Ethical Issues of Sexually Transmitted Infections (STIs)

Ethical Issues of Sexually Transmitted Infections (STIs) Identify a specific situation, from your own experience in practice, where an ethical issue arose. With regard to confidentiality, outline the situation and explore the issues involved. Using appropriate ethical theory/principles, analyse the situation and the action taken to resolve the problem. In this essay we shall consider the case of Mrs.P., a 39 yr. old married mother of three who attended at a gynaecology clinic with menorrhagia. She was investigated and was found to have, amongst other things, a chlamydial infection. She was horrified. On questioning, she was initially incensed and stated that the path lab must have made a mistake and that such a thing â€Å"simply was not possible†, she denied any knowledge of how such an infection could have been contracted and asked the staff if it meant that her husband had been unfaithful. It was about half an hour after the news had been broken and the rest of her problems had been dealt with, that the staff moved onto the delicate matter of contact tracing. It was only then that Mrs.P. eventually confided that she had had a number of clandestine relationships without her husband knowing. One of these relationships was with her husband’s best friend from his work (Mr. H). She was adamant that neither he nor her husband should be told, as she could not face the consequences from the inevitable fall out. The clinic staff were also told that Mr and Mrs H were desperate to have a baby and that Mrs H was about to consider going for referral for infertility investigations. There are many ethical issues in this small clinical encounter and they represent, as a generalisation, issues that are typical of many ethical difficulties that present to healthcare professionals in the UK on a daily basis. The subject of medical ethics has evolved over a huge length of time and is, in part, dependent on the circumstances and environment in which it is applied. (Veitch RM 2002). In this essay we shall consider these ethical difficulties as they pertain to Mrs.P., but before we consider them in detail, let us consider the overriding ethical principles that should guide the actions of those concerned. We can start with a historical note. If we consider Hippocrates’ often quoted dictum â€Å"first do no harm†, (Carrick P 2000), we will see that it underpins the first guiding principle of ethics, that of Non-Maleficence. This means â€Å"no malice†. It places an implied burden on any healthcare professional to not only avoid doing harm to a patient, but also to take active steps to make sure that harm does not occur through accident or negligence. The Principle of Beneficence takes the argument further with an expectation of doing good or â€Å"goodness† as a quality. As we have suggested earlier, this quality is variable and is judged in the circumstances in which it occurs. This is particularly relevant in questions relating to consent which again, is central to the case of Mrs.P. (McMillian J 2005) The third principle of ethics that is relevant to our considerations here is the Principle of Dentology which places an expectation on the healthcare professional to act in a way that means that decisions are made in the patient’s best interests and are not in any way influenced by other considerations such as cost or expediency. (Tà ¤nnsjà ¶ T 2005) There is then the consideration of autonomy. In the case of Mrs.P. this effectively means that she is allowed to make her own decisions based on her own free will and is not forced (either figuratively or expressly) into a situation where she feels pressurised into decisions against her will. She should be allowed to consider what is right for her, in her current circumstances, without feeling that she is being coerced by any form of outside influence.(Mill JS 1982) It clearly follows from this statement that Mrs.P. can only make such a decision if she is in full possession of all of the relevant facts relating to her circumstance and this then opens up another field of debate, one relating to the role of the healthcare professional as an information resource. It is incumbent on the healthcare professionals advising Mrs.P. that they would ensure that she has available to her (in a form that she can understand) all of the information necessary to allow her to make up her own mind on the issues presenting themselves. (Sugarman J Sulmasy 2001) Chlamydia In order to appreciate the full implication of the decisions and dilemmas facing Mrs.P., we should firstly consider the issues of the pathophysiology of chlamydia. It is commonly accepted that a large proportion of what was previously called NSU or even undiagnosed genital discharge, was probably infection due to chlamydia. It currently ranks as being responsible for numerically the greatest number of sexually transmitted diseases in the UK in the present day. (Duncan 1998) The actual incidence of detected chlamydia varies between different sociological groups and is dependent on the study. Adams (et al 2004) produced a huge meta analysis of UK data and suggested that the incidence varies from 8.1% of the under 20 age group to 1.4% of the over 30 group Equally it can be seen that other studies, (Piementa et al 2003), put the incidence in the under 20 group as high as 17% and in antenatal clinics (whole population) at 12%. There is no merit in debating the statistical validity of these figures, they are presented to underline the point that Mrs.P.’s dilemma is not a rare one. If we take an overview of the whole chlamydia issue we can cite the opinion of National Institute for Clinical Excellence (NICE) who quote that, in their rationale for a national screening programme, chlamydia: Is the commonest Sexually Transmitted Infection (STI) in England Is an important reproductive health problem ~ 10-30% of infected women develop pelvic inflammatory disease (PID). In a significant proportion of cases, particularly amongst women, are asymptomatic and so, are liable to remain undetected, putting women at risk of developing PID. Screening may reduce incidence of PID and ectopic pregnancy. These points are presented as underlining the argument that we will make later in this essay, that a diagnosis of chlamydial infection – although commonly asymptomatic (especially in men), is actually far from trivial and therefore should not be taken lightly or dismissively. Discussion With specific reference to Mrs.P. we should note that there are two important factors that should influence our discussions here. One is the relevance to Mr H. and his wife and the possible implications to their apparent infertility, and the second is effectively the contact tracing arguments and the degree that the healthcare professional should be involved in making Mr H. aware of the possibility that he may have the chlamydial infection. Let us begin by considering an excellent and informative paper by Cassell (et al 2003) on the issue of partner notification. The authors are of the opinion that, due to factors such as the explosion in the numbers and the evolution of the Health Service, that the thorny issue of partner notification, which had previously largely fallen into the domain of the GUM clinic nurse, had now evolved to involve General Practice staff, obstetric and gynaecology clinic staff as well as many others. The corollary of this is that this role has lost some of its efficiency in skill resources and time. (D of H 2002). The paper itself is very informative, but if we restrict ourselves to a consideration of those aspects which are directly referable to our considerations here. With regard to the issue of patient confidentiality and contact informing, only 40% of the healthcare professionals questioned thought that partner notification was actually their role. The remaining 60% took the view that it was their role to inform the patient of what they saw was their responsibility to inform their own partners. The reason that we make this point is that over at least the last two decades, there has been a noticeable and welcome shift to the general acceptance of evidence based medicine (Berwick D 2005). The point is therefore made that if this evidence is accepted, then we could assume that the majority of healthcare professionals believe that their responsibility to inform the patient’s partner ends with their discussion of the matter with the patient. This is relevant if one considers the Bolam principal which has been the foundation of the legal view of matters of medical negligence. The Bolam test, when applied to this type of situation states that: A healthcare professional is not negligent if he or she acts in accordance with practice accepted at the time by a responsible body of medical opinion. In other words, if one acts in accordance with the rules that govern normal medical and nursing practice. In these circumstances it would appear that the majority medical opinion is that one’s burden of responsibility is limited to telling the patient that they should tell their own sexual partners of their infection. To a degree, this view is at odds with other ethical considerations, as one might consider that one has an obligation both to Mrs.P.’s husband who may clearly be at risk from chlamydial infection and complications, and also Mr. H and his partner, who may even already be suffering from complications, as they are considering being investigated for infertility. In these eventualities one has to consider if one is breaching any or all of the three principles that we have already outlined above. On the face of it, it would appear that all three principles are being compromised by this course of action. Non-maleficence because of the implied failure to take active steps to protect Mrs.P.’s partners from potential harm. Beneficence because of Mrs.P.’s failure to agree to consent to anyone telling her partners on her behalf Dentology becaues it could be argued that a suggestion that the healthcare professional should tell Mrs.P.‘s partners means that decisions are being made on the grounds of expediency rather than necessarily in Mrs.P.’s best interest (as Mrs.P. sees it). The only principle that appears to be upheld with this particular view is that of Mrs.P.’s autonomy. We can explore this issue further. Mrs.P.’s refusal to inform her partners may be, at first sight, understandable. But there are other issues that we must consider before passing moral judgement on her. If we consider a paper by Duncan (Duncan B et al 1998). This provides a very informative insight into the issues that confront women in this situation and she cites a common finding of equating a perception of â€Å"being dirty† or promiscuity with a positive test. There is also the issue of both men and women feeling embarrassed to get tested, although, with the advent of General Practice based testing and testing away from the stigma of the GUM clinics, this may well be less of a problem. It also follows from this study finding that there is a major Public Health Education paradox here. If it is true that the majority of healthcare professionals actually believe that it is the responsibility of the patient to tell their partner and this fact is augmented by the discovery that another study found that nearly 20% of respondents actually chose to treat chlamydia with a dose of antibiotic which is less than the currently recommended therapeutic level recommended by the Central Audit Group for Genitourinary Medicine, (Stokes et al 1997), it is perhaps not a surprising observation that the level of chlamydial infection is apparently as high in the community as it is. It follows from this that the authors of another study in a similar area can make the comment: If testing in primary care continues to increase without adequate support for partner notification, much of the resource used in testing women will be wasted. (Griffiths et al 2002) To provide a balanced view on the subject we should observe that the converse of our argument so far is put by other workers in the field (EHC 1999), who argue for the enhancement of the contact tracing facilitators and facilities in order to â€Å"properly maximise a reduction in the risk of both personal re-infection and the level of infection in the community† The central importance of this argument is exemplified in an excellent paper by Patel (HC et al 2004). This looked at the reliability of contact tracing mechanisms. The paper itself is both long and involved. It followed up over 250 patients over a five year period. in short, the authors reported that if the infected patient had a regular partner, they were likely to turn up for treatment in about 53% of cases, whereas if there was an extramarital partner only about 13% would receive treatment. The implication is clearly (although it is obviously admitted that there are significant confounding factors), that an infected patient is far more likely to tell their marriage partner than an extramarital sexual partner. Conclusions and suggestions for practice. In order to help with such considerations we note that the main professional bodies issue their own comprehensive guidelines. They are issued jointly by both the BMA and RCN for all healthcare professionals(Dimond. B. 1999). The documents themselves are unsurprisingly enormous, and offer outline guidance on virtually every major issue and they follow the principles that we have already set out. They equally make the point that not every eventuality can either be predicted or catered for, and in these circumstances the healthcare professional is left to make their own judgement based on their interpretation of the underlying principles and circumstances. In our interpretation of these principles, it would appear that the overriding consideration in the case of Mrs.P. is that of autonomy. There may well be a substantial evidence base that we could point to which would suggest that Mrs.P.’s refusal to tell either her husband or sexual partner could have serious and possibly long lasting adverse effects on their health. But in the last analysis, Mrs.P. has the right of consent to her personal details being divulged – either explicitly or by inference and implication – to any other person. If that consent or permission is withheld then the healthcare professional would be expected to respect that right, even if they had personal difficulty with it themselves. There is an implicit obligation on healthcare professional not only to enhance the patient’s autonomy but also to take as many steps as possible to ensure that any decision reached by the patient is truly autonomous. The professional guidelines suggest that one of the best ways of doing this is primarily by the giving of as much information as possible, particularly that information which is judged to be of importance in assisting them in making their decisions (Williamson C 2005) This view seems to be echoed by the legal profession who have pointed to the fact ( in case law) that each adult has a right to their own autonomy. (Donaldson L 1993). The guiding pronouncement in this type of issue is that a legally competent adult has the right to agree or to disagree with any form of treatment or opinion offered by a healthcare professional and does not have to justify the reason for their action to anyone else. It is clearly incumbent on the healthcare professional to try to provide the Public Health information to help the patient make an informed and considered decision. It may even be considered acceptable to suggest or persuade the patient to â€Å"do the honourable thing†, but this clearly must not be interpreted as placing undue pressure on the patient otherwise all of the underlying ethical principles discussed so far will be completely undermined (Hendrick, J. 2000). We should also note that the same professional guidelines cited above also make the suggestion that the nature of the conversation and the topics discussed should be clearly recorded in the patient’s notes and if a decision is made to allow healthcare professionals to contact the other potential partners, then a consent form recording the decision should ideally be signed by the patient. In many instances we acknowledge that it is common practice to advise and take whatever action is perceived to be in the best interests of the patient, but in terms of our ever more litigious society, it appears to be good advice to get written consent for virtually every action however seemingly minor. (Yura H et al 1998), If we had to sum up the thrust of this essay in a sentence it would be that there is no excuse – either ethically, or for that matter in law – for making unfounded assumptions about what the patient wants or will permit. (Gillon. R. 1997). References Adams EJ , A Charlett, W J Edmunds, and G Hughes 2004 Chlamydia trachomatis in the United Kingdom: a systematic review and analysis of prevalence studies Sex. Transm. Inf., October 1, 2004; 80(5): 354 362. Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005; 14: 315 316. Carrick P 2000  Medical Ethics in the Ancient World  Georgetown University press 2000 ISBN: 0878408495 Cassell JA , M G Brook, R Slack, N James, A Hayward, and A M Johnson 2003 Partner notification in primary care Sex. Transm. Inf., June 1, 2003; 79(3): 264 265. Dimond. B. 2001  Legal Aspects of Consent  Salisbury.: Quay Books 2001 D of H 2002  Department of Health. The national strategy for sexual health and HIV: implementation action plan. London: DoH, 2002. Donaldson L 1993  in Re T (Adult: Refusal of Treatment) [1993) Fam 95 5 Duncan B, Hart G. 1998  Screening for Chlamydia trachomatis: a qualitative study of womens views. Prevenir 1998; (suppl 24): 229. EHC 1999  Effective Health Care. Getting evidence into practice.  York: University of York, 1999. Gillon. R. 1997.  Autonomy  London: Blackwell 1997 Griffiths C, Cuddigan A. 2002  Clinical management of chlamydia in general practice: A survey of reported practice. J Fam Plann Reprod Health Care 2002;28:149–52. Hendrick, J. (2000)  Law and Ethics in Nursing and Health Care,  London. Stanley Thornes 2000 McMillan J 2005 Doing whats best and best interests BMJ, May 2005; 330: 1069 ; Mill JS 1982  On Liberty, 1982,  Harmondsworth: Penguin, p 68. Patel HC, Viswalingham ND, Goh BT 2004 Chlamydial ocular infection: efficacy of partner notification by patient referral. Int. J. STD AIDS 2004 Jul-Aug;5(4):244-7. Stokes T, Bhaduri S, Schober P, et al. 1997  GPs’ management of genital chlamydia: a survey of reported practice.  Fam Pract 1997;14:455–60 Sugarman J Sulmasy 2001  Methods in Medical Ethics  Georgetown Univeristy Press 2001 ISBN: 0878408738 Tà ¤nnsjà ¶ T 2005 Moral dimensions BMJ, Sep 2005; 331: 689 691 ; Veitch RM 2002  Cross-cultural perspectives in medical ethics Jones Bartlett 2002 ISBN: 0763713325   Williamson C 2005 Withholding policies from patients restricts their autonomy BMJ, Nov 2005; 331: 1078 1080 ; Yura H, Walsh M. 1998  The nursing process. Assessing, planning, implementing, evaluating. 5th edition. Norwalk, CT: Appleton Lange, 1998. ############################################################# 20.2.06 PDG Word count 3,184

Digital Fortress Chapter 118-122

Chapter 118 â€Å"It's proof,† Fontaine said decidedly. â€Å"Tankado dumped the ring. He wanted it as far from himself as possible-so we'd never find it.† â€Å"But, Director,† Susan argued, â€Å"it doesn't make sense. If Tankado was unaware he'd been murdered, why would he give away the kill code?† â€Å"I agree,† Jabba said. â€Å"The kid's a rebel, but he's a rebel with a conscience. Getting us to admit to TRANSLTR is one thing; revealing our classified databank is another.† Fontaine stared, disbelieving. â€Å"You think Tankado wanted to stop this worm? You think his dying thoughts were for the poor NSA?† â€Å"Tunnel-block corroding!† a technician yelled. â€Å"Full vulnerability in fifteen minutes, maximum!† â€Å"I'll tell you what,† the director declared, taking control. â€Å"In fifteen minutes, every Third World country on the planet will learn how to build an intercontinental ballistic missile. If someone in this room thinks he's got a better candidate for a kill code than this ring, I'm all ears.† The director waited. No one spoke. He returned his gaze to Jabba and locked eyes. â€Å"Tankado dumped that ring for a reason, Jabba. Whether he was trying to bury it, or whether he thought the fat guy would run to a pay phone and call us with the information, I really don't care. But I've made the decision. We're entering that quote. Now.† Jabba took a long breath. He knew Fontaine was right-there was no better option. They were running out of time. Jabba sat. â€Å"Okay†¦ let's do it.† He pulled himself to the keyboard. â€Å"Mr. Becker? The inscription, please. Nice and easy.† David Becker read the inscription, and Jabba typed. When they were done, they double-checked the spelling and omitted all the spaces. On the center panel of the view wall, near the top, were the letters: QUISCUSTODIETIPSOSCUSTODES â€Å"I don't like it,† Susan muttered softly. â€Å"It's not clean.† Jabba hesitated, hovering over the ENTER key. â€Å"Do it,† Fontaine commanded. Jabba hit the key. Seconds later the whole room knew it was a mistake. Chapter 119 â€Å"It's accelerating!† Soshi yelled from the back of the room. â€Å"It's the wrong code!† Everyone stood in silent horror. On the screen before them was the error message: ILLEGAL ENTRY. NUMERIC FIELD ONLY. â€Å"Damn it!† Jabba screamed. â€Å"Numeric only! We're looking for a goddamn number! We're fucked! This ring is shit!† â€Å"Worm's at double speed!† Soshi shouted. â€Å"Penalty round!† On the center screen, right beneath the error message, the VR painted a terrifying image. As the third firewall gave way, the half-dozen or so black lines representing marauding hackers surged forward, advancing relentlessly toward the core. With each passing moment, a new line appeared. Then another. â€Å"They're swarming!† Soshi yelled. â€Å"Confirming overseas tie-ins!† cried another technician. â€Å"Word's out!† Susan averted her gaze from the image of the collapsing firewalls and turned to the side screen. The footage of Ensei Tankado's kill was on endless loop. It was the same every time-Tankado clutching his chest, falling, and with a look of desperate panic, forcing his ring on a group of unsuspecting tourists. It makes no sense, she thought. If he didn't know we'd killed him†¦ Susan drew a total blank. It was too late. We've missed something. On the VR, the number of hackers pounding at the gates had doubled in the last few minutes. From now on, the number would increase exponentially. Hackers, like hyenas, were one big family, always eager to spread the word of a new kill. Leland Fontaine had apparently seen enough. â€Å"Shut it down,† he declared. â€Å"Shut the damn thing down.† Jabba stared straight ahead like the captain of a sinking ship. â€Å"Too late, sir. We're going down.† Chapter 120 The four-hundred-pound Sys-Sec stood motionless, hands resting atop his head in a freeze-frame of disbelief. He'd ordered a power shutdown, but it would be a good twenty minutes too late. Sharks with high-speed modems would be able to download staggering quantities of classified information in that window. Jabba was awakened from his nightmare by Soshi rushing to the podium with a new printout. â€Å"I've found something, sir!† she said excitedly. â€Å"Orphans in the source! Alpha groupings. All over the place!† Jabba was unmoved. â€Å"We're looking for a numeric, dammit! Not an alpha! The kill-code is a number!† â€Å"But we've got orphans! Tankado's too good to leave orphans-especially this many!† The term â€Å"orphans† referred to extra lines of programming that didn't serve the program's objective in any way. They fed nothing, referred to nothing, led nowhere, and were usually removed as part of the final debugging and compiling process. Jabba took the printout and studied it. Fontaine stood silent. Susan peered over Jabba's shoulder at the printout. â€Å"We're being attacked by a rough draft of Tankado's worm?† â€Å"Polished or not,† Jabba retorted, â€Å"it's kicking our ass.† â€Å"I don't buy it,† Susan argued. â€Å"Tankado was a perfectionist. You know that. There's no way he left bugs in his program.† â€Å"There are lots of them!† Soshi cried. She grabbed the printout from Jabba and pushed it in front of Susan. â€Å"Look!† Susan nodded. Sure enough, after every twenty or so lines of programming, there were four free-floating characters. Susan scanned them. PFEE SESN RETM â€Å"Four-bit alpha groupings,† she puzzled. â€Å"They're definitely not part of the programming.† â€Å"Forget it,† Jabba growled. â€Å"You're grabbing at straws.† â€Å"Maybe not,† Susan said. â€Å"A lot of encryption uses four-bit groupings. This could be a code.† â€Å"Yeah.† Jabba groaned. â€Å"It says-‘Ha, ha. You're fucked.' † He looked up at the VR. â€Å"In about nine minutes.† Susan ignored Jabba and locked in on Soshi. â€Å"How many orphans are there?† Soshi shrugged. She commandeered Jabba's terminal and typed all the groupings. When she was done, she pushed back from the terminal. The room looked up at the screen. PFEE SESN RETM MFHA IRWE OOIG MEEN NRMA ENET SHAS DCNS IIAA IEER BRNK FBLE LODI Susan was the only one smiling. â€Å"Sure looks familiar,† she said. â€Å"Blocks of four-just like Enigma.† The director nodded. Enigma was history's most famous code-writing machine-the Nazis' twelve-ton encryption beast. It had encrypted in blocks of four. â€Å"Great.† He moaned. â€Å"You wouldn't happen to have one lying around, would you?† â€Å"That's not the point!† Susan said, suddenly coming to life. This was her specialty. â€Å"The point is that this is a code. Tankado left us a clue! He's taunting us, daring us to figure out the pass-key in time. He's laying hints just out of our reach!† â€Å"Absurd,† Jabba snapped. â€Å"Tankado gave us only one out-revealing TRANSLTR. That was it. That was our escape. We blew it.† â€Å"I have to agree with him,† Fontaine said. â€Å"I doubt there's any way Tankado would risk letting us off the hook by hinting at his kill-code.† Susan nodded vaguely, but she recalled how Tankado had given them NDAKOTA. She stared up at the letters wondering if he were playing another one of his games. â€Å"Tunnel block half gone!† a technician called. On the VR, the mass of black tie-in lines surged deeper into the two remaining shields. David had been sitting quietly, watching the drama unfold on the monitor before them. â€Å"Susan?† he offered. â€Å"I have an idea. Is that text in sixteen groupings of four?† â€Å"Oh, for Christ's sake,† Jabba said under his breath. â€Å"Now everyone wants to play?† Susan ignored Jabba and counted the groupings. â€Å"Yes. Sixteen.† â€Å"Take out the spaces,† Becker said firmly. â€Å"David,† Susan replied, slightly embarrassed. â€Å"I don't think you understand. The groupings of four are-â€Å" â€Å"Take out the spaces,† he repeated. Susan hesitated a moment and then nodded to Soshi. Soshi quickly removed the spaces. The result was no more enlightening. PFEESESNRETMPFHAIRWEOOIGMEENN RMAENETSHASDCNSIIAAIEERBRNKFBLELODI Jabba exploded. â€Å"ENOUGH! Playtime's over! This thing's on double-speed! We've got about eight minutes here! We're looking for a number, not a bunch of half-baked letters!† â€Å"Four by sixteen,† David said calmly. â€Å"Do the math, Susan.† Susan eyed David's image on the screen. Do the math? He's terrible at math! She knew David could memorize verb conjugations and vocabulary like a Xerox machine, but math†¦? â€Å"Multiplication tables,† Becker said. Multiplication tables, Susan wondered. What is he talking about? â€Å"Four by sixteen,† the professor repeated. â€Å"I had to memorize multiplication tables in fourth grade.† Susan pictured the standard grade school multiplication table. Four by sixteen. â€Å"Sixty-four,† she said blankly. â€Å"So what?† David leaned toward the camera. His face filled the frame. â€Å"Sixty-four letters†¦Ã¢â‚¬  Susan nodded. â€Å"Yes, but they're-† Susan froze. â€Å"Sixty-four letters,† David repeated. Susan gasped. â€Å"Oh my God! David, you're a genius!† Chapter 121 â€Å"Seven minutes!† a technician called out. â€Å"Eight rows of eight!† Susan shouted, excited. Soshi typed. Fontaine looked on silently. The second to last shield was growing thin. â€Å"Sixty-four letters!† Susan was in control. â€Å"It's a perfect square!† â€Å"Perfect square?† Jabba demanded. â€Å"So what?† Ten seconds later Soshi had rearranged the seemingly random letters on the screen. They were now in eight rows of eight. Jabba studied the letters and threw up his hands in despair. The new layout was no more revealing than the original. P F E E S E S N R E T M P F H A I R W E O O I G M E E N N R M A E N E T S H A S D C N S I I A A I E E R B R N K F B L E L O D I â€Å"Clear as shit.† Jabba groaned. â€Å"Ms. Fletcher,† Fontaine demanded, â€Å"explain yourself.† All eyes turned to Susan. Susan was staring up at the block of text. Gradually she began nodding, then broke into a wide smile. â€Å"David, I'll be damned!† Everyone on the podium exchanged baffled looks. David winked at the tiny image of Susan Fletcher on the screen before him. â€Å"Sixty-four letters. Julius Caesar strikes again.† Midge looked lost. â€Å"What are you talking about?† â€Å"Caesar box.† Susan beamed. â€Å"Read top to bottom. Tankado's sending us a message.† Chapter 122 â€Å"Six minutes!† a technician called out. Susan shouted orders. â€Å"Retype top to bottom! Read down, not across!† Soshi furiously moved down the columns, retyping the text. â€Å"Julius Caesar sent codes this way!† Susan blurted. â€Å"His letter count was always a perfect square!† â€Å"Done!† Soshi yelled. Everyone looked up at the newly arranged, single line of text on the wall-screen. â€Å"Still garbage,† Jabba scoffed in disgust. â€Å"Look at it. It's totally random bits of-† The words lodged in his throat. His eyes widened to saucers. â€Å"Oh†¦ oh my†¦Ã¢â‚¬  Fontaine had seen it too. He arched his eyebrows, obviously impressed. Midge and Brinkerhoff both cooed in unison. â€Å"Holy†¦ shit.† The sixty-four letters now read: PRIMEDIFFERENCEBETWEENELEMENTSRESPON SIBLEFORHIROSHIMAANDNAGASAKI â€Å"Put in the spaces,† Susan ordered. â€Å"We've got a puzzle to solve.†

Corporate Social Responsibility Essay

Business and society are interdependent. The wellbeing of one depends on the wellbeing on the other. Companies engaged in CSR are reporting benefits to their reputation and their bottom line. We cannot build the case for CSR solely because of its economic benefits – an ethical case must be made for companies taking responsibility for the impact of their relations with society and the environment, otherwise the foundations of CSR will be far too narrow. However, Corporate Social Responsibility (CSR) is becoming an increasingly significant category by which a company’s reputation is evaluated. A variety of social and environmental issues across a broad spectrum of industries have recently been covered in the media – all of which directly affect a company’s reputation and all of which can be considered part of the larger CSR equation. Whether CSR is considered merely the latest trend in business management or whether it is laying the foundation for a newly advanced way of doing business, a brief overview of recent business news and corporate communications shows that CSR is certainly a relevant factor for how a company positions itself in the marketplace. CSR There is no universally agreed statement of just what CSR means and implies, and ideas on the subject are still developing. All the same, a common body of policy has now taken shape and won general approval among those who favors the approach. According to this way of thinking, a combination of recent changes on the world scene and pressures from public opinion now requires businesses to take on a new role, a newly defined mission. They should play a leading part in achieving the shared objectives of public policy and making the world a better place. In doing so, they should embrace the notion of ‘corporate citizenship’. They should run their affairs, in close conjunction with a group of different ‘stakeholders’, to pursue the common goal of ‘sustainable development’. Sustainable development is said to have three dimensions-‘economic’, ‘environmental’ and ‘social’. Hence, companies should set objectives, measure their performance, and have that performance independently audited, in relation to all three. They should aim to meet the ‘triple bottom line’, rather than focusing narrowly on profitability and shareholder value. All this applies to privately owned businesses in general and in particular to large multinational enterprises. Only by acting in this way can companies respond to ‘society’s expectations’. Making such a positive response is presented as the key to long-run commercial success for individual corporations in today’s world. This is because profits depend on reputation, which in turn depends increasingly on being seen to act in a socially responsible way. Thus taking the path of CSR will in fact be good for enterprise profitability: it will bring and sustain support and custom from outside the firm, and make for greater loyalty and keenness from its employees. To embrace corporate citizenship represents enlightened self-interest on the part of business. There is also a wider dimension, going beyond the individual corporation. The adoption of CSR by businesses generally is seen as necessary to ensure continuing public support for the private enterprise system as a whole. Corporate social responsibility Corporate social responsibility is necessarily an evolving term that does not have a standard definition or a fully recognized set of specific criteria. With the understanding that businesses play a key role on job and wealth creation in society, CSR is generally understood to be the way a company achieves a balance or integration of economic, environmental and social imperatives while at the same time addressing shareholder and stakeholder expectations. CSR is generally accepted as applying to firms wherever they operate in the domestic and global economy. The way businesses engage/involve the shareholders, employees, customers, suppliers, governments, non-governmental organizations, international organizations, and other stakeholders is usually a key feature of the concept. While business compliance with laws and regulations on social, environmental and economic objectives set the official level of CSR performance, CSR is often understood as involving the private sector commitments and activities that extend beyond this foundation of compliance with laws. From a progressive business perspective, CSR usually involves focusing on new opportunities as a way to respond to interrelated economic, societal and environmental demands in the marketplace. Many firms believe that this focus provides a clear competitive advantage and stimulates corporate innovation. CSR is generally seen as the business contribution to sustainable development, which has been defined as â€Å"development that meets the needs of the present without compromising the ability of future generations to meet their own needs†, and is generally understood as focusing on how to achieve the integration of economic, environmental, and social imperatives. CSR also overlaps and often is synonymous with many features of other related concepts such as corporate sustainability, corporate accountability, corporate responsibility, corporate citizenship, corporate stewardship, etc. CSR commitments and activities typically address aspects of a firm’s behavior (including its policies and practices) with respect to such key elements as; health and safety, environmental protection, human rights, human resource management practices, corporate governance, community development, and consumer protection, labor protection, supplier relations, business ethics, and stakeholder rights. Corporations are motivated to involve stakeholders in their decision-making and to address societal challenges because today’s stakeholders are increasingly aware of the importance and impact of corporate decisions upon society and the environment. The stakeholders can reward or punish corporations. Corporations can be motivated to change their corporate behavior in response to the business case, which a CSR approach potentially promises. This includes: 1)Stronger financial performance and profitability (e. g. hrough eco- efficiency), 2)Improved accountability to and assessments from the investment community, 3)Enhanced employee commitment, 4)Decreased vulnerability through stronger relationships with communities, 5)Improved reputation and branding. Historical context The view that a business can have obligations that extend beyond economic roles is not new in many respects. Throughout recorded history, the roles of organizations producing goods and services for the marketplace were frequently linked with and include political, social, and/or military roles. For example, throughout the early evolutionary stages of company development in England (where organizations such as the Hudson Bay Company and the East India Company received broad mandates), there was a public policy understanding that corporations were to help achieve societal objectives such as the exploration of colonial territory, setting up settlements, providing transportation services, developing bank and financial services, etc.. During the nineteenth century, the corporation as a business form of organization evolved rapidly in the US. It took on a commercial form that spelled out responsibilities of the board of directors and management to shareholders (i. e. fiduciary duty). In this later evolutionary form, public policy frequently addressed specific social domains such as health and safety for workers, consumer protection, labour practices, environmental protection, etc. Thus, corporations responded to social responsibilities because they were obligated to comply with the law and public policy. They also responded voluntarily to market demands that reflected consumer morals and social tastes. By the mid-point of the twentieth century, business management experts such as Peter Drucker and being considered in business literature were discussing corporate social responsibility in the US. In 1970, economist Milton Friedmann outlined his view that the social responsibility of corporations is to make profits within the boundaries of societal morals and laws (but cautioned that socially responsible initiatives by corporations could lead to unfocused management directions, misallocations of resources, and reduced market competition, opportunity and choice). CSR emerged and continues to be a key business management, marketing, and accounting concern in the US, Europe, Canada, and other nations. In the last decade, CSR and related concepts such as corporate citizenship and corporate sustainability have expanded. This has perhaps occurred in response to new challenges such as those emanating from increased globalization on the agenda of business managers as well as for related stakeholder communities. It is now more a part of both the vocabulary and agenda of academics, professionals, non-governmental organizations, consumer groups, employees, suppliers, shareholders, and nvestors. Diversity of Perspectives The following summaries of perspectives of different organizations serve to indicate the diversity of views on CSR that exist in Canada and around the world. They reflect the challenges and opportunities for both the public and private sectors to effectively operationalize and align CSR between domestic, continental and international levels. They also indicate the challenges and opportunities to develop the most appropriate relationships between shareholders and other stakeholders as well as to use the optimal policy mix of legislative and voluntary instruments.

Taking a Look at Marian Anderson - 1334 Words

Successful classical soprano performer Leontyne Price was one of the first artists to benefit from Marian Anderson’s hard work and dedication. The day after Marian Anderson’s death, April 8th, 1993 Price discussed the ways in which Anderson was able to overcome obstacles while remaining consistently professional and keeping the high standards she set on her performances. Marian Anderson was born on February 27, 1897. She was considered one of the most celebrated African-American artists of the twentieth century. Anderson identified herself as a contralto, which is the lowest frequency female voice with in a choir. Although Anderson is classified as a classical vocalist her repertoire included many genres such as opera, traditional American songs, concert literature and spirituals. Her live performances spanned the years of 1925 to 1965. The majority of her performances were recitals or concerts, some of which took place within major venues. Through Anderson’s successful career she paved a path for many other African-American vocal artists to follow. This paper explores the ways in which Marian Anderson’s career, from her early beginnings, struggle for recognition, and worldwide acclaim shaped her identity as a representation for African-American vocalists after her to follow. Marian Anderson was born in Philadelphia Pennsylvania and spent the majority of her childhood years in Philadelphia. Her parents were John Berkley Anderson, an entrepreneur who sold liquor, ice andShow MoreRelatedThe Fifth Of August By Audre Lorde991 Words   |  4 Pagesevery day when independence is being denied because of racism. In the passage, Lorde’s family vacationed to the capital on July 4th, 1947. However, the family was not celebrating the 4th of July which signified Independence day, rather they were taking a family trip in response to Lorde and her sister Phyllis graduating. 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