Advanced Directive
The 1991 the Patient Self-Determination Act (PSDA) was designed to give patients and their families greater autonomy over making decisions in regards to end-of-life care and minimizing the extension life beyond what would be considered a 'quality' level. It has been said that "advanced care planning increases the quality of life of dying patients, improves the experience of family members and decreases health care costs" for patients of a variety of backgrounds (Eggertson 2013). However, few patients are aware of how to go about constructing such directives even though the evidence indicates that most have clear preferences about how their end-of-life care should be managed. "A recent study in Maryland found that although 'only 34% of respondents had an AD, 61% indicated that they have preferences about medical care in the event they are unable to make such decisions', and of these '83% said it was very important that…...

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References

Brown, L.D. (2012). Stealing on insensibly: End of life politics in the United States. Health Economics, Policy and Law, 7(4), 467-83. doi: http://dx.doi.org/10.1017/S1744133112000254 

Eggertson, L. (2013). Doctors, patients urged to discuss advanced care plans. Canadian Medical

Association Journal, 185(13), E617-8.

Kwon, Y.C., Shin, D.W., Lee, J.H., Heo, D.S., Hong, Y.S., Kim, S., & Yun, Y.H. (2009).

Advanced directive may be one of the most important and underutilized tools in estate planning and health planning. This is partially due to the stigma that people have about advanced directives, as if, by planning how to deal with health issues, they are somehow going to cause health problems. However, the reality is that most people will encounter at least one medical emergency during their lifetime. In the event that the health event renders a person unable to communicate his or her wishes, the advanced directive is a method of ensuring that the patient is still able to communicate his or her wishes. This is specifically relevant in scenarios where third parties may have to make decisions about whether to provide or withhold life-saving treatments.
There are a number of different documents that fall under the rubric of advanced directives. The term encompasses all legally binding written documents that describe an…...

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References

American Bar Association. (Unk.). Myths and facts about health care advance directives.

Retrieved November 14, 2013 from ABA website:

American Hospital Association. (2012). Put it in writing: Questions and answers on advanced directives. Retrieved November 14, 2013 from AHA website:  http://www.aha.org/content/13/putitinwriting.pdf 

Hartocollis, A. (2012, October 14). Daughter's right to die is weighed against family's wish to keep her alive. Retrieved November 14, 2013 from The New York Times website:  http://www.nytimes.com/2012/10/05/nyregion/in-sungeun-grace-lee-case-right-to-die-is-weighed-against-a-familys-wishes.html

However, it does mean that some things will be different from the normal line of treatment. ("Advance Medical Directives.," n. d.); (Feldman, Mitchell D; Christensen, John F. (2007)
The fact that resuscitation of a patient through CP will not add significantly to the quantity and quality of life is an indication that death may not be very far off and that medicine does not have the power to turn around the dying process. CP has not only proved to be ineffective for terminally ill patients but the harsh nature of its functioning make it a technological, cruel and expensive death process. The results of many studies have indicated that the "out-of-hospital survival" rate of patients suffering from multisystem disease like renal failure and advanced cancers have not increased as a result of CP. Conflicts often crop up when the patient's family members, friends or relatives who have a vested interest…...

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References

American Academy of Orthopaedic Surgeons. (2006) "Emergency Care and Transportation

of the Sick and Injured" Jones & Bartlett Publishers.

Billings, Diane M. (2008) "Lippincott's Content Review for NCLEX-RN." Lippincott

Williams & Wilkins.

For example, Wissow and colleagues (2004) collected gender, age, ethnicity, and levels of clinic/ED use. This information may provide valuable insight into who is most likely to create an advanced directive in response to the intervention. The time frame for the study was not mentioned or how long after the intervention the survey instrument would be presented to intervention participants. This could be relevant because some individuals exposed to the intervention may decide to create an advanced directive right away, while others may wait weeks or months before finally making the decision to put into writing their care preferences.
eferences

Hunter-Johnson, L. (2014). Evaluating advanced directive promotion. University of South Alabama.

Wissow, L.S., Belote, a., Kramer, W., Compton-Phillips, a., Kritzler, ., & Weiner, J.P. (2004). Promoting advance directives among elderly primary care patients. Journal of General Internal Medicine,…...

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References

Hunter-Johnson, L. (2014). Evaluating advanced directive promotion. University of South Alabama.

Wissow, L.S., Belote, a., Kramer, W., Compton-Phillips, a., Kritzler, R., & Weiner, J.P. (2004). Promoting advance directives among elderly primary care patients. Journal of General Internal Medicine, 19(9), 944-51.

According to this second view, contemporaneous autonomy trumps precedent autonomy because honoring precedent autonomy imposes preferences and values of a different person, the formerly competent self (Buccafumi, p. 14).
The role that patient's families, doctors, health aides, pastors, chaplains and administrators, health educators and others play is crucial. Few people have executed an advanced directive, much less appointed a healthcare power of attorney by the time they enter a hospital with a debilitating condition. An informed consent form only marks the fact that a conversation has taken place in a health facility. The process that needs to or ought to take place concerning a patient's wishes and ensure one's wishes are empowered are part of the process involved as one fills out the advanced directive for themselves. In California the state has consolidated statutes for advanced directives and added some rights and included the best features of past laws. A…...

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REFERENCES WHICH I DID NOT USE (JUST for YOUR INFO, NOT to BE INCLUDED in THIS PAPER)

American Nurses Association. (1985). American Nurses

Association Code for Nurses with Interpretive Statements, Section 1.1. Washington, DC:ANA.

Docker, C. (1995). Deciding How We Die. The use Limits of Advance Directives. [Online]. Available:  http://www.finalexit.org/wfn27.3.html .

Fishback, R. (1996). Harvard Medical School Division of Medical Ethics. Care Near the End of Life. [Online]. Available: www.logicnet.com/archives/file2001.php.

The main finding sof the study were in addition to correlate identification the development of a more clear idea of the real limitations of prevalence of existing PADs, in that 4-13% of study participants had already created PADs of one or both types and that this same study group had a very high statistical desire to create their own PADs (66-77%) but would like and subsequently lack appropriate assistance in doing so.
Evaluation

This article is really well organized, written and supported. The work provides substantial, timely and comprehensive information about the finer points of PADs and why they are important, as tools to ideally aide mental health consumers in both self-empowerment and to aide providers and caregivers in decision making that falls short of coercive or legal treatment demands. The work provides demonstrative insight with regard to the community need to provide adequate support to mental health consumers regarding the…...

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References

Swanson, J., Swartz, M., Ferron, J., Elbogen, E., & Van Dorn, R. (2006). Psychiatric Advance Directives among Public Mental Health Consumers in Five U.S. Cities: Prevalence, Demand, and Correlates. The Journal of American Academy of Psychiatry and the Law, 34 (1), 43-57.

Cae Planning Analysis
In eality, sound healthcae-elated advanced planning is a continuous convesation, involving pioities, values, QOL (quality of life) and what one's life means. Tool kits, in this context, compise vaious self-help esouces, woksheets, and ecommendations. They aid individuals in pefoming the moe complex tasks of identifying, confiming, and shaing impotant facts with an individual faced with a seious ailment (Ameican Ba Association, 2005). Iespective of whethe the individual is teminally ill o suffeing fom an acute ailment o chonic, long-tem ailment, advanced cae planning (ACP) is capable of facilitating the alleviation of unnecessay suffeing, impoving QOL and offeing a bette gasp of decision-elated challenges faced by the ailing individual, his/he family, and othe caegives. Advanced cae plans may be implemented at any junctue in the patient's life and must be updated when changes occu in patient cicumstances. A peson who contacts a pogessive disease that leaves him/he disabled…...

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references? A Study of the U.S. Medicare Population. Medical care, 45(5), 386.

Centers for Disease Control. (2013). Advance care planning: ensuring your wishes are known and honored if you are unable to speak for yourself. Retrieved 16 February 2016 from  http://www.cdc.gov/aging/pdf/advanced-care-planning-critical-issue-brief.pdf 

Wehri, K. (2011). Living well at the end of life: a national conversation. Caring: National Association for Home Care magazine, 30(9), 38.

Supervision: When to Use Directive Control Behaviors
This paper is about many different aspects of effective supervision, training and evaluation, but the main concern here is control. It can be assumed that the supervisor has control over the supervisory situation, but this would be an oversimplification of the relationship between a line employee and their direct boss. Control is a shared entity because though the supervisor may determine the course an employee must take, the employee decides whether they will follow that direction or not. Thus, the supervisor must prove to the employee that they are competent in the job before they can expect the employee to follow direction.

This is the stance taken by directive control behaviors. A supervisor who uses directive control behaviors has to be a subject matter expert. If they cannot claim an expertise in the elements that the job entails then they are less likely to have…...

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Pistole and Fitch (2008) examined the role of attachment in supervision. The findings in this study were much like those of the cultural study. Two factors influenced the role attachment played in the supervisory relationship: a culture that valued attachment, or a person who did not feel confident in the job that they were doing. The second type of employee seems to thrive under the vertical, directive style of leadership and have productivity decreases when forced to complete a task with little direction (Pistole & Fitch, 2008). This meshes well with other research which suggests what the appropriate role of directive control behaviors are.

Directive control also calls for a leader who is charismatic enough to generate the trust necessary for the directive relationship to succeed. The worker must be able to see that the supervisor has confidence in their skill level before that leader will be accepted. Einstein and Humphreys (2001) looked at how directive leaders were perceived by their subordinates. The most important part of the relationship, according to the research, was the belief by the employees that the leader was an expert. This led to a belief that the direction that was being received was appropriate to meet the set goals. The researchers did find that a leader must be willing to move from "directive to persuasive to involving to inspirational styles of leadership" as the competency and confidence of the employees increased. If the supervisor remained in a directive role for too long then productivity of the employees would decrease.

These studies bear out two points that are important for understanding the role of directive supervisory behavior. First, there are certain groups of people that will generally feel more comfortable when the supervisor takes a more directive role. Second, directive leadership has a very specific window of success. It needs to be used in the correct situations.

Auditing
We are living in times of continuous change that thrives on information. Information is the cornerstone of the financial construct of organizations. Information and access thereto drives the success of organizations in present times. The way the external world receives the statements of organizations is causal to its perception by individuals and institutions in evaluating it. As such, it is imperative that the architects and designers of this vital information need to pursue diligently highest levels of moral, ethical, and professional standards in preparing it. In providing for the financial and economical framework for such information, services of auditors are simply indispensable. The audited reports of an organization is the basis on which the organization makes its statement of intent public and helps aid the process of decision making and perception about it in the capital and investment markets (Franca & Maria, n.d.).

IMPORTANCE OF MATERIALITY IN AUDITING

"Audire" in Latin…...

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Bibliography

Acito, A.A., J.J. Burks, and W.B. Johnson. 2009. Materiality decisions and the correction of accounting errors. The Accounting Review 84 (3): 659-688.

American Institute of Certified Public Accountants (AICPA). 2008. Clarification and Convergence. An AICPA Auditing Standards Board Project. New York: AICPA, July.

Brody, R.G., D.J. Lowe, and K. Pany. 2003. Could $51 million be immaterial when Enron reports income of $105 million? Accounting Horizons 17 (2): 153-160

Eilifsen, A. & Messier, W., 2014. Materiality guidance of the major public accounting firms. Auditing: A Journal of Practice & Theory.

Methods

Methodological consideration on the project is designed as tri-partite study of legal and popular culture on UK immigration and the new formations of labour and capital through: Phase I: Archival esearch; Phase II: Data Analysis; and Phase III: Writing. Iterative archival and internet research will be employed throughout the project in order to craft substantive dialogue into the dissemination and publication of the project.

Implications to the Study

A study on migrant workers in the UK during a radical shift in the global economy, the research promises to offer new information on the mechanistic uses of law to redirect labour where capital flows are no longer adequate to sustain them. Integral to prospectus of the project is a comparative legal perspective, meant to engage and challenge our taken for granted assumptions about the role, rights and responsibilities of foreign nationals as they attempt to participate in Britain's democracy. Outcomes to the study…...

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References

Downturn cuts foreign worker jobs (2009). BBC News. Available at:  http://news.bbc.co.uk/go/pr/fr/-/2/hi/uk_news/politics/8317193.stm 

Employment Act, 2008 (Commencement No. 2, Transitional Provisions and Savings) Order 2009. Office of Public Sector Information (OPSI). Available at:  http://www.legislation.gov.uk/uksi/2009/603/pdfs/uksi_20090603_en.pdf 

Employment Rights Act 1996. Order 2009. Office of Public Sector Information (OPSI). Available at:  http://www.legislation.gov.uk/ukpga/1996/18/contents 

A Gillespie 'The Human Rights Act 1998 and the European Convention on Human Rights (ECHR)' Jurist. Available at:   accessed 24 June 2010http://jurist.law.pitt.edu/World/ukcor3.htm 

Professional oles and Values
A good number of patients visiting emergency departments are in a position to make independent decision concerning their care. Nevertheless, a significant proportion of them are extremely incapacitated either mentally or physically to the extent that they cannot solely make decisions regarding their treatment. Some of the conditions associated with this incapacitation include organic brain disorder, hypoxia, or head trauma. Jones et al. (2005) describes an emergency department as a very hostile environment where patients may lose control of the nature of care they undergo. Such is the case scenario in this current study. Mr. E is developmentally delayed and hypoxic. Dr. K considers his situation as an emergency and a ventilator must support it. The fact that Mr. E had already signed an advance directive under the supervision of a patients advocate that he did not want a ventilator or cardiopulmonary resuscitation complicates the matter even…...

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References

Dickey, S.B. (2003-2004). Nurses should be concerned about the ethical implications of HIPAA regulations (pp. 1-5). Washington, DC: American Nurses Association

Fowler, D.M. (2008). Guide to the code of ethics for nurses. Silver Springs, MD: American Nurses Association

Jones S, Davies K, Jones B (2005). The adult patient, informed consent and the emergency care setting. Accident and Emergency Nursing. 13, 3, 167-170

With regard to the medication administration itself, in a life saving circumstance, which this clearly is not the weight of the potential for depression of respiration and cardiac status is clearly indicated, yet it would seem unethical under these circumstances, if the review of the documentation proves its validity and clearly indicates the patients wishes, to deny at least the smallest dosage (2mg) of ordered Morphine to reduce the pain and potentially allow the patient to regain calm, which will clearly improve his status with regard to short-term treatment.
If the fear of doing harm, drives every medical decision, based on the extreme notion that all patients can be saved under all circumstances then bioethical decisions are futile. The observations and communications of others in the immediate vicinity to care, including the family, other nurses, support staff and most importantly the orders of the doctor to administer palliative care for…...

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References

Andre, J. (2002). Bioethics as Practice. Chapel Hill, NC: University of North Carolina Press.

Forsythe, C.D. (2005). Protecting Unconscious, Medically-Dependent Persons after Wendland & Schiavo. Constitutional Commentary, 22(3), 475.

Mantz, a. (2002). Do Not Resuscitate Decision-Making: Ohio's Do Not Resuscitate Law Should Be Amended to Include a Mature Minor's Right to Initiate a DNR Order. Journal of Law and Health, 17(2), 359.

Saunders, D.E. (2003). Removing the Mask. The Hastings Center Report, 33(2), 12.

The death of elderly individuals takes place in different circumstances and settings such as painless death at home or painful death in a healthcare facility. Social workers have an important role in planning end-of-life care as part of providing essential social support to elderly individuals. The role of social workers in this process is attributable to the significance of their professional practice in a multidisciplinary palliative care team in hospice and hospital settings (Watts, 2013). Since the death of elderly individuals occurs in a variety of conditions and settings, social workers need to plan for end-of-life care. The planning and delivery of end-of-life care helps in helping the elderly cope with serious illness, face mortality or manage the process of dying in an effective manner.
One of the major functions of social workers in their role in planning for end-of-life care is providing psychosocial and practical support to individuals who are…...

I do not believe that wearing glasses or make-up is wrong, even though this is an enhancement of the human body by improving one's life by being able to see, or covering blemishes and unsightly birthmarks that might make an individual self-conscious. Is selecting the best sperm donor really so much different than a man or a woman basing his or her choice of a mate upon that individual's appearance, intelligence, and lack of unpleasant 'skeletons' in the genetic closet? Svaulescu's idea that one has a moral obligation to screen for genetic defects or to personally improve the human race through reproduction makes one queasy, but the idea of leaving everything up to nature, in theory, would mean an end of folic acid for pregnant women or even birth control.
But really, the ultimate argument for allowing patients to attempt to engineer their offspring by selecting 'better sperm' may be…...

For elderly patients who have no one to appoint as their proxy, completing a living will that outlines their wishes is preferable to not providing any information at all about care preferences. This is equally so for patients who want to provide their proxy with some guidance about their treatment preferences and end-of-life care wishes, including artificial nutrition, ventilator support, and pain management. A living will (LW) provides specific instructions to health care providers about particular kinds of health care treatment that an individual would or would not want to prolong life. Living wills are often used to declare a wish to refuse, limit, or withhold life-sustaining treatment when an individual is unable to communicate. All but three states (New York, Massachusetts, and Michigan) have detailed statutes recognizing living wills. The usefulness of LWs is limited, however, to those clinical circumstances that were thought of before the person became…...

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References

Burnell, G.M. (1993). Final Choices: To Live or to Die in an Age of Medical Technology. New York: Insight Books.

Fisher, C.B. (2002). A Goodness-of-Fit Ethic for Informed Consent. Fordham Urban Law Journal, 30(1), 159.

Galambos, C.M. (1998). Preserving End-of-Life Autonomy: The Patient Self-Determination Act and the Uniform Health Care Decisions Act. Health and Social Work, 23(4), 275.

Hardwig, J. (2000). Spiritual Issues at the End of Life: A Call for Discussion. The Hastings Center Report, 30(2), 28.