Study on Movement Time of Individual After Stroke

Study on Movement Time of Individual After Stroke Case scenario A 25 year old male Patient who was apparently well 1 year ago when he met with an accident and got severe head injury, diagnosed with right hemiplegia, was hospitalized for 1 month. Presently Patient complains of, difficulty in getting up from bed, and difficulty in walking. Patient has flexor synergy in Upper limb and extensor synergy is in lower limb, Rom and strength for right is decrease, tone for upper limb and lower limb is increased , grade3 on MAS , reflexes are exaggerated. Presently, Patient is able to sit but only with support and need assistance in toileting and mobility. INTRODUCTION Activities of daily living is refers to those â€Å"sensory motor skills necessary for the performance of usual daily activity† (1). These sensory – motor skills under lie the task of daily self care such as feeding, dressing, hygiene and physical mobility that are known as basic activities of daily living (1). Any problem in performing the ADL can affect personal social life (1),as well as community mobility. Stroke is the sudden loss of neurological function caused by an interruption of blood flow to the brain (1). Stroke can be caused by many reasons like traumatic, pathological etc. Post stroke patient deal with the variety of deficit like cognitive (1), sensory (3), motor (4), balance and coordination (5). All these components are necessary for the optimal performance of any ADL (6). In young population ADL can be affected because of several reasons, but now a days most common problem which young patient are facing is stroke(6) which affect their ADL in terms of transferring like sit to lie or lie to sits which is the basic activity in order to carry out any task. In this study time is measured for the individual to perform a particular activity. Time taken to perform any task measures several components like cognition (7), sensory (8), motor, balance and coordination (8). Any deficit in any one or all the components leads to increase in the time taken to perform any activity (7) (8) (9). Any deficit in cognition patient will have difficulty in interpreting the command given to patient which leads to increase in the time taken to perform the task. Any motor deficit and sensory deficit can cause difficulty in moving limbs and awareness about the orientation of the limbs. Balance and coordination deficit leads to decrease postural control, all these components will hinder the patient to perform the task at appropriate time (7) (8). Although there is no evidence or normative values are yet described which tells about the normal time taken by an individual to perform sit to lie and lie to sit activity. In order to rehabilitate the patient for sit to lie and lie to sit task, it is also necessary to see that at what degree of trunk flexion (0` or 45`) and with which side (dependent or non dependent) it is easy for the patient to perform task which is measured in terms of time taken by individuals to finish the task so that therapist can rehabilitate the patient with minimum difficulty. The normal timing taken by an individual to perform any task can be used both as a qualitative as well as quantitative. It helps to asses the various components of the deficit, and to rehabilitate the patients who have difficulty in performing ADL. Hence objective of this study is to measure the time taken to perform sit to lie and lie to sit activity at 0` and 45` of bed from dependent and non dependent side. This can be use to asses as well as rehabilitate the patient. NEED FOR STUDY Stroke in the young is particularly debilitating as the patient wants to get integrated into the society as early as possible. Also a unique requirement for stroke in the young is that the expectations and the society needs are different from the elderly when comparing community dwelling young adults vs. geriatric populations. There is no normative values are present in literature in order to find out the usual time taken by young individual to perform ADL. Sit to lie and lie to sit are basic bed mobility which patient with stroke generally encounter first. So in reference to these timing it is easy to asses as well as rehabilitate the patient in activities of daily living which is most important requirement of patients with stroke. LITERATURE REVIEW Lindmark B ,Hanrin E ,Tornquist K in 1920 conducted study on 207 stroke patient, they were tested after3 month and 1 year after the stroke, 183 survivors from the original population were assessed with standardized practical equipment which has 12 daily activities which is concerned with cognitive factor and coordination, hand function, mobility and balance . They did not find any significant difference, concluded that there is no difference in the performance of daily activities at 3 month and1 year after stroke and also found out that women had more difficulty in performing compare to men in performing mobility task (6). Podsiodlo D , Richardson S , in 1991 conducted study on 60 elderly patient(mean age 79.5 years) to find out TUG as test for basic functional activity, time is calculated for the patient to perform a rise from chair ,walk for 3 meters and then sit down again to perform a particular ADL, found out that TUG test is reliable and correlates well with berg balance scale and concluded that TUG test is reliable for evaluation of the ADL(10). Owsley C, Sloane M, Mc Gwin, Ball K. in 2001 conducted study on 173 older adults (65-90 yrs), which is large sample size in order to find out visual processing speed and correlation between memory and inductive reasoning with IADL ,time taken to perform the 5 IADL was calculated and found out that individual who have slow processing speed , takes more time to accomplish the task they concluded that cognition especially memory and reasoning are related to time taken to perform any ADL and it is useful in evaluating in cognition(8). Owsley, Cynthia, mcGWIN, Gerald Sloane, Michael E in 2001 conducted a study on 342 older adults who had visual impairment (58-86year) from eye clinic, to find out relation between visual function and time required to complete the IADL, under visual impairment –visual acuity, contrast sensitivity and useful field of view .17 IADL task which includes visual activity was evaluated with time taken. They concluded that visual function is necessary to achieve any ADL (9). Hsieh CL ,Shen CF,Hsueh IP, Wang CH in 2002 conducted a prospective study was on 169 stroke patient to find out relation between trunk control and ADL in early stage in stroke patient after6 month of stroke, postural assessment scale for stroke patient scale(PASS-TC) fugl meyer motor test and balance test was used to asses motor and balance respectively, patients were assessed at 14thday after stroke and 6 month. They concluded that trunk control is related to comprehensive ADL(11). Gregory T, Cullaghan A, Nettelback T ,Wilson C in 2009 conducted study on elderly people to examine whether early inspection time predict future problem in ADL , participant completed IT at baseline, 6 month,18 month and at 14 month after stroke, 2 group of 15 elderly with aged (74-88 years) are assessed for timed IADL, it shows that group with slower IT had poorer performance (took longer time to finish task)on more than half of the functional activity and concluded that slower IT shows difficulty in performing functional activity(12). Emma Barry, Rose Galvin, Claire Keogh, Frances Horgan and Tom Fahey in 2014 did a systemic review and metanalysis to find TUG is a predictor of risk of fall in older adult, a literature search of 25 in systemic review and 10 in metanalysis was done and TUG score> 13.5 sec was used to identify individual with high risk of falling and found out that TUG test has limited ability to predict to predict risk of fall in elderly (13). METHODOLOGY Study design: Cross- sectional study –a pilot study Sample size: n=30(50% male and 50% female) Type of sampling: convenience sampling Source of data collection: M.S. Ramaiah Medical College, Department of Physiotherapy. METHOD OF DATA COLLECTION: A cross- sectional study design was undertaken for the study. Young adult aged between 20 – 25 years fulfilling in M.S. Ramaiah medical college, department of physiotherapy were included in study. Convenience sampling was done and sample of 30 subjects were included in the study. Informed consent of all the 30 subjects are taken prior to undertaking the study and procedure was explained to them. Inclusion criteria: Mentioned conditions directly affect the time taken to perform a particular task. cognition is tested by checking memory reasoning and intelligence. 1. Aged between 20-25 years. 2. Subject should not have any pain, trauma, inflammation, fracture etc by history /reported. 3. Should not have any cognitive deficit. 4. Should have competed consent form. Exclusion criteria: Above mentioned condition can interfere in test and also affect the time taken to perform the  given task. Any reported trauma, inflammation, pain in lower back and lower limbs. History of Low back pain, knee pain. Intake of alcohol in last 24 hrs. Any history of hypotension while performing ADL. Any giddiness while performing IADL tasks Any cognitive or higher mental funti0n deficit. Materials used for the study: Stop watch Adjustable firm couch Height scale Weighing machine Test procedure: Demographic data of young adult was noted, including height, weight, gender etc. subjects to be tested was explained about the procedure of the test. Subjects are asked to sit at edge of bed. When start command was given, the subject had to lie down according to given instruction by using preferable speed to perform the activity, time taken for the subject to perform the sit to lie and lie to sit was noted down. Both these activities were performed at 0` and 45` of elevation of bed end, from dependent side as well as from independent side of elevation of bed end. Starting positions: Sitting Position: neck straight, head in midline, spine erect, Hands on a side, knee and hip at 90`, foot unsupported. Lying position: straight, head in midline, hands on sides, legs together, foot in a neutral position Task was observed from standing in front of patient. The same procedure was repeated and time is taken for 30 subjects, to find out normal value to perform sit to lie and lie to sit in young adult. Picture 1a: Firm and adjustable couch at 00. Picture1b: Firm and adjustable couch  at 450. PICTURE 2a: Starting position at 00 PICTURE 2b: Starting position at  00(side view). Picture 3: Starting position at 450 PICTURE 4a: Final position of sit to lie at 00 PICTURE 4b: Final position of lie to sit 45` Picture5: During test Data Analysis Statistical analysis: Microsoft word and Excel were used to generate data and graphs. Statistical Tests: mean, mode, median of time taken to perform the sit to lie and lie to sit activity was calculated for 30 subjects. Mean is taken to as average time taken to perform the task. t –test was done to compare the values of sit to lie and lie to sit from dependent and non dependent at 0` and 45`. RESULT A cross sectional study consisting of 30 normal healthy young adult is taken to find out the normal time taken by younger individual to perform sit to lie and lie to sit at 00and 450from dependent and non dependent side. This graph is showing average time taken to perform sit to lie and lie to sit. The values of sit to lie and lie to sit which are not showing any statistical significance depending on different side and angle of trunk flexion. Table2: t and p value of the average of time taken to perform sit to lie and lie to sit. t- scorep-score Sit to lieND(00) vs. ND(450)0.7040.483 D(00) vs. ND(450)1.0100.318 ND(00) vs. D(450)-1.0470.299 D(00) vs. D(450)1.3550.180 ND(0) vs. D(0)-0.4090.683 ND(45) vs. D(45)0.7040.483 Lie to sitND(00) vs. ND(450)1.6330.107 D(00) vs. ND(450)1.1700.246 ND(00) vs. D(450)1.5810.119 D(00) vs. D(450)1.1040.273 ND(00) vs. D(00)0.4880.626 ND(450) vs. D(450)-0.1160.907 Sit to lie vs. Lie to sitND(00) vs. ND(00)0.0270.978 D(00) vs. D(00)0.9330.354 ND(450) vs. ND(450)1.1600.250 D(450) vs. D(450)0.9470.347 Table2 the t value and p value are showed non of the data have p value Table 3: Comparison between 00 and 450 in sit to lie and lie to sit. 00450 Sit to lieND (3.497)ND(3.366) D(3.565)ND(3.366) ND(3.497)D(3.321) D(3.565)D(3.216) Lie to sitND(3.491)D(3.156) D(3.375)ND(3.136) D(3.345)D(3.156) ND(3.491)ND(3.156) Above table is showing the comparison between average time taken at 00 and 450. There is not significant difference between the time taken by subject in sit to lie and lie to sit from 00and 450. Figure2a: 00 vs. 450 from sit to lie Figure2b: 00 vs. 450 from lie to sit Given figure 2a is showing comparison of mean time taken to sit to lie from 00 and 450 which is not statistically significant(p Table 4: Comparison between the averages of time taken from dependent vs. non dependent side. Non Dependent Side (sec)Dependent (sec) Sit to lie 450(3.366)450(3.321) 00(3.497)450(3.321) 450(3.366)00(3.565) 00(3.497)00(3.565) Lie to Sit450(3.136)450(3.156) 00(3.491)450(3.156) 450(3.136)00(3.375) 00(3.491)00(3.375) This table presents the comparison between dependent vs. non dependent side from sit to lie and lie , average mean of the sit to lie and lie to sit are statistically not significant , P >0.05 , hence no suitable value can be concluded from this present data. Figure3a: Dependent vs. Non Dependent Figure3b: Dependent vs. Non Dependent from sit to lie. from lie to sit Given fig 3a is showing the comparison between dependent vs. non dependent from sit to lie and fig3b. From, the t scores of these data is not showing any statistical significance (p>0.05). Table 5: Comparison between average time taken in sit to lie vs. lie to sit. Sit to lie vs. lie to sitSit to lie in (sec)Lie to sit in (sec) Nondependent (00)3.4973.491 Dependent(00)3.5653.375 Nondependent(450)3.3663.136 Dependent(450)3.3213.156 This table presents the comparison between the average time taken from sit to lie vs. lie to sit. Statistically these values are not significant (p>0.05). Figure 4: comparison between time taken from sit to lie vs. lie to sit Figure 4: showing the comparison between the time taken from sit to lie vs. lie to sit which is statistically not significant hence is not showing any difference in time taken to perform both these activities. TABLE 6; Average of mean value for sit to lie and lie to sit from dependent and non dependent side at 00 and 450 Mean values Sit to lieNon Dependent(0)3.50 Dependent(0)3.57 Non Dependent(45)3.37 Dependent(45)3.32 Lie to sitNon Dependent(0)3.49 Dependent(0)3.37 Non Dependent(45)3.14 Dependent(45)3.16 Average3.36 In table6, the average of all mean time taken to perform sit to lie and lie to sit, as it is not any statistical significance ,so there is no difference in time taken to perform this task. DISCUSSION The time taken by young adult (20-25 years) to perform sit to lie and lie to sit from dependent and non dependent side at 00 and 450 of trunk flexion has done to find out the normal time taken by young adult to perform this particular activity. This activity is a basic mobility which the stroke patient encounter first and also find difficult to do. Timing of these activity measures cognition, sensory, motor, balance and coordination component of the patient which will help to find out the level of functional activity in reference to the time taken to accomplish the given activity. Activity was measured at different angle of trunk flexion (00 and 450) a well as from different side (dependent and non dependent). Before the study it was assumed that from dependent side it is easy to accomplish the task, as well as from 450 it is easy to lie down as well as get up as therefore should take less time to finish the task, as at 450 the length tension relationship is good and it provide extra leverage to come against gravity, in 450 as the muscle is in tension, muscle fiber recruitment is more. Getting up from dependent side was hypothesized to be easier as compare to nondependent. It was also assumed that as sit to lie and lie to sit are two different activities so time taken to perform both these activity will be different. In our study, on analyzing the result of table 2 ( t – test of the average of the time taken to perform the sit to lie and lie to sit at different plane) is observed that p-value of mean score of time taken to perform sit to lie and lie to sit is statistically not significant. Values at different plane is statistically not significant that may be because of the small sample size as well as population age. Good strength in muscles, balance and coordination in limbs helps to overcome the gravity easily. The t – score and p- value for the comparison of sit to lie and lie to sit is also statistically not significant. Since all comparisons were statistically insignificant, we averaged the mean for condition The average for the sit to lie and lie to sit was found to be 3.36 sec. In order to asses and rehabilitate the stroke patient timed ADL will asses several components in one time. In order to asses the patient who has difficulty in basic mobility like sit to lie or lie to sit can be assessed with respect to time taken to accomplish that activity , any increase in time taken to accomplish the particular activity may suggest need for intervention , and patient can be trained for the same activity for time taken. Time taken can evaluate contribution from different components such as cognition, strength, balance, coordination. Therefore assessing time may help the therapist to quantify these components and give direction to treatment. Thus concluded that sit to lie and lie to sit takes same time irrespective of dominant and non dominant side, and angle of trunk flexion (00 and 450). The average time to perform sit to lie or lie to sit for young adult is 3.36 sec. CONCLUSION From the present study we can conclude that the average time taken to perform the sit to lie and lie to sit activity is 3.36. The time taken to perform sit to lie and lie to sit from dependent and non dependent side at 00 and 450 was the same. It did not differ with the side as well as the angle of trunk flexion. à ¢Ã¢â€š ¬Ã†â€™ Limitation of the Study Video for the task is not taken which can help to evaluate the different components of task and may be helpful to explain the reason behind the variation in timing in different individual. Instruction to use a preferable speed may not reliable for every patient. The sample size is small and taken for only 20-25 year old young adult. Clinical Implication As the time taken to perform sit to lie or lie to sit is 3.36 sec, and in my case scenario patient is 25 year old and has difficulty in bed mobility we can take it (3.36 sec) as a baseline in order to asses and rehabilitate the patient . We can measure the time taken by a patient to complete sit to lie and can further retrain the patient to complete the tasks within 3.36 sec; this will help the patient to achieve the status of community functional mobility. It will help us to plan a treatment parameter such as time taken to complete and components of sit to lie as an outcome measure. So in this case summary we could set a goal of 3.36 sec as the time required to achieve functional mobility.

Reviewing The Film Version Of Brokeback Mountain Film Studies Essay

Reviewing The Film Version Of Brokeback Mountain Film Studies Essay This essay will aim to compare the film version of Brokeback Mountain with Annie Proulxs short story. It will explain, discuss as well as evaluate the ways in which Ang Lee represented key themes and ideas through-out the film. Many themes and ideas were dealt with in the film, some of which will be looked at such as, relationships, love, desire and the gothic. Ang Lee was able to express Jack and Enniss masculinity through their physical features, the jobs that they undertook, as well as through their clothing, throughout the movie. The two men were seen to be working on the land, doing strenuous physical labour and played out the masculine roles in society. In both the movie and the short story Jack and Ennis relationship with nature was masculine in the way that they spent a great deal of time in the open countryside at work. Their relationship with the land strengthened through the depiction of their love making on Brokeback Mountain which showed their deep connection and confidence with their surroundings. Even though the men were portrayed as masculine figures throughout both the film and the story, there was also a very prominent shift in the gender roles, as Jack and Ennis both alternated between the traditional roles of male female. Central to Proulxs thinking is not only the subjectivity of people shaped by geographical constrain ts, limits and opportunities, but also that the social worlds produced reveal personal narratives of engagement which often question determined social roles.  [1]  It could be argued that the short story was wholly about the love of two men for each other and how this impacted on the lives they were expected to lead. However the movie focused more on their home life and domestic roles, such as Ennis failing to provide and care for his children. The short story only briefly mentioned Ennis family life. In the movie, there was great insight into the mens married life whereas in the book there is not much emphasis on this. This would have helped the viewer to delve more deeply into their personal lives and therefore have a better understanding of them. The women in the film version of Brokeback Mountain were more visible, referred to more and had a significantly active role in the story in relation to Jack and Ennis. The viewer was able to see life from the womens points of view and into the hardships of their lives. Whereas in the short story they were merely portrayed as obstacles that stopped Jack and Ennis from pursuing their romantic relationship. It could be argued that Ang Lee did not want women to merely be on the margin in this film, he probably wanted to bring the women to the foreground of the story since conventional relationships are between men and women, unlike Proulx whose version was more closely focused around the relationship between Jack and Ennis. In both versions the women were powerless to affect what was going on, especially after they eventually discovered that Jack and Ennis were more than just friends. There was nothing that they could do, as they were unable to effectively influence the situation in thei r favour,. à ¢Ã¢â€š ¬Ã‚ ¦and the door opening and Alma looking out for a few seconds at Enniss straining shouldersà ¢Ã¢â€š ¬Ã‚ ¦.She had seen what she had seen.  [2]  In addition, this story was set at a time when women were seen to be more dominant in the private domestic sphere, therefore they seemed to be naÃÆ' ¯ve of about the goings on in the outside world and perhaps did not have a loud enough voice to stand up to men. One of the main themes in Ang Lees film version of Brokeback Mountain was the added dimension of nature and the surroundings of the west in which the film was set. Proulx references to the landscape to set the scenes were very descriptive throughout the story. The mountain boiled with demonic energy, glazed with flickering broken-cloud light; the wind combed the grass and drew from the damaged krummholz and slit rock a bestial drone.  [3]  The amazing awe-inspiring shots of the landscape in Ang Lees movie, gave a new dimension to the film as the shots of nature became just as much a part of the film as the story line. The beauty of the shots nearly as important as dialogue  [4]  The impact that nature had on people who already felt comfortable in the open country were given more depth and significance. Spending time together on Brokeback Mountain was like a retreat or a safe haven from society in which Jack and Ennis would have been judged because of the nature of their relationship. Whilst on Brokeback Mountain the emphasis on nature meant that they felt free and at peace away from society and were able to be themselves without the risk of being ridiculed or judged. The image of the dead sheep on the mountain, in the film, acted as a metaphor for the idea that even though the men felt safe and free on the mountain they were still vulnerable in the eyes of society. The main themes that ran through the film were that of love, relationships and desire. There were great similarities in the short story and the movie in the ways in which the characters related to each other, their emotion and concern. The way that Jack was so caring towards Ennis, was expressed perfectly through both mediums. The way their relationship was portrayed was so painful as they could never be together was shown in different ways in both the short story and the movie. They have to privatise their feelings  [5]  . The original dialogue from the story added another dimension to Ang Lees film. As a lot of the time the characters whispered or spoke in a quiet manner, it gives the impression that what they were saying was not to be shared with others. The scene in the movie where Ennis became hysterical after Jacks departure from Brokeback Mountain, was very much more heartfelt and emotional than in the short story, within a mile Ennis felt like someone was pulling his guts out  [6]  . The emotion was not felt whilst reading the book, it was better conveyed in the movie. The reason for this may have been as a result of the musical soundtrack and the close up camera shots which showed Ennis as totally distraught. This was apparent also near the end of the film by the lines, I wish I knew how to quit you'  [7]  , which were spoken, the tone and volume of which this short line was spoken displayed the pain that Ennis and Jack were enduring by being apart. In addition, in the final scene at Jacks house with the two shirts, one inside the other; the scene was portrayed better visually than in the book due to the impact that the music had over the scene, which was not achieved in the short story. However, it the words used in the short story were powerful in their simplicity. The shirt seemed heavy until he saw there was another inside ità ¢Ã¢â€š ¬Ã‚ ¦the pair like two skins, one inside the other, two in one.  [8]  On a literal level this scene added shaped to the story, as the story ended where it started, both with dreams, both with shirts. Both the movie and the short story expressed key elements of the gothic. Two of the most prominent elements were violence and mystery. Proulxs short story had an ambiguous ending in which the reader was unsure of how Jack died and who killed him. His family and Ennis were left wondering if it was an accident or if it was on purpose as a result of someone finding out about his secret relationship with Ennis. The ending was left for the viewer to decide and to use their imagination as to who killed Jack and how he was killed, quite like a murder mystery. Not only did I want to be loyal to [Proulxs] writing, but I needed to do additional scenes to confirm her writing, because we dont have the internal depictions which she did most brilliantly.  [9]  This was true consistently throughout the film. There were many sections in the film that did not appear in the story, such as the argument between Jack and his father-in-law on Thanksgiving, and the scenes where Jack went to Mexico to explore his sexuality and the greater depth and insight into their family lives and the people closest to them. Scenes even appeared in a different order. However things that were missing from the film were filled with extended scenes that were also not in the short story. These extended scenes gave the viewer a greater insight into the lives of Jack and Ennis as well as those that they interacted with. Futhermore in the movie Ang Lee used flashbacks as well as clips which gave the viewer a greater insight into the unknown, and to things that were below the surface of the characters initial thoughts. The viewer always had the fuller picture drawn out for them, which was pieced together by the actual storyline. This was present in the way that Ang Lee used a flashback to show how Ennis father showed him what happened to a man who lived with another male however this was not presented in the same way in the short story. The movie was quite direct and visual and the story had a definitive ending and the audience knew exactly what happened to Jack even if the other characters in film did not. The use of the movie as a visual aid meant that there was more freedom in the idea of the gothic with the gruesome scenes of the man who was castrated as well as the murder of Jack. The book ended as it stated that the love felt by Ennis was endured, but it was only an end to the physical but not emotional love. It was as if the story still continued beyond the text, and would continue to do so as long as society failed to move on. There was some open space between what he knew and what he tried to believe, but nothing could be done about it, and if you cant fix it youve got to stand it.  [10]   The long silences and deep stares that were exchanged between Jack and Ennis throughout the film expressed their unspoken love, this was more effectively displayed in the film than the short story. Because of their stoic characters, the story has much to do with what is unspoken, with the shame and guilt that fills them  [11]  This made the film a lot more powerful than the story as a result of these silences. narrative detail is echoed by Ang Lee cinematically. The beauty and purity of the emotions is matched by the rustic majesty of the landscape; in reducing the story to a universe of simplicity of scenery and emotion, Lee was trying to create a new depth for a love story.  [12]  As a result of the shame and guilt that would have been forced upon them whilst in society Brokeback Mountain gave them a sense of freedom to do things that would not have been acceptable in society at the time. Ang Lee tells us that the focus on emotion cannot be articulated in words, and employs the imagined iconic solitude of the cowboy  [13]  The use of camera shots such as panning and close ups helped to covey the emotion through the screen to the viewer, this therefore enabled the viewer to have a better emotional connection with the characters. One of the main adaptations that Ang Lee made to the film version of Brokeback Mountain was his selection of his cast, especially the main characters. Whereas in the short story Jack and Ennis were not described as overly good looking men, however Ang Lees cast did not portray this.

Evolution and Christianity Essay -- Exploratory Essays Research Papers

     Ã‚  Ã‚  Ã‚  Ã‚   The riddle of the origin of man has been subject to many ponderings and theories for thousands of years. In America, two theories concerning this timeless question have driven a spike through the general populace. These two beliefs, Evolution and Christianity, have driven a riff through the American populace and fueled several debates and conflicts over which is the truer theory. Incidents such as the decision of the Kansas school board to ban schools from including the Evolution Theory from their curriculum are becoming a tragically frequent and threaten to escalate if not checked soon. However, there is a growing belief in America today in the possibility of believing that evolution is an inescapable fact while still prescribing to Christian faith as well. This radical theology, which seems to meld, distort and expand the theory of Evolution and traditional Christian beliefs, has been termed "Theistic Evolution" by its followers and has emerged as a very respec table alternative to choosing between Evolution and Christianity.    Much of the conflict between Traditional Christian and Evolutionary thought stems from the strict, literal interpretation of the Bible used by many individuals and Church groups. One of the fundamental beliefs that most branches of Christianity share is that God created the world and life as we know it in six days. "And on the seventh day God ended His work which He had done, and He rested on the seventh day from all His work which He had done (Genesis 2:2)." Following this chain of thought, many devout Christians go on to further speculate that according to the Bible, Earth and animal life have only existed for a few thousand years. Evolutionists have attacked this speculation relentless... .... It is for this reason that alternatives such as Theistic Evolution are becoming more and more available. As Howard Van Till put it, "Christianity and Evolution are not contradictory. They provide different answers to a different set of questions" (Sheler).       Bibliography Darwin, Charles. The Origin of Species. New York: Avenel Books, 1979. pp. 435-460.    Dorfman, Andrea and Michael D. Lemonick. "Up From the Apes." Time. August 23, 1999. pp. 50-60.    Genesis. Holy Bible: New King James Version. Tennessee: Thomas Nelson Publishers, 1982. Chapter 2, Verse 2.    Sheler, Jeffrey L. (1999). "Is the Bible True?" (Online). USNews Online. November 19, 1999. Available: http://www.usnews.com/usnews/issue/991025/bible.htm    Sunderland, Luther D. Darwin's Enigma. California: Master Book Publishers, 1984. pp. 22-24.

The Variety of Characters in Shakespeares Othello :: GCSE English Literature Coursework

The Variety of Characters in Othello  Ã‚   William Shakespeare has many ways of illustrating his characters through way of dialogue and language patterns. This is his trademark and it is his ultimate strategy for drawing his reader closer, until they are completely immersed in his play. In Othello we see that a character like Iago has been given a very rough and coldhearted aura about him, which in time shows us as readers how cruel he really is. On the contrary Othello himself is rather noble in his speech, but overall just as clever. These characters are clever in their own separate ways: Othello in living a double life of both war and love (which seems to keep him tied to the battlefield, a danger zone) and Iago is clever in his ways of manipulating an entire lot of people to get what he wants. Any excerpt from the play Othello shows how clever Shakespeare is in his own ways, writing traits that cannot be ignored.    A good example of witty Shakespearean playwriting is in the opening Act of Othello- Act I, Scene i., pg. 78-92. The use of language in this Scene is so classic- for example the way Iago and Roderigo play off of each other in speech. Their goal in the middle of the night is to wake Brabantio (Desdemona's father) and tell him of the extravagant affair between Othello and her daughter. In the streets of Venice these men holler their way up to his chambers, arising him to the balcony. Shakespeare's choice of speech is so affective, and so perfect.    Roderigo: Signor (a question of his authority), is all your Family within? Iago: Are your Doors locked? (Instigating panic) [Roderigo/Iago:I.i.87-89]    Shakespeare's choice of words here is beautiful in its shrewdness, and in so many ways affective. Iago in particular seems to push the situation, and operate the conversation as he always does. He goes on to tell Brabantio his state of confusion and in many ways hypnotize the poor man.    Your heart is burst, you have lost half your soul†¦an old black Ram is tupping your white Ewe. [Iago:I.i.89-91]    Shakespeare gives Iago's character such filth, such a stench in the air about him that you can smell it while reading. Here is a character in Othello that is hard to understand, and there have been many views taken on his role.

Ethical Decision Making and Behavior

7 Ethical Decision Making and Behavior As we practice resolving dilemmas we find ethics to be less a goal than a pathway, less a destination than a trip, less an inoculation than a process. —Ethicist Rushworth Kidder WHAT’S AHEAD This chapter surveys the components of ethical behavior—moral sensitivity, moral judgment, moral motivation, and moral character—and introduces systematic approaches to ethical problem solving. We’ll take a look at four decision-making formats: Kidder’s ethical checkpoints, the SAD formula, Nash’s 12 questions, and the case study method.After presenting each approach, I’ll discuss its relative advantages and disadvantages. U nderstanding how we make and follow through on ethical decisions is the first step to making better choices; taking a systematic approach is the second. We’ll explore both of these steps in this chapter. After examining the ethical decision-making process, we’ll see ho w guidelines or formats can guide our ethical deliberations. 235 236——PART III. Ethical Standards and Strategies Components of Moral Action There are a number of models of ethical decision making and action.For example, business ethics educators Charles Powers and David Vogel identify six factors or elements that underlie moral reasoning and behavior and that are particularly relevant in organizational settings. 1 The first is moral imagination, the recognition that even routine choices and relationships have an ethical dimension. The second is moral identification and ordering, which, as the name suggests, refers to the ability to identify important issues, determine priorities, and sort out competing values.The third factor is moral evaluation, or using analytical skills to evaluate options. The fourth element is tolerating moral disagreement and ambiguity, which arises when managers disagree about values and courses of action. The fifth is the ability to integrate m anagerial competence with moral competence. This integration involves anticipating possible ethical dilemmas, leading others in ethical decision making, and making sure any decision becomes part of an organization’s systems and procedures.The sixth and final element is a sense of moral obligation, which serves as a motivating force to engage in moral judgment and to implement decisions. James Rest of the University of Minnesota developed what may be the most widely used model of moral behavior. Rest built his four-component model by working backward. He started with the end product—moral action—and then determined the steps that produce such behavior. He concluded that ethical action is the result of four psychological subprocesses: (1) moral sensitivity (recognition), (2) moral judgment, (3) moral focus (motivation), and (4) moral character. Component 1: Moral Sensitivity (Recognition) Moral sensitivity (recognizing the presence of an ethical issue) is the firs t step in ethical decision making because we can’t solve a moral problem unless we first know that one exists. A great many moral failures stem from ethical insensitivity. The safety committee at Ford Motor decided not to fix the defective gas tank on the Pinto automobile (see Chapter 2) because members saw no problem with saving money rather than human lives.Wal-Mart was slow to respond to concerns raised by employees, labor groups, environmentalists, and others about wage violations, sexual discrimination, poor environmental practices, and other issues. 3 Many students, focused on finishing their degrees, see no problem with cheating. (You can test your ethical sensitivity by completing the â€Å"Self-Assessment: Moral Sensitivity Scenarios. †) According to Rest, problem recognition requires that we consider how our behavior affects others, identify possible courses of action, and determine theCHAPTER 7. Ethical Decision Making and Behavior——237 consequ ences of each potential strategy. Empathy and perspective skills are essential to this component of moral action. If we understand how others might feel or react, we are more sensitive to potential negative effects of our choices and can better predict the likely outcomes of each option. A number of factors prevent us from recognizing ethical issues. We may not factor ethical considerations into our typical ways of thinking or mental models. We may be reluctant to use moral terminology (values, justice, right, wrong) to describe our decisions because we want to avoid controversy or believe that keeping silent will make us appear strong and capable. 5 We may even deceive ourselves into thinking that we are acting morally when we are clearly not, a process called ethical fading. The moral aspects of a decision fade into the background if we use euphemisms to disguise unethical behavior, numb our consciences through repeated misbehavior, blame others, and claim that only we know the â €Å"truth. 6 Fortunately, we can take steps to enhance our ethical sensitivity (and the sensitivity of our fellow leaders and followers) by doing the following: †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ Active listening and role playing Imagining other perspectives Stepping back from a situation to determine whether it has moral implications Using moral terminology to discuss problems and issues Avoiding euphemisms Refusing to excuse misbehavior Accepting personal responsibility Practicing humility and openness to other points of viewIn addition to these steps, we can also increase ethical sensitivity by making an issue more salient. The greater the moral intensity of an issue, the more likely it is that decision makers will take note of it and respond ethically. 7 We can build moral intensity by doing the following: †¢ Illustrating that the situation can cause significant harm or benefit to many people (magnitude of consequences) †¢ Establishing tha t there is social consensus or agreement that a behavior is moral or immoral (e. g. legal or illegal, approved or forbidden by a professional association) †¢ Demonstrating probability of effect, that the act will happen and will cause harm or benefit †¢ Showing that the consequences will happen soon (temporal immediacy) †¢ Emphasizing social, psychological, physical, or psychological closeness (proximity) with those affected by our actions †¢ Proving that one person or a group will greatly suffer due to a decision (concentration of effect) 238——PART III. Ethical Standards and Strategies Finally, paying attention to our emotions can be an important clue that we are faced with an ethical dilemma.Moral emotions are part of our makeup as humans. 8 These feelings are triggered even when we do not have a personal stake in an event. For example, we may feel angry when reading about mistreatment of migrant workers or sympathy when we see a picture of a refu gee living in a squalid camp. Moral emotions also encourage us to take action that benefits other people and society as a whole. We might write a letter protesting the poor working conditions of migrant laborers, for instance, or send money to a humanitarian organization working with displaced persons. Anger, disgust, and contempt are other-condemning emotions.They are elicited by unfairness, betrayal, immorality, cruelty, poor performance, and status differences. Anger can motivate us to redress injustices like racism, oppression, and poverty. Disgust encourages us to set up rewards and punishments to deter inappropriate behaviors. Contempt generally causes us to step back from others. Shame, embarrassment, and guilt are self-conscious emotions that encourage us to obey the rules and uphold the social order. These feelings are triggered when we violate norms and social conventions, present the wrong image to others, and fail to live up to moral guidelines.Shame and embarrassment ca n keep us from engaging in further damaging behavior and may drive us to withdraw from social contact. Guilt motivates us to help others and to treat them well. Sympathy and compassion are other-suffering emotions. They are elicited when we perceive suffering or sorrow in our fellow human beings. Such feelings encourage us to comfort, help, and alleviate the pain of others. Gratitude, awe, and elevation are other-praising (positive) emotions that open us up to new opportunities and relationships.They are prompted when someone has done something on our behalf, when we run across moral beauty (acts of charity, loyalty, and self-sacrifice, for example), and when we read or hear about moral exemplars (see Chapter 3). Gratitude motivates us to repay others; awe and elevation encourage us to become better persons and to take steps to help others. In sum, if we experience anger, disgust, guilt, sympathy, or other moral emotions, the chances are good that there is an ethical dimension to th e situation that confronts us. We will need to look further to determine if this is indeed the case.CHAPTER 7. Ethical Decision Making and Behavior——239 SELF-ASSESSMENT MORAL SENSITIVITY SCENARIOS Instructions Read each vignette and consider the following statement: There are very important ethical aspects to this situation. (1 = strongly disagree, 7 = strongly agree) Then briefly explain your rating for each vignette in the space below it. For more information on the ethical issues raised by the scenarios, see Item 1 under â€Å"For Further Exploration, Challenge, and Self-Assessment. † Vignette 1 One of your most important customers, a medical clinic, called yesterday.The clinic had ordered a product 10 days ago (products are normally delivered within 7–10 days), but it had not arrived. Quickly, you traced the order to the shipping office. You asked the shipping clerk about the order, and she said, â€Å"I shipped it 2 days ago! † As you left the shipping office, you glanced at her desk and saw her shipping receipts. You could clearly see that the order was shipped this morning. You called the client back with the news that the product was on its way. As you talked with the client, you learned that the delay of the product had allowed the condition of some patients to worsen quite dramatically. ___________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Vignette 2 Last Monday, you were sitting at your desk examining a request that a customer had just faxed to you. The customer was proposing a project that would make a tremendous amount of money for your company but had an extremely demanding time schedule.Just as you were about to call the custo mer and accept the project, one of your employees, Phil, knocked on the door. He entered your office, politely placed a letter of resignation on your desk, and told you he was sorry, but in two weeks, he 240——PART III. Ethical Standards and Strategies would be moving to another state to be closer to his ailing parents. After he left, you thought about the proposed project and determined that even though Phil would be gone, you could still meet all of the customer’s deadlines. You called the customer and accepted the project. ___________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Vignette 3 Earlier today, a salesman who works in Iowa called you and told you about an experience he had last week. One of his customers placed a small order of about $1,500 worth of product from corporate headquarters.The home office immediately shipped the package through a freight company, and it arrived the next day at the freight company’s warehouse in Iowa. The salesman went to the warehouse just as it was closing and talked to one of the managers. The manager said that everyone had gone home for the day, but he assured him that the package would be delivered directly to his office the next day. The salesman knew that the customer did not need the materials for at least another 3 days, but he didn’t want to wait.He placed a $20 bill on the counter and asked the warehouse manager one last time if there was anything he could do. The manager found the paperwork, got the product from the back of the warehouse, and brought it out to the salesman. ____________________________________________________________________ ____________________________________________________ ________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________SOURCE: Reynolds, S. J. (2006). Moral awareness and ethical predispositions: Investigating the role of individual differences in the recognition of moral issues. Journal of Applied Psychology, 91, 233–243. Published by the American Psychological Association. CHAPTER 7. Ethical Decision Making and Behavior——241 Component 2: Moral Judgment Once an ethical problem is identified, decision makers select a course of action from the options generated in Component 1. In other words, they make judgments about what is the right or wrong thing to do in this situation.Moral judgment has generated more research than the other components of Rest’s model. Investigators have been particularly interested in cognitive moral development, the process by wh ich people develop their moral reasoning abilities over time. Harvard psychologist Lawrence Kohlberg argued that individuals progress through a series of moral stages just as they do physical ones. 9 Each stage is more advanced than the one before. Not only do people engage in more complex reasoning as they progress up the stages, but they also become less self-centered and develop broader definitions of morality.Kohlberg identified three levels of moral development, each divided into two stages. Level I, preconventional thinking, is the most primitive and focuses on consequences. This form of moral reasoning is common among children who choose to obey to avoid punishment (Stage 1) or follow the rules in order to meet their interests (Stage 2). Stage 2 thinkers are interested in getting a fair deal: You help me, and I’ll help you. Conventional thinkers (Level II) look to others for guidance when deciding how to act.Stage 3 people want to live up to the expectations of those t hey respect, such as parents, siblings, and friends, and value concern for others and respect. Stage 4 individuals take a somewhat broader perspective, looking to society as a whole for direction. They believe in following rules at work, for example, and the law. Kohlberg found that most adults are Level II thinkers. Level III, postconceptual or principled reasoning, is the most advanced type of ethical thinking. Stage 5 people are guided by utilitarian principles.They are concerned for the needs of the entire group and want to make sure that rules and laws serve the greatest good for the greatest number. Stage 6 people operate according to internalized, universal principles such as justice, equality, and human dignity. These principles consistently guide their behavior and take precedence over the laws of any particular society. According to Kohlberg, fewer than 20% of American adults ever reach Stage 5, and almost no one reaches Stage 6. Critics take issue with both the philosophi cal foundation of Kohlberg’s model and its reliance on concrete stages of moral development. 0 They contend that Kohlberg based his postconventional stage on Rawls’s justice-asfairness theory and made deontological ethics superior to other ethical approaches. They note that the model applies more to societal issues than to individual ethical decisions. A great many psychologists challenge the notion 242——PART III. Ethical Standards and Strategies that people go through a rigid or â€Å"hard† series of moral stages, leaving one stage completely behind before moving to the next. They argue instead that a person can engage in many ways of thinking about a problem, regardless of age.Rest (who studied under Kohlberg), Darcia Narvaez, and their colleagues responded to the critics by replacing the hard stages with a staircase of developmental schemas. 11 Schemas are networks of knowledge organized around life events. We use schemas when encountering new s ituations or information. You are able to master information in new classes, for instance, by using strategies you developed in previous courses. According to this â€Å"neoKohlbergian† approach, decision makers develop more sophisticated moral schemas as they develop. The least sophisticated schema is based on personal interest.People at this level are concerned only with what they may gain or lose in an ethical dilemma. No consideration is given to the needs of broader society. Those who reason at the next level, the maintaining norms schema, believe they have a moral obligation to maintain social order. They are concerned with following rules and laws and making sure that regulations apply to everyone. These thinkers believe that there is a clear hierarchy with carefully defined roles (e. g. , bosses–subordinates, teachers–students, officers– enlisted personnel).The postconventional schema is the most advanced level of moral reasoning. Thinking at this level is not limited to one ethical approach, as Kohlberg argued, but encompasses many different philosophical traditions. Postconventional individuals believe that moral obligations are to be based on shared ideals, should not favor some people at the expense of others, and are open to scrutiny (testing and examination). Such thinkers reason like moral philosophers, looking behind societal norms to determine whether they serve moral purposes. Refer to â€Å"Leadership Ethics at the Movies: Michael Clayton† for an example of a leader who shifts to a higher level of moral reasoning. ) Rest developed the Defining Issues Test (DIT) to measure moral development. Subjects taking the DIT (and its successor, the DIT-2) respond to six ethical scenarios and then choose statements that best reflect the reasoning they used to come up with their choices. These statements, which correspond to the three levels of moral reasoning, are then scored. In the best-known dilemma, Heinz’s wife is dying of cancer and needs a drug he cannot afford to buy.He must decide whether to steal the drug to save her life. Hundreds of studies using the DIT reveal that moral reasoning generally increases with age and education. 12 Undergraduate and graduate students benefit from their educational experiences in general and ethical coursework in particular. When education stops, moral development stops. In addition, moral development is a universal concept, crossing cultural boundaries. CHAPTER 7. Ethical Decision Making and Behavior——243 Principled leaders can boost the moral judgment of a group by encouraging members to adopt more sophisticated ethical schemas. 3 Models of cognitive development provide important insights into the process of ethical decision making. First, contextual variables play an important role in shaping ethical behavior. Most people look to others as well as to rules and regulations when making ethical determinations. They are more likely to m ake wise moral judgments if coworkers and supervisors encourage and model ethical behavior. As leaders, we need to build ethical environments. (We’ll take a closer look at the formation of ethical groups and organizations in Chapters 8 and 9. ) Second, education fosters moral reasoning.Pursuing a bachelor’s, master’s, or doctoral degree can promote your moral development. As part of your education, focus as much attention as you can on ethics (i. e. , take ethics courses, discuss ethical issues in groups and classes, reflect on the ethical challenges you experience in internships). Third, a broader perspective is better. Consider the needs and viewpoints of others outside your immediate group or organization; determine what is good for the local area, the larger society, and the global community. Fourth, moral principles produce superior solutions.The best ethical thinkers base their choices on widely accepted ethical guidelines. Do the same by drawing on import ant ethical approaches such as utilitarianism, the categorical imperative, altruism, communitarianism, and justice-as-fairness theory. LEADERSHIP ETHICS AT THE MOVIES MICHAEL CLAYTON Key Cast Members: George Clooney, Tilda Swinton, Tom Wilkinson, Sydney Pollack Synopsis: George Clooney stars as Michael Clayton, the â€Å"fixer† for a large New York City firm. Clayton takes care of any messes involving clients, like hit-andrun accidents and shoplifting charges.When the firm’s top litigator (played by Wilkinson) begins to work for the other side in a $3 billion lawsuit, Clayton must get him back on his medications and under control. Karen Crowder (Swinton) is chief counsel for the conglomerate being sued for manufacturing a toxic chemical. She decides to permanently silence both the rogue lawyer and Clayton. The fixer, whose life and reputation have been tarnished by a series of poor ethical and business choices, must now decide how to respond to illegal wiretapping and murder. Swinton won a Best Supporting Actress Oscar for her (Continued) 44——PART III. Ethical Standards and Strategies (Continued) performance as the ambitious attorney who decides that corporate survival takes precedence over human life. Rating: R for language, including sexual dialogue Themes: moral reasoning, the dark side of leadership, corruption, greed, character, deception Discussion Starters 1. What factors motivated Clayton to become a â€Å"fixer† and the conglomerate’s chief counsel to protect her company at any cost? 2. Was it unethical for the law firm’s top litigator to begin to work for the plaintiffs? Why or why not? 3.What accounts for Clayton’s shift to a higher level of moral reasoning? Component 3: Moral Focus (Motivation) After concluding what course of action is best, decision makers must be focused (motivated to follow through) on their choices. Moral values often conflict with other significant values. For instance, a n accounting supervisor who wants to blow the whistle on illegal accounting practices at her firm must balance her desire to do the right thing against her desire to keep her job, provide income for her family, and maintain relationships with her fellow workers.She will report the accounting abuses to outside authorities only if moral considerations take precedence over these competing priorities. Psychologists report that self-interest and hypocrisy undermine moral motivation. 14 Sometimes individuals genuinely want to do the right thing, but their integrity is â€Å"overpowered† when they discover that they will have to pay a personal cost for acting in an ethical manner. Others never intend to follow an ethical course of action but engage in moral hypocrisy instead. These decision makers â€Å"want to appear moral while, if possible, avoiding the cost of actually being moral. 15 In experimental settings, they say that assignments should be distributed fairly but then assi gn themselves the most desirable tasks while giving less desirable chores to others. Both self-interest and hypocrisy encourage leaders to set their moral principles aside. For example, corporate executives may declare that lower-level employees deserve higher wages. However, whether they really want to help workers or CHAPTER 7. Ethical Decision Making and Behavior——245 just want to appear as if they do, these executives are not likely to pay employees more if it means that they will earn less as a result.Rewards play an important role in ethical follow-through. People are more likely to give ethical values top priority when rewarded through raises, promotions, public recognition, and other means for doing so. Conversely, moral motivation drops when the reward system reinforces unethical behavior. 16 Unfortunately, misplaced rewards are all too common, as in the case of electronics retailers who reward employees for selling expensive extended warranties on new product s. Such warranties are generally a bad deal for consumers. Emotions also play a part in moral motivation. 7 As noted earlier, sympathy, disgust, guilt, and other moral emotions prompt us to take action. We can use their motivational force to help us punish wrongdoers, address injustice, provide assistance, and so on. Other researchers report that positive emotions such as joy and happiness make people more optimistic and more likely to live out their moral choices and to help others. Depression, on the other hand, lowers motivation, and jealousy, rage, and envy contribute to lying, revenge, stealing, and other antisocial behaviors.To increase your moral motivation and the moral motivation of followers, seek out and create ethically rewarding environments. Make sure the reward system of an organization supports ethical behavior before joining it as an employee or a volunteer. Try to reduce the costs of behaving morally by instituting policies and procedures that make it easier to rep ort unethical behavior, combat discrimination, and so on. Work to align rewards with desired behavior in your current organization. Be concerned about how goals are reached. If all else fails, reward yourself.Take pride in following through on your choices and on living up to your self-image as a person of integrity. Tap into moral emotions while making a conscious effort to control negative feelings and to put yourself in a positive frame of mind. Component 4: Moral Character Executing the plan of action takes character. Moral agents have to overcome opposition, resist distractions, cope with fatigue, and develop tactics and strategies for reaching their goals. This helps explain why there is only a moderate correlation between moral judgment and moral behavior.Many times deciding does not lead to doing. The positive character traits described in Chapter 3 contribute to ethical follow-through. Courage helps leaders implement their plans despite the risks and costs of doing so while prudence helps them choose the best course of 246——PART III. Ethical Standards and Strategies action. Integrity encourages leaders to be true to themselves and their choices. Humility forces leaders to address limitations that might prevent them from taking action. Reverence promotes self-sacrifice. Optimism equips leaders to persist in the face of obstacles and difficulties.Compassion and justice focus the attention of leaders on the needs of others rather than on personal priorities. In addition to virtues, other personal characteristics contribute to moral action. 18 Those with a strong will, as well as confidence in themselves and their abilities, are more likely to persist. The same is true for those with an internal locus of control. Internally oriented people (internals) believe that they have control over their lives and can determine what happens to them. Externally oriented people (externals) believe that life events are beyond their control and are the prod uct of fate or luck instead.Because they have personal responsibility for their actions, internals are more motivated to do what is right. Externals are more susceptible to situational pressures and therefore less likely to persist in ethical tasks. Successful implementation also requires competence. For instance, modifying the organizational reward system may entail researching, organizing, arguing, networking, and relationship-building skills. These skills are put to maximum use when actors have an in-depth understanding of the organizational context: important policies, the group’s history and culture, informal leaders, and so on.Following the character-building guidelines presented in Chapter 3 will go a long way to helping you build the virtues you need to put your moral choices into action. You may also want to look at your past performance to see why you succeeded or failed. Believe that you can have an impact. Otherwise, you are probably not going to carry through whe n obstacles surface. Develop your skills so that you can better put your moral choice into action and master the context in which you operate. Decision-Making Formats Decision-making guidelines or formats can help us make better ethical choices.Taking a systematic approach encourages teams and individuals to carefully define the problem, gather information, apply ethical standards and values, identify and evaluate alternative courses of action, and follow through on their choices. They’re also better equipped to defend their decisions. Four ethical decision-making formats are described in the pages to come. All four approaches are useful. You may want to use just one or a combination of all of them. The particular format you use is not as important as using a systematic approach to moral reasoning. You can practice these guidelines by applying them to Case Study 7. and the scenarios described at the end of the chapter. CHAPTER 7. Ethical Decision Making and Behavior—â €”247 You will probably find it difficult at first to follow a format. That’s because using a format takes a significant amount of effort, and we are used to making rapid judgments mentally when faced with ethical choices. 19 Without being conscious of the fact, we quickly invoke decision-making rules we have learned though experience, such as â€Å"it is always good to obey authority† or â€Å"always be as fair as possible. † Or we intuitively come to a rapid decision based on our emotions and cultural background.Often these quick responses are good ones. But not always. There may be times, for instance, when authority needs to be disobeyed or fairness must be set aside for compassion. Our intuitions are wrong when they are based on mistaken cultural beliefs. For example, many Americans used to immediately condemn interracial couples. As time passed, society recognized that this reaction was biased, unfounded, and unjust. I suggest that, when confronted wit h ethical dilemmas like those in Case Study 7. 1, you write down your initial reaction before using a format. Later compare your final decision to your immediate response.Your ultimate conclusion after following a series of steps may be the same as your first judgment. Or you might find that you come to a significantly different decision. In any case, you should be comfortable with your solution because your deliberations were informed both by your preconscious experiences, emotions, and intuitions as well as by your conscious reasoning. 20 CASE STUDY 7. 1 PARKING LOT SHOOTING Over the past year several employees of a national fast-food chain have been shot or injured when intervening in fights or crimes occurring in the restaurant’s parking lots.As a result, corporate headquarters drafted a new policy that forbids workers from leaving the building in such emergencies, instructing them instead to dial 911. Those who violate the policy will immediately be fired. Imagine that y ou are day-shift manager at one of the company’s locations where a shooting has occurred. You call 911 but notice that the victim, who is lying right outside the door, is bleeding profusely. No one else is stepping up to help the injured man. You have first-aid training and believe you can stabilize his condition before the ambulance arrives.The shooter has apparently fled the scene. Would you disobey company policy and help the shooting victim? 248——PART III. Ethical Standards and Strategies Kidder’s Ethical Checkpoints Ethicist Rushworth Kidder suggests that nine steps or checkpoints can help bring order to otherwise confusing ethical issues. 21 1. Recognize that there is a problem. This step is critically important because it forces us to acknowledge that there is an issue that deserves our attention and helps us separate moral questions from disagreements about manners and social conventions.For example, being late for a party may be bad manners and v iolate cultural expectations. However, this act does not translate into a moral problem involving right or wrong. On the other hand, deciding whether to accept a kickback from a supplier is an ethical dilemma. 2. Determine the actor. Once we’ve determined that there is an ethical issue, we then need to decide who is responsible for addressing the problem. I may be concerned that the owner of a local business treats his employees poorly. Nonetheless, unless I work for the company or buy its products, there is little I can do to address this situation. . Gather the relevant facts. Adequate, accurate, and current information is important for making effective decisions of all kinds, including ethical ones. Details do make a difference. In deciding whether it is just to suspend a student for fighting, for instance, a school principal will want to hear from teachers, classmates, and the offender to determine the seriousness of the offense, the student’s reason for fighting, and the outcome of the altercation. The administrator will probably be more lenient if this is the offender’s first offense and he was defending himself. 4.Test for right-versus-wrong issues. A choice is generally a poor one if it gives you a negative, gut-level reaction (the stench test), would make you uncomfortable if it appeared on the front page of tomorrow’s newspaper (the frontpage test), or would violate the moral code of someone that you care a lot about (the Mom test). If your decision violates any of these criteria, you had better reconsider. 5. Test for right-versus-right values. Many ethical dilemmas pit two core values against each other. Determine whether two good or right values are in conflict with one another in this situation.Right-versus-right value clashes include the following: ? Truth telling versus loyalty to others and institutions. Telling the truth may threaten our allegiance to another person or to an organization, such as when leaders and f ollowers are faced with the decision of whether to blow the whistle on organizational misbehavior (see Chapter 5). Kidder believes that truth versus loyalty is the most common type of conflict involving two deeply held values. CHAPTER 7. Ethical Decision Making and Behavior——249 ? Personal needs versus the needs of the community.Our desire to serve our immediate group or ourselves can run counter to the needs of the larger group or community. ? Short-term benefits versus long-term negative consequences. Sometimes satisfying the immediate needs of the group (giving a hefty pay raise to employees, for example) can lead to long-term negative consequences (endangering the future of the business). ? Justice versus mercy. Being fair and even-handed may conflict with our desire to show love and compassion. 6. Apply the ethical standards and perspectives. Apply the ethical principle that is most relevant and useful to this specific issue.Is it communitarianism? Utilitarianism? Kant’s categorical imperative? A combination of perspectives? 7. Look for a third way. Sometimes seemingly irreconcilable values can be resolved through compromise or the development of a creative solution. Negotiators often seek a third way to bring competing factions together. Such was the case in the deliberations that produced the Camp David peace accord. Egypt demanded that Israel return land on the West Bank seized in the 1967 War. Israel resisted because it wanted a buffer zone to protect its security.The dispute was settled when Egypt pledged that it would not attack Israel again. Assured of safety, the Israelis agreed to return the territory to Egypt. 22 8. Make the decision. At some point we need to step up and make the decision. This seems a given (after all, the point of the whole process is to reach a conclusion). However, we may be mentally exhausted from wrestling with the problem, get caught up in the act of analysis, or lack the necessary courage to come to a decision. In Kidder’s words, At this point in the process, there’s little to do but decide.That requires moral courage—an attribute essential to leadership and one that, along with reason, distinguishes humanity most sharply from the animal world. Little wonder, then, that the exercise of ethical decision-making is often seen as the highest fulfillment of the human condition. 23 9. Revisit and reflect on the decision. Learn from your choices. Once you’ve moved on to other issues, stop and reflect. What lessons emerged from this case that you can apply to future decisions? What ethical issues did it raise? Balance Sheet Advantages (Pros) †¢ Is thorough †¢ Considers problem ownership 50——PART III. Ethical Standards and Strategies †¢ Emphasizes the importance of getting the facts straight †¢ Recognizes that dilemmas can involve right–right as well as right–wrong choices †¢ Encourages the search for creat ive solutions †¢ Sees ethical decision making as a learning process Weaknesses (Cons) †¢ It is not easy to determine who has the responsibility for solving a problem †¢ The facts are not always available, or there may not be enough time to gather them †¢ Decisions don’t always lead to action There is a lot to be said for Kidder’s approach to ethical decision making.For one thing, he seems to cover all the bases, beginning with defining the issue all the way through to learning from the situation after the dust has settled. He acknowledges that there are some problems that we can’t do much about and that we need to pay particular attention to gathering as much information as possible. The ethicist recognizes that some decisions involve deciding between two â€Å"goods† and leaves the door open for creative solutions. Making a choice can be an act of courage, as Kidder points out, and we can apply lessons learned in one dilemma to future problems.On the flip side, some of the strengths of Kidder’s model can also be seen as weaknesses. As we’ll see in Chapter 10, determining responsibility or ownership of a problem is getting harder in an increasingly interdependent world. Who is responsible for poor labor conditions in third-world countries, for instance? The manufacturer? The subcontractor? The store that sells the products made in sweatshops? Those who buy the items? Kidder also seems to assume that leaders will have the time to gather necessary information. Unfortunately, in situations like that described in Case Study 7. 1, time is in short supply.Finally, the model seems to equate deciding with doing. As we saw in our earlier discussion of moral action, we can decide on a course of action but not follow through. Kidder is right to say that making ethical choices takes courage. However, it takes even more courage to put the choice into effect. The SAD Formula Media ethicist Louis Alvin Day of Loui siana State University developed the SAD formula in order to build important elements of critical thinking into moral reasoning. Critical thinking is a rational approach to decision making CHAPTER 7. Ethical Decision Making and Behavior——251 that emphasizes careful analysis and evaluation.It begins with an understanding of the subject to be evaluated; moves to identifying the issues, information, and assumptions surrounding the problem; and then concludes with evaluating alternatives and reaching a conclusion. 24 Each stage of the SAD formula—situation definition, analysis of the situation, decision—addresses a component of critical thinking. (See Box 7. 1. ) To demonstrate this model, I’ll use a conflict involving mandatory vaccinations of health care workers. 25 Situation Definition Health care professionals are at risk for contracting infectious diseases and spreading them to their patients.For that reason, the U. S. government determined that h ealth care workers should be one of the first groups to receive flu vaccines such as the one designed to combat the H1N1 (swine flu) virus. Vaccination can reduce the likelihood of catching the flu by 70%–80% and is one of the best ways to prevent a pandemic. However, fewer than half of U. S. health workers get flu shots every year (rates are also low in Great Britain and Hong Kong). Medical personnel who fail to be vaccinated often do so for the same reasons as other Americans.They don’t like shots, it is not convenient to get them, they claim they seldom get sick, or they believe the vaccine makes them ill (though scientists deny that this happens). Health officials have tried a variety of strategies to increase the percentage of doctors and nurses receiving vaccinations, including promotional campaigns and prize drawings. However, these voluntary efforts have fallen short. Concerned about low participation rates, particularly in light of the danger posed by the swin e flu, Hospital Corporation of America, MedStar Health (Maryland), Virginia Mason (Seattle, WA), BJC HealthCare (St.Louis, MO), and the state of New York began mandatory vaccination programs. A number of clinics and doctor’s offices followed suit. Employees were told they would lose their jobs if they did not get the vaccine. Exceptions were made for those likely to have an allergic reaction (eggs are used in the production of the shots) or those with religious objections. Some health care workers and their unions immediately protested the stricter vaccination policies, labeling such programs as intrusive violations of individual rights. Day says that the ethical question to be addressed should be as narrow as possible.In our example, we will seek to answer the following query: Are mandatory flu-vaccination policies for health care workers ethically justified? 252——PART III. Ethical Standards and Strategies BOX 7. 1 THE MORAL REASONING PROCESS Situation Definiti on Description of facts Identification of principles and values Statement of ethical issue or question Analysis Weighing of competing principles and values Consideration of external factors Examination of duties to various parties Discussion of applicable ethical theories Decision Rendering of moral agent’s decision Defense of that decision based on moral theory SOURCE: From Day.Ethics in Media Communications: Cases and Controversies, 5E. Copyright  © 2006 Wadsworth, a part of Cengage Learning, Inc. Reproduced by permission www. cengage. com/permissions. Analysis Evaluation of Values and Principles. Competing principles and values are clearly present in this situation. On the one side, medical administrators and public health officials put a high value on the responsibility of medical personnel to patients and argue that mandatory vaccinations will save lives, particularly those of vulnerable populations like the sick, those with compromised immune systems, pregnant women, the very young, and the elderly.In requiring mandatory vaccinations in New York, the state’s health commissioner asserted: â€Å"The rationale begins with health-care ethics, which is: The patient’s well-being comes ahead of the personal preferences of health-care workers. †26 (The commissioner later rescinded his edict when there was a shortage of the vaccine. ) The chief medical officer of MedStar Health said the decision to require vaccinations â€Å"is all about patient safety. † On the other side of the debate are individuals, employee unions, and groups CHAPTER 7. Ethical Decision Making and Behavior——253 who put their priority on individual rights.They believe that making flu shots a condition of employment takes away the right to make personal medical decisions, and they have concerns about the safety of the vaccines despite the assurances of medical experts. Opponents also worry that mandatory programs will spread from the health ca re sector into other areas of society. Said a representative of an organization wanting to limit government expansion, â€Å"You start with health-care workers but then expand that umbrella to make it mandatory for everybody. It’s all part of an encroachment on our liberties. †27 External Factors.Some influenza strains, like H1N1, pose greater risks than other strains and spread more rapidly, making vaccinations even more important. Medical employees already have to be inoculated for other conditions like mumps, measles, and tuberculosis, and there haven’t been widespread protests about these requirements. In addition, medical personnel have to follow such mandatory safety procedures as washing their hands before surgery. Vaccinations appear to be a safety measure like hand washing. However, past inoculation programs have made some medical professionals skeptical about current efforts.Earlier vaccines did make recipients sore and could cause mild flu-like sympto ms. The H1N1 vaccine seemed to be rushed into production, raising concerns that recipients were serving as â€Å"guinea pigs. † Nurses, doctors, and home health givers, like other Americans, are increasingly worried about substances they put in their bodies. Moral Duties or Loyalties. Professor Day borrows from theologian Ralph Potter for this part of his model. Potter believes we need to take into account important duties or loyalties when making ethical choices. 8 In this case, the following duties have to be kept in mind: †¢ †¢ †¢ †¢ †¢ †¢ Loyalty to self (individual conscience) Loyalty to patients Loyalty to vulnerable populations Loyalty to fellow employees Loyalty to others in the same profession Loyalty to the public Medical officials seem primarily concerned for patients, vulnerable populations, and the larger community. Low vaccination rates threaten patients and clients and help the virus spread. Health care workers who refuse flu shots also damage the credibility of the medical profession. Why should patients be vaccinated if their doctors and nurses don’t think it is safe 54——PART III. Ethical Standards and Strategies or necessary to do so? Vaccination objectors are more concerned for their individual rights and, in some cases, their personal safety. They seem to overlook their primary duty, which is to serve their patients. Yet not all appear to be acting out of selfish motives. Some resistors are concerned about setting a precedent that could reduce the rights of their fellow citizens in the years to come. Moral Theories. Each of the ethical perspectives outlined in Chapter 5 can be applied to this dilemma.From a utilitarian perspective, the benefit of protecting personal rights has to be weighed against the dangers of spreading the flu virus. However, the immediate benefits of slowing the virus also need to be weighed against the long-term costs—loss of individual rights and govern ment intrusion. Based on Kant’s categorical imperative, we could ask if we would want everyone to be vaccinated (probably) or if we would want everyone to refuse to be vaccinated (probably not). However, employees who resist the mandatory shots should carry through on their decision regardless of the consequences, such as losing their jobs.Rawls’s theory could be applied to say that required vaccinations are justified because they protect the least advantaged members of society. Communitarianism also seems to support the mandatory vaccination position. Medical leaders put their emphasis on responsibility to patients, vulnerable groups, and the public. Objectors seem to emphasize individual rights rather than duties. Advocates of mandatory vaccinations have a stronger altruistic focus because such efforts are designed to reduce sickness and suffering. Opponents may argue, however, that they are demonstrating concern by protecting the rights of others.Decision Decisions often emerge out of careful definition and analysis of the problem. It may be clear which course of action is best after external constraints, principles, duties, and moral theories are identified and evaluated. In our example, mandatory flu vaccination programs for health care workers appear to be morally justified. Such programs put the needs of others first and reduce suffering and death. They seem consistent with other requirements placed on health care workers and support the patient-focused mission of the medical profession.Health care employees should prevent sickness, not spread it. This option also seems to be best supported by moral theory. Nonetheless, opponents of mandatory vaccination programs are right to point out that we should be cautious about requiring health CHAPTER 7. Ethical Decision Making and Behavior——255 treatments. Just because mandatory influenza vaccinations are justified for health care workers does not mean that we should require all citi zens to be vaccinated (that’s a different question for analysis) or force citizens into other medical treatments. Balance SheetAdvantages (Pros) †¢ Encourages orderly, systematic reasoning †¢ Incorporates situation definition, duties, and moral theories Disadvantages (Cons) †¢ Failure to reach consensus †¢ Limits creativity †¢ Ignores implementation The SAD formula does encourage careful reasoning by building in key elements of the critical thinking process. Following the formula keeps decision makers from reaching hasty decisions. Instead of jumping immediately to solutions, they must carefully identify elements of the situation, examine and evaluate ethical alternatives, and then reach a conclusion.Three elements of the SAD formula are particularly praiseworthy. First, the formula recognizes that the keys to solving a problem often lie in clearly identifying and describing it. Groups are far less likely to go astray when members clearly outline the question they are to answer. Second, Day’s formula highlights duties or loyalties. In the case of vaccinations, prioritizing loyalties is key to supporting or opposing mandatory vaccination programs. Third, the formula incorporates moral theories directly into the decisionmaking process. The strengths of the SAD model must be balanced against some troubling weaknesses.Day implies that a clear choice will emerge after the problem is defined and analyzed. Nevertheless, that may not always be the case. Even in our example, there is room for dispute. While it appears as if mandatory vaccinations are morally justified, those who put a high value on personal freedoms will likely remain unconvinced. They raise valid concerns about the long-term impact of such programs as well. Focusing on a narrowly defined question may exclude creative options and make it hard to apply principles from one decision to other settings. Finally, the formula leaves out the important implementation stage . 56——PART III. Ethical Standards and Strategies Nash’s 12 Questions Ethics consultant Laura Nash offers 12 questions that can help businesses and other groups identify the responsibilities involved in making moral choices. 29 She argues that discussions based on these queries can be useful even if the group doesn’t reach a conclusion. Managers who answer the questions surface ethical concerns that might otherwise remain hidden, identify common moral problems, clarify gaps between stated values and performance, and explore a variety of alternatives. 1. Have you defined the problem accurately?The ethical decision-making process begins with assembling the facts. Determine how many employees will be affected by layoffs, how much the cleanup of toxic materials will cost, or how many people have been injured by faulty products. Finding out the facts can help defuse the emotionalism of some issues (perhaps the damage is not as great as first feared). 2. How wou ld you define the problem if you stood on the other side of the fence? Asking how others might feel forces self-examination. From a company’s point of view, expanding a local plant may make good sense by increasing production and efficiency.Government officials and neighbors might have an entirely different perspective. A larger plant means more workers clogging already overcrowded roads and contributing to urban sprawl. For example, considering the company’s point of view may impact the decision you reach in â€Å"Focus on Follower Ethics: Paying Back Microsoft† on page 258. 3. How did this situation occur in the first place? This question separates the symptoms from the disease. Lying, cheating customers, and strained labor relations are generally symptoms of deeper problems.Firing an employee for unethical behavior is a temporary solution. Probe to discover the underlying causes. For example, many dubious accounting practices are the result of pressure to pro duce high quarterly profits. 4. To whom and to what do you give your loyalties as a person or group and as a member of the organization? As we saw in Chapter 1, conflicts of loyalty are hard to sort through. However, wrestling with the problem of ultimate loyalty (Work group? Family? Self? Corporation? ) can clarify the values operating in an ethical dilemma. 5. What is your intention in making this decision? . How does this intention compare with the likely results? These questions probe both the group’s intentions and the likely products. Honorable motives CHAPTER 7. Ethical Decision Making and Behavior——257 don’t guarantee positive results. Make sure that the outcomes reflect your motivations. 7. Whom could your decision or action injure? Too often groups consider possible injury only after being sued. Try, in advance, to determine harmful consequences. What will happen if customers ignore label warnings and spread your pesticide indiscriminately, for example?Will the guns you manufacture end up in the hands of urban gang members? Based on these determinations, you may decide to abandon your plans to make these items or revise the way they are marketed. 8. Can you engage the affected parties in a discussion of the problem before you make your decision? Talking to affected parties is one way to make sure that you understand how your actions will influence them. Few of us would want other people to decide what’s in our best interest. Yet we often push forward with projects that assume we know what’s in the best interests of others. 9.Are you confident that your position will be as valid over a long period of time as it seems now? Make sure that your choice will stand the test of time. What seem like compelling reasons for a decision may not seem so important months or years later. Consider the U. S. decision to invade Iraq, for instance. American intelligence experts and political leaders tied Saddam Hussein to terror ist groups and claimed that he was hiding weapons of mass destruction. After the invasion, no solid links between Iraqis and international terrorists or weapons of mass destruction were discovered.Our decision to wage this war doesn’t appear as justified now as it did in the months leading up to the conflict. 10. Could you disclose without qualm your decision or action to your boss, your CEO, the board of directors, your family, or society as a whole? No ethical decision is too trivial to escape the disclosure test. If you or your group would not want to disclose this action, then you’d better reevaluate your choice. 11. What is the symbolic potential of your action if understood? Misunderstood? What you intend may not be what the public perceives (see Questions 5 and 6).If your company is a notorious polluter, contributions to local arts groups may be seen as an attempt to divert attention from your firm’s poor environmental record, not as a generous civic gest ure. 12. Under what conditions would you allow exceptions to your stand? Moral consistency is critical, but is there any basis for making an exception? Dorm rules might require that visiting hours end at midnight on weekdays. Yet, as a resident assistant, is there any time when you would be willing to overlook violations? During finals week? On the evening before classes start?When dorm residents and visitors are working on class projects? 258——PART III. Ethical Standards and Strategies Balance Sheet Advantages (Pros) †¢ Highlights the importance of gathering facts †¢ Encourages perspective taking †¢ Forecasts results and consequences over time Disadvantages (Cons) †¢ Is extremely time consuming †¢ May not always reach a conclusion †¢ Ignores implementation Like the ethical checkpoints, the 12 questions highlight the importance of problem identification and information gathering. They go a step further, however, by encouraging us to engage in perspective taking.We need to see the problem from the other party’s point of view, consider the possible injury we might cause, invite others to give us feedback, and consider how our actions will be perceived. We also need to envision results and take a longterm perspective, imagining how our decisions will stand the test of time. Stepping back can keep us from making choices we might regret later. For example, the decision to test nuclear weapons on U. S. soil without warning citizens may have seemed justified to officials waging the Cold War. However, now even the federal government admits that these tests were immoral. NW E FOCUS ON FOLLOWER ETHICS PAYING BACK MICROSOFT? S Software giant Microsoft made an embarrassing error when it engaged in the first widespread layoffs in the firm’s history. Company officials overpaid an average of $4,000–$5,000 to 25 out of the first 1,400 workers it furloughed. After discovering the error, the firm sent a letter ask ing for repayment from the 25 laid-off workers, requesting a check or money order and apologizing for the inconvenience. Contents of the letter soon appeared on the Internet and in the national media. Microsoft officials then backed off their attempts to get the money back.According to a company spokesperson, â€Å"This was a mistake on our part. We should have handled this situation in a more thoughtful manner. We are reaching out to those impacted to relay that we will not seek any payment from CHAPTER 7. Ethical Decision Making and Behavior——259 those individuals. †1 While Microsoft decided to drop the matter because of negative publicity, the fact remains that some employees received more than they were promised. Except for a clerical error, the company did nothing wrong and has a legal right to ask for restitution.One outplacement expert noted that just because Microsoft is a large company doesn’t mean it should have to automatically pay the cost for this mistake. â€Å"What if they’d put an extra three zeros on it? † he wondered. â€Å"Of course they’d expect to get it back. †2 If you were one of the laid-off workers overpaid by Microsoft, would you give the money back? Why or why not? Would your response be different if the amount of the overpayment was much bigger and the company much smaller? Notes 1. Microsoft will not seek overpaid severance. (2009, February 23). TECHWEB. 2. Microsoft will not seek overpaid severance. Sources Chan, S. P. 2009, May 6). Microsoft may not be done cutting jobs. The Seattle Times, p. A1. Microsoft will not seek overpaid severance. (2009, February 23). TECHWEB. I suspect that some groups will be frustrated by the amount of time it takes to answer the 12 questions. Not only is the model detailed, but discussing the problem with affected parties could take a series of meetings over a period of weeks and months. Complex issues such as determining who should clean up riv er pollution involve a variety of constituencies with very different agendas (government agencies, company representatives, citizens’ groups, conservation clubs).Some decision makers may also be put off by the model’s ambiguity. Nash admits that experts may define problems differently, that there may be exceptions to the decision, and that groups may use the procedure and never reach a conclusion. Finally, none of the questions use the ethical standards we identified in Chapter 5 or address the problem of implementing the choice once it is made. The Case Study Method The case study method is widely used for making medical diagnoses. At many hospitals, groups made up of doctors, nurses, and other staff members 260——PART III. Ethical Standards and Strategies eet regularly to talk about particularly troublesome cases. They may be unable to determine the exact nature of the illness or how to best treat a patient. Many of these deliberations involve ethical is sues such as whether to keep a terminally ill person on life support or how to respond to patients who demand unnecessary tests and procedures. The group solicits a variety of viewpoints and gathers as much information as possible. Members engage in analogical reasoning, comparing the specifics of a particular case with similar cases by describing the patient, her illness, and relationships with her family.Instead of focusing on how universal principles and standards can be applied in this situation, hospital personnel are more concerned with the details of the case itself. Participants balance competing perspectives and values, reach tentative conclusions, and look for similarities between the current case and earlier ones. Medical ethicist and communication scholar David H. Smith argues that the case-based approach is a powerful technique because it is based on narrative or story. 30 When decision makers describe cases, they are telling stories.These narratives say as much about t he storyteller as they do about the reality of the case. â€Å"Facts† are not objective truth but rather are reflections of what the narrator thinks is true and important. Stories knit these perceptions into a coherent whole. When discussing the fate of patients, it is not enough to know medical data. Hospital personnel need to learn about the patient’s history, the costs and benefits of various treatment options, and other factors such as the wishes of relatives and legal issu

My Career Objective

In my first employment, I want to be employed as marketing assistant for a drug Maker Company. Being a fresh graduate with a pharmaceutical degree from the university, I am quite excited to be in the marketing department because the job seemed to fit to my course (a Bachelor’s Degree in Pharmaceutical). The job that I want to have includes the sale of pharmaceutical products, taking orders from the customers, and developing business relations with both new and old customers. Target Market My main target market is the Pharmaceutical Companies in India, which manufacture pharmaceutical products and drugs for export to South East Asia. Most of the drugs are sold over the counter, as these drugs are common medicines for fever, cough, and flu. There are also generic antibiotic medicines such as cefalexin and amoxicillin that are sold cheap. At present, China, Indonesia, Thailand, Philippines, and Malaysia are the emerging pharmaceutical manufacturer and exporter in the region. In order to demonstrate my desire to work in pharmaceutical company in India, I checked for job opportunities in some pharmaceutical companies in India. See appendix A or Job announcements samples from India. This job opportunity requires a minimum of one-year experience but I believe that if the credential is impressive, it may not pose problem. Personal Features To prove my worth to the position, I would like to emphasize five features that describe me as a person, and as a professional. First, I posses a solid communication skills both in person and by phone which I developed during my student days as public information officer in our school organ which   I believe will benefit the marketing department. Second, I am proficient with Macintosh, PC, and spreadsheet applications; I am particularly gifted with technical skills that give me an advantage over other applicants. Third, I can effectively manage important aspect of business operations, including inventory management and account maintenance. I acquired knowledge in this area through my on-the job training at my grand father’s business firm. Fourth, I have a flexible character and I cab easily get along with others. This enables me to have the ability to organize and motivate others. I believe this is important in the work place because working in harmony with others builds teamwork, which is important in creating a productive work environment. Above all these, is that I posses a strong work ethic and enthusiasm to learn. I believe that with all this features I can help the company to boost its sales performance as well as in advancing the company’s competitive advantage. What makes me different from others? I understand that there are many applicants to the position I desired, but I would like to point out my advantage with others, which make the difference. Aside from the five features that I have which I mentioned above, I am a jolly person. I have strong sense of humor and I could easily crack jokes that can uplift the guts of my peers. I am willing to do some technical trouble shooting if necessary, even to the extent of working on twenty-four hours to ensure effective communication facility or to meet the necessary requirements. I am aware that this is not the kind of job I am applying but if I need to do so, I will be willing. My communication skills would be an advantage too. I have communications with a lot of important personality that could provide an important business link. If I will be given the chance to be part of the marketing team, I could work with these important people to advance the companies’ interest and goals. Salary Expectation With regard to the salary, I will not be so particular about how much as long as it is respectable. I mean not really high but not very low also. But this depends on the company situation. If the company is multi-national I would expect salary that will commensurate to my worth in the company. I believe this is justifiable because multi-national company earns enormous profits and it is not a sin to demand a fair share.   I will not demand higher salary, but just the appropriate compensation based on the prevailing salary standard. However if necessary, I am willing to accept lower salary if that meant developing good experience for a better job two to three years from now. I do not think demanding a higher salary at this point is unjustifiable in the sense that I have not proven yet my worth. I need to prove all that I have stated in my resume. The salary that I expect is the current minimum wage for professional. Promotional strategy (why I want This Job) I have learned about the job opportunity in India from the internet at Yahoo job search India. The specific location of the company is in Mumbai. I want this job because I have particular interest in pharmaceutical related work. Besides this is my field of expertise and it would be more comfortable for me if will be in this fieldwork. Perhaps what attracts me to this kind of work is that since childhood, I was fascinated by the pharmacist in their beautiful uniform that I used to see at a nearby drugstore in our neighborhood. I choose to work in India because I want to experience a new culture. India is one of the fastest growing economies in Asia and considered to one of the emerging hegemonic economy after the United States. What do I see my self doing in five years I would say that I will still be in this company five years from now but perhaps as the marketing head of the company’s marketing department. I am quite sure that both my technical and communication skills will be even more developed during the course of my employment and I expect that I can acquire new skills, particularly in management, that could provide me the opportunity for career improvement. I am confident that so long as the top management recognized my worth and justly compensate my effort, I can perform my best and remain loyal to the company’s goals and mission. What do I see my self in ten years? As I mentioned earlier, so long as the company recognized my worth and justly compensate my effort, I will remain loyal to the company and perform my best. In this case I see my self-being in the top management team or perhaps a branch manager in either India or in particular Asian country. My loyalty to the company will remain until the time of my retirement. The company’s trust and confidence in me as well as the fare recognition of my initiative, my effort, and my skills and experience with the company will be the motivating factor behind my commitment. Distributional Strategy I will make the employer aware of the benefit that I can provide through my resume with attached application letter. I must prepare an impressive resume that presents my outstanding qualification specified in terms of acquired skills, personal attributes, co—curricular and community involvement, awards, and most importantly my work experience.   By means of these points of competencies, I can generally pinpoint my advantages over other applicants; and in the same way, the employer can easily determine why he has to select me from the many choices he has. Basically, resume and application letter is the best option for all application in making that first point of contact with the employer.   This is the best way to make personal impression because this reflects your sincerity and personality. Appendix A JOB ANNOUNCEMENT FROM THE INTERNET Marketing Executive Company Profile: The company is into manufacturing of High Quality Pharmaceutical, Chemicals, Cosmetics, Beverages & Food Industries Machineries & Equipments. Job involves : The job will include sale of pharmaceutical Machinery, follow up with client, Taking orders from clients, overall business development of the old and New clients as well. Experience : 1 – 3 yrs Job Category : Marketing / Sales Medical Marketing Associates Company Profile : A Pharmaceutical Group of Company Job involves : Post Graduates/ Graduates in Medicine/ Pharmacy/ science. Experience : 1 – 2 yrs Job Category : Pharmaceutical/ Biotech Keywords – Medical Marketing Associates More Information Salary : Upto Rs 1.75 lacs p.a Location : Ahmedabad, Bangalore, Jaipur Date Posted : Source: http://in.jobs.yahoo.com/jobs.php?jc=Pharmaceutical Work Cited Henry, Merrit. Constructing an Impressive Resume.   The Jamaica Observers.   April 22, 2007. http://www.jamaicaobserver.com/news/html/20070421T210000-0500_122057_OBS_CONSTRUCTING_AN_IMPRESSIVE_R_SUM__.asp. Yahoo Job Search in India. http://in.jobs.yahoo.com/jobs.php?jc=Pharmaceutical