Death and Dying

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Running Head Death and Dying

Death and Dying

Jacqueline Lewis

Medical Ethics

J. Holly.

Outline

Introduction Death and Dying

I. Death

a) Definition

1) Clinical

) Physical

II. Types

a) Physical

b) Clinical

III. Dying

a) Stages

b) Needs

IV. Advance Directives

a) Definition

b) Types

V. Losses / Grief

a) Child

b) Spouse

V I. Conclusion

Death

Death is a cessation of all life (metabolic) processes. Death involves the organism as a whole (Somatic) or is confined to cell and tissues within the organism (physical). Certain criteria determine if death has occurred; loss of a heartbeat, decrease in body temperature, loss of color in the body, and biological disintegration. Some causes of death include but are not limited to injury, acute or chronic disease, and neophasia (cancer).

A physical death is called "Necrobiosis" or death of cells caused by external changes, i.e. an abnormal lack of blood supply (necrosis). A clinical death is known as a "Somatic" death which is the discontinuance of cardiac activity and respirations. This leads to death of all body cells due to a lack of oxygen. However there is a six minute span of time after somatic death in which vital organs have not been damaged and can be revived.

Types

There are only two types of deaths, "clinical and physical" Brain death is another stage of death this is now a legal condition used in most states for declaring deaths. It requires the absence of the behavioral reflux motor functions above the neck, pupillary reflexes, jaw reflex, gag reflex, no response to noxious stimuli, and no respiratory movement for at least twelve hours. Cardiac death is defined as death in which the heart has stopped functioning; this too is considered a legal death. In the United States the top fifteen leading causes of death are, diseases of the heart, cancer, cardiovascular disease, chronic respiratory disease, accidental (unintentional injuries), diabetes, mellitus, influenza and pneumonia, Alzheimer's, nephritis, septicemia, suicide, cirrhosis, hypertension, homicides, and pneumonitis are deaths that occur in larger numbers in the United states yearly.

Dying

The process of dying has been divided into stages. Doctor Elizabeth Kubler-Ross devoted much of her life to studying the dying process. She believes that patient, family members and caregivers all go through these stages. Dr. Kubler Ross states that the stages overlap and may not be experienced by everyone in the stated order, but all are present in the dying patient. (Medical Law and Ethics)

The first stage is, "Denial" a refusal to believe that they are dying. This may be a time when the patient (or family) needs to adjust to the reality of approaching death. This stage cannot be hurried, next is "Anger". The patient may be angry with everyone and may express an intense anger toward God, family, and even health care professionals. The patient may take this anger out on the persons closes to them, usually a family member. In reality, the patient is angry about dying. Third is "Bargaining". This involves attempting to gain time by making promises in return. Bargaining may be done between the patient and God. The patient may indicate a need to talk at this stage. Fourth is "Depression". There is a deep sadness over the loss of health, independence, and eventually life; there is an additional sadness of leaving loved ones behind. The grieving patient may become withdrawn at this time. Finally there is "Acceptance". When this stage is reached there is a sense of peace and calm. The patient makes such comments as, "I have no regrets. I'm ready to die." It is better to let patient talk and not to make denial statements such as, "Don't talk like that. You're not going to die."

Allow the stages to happen naturally and you will find out the patients true wants and needs. Some may express the need for spiritual comfort. At this point patients often take stock of their lives and may contact estranged friends or relatives to address unresolved issues. Spiritual questions and concerns may emerge as a part of a search for personal meaning n their lives. Families should be prepared to listen and encourage patients to address and perhaps resolve unsettled issues.

Patients often need to be able to make choices in the types of medical care they receive. Let them try a limited trial of therapy, like chemotherapy or radiation. The patient's family and physician must be willing to uphold the patient's desire to stop treatment if the patient says so desires. The patient may want to die at home, which is feasible with the necessary support system; hospice care is available in many areas. Hospice is a multidisciplinary system of services for providing palliative care to the terminally ill patient. The hospice philosophy emphasizes quality, not quantity, of life, but it does not advocate assisted suicide. A hospice program offers a primary care physician, skilled nursing care, physical and occupational therapy and counseling for the entire family. Here in hospice is where the planning for the end of life begins.

Advance Directives

Advance Directives are legal documents that state the patients final wishes should the patient not be able to do so themselves. An (AD) tells your doctor what kind of care you would like to have if you become unable to make decisions (if you are in a coma, for example). The goal of advance care planning from the perspective of legal scholars is to assist patients to make treatment decisions for the event of incapacity. From the patient's perspective the advance care planning is more commonly preparing for death and dying. Once a central ritual of social and religious life, death has been hidden, and implicitly made taboo. Advance planning can help people to prepare for death. This tends to help them achieve a sense of control, relieve burdens on loved ones, and reach closure.

Advance Directives come in several forms such as the Durable Power of Attorney for Health Care or DPA. This states who you have chosen to make health care decisions for you. It becomes active anytime you become unconscious or unable to make medical decisions. A DPA is generally more useful than a living will. However a DPA may not be a good choice if you don't have another person you trust to make these decisions for you. A Do Not Resuscitate (DNR) order is another kind of advance directive. A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. (Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing.) You can use an advance directive form or tell your doctor that you don't want to be resuscitated. In this case, a DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states. A patient may also use a living will, another type of advance directive. It only comes into effect when you are terminally ill. Being terminally ill generally means that you have less than six months to live. In a living will, you can describe the kind of treatment you want in certain situations. A living will doesn't let you select someone to make decisions for you.

Advance directives and living wills do not have to be a complicated legal document. They can be short, simple statements about what you want done or not done if you can't speak for yourself. You may change or cancel your advance directive at any time, as long as you are considered of sound mind to do so. Being of sound mind means that you are still able to think rationally and communicate your wishes in a clear manner. Your changes must be made, signed and notarized according to the laws in your state. Make sure that your doctor and any family members who knew about your directives are also aware that you have changed them. If you do not have time to put your changes in writing, you can make them known while you are in the hospital. Tell your doctor and any family or friends present exactly what you want to happen. Usually, wishes that are made in person will be followed in place of the ones made earlier in writing.

Losses / Grief

Grief most commonly comes from the loss of a loved one. In order to understand bereavement, we need to make the distinction between grief and mourning. Grief is a person's internal experience, thoughts and feelings related to the experience of a great loss. Mourning is the external expression of one's grief. Thus, a person may experience extremely painful grief but, because of a need to appear stoic, may not mourn.

Grief and mourning are intensely personal and unique experiences. We often refer to stages of grief, but these often do not occur in an orderly progression. Depending on the situation and the individuals involved, one may not experience some stages, or may cycle in and out of the same emotional state several times.

The dying child does not fear death itself they fear more for their parents and sibs after they are gone. Often times attempting to keep the secret of dying from the child in question creates more problems for the family. Marriages suffer from the stressful demands of treatments for the dying child, many marriages end in divorce. As the illness drags on and death becomes imminent both parents feel the pressure as if they have somehow failed to be a good parent to the child. Most bereaved parents experience one or more of the following emotions tightness in the throat, heaviness in the chest, or a lump in the stomach like a rock, an empty feeling with appetite loss. They might wander aimlessly, forget a thought in the middle of a sentence, neglect to finish tasks, feel restless, look for activity, but cant concentrate. Some may experience respiratory reactions - excessive yawning, gasping, hyperventilating. Parents will have feelings of anxiety, and think they are losing their mind. A parent may even sense the child's presence and expect the child to walk in the door or phone at the usual time of day. They may cry at unexpected times, be unable to cope and then fall back again - a see-saw type of reaction.

Death in the adult or spouse is surrounded mainly by fear. Fear and grief often aggravates itself. Adults may lay in bed worrying, not wanting to deal with the outside world. The list of physical symptoms that can be caused by fear is long, ranging from physiological effects to psychosomatic symptoms. One of the most disturbing losses is the loss of the respect of others that is reflected in their expressions of pity. Unlike feelings of sympathy, pity demeans the person. The loss of respect is aggravated if we patronize, infantilise, or denigrate the patient. Giving the patient space and the ability to be in control is foremost to them.

Conclusion

Dying no matter how clinical it is, is still the cessation of life, be it that of a loved one, a child, a spouse, mother, father, friend, sister, brother. It hurts and makes no sense to the ones left behind. Some say letting a patient go is the most humane thing to do that is until they are the one who has to let go. It has been thought that if your plan for you death it helps the ones you leave behind. No amount of pre-planning will lessen the grief they will feel by the vacancy left from a loved one's passing.

With current approaches in bioethics we have underestimated the importance of social and family ties. Facing death in the context of loved ones may be an important redeeming accomplishment. End-of-life decision making is influenced by culturally shaped values. The principle of autonomy is the domain of ethics in health care.

Reference

1. Black, Dora. The Dying Child (coping with loss, part 8). British Medical Journal 16. 18 May . 17-7

. Bryan-brown, C., Dracup, K. End of Life Care. American Journal of Critical Care.00 July. Bristol-Myers. 00. 1-

. Goodlin, S. Winzeberg. G.Teno, J. Whedon, M, Death in the Hospital. Archives of Internal Medicine 158 no.14. 18 July 7. American Medical Association.18

4. Herbst, L.Lynn, J, Rhymes, A. What do Dying Patients want and need? (Includes related articles). Patient Care no. 4. 15 February 8. Medical Economics Publishing 15. 1-10

5. Martin, D.; Emanuel, L. Singer, P. Planning for the End-of-Life. The Lancet 56 no. 4.The Lancet Ltd. 000.1-8

6. Parkes, Colin Murray. The Dying Adult. (Coping with loss, part 7). British Medical Journal 16 no7140. British Medical Association. 15

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Man's Search for Meaning

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Do furnaces, gas chambers, and death have meaning? Victor Frankl's poignant novel reveals how he discovered that through suffering man is made better and richer. He describes how prisoners, including himself, journeyed through the psychological phases of shock, apathy, and liberation from Hitler's death camps.

Dr. Frankl experiences shock when he first enters one of the camps. "Suddenly a cry broke from the ranks of anxious passengers, 'There is a sign, Auschwitz!'" Dr. Frankl wrote. Everyone on the train felt this shock all at once. They were scared of not just gas chambers. No, they were scared of crematories and massacres as well. Not only that, the train slowly inched its way into the camp. Dr. Frankl wrote that the train acted as though it was mocking them.

In the camps, the prisoners soon learned of the next psychological phase of, apathy. The guards, at the camp, often hit, killed, and corrected the prisoners of the camp for the smallest things. "… I received two sharp blows on my head…at such a moment it is not the physical pain which hurts the most; it is the mental agony caused by the injustice, the unreasonableness of it all." Dr. Frankl experiences. Everyone felt the injustice time after time again. Dr. Frankl again mentions, when he was working on a railroad, that he had stopped working for a second and a guard saw him. "The pain he caused me was not from any blows. That guard did not think it worth his while to say anything, net even swear a word, to the ragged, emancipated figure standing before him, which probably reminded him only vaguely of a human form. Instead, he playfully picked up a stone and threw it at me." Writes Dr. Frankl.

The final stage of psychological phases is liberation of man from the camp. When the men in the camp where liberated, they were all still afraid of leaving. They slowly walked towards the gates. Dr. Frankl and the prisoners stood behind the gate as if they couldn't believe it. "Timidly we looked around and glanced at each other questioningly. Then we ventured a few steps out of camp. This, time no orders were shouted at us, nor was there any need to duck quickly to avoid a blow or a kick." Remembers Dr. Frankl.Order custom research paper on Man's Search for Meaning

Furnaces, gas chambers, massacres, and death do have meaning. Each of the prisoners learned how to appreciate life and liberty while you still have it. Dr. Frankl and his fellow inmates found meaning. Although unfortunately, each and everyone of them found it the hard way.

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FLORENCE NIGHTINGALE

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Florence Nightingale is best known for her radical innovations in nursing care. She was a pioneer in nursing and a reformer of hospital sanitation methods. For most of her life, Florence pushed for reform of the British military health-care system. With that, the nursing profession started gaining the respect it deserved.

Besides being a nurse and reformer, Florence Nightingale was a statistician. She would use new techniques of statistical analysis and apply them to her life's work, such as during the Crimean War when she documented the occurrence of preventable deaths in the military. She developed the polar-area diagram to dramatize the preventable deaths caused by unsanitary conditions. With her analysis, Florence Nightingale revolutionized the idea that social dilemmas could be objectively measured and subjected to mathematical analysis. She was an innovator in the collection, formulation, and graphical display of statistics.

The achievements set forth by Florence Nightingale were amazing considering most Victorian women did not attend universities or pursue professional careers. Her reform efforts occurred in part because she was frustrated with the conditions in England that limited women's life choices to marriage, indolence, or servitude. Her frustration's extended also to the social conditions of most of England's citizens abject poverty or affluence.

Born in Florence, Italy on May 1, 180, in the Villa Colombia, near Porta Romana, Florence was named after the city she was born in. After her birth, the Nightingale family moved to England and settled down in her fathers inherited estate. Although later, her father William Edward Nightingale had a house built for the family in the village of Lea. The house was called the Lea Hurst and served as the summer home to the Nightingale family for the rest of Florence Nightingale's life.

Help with essay on FLORENCE NIGHTINGALE In 185, the Nightingale family moved to a mansion named Embly Park in the Parish of Wellow, in Hampshire. This became the family's main home. Around this same time, and at the early age of five, Florence Nightingale's father began seriously educating both Florence and her older sister, Parthenope. Her father, William Nightingale believed women, especially his children, should get an education. Though both daughters were educated in history, economics, astronomy, science, philosophy, and multiple languages, Florence received an extensive education in mathematics from her father, her aunt Mai and from James Sylvester, her math tutor. Frances, her mother, taught her social skills and leadership qualities. She believed ladies did not need to be educated especially in mathematics.

Florence soon became dissatisfied with the upper class lifestyle she was born into. While growing up, she would care for sick and injured pets. Later she would care for servants who were ill. In 187, Florence said she heard the voice of God tell her she had a mission. Although she did not know what this mission was Florence chose not to follow her heart and desire into the society of marriage. She stated that marriage would destroy her chance of serving God's call. She would later discover this calling.

In June 18, Florence and her sister were presented at Queen Victoria's birthday party. This was the first meeting between Florence Nightingale and Queen Victoria, but would not be the last. The Queen would later become fascinated with the knowledge and education Florence had acquired. In 184, Florence went abroad to study the European hospital system. One year later, she began training at the Institute of Saint Vincent de Paul in Alexandria, Egypt. She then visited the Institute for Protestant Deaconesses at Kaiser worth, Germany. While there, she was asked to write a pamphlet on "The Institute of Kaiserwerth," by the Rev. Pastor Theodore Fliedner. She did but declined any recognition for her work. Soon after, she wrote 1-page, hand written "curriculum" stating her reasons for wanting to be a nurse. She became a probationer (student) in the nursing program at Kaiserwerth.

Then in 185, God again spoke to Florence, asking her if she would do well for him without any reputation. She decided to serve him by serving the "sick poor." Her father supported her with a yearly allowance of 500 pounds, which is equivalent to 40 to $50,000 dollars by today's standards.

Florence went into residence in her first situation (job) and became the superintendent of a London Establishment for Gentlewomen During Illness, but was unpaid for her services. Then in 1854, the Crimean War began. England, France and Sardinia came to the aid of Turkey against Russia. Sidney Herbert, the Secretary of War asked Florence to nurse the wounded British soldiers. After accepting, she assembled a party of thirty-eight nurses and went to Scutari, Turkey to the Barrack Hospital. There, she assumed direction of all nursing operations at the war front. When she first arrived at Scutari, Florence noticed no proper records were being kept. She introduced a system of recording the sickness and mortality data of the military hospitals. The system allowed her to plead her cases successfully. The military officials and doctors in charge of the facility were allowing rats, fleas, and contamination to kill wounded soldiers. But fighting the generals and male doctors who disliked a woman telling them what to do, was almost worse than cleaning the filth. However, this was Florence's opportunity to show the value of female nurses in military hospitals.

Florence Nightingale was nickname The Lady of the Lamp for her nightly walks through the wards. Because she personally checked on every patient, the mortality rate of the wounded dropped from 40% to an astounding %. Florence was instrumental in getting the conditions of the hospital improved. No longer would the wounded die due to unsanitary conditions. Nonetheless, all during her stay, Generals, other officers and doctors tried desperately to remove her from leadership because they felt inferior to her. Florence's managerial skills were often better than those of many officers in the army. But she prevailed with the help of Queen Victoria who could reach statistics and be informed without a male ego getting into the way.

After the war and upon the Queen's request, Florence visited Queen Victoria to talk about her war experiences. The Queen and Florence agreed upon a need to correct wrong doings during the war. The government then issued a warrant (commission) to investigate the disasters of the Crimean War. This was a kind of high-level independent committee that evaluated problems, come to a consensus, and then recommended changes. But because Florence was a woman, she could not be recognized or testify to this committee about her experiences. Instead, she wrote and compiled her findings and facts to them.

During Nightingales time at Scutari, she had collected data and systematized record-keeping practices. Her study of the data in the Crimea convinced her that many of the deaths in hospitals did not need to occur. The results of her personal studies of army medical statistics were in a report titled Notes Affecting the Health, Efficiency and Hospital Administration of the British Army. Her Notes made a profound impression, showing the causes of failure and a means by which the country could best provide for the health of its troops in future wars.

Florence was able to use the data as a tool for improving city and military hospitals. Her calculations of the mortality rate showed that with an improvement of sanitary methods, deaths would decrease. For instance, in February 1855, the death rate at the hospital was 4.7 percent of the cases treated. When Florence's sanitary reform was implemented, that rate tremendously decreased. She took her statistical data and represented it graphically. She had invented polar-area charts. These charts showed the statistics being represented was proportional to the area of a wedge in a circular diagram. The graphical illustrations portrayed, by means of shaded or colored squares, circles and wedges, (1) the deaths due to preventable causes in the hospitals during the Crimean War and () the rate of mortality in the British Army at home.

As Florence demonstrated, statistics provided an organized way of learning. Because of this learning, medical and surgical practices improved and Florence Nightingale became a heroine for her work during the Crimean war. She was also known as the first nurse researcher. She also developed a Model Hospital Statistical Form for hospitals to collect and generate consistent data and statistics. Her skill in using the statistical method in army sanitation reform led to her election in 1858 to fellowship in the Royal Statistical Society. In 1874, the American Statistical Association elected her an honorary member. Nightingale was instrumental in the founding of a statistical department in the army.

Through reading she became an expert on public health care and when Britain invaded India during the Sepoy Rebellion, she became the recognized expert in healthcare and supervised it's nursing. So began her life-long project to sanitize the country. Also during this time, Florence became ill. She was diagnosed with what we call today, Posttraumatic Stress Disorder. After Florence became ill, she never made a public appearance, never attended a public function, and never issued a public statement. Florence Nightingale had become completely reclusive.

The years following, she conducted a huge correspondence from her bed seeing people by appointment and only one at a time. Although she was bedridden, and with the help of her newly invented polar area diagram, Florence was still able to sell her ideas about healthcare and sanitation reform. This practice had never been done before and is common practice now.

Florence later established the Nightingale School for Nurses, at St. Thomas Infirmary the first professional nursing school in the world. Florence paid very close attention to every detail of the school from her flat in London. Florence Nightingale almost single handedly invented modern nursing, as we know it today.

Although her illness had secluded her, Florence accomplished many other works as well. She published a small booklet titled, "Notes in Nursing", which became so popular; it expanded and was published again with a special section on, "Taking care of babies." Florence also published her "Observations" concerning the sanitation problems in India and later publishes "Notes on Lying in Hospitals." Also from her flat in London, Florence worked on setting up a home nursing system, hospitals for births, hospitals for the insane and poor, and she also helped to stop the practice of putting all the "sick poor" together. This included men, women, children, the insane and the sane.

Then in around 10, at the age of eighty-two Florence became very ill and could no longer read or write except with great difficulty. So she accepted the services of a companion/housekeeper/nurse. This help became constant for the rest of her life.

After more than eighty years of helping people, in November the year 107, King Edward bestowed the Order of Merit to Florence Nightingale. This was the first time the Order had been given to a woman. Around the same year she began to go blind and her health gradually failed her. After 110 at the age of ninety, Florence could no longer speak. The end came for her on August 1, 110 when she fell asleep and did not wake again.

Upon her death, the King offered to give her a national funeral and burial but it was her wish before she died that her burial be like anyone else's. She was buried in the family grave at East Wellow and six sergeants of the British Army carried her coffin. The engraving on her tombstone simply reads, Florence Nightingale born 180- died 110. She lived ninety-three years and three months. She is honored each year in a commemorative service at St. Margaret's Church, where she is buried.

Florence Nightingale has been called many things throughout her lifetime, timeless, The Lady of the Lamp, even a saintly woman. She was even the subject of poetry and songs. There are also so many quotes from her that made a profound impression on many people. "You can arrest in some degree the course of the knave, but with the fool you don't know where you will find him next," and "To be a good nurse one must be a good woman, or one is truly nothing but a tinkling bell".Florence Nightingale.

Florence Nightingale was the founder of modern nursing. She saved millions of lives, establishing her with a place in history. Many of her suggestions, theories and practices have been documented as scientifically sound when tested with the application methods of modern research. Florence Nightingale made it possible for people not only in her time, but also in the twentieth century to live longer, healthier and more vibrant lives. Florence Nightingale was a true Godsend.

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Our Day Out by Willy Russell.

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"Our Day Out" is a political play. Willy Russell wants us to think about his characters and the world they inhabit. What is your response to the drama and the way it is told?

I like "Our Day Out" because it makes you think. There are numerous different perspectives to see the story from the children's perspective,Briggs' perspective, even the bus driver's perspective, and each is unique. Willy Russell has created strong and realistic characters who we can believe.

The story begins in Liverpool in 177. The scene is dreary and desolate. The area is a deprived, dilapidated example of post-industrial blight. The kids are products of this environment. It is the "progress class" day out and the headmaster of the tough school they attend is the epitome of society's view of them. He is content to let their hopes and fortunes go by the wayside. Of Mrs. Kay the progress class teacher he says "She keeps 'em happy with their reading machines and plasticine." This is a view that these children have no goal in life, that the system is not prepared to give them an opportunity to work out of poverty. He believes each of them has their goal in life to be a labourer or factory worker.

Mrs. Kay, whose decision it is to go on the trip, is more lighthearted and understanding. She loves and cares for each individual child regardless of their social status or background. For some, she is the closest thing they have to a mother, unloved at home and not cared for. Her authority however is questioned by Mr. Briggs, who is a straight-laced disciplinarian. The two have conflicting views on how the children should be taught and treated, and I feel that Briggs chose to come on the trip at the last minute because he did not trust Kay to keep everything under control.

I also like "Our Day Out" because we get to know some of the characters personally, such as Andrews who has smoked since he was eight, gets beaten at home by his father, and whose mother is a prostitute. He is typical of the unstable, under-privileged backgrounds a lot of the progress class kids come from.

At first, the bus driver is extremely apprehensive at the prospect of a day driving these kids around. He comes onto the steps of his coach and says "No food, no drink" and the like. He is prejudiced. He has condemned these kids before even leaving the school. It makes you think what chance do the kids have in life if people just stereotype them like this? He eventually mellows and gives one boy a pound to go to the sweet shop. It is Kay who makes him do this.

Shortly after leaving the school, the coach reaches the docks. At this point, Briggs is sitting next to Riley and his friend, who are both smoking. Briggs looks out at the dock building and comments on the wonderful history and architecture of the Mersey Docks. Riley's friend and Riley snigger mocking Briggs. Briggs' riposte is "Stop, take a look around. You might see things a little differently".

Riley says that his father works there and hates it. Briggs doesn't pay any attention. It is an ironic statement. Briggs himself is the one who needs to see things a little differently. He is blind to the sufferings of others. It is only later on when Carol Chandler finally makes him realise what an arrogant sod he has been. He is more interested in the architecture than the people. The bus finally goes through the Mersey Tunnel to a huge cheer from the kids. For many, it is the first time they have escaped the shackles of inner-city Liverpool and they are brimming with enthusiasm and vitality.

Having entered Wales, the bus stops at a shop. Having disembarked the bus there is an unruly rush for the shop. Briggs manages to organise them into a straight line. Kay pronounces ironically "A straight line, what a wonderful thing to behold." Briggs replies "With organisation, Mrs. Kay, with organisation." For the first time here, their relationship turns confrontational. They are trying to out-do or "skin" each other, and at times it is juvenile and unnecessary. Briggs is the main culprit I think. He is self-delusional, like Skinner from "The Simpsons". He wants to be able to command respect, but it is actually Kay who is the one the kids listen to. She teaches Briggs a lesson. It is only when he enjoys himself later on at the fair and on the journey home where the kids actually behave for him and respect him. "Our Day Out" is just as much "Briggs' day out" as it is the children's day. While the kids have been taken on a trip, Briggs' mind has been taken on a trip. At the end of the day, everything is back to normal, but everyone who was there will remember it as "Their day out", especially Briggs.

In the shop, the kids steal the sweets when the shopkeeper's backs are turned. It is funny. They are stuffing their pockets, but it is all done amorally. To them, stealing is a part of life. There is no malice. As the bus leaves, the kids are swearing at the shopkeepers in a triumphant, almost ironic gesture.

Kay decides they will go to the zoo, to predictable howls of outrage from Briggs. He is not going to get in her way of having a good time and he definitely is not going to get in the kids' way. Again at the zoo, Kay's style conquers that of Briggs. She persuades Briggs to let them walk around alone. The kids are delighted to be free and are caressing the animals.

They argue about the merits of keeping bears in zoos. Ronson says "It was born in a pit, it's spent all its life in a pit, how will it want anything else?" Ronson is the stupidest of all the progress class. He doesn't know where Wales is ("Will we have to cross the sea?") and struggles to talk English, but here he has spoken words of wisdom. He sees that trapped bear in himself, he sees that pit as Liverpool. The kids are the bears. Liverpool is their pit. Ronson, in making this point, has admitted that he has no chance in life and is not looking for a way out because he simply doesn't think there is on. Carol, in contrast, says "It would love to be free. It's not fair. It kills because it's trapped." The kids also kill because they are trapped. Carol says "We don't have anything nice down our way. If we did, we'd smash it up." Carol is the one who is desperate to leave Liverpool. She threatens to jump into the sea later on. She would prefer to stay in Wales.

"Our Day Out" is implicit. The bear pit is just one of the many metaphors in the story. On the way home, Carol is clutching a goldfish she won at the fair. It is a goldfish, but as far as Carol is concerned, it is gold. Goldfish won from the fair die after a few days, but she doesn't care. Ronson also clutches his ragged teddy bear from the fair tightly. He wants to care for it and love it. After the zoo, the scene on the coach is the most implicit of the whole film. The kids have stolen animals from the zoo. The zoo keeper rushes on to the coach and demands to have them back. Eventually there is crowing and animal noises and the animals are returned. This is implicit because the kids have only taken them to care for them. Nobody cares for them at home. Nobody looks after them. They believe that the animals love them back and show so much interest and affection. Again, like at the sweet shop, there is no malice. Briggs compares the children to animals.

The bus continues to Conwy Castle. I like the way "Our Day Out" is based around the bus. It is the one constant in the story. The journey is circular, it ends like it starts with many different events and emotions in between, but through all of it the bus is there and doesn't change. It gives a sense of how the story progresses without losing the story itself. The coach is an sound base from which the story springs.

At the castle, the kids are running riot. It is their day out, and they are determined to make the most of it. Briggs is despairing and is depressed and embarrassed at the sight of the kids running around wildly. Kay is disgusted with him. It is a DAY OUT, and they are happy, which is the whole aim of the trip, yet Briggs is treating it as if it was a school day! Willy Russell has managed to create all his characters, these two in particular, with strong and conflicting views. It is natural that there will be confrontation. At the castle, we see the biggest clash between Briggs and Kay. The conflict is dramatic. They talk politically and overtly about the kids' places in society. Kay speaks emotionally

"If you're telling me that these kids are factory fodder and the factories of England need them, and given a better chance they would still go and work in the factories, then you are wrong Mr. Briggs, very wrong!"

Briggs is visibly shaken, but remains unmoved, trying to be the dictator he perceives himself to be. Their political opinions are very different. Kay is a socialist. She thinks that the children should not be condemned to eternal mediocrity just because they were born poor. They should be given help and benefits to try and work their way out themselves. Briggs is an ideologist. These kids fit in with his plan of a perfect society. They must work in the docks and factories. He does not care that his ideology places these kids at the bottom of the pile. He believes that it is their destiny.

"You ARE on their side, aren't you?"

"Yes Mr. Briggs, I certainly am."

Willy Russell, writer of "Our Day Out" makes his characters speak polemically and politically about society and life in general, while still making us believe it is the character talking. Watching the film, I did not think of Russell once. It is a credit to his skill. Most of the film is realistic too. He achieves this because the majority of the kids are not real actors. They only have to be natural because he has cast them in their real-life roles. The only two parts of the film which are slightly unrealistic are the sweet shop incident and the stolen animals, which are also the two funniest scenes in the film.

Kay insists on going down to the beach for some more fun and games with the kids"You can't come all the way to the sea side and not go to the beach!" meanwhile Carol has got "lost". Briggs finds her on a cliff edge. She has lost all respect for him. She understands more than most of the other kids the situation she is in and she sees Briggs as a beacon of the system that has failed her. She says "You hate me. You hate all the kids." It is time for Briggs to look at himself. She wants to stay in Wales and threatens to jump off the cliff, but Briggs reassures her that there is a home to go back to and opportunities in Liverpool. I do not think Briggs seriously believes this himself, but it is all he can say to maintain his perceived image. Carol retorts "Don't be friggin' stupid." This language shows contempt and complete lack of respect for Briggs' authority and status. He is to learn from her, not her from him. She breaks down and cries. "If you were my old man, I would have been alright Sir." She sobs and runs to Briggs. It has taken this much for him to realise what a power-craving arrogant sod he is. He abandons all principles and sympathises with Carol. The whole story has been turned on its head. This is a pivotal movement where everything is as far away from the harsh reality of life in dilapidated Liverpool as possible.

The structure of "Our Day Out" is circular. The beginning and ending are the same mould, while at this point things are unusual, almost surreal. Is it possible that the Briggs who likens the kids to animals is the same one who then takes the aforementioned "animals" to the fair?

He enjoys the fair just as much as the children. He is one of them there. It is a complete role reversal. Briggs joins in the singing on the back seat of the coach on the way back from Liverpool, and obviously genuinely enjoys himself. He wears a party hat for a photograph.

The grim reality hits home when they enter Liverpool. The surroundings and familiar sights have an effect on Briggs. He reverts back to type. When the bus pulls into the school, he is given the photo film to develop. He ponders the thought for a second then discards the film. Briggs is an idiot. He tries to fool himself into believing there was no day out, no he did not enjoy himself. But he is not being himself. In his heart of hearts he knows he enjoyed himself today. He is too hell-bent on preserving his image as a dictator that he has forgotten his real self. For the kids, the grim reality has hit home and they are walking the same dirty streets they left in the morning. They will cherish the memories of the day, but tomorrow everything will be back to normal. The circle has returned to its starting point. Mrs. Kay has enjoyed her day and goes out for a drink with two other teachers. Briggs is invited. I think he wants to go, but he forbids himself to. He can't be seen to be having fun. Briggs has learnt a valuable lesson from "Our Day Out". He has to be himself, not what he wants himself to be.

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Protein Synthesis

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Protein Synthesis is the process whereby DNA encodes for the production of amino acids and proteins. An amino acid is a substance that has an amino group on one end and a carboxyl group on the other and is the building blocks for proteins. Proteins are polymers of amino acids and organic compounds that contain nitrogen in addition to carbon, hydrogen, and oxygen. Protein synthesis has two parts in the process, the first being transcription and the second being Translation. Transcription is known also as RNA synthesis and is the process in which a molecule of DNA is copied into a complementary strand of RNA thus transferring information from DNA to RNA. The second step in the process of Protein synthesis is translation. Translation is the decoding of a messenger RNA into a polypeptide chain (protein). The messenger RNA does not produce the polypeptide alone it uses Transfer RNA and ribosomal RNA. The Transfer RNA carries the amino acids to the ribosome, where the amino acids are joined together in order to form polypeptides.

In sexual reproduction the organism needs to inherit a single copy of every gene from the two parents, therefore meiosis separates the set of DNA that is produced when the organism produces its own reproductive cells. The process that separates those cells is meiosis. Meiosis takes place in the reproductive organs and is a process that produces haploid gametes from diploid cells. The sex cells replicate at first in meiosis one, so as a N cell the homologues chromosomes divide. In meiosis two the sister chromosome separate in order to form 1N gametes known as sex cells or sperm and eggs. important part of sexual reproduction. Without it the sperm and eggs would not come together.

What had more impact in a persons life genes or their environment? I believe that there are many traits that can only be decided by genes such as eye color, skin tone, and face shape. However there are many traits people believe are determined by genes that can be changed by their environment, such as weight and a personality. For example if a person's family is obese they may feel that it is their genes to be obese, although if they changed their environment to a healthier one it can overcome what is in their heredity. Thus I fell that it shouldn't be genes vs. environment because in the end it will all be equal.

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MLK

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Todays despair is a poor chisel to crave out tomorrows justice. Everybody has a responsibility of craving out justice in the world. It is up to everybody to make a difference. Some people are in despair because of the unjust actions of others. That is why they need us to help them. As fellow human beings, it is our duty to chisel away the despair and care out of justice.

There are many unjust things in our world. On television, radios, and in newspapers we see or about the injustices child labor, abortion, age and race discrimination, poverty, child abuse, and terrorism. These things are ruining peoples lives and preventing everybody from being treated equally or fairly.

We have many tools to fight against injustices. Patience, caring, and kindness can bring out justice. If we are patient with others who are not like us, and if we are kind and caring to others, we can set an example for people. We can show others that all people should be treated equally.

A hammer is a force that puts two boards together to build a structure. We can be hammers that build justice by writing letters to our mayor and other city leaders about poverty in our city. We can also write important letters to the President of the United States to fight injustices like abortion, world hunger, and discrimination.

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It is important to get involved in church activities for the poor, handicapped, and homeless people. We need the tools of patience, caring, and kindness for these jobs. These are like the nails that hold boards together. If we are patient, kind, and caring we will hold people together and help bring justice to the world.

There other action we can take at our own school. We can talk to teachers, principles, and fellow students about injustices in our school. We can brainstorm on ways to treat everybody fairly. We can collect food, money , and clothes for poor children. We can be like saws that cut away at the bad wood. We can also practice forgiveness if somebody does something wrong. We need to forgive the people who act unjustly and pray for them. If we pray and forgive, we will be like the cement that holds bricks together. We will bring people together by doing those things.

These are some of the ways we can chisel away at despair and crave out justice. If everyone uses even one of these tools of justice, the world would be a better place to live. We can help bring about liberty and justice for all of us so we can live a life with out any injustices with these tools. By doing all that you will fulfill your duty of making the world a better place.

Please note that this sample paper on MLK is for your review only. In order to eliminate any of the plagiarism issues, it is highly recommended that you do not use it for you own writing purposes. In case you experience difficulties with writing a well structured and accurately composed paper on MLK, we are here to assist you. Your cheap research papers on MLK will be written from scratch, so you do not have to worry about its originality.

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Jane eyre

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Mystery and suspense in Brontes novel Jane Eyre provides a crucial element to the readers interpretation of the novel, allowing Bronte to subtly aid the reader in foreboding coming events. Bronte successfully creates mystery and suspense in her novel through the use of both features of plot and narrative techniques. Brontes features of plot which allow her to create mystery and suspense are the esoteric nature of Grace Poole, the visit of the fortune teller at Thornfield, and the fire in Rochesters bedroom and the subsequent mystery of what is in the attic. Brontes narrative techniques are the use of literary symbolism and dreams, both of which are used to convey a Gothic and supernatural setting. Through the use of these literary devices, Jane Eyre becomes both cabbalistic and prophetic.

Brontes character Grace Poole is surrounded by a obscure haze from the readers first introduction to her, an effective device used in order to create a mysterious atmosphere in the novel. Jane first learns of the occult Grace Poole upon hearing her laugh upon being shown the attic by Mrs Fairfax. Bronte first creates an ambience of mystery through the initial description of the setting. The attic is described by Jane as being black as a vault (chapter 11, page 1) and the leading passageway as narrow, low, and dim (chapter 11, page 1). Jane observes all the doors being shut, which allows the reader to interpret the third story of Thornfield as inaccessible and isolated, perhaps intentionally attempting to conceal something, much likened to Bluebeards castle (chapter 11, page 1) in which behind the locked doors was hidden the deadly secret of the castle. The laugh which Jane hears is described by Jane as being a curious laugh; distinct, formal, mirthless (chapter 11, page 1). The peculiarity of laugh, it not being cheerful nor delighted, perplexes Jane as well as the reader, this intimating that the origin of the laugh is not of the typical sort. Janes curiosity prompts her to ask of Mrs Fairfax the origin of the laugh. Mrs Fairfaxs vague answer does not satisfy Jane, even less so after hearing the laugh once more, it being tragic, as preternatural a laugh as any I ever heard (chapter 11, page 1). That another inquisitive remark made by Jane is again answered vaguely after which the subject of the conversation is soon changed only adds to the suspense of the incident. Following the fire in Rochesters bedroom, Jane observes Grace Poole the next day in the room. The circumstances in which this occurs are largely ordinary. It is morning and Grace is dressed in her usual attire, her expression showing nothing either of the paleness or desperation one would have expected to see marking the countenance of a woman who had attempted murder (chapter 16, page 176). The extreme ordinarity of her provokes the reader into thinking past her exterior appearance whilst simultaneously adding to the suspense of the situation. Bronte again uses the outwardly evident normalcy of Grace Poole in contrast to the earlier mysterious descriptions of her to further develop the suspense surrounding her character as Jane recounts to Rochester her dream of the unknown figure in her closet who tears her wedding veil. Janes fear is momentarily subsided by Rochesters solving of the mystery (chapter 5, page 1) in a way which does not nearly satisfy the readers curiosity due to Janes vivid description of the event and her horrifying fear. Bronte uses Grace Poole to create an atmosphere of mystery and suspense through vivid descriptions of the ghostly atmosphere which emanates whenever she is present as well as a contrasting ordinarity which further compels the reader to see Grace Poole in light of a an enigmatic character (chapter 16, page 178).

The use of a fortune teller at Thornfield by Bronte allows her to add mystery and suspense through the mystic and strange nature of fortune tellers of that time. Bronte initially establishes a suspenseful ambience through Janes remark; and the Sybil - if Sybil she were (chapter 1, page 1) which suggests to the reader that her character is perhaps doubtful and she may not be who she at first seems. The reader is made eager to hear the fortune of our heroine through Janes apathetic indifference as to whether it is read or not; I dont care about it, mother; but you may please yourself (chapter 1, page 1). Possibly the most mysterious and suspenseful feature of plot is the fortune tellers precisely accurate account of Janes predicament; You are cold, because you are alone no contact strikes the fire from you that is in you. You are sick; because the best of feelings, the highest and the sweetest given to man, keeps far away from you. You are silly, because, suffer as you may, you will not beckon it to approach; nor will you stir one step to meet it where it awaits you. (chapter 1, page ). This description of Janes circumstance both compels the reader to trust the source, it being rather accurate, whilst also creates suspense as to what shall become of Jane and Rochester, which the reader is well aware that such is what the fortune teller is alluding to. Upon her mention of the enigmatic Grace Poole, both Jane and the reader are startled. The reader is again drawn into the abstruseness of the situation through the fortune tellers astounding knowledge of Janes habits, and even more so by her subtle but discernible quest for some sort of information, neither the reader nor Jane knowing what exactly it is she wants to hear, however this adds to the suspense in our desire to know. As the subject of Mr Rochester is brought up it seems as if the fortune teller has struck her chord. However it is with her revelation of his forthcoming marriage which more interests the reader. A climax of suspense and mystery is reached as Rochester steps out of his disguise. Although it can be said that the divulgence of his identify somewhat solved the mystery, it is even more accurate to say that this revelation merely added to the mystery, his intended purpose still to be discovered. Rochesters apparent disturbance at the knowledge of Masons residence at Thornfield provokes the readers attention, creating suspense as to his purpose and coming events. Bronte leaves the reader ill at ease with Janes closing comment; the gay tones set my heart at ease (chapter 1, page 0). The reader is well aware that this will be no peaceful nights sleep. Bronte has successfully created tension and suspense as to the almost certainly tragic impending events.

The fire in Rochesters bedroom not only forms a sense of mystery regarding Thornfield, but also alerts the reader as to the enigma of what is in the attic. Prior to the the fire, Bronte establishes a supernatural and ghostly setting; the night was drearily dark; my spirits were depressed (chapter 15, page 167). The hushing of the vague murmur, peculiar and lugubrious (chapter 15, page 167) and Janes anxiously betting heart creates a tense and suspenseful atmosphere. Bronte creates a setting much alike some sort of horror story through Janes descriptions; my chamber door was touched; as if fingers had swept the panels in a groping way along the dark gallery outside (chapter 15, page 167). Very successful in adding to the tenseness of the situation is Janes frequent calming; The idea [that the sound may be Pilot] calmed me somewhat I lay down. Silence composes the nerves (chapter 15, page 167) which is ultimately followed by another startling sound, even more frightful that the preceding one; a dream scarcely approached my ear, when it fled affrighted, scared by a marrow-freezing incident enough (chapter 15, page 168). Janes response to the laughter which rings at her chamber door perturbs the reader; my first impulse was to rise and fasten the bolt (chapter 15, page 168). Janes continual reference to the origin of the laughter as something and not someone alerts the reader as to the nature of this origin. Bronte again establishes a suspenseful tension this time though Janes preoccupation with the fire and her momentary disregard of the laughter which the reader is eager to know more about. Upon the fire having been extinguished, Rochester resolves to pay a visit to the third storey (chapter 15, page 170). Rochesters instructions to Jane not to move nor call anyone alert the reader to impending danger. As time passes the atmosphere in which Jane sits calms, no noises being heard and the night growing cold. Rochester returns, in an equally calm state, setting the reader ill at ease. Rochesters failure to say more on the subject of the fire adds suspense, his vague answers bearing no satisfaction. As the suspense of impending danger fades, a new suspense mounts, the latter of Janes unresolved feelings for Rochester and their consequences. Write your Jane eyre research paper

Brontes use of literary symbolism is a highly effective means by which she is able to subtly warn and inform her readers of impending events in order to establish a degree of suspense in the novel. Upon Jane having accepted Rochesters proposal of marriage, Jane tells her readers that the great horse chestnut tree at the bottom of the orchard had been struck by lighting in the middle of the night, half of it having been split away; I faced the wreck of the chestnut tree; it stood up black and riven the trunk, split down the centre, gaped ghastly (chapter 5, page 0), a clear reference to Jane and Rochesters separation. At Ferndean upon Jane and Rochesters unity, Rochester refers to himself as; no better than the old lighting struck chestnut tree in Thornfield orchard (chapter 7, page 4) however Jane assures him that plants will grow about your roots (chapter 7, page 4), this being a clear providential warning of their future children. Another source of suspense for the reader is Bessies ballad at Gateshead in which a poor orphan child (chapter , page ) is described wandering through the moors thinking of hard-hearted (chapter , page ) men. This is a direct prophecy of Janes wanderings after leaving Rochester prior to her arrival at Moor House. The ballad describes the presence of God who is with the orphan child, much like Jane remembered God during her wanderings and struggle for survival. Just before his intended marriage to Jane, Rochester plays for Jane a love song in which may symbols and prophecies can be found. The song describes a man whos lovers parting was my pain (chapter 4, page 04), alluding to Janes forthcoming fleeing of Thornfield. The man pressed to her As blind as eagerly, a subtle yet later obvious reference to Rochesters blindness. At the end of the song Rochester sings how My love has placed her little hand with noble faith in mine, And vowed that wedlocks sacred band our natures shall entwine (chapter 4, page 05), alluding that he and Jane will eventually be wed. Through these hidden prophecies Bronte creates suspense for the reader through the subtle warning of forthcoming events.

Throughout the novel, Jane experiences many dreams, particularly in Thornfield. These dreams allow Bronte to create suspense through foreboding warnings of impending events and also to establish a mysterious and supernatural atmosphere. Just before Bessie is called to the deathbed of her dying sister, Jane dreams of a child. Jane remembers her childhood and Bessie saying that to dream of children was a sure sign of trouble, either to ones self or ones kin (chapter 1, page 48). Soon after, Jane herself dreams of a child for seven successive nights (chapter 1, page 48). Due to Bessies tragic experience following Janes first dream, the reader is drawn into a tense atmosphere where there is surely to be some impending event. The next night, Jane is visited by Robert from Gateshead who informs her of John Reeds death a week before and Mrs Reeds imminent death. These drams of infants not only warn the reader of events to come but also allow Bronte to establish a Gothic and supernatural ambience of mystery. Just prior to Jane and Rochesters wedding day, the night before when Rochester kept Jane to her promise of staying up with him, Jane tells him of two of her dreams. In the first, Jane remembers a Gothic and mysterious setting; a dark and gusty night (chapter 5, page 15) whereby Jane experienced a strange, regretful consciousness of some barrier dividing us (chapter 5, page 5). This allusion to Bertha and all she represents is possibly one of Brontes most explicit providential warnings to her readers. Jane goes on to describe herself following the windings of an unknown road; total obscurity environed me; rain pelted me (chapter 5, page 15), this also candidly referring to Janes wanderings after her leaving Rochester and Thornfield. In her second dream, Jane sees Thornfield Hall was a dreary ruin (chapter 4, page 16). This reference to the impending fire at Thornfield allows Bronte to reach the climax of her prophetic warnings. Jane remembers the wall crumbled (chapter 4, page 16) much like it did following Berthas jumping from the battlements. Like Bertha did in reality, Jane in her dream lost my balance, fell, and woke (chapter 4, page 16). These dreams create a mysterious sense of foreboding as well as add to the Gothic and supernatural setting of the novel.

Please note that this sample paper on Jane eyre is for your review only. In order to eliminate any of the plagiarism issues, it is highly recommended that you do not use it for you own writing purposes. In case you experience difficulties with writing a well structured and accurately composed paper on Jane eyre, we are here to assist you. Your persuasive essay on Jane eyre will be written from scratch, so you do not have to worry about its originality.

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