Columbine High School massacre, Essay

A video game is an electronic game that involves human interaction with a user interface to generate visual feedback on a video device. Video games typically use additional means of providing interactivity and information to the player. Audio is almost universal, using sound reproduction devices, such as speakers and headphones. Other feedback may come via haptic peripherals, such as vibration or force feedback, with vibration sometimes used to simulate force feedback. In the early days of cartridge consoles; they were sometimes called TV games. It has been shown that action video game players have better hand-eye coordination and visuo-motor skills, such as their resistance to distraction, their sensitivity to information in the peripheral vision and their ability to count briefly presented objects, than nonplayers. Researchers found that such enhanced abilities could be acquired by training with action games, involving challenges that switch attention between different locations, but not with games requiring concentration on single objects. It has been suggested by a few studies that online/offline video gaming can be used as a therapeutic tool in the treatment of different mental health concerns. In Steven Johnson’s book, Everything Bad Is Good for You, he argues that video games in fact demand far more from a player than traditional games like Monopoly. To experience the game, the player must first determine the objectives, as well as how to complete them. They must then learn the game controls and how the human-machine interface works, including menus and HUDs. Beyond such skills, which after some time become quite fundamental and are taken for granted by many gamers, video games are based upon the player navigating a highly complex system with many variables. Learning principles found in video games have been identified as possible techniques with which to reform the U. S. education system. It has been noticed that gamers adopt an attitude while playing that is of such high concentration, they do not realize they are learning, and that if the same attitude could be adopted at school, education would enjoy significant benefits. Students are found to be â€Å"learning by doing† while playing video games while fostering creative thinking. Video game development and authorship, much like any other form of entertainment, is frequently a cross-disciplinary field. Video game developers, as employees within this industry are commonly referred, primarily include programmers and graphic designers. Over the years this has expanded to include almost every type of skill that one might see prevalent in the creation of any movie or television program, including sound designers, musicians, and other technicians; as well as skills that are specific to video games, such as the game. All of these are managed by producers. 97% of 12-17 year olds in the US played video games in 2008, thus fueling an $11. 7 billion domestic video game industry. In 2008, 10 of the top 20 best-selling video games in the US contained violence. Violent video games have been blamed for school shootings, increases in bullying, and violence towards women. Critics argue that these games desensitize players to violence, reward players for simulating violence, and teach children that violence is an acceptable way to resolve conflicts. Video game advocates contend that a majority of the research on the topic is deeply flawed and that no causal relationship has been found between video games and social violence. They argue that violent video games may reduce violence by serving as a substitute for rough and tumble play and by providing a safe outlet for aggressive and angry feelings. The controversy over violent video games resurfaced following the massacre of 13 people at Columbine High School in Jefferson County, CO on Apr. 20, 1999. The two teenage shooters were revealed to be avid players of weapon-based combat games Wolfenstein 3D and Doom. Following the shooting, 176 newspaper articles across the country focused on the allegation that video games were the cause of the tragedy. On Oct. 7, 2005, California passed a law that required violent video games to include an â€Å"18† label and criminalized the sale of these games to minors. The law was blocked by the US District Court for the Northern District of California and was struck down in Feb. 2009 by the 9th US Circuit Court of Appeals citing First Amendment protections and the inability of the state to demonstrate a link between violence in video games and real-world violence. As of Dec. 2008, six other state statutes and two city ordinances concerning the sale of violent video games to minors have been stricken down on similar grounds. On June 27, 2011, the US Supreme Court ruled 7-2 in Brown vs. Entertainment Merchants Association that the California law banning the sale of violent video games to minors violated free speech rights. In the majority opinion, Justice Antonin Scalia wrote, â€Å"A state possesses legitimate power to protect children from harm†¦ but that does not include a free-floating power to restrict the ideas to which children may be exposed. † Several games have garnered significant media attention, including 2004’s JFK assassination reenactment JFK Reloaded, 2005’s Columbine shooting reenactment Super Columbine Massacre RPG! , and 2006’s Rape Lay, a Japanese video game where the player stalks and rapes a mother and her two daughters. Prior to the release of Call of Duty: Modern Warfare 2, which went on to gross $550 million in the first five days after its Nov. 10, 2009 release, leaked footage of the game stirred enough controversy that publisher Activision issued a response defending the game’s violent imagery. Some cons to the question â€Å"Does Video Games promote violence are the following: Violent juvenile crime in the United States has been declining as violent video game popularity has increased. The arrest rate for juvenile murders has fallen 71. 9% between 1995 and 2008. The arrest rate for all juvenile violent crimes has declined 49. 3%. In this same period, video game sales have more than quadrupled. Another con would be violent video games provide healthy and safe opportunities for children to virtually explore rules and consequences of violent actions. Violent games also allow youth to experiment with issues such as war, violence and death without real world consequences. In conclusion I have learned throughout this research that video games in fact do have a major impact on young adolescents in today’s time whether it’s positive or negative. I’ve also realized that for one some kids may act out because of theses sometime violent games and that for two they may improve in their behavior by these games as well. There isn’t really a yes or no answer to this research topic ,but maybe parents should just get games more appropriate for their child’s age . Work Cited â€Å"Video Games ProCon. org. † ProConorg Headlines. N. p. , n. d. Web. 12 Nov. 2013. â€Å"Video Game. † Wikipedia. Wikimedia Foundation, 11 Dec. 2013. Web. 12 Nov. 2013. â€Å"Children and Video Games: Playing with Violence. † Children and Video Games: Playing with Violence. N. p. , n. d. Web. 12 Nov. 2013.

Scarf

MOTIVATION with a SCARF twist The SCARF (an acronym for Status, Certainty, Autonomy, Relatedness, Fairness) model, a brilliant gift of neuroscience invented by Dr. David Rock, is an interesting tool to understand an individual’s social behavior in a group. The model is broadly based on two themes, â€Å"Minimizing threat, Maximizing reward† & â€Å"Correlating several social experiences to primary social needs†. Knowing the SCARF model aids to understanding the drivers that cause a threat or beget a reward response thus enabling an individual to implement the optimized interaction path with others.Though the other two articles on â€Å"Managing the brain† (also sketching out the SCARF model) and â€Å"Six thinking hats† were fairly interesting reads, but reading about the SCARF model really grabbed my attention since I was now able to correlate a lot of management techniques/decisions I have seen in the past to this model. Motivation strategies and the SCARF model have a close tie. Typically motivation is aimed at bringing about some form of reward response from the individual(s).I have sketched a few ‘low-cost’ motivation techniques Organizations may implement during economic turmoil, relating them to the threat and reward responses of the SCARF model. 1. Communication: Threat: Uncertainty – During economic downtimes many Employees fear uncertainty. There is a baseline fear of losing jobs, taking salary cuts or being transferred to other departments. Reward Response: Motivating Employees using the ‘open communication’ tool, giving them the reward response of certainty, minimizes this threat.If an Organization chooses to throttle increments, bonuses or promotions it becomes imperative to clearly communicate its rationale to the Employees. Employees always appreciate a transparent management style in matters that directly impact them. 2. Leadership: Threat: Autonomy – During low performin g quarters Organizations do not want to go wrong anywhere. This fear is at times is converted to micro management, increased rigidity in rules and a so called â€Å"Authoritarian† behavior which is perceived my the Employees as a threat to their autonomy Reward Response: Motivating Employees during these tough times can become even more critical.Targeting Employee strengths and assigning project ownership accordingly can help reduce this threat. Giving the Employees an opportunity to avail of flexi-time can also create autonomy. 3. Appreciation: Threat: Status – In a disturbed economy Organizations face budgetary restrictions thereby making tough decisions of promoting only a handful of Employees. But what about the rest? They too have worked as hard as the others. These Employees certainly face a status threat in the Organization. Reward Response: Employers should take time to appreciate good work.Appreciation can be done verbally during team meetings or via e-mail, m arking a copy to the entire Department. A simple but meaningful â€Å"thank you† via e-mail can prove to be a very effective motivation tool. Employees feel internally rewarded and motivated when they know their work is valued and recognized in the Organization. 4. Low cost events: Threat: Relatedness – Organizations tend to become very competitive during a tough economy. People are faced with competition within the Organization.Often Employees are shuffled between departments to optimize the productivity. People who move to the new departments often face the threat to relatedness, as they in turn are perceived as a threat to the existing members of the department. Information sharing with the new members could be limited. Reward Response: In this situation an Organization should dedicate some time to conduct low cost events to increase the organizational citizenship behavior (going beyond the call of duty) not only inside departments but also outside departments. E. . : Have a ballot box in the office and encourage people to thank each other for any activity from which the other person benefitted (not directly related to work) for e. g. â€Å"Thank you Mary for sharing the sales figures for last month, this helped me come up with the forecasts quicker than expected. † Every Friday call for a â€Å"Thanks giving event† where these papers are read out in front of the organization and each one gets small rewards like chocolates, donuts, pens etc. This will increase the reward response for relatedness and status. 5.Performance Based Pay: Threat: Fairness: It is a challenge for the Employers to be fair in terms of the financial rewards given to the Employees. An Employee often gets demotivated when he/she hears that their colleagues are being paid more than him/her especially when they feel that they are putting in more effort and yielding a greater result for the department. Reward response: To curtail this threat to fairness an Organi zation should have a transparent performance based pay structure. This structure should be known to every Employee to beget transparency.Finally I would like to say that motivating Employees is important for every Employer, at all times. An Organization does not need to invest in expensive trainings, huge increments or even arranging extravagant holiday packages in order to motivate its Employees. Motivation has a strong negative correlation to the threats that an Employees faces in an Organization and if those threats are identified correctly and mitigated using the SCARF principles the overall productivity can be tremendously boosted.

The legal drinking age should be 18 years of age Essay

The legal drinking age should be 18 years of age - Essay Example tion; however, the officially permitted age for alcohol intake varies according to each country, but most countries the legal is 21years of age. However, the legal age for alcohol consumption should be reduced from 21years of age to 18years since the later are responsible young adults entitled to vote, marry; and considering the menace of over-consumption due to curiosity and experimentation. In most countries, whenever an individual attains 18 years of age, he/she has a right to vote, get an identity card, get married, secure a job in any organization, be able to serve in the military and even sign contracts. This means that an 18 year old person understands whom a potential leader is who will serve a country well and who cannot lead effectively through taking part in voting. Likewise, being able to secure a job in any organization or serve in a military means this person can be responsible and can as well make adequate decisions. Additionally, being able to acquire an identity card means he/she is of age to do things responsibly. In order to get married means an individual knows how to be responsible by taking care of his/her partner and children. Therefore, such an individual has a right and should be allowed to buy and consume alcohol without any restrictions because he/she knows how to be responsible (National Research Council and Institute of Medicine 25). In addition, there is a challenge of alcohol consumption out of curiosity; forbidden fruit syndrome, as anyone who has not attained 21 years of age perceives alcohol as forbidden and that it should not be consumed. This increases curiosity among them because they are curious to know why they are not allowed to drink; furthermore, when in college those under the age of 21 are not allowed to drink at the same place with their seniors, and this equally increases their interest to know what is behind alcohol intake. They rebel and they certainly yearn to know what is in alcohol that they are kept away from hence they decide to give it a try. Therefore, by forbidding 18 year old individuals from drinking in bars, restaurants and licensed places makes them to drink in privacy, for example, in parties. This may lead to dangerous behavior, for example, they may decide to over drink because they do not know when next they will have a chance to consume alcohol. As a consequence, problems like deaths or unprotected sex may arise; therefore, if alcohol consumption is legally allowed for 18 years and above, the curiosity dilemma will no longer be present. In addition, unwanted behaviors and deaths of 18 year old teenagers resulting from alcohol consumptions will greatly reduce since every individual will be responsible of his/her drinking, and will not be driven to over-indulgence because of curiosity (Trapp 78). However, reducing the age for alcohol consumption to 18 years of age is dangerous to the health and is also medically wrong. This is because the brains interior of an individual is vi tal for functions like

Summary Essay Example | Topics and Well Written Essays - 250 words - 83

Summary - Essay Example They include; cloud computing, SAP Business Communication Management, Viral Marketing, and Multi-Protocol Label Switching (MPLS). On the other hand, other factors need to be considered so as business communication can be efficient. These factors are known as the seven gems. These aspects include structure, clarity, consistency, medium, relevancy, primacy, and the psychological rule of seven plus or minus two. Moreover, one may be highly qualified but unable to communicate. Therefore, training programs on a regular basis is essential in the essence in improving the communication skills of the employees. This should be limited to problem-solving approaches, building trust, and increasing productivity, quality and teamwork. The employees, on the other hand, must be willing to accommodate criticism. However, criticism should be constructive, as this will boost employee morale. This means that business goals and objectives are meant to revolve around the model of business communications. This is the case as highlighted in the Tata Quality Management Services (TQMS). This can only be achieved if all the participants of the organization are involved. Finally, success in business can be attributed in possessing of the latest information and

Operation and finances Research Paper Example | Topics and Well Written Essays - 1000 words

Operation and finances - Research Paper Example The price of the product must always be in consistence with the fixed price within the area. There is a need for the company to identify the fixed price of the product so that it finds ways of adapting their operation to the prices without realizing losses (Handlechner, 2008). Further, the company would need to determine the correct discount value that they should be offering on their products. Identifying the right place for marketing is beneficial because it would determine the number of the customers that would be buying the products. The company would have to identify the strategic places where the customers will assess the product easily. The business would have ease in establishing the effective distribution channel after determining the right place. It would also have to determine and study the competitors within the place of establishment. Studying the competitors will help in identifying the weakness of the competitors subsequently looking for the better way of outcompeting the m in the market. Identifying the place would also help the business in determining whether they would use a sale force or the trade fairs depending on the customers residing in the place. Determining a suitable sales strategy involves a company determining the suitable plan of making its product gain a competitive advantage. The company would focus on the identifying a sales strategy that help the sales in focusing the target market. Since the company is still new in the market, the best selling strategy in the market will be direct selling (Handlechner, 2008). This is because the business would have to identify with their customers before introducing their products and services in the market. The indirect selling is not suitable since it will involve analysis of the competition that will be unnecessary to the business. It will only need indirect selling once it has established itself in the market and have enough

New Products Adoption in the Contemporary Market Essay

New Products Adoption in the Contemporary Market - Essay Example Because of such differentiation, a bifurcation has been observed in the process of buyer behavior related theoretical development. Although beneficial for the purpose of teaching and planning, according to the author, such divergence has prevented the development of theoretical structures that act as generic to both forms of buyer behavior. Although traditionally consumers are distinguished from organizations particularly in case of buying behavior due to the implicit understanding that while the consumer as an individual decision maker tends to be whimsical and responsive to sudden bursts of irrationality, organizations do not and professional organizational behavior is bound to be rational as it is the result of joint decision making in the presence of constraints like set objectives and priorities which prevent irrational and indulgent choices, the author argues against such distinctions pointing out the individual buyer although does not have to abide by constraints faced by professional organizations, has to make choices always being constrained by being a part of another organization – society. The differentiation is disagreed with by questioning the assumption that same individuals act differently under organizations that are contextually different, one being a professional organization while the other is the society the individual is embedded in. It is posited that theoretical enrichment is to be derived if buyer behavior is studied without differentiating between consumers and organizations. That in spite of consumers and organizations exhibiting different motivations and patterns in buying at times there are significant overlaps which lead to enhanced perceptions regarding the necessity of development of a general theoretical framework that can elucidate the differences of buying practices which are observed in different contextual settings.

The Strategic Management Process of a Major Apparel and Denim Brand, Case Study

The Strategic Management Process of a Major Apparel and Denim Brand, Levi Strauss - Case Study Example In this paper, the case of â€Å"Levi Strauss- The Boss and the Yogi† as published in the Economist in the year 2014 is analyzed through the application of relevant business and corporate strategy models with the aim of identifying the current strategic position of the brand, understanding the core and contemporary strategies taken up by the company in the recent years, identifying the success of the employment of the new strategies and finally for recommending a suitable future strategic direction for the company. Levi Strauss uses the generic strategies of cost leadership and cost focus in which the company is trying to reduce the overall expense of the business by developing more efficient logistics and procurement systems in their global operations, trying to increase the profit levels by decreasing the operating costs while at the same time maintaining the product prices as per the industry standard. The company is also using the cost focus strategy to ensure that it can leverage on the customer sentiments associated with the brand and maintain the high prices of the products while at the same time remaining sufficiently competitive in the markets of operation. The intensity of competitive rivalry: The intensity of competitive rivalry is extremely high for Levi Strauss. Over the last few years, both the revenues and profits of the company have dropped by considerable extents due to the high degree of competiveness in the industry and the internal weaknesses of the company itself. Currently, the company is experiencing a declining market share in the American as well as global denim markets. The shares of the company have decreased from 7.2% to 5.3% in the period from 2004 to 2013. The threat of new entrants: The threat of new entrants is medium for Levi Strauss. This is because  there are many established big and small players in the denim market which create high entry barriers for a new player in the market. Also, this market is so intensely con centrated that there is hardly any market gap left for a new company to enter into and position itself.  

Characterization of clytemnestra. I will need the works cited Essay

Characterization of clytemnestra. I will need the works cited - Essay Example As a talented playwright, Aeschylus skillfully reversed her roles to those of male characters in ancient Greece. Apart from been depicted as an authoritative and dominating woman, she is also depicted as vengeful wife and a troubled wronged mother. Due to hear strength, she skillfully and willfully gains her success of revenging against her husband. Aeschylus used her as symbol of versatility and courage within the male dominated Greek society, since it was very hard for a woman of time to exhibit such influence and authority. A character like Clytemnestra’s requires clever and calculated handling especially when one reflects on the play’s setting of Greek society in mind hence Aeschylus must have developed her with a lot of skill. She is introduced to the reader, following her husband’s murder of Iphigeni, her daughter. Agamemnon, her husband had sacrificed Iphigeni to goddess Artemis so as to have favorable winds in the journey to troy. The sacrifice greatly angered her and she made a decision to revenge upon her husband’s return. Later on, she succeeds in her revenge by killing her husband and his concubine, Cassandra. The elder see her as untrustworthy but had not suspected she would go ahead to murder her husband. She talks using plain words that have very deep hidden meaning to the individuals around her (Winnington 133). Her courage is depicted when she alludes to undertake the murder plan without fearing being detected. In fact, her character is so strong that, only the audience can easily read her motives. Clytemnestra is portrayed as a cunning woman. She managed to coax Agamemnon into submission. Her hopes in requesting him to walk over the rich purple tapestries is get support of the angered gods in her murder plan. She manages to convince him to accept her offer by cunningly challenging him to prove his manhood. In this case, she actually calls him

Oliver Twist Essay Example for Free

Oliver Twist Essay Oliver Twist was novel written by Charles Dickens that had been brought to the big screen. It is about a young orphan boy named Oliver who only tries to stay good in a society of the upper class that refuses to help the people under them. Oliver gets sent into a workhouse once he turns nine and soon finds himself in a gang of pickpockets that work for a man named Fagin. At each turn he is threatened by characters that believe their deliberate cruelty and lack of compassion to be the highest expressions of charity. They continue to insist that things for Oliver will end up working out in the end. Class and society is one of the main themes in the film of Oliver Twist. The superficialness of class structures emphasize that each individual is the same regardless of their social class into which they were born. But most of the scenes uncover the fact that the Victorian society was cruel and unsympathetic towards the poor because they were so self-absorbed. The Victorian society also firmly believed that the systems taking care of the poor were the most humane systems possible; therefore, leaving nothing for them to help out with. Another theme in the film of Oliver Twist is poverty. The theme is closely related to the theme of class. But as that theme is concerned with showing how the social class system is just invented by society to justify the existing state of affairs. We can see in this film just how miserable the lower classes really were due to the desperateness of stealing. Oliver Twist, doesn’t shy away from representing the terrible conditions of the poor in all their misery with gritty realism. Lastly, fate and free will is another theme in the film of Oliver Twist. The characters Oliver, Mr. Brownlow and the Maylies are liberated and live happily ever after at the end while the other characters aren’t able to escape the complications that the city, their social class, and the systems of justice seem to have created towards the people. Certain characters seem to give up their free will at certain points to abandon themselves in the inevitable. Throughout the movie we try to figure out how much free will each character has. We also question how each character is trapped in the systems of social class and if they will be able to make their own choices in the end. One of the strengths of this film is the inspiring character of Oliver Twist. He continues to believe in his faith in God throughout the entire film, no matter what complicated situation he was going through. Oliver also always believed that the best would come out of everything that was happening and possessed a sincere sorrow at the choices made by some of the other characters in the movie. Oliver’s character was brought to life through depth and the continuation of his faith in God. The only weakness of this film I would say is probably be the length of it. If you don’t know where the story is going, it can seem to go on for a while for someone who is being introduced to Oliver Twist. But if you look back at the history of movies, many of the best films are quite long. This statement is proven because at the end of the film Oliver gains strength in himself and ends up with a family of his own and surrounded by caring and loving people. In conclusion, Oliver Twist was worth watching because it truly captures a realistic Victorian era of the slums in London with the gloomy workhouses and the upper class residents who show no interest in caring for the poor. I was definitely surprised by the realism in this movie and how it shows the many faces that evil has. I also thought that the film gave an immense impression of Oliver’s determination to follow what he knows to be right. Although I have not read the novel that this film was based on, I have a good reason to believe that the film most likely did the story justice.

Study On The Salem Witchcraft Crisis History Essay

Study On The Salem Witchcraft Crisis History Essay The Salem Witchcraft Crisis of 1692 represents a low point in the history of colonial New England. There have a variety of interpretations crafted in an effort to explain the rise of this period of crisis. Some interpretations blame ergot poisoning or an outbreak of encephalitis as the primary causes of the SajgmJWitchcraft Crisis.1 Other historians have argued that it was the social and political discord among the men of Salem that engineered the rise of the Salem witchcraft calamity.2 Mary Beth Norton, in her work In The Devils Snare, offers a significant departure from the current historiography of the Salem witch craft crisis. Norton argues that the Salem Witchcraft Crisis of 1692 can only be understood by examining the military conflict between the English settlers and the New England Native Americans which occurred for the better part of two decades. The author is quick to note that the military conflicts did not cause the crisis that befell Salem rather, these conflicts create d the circumstances that enabled the events in Salem to develop as quickly and as completely as they did.4 In developing her thesis, Norton presents her interpretation in a chronological fashion focusing primarily on the events swirling out of control in Essex County, Massachusetts in the early 1690s.5 Not only does Norton make the link between the ensuing military conflicts of the settlers and the natives with the ongoing witchcraft crisis, she also discusses a myriad of other topics. Norton through the course of her work examines the change of the Salem Witchcraft Crisis over time, the unique elements inherent to the Salem Witchcraft Crisis, and she also provides an historical look at the first and second Indian wars.6 In order for Norton to engage in an intelligent discourse of these aforementioned topics she uses a generous amount of journal articles, secondary source materials, and primary sources. She draws upon such secondary source works as Salem-Village Witchcraft, and A Quest For Security: The Life of Samuel Paris; The 1 Mary Beth Norton, In The Devils Snare (New York: Alfred A. Knopf, 2002), p.4. 2 Norton, Devils Snare, p.4. J Norton, Devils Snare, pp.5,12. 4 Norton, Devils Snare, p.298. 5 Norton, Devils Snare, p.7. 6 Norton, Devils Snare, pp.6,8,11. Sermon Notebook of Samuel Paris, 1689-1694, and Cotton Mathers Wonders Of The Invisible World are among the primary source materials that are used by Norton. By understanding Nortons thesis, viewing the various topics addressed in this work, and the sources used to construct this interpretation one must consider the main points Norton brings up in support of her thesis. The lives of two New England women, and a household slave were irrevocably altered on February 25, 1692. Upon that very day Sarah Good, Sarah Osborne, and a slave named Tituba were accused of being beholden to Satan, and in his employ as witches. Of the three women that were accused of witchcraft, Norton argues, it is the charges against Tituba that are the most significant.7 The racial identity of Tituba, Norton notes, played a decisive role in her joining both Sarah Good and Sarah Osborne among the first of the accused. Historians have debated as to whether Tituba was an African or even a half-African slave, but Norton explains that in the surviving records related to this event villagers commonly referred to Tituba as Tituba Indian or the o Indian woman. This racial connection between Tituba, as an Indian, placed her within a similar vein of hatred that was solely reserved for the New England Native Americans by the settlers of Essex County, and ultimately elsewhere in the New England colonies.9 Norton notes the significant timing of this accusation of witchcraft against an Indian slave: Less than a month after the devastating raid on York and following more than three years of unrelenting frontier warfare. . .the first person identified as a witch in the crisis of 1692 was someone known to all primarily as an Indian. . . .[The accusers] thus named a woman with whom they were intimately acquainted, and who could be seen as representing the people who were then tormenting New England as a whole.10 The accusation of Tituba was to send in motion a calamity, Norton argues, that was to be inextricably linked with the violence between the English settlers and the New England Native Americans.11 7 Norton, Devils Snare, p.21. 8 Norton, Devils Snare, p.21. 9 Norton, Devils Snare, p.21. 10 Norton, Devils Snare, p.21. 11 Norton, Devils Snare, p.21. The accusation brought against the Indian slave Tituba unleashed a torrent of witchcraft accusations throughout Essex County. Another woman, Martha Corey, was accused on March 18,1692. Corey, through the course of her examination on March 21, was to further link the witchcraft crisis in Essex County to the ongoing violence with the Native Americans. Martha Coreys examination added the figure of the spectral black man.12 The spectral black man was witnessed by one Coreys accusers, Abigail Williams, who stated, There is a black man whispering in [Martha Coreys] ear.1 Norton explains that the term black man was generally employed interchangeably with Indian during this period in New England, as a means of addressing the native people of New England.14 It is Cotton Mather in his work Wonders of the Invisible World who makes the connection absolutely explicit, [T]he Black Man. . .they [the confessing witches and accusers] generally say he resembles an Indian.15 It is casually remarked by Norton that such an association between Indians this black man and Satan would not have been surprising to the residents of Essex County: English settlers. . .had long regarded North Americas indigenous residents as devil worshippers. . . .Puritan New Englanders. . .were particularly inclined to see themselves as antagonists of the devilish Indians.1 Martha Coreys fraternization with a spectral black man implied a direct alliance between Satan and the Native Americans of New England.17 The frequent references by confessors and those afflicted by witchcraft proved to establish an illicit connection between the witchcraft crisis of Salem and the ongoing military conflicts with Native Americans. The link between the witchcraft crisis and the military conflicts between the 18 Native Americans was made absolutely clear by the confession of Abigail Hobbs. On April 19, 1692 Abigail Hobbs confessed. Through the course of her examination, Hobbs 12 Norton, Devils Snare, p.58. lj Norton, Devils Snare, p.58. 14 Norton, Devils Snare, p.58. 15 Norton, Devils Snare, pp.58-59. 16 Norton, Devils Snare, p.59. 17 Norton, Devils Snare, p.59. 18 Norton, Devils Snare, p.81. admitted to having met the devil on the Maine frontier in 1688.iy During her time in Maine Hobbs stated that she encountered the devil in the woods near her home in Falmouth, Maine, which was one of the main areas attacked by the Native Americans in both the first and second Indian wars.20 To any who were present at this examination on April 19 the connection was clear: Satan and their Native American nemesis were aligned in a covenant to utterly destroy the goodly Christians of New England. Abigail Hobbs confession of having secured a pact with Satan in the woods of Falmouth. Maine left the residents of Essex County emotionally and spiritually shaken. Norton notes two specific events that demonstrate how deeply ingrained this connection between Satan and the New England Native Americans was in the collective psyche of the colonist In mid July of 1692 the port town of Gloucester many residents were convinced that their beloved town would soon be descended upon by the natives and their detested French allies. The Babson family was among the first to hear ominous sounds around their home almost every night in mid July. Ebenezer Babson and his family reported constantly heard, at night, men fleeing into the shadows discussing a plot to invade Gloucester. Norton explains that Ebenezer at one point thought, that he saw two Frenchmen. . .[and] at other times, he and others believed they spotted Indians.23 After these encounters for a period of two weeks the militia of Gloucester had occasional encounters with spectral assailants who seemed to melt into the shadowy confines of the Gloucester wood. On July 18, with the injection of some sixty militia men from Ipswich and after another week of sightings, caused the people to conclude that their shadowy tormentors were only figments of their imagination.24 This incident of a large scale case mass hysteria clearly shows the extent of the fear caused by the recent connection between the witchcraft crisis and the conflict with the Native Americans in New England. 19 Norton, Devils Snare, p.81. 20 Norton, Devils Snare, p.81. 21 Norton, Devils Snare, p.297. 22 Norton, Devils Snare, p.232-233. 23 Norton, Devils Snare, p.232. 24 Norton, Devils Snare, p.232.

Management Essays Force Field Analysis

Management Essays Force Field Analysis Force Field Analysis One of the vital tools for organizational transformation is the use of the Force Field Analysis. According to Wilson (2000, p. 207), most situations that have something to do with work can be envisioned as having two sets of forces those that encourage the situation and those that prevent or discourage it. Driving forces are those forces or factors affecting a situation which are pushing in a particular direction (Jenkins). Driving forces tend to initiate a change and keep it going. Restraining forces may be likened to walls or barriers (Jenkins). They only put a stop and prevent movements towards improvements. These forces are acting to restrain or decrease the driving forces. In any group or organization, there are both driving and restraining forces at times of change. The Force Field Analysis suggests ways of dealing with these opposing forces. With reference to this model, analyze the essential stages in the change process, the characteristics of crises and conflict, and the managerial approaches for successfully implementing change. Introduction: Many years ago, Kurt Lewin told us that the best way to understand an organisation is to try to change it (Carter, et al, 2001 p. 4). Different organisations have a number of barriers and challenges to overcome. These can come both from their external and internal environments. These barriers constitute a force for change. Change has always been one of the main features of organisational life. It may not always be welcomed and desirable but it is proving to be the one of the main constant in todays changing environment. An organisation that does not recognize change is an organisation that has ceased to exist in the real world. Organisations respond to different challenges in different ways. Most of these challenges are brought about by the emergence of new technologies, new competitors, new markets, and new customer demands (Harvard). These challenges bring about the need to embrace organisational change in structure, culture, and process. If organisations are contemplating changes, then it will be helpful to determine what forces are acting for or against these changes. As these organisations are moving about and implementing change, they are constantly being bombarded with environmental, social, economic, political, and leadership challenges and pressures. These challenges breed different types of forces. Carefully analyzing the forces that bring about these challenges can help organisations decide, control, and implement balanced change programs in difficult and uncertain times. A model of change calls for identifying the different ways of dealing with these forces by understanding and following the change process, the identification and resolution of crisis and conflicts, and the different managerial approaches to successfully implementing change. Force Field Analysis One of the vital tools for organizational transformation is the use of the Force Field Analysis. According to Wilson (2000, p. 207), most situations that have something to do with work can be envisioned as having two sets of forces those that encourage the situation and those that prevent or discourage it. Driving forces are those forces or factors affecting a situation which are pushing in a particular direction (Jenkins). Driving forces tend to initiate a change and keep it going. Restraining forces may be likened to walls or barriers (Jenkins). They only put a stop and prevent movements towards improvements. These forces are acting to restrain or decrease the driving forces. When driving forces are countered by restraining forces, a certain level of equilibrium develops. This equilibrium can be raised or lowered by changes in the relationship between the driving force and the restraining force. Sometimes, in order to maintain this equilibrium, driving forces may be increased or decreased. In the course of doing so however, additional restraining forces may emerge. Different forces can be modified by reducing or removing forces, stretching or adding forces, and changing the direction of forces. Force field analysis is a management technique developed by Kurt Lewin, a pioneer in the field of social sciences for diagnosing situations (Accel-team). It is often useful when looking at the variables involved in planning and implementing a change program and in trying to overcome resistance to change and inertia. It is also widely used to inform decision-making and planning and implementing change management programs in different organizations. As a vital tool in organisational change, it can identify the relative priority of factors on each side of organizational issues. It can also be used to analyse the forces affecting these issues and situations. Force Field Analysis Process This analysis is carried out with a group using a flip chart or overhead transparency. Usually, the first step is to assess the current situation and agree on the goal of the policy or institutional change. This goal should be written between two columns. All the forces for change (usually, driving forces) and encouraging improvements should be listed on one column and all forces against change (restraining forces) in the other. The next step is to try to establish the weight of each force, that is, how much influence is being exerted by that force using a scale of 1 to 5 where 1 denotes a weak influences and 5 denotes a strong influence. Equilibrium is usually achieved when the sum of the weights of the driving forces equals the sum of the weights of the restraining forces. Force Field Analysis as a Model of Change Wilson (2000, p. 224) says that for most organisations that are about to embark on change process, one of the first steps is for senior managers to spend time reviewing strategies and exploring alternatives. This process may involve away days, seminars, and conferences. Another strategy is to define specific problems and ask specific questions related to the different problems. This may be a difficult task considering the level of energy needed to break the opposition to change and inertia. For example, in analyzing how to improve and increase the number of enrollees in most higher education institutions, questions like, why dont we change the way we screen and accept students or what are the forces which are keeping our strategies in their present trend? The education sector is in a very competitive environment nowadays. Colleges and universities around the world are keen on attracting an even greater number of students even from distant places through different online programs. However, as school administrators are slowly exploring deeper into the root causes of falling number of college students, it becomes clearer that there may be some strong forces preventing substantial changes in strategies from occurring as well as strong forces pressing toward changing the nature of the entire educational system. There might be several forces which point toward more acceptable levels of screening techniques and even ways of attracting prospective college students: Students desire more flexible schedules and more convenient ways of dealing with their instructors. College entrance examinations may not always be the most reliable way of screening and evaluating prospective college students. Technology makes it possible for education related services to simulate traditional classroom environments and interactions. In addition to these forces, schools desire to be the center of excellence on specific fields of learning. Today, schools are continually trying to improve on all the aspects of their student services. There might be other forces which seem to be opposed to these changes. Some of these forces are: 1. Many faculty members in most colleges and universities lack formal training in technology-based educational system. 2. Easing on the present method of screening students and experimenting with the unknown makes everyone involved feel insecure. 3. Testing with new scheduling methods may be risky and can contribute to the deterioration of classroom instructions and the quality of other services. During the clarification stage of the change process, one of the goals of this stage is to be able to clarify misconceptions and provide the forum and venue where doubts can be raised and addressed properly. Identifying the driving and restraining forces are concentrated on reaching a common understanding of what the proposed changes would mean and how it relates to the entire organisation. One of the driving forces is the need to see and visualize the short and long term benefits of any proposed changes. The restraining force may be the lack of specific and detailed information and supporting documentation with regards to the proposed changes. During the implementation phase of the change process, it is necessary to attain a certain level of success. After having clarified some goals, senior management can spend more time developing clear measures of success. Some of the driving and restraining forces can be centered on how and when to measure the success of the implemented changes. In each stage of the change process, it is crucial to attain a certain level of equilibrium so that change can be sustained and be kept going. Force Field Analysis Example The force field analysis has been used in diverse fields ranging from organisational change to self-development. In another example of using the force field analysis for change, let us examine the goal of one manufacturing company. This manufacturing company would like to use new strategies and new technologies in their marketing operations. The driving and restraining force are sorted on common themes and are prioritized according to their magnitude towards change by assigning a score or rating to each force, ranging from 1 to 5 where 1 denotes a weak force and 5 as the strong force. Driving forces Score/Rating Customers want new information on products 4 Improve speed of information delivery to customers 3 Raise level of product awareness 4 Marketing costs are increasing 3 ___________ Total 14 Restraining forces Score/Rating Loss of staff overtime 2 Staff frightened by new technologies 3 Environmental impact of new technologies 3 High cost of new technologies 3 Disruption to daily marketing operations 2 ___________ Total 13 Based on the previous example, it is clear that the driving forces are pushing for new ways of marketing products and services. One of the new technologies which can be used to market these products and services can be the use of web-based technologies and the Internet. The use of the web provides customers a lot of opportunities to gain access to real-time information at a much faster rate compared to traditional marketing techniques like the printing and distribution of card catalogs containing new product information and specifications. This strategy also raises the level of awareness of these products and services as it can cover a wider customer base. Although initially, investing on new technologies can be cost-prohibitive, in the long run, as marketing costs related to printing and manpower eventually rises, the use of web and Internet technologies may prove to be much more cheaper in the long run. One of the restraining forces is the loss of staff overtime. It is one restraining force because these overtimes provide additional pay to employees and it would make it more difficult for these employees to come to terms with these losses due to changes in marketing strategies. The use of the web virtually lessens the need to do overtime marketing jobs especially for those who are working on the field. Sometimes, the staff may be averse to the introduction of new technologies as there is always the degree of uncertainty and job loss to be brought about by them. Crisis and Conflicts Problem solving is often concerned with shifting the balance (Wilson, p.207). As organisations adapt changes, certain relationships are created, certain policies are changed, and some techniques are developed. In handling conflicts and crisis brought about by change, the force field analysis can help identify the different forces that bring about negative and positive feedbacks and reactions from people. Individuals are being asked to give up practices, relationships, attitudes, and sometimes emotions (Wilson, p. 218). In trying to resolve conflicts and crisis situations associated with planned changes, the force field analysis can reduce or remove the force that is causing the conflict situation. It can also stretch or add new forces to counter another force. In certain instances where conflicts cannot be resolved through the addition or removal of certain forces, changing the direction of these forces can be an alternative. If organisations are to put a new philosophy in conflict r esolution, then they are adding a new driving force. Managerial Approaches for Successfully Implementing Change It is a must for organisations undergoing change to create effective processes and approaches for the planning and management of change (Pieters, p.119). Managing change through the use of the force field analysis may inevitably bring forth new ways of identifying factors that can contribute to the success or failure of the change process. Management of change processes must consider not only short term goals but also long term ones. The force field analysis can be seen as the framework in diagnosing interrelationships between the intervening variables in the organisational setup. Management approaches in organisational change should not upset the equilibrium. Sometime, top level managements desire to achieve and see immediate results through increased profits and productivity by increasing the driving forces can breed different sets of restraining forces. A manager that is autocratic and imposes high working standards and discipline on the entire organisation can expect to achieve an immediate increase in output in the short term. However, new restraining forces may develop in the form of increased antagonism and hostility towards the manager and the organisation in general. It may generate discontentment, disillusionment, and increased resistance to change. By the time a new manager takes over, there would already be an increased activity related to the different restraining forces which can cause lower productivity and output. This new equilibrium may need a new set of managerial approaches in order to stabilize the situation. The manager may see the need t o increase output and productivity right away but may try another approach. He may not immediately increase the driving forces but might even try to lessen the restraining forces by engaging in dialogs and other problem solving techniques. With the possible elimination of hostility and negative attitudes towards management, in the long term, the equilibrium (increased productivity) needed to attain a certain level of increased productivity may begin to be achieved through increase in skills and commitment to organisational objectives. It is also important to develop the habits of participative work since it is likely possible that the identification of the different forces can come from the different levels of the organisation (Harvard). Specifically, some of these approaches are the following: Push the decision making down to the lowest possible. The identification of the root causes of problems and the possible solutions to these problems can be found on those that are in the frontline. Begin sharing information freely. By sharing information freely, members of the organisation are encouraged to share their own problems and experiences. Make communication a two way street. It is important to talk and listen at the same time. Eliminate unnecessary symbols of hierarchy and unequal status. These symbols can come in the form of executive lunch rooms and parking spaces. Encourage participatory management. It is important to keep in mind that everyone is also capable of managing different aspects of their life. Get into the trenches with frontline employees and encourage other managers to do the same. This management approach would be construed as a way of bridging the gap between management and the workforce. Give people practice in collaborative work between functions by attacking projects and problems through cross-functional teams. This approach encourages more interaction and communication not only between management and the employees but from among the employees themselves. Help people see the why of change, and work with them to discover the what. It is easy to explain and understand the need for change. What is difficult to understand and see is the why. There are interlocking problems and complex issues that need to be simplified for every individual to see. With respect o cultural change, the following steps and approaches should be considered: Uncover beliefs and values. Acknowledge, respect, and discuss differences between core values and beliefs of different sub cultures within the organisation. Look for incongruencies between conscious and unconscious beliefs and values and resolve by choosing those to which the organisation wishes to commit. Conclusion: It is assumed that in any situation, there are driving and restraining forces that influence any change that can occur. Organisations that are planning some form of changes need to be able to adopt a specific change model that would address most of the issues and problems that would be associated with it. The force field analysis can be a good model for change. This analysis provides a lot of opportunities for organisations contemplating on change to view different situations and identify different sets of forces that can directly influence the change process, conflict and crisis resolution, and managerial approaches to these changes. It also allows the organisation to weigh these forces and adopt priority measures based on the strengths of these forces. In general, it means that the organisation has gotten into grips with the problems that they are currently experiencing and have thought of all the consequences of all the possible solutions. Driving forces tend to initiate change while restraining forces tend to decrease or even stop the driving forces from initiating change. The current setup of todays organisations and the way they adapt to changing environments influenced by a lot of factors and forces makes the force field analysis one of the best models in managing and implement ing organisational change. The harsh reality of life nowadays encourages the removal of restraining forces rather than develop overpowering and driving forces. These strategies provide one of the strongest analytical tools yet for organisational change. Bibliography Duck, Jeanie (2001), The Change Monster, Crown Business, New York. Harvard Business Essentials (2003), Managing Change Transition, Harvard Business Carter, L et al (2001), Best Practices in Organizational Development and Change, Wiley, San Francisco. Kanter, Rosabeth (1992), The Challenge of Organizational Change, Free Press, Canada. Nutt, Paul (1992), Managing Planned Change, McMillan, Singapore. Pieters, Gerald (2000), The Ever-Changing Organization: Creating the Capacity for Continuous Change, Learning, and Improvement, St. Lucie Press, Florida. Wilson, Graham (2000), Problem Solving, 2nd edn, Kogan Page, London. Jenkins, David (1949), Force Field Analysis Applied to a School Situation, Retrieved: May 30, 2005 from http://www.crossroad.to/Quotes/brainwashing/force-field.htm. Force Field Analysis, Retrieved: May 28, 2005 from http://www.pyswww.com/mtsite/forcefield.html. Force Field Analysis, Retrieved: May 30, 2005 from http://www. Asem.org/conferences/2004/conferenceproceedings/koplyay150.pdf Team Building: Force Field Analysis, Retrieved: May 28, 2005 from http://www.accel-team.com/techniques/force_field_analysis.html Sustainable Change Management, Retrieved: May 29, 2005 from http://www.challengequest.com/pdf/sustainable_change_management.pdf Organizational Culture: Change Process, Retrieved: May 30, 2005 from http://www.soi.,org/readaing/change/process.shtml

Eating Disorder Essay - Bulimarexia Changed My Life -- Personal Narrat

Bulimarexia Changed My Life It was a frigid day in September 2003, and I was on my way into school. This was the first day of school, in my Senior year. Everyone said it is suppose to be the best year of your high school career. However, it wasn't that way for me. I walked into school on that day, and I felt as if I had some terrible disease. People were avoiding me, ignoring me, and this had never happened before. I was always Miss Popularity all throughout school and I constantly had someone around me. Therefore, getting the cold shoulder was new to me. Day after day I would come to school feeling left out and alone. I had no idea what was happening to all my friends. Until one day I overheard some people talking about me. I was so hurt to hear the things being said, because it was far from the truth. These lies and rumors went on until November, when Homecoming was over. Every week there was a new rumor, a new lie, a new way to hurt me. One week I was a lesbian, the next week I dated every guy in school, any lie that anyone would believe. At first, I let it go in one ear and out the other. Even though it hurt, I didn't want anyone to know it bothered me. However, holding it inside was even worse. At this point I felt like I had no one to lean on, and nowhere to escape from this nightmare. I tried everything to make myself wake up and realize this was all a terrible dream. However, I never woke up and the horror continued. During this time my parents were having troubles as well. Hence, I felt like everything was coming down around me and I had no idea how to stop it. Finally, after about a month, I could not hold my feelings in any longer. I ended up falling into the horrible disease called bulimarexia. Bulimarexia is ... ...veryone is different and nothing is wrong with that. However, there is something wrong with a world made of the same mold. If God would have done that, do you know how boring this world would be? We would all know everything about one another, there would be nothing new to learn. Everyone is different for a reason and if someone can't accept that, then they are not worth your time or energy. To be yourself is a wonderful thing, and I am glad that I realized this now instead of later. I am enjoying myself and getting to live a less stressful life. I am so thankful to be able to share my story and hope that it will help everyone in some way. Remember that you are important just the way you are and that everyone should accept that, if they are your true friends. You are not a puppet and no one should expect that of you, if they respect your feelings and friendship! !!

The Beat Generation Essay -- essays research papers fc

The â€Å"beat movement† is a literary period born out of World War II. This movement in American Literature has become an important period in the history of literature and society in America. Characterized by personal alienation and contempt for convention, the movement celebrated stylistic freedom and spontaneity. The Beat writers created a new vision of modern life and altered the nature of awareness in America. The Beat Generation was one of the first groups of writers to break down the barriers of traditional literature and set a precedent for future writers with their writing style, their way of life, and by the messages they portrayed. They were the kids dressed in black, hanging out at coffee shops, reading their latest poetry. They protested wars, were drug users, and openly expressed homosexuality, as they expressed every aspect of their life candidly. But, the Beats are best known for their writing style. It was unique for that time to cast aside conventional structures of sentences and poetry. They used dashes instead of commas and periods; to write the way a person hears speech. Their poetry had a style of it’s own, unknown to any other groups of poets at the time; no rhyming, no structure, and non-conforming beauty. The Beat writers formed in New York City, started with only a few members, but grew to have an impact on American society, especially in literature and politics, which still lasts today. Jack Kerouac and Allen Ginsberg were the founders of the Beat G...

Case Management Essay

Workflow, Business Process Management and the management of Unstructured Documents Plethora of unstructured documents such as text documents, spreadsheets, images, XML components, videos, podcasts, email messages that exists around in a large enterprise and it represents the enterprise’s information assets. The problem is that in today’s competitive environment there is an ever increasing generation and use of unstructured electronic documents. It has become highly imperative that there has to be an enterprise wide lifecycle management of these documents which can enable the workers to access the documents in a relative business context. Many product companies and experts dealing in the area of content management and business process management have proposed that a semantic relation is to be derived between documents and business domain. Thus, the semantic network that eventually gets formed will result in efficient search and filtering of these unstructured documents. Types of data: Structured and unstructured data People use and create unstructured data on daily basis. Although they may not be aware, people create, store, retrieve unstructured data in the form of emails, word documents, excel spreadsheets and other forms. The unstructured content has no data type as such so it requires human intervention to tag the data with some relevant keywords and meta tags so that it can be read by machines and applications. Structured data is also being used by people and such data is easily managed by technology being allowed for querying and reporting as the data type is predetermined and relationships are explicit. There are two categories of unstructured data: 1) Bitmap Objects: Images, videos, audio and other non-language based files 2) Textual Objects: Word documents, Spreadsheets, Emails and other written or printed language documents Most of these object types can’t be tapped easily to extract relevant information by technology or methodology as technology today can only address textual objects. With the advent of technologies like Enterprise Content Management (ECM), it has become possible to address unstructured data. Data mining and other analysis tools exist to query and analyze structured data. However, the challenge remains in bringing both the worlds of structured and unstructured data together. Once when they are brought together is when the most value can be derived and gained but this is where the highest level of challenge exists. Few challenges are listed below: 1) Irrespective of having the data in a word document format it may not be consumable from a semantic level perspective 2) A compatible technology may not be able to give insight in to the context of the information unless it is read 3) The way we interpret is largely subjective Organizational Challenges Today the organizations are inherently complex in structure and the departments are loosely connected while they work in isolation. They only come together when there is a need which leads to an internally disconnected approach. These large organizations need to be responsive to the customer and market needs. In order to be responsive they need to be agile and flexible when it comes to leveraging their matrix management structure as a whole. This can pose some long term as well as short term challenges. The path to overcome these challenges is to have follow business process which entail the entire organizations. In most organizations, wherever the business processes exist they tend to be isolated to a specific department and are usually manual. This leads to manifestation of various management and operational challenges. Some of the consequences that come up due to these challenges are listed below: 1) Due to inaccurate and untimely information generated as a result of isolated units of an organization, it becomes difficult for management and employees to take correct decisions 2) As information may not be aligned to business context or a business process it may lead to inconsistent decisions 3) Broken or incomplete workflows lead to generation of inconsistent and poor information 4) IT systems may act as inhibitors even if they support business processes when they lack system integration that would hide a single view of the information 5) Strict business rules, policies and procedures can lead to delay in fetching important information Organization and business process alignment These hurdles and challenges which the organization faces are due to factors such as inflexible procedures, legacy infrastructure, orthodox management which include: 1) Manual approach even when business processes and frameworks exist 2) IT enablers found in departments and functional silos making information sharing and gathering labour intensive and tedious 3) IT and other infrastructure is maintained centrally which may not provide quick solutions and service to meet the requirement of internal users 4) As organization is dependent on vendors or contractors for maintenance, support and development of IT and other infrastructure it raises issues of managing changes by themselves. Organizations need to orient themselves around process rather than functionally. They have the necessary infrastructure and technology in place but the challenge is to align all of it together using business processes. Aligning the organization to business processes and automating the same will help in solving decision making bottlenecks and will integrate functions, departments, core systems to deliver measurable business value. As of now most of the organizations, have IT infrastructure which comprise of applications that address each department separately. These departments may have business processes that cater to the purpose of the department specific function but this may lead to creation of unstructured and structured data in isolation from other departments defeating the purpose of one goal of the organization. Due to lack of integration between department’s applications and business processes it leads to creation of islands of redundant information for each department. Knowing that there is duplicate information across various applications residing in various departments there will be multiple points of integration which makes it even more complicated. There is a requirement of point to point integration to resolve this. This increases business risk, delivery costs and it becomes even more important to retain existing talent who can handle the data and information well. IT challenge On drilling down, the problem of not being able to use unstructured data along with structured data semantically whilst the data is specific to each department’s function and not business process of the organization is a challenge for the IT support department of organizations. Integration of silo applications and automated business processes across departments with respect to the overall business context pose many intricacies which makes it is a very challenging and a costly exercise for the IT function. Few of the reasons are listed below: 1) Laborious task to integrate a variety of business processes and applications 2) Changes in particular to each function may become difficult to replicate across the organization each time 3) Data across functions can’t be normalized due to existence of data in multiple format 4) Data inconsistencies due to unavailability of an information master leads to dependency on data stored on spreadsheets These kind of challenges have typically no end so a comprehensive solution has to be worked out which is robust and serves the goal of the organization by delivering value flawlessly. Workflow Model, Business Process Management (BPM) and Enterprise Content Management (ECM) It is Workflow Automation and a Business Process Management System that will solve the business and technical problems that have been described in this paper so far. A workflow model is automation or a semi-automation of business processes. On the other hand Business Process Management is a method for managing the workflow model while continuously evaluating its performance and closing the feedback loop. Business processes form the nervous system of an organization or an enterprise. Business Process Management (BPM) is a discipline that empowers an organization to analyze, automate, re-design, streamline, monitor and improve business process while providing end to end visibility and control from technology to people. An organization has numerous business processes which take place every now and then. They may be simple or complex and may rely on unstructured data. For e. g. Banks have a business process to process the fresh loans application, local retailer has a business process to order new inventory and more. Business processes are the means which enable people, system and information to work simultaneously in order to meet organizations’ goals. However, it is not as easy as it sounds. Consider an example where in an insurance company the claim officials need digital photos to process a claim, customer representative need customer records and statements, accounts personnel need invoice approvals to disburse the required amount. To address such multi dimensional situation companies are resorting to capabilities of Enterprise Content Management (ECM) which is Business Process Management (BPM) to integrate, optimize, and automate processes and information. This solution enables organizations to make timely and accurate decisions. Together BPM and ECM businesses are able to deal with explosion of business related content which in turn helps them in becoming nimble and agile. Primarily, there are three changes that drive the need for businesses to become nimble and agile. They are: 1) Creation of islands of business relevant content internal and external to the organization 2) High maintenance cost of information created and stored by disparate sources 3) Incremental strain on IT to meet core business requirements while driving process innovation In response to these needs ECM and BPM enable organizations with the following: 1) Empower all employees to develop process centric solution 2) Quickly synchronize information from disparate internal as well external data sources 3) Couple processes and content to meet business requirements Businesses today need to use the content that is available across the business processes rather than letting it remain restricted under applications specific to a department or a function. Holistically, the content needs to be put to use for a greater benefit and a better ROI. Management of Unstructured Documents ECM has become one of the major software category post consolidation of various solutions like Document Management, Document Imaging, Web Content Management, Digital Asset Management while collaborating with BPM. It shouldn’t be treated as only a software category but can be primarily looked at as a strategy to manage all unstructured information – images, web content, media assets and records. Secondly, its job is to ensure that the content is put to use by the business users as per the business processes. The ECM solutions available today are built to support today’s dynamic requirements of the organization. They are scalable and high on performance when it comes to handling islands of new content and information with respect to complex business processes. Their design is such that they can integrate any kind of unstructured information with business processes and provide features such as process modelling, analytic capabilities, simulation and activity monitoring. They are also capable to handle process exceptions and can respond to demands for content from associates or customers. It is deduced that ECM as a technology and as a strategy enable information management professionals to manage the unstructured information in the organization to reduce risk, improve productivity in order to bring customer delight. Market Overview Organizations are increasingly adopting ECM to manage the increasing volume and growing diversity of unstructured content which now represents around 80% of the information residing in the enterprise. The opportunity identified is to devote similar rigor to unstructured data as being given to structured data. The market for ECM registered a double digit growth between the year 2004 to 2007 but it slowed down to single digit in 2008 primarily due to recessionary conditions. As per data gathered by Gartner, around $3. 3bn was collected as license and maintenance revenue for ECM. The ECM market has forecasted compounded annual growth rate of 9. 5% through till 2013. It is expected that the revenue generated from ECM markets worldwide would exceed $5. 1bn by 2013. The ECM market has seen major consolidation between the periods of 2003 to 2007. Large players such as IBM, Oracle, EMC have been acquiring companies to capitalize in this space. For example, EMC went on spree acquiring Legato, Document, Captiva and Document Sciences. Autonomy acquired Interwoven and Open Text purchased Vignette to become the largest independent vendors in this space competing directly with Microsoft’s Sharepoint. Market Drivers In spite of the recession which forced businesses to refrain from technology spending, the ECM market remained insulated from it for the following reasons: 1) Increase in volume and complexity of content is the reason for concern and investments in ECM henceforth 2) Pricing pressure from open-source vendors stimulating higher demand 3) It targets the overall ROI of the organization As there is a need to manage risks that come along with tonnes of paper and vast variety of digital content, a focus has been brought on governance and content rationalization. Vendors are addressing this by providing different stakeholders or customers with products that serve their purpose while keeping in mind the overall business processes of the organization. Recognizing this focus area many enterprises have become conscious about the lifecycle, access management, availability and cost of the content. There has been a slowdown in the ECM market due to the recessionary climate as it made the decision makers cautious about investments. In a research conducted by Gartner it was noticed that during this period companies have started looking for a thorough business case and ROI justifications for any kind of technology expenditure. However this could also turn out to be positive for the ECM market as these are the times when the organizations will realize the benefits of ECM solutions and frameworks. Conclusion Business Process Management and Workflow are not about moving documents across departments. It is about aligning businesses to their core processes and they provide the catalyst to exploit knowledge base to provide improved customer service. Thus, help in delivering measurable bottom line benefits in variety of business cases. List of References Toby Bell, Karen M. Shegda, Mark R. Gilbert, Kenneth Chin, Mick MacComascaigh. ( October, 2009), Magic Quadrant for Enterprise Content Management http://www. gartner. com/technology/media-products/reprints/microsoft/vol10/article3/article3.html, Gartner Hakan Akbas (August 2009), Consolidation in the Enterprise Content Management Industry – Who Will Be Next – Autonomy or Open Text? http://www. cmswire. com/cms/enterprise-cms/consolidation-in-the-enterprise-content-management-industry-who-will-be-next-autonomy-or-open-text-part-i-005174. php, Cmswire Icon Resources and technologies ( 2007), Document/Business Process Management http://www. iconresources. com/new/irt_bps. html Hinnerk Brugmann, ConSense: Management of unstructured Documents using semantic Meta-Information http://www.wi2. uni-erlangen. de/index. php? id=consense PNMSOFT, Sequence and Sharepoint, http://www. pnmsoft. com/sharepoint_workflow_integration. aspx PNMSOFT, SEQUENCE BPM & workflow software platform, http://www. pnmsoft. com/sequence_bpm_workflow. aspx Rivet Logic Corporation (October 2008), Enterprise Content Management 2. 0: The Case for an Open Source Approach http://viewer. bitpipe. com/viewer/viewDocument. do? accessId=12186060, Bitpipe Research Kyle McNabb (March 2008), Enterprise Content Management http://www. forrester.com/rb/Research/topic_overview_enterprise_content_management/q/id/40327/t/2, Forrester Research Ann All (March 2010), Case Management Is Step Forward in BPM Evolution , http://www. itbusinessedge. com/cm/community/features/interviews/blog/case-management-is-step-forward-in-bpm-evolution/? cs=39882&page=2 Strategy Partners (2003), Business Process Management and Workflow, http://www. aiim. org. uk/download_files/aiimuserguides/5_BPM_and_Workflow. pdf, AIIM International – ECM Association Barclay T. Blair (October 2004), An Enterprise Content Management Primer, The Information Management Journal

An Essay on Clinical Negligence

An Essay on Clinical Negligence â€Å"We have always thought of causation as a logical, almost mathematical business. To intrude policy into causation is like saying that two plus two does not equal to four because, for policy reasons, it should not. † (Charles Foster NLJ 5/11/2004 page 1644). To what extent do you consider that Charles Foster is correct in that causation and clinical negligence should be a â€Å"mathematical business† and the courts have, by introducing matters of policy, confused what should be a logical approach? Introduction: In the article of â€Å"It should be, therefore it is†1, its author, Charles Foster examined the surprise House of Lords judgment in Chester v Afshar2, what he described as â€Å"an exercise in legal creativity that abolishes the requirement for causation in any meaningful sense. † To discuss the above issue, one must consider the legal requirements of clinical negligence. In order for a patient to succeed in a claim for clinical negligence against his doctor, he must be able to satisfy three requirements: first, he must establish that a duty of care was owed by the doctor or hospital to himself; second, he must prove that the doctor has breached that duty of care by failing to reach the standard of care required by the law; lastly, the patient must prove that his injury was caused by the doctor’s negligent act. Each of these requirements for negligence will be considered as the strict requirements for a successful claim of the patient suffering from an adverse event in a medical context. These steps were referred by Charles Foster as the logical â€Å"mathematical business† 3towards establishing the causation in a clinical negligence case. Is Chester’s case a relaxation of the causation requirements? To discuss this statement, one must consider whether the breach of duty causes the harm to the patient. Even if a doctor breaches his duty of care by falling below the standard of care, a patient can only recover his damages if he can prove that breach has caused some harm to him. 1. â€Å"It Should Be, Therefore It is† (2004) 154 New Law Journal 7151. 2. [2004] UKHL 41. 3. Charles Foster New Law Journal 5/11/2004, p. 644. If the doctor breaches his duty of care, but the patient suffered no injury, or would have suffered an identical harm regardless of the doctor’s failing, then the doctor is not proven negligent. This can be illustrated by the case of Barnett v Chelsea and Kensington Hospital Management Committee4. In this case, the doctor ha s breached his duty of care to the deceased man by not examining him personally, but the action for clinical negligence failed, because even if the patient had been seen by the doctor, the arsenic poisoning was regarded as too far advanced for an antidote to be life-saving. In other words, by the time the patient arrived at the hospital, he was destined to die irrespective of the actions or negligent omissions of the doctors. Although his doctor failed to meet the requisite standard pf care in treating him, this did not in itself cause any harm to the patient. 4. There are two ways of interpreting this causation requirement. On the one hand, there exists a reasonable principle that a person should not be held liable for damage which he did not cause. On the other hand, there is no legal evidence for incompetent medical care unless the patient can prove that the doctor’s action indeed caused some identifiable harm. The particular patient is Barnett should have been attended by a doctor, but the fact that he was not subject to compensation. In recent years, the English legal system has recognized that a very strict application of the causation requirement can result in injustice for the patient and therefore there have been gradual moves towards a relaxation of this requirement. In Bolitho v City & Hackney Health Authority5, for instance, a strict application of the traditional causation test of â€Å"but for† – that is the harm would not have been caused but for the doctor’s clinical negligence- was self-evidently not satisfied. It could be recalled in this case the doctor failed to attend the patient but argued that, if she had indeed attended, she would not have provided the treatment (intubation) which could have save the child. Therefore, it is crystal clear that the harm of the child’s death would have occurred even if the doctor had met her duty of care by attending the patient. Despite the court was not willing to settle for this conclusion and instead enquired into whether the doctor’s intended failure to intubate if she had attended would have been clinically negligent in itself. This implies that it was considered by the court at all is an indication that, if some serious harm has occurred, the courts will take into considerations the entire circumstances of the case before coming to the conclusion as to whether the causation requirement has been satisfied. 4. [1968] 1 A11 ER 1068. 5. [1997] UKHL 46, HL. The approach can be seen even more controversially in the 2004 case of Chester v Afshar6, which Charles Foster has made his comment on as mentioned. This case involved a doctor’s clinical negligent failure to warn a patient about the risk inherent in a medical procedure. There exists a need for the patient’s consent to medical treatment to be fully informed. The complication with respect to causation arose because the patient admitted that she would have still undergone the surgery even if she had been warned about the risks of paralysis which unfortunately materialized during the medical procedure. Therefore, the doctor’s failure to disclose this risk, although a breach of his duty of care, did not on the strict application of the causation requirement, cause the harm suffered by the patient. When Chester reached the House of Lords, the House was divided on the issue of causation. The Court of Appeal, taking a strong and pragmatic approach, held that the claimant could succeed by applying conventional causation principle. Therefore it could be said that the claimant’s injury had resulted from receiving a particular operation at a particular time. If the defendant had warned her about the risks, she would not have that particular operation- she would have had an operation (with the same risks) at a later date. If she had had this later operation, in all probability, the very small risk of disability would not have happened. On this basis, it could be said that the defendant’s failure to warn had led to the claimant’s disability. However, the House of Lords did not find this kind of approach attractive. As Lord Hoffman put it, the approach of the Court of Appeal was: †¦about as logical as saying that if one had been told, on entering a casino, the odds on the number 7 coming up were only 1 in 37, one would have gone away and come back next week or gone to a different casino. The question is whether one would have taken the opportunity to avoid or reduce the risk, not whether one would have changed the scenario in some irrelevant detail. †7 In the House of Lords, both the majority and minority rejected r easoning of the Court of Appeal and held that the claimant could not succeed in proving causation on conventional principles. For the minority (Lord Hoffman and Bingham), this was sufficient to dispose the case. However, the majority went on to state that, for policy reasons, the traditional rules of causation ought to be relaxed to allow the claimant to 6. [2004] UKHL 41 7. [2005] 1 AC 134, per Lord Hoffman, at paragraph 31. succeed. Central to their Lordship’s reasoning was the need to give effect to the right of a patient to make an informed choice about whether and when to undergo medical treatment. In law, this right was made possible by a doctor’s duty to warn the patient about any significant risks involved in the medical treatment. There would therefore be injustice if breach of this duty did not lead to a remedy. If the doctor were not made liable for such a breach, the duty to inform the patient about significant risks would, as Lord Hope put it, be a â€Å"hollow one†. His Lordship said: â€Å"The function of the law is to enable rights to be vindicated and to provide remedies when duties have been breached. Unless this is done the duty is a hollow one, stripped of all practical force and devoid of all content. It will have lost its ability to protect the patient and thus to fulfill the only purpose which brought it into existence. On policy grounds therefore I would hold that the test of causation is satisfied in this case. †8 Lord Steyn shared this view that the vindication of the patient’s rights was the overriding considerations: â€Å"Her right of autonomy and dignity can and ought to be vindicated by a narrow and modest departure from traditional causation principles†¦This result is in accord with one of the most basic aspirations of the law, namely to right wrongs. †9 On policy grounds, therefore, Lord Hope, Steyn and Walker held that the test of even though they agreed with Lord Bingham and Hoffman that this required a departure from the traditional principles. The simple fact that the patient’s injury was â€Å"intimately involved with the duty to warn†10 was sufficient for Lord Hope, while Lord Walker emphasized that the doctor had failed in his professional duty and the patient â€Å"has suffered injury directly within the scope and focus of that duty†. 11 In summary, the two dissenting Lords emphasized that Miss Chester had failed to prove that the doctor caused her injury. Lord Bingham said that â€Å"she cannot show that the clinical negligence proved against Mr. Afshar was, in any ordinary sense, a cause of her loss†12 and Lord Hoffman noted that â€Å"on ordinary principles of tort law the 8. 2005] 1 AC 134, per Lord Hope, at paragraph 87. 9. [2004] 4 A11 ER 587, per Lord Steyn, paragraph 24-25. 10. [2004] 4 A11 ER 587, per Lord Hope, paragraph 87. 11. [2004] 4 A11 ER 587, per Lord Walker, paragraph 101. 12. [2004] UKHL 41, per Lord Bingham, paragraph 9. defendant is not liable†. 13 Both of these j udges therefore held that Miss Chester could not recover damages with respect to Mr. Afshar’s negligent disclosure. Even the judges in the majority acknowledged that the traditional causation requirement had not been satisfied in this case. Lord Hope, for instance, who gave the leading judgment, accepted that â€Å"a solution to this problem which is in Miss Chester’s favour cannot be based on conventional causation principles†. 14 The majority allowed Miss Chester to recover damage based on some vague policy reasons. Lord Hope elaborated that the key question for the House of Lords was â€Å"whether in the unusual circumstances of this case, justice requires the normal approach to causation to be modified†. 15 Lord Hope further explained that â€Å"the function of the law is to enable rights to be vindicated and to provide remedies when duties have been breached. Unless this is done, the duty is a hollow one, stripped of all practical force and devoid of all content†. 16 Lord Steyn shared this view that the vindication of the patient’s rights was the overriding consideration: â€Å"Her right of autonomy and dignity can and ought to be vindicated by a narrow and modest departure from traditional causation principles†¦This result is in accord with one of the most basic aspirations of the law, namely to right wrongs. †17 As a result, the consequence is that where there is a breach of duty to disclose and the plaintiff suffers from . he actual harm he or she should have been warned about, then a claim for damages is more likely to succeed. The patient would recover if they would have deferred the procedure. The plaintiff no longer have to demonstrate that he or she would have refused the procedure completely if he or she had been told about the undisclosed risk. The adaptation of the causation requirement in Chester v Afs har has been the subject of considerable debate and criticism. Green18, for example, argues that the law of torts â€Å"is concerned not with compensating those who have suffered loss as a result of the defendant’s breach of duty†. This very point is emphasized by Lord Bingham in his dissent when he argues that â€Å"a claimant is not entitled to be compensated, and a defendant is not bound to compensate the claimant, for damage not caused by the negligence complained of†. 19 To some extent this is a convincing argument. 13. [2004] UKHL 41, per Lord Hoffman, paragraph 32. 14. [2004] UKHL 41, per Lord Hope, paragraph 81. 15. [2004] 4 A11 ER 587, per Lord Hope, paragraph 85. 16. [2004] 4 A11 ER 587, per Lord Hope, paragraph 87. 17. [2004] 4 A11 ER 587, per Lord Steyn, paragraph 75. 18. Sarah Green, â€Å"Coherence of Medical Negligence Cases: A Game of Doctors and Purses†. (2006) 14 Med Law Rev. 1, p. 4. 19. Chester v Afshar [2004] 4 A11 ER 587, paragraph 9. Miss Chester was awarded full damages for the injury she suffered even though this injury was not really caused by the doctor’s actions, which seems unjust. However, the point which is missed here is that the doctor’s negligent non-disclosure did cause a different loss to Miss Chester. Green20 argues that Miss Chester â€Å"lost nothing of value†, but I believe this is not true: she lost her right to make an autonomous choice about her medical treatment. In daily clinical practice, autonomy with respect to healthcare requires that a patient is fully informed about the medical treatment before he or she can consent to it. On the other hand, the right to refuse consent to medical treatment, which is protected in both English common law and international human right law, requires that an informed choice be made by the patient. In Miss Chester’s case, she was denied of this particular right. She agreed to undergo the surgery in ignorance of its risks and true nature. Her right to autonomy was therefore denied. Green’s opposing view can be explained as follows: â€Å"A patient’s dignity and right to decide is protected by the law of tort’s recognition that a doctor has a duty to warn, not by the readiness to override causal considerations in the claimant’s favour. If a breach of that duty to warn causes the patient no loss, then a finding of no liability does not violate that right. It merely serves as an acknowledgment that the patient’s inability to exercise that right did not, on this occasion, causes any harm†. 21 A fundamentally different viewpoint of this situation is taken here. The inability to exercise a right to autonomy is regarded as a harm in itself, regardless of the actual physical injury resulted. This rights-based approach means that Mason and Brodie22 are correct to regard the award of full damages to Miss Chester as inconsistent with the House of Lords’ modified approach to causation as follows: â€Å"One can understand the concern to allow the plaintiff to vindicate her rights. However, the measure of damages allowed does not, in truth, reflect the loss suffered because, at the end of the day, the loss lay in an invasion of autonomy per se, and an award of full damages can be said to over-compensate. 23 20. Sarah Green, â€Å"Coherence of Medical Negligence Cases: A Game of Doctors and Purses†. (2006) 14 Med Law Rev. 1, p. 14. 21. Sarah Green, â€Å"Coherence of Medical Negligence Cases: A Game of Doctors and Purses†. (2006) 14 Med Law Rev. 1, p. 9-10. 22. K Mason and D Brodie, â€Å"Bolam, Bolam- Wherefore Are Thou Bolam? † (2005) 9 Edin LR298, p. 305. 23. K Mason and D Brodie, â€Å"Bolam, Bolam- Wherefore Are Thou Bolam? † (2005) 9 Edin LR298, p. 305. The House of Lords judgment in Chester v Afshar represents a significant departure from the traditional requirements of a negligence action. It is an imperfect the emphasis upon vindication of the patient’s rights is insufficiently explained and justified. But it is also encouraging from a human rights perspective to see this judicial recognition at the highest level that causation requirements should not act as a barrier to recovery where a patient’s rights have been infringed during the provision of medical care. Manson and Laurie24 refer to a trend to â€Å"assist the plaintiff over the causation hurdle in medico-legal cases†25 and, given the great hurdle still in place with respect to proving a breach of the duty of care, this should in general be welcome. Andrew Grubb26 argues that the majority in Chester made the right decision: â€Å"It is difficult to argue with [the majority’s] reasoning. It would undermine the rule and be unjust for a doctor to require a patient to show that she would never have a particular procedure in the future. It is also counterintuitive to think that because the patient may run the risk in the future- by agreeing to and having the procedure- the negligence is not connected to her injury. At worst, she will be exposed to a small risk of injury which is unlikely then to eventuate. She had in a real and immediate sense suffered injury that she would not otherwise have suffered. That should be sufficient to establish a causal link†. 27 If Miss Chester‘s loss is better described as the loss of the right to make an informed consent, rather than exposure to a risk which she would have avoided if given proper information, it could be argued that damages should be directed towards compensating her for this deprivation of autonomy, rather than for the physical injury she suffered. It is interesting that the majority in Chester did not consider the possibility of making a â€Å"conventional award† as they had done in Rees v Darlington memorial NHS Trust28, for the patient’s loss of autonomy. The majority awarded Miss Chester full damages for physical injury, despite the fact that their judgments describe the real loss in this case as the deprivation of the right to make an informed choice. As 24. JK Mason, A McCall Smith & G Laurie, Law and Medical Ethics, 7th edit, (Oxford, Oxford University Press, 2006), p. 39. 25. JK Mason, A McCall Smith & G Laurie, Law and Medical Ethics, 7th edit, (Oxford, Oxford University Press, 2006), p. 339. 26. â€Å"Consent to Treatment: The Competent Patient†, 31-203 in A Grubb with J Laing(eds), Principles of Medical Law, 2nd edition, (Oxford, Oxford University Press, 2004), p. 200. 27. â€Å"Consent to Treatment: The Competent Patient†, 31-203 in A Grubb with J Laing(eds), Principles of Medical Law, 2n d edition, (Oxford, Oxford University Press, 2004), p. 200. 28. [2003] UKHL 52. J Kenyon Mason and Douglas Brodie29 point out, this may mean that Miss Chester was over-compensated: â€Å"However, the measure of damages allowed does not, in truth, reflect the loss suffered because, at the end of the day, the loss lay in an invasion of autonomy per se, and an award of full damages can be said to over-compensate. What is, in some ways, surprising is that, the solution adopted in Rees v Darlington Memorial NHS Trust was not applied here. There, the requirements of distributive justice meant that damages should not be awarded to compensate the plaintiff for the loss that ad arisen as the result of a failed sterilization operation†¦The solution adopted was to award a â€Å"modest† conventional sum by way of general damages to acknowledge the infringement of the plaintiff’s autonomy by the fault of the defendant†. 30 The possibility of a conventional award was mentioned by Lord Hoffman, in his dissenting judgment: †I can see that there m ight be a case for a modest solatium. †31 In the end, he rejects this solution for two reasons: it would be difficult to settle on an appropriate amount, and on the grounds of costs, the courts would be an unsuitable place to pursue what would always be a modest award. Effectively, then, the consequence of Chester’s case is that autonomy-based right to make an informed consent is so important that doctors who fail to warn patients about material risks associated with treatment may have to indemnify patients should those risks materialize, despite the exercise of all proper skill and care in carrying out the operation, and critically, despite the fact that the patient admits that they would have been prepared, in fact, to knowingly run this risk on another occasion. Difficulty in proving causation: The full impact of the House of Lords’ relaxation of causation principles in Chester v Afshar remains to be seen. There are a number of reasons why the causation requirement raises particular difficulties in actions for negligence non-disclosure of relevant information. 29. â€Å"Bolam, Bolam- Wherefore Are Thou Bolam? † (2005) 9 Edin Law Rev. p. 298-305. 30. â€Å"Bolam, Bolam- Wherefore Are Thou Bolam? † (2005) 9 Edin Law Rev. p. 298-305. 31. [2004] UKHL 4, per Lord Hoffman, paragraph 34. 32. â€Å"A warning about causation† (1999) 115 Law Quarterly Rev. 1-27, p. 23. 33. â€Å"From Informed Consent to Patient Choice: A New Protected Interest† (1985) 95 Yale Law Journal 219. 34. â€Å"From Informed Consent to Patient Choice: A New Protected Interest† (1985) 95 Yale Law Journal 219. First, a successful claim in negligence for failure to disclose a material risk is in practice synonymous with strict liability for medical mishaps. Informed cons ent therefore becomes a route for patients to seek financial compensation for unfortunate but blameless medical outcomes. Doctors who exercised all reasonable care and skill in performance of an operation will be found liable for the consequences of an accident which they could have done nothing to prevent just because their pre-operation disclosures were inadequate. As Peter Cane32 explains, â€Å" whatever the ideological basis of the duty to warn (or, in other words, the interest which it protects), its importance in practice lies in providing a basis for imposing liability for physical injury not caused by clinical negligence†. Secondly, because the claimant must prove that the inadequate disclosure caused her injury, cases only come before the courts where the patient has not been informed about the risk of an adverse outcome which has then materialized. Adequate information is not, however, confined to disclosure of risks. In order to exercise meaningful choice, it is important that the patients are told about alternatives to the proposed treatment. As Marjorie Maguire Shultz33 explains, negligently depriving the patient of choices will rarely result in the sort of damage or injury which is recognized in tort law: [P]reemption of patients’ authority by doctors may also give rise to injuries that are real but intangible, or to physical outcomes that are arguably not â€Å"injurious† except from the individual’s vantage point. These outcomes may be excluded from negligence doctrine’s definitions of harm. Thus, a patient not told about a method of sterilization that is more revers ible than the one performed may have difficulty convincing the court that non-reversibility is a cognizable physical injury. A patient who alleges that, properly informed, she would have chosen a lumpectomy rather than a radical mastectomy might find it hard, under existing negligence rules, to characterize the successful operation that removed her breast and eradicated her cancer as having â€Å"injured† her. Similarly, the patient with a desire to go home or to a hospice to die, who is instead maintained alive by hospital machinery, might have difficulty establishing â€Å"injury† under definitions of an interest in physical well-being rather than choice†. 34 Thirdly, â€Å" cause† appears to have acquired a rather special meaning in failure to warn cases, Peter Cane has explained, the doctors in these cases rarely â€Å"caused† the injury in question â€Å"in the central sense of the word â€Å"cause† as it is used outside the law†, because â€Å"failure to warn of a risk does not â€Å"cause â€Å" the materialization of the risk†. Rather the injury has usually been caused by an unfortunate and inherently unlikely combination of circumstances, and the doctor simply created the situation in which this extraordinary sequence of events could occur. The question of whether a doctor should be liable for a failure to disclose a risk is more accurately stated as whether she should be liable for creating the situation in which an accidental injury might or might not occur. Conclusion: There is an elegance to a legal structure that requires doctors to owe a â€Å"single comprehensive duty† in negligence covering diagnosis and treatment, and the associated obligations to inform. Diagnosis and treatment are essentially the exercise of the medical professional skills and therefore fall fairly into the arms of negligence. The duty to inform, however, seeks to protect the patient interest in self-determination. This seems more fairly addressed by an action that is complete with the injury to the interest protected. Such an action would be more akin to an action in battery. The fact that legal action for inadvertent misinformation in relation to the inherent risks/benefits of treatment lies in negligence rather than in battery leaves a legal structure that has some tension within in it. Where battery, constrained as it is by touching, is an ill-fitting robe negligence barely covers the mischief. In English law, negligence actions for negligent misinformation have seen this tension expressed as a strong dissent by Lord Scarmen in the case of Sidaway v Bethlem Royal Hospital Governors35, and then as a weakening of the causation rule in Chester v Afshar. Notice how weakening the causation rule in Chester v Afshar. Notice how weakening the causation requirement makes the action of clinical negligence more akin to a battery action- the very action precluded by the rule in Reibl v Hughes in such cases. In Chester v Afshar, the plaintiff would have had the operation at a different time and so something would have changed had the information about risk been given. The core of the principle in this case comes when the plaintiff does not change anything as a result of the misinformation. Can they still succeed where they suffer the very harm they should have been worried about? If so, we have a clinical negligence action that looks suspiciously like a battery action but protects the interest of self-determination. The use of clinical negligence in this context has arisen by default. The structure of a claim in clinical negligence is simply the wrong one to protect a fundamental interest like self-determination and the strain is telling.