG2 Cells

Measuring Cytotoxicity in HepG2 Cells Measuring cytotoxicity in HepG2 cells treated with cisplatin or 5-fluorouracil, via flow cytometry as a measure of effectiveness of the drugs at treating cancer Introduction Cytotoxicity is the quality of being toxic to cells, resulting in cell death (Rang et al. 2012). In the majority of therapeutics cytotoxicity is not a desirable characteristic. However, in the treatment of cancer many chemotherapy drugs, through cytotoxicity are designed to selectively induce apoptosis, a form of cell death (Rang et al. 2012). There are three main forms of cell death, these are: apoptosis, autophagy and necrosis. Apoptosis is the physiological process by which cells are destroyed in a controlled manner (Elmore 2007). There are four basic steps involved; the first is cell shrinkage, blebs begin to form and condensation of chromatin occurs. Next, membrane blebbing occurs and enzymes begin the process of nuclear fragmentation. In the late stages of apoptosis, the cell is broken down into apoptotic bodies which contain the cells components and nuclear fragments. The final stage is the phagocytosis of apoptotic bodies (Ulukaya et al. 2011). One of the main ways in which phagocytes recognise apoptotic cells is the presentation of phosphatidylserine (PS). Ordinarily, this phospholipid is found on the inner leaflet of the membrane bilayer, during apoptosis it translocates to the outer leaflet and binds to a PS receptor present on the phagocyte (Wu et al. 2006). In autophagy, targeted components such as organelles are isolated in an autophagosome; a form of vesicle with a lipid bilayer membrane. These autophagosomes are degraded by lysosomes (Kroemer, G et al. 2009). Necrosis is often thought of as uncontrolled cell death. However, there is an increasing amount of evidence that suggests it is regulated by transduction pathways and other mechanisms (Kroemer, G et al. 2009). It is caused by factors such as trauma, infection and toxins. It is characterised by the swelling of cells which causes the cell membrane to rupture, resulting in the release of intracellular components. These intracellular components can trigger a local inflammatory response. In contrast to apoptosis, the phagocytic stage does not occur in necrosis (Golstein, Pierre and Kroemer, Guido 2007). As a result, dead cells and their intracellular components remain at the site of necrosis, this build-up of debris may lead to conditions such as gangrene. Due to its detrimental effects, it’s preferential that necrosis is not produced by therapeutics. Cisplatin and 5-fluorouracil are chemotherapy agents, which both cause apoptosis by interfering with DNA via its replication and repair. Cisplatin crosslinks with purine bases in DNA which interferes with DNA repair mechanisms, this means that DNA damage is not fixed triggering apoptosis (Dasari and Bernard Tchounwou 2014). 5-flurouracil is an antimetabolite, it is metabolised into 5-fluorodeoxyuridine monophosphate (5-FdUMP) which is then incorporated into both DNA and RNA and also inhibits thymidilate synthase (Parker and Stivers 2011). HepG2 cells are derived from the hepatocellular carcinoma cells of a 15 year old, American, Caucasian, male and are epithelial in nature. They are commonly used as an in vitro model of human hepatocellular carcinoma (Costantini et al. 2013). Flow cytometry is a powerful tool that allows for the rapid differentiation and characterisation of particles including cells. A flow cytometer is made up of three main components: fluidics, optics and electronics. When a sample is injected into a flow cytometer, the fluidics system is responsible for producing a stream of single particles, this relies on the principle of laminar flow. This allows the particles to be interrogated by the laser beam individually. When a particle passes through the laser beam it scatters light. The amount of forward scatter is proportional to the size of the cell. The side scatter is proportional to the complexity of the cell. If a fluorophore is present, it can be excited by a specific wavelength of light. It will then undergo a Stokes shift and a different wavelength of light will be emitted which can be measured by the electronics of the flow cytometer (Macey 2007, Maxwell and Hannon-Fletcher 2009). The fluorophore can be conjugated with proteins suc h as annexin V which have a known high affinity to specific molecules present on the cell surface. Annexin V is a 35.7kDa, calcium sensitive, phospholipid binding protein. It has a high affinity to phosphatidylserine. The binding of fluorophore labelled annexin V is used as a common measure of apoptotic cells by flow cytometry (van Genderen et al. 2008). Aims To measure the effectiveness of two anti-cancer drugs by measuring the level of apoptosis in a population of HepG2 cells after being treated with cisplatin (15 µg/mL) or 5-fluorouracil (25 µg/mL) for 48 hours and compare those to a population of untreated cells via flow cytometry. Objectives To count and fix a population of HepG2 cells before staining them with fluorescently labelled Annexin V in preparation for analysis using a flow cytometer. To measure the level of fluorescence in 5000 treated and untreated cells using a flow cytometer as well as measuring the minimal and maximal fluorescence in a negative and positive control. Based on the fact the fluorescence is directly proportional to apoptosis determine which treatment is significantly better and provide evidence from the literature as to why this is the case. Methods Please refer to laboratory schedule (Hatch 2014). Following the collection of data descriptive statistics and a one-way ANOVA test were carried out the results of which can be found in the appendix. Results The negative control was used to identify if there was any background fluorescence. In table 1 (found in the appendix) the mean fluorescence for the negative control was 144. Therefore, fluorescence that is significantly higher than this level can be attributed to the excitation of the fluorophore (Alexa 488). Figure 1 Cytotoxicity of HepG2 cells measured as fluorescence using flow cytometry. The bars are means of triplicates, the standard error has been used for the error bars. *statistically significant compared to control (blue for negative, red for positive), p In figure 1, a greater level of fluorescence was seen for the samples treated with cisplatin and 5-fluorouracil compared to that of the untreated sample. Cisplatin produced the greatest level of fluorescence of the two treated samples. Discussion The data used was a class set, some of the data provided was produced by those running the laboratory session as some samples did not contain a pellet which was needed to run the flow cytometry analysis. The five sets of data were compared with one another, it was found that the differences were statistically significant (p As mentioned in results, cisplatin showed a greater mean fluorescence compared to 5-fluorouracil, Results were 726 and 540 respectively. Seeing as fluorescence is directly proportional to phosphotidylserine expression, which in turn is a direct measure of apoptosis. It can be assumed that cisplatin produced the highest level of apoptosis and is most cytotoxic to HepG2 cells. Although a higher concentration of the drugs were used (150 µg/mL) this result has also been seen in the literature (Brenes et al. 2007). Although it was not stained with annexin V, the negative control showed a mean fluorescence of 144; this is due to auto fluorescence of the cells. The fluorophore which was conjugated with annexin V was Alexa 488. It fluoresces at a wavelength of 488nm, this is within the green part of the spectrum. It is well documented that molecules found within all cells, including hepatocytes also fluoresce at a green wavelength, the most notable of these are flavins which fluoresce at around 560nm (Croce, Anna Cleta et al. 2007, Croce, Anna C et al. 2014). FAD (flavin adenine dinucleotide) is an example of a flavin and is a redox cofactor used in metabolism. HepG2 cells are a liver carcinoma cell line. Due to their cancerous nature there would be a high level of metabolism within these cells and hence, a high level of FAD. The low level of fluorescence seen in the untreated sample is expected as there should be no apoptosis induced by cytotoxicity. Therefore, it is not surprising that the difference between the fluorescence of the untreated sample and the negative control and the treated samples is less statistically significant. In this experiment, only one stain was used in this experiment (Annexin V), this allows for the identification of cells that are cytotoxic. To evaluate the true effectiveness of a chemotherapy drug, the cell viability and necrosis is also needed. Necrosis and late stage apoptosis can be measured using propidium iodide (PI). PI binds to nucleic acids and is impermeable to intact membranes, it is often used in combination with annexin V as it fluoresces red and there is little overlap between the wavelengths of red and green light. Therefore, compensation is not needed after flow cytometry has been carried out. It has been observed in the literature that the cytotoxicity of 5-fluorouracil is dependent on both dose and exposure time (Okamura et al. 2008). We only looked at one dose and exposure time for both drugs. It has also been observed that the use of cisplatin in combination with 5-fluorouracil or other chemotherapy drugs has a synergistic and additive effect in hepatoma cell lines (Kogure et al. 2004), both of these could be investigated further is the experiment were carried out again. Conclusion In conclusion, cisplatin was shown to produce a higher level of apoptosis in HepG2 cells than 5-fluorouracil. However, to fully evaluate the effectiveness of an anti-cancer agent, measures of viability and necrosis are also needed. The differences between the two drugs may be due to the different mechanisms by which the drugs work. The introduction of 5-dUMP into DNA and RNA is a more subtle mechanism compared to the cross-linking of DNA via cis-platin. This cross-linking may be detected by cells more readily resulting in higher levels of apoptosis. As HepG2 cells were used, these results may only be the case for hepatocellular carcinomas. References Brenes, O., Arce, F., Gà ¤tjens-Boniche, O., and Dà ­az, C. (2007) â€Å"Characterization of Cell Death Events Induced by Anti-Neoplastic Drugs Cisplatin, Paclitaxel and 5-Fluorouracil on Human Hepatoma Cell Lines: Possible Mechanisms of Cell Resistance.† Biomedicine pharmacotherapy = Biomà ©decine pharmacothà ©rapie 61 (6), 347–55 Costantini, S., Di Bernardo, G., Cammarota, M., Castello, G., and Colonna, G. (2013) â€Å"Gene Expression Signature of Human HepG2 Cell Line.† Gene 518 (2), 335–45 Croce, A.C., Ferrigno, A., Santin, G., Piccolini, V.M., Bottiroli, G., and Vairetti, M. (2014) â€Å"Autofluorescence of Liver Tissue and Bile: Organ Functionality Monitoring during Ischemia and Reoxygenation.† Lasers in surgery and medicine 46 (5), 412–21 Croce, A.C., De Simone, U., Vairetti, M., Ferrigno, A., and Bottiroli, G. (2007) â€Å"Autofluorescence Properties of Rat Liver under Hypermetabolic Conditions.† Photochemical photobiological sciencesà ¢Ã¢â€š ¬Ã‚ ¯: Official journal of the European Photochemistry Association and the European Society for Photobiology 6 (11), 1202–9 Dasari, S. and Bernard Tchounwou, P. (2014) â€Å"Cisplatin in Cancer Therapy: Molecular Mechanisms of Action.† European journal of pharmacology 740, 364–378 Elmore, S. (2007) â€Å"Apoptosis: A Review of Programmed Cell Death.† Toxicologic pathology 35 (4), 495–516 Van Genderen, H.O., Kenis, H., Hofstra, L., Narula, J., and Reutelingsperger, C.P.M. (2008) â€Å"Extracellular Annexin A5: Functions of Phosphatidylserine-Binding and Two-Dimensional Crystallization.† Biochimica et biophysica acta 1783 (6), 953–63 Golstein, P. and Kroemer, G. (2007) â€Å"Cell Death by Necrosis: Towards a Molecular Definition.† Trends in biochemical sciences 32 (1), 37–43 Hatch, E. (2014) â€Å"M19BMS Laboratory Schedule†. Coventry University Kogure, T., Ueno, Y., Iwasaki, T., and Shimosegawa, T. (2004) â€Å"The Efficacy of the Combination Therapy of 5-Fluorouracil, Cisplatin and Leucovorin for Hepatocellular Carcinoma and Its Predictable Factors.† Cancer chemotherapy and pharmacology 53 (4), 296–304 Kroemer, G., Galluzzi, L., Vandenabeele, P., Abrams, J., Alnemri, E.S., Baehrecke, E.H., Blagosklonny, M. V, El-Deiry, W.S., Golstein, P., Green, D.R., Hengartner, M., Knight, R.A., Kumar, S., Lipton, S.A., Malorni, W., Nuà ±ez, G., Peter, M.E., Tschopp, J., Yuan, J., Piacentini, M., Zhivotovsky, B., and Melino, G. (2009) â€Å"Classification of Cell Death: Recommendations of the Nomenclature Committee on Cell Death 2009.† Cell death and differentiation 16 (1), 3–11 Macey, M.G. (2007) Flow Cytometryà ¢Ã¢â€š ¬Ã‚ ¯: Principles and Applications. ed. by Macey, M.G. Humana Press, Inc Maxwell, P. and Hannon-Fletcher, M. (2009) â€Å"Advanced Techniques in Diagnostic Cellular Pathology†. in Advanced Techniques in Diagnostic Cellular Pathology. Hoboken: Wiley, 69–97 Okamura, M., Shimada, J., and Sakagami, H. (2008) â€Å"Comparative Analysis of Cell Death Induction by Cisplatin and 5-FU in Human Oral Squamous and Hepatocellular Carcinoma Cell Lines†. Anticancer research 260, 253–259 Parker, J.B. and Stivers, J.T. (2011) â€Å"Dynamics of Uracil and 5-Fluorouracil in DNA.† Biochemistry 50 (5), 612–7 Rang, H., Dale, M., Ritter, M., Flower, R., and Henderson, G.. (2012) â€Å"Anticancer Drugs†. in Rang and Dale’s Pharmacology. 7th edn. Elesevier, 676–677 Ulukaya, E., Acilan, C., and Yilmaz, Y. (2011) â€Å"Apoptosis: Why and How Does It Occur in Biology?†. Cell biochemistry and function 29 (6), 468–80 Wu, Y., Tibrewal, N., and Birge, R.B. (2006) â€Å"Phosphatidylserine Recognition by Phagocytes: A View to a Kill.† Trends in cell biology 16 (4), 189–97 Appendix Table 1: Table showing mean fluorescence for each sample where 1.00 represents the negative control, 2.00 represents the positive control, 3.00 the untreated sample, 4.00 the sample treated with cisplatin, 5.00 with 5-fluorouracil N Mean Std. Deviation Std. Error 95% Confidence Interval for Mean Minimum Maximum Lower Bound Upper Bound 1.00 3 144.3333 11.93035 6.88799 114.6967 173.9700 136.00 158.00 2.00 3 1866.6667 32.65476 18.85323 1785.5477 1947.7856 1836.00 1901.00 3.00 3 214.3333 10.59874 6.11919 188.0046 240.6621 203.00 224.00 4.00 3 864.0000 20.22375 11.67619 813.7614 914.2386 849.00 887.00 5.00 3 540.6667 51.93586 29.98518 411.6508 669.6825 484.00 586.00 Total 15 726.0000 647.67772 167.22967 367.3280 1084.6720 136.00 1901.00 Table 2 Descriptive statistics where 1.00 is the negative control, 2.00 is the positive control, 3.00 is the untreated sample, 4.00 is the sample treated with cisplatin and 5.00 is the sample treated with 5-fluorouracil. N Mean Std. Deviation Std. Error 95% Confidence Interval for Mean Minimum Maximum Lower Bound Upper Bound 1.00 3 144.3333 11.93035 6.88799 114.6967 173.9700 136.00 158.00 2.00 3 1866.6667 32.65476 18.85323 1785.5477 1947.7856 1836.00 1901.00 3.00 3 214.3333 10.59874 6.11919 188.0046 240.6621 203.00 224.00 4.00 3 864.0000 20.22375 11.67619 813.7614 914.2386 849.00 887.00 5.00 3 540.6667 51.93586 29.98518 411.6508 669.6825 484.00 586.00 Total 15 726.0000 647.67772 167.22967 367.3280 1084.6720 136.00 1901.00 Table 3 ANOVA analysis carried out on the data Sum of Squares df Mean Square F Sig. Between Groups 5863955.333 4 1465988.833 1655.612 .000 Within Groups 8854.667 10 885.467 Total 5872810.000 14 Table 4 Ad-hoc test Tukeys range tests and LSD showing statistical significance between groups. All differences between groups are statistically significant (p Multiple Comparisons Dependent Variable: Fluorescence (I) Treatment (J) Treatment Mean Difference (I-J) Std. Error Sig. 95% Confidence Interval Lower Bound Upper Bound Tukey HSD 1.00 2.00 -1722.33333* 24.29632 .000 -1802.2945 -1642.3722 3.00 -70.00000 24.29632 .094 -149.9612 9.9612 4.00 -719.66667* 24.29632 .000 -799.6278 -639.7055 5.00 -396.33333* 24.29632 .000 -476.2945 -316.3722 2.00 1.00 1722.33333* 24.29632 .000 1642.3722 1802.2945 3.00 1652.33333* 24.29632 .000 1572.3722 1732.2945 4.00 1002.66667* 24.29632 .000 922.7055 1082.6278 5.00 1326.00000* 24.29632 .000 1246.0388 1405.9612 3.00 1.00 70.00000 24.29632 .094 -9.9612 149.9612 2.00 -1652.33333* 24.29632 .000 -1732.2945 -1572.3722 4.00 -649.66667* 24.29632 .000 -729.6278 -569.7055 5.00 -326.33333* 24.29632 .000 -406.2945 -246.3722 4.00 1.00 719.66667* 24.29632 .000 639.7055 799.6278 2.00 -1002.66667* 24.29632 .000 -1082.6278 -922.7055 3.00 649.66667* 24.29632 .000 569.7055 729.6278 5.00 323.33333* 24.29632 .000 243.3722 403.2945 5.00 1.00 396.33333* 24.29632 .000 316.3722 476.2945 2.00 -1326.00000* 24.29632 .000 -1405.9612 -1246.0388 3.00 326.33333* 24.29632 .000 246.3722 406.2945 4.00 -323.33333* 24.29632 .000 -403.2945 -243.3722 LSD 1.00 2.00 -1722.33333* 24.29632 .000 -1776.4689 -1668.1978 3.00 -70.00000* 24.29632 .016 -124.1356 -15.8644 4.00 -719.66667* 24.29632 .000 -773.8022 -665.5311 5.00 -396.33333* 24.29632 .000 -450.4689 -342.1978 2.00 1.00 1722.33333* 24.29632 .000 1668.1978 1776.4689 3.00 1652.33333* 24.29632 .000 1598.1978 1706.4689 4.00 1002.66667* 24.29632 .000 948.5311 1056.8022 5.00 1326.00000* 24.29632 .000 1271.8644 1380.1356 3.00 1.00 70.00000* 24.29632 .016 15.8644 124.1356 2.00 -1652.33333* 24.29632 .000 -1706.4689 -1598.1978 4.00 -649.66667* 24.29632 .000 -703.8022 -595.5311 5.00 -326.33333* 24.29632 .000 -380.4689 -272.1978 4.00 1.00 719.66667* 24.29632 .000 665.5311 773.8022 2.00 -1002.66667* 24.29632 .000 -1056.8022 -948.5311 3.00 649.66667* 24.29632 .000 595.5311 703.8022 5.00 323.33333* 24.29632 .000 269.1978 377.4689 5.00 1.00 396.33333* 24.29632 .000 342.1978 450.4689 2.00 -1326.00000* 24.29632 .000 -1380.1356 -1271.8644 3.00 326.33333* 24.29632 .000 272.1978 380.4689 4.00 -323.33333* 24.29632 .000 -377.4689 -269.1978 *. The mean difference is significant at the 0.05 level.

Attitudes Towards Euthanasia | Literature Review

Attitudes Towards Euthanasia | Literature Review Introduction This literature review is based upon peoples attitudes towards Euthanasia, which comes from the Greek meaning good death and in English means the killing of one person by another to relieve the suffering of that person and Physician Assisted Suicide (PAS), which is described as; a medical professional aiding a person who is incapable of the act themselves to commit suicide, (NHS, 2010). For this literature review, a literature search was performed using the Cochrane library, Science Direct, EBSCOhost and Sage using the key words: Assisted suicide Euthanasia Opinions Attitude United Kingdom Public Right to Die Assisted Dying Most of these words (with the exception of Assisted Suicide and Assisted Dying) were used in each of the search engines individually and also used to form sentences, however, the only electronic databases that gave this search the information it required was Sage. This provided a substantial amount of journals, a lot of the others used were subscription based or a fee was required, but from the free to use information two of the most relevant to the subject I wished to perform the review on were chosen. The two papers were chosen from surveys and studies performed in the United Kingdom, because it was decided to research what the thoughts and feelings of medical professionals were in a place where this practice was presently illegal. Use in the literature search, but this was difficult to come by. The titles of the three journals are: Legalisation of Euthanasia or Physician Assisted Suicide: Survey of Doctors Attitudes, and Opinions of the Legalised of Physician Assisted Suicide. Des pite not inputting the word physician into the search engine, a lot of the searches came up with types of journals which mention this anyway. This review will critically evaluate the information in the journals and will be compared with each other, discussing the disadvantages of the surveys and the advantages. The review will also include the various research methods used in the research. The Literature Review The first paper reviewed is in English by Clive Seale, PhD, from the Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, London and is called The legalisation of Euthanasia or Physician-Assisted Suicide: Survey of Doctors Attitudes. The protocol was to determine what doctors opinions about the legalisation of medically assisted dying (which includes the terms, euthanasia and physician-assisted suicide (PAS)) were and this was done in comparison with the opinions of the general public of the UK. The methodology was to send out structured questionnaires with a series of questions using qualitative methods and then analyse the results in a quantitative manner. In 2007, Binleys database (http://www.binleys.com) was used to send questionnaires to 8857 currently working medical practitioners all over the UK, this was broken down into 2829 (7%) GPs, 443 (43%) neurologists, 836 (21% of these were doctors) specialists in the care of the elderly, 462 (54% of thes e were also doctors) specialists in palliative medicine and 4287 workers in other hospital based specialities. This is quite a large sample to use and covers a wide range of specialities. It is not clear in what month in 2007 these questionnaires were sent out but follow-up letters were sent to non-respondents between November 2007 and April 2008 to enquire as to why they did not respond, in which 66 doctors in all responded with the most common reason being lack of time to complete the survey. Overall the response rate was 42.1% with specialists in palliative medicine being the most responsive with 67.3% of people returning their questionnaire, along with specialists in the care of the elderly (48.1%) neurologists (42.9%) other hospital specialties (40.1%) and GPs (39.3%). Despite the large sample of people, 42.1% of replies are quite disappointing, although it is a very emotive subject. The questions consisted of personal questions such as age, gender, grade, ethnic origin, and speciality of the respondent and, on average, the number of deaths attended. They were all asked four questions about their attitude towards euthanasia and assisted suicide, in order to obtain the questionnaire in full the author of the survey invited people to contact him. An email was sent: Appendix (a) and a reply was received the next day: Appendix (b). Previous surveys regarding this subject were performed in the Netherlands, Oregon (USA) and Belgium majority support from the medical profession has been important in passing permissive legislation in these countries. The keywords used in this study were assisted dying; euthanasia; physician-assisted suicide; right to die and terminal care. The distribution of questionnaires meant that the methodology used was right as it was discreet and reached a lot of people in a short amount of time, the only danger with this method was that the medical professionals did not have to respond which was shown in the return response of 42.1% there was no financial or other incentive as this would go against all ethical considerations. Ethical approval for this study was granted by the South East Research Ethics Committee. The results showed that those who were specialists in palliative medicine were more opposed to euthanasia or PAS being legalised than the other specialities, although this could be down to the higher response rate in this area. Those that expressed their religious beliefs were more opposed to the legalisation also. The study showed that the most widely held view was that British doctors do not s upport legalising assisted dying in either euthanasia or PAS; this differs from the British Social Attitudes (BSA) survey which has tracked changes in public opinion since 1984, and is the most consistent source of data (http://www.britsocat.com). The second paper reviewed is Survey of doctors opinions of the legalisation of physician assisted suicide by William Lee, Annabel Price, Lauren Rayner and Matthew Hotopf from the Institute of Psychiatry. Kings College, London. The protocol is similar to the first paper in that they were looking at practitioners opinions on euthanasia and PAS. The article begins by saying that there is wide support among the general public for assisted dying but not so much for those who care for the dying. The methodology was to send out a postal survey of a 1000 senior consultants and medical practitioners were selected randomly from the commercially available Informa Healthcare Medical Directory (2005/2006), retired doctors were excluded from the survey. Questionnaire were sent firstly in February 2007, 12 weeks later, in May, non-respondents were contacted and then six weeks later they were telephoned, it was discovered that that some of the possible contributors had moved, died or retired. This i nformation was adjusted to take this into account. The authors completed separate univariable (a single variable) and multivariable (containing more than one variable) predicting the outcomes using polytomous methods which would allow two outcomes to be predicted together. The response rate to the survey was 50% once the exclusions were accounted for, which is higher than the first paper and still gave a lot of date to work with. Included in the survey the authors included a brief outline of the Assisted Dying for the Terminally Ill Bill (2006) 32% of the doctors who responded had read some of the Bill. Gender, speciality and years in post had no effect on opposition or support for a new law. An interesting point noted is that the views of doctors who do not care for the dying tally with the general publics view, so there is some correlation there with 66% of those who never cared for the dying supporting a change in the law. The outcome of interest for the authors was to what level practitioners agreed with the statement: The law should not be changed to allow assisted suicide. A second outcome of interest was the level of agreement with the statement I would be prepared to prescribe a fatal drug to a terminally ill patient who was suffering unbearably, were that course of action to become legal. (Hotopf, et. al. 2007:3). The findings of this questionnaire can be found in Appendix (c). Both of these questions were determined using five-point Likert-type scales, used commonly in questionnaires, following this were converted into three-point scales comprising of agree, neither agree nor disagree and disagree with a change in law. The survey shows that senior doctors are split abut their views regarding a change in the law; fewer are in favour than the general public in the United Kingdom. These findings have been noted in the US, as well as Canada, Finland and the Netherlands as well as the UK. Ethical permission was gained from the Institute of Psychiatry, Kings College London Research Ethics Committee. Comparisons and Conclusions There are many comparisons between the two papers, for example, both sent out questionnaires to their target group, who were specialists in certain fields. However, the first paper surveyed over double the amount of people the second paper did but got less replies. Both studies were done in the same year but it is difficult to tell who started theirs first as the date for first paper is unknown other than it was performed in 2007. The second survey is far more in depth that the first one, and it suggests that qualitative research is needed to understand doctors views better whereas the first paper did not state which the preferred method was. The second paper suggests that doctors who oppose a change in the law comes from an over-optimistic credence in their ability to relieve the suffering of the dying. (Hotopf, et.al. 2007). It is possible to argue against this though and the knowledge and experience of patients who are dying influences views about PAS. Both compare the attitudes b etween the general public and the specialist doctors and note a big difference between them. On the whole both papers conducted a thorough and precise survey but there is room for further research and investigation. References Hotopf, L, Lee, W, Price, A, and Rayner, L. (2009) Survey of Doctors Opinions of the Legalisation of Physician-Assisted Suicide, Bio-Med Central, [Online], Available from: http://www.biomedcentral.com/content/pdf/1472-6939-10-2.pdf [Accessed: 22nd April 2010]. NHS (2010) Euthanasia and assisted suicide [Online], London. Available from: http://www.nhs.uk/Conditions/Euthanasiaandassistedsuicide/Pages/Definition.aspx [Accessed 22nd April 2010]. Seale, C. (2009) Legalisation of Euthanasia or Physician-Assisted Suicide: Survey of Doctors Attitudes, Palliative Medicine, [Online], Available from: http://pmj.sagepub.com/cgi/content/abstract/23/3/205 [Accessed 22nd April 2010]. Papers used in Literature Search: Hotopf, L, Lee, W, Price, A, and Rayner, L. Survey of Doctors Opinions of the Legalisation of Physician-Assisted Suicide. Seale, C Legalisation of euthanasia or physician-assisted suicide: survey of doctors attitudes. Appendix (a) Original Message From: Katy Marsland (08111890) [mailto:[emailprotected]] Sent: 26 April 2010 19:25 To: [emailprotected] Subject: A Questionnaire request. Dear Sir, I am at the University of Lincoln and am doing a literature review for my degree in Health and Social care involving your survey on the Legalisation of Euthanasia or Physician-Assisted Suicide: Survey of Doctors Attitudes, and was wondering if it were possible for you to forward me a copy of the questions in order to aid my review? Many thanks in advance Katy Marsland Reply: Here is the questionnaire. Clive (b) END OF LIFE DECISIONS IN MEDICAL PRACTICE: CONFIDENTIAL ENQUIRY PLEASE TICK THE BOXES TO INDICATE YOUR ANSWERS THANK YOU FOR YOUR ASSISTANCE à ¯Ã‚ Ã‚ ¯ General Background Questions Your age à ¯Ã‚ Ã‚ ¯ under 35 years of age à ¯Ã‚ Ã‚ ¯ 36 to 45 years of age à ¯Ã‚ Ã‚ ¯ 46 to 55 years of age à ¯Ã‚ Ã‚ ¯ 56 to 65 years of age à ¯Ã‚ Ã‚ ¯ over 65 years of age Your gender à ¯Ã‚ Ã‚ ¯ male à ¯Ã‚ Ã‚ ¯ female Your medical specialty à ¯Ã‚ Ã‚ ¯ General practice à ¯Ã‚ Ã‚ ¯ Palliative medicine à ¯Ã‚ Ã‚ ¯ Neurology à ¯Ã‚ Ã‚ ¯ Elderly Care à ¯Ã‚ Ã‚ ¯ Other, please specify Grading of your post à ¯Ã‚ Ã‚ ¯ Consultant à ¯Ã‚ Ã‚ ¯ Specialist registrar à ¯Ã‚ Ã‚ ¯ Associate specialist / staff grade à ¯Ã‚ Ã‚ ¯ SHO / HO / F1 / F2 à ¯Ã‚ Ã‚ ¯ GP principal à ¯Ã‚ Ã‚ ¯ GP registrar Please indicate the number of deaths, on average, for which you would be the treating or attendant doctor in the normal course of your duties Answer only one of (a), (b) or (c). (Please give the most accurate estimate you can) (a)_______________per week (b)_______________per month (c)_______________per year Have you been the treating or attendant doctor in the case of a death in the last 12 months? à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ no Please go to question 30, on page 7 SPACE FOR COMMENTS ONCE YOU HAVE FINISHED THIS QUESTIONNAIRE Once you have completed this questionnaire, you can use this space to provide any clarifications to your answers or make other points PLEASE TRY TO RECALL AS CAREFULLY AS POSSIBLE THE MOST RECENT DEATH WITHIN THE LAST 12 MONTHS FOR WHICH YOU WERE ACTING AS THE TREATING OR ATTENDANT DOCTOR, AND ANSWER ALL OF THE QUESTIONS 1 TO 29 FOR THAT PARTICULAR DEATH It is, of course, impossible to do justice to all the finer nuances of decisions concerning the end of life in a short questionnaire. But please indicate those answers which approach the actual circumstances of this death as closely as possible. 1 Sex of the deceased à ¯Ã‚ Ã‚ ¯ male à ¯Ã‚ Ã‚ ¯ female 2 Age of the deceased (please estimate if unsure) à ¯Ã‚ Ã‚ ¯ under 1 year à ¯Ã‚ Ã‚ ¯ 1-9 years à ¯Ã‚ Ã‚ ¯ 10-19 years à ¯Ã‚ Ã‚ ¯ 20-29 years à ¯Ã‚ Ã‚ ¯ 30-39 years à ¯Ã‚ Ã‚ ¯ 40-49 years à ¯Ã‚ Ã‚ ¯ 50-59 years à ¯Ã‚ Ã‚ ¯ 60-69 years à ¯Ã‚ Ã‚ ¯ 70-79 years à ¯Ã‚ Ã‚ ¯ 80-89 years à ¯Ã‚ Ã‚ ¯ 90 years and over 3 Place of death à ¯Ã‚ Ã‚ ¯ hospital à ¯Ã‚ Ã‚ ¯ hospice à ¯Ã‚ Ã‚ ¯ care home à ¯Ã‚ Ã‚ ¯ deceaseds own home à ¯Ã‚ Ã‚ ¯ other (please specify) 4 Cause of death *This does not mean the mode of dying, such as heart failure, asphyxia, asthenia, etc: it means the disease, injury, or complication which caused death 1a Disease or condition directly leading to death* 1b Other disease or condition, if any, leading to 1 (a) 1c Other disease or condition, if any, leading to 1 (b) 2 Other significant conditions contributing to the death but not related to the disease or condition causing it 5 With respect to this death, when was your first contact with the patient? à ¯Ã‚ Ã‚ ¯ before or at the time of death: go to Question 6 à ¯Ã‚ Ã‚ ¯ after death: go to question 30, on page 7 6 How long had you known this patient? à ¯Ã‚ Ã‚ ¯ more than six months à ¯Ã‚ Ã‚ ¯ one to six months à ¯Ã‚ Ã‚ ¯ one to four weeks à ¯Ã‚ Ã‚ ¯ between one day and one week à ¯Ã‚ Ã‚ ¯ less than 24 hours Medical actions 7a 7b 7c Concerning this death, did you or a colleague: withhold a treatment* (or ensure that this was done)? withdraw a treatment* (or ensure that this was done)? use any drug to alleviate pain and/or symptoms? (please tick as many answers as apply) * IN THIS STUDY TREATMENT INCLUDES CARDIO-PULMONARY RESUSCITATION (CPR), ARTIFICIAL FEEDING AND/OR HYDRATION à ¯Ã‚ Ã‚ ¯ no à ¯Ã‚ Ã‚ ¯ yes (please specify treatments withheld) à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. à ¯Ã‚ Ã‚ ¯ no à ¯Ã‚ Ã‚ ¯ yes (please specify treatments withdrawn) à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. à ¯Ã‚ Ã‚ ¯ no à ¯Ã‚ Ã‚ ¯ yes, morphine or another opioid à ¯Ã‚ Ã‚ ¯ yes, benzodiazepine à ¯Ã‚ Ã‚ ¯ yes, other drug 8a 8b In withholding a treatment, did you or your colleague consider it probable or certain that this action would hasten the end of the patients life? In withdrawing a treatment, did you or your colleague consider it probable or certain that this action would hasten the end of the patients life? à ¯Ã‚ Ã‚ ¯ no à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ no treatment withheld à ¯Ã‚ Ã‚ ¯ no à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ no treatment withdrawn 9a 9b Concerning the drugs used to alleviate symptoms, (Questions 7c), were these administered knowing this would probably or certainly hasten the end of life? partly intending to end life? à ¯Ã‚ Ã‚ ¯ no à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ no drugs used to alleviate symptoms à ¯Ã‚ Ã‚ ¯ no à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ no drugs used to alleviate symptoms 10a 10b In withholding a treatment, did you or your colleague have the explicit intention of hastening the end of life? In withdrawing a treatment, did you or your colleague have the explicit intention of hastening the end of life? à ¯Ã‚ Ã‚ ¯ no à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ no treatment withheld à ¯Ã‚ Ã‚ ¯ no à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ no treatment withdrawn 11a 11b Was death caused by the use of a drug prescribed, supplied or administered by you or a colleague with the explicit intention of hastening the end of life (or of enabling the patient to end his or her own life?) If yes, who administered this drug (i.e. introduced it into the body)? à ¯Ã‚ Ã‚ ¯ no à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ the patient à ¯Ã‚ Ã‚ ¯ you or another health care colleague à ¯Ã‚ Ã‚ ¯ a relative à ¯Ã‚ Ã‚ ¯ someone else NOTE: IF YOU ANSWERED NO TO ALL THE QUESTIONS ON THIS PAGE, GO TO QUESTION 23 Decision making NOTE: QUESTIONS 12 TO 22 REFER THE LAST-MENTIONED ACT OR OMISSION, THAT IS, THE LAST YES THAT YOU TICKED ON THE PREVIOUS PAGE (QUESTIONS 7 TO 11) 12 Which were the most important reasons for the last-mentioned act or omission? (please tick all that apply_ à ¯Ã‚ Ã‚ ¯ patient had pain à ¯Ã‚ Ã‚ ¯ patient had other symptoms à ¯Ã‚ Ã‚ ¯ request or wish of the patient à ¯Ã‚ Ã‚ ¯ request or wish of relatives à ¯Ã‚ Ã‚ ¯ expected further suffering à ¯Ã‚ Ã‚ ¯ no chance of improvement à ¯Ã‚ Ã‚ ¯ treatment would have been futile à ¯Ã‚ Ã‚ ¯ further treatment would have increased suffering à ¯Ã‚ Ã‚ ¯ other (please specify below) à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. 13 In your estimation, how much was the patients life shortened by the last mentioned act or omission? à ¯Ã‚ Ã‚ ¯ more than six months à ¯Ã‚ Ã‚ ¯ one to six months à ¯Ã‚ Ã‚ ¯ one to four weeks à ¯Ã‚ Ã‚ ¯ between one day and one week à ¯Ã‚ Ã‚ ¯ less than 24 hours à ¯Ã‚ Ã‚ ¯ life was probably not shortened at all 14 Did you or a colleague discuss the last-mentioned act or omission with the patient? à ¯Ã‚ Ã‚ ¯ yes, at the time of performing the act/omission or shortly before: go to Question 15 à ¯Ã‚ Ã‚ ¯ yes, some time beforehand: go to Question 15 à ¯Ã‚ Ã‚ ¯ no, no discussion: go to Question 19 15 At the time of this discussion, did you consider the patient had the capacity to assess his/her situation and make a decision about it? à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ no 16 Did this discussion include the (probable or certain) hastening of the end of the patients life by this last-mentioned act or omission? à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ no 17 Was the decision concerning the last mentioned act or omission made in response to an explicit request from the patient? à ¯Ã‚ Ã‚ ¯ yes, upon an oral request à ¯Ã‚ Ã‚ ¯ yes, upon a written request à ¯Ã‚ Ã‚ ¯ yes, upon both an oral and a written request à ¯Ã‚ Ã‚ ¯ no: go to Question 21 18 At the time of this request, did you consider the patient had the capacity to assess his/her situation and make a decision about it? à ¯Ã‚ Ã‚ ¯ yes: go to Question 21 à ¯Ã‚ Ã‚ ¯ no: go to Question 21 ONLY ANSWER QUESTIONS 19 and 20 IF YOUR ANSWER TO QUESTION 14 WAS NO, NO DISCUSSION 19 Did you consider the patient had the capacity to assess his/her situation and make a decision about it? à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ no 20 Why was the last mentioned act or omission not discussed with the patient? (Please fill in as many answers as apply) à ¯Ã‚ Ã‚ ¯ patient was too young à ¯Ã‚ Ã‚ ¯ the last mentioned act or omission was clearly the best one for the patient à ¯Ã‚ Ã‚ ¯ discussion would have done more harm than good à ¯Ã‚ Ã‚ ¯ patient was unconscious à ¯Ã‚ Ã‚ ¯ patient had significant cognitive impairment à ¯Ã‚ Ã‚ ¯ patient was suffering from a psychiatric disorder à ¯Ã‚ Ã‚ ¯ other, please elaborate at the end of the questionnaire 21 Did you or a colleague discuss with anybody else the (possible) hastening of the end of the patients life before it was decided to take the last mentioned act or omission? (Please fill in as many answers as apply) à ¯Ã‚ Ã‚ ¯ with one or more medical colleagues à ¯Ã‚ Ã‚ ¯ nursing staff /other caregivers à ¯Ã‚ Ã‚ ¯ by partner/relatives of the patient à ¯Ã‚ Ã‚ ¯ someone else à ¯Ã‚ Ã‚ ¯ nobody 22 Which were the most important reasons for the last-mentioned act or omission? (please tick all that apply) à ¯Ã‚ Ã‚ ¯ patient had pain à ¯Ã‚ Ã‚ ¯ patient had other symptoms à ¯Ã‚ Ã‚ ¯ request or wish of the patient à ¯Ã‚ Ã‚ ¯ request or wish of relatives à ¯Ã‚ Ã‚ ¯ expected further suffering à ¯Ã‚ Ã‚ ¯ no chance of improvement à ¯Ã‚ Ã‚ ¯ further treatment would have been futile à ¯Ã‚ Ã‚ ¯ further treatment would have increased suffering à ¯Ã‚ Ã‚ ¯ other (please specify below à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦ NOTE: QUESTIONS FROM HERE ONWARDS SHOULD BE ANSWERED WHETHER OR NOT YOU ANSWERED YES TO ANY OF THE ACTS OR OMISSIONS MENTIONED ON PAGE 3 (QUESTIONS 7 TO 11) 23 Was an explicit request to hasten the end of the patients life made by any of the following? (Please tick all that apply) à ¯Ã‚ Ã‚ ¯ partners/relatives of the patient à ¯Ã‚ Ã‚ ¯ nursing or other care staff à ¯Ã‚ Ã‚ ¯ someone else à ¯Ã‚ Ã‚ ¯ no explicit request 24 As far as you know, did the patient ever express a wish for the end of his/her life to be hastened? à ¯Ã‚ Ã‚ ¯ yes, clearly: go to Question 25 à ¯Ã‚ Ã‚ ¯ yes, but not very clearly: go to Question 25 à ¯Ã‚ Ã‚ ¯ no: go to Question 26 25 Did the patients wish for this outcome reduce or disappear over time? à ¯Ã‚ Ã‚ ¯ no à ¯Ã‚ Ã‚ ¯ yes, in response to care provided à ¯Ã‚ Ã‚ ¯ yes, other reason 26 The treatment during the last week was mainly aimed at: à ¯Ã‚ Ã‚ ¯ recovery à ¯Ã‚ Ã‚ ¯ prolonging life à ¯Ã‚ Ã‚ ¯ support during the dying process 27 Which caregivers were involved in the care for the patient during the last month before death (beside yourself and as far as you know)? (please tick all that apply) Of those not involved, which ones might have helped? Involved Not involved and might have helped general practitioner à ¯Ã‚ Ã‚ ¯ à ¯Ã‚ Ã‚ ¯ specialist in pain relief à ¯Ã‚ Ã‚ ¯ à ¯Ã‚ Ã‚ ¯ palliative care team à ¯Ã‚ Ã‚ ¯ à ¯Ã‚ Ã‚ ¯ psychiatrist / psychologist à ¯Ã‚ Ã‚ ¯ à ¯Ã‚ Ã‚ ¯ nursing staff à ¯Ã‚ Ã‚ ¯ à ¯Ã‚ Ã‚ ¯ social care worker à ¯Ã‚ Ã‚ ¯ à ¯Ã‚ Ã‚ ¯ spiritual caregiver à ¯Ã‚ Ã‚ ¯ à ¯Ã‚ Ã‚ ¯ volunteer à ¯Ã‚ Ã‚ ¯ à ¯Ã‚ Ã‚ ¯ family member à ¯Ã‚ Ã‚ ¯ à ¯Ã‚ Ã‚ ¯ 28a 28b 28c 28d Was the patient continuously and deeply sedated or kept in a coma before death? Which medication was given for sedation? (please tick as many answers as apply) At what time before death was continuous sedation of the patient started? Which were the most important reasons for this sedation? (please tick all that apply) à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ no: go to Question 29a à ¯Ã‚ Ã‚ ¯ midazolam à ¯Ã‚ Ã‚ ¯ other benzodiazepine à ¯Ã‚ Ã‚ ¯ morphine or another opioid à ¯Ã‚ Ã‚ ¯ other type of medication à ¯Ã‚ Ã‚ ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. hours before death à ¯Ã‚ Ã‚ ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. days before death à ¯Ã‚ Ã‚ ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. weeks before death à ¯Ã‚ Ã‚ ¯ patient had intractable pain à ¯Ã‚ Ã‚ ¯ patient had intractable psychological distress à ¯Ã‚ Ã‚ ¯ patient had other intractable symptoms à ¯Ã‚ Ã‚ ¯ request or wish of the patient à ¯Ã‚ Ã‚ ¯ request or wish of relatives à ¯Ã‚ Ã‚ ¯ other (please specify below à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦ 29a 29b 29c Did the patient receive morphine or another opioid during the last 24 hours before death? How much time before death was the administration of morphine or another opioid started? Which figure best illustrates the dosage of morphine or another opioid during the last 3 days before the patients death? à ¯Ã‚ Ã‚ ¯ yes à ¯Ã‚ Ã‚ ¯ no go to Question 30 à ¯Ã‚ Ã‚ ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. hours before death à ¯Ã‚ Ã‚ ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. days before death à ¯Ã‚ Ã‚ ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. weeks before death à ¯Ã‚ Ã‚ ¯ No increase à ¯Ã‚ Ã‚ ¯ Gradual increase à ¯Ã‚ Ã‚ ¯ Strong increase last day Attitudes and beliefs Questions 30 and 31 are about voluntary euthanasia (that is, when someone ends the life of another person at their request), worded in the same way as those used in surveys of general public opinion. 30 30a 30b First, a person with an incurable and painful illness, from which they will die for example, someone dying of cancer. Do you think that, if they ask for it, a doctor should ever be allowed by law to end their life, or not? And do you think that, if this person asks for it, a doctor should ever be allowed by law to give them lethal medication that will allow the person to take their own life? à ¯Ã‚ Ã‚ ¯ Definitely should be allowed à ¯Ã‚ Ã‚ ¯ Probably should be allowed à ¯Ã‚ Ã‚ ¯ Probably should not be allowed à ¯Ã‚ Ã‚ ¯ Definitely should not be allowed à ¯Ã‚ Ã‚ ¯ Definitely should be allowed à ¯Ã‚ Ã‚ ¯ Probably should be allowed à ¯Ã‚ Ã‚ ¯ Probably should not be allowed à ¯Ã‚ Ã‚ ¯ Definitely should not be allowed 31 31a 31b Now, how about a person with an incurable and painful illness, from which they will not die. Do you think that, if they ask for it, a doctor should ever be allowed by law to end their life, or not? And do you think that, if this person asks for it, a doctor should ever be allowed by law to give them lethal medication that will allow the person to take their own life? à ¯Ã‚ Ã‚ ¯ Definitely should be allowed à ¯Ã‚ Ã‚ ¯ Probably should be allowed à ¯Ã‚ Ã‚ ¯ Probably should not be allowed à ¯Ã‚ Ã‚ ¯ Definitely should not be allowed à ¯Ã‚ Ã‚ ¯ Definitely should be allowed à ¯Ã‚ Ã‚ ¯ Probably should be allowed à ¯Ã‚ Ã‚ ¯ Probably should not be allowed à ¯Ã‚ Ã‚ ¯ Definitely should not be allowed 32 Religion: what is your religion? à ¯Ã‚ Ã‚ ¯ None à ¯Ã‚ Ã‚ ¯ Christian (including Church of England, Catholic, Protestant and all other Christian denominations) à ¯Ã‚ Ã‚ ¯ Buddhist à ¯Ã‚ Ã‚ ¯ Hindu à ¯Ã‚ Ã‚ ¯ Jewish à ¯Ã‚ Ã‚ ¯ Muslim à ¯Ã‚ Ã‚ ¯ Sikh Any other religion, please write in 33 Religion: would you describe yourself as: à ¯Ã‚ Ã‚ ¯ extremely religious à ¯Ã‚ Ã‚ ¯ very religious à ¯Ã‚ Ã‚ ¯ somewhat religious à ¯Ã‚ Ã‚ ¯ neither religious nor non-religious à ¯Ã‚ Ã‚ ¯ somewhat non-religious à ¯Ã‚ Ã‚ ¯ very non religious à ¯Ã‚ Ã‚ ¯ extremely non religious à ¯Ã‚ Ã‚ ¯ cant choose 34 What is your ethnic group? Choose ONE section from A to E, then tick the appropriate box to indicate your ethnic group A White à ¯Ã‚ Ã‚ ¯ any White background B Mixed à ¯Ã‚ Ã‚ ¯ White and Black Caribbean à ¯Ã‚ Ã‚ ¯ White and Black African à ¯Ã‚ Ã‚ ¯ White and Asian à ¯Ã‚ Ã‚ ¯ Any Other Mixed background, please write in C Asian or Asian British à ¯Ã‚ Ã‚ ¯ Indian à ¯Ã‚ Ã‚ ¯ Pakistani à ¯Ã‚ Ã‚ ¯ Bangladeshi à ¯Ã‚ Ã‚ ¯ Any Other Asian background, please write in D Black or Black British à ¯Ã‚ Ã‚ ¯ Caribbean à ¯Ã‚ Ã‚ ¯ African à ¯Ã‚ Ã‚ ¯ Any Other Black background, please write in E Chinese or other ethnic group à ¯Ã‚ Ã‚ ¯ Chinese à ¯Ã‚ Ã‚ ¯ Any Other, please write in To clarify any answers or to make further comments, please use the space on page 1. Thank you for your help with this important survey. Now that you have finished the questionnaire, to ensure the anonymity of your answers you will need to do two things. Place the completed questionnaire in the reply-paid envelope, seal it and post it as soon as possible Post the reply-paid response notification card with your name on it if you wish to avoid receiving follow-up reminders. These two items will be received by different people in different locations and kept separate. It will not be possible to link your questionnaire with your name. This questionnaire has been sent to a random sample of 10,000 doctors. It will not be possible for the researchers or anyone else to use your replies to discover your identity or the identity of the patient on whose care you have reported. We understand that recalling events of this nature can be a distressing experience. If you wish to talk to someone about your feelings concerning end-of-life care, the Confidential Counselling Helpline of the British Medical Association can assist you. Their number is: 0645 200 169 (c) Euthanasia and Assisted Suicide in the United Kingdom A Research Proposal Part B By Katy Marsland 08111890 University of Lincoln Hand in Date: 4th May 2010 (1,352 Words) Julie Burton NUR2002M-0910 research Methods 2009/2010 Table of Contents: Page Title 26 Research Questions 27 Aims of Project 28 Initial Literature Review 29-30 Methodology 31 Ethical Considerations and Practical Constraints 32 Timetable for Dissertation Research 33-34 References 35 A Research Proposal 1. Title: Euthanasia and Assisted Suicide in the United Kingdom. 2. Research Questions Should Euthanasia and Assisted Suicide be made legal? What are the arguments for and against policy change in the United Kingdom? Which section of society is most supportive of a change in the law? Which section is most opposed and why? 3. Aims of Project This research aims to investigate, using secondary data, whether a change in the law is needed to clarify the position of euthanasia and assisted suicide in the United Kingdom, and whether this should be made legal just for those who are terminally ill or for

Introduction to Ethics Essay -- essays research papers

Ethics â€Å"What are we like, and what should we do?†   Ã‚  Ã‚  Ã‚  Ã‚  As humans we are faced with many decisions in life, which in and of itself, distinguishes us from the animal kingdom. I’m sure other animals make decisions, but as humans we take into account our values and morals. In choosing which path to take with some of life’s decisions, ethics, are often at the center; heavily influencing our choices between what is right and what is wrong. Which are usually defined by society, as to what is acceptable and what is not. As time goes on, society evolves, so do the right and wrongs, our values and morals, and ethics. In philosophy, there were three ethical theories by Aristotle, Kant, and Bentham & Mill and they were the â€Å"Golden Mean†, â€Å"Categorical Imperative†, and â€Å"Greatest Good for the Greatest Number† respectively.   Ã‚  Ã‚  Ã‚  Ã‚  Aristotle believed the one goal everyone strived for was â€Å"happiness† for one’s ownself. If you were a happy person, that would eventually lead to being a good person. He also believed that all living things had certain capacities, and that if one lives up to their full capacities, they will have lived well and had a fortunate life. He went on to state that the perfection of reason leads to the development of two desirable â€Å"virtues†, Moral and Intellectual. Moral virtues dealt with emotions. A person must keep these in balance, to go in either extreme of too much and too little, would be called â€Å"the excess† and â€Å"the defect†, respectively. The balance would be the â€Å"mean†. For example, courage is the mean between rashness (excess) and cowardice (defect). The golden mean is further analyzed in NICOMACHEAN ETHICS. The RHETORIC, is where Aristotle sums up the three categories in an analogical description of life with the Youthful Man (excess), the Elderly Man (defect), and the Man in His Prime (golden mean).   Ã‚  Ã‚  Ã‚  Ã‚  The Intellectual virtues dealt with foresight and wisdom. Aristotle stated the attainment of these virtues could only be done by a select few. For one to be highly intellectual, is to be practically divine, next to the gods. With that being said, it discouraged a lot of people of that era. That’s when his theory was challenged and questioned. What about the artists or craftsmen? Are they denied happiness, because they haven’t attained intellectual perfection? Is in... ...ame-sex marriages and so on. It seems we’re in a shift of paradigms with the myriad of societal changes and acceptances. Is the solidarity of the human race degrading or evolving. Will today’s ethics, be the same tomorrow or in the future? Will they evolve? It seems the chaotic world we live in, the right and wrong seem to favor those in power, or at least be influenced by those people. It also seems, we lower our standards to suit the masses. For example, the carrying of back packs in uniform, before it was prohibited for a Sailor to throw a bag over their shoulder. Only if it was a seabag and only if both straps were on the shoulders. That standard has been altered, to allow plain black back packs to be carried with both straps over the shoulders. There are too many people carrying the backpacks with one strap on the shoulder, presenting a relaxed unprofessional appearance. Is the same happening to society with what is right and wrong? Are we lowering our standard s? References: THE STUDY OF PHILOSOPHY 5TH EDITION, S.MORRIS ENGEL ARISTOTLE ON THE MEAN, G.ZINIEWICZ KANT, DUTY, AND RESPECT, P.STRATTON-LAKE THE NINETEENTH CENTURY ROUTLEDGE HISTORY OF PHILOSOPHY VOL. 7, C.L. TEN Introduction to Ethics Essay -- essays research papers Ethics â€Å"What are we like, and what should we do?†   Ã‚  Ã‚  Ã‚  Ã‚  As humans we are faced with many decisions in life, which in and of itself, distinguishes us from the animal kingdom. I’m sure other animals make decisions, but as humans we take into account our values and morals. In choosing which path to take with some of life’s decisions, ethics, are often at the center; heavily influencing our choices between what is right and what is wrong. Which are usually defined by society, as to what is acceptable and what is not. As time goes on, society evolves, so do the right and wrongs, our values and morals, and ethics. In philosophy, there were three ethical theories by Aristotle, Kant, and Bentham & Mill and they were the â€Å"Golden Mean†, â€Å"Categorical Imperative†, and â€Å"Greatest Good for the Greatest Number† respectively.   Ã‚  Ã‚  Ã‚  Ã‚  Aristotle believed the one goal everyone strived for was â€Å"happiness† for one’s ownself. If you were a happy person, that would eventually lead to being a good person. He also believed that all living things had certain capacities, and that if one lives up to their full capacities, they will have lived well and had a fortunate life. He went on to state that the perfection of reason leads to the development of two desirable â€Å"virtues†, Moral and Intellectual. Moral virtues dealt with emotions. A person must keep these in balance, to go in either extreme of too much and too little, would be called â€Å"the excess† and â€Å"the defect†, respectively. The balance would be the â€Å"mean†. For example, courage is the mean between rashness (excess) and cowardice (defect). The golden mean is further analyzed in NICOMACHEAN ETHICS. The RHETORIC, is where Aristotle sums up the three categories in an analogical description of life with the Youthful Man (excess), the Elderly Man (defect), and the Man in His Prime (golden mean).   Ã‚  Ã‚  Ã‚  Ã‚  The Intellectual virtues dealt with foresight and wisdom. Aristotle stated the attainment of these virtues could only be done by a select few. For one to be highly intellectual, is to be practically divine, next to the gods. With that being said, it discouraged a lot of people of that era. That’s when his theory was challenged and questioned. What about the artists or craftsmen? Are they denied happiness, because they haven’t attained intellectual perfection? Is in... ...ame-sex marriages and so on. It seems we’re in a shift of paradigms with the myriad of societal changes and acceptances. Is the solidarity of the human race degrading or evolving. Will today’s ethics, be the same tomorrow or in the future? Will they evolve? It seems the chaotic world we live in, the right and wrong seem to favor those in power, or at least be influenced by those people. It also seems, we lower our standards to suit the masses. For example, the carrying of back packs in uniform, before it was prohibited for a Sailor to throw a bag over their shoulder. Only if it was a seabag and only if both straps were on the shoulders. That standard has been altered, to allow plain black back packs to be carried with both straps over the shoulders. There are too many people carrying the backpacks with one strap on the shoulder, presenting a relaxed unprofessional appearance. Is the same happening to society with what is right and wrong? Are we lowering our standard s? References: THE STUDY OF PHILOSOPHY 5TH EDITION, S.MORRIS ENGEL ARISTOTLE ON THE MEAN, G.ZINIEWICZ KANT, DUTY, AND RESPECT, P.STRATTON-LAKE THE NINETEENTH CENTURY ROUTLEDGE HISTORY OF PHILOSOPHY VOL. 7, C.L. TEN

Violin Essay examples -- Literature Music Composers Essays

Violin Music and art, the feelings that go through a person while the music of Mozart and Beethoven are playing, are indescribable. Listening to music can take a person away to a different era. Music like Mozart or Beethoven can really take a person's imagination soaring in a whole new perspective. Composers throughout the novel, Violin were Beethoven, Mozart, and Tchaikovsky. Violin was a truly fabulous name for this story. It contains many fantastic elements as well as realistic elements; however, it should not be confused with magical realism. Violin copy written in 1997 by Anne Rice. She has written several novels that were imaginary and fantastic. The novels that Anne Rice has written have that kind of effect on a person while reading her novels. During the story, the unreal elements of the story started with the fact that she kept her husband with her after he had been passed away for several days. The unreal elements of this situation is that anybody in her right mind wouldn't keep a dead body in the house with her and not tell anybody that he was dead. In a matter of time, the body would start to smell and start to rot. One of the unreal elements that are in the story was the man standing outside playing the violin. The man would stand in the light of the lamppost in the alley and play the violin. Watching the man playing the violin through the window made the main character think that she was dreaming. Listening to the music during the course of this type of emotional state that she was in made her stay calm and find herself in a type of dreamland. The music would take her somewhere else besides reality. Music can take a person elsewhere, in the future, in the past, and in la la land. Even though music can b... ...gical realism is in the fact that the woman didn't want to give up her husband and face reality. She kept him as long as she could to her self until she had to give him up. Grief happens this way in the real world. The family members do not want to give up the family member who has passed away. The magic was in the story; fantastic was also here in the story. Also, the music by Mozart and Beethoven can really take a person's imagination soaring in a whole new perspective. The Violin has suspense and excitement' the anticipation of the happenings during the story was uneventful. Works Cited Rice, Anne, Violin. N.Y.: Alfred A. Knopf, 1997. Robkin, Eric S. The Fantastic in Literature. Princeton, N.J. : Princeton UP, 1978. Todorov, Tzvetan. The Fantastic: A Structural Approach to a Literary Form. Cleveland: The Press of Case Western Reserve University, 1973.

Marijuana: The Legalization :: social issues

Marijuana: The Legalization Their Side: After the sustaining vote in November of 1996 and coming into effect the beginning of this year, marijuana is now legal to medical patients in California and Arizona. Proposition 215 reads as follows: The people of the State of California hereby find and declare that the purposes of the Compassionate Use Act of 1996 are as follows: (A) To ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes where that medical use is deemed appropriate and has been recommended by a physician who has determined that the person's health would benefit from the use of marijuana in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief. (B) To ensure that patients and their primary care givers obtain and use marijuana for medical purposes upon the recommendation of a physician are not subject to criminal prosecution or sanction. C. To encourage the federal and state governments to implement a plan for the safe and affordable distribution of marijuana to all patients in medical need of marijuana. (Proposition 215 Section 11362.5) Of course, it goes on and breaks into fine detail into which I choose not to venture. To summarize it all, if you're sick, or think you are, your doc can get you some pot. Just like that. So what's so great about this? It supposedly brings relief to those with terminal illnesses. (Such were listed in 215) Cancer sufferers who are inflicted with nausea due to chemotherapy have reported that a puff or two of a marijuana cigarette relieves the pain. (Theorized after study by psychiatrist Lester Grinspoon of Harvard Medical School) It has also been reported to relieve the pain suffered by AIDS patients. Despite all this great relief, one question remains unanswered, what about the side effects? Exactly how harmful and addicting is this stuff? MY SIDE: (the important stuff) My personal opinion: Marijuana should remain illegal because of the enormous side effects and addiction that results after using the drug. My first fact to back my opinion would have to be this, marijuana is what it is, a drug! You can't change that no matter how many people vote on it. Sure, there are prescription drugs on the market that are potentially dangerous but their effects are nothing compared to that of marijuana.

Negotiation: Game Theory

Negotiation| | The use of Game Theory could be a powerful force in negotiation. Investigate the different ways that Game Theory can be used or manipulated to change an outcome in a negotiation. | | Negotiation| | The use of Game Theory could be a powerful force in negotiation. Investigate the different ways that Game Theory can be used or manipulated to change an outcome in a negotiation. | | Quentin Dutartre Yash Ruia Damien Canneva Kilian Bus Emilien Allier David Schil Quentin Dutartre Yash Ruia Damien Canneva Kilian Bus Emilien Allier David Schil Contents Introduction2 What is the Game theory? Theory4 Making commitments: promises and threats4 Basic situation4 Unique Win/Win situation5 Commitments and side payments5 Prisoner’s dilemma7 The Simplest Game: Two Person with a Fixed Pie8 Tacit Barganining8 How to act during a negotiation9 Breakthrough Strategy9 Tactics10 Limits11 The modelisation11 The interpretation12 Conclusion13 Sources13 Introduction Our group decided to work on the topic three: â€Å"The use of Game Theory could be a powerful force in negotiation. Investigate the different ways that Game Theory can be used or manipulated to change an outcome in a negotiation†.The modern Game Theory was created in 1944 with the book â€Å"Theory of games and economic behavior† by Oskar Mogenstern and John Von Neumann. It was also developed a lot in the 1950’s with several studies by John Nash. After our seminary about negotiation we thought it would be very interesting to make some research about the Game Theory. Indeed, we made some researches on the Game Theory in our first year in IESEG in our economic classes. That is why we were a bit surprised to see that this theory could be also used in a negotiation process to analyze it.It seems to be obvious that using the concepts of that theory could change the course of a negotiation and be understood as a manipulation or just a skill to achieve the goals of the agents in a negotiation . We decided to divide our work in three parts. First, we will define the Game Theory and make some examples. Secondly, we will make an synthesis on how to act as a negotiator during a negotiation. Finally, on the third part we will talk about the limits and the interpretation we can make on that subject. Generally, we can say that our goal is to extend the concept of Game Theory.Indeed, we imagined it only in an economic vision and we want to extend it to a negotiation vision. What is the Game theory? The Game theory is a method to study the strategic decision-making. More formally, it is  «the study of the mathematical models of conflict and the cooperation between intelligent reasonable decision-makers. † An alternative term suggested  «as a more descriptive name for the discipline † is the theory of interactive decision. The Game Theory is mainly used in the economy, the political science and the psychology, as well as the logic, negotiation and the biology.The s ubject of the (landed) at first sent zero-sum games, such as the earnings(gains) of a person equal exactly the clear(net) losses of the other participant (s). Today, however, the Game theory applies to a vast range of relations of class and developed in a term of umbrella for the logical side of science, to include both man and non-people, as computers. Classic uses include the direction of the balance in numerous games, where every person found or developed a tactics which cannot successfully better its results, given the other approach.Theory Making commitments: promises and threats The first assumption to be made is that the goal of any negotiation is to enlarge the pay off for both sides, and in most cases agreements has to be made in order to achieve getting a Win/Win situation. These agreements can be made by making either promises or threats. In both cases, the idea is to benefit from an enlargement of the total pie obtained by making commitments. Basic situation In the follo wing example, both sides are looking forward to getting the better pay off.At first sight, Neil seems to have a better hand since he is able to have payments by using both of his strategies while Bob can only win by using strategy 1. It is obvious that Neil would better use strategy 1 in order to maximize his payoffs expectations. But Bob would probably prefer using his second strategy than winning less than Neil, though it would result in a Loose/Loose situation. Bob will probably threatens to take strategy 2 if Neil chooses the first one. The only way to obtain a Win/Win situation though is for Neil to make a commitment: he must promise to choose 2 if Bob chooses 1.This is the most basic commitment example. Unique Win/Win situation In the following one, there is one only scenario which allows the two player to win, but commitments must be made buy both sides in order to reach the best situation for both. Here, Neil will probably initially chose strategy 1 in order to avoid loss, b ut he won’t be able to gain anything though. Bob would probably choose to maximize his payoffs expectations by choosing the first strategy. Finally, neither Bob nor Neil will get payoffs, so that we obtain a Loose/Loose result, which is not acceptable.They both have to promise to choose the second strategy in order to win. Commitments and side payments In this last example, it is not possible to reach a Win/Win agreement but by making side payment. Side payments allows to change the total pie, and though to reach the targeted situation. In this particular scenario, initially Neil would choose the first strategy, which is not acceptable for Bob in both cases. Moreover, Bob can’t threaten Neil to choose either a strategy or another. This is a very bad situation for Bob.He will probably choose strategy 1 in order to minimize Neil’s payoffs, and though gain nothing. But, fortunately he can also promise side payments, which could change the total pie. As a matter of fact, if he pays $2 for Neil to pick strategy 2, we create a Win/Win situation which will allow both sides to get payoffs. Through this part we’re going to apply the concept of promises and threats into a concrete situation of negotiation. We set the situation, we have two participants, one will be selling an apartment two a possible buyer. At first sight, the man in power is the seller as he fixes the price.Nevertheless, the buyer can use the threat technique, saying he won’t accept the offer. This decision would place our two actors in a lose/lose situation. Indeed, if the buyer is in the situation of losing the negotiation he will choose to make his opponent loose too. Thus in order to obtain a win/win situation, the seller must not be too greedy to convince his customer. In another way, if the seller wants to be sure to succeed, he can promise the buyer an offer that will automatically put the buyer in a state of winning. Prisoner’s dilemma The prisoner†™s dilemma is one of the most famous games.It is quite easy to understand and gives a good idea of different possibilities in negociation and the interest of cooperation. The main idea is that two burglars get caught by the police after a robbery, and they are interrogated separately. They have two options: either they say that the other guy is guilty or they say he’s not. Considering one’s interest separately, the best situation for him is to use the guilty option while the other chooses the not guilty option. In this case, the first guy will get only 1year of jail while the other one will get 5 years.Therefore it is very risky to choose the not guilty option. If we consider the two as one, the most interesting situation is that both of them choose the not guilty option, whereas the worst is both choosing the guilty option. This is one of the simplest examples of a Win/Win, Win/Loose or Loose/Loose situation. They can both act individually using the guilty option, a nd get 3 years of jail each, or they can cooperate, use the not guilty strategy and get only 2 years both. The major thing to be remembered is that trust is crucial in negotiations.It leads to the only Win/Win situation possible and credibility is needed to avoid defection. The Simplest Game: Two Person with a Fixed Pie When think of people negotiating, a very simple scenario comes into mind, where one person wins and the other fails to win. This is a very simple scenario and one of the first that game theory attempted to solve. Let’s take a very simple example where Nathan owes Barbara some money and they can’t decide on how much. Both of them have two options available to them, but the final decision depends not only on what strategy they choose, but also on what strategy is chosen by their opponent.Nathan will choose to pay a minimum of 40 and Barbara will want to take the maximum of let’s say, 60. This is a very simple scenario and one can easily figure out that the outcome will be 50. 40| 50| 50| 60| However this illustrated a very important concept called the Minimax theorem which tells us to pick the strategy the minimizes the opponents maximum gain. Nathan will pick strategy 2 in order to not pay 60 while Barbara would pick strategy 1 to avoid only getting paid 40. The more variables one has, the more complex the game becomes to solve.Therefore it is a good idea to have lesser number of variables, similarly we need to have a clear idea of what we need in order to reduce unimportant options. Reducing the number of variables one has is always a good idea, even if one is not really reducing the number of variables it is important to show to the opponent that you only have some variables to win. For example, when a customer asks for something one can refer to standardized guidelines or not having permission from the boss to reduce variables. Tacit Barganining. This term was first coined by Thomas Schelling.Who did some experimental res earch and found out the following facts: * When asked to pick any number, 40% chose the number 1. * When asked to pick any amount of money almost all people chose a figure divisible by 10 * When people were told that they had to meet someone else – but had to guess the time – almost all chose noon. We often succumb to a lot of convections even without doing it consciously. It is normal for people to follow the laws of fairness and equilibrium; no one wants to be seen as deviating from the norm.Therefore its usually a good idea to make the first move in a negotiation so that you can create the framework and make clear that you are precedent. In a negotiation, taking the initiative doesn’t seem to be the best thing to do when you start it. Indeed, when you ask somebody to start negotiations, generally he is reticent to do so. Nevertheless asking the first proposal allows you to be able to negotiate on this basis, that’s why you should do it first. Establish a precedence as we said before is a tool to start negotiating. The thing is, there is always a argaining whereas you don’t even notice it. It’s called the â€Å"tacit bargaining†. How to act during a negotiation Breakthrough Strategy In order to reach your goals through using the game theory to negotiate you will need to apply a strategy you will respect during the entire negotiation. That’s why we can use the breakthrough strategy. This breakthrough strategy is based on five steps and permits to solve issues during the negotiation process. Its aim is to offer the two parties the possibility to work together rather than appearing as two adversaries.Nevertheless, this strategy needs to be remembered and followed as it wouldn’t be the intuitive reaction. These five steps are to firstly stay focused. In fact, the goal is to have your mind clear and not be parasite by your emotions. You need to have an overall view on the entire negotiation and to not get lose on a specific point. Then, you need to accept the counter-party. Indeed, being as empathic as possible is very important throughout the negotiation process as creating a climate of exchange is primordial to obtain a win/win situation.This can be perfectly illustrated by the prisoner dilemma. Both parties searching for their proper interest without regarding his opponent situation will lead to lose/lose. Thereafter, the participant will reframe the negotiation. It is based on rephrasing the opponent arguments enhancing the common interest. This will permit that both side look for the fairest deal possible. Once again you need to look through the other negotiators eyes in building a â€Å"golden bridge. This means trying to understand if, in his situation, you will accept the deal as it is now.You will therefore see when to finalize the negotiation in order that the counter-party doesn’t feel pushed in the conclusion. Finally, to make it hard to refuse by using the p ower game as threats or bluff is the most common mistake made at the end of the negotiation. In fact, by using lowering his chance to refuse you also lower his chance to accept the deal. Thus, by having used the four precedent steps, you have create a negotiation climate that will present your golden bridge as the best common interest for the parties. Tactics Tactic is about anticipating what the negotiator is going to do.You have to prepare several strategies in order to obtain what you want from these negotiations. First, there are the behavioral tactics, whose aim is to differentiate the negotiation in its role of representation of a third person or a company and the person who plays this role. Negotiators when using these tactics can operate in many ways. They can use a spokesman for representation, or the executive person or a delegated representative. You have to create a positive frame if you want to obtain concessions from the person you’re negotiating with.Moreover, you have to establish limits in your area of negotiation. Anchoring is a tool that has to be established in order to be able to make adjustments between the two parties in the future. Adjustments and anchoring are important because they have an impact on negotiators. They lead them to what is possible and doable during the negotiation. Another mean is to influence the negotiator as an individual. As if, the negotiator is using its unique and common sense during an argumentation. Some tactics can be based on ethic and morality.If you think the proposition is unfair or contrary to the usual behavior or even illegal, you can use these tactics by pointing up the fact that the proposition is unethical. Tactics is not only about the human and the social part; there is also a part of a negotiation that is about the balance of power between the two parties. The main goal of this tactic is to let the other party know that accepting one request would have an important impact on the cost and t hat we are going to make them pay for that. The deterrence impact shouldn’t be ignored in a negotiation.Commitment in a negotiation is of paramount importance. It is one of the three strategic strikes with bluff and threat. The thing is that negotiators have naturally the tendency to commit themselves into the negotiation. Instead of trying to develop its requirements and modifying its position, he will start conflict in order to put pressure on its opponent. It puts the opponent in a tough position; accept our request or he will have to face the failure of the negotiation. And that’s exactly what he wants to avoid. Otherwise, its role would be useless.This tactic can lead to a dead-end, but it’s a stuck situation that doesn’t consider the balance of power between the two parties. Threats are different from commitment as they are more flexible and have a longer range of existence. They are various as they can be explicit or implicit. They are the direct c onsequences of the failure of negotiations and can be introduce by the company of the negotiator. They have to be used sparingly because threats without any actions discredited any negotiators and especially its company. In the future, it would have an impact on the approach of the opponent regarding the company.Limits The study of a complex negotiation situation with the help of a model places two major complementary problems: the modeling itself (the passage of the reality to a version idealized of this reality) and the interpretation (inverse approach) The modelisation Modelisation is a very hard job. We can resume it as the stage of transforming reality problem into a matrix. The modelisation consists in creating a representation simplified by a problem: the model. But as every transformation, problems could be highlight. Some characteristics, some influence can be overestimated or less estimated. How to model the respective influences of the parameters (functional dependence, i ndeed if such or such parameter exercises one dominating influence or on the contrary, unimportant in first estimate, etc. ) * How measure the values of the parameters (variables of situation or history of the previous negotiations for example) and how fire of a model of the theoretical results (or of experimental simulation). And at least the human factor is very difficult to imagine and to predict. The process of modelisation tries doing it.But through his experience, his character, his objectives or his approach, each human is different. So a model would try to simplify it but of course will make errors. The interpretation Indeed, we already possess a completely realistic model: it is the real world itself. Yet this model is too much complicated to be understandable. †¦ It is only when a simplifying postulate ends in a model which supplies incorrect answers to the questions which it is supposed to answer that its lack of realism can be considered as an imperfection. †¦ Otherwise, its lack of realism is then a virtue.In that case, the simplifying postulate allows to isolate certain effects and to facilitate the understanding. How to interpret the results supplied by the model, suppose that there is (problem of adequacy of the model to the reality). Does such result of the model express suitably the real situation, in spite of the simplifications and the untidy parameters? Like the modelisation, Interpretation is a tuff job. The human factor is a hard to forecast. Game theoretic predictions may not be confirmed in experiments (the real life). Is this a fault of game theory? Yes: people are simply not rational †¦ * No: maybe we get the information technology wrong (absentmindedness), or payoffs are not specified correctly (altruism). The advantage of assuming rationality is that we can think through situations (how can irrationality be modeled). The advantage of assuming selfish behavior is that it is â€Å"unique† (what means altruism, i nequity aversion etc. ). Conclusion As a conclusion we have studied all the aspects about the Game Theory and that helped us to understand that it is a useful tool not only about economic classes but also for negotiation.Indeed, we have made a link between the different sorts of Game Theory and the different cases you can face during a negotiation process. As it is often the case, we found that one of the strongest conditions to succeed in a negotiation is to be able to adapt your body language and attitude according to the characters and features of your contradictor(s). Using the Game Theory could help you to make a strategy and to adapt your goals to any case which is in front of you.However, it is never possible to make a perfect prediction of how the person who is just in front of you and it is very important to be cautious enough, that means that you must rank the risks of any strategy you will try during a negotiation. We can take a final example: You start a meeting being su re you will use the theory of the prisoner’s dilemma because you thought you perfectly understood the mood of the other agent. Imagine one second that you made a very big mistake because you don’t know that the person in front of you has just been left by his wife (for example) and he is very upset.That situation is a good illustration of the risks of using the Game Theory as a perfect and trusting strategy for negotiation. We can finally say that using the Game Theory can be very positive in a negotiation and you can consider it as a very useful tool. However, we have to be very careful because some parts of this theory can be assimilated as a manipulation and this theory is not a miracle solution: every negotiation is different and you can’t always predict the features and mood of your contradictors. Sources * http://dlhoh. hubpages. com/hub/Negotiation-Skill-Dilemma * http://hbswk. hbs. du/item/2773. html * http://www. digitaltonto. com/2009/game-theory-guide -to-negotiations/ * http://www2. warwick. ac. uk/fac/soc/economics/staff/academic/muthoo/publications/bargwc. pdf * http://www. negotiation. hut. fi/learning-modules/IntroToGTAndNego/index. html * http://www. economist. com/node/21527025 * http://www. google. fr/url? sa=t&rct=j&q=negotiation+game+theory&source=web&cd=9&ved=0CHoQFjAI&url=http%3A%2F%2Ffaculty. haas. berkeley. edu%2Frjmorgan%2Fmba211%2FCourse%2520Overview. ppt&ei=vgibT_juBoek4AS8ys2pDg&usg=AFQjCNF5FpD-1CO77pM9Ae0oXFzY0SeGCQ&cad=rja