Leading discussion Assignment Example | Topics and Well Written Essays - 1500 words

Leading discussion - Assignment Example The defendant possessed a big collection of videos and photographs containing nude teenage boys involved in uncensored activities. Sharpe invoked the actions of the prosecutor as a violation of his right to freedom of expression, trying to prove the in-constitutionality of the Criminal Code provisions prohibiting possession of materials containing child pornography. Sharpe made an intensive attempt to refute the prosecutor’s arguments and to prove that he is not guilty of anything. The main legal issues that have arisen in this case regarded the following: a) is the possession of child pornography protected by the right to freedom of expression? b) are the provisions of the Criminal Code of Canada somehow infringing the liberties guaranteed by the Constitution? 2. Court’s ruling: The Court was forced to face and solve a constitutional challenge, aroused by a child pornography fan, which would have formed a powerful precedent in Canadian law. The Court agreed with the defendant in one thing: the prohibition of the Criminal Code provisions did represent a limitation of the freedom of expression. Nevertheless, this limitation was necessary in a country where morality is respected and protecting children is one of the main objectives of the whole society. However, the Court decided that possession of child pornography for exclusive personal usage does not harm the child directly, so it should not be outlawed. The charges against Sharpe were dropped, except the ones referring to the photographs. Sharpe was charged with the crimes of gross indecency (article 157 Criminal Code of Canada) and indecent assault against a minor boy (article 156 Criminal Code of Canada). 3. My opinion: I believe that ownership of child pornography for private usage should be also outlawed and declared as an exception to of the freedom of expression. It is almost impossible to control if the owner uses this material for

Selecting venuse for an academic conference Dissertation

Selecting venuse for an academic conference - Dissertation Example On the average these facilities range from three star, to five star facilities with regards to the kind and class of service provided (Van-der Wagen, 2006). The major distinctions of these facilities are mainly in line with their physical locations in relation to some of Central London’s attractions, airports, train stations, and other facilities that might attract the guests who attend the conference. Specific considerations that were factored in this selection process included the distance from major airports and train stations. This was important since the one-day event relied heavily on punctuality. Central London Famous Facilities Many conference facilities in Central London have suited their conference spaces with the architectural flexibility that allows both small and large conferences. Some of these facilities are complete with break out rooms, state of the art audio visual systems, and lecture theatres. The variations across many of these hotels and guest house are m ainly in form of style and incentives. The academic conference was tailored on a cost-effective system that would allow the guests to enjoy quality catering of simple but sumptuous buffets. In this process ten facilities were considered so that the best three facilities were arrived at after competitive bidding. The sampled facilities included The Cinnamon Club, The British Academy, The UK Supreme Court, the Grange Rochester Hotel, the 8 Northumberland, Royal Institute of British Architects, the Number 45 Millbank, the 116 Pallmall- Home of the Institute of Directors, the One Great George Street, and the Bafta. These facilities are situated close to some of the grand attractions such as the West Minster’s Abbey and other historical and aesthetical delights of Central London. The academic conference selection was arrived at through a delicate consideration system that sought a balance between the proximity of the heart of Central London versus the need for the most serene and quiet environment that would align well with the demands of an academic gathering. The most ideal location therefore was made in according with the distance away from the bustle of the city, low industrial noise, and the cacophony of heavy London traffic. After a general assessment was done three facilities out of the mentioned ten passed the threshold for utility and convenience because of some of their unique features and flexibility in their pricing regimes. These were The Cinnamon Club, The British Academy, and Central Hall Westminster. The Cinnamon Club The Cinnamon Club has an ambience suitable for academic conferencing. Its conference room is spacious and fitted with state of the art audio visual. The conference rooms are partitioned according to the specifics of utility. They are mainly in the form of executive, leisure, and academic. The executive sections are made up with the oak paneled facilities that vibrate with the rhythm of class and elegance. The furniture and sitti ng arrangement in the conference room are ordered in a classroom or theater fashion of rows and columns which gives the participants in the conference a comfortable view without any physical strains. The facility is a stunning architectural marvel situated on central London Avenue. Some of the cuisine it features includes the Indian cuisine,

Feasibility Study Essay Example for Free

Feasibility Study Essay 2.1 FEASIBILITY STUDY The feasibility of the project is analyzed in this phase and business proposal is put forth with a very general plan for the project and some cost estimates. During system analysis the feasibility study of the proposed system is to be carried out. This is to ensure that the proposed system is not a burden to the company. For feasibility analysis, some understanding of the major requirements for the system is essential. Three key considerations involved in the feasibility analysis are ECONOMICAL FEASIBILITY TECHNICAL FEASIBILITY SOCIAL FEASIBILITY ECONOMICAL FEASIBILITY This study is carried out to check the economic impact that the system will have on the organization. The amount of fund that the company can pour into the research and development of the system is limited. The expenditures must be justified. Thus the developed system as well within the budget and this was achieved because most of the technologies used are freely available. Only the customized products had to be purchased. TECHNICAL FEASIBILITY This study is carried out to check the technical feasibility, that is, the technical requirements of the system. Any system developed must not have a high demand on the available technical resources. This will lead to high demands on the available technical resources. This will lead to high demands being placed on the client. The developed system must have a modest requirement, as only minimal or null changes are required for implementing this system. SOCIAL FEASIBILITY The aspect of study is to check the level of acceptance of the system by the user. This includes the process of training the user to use the system efficiently. The user must not feel threatened by the system, instead must accept it as a necessity. The level of acceptance by the users solely depends on the methods that are employed to educate the user about the system and to make him familiar with it. His level of confidence must be raised so that he is also able to make some constructive criticism, which is welcomed, as he is the final user of the system.

Homeless Children Negatively Affects Society Children And Young People Essay

Homeless Children Negatively Affects Society Children And Young People Essay Homeless Children refer to Children who live on the streets. They are deprived of family care and protection. Most of them are between the ages of 5 to 18 years old. Its a new phenomenon that has been occurred in the developed and less developed countries such as USA, India and Egypt. This Problem has evolved in some countries because of the gap between the rich and the poor and unequal distribution of the income. According to the United Nations Office for Drug Control and Crime Prevention researchers in Egypt found that the average number of Children street is vary between boys and girls which is 45,5 respectively . This paper will examine the problem of homeless children focusing on Poverty, Child Abuse and Child labor as well as the proposing solutions to overcome this problem. Homeless Children is a significant cause of poverty that results from low. The (UNO) in Egypt had interviewed 50 sample of street children and found that Low income and educational level of the family (98% of the sample come from low income level families, whereas 66% of them were low educational level families). Many families cannot support its family because of their low income and because most of these people are not educated so they cannot be employed in high positions to support the needs of the family. In addition, these conditions encourage the parents to let their children drop their schools and support them to be source of money to provide their families with food, clothes and other basic needs. Poverty will keep the child poor throughout his life. In order to survive, children wont have the chance to go to school and will be forced to work to get money so they will remain at the bottom of the social level. Most of the homeless children have many siblings according to their illiteracy that will increase this problem. Most of the time, overpopulation is associated with poverty because of their families low income. For example in Egypt a poor family could have 8 children and the bread winners income is 100 EGP distributed in 8 Child which is not covering half of their needs. Child Abuse is a cause of street children which lead the child to run away from home to avoid any kind of abuses such as physical or sexual abuses. However, running away from home may cause further abuses. Most of street children have been beaten up or sexually abused by their parents, step parent or in the work which led them to resorting to street, (Hussein, 1998). Furthermore, these children are forced to leave homes because they feel that they are neglected and being unwanted by their families. Another cause of street children is child labor which lead that child bears the burdens outweighs his/her ability. Street children can work in factories and carrying heavy equipment and bags. They usually dont live their lives as they should, they have been treated as adult because they have grew up before their times. Child labor is associated with child abuse. Children are being abused physically by their bosses who insult and beat them continuously. Homeless Children negatively affects the entire society. It affects their unstable lifestyles where they do not have a regular place to stay in and they might not see their biological parents daily which make them unstable emotionally. In addition, These Children lack of medical care and they have higher susceptibility of getting chronic diseases gastrointestinal disorders, and sexually-transmitted diseases such as HIV. They could get these diseases as eat from garbage and are not aware of cleaning habits to avoid those diseases. In Mumbai, India it is estimated that 30% of the prostitutes in this city are less than 20 years of age. Nearly half of them became commercial sex works when they were minors, (Rhode, 2004). In addition, adults are using street children in drug trade and studies found that 90% of the homeless children are using some psychoactive drugs such as heroin, alcohol, cigarettes and some industrial products that are available such as shoe glue. Street Children are more likely to acquire behaviors such as violence from the community or while working with others or with how the people react toward them in the streets. They obtain this behavior to protect themselves from the surrounding community and they dont feel valuable in their society. Most of these children are abused and violence is a normal result of this act which is associated with most of street children. They experienced many things and they saw the black side of life very early and because they feel unwelcomed by the people based on their appearance or their behavior, people tend to drive them away using violence. Street children have a fear of being arrested by police because they are afraid of giving them back to their families. There are some solutions that have been used previously but didnt succeed to overcome this problem or reduce the rate of homeless children in some countries such as volunteering in organizations, government, emergency call services and provide awareness and education. One of the solutions to reduce the problem of street children is volunteering in charitable organizations. These kinds of organizations provide help to street children to have a stable lifestyle and offer them the basic needs and rights as children. However, street children have adopt to the street and of course they dont want to stay in streets for the rest of their lives, but these organizations offer help for the children not for their parents, so if the child went back home they will repeat the cycle again.so, these organizations actually isnt the final solution this problem. Another solution for this problem is the help offered by the government to eliminate this problem. Governments provide money to these children and their families, so that later there is no need to let the child work or the child is forced to leave the home. By this money, the family can afford their children needs. However, this solution has a drawback which is that the money is going to finish and the government is not and these families cant rely on governments as source of money. Government will offer them allowance this month but maybe the next month they wont. In addition, these children have acquired some behaviors such as the use of drugs, so these children might use the money provided by the government in the drugs and other illegal things. According to NGO,in Brazil, sometimes governments have roundups when they remove all the children from city streets and place them in orphanages or arrest them. Which might lead the child to leave the orphanage and go back to street again and there are some orphanages that take advantages of these children and let them work for them which cause to the same problem again. A third solution for reducing the street children problem is emergency call. This service is done by the Human Rights to do their best in helping these children and offer them a stable life. These emergency calls are like hotline which the child dial their number and ask for help and then the responsible people come and help this child. However, most of these children have a fear of people and a fear that the community are not accepting them as part of the society, which result that not many children is going to call them. Moreover, this service also can be used by adults who are seeing street children and want to call a help for them but these children are not aware that they are being helped by the human rights and they will see it as they are being forced to go back to orphanages and child care and others. The best solution that we recommend to reduce the rate of street children in our world is a combination between education and angle investors. First of all, these children wont understand that they are being helped unless they understand that they are in severe danger. Education is a powerful weapon that will bring the children back into their societies and will help them to build their futures. The main purpose of offering education for street children is that they are going to feel valuable in their society and willing to improve themselves to better, (ANPPCAN, 1995). Small team of volunteers can offer an interesting and good environment of education to encourage them to attend school. In addition, the angle investors could help in providing money to their families as a persuasion but the money is given to start a small business with it such as supermarkets, laundry and joinery and others. So, they could have a stable source of money to provide their children with the basic needs r equired, and their children could attend school to improve their quality of life. Street children have many negative effects on the entire society. In addition higher rate of homeless children could increase the probability that the country wont be secure, stable and developed. Reducing this problem is important because they are part of our society and have needs and rights that should be achieved to get the best possible outcomes from them and raise the level of social and economy to the better. Something needs to be done to reduce and prevent street children from increase. There are several solutions you can do to decrease the disadvantages associated with the street children. While you can volunteer as a teacher, encourage investors to invest in small businesses to allow their families to work in it, support the governments to raise awareness about this problem and how it could be solved or reduced. However the best way for us to make an impact on this problem is to educate these children and make them believe that they are not the problem itself but their surr ounded conditions were the problem. Solving this problem is important, we all need to take an action because we have to live in secure country and have a use of each person in our society to make it a better place to live in and create a better quality of life for everyone without exceptions.

Essay --

Operational Plan Business Environment: The environment at BoxofLove is based on the culture of performance and production. For employees, we try to provide the proper motivation in our organization. â€Å"Abraham Maslow broke down on what people needed for motivation into two different categories in five factors. Category one will lower level needs and concentrate on factors such as physiological, safety, and social needs. The second category is having higher level needs such as self-esteem and self-actualization (http://www.businessballs.com/maslow.htm)†. Having to focus on higher level of needs, we will be able to motivate the our employees within in the organization to achieve high levels of performance. We are committed to reduce the operating costs to reflect the values of our customers for our good business sense. Location: BoxofLove.com is a new company that will be entering the industry with other competitors. This is an ecommerce business, which has a variety of themed care package for students in greater Chicago land area. The building is an office in the Elk Grove Village area with 400 sq. ft. which provides 11’ by 13’ overhead door and 17’ inside the office. The village gave us the permission to build the office with hours from 9 am to 5pm Monday thru Friday, 8am to 12pm on Saturdays, and closed on Sundays. Our office will include rooms that will be used for operations with project management, finance, designing, and administrative tasks required in the operations of the ecommerce. The office uses Nicor, ComEd, and Comcast business program. During the summer time Nicor would require to use less gas and winter time it would use more gas to heat the building for employees. The... .... related materials. Abraham Maslow's Hierarchy of Needs and diagrams of Maslow's motivational theory. Retrieved January 14, 2014, from http://www.businessballs.com/maslow.htm Imani, F. (2014, January 1). How to Keep Track of Inventory Manually. Small Business. Retrieved January 15, 2014, from http://smallbusiness.chron.com/keep-track- inventory-manually-21920.html LOOKING FOR OFFICE SUPPLIES? WORK WITH US.. (2012, January 1). Office Supplies, Office Furniture & Office Technology at OfficeMax. Retrieved January 12, 2014, from http://www.officemax.com/ Summary. (2014, January 8). U.S. Bureau of Labor Statistics. Retrieved January 15, 2014, from http://www.bls.gov/ooh/production/quality-control- inspectors.htm#tab-2 Quality control. (2014, January 1).Wikipedia. Retrieved January 15, 2014, from http://en.wikipedia.org/wiki/Quality_control

Toni Morrison Essay examples -- essays research papers

Toni Morrison The issue of abandonment and the will that it takes to survive the hardship of it is a reoccurring theme in Toni Morrison’s writing. Tar Baby, Sula and Paradise all deal with the issue of abandonment and how it relates to the characters in her stories. â€Å"Through her fiction, Toni Morrison intends to present problems, not their answers† (Moon). Her stated aim is to show "how to survive whole in a world where we are all of us, in some measure, victims of something." (Morrison) Morrison's broad vision extends beyond the individual to one that explores self-discovery in relation to a "shared history." In order to dramatize the destructive effects of this kind of dependency, she intentionally exaggerates to find the limits. In a film interview, Morrison has stated, "I suppose that in many of my novels I tend to discuss one's dependency on the world for identification, self-value, feelings of worth. The abandonment that it takes for one to gain th ese qualities is prominent in my writing.† Toni Morrison has been consistently insightful and helpful critic of her work. With regard to her novels, she has indicated that her plan was to take love and the effects of its scarcity in the world as her major themes, concentrating on the interior lives of her characters, especially those of an enclosed community. Born Chloe Anthony Wofford, on February 18, 1931, in Lorain, Ohio. The daughter of George Wofford, a shipyard welder, and his wife Ramah, Morrison was schooled by her parents in the richness of her African-American heritage and the joys of great literature. When she entered first grade, she was the only black student in her class and also the only child who had already learned to read. Since many people couldn't pronounce her first name correctly, she changed it to Toni, a shortened writing". version of her middle name. She joined a repertory company, the Howard University Players, with whom she made several tours of the South. She saw firsthand the life of the blacks there, the life her parents had escaped by moving north. After graduating, Toni was offered a job at Texas Southern University in Houston, where she taught introductory English. Unlike Howard University, where black culture was neglected or minimized, at Texas Southern they celebrated black heritage with Negro hist ory week and introduced to her the idea of b... ... of her birth, to marry, to raise a family, to become a pillar of the tightly knit black community. The other, Sula Peace, rejects all that Nel has accepted. She escapes to college, submerges herself in city life, and when she returns to her roots, it is as a rebel, a mocker, a wanton sexual seductress.†(Back Cover) The relationship between the young women throughout a certain portion of their lives was put on hold due to the distance between them. Sula chose to move away from Ohio when she was young and therefore somewhat abandoned the life that the two girls had in previous years. When reunited with Sula, Nel expresses her thoughts on the abandonment of herself by her friend: â€Å"[Sula] said doing anything forever and ever was hell. Nel didn't understand it then, but now in the bathroom, trying to feel, she thought . . . "Sula was wrong. Hell ain't things lasting forever. Hell is change." Not only did men leave and children grow up and die, but even that misery didn't last. One day she wouldn't even have that. This very grief that had twisted her into a curve on the floor and flayed her would be gone. She would lose that too†. (Morrsion, 108)

Ethical and Legal Issues in nursing Essay

The nursing regulatory body, the Nursing and Midwifery Council requires all registered nurses to have an understanding of the ethical and legal principles which underpin all aspects of nursing practice(NMC,2010). A comprehensive understanding of current legal and ethical frameworks facilitates the delivery of appropriate skilled nursing care. The purpose of this assignment will be to critically discuss an episode of care encountered whilst on clinical placement. The episode of care involves the covert administration of medication to an elderly patient. The decision to covertly administer the medication will be critically assessed in this assignment. The Gibbs(1988) reflection model will be used to guide the discussion. The discussion will also consider the legal, ethical and professional issues surrounding covert medication. In the mental health sector, medication non-adherence remains a serious health-care problem with far-reaching ramifications for patients, their relatives and health-care professionals. Harris et al. (2008) found that between 40 and 60% of mental health patients fail to adhere to their medication treatment plan. This number increased to 50 and 70% for elderly patients with dementia, and between 75 to 85% among patients with schizophrenia and bi-polar disorders. In such cases, where the patient’s well being is at risk and the treatment is essential, health-care professionals may resort to disguising medications in food and drink. The medication is crushed or liquefied and mixed with foodstuff. This practice of concealment is called covert medication(NMC,2008). By covertly administering medication, the patient consumes a drug without the required informed consent. The Gibbs(1988) reflection model has been chosen for the purpose of this assignment as it allows the author to reflec t and think systematically about the episode of care. The initial stage of Gibbs’ reflective cycle is ‘Description’; in which the author is required to describe the events which occurred. In order to comply with the NMC(2010) code of conduct and guidelines on patient confidentiality, the patient will be called Mr Walker. Mr Walker, an 80-year-old service user was temporary placed at the respite care home. Mr Walker had severe dementia, and was  unable to communicate effectively. He frequently resisted all essential nursing care. Mr Walker’s medical history also included hypertension and angina. He was prescribed blood pressure medication (enapril tablets) to stabilise his blood pressure and to reduce the risk of stroke and heart attacks. He was also prescribed diuretics and medication to prevent further angina attacks. Mr Walker frequently refused to take his medication; spitting out the tablets and refusing to swallow. The nurse in charge, concerned about the deterioration of Mr Walker’s health, considered the option to covertly administer his medication. The MDT held a meeting and reached the decision to covertly administer Mr Walker’s medicat ion. The second stage of the Gibbs’ reflective cycle is ‘Feelings’, requiring the author to briefly discuss her reactions and feelings. The author felt the decision to covertly administer medication was morally correct and ethically permissible. The author refers to the deontology ethical theory to support her thoughts and feelings. The NMC code of conduct considered by Beckwith and Franklin(2011) as a model of rule deontology states that all health-care professionals should â€Å"safeguard and promote the interests and well-being of patients†. The act of covertly administering medication could therefore be deemed morally correct. The practitioners intended on acting in the best interest of Mr Walker irrespective of the consequences of their actions (breaching patient autonomy). Their actions promoted and safeguarded Mr Walker’s health and well-being. Husted (2008) argues that from a deontological point of view, violating an individual’s autonomy is sometimes necessary to promote the individual’s best interest. In this case it could therefore be ethically permissible to covertly administer medication without Mr Walker’s consent. The medication is essential and promotes Mr Walker’s long-term autonomy and safeguards his health and well-being. Similarly, the ethical princip les of beneficence and non-maleficence could be used to justify the use of covert-medication (Wheeler 2008). The principle of beneficence is an ethical principle derived from the duty to provide benefits and to consider the benefits of an action against the risk. According to Masters(2005), health-care practitioners have a professional duty and an ethical obligation to carry out positive actions with the aim of safeguarding their patient’s health and well-being. With this notion in mind, covert medication could be morally justified if it safeguards the  welfare of the patient. In this case, the discontinuation of medication would have had a detrimental effect on Mr Walker. Thus administering the medication covertly was in accordance with the principle of beneficence. In this case, one could also argue that the medication was actually acting as an autonomy restoring agent (Wong et al,2005). Mr Walker’s autonomy was restored in that he was relieved of severe pain. The medication also worked by improving his quality of life. Several studies on the chemical and physical restrain t of aggressive dementia patients also often show a preference to covert medication (Treolar et al,2001). Covert medication is often considered the least ‘restrictive’ and ‘inhumane’ way of administering medication when considering alternatives like physical and technical restraint to administer medication by force (Engedal,2005). Such alternatives to covert medication are unsafe and can have long lasting negative psychological effects on the patient (Wong et al, 2005). However, covert medication is not without its shortcomings. The team was deceiving Mr Walker, an already confused, poorly, frail, weakened and vulnerable individual. In the Dickens et al(2007) study, many patients expressed this view of covert-medication as an act of deception. They considered covert medication as an extremely coercive practice violating their personal rights. This resultantly damaged the therapeutic nurse-patient relationship and patients felt they were no longer in a safe, therapeutic environment. The nursing ethical principle of non-maleficence is similarly relevant to this discussion. It requires practitioners to safeguard their patients’ welfare by not inflicting pain or harm (Koch et al,2010). This requirement poses serious ethical dilemmas. It is difficult to uphold this ethical standard as all forms of medical intervention entail some element of harm. Koch et al,(2010) suggest that perhaps for the harm caused to be ethically permissible it should be pr oportional to the benefits of the medical treatment. The author thus feels that covert medication in Mr Walker’s case could be ethically justified under these ethical principles. The author will now focus on the ‘Analysis’ stage of Gibbs’ reflection model. Here, the author will critically analyse the events which occurred including the decision making process and the decision itself. The author will firstly discuss the issue of consent in relation to covert medication. The covert administration of medication is indeed a complex issue. It derives from the  essential principles of consent and patient autonomy which are deeply rooted in the UK statute, common law and the Human Rights Act 1998 (Lawson and Peate,2009). The UK law clearly considers bodily integrity a fundamental human right; a mentally competent adult has the right to refuse medical treatment regardless of how essential the treatment is to their health and well being (Kilpi, 2000). The freedom of choice which is reinforced by the ethical principle of respect for autonomy is an important right. The NMC(2008) further highlights in the Code that it is the nurses’ professional, legal and ethical duty to respect and uphold the decision made by the patient. If a nurse administers covert medication to a mentally competent individual, the nurse will be acting unethically (disregarding autonomy) and in breach of the law which could constitute grounds for trespass, assault or battery (NICE,2014), as shown in the cases R v SS [2005] and R v Ashworth Hospital [2003]. Thus practitioners have a professional, legal and ethical duty to respect the autonomous wishes of each patient. In Mr Walker’s case an MDT meeting was held prior to the covert administration of medication to consider Mr Walker’s lack of consent and his mental capacity to consent. The MDT consisted of: the general practitioner, psychiatrist, junior house officer, nurse-in-charge, home-manager, occupational-therapist, physio-therapist, speech and language therapist, pharmacist, dementia nurse specialist, student nurse, and two relatives. By holding an MDT meeting, the practitioners were acting in accordance with local policies and guidelines. The NICE(2014) guidelines state that health-care practitioners have a legal duty to investigate and take into account the patient’s wishes, as well as the views of their relatives, carers and other practitioners involved in the patient’s care. By consulting with the relevant parties, the decision made will be, â€Å"based on what the person would have wanted, not necessarily what is best for their physical or mental health†(Latha,2010). Latha thus argues that decisions based on the patient’s wishes show some respect for the patient’s autonomy and are much more ethical than isolated decisions to covertly administer medication. As such, a failure to consult the relevant parties may constitute a breach of legal, professional and ethical duty as shown in the Gillick v West Norfolk  Health case (Nixon,2013). However, the Dickens et al, (2007) study shows that nurses frequently administer covert medication without any prior discussion with the MDT, relatives or even the pharmacist. Such practice has led to some nurses being disciplined and charged with various offences (Wong et al,2005). Under UK law, covert medication could be legally justified and considered ethical if the patient is admitted to the hospital under the Mental Health Act (1982). It could also be justified if it is shown that the patient lacks capacity under the Mental Capacity Act(2005). The MCA(2005) introduced the 2 stage capacity test. This 2 stage-capacity-test was used by the MDT in Mr Walker’s case. The MCA test required the MDT to consider whether Mr Walker’s cognitive impairment rendered him mentally incompetent to make treatment decisions. The physician used the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and the Mini-Mental Status Examination tool (MMSE) to assess Mr Walker’s cognitive function and his capacity to consent. The MacCAT-T interview tool was used to assess Mr Walker’s ability to (1) understand his medical condition and the benefits/ risks of the medical treatment (2) his ability to appreciate this information (3) his reasoning ability and (4) his ability to communicate and express his decision. The results showed Mr Walker as mentally incompetent and lacking the capacity to consent. Mr Walker was (1) unable to understand the information given to him regarding his treatment (2) he was unable to retain or weigh up the information given to reach a decision (3) he was unable to communicate his decision effectively even when encouraged to use non-verbal communication such as blinking or squeezing a hand. The Mini-Mental Status Examination (MMSE) tool was also used by the physician to assess Mr Walker’s cognitive function. Mr Walker following the assessment scored a low score of 12 on the MMSE. The MDT provided further clinical evidence (screening tools, clinical data, memory tests , medical imaging results).There were some disadvantages associated with using the MacCAT-T assessment tool. The MacCAT-T tool itself does not give ‘cut off scores’ to clearly ascertain the boundary between capacity and incapacity. This is certainly a limitation. As shown in the Palmer et.al. (2002) study, this can lead to some patients with low scores being wrongly assessed as lacking capacity. The MacCAT-T tool also fails to recognise the emotional aspects of decision making (Stoppe, 2008). It assumes that people only rely on a  rational, analytic, rule-based thought process to make decisions. Breden and Vollman (2004) thus argue that, â€Å"the restriction to only logical rationality runs the risk of neglecting the patient’s normative orientation†. Other factors including situational anxiety, severity of the medical condition, medication could also impact on a person’s ability to articulate their decision making process. Furthermore, assessment tools like the MacCAT-T tool, largely depend on the clinician’s ability to carry out a clinical interview with the patient. It requires the physician to make an isolated evaluation and decision. Isolated judgements and evaluations can be unreliable as they can be influenced by factors such as subjective impressions, professional experience, personal values, beliefs and even ageism as shown in the Marson et.al. empirical study (Sturman,2005). In the study only 56% of physicians who participated in the capacity assessment of patients were able to agree on a capacity judgement. Many physicians found that they were unable to agree due to differences in medical experience, personal beliefs and subjective impressions. Such empirical evidence certainly questions the reliability of capacity assessment tools. Following on, effective communication skills were essential at this first stage of the capacity assessment as the team was required to consider whether Mr Walker was likely to recover capacity. Effective communication is certainly important in such MDT settings as, â€Å"effective communication, which is timely, accurate, complete, unambiguous, and understood by the recipient, reduces errors and results in improved patient safety† (Bretl,2008). Several studies have shown ineffective communication as a contributing factor in medical error cases (Rothschild, 2009). Through effective communication, each member of Mr Walker’s MD team understood the discussion at hand and was thus able to contribute new suggestions and solutions. The team implemente d communication skills such as negotiation, listening and goal setting skills.The MDT with input from Mr Walker’s relatives concluded that a best interest decision would have to be made on Mr Walker’s behalf. The general practitioner made it clear that the best interest decision would have to comply with the UK legal framework. The European Convention of Human Rights (ECHR) requires the medical treatment given to be respectful to the patient (Pritchard, 2009). In discussing Mr  Walker’s case, it was firstly established (during the medication review), that the treatment in question had both ‘therapeutic necessity’ and ‘therapeutic effects’ for the patient. The MDT when making a best interest decision also considered the risks and benefits of treatment in accordance with the ECHR requirements. The ECHR states that the medical treatment should not be given in a sadistic, inhumane or degrading manner (Human Right Review,2012). Similarly, the NICE(2014) guideline states that the harm that would be caused by not administering the medication covertly, must be greater than the harm that would be caused by administering the medication covertly. This requirement was satisfied by the practitioners in Mr Walker’s case. An in-depth risks and benefits assessment was carried out. The pharmacist’s input was essential at this stage. The pharmacist presented an evidence-based argument; discussing the essential medication with medical necessity. The pharmacist also provided guidance on the most appropriate form of administration; for example he suggested prescribing enapril in its liquid form (enaped). The pharmacist also provided guidance on the most appropriate method of administration; for example; not mixing the medication with large portions of food or liquid. Following this discussion with the pharmacist, a best interest decision was made to covertly administer Mr Walker’s medication. It was important for the MDT to consult with the pharmacist. The method of crushing, smashing tablets or opening capsules which is a commonly used when covertly administering medication is an unlicensed form of administration (NMC, 2008). It can inflict harm by altering the therapeutic properties which can cause adverse reactions and fatalities. When using this unlicensed method of administration, the practitioner is also unable to establish whether the patient has received the prescribed amount. If the patient is not receiving the correct dosage required for his treatment, the treatment is ineffective (Wong et al,2005). The pharmacist should therefore be consulted with. However, as demonstrated by the McDonald et al,(2004) study pharmacists are rarely consulted with. In the study, 60% of nurses working in UK care homes admitted to crushing tablets on each drug round to help patients with swallowing difficulties without firstly consulting with a pharmacist. Fortunately, in Mr Walker’s case, the pharmacist was able to provide guidance on the most appropriate method of administration. Following on, in such cases where the patient is  proven to lack capacity to consent to medical treatment, the Mental Capacity Act promotes the use of ‘best interest decisions’. In Mr Walker’s case, the MDT reached a ‘best interest’ decision to covertly administer his medication. However, there are some problems associated with the practice of relying on ‘best interest decisions.’ Baldwin and Hughes (2006), highlight the numerous problems associated with making best i nterest decisions. In their empirical study, Baldwin and Hughes found that practitioners and relatives often evaluate a patient’s quality of life differently. The results showed the poor performance of relatives and practitioners at predicting patients’ medical treatment preferences. Differences in cultural backgrounds, professional experiences, values and beliefs mean that decisions made may actually go against what the patient would have wanted. The failure to consider the patient’s values and believes was found to be a common occurrence in the Dickens et al,(2007) study. In this study, 18% of the nursing staff interviewed admitted that they would be willing to covertly administer medication to even those patients with capacity to consent, regardless of their values and beliefs, if the treatment was essential for their well-being. The legal framework in the UK was indeed established with the aim of safeguarding the welfare of the incapacitated person. However, with such results, it remains unclear the extent to which health-care professionals are actually adhering to the legal requirements. The Mental Health Foundation(2012) argues that the MCA, â€Å"needs revising to enable more effective ‘best interests decisions’ by health and social care staff.† In its investigation, the Mental Health foundation found that although a large number of health-care staff found the MCA to be an effective tool in ba lancing the ethical principle of autonomy and safeguarding patients lacking capacity, 63% of health-care practitioners felt the definition of mental capacity was not made clear, with many expressing the view that the legal framework does not â€Å"encompass the complexity of capacity assessments in practice† (MHF, 2012). The Griffith (2008) study and the Roy et al. (2011) further found that due to this lack of understanding, a large number of mental-health patients were wrongly assessed as lacking capacity, depriving them of their personal rights. These results suggest that health-care professionals perhaps require further training and education about the legality and practicalities of covert  medication. When used without the correct legal safeguards in place, covert medication undoubtedly becomes an extremely paternalistic unlawful and unethical practice. Following the anonymous ‘best interest’ decision to covertly administer Mr Walker’s medication. The decision making process was clearly documented; the mental capacity assessment, the best interest decision, method of administration (stating explicitly that the least restrictive method will be used) were all documented in Mr Walker’s care-plan and medication-chart. Accurate documentation and record keeping is essential as it safeguards service users’ human rights and ensures that health care professionals follow the legal framework as well as local policies and guidelines. Article 6 of the HRA, ‘right to a fair and public hearing’, also requires clinical records to be comprehensible, clear and concise so that they can be referred to if needed in a fair and public hearing. Following the MDT meeting, Mr Walker’s care plan was frequently discussed and reviewed by the MDT in monthly formal review meetings in compliance with local policies and guidelines. NICE (2013) guidelines state that it is important to frequently review covert medication decisions. Each individual is different and an individual’s mental state and capacity can change over time. By carrying out the monthly formal review meetings, the practitioners safeguard their client’s rights by ensuring that covert medication is still the most appropriate, lawful and ethical method of administration. In conclusion, the nurses of today certainly practice in a complex health care system. It is thus essential for nurses to have a good understanding of the ethical principles which underpin good nursing practice. In the nursing literature, nurses are often described as the â€Å"moral agents† of the health-care system (Sellman,2011). This means that nurses should value ethical reasoning; acting in such a way which balances good intentions against risk and the best outcome. Through good ethical reasoning nurses are able to promote patient comfort, patient’s safety, ease suffering, and promote patient welfare to enhance recovery. The covert administration of medication should therefore not be an isolated decision, it should comply with the legislation, ethical principles, local policies and guidelines. Bibliography The National Institute for Clinical Excellence, (2014). Managing medicines in care homes. [online] NICE. Available at: http://www.nice.org.uk/media/B5F/28/ManagingMedicinesInCareHomesFullGuideline.pdf [Accessed 17 Apr. 2014]. Beckwith, S. and Franklin, P. (2011). Oxford handbook of prescribing for nurses and allied health professionals. 1st ed. Oxford: Oxford University Press. Breden, T. and Vollmann, J. (2004). The cognitive based approach of capacity assessment in psychiatry: A philosophical critique of the MacCAT-T. Health Care Analysis, 12(4), pp.273–283. Bretl, A. (2008). Patient safety rounds. 1st ed. Oak Brook, Ill.: Joint Commission on Accreditation of Healthcare Organizations. Nursing and Midwifery Council, (2010). The Code. [online] NMC. Available at: http://www.nmc-uk.org/Documents/Standards/nmcTheCodeStandardsofConductPerformanceAndEthicsForNursesAnd- Midwives_LargePrintVersion.PDF [Accessed 16 Apr. 2014]. Dickens, G., Stubbs, J. and Haw, C. (2007). Administering medication to older mental health patients. Nursing times, 103(15), pp.30-31.Engedal, K. and Kirkevold, O (2005). Concealment of drugs in food and beverages in nursing homes: cross sectional study. BMJ, 330(7481), p.20.Equality Human Rights (2012). Article 3: Freedom from torture and inhumane and degrading treatment or punishment. [online] Available at: http://www.equalityhumanrights.com/uploaded_files/humanrights/hrr_article_3.pdf [Accessed 12 Apr. 2014]. Gibbs, G. (1988). Learning by doing. 1st ed. [London]: FEU. Griffith, R. and Tengnah, C. (2008). Mental Capacity Act 2005: assessing decision-making capacity 2. British journal of community nursing, 13(6), pp.284-293.Harris, N., Baker, J. and Gray, R. (2009). Medicines management in mental health care. 1st ed. Chichester, U.K.: Wiley-Blackwell. Hughes, J. and Baldwin, C. (2006). Ethical issues in dementia care. 1st ed. London: Jessica Kingsley Publishers. Husted, J. and Hust ed, G. (2008). Ethical decision making in nursing and health care. 1st ed. New York: Springer Pub. Co.Koch, S., Gloth, F. and Nay, R. (2010). Medication management in older adults. 1st ed. Totowa, N.J.: Humana. Latha, K. (2010). The noncompliant patient in psychiatry: The case for and against covert/surreptitious medication. Mens sana monographs, 8(1), p.96. Lawson, L. and Peate, I. (2009). Essential nursing care. 1st ed. Chichester, West Sussex, UK: Wiley-Blackwell. Leino-Kilpi, H. (2000). Patient’s autonomy, privacy, and informed consent. 1st ed. Amsterdam: IOS Press. Macdonald, A., Roberts, A. and Carpenter, I. (2004). De facto imprisonment and covert medication use in general nursing homes for older people in South East England. Ageing clinical and experimental research,16(4), pp.326-330. Masters, K. (2005). Role development in professional nursing practice. 1st ed. Sudbury, Mass.: Jones and Bartlett. Mental Health Foundation, MCA Code of Practice needs revising to enable more effective best interests decisions to be made. (2012). MHF News Archieve, [online] p.1. Available at: http://www.mentalhealth.org.uk/our-news/news-archive/2012/12-01-31/ [Accessed 12 May. 2014]. Nixon, V. (2013). Professional practice in paramedic, emergency and urgent care. 1st ed. Chichester, West Sussex: Wiley-Blackwell. NMC, (2008). Standards for medicines management. [online] Available at: http://www.nmc-uk.org/Documents/NMC-Publications/NMC-Standards-for-medicines-management.pdf [Accessed 16 Apr. 2014]. Palmer, B., Nayak, G., Dunn, L., Appelbaum, P. and Jeste, D. (2002). Treatment-related decision-making capacity in middle-aged and older patients with psychosis: a preliminary study using the MacCAT-T and HCAT.The American journal of geriatric psychiatry, 10(2), pp.207-211. Pritchard, J. (2009). Good practice in the law and safeguarding adults. 1st ed. London: Jessica Kingsley Publishers. Rothschild, A. (2009). Clinical manual for diagnosis and treatment of psychotic depression. 1st ed. Washington, DC: American Psychiatric Pub. Roy, A., Jain, S., Roy, A., Ward, F., Richings, C., Martin, M. and Roy, M. (2011). Improving recording of capacity to consent and explanation of medication side effects in a psychiatric service for people with learning disability: audit findings. Journal of Intellectual Disabilities, 15(2), pp.85-92.Sellman, D. (2011). What makes a good nurse. 1st ed. London: Jessica Kingsley Publishers. Stoppe, G. (2008). Competence assessment in dementia. 1st ed. Wie n: Springer. Sturman, E. (2005). The capacity to consent to treatment and research: a review of standardized assessment tools. Clinical psychology review, 25(7), pp.954-974. Treloar, A., Beats, B. and Philpot, M. (2000). A pill in the sandwich: covert medication in food and drink.Journal of the Royal Society of Medicine, 93(8), pp.408-411. Treloar, A., Beats, B. and Philpot, M. (2000). A pill in the sandwich: covert medication in food and drink.Journal of the Royal Society of Medicine, 93(8), pp.408-411. Wheeler, K. (2008). Psychotherapy for the advanced practice psychiatric nurse. 1st ed. St. Louis, Mo.: Mosby Elsevier. Wong, J., Poon, Y. and Hui, E. (2005). I can put the medicine in his soup, Doctor!. Journal of medical ethics,31(5), pp.262-265.