Sunday, January 26, 2020
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‚  ¯ General Background Questions Your age à ¯Ã‚  ¯ under 35 years of age à ¯Ã‚  ¯ 36 to 45 years of age à ¯Ã‚  ¯ 46 to 55 years of age à ¯Ã‚  ¯ 56 to 65 years of age à ¯Ã‚  ¯ over 65 years of age Your gender à ¯Ã‚  ¯ male à ¯Ã‚  ¯ female Your medical specialty à ¯Ã‚  ¯ General practice à ¯Ã‚  ¯ Palliative medicine à ¯Ã‚  ¯ Neurology à ¯Ã‚  ¯ Elderly Care à ¯Ã‚  ¯ Other, please specify Grading of your post à ¯Ã‚  ¯ Consultant à ¯Ã‚  ¯ Specialist registrar à ¯Ã‚  ¯ Associate specialist / staff grade à ¯Ã‚  ¯ SHO / HO / F1 / F2 à ¯Ã‚  ¯ GP principal à ¯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‚  ¯ yes à ¯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‚  ¯ male à ¯Ã‚  ¯ female 2 Age of the deceased (please estimate if unsure) à ¯Ã‚  ¯ under 1 year à ¯Ã‚  ¯ 1-9 years à ¯Ã‚  ¯ 10-19 years à ¯Ã‚  ¯ 20-29 years à ¯Ã‚  ¯ 30-39 years à ¯Ã‚  ¯ 40-49 years à ¯Ã‚  ¯ 50-59 years à ¯Ã‚  ¯ 60-69 years à ¯Ã‚  ¯ 70-79 years à ¯Ã‚  ¯ 80-89 years à ¯Ã‚  ¯ 90 years and over 3 Place of death à ¯Ã‚  ¯ hospital à ¯Ã‚  ¯ hospice à ¯Ã‚  ¯ care home à ¯Ã‚  ¯ deceaseds own home à ¯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‚  ¯ before or at the time of death: go to Question 6 à ¯Ã‚  ¯ after death: go to question 30, on page 7 6 How long had you known this patient? à ¯Ã‚  ¯ more than six months à ¯Ã‚  ¯ one to six months à ¯Ã‚  ¯ one to four weeks à ¯Ã‚  ¯ between one day and one week à ¯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‚  ¯ no à ¯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‚  ¯ no à ¯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‚  ¯ no à ¯Ã‚  ¯ yes, morphine or another opioid à ¯Ã‚  ¯ yes, benzodiazepine à ¯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‚  ¯ no à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no treatment withheld à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes à ¯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‚  ¯ no à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no drugs used to alleviate symptoms à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes à ¯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‚  ¯ no à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ no treatment withheld à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes à ¯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‚  ¯ no à ¯Ã‚  ¯ yes à ¯Ã‚  ¯ the patient à ¯Ã‚  ¯ you or another health care colleague à ¯Ã‚  ¯ a relative à ¯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‚  ¯ patient had pain à ¯Ã‚  ¯ patient had other symptoms à ¯Ã‚  ¯ request or wish of the patient à ¯Ã‚  ¯ request or wish of relatives à ¯Ã‚  ¯ expected further suffering à ¯Ã‚  ¯ no chance of improvement à ¯Ã‚  ¯ treatment would have been futile à ¯Ã‚  ¯ further treatment would have increased suffering à ¯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‚  ¯ more than six months à ¯Ã‚  ¯ one to six months à ¯Ã‚  ¯ one to four weeks à ¯Ã‚  ¯ between one day and one week à ¯Ã‚  ¯ less than 24 hours à ¯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‚  ¯ yes, at the time of performing the act/omission or shortly before: go to Question 15 à ¯Ã‚  ¯ yes, some time beforehand: go to Question 15 à ¯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‚  ¯ yes à ¯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‚  ¯ yes à ¯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‚  ¯ yes, upon an oral request à ¯Ã‚  ¯ yes, upon a written request à ¯Ã‚  ¯ yes, upon both an oral and a written request à ¯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‚  ¯ yes: go to Question 21 à ¯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‚  ¯ yes à ¯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‚  ¯ patient was too young à ¯Ã‚  ¯ the last mentioned act or omission was clearly the best one for the patient à ¯Ã‚  ¯ discussion would have done more harm than good à ¯Ã‚  ¯ patient was unconscious à ¯Ã‚  ¯ patient had significant cognitive impairment à ¯Ã‚  ¯ patient was suffering from a psychiatric disorder à ¯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‚  ¯ with one or more medical colleagues à ¯Ã‚  ¯ nursing staff /other caregivers à ¯Ã‚  ¯ by partner/relatives of the patient à ¯Ã‚  ¯ someone else à ¯Ã‚  ¯ nobody 22 Which were the most important reasons for the last-mentioned act or omission? (please tick all that apply) à ¯Ã‚  ¯ patient had pain à ¯Ã‚  ¯ patient had other symptoms à ¯Ã‚  ¯ request or wish of the patient à ¯Ã‚  ¯ request or wish of relatives à ¯Ã‚  ¯ expected further suffering à ¯Ã‚  ¯ no chance of improvement à ¯Ã‚  ¯ further treatment would have been futile à ¯Ã‚  ¯ further treatment would have increased suffering à ¯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‚  ¯ partners/relatives of the patient à ¯Ã‚  ¯ nursing or other care staff à ¯Ã‚  ¯ someone else à ¯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‚  ¯ yes, clearly: go to Question 25 à ¯Ã‚  ¯ yes, but not very clearly: go to Question 25 à ¯Ã‚  ¯ no: go to Question 26 25 Did the patients wish for this outcome reduce or disappear over time? à ¯Ã‚  ¯ no à ¯Ã‚  ¯ yes, in response to care provided à ¯Ã‚  ¯ yes, other reason 26 The treatment during the last week was mainly aimed at: à ¯Ã‚  ¯ recovery à ¯Ã‚  ¯ prolonging life à ¯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‚  ¯ à ¯Ã‚  ¯ specialist in pain relief à ¯Ã‚  ¯ à ¯Ã‚  ¯ palliative care team à ¯Ã‚  ¯ à ¯Ã‚  ¯ psychiatrist / psychologist à ¯Ã‚  ¯ à ¯Ã‚  ¯ nursing staff à ¯Ã‚  ¯ à ¯Ã‚  ¯ social care worker à ¯Ã‚  ¯ à ¯Ã‚  ¯ spiritual caregiver à ¯Ã‚  ¯ à ¯Ã‚  ¯ volunteer à ¯Ã‚  ¯ à ¯Ã‚  ¯ family member à ¯Ã‚  ¯ à ¯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‚  ¯ yes à ¯Ã‚  ¯ no: go to Question 29a à ¯Ã‚  ¯ midazolam à ¯Ã‚  ¯ other benzodiazepine à ¯Ã‚  ¯ morphine or another opioid à ¯Ã‚  ¯ other type of medication à ¯Ã‚  ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. hours before death à ¯Ã‚  ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. days before death à ¯Ã‚  ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. weeks before death à ¯Ã‚  ¯ patient had intractable pain à ¯Ã‚  ¯ patient had intractable psychological distress à ¯Ã‚  ¯ patient had other intractable symptoms à ¯Ã‚  ¯ request or wish of the patient à ¯Ã‚  ¯ request or wish of relatives à ¯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‚  ¯ yes à ¯Ã‚  ¯ no go to Question 30 à ¯Ã‚  ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. hours before death à ¯Ã‚  ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. days before death à ¯Ã‚  ¯Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. weeks before death à ¯Ã‚  ¯ No increase à ¯Ã‚  ¯ Gradual increase à ¯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‚  ¯ Definitely should be allowed à ¯Ã‚  ¯ Probably should be allowed à ¯Ã‚  ¯ Probably should not be allowed à ¯Ã‚  ¯ Definitely should not be allowed à ¯Ã‚  ¯ Definitely should be allowed à ¯Ã‚  ¯ Probably should be allowed à ¯Ã‚  ¯ Probably should not be allowed à ¯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‚  ¯ Definitely should be allowed à ¯Ã‚  ¯ Probably should be allowed à ¯Ã‚  ¯ Probably should not be allowed à ¯Ã‚  ¯ Definitely should not be allowed à ¯Ã‚  ¯ Definitely should be allowed à ¯Ã‚  ¯ Probably should be allowed à ¯Ã‚  ¯ Probably should not be allowed à ¯Ã‚  ¯ Definitely should not be allowed 32 Religion: what is your religion? à ¯Ã‚  ¯ None à ¯Ã‚  ¯ Christian (including Church of England, Catholic, Protestant and all other Christian denominations) à ¯Ã‚  ¯ Buddhist à ¯Ã‚  ¯ Hindu à ¯Ã‚  ¯ Jewish à ¯Ã‚  ¯ Muslim à ¯Ã‚  ¯ Sikh Any other religion, please write in 33 Religion: would you describe yourself as: à ¯Ã‚  ¯ extremely religious à ¯Ã‚  ¯ very religious à ¯Ã‚  ¯ somewhat religious à ¯Ã‚  ¯ neither religious nor non-religious à ¯Ã‚  ¯ somewhat non-religious à ¯Ã‚  ¯ very non religious à ¯Ã‚  ¯ extremely non religious à ¯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‚  ¯ any White background B Mixed à ¯Ã‚  ¯ White and Black Caribbean à ¯Ã‚  ¯ White and Black African à ¯Ã‚  ¯ White and Asian à ¯Ã‚  ¯ Any Other Mixed background, please write in C Asian or Asian British à ¯Ã‚  ¯ Indian à ¯Ã‚  ¯ Pakistani à ¯Ã‚  ¯ Bangladeshi à ¯Ã‚  ¯ Any Other Asian background, please write in D Black or Black British à ¯Ã‚  ¯ Caribbean à ¯Ã‚  ¯ African à ¯Ã‚  ¯ Any Other Black background, please write in E Chinese or other ethnic group à ¯Ã‚  ¯ Chinese à ¯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
Saturday, January 18, 2020
Populism and the Jacksonian Democrats Essay
Question: In what ways were the late nineteenth-century Populists the heirs of the Jacksonian-Democrats with respect to overall objectives and specific proposals for reform? The Populists of the late nineteenth-century were in many aspects the heirs of the Jacksonian Democrats, carrying on the legacy and tradition left behind. The Populists were very similar to the Jacksonians in many of their overall objectives and specific reform proposals. During the Jacksonian Era from about 1828-1842, the Democrats set the standard to be carried on later by the Populists. The Jacksonian Democrats identified with the common man. They wanted all democrats to agree. In 1828, Andrew Jackson was elected president and he was later reelected in 1832. In the year of his reelection, Jackson established the spoils system to reform the government, removing some federal officeholders (â€Å"To the victor belong the spoils†) and made the right of elected officials to appoint their own followers to public office and established feature of American politics. Also in this year, Jackson vetoed the bill to recharter the Bank of the United States. This sets the tone for his, and the Democrats, ongoing battle with the Bank and its president, Nicholas Biddle, later to rise to climax when Jackson removed federal deposits from the Bank of the United States. A year later, in 1833, the nullification crisis erupted, pushing Jackson and his Democrats into another battle, this one with John Calhoun and nullification. Jackson insisted that nullification was treason and those implementing it were traitors. The nullification crisis was averted by compromise: the lowering of the tariff of 1828, the tariff of abominations, gradually be lowered. Jackson believed in a distinct, but simple theory of democracy, that it should offer â€Å"equal protection and equal benefits†to all its white male citizens and favor no region of class over another. This meant an assault on what he considered the citadels of the eastern aristocracy and an effort to extend opportunities to the rising classes of the west and south. It also meant a firm commitment to the continuing subjugation of African Americans and Indians, keeping these â€Å"dangerous†elements from the politic body to keep the white-male democracy they valued in preservation. Carrying on the Jacksonian legacy, the Populists were mostly farmers and industrial workers; they were the common man. They believed that wealth belonged to the working class, those who create the wealth, not the owners and a graduated income tax (as the income goes up, the tax rate goes up, so wealthier people pay more taxes than the poor). The Populists were champions of the workingman, pushing for better work conditions and a shorter workweek, as well as putting more money in the hands of the workers. One of the biggest reform proposals of the populists was bimetallism and free coinage of silver. Free coinage of silver would have increased the supply of money since silver was in easy circulation. An increase in the supply of money would generally lead to inflation unless the supply of goods and services by at least as much. As did many industrial workers fearing for their jobs, the Populists wanted to limit immigration. In carrying on the legacy left by the Jacksonian Democrats, the Populists exhibited many of the same ideas and proposals. The election of Andrew Jackson to the presidency in 1828 marked not only the triumph of a particular vision of government and democracy, it represented the emergence of a new political world. The Populists emergence in 1873 represented the emergence of a new political world as well. The Jacksonians may have represented and identified with the common man, but the Populists were the common man. During both eras, a main reform movement of each was to upset the eastern powers; Jackson was to defeat the stranglehold of the aristocratic east on the nation’s economic life; the Populists were set to defeat the stranglehold of the industrial east on the nation’s economic life. Both parties were champions of the common man, although it was the Populists championing themselves. The legacy and tradition left behind by the Jacksonian Democrats was aptly picked up by the Populists of the nineteenth-century.
Thursday, January 9, 2020
What You Dont Know About Problem Solution Essay Topics
What You Don't Know About Problem Solution Essay Topics The central area of the article that's the body will explain the issue in detail and provide a clear way to solve the issue also. As soon as you locate a service you prefer, don't neglect to look at my review of it. Solution is a procedure or action that settles the issue. The issue and solution essay writing procedure can be created easy when you've got a plan in mind. Key Pieces of Problem Solution Essay Topics Additionally, when writing an essay, it is likewise required to think about picking a topic that has a viable or practical solution. After that, write about the way in which the issue is usually resolved within the book in addition to your own ideas about how you would address the issue. When you're assigned to compose a problem-solution essay or research paper, picking a fantastic topic is the initial dilemma you have to work out. Writing a problem solution essay can be hard, particularly if you are the perso n choosing the topic. Choosing Good Problem Solution Essay Topics The feedback you get from any certain post updates in real-time and changes every moment. Task response you should be certain that you fully grasp the question and create the answers appropriately. Thinking up a thesis statement can be difficult, but it helps in case you pick a topic you feel strongly about. Writing an issue and solution essay might appear challenging in the beginning, but after you've got your subject, you're golden. Problem-solution essays argue for a specific remedy to an issue or demonstrate an urgent need to address the issue. Whichever problem solution topic you select, you're going to be able to earn every reader interested, raise some very important questions, and talk about the issues of urgent importance. The definition of an issue solution essay specifies it is supposed to contain identification of a specific problem with a corresponding solution or plan of the way to deal with the presented problem. If you don't have a thing to write about in regards to your essay it's an issue. A story which makes the problem seem essential and dramatic is the ideal way to begin a problem solution essay there are lots of issues on the planet, and should you need your reader to think yours is an important one to solve, you will need to catch their attention with something they'll remember. When writing an essay, you want to understand that however much you know about the topic, there's always more to learn. For some thing to turn into an exceptional powerful essay matter, it needs to be a controversial matter. What You Must Know About Problem Solution Essay Topics The argument concerning child nutritional issues, particularly being overweight, can be managed. You should state who will be responsible for implementing the issue and the way they'd go about doing it. A great topic might be something as easy as improving time management to address the issue of getting to school in time daily or as complex as finding ways to cut back the amount of violent crimes. Superior topics of interest will appear into reasons on the other side of the controversy and give potential solutions to help others understand people's position on the issue. During the duration of your academic career, whether at school or university, you'll almost certainly have to write a minumum of one problem solution essay. In case that you still have questions, a good idea is to seek advice from your teacher. In order for those students to fix a problem in a mathematics classroom they must first understand the issue or understand what they're requested to find or do. Each participating student or family is necessary to purchase a Student Publication. The Debate Over Problem Solution Essay Topics As stated earlier, there are 9 varieties of essays. Writing the essay Now that each one of the necessities of an essay are planned well, you can begin writing the essay. Hence, yo u've been provided with the simplest topic for problem solution essays, you can pick any on of the above mentioned and get started writing your essay immediately. Taking into account that lots of persuasive essays concern controversial topics, before writing, you might want to sit down and think of what your opinion on the topic actually is. It's feasible for you to find problem solution essays help if you make an order for your paper from us. You want to obey a certain structure as such kind of paper usually contains many components. You can open a chain reaction by means of your essay. Family abuse is just one of the burning problems of nowadays. Folks want the solutions to the issues that aren't costly. Lately, a great deal of working professionals are migrating to developed countries for the interest of jobs. UKWriting's writers are lots of the greatest in the uk. There are many problems, even on your own campus, which need to be resolved. The main issue for everyone who hopes to migrate to a huge city is that the price of living is probably going to be greater than it's in a little town or village. There are additionally some descriptions so you might secure the fullest picture of what a terrific topic ought to be. It's possible for you to discover some topics in lots of places. Otherwise, then the very first point to know is that you ought to start by viewing a range of topics before choosing one that's suitable. The variety of paragraphs are determined by the amount of solutions.
Wednesday, January 1, 2020
My I Wish You d Die - 816 Words
â€Å"I wish you’d die†I whispered on the night of July 22, 2013. I laid in bed thinking about my, unfortunately, biological father. I was comparing him to my step-dad. Did I think he could of ever been as close of a father like my step-dad? A few days ago he had promised to pick me up earlier that evening so that we could spend a whole day together the following day, but he never showed up. Many times this had happened and I couldn’t stand it no longer. I looked at the clock and it ticked slowly, it seemed to be more tired than I was. A second seemed like a minute, a minute seemed like an hour, the night seemed like an eternity. I anxiously waited for sleep to engulf me. Hours later when the night sky was no longer black, like the ocean†¦show more content†¦Ã¢â‚¬Å"Remember when I left to my room last night when Gabriel didn’t show up so that we could spend all day together today? Well, when I left to my room I just fell asleep right away†I lied. â€Å"Oh. I m sorry he didn’t show up honey†then she went on telling me how he was irrelevant in my life, despite him being my biological father. A few minutes later as I enjoyed a delicious cup of chocolate the house phone rang. I has offered to pick it up but my grandmother was already on her way. I sat in the kitchen sipping on my cup looking out the window. The sky had grown gray and I felt the hairs on my back stand up. My grandmother returned to the kitchen with eyes of sadness that stared at me as she stood under the arch. She tried to say something but no words were produced. â€Å"Is something wrong I said asked?†I had said as got up from my seat and made my way to the entrance of the kitchen. â€Å"Your mother is on the phone. She, she wants to talk to you†We made our way to the living room where the phone was kept. I reached the phone and slowly placed it next to my ear. â€Å"Hello?†I spoke with fear. â€Å"Christian†She had replied softly. â€Å"Is something wrong?†I asked as scenarios of what was possibly wrong with her took over my head. â€Å"Christian,†she sniffed. Had she been crying? â€Å"Mom what’s wrong?†I asked urgently. Did she have cancer? Was she going to die? â€Å"Your father, he
Tuesday, December 24, 2019
A Student With A Learning Disability - 1084 Words
Meiling is a 6th grade student attending Northeast Middle School. As a result of the reevaluation conducted on December of 2015, she is currently identified as a student with a Specific Learning Disability in Basic Reading Skills, Reading Comprehension, Written Expression, Mathematics Computation, and Mathematics Problem Solving as well as a Speech and Language Impairment. Meiling receives academic support twice in a six-day cycle with the learning support teacher. She is in an itinerant learning support classroom and the learning support teacher is with her in all academic classes. REEVALUATION INPUT: Meiling obtained an overall Full Scale IQ score within the Extremely Low Range, as reflected by a standard score of 63. Meiling’s performance produced a standard score of 70. Standardized Achievement Assessment Standard Score Qualitative Description ORAL LANGUAGE COMPOSITE Listening Comprehension 72 (61-83) Below Average READING SOUND SYMBOL COMPOSITE 71 (65-77) Below Average Phonological Processing 76 (67-85) Below Average Nonsense Word Decoding 73 (67-79) Below Average DECODING COMPOSITE 68 (64-72) Low Letter Word Recognition 65 (59-71) Low Nonsense Word Decoding 73 (67-79) Below Average READING FLUENCY COMPOSITE 72 (64-80) Below Average Silent Reading Fluency 82 (71-93) Below Average Word Recognition Fluency 76 (63-89) Below Average Decoding Fluency 66 (53-79) Below Average WIAT-III Reading Fluency assessment results Oral Reading Fluency 79 (72-86)Show MoreRelatedStudents With Disabilities With Learning Disabilities Essay2573 Words  | 11 Pages 1 Students with Disabilities Intro Robert Hansel said, ?I have a Disability yes that?s true, but all that means is I may have to take a slightly different path than you.? This is very true for the many students who are living with a disability. Every learner needs to take their own unique path to acquire the skills needed to succeed in school and in life. For students with learning disabilities, this means that they may have special accommodations to help them along the way. These accommodationsRead MoreStudent Students With Learning Disabilities784 Words  | 4 PagesDiscussion Expected Findings Students with learning disabilities often experience more motivational problems than their peers, and by teaching goal setting, students will have access to a strategy they can use to achieve greater motivation and success. The researcher expects the participants to experience increased motivation and self-efficacy, and improved performance in the areas of reading, math, and behavior after learning how to set short-term goals for themselves. If the goal setting strategyRead MoreLearning Disabled Students With Learning Disabilities Essay1804 Words  | 8 PagesA learning disabled student not only suffers from being below average in academics, but in many cases these students suffer with mental illnesses. Students with learning disabilities have lower self-determination in academics and struggle in post-secondary education (Jameson, 2007). Higher levels of anxiety and test taking anxiety can additionally be found in students with learning disabilities (Nelson, Lindstrom, Foels, 2 015). Studies also show that students with learning disabilities have a higherRead MoreTeaching And Learning For Students With Disabilities775 Words  | 4 Pages In order for students with disabilities to learn in a science classroom, there needs to be a balanced approach to learning that includes both instructed and constructed learning activities. Direct teaching and mnemonic strategies can be used in order for students to learn vocabulary and facts. 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But ones with minor learning differences will be seenRead MoreThe Learning Of Students With Severe Disabilities1123 Words  | 5 Pagesof grade level biographies adapted and read to students with severe disabilities and then using least intrusive prompts and organizers to answer comprehension questions starting with wh and sequence of the story. Previous studies used time delay and task analysis to study the learning of students with severe disabilities. Para professionals showed constant time delay worked for students learning science and history. Students with severe disabilities were also taught using multiple exemplar trainingRead MoreMotivation Students With Learning Disabilities886 Words  | 4 PagesMotivation in Students with Learning Di sabilities Rizka Puspitarani (3490616) What is Learning Disability? Learning disabilities (LD), or in some clinical cases called specific learning disorder, is a neurodevelopmental disorder which the individual is experiencing difficulties in learning and using academic skills (American Psychiatric Association, 2013). Person with LD usually shows at least one difficulty in literacy (i.e.: inaccurate or slow and takes effort to read, difficult to understandRead MoreOnline Learning For Students With Disabilities948 Words  | 4 PagesThe cast website was designed to give teachers and future teachers some tools on how to better teach their students, while also promoting the use of something called the Universal Design of Learning better known as (UDL). The reason that this website is promoting the Universal Design of Learning is so that teachers can reach all of their students learning types, while only having to teach a subject one time rather than multiple times. Some other reasons why this program is important for teachersRead MoreInclusion For St udents With Learning Disabilities2259 Words  | 10 Pages[Inclusion for students with learning disabilities] [Inclusion for students with learning disabilities] 13 The Inclusion for Students with Learning Disabilities in Special Education Lehigh University Bowei Chen Many researches show that students with learning disabilities have a high rate of victimization. This paper gives few case studies about how elementary schools implement the policy and guidelines to inclusive the students with learning disabilities. The purposeRead MoreClassroom And Student Implications : Students With Learning Disabilities964 Words  | 4 PagesClassroom/Student Implications: In the classroom, the student with learning disabilities, notably struggles with pronouncing simple words, reading, or solving math problems as their peers. The major ramification of learning disabilities is the underachievement in one or more academic skills that are shared by most students with LD, with reading as the most difficult area for students. Later, their struggling might reach a point of dropping out of school, which rate is 8% (one out five students with
Monday, December 16, 2019
Blood Promise Chapter Nine Free Essays
string(70) " He took a step closer to where I sat, and I saw his guardians tense\." â€Å"I thought you were a dream,†I said. They all remained standing, the dhampirs fanning out around the Moroi in a sort of protective formation. Abe’s was the strange face I’d seen while I’d been going in and out of consciousness after the fight by the barn. We will write a custom essay sample on Blood Promise Chapter Nine or any similar topic only for you Order Now He was older than me, close to Olena’s age. He had black hair and a goatee, and about as tan a complexion as Moroi ever had. If you’ve ever seen tan or dark-skinned people who are sick and grow pale, it’s a lot like that. There was some pigment in his skin, but it was underscored by an intense pallor. Most astonishing of all was his clothing. He wore a long dark coat that screamed money, paired with a cashmere crimson scarf. Below it, I could see a bit of gold, a chain to match the gold hoop earring he wore in one of his ears. My initial impression of that flamboyance would have been pirate or pimp. A moment later, I changed my mind. Something about him said he was the kind of guy who broke kneecaps to get his way. â€Å"Dream, eh? That,†the Moroi said, with the very slightest hint of a smile, â€Å"is not something I hear very often. Well, no.†He reconsidered. â€Å"I do occasionally show up in people’s nightmares.†He was neither American nor Russian; I couldn’t identify the accent. Was he trying to impress me or intimidate me with his big, bad reputation? Sydney hadn’t been afraid of him, exactly, but she’d certainly possessed a healthy amount of wariness. â€Å"Well, I assume you already know who I am,†I said. â€Å"So, the question now is, what are you doing here?†â€Å"No,†he said, the smile turning harder. â€Å"The question is, what are you doing here?†I gestured back to the house, trying to play it cool. â€Å"I’m going to a funeral.†â€Å"That’s not why you came to Russia.†â€Å"I came to Russia to tell the Belikovs that Dimitri was dead, seeing as no one else bothered to.†That was turning into a handy explanation for me being here, but as Abe studied me, a chill ran down my spine, kind of like when Yeva looked at me. Like that crazy old woman, he didn’t believe me, and again I felt the dangerous edge to his otherwise jovial personality. Abe shook his head, and now the smile was gone altogether. â€Å"That’s not the reason either. Don’t lie to me, little girl.†I felt my hackles going up. â€Å"And don’t interrogate me, old man. Not unless you’re ready to tell me why you and your sidekicks risked driving that road to pick up Sydney and me.†Abe’s dhampirs stiffened at the words old man, but to my surprise, he actually smiled again-though the smile didn’t reach his eyes. â€Å"Maybe I was just helping out.†â€Å"Not from what I hear. You’re the one who had the Alchemists send Sydney with me here.†â€Å"Oh?†He arched an eyebrow. â€Å"Did she tell you that? Mmm†¦ that was bad behavior on her part. Her superiors aren’t going to like that. Not at all.†Oh, damn. I’d spoken without thinking. I didn’t want Sydney to get in trouble. If Abe really was some kind of Moroi Godfather type-what had she called him? Zmey? The snake?-I didn’t doubt he could talk to other Alchemists to make her life even more miserable. â€Å"I forced it out of her,†I lied. â€Å"I†¦ I threatened her on the train. It wasn’t hard. She’s already scared to death of me.†â€Å"I don’t doubt she is. They’re all scared of us, bound by centuries of tradition and hiding behind their crosses to protect them-despite the gifts they get from their tattoos. In a lot of ways, they get the same traits as you dhampirs-just no reproductive issues.†He gazed up at the stars as he spoke, like some sort of philosopher musing on the mysteries of the universe. Somehow, that made me angrier. He was treating this like a joke, when clearly he had some agenda regarding me. I didn’t like being part of anyone’s plans-particularly when I didn’t know what those plans were. â€Å"Yeah, yeah, I’m sure we could talk about the Alchemists and how you control them all night,†I snapped. â€Å"But I still want to know what you want with me.†â€Å"Nothing,†he said simply. â€Å"Nothing? You’ve gone to a lot of trouble to set me up with Sydney and follow me here for nothing.†He looked back down from the sky, and there was a dangerous glint in his eyes. â€Å"You’re of no interest to me. I have my own business to run. I come on behalf of others who are interested in you.†I stiffened, and at last, true fear ran through me. Shit. There was a manhunt out for me. But who? Lissa? Adrian? Tatiana? Again, that last one made me nervous. The others would seek me out because they cared. But Tatiana†¦ Tatiana feared I’d run off with Adrian. Once more I thought that if she wanted me found, it might be because she wanted to ensure I didn’t come back. Abe struck me as the kind of person who could make people disappear. â€Å"And what do the others want? Do they want me home?†I asked, trying to appear unafraid. â€Å"Did you think you could just come here and drag me back to the U.S.?†That secretive smile of Abe’s returned. â€Å"Do you think I could just drag you back?†â€Å"Well,†I scoffed, again without thinking, â€Å"you couldn’t. Your guys here could. Well, maybe. I might be able to take them.†Abe laughed out loud for the first time, a rich, deep sound filled with sincere amusement. â€Å"You live up to your brash reputation. Delightful.†Great. Abe probably had a whole file on me somewhere. He probably knew what I liked for breakfast. â€Å"I’ll make a trade with you. Tell me why you’re here, and I’ll tell you why I’m here.†â€Å"I already told you.†In a flash, the laughter was gone. He took a step closer to where I sat, and I saw his guardians tense. You read "Blood Promise Chapter Nine" in category "Essay examples" â€Å"And I told you not to lie to me. You’ve got a reason for being here. I need to know what it is.†â€Å"Rose? Can you come in here?†Back toward the Belikov house, Viktoria’s clear voice rang out in the night. Glancing behind me, I saw her standing in the doorway. Suddenly, I wanted to get away from Abe. There was something lethal underneath that gaudy, jovial facade, and I didn’t want to spend another minute with him. Leaping up, I began backing toward the house, half-expecting his guardians to come kidnap me, despite his words. The two guys stayed where they were, but their eyes watched me carefully. Abe’s quirky smile returned to his face. â€Å"Sorry I can’t stay and chat,†I said. â€Å"That’s all right,†he said grandly. â€Å"We’ll find time later.†â€Å"Not likely,†I said. He laughed, and I hastily followed Viktoria into the house, not feeling safe until I shut the door. â€Å"I do not like that guy.†â€Å"Abe?†she asked. â€Å"I thought he was your friend.†â€Å"Hardly. He’s some kind of mobster, right?†â€Å"I suppose,†she said, like it was no big deal. â€Å"But he’s the reason you’re here.†â€Å"Yeah, I know about him coming to get us.†Viktoria shook her head. â€Å"No, I mean here. I guess while you were in the car, you kept saying, ? ®Belikov, Belikov.’ Abe figured you knew us. That’s why he took you to our house.†That was startling. I’d been dreaming of Dimitri, so of course I would have said his last name. But I’d had no idea that was how I’d ended up here. I’d figured it was because Olena had medical training. Then Viktoria added the most astonishing thing of all. â€Å"When he realized we didn’t know you, he was going to take you somewhere else-but grandmother said we had to keep you. I guess she’d had some dream that you’d come to us.†â€Å"What?†Crazy, creepy Yeva who hated me? â€Å"Yeva dreamed about me?†Viktoria nodded. â€Å"It’s this gift she has. Are you sure you don’t know Abe? He’s too big-time to be here without a reason.†Olena hurried over to us before I could respond. She caught hold of my arm. â€Å"We’ve been looking for you. What took so long?†This question was directed to Viktoria. â€Å"Abe was-â€Å" Olena shook her head. â€Å"Never mind. Come on. Everyone’s waiting.†â€Å"For what?†I asked, letting her drag me through the house to the backyard. â€Å"I was supposed to tell you,†explained Viktoria, scurrying along. â€Å"This is the part where everyone sits and remembers Dimitri by telling stories.†â€Å"Nobody’s seen him in so long; we don’t know what’s happened to him recently,†said Olena. â€Å"We need you to tell us.†I flinched. Me? I balked at that, particularly when we emerged outside and I saw all those faces around the campfire. I didn’t know any of them. How could I talk about Dimitri? How could I reveal what was closest to my heart? Everyone seemed to blur together, and I thought I might faint. For the moment, none of them noticed me. Karolina was speaking, her baby in her arms. Every so often she’d pause, and the others would laugh. Viktoria sat down on a blanket-covered spot on the ground and pulled me down beside her. Sydney joined us a little while later. â€Å"What’s she saying?†I whispered. Viktoria listened to her sister for a few moments and then leaned closer to me. â€Å"She’s talking about when Dimitri was very young, how he used to always beg her and her friends to let him play with them. He was about six and they were eight and didn’t want him around.†Viktoria paused again to take in the next part of the story. â€Å"Finally, Karolina told him he could if he agreed to be married off to their dolls. So Karolina and her friends dressed him and the dolls up over and over and kept having weddings. Dimitri was married at least ten times.†I couldn’t help but laugh as I tried to picture tough, sexy Dimitri letting his big sister dress him up. He probably would have treated his wedding ceremony with a doll as seriously and stoically as he did his guardian duties. Other people spoke, and I tried to keep up with the translations. All the stories were about Dimitri’s kindness and strength of character. Even when not out battling the undead, Dimitri had always been there to help those who needed it. Almost everyone could recall sometime that Dimitri had stepped up to help others, going out of his way to do what was right, even in situations that could put him at risk. That was no surprise to me. Dimitri always did the right thing. And it was that attitude that had made me love him so much. I had a similar nature. I too rushed in when others needed me, sometimes when I shouldn’t have. Others called me crazy for it, but Dimitri had understood. He’d always understood me, and part of what we’d worked on was how to temper that impulsive need to run into danger with reason and calculation. I had a feeling no one else in this world would ever understand me like he did. I didn’t notice how strongly the tears were running down my cheeks until I saw everyone looking at me. At first, I thought they considered me crazy for crying, but then I realized someone had asked me a question. â€Å"They want you to talk about Dimitri’s last days,†Viktoria said. â€Å"Tell us something. What he did. What he was like.†I used my sleeve to clean my face and looked away, focusing on the bonfire. I’d spoken in front of others before without hesitation, but this was different. â€Å"I†¦ I can’t,†I told Viktoria, my voice strained and soft. â€Å"I can’t talk about him.†She squeezed my hand. â€Å"Please. They need to hear about him. They need to know. Just tell us anything. What was he like?†â€Å"He†¦ he was your brother. You know.†â€Å"Yes,†she said gently. â€Å"But we want to know what you think he was like.†My eyes were still on the fire, watching the way the flames danced and shifted from orange to blue. â€Å"He†¦ he was the best man I’ve ever met.†I stopped to gather myself, and Viktoria used the opportunity to translate my words into Russian. â€Å"And he was one of the best guardians. I mean, he was young compared to a lot of them, but everyone knew who he was. They all knew his reputation, and lots of people relied on him for advice. They called him a god. And whenever there was a fight†¦ or danger†¦ he was always the first one to put himself out there. He never flinched. And a couple months ago, when our school was attacked†¦Ã¢â‚¬ I choked up here a bit. The Belikovs had said they knew of the attack-that everyone knew about it-and from the faces here, it was true. I didn’t need to elaborate on that night, on the horrors I’d seen. â€Å"That night,†I continued, â€Å"Dimitri rushed out to face the Strigoi. He and I were together when we realized they were attacking. I wanted to stay and help him, but he wouldn’t let me. He just told me to go, to run off and alert others. And he stayed behind-not knowing how many Strigoi he’d have to take on while I went for help. I still don’t know how many he fought-but there were a bunch. And he took them all down alone.†I dared to look up at the faces around me. Everyone was so quiet and still that I wondered if they were breathing. â€Å"It was so hard,†I told them. Without realizing it, my voice had dropped to a whisper. I had to repeat myself more loudly. â€Å"It was so hard. I didn’t want to leave him, but I knew I had to. He taught me so much, but one of the biggest things was that we have to protect others. It was my duty to warn everyone else, even though I just wanted to stay with him. The whole time, my heart kept saying, ? ®Turn around, turn around. Go to him!’ But I knew what I had to do and I also knew part of him was trying to keep me safe. And if the roles had been reversed†¦ well, I would have made him run too.†I sighed, surprised I’d revealed so much of my heart. I switched back to business. â€Å"Even when the other guardians joined him, Dimitri never backed down. He took down more Strigoi than almost anyone.†Christian and I had actually killed the most. â€Å"He†¦ he was amazing.†I told them the rest of the story that I’d told the Belikovs. Only I actually forced a little detail this time, telling them vividly just how brave and fierce he had been. The words hurt me as I spoke, and yet†¦ it was almost a relief to get them out. I’d kept the memories of that night too close to me. But eventually, I had to tell them about the cave. And that†¦ that was the worst. â€Å"We’d trapped the escaping Strigoi in a cave. It had two entrances, and we came at them from both sides. Some of our people got trapped, though, and there were more Strigoi than we’d expected. We lost people†¦ but we would have lost a lot more if Dimitri hadn’t been there. He wouldn’t leave until everyone was out. He didn’t care about the risk to himself. He only knew he had to save others†¦Ã¢â‚¬ I’d seen it in his eyes, that determination. Our plan had finally been to retreat as soon as we were all out, but I’d had the feeling he would have stayed and killed every Strigoi he could find. But he’d followed orders too, finally beginning his retreat when the others were safe. And in those last moments, just before the Strigoi had bitten him, Dimitri had met my eyes with a look so full of love that it was like that whole cave filled with light. His expression had said what we’d talked about earlier: We can be together, Rose. Soon. We’re almost there. And nothing will ever keep us apart again†¦ I didn’t mention that part, though. When I finished the rest of the tale, the faces of those gathered were grim but filled with awe and respect. Near the back of the crowd, I noticed Abe and his guardians listening as well. His expression was unreadable. Hard, but not angry or scary. Small cups began circulating through the group, and someone handed me one. A dhampir I didn’t know, one of the few men present, stood up and raised his cup in the air. He spoke loudly and reverently, and I heard Dimitri’s name mentioned several times. When he finished, he drank from the cup. Everyone else did too, so I followed suit. And nearly choked to death. It was like fire in liquid form. It took every ounce of strength I had to swallow it and not spray it on those around me. â€Å"Wh†¦ what is this?†I asked, coughing. Viktoria grinned. â€Å"Vodka.†I peered at the glass. â€Å"No, it isn’t. I’ve had vodka before.†â€Å"Not Russian vodka.†Apparently not. I forced the rest of the cup down out of respect to Dimitri, even though I had a feeling that if he were here, he’d be shaking his head at me. I thought I was done being in the spotlight after my story, but apparently not. Everyone kept asking me questions. They wanted to know more about Dimitri, more about what his life had been like recently. They also wanted to know about me and Dimitri as a couple. They all seemed to have figured out that Dimitri and I had been in love-and they were okay with it. I was asked about how we’d met, how long we’d been together†¦ And the whole time, people kept refilling my cup. Determined not to look like an idiot again, I kept drinking until I could finally take the vodka down without coughing or spitting. The more I drank, the louder and more animated my stories became. My limbs started to tingle, and part of me knew this was all probably a bad idea. Okay, all of me knew it. Finally, people began to clear out. I had no idea what time it was, but I think it was the middle of the night. Maybe later. I stood as well, finding it much harder to do than I’d expected. The world wobbled, and my stomach wasn’t very happy with me. Someone caught a hold of my arm and steadied me. â€Å"Easy,†said Sydney. â€Å"Don’t push it.†Slowly, carefully, she led me toward the house. â€Å"God,†I moaned. â€Å"Do they use that stuff as rocket fuel?†â€Å"No one made you keep drinking it.†â€Å"Hey, don’t get preachy. Besides, I had to be polite.†â€Å"Sure,†she said. We made it inside and then had the impossible task of getting up the stairs to the room Olena had given me. Each step was agony. â€Å"They all knew about me and Dimitri,†I said, wondering if I’d be saying any of this sober. â€Å"But I never told them we were together.†â€Å"You didn’t have to. It’s written all over your face.†â€Å"They acted like I was his widow or something.†â€Å"You might as well be.†We reached my room, and she helped me sit down on the bed. â€Å"Not a lot of people get married around here. If you’re with someone long enough, they figure it’s almost the same.†I sighed and stared off without any particular focus. â€Å"I miss him so much.†â€Å"I’m sorry,†she said. â€Å"Will it ever get better?†The question seemed to catch her by surprise. â€Å"I†¦ I don’t know.†â€Å"Have you ever been in love?†She shook her head. â€Å"No.†I wasn’t sure if that made her lucky or not. I wasn’t sure if all the bright days I’d had with Dimitri were worth the hurt I felt now. A moment later, I knew the truth. â€Å"Of course they were.†â€Å"Huh?†asked Sydney. I realized I’d spoken my thoughts out loud. â€Å"Nothing. Just talking to myself. I should get some sleep.†â€Å"Do you need anything else? Are you going to be sick?†I assessed my queasy stomach. â€Å"No, but thanks.†â€Å"Okay.†And in her typically brusque way, she left, turning off the lights and shutting the door. I would have thought I’d pass out right away. Honestly, I wanted to. My heart had been opened up to too much of Dimitri tonight, and I wanted that pain to go away. I wanted blackness and oblivion. Instead, maybe because I was a glutton for punishment, my heart decided to finish the job and rip itself completely open. I went to visit Lissa. How to cite Blood Promise Chapter Nine, Essay examples
Sunday, December 8, 2019
Diary Entry free essay sample
Father doesn’t agree that we should go back to Berlin. â€Å"Karl’s not here and Daniel’s not here and Martin’s not here and there are no other houses around us and no fruit and vegetable stalls and no streets and no cafes with tables outside and no one to push you from pillar to post on a Saturday afternoon. †This place is just horrible. But I am shameful that I spoke to father in such disrespect. I didn’t really mean it, I just wanted father to know how horrible this place is and how nobody is ever going to happy here and we should really move back to the house in Berlin. I was really surprised that I shouted at father, I didn’t even know that I was going to shout at father. It was a complete surprise to me. I thought father was going to get really angry and I was even ready to make a run for it but nothing seemed to make father angry today. We will write a custom essay sample on Diary Entry or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page If I were to be honest with myself, I would have admitted that father rarely became angry. Instead he became distant and quiet and always had his way in the end anyway and rather than shouting at him or chasing him around the house, he just shook his head and indicated that their debate was at an end. Before leaving father’s office I asked him a final question but there was no point because I didn’t even understand what he meant. I asked him about the people that I can see from my bedroom window and he said that they aren’t even people. So who could they be? Father also said that I have nothing in common with those people and should stay clear from them. Then our conversation was finally to an end. I wish we go back home quickly and meet grandmother and grandfather and of course, my friends.
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