Developing Patient Choice In Nhs Health And Social Care Essay

Developing Patient Choice In Nhs Health And Social Care Essay This essay investigates how patient choice in the NHS has been developed by New Labour and coalition government. I will do this by first defining the term choice and then providing some background information on the emergence of choice agenda under the 1979-1990 government of Margaret Thatcher. . I will then go on to discuss how patient choice has been developed under the New Labour and coalition governments that followed by discussing the reforms that both have implemented in relation to the patient choice agenda. Finally, I will examine the uptake of patient choice agenda. This is likely to include patient travel distances in order to access better and faster healthcare, as well as the performance ratings of hospitals, which are published online and so available to the public to use. However, people that live in certain areas in the UK tend to have a somewhat limited choice of medical care providers. Overall, choice empowers the general public, offering them the ability to make aut onomous decisions about their health-care providers and likely to improve the health outcomes of the British people. The patient choice agenda outlined above relates to offering patients a choice among various types of service providers in the NHS analogous to that of the private healthcare market . Central to it is the notion that without competition, there is no real choice, and therefore a choice among competing options is offered which is intended to improve quality and efficiency. This market discipline will motivate less competitive healthcare providers to upgrade their services to attract customers while giving customers a wider range of options (Le Grant, 2007). Thatcher Government (1970-1990) developed patient choice in order to create a dynamic market-orientated system in the NHS. She intended to introduce this form of internal market as a means of increasing efficiency and to develop the NHS into a more business-type model (Driver and Martell, 1998).Thatchers administration intended to achieve these changes though the adoption of a privatisation scheme focused on providers and purchasers . The idea of patient choice derived from the fact that GPs exercised choice on behalf of patients. Extending the choice agenda aims to eliminate or minimise the healthcare inequalities faced by less affluent patients, to whom it offers equal opportunities of services (Dixon and Le Grand, 2006). In 2005, MORI reported that 50 percent of the general public preferred to select healthcare providers outside of their local areas, which was something that the NHS had not provided for in its original manifestation (Popper, Wilson and Burgess, 2005). Thus, a large proportion of the general public clearly favours the idea of being able to select alterative healthcare providers. However, merely increasing patient choice may not successfully eliminate inequities (Oliver and Evans, 2005, p. 68). Certainly, offering choice to the general public is less likely to improve inequity if non-existent varieties exist within the uptake of choice. Wealthy patients have resources to opt for private healthcare providers if they believe that their local providers offer poor quality of services and low rating (Davies, Tavakoli, Malek, 2001). Therefore, the idea of equal access for meeting the equal needs of all people has failed. New Labour accepted the neoliberal model that had been developed by Thatchers administration during the 1980s and further developed by the Major government of the early-mid 1990s. In 1997, with New Labours ascent to power, patient choice was increased with some important reforms that promoted the patient choice agenda, including the establishment of Foundation Trusts (FTs) and the rating system (Driver and Martell, 1998). These reforms aimed to produce cheaper, better quality services by incentivising healthcare providers to compete for funding that equated to the number of patients they treated (Peck, 2003). Another reform introduced was Payment by Results, which pays secondary care providers using a standard fee tariff linked with the amount of patients treated. This reform enabled patient choice upon referral from GPs. Thus, this conception of the choice agenda served to improve waiting list times and the quality of services offered. Lastly, the government put in place a targets s ystem that measured the uptake of choice. The government also shifted the focus from competition while continuing to promote the business model by promoting partnerships between healthcare providers (Peck, 2003). In order to promote real choice, the market is obliged to offer alternative providers of goods and services (Smith, 2005). Private healthcare providers have operated within the internal market since 1948, providing their services at a standard tariff (Peck, 2003). The internal market that was operated under New Labour was less focused on competition, but rather towards promoting the efficiency and quality of services. Davies, Tavakoli, Malek (2001) argue that patients opt for private healthcare providers over public healthcare providers when they are able to because private providers offer good service quality. In general, patient choice tends to enhance competition among providers, who strive to attract customers in the way that any other private firms do. Private healthcare providers generally cover limited, mainly non-emergency services and as private businesses, are primarily focused on making profits. Therefore, private providers cost more than services offered by the NHS and hence this market attracts wealthier competitive patients (Le Grant, 2007). Middle class patients are likely to select private providers because material resources are not an issue.  [1]   In the 2010 White Paper, Equity and Excellence: Liberating the NHS, the coalition government set out to promote patient choice by introducing a commissioning board to the NHS. The Commissioning Board monitors the performance of primary care providers to ensure that high standards of service care are offered and that patients are involved in decision making as much as possible. The Commissioning Board is also responsible for improving equity within healthcare. Finally, the government seeks to promote patient choice though increasing competition among medical providers. Under the Foundation Trusts obtained the role as regulators that supervise tariff costs and encourages efficiency. Despite these developments, the fact remains that choice is not real possibly for patients living in certain areas of the UK (Spiers, 2008). People that live in rural area are likely to be excluded from selecting their healthcare providers. One of the reasons for this is that less affluent patients are less motivated to travel greater distances due to car ownership being lower among disadvantaged groups (Appleby and Dixon, 2004). Some people in low-paid employment are also unable to take time off from work to seek medical attention, preventing them from further exercising choice. Additionally, people travelling long distances tend to have poor attendance records for primary care appointments. A study conducted by RAND in 2008 also shows that age, gender and social class differences can serve as obstacles to people in exercising choice, while people over the age of 60, housewives and the working class tend to limit their travelling distances for providers (both primary and secondary c are (Powell, 2008). Hence, gender, social class and age are found to be important factors that determine the uptake of choice for healthcare providers. Affluent patients often have resources to purchase houses in areas near to good-quality healthcare providers. However, Popper, Wilson and Burgess (2005) argue young, affluent patients and those living in inner city areas of London are likely to opt for alternative healthcare providers, whereas disadvantaged patients with low levels of education are found to opt for alternative medical providers the least. Certainly the uptake of choice among less well-off patients would be more likely to improve if subsidised transport were offered to people and covering additional transport funding incurred by people who are not located close to alternative providers. Thus, an effort to improve these issues may encourage poor patients to travel longer distances to have their treatments.  [2]   Another factor is the lack of available information, which can prevent patients from exercising choice over medical providers (Fotaki, Roland, Boyd et al., 2008). It is believed that some people require additional support in their choice of healthcare providers. Often, less well-off patients, those with low levels of education and the elderly require supplementary assistance in order to be able to make effective choices (Powell, 2008). These types of groups are less likely to have access to the internet and friends working as medical professionals in the NHS to help them navigate the system. However, making use of internet sources have been criticised for being resource-intensive and a real problem for those who are not computer literature. Published data is a key element for choice and outlines the performance of various healthcare providers. Making use of this type of data can serve to make patients more autonomous and responsible for their own health (Davies, Tavakoli and Malek, 2001). In general, healthcare providers services are rated using ranking systems. With their reputations at stake, medical providers are motivated to improve the quality of their services in order to remain in business. Often, disadvantaged groups use performance data more than middle class people to make healthcare choice (Collins, Britten, and Ruusuvuori, 2007). A lack of available data though is a major factor preventing them from exercising their choices. The patient choice agenda aims to lead to inequality in the medical system. Appleby and Dixon (2004) claim patient choice agenda in healthcare is far more complex rather than just focusing solely on resources. Poor people tend to lack the self-confidence and knowledge to converse with healthcare providers in a medical vocabulary  [3]  . Oliver and Evans (2005) state patients poor abilities of expression create imperfect freedom of choice in decision-making amongst individuals. Hence, these issues lead to an unequal ability to navigate the system (Mandelstam, 2007, p. 109) Providing people with choice rather than voice to express tend to be more effective for less well-off patients (Barr and Fenton, 2008). The patient choice agenda offers disadvantaged groups the opportunity to be heard and promotes the necessary self-confidence to exercise choices, in parallel. Thus, choice empowers patients who are the least knowledgeable about how to use the system to their advantage. Middle class people, on the other hand, have the educational capacities, resources and skills to manipulate the system in a way that suites their interests (Spiers, 2008). Certainly, affluent patients are more proactive than less-well of patients in relation to the uptake of choice. Hence, privileged patients are more articulate, confident and persistent, which means that the system in its current form suites privileged patients over poor people. The impact of patient choice on health service delivery provides mixed views. Patient choice may improve the quality of services offered in the internal market in response to waiting list times, which it may also markedly reduce (Le Grant, 2007). GP fund-holders can improve waiting list times upon referral to hospitals and may also reduce prescription costs. An example that illustrates this capacity is found in a study conducted by the London Patient Choice Project during 2006 (Dixon and Le Grand, 2006). This study states that patients are inclined chooses for alternative providers in order to reduce waiting list times. Certainly, competition, along with large numbers of healthcare providers, may further reduce waiting list times. However, patients dissatisfied with services offered by medical providers can opt to search for alternative medical providers that meet their needs. Under the internal market, money dictates the choices that patients make, meaning that hospitals lose money if patients choose alternative medical providers (Dixon and Le Grand, 2006). Thus, healthcare providers must be responsive to consumer demands in order to remain in business, unless they are likely to face closure. Patients often empower medical experts to decide on their treatments because of the generally held view that the doctor knows best (Burge, Devlin, Appley, et al., 2004, p. 190) Often, patients shift choice into the hands of doctors, particularly in life-threatening situations. In such serious situations, medical staff are likely to decide on treatments on behalf of patients. Therefore, the choice agenda in this case is not taken into account. However, Popper, Wilson and Burgess (2005) suggest that seven out of ten patients prefer to relocate treatment choices to primary care providers. This example tells us that people like the idea of having an input in relation to deciding on medical providers. In reality, GPs are seen as the gatekeepers for making medical choices (Powell, 2008, p. 77). They act as agents for the patients, and are often empowered to select treatments on their behalf, thus undermining the ability of patients to exercise choice. This happens because of people tend to have limited skills and access to information that could otherwise inform them of the various treatment options available. As mentioned above, middle class people are often also better informed of premium treatments options, usually having better access to the internet and sources such as books and journals that inform them of the various treatments available. People with lower levels of education do not generally have access to journals and books which would allow them to make meaningful choices. The London Patient Choice Pilot study (in 2008) on the other hand, contradicts this view. This study claims that the up-take of choice among people with various levels of education has little significan ce, with only a two percent difference between people with various levels of education with regard to looking for hospitals that provide treatment (Spiers, 2008). In conclusion, middle class people benefit from the choice agenda to a far greater degree than the working class. Middle class groups have higher levels of income, which allow them to purchase houses near good-quality medical providers. In addition, the middle classes have access to information and money that enables them to travel further in order to have access to the best services. It must also be questioned as to whether patients want choice rather than just high overall quality, as most patients like the idea of a good local medical provider (both primary and secondary providers), rather than travelling longer distances to have their treatment.

Team Player Essay -- Short Story Track Running Essays

Team Player It is a cold, wet October morning in Slippery Rock, PA. The school bus carrying 50 sleeping high schoolers pulls into a gravel parking lot, joining a crowd of buses and vans already lining the edge of a vast grassy field. A never-ending white line is painted on the short-clipped grass marking a trail. It follows the outside of the expanse, along the parking lot, beside the road, up and down the hills and valleys, and through small patches of trees and brush at the far end of the field. Football goalposts crown the crest of a hill in the distance and white wooden posts guard the insides of the curves of the white line. As the bus driver turns off the motor, the girls begin to stir and sit upright in their seats. They wipe the beads of condensation from the inside of the windows and look outside, absorbing this beautiful scenery. A few begin to talk to the person sitting next to them. Others stretch and let out loud groans. This is the morning they have been preparin g for since the summer months: this morning, this very group of girls will try to prove themselves as the highest-ranking, fastest-running cross country team in western Pennsylvania. Soon, this calm field will be overtaken by swarms of coaches, runners, parents, and officials. As the morning moves on, more and more people gather around the tents that have popped up between areas of the course. After about two hours of preparation, the teams start gathering near the starting line for the first race. First to run are the boys’ junior varsity teams, followed forty minutes later by boys’ varsity. And then it’s my turn. Coach LeDonne gathers all of the girls on the JV team around him in front of our duck-y... ... that I gave as much to the team today as any other girl walking in those doors with me. And at that moment I realize that I contributed an equal amount to the victory as the first runner or the fourth runner, or the last runner on my team. Perhaps running is my secondary duty for the team. Maybe it is equally important that I helped Amy push up that hill in her race as it is important that I finished my own race with an average personal time in mine. Even though the team as a whole may value speed over every other quality, I realize that it isn’t necessarily the most important for every runner. The team could never run well without a steady support, a push from behind to run up the steepest hill. I was never meant to be the fastest runner on the team. But I could still have that same importance by being a proud, supportive member of the team.

Reye Syndrome :: essays research papers

Reye Syndrome Reye Syndrome is an extremely rare, non-contagious disease thought to be triggered by aspirin use. The actual origin of the disease is unknown. Reye's Syndrome, occasionally called Reye-Jacobsen's Syndrome, is known to follow any viral infection. Two of the most common viral infections it precedes is influenza, â€Å"the flu†, and chicken pox. A now-familiar warning on bottles of aspirin, most notably Tylenol, is not to give Tylenol to a child who is recovering from the chicken pox, a fever, or any other viral infection. The link between aspirin and Reye's Syndrome and is not fully understood, but all reported cases of Reye's Syndrome include a child who has received aspirin before infection. Symptoms of Reye's Syndrome may often be mistook for a recurrence of the flu, or extreme exhaustion. These symptoms include vomiting, confusion, lack of coordination, distorted balance, irritability, a stupor-like state, and a recent infection from a viral illness. The symptoms often begin with vomiting and progress to a stupor and near comatose state. This disease is often found in young children and infants. Over sixty percent of reported Reye's Syndrome cases occur in children under the age of sixteen, with the majority of these cases being in children under six. Although less than five percent of Reye's Syndrome cases occur in people over the age of sixty, the elderly are often the most severely affected, due to old age and weakening immune systems. Infants, while hindered by their young age, can often fight the infections of Reye Syndrome better, for reasons doctors do not yet fully understand. The severity of Reye's Syndrome is classified on a scale of 1-5, with one and two being the onset of symptoms and four and five being the most severe, with the patient being comatose. With the most severe of Reye's Syndrome cases, internal fluid builds up in the brain and there is irreversible brain damage or even death. While the disease is not often fatal, it is essential to treat the disease early. Reye's Syndrome is not contagious, but the diseases that can lead to, such as the flu, and chicken pox, are highly communicable. The first case of Reye's Syndrome was diagnosed in 1963. Looking back into medical journals, there were many â€Å"mystery illnesses† that had the same symptoms as Reye's Syndrome, but no cases were positively diagnosed as being Reye Syndrome until this date. The definitive tests for this disease are a liver biopsy and blood analysis. The liver biopsy can help determine the presence of fat and lipid formation in the liver. Upon surgical examination, the liver is slightly enlarged, firm, and bright yellow.

Still Life :: Personal Narrative Papers

Still Life "Each of us is a kind of crossroads where things happen. The crossroads is purely passive, something happens there. A different thing, equally valid happens elsewhere. There is no choice, it is a matter of chance." à  Levi-Strauss "It was boring." "How could you find it boring?" "It just...sat there. Mooned over itself. It was talky." "It was...great. I dunno. I think it says something to people in transition." "Well, I'd hardly think of my life as...I don't know..." "Static?" "Right." My mother, my sister, my father and I walked two blocks, and took the subway back to our hotel. That wasn't the first time I'd seen the movie. The summer I learned how to wear cologne, I was burning my last bridge to the city of Los Angeles, one kiss at a time in a Venice Beach apartment. There was an early cut of Lost In Translation playing on a gaudy television, in a gaudy entertainment center, in a gaudy black leather-smeared den, in a rundown walk-up. You can see without seeing, obviously. I can certainly tell you the converse is true. I'd been working most of that summer as an overnighter in a chic department store catering to aging Westwood matriarchs, leaving the sales floor perfumed with my distaste for high fashion. But I remember, more than anything else from that last tango on Figueroa, Scarlett Johansson in a pink wig, singing "Brass In Pocket" to a dried-up matinee idol. "You know, looking back, I'm beginning to realize...those characters were assholes! How did we like them?" "Maybe they were but...I dunno. I just see something in Charlotte that's so...'I am trapped here, and I don't know it.'" "But Bill Murray! What a fuckin' dick!" "I don't see that. I just...Maybe this rings to me in a way it shouldn't." "I'm not trying to make fun of the movie, I liked the movie too, but you've got to--" "I know. You're very even-handed, Josh, and I'm putting on extra eyeshadow." "Fuck you, you know what I mean." "You workin' today?" "Shit, yeah. Call after you're out of seminar." "Cool." I walk home, and sure as silver, we meet at 7. He is certainly not wrong, but he forgets completely why I, and many others, are completely in love with these two unlikely friends. Chance. The best part of Lost In Translation is not what everyone points out - the imagery, the music, the acting, the sweetness and strangeness of the narrative, but it is how the viewer finds it.

Emptiness in Mahayana Buddhism

Buddhism is an orthopraxy where identity comes from implementing â€Å"correct† behavior, rather than orthodoxy where identity is found through â€Å"correct† beliefs. Mahayana Buddhism, termed â€Å"the Great Way† is essentially a vision of what Buddhism is really about. Although the permeation of Mahayana was harmless, the status of the sutras was constantly disputed. From the very onset of Buddhism, the concepts of Self/not-Self and dependent arising were prominent and fundamental. The Not-Self teaching has been considered by Buddhists to be the unique breakthrough of the Buddha, the discovery that solidifies his superiority over other teachers.According to the Buddha, for something to be characterized as â€Å"Self,† it would not lead to suffering, it would have to be permanent, and also it would obey the person of whom it is the Self. If something were to be a Self, it certainly must be controllable and conducive to happiness; or at least not conduciv e to suffering. Furthermore, in contemplating the existence of a Self, he stresses that the five plausible candidates for â€Å"Self† (the five aggregates) in fact cannot be the Self because they do not meet these criteria. These five aggregates (form, sensation, conception, disposition, consciousness) are certainly not permanent.They could be considered analogous to a tornado in that they arise from certain conditions and circumstances and are not extractable from the environment in which they occur. Any part of our psychophysical make-up, anything that can be classified under one of the five groups, cannot fit the description of a Self and therefore they are all not Self. In response to claims of having found an unchanging Self, the Buddha asserts that if there is at all a Self, it is only a result of the coming together of causal conditions (dependent origination). In this case, it could not be permanent, and therefore could not be a Self.Through further analysis and insig ht meditation after the death of the Buddha, the five aggregates were seen to be dissolvable into simpler elements. This sort of investigation came to encompass not only the psychophysical aggregates associated with beings, but everything in the universe as well. These elements (dharmas) are irreducible to any further factors or sources. The Buddhist school of Sarvastivada held a definitive distinction between the way dharmas exist as ‘primary existents’ and the way complex entities (secondary existents) exist essentially as constructions of dharmas.The name Sarvastivada itself means â€Å"the doctrine that all exist,† and this school introduces the notion of the own-existence of the dharma. Regardless if a dharma is past, present, or future, it nevertheless still exists. These dharmas are ultimate truths. Primary existents must be the terminating point of analysis, and must not arise dependently the way people, tables, and chairs do. Thus, secondary existents la ck this inherent existence. The Prajnaparamita is the earliest form of literature known to be specifically Mahayana; paramita meaning perfection and prajna meaning wisdom.In Buddhist terminology, to have prajna is to encompass an understanding that distinguishes how things actually are from how things seem to be. In the abhidharma setting, prajna is used to determine the value of primary existents (dharmas), which are distinguishable from conceptual constructs. Perfection of wisdom (Prajnaparamita) does not imply the wrongness of what had previously been considered to be wisdom, but rather its perfection. The perfection of prajna is the final, proper understanding of the way things truly are.Mahayana philosophers felt the nature of the Abhidharma to be too objective and systematic. Characteristically, these sutras are not methodically philosophical nor do they imply doctrinal adherence. The texts entail clear messages that are illustrated repetitively and can be seen as messages tha t aim to urge or advise those in the non-Mahayana world. As we have seen from pre-Mahayana philosophy, secondary existents are in essence ‘empty’ of primary existence, empty of own-existence. In this sense, all things such as people, sand, grass, the ocean, etc. re empty not only of Self, but also of primary existence. In agreement with these Abhidharma texts, there then must exist things that indeed have primary existence in order to contrast them to secondary existents that are empty of such a quality. However, the Prajnaparamita sutras do not heed this theory. These Mahayana sutras claim that absolutely all things have the same status as people, sand, tables, etc because they are all constructs that cannot be grasped. They claim that everything is empty, and that all things are conceptual constructs lacking own-existence.In the eyes of the Mahayana philosophers, to claim that there is own-existence in a way that emphasizes the how essential the dharmas are in the Abh idharma seems too methodical. It makes the dharmas themselves suitable to become objects of attachment. Instead, the dharmas should be used the way the raft was used in the parable told by the Buddha in the Alagaddupama Sutra. They should be used as tools that are let go of after use; they should not be clung to. Suffering is the result of attachment, so to grasp to the dharmas is to imply suffering.One cannot become attached to these things because to attach is to miss enlightenment. In this way, ceasing attachment involves seeing sources of attachment (people, for instance) as empty. One cannot avoid attachment as long as they see a contrast between primary existents and conceptual existents. In the Heart Sutra, the bodhisattva explains that after engaging in deep meditation on the perfection of wisdom, bodhisattvas fully awaken to a state of complete liberation and perfect enlightenment.The bodhisattva explains to the inquiring Sariputra that the perfection of wisdom involves see ing that the five aggregates are empty, as well as the dharmas that make up these aggregates. Dharmas are not fundamental; they are merely intellectual constructs just as are people and trees. The Sutra illustrates that all beings, things, and ideas, which we experience as â€Å"real†, have no inherent existence and this â€Å"reality† is merely a construction of the mind. Dharmas, too, are empty and do not ossess the specific characteristics that they have previously been associated with. Nothing comes to be as an inherently existing entity, and therefore nothing can cease. Likewise, nothing is complete or incomplete. The bodhisattva specifically states, â€Å"form is emptiness; emptiness is form. Emptiness is not other than form, form is not other than emptiness. † This is logical because if nothing at all inherently exists, things and concepts such as â€Å"form† and â€Å"emptiness† are one and the same. Emptiness itself is empty because it doe s not inherently exist.The bodhisattva also references the 12 stages of dependent origination and the four noble truths in order to solidify that they too lack inherent existence and are empty. Nothing in existence is separate from anything. The Diamond Sutra speaks repetitively about quantity of merit. The idea of repeating four lines of this Sutra is illustrated over and over again, with the message that teaching just four lines to another person would generate an incalculable amount of merit. In relation to this merit, the sutra places a strong emphasis on the idea of giving without becoming attached to any related notion.The only way to achieve limitless merit is to selflessly give in this way. The Buddha tells Subhuti that those on the bodhisattva path should have this thought: â€Å"However many living beings are comprised in the total aggregation of living beings†¦I should bring all of them to the final extinction in the realm of extinction without substrate remaining. † Essentially, the Buddha is stressing the act of enabling all beings to reach Nirvana-without-remainder and, in doing so, surpassing the cycle of continuous death and rebirth.However, for this to be accomplished, one cannot dwell on the notion of having helped all of those beings. The Buddha goes on to say that after he has brought all of them to final extinction, no living being has been brought to extinction. That is because to give like this reveals the emptiness of giving. Since all of these beings are empty of Self, while all of them have been brought to nirvana, at the same time no one has been brought to nirvana. The mind must be free of thoughts of ‘self’ as opposed to ‘others. ’ There should be no identified â€Å"giver† or â€Å"receiver† or â€Å"gift. Such an act would yield the highest merit in giving. The end of the Sutra contains the verse â€Å"an illusion, a drop of dew, a bubble, a dream, a lightning’s flashâ € ¦Ã¢â‚¬  in order to indicate the insubstantiality, or the emptiness, of the world. Like the Heart Sutra, the Diamond Sutra also stresses that everyday reality is like an illusion. Paradoxical phrases similar to â€Å"what is called the highest teaching is not the highest teaching† are used frequently to emphasize that the two ideas are inseparable because they are both empty.The Buddha attempts to help Subhuti â€Å"unlearn† the preconceived notions that he has about reality and perception. The distinction between arhats and bodhisattvas is clear; and Subhuti learns that the bodhisattva’s compassion is not calculable. The Diamond Sutra asserts that there is nothing in the world that is unchanging, nor is there anything that independently exists, therefore everything is empty. A life without attachment means a peaceful life in emptiness. This teaching of emptiness was frightening for some, because it seems very similar to nihilism in the way that it encourag es such deep letting go.Nagarjuna’s explanations of the perfection of wisdom claim that all things seem to be illusions was by showing that all things are without their own-existence. In previous Abhidharma terms, a primary existent is an irreducible into which a secondary existent can be analysed. In a way, to be a primary existent is not necessarily unrelated to causes and conditions, so it does not necessarily have â€Å"own-existence. † Nagarjuna’s view is that the concept of svabhava must boil down from that of â€Å"own existence† to â€Å"inherent existence† that is fully self-contained and is not bestowed upon it from any other sources.Inherent/intrinsic existence means independence from the causal process that characterizes secondary existence. Dharmas are irreducible, but are still the result of causes. Svabhava should be the equivalent of existing on its own, which is independent of the causal process. While he holds that there could sti ll be a distinction between primary and secondary existents, anything that is the result of conditions must be nihsvabhava, empty. Emptiness here is understood to be the middle way between nihilism and eternalism.He says that all things are empty of independent existence because all things arise dependently on conditions that are out of their own power, even primary existents. Nagarjuna declares emptiness whenever anything is found to be the result of causes of any sort. He claims that the alternative to emptiness is inherent existence. Moreover, Nagarjuna asserts that emptiness is also dependent on things. Emptiness is the lack of inherent existence of a table, for example. If there were no table, consequently there could not be an emptiness of the table.In this way, emptiness exists in dependence upon that which is empty. By definition, as originated dependently on something, emptiness itself is accordingly empty as well. Another new concept introduced by Nagarjuna is the doctrine of two truths. This doctrine differentiates between conventional truth and ultimate truth, both of which co-exist. An ultimate truth is something resistant to analysis, such as a primary existent. Conventional truth is how things really or ultimately are, or what is found in analysis when searching for primary existence.Essentially, what is found is the lack of primary existence, emptiness. Once a Mahayana follower understands these truths, he can engage in the world for the benefit of others with complete compassion. Nagarjuna applies analytic investigation to principal Buddhist ideas. The assertions of complete emptiness as presented in the Prajnaparamita sutras as â€Å"like an illusion† are demonstrated through his investigations. Nagarjuna introduces the approach of taking a category that can withstand analysis and analyze it.He says that there cannot be causation, because it cannot be explained between a cause and effect that are the same. Finally, Nagarjuna makes a cl arifying point that the Prajnaparamita sutras fail to address. He says, â€Å"Emptiness is not a way of looking at something. It is the quality of that thing which is its very absence of inherent existence. † This is his way of explaining that emptiness is a way of looking at things, it is an adjective, and it certainly is not nihilism.

The New Normal Challenges Societal Issues

Ryan Murphy is known for his ability to keep things interesting, and in his new sitcom The New Normal he has not fallen short on that expectations. In this series Bryan and David, a happy gay couple living in L. A. with respectable jobs, seem to have everything except for the one thing they want most, a child. The couple hires Goldie, a young mother who had just left her adulterous husband in Ohio and ran away to L. A. with daughter, Shania, to start over and forget her old life, to be a surrogate mother for them.Jane, Goldie's conservative and overly bigoted grandmother, follows them against her granddaughter's wishes, causing an uproar in Goldie’s new life in the city because she is so disproving of Goldie’s decision to be a surrogate and Bryan and David’s lifestyle. Immediately after airing in September of 2012, the show was criticized tremendously. The people of the broadcasting network in Salt Lake City, Utah were so offended by the show that they went on to ban the show from their show time schedule. NBC Utah affiliate KSL-TV, the network which banned the show from airing in Utah, says that the show was â€Å"inappropriate on several dimensions. They went on to say that the dialogue was excessively rude and crude and the scenes were too explicit and the characterizations seem offensive. KSL-TV also insist that it challenges traditional family values and portrays bad role models. The trouble the show experienced from attempting to air in Utah was not the only trouble the show had endured. In July, before the show aired, One Million Moms publicly announced that they would be boycotting the show for being harmful to our society, accusing the dialogue of being too offensive.Many members of the gay community also claimed to be boycotting the show for portraying offensive stereotypes of homosexuals. I must admit that I can see how the dialogue seems excessively crude and offensive. For example, in the pilot alone Jane uses the offensive ph rases; â€Å"gay peacocks†, â€Å"ass campers†, â€Å"Jewed done the cost†, and â€Å"salami smokers†. It’s easy to see how people could take her bigoted words offensively. It’s obvious from her first scene in the show that her prejudices are very overzealous and over the top but that is precisely the point.Nana seems as a nasty, hateful woman who has a potty mouth that anyone with a moral conscience would not want to replicate. Jane is used to show a societal problem in America today. A discussion of her behavior through the show should be of interest to more than just the fans and critics. Beyond these limited audiences, Nana is relevant to everyone in America because her bigotry was used by Ryan Murphy to display a nasty problem in our nation today. Her prejudice towards everyone that surrounds her is a mockery of many bigoted minds of Americans.Indeed, it does seem excessive, but Murphy wanted to make sure the point of how offensive and wrong this behavior is was clear. While I see how this crass behavior and crude dialogue is inappropriate for children, the show is a somewhat late night sitcom with a target audience of adults. As adults who have experienced shows with far worse dialogues such as Jersey Shore, we should be able to stomach the harmless dialogue of The New Normal especially when there is such an important point behind it. Shows like Jersey Shore aren’t refused to air because of their horrible dialogues because of Americans’ love for their trash TV.I believe that point shows that the problem with this show is truly just bigotry towards gay couples having children not the dialogue, which is Murphy’s entire point of making this show. It’s not just about entertaining television, it’s about making a stance on the problematic issue in America of bigotry and prejudice. The complaints given to show that it challenges family values seems to stem from the fact that it isnâ₠¬â„¢t a traditional nuclear family that is headed by a man and woman. Many happen to have a major issue with gay couples creating a family. However, the show proves that the couple holds family values.Firstly and most importantly they know and show how much they will love and provide for their child. They also show many other important family values and attributes. For example Bryan shows what a great father he will be and the confidence he will instill in his child in the second episode â€Å"Sofa’s Choice† when he talks to Shania because she’s having trouble fitting in at her new school. Shania says â€Å"Those kids don’t get me at all† Bryan replies â€Å"When I was in school no one got me either. This might be hard to believe Shania but I didn’t always fit in like I do now.I always felt different just like you† Shania shouts â€Å"Bryan I’m a weirdo and I don’t want to be. I just want to be normal. † Bryan mat ter-of-factly says â€Å"That’s a stupid short sided wish. † Bryan then moves to the couch to sit beside Shania and puts his arm around her comfortingly and says â€Å"You don’t know this yet, but the most unique parts of you are also the ones that lead you to greatness. † Shania says â€Å"How come you get me but my own mom doesn’t? † Bryan says â€Å"Your mom may not completely get you, but she lets you be who you are and she loves you for it, and that’s what makes her a great mom.Don’t be afraid to be who you are, Shania because you’re spectacular. † This shows how supportive and problem solving he can be as a dad but also shows that he thinks it is very important for children to be accepted and loved no matter who they are and that they know it’s wonderful to be the person they are no matter what anyone else says. In the episode â€Å"Stay-at-home Dad† David and Bryan decide to send Goldie on a s pa vacation and request to babysit Shania while she is gone because they want to experience and prepare for being stay at home dads.While Goldie is gone David takes off time from his very important job as a doctor to wake up early to make her breakfast and study before taking her to school. This is an example of how he will be a responsible dad who will compromise the job he loves to take care of his kid. These are the family values and concern you must have for your children in order to be great parents, and while David and Bryan don’t have everything about parenting figured out ,because no one does before having children, they have the mindset, love, and values that can potentially make great parents.While the show does show some unexpected characters and a family with an unusual dynamic it is in no way lacking great role models. While the adult characters in no way lack their fair share of dysfunction they are also great role models for America and for the young girl in th e show Shania. The excerpt from the beginning of the previous paragraph is also a great example of how Bryan is an exceptional role model for Shania. Goldie while often times seems to act on a whim is a great role model.In the same episode Bryan and David decide that they want Goldie and Shania to live in their luxurious guest house instead of their frumpy little house. Goldie turns the house down because she didn’t earn it and she wants to be a successful independent woman to give her daughter a great example so that one day she can become one as well. The most confrontational adult in the show is Nana, Jane. While her bigotry is repulsive she does not lack other admirable qualities.Despite her overzealous prejudice that seems to constantly be spewing from her mouth, she is a strong independent woman and a great grandmother. When Goldie and Shania run away to California, Nana follows them and decides to stay even though she is disproving of Goldie’s decision and Bryan and David’s lifestyle because she cannot stand the thought of not being there to spend time with and protect her family. Nana also raised Goldie from eight years old when her daughter decided she didn’t want to and ran away. She also housed Goldie and Shania up until they ran away to California.All of those attributes are wonderful to have, but the most important is that she has always been there for her family no matter what. Which Goldie admits in the episode â€Å"The Para-New Normal†, the Halloween episode, after an argument they’ve had about Goldie moving back to Ohio. Goldie says â€Å"God Nana, sometimes you make me so crazy, you know that? The things you say. † Nana replies â€Å"I am what I am, I’m not about to change now. † Goldie recedes â€Å"Well, then I guess I need to remember that. When I saw you trick-or-treating tonight, the way you were with Shania.It made me think. You are the one person who has always been there for me. The only one actually. † Goldie goes on to remember when her Nana took her trick-or-treating every year when she was young because her mother wasn’t there. â€Å"I like to think that I’m a good mom, Nana, but I didn’t learn that from my mom. I learned it from you. Thank you for always being there for us. † Nana responds â€Å"Well, I couldn’t just leave you. † â€Å"Well of course you could have, but you didn’t. And even now that I’m all grown up with people and choices that you don’t understand still†¦. ou still haven’t left. † It may have taken Goldie a long time to realize it but her Nana is a great role model for her and in many of the same ways is for America. Even the child in this show is a great role model because she learns to be proud of who she is with the help of the adults around her and doesn’t try to hide her quirky ways which is a great thing to show America, becau se no one should ever be ashamed of who they are. Many people see The New Normal’s message to be that the new normal of families in America will be led by a gay couple.This however, is a misunderstanding. The New Normal’s message is that no matter how untraditional a family is it is still a family with the same amount of love and values as traditional families. In the pilot this was made clear by giving examples of many other untraditional families. It showed a midget woman who married a man of normal height and had a daughter who was 6 years old and almost taller than her mother, a single mom of two twin toddlers who was much older than most new mothers; in fact, she looks old enough to be their grandmother.They even go as far to mention examples from pop culture today such as Barack Obama and Mariah Carey, who were both raised by what Bryan refers to as â€Å"half-rican American† Grandmothers. When the show says â€Å"abnormal in the new normal† it is n ot to say that families led by gay couples in the only new normal but that none of these untraditional families should be seen as anything less than the average traditional family. The New Normal defies stereotypes in many different ways. Although the show does show one of the gay men as a very effeminate male, Bryan.Which is why I can understand why many people in the gay community show offense as they see this as portrayal of a stereotypical gay men. However Bryan’s character is meant to portray the writer of The New Normal, Ryan Murphy. I think the character is important to show that effeminate males do exists and to show Ryan Murphy’s side of things and how the bigotry of others has affected him. Murphy saw it was important to show his own personal experiences in the show which is why he decided to create a character based on himself.It is not as if the show portrays all gay men to be effeminate. Bryan’s partner, David, is a gay man who is the average guyâ⠂¬â„¢s guy with no interest in fashion, and the many other favored interest of his partner, the â€Å"stereotypical gay man. † David is a doctor who loves to watch football and play sports. While the show does show someone who does fit a stereotype, David’s character defies said stereotype because he is a gay man who this prejudice doesn’t apply to. The show also defies the common stereotype that all black people are content with being bottom feeders of society.Rocky, Bryan’s assistant, is a very accomplished black woman with very high aspirations and goals. She has come a long way from where she grew up in an impoverished home to become an assistant for a producer of a very famous TV show. She is an example of a much empowered black woman who has worked very hard to be successful. Though The New Normal is just a TV show, it provides a lens through which we can examine the societal problems of bigotry and prejudice. Indeed, many problems such as the way p eople throughout the show treat David and Bryan as if they are less than their equal in the show can be seen in real life.For example, many people in America today have shown their disapproval of homosexuals by not only denying them adoption and marriage equality but by going as far as committing hate crimes against them. But the prejudice in the show and in real life doesn’t stop there; it is directed at anyone who is different by race, sexuality, living conditions, and plenty of others thing. The point of this show is to show people that we are all humans with flaws and great qualities and that everyone should be treated equally. We do live in the land of the free after all.

An Inconvenient Truth

An Inconvenient Truth (Narrative Report) Through lectures, writings, and a documentary film, he sought to raise awareness of global warming. The film An Inconvenient Truth (2006) gave him a platform for illuminating the dangers of climate change before a wide audience. It received an Academy Award for best documentary. The Nobel committee cited Al Gore as â€Å"the single individual who has done most to create greater worldwide understanding of the measures that need to be adopted† to halt global warming.Given this historic blizzard, should this most recent evidence of a global warming trend be taken seriously? Is there conclusive evidence of global warming? Does global climate change have serious consequences when many of us live or travel in climate-controlled structures that are cooled in summer and heated in winter? The general consensus of the scientific community is that the earth's surface is warming.Research centers in Great Britain and the United States maintain two l ong-term data sets on global surface temperatures; the most recent data from these centers indicated that 2005 was the warmest year on record. As Al Gore discussed on the film, he mentioned that warming  temperatures  are already causing significant changes to mountain glaciers around the world, ice sheets in Greenland and the Antarctic, and polar sea ice in the Arctic. From Europe to Africa to Asia to North America, mountain glaciers have receded over the 20th century, and melting is becoming more rapid.The large-scale melting of ice may accelerate the pace of global warming in what is known as a feedback process. Because ice reflects sunlight back out to space, it has a cooling effect. Water and land, which are darker than ice, absorb and retain more heat. And he also discussed that the global average temperatures strongly suggest that global warming has actually begun to take place. This is not, however, a simple trend to document. Temporary confounding factors can mask an ov erall trend in average temperatures.He also mentioned about the ice berg in the Antartic and Artic zones. He said that the reason why it melted so fast in our century is that the stronger heat from the the sun. Mr. Al Gore is only concerned to our mother Earth today. ‘Coz he said that maybe after 50 more years, most of the lands on our planet will be submerged on water. And he also said that the risk of happening this is almost 65% in reality! Indeed, a global convention would not otherwise have been possible.It is important to remember that an alteration of the global climate system is unlikely to be one of just gradual change, but that dramatic changes and shifts are possible. Also, for any factor, such as increased high-altitude cloudiness, that could lessen the effects of global warming, there is likely to be a factor that could heighten the effects. In the end, it is common sense to do something to avert global warming. This is not a backyard experiment that humankind can walk away from. We are experimenting with the entire planet, and this is where we live. An Inconvenient Truth The movie we watched last Friday was â€Å"An Inconvenient Truth. † For me, it is entitled â€Å"An Inconvenient Truth† because the main topic there, which is climate change and climate crisis, is a very inconvenient reality that we’re facing today. The man discussing the issue was former United States Vice President Mr. Al Gore, who was a politician and a very concerned man about the environment. An Inconvenient Truth focuses on Al Gore and his travels in support of his efforts to educate the public about the severity of the climate crisis. The main issue presented in the clip wasclimate change and climate crisis. Mr. Al Gore explained this topic through a Power Point presentation. He travelled all over the world to show people this presentation. He had a vision: to convince people that global warming is a reality that we’re currently facing today and we should start taking care of Mother Earth. According to him, global warming is now melting glaciers, ice, and it is destroying the beauty of Earth. He said that the main cause of this is the Greenhouse Effect, which is caused by a lot of Carbon Dioxide (CO2) that are trapped within the Earth. The Earth was said to â€Å"breathe out† CO2. CO2 was trapped in the Earth because of the unusual thickening of the Earth’s ozone layer, and now it â€Å"breathes out† little CO2 than before. The greenhouse effect is bad to the living organisms on Earth because it contributes to a lot of damage to the planet. The human activity that caused the greatest release of greenhouse gases is the smoke released from factories. It releases harmful substances that damage our ozone layer. But, there are also other causes, such as what Mr.  Al Gore said: â€Å"Each one of us is a cause of global warming, but each one of us can make choices to change that with the things we buy, the electricity we use, the cars we drive; we can make choices to bring our individual carbon emissions to zero. The solutions are in our hands, we just have to have the determination to make it happen. We have everything that we need to reduce carbon emissions, everything but political will. But in America, the will to act is a renewable resource. Throughout the movie, Gore discusses the scientific opinion on climate change, as well as the present and future effects of global warming and stresses that climate change â€Å"is really not a political issue, so much as a moral one,† describing the consequences he believes global climate change will produce if the amount of human-generated greenhouse gases is not significantly reduced in the very near future. Gore also presents Antarctic ice coring data showing CO2 levels higher now than in the past 650,000 years. Yes, I believe Al Gore. I believe that global warming is happening right now. In the realities happening now, who wouldn’t believe that it’s happening right now? A particular event that cited why Mr. Al Gore gives proof that global warming is happening was the melting of glaciers in Antarctica and temperature rise. What inspired his interest in the issue was his college education with early climate expert Roger Revelle at Harvard University; his sister's death from lung cancer and his young son's near-fatal car accident. Gore recalls a story from his grade school years, where a fellow student asked his geography teacher about continental drift. During the film's end credits, a diaporama pops up on screen suggesting to viewers things at home they can do to combat climate change, including â€Å"recycle†, â€Å"speak up in your community†, â€Å"try to buy a hybrid vehicle†, â€Å"vote for leaders who are concerned about caring for the environment† and â€Å"encourage everyone you know to watch this movie. † Well, I’ll definitely encourage everyone to watch this movie because it really inspired me and it showed me what’s really happening in reality. I learned a lot of things in the movie, and there’s no doubt that everyone will learn a lot and be inspired by it too. An Inconvenient Truth An Inconvenient Truth (Narrative Report) Through lectures, writings, and a documentary film, he sought to raise awareness of global warming. The film An Inconvenient Truth (2006) gave him a platform for illuminating the dangers of climate change before a wide audience. It received an Academy Award for best documentary. The Nobel committee cited Al Gore as â€Å"the single individual who has done most to create greater worldwide understanding of the measures that need to be adopted† to halt global warming.Given this historic blizzard, should this most recent evidence of a global warming trend be taken seriously? Is there conclusive evidence of global warming? Does global climate change have serious consequences when many of us live or travel in climate-controlled structures that are cooled in summer and heated in winter? The general consensus of the scientific community is that the earth's surface is warming.Research centers in Great Britain and the United States maintain two l ong-term data sets on global surface temperatures; the most recent data from these centers indicated that 2005 was the warmest year on record. As Al Gore discussed on the film, he mentioned that warming  temperatures  are already causing significant changes to mountain glaciers around the world, ice sheets in Greenland and the Antarctic, and polar sea ice in the Arctic. From Europe to Africa to Asia to North America, mountain glaciers have receded over the 20th century, and melting is becoming more rapid.The large-scale melting of ice may accelerate the pace of global warming in what is known as a feedback process. Because ice reflects sunlight back out to space, it has a cooling effect. Water and land, which are darker than ice, absorb and retain more heat. And he also discussed that the global average temperatures strongly suggest that global warming has actually begun to take place. This is not, however, a simple trend to document. Temporary confounding factors can mask an ov erall trend in average temperatures.He also mentioned about the ice berg in the Antartic and Artic zones. He said that the reason why it melted so fast in our century is that the stronger heat from the the sun. Mr. Al Gore is only concerned to our mother Earth today. ‘Coz he said that maybe after 50 more years, most of the lands on our planet will be submerged on water. And he also said that the risk of happening this is almost 65% in reality! Indeed, a global convention would not otherwise have been possible.It is important to remember that an alteration of the global climate system is unlikely to be one of just gradual change, but that dramatic changes and shifts are possible. Also, for any factor, such as increased high-altitude cloudiness, that could lessen the effects of global warming, there is likely to be a factor that could heighten the effects. In the end, it is common sense to do something to avert global warming. This is not a backyard experiment that humankind can walk away from. We are experimenting with the entire planet, and this is where we live.