The Contemporary Indian Society

Background Information Vikas Swarup’s novel, Q A (Slumdog Millionaire), employs the life of an orphan, brought up in the slums of Mumbai, to portray the contemporary Indian society. The police arrest Ram on allegations of cheating in the quiz show, â€Å"Who Will Win a Billion (W3B)†.Advertising We will write a custom research paper sample on The Contemporary Indian Society specifically for you for only $16.05 $11/page Learn More In justifying his innocence, Ram narrates events and experiences in his life, which were the basis of his ability to answer the quiz promptly. The flashback on his life events constitutes the bulk of the story. It portrays the author as an individual who has keenly watched the issues that an ordinary member of the Indian society has to tolerate in his/her attempts to earn a living. The author, by giving the details of Ram’s ability to answer all the quiz questions, shows that life is the best teacher especi ally to those who are less privileged in life. Slumdog Millionaire is extremely close to reality as it portrays many aspects of the real Indian society with great verisimilitude and its realism outweighs its adventurous story and fairy tale elements. The Indian society as portrayed in the story The novel reveals lives of the impoverished individuals in the Indian society. These people live in the Mumbai slums. They do not acquire quality education thus end up becoming servants of the well up in the society. Ram works for an Australian diplomatic family and for a Bollywood megastar. Working as a waiter is part of his wide range of unprofessional occupations that Ram assumes in his lifetime. There is a clear distinction between those who are wealthy and the poor. The wealthy are very influential especially to the authority as evidenced when the producer of the television quiz is able to convince the police to arrest Ram, the poor orphan. The police, though lacking concrete evidence of the allegations, act accordingly. According to Proust this portrays the oppression of the poor by the rich in the society because as it occurs later that, the producer of the television show did not have the money to give to the winner of the quiz (25). According to him (the producer), the police would help him stop the poor winner from demanding the rightfully won prize. Proust argues that this vice is characteristic of the contemporary Indian society whereby the rich use their influence to deprive the poor their rights. The impoverished in the Indian society are not supposed to mingle with families of the well-up members of the society. For instance, Mr. Shantaram arrives in the slums and orders his family not to interact with their neighbors. Ram hears Shantaram saying,Advertising Looking for research paper on literature languages? Let's see if we can help you! Get your first paper with 15% OFF Learn More â€Å"This place is nothing less than a black hole. It is totally beneath my dignity to be staying here, but just for the sake of you two, I will endure this humiliation until I get a proper job. Listen, I do not want any of the street boys to enter the house. God knows what hellholes they have come from. There are two right next to us. Rascals of the highest order, I think. And Gudiya, if I catch you talking to any boy in the chawl, you will receive a hiding with my leather belt, understood?† (Swarup 24). Though Shantaram’s family moves to the slums due to financial constraints, they still do not admit to stoop to the level of the rest of the people in the slums. This trend is true about the Indian society where the rich have defined their boundaries clearly to avoid any interactions with the poor (Neville 56). This has led to the distinct social classes in society. The novel also gives a picture of the extremes of religious differences exhibited in the Indian society. The two prominent religious groups in India are Muslim an d Hindu. The differences between the two groups are so severe to the extent of claiming people’s lives. The author tries to strike a balance between all the religious groups in the nation by giving his main character a name, Ram Mohammad Thomas, which has an aspect of each of the religions. Ram is a Hindu name; Mohammad signifies the Muslim faith while Thomas is a name of one of the Christian saints. The name to this actor makes him neutral as far as the religions are concerned. Salim lost his family at a tender age in religious-based riots. One day as he is travelling in a bus, he finds people rioting; a group of people is arguing over a water tap and this argument turns into a heightened fight between the Hindus and Muslims. The ruffians force the people to alight from the bus based on their religion. The Muslims, Salim being one of them, remain in the bus where he experiences a terrifying incidence based on his conversation with the ruffians: â€Å"What is your name?† the leader asked me. ‘I could have said Ram or Krishna, but I became tongue-tied. One of the attackers pointed to the tabeez around my neck. â€Å"This bastard is definitely a Muslim, let’s kill him,† he urged. â€Å"No. Killing him would be too easy. We will burn this motherfucker alive in this bus. Then he and his community will learn never to touch our homes,† said the leader, and laughed (Swarup 78). The other Muslim in the Mumbai bus, Ahmed Khan, confronts the ruffians, saves Salim’s life, takes the poor orphan, and employs him as his servant.Advertising We will write a custom research paper sample on The Contemporary Indian Society specifically for you for only $16.05 $11/page Learn More Child abuse is rampant in the contemporary Indian society. Ram and Salim attest that both in Mumbai and Delhi cruel relatives and police officers exist; for instance, a Maman transforms young children into slaves. Ashok, a thir teen-year old child narrates the children’s ordeal to Ram and Salim. He says that they are not schoolchildren but beggars in the local trains and others are pickpockets. They (the children) give the money the collected money to Maman’s men in exchange of food and shelter. In addition, if one of the children does not meet the daily target, Maman’s men punish him/her. The children under Maman’s custody cannot escape because they are afraid of other gangs in Mumbai. Shankar’s illness and death is another example of child abuse cases in the Indian society. Though his mother is capable of paying for the medical expenses for the treatment of the boy, she does not bother about it leading to the eventual death of the boy. We learn this from Ram when he takes Shankar’s corpse to the poor boy’s mother. He says, â€Å"Mrs. Swapna Devi, if this is your palace, and you are its queen, then acknowledge the prince. I have come to deliver the dead bo dy of your son Kunwar Shankar Singh Gautam to you. He died half an hour ago, in the outhouse where you have kept him hidden all these years. You did not pay for his treatment. You did not fulfill the duty of a mother. Now honor your obligation as a landlady. Please pay for the funeral of your penniless tenant† (Swarup 112). This mother did not treat his son justly The plight of women in a male dominated society is a controversial issue in the Indian society. Male chauvinism has snuffed the rights of women in the society (Watkins 12). For instance, Shaym uses Nita as a money making tool in his brothel. One of the men that he sends to Nita abuses her leaving her in much pain. When Raju goes looking for Nita, he is shocked by what he sees and upon inquiry, Nita explains, â€Å"†¦a man from Mumbai. Shyam send me to his room at the Palace Hotel. He tied me up and did all this to me. What you see on my face is nothing. See what he did to my body† (Swarup 112). Shyam late r tells that, in exchange of getting Nita back, he has to give him quite an amount of money and it occurs this is the sole reason why Ram participates in the television quiz to raise the money. Earlier on when Ram asks Nita to tell him her name, she does not give her surname; she posits, â€Å"Prostitutes don’t have surnames. Like pet cats and dogs, we are called only by our first names† (Swarup 102). By portraying Nita’s acceptance not to use her surname, the writer implies that women in the Indian society are quite contented with their low social status. However, some women have climbed the social ladder including Neelima Kumari, the actress, and Smita, Ram’s lawyer.Advertising Looking for research paper on literature languages? Let's see if we can help you! Get your first paper with 15% OFF Learn More They represent Indian women who have stood to improve the image of the women in the Indian society. Dunham claims that the novel gives a biased picture of the Indian society (86). He says that Swarup’s story is a colonialist’s view of the society, which majors in its imperfections. India is not a nation filled with much misery, heartbreaks and evils among other forms of inhumanity. These are vices characteristic of any other nation. Throughout the story as discussed above, the author, through his characterization, clearly covers the entire social spectrum of the contemporary Indian society, which includes prostitutes, diplomats, slum dwellers, gangs, and beggars. His use of flash back in building the story is instrumental because it portrays life as a learning process. The challenges that one undergoes help in building his/her knowledge. Swarup vividly portrays that the only instrumental aspect in Ram’s ability to answer all the questions was his life experience . However, Branston, and Stafford believe that, Slumdog millionaire is more of an entertaining story than one that carries important social significance in the lives of the Indians (71). It is because of its use of dramatic humor with an incisive social comment. Conclusion The author of the novel Slumdog Millionaire has employed his vast skills in literature to bring out the image of the contemporary Indian society. His theme was to show that life is a learning process. For anyone who has grown in the slums, it is inevitable to meet all kinds of social evils ranging from misery, heartbreaks, and retribution among others. In attaining his theme, he chose to use the image of the contemporary Indian society. The story gives a full spectrum of the Indian society comprising of all forms of people ranging from diplomats to slum dwellers. It highlights the challenges that people go through that help in building knowledge about life. Despite the extensive use of drama in the story, Slumdog millionaire is a true depiction of the Indian society. The heavy doses of realism in the story outweigh the drama and adventure in the Slumdog millionaire. Works Cited Boyle, Danny, and Dunham, Brent. Danny Boyle: Interviews. Mississippi: University Press of Mississippi, 2011. Branston, Gill, and Stafford, Roy. The Media Students Book. New York: Taylor and Francis, 2010. Neville, Carl. â€Å"Classless.† Recent Essays on British Film. Britain: O Books, 2008. Proust, Marcel. â€Å"I have been arrested for winning a Quiz Show.† Pechorin’s Journal, 11 June 2011. Web. https://pechorinsjournal.wordpress.com/2008/11/03/vikas-swarup-qa/ Swarup, Vikas. Slumdog Millionaire. Britain: Harper Collins Publishers, 2006. Watkins, Tony. Rags and Riches: Exploring the Message behind the Media, 11 June 2011. Web. This research paper on The Contemporary Indian Society was written and submitted by user The Fury to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Free Essays on WalMart Stores Inc

Wal-Mart Stores, Inc. Wal-Mart Stores, Inc. is the world’s largest retailer, with $256.3 billion in sales in the fiscal year ended Jan. 31, 2004, 1.6 million associates worldwide, and more than 3,600 facilities in the U.S. and 1,570 units elsewhere. It is estimated that more than 138 million customers per week visit Wal-Mart stores worldwide. Wal-Mart has four retail divisions – Wal-Mart Supercenters, Discount Stores, Neighborhood Markets, and SAM’S CLUB warehouses. Each of these is guided by a passion for customer satisfaction and â€Å"Every Day Low Prices.† Sam Walton, the founder of Wal-Mart, opened his first Wal-Mart in Rogers, Arkansas in 1962. In recent years, Wal-Mart has been named â€Å"Retailer of the Century† by Discount Store News and has topped the FORTUNE 500 list. (www.walmartfacts.com) Sam Walton’s basic beliefs were simple: â€Å"Give people high value, low prices and a warm welcome.† Walton built a culture based on one principle: make the customer number one and four basic beliefs: excellence in the workplace, respect for the individual, customer service, and â€Å"everyday low pricing.† Wal-Mart built its own warehouses so it could buy in bulk and have room to store the merchandise, then built stores in areas around the distribution points which cut the company’s costs and gave it more control over operations. Wal-mart lead the way with the development of their â€Å"hub-and-spoke† distribution system as more and more stores were opened. This allowed Wal-Mart to re-stock its stores quickly and kept the amount of unproductive store space to an absolute minimum which in turn resulted in higher sales per square foot and rapid inventory turnover (www.walmartstores.com). As 2003 came to a close, Wal-mart faced some major challenges; some of them being, an unstable business environment, weak economic growth, and nervous consumers. All of which lead to minimal growth opportunities. European retailers wer... Free Essays on WalMart Stores Inc Free Essays on WalMart Stores Inc Wal-Mart Stores, Inc. Wal-Mart Stores, Inc. is the world’s largest retailer, with $256.3 billion in sales in the fiscal year ended Jan. 31, 2004, 1.6 million associates worldwide, and more than 3,600 facilities in the U.S. and 1,570 units elsewhere. It is estimated that more than 138 million customers per week visit Wal-Mart stores worldwide. Wal-Mart has four retail divisions – Wal-Mart Supercenters, Discount Stores, Neighborhood Markets, and SAM’S CLUB warehouses. Each of these is guided by a passion for customer satisfaction and â€Å"Every Day Low Prices.† Sam Walton, the founder of Wal-Mart, opened his first Wal-Mart in Rogers, Arkansas in 1962. In recent years, Wal-Mart has been named â€Å"Retailer of the Century† by Discount Store News and has topped the FORTUNE 500 list. (www.walmartfacts.com) Sam Walton’s basic beliefs were simple: â€Å"Give people high value, low prices and a warm welcome.† Walton built a culture based on one principle: make the customer number one and four basic beliefs: excellence in the workplace, respect for the individual, customer service, and â€Å"everyday low pricing.† Wal-Mart built its own warehouses so it could buy in bulk and have room to store the merchandise, then built stores in areas around the distribution points which cut the company’s costs and gave it more control over operations. Wal-mart lead the way with the development of their â€Å"hub-and-spoke† distribution system as more and more stores were opened. This allowed Wal-Mart to re-stock its stores quickly and kept the amount of unproductive store space to an absolute minimum which in turn resulted in higher sales per square foot and rapid inventory turnover (www.walmartstores.com). As 2003 came to a close, Wal-mart faced some major challenges; some of them being, an unstable business environment, weak economic growth, and nervous consumers. All of which lead to minimal growth opportunities. European retailers wer...

The Best ACT Score Predictor

The Best ACT Score Predictor SAT / ACT Prep Online Guides and Tips Taking the ACT is stressful- some test you’ve never seen before will affect where you go to college. As a high school student, I felt anxious taking the ACT because I hadn’t done any practice and had no idea whether I’d reach my target score. One way to mitigate nerves surrounding the ACT is to try to predict your ACT score. If you find out your estimate is close to your target score, you’ll feel relieved. If it’s low, at least you’ll know you need to do more preparation before taking the test. What is the best ACT score predictor? What should you do with your estimated ACT score? In this guide, I’ll walk you through the different ways to predict your ACT score and explain the pros and cons of each. I’ll also let you know how to use your estimated score to your advantage. What’s the Best Way to Predict Your ACT Score? The most accurate ACT score predictoris taking a full-length ACT practice test under realistic testing conditions. It's the closest thing tothe real ACT- your using an official ACT practice test from the ACT makers and taking it under similar testing conditions. This process is very time-consuming - it’ll take about four hours - but it’s worth it. Afterward, you have an ACT score from a real ACT test, whichyou can use to checkyourpreparedness to take the actual test, but I'll dive into that later. Where Can You Find a Practice Test? There are five free official ACT practice test PDFs available online, or if you own The Real ACT 3rd Edition, you could use one of those tests. If you’re using one of the free online tests, to give yourself the most realistic testing experience (and to avoid the distractions on the internet), I’d recommend that you print out a copy of the test. Key Tips fora Realistic Testing Experience Your goal is to try to accurately predict your ACT score. To do so, you need to mirror the circumstances of the actual ACT. Clear your desk.You should not have your phone, computer, dictionary or any other outside help.Note: Your phone should be off during the entire practice test.Only put some pencils, an eraser, a pencil sharpener, a calculator and extra batteries on your desk. Keep time on a watch, and stick to the exact timing for each section.Note: the time permitted is printed at the start of the section.Don’t allow yourself extra time; if you allow even an extra minute, you could end up with an inaccurate estimate.Also, you’re only allowed to work on one section during the allotted time. Don’t work on the next section if you finish early, and don’t do work on a previous section. How Do You Score Your Practice Test? Each practice test comes with scoring instructions, which are locatednear the end of the PDFs (typically in the last tenpages). You’ll start by calculating your raw score or the number of questions you answered correctly.Then, you use that raw score and a chart to find your scaled score for each section.You average the foursection scores to find your composite score. Note: This is only a baseline score- you can do dedicated ACT prep and raise your score. Start by creating a study schedule, and if you need a launching off point for your prep, read our free ACT study guides for Reading, Math, English, and Science. Create a schedule for test prep success! What Are Other Less Time Consuming Predictors? Did you take the PreACT* or SAT? If so, you can use that score to predict your ACT score. These test scores make good estimates because they’re taken under the same conditions as an ACT test (in the morning, with other students, etc.).I’ll give an overview of the pros and cons of using these tests as ACT score predictors. *Note:The PreACT is a brand new test that's debuting in the 2016-2017 school year. No one has taken it yet- the firsttest dates will be in Fall 2016. PreACT The PreACT is the next best option to taking an official ACT practice test.The PreACT was created by ACT, Inc., the same company that makes the ACT, to help predict your ACT score.It covers the same content as the ACT.Its difficulty level is similar to the ACT since it uses old ACT questions. The PreACT is graded on the same 1-36 scale.However, it’s much shorter than the actual ACT; it’s only 1 hour and 55 minutes (compared to almost 4 hours for the ACT plus Writing), so it doesnt' require the same level of endurance as the full test. Pros The PreACT was created by the same company as the ACT. It covers the same content as the ACT. The difficulty level is on par with the ACT. It is specificallyintended to predict your ACT score. Cons It’s much shorter than the actual ACT. SAT Score There are easy-to-use conversion tables that will convert your 400-1600 SAT score to a 1-36 score, but this isn’t as reliable as using a PreACT score.While the SAT is similar to the ACT and PreACT, the SAT was made by the College Board, not ACT, Inc. Though there is some matching content on the SAT and ACT, the material is not the same.For instance, while the ACT has a science section, the SAT doesn’t, and while the SAT has a no-calculator math section, the ACT doesn’t. If you use an SAT score to estimate your ACT score, the prediction could be off by up to 4 points.As an example, I got a 1420 on my SAT. Using this score and the conversion table, I found out my ACT score prediction would be 31, but I got a 34, 3 points more than the estimate.Some people do better on the ACT than the SAT (and vice versa). Pros Like the ACT, the SAT is designed to show college preparedness. Like the ACT, the SAT covers Math, Reading, and Writing topics. Cons The SAT was not created by ACT, Inc. The SAT doesn’t cover all of the material on the ACT. Estimates may not be exact (could be off by up to 4 points). Also, comparisons between the two tests are difficult to make since the SAT just underwent major changes. Some students simply performbetter on the ACT than SAT (and vice versa). Now that you know the good predictors let's examine the bad: What Won’t Be Good Predictors? I’d recommend avoiding any estimation method not mentioned above. However, here are some of the more commonly used ACT score predictors that I wouldn’t recommend. Non-Official Practice Tests Online you might find some non-official ACT practice tests (ones not created by ACT, Inc.).These will not give you a reliable ACT score prediction because they’re too dissimilar to the ACT.They don’t cover the same topics and don’t accurately copy the test format. While some students end up with scores close to the non-official prediction, the majority end up with scores 5-10 points higher or lower than the estimate. GPA Some students assume ACT scores correlate to GPA.If you have straight A’s, then you’ll get a 36; if you have a low GPA, then you’ll get a low ACT score.However, that’s not necessarily true. Some test-takers with low GPAs can get high ACT scores while others with high GPAs can end up with low scores.Don’t rely on your GPA to estimate your ACT score. AP/IB Tests Other students think that AP and IB exam score will be good ACT predictors since they cover college level material. However, these tests cover very specific, high-level subject matter such as Biology, Calculus, Economics, and History.These tests surpass the level of content covered by the ACT.Excelling or failing AP and IB exams has no correlation with ACT success. Use your predictor to see if you meet your target score. What Should You Do With Your Prediction? Are you unhappy with your predicted score? If so, you need to create an ACT prep schedule to help raise your score.Here is a rough estimate of how many hours you need to study to achieve certain score improvements: 0-1 ACT Composite Point Improvement: 10 hours 1-2 Point Improvement: 20 hours 2-4 Point Improvement: 40 hours 4-6 Point Improvement: 80 hours 6-9 Point Improvement: 150 hours+ Check out our ACT study guide for the Reading, Math, English, Science, and Writingsections to help you get started with your preparation. Are you happy with your estimated score? If so, you should still do a little ACT prep.Study for at least 10 hours.Take two practice tests with in-depth review. This way you’ll get more comfortable with the ACT test format, and you’ll be able to double check that your practice test scores match the original prediction. The ACT plusWriting has five sections:English,Math,Reading,Science, and Writing- they always appear in that order.Below is a breakdown of the timing and number of questions per section: English - 45 minutes - 75 questions Math - 60 minutes - 60 questions Reading- 35 minutes - 40 questions Science - 35 minutes - 40 questions Writing - 40 minutes - 1 essay Disclaimer: Remember that no estimate is 100% accurate, not even taking an official ACT practice test.Therefore, you should plan to take the real ACT more than once. That way, if you don’t reach your target score the first time, you have another chance. What’s Next? Now that you found your estimated ACT score how does it compare to your target score? Not sure where you’d like to go to college? Read our guide to finding your target school. Need help with your college application? Learn how to write about extracurriculars on your college application; get advice on the Common App essays. Want to improve your ACT score by 4+ points? Download our free guide to the top 5 strategies you need in your prep to improve your ACT score dramatically.

Southeast Medical Center Case Study Essay Example | Topics and Well Written Essays - 500 words

Southeast Medical Center Case Study - Essay Example In addition, other development projects resulted in the establishment of freestanding rehabilitation center with a 59 bed capacity. Moreover, SMC management also established a physicians’ building that served as their office. Besides, in 1989 the hospital acquired medical helicopters and expanded its trauma services. Furthermore, the hospital has grown into a neonatal, transplant care, and burn center within the State. Other strategic plans have led into SMC expansion into a large referral center for both local and international health care. The hospital boasts of more than 800 beds for acute care. In addition, development projects have resulted into establishment SMC community centers in various locations across the State. Consequently, the hospital has specialized in the provision of unique, sophisticated medical services that attracts numerous foreign patients. Moreover, SMC provides ambulatory services and facilities for health plan. The hospital operates an HMO health plan for charity care patients. The health care plan acts as a Medicaid insurance for States citizens who cannot afford health services (Wolper, 2011). SMC has also undergone various changes in its governance form public hospital to a private institution. In 1920s hospital board managed the hospital that later changed to a public authority. After board of trustees voted to turn the hospital over to private management, SMC has remained a not-for-profit academic health facility. Despite expansion of SMC, the hospital struggles from financial shortage. Shortage of finances has resulted from State’s decision of not providing a subsidy for SMC. Shortage of finances has resulted into the hospital loss of competitive advantage in the market. In addition, SMC cannot afford modern facilities relevant for teaching, research, and provision of health care. Consequently, SMC decided to increase costs of medical

Sentencing in international law requires reasoned discrimination Essay

Sentencing in international law requires reasoned discrimination. Critically evaluate this statement with reference to role of international tribunals - Essay Example licies regarding the international criminal court (ICC).2 Various states recognised the role of ICC in a multilateral system aiming to put to end impunity and set up the rule of law in the declaration, which was adopted in the meeting. As per the declaration, it is right to say that the key role of ICC is the enforcement and inducement of compliance in regard to the specific norms of international law prohibit and prevent mass violence.3 Following the extensive perpetration of unspeakable atrocities which were the consequences of the Second World War, the international community passed an unparalleled call for justice.4 The community sought to end serious crimes via inter alia, which is adopting the convention of preventing and punishing all crime genocides, the four Geneva conventions and the principles of Nuremberg.5 Despite the fact that sentencing in domestic jurisdictions’ importance has grown over time, it still remains part of international criminal law which is undergoing construction and is likely to be unregulated in various aspects. International sentencing law and practice has not yet been defined by proper specific norms and principles under which one should be prosecuted. International judges have continued receiving little guidance on matters concerning prosecution of individuals. Yugoslavia (ICTY) and Rwanda (ICTR) are the best examples of international sentencing which can comprehensively and coherently explain how the system works. Despite the lack of credible enforcement mechanisms, violating international humanitarian laws have continued over time with glowing impunity. The international community has responded promptly by taking a joint action that involves creating an interconnection system of international justice aiming at preventing impunity for the worst atrocities likely to happen to mankind.6 This vision came into reality in 1998 when states approved and adopted the multilateral treaty by the name Rome Statute of the International

Case Analysis for Nursing Ethics Paper Essay Example for Free

Case Analysis for Nursing Ethics Paper Essay Overview A forty-eight year old female patient was brought into the emergency department with petechiae/purpura distributed over her skin. Her husband reported that she started to bleed from her nostrils and mouth. She suddenly appeared to have had what seemed to be unexplained bruises on her body and was semi comatose. In a state of panic, her husband brought her to the emergency department. With a heart rate of 180, her blood pressure was 60/24 and she was going into endotoxic shock. She received emergency care that made her stable enough to be transferred to the ICU where she became conscious and able to communicate. The medical team explained the seriousness of her condition and their plans for her treatment but she declined their proposal for further care and complained about inadequate insurance coverage for that hospital. She further professed her faith in God for divine healing. The medical team was then faced with offering this patient treatment regardless of her ability to pay to avoid the imminent danger of her leaving the hospital at that time. Medical Indications This forty eight year old female patient, who had no medical history in this hospital was diagnosed with Disseminated Intravascular Coagulation (DIC). DIC is a rare, life-threatening condition that prevents normal blood clotting in an individual. A treatment refusal or decline may hasten the disease process resulting in excessive clotting (thrombosis) or bleeding (hemorrhage) throughout the body leading to shock, organ failure or even death. Prognosis varies depending on the underlying disorder and the extent of clotting. Regardless of the cause, the prognosis is often poor, with 10-50% of patients dying. The goal of treatment is to stop bleeding and prevent death. According to WebMD (2007), in DIC, the body’s natural ability to regulate clotting does not function properly. This causes the platelets to clump and clog small blood vessels throughout the body. This excessive clotting damages organs, destroys blood cells, and depletes the supply of platelets and other clotting factors so that the blood is no longer able to clot normally. This often causes widespread bleeding, both internally and externally, a condition that can be reversed if treatment is carried out  promptly. Current indication for treatment include interventions such as transfusion of blood cells and other blood products to replace what has been lost through bleeding. Numerous tests to establish the probable cause of this condition have to be done because it is usually a first symptom of a disease such as cancer or it could be triggered by another major health problem. Patient Preferences The patient is informed of the benefits of follow up interventions after emergency care as well as the likelihood of losing functions of major organs and even death without following interventions being implemented. The principle of autonomy comes to play since it is her right to choose where, when and how she gets her health care. Based on the medical report and her personal reasons for deciding to leave the hospital against medical advice, there seems to be no evidence that she is mentally incapable. There is also no justification in disregarding her requests nevertheless, it is doubtful if she actually understands and appreciates the situation. Her preferences were to be signed AMA (against medical advice) so she can find cheaper, alternative care. Her husband, who was present with her, tried to convince her to accept the teams’ proposal but she insisted that she could not afford it. In my opinion, the patient decision was as a result of her ignorance of what choices was av ailable to her. Quality of life The quality of life for this patient is severely compromised because of the symptoms associated with this diagnosis (bleeding, syncope, weakness, shortness of breath, etc). As stated earlier, DIC could be as a result of an underlying disease such as cancer. If so, chemotherapy and radiation could help alleviate symptoms and give her a vibrant life expectancy. Also, there is the possibility that she would experience tremendous medical progress with treatment if her diagnosis has to do with platelet malfunction. However, we cannot tell, since she turned down any advice by the team to carry out blood tests. Without immediate treatment, she runs the risk of damage to major organs of her body, which could eventually lead to death. Time is of essence here because the longer she delays intervention, the more likely she has irrevocable damage that might negatively alter her previous  quality of life. Ethical issues that would arise with this patient is the emergency care she got, it got her stable enough to where she could refuse treatment. An assumption that we could make about receiving that care is, ‘what if she got into a DIC coma and had to be on a ventilator?’. She would have been unconscious and would probably not be able to debate whether she receives care or not. Contextual features Without casting aspersions, the reason, obvious to me, for refusal of care is financial. The patient talked about shopping for cheaper healthcare. This is a patient born to American missionaries in Brazil. As an American citizen, she took up the calling of her parents and was also a missonary in Brazil for most of her life. She married a man from England who is unaware of how the American system works. Her reason is justified because she probably had little to no social security and with her sojourn in Brazil, we can say that she has been accultured. Therefore her outlook and way of thinking would affect her decision about healthcare in America. Another contextual feature is that of religion and faith, the patient said that her faith in God would heal her but failed to see that this might be why she was at the hospital at that time. It is difficult to attribute her decision solely to faith or finance alone but one thing that stands out is the fact her husband tried to convince her otherwise. Still, she kept saying this was what she wanted. Her husband seemed helpless as he tried to communicate with the team however the patient kept saying that this was about her not him. My patient’s lack of insurance, her job as a missionary and her inability to pay acts as a bias that would prejudice the providers’ evaluation of her quality of life. Analysis The goal of medicine involves promoting health, curing disease, optimizing quality of life, preventing untimely death, improving function (maleficence), educating and counseling, avoiding harm (non-maleficence) and assisting in a peaceful death. The ethical dilemma is deciding to let her go based on her wishes (autonomy) versus doing what seems to be the overall right thing (paternalism), which is giving her treatment (beneficence), thus preventing harm (non-maleficence). The maleficent nature of medicine propels the team to convince the patient of what they think would restore her  health. In a bid to ‘do good(maleficence), she got emergency care that made her stable enough to communicate and state her wishes. Apart from maleficence and non-maleficence there are multiple ethical issues embedded in this case; the medical team is faced with honoring this patient’s autonomy and letting her go when they know she could be dead in a few hours without treatment. Nevertheless the patient is exercising her autonomy at her own detriment because she and her husband got adequate disclosure communicated clearly by the healthcare team about the reasons for treatment and the benefits burdens related to her decision. The team’s scope of disclosure covered her current medical state, the possible interventions to improve prognosis and their recommendation based on clinical judgement. In addition, they are faced with medically determining her decisional capacity because of the possibility that her mental state might be affected by the pathology and her inability to afford care. If proven to be incompetent, then interventions are carried out regardless of what she wants. Hence, the medical team will deliberately override this patient’s autonomy because of their perceived notion of beneficence (paternalism). As medical practitioners, the team weighs the consequence (utilitarianism) of letting her go. To them, the action that would produce the best overall result is to go ahead and give her treatment. The ethical theory of deontology gives the team, the moral duty and obligation to do good and prevent harm. Compassion and sympathy (Ethics of care) also play a big role here, consider a patient who had committed her life to helping others, yet in her time of need could not get reciprocity. These emotions should play a major role in how the team decides to proceed. The nurse involved with this patient has an obligation to get to know this patient so that she can effectively advocate for her. Inasmuch as I know she has the right to refuse treatment, I strongly believe that her refusal is based on the insubstantiality of information and her lack of knowledge of what is accessible to her. Recommendation I recommend that the patient’s autonomy be empowered not overpowered by giving her information on what is available to her. An advocate (her nurse, case manager or social worker) should be assigned to her. In addition, the Chaplain should be invited to offer spiritual counseling. Asking the right questions, getting to understand her fears and giving her hope. Many  hospitals and clinics have patient navigators that can help determine financial aid for patients who cannot afford care or who do not have Medicaid/insurance. The team should encourage the patient that at this point money is of no consequence, her life and health come first in other words everything will be done to get her aid. I also recommend that the team critically asseses the decision-making capacity of the patient since it determines whether a patient’s health care decisions will be sought and accepted. Furthermore the patient should also be educated on and encouraged to put in place advanced directives to promote her autonomy and avoid a situation where there is no one to decide in case she is incapacitated. Justification In my opinion, Individuals respond favorably to people, things, beliefs and circumstances that hold significance, value and passion for them. Pesut’s (2009) article, confirms that incorporating spirituality into care where appropriate, has the potential to maximize health care quality. For this to be effective, the healthcare team has to look at the patient holistically, they have to put into consideration her profession of faith and how getting the chaplain involved will convince her that the medical team does not just want her money rather they value her worth. Subsequently, paternalism as a recommendation seems to be arbitrary and counteracts the autonomy of the patient, yet Whitney and McCullough (2007) in their article Physicians Silent Decisions: Because Patient Autonomy Does not Always Come First, give support to selective paternalism. They argue that Patients values and preferences play varying roles in medical decisions (Whitney et al. 2004). Indeed my patients refusal to accept care was not because she wanted to die but because her values of faith and her preference to spend within her means trumped getting the immediate intervention. Suffice to say that culture can be considered in this case because it influences values and preferences. My patients background was Brazilian, this is a country where there is little trust for the healthcare system. Hospitals and clinics are more interested in how much money they can make. So, Individuals that reside there, do not have routine checkup, they often wait till they are about to die before they go to a physician. And in this time they are constantly visiting places of worship in belief that they would be miraculously healed. As a result, my  patient probably had many symptoms over a period of time but did not go to the hospital, incidentally when she was brought in, it was a matter of life and death. With the team’s knowledge of her diagnosis and its prognosis, my patie nts preference became largely irrelevant. Yet, the physicians wanted to respect her autonomy and her sense of dignity by maintaining her part in the decision-making. As medical practitioners we uphold the goals of shared decision-making and of empowering patients to make important choices. However, these objectives provide important insights, not universal answers. In medicine, as elsewhere, individual choice, however highly we value it, must compete with individual welfare and with constraints of time and money hence the decisive factor will depend on the particular situation at hand. (Whitney and McCullough 2007 p. 37). Next, they explained that decision-making, whether silent or spoken by the physician must be understood in terms of the clinical encounter. In fact the overriding of her autonomy was for her own good. My rationale for encouraging advanced directives especially if she is deemed competent at the moment is, in the event that she can no longer make a decision in the future, something and someone will be in place to help. It will help to guide future clinical decisions and promote confidence in the decision of the surrogate she choos es. According to Lynch, Mathes and Sawicki (2008), patients are in the best position to make choices for themselves, or at least a position that is superior to that held by any other party. Therefore, patient directives must be enforced, though not through the mechanism of strict liability. (p. 158). Therefore, a decision written and signed by the patient legally would prevail, in the event that she becomes incapacitated and cannot decide she would already have that in place. Medical practitioners are encouraged to inform all patients’ about the importance of advance directives because it removes the burden of dealing with what the patients would have wanted. In summary, the discussion and justification of proceeding with medical intervention yet disregarding the patient’s decision, proves that autonomy can be respectfully countered. This is congruent in continuing with medicine’s obligation to do no harm, do good and serve in the best interest of the patient. Evaluation The desired outcome was that this patient receives the care and intervention  that she needed in time to prevent gross damage to her body thus altering her quality of life. With the input of the chaplain, her husband, the advocate and careful communication with this patient, the patient admits that she wanted the best care. She accepts the offer for financial assistance and receives the appropriate intervention. The nurse and medical personnel express satisfaction in saving her life (maleficent), Her husband is elated and he also signs an advanced directive for himself. It seemed difficult to convince the patient at first but once the suggestion for financial aid and the Chaplain was received, the patient complied with all other recommendations. References Lynch, H. F., Mathes, M., Sawicki, N.N., (2008). Compliance With Advance Directives: Wrongful Living And Tort Law Incentives. The Journal Of Legal Medicine, 29:133–178. Retrieved from http://www.ncbi.nlm.nih.gov.proxy.medlib.iupui.edu/pubmed/18569439 Pesut, B. (2009). Incorporating patients spirituality into care using Gadows ethical framework. Nurs Ethics. 2009 Jul;16(4):418-28.Retrieved from http://nej.sagepub.com.proxy.medlib.iupui.edu/content/16/4/418.long WebMD, (2007). Retrieved November 26, 2012, from http://www.webmd.com/a-to-z-guides/disseminated-intravascular-coagulation-dic-topic-overview Whitney, S. N., McCullough, B. L. (2007). Physicians’ Silent Decisions: Because Patient Autonomy Does Not Always Come First. The American Journal of Bioethics, 7(7): 33–38, 2007. Retrieved from http://mcr.sagepub.com.proxy.medlib.iupui.edu/content/early/2012/10/31/1077558712461952.long

A Bout De Souffle :: A bout de souffle Jean-Luc Godard

'A bout de souffle', Jean-Luc Godard's eerste 'feature' film (1960), heeft een vrij simpele verhaallijn, dat geschreven is door vroegere collega en vriend Francois Truffaut: Een man steelt een auto in Marseilles en rijdt naar Parijs. Tijdens deze rit wordt de hoofdpersoon, Michel Poiccard, aangehouden door de politie wegens het overschrijden van de maximum snelheid, waarna hij een agent neerschiet en rennend verder gaat naar de lichtstad. In Parijs moet hij geld ophalen bij een vriend van hem en probeert hij een Amerikaanse vrouw, Patricia, over te halen om mee te vertrekken naar Rome. Zij twijfelt over haar liefde voor Michel, wat resulteert in verraad, aangezien ze uiteindelijk, wanneer ze op het punt staan Parijs te verlaten, de politie informeert over het adres waar Michel op dat moment zich bevindt. In plaats van te vluchten besluit Michel te blijven en op de politie te wachten om naar de gevangenis te gaan. Maar wanneer de politie arriveert, werpt een vriend een pistool naar he m in een laatste poging hem te redden. De politie raakt in paniek en schiet Michel neer, waarna hij wankelend door de straten loopt om uiteindelijk aan het einde door zijn knieà «n te zakken en te sterven. Dit is in grote lijn het verhaal in 'A Bout de Souffle' en hoewel de film amuserend kan zijn zonder een poging te ondernemen de film te analyseren, kan de status van 'meesterwerk' alleen begrepen worden door een analyse van zijn historische context. We moeten, vooral in een film als 'A Bout de Souffle', proberen de cinematografische stijlen in Europa en Amerika in 1960 te begrijpen. Er zijn drie aan elkaar gerelateerde feiten over Godard en zijn 'A Bout de Souffle' die de film tot een nieuw historische mijlpaal maken op het gebied van de kunst (met name de audiovisuele kunst). Ten eerste, was Godard extreem bewust van de relatie van zijn medium met andere vormen van expressie. Vooral literatuur, filosofie en de schilderkunst. In zijn stijl valt deze 'interconnectiviteit' tussen de verschillende media duidelijk op te merken. In een interview in 1962 zegt hij: "Voor mij is de continuà ¯teit van alle vormen van expressie erg belangrijk."# Ten tweede, hoewel 'A Bout de Souffle' een enorme afkeer kent van de geaccepteerde methodes van cinematografie, kende Godard zijn plek in de evolutie van filmstijl, en kunnen we zien dat deze afkeer een manifestatie is van het bewust zijn van die geaccepteerde norm.