About the US Inspectors General

About the US Inspectors General A U.S. federal inspector general (IG) is the head of an independent, non-partisan organization established within each executive branch agency assigned to audit the agency’s operation in order to discover and investigate cases of misconduct, waste, fraud and other abuse of government procedures occurring within the agency. Within the federal agencies are politically independent individuals called Inspectors General who are responsible for ensuring that the agencies operate efficiently, effectively and legally. When it was reported in October 2006 that Department of Interior employees wasted $2,027,887.68 worth of taxpayer time annually surfing sexually explicit, gambling, and auction websites while at work, it was the Interior Departments own Office of Inspector General that conducted the investigation and issued the report. The Mission of the Office of Inspector General Established by the Inspector General Act of 1978, the Office of Inspector General (OIG) examines all actions of a government agency or military organization. Conducting audits and investigations, either independently or in response to reports of wrongdoing, the OIG ensures that the agencys operations are in compliance with the law and general established policies of the government. Audits conducted by the OIG are intended to ensure the effectiveness of security procedures or to discover the possibility of misconduct, waste, fraud, theft, or certain types of criminal activity by individuals or groups related to the agencys operation. Misuse of agency funds or equipment is often revealed by OIG audits. There are currently 73 offices of US inspectors general, far more than the initial 12 offices created by the Inspector General Act of 1978. Along with administrative staff and several financial and procedural auditors, each office employs special agents- criminal investigators who are often armed. The work of the IG offices involves detecting and preventing fraud, waste, abuse, and mismanagement of the government programs and operations within their parent agencies or organizations. Investigations conducted by the IG offices may target internal government employees or external government contractors, grant recipients, or recipients of loans and subsidies offered through federal assistance programs.   To help them carry out their investigative role, Inspectors General have the authority to issue subpoenas for information and documents, administer oaths for taking testimony, and can hire and control their own staff and contract personnel. The investigative authority of Inspectors General is limited only by certain national security and law enforcement considerations. How Inspectors General Are Appointed and Removed For the Cabinet-level agencies, Inspectors General are appointed, without regard to their political affiliation, by the President of the United States and must be approved by the Senate. Inspectors General of the Cabinet-level agencies can be removed only by the President. In other agencies, known as designated federal entities, like Amtrak, the U.S. Postal Service, and the Federal Reserve, the agency heads appoint and remove Inspectors General. Inspectors General are appointed based on their integrity and experience in: Accounting, auditing, financial analysisLaw, management analysis, public administrationInvestigations Who Oversees Inspectors General? While by law, Inspectors General are under the general supervision of the agency head or deputy, neither the agency head nor the deputy can prevent or prohibit an Inspector General from conducting an audit or investigation. The conduct of the Inspectors General is overseen by the Integrity Committee of the Presidents Council on Integrity and Efficiency (PCIE). How Do Inspectors General Report Their Findings? When an agencys Office of Inspector General (OIG) identifies cases of egregious and flagrant problems or abuses within the agency, the OIG immediately notifies the agency head of the findings. The agency head is then required to forward the OIGs report, along with any comments, explanations, and corrective plans, to Congress within seven days. The Inspectors General also send semiannual reports of all their activities for the past six months to Congress. All cases involving suspected violations of federal laws are reported to the Department of Justice, via the Attorney General.

Free Essays on Research Paper History Boxing

Joe Louis and his beloved trainer Jack Blackburn were preparing to walk down the aisle for a big championship fight. Blackburn who had recently endured some serious health set backs, was breathing hard and suddenly blurted out: :"Chappie, I don't think I can make it up them steps tonight". What was Louis to do? His opponent Buddy Baer was a tough fighter who had scored a knockdown over Louis in their previous title bout. Without hesitation Louis replied: "Don't worry Chappie, you'll only have to go up and down them steps one time." Louis, keeping his word, knocked Buddy out cold with a paralyzing right hand in the first round. When Joe Louis meant business no-one could stand up to his dreadful assaults. Such was the power and mettle of the man the world called "The Brown Bomber". THE PERFECT FIGHTING MACHINE There never has been a more complete fighter than Joe Louis. He more than any other heavyweight most closely resembles the perfect fighter. Imagine the task of building a perfect heavyweight. First he would have to have two-fisted punching power equal to that of Jack Dempsey or Mike Tyson. His hand speed would have to be among the best including Ali, Patterson and Tyson. The left jab an offensive weapon like that of Sonny Liston's. The left hook as powerful as Joe Frazier's. His right cross as crushing as Lennox Lewis. His combination punching comparable to pound for pound great Ray Robinson. His counter-punching ability on par with Jack Johnson. He would have the inside fighting ability of Rid*censored* Bowe. He would also have the analytical ability of Gene Tunney in spotting the weakness of an opponent's style. Joe Louis had all of these attributes in one compact explosive package of heavyweight TNT. As a boxer Louis had everything. He is without doubt the greatest combination puncher to ever lace on the gloves. No one could put their punches together as beautifully as did Louis. He threw every punch in the boo... Free Essays on Research Paper History Boxing Free Essays on Research Paper History Boxing Joe Louis and his beloved trainer Jack Blackburn were preparing to walk down the aisle for a big championship fight. Blackburn who had recently endured some serious health set backs, was breathing hard and suddenly blurted out: :"Chappie, I don't think I can make it up them steps tonight". What was Louis to do? His opponent Buddy Baer was a tough fighter who had scored a knockdown over Louis in their previous title bout. Without hesitation Louis replied: "Don't worry Chappie, you'll only have to go up and down them steps one time." Louis, keeping his word, knocked Buddy out cold with a paralyzing right hand in the first round. When Joe Louis meant business no-one could stand up to his dreadful assaults. Such was the power and mettle of the man the world called "The Brown Bomber". THE PERFECT FIGHTING MACHINE There never has been a more complete fighter than Joe Louis. He more than any other heavyweight most closely resembles the perfect fighter. Imagine the task of building a perfect heavyweight. First he would have to have two-fisted punching power equal to that of Jack Dempsey or Mike Tyson. His hand speed would have to be among the best including Ali, Patterson and Tyson. The left jab an offensive weapon like that of Sonny Liston's. The left hook as powerful as Joe Frazier's. His right cross as crushing as Lennox Lewis. His combination punching comparable to pound for pound great Ray Robinson. His counter-punching ability on par with Jack Johnson. He would have the inside fighting ability of Rid*censored* Bowe. He would also have the analytical ability of Gene Tunney in spotting the weakness of an opponent's style. Joe Louis had all of these attributes in one compact explosive package of heavyweight TNT. As a boxer Louis had everything. He is without doubt the greatest combination puncher to ever lace on the gloves. No one could put their punches together as beautifully as did Louis. He threw every punch in the boo...

Marketing Individual Reflective Report Essay Example | Topics and Well Written Essays - 1000 words

Marketing Individual Reflective Report - Essay Example This paper is an individual reflection of a marketing report that was prepared by my group members and since it is an individual reflection, I will highlight what I acquired through the learning process and what I found out after research of my own abilities as well as that of marketing dynamics. Individually speaking, I am of the opinion that the challenge within the report was such that I had to seek alternatives as per its launch strategy. However I found out that the launch could have been done in a number of different ways but the best option was chosen for this report and hence we moved ahead with it. If I had another chance I would still choose the manner in which we moved ahead with this report because I believe this played the trick and brought in a number of positives for the report and indeed our understanding. It made us believe what we could learn and for my individual comprehension, I discerned that the manner in which marketing is done worldwide is something that I mus t ponder deep into, and thus give my very best day in and day out. Therefore I would not make any change if I am given another chance to implement my truest sense within the preparation of this marketing report (Copeland 2009). ...Same happened within this scenario as well where I worked my way through the tough times and gained upright knowledge and understanding regarding the Brakes Brothers which is a leading supplier of prepared and fresh food to caterers and restaurants around the United Kingdom. This experience helped me immensely at understanding how I need to shape up my work tasks and what I must do in order to learn and acquire new things which will bring me success at the end of the day (Kitchen 2004). As far as this success is concerned, I am of the view that the report on Brakes Brothers provided me a thorough understanding of how different forces shape up and what needs to be done in order to find out how the company operates within the whole of United Kingdom. This br ings in the much needed value for the end consumers. I would apply this knowledge within my future endeavours as it has helped me sustain the strengths and look after the weaknesses. As far as my work domains are related, I would surely apply the learned skills within my career aspirations and learn a number of new things which come directly under the aegis of marketing. The group work assisted me at comprehending how I need to move ahead with the changing times and thus learn new aspects of Brakes Brothers’ work routines and processes. Brakes Brothers is a very useful case study because it makes me understand how to gain an in-depth knowledge into the territories of growth within a business’ entirety and how the same can be translated across the board for the benefit of all and sundry – the stakeholders and customers in essence (Watkins 2005). I would make use of my knowledge that I have attained by pinpointing how

Traveling Canadians in Britain and the USA Research Paper

Traveling Canadians in Britain and the USA - Research Paper Example As part of the British Commonwealth, Canada followed the passport regulations introduced by Britain and has enjoyed many of the privileges of British international connections throughout the twentieth century. As part of the network of Commonwealth countries, Canadians have been able to visit most countries throughout the world with no problems. Canada’s own decision to include both French and English languages means also that the passport is easily understood throughout Africa and other areas where both English and French are commonly spoken.  From the middle of the twentieth century onwards there has been a greater emphasis on security between different countries. The two world wars of 1914-1918 and 1939-1945 created mistrust between nations, and a renewed concern to be aware of possible harm that can come from people outside each sovereign nation. In the post-war period, Canada stayed largely outside major conflicts like the Vietnam War in South East Asia from 1955-1975. This meant that Canada has avoided the criticisms that were leveled against imperialist countries like the United States: â€Å"Anti Americanism increased tenfold by 1969 as a result of the war in Vietnam.†Ã‚  Canadians have a similar culture, language and general outlook to American, but the reputation of the two countries is very different. Canada promotes an image of peace and contentment within its own vast boundaries and does not seek a dominant presence on the world stage. This cannot be said of the likes of the United States, which repeatedly gets involved in contentious world events.   In the latter half of the twentieth century and again in the  new millennium, international criticism of American, and to a lesser extent also British and European, involvement in hostilities in the Middle East and Afghanistan has increased still further. In Arab countries, there is an understandable suspicion of American and British passports because of a long history of invasions and military actions. However justified these actions may seem to Western countries, they will still cause a negative reaction in the places where they occur. When terrorist capture westerners, for example, they are much more likely to focus on American or British passport holders for acts of retribution because they hold such resentment about past actions undertaken by these countries. An objective measure for checking how welcome a Canadian passport is can be found in the Henley Visa restrictions index, which measures how many countries a person with a particular passport can enter, without having to apply for a special visa: â€Å"This is the first time that a global ranking shows the international travel freedom of citizens of the various countries as well as the international relations and status of individual countries relative to others.†3 In a list of 98 countries, Canada is ranked in 9th place, allowing access to 157 countries, and this is the same as Australia and N ew Zealand. The United Kingdom and some Scandinavian countries have higher scores around 162-166, and the United States has a slightly higher score of 159. This compares very favorably with countries such as South Africa (88), India (57) China (38) and Afghanistan (26).

Microbiological effects from baby bottle misuse Research Paper

Microbiological effects from baby bottle misuse - Research Paper Example Moreover, the inherent immune elements in milk offer defense against infectivity. There are oligosaccharides present in the milk that avert accessory of normal respiratory micro-organisms like Streptococcus pneumoniae and Haemophilus influenzae (Gurtler, Kornacki & Beuchat, 2005). Misuse of bottle feeding is risky in the sense that the bottle formulae lack the Glycosaminoglycans which is normally present in the natural breast milk that averts attachment pathogens hence minimizing the risk of transmission. It must be noted that human milk administered through the normal breastfeeding adds up to inherent immunity. Long formula fed babies have the risk of contaminating and being infected with Giardia lamblia, H influenzae and the B streptococci, S epidermis and other micro-organisms such as the respiratory syncytial virus (RSV) (Gurtler, Kornacki & Beuchat, 2005). Misuse of baby bottle can also lead to infection of the lower respiratory tract. According to analysis of 7 group research o f healthy term babies in affluent locations, it was established that babies who were bottle-fed experienced a 3.6-fold higher risk of being hospitalized for infection of the lower respiratory tract in the initial year of their existence in comparison with babies who were wholly breastfed for a period of over 4 months. These research comprised modification for socioeconomic condition and parental smoking. Many of the infants hospitalized from respiratory infections arise from the respiratory syncytial virus. The human milk contains lipids which tend to have an antigen against RSV. Moreover, multifaceted researches also claim that bottle fed infants or formulated infants have a higher risk of contracting gastrointestinal pathogens and diarrhea. Similarly, 14 group studies meta-analysis established that infants who were bottle fed or formula fed were 2.8 times more probably to get infected with gastrointestinal pathogens compared to those who were totally breastfed (UNCF, 2003). Findin gs from PROBIT (promotion of breastfeeding intervention trial) reveal that infants who were used in the control experiment were 1.7 times more probably to get infected with gastrointestinal infection compared to those used in the intercession group. In this research 31 maternity hospitals were randomized to the Baby Friendly Hospital Initiative (BFHI) and a set of proof-found activities accommodating of breastfeeding, against the normal care. The entire 17,046 babies in the PROBIT research were breastfed, entirely at 3 months. It was found that 6.4% of the control studies were totally breastfed in comparison with the 43.3% of the intercession babies (UNCF, 2003). According to various epidemiologic researches it is suggested that infants and children who are exclusively bottle-fed on formula products are more probably to develop a condition of obese or develop type II diabetes. Furthermore, a meta-analysis study reveals that formula feeding among the infants is also related to the 1. 6 fold risk of the type 2 diabetes in comparison to the exclusively breast-fed children. Other studies have also claimed that a higher risk of diseases related to cardiac vacuoles inclusive of the high pressure of the blood and reduced favorable lipid profile also looms for children who are formula-fed even though the literature varies (Drudy, et al., 2006). Scholars have suggested that numerous interventions to describe these

In Sidaway v Board of Governors of the Bethlehem

In Sidaway v Board of Governors of the Bethlehem In Sidaway v Board of Governors of the Bethlehem Royal Hospital [1984] 1 ALL ER 1018 Dunn LJ stated in the Court of Appeal that 'the concept of informed consent plays no part in English law' (per Dunn LJ at 1030). Is this still an accurate reflection of the law? In Sidaway, the plaintiff brought an action against the hospital and surgeon who performed an operation on her back. The operation she had undergone carried an inherent risk to her spinal column and nerve roots. Even if it was performed perfectly, there was still about a two per cent chance that she would suffer injury to her spinal column. As it turned out, the operation was performed correctly, but nevertheless, the plaintiff suffered injury to her spinal column. She brought an action for negligence based solely on the ground that she had not been warned of the inherent risks of the procedure and that she would not have consented to the operation had she been so informed. It was found in fact at the trial that the surgeon failed to inform the plaintiff that the operation was not necessary and was actually optional. It was also found that while she had been warned of the risk of damage to the nerve roots, she had not been warned of the less likely, but potentially more serious, ris k to the spinal column. It was also accepted that had the plaintiff been aware of these facts she would not have undergone the surgery. However, the trial judge also found that the course the surgeon had taken was backed by a ‘responsible body of medical opinion’ and therefore, applying the test formulated in Bolam v Friern Hospital Management Committee [1957] 1 WLR 582, the standard of care that the surgeon owed the patient had been discharged. This ruling was upheld by the Court of Appeal and made its way to the House of Lords, where Dunn LJ’s quotation in the title is taken from. The House of Lords, by applying the Bolam test, also upheld the judgment on the ground that if a responsible body of medical opinion supported a course of action, this was sufficient to discharge the duty of care owed to a patient by a doctor. However, the reasoning in the case on the issue of informed consent is very enlightening. The first point to note is that Lord Scarman was the sole dissenting opinion in the case. Lord Scarman was of the opinion that, ‘the doctor’s duty arises from his patient’s rights. If one considers the scope of the doctor’s duty by beginning with the right of the patient to make his own decision whether he will or will not undergo the treatment proposed, the right to be informed of significant risk and the doctor’s corresponding duty are easy to understand: for the proper implementation of the right requires that the doctor be under a duty to inform his patient of the material risks inherent in the treatment.’(p. 888) Lord Scarman’s conclusion therefore was that the law ‘recognizes a right of a patient of sound understanding to be warned of material risks save in [exceptional circumstances]. This was not however the view of the other judges. Lord Bridge of Harwich for example, gave three reasons why the imposition of such a duty on patients would not be practical under English law. The first is that it would fail to take into account the reality of the doctor patient relationship in many situations. The doctor bases his decision to follow a certain course of treatment on a variety of factors and it would be impractical to expect him to educate the patient of the full implications of all of these factors. In fact, doing so may increase the trauma and stress of some patients. Secondly, the question of whether disclosure of information should have been made in any case would be best answered by reference to expert medical opinion on a case by case basis and not as a general rule applicable to all cases. Thirdly, Lord Bridge thought it would be impossible in practice for a court to apply a subjective test to the question of what was a ‘material risk’ that a pati ent should have been informed of, and what was an immaterial risk that would not require disclosure. This subjective test being one put forward in the American case of Canterbury v Spence (1972) 464 F. 2d 772. The statement of Dunn LJ quoted above was firmly upheld in the House of Lords. Sidaway however, was a case decided in 1984 and 1985. Massive advancements have been made both in the standard of medical care provided by doctors, and the requirements of the law in this field, in the intervening years. Therefore, it falls to be discussed, does the principal in Sidaway still apply? Perhaps the best starting place for such a discussion would be to follow Lord Scarman’s approach, quoted above, of looking at the right of the patient. The first right that all of us have, dating back to the early sources of the common law, is the right to bodily integrity. This right is so ingrained in our law that it can rarely be violated, even with the victim’s consent. As Swift J stated in the case of R v Donovan [1934] 2 KB 498 at 507, when it comes to violation of the principle of bodily integrity, ‘consent is immaterial.’ Furthermore, for the most part, the motive of the violator is often irrelevant and even the good intentions of a doctor will not excuse a violation of the principle. In the American case of Schloendorff v Society of New York Hospital 105 NE 92 (NY, 1914) Cardozo J put it clearly when he said that ‘a surgeon who performs an operation without the patient’s consent commits an assault,’ This position has been affirm ed in England in A-G’s Reference (No 6 of 1980) [1981] QB 715 where it was clearly asserted that it is the patient’s consent alone, and not the good motives of the doctor or any other public interest that make a doctor’s interference with the patient lawful. However, absolute as the twin principles of bodily integrity and patient consent appear, there are a number of exceptions in practice. The law distinguishes involuntary treatment, that is treatment that the patient does not consent to, from non-voluntary treatment, that is treatment that the patient is unable to consent to because he is for example unconscious or otherwise unable to provide valid consent. One justification for non-voluntary treatment is that the patient is presumed to consent, as it is highly likely that he would have done so had he been conscious. This approach however, does not have universal academic support (Mitchell, 1995). The more favoured justification comes from the law of necessity, which recognizes the need to act in an emergency, despite the fact that the necessary consent has not been obtained (Skegg, 1974). The requirements for this exception to apply are that the patient is unable to consent, that there is no one capable of consenting on his behalf, th at there is genuine urgency and that there are no known objections to treatment from the patient (In re Boyd, 403 A2d 744 (DC 1979)). The basic approach has been summed up succinctly by Lord Devlin (1962: p. 90) where he said ‘The Good Samaritan is a character unesteemed in English law.’ The principle has been developed further by the Canadian Supreme Court which has developed a distinction between procedures which are necessary and procedures which are convenient. While a doctor may be justified in performing a necessary procedure without consent, to perform a merely convenient one would be beyond what he is authorized to do. Two colourful Canadian cases illustrate the distinction well. The first, Marhsall v Curry [1933] 3 DLR 260, concerns a case where a doctor removed a testicle during the course of a hernia operation. While the patient was naturally dismayed to wake up to the discovery, the court held that the doctor had been justified in acting as he had because of the nature of the patient’s condition and the fact that the operation could not have been regarded as successful but for the doctor’s decision. This case is contrasted with that of Murray v McMurchy [1949] 2 DLR 442 in which the doctor tied a defective fallopian tube during the course of a caesarian section. This was held to have been convenient as the woman would have been at risk, had she undergone another pregnancy, and a separate operation to tie the tube could be avoided by performing the procedure now. However, the court found that the operation was not necessary in the legal sense and therefore a breach of the patientà ¢â‚¬â„¢s right. The relevance of these cases to English law was affirmed by the Court of Appeal in Devi v West Midland Regional Health Authority [1981] CA 491 which followed the Canadian courts reasoning. It should also be clearly noted that the consent of the patient, and the principle of patient autonomy takes precedence over any arguments of medical paternalism. This fact was stated in the two highly publicized and controversial cases of Re T (adult: refusal of medical treatment) [1992] 4 All ER 649 and Airedale NHS Trust v Bland [1993] 1 All ER 821. Also, where a doctor acts without any consent at all, law sees this situation as appropriate for a charge of battery. This will be the case where a doctor proceeds to act on a patient, despite the fact that the patient has expressly refused the treatment (Molloy v Hop Sang [1935] 1 WWR 714). It is also the case where the doctor proceeds to provide a patient with treatment that is materially different from the treatment that the patient consented to. This was the case in Schweizer v Central Hospital (1974) 53 DLR (3D) 494 where a patient consented to a toe operation, and the surgeon subsequently operated on the patient’s back. This is therefore. The starting position that led Lord Scarman to dissent from his colleagues in the Sidaway judgment. It is clear that the principle of bodily integrity is given the highest level of respect and protection under English law. Lord Scarman was saying that in order for a patient to exercise and enforce this right, he had to be informed of the details, risks and nature of a medical procedure. Further to this, Lord Scarman also was of the opinion that if a patient gave his consent without being properly informed of the risks and nature of the procedure he was consenting to, then this consent was in an important sense defective. This is the nature of the principle of informed consent, and requires that in order for a patient’s consent to be effective, and in order for a doctor to be able to properly act on it, the patient must have understood what he was consenting to. Sidaway was clearly a decision that rejected the concept of informed consent. This was recognized in Canada where the courts expressly refused to follow the decision and instead opted for upholding the informed consent requirement. One example of many is that of Haughian v Paine [1987] 4 WWR 97 in which the Saskatchewan Court of Appeal decided not to follow Sidaway and instead ruled that a doctor had been negligent in performing an operation for which the patient had not been told the consequences of undergoing no treatment at all. This case followed quickly on the heals of Sidaway. However, as late as 1997, academics in England were still confidently asserting that â€Å"English law does not recognize the doctrine of informed consent† (Grundy, 1997: p. 211). However, by this time, the attention had shifted to another principle in English law that was providing patient’s with a choice. This principle can also be traced to the Sidaway decision, the very case that rejected the application of informed consent in England. In his dissenting judgment, Lord Scarman said (at p. 884), ‘Unless statute has intervened to restrict the range of judge-made law, the common law enables the judges, when faced with a situation where a right recognized by the law is not adequately protected, either to extend existing principles to cover the situation or to apply an existing remedy to redress the injustice.’ It is this principle of the law that has been leading to significant inroads being created into the Bolam test in the context of the information given to a patient to enable him or her to make a decision. The view of Lord Bridge that it would be impractical to expect the doctor to explain absolutely everything to the patient, has in fact been flipped on its head, and the prevailing sentiment now seems to be that it would be unreasonable for the patient to explain the entire circumstances of his life, medical, social, economic and otherwise, that would be necessary to make a truly informed decision and that therefore, it is the patient who is in a far better position to make the best decision based on the information available. Even in Sidaway a pure Bolam approach was being compromised. Both Lord Bridge and Lord Keith were of the opinion that, ‘When questioned specifically by a patient of apparently sound mind about risks involved in a particular treatment proposed, the doctor’s duty must, in my opinion, be to answer both truthfully and as fully as the question requires’ (per Lord Bridge at 898). If one was to think about this statement in practice, it is in fact a lot more significant a compromise than it may seem. In reality, it is extremely likely that the vast majority of patients would ask their doctor a large number of questions concerning the risks and relative benefits of different courses. It would be a rare patient these days who would see a doctor, hear of a course of recommended treatment, and then accept it unquestioningly. The easy availability of medical information, and access to education and awareness of relevant issues has been promoted in the last couple of decades to the standard where patients are likely to be highly informed on their conditions and the options available to them, and they will certainly expect to engage in a frank discussion with their doctor on the courses of treatment available. It could almost be assumed, that in cases where a patient did not ask about the risks of a procedure of his doctor, either he had sufficient knowledge and cons ented to the doctor’s approach, or abrogated his right to further information in favour of accepting the doctor’s assessment. The second inroad contained in Sidaway itself was asserted by Lords Bridge, Templeman and Keith to the effect that (per Lord Bridge at 900), ‘Even in a case where, as here, no expert witness in the relevant medical field contends the non-disclosure as being in conflict with accepted and responsible medical practice, I am of the opinion that the Judge might in certain circumstances come to the conclusion that disclosure of a particular risk was so obviously necessary to an informed choice on the part of the patient that no reasonably prudent medical man would fail to make it.’ Combined with the previously mentioned inroad, the two conditions together provide significant safeguards to the patient’s right to meaningfully consent. Even if the patient fails to touch on serious issues and risks in his own research, or conversation with the doctor, the doctor is also under an obligation to raise of his own initiative, particular risk that are obviously necessary for ‘an informed choice on the part of the patient.’ Without actually using the phrase, the standard that the court was setting out in Sidaway was in fact starting to sound quite close to the concept of informed consent, at least for the vast majority of cases, in practice. As identified by Gurndy (1997: p. 213) the approach adopted in Sidaway is in fact a limited form of informed consent, ‘for it acknowledges that: a patient’s right of decision should be recognized and respected; where the patient undergoes an operation involving a substantial risk of grave adverse consequences a doctor failing to disclose such risk would be negligent save for circumstances where there was some cogent clinical reason why the patient should not be informed.’ Since Sidaway therefore, there have been a number of cases highlighting the importance of the patient’s right to know, and putting the Bolam test into a subsidiary role as merely one of a number of factors that should be taken into account. In Blyth v Bloomsbury Health Authority [1993] 4 Med LR 151 (per Kerr LJ at 157) it was said, ‘The question of what a plaintiff should be told in answer to a general enquiry cannot be divorced from the Bolam test any more than when no such enquiry is made. In both cases the answer must depend upon the circumstances, the nature of the enquiry, the nature of the information which is available, its reliability, relevance, the condition of the patient and so forth.’ Without creating an express right to all information that is available, the court was saying that Bolam is just one of the factors that are relevant in questions of this type. In Smith v Turnbirdge Wells Health Authority [1994] 5 Med LR 334 (per Mr. Justice Morland at 399) the court went against Bolam when it said, ‘By 1988 although some surgeons may still not have been warning patients similar in situation to the plaintiff of the risk of impotence, that omission was neither reasonable nor responsible.’ Therefore, despite passing the Bolam test, the defendants failed on the grounds of a reasonable and responsible test. In Moyes v Lothian Health Board [1990] 1 Med LR 463 the court found that the overarching test was ‘whether the doctor has shown reasonable care for the safety of his patient.’ In Abbas v Kenney [1996] 7 Med LR 47 the court stated that ‘A doctor has a duty to explain what he intends to do and the implications of what he is going to do. It must be explained in such a way that the patient can understand.’ Therefore, to conclude, it is possible to say that while the courts purport to be applying the Bolam test, as set out in Sidaway, the fact of the matter is that they are actually operating on principles much closer to a practical understanding of a modified form of informed consent. There are numerous cases that show that the mere fact that a body of professional opinion would not have disclosed certain information will not be enough for a doctor to avoid a finding of negligence. At the same time, there are numerous judicial statements to the effect that doctors must inform their patients of the basic information necessary in order for them to exercise their right to consent. Therefore, while in theory there is no doctrine of informed consent in English law, the practical approach, stemming from Sidaway and subsequent practice, is that a modified doctrine of informed consent does prevail in English law, and any doctors who ignored this fact would be standing on very shaky legal groun d. Reference List Texts and Articles Beauchamp Childress, Principles of Biomedical Ethics, 3rd ed. 1990, Cambridge Buchanan Brock, Deciding for Others, 1989, London Campbell, Moral Dilemmas in Medicine, 3rd ed. 1984, Oxford University Press Castiglioni, A history of Medicine, trans and ed E B Krunghaar, 2nd ed. 1947 Fulford, Moral Theory and Medical Practice, 1989, Oxford Grundy, P., Bolam, Sidaway and the Unrecognised Doctrine of Informed Consent: A Fresh Approach, (1997) JPIL, Dec. 211 Lord Devlin, Samples in Law Making, (1962) Oxford University Press, Oxford Mason McCall Smith, Law and Medical Ethics, 4th ed. 1994, Butterowrths, London Mitchell, J., A Fundamental Problem of Consent (1995) 310 BMJ 43 Skegg, A., A Justification for Medical Procedures Performed without Consent, (19740 90 LQR 512 Cases Abbas v Kenney [1996] 7 Med LR 47 A-G’s Reference (No 6 of 1980) [1981] QB 715 Airedale NHS Trust v Bland [1993] 1 All ER 821 Blyth v Bloomsbury Health Authority [1993] 4 Med LR 151 Bolam v Friern Hospital Management Committee [1957] 1 WLR 582 Canterbury v Spence (1972) 464 F. 2d 772 Devi v West Midland Regional Health Authority [1981] CA 491 Haughian v Paine [1987] 4 WWR 97 In re Boyd, 403 A2d 744 (DC 1979) Marhsall v Curry [1933] 3 DLR 260 Molloy v Hop Sang [1935] 1 WWR 714 Moyes v Lothian Health Board [1990] 1 Med LR 463 Murray v McMurchy [1949] 2 DLR 442 R v Donovan [1934] 2 KB 498 Re T (adult: refusal of medical treatment) [1992] 4 All ER 649 Schloendorff v Society of New York Hospital 105 NE 92 (NY, 1914) Schweizer v Central Hospital (1974) 53 DLR (3D) 494 Sidaway v Board of Governors of the Bethlehem Royal Hospital [1984] 1 ALL ER 1018 Smith v Turnbirdge Wells Health Authority [1994] 5 Med LR 334

Charles Dickens A Tale of Two Cities :: GCSE English Literature Coursework

In society today, all people determine their lifestyle, personality and overall character by both positive and negative traits that they hold. Sydney Carton in Charles Dickens’ A Tale of Two Cities was a drunken lawyer who had an extremely low self- esteem. He possesed many negative characteristics which he used in a positive way. Carton drastically changed his life around and became a new man.   Ã‚  Ã‚  Ã‚  Ã‚  Sydney is not the man he first appeared to be. He is first described at Darnay’s trial as slouching and not paying attention. He is seen as a drunk who had many personal issues. Carton feels that there is no hope for him, and that his life will never improve. He has much more potential and could be so much more in life, yet he chooses to remain in the shadow of others. Sydney has a dramatic life and is an alchoholic who sees nothing positive in himself.   Ã‚  Ã‚  Ã‚  Ã‚  Carton demonstrates a sensitivity which helps others in the long run. His partner, Mr. Stryver relaxes while Sydney works long hard hours to prepare the defense materials for the following days. Carton does most of Stryvers work, he is a man of great talent but lacks the character traits that would make those talents work to his own advantage instead of others that he helps. He always use to be satisfied with faling into his rank and never did anything to attempt to change his life. He further destroys himself with drinking and although he is not satisfied with his life now, he feels that he cannot do anything to change it.   Ã‚  Ã‚  Ã‚  Ã‚  Sydney’s love for Lucie Manette changed him greatly in a positive way. One day when Sydney visited the Manette residence he called on Lucie and pledged his love to her. After hearing this, Lucie feels nothing but compassion for Carton. He asked nothing more of Lucie than to always remember how deeply he cared for her, and that he would make any sacrifice to her or anyone dear to her. Lucie was the main reason for bringing out the new , more positve Sydney Carton. He now looked at things with a more positive attitude and a new personal strength was seen in his later actions.   Ã‚  Ã‚  Ã‚  Ã‚  Carton’s final act in this novel shows what a brave man he was and he acts upon his true love for Lucie. After the second arrest of Charles Darnay, Carton urges Dr. Manette to attempt to use his influence to free Charles. When Carton is speaking with little Lucie, Charles and Lucie’s daughter, she begs him to do something to save her