Principle of Non-maleficence Violation: Case Study

Principle of Non-maleficence Violation: Case Study Introduction Pakistan is a developing country with 184 million populations; majority of people is living in rural areas, where literacy rate is very low. The burden of Chronic liver disease (CLD) is increasing day by day due to poor compliance to preventive measures. According to Qureshi, Bile, Jooma, Alam and Afridi (2010) the burden of hepatitis B and C is increasing in general population and it is currently 7.6%. High prevalence of hepatitis B and C will result in increased incidence of CLD. Quality of life among CLD patients is very poor and the only option for them is liver transplantation. Unlike liver transplantation renal transplantation started early in 1985, currently facility is available both in public and private hospital across the country. On other hand very few liver transplantation were performed in the country despite the fact that every year 10,000 people die due to CLD (Ali, Qureshi, Jilani, Zehra 2013). The liver transplant project was initiated in 2011 at Pakistan Institut e of Medical sciences under special instruction from prime minister of Pakistan. The purpose of this project was to provide liver transplant facility in the country on affordable cost. Scenario 32 years old male having three children diagnosed with CLD, was operated liver transplantation in public sector hospital. The liver was taken from live donor 28 years old wife of the patient. On 3rd post op day the patient start severe bleeding with tachycardia and hypotension. Patient become unconscious and was rushed to operation room (OR). Meanwhile patient crashed and Cardio Pulmonary Resuscitation (CPR) started. After 6 hours of CPR patient cardiac activity was resumed, but still bleeding from drain and body orifices. Patient was on high inotropic support and back to back transfusion of blood and blood product to maintain hemoglobin and platelet of patient. Later on patient expired and his wife remain in hospital till her recovery Analysis of ethical issue The procedure was performed without enough resources and principle of non-maleficence was violated. The hospital management and transplant team were responsible for the malpractice. They assured the patient and his family that the hospital has cutting age technology, expert human resource and outstanding material resource comparable with other advance liver transplant center in the developed countries. But in reality the situation was worse with no training of health care staff, three bedded intensive care unit (ICU) without isolation, and small operation theater with poor infection control measures. Lack of standard laboratory without computerization increases the misfortunes of liver transplant center. In short these facilities were not sufficient for such advance level surgery which risks the life of donor as well recipient. These leads to negligence and malpractice on part of hospital management and liver transplant team which arise the question in mind that â€Å"Is this ethica l to perform liver transplant in limited human as well material resources.†? The ethical principle of justice non-maleficence and virtue of veracity are violated. Moreover, the act of hospital management and transplant team were against the theory of deontology. According to news in media initially a memorandum was signed between the hospital and Royal Free Hospital, London but later on after inspection of infrastructure and human resource they refused to perform such complicated procedure in this facility (Wasif, 2012). Although government provided 200 million PKR to build state of the art facility in capital city of Pakistan but these huge amounts were wasted and golden opportunity of liver transplant in public sector hospital was misused. Ethical principle violated in decision making to perform liver transplant My preposition is that without adequate expertise and material as well as human resource performing such intricate surgery is not justifiable and against the ethical principles. While performing their duties health care professionals must adhere to ethical principle and rules. Any breach or violation of these principles may lead to malpractice and negligence. The patient trust on health care professionals and believe that they will apply their knowledge and skills to provide benefit to patient. Similarly, according to Hippocratic pledge health care professionals will abstain their self from harmful and mischievous act (Markel, 2004). Obligation of non-maleficence not only include to avoid harm but also not to impose risk of harm (Beauchamp and Childress, 2001). In the above situation the health care workers lack proper training, skills and material resources to perform such sophisticated procedure. Moreover the professional standards were violated which determine due care in such situation and risk of harm was inflicted on patient. The hospital management and liver transplant team act negligently and harm the patient, his family and specially his wife. Hospital management and transplant team stance The health care team stance was to maximize the benefit and happiness to the society. They support their position using act utilitarianism for the greater happiness of greater number of people. According to act-utilitarianism an action is right if it produces consequences like any other action available to the agent (barns, 1971). The hospital management and transplant team argued that patient was known case of CLD with complication and no other alternative, So according to act-utilitarianism our action is justified and if successful this center will provide care to thousands CLD patients waiting for miracle in the country. Our intention was good and according to Islamic principle of ethics actions are judged according to intention. One of the saying of Prophet Muhammad peace be upon him â€Å"the reward of deeds depends upon the intentions and every person will get the reward according to what he has intended.† (Bukhari: 1). Justification of my stance using deontology To justify my position, I will refer to famous philosopher Emanuel Kant and his theory of deontology. I According to Emanuel Kant action are not justified on basis of consequences, rather they should be judged independently of its outcome (Beauchamp and Childress, 2001). If we judge the action of hospital management and liver transplant team independently of its outcome we came to result that action was performed without enough evidence which harm the patient and against the basic principle of ethics. According to Nathaniel and Burkhardt (2008) deontology stresses that individual must fulfill their obligation and in the above scenario the obligation to do no harm and provide beneficence was violated. Furthermore one principle of Islamic ethics is certainty which mean evidence based practice (Mustafa, 2013); this principle of certainty was violated as performing liver transplantation without standard human and material resource, which is against the evidence base practice. Consequences of Acting on my Position If the hospital management started this project after appropriate training for different professionals along with good infrastructure equipped with modern equipment and according to international standards, then the consequences will be different for patient me and other staff. The patient life could be saved and new patients will be enrolled for transplantation. The other staff will remain in the center providing care to liver transplant patients. I myself will be there taking care of patient and contributing towards the betterment of community and huge money will be utilized in appropriate place according to the need of public. Recommendation On basis of above scenario and analysis, I am going to put forward some suggestions to stakeholders. First of all such sophisticated project must be plan and each and every step should be taken according to plan. The second is hiring of proper and competent professional; these professionals include doctors, nurses, technicians, laboratory, and radiology staff. Training for these professionals should be arranged in leading liver transplant center of the world. The third is that all the units including ICU, OR, laboratory, radiology and pharmacy should be under one roof preferably in separate building and equipped with contemporary instruments. Moreover these units should be connected with each other through computer and internet.

In ‘Of Mice and Men’ Steinbeck explores the idea of the American dream Essay

The story’ Of Mice and Men’ is a novella written by John Steinbeck. Although Steinbeck writes the story in the late 1930’s, he sets it in California, Soledad, while the Great Depression was being taking place in America, which followed the Stock Market collapse of 1929, and the Californian farmers had little money to spare to pay these itinerant workers. This caused millions of workers to lose their jobs, which lead to poverty and unemployment. A lot of men could not find work and there families suffered evection and starvation. Steinbeck witnessed the hardship around him and his great novels including ‘The Grapes of Wrath’ and ‘Cannery Row’ these novels describe life during the Great Depression. ‘Of Mice and Men’ shows how there were a shortage of work and describe the lives of two itinerant workers, George and Lennie. George and lennie are the two main characters in the book, and showed the relationship between the two friends. George was small and restless; he had a dark face with restless eyes and sharp strong features. He was bright, quick and clever who looks after the mentally disabled strong ‘Lennie’. Lennie has a child’s mind and is very childlike by wanting to feel soft things. His body is immensely strong and has never learnt how to control his body strength. He is described in terms of an animal because of his strength â€Å"dragging his feet a little, the way a bear drags his paw.† George and Lennie are both workers, moving from ranch-to-ranch searching for jobs in Soledad, which is the Spanish for ‘lonely’. In spite of this each worker has a â€Å"dream†. George and lennie like all workers have had a dream too, †to live off the fatta the lan†, George and Lennie’s dream was to have a farm and then to do their own thing were no-one can allow to push them around or tell them what to do. All men had a dream similar to this, to own a piece of land of there own, this was something on all workers mind, which kept them going. However the novella ends in tragedy. Steinbeck introduces the main characters, George and Lennie early in the book. It is Friday evening and they are on their way to the ranch in Soledad. When the bus driver drops them off, he doesn’t really care. They are shown as victims of society from the beginning of the book, where George and Lennie wanted to be dropped off at the ranch were the bus driver then made them walk ten miles when he said the bus doesn’t go round that end, and while the were walking the saw the bus go by which made George very mad. Steinbeck writes that â€Å"two men emerged from the path and came to the green pool† this is the pool of the Salinas River where the novel starts and ends. The two men are described as complete opposites. Lennie was a big man, but had a mind of a child, which he was mentally disabled. George is like a father to him, George expresses Steinbeck’s attitude towards Lennie as a compassionate and sympathetic person. George and Lennie’s relationship is of friendship and dependence, although they both depend of each other; it seems at first as if Lennie totally depends on George, this is shown when Lennie panics because he thinks he has lost his work card and his bus tickets he says: † George, I aint got mine, I musta lost it† where as there relationship is like a parents child relationship. Through the first paragraph George starts telling Lennie about the future and what they want. He tells Lennie in a child like way of that they want to â€Å"live off the fatta the lan†, with a garden and were Lennie can tend the rabbits. Lennie likes hearing this; it’s like a favorite story where he knows all the words off by heart. In ‘Of Mice and Men’ Steinbeck explores the idea of the American dream. This idea is still prevalent today where people still have a dream, to do something and it basically means that anybody can ‘make it big’ in America. This is based on equality and independence and put forward the idea that everybody can get rich, is free and equal regardless of religion, race or country of origin, and also the American dream promises the freedom from persecution. In order to achieve the dream, you have to work hard. Each character had a dream: Curley’s dream was to just be stronger than anyone. Which he shows his aggressive behavior towards those weaker than himself. Curley’s wife wants to be a film star, which her dream can’t happen as she is married to Curley where he doesn’t allow her to do or speak to anyone apart from himself. It shows that the marriage has failed, maybe, as he can’t satisfy her emotionally or physically. Due to her loneliness she try’s to seek attention with other men and can’t escape from the sexual image of what other men have of her. Because of the circumstances of her own isolation she therefore cultivates this image as a means of getting noticed, to talk to someone. Candy wants to work on his own land and no one to push him around. Crooks is the only black person on the ranch his dream was also to have his own ranch and no one to tell him what to do and to have no racist comments. So for the ranch workers to get this life they will have to work very hard. However for George and Lennie the dream could only ever be a dream. They want to believe in its reality but it is only ever ‘wishful thinking’. George and Lennie’s dream is all to do with having freedom, to not have to be ‘canned’ to not work on days they didn’t want to. They wanted to work in a place and live in a place that is cosy and have of food. And Lennie’s dream is to ‘live off the fatta the lan’ and tend rabbits and other creatures and have a comfortable, rich life where they can have there own independence, but Lennie is volatile, violent, huge and strong. Lennie constantly gets them into trouble, for example: we are first introduced George and Lennie when they flee from weed.† Where Lennie was accused of rape but really didn’t do anything, as he only grabbed the ladies dress to feel the softness of it. There are number of things to suggest the dream is only ever fantasy. Another thing to support this is that they wanted to re-create happier times when they were younger and part of a family Lennie describes his childhood with aunt Clara†¦Ã¢â‚¬ I remember a lady, she gave we mice†. In Of Mice and Men, Steinbeck shows how the badly the workers were treated in the Great Depression they were at mercy of cruel bosses, which in this state in the book was Curley as he was the boss’s son. One key aspect of their dream is that George and Lennie fantasize about better working condition ‘of not getting canned’. One thing Steinbeck explains is the basic needs of companionship, loyalty and having something to look forward to, as without any hope of doing something there’s nothing to look forward to, and nothing to live for. The notion of all the characters in the novella being lonely victims is emphasized. They all have dreams one character in the book is Candy, he is a nice fella, he had lost his right hand in a farm accident and is reduced work of a ranch’swamper’. Candy has a dog that he is devoted to. The other ranch worker despite the dog, as he is old and smells very bad, so they confront Candy to let it out of his misery by shooting the dog, this illustrates the harshness of the relationships and the environment of which Steinbeck describes. It also predicts the end of the novel It is only because of Candy’s offer to join George and Lennie in their dream to buy a ranch that it becomes a possibility of fulfilling their dream. As he said â€Å"s’pose I went in with you guys†. â€Å"They fell into a silence. They looked at on another, amazed. This thing they had never really believed in was coming true†. Steinbeck’s portrayal of Lennie is always compassionate but realistic. He is described in terms of an animal because of his strength. â€Å"Lennie dabbled his paw† He shows a victim of mental disabilities who cannot cope in harsh, unfriendly world. The society of the 1930’s did not make allowance for the mentally ill. George cares for Lennie but is manipulated by him. Lennie has a huge amount of strength and cannot control himself. He has a tendency to panic, which creates a problem like when he broke Curley’s arm as he was trying to struggle out Lennie held on tighter. Lennie never leaves a sight off George but when he is away he tend to get into trouble. Lennie is cunning and aware of this in another sense, and does not and cannot learn from his mistakes and is victim. Another time where he panics was the killing of Curley’s wife he didn’t mean it he just wanted to feel her hair, he is also selfish in ways as he ended up killing her as she was screaming, and all because that George may tell him off and not let him tend the rabbits. In conclusion the only person who achieves their dream is Lennie, as he dies thinking about their dream where George was reciting it to him at the Salinas River, before he dies knowing that the dream was in his mind. Steinbeck successfully shows the working life of that time and the dreams, of what everyone wanted to be ‘to have a rich, and relaxed life’, which people still have that dream today. Steinbeck’s sympathy and compassion for the characters, evident his storytelling is on their side. The title ‘Of mice and Men’ links to the poem ‘To a Mouse’ by Robert burns, he said ‘†¦the best laid schemes o’ mice and men, gang aft agley’. And means ‘no matter how well we may plan the future things often go wrong’. And this is where Steinbeck chose this as a title. Steinbeck’s style is very good and adapts to his subject matter, imagery and dialogue. He tells this story in a convincing way without explaining in detail why everything happened and that it was nobody’s fault in particular events and why they turned out as they did.

Littlefield Simulation Report Essay - 1541 Words

Executive Summary Our team operated and managed the Littlefield Technologies facility over the span of 1268 simulated days. Our team finished the simulation in 3rd place, posting $2,234,639 in cash at the end of the game. We did intuitive analysis initially and came up the strategy at the beginning of the game. And then we applied the knowledge we learned in the class, did process analysis and modified our strategies according to the performance results dynamically. We have reinforced many of the concepts and lessons learned in class and had a better understanding of the operation of the Littlefield Technologies facility and how certain modifications would affect the throughput and lead time. The Plan - Initial Strategy Our team’s†¦show more content†¦If we change batch size to 1*60, based on day1-50 data, the lead time is always 0.3, and we could not use contract number 2Contract 2 to increase revenue and still have to use Ccontract number 11 Revenue will be the same as 1 which is $1,596,000 . c. If we buy machine 3 because its a bottleneck, without changing anything else, utilization for station 3 will become less which will cause less queue, less waiting time, less lead time, no or less penalty, more revenue. Revenue (roughly) = 12 * 1500 * (268-135) = 12*133*1500 = $2,394,000 Machine cost = 100,000 $2,394,000-$100,000 = $2,294,000 $1,596,000 According to our analysis, So , c) is a betterthe optimal choice whichchoice, which confirmed our aggressive machine buying strategy since Day 135. And on Day 149, and Day 170, we immediately bought machine for station 2 and 1 again when the stationsit becomes bottle neck or when lead time is more than 0.28 which caused revenue decreased to $1,200. 3. Changing lot size : We changed lot size for 3 times. On Day 58, we changed to 2 lots/job in order to take Contract number 2 to make earn more money. On Day 64, we changed to 3 lots/job and hope the lead time would decrease. This was a big mistake we made. After this change, we noticed the queue for station #3 is very high, station #3 became bottleneck and ourShow MoreRelatedLead Time Management at Littlefield Labs642 Words   |  3 PagesLead Time Management at Littlefield Labs Background Littlefield Laboratories has opened a new blood testing lab. This laboratory uses the same process as the lab encountered in your prior assignment, Capacity Management at Littlefield Labs—neither the process sequence nor the process time distributions have changed. 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Thomas Paine Towards An Independent Nation - 1718 Words

Thomas Paine: Towards an Independent Nation Thomas Paine is most known for his influence in the freedom loving American colonies. With his excellent use of rhetoric and his charisma, he quickly began to gain followers. In his writings, such as Common Sense, The Rights of Man, and The Age of Reason, he used these skills to call the Americans to action. Thomas Paine influenced American society and literature with his argumentative pamphlets and influential writings which inspired Americans to take action against Britain. Thomas Paine s most argumentative pamphlet, Common Sense, was one of the major ways he got his word across to others. The pamphlet was published on January 10,1776 and is regarded as Paine s most influential piece of work. This persuasive piece was mainly directed towards the American colonists. It presented all of the political, economic, and military reasoning behind the need for detachment from Britain. Paine s message spread very quickly with over 120,000 copies be ing sold in just three months. Tensions with were already high during this time due to events such as the Boston Massacre, Boston Tea Party, Stamp Act, Sugar Act, Townshend Acts, and Coercive Acts. Common Sense listed the current problems and the colonists need for a resolution was further ignited. These problems were used as a gateway, and basis, for the escalation of the ongoing rebellion to a full scale revolution. Paine displayed these problems through a format of 46 pagesShow MoreRelatedThe Ideas Of The Enlightenment, By Thomas Paine And The Declaration Of Independence767 Words   |  4 Pagesas defined in Thomas Paine’s Common Sense, can be broadly defined is the movement towards reason and individualism rather than tradition. The text, by Thomas Paine, challenged the principles of liberty, equality, and justice. 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