Tuesday, August 6, 2019
Sports and gamesan essential part Of Essay Example for Free
Sports and gamesan essential part Of Essay Sports is something that attracts every person in this world towards itself. Sports has become a very common field that everybody has interested in. People are gaining more and more interest in different sports from all over the world. And that is why sports engineering is gaining significance and recognition. It is a special field of engineering, which involves everything from the development to the testing of the different sports equipment. The discipline includes numerous activities and everything related to sports and sports equipment. The sports engineers have several responsibilities that are discussed here at length. The very first responsibility of a sports engineer is the designing of the sports equipment. With the development of different sports and an increase in their popularity, people are eager to make use of the best of the sports equipment. And this is where the sports engineers can contribute by developing new equipment that would help the athletes perform better. Sports engineers are also responsible for carrying out a complete lab and experimental testing of the sports equipment, athletes and the interaction between them. This is one of the most important parts of the job of a sports engineer because it is not possible to make use of anything without testing the equipment and the nature of interactions the users would have with the equipment. The sports engineers not only carry out laboratory testing but are also required to test the performance of the athletes and different devices in the field, i. e. the environment of the sports. Field testing needs to be completely accurate so that there is no scope of mistakes and the athletes are prepared to use their equipment in the real conditions and situations. Computational modeling has been used only for scientific purposes till now. Computational modeling approach is usually employed in physics and other scientific applications, whether it is fluid dynamics or any other experiment. Sports engineers are also making use of this technique and approach for determining the forces acting upon the working of the equipment and for stimulating its working before actually developing them. Sports engineers also need to continuously work with the different government bodies and the authorities for making sure that the rules are adhered to and everything is carried out within the pre-defined guidelines. Sports engineers also have to work with the athletes to regularly keep a track and improve the performance of the different athletes in different fields. They need to find out new ways and measures for enhancing the performance of the sportsmen. Thus, we see that sports engineers are extremely important people and they need to carry out all of their responsibilities sincerely for the development of different sports and for the betterment of the athletes. Reference link: http://classof1. com/homework-help/engineering-homework-help.
Monday, August 5, 2019
The North And South Gap In Economic Development
The North And South Gap In Economic Development According to dependency perspective has globalization increase or reduce the North and South gap in economic development? The international political economy is determined by two significant income gaps. The first is the significant gap between the rich and poor nations, and the second is the growing differences between groups of LDCs. When we analyze North-South differences, we observe the North and Souths problems -Western system-. North-South debate had became great significant at the end of the 20th century. The return from an investment on a sustainable basis gap between North and South is growing. Also, the objects produced by the states of the South become lesser costly for developed countries. Such situation enables the less developed nations to create more in order to buy even lesser goods from the wealth countries. It decreases the skills of the less developed countries to direct the global economy because their goods are not needed and their view is not taken into account by the rich countries. Therefore less developed countries are usually discomfort with the direction of the global economy because of the little role that they play in its organization. The North-South issue was studied by the three different philosophical approaches, which argued whether this gap could be decreased in the global economic system. Liberal theory of economic improvement is the theories in the International economy. Globalist or Marxist approaches look the problem in the free-trade system. Structuralists are between liberals and globalists because they claim that the system is not optimal however can be in peaceful manner reformed and organized again. All theories can be made judgments at many point, but all of them contain significant information for the complex view of the issue. Marxists keen on the economics of South by North, which is an initial pattern of the capitalist system. They claim that free-trade represents a non equal exchange between the North and the South in the economy dominated the North. Thats why because of its direction ability, a requirement for the raw materials and markets abroad, the North decreases prices on the materials exported from the North. The problem with this approach is that the Third World is not any longer very important to the wealth nations. Its exports goods dont have affect on the North because each consumptions of raw materials reduces because of changing growth patterns, conservation, substitution and technological developments. Structuralists has same view with Marxists that free trade is not equal exchange with most of its benefits belonging to the rich countries. But, they argue that it is not a required view of the system. They say the two structure of society when some people has primal conditions and some has the global economy due to their job in export industry. By regional integration structuralists say creating of trade associations among many developing nations to require attractive and reliable to the foreign investors. This theory problem is the question of its practical act of implying. There is a political trouble connected to the economic realm: how can the weakest state change their situation against the will of the strongest state? Another question is whether regulation can be do and what is needed to do for its strengthened. Since the end of World War ll, developing countries have searched several different ways in an effort to change their dependence. In the Bretton Woods era, developing countries were dependent on the developed North and pursued national strategies designed to isolate or protect themselves from the international economic system. The major aims of the developing countries are to handle poverty and inequality, growing and to has an important role in the global economy decision process. Developing nations demand to change the system or to adapt to it with the lowest cost to their economy. There are many general Southern strategies to achieve these aims, which were acquired many years later of samples and mistakes, such as the attempt to delink themselves from some aspects of the International economic system, the try to change the economic rule itself, and the try to increase the greatest level the gains from integration into the common system. After the decolonization period, the non wealth countries made political independence however did not provide economic level. In many situations developing countries experienced suffering in having some countries but their main state as their financial suppliers. The Developing states economies were limited of capital and technical skills. Both factors comprised the dependence of the Southern states on the technology realm and economic resources of the more developed countries. The other wave of dependence was that developing countries depend their economies on one exporting material and so soon became dependent on their main countries. Bad result of the dependence situation of the developing countries on a only one commodity was that the price decreased this very commodity effected the all economy and destabilized it. Free-trade system looked like to advantages all however the developing countries; therefore they were distrustful of its effectiveness. To restrain their dependence, d eveloping states began two new strategies; the import substitution strategy (IS) the export substitution strategy (ES). The other strategy to achieve economic improvement for developing nations was to want the United Nations assisting in the sense of aid from foreign and special trade choices for example lower tariffs. As a result of this together cry for changes G-77 was made to behave as last indefinitely political parts representing the interests of the developing nations in the UN. The structure of the (UNCTAD) -United Nations Conference on Trade and Development- which deliver the opinion of structuralists about the greater aid flows, limiting of free trade and control of MNCs, showed the confrontations between LDCs and wealth countries in UN. The tries of the LDC to establish their assembly to affect the wealth countries went beyond. In 1974 developing nations called for a New International Economic Order, which promises to solve the economic crises. Its achievement depended on the integrity of the Southern nations, credibility of their export goods and meaning their vulnerability by North. The New International Economic Order failed because of these three steps was not completed. Firstly, there was a high gap between the Newly Independent Nations and the less developed countries. In addition, the commodity became less costly for North, whose want raw materials were reducing. The other factor was that the North did not demand to make any changes besides what they were eager to do. The North suggest its help by agreeing to send the funds, to offer advise to learn about export strategies, to avoid degradation of the global circumstances and to decrease the flow of the Souths people to the North.    The shortcoming of the New International Economic Order did not solve the North-South issue. After 2. shock it became clear that oil suppliers and developing nations succeeding the export substitution strategy very well. Criticisms of Washington Consensus The term Washington Consensus was firstly coined in 1989 to describe a set of ten important economic policy offers that he considered should constitute the reform package provide for crisis-wracked developing countries based institutions such as the International Monetary Fund (IMF), World Bank, and the US Treasury Department. It has been criticized by people such as Joseph E. Stiglitz. This is the most important point of Stiglitzs criticisms of the IMF neo-classical approach in the South. They simply do not have the institutions or information transparency for the neo-classical model to work. Stiglitzs criticisms are about the disadvantages of globalization. He stated some problems about this consensus. The South is getting screwed by asymmetrical trade opening. The South is getting a raw deal on the opening up of services and intellectual property rights. The South would gain more from trade than aid. The IMF is too doctrinaire and ideological in applying its one size fits all to countries around the world. The IMF screwed up in East Asia, by mis-diagnosing the basic causes of the problem. The result of capital account crises combined with the IMFs classic medicine has been disaster. There is a huge market failure in world capital markets. All of the risk is being carried by the South because they cannot borrow long-term in their own currencies. Hence, the borrowers, not the rich lenders take the risk. CONCLUSION While both Liberals and Marxist advocate growth ideology, especially economic growth, these approaches do not give importance to power structures and relations. The main aim of these approaches that how can developing countries reach the standart of developing economy in the North. Whereas, social transformation is of highly importance for this transformation. After examining many different views to deal with the North-South issue, It can be said that solution of this problem is not simple. Gap between North and South can be decreased by some reforms. In light of these reforms, economy of developing countries must be developed. On the other hand, social development is of highly importance in terms of reducing of North-South gap. Equality of member in society must be provided.
Sunday, August 4, 2019
The Develoment of the Horror Genre Essay -- essays research papers fc
The term Gothic is significant for the understanding of the origins and development of the horror genre. Both of these genres differ, whilst Gothic literature is the text that explores the frightening extremes in mankind, horror focuses more on the unknown. The Gothic horror genre has changed over time and retains importance because it is the antecedent of the horror genre. Factors such as the definition of the word Gothic, the archetypes of the genre, and its social and historical contexts, have altered considerably as time progressed. The value and popularity given to the gothic horror genre has also varied during the past few centuries. As a result, in order to understand the horror genre’s foundations, it is important to observe the Gothic novel’s modifications. Horror stories have existed for thousands of years, initially in the form of verbal communication. The themes of ruthless enemies and supernatural beings were common themes in myths in an attempt to set morals. However, at present, the true horror literature in its written form mostly aims to entertain. Its forerunner, the Gothic novel, rose in the eighteenth century and was extremely popular until the nineteenth century in England. The meaning of ‘gothic’ varies exceedingly. The word initially refers to German tribes that took part in overthrowing Rome. This word can be perceived as a synonymous for barbarous and dreadful. Similarly, the horror genre also has factors of monstrosity and dread. The â€Å"Gothic†style of architecture was famous in the middle ages and has been found on many cathedrals such as Notre Dame. Historians would describe this style as â€Å"gothic†to suggest their negative opinion of the architecture, that it was tasteless and dry. Instead of conforming to this perception, people were only led to believe the word to mean â€Å"dark and ominous†. Gothic architecture, with the foreboding atmosphere posed around it, correlates with the Gothic novel because it has been a prevalent backdrop to gothic novels in the 19th century, such as Mary Shelley’s Frankenstein. These Gothic horror stories were some of the first examples of the horror genre, and are therefore vital for the understanding this field. In its historical context, the gothic horror genre is believed to have emerged as a response to a time of rational thought, the Enlightenment or the Age of Reason. This intellectual movement a... ...tablished in the modern horror genre, thus it is practical to observe the archetypes of the Gothic novel as well. This allows the responders to grasp a better understanding of the origins of horror elements. It is therefore evident that the Gothic horror genre has evolved a great deal over the past two hundred years or so. The Gothic novel has affected the horror genre because of the intrigue created with the intense emotions and aspects of human nature. This as a result creates Gothic horror, similar to the horror genre but instead plays on the horrifying attributes of the radical human mind rather than the dread of the unknown and the irregular. In order to become more aware regarding the origins of the horror genre, it is important to understand the progress of the Gothic. It is notable to recognise the meaning of the term, its changing values, historical context and the varying archetypes of the Gothic novel in order to become acquainted with the horror genre’s development. Bibliography: http://academic.brooklyn.cuny.edu/english/melani/gothic/history.html http://www.wwnorton.com/nael/romantic/topic_2/welcome.htm http://cai.ucdavis.edu/waters-sites/gothicnovel/155breport.html
menopause Essay -- essays research papers
 ·Ã‚     Menopause is the time in a woman’s life when the function of the ovaries ceases. The ovary, or female gonad, is one of a pair of reproductive glands in women.  ·Ã‚     The process of menopause does not occur overnight, but rather is a gradual process. This so-called perimenopausal transition period is a different experience for each woman.  ·Ã‚     The average age of menopause onset is 51 years old. There is no single method to predict when a woman will experience menopause.  ·Ã‚     The age at which a woman starts having menstrual periods is not related to the age of menopause onset.  ·Ã‚     A women is in menopause when she has had no menstrual periods (menses) for 12 months and has no other medical reason for her menses to stop.  ·Ã‚     Symptoms of menopause can be divided into early and late onset symptoms. Early symptoms include abnormal vaginal bleeding, hot flashes, and mood changes. Late symptoms include vaginal dryness and irritation, osteoporosis, and heart disease.  ·Ã‚     Treatments for menopause are directed toward alleviating the symptoms present in the particular woman affected. *What is menopause? Menopause is the time in a woman’s life when the function of the ovaries ceases. The ovary, or female gonad, is one of a pair of reproductive glands in women. They are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries produce eggs (ova) and female hormones. During each monthly menstrual cycle, an egg is released from one ovary. The egg travels from the ovary through a fallopian tube to the uterus. The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. The hormones also regulate the menstrual cycle and pregnancy. The process of menopause does not occur overnight, but rather is a gradual process. This so-called perimenopausal transition period is a different experience for each woman. Scientists are still determining all the factors that affect when this transition begins and the details of how it occurs. The average age of menopause is 51 years old. Although women tend to undergo menopause at an age simil... .... HTML1DocumentEncodingutf-8What is menopause? When does a woman know she is in menopause? Are hormone levels or other blood tests helpful in detecting menopause? What are the symptoms of menopause?  ·Ã‚      ·Ã‚     Abnormal Vaginal Bleeding  ·Ã‚      ·Ã‚     Hot Flashes  ·Ã‚      ·Ã‚     Mood Symptoms  ·Ã‚      ·Ã‚     Vaginal Symptoms  ·Ã‚      ·Ã‚     Osteoporosis  ·Ã‚      ·Ã‚     Heart disease What are the treatment options for menopause?  ·Ã‚      ·Ã‚     Abnormal Vaginal Bleeding  ·Ã‚      ·Ã‚     Hot Flashes  ·Ã‚      ·Ã‚     Mood Symptoms  ·Ã‚      ·Ã‚     Vaginal Symptoms  ·Ã‚      ·Ã‚     Osteoporosis  ·Ã‚      ·Ã‚     Heart Disease
Saturday, August 3, 2019
Software Piracy Essay -- Illegal Computer Software Program Distributio
Software Piracy Software piracy is the illegal reproduction and distribution of software applications, whether it is for personal use or business. In society today, Internet users are obtaining millions of dollars in software illegally. Piracy includes the illegal copying of programs, counterfeiting and distributing software, and even sharing a program with a friend. Software has become such an important productivity tool, the illegal copying and distribution of software piracy persists globally. In fact, in the United States is one in four software programs that is unlicensed. According to the Business Software Alliance (BSA), more than 800,000 web sites illegally sell or distribute software (Microsoft.com). There are many types of software piracy such as uploading and downloading, softlifting, counterfeiting, OEM bundling, hard disk loading and renting. By having familiarity with them can protect you from any connection. Softlifting is purchasing a licensed copy of software and uploading it on several computers against the license terms. Some examples of softlifting are sharing software with friends, co-workers and others. Uploading and downloading is another form of piracy, such as when making unauthorized copies of copyrighted software available to end users connected by a modem to online service providers and or the Internet. Another one is software counterfeiting which is illegal duplicating and selling copyrighted software and a form designed to make it appear legitimate. OEM bundling is selling stand alone software that was intended to be bundled with specific accompanying hardware. Hard disk loading is installing unauthorized copies of software onto the hard disks of personal com puters, often as an incentive for th... ...t the economic implications of software piracy and software copyrights. Other analysts feel that copyright enforcement should be increased by implementing more efforts to prosecute pirates ( Parsons 165). Survey about Software Piracy Survey questions on Software Piracy YES NO 1. Do you know what software piracy actually is? 15 10 2. Do you know the negative effects of software piracy? 8 12 3. Do you even care about software piracy? 16 9 4. Do you feel that the media discusses the issue of software piracy? 7 13 Works Cited www.microsoft.com www.aladdin.com Computer Concepts. New Perspectives. June Parsons. Course Technology. 5 Feb 2003.
Friday, August 2, 2019
Metternich’s Political Confession of Faith Essay
Prince Klemens von Metternich was the leading personality during the Congress of Vienna which sought to restore Europe back to the status quo, undoing the â€Å"disorder†caused by Napoleon. Besides being instrumental in â€Å"cleaning up Napoleon’s mess,†Metternich was a conservative at heart and saw the â€Å"damage†the French Revolution had brought to France and how Napoleon tried to import the legacy of the French Revolution, as well as the Enlightenment, to the rest of the lands in Europe he conquered and the subsequent effects thereafter. Metternich wrote â€Å"Political Confession of Faith†which he addressed to Russian Tsar Alexander I as a â€Å"secret†memorandum in 1820. This also came at a time when there were similar revolutions, led by liberals in parts of Spain, Italy and Germany. This document revealed Metternich’s sentiments about the emerging trend in Europe – the rise of liberalism. For Metternich, this was a trend that was a major area of concern not only for him but for the rest of Europe. He had singled out France for being the â€Å"cradle of the Enlightenment†when he said: â€Å"France had the misfortune to produce the greatest number of these men. It is in her midst that religion and all that she holds sacred, that morality and authority, and all connected with them, have been attacked with a steady and systematic animosity, and it is there that the weapon of ridicule has been used with the most ease and success. Drag through the mud the name of God and the powers instituted by His divine decrees, and the revolution will be prepared! Speak of a social contract, and the revolution is accomplished! †A staunch conservative monarchist, He saw what the French Revolution, whose leaders were imbued with Enlightenment ideas toppled the monarchy which they regarded as obsolete and irrelevant owing to its inability to care for its people, did to French society. For the French people, they no longer recognized the Divine Right of kings and instead saw it from a different prism – King Louis XVI did not live up to the â€Å"social contract†and in doing so, lost his legitimacy to rule and when Louis tried to stifle their rights, they took drastic action that led to his overthrow. What happened next was something that made Metternich concerned – the Reign of Terror which saw what Metternich noticed as a spree of persecution with reckless abandon of those said to be colluding with the old regime. Not only was Louis XVI and his wife Marie Antoinette, the daughter of Austrian Empress Maria Theresa, executed, but several others who had no connection with them, including members of the clergy were also persecuted or sent to the guillotine. He deplored Napoleon for making quite a mess of European society: â€Å"Nevertheless the revolutionary seed had penetrated into every country and spread more or less. It was greatly developed under the regime of the military despotism of Bonaparte. His conquests displaced a number of laws, institutions, and customs; broke through bonds sacred among all nations, strong enough to resist time itself; which is more than can be said of certain benefits conferred by these innovators. From these perturbations it followed that the revolutionary spirit could in Germany, Italy, and later on in Spain, easily hide itself under the veil of patriotism . †For Metternich, as shown in his secret memorandum to the Russian Tsar, liberalism was regarded as a menace to the status quo of Europe where most of the states were still monarchical. Whereas the relatively young republic of the United States of America would be all praises of liberalism, Metternich and his ilk were not. The French Revolution, particularly the Reign of Terror served as a wake-up call to the remaining monarchies to make them stand up and take notice on what could possibly happen if they would allow liberal ideas to germinate in their societies. He warned the other surviving monarchical governments to be on guard by saying, â€Å"The first principle to be followed by the monarchs, united as they are by the coincidence of their desires and opinions, should be that of maintaining the stability of political institutions against the disorganised excitement which has taken possession of men’s minds†¦ In short, let the great monarchs strengthen their union, and prove to the world that if it exists, it is beneficent, and ensures the political peace of Europe: that it is powerful only for the maintenance of tranquillity at a time when so many attacks are directed against it; that the principles which they profess are paterllal and protective, menacing only the disturbers of public tranquillity . †Metternich’s admonition paid off as it was evident during the revolutions of 1848 when liberal movements failed to gain a foothold or emulate the success of the French Revolution. The reason being was that these societies had no long history of empowering the people and only radical means was necessary to do it. The bottom line Metternich was pointing out was that liberalism could not be drastically erected and revolution was not always the answer to addressing the social and political problems. Furthermore, the Reign of Terror also saw how ugly liberalism would go when taken to the extreme in bringing even more instability in exchange for bringing too much freedom to the people. Bibliography Metternich, Klemens von. â€Å"Political Confession of Faith. †Fordham University Modern History Sourcebook. December 20, 1820. http://www. fordham. edu/haslall/mod/1820 metternich. html/
Thursday, August 1, 2019
An Essay on Clinical Negligence
An Essay on Clinical Negligence â€Å"We have always thought of causation as a logical, almost mathematical business. To intrude policy into causation is like saying that two plus two does not equal to four because, for policy reasons, it should not. †(Charles Foster NLJ 5/11/2004 page 1644). To what extent do you consider that Charles Foster is correct in that causation and clinical negligence should be a â€Å"mathematical business†and the courts have, by introducing matters of policy, confused what should be a logical approach? Introduction: In the article of â€Å"It should be, therefore it is†1, its author, Charles Foster examined the surprise House of Lords judgment in Chester v Afshar2, what he described as â€Å"an exercise in legal creativity that abolishes the requirement for causation in any meaningful sense. †To discuss the above issue, one must consider the legal requirements of clinical negligence. In order for a patient to succeed in a claim for clinical negligence against his doctor, he must be able to satisfy three requirements: first, he must establish that a duty of care was owed by the doctor or hospital to himself; second, he must prove that the doctor has breached that duty of care by failing to reach the standard of care required by the law; lastly, the patient must prove that his injury was caused by the doctor’s negligent act. Each of these requirements for negligence will be considered as the strict requirements for a successful claim of the patient suffering from an adverse event in a medical context. These steps were referred by Charles Foster as the logical â€Å"mathematical business†3towards establishing the causation in a clinical negligence case. Is Chester’s case a relaxation of the causation requirements? To discuss this statement, one must consider whether the breach of duty causes the harm to the patient. Even if a doctor breaches his duty of care by falling below the standard of care, a patient can only recover his damages if he can prove that breach has caused some harm to him. 1. â€Å"It Should Be, Therefore It is†(2004) 154 New Law Journal 7151. 2. [2004] UKHL 41. 3. Charles Foster New Law Journal 5/11/2004, p. 644. If the doctor breaches his duty of care, but the patient suffered no injury, or would have suffered an identical harm regardless of the doctor’s failing, then the doctor is not proven negligent. This can be illustrated by the case of Barnett v Chelsea and Kensington Hospital Management Committee4. In this case, the doctor ha s breached his duty of care to the deceased man by not examining him personally, but the action for clinical negligence failed, because even if the patient had been seen by the doctor, the arsenic poisoning was regarded as too far advanced for an antidote to be life-saving. In other words, by the time the patient arrived at the hospital, he was destined to die irrespective of the actions or negligent omissions of the doctors. Although his doctor failed to meet the requisite standard pf care in treating him, this did not in itself cause any harm to the patient. 4. There are two ways of interpreting this causation requirement. On the one hand, there exists a reasonable principle that a person should not be held liable for damage which he did not cause. On the other hand, there is no legal evidence for incompetent medical care unless the patient can prove that the doctor’s action indeed caused some identifiable harm. The particular patient is Barnett should have been attended by a doctor, but the fact that he was not subject to compensation. In recent years, the English legal system has recognized that a very strict application of the causation requirement can result in injustice for the patient and therefore there have been gradual moves towards a relaxation of this requirement. In Bolitho v City & Hackney Health Authority5, for instance, a strict application of the traditional causation test of â€Å"but for†– that is the harm would not have been caused but for the doctor’s clinical negligence- was self-evidently not satisfied. It could be recalled in this case the doctor failed to attend the patient but argued that, if she had indeed attended, she would not have provided the treatment (intubation) which could have save the child. Therefore, it is crystal clear that the harm of the child’s death would have occurred even if the doctor had met her duty of care by attending the patient. Despite the court was not willing to settle for this conclusion and instead enquired into whether the doctor’s intended failure to intubate if she had attended would have been clinically negligent in itself. This implies that it was considered by the court at all is an indication that, if some serious harm has occurred, the courts will take into considerations the entire circumstances of the case before coming to the conclusion as to whether the causation requirement has been satisfied. 4. [1968] 1 A11 ER 1068. 5. [1997] UKHL 46, HL. The approach can be seen even more controversially in the 2004 case of Chester v Afshar6, which Charles Foster has made his comment on as mentioned. This case involved a doctor’s clinical negligent failure to warn a patient about the risk inherent in a medical procedure. There exists a need for the patient’s consent to medical treatment to be fully informed. The complication with respect to causation arose because the patient admitted that she would have still undergone the surgery even if she had been warned about the risks of paralysis which unfortunately materialized during the medical procedure. Therefore, the doctor’s failure to disclose this risk, although a breach of his duty of care, did not on the strict application of the causation requirement, cause the harm suffered by the patient. When Chester reached the House of Lords, the House was divided on the issue of causation. The Court of Appeal, taking a strong and pragmatic approach, held that the claimant could succeed by applying conventional causation principle. Therefore it could be said that the claimant’s injury had resulted from receiving a particular operation at a particular time. If the defendant had warned her about the risks, she would not have that particular operation- she would have had an operation (with the same risks) at a later date. If she had had this later operation, in all probability, the very small risk of disability would not have happened. On this basis, it could be said that the defendant’s failure to warn had led to the claimant’s disability. However, the House of Lords did not find this kind of approach attractive. As Lord Hoffman put it, the approach of the Court of Appeal was: †¦about as logical as saying that if one had been told, on entering a casino, the odds on the number 7 coming up were only 1 in 37, one would have gone away and come back next week or gone to a different casino. The question is whether one would have taken the opportunity to avoid or reduce the risk, not whether one would have changed the scenario in some irrelevant detail. †7 In the House of Lords, both the majority and minority rejected r easoning of the Court of Appeal and held that the claimant could not succeed in proving causation on conventional principles. For the minority (Lord Hoffman and Bingham), this was sufficient to dispose the case. However, the majority went on to state that, for policy reasons, the traditional rules of causation ought to be relaxed to allow the claimant to 6. [2004] UKHL 41 7. [2005] 1 AC 134, per Lord Hoffman, at paragraph 31. succeed. Central to their Lordship’s reasoning was the need to give effect to the right of a patient to make an informed choice about whether and when to undergo medical treatment. In law, this right was made possible by a doctor’s duty to warn the patient about any significant risks involved in the medical treatment. There would therefore be injustice if breach of this duty did not lead to a remedy. If the doctor were not made liable for such a breach, the duty to inform the patient about significant risks would, as Lord Hope put it, be a â€Å"hollow one†. His Lordship said: â€Å"The function of the law is to enable rights to be vindicated and to provide remedies when duties have been breached. Unless this is done the duty is a hollow one, stripped of all practical force and devoid of all content. It will have lost its ability to protect the patient and thus to fulfill the only purpose which brought it into existence. On policy grounds therefore I would hold that the test of causation is satisfied in this case. †8 Lord Steyn shared this view that the vindication of the patient’s rights was the overriding considerations: â€Å"Her right of autonomy and dignity can and ought to be vindicated by a narrow and modest departure from traditional causation principles†¦This result is in accord with one of the most basic aspirations of the law, namely to right wrongs. †9 On policy grounds, therefore, Lord Hope, Steyn and Walker held that the test of even though they agreed with Lord Bingham and Hoffman that this required a departure from the traditional principles. The simple fact that the patient’s injury was â€Å"intimately involved with the duty to warn†10 was sufficient for Lord Hope, while Lord Walker emphasized that the doctor had failed in his professional duty and the patient â€Å"has suffered injury directly within the scope and focus of that duty†. 11 In summary, the two dissenting Lords emphasized that Miss Chester had failed to prove that the doctor caused her injury. Lord Bingham said that â€Å"she cannot show that the clinical negligence proved against Mr. Afshar was, in any ordinary sense, a cause of her loss†12 and Lord Hoffman noted that â€Å"on ordinary principles of tort law the 8. 2005] 1 AC 134, per Lord Hope, at paragraph 87. 9. [2004] 4 A11 ER 587, per Lord Steyn, paragraph 24-25. 10. [2004] 4 A11 ER 587, per Lord Hope, paragraph 87. 11. [2004] 4 A11 ER 587, per Lord Walker, paragraph 101. 12. [2004] UKHL 41, per Lord Bingham, paragraph 9. defendant is not liable†. 13 Both of these j udges therefore held that Miss Chester could not recover damages with respect to Mr. Afshar’s negligent disclosure. Even the judges in the majority acknowledged that the traditional causation requirement had not been satisfied in this case. Lord Hope, for instance, who gave the leading judgment, accepted that â€Å"a solution to this problem which is in Miss Chester’s favour cannot be based on conventional causation principles†. 14 The majority allowed Miss Chester to recover damage based on some vague policy reasons. Lord Hope elaborated that the key question for the House of Lords was â€Å"whether in the unusual circumstances of this case, justice requires the normal approach to causation to be modified†. 15 Lord Hope further explained that â€Å"the function of the law is to enable rights to be vindicated and to provide remedies when duties have been breached. Unless this is done, the duty is a hollow one, stripped of all practical force and devoid of all content†. 16 Lord Steyn shared this view that the vindication of the patient’s rights was the overriding consideration: â€Å"Her right of autonomy and dignity can and ought to be vindicated by a narrow and modest departure from traditional causation principles†¦This result is in accord with one of the most basic aspirations of the law, namely to right wrongs. †17 As a result, the consequence is that where there is a breach of duty to disclose and the plaintiff suffers from . he actual harm he or she should have been warned about, then a claim for damages is more likely to succeed. The patient would recover if they would have deferred the procedure. The plaintiff no longer have to demonstrate that he or she would have refused the procedure completely if he or she had been told about the undisclosed risk. The adaptation of the causation requirement in Chester v Afs har has been the subject of considerable debate and criticism. Green18, for example, argues that the law of torts â€Å"is concerned not with compensating those who have suffered loss as a result of the defendant’s breach of duty†. This very point is emphasized by Lord Bingham in his dissent when he argues that â€Å"a claimant is not entitled to be compensated, and a defendant is not bound to compensate the claimant, for damage not caused by the negligence complained of†. 19 To some extent this is a convincing argument. 13. [2004] UKHL 41, per Lord Hoffman, paragraph 32. 14. [2004] UKHL 41, per Lord Hope, paragraph 81. 15. [2004] 4 A11 ER 587, per Lord Hope, paragraph 85. 16. [2004] 4 A11 ER 587, per Lord Hope, paragraph 87. 17. [2004] 4 A11 ER 587, per Lord Steyn, paragraph 75. 18. Sarah Green, â€Å"Coherence of Medical Negligence Cases: A Game of Doctors and Purses†. (2006) 14 Med Law Rev. 1, p. 4. 19. Chester v Afshar [2004] 4 A11 ER 587, paragraph 9. Miss Chester was awarded full damages for the injury she suffered even though this injury was not really caused by the doctor’s actions, which seems unjust. However, the point which is missed here is that the doctor’s negligent non-disclosure did cause a different loss to Miss Chester. Green20 argues that Miss Chester â€Å"lost nothing of value†, but I believe this is not true: she lost her right to make an autonomous choice about her medical treatment. In daily clinical practice, autonomy with respect to healthcare requires that a patient is fully informed about the medical treatment before he or she can consent to it. On the other hand, the right to refuse consent to medical treatment, which is protected in both English common law and international human right law, requires that an informed choice be made by the patient. In Miss Chester’s case, she was denied of this particular right. She agreed to undergo the surgery in ignorance of its risks and true nature. Her right to autonomy was therefore denied. Green’s opposing view can be explained as follows: â€Å"A patient’s dignity and right to decide is protected by the law of tort’s recognition that a doctor has a duty to warn, not by the readiness to override causal considerations in the claimant’s favour. If a breach of that duty to warn causes the patient no loss, then a finding of no liability does not violate that right. It merely serves as an acknowledgment that the patient’s inability to exercise that right did not, on this occasion, causes any harm†. 21 A fundamentally different viewpoint of this situation is taken here. The inability to exercise a right to autonomy is regarded as a harm in itself, regardless of the actual physical injury resulted. This rights-based approach means that Mason and Brodie22 are correct to regard the award of full damages to Miss Chester as inconsistent with the House of Lords’ modified approach to causation as follows: â€Å"One can understand the concern to allow the plaintiff to vindicate her rights. However, the measure of damages allowed does not, in truth, reflect the loss suffered because, at the end of the day, the loss lay in an invasion of autonomy per se, and an award of full damages can be said to over-compensate. 23 20. Sarah Green, â€Å"Coherence of Medical Negligence Cases: A Game of Doctors and Purses†. (2006) 14 Med Law Rev. 1, p. 14. 21. Sarah Green, â€Å"Coherence of Medical Negligence Cases: A Game of Doctors and Purses†. (2006) 14 Med Law Rev. 1, p. 9-10. 22. K Mason and D Brodie, â€Å"Bolam, Bolam- Wherefore Are Thou Bolam? †(2005) 9 Edin LR298, p. 305. 23. K Mason and D Brodie, â€Å"Bolam, Bolam- Wherefore Are Thou Bolam? †(2005) 9 Edin LR298, p. 305. The House of Lords judgment in Chester v Afshar represents a significant departure from the traditional requirements of a negligence action. It is an imperfect the emphasis upon vindication of the patient’s rights is insufficiently explained and justified. But it is also encouraging from a human rights perspective to see this judicial recognition at the highest level that causation requirements should not act as a barrier to recovery where a patient’s rights have been infringed during the provision of medical care. Manson and Laurie24 refer to a trend to â€Å"assist the plaintiff over the causation hurdle in medico-legal cases†25 and, given the great hurdle still in place with respect to proving a breach of the duty of care, this should in general be welcome. Andrew Grubb26 argues that the majority in Chester made the right decision: â€Å"It is difficult to argue with [the majority’s] reasoning. It would undermine the rule and be unjust for a doctor to require a patient to show that she would never have a particular procedure in the future. It is also counterintuitive to think that because the patient may run the risk in the future- by agreeing to and having the procedure- the negligence is not connected to her injury. At worst, she will be exposed to a small risk of injury which is unlikely then to eventuate. She had in a real and immediate sense suffered injury that she would not otherwise have suffered. That should be sufficient to establish a causal link†. 27 If Miss Chester‘s loss is better described as the loss of the right to make an informed consent, rather than exposure to a risk which she would have avoided if given proper information, it could be argued that damages should be directed towards compensating her for this deprivation of autonomy, rather than for the physical injury she suffered. It is interesting that the majority in Chester did not consider the possibility of making a â€Å"conventional award†as they had done in Rees v Darlington memorial NHS Trust28, for the patient’s loss of autonomy. The majority awarded Miss Chester full damages for physical injury, despite the fact that their judgments describe the real loss in this case as the deprivation of the right to make an informed choice. As 24. JK Mason, A McCall Smith & G Laurie, Law and Medical Ethics, 7th edit, (Oxford, Oxford University Press, 2006), p. 39. 25. JK Mason, A McCall Smith & G Laurie, Law and Medical Ethics, 7th edit, (Oxford, Oxford University Press, 2006), p. 339. 26. â€Å"Consent to Treatment: The Competent Patient†, 31-203 in A Grubb with J Laing(eds), Principles of Medical Law, 2nd edition, (Oxford, Oxford University Press, 2004), p. 200. 27. â€Å"Consent to Treatment: The Competent Patient†, 31-203 in A Grubb with J Laing(eds), Principles of Medical Law, 2n d edition, (Oxford, Oxford University Press, 2004), p. 200. 28. [2003] UKHL 52. J Kenyon Mason and Douglas Brodie29 point out, this may mean that Miss Chester was over-compensated: â€Å"However, the measure of damages allowed does not, in truth, reflect the loss suffered because, at the end of the day, the loss lay in an invasion of autonomy per se, and an award of full damages can be said to over-compensate. What is, in some ways, surprising is that, the solution adopted in Rees v Darlington Memorial NHS Trust was not applied here. There, the requirements of distributive justice meant that damages should not be awarded to compensate the plaintiff for the loss that ad arisen as the result of a failed sterilization operation†¦The solution adopted was to award a â€Å"modest†conventional sum by way of general damages to acknowledge the infringement of the plaintiff’s autonomy by the fault of the defendant†. 30 The possibility of a conventional award was mentioned by Lord Hoffman, in his dissenting judgment: †I can see that there m ight be a case for a modest solatium. †31 In the end, he rejects this solution for two reasons: it would be difficult to settle on an appropriate amount, and on the grounds of costs, the courts would be an unsuitable place to pursue what would always be a modest award. Effectively, then, the consequence of Chester’s case is that autonomy-based right to make an informed consent is so important that doctors who fail to warn patients about material risks associated with treatment may have to indemnify patients should those risks materialize, despite the exercise of all proper skill and care in carrying out the operation, and critically, despite the fact that the patient admits that they would have been prepared, in fact, to knowingly run this risk on another occasion. Difficulty in proving causation: The full impact of the House of Lords’ relaxation of causation principles in Chester v Afshar remains to be seen. There are a number of reasons why the causation requirement raises particular difficulties in actions for negligence non-disclosure of relevant information. 29. â€Å"Bolam, Bolam- Wherefore Are Thou Bolam? †(2005) 9 Edin Law Rev. p. 298-305. 30. â€Å"Bolam, Bolam- Wherefore Are Thou Bolam? †(2005) 9 Edin Law Rev. p. 298-305. 31. [2004] UKHL 4, per Lord Hoffman, paragraph 34. 32. â€Å"A warning about causation†(1999) 115 Law Quarterly Rev. 1-27, p. 23. 33. â€Å"From Informed Consent to Patient Choice: A New Protected Interest†(1985) 95 Yale Law Journal 219. 34. â€Å"From Informed Consent to Patient Choice: A New Protected Interest†(1985) 95 Yale Law Journal 219. First, a successful claim in negligence for failure to disclose a material risk is in practice synonymous with strict liability for medical mishaps. Informed cons ent therefore becomes a route for patients to seek financial compensation for unfortunate but blameless medical outcomes. Doctors who exercised all reasonable care and skill in performance of an operation will be found liable for the consequences of an accident which they could have done nothing to prevent just because their pre-operation disclosures were inadequate. As Peter Cane32 explains, â€Å" whatever the ideological basis of the duty to warn (or, in other words, the interest which it protects), its importance in practice lies in providing a basis for imposing liability for physical injury not caused by clinical negligence†. Secondly, because the claimant must prove that the inadequate disclosure caused her injury, cases only come before the courts where the patient has not been informed about the risk of an adverse outcome which has then materialized. Adequate information is not, however, confined to disclosure of risks. In order to exercise meaningful choice, it is important that the patients are told about alternatives to the proposed treatment. As Marjorie Maguire Shultz33 explains, negligently depriving the patient of choices will rarely result in the sort of damage or injury which is recognized in tort law: [P]reemption of patients’ authority by doctors may also give rise to injuries that are real but intangible, or to physical outcomes that are arguably not â€Å"injurious†except from the individual’s vantage point. These outcomes may be excluded from negligence doctrine’s definitions of harm. Thus, a patient not told about a method of sterilization that is more revers ible than the one performed may have difficulty convincing the court that non-reversibility is a cognizable physical injury. A patient who alleges that, properly informed, she would have chosen a lumpectomy rather than a radical mastectomy might find it hard, under existing negligence rules, to characterize the successful operation that removed her breast and eradicated her cancer as having â€Å"injured†her. Similarly, the patient with a desire to go home or to a hospice to die, who is instead maintained alive by hospital machinery, might have difficulty establishing â€Å"injury†under definitions of an interest in physical well-being rather than choice†. 34 Thirdly, â€Å" cause†appears to have acquired a rather special meaning in failure to warn cases, Peter Cane has explained, the doctors in these cases rarely â€Å"caused†the injury in question â€Å"in the central sense of the word â€Å"cause†as it is used outside the law†, because â€Å"failure to warn of a risk does not â€Å"cause â€Å" the materialization of the risk†. Rather the injury has usually been caused by an unfortunate and inherently unlikely combination of circumstances, and the doctor simply created the situation in which this extraordinary sequence of events could occur. The question of whether a doctor should be liable for a failure to disclose a risk is more accurately stated as whether she should be liable for creating the situation in which an accidental injury might or might not occur. Conclusion: There is an elegance to a legal structure that requires doctors to owe a â€Å"single comprehensive duty†in negligence covering diagnosis and treatment, and the associated obligations to inform. Diagnosis and treatment are essentially the exercise of the medical professional skills and therefore fall fairly into the arms of negligence. The duty to inform, however, seeks to protect the patient interest in self-determination. This seems more fairly addressed by an action that is complete with the injury to the interest protected. Such an action would be more akin to an action in battery. The fact that legal action for inadvertent misinformation in relation to the inherent risks/benefits of treatment lies in negligence rather than in battery leaves a legal structure that has some tension within in it. Where battery, constrained as it is by touching, is an ill-fitting robe negligence barely covers the mischief. In English law, negligence actions for negligent misinformation have seen this tension expressed as a strong dissent by Lord Scarmen in the case of Sidaway v Bethlem Royal Hospital Governors35, and then as a weakening of the causation rule in Chester v Afshar. Notice how weakening the causation rule in Chester v Afshar. Notice how weakening the causation requirement makes the action of clinical negligence more akin to a battery action- the very action precluded by the rule in Reibl v Hughes in such cases. In Chester v Afshar, the plaintiff would have had the operation at a different time and so something would have changed had the information about risk been given. The core of the principle in this case comes when the plaintiff does not change anything as a result of the misinformation. Can they still succeed where they suffer the very harm they should have been worried about? If so, we have a clinical negligence action that looks suspiciously like a battery action but protects the interest of self-determination. The use of clinical negligence in this context has arisen by default. The structure of a claim in clinical negligence is simply the wrong one to protect a fundamental interest like self-determination and the strain is telling.
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