Concept and History of the Liberal Feminism

Biography Bill Clinton †The 42nd President

Biography Bill Clinton – The 42nd President Free Online Research Papers Bill Clinton, the 42nd president of the United States, was born William Jefferson the III on August 19, 1946, in Hope, Arkansas. His father died in a traffic accident three months before he was born. When he was four years old, his mother married Roger Clinton. Bill took the Clinton family name at the age of 14. Bill Clinton was a great student and saxophone player, and once thought about becoming a professional musician. In high school, he was a delegate to Boys Nation and met President John Kennedy in the White House Rose Garden. When he met John Kennedy it made him want to pursue a life in public services. Clinton graduated from Georgetown University, and then in 1968, won a Rhodes Scholarship to Oxford University. After earning a law degree from Yale University in 1973, he entered politics in Arkansas. He was defeated in his 1974 campaign for Congress in Arkansas. The next year he married Hillary Rodham, a graduate of Wellesley College and Yale Law School. Clinton was elected Arkansas Attorney General in 1976, and then went on to become governor in 1978. Elected to office at the age of 32, he was the youngest governor in the country. He lost a bid for a second term, but was re-elected four years later. He served as governor of Arkansas until he defeated President George Bush in the 1992 presidential race. His running mate was Tennessee Senator Al Gore, Jr. Clinton became the third youngest president in history, following Theodore Roosevelt and John F. Kennedy. He went on to serve two terms (1993 2001). In 1998, Clinton was impeached because of aligations of sexual indiscretion with a young female White House intern. He was the second U.S. president to be impeached by the House of Representatives. He was tried in the Senate and found not guilty of the charges brought against him. He apologized to the nation and continued to have astounding approval ratings as president, even though many Americans questioned his morals. During Clintons presidency, the nation enjoyed more peace and economic security than at any other time in its history, the lowest unemployment rate in recent history, the lowest inflation in 30 years and the highest home ownership in the nations history. Crime rates also dropped in many cities and unemployment rolls were reduced. During his administration, he proposed the first balanced budget in years and achieved a budget surplus. As part of a plan to celebrate the millennium in 2000, he called for a national initiative to end racial discrimination. Since leaving office, Clinton has been involved in public speaking and humanitarian work. He founded the William J. Clinton Foundation, which promotes international causes, such as treatment and prevention of HIV/AIDS and global warming. In 2004, he released his autobiography, My Life. Clinton currently resides in New York with his wife, Hillary, Who is now running to be the First Women President of the United States of America! They have one daughter, Chelsea, who was born in 1980. Research Papers on Biography Bill Clinton - The 42nd PresidentNever Been Kicked Out of a Place This Nice19 Century Society: A Deeply Divided EraPersonal Experience with Teen PregnancyWhere Wild and West MeetThe Effects of Illegal ImmigrationHip-Hop is ArtPETSTEL analysis of IndiaAssess the importance of Nationalism 1815-1850 EuropeHonest Iagos Truth through DeceptionAnalysis of Ebay Expanding into Asia

Identifying Success Factors Implementing ERP in Small Organisations Dissertation

Identifying Success Factors Implementing ERP in Small Organisations - Dissertation Example Center of discussion in this paper are Enterprise Resource Planning (ERP) systems. They are computer software packages that enable companies to manage all of their operations, such as sales, manufacturing, inventory, accounting, etc. using a single platform. ERP systems officially arrived in the early 1990s, though they evolved over the previous few decades as the separate programs of each functional area began to be integrated into one program. The intent of a single integrated software package was to reduce the direct costs associated with multiple packages (re-entering, reformatting, and reconciling redundant data) while aiding the communication between the functional areas of a business, such as sales and production. The market for ERP systems continues to grow faster than any other software market with significant number of companies worldwide have already implemented an ERP system. The vast scope of an ERP system magnifies the typical "risk-reward" relationship of any business initiative. Davenport described ERP systems as profoundly complex pieces of software that require large investments of money, time and expertise. Correspondingly, he stated that although implementing an ERP system could deliver great rewards for a company, implementation failure could be fatal. In fact, many well- known companies experienced significant challenges implementing their ERP systems. This led researchers to provide insight into what organisations could do to increase their chances of implementation success, resulting in the identification of ERP system implementation Critical Success Factors (CSFs) (Al-Fawaz, Al-Salti, & Eldabi, 2008). Various authors have developed lists of CSF's (Al-Fawaz et al., 2008, AI-Mashari et al., 2003, Stratman and Roth, 2002, Umble et al., 2003). These factors are not specific to any particular ERP software program as they are based on the organisational aspects of the implementation rather than the technical functionality of the program. Exam ples of such factors include strategic visioning/planning, management support, project management, and training. Proficiently addressing these CSFs should increase the chances of a successful implementation (Ehie, 2005; Thomas & Huq, 2007). However, with so many factors involved in an ERP system implementation project, there can be no guarantee of implementation success. ERP systems, like many other technological advances, were initially implemented only at large organisations. Over the years, software vendors began to provide ERP systems specifically targeted for midsize market price tolerance and functionality requirements, leading more and more small organisations to implement ERP systems. Small organisations have been shown to posses significantly different characteristics when compared to large organisations (McAdam, 2002, Ghobadian and Gallear, 1996, Lee and Oakes, 1995). Their organisational structures and culture are relatively informal, their leadership is intimately involv ed in daily operations and typically lack long-term strategic planning. Furthermore, they have limited human and financial resources, and often lack a dedicated full-time Information Technology (IT) person. All of these factors combine into a significantly different organisational environment for an ERP system implementation when compared to large organisations. The existing research on ERP CSFs is heavily based on experiences at large organisations. This is understandable, considering that only a few small organisations had previously implemented ERP systems, which limited the ability to conduct research that is small organisation specific. Thus, more research is needed to identify the CSFs of ERP implementations at small organisations and how they compare to the established list of CSFs that is based on large organisatio

Term paper-ceramics Paper Example | Topics and Well Written Essays - 2000 words

-ceramics - Term Paper Example The input of ceramic materials to automobile technologies ranges over driving performance, fuel efficiency and exhaust gas purification. A number of ceramic parts, such as knock sensors, oxygen sensors, exhaust gas catalysts, and silicon nitride components for automotive engines, have been well utilized to automobiles. Ceramics revolution is not just confined to the automotive industry- producers in aerospace, defense, medical and telecommunication firms are also progressively utilizing ceramic alternatives. The material is fast becoming to be much known for its application in earthenware and pottery and more for the opportunities it creates in the production of goods necessary in our daily lives. This paper will examine the contribution of the ceramics to advances in automotive technologies. It will also try to explore the possible contributions of ceramics in the future such as ceramic gas turbines, adiabatic turbo-compound diesels, electric vehicles and fuel cells due to advances in ceramic technologies. Ceramics is an inert composite containing a metal and a non metal or several non metals. These materials have several properties that identify them. For instance, they are delicate thus easily broken, elastic, quite hard, and need high melting temperatures. They are also electrical, act as thermal insulators and have a high chemical stability. Examples of ceramics include silica (an ingredient used in glass products and contains silicon dioxide), alumina (used in abrasives and contains aluminum oxide) and complex compounds that contain hydrous aluminum silicate used mostly in clay products. Ceramic products are clay in form of bricks, cement used for construction, intractable ceramics that can withstand high temperatures like furnaces used in factories, glass and glass fibers, abrasives, and white ware products. Ceramics are divided in three categories: Traditional ceramics, new ceramics and glass. Ceramics are stronger than metals thus are

Effects of Different Disinfectants

Effects of Different Disinfectants Abstract Introduction: Dentists, dental equipments and dental laboratories are exposed to different types of pathogenic microorganisms. The aim of this study was to investigate the effect of spraying three different types of disinfectant agents: sodium hypochlorite 0.525 %, Epimax and Deconex, on condensational silicon after 5 and 10 minutes. Method and materials: In this in vitro experimental study, 66 circular samples of condensational silicon impression materials of 1cm diameter and 2mm thickness (1.5 mm thickness of puty and 0.5 mm thickness of wash) were contaminated with Staphylococcus aureus ,(ATCC29213) Pseudomonas aeruginosa (ATCC27853) and Candida albicans fungus (PTCC5027). Except for control samples all of them were disinfected with sodium hypochlorite 0.525%, Deconex and Epimax by way of spraying. Afterwards, they were kept in plastic bags filled with humid cotton rolled for 5 and 10 minutes. In order to isolate bacteria the samples were immersed in 2% trypsin for one hour and then the solution was diluted with normal salin in portion of 1,1/2 and 1/4. The trypsin suspensions were transferred to culture plates and the number of colonies was counted after 24 and 48 hours for bacteria and after 72 hours for fungus. All data was analyzed by Mann Whitney test in SPSS software program (=0.05). Results: There was a significant difference between disinfection capability of Epimax and Deconex for all mentioned microorganisms after 5 minutes (P value=0.034). Also the difference was significant between disinfection ability of hypochlorite sodium 0.525% and Epimax for Staphylococcus aureus (P value=0.043) and Pseudomonas aeruginosa (P value=0.046) after 5 minutes. There was a significant difference between disinfection effects of Epimax and Deconex(P value=0.034) and hypochlorite sodium0.525% and Epimax(P value=0.034) for Pseudomonas aeruginosa after 10 minutes. By changing time from 5 minutes to 10 minutes, disinfection efficacy of Epimax and Hypochlorite sodium 0.525% changed dramatically. Deconex was completely efficient in eliminating 100 % of microorganisms in both 5 and 10 minutes. Conclusion: This study revealed that condensational silicon can be effectively disinfected by three types of disinfectant agents by spraying method, although Deconex showed the best results compared to the other agents which indicate that this agent can be selected as a first choice to disinfect condensational silicon impression materials. Key words: Condensational silicone, Disinfection, Impression materials, Introduction: Dentists and dental laboratories are exposed to different types of pathogen microorganisms. The main sources of transition of oral infections from patients to laboratory are impression materials, impression trays and poured stone casts. (1) New studies have shown that, 67% of materials which are sent to dentallaboratories are infected by various microorganisms (2). The most frequently identified microorganisms are Streptococcus species, Staphylococcus species, Escherichia coli species, Actinomyces species, Antitratus species, Pseudomonas species, Enterobacter species, Klebsiella pneumonia and Candida species.(3). therefore, an effort should be made to eliminate most of these microorganisms and reduce the rate of infection transmission to dentistry laboratories. The International Dental Federation consequently have insisted on disinfecting all impressions from patients before sending them to laboratories (4). Also the American Dental Association has advised all dental workers to disinfect all patients’ impression trays (5). In some studies, it has been declared that washing the impression materials with tap water; only removes 40% of bacteria but other studies have reported that it has the capacity to reduce micro organisms up to 90 %( 6). The most common chemical disinfectants used by dentists are Alcohols, Aldehydes, Chlorine combinations, phenols, Biguanides, Iodide combinations and Ammonium (7). Based on the type of chemical disinfectant, there are two common methods to disinfect dental materials: 1) immersion 2) spraying (6). Disinfection by immersing in the chemical materials has been proved to cover all surfaces in one time (8) while spraying is not capable of disinfecting all surfaces effectively and also cannot cover all undercuts, it significantly reduces the amount of distortion that take place in immersing method (6). Silicon impression materials are the first group of polymeric impression materials (9). These materials have the best dimensional stability. Polyvinyl impression materials are the only impression materials which can be disinfected without any dimensional changes (10). Also, different methods such as soaking in glutaraldehyde for 30 minutes have been suggested to disinfect these materials. Use of hypochlorite sodium and phenol combinations with the soaking time less than pouring time have been suggested by Some studies (11). J.Bustos investigated the effect of 0.05 % hypochlorite sodium and glutaraldehyde after 5 and 10 minutes on silicon impression materials. He declared that both of these disinfectants can efficiently prevent the bacterial growth on these impressions materials (12). Ghahremanloo A et al also conducted a research in 2009 and investigated the antimicrobial effect of sodium hypochlorite 0.525 %, Deconex and Sanosil. They concluded that the use of 0.525 % sodium hypochlorite spray on the surface of alginate; effectively disinfects 96.6 % of the samples (13). Since none of the mentioned disinfectant methods and agents have been accepted as a gold standard for disinfecting dental materials, finding an appropriate way seems rational. The aim of this study was to investigate the disinfectant ability of spraying Deconex, Sodium hypochlorite 0.525 % and Epimax on condensational silicon impression material in 5 minutes and 10 minutes. Methods and Materials This randomized experimental and microbiological study was carried out with the cooperation of dental school and microbiology department of the Isfahan University of Medical Sciences, aiming to evaluate the disinfection effect of: Sodium Hypochlorite0.525%, Deconex and Epimax on the condensational silicon impression material. Sampling Methods: In order to prepare samples, the heavy body impression material (putty) was mixed with the catalyst according to manufacturer instructions. The mixture was placed in a syringe with one centimeter diameter so that samples with 1.5 millimeter thickness were gained. Then the light body impression material (Wash) was mixed with the catalyst on a paper pad with a sterile spatula and was placed in the upper 0.5 millimeter of the syringe. Eventually 66 samples, with 2mm thickness and 1 cm diameter, were prepared. In order to ensure that samples were kept sterile during preparation, three samples were selected as negative controls (blank) and were incubated on TSB culture for 24 to 48 hours; after which the bacterial growth was examined. For each bacterial type, 21 samples were used. Sodium hypochlorite0.525% was used to disinfect three of them for five minutes and three others for 10 minutes. Three samples were disinfected with Deconex for five minutes and three others for 10 minutes. And three samples were disinfected with Epimax for five minutes and three others for 10 minutes. At Last, three more samples were used as positive controls to check for any microbial pollution. Preparation of Microbial Solution and Yeast For many types of susceptibility testing, a standard inoculum of bacteria must be used. The standard inoculums were prepared according to 0.5 McFarland (1.5Ãâ€"108cfu/ml) by transferring 1-2 colonies of 18-24 hours cultures to TSB medium and incubated at 35 °c until 0.5 McFarland turbidity of media was gained. For Candida albicans fungus, the sample was taken from 48 hour Saborose and Dextrose Agar cultures. Contamination of Samples To evaluate the disinfection effect of three mentioned substances, samples were separately polluted with microbial suspensions of Staphylococcus aureus (ATCC29213), Pseudomonas aeruginosa (ATCC27853) and Candida albicans fungus (PTCC5027). The impressions were put in sterile test tubes separately with 2 milliliter of microbial suspension in each tube and then all samples incubated at 35 º C for one hour. Disinfection of Samples and microbiological Surveys: After contamination, all samples were rinsed with sterile distilled water for 30 seconds. In order to disinfect all samples, except controls, Sodium Hypochlorite 0.525%, Deconex and Epimax were separately sprayed 10 times on each sample for 15 seconds. Then the samples were put into sterile plastic bags containing sterile cotton, humidified with sterile distilled water to form a moisturized environment for 5 and 10 minutes. Protease Trypsin, which is able to isolate the microbes from contaminated environments, was used. The ideal time and dilution for effective use of Trypsin is 60 minutes and 2% respectively. This time and dilution are based on the maximum microorganisms than can be isolated from the samples. After washing the samples with sterile distilled water for 30 seconds, they were put in Trypsin 2% solution for 60 minutes. Trypsin Suspensions with 1, and dilution were then prepared. Using 100 micro liter samplers, these samples were transferred to Muller Hinton Agar for Pseudomonas aeroginosa and Staphylococcus aureus bacteria and Saborow Dextrose Agar culture was selected for Candida albicans fungus. Using a Pasteur pipet bent with heat at 90 degrees, the samples were spread on cultures. After 24 and 48 hours incubation, the grown bacterial colonies on culture were counted. The grown fungus colonies of Candida albicans on Saborow culture were counted after 72 hours. All results, were analyze d by Mann Witney test in SPSS software program.(ÃŽ ±=0.05) Results: According to the table 1, there is a significant difference between disinfection ability of Deconex and Epimax in 5 minutes (P Value=0.034). This difference is also significant for hypochlorite sodium and Epimax just for pseudomonas aeruginosa (p value=0.046) and staphylococcus Aureus (p value=0.043). In other cases, there is no significant difference in disinfection ability of materials in 5 minutes. (P value>0.05) According to the table 2, significant difference between disinfection capability of hypochlorite sodium – epimax and deconex- epimax was just seen after 10 minutes for pseudomonas aeruginosa. According to the table 3, Deconex completely eradicated all three kinds of microorganisms after 5 and 10 minutes. This is not true for hypochlorite sodium, as this material just eradicated staphylococcus Aureus and pseudomonas aeruginosa after 10 minutes 98.68 % eradication of pseudomonas aeruginosa was seen after 5 minutes. After 5 minutes, epimax could eradicate 95.78 % of pseudomonas aeruginosa. This agent can completely eradicate candida Albicans and Staphylococcus Aureus after 10 minutes. By increasing time from 5 to 10 minutes, disinfection ability of all agents increased, except for Deconex which is 100 % for all microorganisms in both 5 minutes and 10 minutes. When there are large numbers of bacterial colonies, which are not countable, we can count the number of colonies using inverse dilution coefficient. Since real number of colonies was countable in dilution#1, and all results from other dilutions were similar to mentioned results, the results regarding to the number of colonies in other two dilutions were not reported. Discussion: Dentists practicing dentistry, encounter potentially harmful microorganisms. Patients are the most common source of microorganisms (14). Studies indicate that the surface of impressions taken out of the mouth is polluted with bacteria (15-18). As impressions and occlusal records cannot be sterilized by heat, chemical disinfection is still the common practicable method to eradicate microorganisms (19-21). So far there is no global way to disinfect impression materials (22). The American Dental Association (ADA) recommends soaking impression materials in disinfectant solutions for less than 30 minutes (23). Muller Bolla et al found that in European schools of dentistry, the soaking method is applied for 63% and 73% of Alginate impressions and silicon impressions respectively. The approximate time of disinfection was 10.3 ±6.3 minutes (20). But Hiroshi Egusa and colleagues in 2008 showed that impressions from patients mouths contain hazardous microorganisms like Streptocci, Staphylococcus aureus, Methicillin resistant Staphyloccocus, , Candida, Pseudomonas aeruginosa with rate of 100%, 55.6% 25,9%,5.6 % and 5.6 % respectively(22). These are opportunist pathogens that spread and transfer through the oral cavity (22). Candida causes common opportunist infections known as oral candidiasis, found in patients with immune deficiency (23). Pseudomonas aeruginosa is a deadly infectious agent that exists epidemically in hospital appliances and instruments (22) However, studies show that among population the spreading rate of S. pyogenes, S. pneumonia and S. aureus to pharynx is 10%, 20 to 32% and 30% respectively (14). This is the reason that in this survey, Staphylococcus aureus, Candida albicans and Pseudomonas aeruginosa were selected to investigate the disinfection capability of disinfectant agents. By the year 1991, washing the impression materials with running water was the common way to remove microorganisms (22). This method can reduce about 90% of bacteria. (24) Running water can wash up saliva, blood and debris. But recent studies indicate that such methods cannot eliminate microorganisms from impression materials completely. Therefore washing the impression materials with running water, without disinfectants is not rational (22). In this survey three common disinfectant agents were used. One of them is Hypochlorite sodium 0.525 %. which is used in housework too. This disinfectant can efficiently prevent microorganisms growth and disinfect the impression materials. In a study by J.Bustos (12), it was shown that immersing silicon impressions in 0.5% hypochlorite sodium after 5 and 10 minutes dramatically prevent the bacterial growth in compare to the control group. Although in the recent study spraying method was used, results of the recent study are consistent with the mentioned study. On the other hand Westerholm, Reuggeberg and colleagues also showed that spraying Sodium hypochlorite can effectively disinfect the impression materials (25-26). The Westerholm and et al study showed that Sodium hypochlorite can almost completely (99.99%) prevent the growth of S. aureus and this rate is about 99.60 % after 5 minutes and 100 % after 10 minutes for s.aureus in the present study. In another study by Ghahramanloo et al, spraying Sodium Hypochlorite 0.525 % could disinfect samples effectively (96.6%) after 10 minutes which is a good indicator of high capability of this agent (13). In studies by Westerholm, Rueggeberg and Ghahramanloo disinfection effect of these agents were assessed on irreversible hydrochloride (Alginate), but in this survey this effect has been assessed on condensational silicon. The results showed that there is no difference in disinfection capability of hypochlorite sodium regardless of impression material and this is a good proof for high penetration of this agent into impression materials porosities. Decnex is an alcoholic based disinfectant agent, which in this study could effectively disinfect impression materials after 5 and 10 minutes (100 %). But in Ghahremanloo A et al study, this agent could eradicate 70.4 % of microorganisms (13). Maybe the main reason for this difference is that Ghahramanloo A used irreversible hydrochloride, which has more porosities and cause deep penetration of microorganism into this impression material and can define the lesser capability of disinfectant agent in eradicating microorganisms. The specific feature about this agent is that there is no difference in disinfection ability of Deconex after 5 minutes and 10 minutes. In the present study, for the first time the antimicrobial effect of Epimax on impression materials was investigated. This agent could not effectively eradicate microorganism after 5 minutes in compare to two other agents, but after 10 minutes it completely (100 %) eradicated candida albicans and staphylococos aureos but this rate was 97.89 for Pseudomonas aeroginosa which shows the importance of using this agent for longer duration. However, it should be mentioned that the results of the present study are not completely consistent with the results of other studies, due to different impression materials brands and usage time. One of the shortcomings of the present study is that it is an in-vitro experimental study which is different from clinical and in-vivo situations. Usually impression materials remain 3 to 5 minutes in patients mouth, while in our study it took 60 minutes to attach all the bacterial types to the samples as 60 minutes is an effective time for bacterial adherence. Also pressure while taking an impression and saliva can alter bacterial adherence capacity. This study investigated the effect of three common disinfectant agents on two types of bacteria and one fungus. As so many dentists are concerned about viruses such as HIV and HBV, further studies should be conducted to find an effective way to eradicate these kinds of pathogens. Conclusion: It can be concluded that sodium hypochlorite, Deconex and Epimax can effectively disinfect condensational silicon. This capability is higher for Deconex and it is recommended that Deconex can be the first choice to disinfect condensational silicon impression materials. Acknowledgement: We would like to express our sincere acknowledgement in the support and help of microbiology department of Isfahan medical university and research department of dentistry faculty of Isfahan University of medical science.

Essay --

Gender Differences and the Brain Brandon Moore LTCY 199 November 21, 2013 As we all know the brain is one of the most amazing mysteries in the world; there is a lot to be discovered. This topic hits home for me because most of my life I have always wanted to know how is the brain any different between men and women. From the very beginning of life boys and girls are already different. The common topic of discussion is which gender’s brain matures faster. People often hear that girls mature much faster than boys. In fact this is not true; the genders don’t really play a part in the maturation process, because it is all about what you are exposed to in life. Although research has shown girls to have way more verbal skills through the preschool stages, but it then declines drastically around age seven . Girls have also been proven to do better than boys in reading and writing all the way through high school. Most of these studies were done in co-ed schools. Studies have shown that single gender schools are more helpful for both genders. The statistics were basically the same from these types of schools. I do think your brain matures faster based of the things you are exposed to. When these say research was done globally, the statistics varied, some siding with girls and some in favor with boys. So this proves, that there is a real gender difference, but there is not a proven gender maturation rate in the brain. Self-esteem is another big gender difference. It ties in with topics like emotions, coping, depression, and behavior. All through adolescence boys have been shown to have a greater self-esteem than girls. This means guys are less likely to become depressed over something. Research done by Reiko Miyamoto and Yoshiaki Kiku... ..., Szatkowskal, l., & Baron, J. (2012). Sex, Lies and fMRI Gender Differences in Neural Basis of Deception. Plos ONE, 7(8), 1-11. doi:10.1371/journal.pone.0043076 Farace, E., & Alves, W. M. (2000). Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome. Journal of Neurosurgery, 93(4), 539-545. Xu, J., Kobayashi, S., Yamaguchi, S., Iijima, K. I., Okada, K., & Yamashita, K. (2000). Gender effects on age-related changes in brain structure. American Journal of Neuroradiology, 21(1), 112-118. Schulte-RÃ ¼ther, M., Markowitsch, H. J., Shah, N. J., Fink, G. R., & Piefke, M. (2008). Gender differences in brain networks supporting empathy. Neuroimage, 42(1), 393-403. Eccles, J. S., & Harold, R. D. (1991). Gender differences in sport involvement: Applying the Eccles' expectancy-value model. Journal of applied sport psychology, 3(1), 7-35.

Analysis of an Ethical Dilemma Essay

There are times when life takes an unforeseen route, and one is faced with an obstacle or situation that was not expected. Many people are diagnosed with terminal diseases, have accidents and are left with severe impairments, and suffer horrendous complications from medical issues. One has the right, according to law, to make medical decisions about their care and treatment options. But should one have the right to end their life? Assisted, or voluntary euthanasia, is the direct administration of a lethal agent to end one’s life at the request of the patient (Tamayo-Velazquez, Simon-Lorda, & Cruz-Piqueras, 2012, p. 678). Should a person have to intolerably suffer for the duration of their disease or disability, or should they have the right to choose to end their life? Related Ethical Implications and Obligations Voluntary euthanasia naturally sparks the debate between â€Å"morality and legality† (Young, 2010). Ethical implications come with being faced with if assisted euthanasia is morally justified, or if respecting one’s right to make choices about their life, including end of life decisions, supersedes all other aspects of the subject. Nurses are an integral part in end of life care of patients, and often times are witness to those expressing the desire to die. Ethical dilemmas are currently high regarding end of life care in nursing, and would only grow more complicated and severe if assisted euthanasia became legal worldwide, as nurses would not only provide comfort measures, but rather be a part of ending life. Currently, assisted euthanasia is legal in three countries; the Netherlands, Belgium, and Luxembourg. Euthanasia is considered murder in every other place in the world. (â€Å"Assisted Suicide & Death with Dignity,† 2013). In the United States, there are currently three states, Oregon, Montana, and Washington, where Physician Assisted Suicide, or PAS, is legal. PAS is referred to as the â€Å"Death with Dignity Act â€Å"and permits doctors to prescribe a lethal  overdose to a patient who is expected to die within six months. This decision is totally dependent upon patient wishes, and physicians are not obligated to inform families, only to write the prescription (â€Å"Analysis of Assisted Suicide Initiative,† 2013). In any other state, assisted suicide is considered manslaughter and is punishable by law. Assisted euthanasia remains a hot topic worldwide, and aims to pass laws are constantly challenged. Ethical Theories Ethical decisions are always difficult for the nurse to make in a challenging situation Confidentiality and privacy are part of ethical issues but can raise confusion as to the best direction of an action for a nurse to take. There is a need for nurses to know that patient obligations and laws concerning privacy and confidentiality matters. Healthcare has the HIPAA law that guides patient’s privacy (HIPAA. ORG, 2008) which is essential for nurses to understand the pertinent guidelines or rules on confidentiality so as to carry out their practices based on the law guidelines. The code of ethics states, â€Å"The nurse advocates for, promotes and strives towards safety, health and the patients’ rights (ANA, 2010). (ANA, 2010) stated that Deontology theory is helpful for the nurse to judges the morality of an action based on the action’s adherence to rules. Whether an action is ethical depends on the intentions behind the decisions rather than the outcomes that result. Beneficence represents compassion on the other hand, taking positive action to help others and desire to do good which is the core principle of our patient advocacy. (Butts, J. B., & Rich, K. L, 2008). Autonomy theory hel p nurses respect and honor a patients or clients right to make a course of action and support independent decision making. While the right to autonomy is not to hurt or negatively impact an outcome, it often gives the nurse a sense of freedom to choose a moral decision. Voluntary assisted euthanasia may be justified with the Beneficence theory but ethically wrong for the nurse in assisting. Impact of social valves, morals, and norms The Terry Schiavo case was perhaps the highest profile case to ever address the issue of prolonging one’s life when that person suffers a life-altering medical tragedy. With her husband fighting on one side for the right to not prolong her life and multiple parties, including her other family members, fighting for the right to prolong her life, this case took national media and even the courts by  storm. The case brought to light what has been called the â€Å"right-to-die† question. Because she lacked a living will, the courts were left to determine what her finals wishes would have been in a situation like this. Legally speaking, the court in Florida found that people have the right to refuse medical treatment, and that right extends to them even when they are in a vegetative state. This case was complicated because there was no clear consensus on whether Schiavo would have liked to exercise that right. Ultimately, her husband was able to convince the court of this, and his persuasiveness came largely because he was the closest person to her and was thus in the best position to understand her wishes. The case brought about complicated ethical issues, especially for the medical professionals involved. Nurses and doctors are under an oath to preserve life whenever possible, but they must also respect the wishes of patients. Because the decision involved removing a feeding tube rather than taking any direct action to harm the patient, medical professionals were able to comply with court orders without violating their oath. It is also worth noting that this case was complicated by social and political issues. Pro-life groups advocated on behalf of Schiavo’s family, and President George W. Bush even tried to intervene. Some argue that these things were designed to make a political point. Implementing an ethical theory Implementing an ethical theory or principle to address an ethical dilemma should involve identifying the type of ethical problem. Doing this lays the groundwork for the trajectory in the caring response. From here, an ethical theory can be implemented and methodically followed to conclude with the best caring response. In the case of Terry Schiavo, there were ambiguities of who should make the decisions. With this, a locus of authority was established to this ethical problem and ultimately, the Supreme Court would act as the moral agent. With the trajectory set, the Supreme Court was now going to be held responsible for the caring response outcome. Furthermore, the Courts would likely have to rely on a narrative approach to ethical decision making. Purtilo and Doherty  (2011) define the narrative approach as information told through stories that, as a result, affect the human experience. With the barrage of coming from the Schiavo case, the Supreme Court must be sure to gather all the relevant details in order to establish facts, relationships and values. Consequently, this is the first step in many ethical theories as well as Purtilo and Doherty’s (2011, p. 103) six steps to ethical decision making. The determination of an ethical decision in deeply rooted in personal and societal values. The ethical theory provides the framework, but it is the value-laden details that guide the decision (Aulisio & Arnold, 2008). With this said an accurate prediction with regard to cases such as Terry Schiavo would be the immediate intervention of ethics committees to mitigate lengthy legal processes and preserving a caring response. Conclusion In this case all of the moral and social valves that were implicated involved nursing ethics. Nurses play an important role in caring for patients that are at the end of life. Nurses must understand the issues that involve assisted euthanasia because of the legal and ethical implications that are involved. Nurses must have adequate knowledge and understanding of assisted death to prevent themselves from violating their personal and professional ethics. References Analysis of Washington Assisted Suicide Initiative {I-1000}. (2013). Retrieved from www.patientsrightcouncil.org/site/analysis-washington-state/ Assisted Suicide & Death with Dignity: Past, Present & Future – Part III. (2013). Retrieved from http://www.patientsrightcouncil.org/site/rpt2005-part3/ Aulisio, M. & Arnold, M. (2008). Role of the Ethics Committee: Helping To Address Value Conflicts or Uncertainties. Retrieved from http://journal.publications.chestnet.org/article.aspx?articleid=1086034 Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed., pp. 38- 39).New York, NY: Oxford University Press. Butts, J. B., & Rich, K. L. (2008). Nursing ethics across the curriculum and into practice (2nd ed., pp. 21-22). Sunbury, MA: Jones and Bartlett. Purtilo, Doherty. (2011). Ethical Dimensions in the Health Professions (5th ed). W.B. Saunders Company. Retrieved from http://pageburstls.elsevier.com/books/978-1-4377-0896-7/id/B9781437708967000138_p0300 Tamayo-Velazquez, M., Simon-Lorda, P., & Cruz-Piqueras, M. (2012). Euthanasia and physician assisted suicide: Knowledge, attitudes and experiences of nurses in Andalusia {Spain}. Nursing Ethics, 19{5}, 677-691. http://dx.doi.org/10.1177/0969733011436203 Young, R. (2010). Voluntary Euthanasia. Retrieved from http://plato.standford.edu/entries/euthanasia-voluntary/