The Love Song of J Alfred Prufrock Essay Example For Students

The Love Song of J Alfred Prufrock Essay The Love Song of J. Alfred Prufrock demonstrates the effects of social and economic pressure in the life of a Victorian man. T. S. Eliot shows us, in an ironic monologue, how the reality of age and social position paralyzes his character with fear. The poem opens with six lines from Dante s Infernio. This particular stanza explains that the speaker is in hell and the message can only be told to someone else in hell. The speaker tells us that it is OK for the listener to hear the message, since in order to hear you must already be in hell and no one ever returns from there. We will write a custom essay on The Love Song of J Alfred Prufrock specifically for you for only $16.38 $13.9/page Order now So the message will never leave. I believe Eliot uses this message to infer that only a reader who understands the loneliness and desperation of Prufrock can truly understand the poem. However, in my research, I have found as many different interpretations of the poem as I have found readers. Most agree; however, that Prufrock is speaking to the reader when he says you and I (Line 1). Many readers also agree that Prufrock is a lonely man, but what type of company he desires seems to vary greatly. Interpretations include sex, social company, long term love, and even death. I believe Prufrock yearns for the sense of belonging, both with a female and with his society. He struggles with issues of sex, age and social change. The beginning lines of the poem(1-25) paint for a very descriptive picture of the street where Prufrock is walking. It also alerts the reader of Prufrock s distaste for this area and this society. He describes it as have deserted, muttering. one-night cheap hotels and sawdust restaurants . (5-7) He contrasts that with his destination of a room where women come and go/Talking of Michelangelo (1314). Prufrock doesn t give the reader much insight into his houghts until line 26. From this line forward, we get a glimpse of what it must be like to be Prufrock. He tells us There will be time, there will be time/ To prepare a face to meet the faces that you meet (27-28), indicating repression. He must prepare himself mentally to be able to put on the correct social image before he makes his visit (12). The rest of the poem simply reinforces his struggle between the way he would like to be and the reality of his life. He begins to ponder the overwhelming question (11) of whether or not he could have a romantic interlude ith one of the ladies he is gong to visit, but the socially acceptable and slightly neurotic side of him emerges and he quickly switches his thoughts to his thinning hair. I believe he is trying to gather the courage to approach one of these ladies (42-4345-46) but looses the courage as quickly as it came to him. He then laments about his indecision and lack of courage, in a minute there is time/ For decision and revisions with a minute will reverse. The theme of Prufrock s fickle thoughts run throughout the poem, as illustrated in his confidence about his outfit and taste, hen just the next line he his back to the insecurity about his age But how his arms and legs are thin. (45) Prufrock goes on to tell the reader of his experience I have known them all–/Have known the evenings, mornings, afternoons, (50) describing the stages of his life from his youth through his young adulthood to his present state, as a middle aged man. He feels the age and eventual death of not only himself but of the society he is a part of. He hears voices dying†¦.. .u78ccc16cc297a524a61375cf0c599933 , .u78ccc16cc297a524a61375cf0c599933 .postImageUrl , .u78ccc16cc297a524a61375cf0c599933 .centered-text-area { min-height: 80px; position: relative; } .u78ccc16cc297a524a61375cf0c599933 , .u78ccc16cc297a524a61375cf0c599933:hover , .u78ccc16cc297a524a61375cf0c599933:visited , .u78ccc16cc297a524a61375cf0c599933:active { border:0!important; } .u78ccc16cc297a524a61375cf0c599933 .clearfix:after { content: ""; display: table; clear: both; } .u78ccc16cc297a524a61375cf0c599933 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u78ccc16cc297a524a61375cf0c599933:active , .u78ccc16cc297a524a61375cf0c599933:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u78ccc16cc297a524a61375cf0c599933 .centered-text-area { width: 100%; position: relative ; } .u78ccc16cc297a524a61375cf0c599933 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u78ccc16cc297a524a61375cf0c599933 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u78ccc16cc297a524a61375cf0c599933 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u78ccc16cc297a524a61375cf0c599933:hover .ctaButton { background-color: #34495E!important; } .u78ccc16cc297a524a61375cf0c599933 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u78ccc16cc297a524a61375cf0c599933 .u78ccc16cc297a524a61375cf0c599933-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u78ccc16cc297a524a61375cf0c599933:after { content: ""; display: block; clear: both; } READ: The First Impression EssayBeneath the music from a farther room (52-53), and realizes that he is at the end of his ime. I think he realizes that he is not a member of the modern society, nor am I sure he wants to be. But he does feel that he is watched like a specimen formulated, sprawling on a pin (57). But unlike a bug in a bug collection, he is still alive and tortured wriggling on the wall (58). He realizes that his customs are a part of the past, but he is unable to see the way to move on. He thinks perhaps he should spit out the butt-ends of my days and ways (60) but realizes he wouldn t know how to resume life in the new world And how should I presume? (61).

The Effects of Domestic Violence

The Effects of Domestic Violence Domestic violence can happen to people from all races, age, sexual orientation, social status and gender. Forms of domestic violence include rape, stalking and abusive behaviour against a person. Domestic violence has adverse effects on those who go through it as well as those who witness it.Advertising We will write a custom report sample on The Effects of Domestic Violence specifically for you for only $16.05 $11/page Learn More The effects range from physical injury, body and mental health complications and economic loss in terms of money used in treatment. It is worth noting that violence caused by men is not a result of their mental illnesses, but by the lack of anger and stress management skills. There are myths and realities about domestic violence, but with the knowledge of prevention tips many cases can be avoided. The information provided in the handout is very important in empowering women. According to statistics and research provided in the hand out, women are at a higher risk of being victims of domestic violence. This has put me on the watch out as it is clear that rapists and stalkers are looking for opportunities to exert their control. The handout has also proven important as it has helped me to understand why in spite of a lot of public awareness; domestic violence is still going on. As is explained, our parents often assault one another in front of the children while paying no attention to the bad lessons the children could learn from their uncivilized behaviours. Later on in life, children get involved in violence thinking it is a normal way of life. There are so many ways of preventing domestic violence. As a woman, I believe it is my role to educate my children on domestic violence while they are still young, so that they may not part from the teachings when they become adults. The handout has helped me realise that stalking is just as dangerous as other forms of domestic violence. Stalking instil fear in a person , making him or her lose his or her freedom. This can lead to death, mental illness and the victim can hardly do tasks expected of them since they do not know what will happen next. Stalking is worsened by the fact that there are no behavioural facts that can predict what a stocker will eventually do. They may torture their victims, assault them, rape them or even kill them. The government and the organizations that work toward helping victims of violence should involve all people in the community especially women who are the key in enhancing and implementing change. As a woman, I should have nothing to be ashamed of in taking measures against a stalker or rapist since I am the victim. Having learned of the great effects of domestic violence, loss in low work output, failure to go to work, employment problems due to the self-doubt, depression and confusion experienced by the victims, I have not just made it my point to be more careful, but also to assist victims by taking them for c ounselling. So as to fight domestic violence, ladies and women being the most affected, need to be aware of all the preventive tips towards rape and stalking.Advertising Looking for report on gender studies? Let's see if we can help you! Get your first paper with 15% OFF Learn More Ignorance is no defence and therefore, people should not live on assumptions and myths. In conclusion, the handout is not just informative, but also inspiring. However, the latest cases of rape have involved people who the victims are well acquainted with. It is therefore important to emphasize to all that caution should be taken even against close friends when it comes to rape.

What Types Of Grouping And Peer Interactions Generate Authentic Essay

What Types Of Grouping And Peer Interactions Generate Authentic Student Engagement And Positive Learning Outcomes - Essay Example The study also observed that peer directed small groups can help in effective grouping techniques that eliminates the discrimination and improve positive learning outcomes. Most activities in science classes involve group work. When students work in groups, the experience is meant to be authentic and engaging, and should lead to meaningful learning. Teachers have often seen, however, group interactions that lead to student frustration. Often, poor group dynamics result in poor cooperation and communication. A lack of cooperation and communication will lead to passive compliance, rebellion or a refusal to participate. The purpose for choosing this topic is to research how to create positive group dynamics to improve student engagement. An overlying goal of this research is to develop a systematic approach to with-in class grouping, which promotes and fosters positive social interactions, increased student performance, and high levels of authentic student engagement. The Social Development Theory of learning suggested by Vygotsky will correspond to this review of research. Social Development Theory states that children learn through social interaction (Kearsley, 2008). These types of interactions are key to forming work groups that do, indeed, produce positive learning outcomes.... When some students are performing equally well with other students, a grouping of such students can help to revise the syllabus items for those students. However, there are different grouping styles observed in classes called, ability grouping, tracking etc., depending on the circumstance and need. Ability grouping also called instructional grouping, usually used for reading purposes in elementary schools. Whereas, tracking is usually observed in middle and higher classes to direct them to take particular courses basing on their performance levels in previous classes. Many teachers and scholars believe that grouping leads to 'discrimination and permanent labeling', hence do not observe grouping in teaching-learning process. One study conducted on Japanese teachers notified teacher's expressing that grouping hurts students emotionally, so they prefer having mixed-ability classrooms instead of grouping. Also some argue that grouping not only brings discrimination but also makes the children adopt the unwanted behaviors from other children in grouping, as grouping is a close social context. Though placing students into groups is an instructional technique to maximize the effectiveness of learning and classroom management, it should be done with careful planning and clear purpose. However, Cohen E.G., specifies some conditions that help the class room grouping to be productive and effective for the learning process. The paper observes the review of studies of interaction and while concentrating on the aspects like - interaction and achievement; task and interaction; the helpfulness of helping; interdependence and interaction; and reward interdependence. The author identified the aspects like- structuring the

FINAL EAM HIS. 101 Essay Example | Topics and Well Written Essays - 500 words

FINAL EAM HIS. 101 - Essay Example Because of this, cities and factories were developed. The factories were responsible for the processing of the agricultural products. Growth of factories facilitated the development of commercial centers. It is also during this period that the phenomenon of enlightment was experienced. A number of scholars started emerging during this period. These scholars contributed to the development of research (McKay, 123). It was also during this period that the phenomenon of renaissance was experienced. Renaissance or re-birth contributed significantly towards the growth of commercial centers because it enabled the Europeans to widen their scope of thinking (McKay, 127). The development of the learning institutions such as universities also had a role to play as far as growth of commercial centers is concerned. Through universities, innovation and inventions rose drastically. This facilitated the growth of commercial centers. Increase in population is another factor that contributed to the growth of commercial centers. It is clear that Europe population stated rising significantly during this period. This was due to improved medical care. The rise in population demands of commodities and hence leads to the development of commercial businesses. Technological advancement is another factor that facilitates the growth of commercial centers. This is because the advent of technology facilitated the development of industries which in turn promoted the development of other commercial centers such as banks. In order to achieve this there was a great need of business expansion which in turn led to the rise of commercial centers (Coffin et. al, 259) The rise of these commercial centers in Europe brought several benefits to the population. The first benefit of development of commercial centers is that it leads to improvement of the living standards. This is because the people could get money through selling services or goods the rise of commercial

Student Veteran Essay Example for Free

Student Veteran Essay No matter who you are, where you’re from, what your job, and how old are you, every single person in the universe has the right to persuade the education as they wish. As the war of Iraq ended and budget cutting for military spending, thousands of newly discharged soldiers are thinking about what to do next. Most of the soldiers, Marines, Airmen, and Sailors joined the military before their 21st birthday, and it’s often the only job they’ve ever held. So, most of them are deciding to go back to school for their education. In the article of â€Å"The veterans are coming! The veterans are coming! † by Edward F. Palm, he states that It is good to know that after the soldiers come from war some of the veterans are ready for a post-secondary education. Palm gives advice to teachers and staff from college and universities on how to treat veterans on campuses. Edward Palm uses personal stories and gives some advice that helps veterans feel confident when they go back to school; also, Palm makes readers believe his credibility by employing pathos and ethos appeal combined with friendly and proud tone that creates and affective argument. After reading â€Å"The veterans are coming! The veterans are coming! †, I agreed  that student veteran in the college is feeling very alone on the campus. We should have treated them with respect and normal like any other students, and college and university should have educated students how to treat with Veteran student. Student veteran in the college can be very autistic. When the service member is discharged from the military, they feel the separation and disorientation with the society. It is because they just spent the last several years inextricably tied to military type of social system, whether it was a brigade, battalion, company, platoon, squad, team, or just one on one with a  battle buddy. During those years, solitude was rare. Now, suddenly they’re no longer attached to those systems, and the feeling of vulnerability can be terrifying. The loss of friendships, purpose, identity, structure, and income is enough to push most people to their limits. Now they are in the college society, which is completely different social system that bears no resemblance to military and command free society. Moreover, student veterans are also older and more experienced than their freshman peers, which helps them keep things in perspective and not sweat the small stuff. They can, and  do, manage huge amounts of pain, both physical and mental, without complaint. But consequently, they also bristle at trivial matters called â€Å"crises† by others, and scorn the frequent self-absorption of their peers. They often see most civilian students as not emotionally strong enough to be their friends. So, they usually isolate themselves in school. Additionally, we need to treat student veterans with respect and normal like any other students on the campus. We need to put a lot of patients to communicate with student veteran. I have a personal experience with the student veteran when I took my chemistry class two years  ago. He is one of my classmates in chemistry class. He is a return solider from Afghanistan, when President Obama ended the Afghanistan war in 2008. He lost the ability of hearing in the war. My first impression of him thought that he is only one the disable students on campus. I can feel he is so shy, fear and low self-esteem around the class because I saw him, he is setting at the corner with his deaf interpreter. I thought his low self-esteem is only coming from his disabilities, but I never anticipated that he is one of the return solider. Then, in the first day of the  chemistry laboratory, we need to choose the group to do all the experiment together for the whole semester. Most of the students have their own group with their friends, but I did not any friends because I am a college freshman. So, I formed a group with him and another college freshman. We really have not talked for a few weeks, even we try to discuss about the experiment because he is too shy around other students and also we cannot communicate orally. So, I found the way to communicate with him by writing, and he started comfortable around the group, and we become a good friend. After a few weeks, he told me that he does not want to do the experiment on the creating flame color and told me he has anxiety on the fire because he saw his battle buddy burn alive to dead in the war. Since then, he has been diagnosed with Post- Traumatic Stress Disorder. So, we discussed on his situation with the professor and made him out of the experiment. It make remember what Palm said â€Å"when it comes to what they did in the war, don’t ask; wait for them to decide if and when they want to tell. The experience of combat is largely ineffable. It  cannot be adequately expressed or shared with people who have not experienced it, and most who have are conflicted about it. If they do choose to share, do not judge. † (Palm 793). I did not ask how he loses his hearing even when we are start talking. But I believe it will not be a happy story behind it. So, I did not ask how about it and even when he told his story I choose not to judge or comment on his tragedy event. Therefore, the student veteran can be really scared and unconfident in the campus because they are really emotionally sensitive about their tragedy that happened in the warzone. But if we treat them normally, patiently and connecting them can effectively ease the social isolation, they will feel very comfortable around other students in the campus. Finally, I think the college and university should acknowledge the students how to communicate with student veteran. I think there are a few questions not to ask the student veteran and not to thank to a student veteran for not knowing their services. The question that we should never ask to student veteran are â€Å"These wars were atrocities and a waste of human life,† â€Å"I don’t get why you’re having so much trouble—you volunteered, right? † And worst of all, â€Å"Did you kill anyone? † These comments do more than upset veterans; they wound the hearts of men and women who are already overburdened with sorrow. Most students cannot image about how the warzone look like. They will very curious and will ask the questions that hurtful to a student veteran. For this reason, I think the college and university should acknowledge students to prevent a student from saying something hurtful and explain how these comments might be hurtful. Then, we should not never thank to the veteran. In the article, Palm stated that  Ã¢â‚¬Å"To thank a veteran you don’t know for his or her service is to put that veteran on the spot. It assumes an ideological and political kinship that may or may not exist. I know it makes me uncomfortable. Keep in mind as well that some will doubt your sincerity, wondering if what you’re really saying is, I’m glad you went so that I [or my son or daughter] didn’t have to go. (Palm 793). By say thank you to student veteran will make them think that you, your son or daughter can living safety in the country because they are going to war for you and your son or daughter. It  will make them feel that they are going to die for you. In conclusion, students veteran on campus are usually isolated themselves with the college society. But if we have enough patient and normal treat as other college peers, and teach other students the way to communicate with them, they will blend to the college society. Work Cited Edward F. Palm. â€Å"The Veterans Are Coming! The Veterans Are Coming! † Everything’s an Argument with Reading. 6th Ed. Andrea A. Lunsford, John J. Ruszkiewicz and Keith Walters. Boston, New York Bedford/ St. Marthin’s 2013. 788-794. Print.

Essay --

Virginia Henderson was known as a modern legend of nursing. She was born in Kansas City, Missouri on November 30, 1897. Henderson graduated in 1921 from the Teachers College at Columbia University, for a Bachelor of Science degree, which she completed in 1931. She also earned a Master’s of Science degree in 1934 (Tlou, 2001). She wrote and edited numerous editions of the Principles and Practice of Nursing. Henderson’s main idea of nursing was that the unique function of the nurse is to assist the individual, either if they are sick or well. Nursing Theory Virginia Henderson categorized nursing activities into 14 components, based on our basic human needs. She described the nurse's role, as doing for the patient, helping the patient, working with the patient, and with the objective of helping the patient become as independent as possible. The 14 components started off with breathing normally and to eat and drink effectively. You must eliminate body waste, have good posture and gait, and you must sleep and rest. When dressing a patient you should pick appropriate wear. By checking the patient’s temperature, this would keep it sustained. Henderson believed that keeping the body well cleaned and groomed would make the patient more comfortable and confident. You must avoid injuries and dangerous situations, and communicate with others expressing emotions, needs, fears, or opinions. You must respect one’s ethnicity and belief. A nurse should always feel accomplished and participate with patients in recreational activities. Las t of the 14 components of health was to learn from your mistakes as a nurse and to encourage normal development and health. (Dijkstra et al., 2012). Henderson’s nursing theory had four main concepts; individual, e... ...s theory relates to the future practice of nursing because we are being taught to promote independence, which Henderson had a strong belief in. We are to encourage patients to get better again and provide reassurance. Her theory works well with the future of nursing. She focused on patients basic needs which are one of the most important features of nursing. Us as future nurses should promote independence, provide basic necessities, respect the patient’s ethnicity and beliefs, and lastly to assist the individual even if they are not ill. Conclusion Henderson said to be the patient and supplement their strengths and weaknesses according to their needs. She highlighted the importance of promoting independence for future knowledge to patients. Communication is key when dealing with your patient. Without good communication, the level of care and independence weakens.

Exploring the Issues behind Patient-Assisted Suicide Essay

Death is as much a part of human existence, of human growth and development, like birth. All humans need to undergo all these processes as they journey through life. However, death sets a limit on our time in this world, and life culminates in death. However, when we intervene with some of these natural processes, problems arise because it intrudes in life’s natural processes. This is why, suicide is not just perceived as a medical problem because it also involves legal, ethical, social, personal, and financial considerations. It is not just morally reprehensible for a physician, or any medical practitioner, to assist the patient to conduct this procedure because it negates their responsibility to preserve life, suicide also devalues the life of the patient as its fate is put entirely in the hands of a human being to intrude with the natural process of things. For this reason, the debate over euthanasia (or patient-assisted suicide) involves many professionals, as well as the patients and their families. The arguments now have to do with the dignity of the patients, the quality of their lives, their mental state, and sometimes their usefulness to society. For example, the patient who is in a vegetative state is considered dead by some but not by others, and this case presents substantial ethical and logistical problems. The Oxford Dictionary of English (2005) defines euthanasia as â€Å"the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma†. However, euthanasia means much more than a â€Å"painless death†, or the means of procuring it, or the action of inducing it. The definition specifies only the manner of death, and if this were all that was implied a murderer, careful to drug his victim, could claim that his act was an act of euthanasia. We find this ridiculous because we take it for granted that in euthanasia it is death itself, not just the manner of death. How can someone administer a medical â€Å"procedure† to the one who dies in the end? If a person requests the termination of his or her life, the action is called voluntary euthanasia (and often also assisted suicide). If the person is not mentally competent to make an informed request, the action is called non-voluntary euthanasia. Both forms should be distinguished from involuntary euthanasia, which involves a person capable of making an informed request, but who has not done so. Involuntary euthanasia is universally condemned and plays no role in current moral controversies. A final set of distinctions appeals to the active–passive distinction: passive euthanasia involves letting someone die from a disease or injury, whereas active euthanasia involves taking active steps to end a person’s life. All of these distinctions suffer from borderline cases and various forms of ambiguity. The focus of recent public and philosophical controversy has been over voluntary active euthanasia (VAE), especially physician-assisted suicide. Supporters of VAE argue that there are cases in which relief from suffering supersedes all other consequences and that respect for autonomy obligates society to respect the decisions of those who elect euthanasia. If competent patients have a legal and moral right to refuse treatment that brings about their deaths, there is a similar right to enlist the assistance of physicians or others to help patients cause their deaths by an active means. Usually, supporters of VAE primarily look to circumstances in which (1) a condition has become overwhelmingly burdensome for a patient, (2) pain management for the patient is inadequate, and (3) only a physician seems capable of bringing relief (Dworkin, Frey & Bok, 1998). One well-known incident that VAE came into the headlines was when it was provided by the bizarre activities of Dr.  Jack Kevorkian in early 1990s (or â€Å"Dr Death† as the media have dubbed him) in the USA. Dr. Kevorkian, a retired pathologist, assisted over forty people to commit suicide in recent years in circumstances which were somewhat removed from regular medical practice. These people travelled to Kevorkian from all over the USA to seek his assistance in suicide. He assisted them, sometimes by attaching them, in the back of his rusting Volkswagen van, to his ‘suicide machine’, which injected them with lethal drugs when they activated it. Despite being prosecuted for assisted suicide on several occasions, Kevorkian escaped conviction and continued his personal campaign for relaxation of the law in his peculiar way. It was only when he moved from assistance in suicide to euthanasia that he was finally convicted. He filmed himself administering a lethal injection, and the film helped secure his conviction for murder (Keown 2002, p. 31). Of course, his actions provoked discussion of the thin line separating passive euthanasia, which is legal in this country, and active euthanasia. Opponents of Kevorkian’s actions state that he is practicing assisted suicide, which is illegal. Proponents of Kevorkian’s actions argue that the patient’s right to control his or her medical treatment is sufficient justification for assisted suicide. Euthanasia is Not Ethical According to Somerville (2006), there are two major reasons why people should not allow euthanasia to be legalized. One is based on principle: it is wrong for one human to intentionally kill another (except in justified self-defense, or in the defense of others). The other reason is utilitarian: the harms and risks of legalizing euthanasia, to individuals in general and to society, far outweigh any benefits. While Mak, Elwyn & Finlay (2006) reasoned that â€Å"most studies of euthanasia have been quantitative, focusing primarily on attitudes of healthcare professionals, relatives, and the public†. Pain is usually identified as a major reason for requesting euthanasia; other influences included functional impairment, dependency, burden, social isolation, depression, hopelessness, and issues of control and autonomy. This is why, Mak, Elwyn & Finlay (2006) thought that legalizing euthanasia is a â€Å"premature† move when research evidence from the perspectives of those who desire euthanasia is not yet proven to be necessary. They said â€Å"more qualitative patient based studies are needed to broaden our understanding of patients†. What needs to be done, they deemed, should be the â€Å"inclusion of medical humanities, experiential learning, and reflective practice into medical education should help ensure doctors have better communication skills and attitudes†. By examining ways to improve care at all levels, healthcare professionals can eliminate the side effects of poor end of life care, then euthanasia would not be needed anymore. In 1988, the Journal of the American Medical Association published a statement on its take about patient-assisted suicide when a gynecology resident agreed to conduct assisted suicide to a young woman, dying of cancer, whom he has never seen before. Horrified by her severe distress, and proceeding alone without consultation with anyone, the doctor gives her a lethal injection of morphine. The publishing of this gynecology resident’s letter caused media hype and was featured in the previous issue in JAMA, where it was titled as â€Å"It’s Over Debbie† (1988). This is how the JAMA took its position regarding the matter: 1. ) On his own admission, the resident appears to have committed a felony: premeditated murder. Direct intentional homicide is a felony in all American jurisdictions, for which the plea of merciful motive is no excuse. That the homicide was clearly intentional is confirmed by the resident’s act of unrepentant publication. Law aside, the physician behaved altogether in a scandalously unprofessional and unethical manner. He did not know the patient: he had never seen her before, he did not study her chart, he did not converse with her or her family. He never spoke to her physician. He took as an unambiguous command her only words to him, â€Å"Let’s get this over with†: he did not bother finding out what precisely she meant or whether she meant it wholeheartedly. He did not consider alternative ways of bringing her relief or comfort; instead of comfort, he gave her death. This is no humane and thoughtful physician succumbing with fear and trembling to the pressures and well-considered wishes of a patient well known to him, for whom there was truly no other recourse. This is, by his own account, an impulsive yet cold technician, arrogantly masquerading as a knight of compassion and humanity. (Indeed, so cavalier is the report and so cold-blooded the behavior, it strains our credulity to think that the story is true. ) Law and professional manner both aside, the resident violated one of the first and most hallowed canons of the medical ethic: doctors must not kill. Generations of physicians and commentators on medical ethics have underscored and held fast to the distinction between ceasing useless treatments (or allowing to die) and active, willful taking of life; at least since the Oath of Hippocrates, Western medicine has regarded the killing of patients, even on request, as a profound violation of the deepest meaning of the medical vocation. The Judicial Council of the American Medical Association in 1986, in an opinion regarding treatment of dying patients, affirmed the principle that a physician â€Å"should not intentionally cause death. † Neither legal tolerance nor the best bedside manner can ever make medical killing medically ethical (Baird & Rosenbaum 1989, p. 26). Indeed, the laws of most nations and the codes of medical and research ethics from the Hippocratic Oath to today’s major professional codes strictly prohibit VAE (and all forms of merciful hastened death), even if a patient has a good reason for wanting to die. Although courts have often defended the rights of patients in cases of passive euthanasia, courts have rarely allowed any form of what they judged to be VAE. Those who defend laws and medical traditions opposed to VAE often appeal to either (1) professional-role obligations that prohibit killing or (2) the social consequences that would result from changing these traditions. The first argument is straightforward: killing patients is inconsistent with the roles of nursing, care-giving, and healing. The second argument is more complex and has been at the center of many discussions. This argument is referred to as the wedge argument or the slippery slope argument, and proceeds roughly as follows: although particular acts of active termination of life are sometimes morally justified, the social consequences of sanctioning such practices of killing would run serious risks of abuse and misuse and, on balance, would cause more harm than benefit. The argument is not that these negative consequences will occur immediately, but that they will grow incrementally over time, with an ever-increasing risk of unjustified termination (Dworkin, Frey & Bok, 1998). Refusal of Treatment When a patient refuses treatment, the physician is faced with a great dilemma. Doctors maintain that if the patient does not want treatment, physicians do not have a duty to start it. Once treatment is started, however, physicians have a duty to continue it if discontinuing it would lead to the patient’s death. They are not required to force a patient to go on a respirator if the patient refuses, but once the patient has gone on the respirator, doctors have a duty to keep him on it, even contrary to the patient’s wishes, if taking him off would result in his death. Suffice it here to point out one important limit: a doctor is not ethically bound to assist a refusal of treatment which is suicidal, that is, made not because the treatment is futile or excessively burdensome but in order to hasten death (Keown, 2002, p. 253). Actual suicide has been a felony in England in the past but today, suicide has been decriminalized in most part of the world. Attempting to take one’s own life, however, remains criminal in some jurisdictions. In these as well as in those states where it is not a crime, the state has intervened in some cases to order life-sustaining treatment in the face of objection by a competent adult. The most widely cited case in which this was done is John F. Kennedy Memorial Hospital v. Heston (1971), where a twenty-two-year-old unmarried woman refused a blood transfusion because she was a Jehovah’s Witness. She was forced to have one anyway on the theory that there is no difference between passively submitting to death and actively seeking it. The state regards both as attempts at self-destruction and may prevent them. Since this case, however, the trend of cases has been away from this reasoning and toward subordinating the state’s interest in the prevention of suicide to the rights of patients to forgo or have withdrawn life-sustaining treatment (Berger 1995, p. 20). However, when the patient is terminal and death is imminent, no treatment is medically indicated, and the competent patient’s rightful refusal of treatment does not conflict with the health provider’s form of beneficence. There may be an emotional problem in admitting defeat, but there should be no ethical problem. It should be noted that, although the patient may not be competent at the end, refusal of treatment may be accomplished through a living will or a surrogate, especially through a surrogate who has durable power of attorney for health matters. In the case when the patient is terminal but death is not imminent, for example when the disease or injury progresses slowly, and granted the consent of the patient or surrogate, it appears ethical to omit treatment on the ground that nothing can be accomplished in thwarting the progress of the disease. But it is not ethical to omit care, since human dignity is to be respected. To solve this dilemma, the AMA Council on Ethical and Judicial Affairs (1996) takes a clear stand on the issue: E-2. 20 Even if the patient is not terminally ill or permanently unconscious, it is not unethical to discontinue all means of life-sustaining medical treatment in accordance with a proper substituted judgment or best interests analysis. The treatments include artificially supplied respiration, nutrition, or hydration. In its recent opposition to physician-assisted suicide, the AMA has strongly endorsed a program to educate physicians to the appropriateness of switching from therapeutic treatment to palliative care. The group has gone from a tentative, negative position (â€Å"not unethical†) to a much stronger positive stand (AMA, 1996). On the other hand, we should also consider the reasoning behind the ethical correctness of not beginning or of stopping treatment in the case of the consenting patient who is terminally ill. First, the health care provider has no obligation to prolong dying merely for the sake of prolonging it. That is, it makes no sense to prolong life when the true result is the prolongation of the dying process. Furthermore, when treatment is only prolonging the agony of the patient, its continuation is unethical as an insult to human dignity (Cahill, 1977). In such cases, the health care provider would be ethically justified in discontinuing treatment, except when the patient insists on treatment. Even in this case, however, there can be exceptions. When there is a severe shortage of medical resources, the physician might be justified in stopping nonindicated treatment even over the protests of the patient. We say â€Å"might be justified,† since justification would depend, among other things, on a new social consensus about the duties of health care professionals and on a reasonable certainty that a shortage exists. There are also problems in discontinuing treatment when the patient’s surrogate(s) objects. It should be noted that cessation of life-sustaining treatment does not always bring about a swift and painless death, even though it may speed up the process of dying. For example, if kidney dialysis is discontinued, the person remains conscious and suffers vomiting, internal hemorrhage, and convulsions. The removal of a respirator does not lead to death immediately, and the patient suffers the pain and panic of suffocation. The obligation to care for the patient demands that every ethical effort be made to alleviate these sufferings with drugs and other methods that will not prolong life. Much recent research suggests that physicians are particularly deficient in their willingness and ability to provide adequate pain palliation for dying patients (SUPPORT, 1995). This could be one of the main concerns that drive the interest in physician-assisted suicide. Beyond this, when such pain relief is not possible for the patient, or when the harm is not the pain, but the insult to dignity, there arises the difficult problem of actively cooperating in the suicide of the patient. Religious Issues Several religions have a negative take on any form of suicide. Those who oppose active euthanasia on religious grounds, the basic concern seems to be the view that our lives are not ours but gifts from God. In this view, humans hold their lives as a trust. If this is true, then we are bound to hold not only the lives of others inviolate but also our own, since to take our life is to destroy what belongs to God. For Christians, in Exodus 34:7 and Daniel 13:53, scriptures taken from the Old Testament, the doctrine of the sanctity of life principle is upheld, except in rare instances of self defense. Judeo-Christian precepts generally condemn active euthanasia in any form, but allow some forms of passive euthanasia. The difference is that of omission and commission: While the Judeo-Christian philosophy might tolerate the allowance of death, acts that permit death, it draws the line in regard to acts that cause death. For Buddhists, they perceive it as an involvement of the intentional taking of life. This is why euthanasia is contrary to basic Buddhist ethical teachings because it violates the first of the Five Precepts. It is also contrary to the more general moral principle of ahimsa. This conclusion applies to both the active and passive forms of the practice, even when accompanied by a compassionate motivation with the end of avoiding suffering. The term ‘euthanasia’ has no direct equivalent in canonical Buddhist languages. Euthanasia as an ethical issue is not explicitly discussed in canonical or commentarial sources, and no clear cases of euthanasia are reported. However, there are canonical cases of suicide and attempted suicide which have a bearing on the issue. One concerns the monastic precept against taking life, the third of the four parajika-dharmas, which was introduced by the Buddha when a group of monks became disenchanted with life and began to kill themselves, some dying by their own hand and others with the aid of an intermediary. The Buddha intervened to prevent this, thus apparently introducing a prohibition on voluntary euthanasia. In other situations where monks in great pain contemplated suicide they are encouraged to turn their thoughts away from this and to use their experience as a means to developing insight into the nature of suffering and impermanence (anitya) (Dictionary of Buddhism, 2003). Nonreligious arguments against active euthanasia usually follow a slippery slope or wedge line of reasoning. In some ways the arguments recall the parable of the camel who pleaded with his owner to be allowed to put his nose into the tent to keep it warm against the cold desert night. Once the nose was allowed, other adjustments were requested, and the owner found himself sleeping with his camel. Is there something so persuasive about putting others to death that, if allowed, would become gross and commonplace? The Nazi â€Å"final solution,† which brought about the death of millions of Jews, gypsies, and other eastern Europeans, could be traced to compulsory euthanasia legislation that, at the time of its enactment, included only mental cases, monstrosities, and incurables who were a burden of the state. Using the Nazi experience as a guide, critics of active euthanasia do see some seductiveness to killing that humans do not seem able to handle. Perhaps Sigmund Freud (1925) was right as he wrote: What no human soul desires there is no need to prohibit; it is automatically excluded. The very emphasis of the commandment â€Å"Thou shalt not kill† makes it certain that we spring from an endless ancestry of murderers, with whom the lust for killing was in the blood, as possibly it is to this day with ourselves. The religious take on euthanasia often focus on the sanctity/inviolability of life. In Western thought, the development of the principle has owed much to the Judaeo-Christian tradition. That tradition’s doctrine of the sanctity of life holds that human life is created in the image of God and is, therefore, possessed of an intrinsic dignity which entitles it to protection from unjust attack. With or without this theological underpinning, the doctrine that human life possesses an intrinsic dignity grounds the principle that one must never intentionally kill an innocent human being. The ‘right to life’ is essentially a right not to be intentionally killed (Keown, 2002, p. 40).