Unemployment Rates in the United States and Japan from 2010 to 2014 Research Paper

Joblessness Rates in the United States and Japan from 2010 to 2014 - Research Paper Example In America, the U.S Bureau of Labor Statistics characterizes a jobless individual as somebody who doesn't have an occupation and has effectively scanned for work in the ongoing occasions, just as right now being accessible for work. Continuing further, Remer (22) declares that individuals who are not in the work power are not considered as utilized or jobless. In such manner, the work power includes both the utilized alongside the jobless. Anderton (11) confirms that individuals who are not in the work power are either in school or resigned. In the U.S, Walton, and Hugh noticed that the pace of joblessness rates increased during that time to top in 2010 at 10.9 percent before starting to tumble to 5.8 percent as of November 2014. Somewhere in the range of 2010 and 2014, the pace of joblessness has been on a descending pattern. As of November 2014, the joblessness rate was 5.8 percent and the quantity of the jobless individuals was 9.1 million. Among the major workgroups, the pace of joblessness for the grown-up men expanded to 5.4 percent, grown-up ladies 5.3 percent, youngsters 17.7 percent, blacks 11 percent, whites 4.9 percent, and the Hispanics 6.5 percent, just as 4.8 percent among the Asians. Following this further, the quantity of the drawn out jobless was 28 million. These individuals represented 30.7 percent of the jobless populace. Be that as it may, from 2010 to 2014, the quantity of the jobless has diminished by 1.2 million. The quantity of people utilized low maintenance for financial reasons was 6.9 million and these individuals would have favored all day business.

Hamlet is a thinker not a man of action Essay Example for Free

Hamlet is a scholar not a man of activity Essay Villages one strategic the play is to vindicate the passing of his dad by killing Claudius, anyway his delaying prompts his inconvenient demise, the passings of numerous others in the Danish court and the surrender of Denmark to Fortinbras. Villas first words show a craving of vengeance towards Claudius somewhat more than family and not exactly kind. In any case, later in his speech we see that he is in reality nearer to murdering himself, than slaughtering Claudius or the culprit: O this too contaminated tissue would soften,/Thaw and resolve itself into a dew, He doesnt even think about executing Claudius; he trusts that the circumstance will settle itself, which it never will, demonstrating his reluctance to act. This discourse additionally shows that he isn't the most intrepid of individuals, as should be obvious his mom how he truly feels, another prohibitive character characteristic when attempting to vindicate somebody: But break, my heart for I should hold my tongue. In his discourse straight after Hamlets discussion with the Ghost he appears decide to execute his uncle, thy edict alone will live/Within the book and volume of my mind. The utilization of the word rule shows that he will follow the Ghosts word strictly. This shows he is undaunted, as a man of activity would be. Notwithstanding, this is countered very quickly toward the finish of the scene O reviled demonstrate hatred for,/That ever I was destined to fix it. This shows Hamlet is terrified to do what he needs to do, he would much preferably another person vengeance his dad over he. The primary gadget that Hamlet uses to complete his retribution is to claim to be frantic. By this affectation he wants to keep the from noticing of the court away from him with the goal that he can watch and follow Claudius to check whether he is giving any indications of blame. He tells Guildenstern of his frenzy. I am distraught however north-north-west. At the point when the breeze is/southerly, I know a bird of prey from a handsaw. His expressed goal is to increase unquestionable proof of Claudiuss villainy. He starts this by visiting Ophelia in a condition of disrobe and giving her an affection letter, making Polonius accept that his franticness is expected to Ophelias dismissal of him. Hamlet utilizes his faked frenzy to show his actual feelings and affront individuals he doesnt like: You are a fishmonger. A fishmonger in Elizabethan occasions could have implied pimp, demonstrating that Hamlet imagines that Polonius is utilizing his little girl to pick up favor inside the court. Villages pretended frenzy affects Claudius: in the principal demonstration he conveys long talks, however by Act 2 he is diminished to short sentences like We will attempt it. This is an activity, however it is one that permits him to delay. At the point when Hamlet is disregarded he regrets his shortcoming and idleness. An on-screen character could sob at the envisioned despondency of Hecuba, while Hamlet neglects to react to the homicide of his dad: Tears in his eyes, interruption in his perspective,/A messed up voice, and his entire capacity fitting/structures to his pride? And just for nothing! /For Hecuba! Villages standards cause him a lot of self-analysis: Why what an ass am I! This is generally daring,/That I the child of a dear dad murderd,/Prompted to my retribution by paradise and heck,/Must like a prostitute unload my heart with words/And fall a-reviling like an extremely dull, He reviles his dormancy, demonstrating that, in spite of the fact that he is a mastermind, he would want to take care of business of activity. Toward the finish of the talk he appears to be made plans to vindicate Claudius, the Mouse-Trap play is a type of vengeance against Claudius, however again it isn't immediate retribution, as he is as yet hesitating. The way that he has not gone up against Claudius four months after affirmation from the apparition that Claudius is the liable party shows that he is certainly a scholar. Villages monologue toward the beginning of Act 3 despite everything demonstrates his staggering want to think, especially about self destruction To be or not to be. The way that he is still possesses energy for discourses, and that he isn't attempting to chase Claudius down and execute him, shows that he is certainly a mastermind. Hamlet shows an absence of self information as he can't, as he planned in Act 1 sc 5 with wings as quick/As reflection or the musings of adoration/May clear to my vengeance. Rather he agonizes on his dads demise and in any event, when he gets evidence from Claudiuss response to the Mouse Trap play, Ill take the apparitions word for a thousand pound. He wavers and needs further prodding by the apparition in Act 3 to whet thy nearly blunted reason. Hamlet has the ideal chance to execute Claudius in Act 3 sc 3, yet again he lingers, letting himself consider what will befall Claudius soul A scalawag murders my dad, and for that I, his sole child, do this equivalent lowlife send to paradise. He doesnt act, since he feels that Claudius is supplicating, purging his spirit. This would send him to paradise, not hellfire where he has a place. The incongruity is that Claudius himself has a lot on his still, small voice and can't implore, My words fly up, my considerations stay underneath. /Words without musings never to paradise go. Hamlet curses himself in a later monologue for his absence of activity. Villas first activity of physical retribution is to cut Polonius behind the arras. This activity shows that he can just accomplish something spontaneously. On the off chance that hed had the opportunity to consider it, he would have discovered a route around cutting the individual behind the arras, choosing rather to tarry. Hamlet meets Fortinbras armed force in Act 4 sc 4, which causes him to feel discouraged when he analyzes himself to Fortinbras: the Norwegian Prince is set up to battle about something of next to no esteem, while he hasnt yet rendered retribution for the homicide of his dad and the enticement of his mom: How all events do advise against me,/And spike my dull vengeance. Hamlet does what he generally does when gone up against with an issue; he has a monologue. In any case, this is his last monologue, which could propose that he is finished with speculation now, and will at long last do his vengeance. Hamlet shows another conclusive activity, in managing the selling out of his one-time companions, Rosencrantz and Guildenstern and with Claudius endeavor to have him killed on his approach to England. He replaces his own name with that of Rosencrantz and Guildenstern in the letter, guaranteeing that they will be murdered in his place. He likewise Boards a privateer transport with the goal that he can come back to Denmark, these are for the most part conclusive activities centered to towards vindicating his dads passing. Villages entrance into Ophelias burial service absolutely is more activity focussed than his past activities: This is I,/Hamlet the Dane. His battle with Laertes, revelation of his affection for Ophelia and his change from exposition to refrain show that he is longer convincing his self to lie and deceiving others. In this manner he isn't thinking as much as he is acting. Villages next activity is to duel with Laertes, not realizing that it has been fixed so Hamlet will pass on, yet similarly as with most methodologies in the play, it goes as indicated by plan: Both Laertes and Hamlet are injured by the harmed blade, Gertrude drinks the harmed wine, and one of Hamlets kicking the bucket demonstrations is to drive Claudius to drink the harmed wine, which he does with relish, getting a charge out of the force he has, and the way that he is murdering the individual who executed his dad, enticed his mom, taken his tossed and plotted to slaughter him twice Here thou forbidden, murdrous, cursed Dane,/Drink off this elixir. Is thy association here? /Follow my mom. His activity here was done absolutely, with no idea. As he passes on Hamlet names Fortinbras as his replacement to the seat of Denmark. He respects Fortinbras as a man of activity, seeing that that is the thing that his nation needs to return soundness to it, I do forecast thelection lights/On Fortinbras. He has my perishing voice. The time period of the play assists with fortifying the impression of time passing. People in the play make a trip from Denmark to Norway, Poland and England, from the court to the open country. Differentiating the action of Laertes and Fortinbras with the drawn out dormancy of Hamlet. As the legend in this catastrophe Hamlet doesnt have one, sole, character imperfection that prompts his troublesome demise. He is a mastermind engaged with an issue that must be fathomed effectively by a man of activity. His failure to act quickly and unequivocally without high inspiration regarding his dads murder carries devastation to the Danish court, his own demise and the passing of numerous others in the court. On the off chance that he had been a man of activity Claudius would have been killed a long time previously.

How Long Does Norco Stay in Your System

How Long Does Norco Stay in Your System Addiction Drug Use Opioids Print How Long Does Norco Stay in Your System? Norco in Your Blood, Urine, Hair, Saliva By Buddy T facebook twitter Buddy T is an anonymous writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism. Learn about our editorial policy Buddy T Medically reviewed by Medically reviewed by Steven Gans, MD on September 26, 2019 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on January 08, 2020 Verywell / Gary Ferster More in Addiction Drug Use Opioids Cocaine Heroin Marijuana Meth Ecstasy/MDMA Hallucinogens Prescription Medications Alcohol Use Addictive Behaviors Nicotine Use Coping and Recovery In This Article Table of Contents Expand Effects Duration Detection Times Symptoms of Overdose Getting Help View All Back To Top Norco is the brand name for a prescription medication that combines hydrocodone, an opioid pain reliever, with  acetaminophen. Acetaminophen is  an  over-the-counter (OTC) non-opioid pain reliever. Its often sold under the brand name  Tylenol and also is a common active ingredient in OTC cough, cold, and fever medications. There are quite a few prescription pain relievers that have these same two components. One of the most familiar is Vicodin; other hydrocodone/acetaminophen combination drugs include Anexsia, Lorcet, and Lortab. The main difference between most of these medications is the amounts of hydrocodone and acetaminophen. Theyre all prescribed to treat moderate to severe pain. All versions of Norco come as a tablet.?? Combination drugs with less than 15 milligrams of hydrocodone per dose unit like Norco are classified as Schedule II substances, meaning they are considered to have a high potential for misuse, with use potentially leading to severe psychological or physical dependence. ?? How Long Does Norco Stay in Your System? Blood: Up to 24 hoursUrine: Up to three daysSaliva: Up to three daysHair: Up to 90 days What You Should Know About Hydrocodone/Acetaminophen How Long Does It Take to Feel Effects? Norco is taken orally in tablet form and the drug must pass through the digestive system before it begins to take effect. The acetaminophen in Norco tends to be rapidly absorbed in the gastrointestinal tract and begins to take effect within 10 to 30 minutes of ingestion. The hydrocodone component of Norco is slower-acting but begins to relieve pain about 30 to 60 minutes after ingestion.  ?? The pain-relieving effects of Norco typically last between four and eight hours. How Long Does Norco Last? When talking about how long a particular medication remains active in the body it helps to understand the concept of half-life. Half-life refers to the amount of time it takes for half of the dose of a particular drug to be eliminated from the body.  When discussing Norco, of course, its necessary to consider both the half-life of hydrocodone and the half-life of acetaminophen. The  half-life  of hydrocodone is about four  hours.??? After five or six half-lives, the drug has been mostly eliminated from your system. However,  it is important to note that even at this point, hydrocodone can be detected in the urine for up to three days. This means that if you take a urine drug screen after being on Norco, it is likely to test positive for opiates even if your last dose was days earlier. Hydrocodone is metabolized by the liver into its major metabolites hydromorphone and dihydrocodeine.  Around 85% of an oral dose is excreted through the urine within 24 hours, mostly in the form of glucuronide conjugate, other conjugates, and small amounts of the unchanged drug.?? The acetaminophen in Norco has a half-life in the blood of one and a quarter hours to three hours. Acetaminophen is rapidly absorbed in the gastrointestinal tract and eliminated primarily by the liver and later excreted by the kidney as metabolites. Most acetaminophen has passed out of the body through the urine after 24 hours.?? Urine Norco may be detectable in the urine for up to three days after taking a dose.?? Urine tests are among the most common types of drug tests because they are less invasive, less expensive, and are easy to administer. If you have been taking Norco, you may test positive for opioids on a standard immunoassay urine drug screening. You should inform the lab that you have been taking this prescription medication for pain management so that they are able to interpret your results accurately. Blood Because urine tests are sometimes susceptible to false positives, a positive test for opioid use on a standard drug screen may be followed up with a blood test to confirm the results.?? However, the detection window in blood is much shorter. Norco may be detectable by a blood test for up to 24 hours after ingesting the last dose. While blood tests provide greater accuracy, they are also much more invasive and costly. Because of this, this type of testing is not often used in occupational settings but is more common in forensic and legal contexts. Saliva Due to its hydrocodone contents, Norco may be detectable by saliva for up to three days after ingestion. While saliva testing has some advantages, including being fairly easy to administer and non-invasive, the small specimen size can present testing challenges.?? Hair Hair testing can detect Norco metabolites in hair follicle samples for up to 90 days after the last dose. While such testing can be effective at detecting the past use of a drug, it can also be more costly. It may be used in instances where employers or law enforcement are looking at past drug use or misuse. Factors That Affect Detection Time There are a number of different individual factors that can play a role in how long Norco remains detectable in the body. Such factors include: Age: Older adults tend to clear the drug more slowly than younger adults.Liver function: Because the liver is important in the metabolism of the drug, impaired liver function can mean that it takes longer to metabolize Norco.Weight and size: People who are taller and heavier may metabolize the drug more quickly, while people who are shorter and lighter may process the substance at a slightly slower rate.Frequency of use: If you have been taking Norco for a while, it will take longer for the drug to completely clear your system.Dosage: Taking a higher dose of the substance means that it will take longer to process and excrete the drug.Metabolism: People with slower metabolisms may clear the drug at a slower rate.Hydration: Taking in more fluids can dilute the amount of the drug present in urine samples, making it more difficult to detect.Alcohol and other substances: Ingesting other substances at the same time can make it more difficult for the body to process and clear Norco from you r system. Its important to know how long a medication like Norco stays in the body since substances such as alcohol as well as other medications can lead to potentially dangerous interactions with either hydrocodone or acetaminophen.??  This information also is vital for preventing overdoses of either ingredient. For example, if you were to take significant amounts of Tylenol or an OTC cold or cough medication containing acetaminophen before Norco has cleared from your system, you potentially could wind up with an overdose of acetaminophen in your bodyâ€"a situation that has been found to lead to severe liver damage, according to the U.S. Food and Drug Administration  (FDA).?? By understanding how long Norco remains active in the body and when it will clear can help you and your doctor time your doses so that you get the most benefit without the risk of side effects. Symptoms of Overdose Knowing how long Norco remains in the system also can help prevent an accidental overdose caused by taking too much of the medication too soon.   The following are some of the signs and symptoms of a Norco overdose: Bluish-colored fingernails and lipsBreathing problemsCold, clammy skinComaConfusionDizzinessDrowsinessFatigueLightheadednessLow blood pressureMuscle twitchesPinpoint pupilsSeizuresSpasms of the stomach and intestinesWeaknessWeak pulseLoss of consciousness If you or someone youre caring for is taking Norco and experiences any of these symptoms, call 911. In the event the overdose has caused loss of consciousness, first responders can administer a drug called  Narcan  (naloxone) to counteract the effects of the hydrocodone. Understanding Opioid Overdoses Interaction Risks Because hydrocodone is an opiate narcotic, it brings a risk of dangerous interactions with a number of different substances including alcohol and other drugs. Drinking while taking Norco can lead to serious side effects caused by either the combination of alcohol with hydrocodone or the combination of alcohol with acetaminophen, according to the National Institute on Alcohol Abuse and Alcoholism, a division of the National Institutes of Health (NIH).?? Alcohol Risks With Norco Alcohol and hydrocodone can cause drowsiness, dizziness, an increased risk of overdose, breathing problems, impaired motor control, unusual behavior, and memory problems.Alcohol plus acetaminophen can lead to stomach problems and liver damage. Liver damage caused by acetaminophen is a particularly serious problem. That may seem odd since Tylenol and other over-the-counter medications containing acetaminophen are so accessible, but thats part of the problem: People often will unknowingly take more than one medication containing acetaminophen at a time. Research has found that exceeding 4,000 milligrams (mg) a day can lead to potentially irreversible and even fatal liver damage.?? Accidental overdoses and even deaths may occur in this scenario. For that reason, any medication that combines acetaminophen with another ingredient can have only 325mg of acetaminophen. Norco, for example, comes in several strengths of hydrocodone, ranging from 2.5mg to 10mg, but all of these versions have only 325mg of acetaminophen.   Of the medications that can cause problems when taken while Norco is in your system, the ones that are most dangerous are those that can interact with hydrocodone, particularly benzodiazepines. Examples include Xanax (alprazolam), Librium (chlordiazepoxide), Klonopin (clonazepam), Valium (diazepam), Ativan (lorazepam), and Halcion (triazolam). These are  prescription depressant drugs used most often to treat anxiety, muscle spasms, and seizures.   The potential dangers of mixing hydrocodone with a benzodiazepine medication are so potentially serious that ?an August 2016 review by the FDA resulted in the addition of boxed warnings on both types of drugs about side effects of mixing them, including slowed or difficult breathing and even death.?? Other types of medications that can interact with Norco include muscle relaxants, sedatives, sleeping pills, tranquilizers, and certain treatments for mental illness or nausea. The best way to protect yourself from harm while taking Norco is to make sure your doctor knows about all drugs and supplements you take before you begin treatment and to be clear about how long you need to wait after finishing being on Norco before resuming any medications that might interact before its out of your system.   Getting Help Like other opioids, the hydrocodone content of Norco can lead to tolerance and physical dependence, even if you take them exactly as prescribed. Tolerance means that people require larger doses of the drug to feel the same pain-relieving effects. If this happens, you should talk to your doctor. Never take a larger dose than what you have been prescribed. Your doctor may adjust your dose or switch you to another type of medication. Physical dependence occurs when the body becomes accustomed to the presence of a substance. When a person develops a dependence on a drug, they need to continue taking it in order to avoid experiencing symptoms of withdrawal. When you decide to stop taking Norco or another type of opioid medication, your doctor may gradually lower your dose in a process called tapering in order to avoid withdrawal effects. Symptoms of Norco withdrawal can include: Muscle achesVomitingRunny noseSweatingDiarrheaFatigueHeadachesAnxietyChills Such symptoms typically last for five to seven days, but your doctor can prescribe medications that will help you cope during the withdrawal period. If you suspect that you might be dependent or addicted to Norco or another hydrocodone-containing medication, help is available. Start by talking to your doctor who can help you taper off the drug and find another medication that will alleviate your pain. Your doctor may also recommend inpatient or outpatient residential treatment or refer you to a mental health professional who specializes in addiction treatment and recovery. You can also contact the Substance Abuse and Mental Health Services Administration at 1-800-662-4357 or use their online tool to find treatment resources in your area.   Treatment for Opioid Addiction

Review Of Jeremiah Crowell s National Geographic Channel...

Directed by Jeremiah Crowell, National Geographic Channel aired its new show Brain Games: Watch This on Oct. 9, 2011. The settings took place in multiple locations, like a park, beach, movie studio, and dance studio. The show also starred Neil Patrick Harris, as the narrator. The rest of the cast is as follows: Beau Lotto, Bas Rokers, John Crawford, Robin Harlan, Sarah Monat-Jacobs, Josh McDermott, Dr. Lera Boroditsky, Daniel Kish, Cynthia Moss, and the research/experimental volunteers. As far as our perception and senses are concerned, I was amazed at how the director, characters, and the rest of the crew was able to put all aspects to help the curious understand how our brain functions. By way of not completely trusting our senses, it promoted skepticism. In this episode of Brain Games, the characters demonstrated and exposed us to our perception of objects that are different than what they actually are. Considering we discussed perception in our Psychology class, it caught my atte ntion when I first saw the title of this show and thought I’ll check it out. Brain Games: Watch This is a show that hacks the human brain using shapes, sounds, motions, colors, language, senses, sensations that created a mind-blowing sensory illusions and how our brain can mislead us. Our perception of things that are different than what they actually are. Each cast has their own unique expertise in each segment of the show and are experts in their field. For instance, Beau Lotto,

Welcome, Pony Express students, parents, teachers, and...

Welcome, Pony Express students, parents, teachers, and staff who are gathered here today to honor and support us at our sixth grade promotion and during one of the most important transitions of our lives. We have so many vital people to thank for helping us get to this point: all of our teachers, who have boosted us and given us the push we need to achieve success; our parents, who have always been at our sides to offer us a hand and help us up when we fall, to magnify our self-esteem when we feel as tiny, low, and unimportant as ants, and to nourish us with love; and, of course, the students themselves. You were so friendly and welcoming from the moment I first stepped foot on our campus, a new and frightening land that now seems like a†¦show more content†¦We have all been through both tough and good times, but without the shadows of heartbreaking loss to bring out the pastels and lighter shades of the bright, hopeful beginning that is sure to come, a painting would not be complete. I speak for every student in this room when I say that we are deeply grateful to everyone who has guided us through our childhood, helped us through each stage of our lives up to this point of departure, for we are all thankful beyond what words can express to each and every individual who has given up some of their life story to help us write our own. I know that I will miss all of you, and that farther down the road in life I will be able to look back upon my years of elementary school fondly and reflect upon my cherished memories and bonds. As a line from the movie Catching Fire so wisely quoted: â€Å"Our lives are not measured by the number of years we live, but by the number of lives we touch.† Every person in this room has done that, sparked a touch of magic into each of our lives, brightened our souls with one more ounce of shared strength. And now it’s finally time to use that strength, to suck up every drop of power we have and channel it, along with all our effort, into building and sculpting our futures out of the soft clay of our pasts. The endpoints of our voyages through the deep seas of our lives are still hidden in the murkyShow MoreRelatedManagement Course: Mba−10 General Management215330 Words   |  862 PagesCapitol 1. New Management for Business Growth in a Demanding Economy Text  © The McGraw−Hill Companies, 2004 6 THE POWER OF MANAGEMENT CAPITAL leadership and as a necessary condition for the profitability and effectiveness of technology. Today another economic force—the quality of productivity—is being recognized as essential for shoring up the economy, especially when business slows down. From SUVs and computers to Internet services and home furnishings, the quality value that buyers perceive

My Sisters Keeper Free Essays

An Ethical Discussion of My Sister’s Keeper Trudy German Wayland Baptist University An Ethical Discussion of My Sister’s Keeper Introduction and Thesis: Preimplantation Genetic Diagnosis (PGD) to provide a genetically matched donor for an older sick child and to use the organs of the younger to the medical benefit of the elder is not morally justifiable using rule utilitarian ethical theory. This principle is not justifiable due to both the nature of the proposed rule regarding PGD and, primarily, to the nature of utilitarian ethical philosophy in general. Arguments Supporting Thesis: Rule utilitarianism is a moral philosophy holding that general rules for moral guidance should be developed that will act as an aid in making ethical decisions. We will write a custom essay sample on My Sisters Keeper or any similar topic only for you Order Now For example, one such rule might by that one ought to keep promises. Given this general rule, when faced with a moral decision, an individual should look at the list of rules and see if any of these rules apply to the current situation. Using the above example, if the situation involves keeping a promise or not, then one should keep the promise. According to this philosophy, even if the consequences of a particular act of promise keeping are bad, the person behaving in accordance with the established utilitarian rule is morally not at fault. However in an attempt to establish a new utilitarian moral rule, each individual event will affect the attempt to establish a moral rule. This ethical theory requires development of rules of action based on the potential rule’s likelihood to bring about the most good for the most people. For the purposes of this discussion a reasonable rule would be: parents should use PGD to provide a genetically matched donor for an older child and use the expendable organs of the younger child to repair life threatening medical conditions of the older. For the sake of argument, this paper assumes that any procedures that would necessarily result in the death of the younger child would not be performed. For example, if the elder child needs a heart transplant, this rule could not be used to justify the death of the younger by removing the younger sibling’s heart and transplanting it into the elder. The suggested rule makes use of other, more fundamental utilitarian rules such as one shouldn’t cause pain or one should prevent pain. Neither of these rules in itself is sufficient to establish the more specific utilitarian rule suggested in the preceding paragraph. To determine if this potential utilitarian rule should be adopted, some cases, using Picoult’s novel My Sister’s Keeper as a springboard should be examined. The first case to examine is the simplest case. If the proposed rule proves inadequate for a simple application, it is unlikely that more complex, and more realistic scenarios will be adequately served by the proposed rule. The simplest case within this context would be the case originally conceived of by Kate’s parents, Sara and Brian Fitzgerald. In this scenario Sara and Brian had two children, the elder, Jesse, is approximately seven years old. His little sister, Kate is a about two years old when she is diagnosed with acute promyelocytic leukemia (APL). Since Jesse is not a compatible donor, her parents elect to use PGD to produce a genetically compatible donor as a potential solution for their daughter’s health problem. Initially, the younger daughter, Anna, is to be used to donate blood cells from the umbilical cord to provide needed blood cells for Kate. Theoretically, these cells would put Kate’s APL into remission and that would be the end of medical treatment. All three children would be healthy, have little or no memories of the procedure and the Fitzgerald family would live happily ever after. Does this scenario provide the greatest good for the most people? Although others are involved in My Sister’s Keeper, such as the nurses, surgeons, and hospital staff, it is reasonable to consider just the impact of the Fitzgerald family. It appears that the most people have received the greatest good. Kate has her normal life expectancy back; Jesse now has not one, but two little sisters to tease and torment, while Sara and Brian have three happy, healthy children. It appears to be a winning situation for everyone. This scenario provides support that the proposed rule may be a viable utilitarian rule, at least in this simplified situation. Unfortunately, all the cases these proposed rules are to be applied to aren’t this simple. The Fitzgeralds’ experiences provide an example where the simple case doesn’t prevail and the situation is complicated by other events. Initially in My Sister’s Keeper, it appears the umbilical cord blood cells take at Anna’s birth have done the job. Kate goes into remission for five years. However, at this point Kate’s APL flairs up and lymphocytes are drawn from Anna three times and inserted into Kate. Again this appears to work for the short term, but ultimately, the procedure fails. For the next eight years the process is repeated over and over again; Kate becomes ill, Anna donates something which should help her get better, the treatment works for a while but then stops working and a new, more invasive and painful donation and treatment is attempted. The situation during this period is not so simple and clear-cut. In the process, everyone in the family suffers: physically, emotionally, financially, and/or socially within the family and outside the home. Both Kate and Anna suffer physical pain with each procedure. Jesse begins to act up in an attempt to get attention from both his parents. The relationship between the parents suffers as Sara becomes more and more obsessed about the physical needs of Kate. The family is not the happy unit anticipated in the simpler case. In fact, at the time of Anna filing the lawsuit for medical emancipation, the only good that has resulted is that Kate’s life as been extended for twelve or thirteen years. All of the benefits of the Kate’s continuing to live have come at the expense of the rest of the family and of Kate herself, who suffers considerable pain during the process. In these more complicated circumstances it is not so easy to determine the net good or the net harm. It is no longer so clear that a rule utilitarian imperative can be established to justify PGD and the subsequent harvesting of organs. As long as the medical procedure works, it is more easily justified on a rule utilitarian basis. When the procedure fails, the amount of good, if any doesn’t appear to outweigh the amount of harm. These points out a fundamental weakness in moral rule utilitarianism as an ethical theory. It does not have much utility. First, calculating the potential harm and the potential good resulting from a proposed medical procedure is difficult, perhaps even impossible, to calculate. In the simple case, it is easy to calculate the net good because only two people are involved in the process: Anna the donor doesn’t suffer at all, and Kate has her pain relieved for five years. It is clear that more good than harm results from the PGD, birth of Anna, and Kate’s used of the cord blood cells from Anna is a good thing on an utilitarian basis. However, with every additional complication, the calculation of net good becomes more difficult. When lymphocytes are drawn from Anna three times at the age of five, it is clear she feels pain and is at some amount of risk of life due to the use of general anesthesia. It is also clear that Kate receives some benefit from the donated cells. What aren’t clear is how much physical pain Anna suffers and how much benefit Kate receives. There are no clearly quantifiable measures of pain. There are scales of pain used by physicians to try and measure pain, but they are estimations by the patient and extremely subjective. Suppose, to salvage the utilitarian principle, one were able to establish a unit measure of pain and relief of pain. Suppose Anna reports that she has pain at a level three for twelve hours for a total of thirty-six â€Å"pain hours,† level two for six hours for twelve â€Å"pain hours† and pain level one for 3 hours for three â€Å"pain hours†. This gives Anna a total of fifty-one â€Å"pain hours†. Presumably, on Kate’s side, if one assumes a one for one exchange of pain values between Anna and Kate, as long as her net relief of pain is greater than fifty-one â€Å"pain hours† the procedure is justifiable from a rule utilitarian point of view. This result is remarkably similar to the conclusion above in that as long as the medical procedure is successful, the performing of the procedure add credence to the establishment of a new moral rule. This is not a satisfactory moral principle. It fails to consider far too many aspects of the entire situation and bases the moral evaluation purely on the result. For example, as any medical provider knows from personal experience, sometimes people die regardless of the treatment they have received. In the above case, suppose that Kate, after receiving the lymphocytes, and despite the fact that the medical team is well qualified and performed the procedure in accordance with the best established procedures, dies shortly after the procedure. Autopsy and postmortem investigation finds no particular reason for the death. For all intents and purposes, Kate randomly dies when she was expected to live. According to rule utilitarian ethics, this procedure was a failure and should not be used to support a potential rule for future behavior and presumably should count against the potential rule. However this wasn’t the fault of the procedure and, intuitively, shouldn’t count against PGD and the subsequent use of donor tissues. A second objection to utilitarian rules is that it is unclear when a new rule becomes established. Except for fundamental rules which lack substance, such as truth telling is good, loyalty is good, promise keeping is good that are already established, when a proposed rule has enough evidence to be a new moral imperative. There isn’t a Governing Board of Utilitarian Theory (GOUT) that meets periodically and either approves or denies potential utilitarian rules of ethics. One wonders then if a utilitarian rule can ever be established beyond basic, fundamental rules such as those mentioned above. It is counterintuitive to think that an ethical rule can only be established when it has been tested a sufficient number of times. The whole point of ethical rules is to give people ethical guidance. If one is forced to rely on only the more basic rules such as â€Å"causing pain is bad† and â€Å"relieving pain is good† until the new rule has been established with sufficient data, one is often at a loss since such rules are extremely general and can be, and often are, contradictory. In the case of My Sister’s Keeper to relieve Kate’s pain, Anna must be caused pain. This is essentially a wash that really leaves one with no answer at all. Objections that Rule Utilitarian Cannot Justify PGD: The biggest objection to the conclusion that rule utilitarianism cannot justify using PGD to provide a potential donor for a critically ill child is that if feels like one should be able to use rule utilitarianism to make this decision. One ought to be able to look at this issue and say â€Å"yes it is moral to provide a potential donor for a child using PGD† or â€Å"no, it is not moral do so. If one cannot use rule utilitarianism to help make a decision what good is it? Response to Objection: That is precisely the point. Rule utilitarianism, in fact even act utilitarianism as well, is inherently flawed. Instead of looking at the entire issue of is it moral to perform an act it shifts the focus to will performing such an act result in a net positive value instead of dealing with the social issue the person who posed the ethical question, utilitarianism deals with an unwieldy ethical system of bookkeeping. This is unsatisfactory because it skirts the real issue. Human ethics is not bookkeeping. Results of an act are important in evaluating the morality of an act, but this is only one part of the entire equations. Equally important, and oftentimes more important are other factors that ought to be considered: motive of the people involved, capabilities of those involved and the rights of those involved are essential ingredients in making ethical decisions and rule utilitarianism makes no allowance for these vital concerns. In fact, it is the question of the rights of Anna Fitzgerald that is central to this novel. It is these other factors that are most revealing and the most interesting from an ethical and sociological point of view. Summary of Paper: Rule utilitarian ethics is unable to establish the rule that using a PGD child to provide a transplant source for an older, critically ill child. This is due to rule utilitarianism ethics not being a particularly viable ethical system. The unwieldiness of trying to calculate the net good or bad makes rule utilitarianism impractical. In addition, rule utilitarianism fails to account for anything other than the results which are a small, uninteresting part of any ethical dilemma. This bookkeeping approach to ethics is inadequate. A moral dilemma is not easily solved and is never solved without considering, the agent, the act and the reasonably expect consequences of the act. It is for this reason that utilitarianism cannot, in fact, justify itself as an ethical system. References Picoult, J. (2004). My Sister’s Keeper. New York: Atria Books. Volbrecht, First Initial. (Date of Publishing). Title of Book in Italics. City of Publication: Publisher. How to cite My Sisters Keeper, Essay examples

Price Discrimination in Health Care free essay sample

However, efficiency and fairness demand that new ways should be found to avoid price discrimination in health care in order to ensure patients equal access to care and economic justice. Uninsured or self-pay patients should not be charged rates significantly higher than those with Medicare, Medicaid, or insurance. Prices for health care should also be more transparent to allow patients to accurately shop for best prices and values in health care. Imagine a system in which you go to the grocery store and are told that the price you must pay for your groceries is dependent on whether you have a job, and if you have a job the price is dependent on where you work. If you are work for a certain employer the price you will pay is near wholesale, for another retail, another twenty to thirty percent more, and if self-employed or unemployed you must pay a price three to four times higher for these groceries. We will write a custom essay sample on Price Discrimination in Health Care or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Unfortunately this is the way our current health system works. Most hospitals charge those without insurance three to four times the price of that paid by those with insurance or government coverage such as Medicare or Medicaid. New ways should be found to avoid price discrimination in health care in order to ensure patients equal access to care and economic justice. Uninsured or self-pay patients should not be charged rates significantly higher than those with Medicare, Medicaid, or insurance. Prices for health care should also be more transparent to allow patients to accurately shop for best prices and values in health care. Price discrimination Price discrimination is the practice of charging different customers different prices for the same product or service. While price discrimination is not necessarily unethical, the price should have commensurate value for the price charged. If this condition is met price discrimination is not necessarily wrong. It can be considered ethical for one to be given a better deal than another. However, if it is used to take advantage of those with a special need or the ignorance of customers it may be unethical. Under the Robinson-Patman Act 1936 it is unlawful when it substantially lessons competition or tends to create a monopoly. This has been cited in numerous lawsuits against hospitals and HMO’s. Because an uninsured person has limited resources to contest hospital rates class action attorneys have tried to obtain class action status for clients with limited success (Anderson, 2007). Many industries and firms utilize price discrimination because it can have a huge impact on company profits. It is much easier today because of improvements in technology to separate patients by demographic information to maximize the amount they are willing or able to pay (Elegido, 2009). Price discrimination is an attempt to get each consumer to pay for the product the highest price he is willing to pay. Price discrimination is common in industries that have high fixed costs and low marginal costs. Setting prices at the level of marginal costs would make it difficult to recover original investment costs. In order for price discrimination to occur there are several conditions that must exist. The producer must have information about what the maximum price of each group of consumers are or have reliable indicators of such. This information is obtained through prices for services set by government diagnosis related groupings for payment that set a near minimum price. The hospital then establishes a charge-master file that is several times more for each item. This may be updated several times a year and is not published for the public. There must not be significant competition from rival firms. For any consumers there are not multiple options for hospital care resulting in limited competition that might lesson cost. Arbitrage must not be possible. The buyer cannot resell the product for a higher price to others (Elegido, 2009). The uninsured or self-pay patient In a study published as a Web Exclusive by the journal Health Affairs, it was determined that approximately half of U. S. bankruptcies, were reportedly attributable to illness or medical bills (Anderson, 2007). It is estimated that three-fourths of these individuals were covered by insurance when they got sick. However, skimpier policies, rising health care costs, and the cancellation of coverage when illness results in job loss have increased the financial risk for those with insurance as well as the uninsured. When patients lose their insurance due to inability to work they become vulnerable to higher self-pay prices. While there are many uninsured that are unable or won’t pay their bills, hospitals pursue those that don’t pay with aggressive collections activities. Price discrimination in health care Hospitals do not charge every patient the same price. Uninsured and self-pay patients are often charged two and one half to four times as much for the same care as those covered by insurance or government plans such as Medicare or Medicaid. This gap has grown substantially since the mid 1980’s (Anderson, 2007). Patients that are uninsured or self-pay are often presented with bills that reflect full charges derived from the hospital’s charge-master file. There are five categories of patients that routinely receive undiscounted bills based on charge-master files created by each hospital. These include those that are international visitors, those that are uninsured, people covered by automobile insurers, people covered by workman’s compensation plans, and those covered by health plans that are lacking contracts with the hospital such as individuals that utilize health care savings accounts or are out of network. Equals should be treated equally in order to satisfy justice and should appropriately balance the gains of trade between buyer and seller with neither side having disproportionate power over the other (Tiemstra, 2006). If prices are directly related to costs and equal for all, the allocation of resources will be more efficient. The ratio of charges to costs measures the relationship between actual charges for services and Medicare allowable charges. In 2004 this ratio for U. S. hospitals was 3. 7 meaning that for every $100 in Medicare charges the average charge was $307. There is considerable variation in hospital charges depending on the type of hospi tal and the setting, rural or urban. The gross to net revenues overall averaged 2. 57 meaning that collected from all payers, for each $100 collected the initial charge was $257. Since 1984 the charge to cost ratio has increased from 1. 35 to 3. 07 and the gross to net revenues from 1. 25 to 2. 57 in 2004 (Anderson, 2007). Hospital charges have increased faster than costs. Increased charges have not been shown to significantly increase revenues however because as charges rise insurers negotiate for larger discounts and only self-pay patients are expected to pay these higher charges (Anderson, 2007). In Pennsylvania, hospitals collect only about one fourth of what they charge. These discounts are reflected on explanation of benefits forms from insurers. The only ones expected to pay the full charges are often those least able to pay them (Miller, 2012). There is evidence that discounts and price discrimination are making health care less affordable because fixed prices, discounts, and variable reimbursement systems distort normal marketplace competition. Patients and business are the losers as hospitals and health plans try to get bigger to â€Å"win† price negotiation. Insurance is discounted from the standard billed charge, Medicare and Medicaid pay flat rates and those without medical insurance pay the highest charges. When money spent is from somewhere else such as insurance or government coverage there is no incentive for hospitals or patients to control costs and may result in unnecessary medical costs for unneeded tests and procedures when insurance deductibles are met (Lilly, 2011). Cost shifting Cost shift policies in hospitals have resulted in shifting of costs to private patients due to inadequate payments from state and federal government plans such as Medicare and Medicaid. Cost shifting is also use to cover bad debts of unpaid hospital bills. Cost shifting acts like a tax on the costs of private pay patients. The burden of cost shifting falls on non-Medicare and non-Medicaid households in proportion to the sum of their out of pocket expenses and hospital premiums. The government does not assume costs of serving people that are ineligible for government programs but that are unable to pay their bills. They also do not cover common costs for research and teaching. Private pay patients subsidize public program beneficiaries through cost shifting. Because Medicare and Medicaid patients utilize socially valuable resources these costs must be borne by society. These costs may be covered implicitly through cost shifting by price discrimination or explicitly when government taxes are used to finance the full cost (Meyer Johnson, 1983). Hospitals obtain what revenues they can from insurers and those over whom they have little control such as Medicare and Medicaid. They then demand as much as possible from those over whom they have the most leverage. Over fifty percent of health care costs are paid by state and federal governments. This system results in lower incentives to be more efficient and contain costs. Charges for self-pay and uninsured patients are inflated to compensate for discounts given to insurers and low reimbursement rates of Medicare and Medicaid. Public program beneficiaries are subsidized by private pay patients (Lilly, 2011). Recommendations The commercial health industry has called for equitable payment rules for all patients including mandatory rate setting or doing away with rates by diagnosis and cost shifting in favor of transparency and the same rate no matter the payer source. One regulatory approach might be to have the government regulate prices so hospitals cannot charge more based on their type of insurance coverage. Maryland has done this and their hospital costs are lower than other states. However the regulation of prices removes incentives for hospitals to look for innovations to deliver care in a more cost effective way. Another option would be to establish maximum rates that can be charged to all payers for medical care. This may be set by the hospital voluntarily, be set by legislation, or have the rate determined by courts. A single rate would also decrease administrative and collection costs associated with multiple charge rates by payer type. Price transparency has been suggested as a tool to allow patients to comparison shop. Hospitals may increase transparency by limiting the price that can be charged above the Medicare rate. Hospitals could advertise their charge as being a certain percentage above the Medicare rate for comparison. Another approach would be systemic changes that let hospitals charge patients any price but all must be charged the same and prices must be made public. Instead of being restricted to in-network providers, patients could go anywhere but be able to make choices based on quality of care and pricing. Greater transparency in pricing and an ability to make informed decisions based on quality of care and price may allow patients to choose those hospitals that give quality care at lower costs. Transparency in pricing would encourage people to economize on the use of routine health services. These changes would make consumers more aware of and accountable for health decisions based on choice, limits, and patient responsibility (Miller, 2012).