Mark Twain Writings Essays - Lecturers, Mark Twain,

Mark Twain Writings Mark Twain is regarded as one of the most prominent American authors. Twain was born Samuel L. Clemons several years prior to the Civil War in a small town of Hannibal, Missouri. Much of his boyhood was spent frolicking in the muddy brown waters of the Mississippi. After his fathers death early in his life, Twain was hired for his dream job as a Steamboat Captain on the Mississippi River. This chance was cut short by the start of the Civil War. Twain spent several years as a confederate volunteer, but this did not last either. Twain struck out for the west hoping to make a fortune as a silver prospector. The only richness Twain achieved searching for silver was plenty of experiences on which he could write. His first successful publication "Jim Smiley and His Jumping Frog" is a collection of stories Twain heard while living in the mining camp in Nevada. After his failed attempt at a quick fortune, Twain returned to the east. This is where he published his most famous works which included Tom Sawyer and it's sequel Huckleberry Finn. Twain was regarded as a humorist because of his lively imagination that sent his stories into the realm of outlandish. His most highly acclaimed novel Huckleberry Finn appears to be nothing more than a boys tale at first glance, but in actuality it is taught in college literature classes because of it's underlining satires and themes. It was even considered to be subversive at the time when it was written because of it's anti-government ideas. This story as it appears tells of a young boy, Huckleberry Finn, and his adventures as he travels down the Mississippi. Along the way he picks up a few passengers. The first of these is Jim, a runaway slave. Huck, as he is called for short, decides instead of turning Jim into the authorities, that he will help him get to the free state. Before long Huck and Jim are accompanied by to scam artists, the King and the Duke. The novel elaborates on the tales of these four completely different individuals as the float lazily down the Mississippi. Huck journey down the rivers is not only an adventure, but it is also a conversion from boyhood into an adult. Twain uses the cover of an adventurous boys tale to satirize many of the things that he found to be wrong with society. Although the book was published more than a decade ago, many of the problems that occurred in Twain's society are still prevalent today. One such topic that Twain satirizes heavily in the book is the institution of religion. This criticism of religion can be seen from the start of the book all the way through to the very end. A problem that Twain finds very disgusting about the institution of religion is the hypocrisy. An example of this is the Widow Douglas. The Widow Douglas is more concerned with the behavior of other people than she is of herself. In one case she tells Huck that he cannot smoke because it is dirty; God would not approve, but she herself dips snuff. Another thing that Mark Twain finds ridiculous about religion is the pure stupidity of it all. As in his short story "Letters From Earth" where Twain criticizes humans belief of heaven, Twain does so in a more light hearted manner in Huckleberry Finn: "she went on and told me all about the good place. She said all a body would have to do there was to go around all day long with a harp and sing , forever and ever. So I didn't think much of it. But I never said so." Although it doesn't seem like much of an attack on religion, Twain so cleverly does this many times throughout the story to make a vivid point. If Mark Twain were to write Huckleberry Finn today, there is no doubt that he would be quick to make these criticisms about religion again. Everyday people have to open there newspapers and turn on their televisions to news of Priests and ministers molesting young boys and stealing others money. If anything it has become worse of a problem than before. There are men that stand out on college campuses and on busy street corners yelling and screaming about the downfall of the sinner society of which many are a part of. The Brownsville Revival in Pensacola would no doubt be a critical point for Mark Twain if he were

Character Analysis of Hermia and Her Father

Character Analysis of Hermia and Her Father To deepen your understanding of William Shakespeares A Midsummer Nights Dream, here is a character analysis of Hermia and her father. Hermia, Believer in True Love Hermia is a feisty young lady who knows what she wants and does whatever she can to get it. She is even prepared to give up her family and way of life to marry Lysander, agreeing to elope with him into the forest. However, she is still a lady and ensures that nothing untoward goes on between them. She keeps her integrity by asking him to sleep away from her: â€Å"But gentle friend, for love and courtesy/Lie further off in humane modesty† (Act 2, Scene 2). Hermia assures her best friend, Helena, that she is not interested in Demetrius, but Helena is insecure about her looks in comparison with her friend and this somewhat affects their friendship: â€Å"Through Athens, I am thought as fair as she./But what of that? Demetrius thinks not so?† (Act 1, Scene 1) Hermia wishes the best for her friend and wants Demetrius to love Helena: â€Å"As you on him, Demetrius dote on you† (Act 1, Scene 1). However, when the fairies have intervened and both Demetrius and Lysander are in love with Helena, Hermia gets very upset and angry with her friend: â€Å"O me, you juggler, you canker blossom/You thief of love- what have you come by night/And stol’n my loves heart from him† (Act 3, Scene 2). Hermia is again compelled to fight for her love and is willing to fight her friend: â€Å"Let me come to her† (Act 3, Scene 2). Helena confirms that Hermia is a feisty character when she observes, â€Å"O, when she is angry she is keen and shrewd!/She was a vixen when she went to school./And though she is little, she is fierce† (Act 3, Scene 2). Hermia continues to defend Lysander even when he has told her that he no longer loves her. She is concerned that he and Demetrius will fight, and she says, â€Å"Heavens shield Lysander if they mean a fray† (Act 3, Scene 3). This demonstrates her unerring love for Lysander, which drives the plot forward. All ends happily for Hermia, but we do see aspects of her character that could be her downfall if the narrative were different. Hermia is determined, feisty, and occasionally aggressive, which reminds us that she is Egeus’ daughter, but we admire her steadfastness and faithfulness to Lysander. Headstrong Egeus Egeus father is domineering and overbearing to Hermia. He acts as a foil to the fair and even-handed Theseus. His proposal to bring the full force of the law on his daughter- the penalty of death for disobeying his orders- demonstrates this. â€Å"I beg the ancient privilege of Athens/As she is mine, I may dispose of her- /Which shall be either to this gentleman/Or to her death- according to our law/Immediately provided in that case† (Act 1, Scene 1). He has decided, for his own reasons, that he wants Hermia to marry Demetrius instead of her true love, Lysander. We are unsure of his motivation, as both men are presented as eligible; neither one has more prospects or money than the other, so we can only assume that Egeus simply wants his daughter to obey him so he can have his own way. Hermias happiness appears to be of little consequence to him. Theseus, Duke of Athens, placates Egeus and gives Hermia time to decide. Thus, the problem is resolved as the story unfolds, though this is no real comfort to Egeus. In the end, Hermia gets her way and Egeus has to go along with it; Theseus and the others happily accept the resolution, and Demetrius is no longer interested in his daughter. However, Egeus remains a difficult character, and  the story  ends happily only due to intervention by the fairies. Had they not been involved, its possible that Egeus would have gone ahead and executed his own daughter had she disobeyed him. Fortunately, the story is a comedy, not a tragedy.

The EU Budget Essay Example | Topics and Well Written Essays - 2250 words

The EU Budget - Essay Example The main principle is that EU funding has to be utilised only when sharing resources looks sensible to the Union's member countries. The EU's yearly budget totals to around '130 billion. This is approximately 1% of the economic wealth yielded by the member countries every year. The budget determines income and expenditure for the year, lists all the actions that are to be financed and also fixes total amount of money and staff obtainable for each. The budget also determines the amount of each payment and its authorisation. A ceiling on the expenditure limit is accorded by the member states' governments and parliaments. The limitation at present is set at 1.24% of the Union's gross national income. The budget in the year 2008 has apportioned 45% of its total expenditure to make the EU economy more aggressive and lively. This year the EU budget has plans to narrow the space between the rich and the poor member states and regions. Agriculture is apportioned with 32% of the budget which is also a major area of expenditure. Rural development and environment takes 11% and the total cost for the administrative to run the EU works up to 6% of the total expenditure. 2. An upper limit for expenditure which is agreed by the member states' governments and parliaments. ... The budget of the EU is dependent on 3 constraints: 1. The treaties, which influence the EU budget not to be in deficit which means that the total income has to cover the total expenditure. 2. An upper limit for expenditure which is agreed by the member states' governments and parliaments. This is the personal resources cap. This cap forms 1.24% of the Union's gross national income (GNI) which is to be used for payments. This amounts roughly to EUR 293 per EU citizen on average. 3. A fiscal structure established by the European Parliament, the Council of Ministers and the European Commission, would check the development of the EU budget set by expenditure category for a period of time. The present fiscal structure runs from 2007 to 2013. The EU has its individual resources to fund its spending. By law, these resources are of the Union. Member states who accumulate them in lieu of the EU and shift them to the EU budget. The 3 kinds of EU's own resources are: 1. Traditional own resources (TOR) which is made up of duties billed for imports from a non-EU state which approximated to around 15% of total revenue, in the year 2007. 2. Value added tax (VAT) is a consistent percentage rate which is applicable on each member state's harmonised VAT revenue forms yet another resource. This was around 15% of total revenue, for the year 2007. The gross national income (GNI) which is 0.73% and is applicable to the GNI of each member state. Even though it is a complementary item it is the prime source of revenue and amounted to around 70% of total revenue for the year 2007(http://www.eu2008.si/en/ About_the_EU /Budget/ index. html accessed on 4th June 2009). : Source: Commission of the European Communities Other sources of revenue are taxes paid by EU

Thread #4 Essay Example | Topics and Well Written Essays - 250 words

Thread #4 - Essay Example e that Subway is the undisputed leader in fast and healthy food because they offer easy to prepare sandwiches which are â€Å"made to order-right in front of the customer - using freshly baked breads, select sauces and a variety of delicious toppings† (Doctors Associates, Inc., 2011). And the third reason which is very important is the continuous support network that it offers its franchisees. Subway’s support system includes training, product development, advertising, purchasing cooperative and field support (Doctors Associates, Inc., 2011). The total investment in starting a Subway franchise is somewhere between $84,300 to $258,300. This amount includes the franchise fee, on-going royalty fee, start-up cost, equipment, payroll and inventory (Entrepreneur Media, Inc., 2011). This means that a franchisee must also consider looking into the possible financing options open to him to fund the total investment to be made. Aside from these costs, a business experience is needed to own a subway franchise. The manpower needed to run the franchise will be around six to ten employees. There should also be a total commitment from the franchisee because Subway does not allow absentee ownership and the terms of agreement is for 20

The Healthcare Dilemma Essay Example | Topics and Well Written Essays - 250 words

The Healthcare Dilemma - Essay Example Later on, the Supreme Court stated that the Obama care had forced the state to register illegally for a Medicaid expansion together with the federal money that is set aside for it, in addition to threats of cutting off of Medicaid funds if they do not adhere to that. Many people who had embraced this act have been affected tremendously. For instance, some have been forced to deploy some of their workers in their companies, hence counting losses. This was a result of the cuts made to Medicaid reimbursement, and even some people are now left with dilemmas on what to do. It is usually painful and disturbing for an individual to incur losses on something that he/she did not expect, but coming into terms with it and accepting the situation the way it is is usually the surest way to find peace. Finally, I would like to advice all people affected by this act that they should try to view everything positively. This is because I am also affected and I have lost a lot, but I usually keep the fire burning bearing in mind that I still have a long life to

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

The Theme of Disguise in Hamlet :: English Literature Essays

Deep within the scorching desert sands lurks a creature, moving cautiously into position as it readies itself for a strike upon its unsuspecting prey. The prey detects a slight disturbance in the sand, but anticipating no danger, carries on about its normal activities. Then suddenly, the comfortable silence is broken by the onset of splashing sand followed by a short struggle. Before long the quietness returns to the sandy landscape, where everything seems to be the same as it was before, except that it is not. The lurking creature, a chameleon was hungry prior to the strike, but now is quite content. In this situation, it is obvious that the chameleon killed its prey, however, what is not so obvious is how the chameleon was able to achieve that end. At first glance, the chameleon does not seem to possess a wide range of arsenals when compared with other creatures in the animal kingdom. Nonetheless, it does have one element most others do not, and that is its ability to disguise and camouflage itself in order to blend in with its surrounding environment. This characteristic is important to the survival of the chameleon as it serves a dual purpose with regard to offense (such as catching its prey) and defense (such as hiding from other predators). Similarly, just as a chameleon alters its external appearance in order to deceive its prey, so too do certain characters in William Shakespeare’s Hamlet; namely Hamlet, Claudius, and Polonius, who disguise their appearances, using a variety of tactics to achieve a particular end. The characters in Hamlet modify their appearance by acting differently as a means of a defense mechanism as well as an offensive one. The theme in the play of Hamlet consists of many instances in which the external appearance of things appears to be true when in reality it is the opposite. Not surprisingly, the main character of the play Hamlet becomes the master of disguise and deception. Hamlet seeks revenge against Claudius shortly after he learns of the King’s involvement in his father’s death, a â€Å"murder most foul† (Act I, Sc. 5, 27). The revenge by Hamlet will take some time to execute; therefore Hamlet must devise a plan to divert attention away from himself. He does so by pretending to act in a mad manner such that his intended subjects (i.e. Claudius, Polonius, Gertrude, and Ophelia) will be completely unsuspecting.

Green Revolution Essay

Interaction between humans and the environment has always had a great importance in the development of humankind; according to Marx, what differentiates humans from other animals is the fact that humans can transform their surroundings to suit their needs, through labor. The Green Revolution is not the exception to that. In times of need the human being manipulated its environment to be suitable for its development, however, the question lingers, how efficient was it, how positive? The Green Revolution, from 1945 to the present, was motivated by the need to increase the production of food to supply for the increasing demand as population grew, to promote national self-sustainability in terms of food. However, during that period the effect of the Revolution have been detrimental to the environment and society: they have damaged agricultural diversity and heritage, damaged the lands, and put at risk food security; also, they have widened the gap between the very rich and the very poor, monopolizing the food industry. The Green Revolution originated after an urgent need to promote food security with a growing trend in global population, as a way to promote self-sustainability and independence. As it is clear in the report given by the Food and Agriculture Organization (DOC 2), in the period ranging from around 1929 (great depression) and 1945 (end of World War II) the global food supply index was below the world population. What this means is that there was literally not enough food being produced world wide to feed the world population. This struggle of human kind to stay afloat in supplying the minimum needs for survival meant that a change needed to occur. The answer, as Dr. Norman Borlaug stated in his Nobel Lecture (DOC 4) was not simply planting more in the developing nations, since the lands in those areas were â€Å"tired, worn out, depleted of plant nutrients†¦Ã¢â‚¬  Clearly, what the document refers is that a new, more effective way of growing food had to be developed. In fact, Dr. Borlaug states that the priority of the developments of the green revolution concentrated in the millions that were lurked by hunger, a large problematic that clearly was under the spotlight. As a proof that the world was prioritizing the deficient food supply is the statement given by President Harry Truman (DOC 3). President Truman was the leader of the most powerful nation in the world at the time, the one with the largest technological developments, and his word was the one that would set the course of the world. This particular speech is vital, since it is the inaugural speech, where he was to set the priorities of the government and address the world with what the United States had as a course for the future. In this speech, he clearly refers to the shocking figure that â€Å"more than half the people of the world are living in conditions approaching misery† and says that the United States will help provide â€Å"technical knowledge†¦ to produce more food† In the speech President Truman refers often to liberty, thus meaning that self-sustainability will provide freedom. This speech is the perfect example, the jewel of the trend that the world was seeing with regard to prioritizing food. The mention of â€Å"technical knowledge† is vital in the construction of the green revolution as a response to the lack of food, with technological developments in the agricultural field. Some have said that the Green Revolution has been a success in improving the food industry, and improving living conditions for everyone; nevertheless the numbers today reflect a mediocre success. Indian minister for food and agriculture (1964-1967) states in an interview (DOC 5) that the farmers of the state of Punjab competed to use the technology that was introduced by the green revolution the best. It is stated with a positive connotation, as to refer to the great feats of Punjab. This seems very positive, however, the most likely reason for this to have occurred is the fact that multinational corporations were kicking them out of the market and they were forced into utilizing the technology that those same corporations were imposing on them. If this were true, which it most likely is, as it has happened in many places around the world, it would discredit the great success that the Green Revolution supposedly is. Furthermore, the claim is that the Green Revolution has brought prosperity, however, to whom, to the ones that were rich already? A perfect example of this negative impact of the Green Revolution is the conversation between Mrs. Dula and the United Nations official (DOC 6), which gives a not very realistic perspective of the impact of the green Revolution and is concentrated exclusively in the sector of the very rich. This document is indeed quite revealing, as the speaker is an aristocratic woman of Mexico, probably a housewife who sees the world through the optic of his husband, a man who earns a salary if the revolution which he works for is successful; in fact, she is most likely part of one of the clubs she talks about herself. The occasion of this statement is a simple conversation with a UN official, probably at some sort of a social event, where the high class is all joined together, with perfectly slanted people who are not really analyzing the global impact of the Green Revolution. This document gives a crystal clear proof of how much the Green Revolution has made the â€Å"rich Mexican farmers† richer probably at the expense of making the poor laborers, poorer, however, this document presents only one, very bright point of view to sell the revolution. With regards to India once again, socially, they sell the idea of improvement, like in the report of the State of Punjab (DOC 9) where it says that the Green Revolution has seen with it the â€Å"emergence of middle and rich peasants† a very undesirable euphemism to conceal the actual situation. This document seems to give a perspective of social growth and development, of a population going for education, yet once again, it seems very idealistic in its tone, when in reality India has totally different conditions. With regards to that, India has one of the largest Gini index’s in the world, meaning a huge social inequality, and has one of the smallest middle classes in the world, which has diminished even more throughout the years, meaning that in reality, India may have had a somewhat positive year, but the general trend is of a very pronounced downturn in social progress, all related to the Green Revolution which is destroying the small farmers. The Green Revolution, in truth has brought more ill than it has brought good, in the environmental and social aspects. Regarding environmental harm, the FAO Wheat Yield report (DOC 1) is very good in demonstrating the introduction of massive scale crops that the Green Revolution brings forth with it. The introduction of these crops damages the lands since they are not prone to such production. The graphs show that in both Mexico and India the crop yields were extremely irregular, and as time passed they have become even more, this is due to the fact that they are not proper to those areas and its planting is something totally synthetic and with complete disrespect towards the natural balance. The article by Dr. Vandana Shiva (DOC 8) reveals how much damage the crops, especially Genetically Modified Organisms; do to the land they are planted in. The â€Å"reduced genetic diversity, increased vulnerability to pests, soil erosion, water shortages†¦Ã¢â‚¬  are effect that will leave marked the land for a long time, as Dr. Shiva states, and are a threat to future generations, which will have totally barren land where it will be impossible to plant food. Dr. Shiva also refers to the social problematic that the Green Revolution is planting alongside its seeds. For instance the fight for water to provide irrigation, previously not needed in India, has lead to â€Å"conflict and violence† and as it has become a worldwide trend, the career for water dominance is â€Å"leading to both local and interstate water conflicts. † This clearly shows how disadvantageous the spread of the Green Revolution has been, since it has brought unmeasured changes that have not been made responsibly, but rather abruptly, causing enormous damage. Dr. Shiva is an Indian Physicist, and being from India she probably has had a very direct contact with the Green Revolution, considering that one of its birthplaces was in fact the State of Punjab. In this occasion she is writing for the Ecologist magazine, a publication read by people with primary interest in the environmental issues, including organization leaders and maybe politicians who will probably get concerned, especially due to the tone of annoyance and hatred that she employs in the article. Expanding on social implications, the Guatemalan National Coordinating Committee of Indigenous peasants (DOC 10) gives a different perspective. Although it may sound somewhat as mysticism from indigenous people, saying that they have contaminated the seeds is not a joke, considering the hormones that can be found in GMO plantations. This also acknowledges a vital issue, the loss of diversity and heritage that society is killing with the systematic Green Revolution trends, like the Mayan traditions, which have been present for â€Å"five thousand years. † Furthermore, the social disaster does not stop there, but stumbles over women, which according to the FAO Newsletter (DOC 7) have been forced to change their job. In this case the implications have made woman, traditionally in other roles, have even less opportunities to succeed, as the increased need for cash income made the woman be forced to work. This implies a social catastrophe since it denies the right of woman to equal opportunities, which are stripped off with the Green Revolution, which makes them simply one more laborer forced to work. Additional to the information presented in the documents it would be vital to contain the point of view of a small scale male farmer that has to compete with the multinational corporations, which have been installed after the start of the Green Revolution circa 1945. This would be important since it would show the first hand effects of the monopolies that the Green Revolution has brought, with regards to the social impact it has made, and whether that impact is positive or negative. As discussed throughout the essay, the Green Revolution, which has lasted from 1945 until the present day, was originated with a need to secure food production in a starving world. However its effects were not so positive, since today many starve, and the Green Revolution has damaged the environment and widened the gap between the social classes. The setup of crops that have give no benefit to the places in which they are grown, with complete disregard to the ecological balance that was being destroyed have caused issues ranging from soil erosion to water shortages and crops with pest vulnerability. The Green Revolution has also made the rich farmers richer at the cost of the poor being poorer, since the costs of the new technologies are not easily accessible, but the yields that they provide take the small farmers out of business. In general, although certain governments sponsor the Green Revolution and make it seem positive, it has brought about large changes in the way humans interact with the environment, with a generalized destruction of it to get short-term solutions to the problem of food shortages.

Ulysses S Grant at the Battle of Shiloh

Ulysses S Grant at the Battle of Shiloh General Ulysses Grant’s overwhelming victories at Forts Henry and Donelson in February 1862 caused the withdrawal of Confederate forces not only from the State of Kentucky but also from most of Western Tennessee. Brigadier General Albert Sidney Johnston positioned his forces, numbered at 45,000 troops, at and around Corinth, Mississippi. This location was an important transportation center since it was a junction for both the Mobile Ohio and Memphis Charleston railroads, often referred to as the crossroads of the Confederacy. General Johnston Dies During a Sneak Attack By April 1862, Major General Grant’s Army of Tennessee had grown to nearly 49,000 soldiers. They needed a rest, so Grant made camp on the western side of the Tennessee River at Pittsburg Landing while he was awaiting re-enforcements and also training soldiers who had no battle experience. Grant was also planning with Brigadier General William T. Sherman for their attack on the Confederate Army at Corinth, Mississippi. Further, Grant was waiting for the Army of Ohio to arrive, commanded by Major General Don Carlos Buell.   Instead of sitting and waiting at Corinth, General Johnston had moved his Confederate troops near Pittsburg Landing. On the morning of April 6, 1862, Johnston made a surprise attack against Grant’s Army pushing their backs up against the Tennessee River. Around 2:15 p.m. that day, Johnston was shot behind his right knee and  died within an hour. Before his death, Johnston sent his personal physician to treat injured Union soldiers. There is speculation that Johnston didn’t feel the injury to his right knee due to numbness from a wound to his pelvis that he suffered from a duel fought during the Texas War for Independence in 1837. Grants Counter Attack The Confederate forces were now led by General Pierre G.T. Beauregard. Though Grants forces were believed to be vulnerable, Beauregard made what would prove to be an unwise decision to cease fighting near dusk of that first day. That evening, Major General Buell and his 18,000 soldiers finally arrived at Grant’s camp near Pittsburg’s Landing. In the morning, Grant made his counter-attack against the Confederate forces resulting in a major victory for the Union Army. In addition, Grant and Sherman forged a close friendship on the Shiloh battlefield that remained with them throughout the Civil War and arguably led to the ultimate victory by Union at the end of this conflict.   Battle of Shiloh The Battle of Shiloh is probably one of the most significant battles of the Civil War. In addition to losing the battle, the Confederacy suffered a loss that may have cost them the war- Brigadier General Albert Sidney Johnston’s death that happened on the first day of the battle. History has considered General Johnston to have been the Confederacy’s most able commander at the time of his death – Robert E. Lee was not a field commander at this time- as Johnston had been a career military officer with over 30 years of active experience. By the end of the war, Johnston would be the highest ranking officer killed on either side.   The Battle of Shiloh was the deadliest battle in the history of the U.S. up until that time with casualties that exceeded a total of 23,000 for both sides. After the Battle of Shiloh, it was quite clear to Grant that the only way to defeat the Confederacy would be to destroy their armies. Grant Excels Despite His Alcoholism Although Grant received both praise and criticism for his actions leading up to and during the Battle of Shiloh, Major General Henry Halleck removed Grant from command of the Army of the Tennessee and transferred command to Brigadier General George H. Thomas. Halleck based his decision partially on allegations of alcoholism on the part of Grant and promoted Grant to the position of being second-in-command of the western armies, which essentially removed Grant from being an active field commander. Grant wanted to command, and he was ready to resign and walk away until Sherman convinced him otherwise. After Shiloh, Halleck made a snail crawl to Corinth, Mississippi taking 30 days to move his army 19 miles and in the process allowed the entire Confederate force stationed there just to walk away. Needless to say, Grant was returned to his position of commanding the Army of the Tennessee and Halleck became the Union’s general-in-chief. This means that Halleck moved away from the front and became a bureaucrat whose major responsibility was the coordination of all Union forces in the field. This was a key decision as Halleck was able to excel in this position and work well with Grant as they continued to fight the Confederacy.

Ancestry of Barack Obama - Fourth Generation

Ancestry of Barack Obama - Fourth Generation Barack Obama Family Tree, Generations 1-3 Fourth Generation (Great Grandparents): 8. Obama was born in Kendu Bay, Kenya 9. Nyaoke Obama had four wives, one of whom was Nyaoke. She fathered many children, of whom Onyango was the fifth son. 12. Ralph Waldo Emerson DUNHAM was born 24 December 1894 in Argonia, Sumner County, Kansas and died 4 October 1970 in Wichita, Sedgwick, Kansas. 13. Ruth Lucille ARMOUR was born in 1900 in Illinois and died (by suicide) on 25 November 1926 in Wichita, Sedgwick County, Kansas. Ralph DUNHAM and Ruth ARMOUR were married on 3 October 1915 in Wichita, Sedgwick County, Kansas and had the following children: i. Ralph Emerson DUNHAM, Jr., born 29 August 1916 (spouse Elizabeth Smith)6. ii. Stanley Armour DUNHAM The family is found living with Ruths parents in the 1920 federal census of Sedgwick County, Kansas. In 1930, Ralph Jr. and Stanley are with their maternal grandparents in Butler County, Kansas, while their father, Ralph Sr. was enumerated with his parents in Sedgwick County, Kansas. 14. Rolla Charles PAYNE was born 23 August 1892 in Olathe, Johnson County, Kansas and died in Kansas in October 1968. 15. Leona MCCURRY was born about May 1897 in Kansas. Rolla Charles PAYNE and Leona MCCURRY married in Kansas about 1922 and had the following children: 1. i. Madelyn PAYNEii. Charles Thomas PAYNE born in 1925.iii. Arlene PAYNE born about 1926.

Current Ethical Issues in Managerial Accounting Report Research Paper

Current Ethical Issues in Managerial Accounting Report - Research Paper Example The ethical issues might generate from these activities or functions which perform by the managerial accountants in an organization. The various ethical issues which are currently prevailing in management accounting reports are related to overproduction, cost allocation, replacement of assets and conflicting interests amid the stakeholders (Taicu, n.d.). This paper intends to identify a particular ethical issue that is currently being debated. Moreover, a detailed analysis of the identified ethical issue, recognition of the relevant stakeholders and suitable recommendations as well as rationale to mitigate with the ethical issues will also be depicted in this paper. A Brief Overview of the Recent Ethical Issue A recent ethical issue has been observed in an organization named UBS, a global business firm which offers different financial services to the customers in over 50 nations. It has been viewed that the organization faced substantial financial loss of nearly UK$ 2.3 billion in th e year 2011 due to the involvement of certain ethical issues. The ethical issues which were involved in this case were regarding false accounting and fraudulent activity of misinterpretation of the financial statements which can be related to the process of managerial accounting. In relation to this case, the former trader of UBS named Kweku Adoboli was alleged for the conduct of such ethical issues. False accounting can be considered as one of the major ethical issues as it occurs when the assets or liabilities of an organization are overstated for the motive of making the financial position of the business more stronger. The ethical issue of false accounting generally occurs due to various reasons like hiding losses, inflating the share prices, reporting unrealistic profits and obtaining additional financing from banks. The ethical issue of false accounting was majorly involved with the case of UBS. The former trader of the company i.e. Kweku Adoboli may perform the ethical issue of false accounting by adopting any one of the aforementioned unethical practices. Consequently, the former trader was arrested due to the conduct of unethical practices in terms of false accounting and fraudulent activity of misinterpretation of the financial statements (Shirbon, 2012). Identification of the Relevant Stakeholders The stakeholders are regarded as individuals or groups upon whom an organization depends for its success. They invest significant amounts of money into an organization and anticipate attaining greater financial return. With regard to the ethical issues, it has been apparently observed that the organization suffered huge financial loss of nearly UK$ 2.3 billion in the year due to the prevalence of significant moral issues. The ethical issues include false accounting practices and fraudulent acts of misinterpretation of financial statements. The relevant stakeholders who were involved with the ethical practices are the company itself and the former trader of UBS named Kweku Adoboli. The potential reason of this stakeholder i.e. Kweku Adoboli to conduct the ethical practice of false accounting was to strengthen his financial position and also to attain significant earnings (Shirbon, 2012). Recommendations and Rationale After acquiring a brief idea about the ethical pract

Career Development Essay Example | Topics and Well Written Essays - 1750 words

Career Development - Essay Example Active career development initiatives by a company are a key retention tool to keep the best talent within its fold. It is one of the greatest motivators to keep an employee happy and engaged. Most organizations consider career development as part of their critical human resource strategy. Form the employee’s point of view career development initiatives gives them a clear focus about their career track. Economic and technological changes have resulted in working careers becoming more unpredictable. Presently, career opportunities tend to be seen in the light of employability recognizing that career development frequently goes beyond the boundaries of one organization. Career development can be understood as an enumeration of consecutive job and training. In continuation with demands of the modern labour market, there is increased emphasis on employees’ active role and level of involvement with respect to his or her career. This is reflected in concepts such as personal initiatives, employability, or preparedness to change