Arguments For and Against Euthanasia

Arguments For and Against Euthanasia Euthanasia: Whose decision is it I. Introduction In a 1988 issue of the Journal of the American Medical Association, an article titled Its Over Debbie describes how an anonymous doctor administers a fatal dose of morphine to a woman dying of ovarian cancer (Anonymous, 1988). In a 1989 issue of the New England Journal of Medicine, ten doctors associated with the nations leading hospitals and medical schools declare their belief that it is not immoral for a physician to assist in the rational suicide of a terminally ill person (Wanzer, et. al., 1989). In 1991, the New England Journal of Medicine published a detailed account written by Dr. Timothy Quill which discussed his decision to help a patient suffering from leukemia commit suicide (Quill, 1991). In 1990, Dr. Jack Kervorkian uses his suicide machine to help a woman suffering from Alzheimers disease, one Janet Adkins, end her life in the back of a Volkswagen bus (Risen, 1990). Janet was the first of twenty patients who have been aided by Kervorkian in the past three years. He rem ains committed to his practice. In 1991 the Hemlock Society publishes a how-to manual on committing suicide. Entitled Final Exit, it zooms to the top of the national best seller lists and stays there for several weeks (Altman, 1991). Each of these events has served to provoke ever widening media coverage of the issues surrounding euthanasia and physician assisted suicide, and a national debate has arisen around these practices. This debate is not merely limited to attorneys and physicians. Suddenly, these issues and this debate are now a part of life in mainstream America, and many Americans face dilemmas that did not exist in simpler times; dilemmas that many would rather not have to face. II. Review of the Literature a. Euthanasia: The Nature of the Debate It is this sudden change in the way Americans are dealing with death, the nature and scope of the debate about dying, which prompts this analysis of the issues surrounding euthanasia. This debate is largely a debate about what is ethical. Questions the debate attempts to answer include: Is it right to commit suicide? Is it ethical for someone else to help? Is it right to put others to death at their own request or at the request of family members? These questions are important because they help to define our society and our culture. The way people deal with and respond to issues of life, ritual, and death serves to shape the nature of our society. This is why society must attempt to decide what is right; what is ethical conduct for the various actors in our communities when we face death. There are several reasons why this debate has surfaced in the 1980s. Death is nothing new, it has existed for thousands of years. Each culture has developed its own rituals and mechanisms for dealin g with death. These mechanisms serve to provide solace, a sense of continuity, and allow the culture to continue even as the members of the community cannot. However, our own culture has experienced many shattering changes that have altered the nature of dying. Suddenly we are forced to rethink the issue of death and we must decide what types of behavior are ethical when someone is dying. Before we can examine the debate about the ethics of dying, we must examine why the debate exists. Perhaps the main reason that death has changed in western culture has to do with advances in medicine and technology. Many of the diseases that have historically killed people are now no longer a threat to most individuals. Medicine has made a variety of advances in the treatment of diseases such as smallpox, tuberculosis, malaria, pneumonia, polio, influenza, and measles. People now rarely die of such traditional causes. Life expectancy has risen to almost 75 years in the United States. The quality o f life has also changed fundamentally during the past 100 years. Not only does almost everyone in the United States have enough to eat, but people eat higher on the food chain. There is a great deal more meat and animal fat in modern diets. Just these differences alone have changed death significantly. People now develop heart disease, adult onset diabetes, cancers, and AIDS. These types of diseases are more the result of lifestyle than bacteria. With these new diseases, suffering is often more prolonged and treatment is frequently quite painful. Also, as people are living longer, the diseases of the aged have become increasingly prevalent. Many more people now suffer from problems like senile dementia and Alzheimers disease. These diseases ruin the mind while preserving the body, allowing life to continue long after any quality that the life might have is gone. If what we die of has changed, perhaps the way that we die has changed even more. Throughout history, death has been a family affair. People usually died in the home after a short bout with an illness or as the result of an accident. Today, increasingly, death occurs in an institutional setting such as a convalescent home or a hospital, after a variety of technologies are applied in an attempt to prolong the life of the sick person. Often these technologies can be quite effective. People can now live for months and even years attached to a variety of tubes and technol ogies. About 75% of all deaths in 1987 occurred in hospitals and long term care facilities, up from 50% in 1950 . . . The Office of Technology Assessment Task Force estimated in 1988 that 3775 to 6575 persons were dependent on mechanical ventilation and 1,404,500 persons were receiving artificial nutritional support. This growing capability to forestall death has contributed to the increased attention to medical decisions near the end of life. (CEJA, 1992, p. 2229) People realize that the chances of facing the institutionalization of death increase daily, and they feel a profound lack of control. Surveys have consistently indicated that a large majority of people in the United States would like to be allowed to end their lives before incurable and painful diseases finally kill them (CEJA, p. 2229). Because of the changes that have impacted death, with regard to both how and where we die, the debate about how we should be allowed to die has been renewed. This paper will examine the s everal facets of this debate. It will define the terms that are relevant to the debate, examine the legal state of euthanasia today, discuss the ethics of euthanasia by examining arguments made by proponents and opponents of euthanasia, and by applying several Normative Ethical Theories to the issue. Finally, it will explore the power implications that infuse the debate on euthanasia and present arguments in favor of moving toward a care based ethic of dying and away from the current rights based ethic. b. Definitions If we are to effectively understand the debate about the right to die in the United States, it is imperative that a few basic terms be understood. The first and most important term is euthanasia. Originating from the Greek terms eu (happy or good) and thanatos (death), euthanasia means literally happy death or good death. The American Medical Associations Council on Ethical and Judicial Affairs defines the term as follows: Euthanasia is commonly defined as the act of bringing about the death of a hopelessly ill and suffering person in a relatively quick and painless way for reasons of mercy. In this report, the term euthanasia will signify the medical administration of a lethal agent to a patient for the purpose of relieving the patients intolerable and incurable suffering. (p. 2230) Other sources have defined euthanasia variously: The act or practice of painlessly putting to death persons suffering from incurable conditions of diseases. (Wolhandler, 1984, p. 363), . . . to refuse un wanted medical treatment or to have ongoing care withdrawn even though the patient will die if treatment is terminated. (Adams, et. al., 1992, p. 2021). Euthanasia is a general term that can actually mean a variety of different things depending upon the context in which it is used. For this reason, a number of supporting terms has become the convention when discussing euthanasia. These terms help to narrow the subject matter and distinguish between different types of euthanasia. The important terms that help to subdivide and classify euthanasia by type are voluntary/involuntary and active/passive. Voluntary euthanasia is a death performed by another with the consent of the person being killed. This consent may be in writing as in the case of a living will or advance directive. Involuntary euthanasia is a death performed by another without the consent of the person being killed. The AMAs Council on Ethical and Judicial Affairs makes three distinctions concerning consent and euthanasia: Voluntary euthanasia is euthanasia that is provided to a competent person on his or her informed request. Non-voluntary euthanasia is the provision of euthanasia to an incompetent person according to a surrogates decision. Involuntary euthanasia is euthanasia performed without a c ompetent persons consent.(p. 2230) Wolhandler compares the terms in a different context.Those who condemn euthanasia of both kinds would call the involuntary form murder and the voluntary form a compounded crime of murder and suicide if administered by the physician, and suicide alone if administered by the patient himself. As far as voluntary euthanasia goes, it is impossible to separate it from suicide as a moral category; it is, indeed, a form of suicide. Voluntary euthanasia may involve participation of second parties. (p. 366) The distinction between active and passive euthanasia is not nearly as clear as the previous distinction. Although many authors claim that the difference between the two types cannot be identified or is irrelevant at best, much of the debate on the subject is over this distinction and most of the current legal issues turn on this distinction. While this paper will contend that the difference between the two should not be recognized, it is both useful and important to know where the line is drawn. The AMA, which is strongly opposed to active euthanasia, has seen fit to endorse passive euthanasia in appropriate situations. The Council on Ethical and Judicial Affairs makes the distinction as follows: The physician is obligated only to offer sound medical treatment and to refrain from providing treatments that are detrimental, on balance, to the patients well being. When a physician withholds or withdraws a treatment on the request of a patient, he or she has fulfilled the obligation to offer sound treatment to the patient. The obligation to offer treatment does not include an obligation to impose treatment on an unwilling patient. In addition, the physician is not providing a harmful treatment. Withdrawing or withholding is not a treatment, but the foregoing of a treatment. (p. 2231) According to Wolhandler, (p. 367) it is t he nature of the acts performed by the second party that distinguishes between active and passive euthanasia. The courts have held that acts of omission (removal of respiratory assistance, hydration, and feeding tubes) are allowable behavior. Although unplugging a respirator and switching off a dialysis machine are arguably acts of commission, an increasing number of judges and commentators have accepted these acts as permissible passive euthanasia in both voluntary and involuntary settings. Gifford (1993) describes the difference between the two types of euthanasia this way: Passive euthanasia involves allowing a patient to die by removing her from artificial life support systems such as respirators and feeding tubes or simply discontinuing medical treatments necessary to sustain life. Active euthanasia, by contrast, involves positive steps to end the life of a patient, typically by lethal injectiond (p. 1546) The right to passive euthanasia has also been termed the right to die by some authors (Adams, et. al., p. 2021-22). With an understanding of the different types of euthanasia, we can now define some other key terms. It is important to understand how physician assisted suicide differs from euthanasia, and it is also necessary to define the terms advance directive and competence since they are crucial in determining the difference between voluntary and involuntary euthanasia. The term physician assisted suicide is somewhat self-explanatory. It occurs when a physician provides aid to a patient so they can commit suicide. However, it is also necessary to see the difference between this type of action and euthanasia. The AMAs Council on Ethical and Judicial Affairs states that Euthanasia and assisted suicide differ in the degree of physician participation. Euthanasia entails a physician performing the immediate life ending action (e.g., administering a lethal injection). Assisted suicide occurs when a physician facilitates a patients death by providing the necessary means and/or information to enable the patient to perform the life-ending act (e.g., the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide). (p. 2231) It is important to realize that the difference between euthanasia and assisted suicide lies in the behavior of the physician. This difference in behavior has recently become a major legal battleground that will be explored in the following pages. The advance directive has recently become an important new device to aid the terminally ill. Many states have legalized the advance directive, partly in an attempt to avoid dealing with problems associated with active euthanasia, and partly to help ease the burdens on the dying and their families. Singer (1992) provides a good definition of advance directive and explains how it is used. An advance directive is a written document completed by a competent person that aims to guide medical treatment after the person becomes incompetent. There are two types: instruction directives, which focus on the types of life-sustaining treatment that the person would want under various clinical situations, and proxy directives, which focus on who the person would want to make health care decisions if the person were unable to do so. (p. 22) The advance directive is useful because it can theoretically eliminate the need for involuntary euthanasia. It ensures that a voluntary decision is made in advance, even if the individual could not make such a situation at a later date. If everyone made use of the advance directive, there would be no need to debate policy decisions that must be made in the case of an incompetent person on life support. Because advance directives have neither been accepted nor widely used by the general public, many of the problems that could potentially be solved remain. This situation caused right to die groups in both California and Washington to propose ballot initiatives that would legalize active euthanasia (Gifford, p. 1550-51). Although active euthanasia is not legal in any United States jurisdiction, passive euthanasia is generally allowed at the request of a competent individual. Because of this it is critical to understand what constitutes competence. Courts have defined legal competence as the mental ability to make a rational decision, which includes the ability to perceive, appreciate all the relevant facts, and to reach a rational judgement upon such facts. In the euthanasia context, legal competence is the incurable s ability to understand that in requesting active euthanasia he is choosing death over life. Only clear and convincing evidence should suffice for a finding of an incurables competence. (Wolhandler, p. 366-67) c. The Legal State of Euthanasia With a knowledge of the meaningful terms that will be involved, it is important to discuss the legal state of euthanasia in the United States today. As technology has placed more and more people on life sustaining devices in this country, the courts have had to deal with several cases that pertain to euthanasia in a variety of ways. This section of the paper is designed to review those cases briefly and to assess how the rulings in those cases have set the policy for the practice of euthanasia today. The courts first dealt with euthanasia in the Quinlan case in 1976. Karen Ann Quinlan lapsed into a coma after mixing a variety of pills and alcohol at a party. After it became apparent that she would not be revived, her parents went to court to have her respirator removed. The New Jersey Supreme Court ruled that her parents had the right to have the respirator removed and that Karen be allowed to die. Ironically, because her parents did not request removal of feeding and hydration tubes , she survived nine more years curled in a fetal position in a New Jersey rest home (Wolhandler, p. 366). In this case, the New Jersey court effectively sanctioned nonvoluntary passive euthanasia. The next prominent case was decided by the New York Supreme Court in Superintendent of Belchertown State School v. Saikewicz. Here the court found that a competent patient had the right to refuse medical treatment, allowing for a patient to decide in cases of voluntary passive euthanasia (Gifford, p. 1575-76). Later, in Satz v. Perlmutter, a Florida District Court of Appeals came to essentially the same conclusion (Wolhandler, p. 372-73). In Severns v. Wilmington Medical Center, the Delaware Supreme Court gave the husband of a comatose woman the right of guardianship and the authority to remove her respirator or withhold other treatment as he saw fit. In this case the court relied on previous decisions made in Quinlan, Saikewicz, and Satz for its finding (Wolhandler, p. 373). In Thor v. Su perior Court (California), the court granted the request to withhold treatment from a severely depressed quadriplegic only after a psychiatric evaluation determined that the request was based on poor quality of life and not just on severe depression (Pugliese, 1993, p. 1326). The courts have not restricted the right of passive euthanasia to just the terminally ill. Elizabeth Bouvia was a relatively young woman who suffered from severe cerebral palsy and attempted to starve herself to death in a California hospital by requesting the removal of a nasogastric feeding tube. She was denied this request because the hospital feared it would be party to suicide. The California court of appeals ordered the physicians to remove the tube and argued that she had the right to enlist the assistance of others in ending her life (Sprung, 1990, p. 2213). The courts have also found that doctors and hospitals must at least obtain consent from third parties that would have a significant interest in the patients outcome if the patient is incompetent. In the case of Helga Wanglie, a Minnesota court denied a hospital administrator permission to disconnect her respirator against the wishes of her husband (Gifford, p. 1571). In sum, these cases indicate an emerging consensus that courts will generally allow treatment to be withheld from patients who are terminally ill if it is in the best interests of the patient and at the request of patients or family members. It is this emerging consensus that made the U.S. Supreme Courts decision in the Cruzan case so interesting. In the only euthanasia case heard to date by the U.S. Supreme Court, the justices, in a 5-4 decision, allowed to stand the decision made by the Missouri Court of Appeals not to disconnect the life support apparatus from Nancy Cruzan (Cruzan v. Director, Missouri Dept. of Health, 1990). Although the court did find that a right to refuse treatment could be found in the Due Process clause of the Fourteenth Amendment, and did not prohibit the courts from looking in other areas for this right (Adams, et. al., p. 2025), it also upheld the right of the State of Missouri to require . . . clear and convincing evidence that Ms. Cruzan would have desired withdrawal of these treatments. (Newman, 1991, p. 175). In the realm of physician assisted suicide, only two major cases have been decided. In the case against Dr. Timothy Quill that arose because of the publication of his article in the New England Journal of Medicine, the grand jury for the state of New York refused to return an indictment (Bender, 1992, p. 524). In the more publicized case of Dr. Jack Kervorkian, the courts have not yet decided on the constitutionality of the Michigan law that bans physician-assisted suicide. Kervorkian is currently free on bond and continues to aid other patients who wish to commit suicide (Pugliese, p. 1300-05).(1) A brief assessment of the cases described above indicates that the courts have essentially legalized voluntary passive euthanasia, finding justification to refuse or have medical treatment withheld in the constitutional right to privacy, the common law right of self determination, or the more general concept of autonomy (Gifford, p. 1575-78). With regard to involuntary passive euthanasia, the courts are generally supportive of the practice, but they have the right to insist on a more stringent standard of evidence before approving such procedures. The courts have generally employed a balancing test that weighs the patients right to privacy and self-determination against the interest of the state in preserving life. The interests of potential third parties that might desire that the patient continue to live, and the ethical image of the medical profession (Adams, et. al., p. 2022). In cases of assisted suicide, some states have laws against the practice, the AMA forbids it, most juries are refusing to find the actors guilty, and the courts have yet to decide the question. Both voluntary and involuntary active euthanasia remain illegal. d. The Debate About Euthanasia The movement to legalize active euthanasia has existed for quite some time. Initially popularized in Britain during the 19th century, it gained some adherents in the United States during the 1920s. It was the Nazi program of active euthanasia in the 1930s and 4os that cast a pall of disrepute over the practice that remains today. The revival of this movement today can largely be attributed to the onset of the issues discussed at the beginning of this paper, and to the efforts of the Hemlock Society, a group of individuals that actively promotes the right to dignified death. The Hemlock Society recently promoted ballot initiatives in both Washington and California that would have legalized active euthanasia in those states (Gifford, 1993). This revival of the right to die movement has led to hotly contested debate about the practices of active euthanasia and physician assisted suicide. This paper will attempt to encapsulate this debate by presenting the arguments made by both opponents and supporters of these procedures. Since arguments made by both sides are used in cases of euthanasia and assisted suicide, the generic term euthanasia is used for simplicity to suggest the concept of aided death unless otherwise indicated. Those opposed to euthanasia and assisted suicide present a variety of arguments in support of a ban. e. The Case Against Euthanasia Euthanasia destroys societal respect for life. By becoming commonplace and used in medical practice along with more traditional methods of healing, society becomes desensitized toward death to the point where life is no longer valuable. This attitude serves to degrade humanity and leads to a variety of social ills. In a society that devalues life, people have no compunctions about committing violent crimes and murdering others. The overall quality of life becomes seriously undermined and society as a whole deteriorates (Doerflinger, 1989, p. 16-19, Koop, 1989, p. 2-3). Once euthanasia becomes legal, opponents contend, the potential for abuse at the hands of caregivers vastly increases. Closely related to this argument is the argument that those who enjoy the exercise of power over others might become intoxicated with it and actually come to enjoy killing. One step down the path toward euthanasia simply makes it that much easier in the future to take further steps. This argument is al so referred to as the wedge theory or the slippery slope. One of the most outspoken opponents of euthanasia, University of Michigan professor of law Yale Kamisar, has articulated a three pronged attack that utilizes the wedge theory, the risk of abuse, and the risk of mistake. The proponents of the wedge theory argue that Once society accepts that life can be terminated because of its diminished quality, there is no rational way to limit euthanasia and prevent its abuse. According to this theory, voluntary euthanasia is just the thin edge of a wedge that, once in place, will be driven deeply into our society. Kamisar concludes that legalized voluntary euthanasia inevitably would lead to legalized involuntary euthanasia because it is impossible to draw a rational distinction between those who seek to die because they are a burden to themselves and those whom society seeks to kill because they are a burden to others.(2) (Wolhandler, p. 377) Many who raise the wedge or slippery slope a rgument use the Nazi experience with euthanasia as an empirical example of this process in action. They argue that a public policy of murder inexorably follows from an initial, limited step, namely the adoption of a carefully defined euthanasia program, and that a program designed to get rid of those with lives unworthy of life quickly degenerated into the holocaust (Newman, p. 167). What follows is a description of the Nazi euthanasia program excerpted from Liftons (1986) book: National Socialist euthanasia or mercy death was a program of killing persons with unworthy lives. These persons were not moribund, and their families, with the rarest exceptions, wanted them to live. It was not a good death, as the word denotes, but a systematic program of killing without any mercy whatsoever . . . The program, referred to in the National Socialist bureaucracy as T4, was not based on any law, but was initiated by a secret order traceable to Hitler and his chief physician, Karl Brandt . Ment al hospitals were required to report all chronic schizophrenics, manic-depressives, mental defectives, epileptics, and later, debilitated old persons. A separate division, the Public Transport division for the Sick, took care of the collection and transport of such patients to institutions where they were put to death . Relatives received false death certificates and even letters of condolence . . . It is estimated that during two years of this program, ninety thousand persons went to their deaths. While this description of the Nazi euthanasia program is indeed chilling, it provides within it a devastating attack against using it as justification for the slippery slope argument. Proponents of euthanasia in the United States point out that the Nazi program was not one of euthanasia, but a program of mass murder disguised as euthanasia. Gifford (p. 1570) sums up the response of several authors by stating that The Nazis hid their racist, eugenic agenda behind the term euthanasia, termi nating in secret the lives of undesirables. It must never be forgotten that the Nazi euthanasia program was never euthanasia at all. That the Nazis co-opted the term for their own purposes should not obscure the fact that their motive was, from the very beginning, entirely different from that of todays euthanasia proponents. The current euthanasia movement is anything but covert. The Hemlock Society and other supporters of the right to receive aid in dying have spent millions of dollars to publicize their efforts. In this context, death is presented as a positive alternative to pain and suffering, not a utilitarian tool. Proponents of euthanasia also attempt to refute the slippery slope argument in a variety of other ways. They contend that the current mechanisms used by the courts could easily prevent any slide toward involuntary euthanasia,(3) that the current practice of passive euthanasia proves that the slope isnt all that slippery since we havent witnessed any massive killing programs, and that the example of how forced sterilization in the U.S. has diminished rather than increased, provides a more appropriate example to rely on. Even Callahan (1989), a vocal opponent of active euthanasia, admits that the Nazi experience is not particularly applicable to the U.S. experience and that Lives are not b eing shortened. They are steadily being lengthened, and particularly for those who are the most powerless: sick children and the very old, the mentally and mentally retarded, the disabled and the demented (p. 4). Newman (1991) also attacks the concept of the slippery slope itself. Arguing that just pointing out that one type of action could conceivably lead to another constitutes a very unpersuasive argument and that for the premise to hold true, it must be shown that pressure to allow further steps will be so strong that these steps will actually occur. He also reminds us that such arguments are frequently abused in legal and social policy debate (p. 169). Besides Kamisar, the risk of abuse argument has also been put forth by a host of other authors who variously claim that assisted suicides might result in flagrant murders that may be perpetrated by deliberately forcing or coercing self-destruction and that others may advance personal motives by aiding in suicide (Adams, et. al., p. 2031); that when the entire medical profession is involved in euthanasia, including the poorly trained, the insensitive, the less skilled, there becomes the danger that physicians might not do whatever they can to avoid euthanasia if possible (Newman, p. 177); and that some people who enjoy the exercise of power over others might become addicted to the process (Doerflinger, p. 19). It is this fear of abuse that leads the AMAs Council on Ethical and Judicial Affairs to argue that the ban on active euthanasia is a bright line distinction that deters this type of potential abuse. They state: Allowing physicians to perform euthanasia for a limited group of patients who may truly benefit from it will present difficult line-drawing problems for medicine and society. In specific cases it may be hard to distinguish which cases fit the criteria established for euthanasia. For example, if the existence of unbearable pain and suffering was a criterion for euthanasia, the definition of unbea rable pain and suffering could be subject to different interpretations, which might lead to abuse of the process in the case of certain practitioners. (CEJA, p. 2232). Proponents of euthanasia argue that the risk of abuse, while certainly present, is not really much of a threat. This is true first, because laws against homicide are severe enough to provide a strong deterrent (Newman, p. 178); second, because a clear set of guidelines prescribing when active euthanasia is allowed will prevent confusion (Adams, et. al., Gifford); third, because we already risk the practice of abuse by allowing passive euthanasia, and such abuse has not occurred (Newman, p. 178); and finally, that the current state of illegality promotes an absence of discussion and actually encourages the practice of clandestine euthanasia (Newman, p. 177). As Gifford (p. 1572) succinctly puts it, what slope could be more slippery than one with no guardrails whatsoever? Additionally, the balancing tests already in place by the legal system should serve to eliminate this problem. Adams, et. al., (p. 2034) explain: For example, some opponents of physician-assisted suicide argue that pe rmitting some assisted suicides may lead to the killing of patients who want to live. This slippery slope argument expresses a utilitarian rationale for prohibiting suicide assistance. Others argue that suicide and the assistance of suicide is intrinsically evil, and that sanctioning them will damage the fabric of social morality. These and other utilitarian and moral considerations are encompassed within the states interest in preserving the sanctity of all life and affect its weight in the balance against the patients interest in self-determination. Opponents of euthanasia contend that there is no guarantee that euthanasia will be strictly voluntary. The potential for sub Arguments For and Against Euthanasia Arguments For and Against Euthanasia Euthanasia: Whose decision is it I. Introduction In a 1988 issue of the Journal of the American Medical Association, an article titled Its Over Debbie describes how an anonymous doctor administers a fatal dose of morphine to a woman dying of ovarian cancer (Anonymous, 1988). In a 1989 issue of the New England Journal of Medicine, ten doctors associated with the nations leading hospitals and medical schools declare their belief that it is not immoral for a physician to assist in the rational suicide of a terminally ill person (Wanzer, et. al., 1989). In 1991, the New England Journal of Medicine published a detailed account written by Dr. Timothy Quill which discussed his decision to help a patient suffering from leukemia commit suicide (Quill, 1991). In 1990, Dr. Jack Kervorkian uses his suicide machine to help a woman suffering from Alzheimers disease, one Janet Adkins, end her life in the back of a Volkswagen bus (Risen, 1990). Janet was the first of twenty patients who have been aided by Kervorkian in the past three years. He rem ains committed to his practice. In 1991 the Hemlock Society publishes a how-to manual on committing suicide. Entitled Final Exit, it zooms to the top of the national best seller lists and stays there for several weeks (Altman, 1991). Each of these events has served to provoke ever widening media coverage of the issues surrounding euthanasia and physician assisted suicide, and a national debate has arisen around these practices. This debate is not merely limited to attorneys and physicians. Suddenly, these issues and this debate are now a part of life in mainstream America, and many Americans face dilemmas that did not exist in simpler times; dilemmas that many would rather not have to face. II. Review of the Literature a. Euthanasia: The Nature of the Debate It is this sudden change in the way Americans are dealing with death, the nature and scope of the debate about dying, which prompts this analysis of the issues surrounding euthanasia. This debate is largely a debate about what is ethical. Questions the debate attempts to answer include: Is it right to commit suicide? Is it ethical for someone else to help? Is it right to put others to death at their own request or at the request of family members? These questions are important because they help to define our society and our culture. The way people deal with and respond to issues of life, ritual, and death serves to shape the nature of our society. This is why society must attempt to decide what is right; what is ethical conduct for the various actors in our communities when we face death. There are several reasons why this debate has surfaced in the 1980s. Death is nothing new, it has existed for thousands of years. Each culture has developed its own rituals and mechanisms for dealin g with death. These mechanisms serve to provide solace, a sense of continuity, and allow the culture to continue even as the members of the community cannot. However, our own culture has experienced many shattering changes that have altered the nature of dying. Suddenly we are forced to rethink the issue of death and we must decide what types of behavior are ethical when someone is dying. Before we can examine the debate about the ethics of dying, we must examine why the debate exists. Perhaps the main reason that death has changed in western culture has to do with advances in medicine and technology. Many of the diseases that have historically killed people are now no longer a threat to most individuals. Medicine has made a variety of advances in the treatment of diseases such as smallpox, tuberculosis, malaria, pneumonia, polio, influenza, and measles. People now rarely die of such traditional causes. Life expectancy has risen to almost 75 years in the United States. The quality o f life has also changed fundamentally during the past 100 years. Not only does almost everyone in the United States have enough to eat, but people eat higher on the food chain. There is a great deal more meat and animal fat in modern diets. Just these differences alone have changed death significantly. People now develop heart disease, adult onset diabetes, cancers, and AIDS. These types of diseases are more the result of lifestyle than bacteria. With these new diseases, suffering is often more prolonged and treatment is frequently quite painful. Also, as people are living longer, the diseases of the aged have become increasingly prevalent. Many more people now suffer from problems like senile dementia and Alzheimers disease. These diseases ruin the mind while preserving the body, allowing life to continue long after any quality that the life might have is gone. If what we die of has changed, perhaps the way that we die has changed even more. Throughout history, death has been a family affair. People usually died in the home after a short bout with an illness or as the result of an accident. Today, increasingly, death occurs in an institutional setting such as a convalescent home or a hospital, after a variety of technologies are applied in an attempt to prolong the life of the sick person. Often these technologies can be quite effective. People can now live for months and even years attached to a variety of tubes and technol ogies. About 75% of all deaths in 1987 occurred in hospitals and long term care facilities, up from 50% in 1950 . . . The Office of Technology Assessment Task Force estimated in 1988 that 3775 to 6575 persons were dependent on mechanical ventilation and 1,404,500 persons were receiving artificial nutritional support. This growing capability to forestall death has contributed to the increased attention to medical decisions near the end of life. (CEJA, 1992, p. 2229) People realize that the chances of facing the institutionalization of death increase daily, and they feel a profound lack of control. Surveys have consistently indicated that a large majority of people in the United States would like to be allowed to end their lives before incurable and painful diseases finally kill them (CEJA, p. 2229). Because of the changes that have impacted death, with regard to both how and where we die, the debate about how we should be allowed to die has been renewed. This paper will examine the s everal facets of this debate. It will define the terms that are relevant to the debate, examine the legal state of euthanasia today, discuss the ethics of euthanasia by examining arguments made by proponents and opponents of euthanasia, and by applying several Normative Ethical Theories to the issue. Finally, it will explore the power implications that infuse the debate on euthanasia and present arguments in favor of moving toward a care based ethic of dying and away from the current rights based ethic. b. Definitions If we are to effectively understand the debate about the right to die in the United States, it is imperative that a few basic terms be understood. The first and most important term is euthanasia. Originating from the Greek terms eu (happy or good) and thanatos (death), euthanasia means literally happy death or good death. The American Medical Associations Council on Ethical and Judicial Affairs defines the term as follows: Euthanasia is commonly defined as the act of bringing about the death of a hopelessly ill and suffering person in a relatively quick and painless way for reasons of mercy. In this report, the term euthanasia will signify the medical administration of a lethal agent to a patient for the purpose of relieving the patients intolerable and incurable suffering. (p. 2230) Other sources have defined euthanasia variously: The act or practice of painlessly putting to death persons suffering from incurable conditions of diseases. (Wolhandler, 1984, p. 363), . . . to refuse un wanted medical treatment or to have ongoing care withdrawn even though the patient will die if treatment is terminated. (Adams, et. al., 1992, p. 2021). Euthanasia is a general term that can actually mean a variety of different things depending upon the context in which it is used. For this reason, a number of supporting terms has become the convention when discussing euthanasia. These terms help to narrow the subject matter and distinguish between different types of euthanasia. The important terms that help to subdivide and classify euthanasia by type are voluntary/involuntary and active/passive. Voluntary euthanasia is a death performed by another with the consent of the person being killed. This consent may be in writing as in the case of a living will or advance directive. Involuntary euthanasia is a death performed by another without the consent of the person being killed. The AMAs Council on Ethical and Judicial Affairs makes three distinctions concerning consent and euthanasia: Voluntary euthanasia is euthanasia that is provided to a competent person on his or her informed request. Non-voluntary euthanasia is the provision of euthanasia to an incompetent person according to a surrogates decision. Involuntary euthanasia is euthanasia performed without a c ompetent persons consent.(p. 2230) Wolhandler compares the terms in a different context.Those who condemn euthanasia of both kinds would call the involuntary form murder and the voluntary form a compounded crime of murder and suicide if administered by the physician, and suicide alone if administered by the patient himself. As far as voluntary euthanasia goes, it is impossible to separate it from suicide as a moral category; it is, indeed, a form of suicide. Voluntary euthanasia may involve participation of second parties. (p. 366) The distinction between active and passive euthanasia is not nearly as clear as the previous distinction. Although many authors claim that the difference between the two types cannot be identified or is irrelevant at best, much of the debate on the subject is over this distinction and most of the current legal issues turn on this distinction. While this paper will contend that the difference between the two should not be recognized, it is both useful and important to know where the line is drawn. The AMA, which is strongly opposed to active euthanasia, has seen fit to endorse passive euthanasia in appropriate situations. The Council on Ethical and Judicial Affairs makes the distinction as follows: The physician is obligated only to offer sound medical treatment and to refrain from providing treatments that are detrimental, on balance, to the patients well being. When a physician withholds or withdraws a treatment on the request of a patient, he or she has fulfilled the obligation to offer sound treatment to the patient. The obligation to offer treatment does not include an obligation to impose treatment on an unwilling patient. In addition, the physician is not providing a harmful treatment. Withdrawing or withholding is not a treatment, but the foregoing of a treatment. (p. 2231) According to Wolhandler, (p. 367) it is t he nature of the acts performed by the second party that distinguishes between active and passive euthanasia. The courts have held that acts of omission (removal of respiratory assistance, hydration, and feeding tubes) are allowable behavior. Although unplugging a respirator and switching off a dialysis machine are arguably acts of commission, an increasing number of judges and commentators have accepted these acts as permissible passive euthanasia in both voluntary and involuntary settings. Gifford (1993) describes the difference between the two types of euthanasia this way: Passive euthanasia involves allowing a patient to die by removing her from artificial life support systems such as respirators and feeding tubes or simply discontinuing medical treatments necessary to sustain life. Active euthanasia, by contrast, involves positive steps to end the life of a patient, typically by lethal injectiond (p. 1546) The right to passive euthanasia has also been termed the right to die by some authors (Adams, et. al., p. 2021-22). With an understanding of the different types of euthanasia, we can now define some other key terms. It is important to understand how physician assisted suicide differs from euthanasia, and it is also necessary to define the terms advance directive and competence since they are crucial in determining the difference between voluntary and involuntary euthanasia. The term physician assisted suicide is somewhat self-explanatory. It occurs when a physician provides aid to a patient so they can commit suicide. However, it is also necessary to see the difference between this type of action and euthanasia. The AMAs Council on Ethical and Judicial Affairs states that Euthanasia and assisted suicide differ in the degree of physician participation. Euthanasia entails a physician performing the immediate life ending action (e.g., administering a lethal injection). Assisted suicide occurs when a physician facilitates a patients death by providing the necessary means and/or information to enable the patient to perform the life-ending act (e.g., the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide). (p. 2231) It is important to realize that the difference between euthanasia and assisted suicide lies in the behavior of the physician. This difference in behavior has recently become a major legal battleground that will be explored in the following pages. The advance directive has recently become an important new device to aid the terminally ill. Many states have legalized the advance directive, partly in an attempt to avoid dealing with problems associated with active euthanasia, and partly to help ease the burdens on the dying and their families. Singer (1992) provides a good definition of advance directive and explains how it is used. An advance directive is a written document completed by a competent person that aims to guide medical treatment after the person becomes incompetent. There are two types: instruction directives, which focus on the types of life-sustaining treatment that the person would want under various clinical situations, and proxy directives, which focus on who the person would want to make health care decisions if the person were unable to do so. (p. 22) The advance directive is useful because it can theoretically eliminate the need for involuntary euthanasia. It ensures that a voluntary decision is made in advance, even if the individual could not make such a situation at a later date. If everyone made use of the advance directive, there would be no need to debate policy decisions that must be made in the case of an incompetent person on life support. Because advance directives have neither been accepted nor widely used by the general public, many of the problems that could potentially be solved remain. This situation caused right to die groups in both California and Washington to propose ballot initiatives that would legalize active euthanasia (Gifford, p. 1550-51). Although active euthanasia is not legal in any United States jurisdiction, passive euthanasia is generally allowed at the request of a competent individual. Because of this it is critical to understand what constitutes competence. Courts have defined legal competence as the mental ability to make a rational decision, which includes the ability to perceive, appreciate all the relevant facts, and to reach a rational judgement upon such facts. In the euthanasia context, legal competence is the incurable s ability to understand that in requesting active euthanasia he is choosing death over life. Only clear and convincing evidence should suffice for a finding of an incurables competence. (Wolhandler, p. 366-67) c. The Legal State of Euthanasia With a knowledge of the meaningful terms that will be involved, it is important to discuss the legal state of euthanasia in the United States today. As technology has placed more and more people on life sustaining devices in this country, the courts have had to deal with several cases that pertain to euthanasia in a variety of ways. This section of the paper is designed to review those cases briefly and to assess how the rulings in those cases have set the policy for the practice of euthanasia today. The courts first dealt with euthanasia in the Quinlan case in 1976. Karen Ann Quinlan lapsed into a coma after mixing a variety of pills and alcohol at a party. After it became apparent that she would not be revived, her parents went to court to have her respirator removed. The New Jersey Supreme Court ruled that her parents had the right to have the respirator removed and that Karen be allowed to die. Ironically, because her parents did not request removal of feeding and hydration tubes , she survived nine more years curled in a fetal position in a New Jersey rest home (Wolhandler, p. 366). In this case, the New Jersey court effectively sanctioned nonvoluntary passive euthanasia. The next prominent case was decided by the New York Supreme Court in Superintendent of Belchertown State School v. Saikewicz. Here the court found that a competent patient had the right to refuse medical treatment, allowing for a patient to decide in cases of voluntary passive euthanasia (Gifford, p. 1575-76). Later, in Satz v. Perlmutter, a Florida District Court of Appeals came to essentially the same conclusion (Wolhandler, p. 372-73). In Severns v. Wilmington Medical Center, the Delaware Supreme Court gave the husband of a comatose woman the right of guardianship and the authority to remove her respirator or withhold other treatment as he saw fit. In this case the court relied on previous decisions made in Quinlan, Saikewicz, and Satz for its finding (Wolhandler, p. 373). In Thor v. Su perior Court (California), the court granted the request to withhold treatment from a severely depressed quadriplegic only after a psychiatric evaluation determined that the request was based on poor quality of life and not just on severe depression (Pugliese, 1993, p. 1326). The courts have not restricted the right of passive euthanasia to just the terminally ill. Elizabeth Bouvia was a relatively young woman who suffered from severe cerebral palsy and attempted to starve herself to death in a California hospital by requesting the removal of a nasogastric feeding tube. She was denied this request because the hospital feared it would be party to suicide. The California court of appeals ordered the physicians to remove the tube and argued that she had the right to enlist the assistance of others in ending her life (Sprung, 1990, p. 2213). The courts have also found that doctors and hospitals must at least obtain consent from third parties that would have a significant interest in the patients outcome if the patient is incompetent. In the case of Helga Wanglie, a Minnesota court denied a hospital administrator permission to disconnect her respirator against the wishes of her husband (Gifford, p. 1571). In sum, these cases indicate an emerging consensus that courts will generally allow treatment to be withheld from patients who are terminally ill if it is in the best interests of the patient and at the request of patients or family members. It is this emerging consensus that made the U.S. Supreme Courts decision in the Cruzan case so interesting. In the only euthanasia case heard to date by the U.S. Supreme Court, the justices, in a 5-4 decision, allowed to stand the decision made by the Missouri Court of Appeals not to disconnect the life support apparatus from Nancy Cruzan (Cruzan v. Director, Missouri Dept. of Health, 1990). Although the court did find that a right to refuse treatment could be found in the Due Process clause of the Fourteenth Amendment, and did not prohibit the courts from looking in other areas for this right (Adams, et. al., p. 2025), it also upheld the right of the State of Missouri to require . . . clear and convincing evidence that Ms. Cruzan would have desired withdrawal of these treatments. (Newman, 1991, p. 175). In the realm of physician assisted suicide, only two major cases have been decided. In the case against Dr. Timothy Quill that arose because of the publication of his article in the New England Journal of Medicine, the grand jury for the state of New York refused to return an indictment (Bender, 1992, p. 524). In the more publicized case of Dr. Jack Kervorkian, the courts have not yet decided on the constitutionality of the Michigan law that bans physician-assisted suicide. Kervorkian is currently free on bond and continues to aid other patients who wish to commit suicide (Pugliese, p. 1300-05).(1) A brief assessment of the cases described above indicates that the courts have essentially legalized voluntary passive euthanasia, finding justification to refuse or have medical treatment withheld in the constitutional right to privacy, the common law right of self determination, or the more general concept of autonomy (Gifford, p. 1575-78). With regard to involuntary passive euthanasia, the courts are generally supportive of the practice, but they have the right to insist on a more stringent standard of evidence before approving such procedures. The courts have generally employed a balancing test that weighs the patients right to privacy and self-determination against the interest of the state in preserving life. The interests of potential third parties that might desire that the patient continue to live, and the ethical image of the medical profession (Adams, et. al., p. 2022). In cases of assisted suicide, some states have laws against the practice, the AMA forbids it, most juries are refusing to find the actors guilty, and the courts have yet to decide the question. Both voluntary and involuntary active euthanasia remain illegal. d. The Debate About Euthanasia The movement to legalize active euthanasia has existed for quite some time. Initially popularized in Britain during the 19th century, it gained some adherents in the United States during the 1920s. It was the Nazi program of active euthanasia in the 1930s and 4os that cast a pall of disrepute over the practice that remains today. The revival of this movement today can largely be attributed to the onset of the issues discussed at the beginning of this paper, and to the efforts of the Hemlock Society, a group of individuals that actively promotes the right to dignified death. The Hemlock Society recently promoted ballot initiatives in both Washington and California that would have legalized active euthanasia in those states (Gifford, 1993). This revival of the right to die movement has led to hotly contested debate about the practices of active euthanasia and physician assisted suicide. This paper will attempt to encapsulate this debate by presenting the arguments made by both opponents and supporters of these procedures. Since arguments made by both sides are used in cases of euthanasia and assisted suicide, the generic term euthanasia is used for simplicity to suggest the concept of aided death unless otherwise indicated. Those opposed to euthanasia and assisted suicide present a variety of arguments in support of a ban. e. The Case Against Euthanasia Euthanasia destroys societal respect for life. By becoming commonplace and used in medical practice along with more traditional methods of healing, society becomes desensitized toward death to the point where life is no longer valuable. This attitude serves to degrade humanity and leads to a variety of social ills. In a society that devalues life, people have no compunctions about committing violent crimes and murdering others. The overall quality of life becomes seriously undermined and society as a whole deteriorates (Doerflinger, 1989, p. 16-19, Koop, 1989, p. 2-3). Once euthanasia becomes legal, opponents contend, the potential for abuse at the hands of caregivers vastly increases. Closely related to this argument is the argument that those who enjoy the exercise of power over others might become intoxicated with it and actually come to enjoy killing. One step down the path toward euthanasia simply makes it that much easier in the future to take further steps. This argument is al so referred to as the wedge theory or the slippery slope. One of the most outspoken opponents of euthanasia, University of Michigan professor of law Yale Kamisar, has articulated a three pronged attack that utilizes the wedge theory, the risk of abuse, and the risk of mistake. The proponents of the wedge theory argue that Once society accepts that life can be terminated because of its diminished quality, there is no rational way to limit euthanasia and prevent its abuse. According to this theory, voluntary euthanasia is just the thin edge of a wedge that, once in place, will be driven deeply into our society. Kamisar concludes that legalized voluntary euthanasia inevitably would lead to legalized involuntary euthanasia because it is impossible to draw a rational distinction between those who seek to die because they are a burden to themselves and those whom society seeks to kill because they are a burden to others.(2) (Wolhandler, p. 377) Many who raise the wedge or slippery slope a rgument use the Nazi experience with euthanasia as an empirical example of this process in action. They argue that a public policy of murder inexorably follows from an initial, limited step, namely the adoption of a carefully defined euthanasia program, and that a program designed to get rid of those with lives unworthy of life quickly degenerated into the holocaust (Newman, p. 167). What follows is a description of the Nazi euthanasia program excerpted from Liftons (1986) book: National Socialist euthanasia or mercy death was a program of killing persons with unworthy lives. These persons were not moribund, and their families, with the rarest exceptions, wanted them to live. It was not a good death, as the word denotes, but a systematic program of killing without any mercy whatsoever . . . The program, referred to in the National Socialist bureaucracy as T4, was not based on any law, but was initiated by a secret order traceable to Hitler and his chief physician, Karl Brandt . Ment al hospitals were required to report all chronic schizophrenics, manic-depressives, mental defectives, epileptics, and later, debilitated old persons. A separate division, the Public Transport division for the Sick, took care of the collection and transport of such patients to institutions where they were put to death . Relatives received false death certificates and even letters of condolence . . . It is estimated that during two years of this program, ninety thousand persons went to their deaths. While this description of the Nazi euthanasia program is indeed chilling, it provides within it a devastating attack against using it as justification for the slippery slope argument. Proponents of euthanasia in the United States point out that the Nazi program was not one of euthanasia, but a program of mass murder disguised as euthanasia. Gifford (p. 1570) sums up the response of several authors by stating that The Nazis hid their racist, eugenic agenda behind the term euthanasia, termi nating in secret the lives of undesirables. It must never be forgotten that the Nazi euthanasia program was never euthanasia at all. That the Nazis co-opted the term for their own purposes should not obscure the fact that their motive was, from the very beginning, entirely different from that of todays euthanasia proponents. The current euthanasia movement is anything but covert. The Hemlock Society and other supporters of the right to receive aid in dying have spent millions of dollars to publicize their efforts. In this context, death is presented as a positive alternative to pain and suffering, not a utilitarian tool. Proponents of euthanasia also attempt to refute the slippery slope argument in a variety of other ways. They contend that the current mechanisms used by the courts could easily prevent any slide toward involuntary euthanasia,(3) that the current practice of passive euthanasia proves that the slope isnt all that slippery since we havent witnessed any massive killing programs, and that the example of how forced sterilization in the U.S. has diminished rather than increased, provides a more appropriate example to rely on. Even Callahan (1989), a vocal opponent of active euthanasia, admits that the Nazi experience is not particularly applicable to the U.S. experience and that Lives are not b eing shortened. They are steadily being lengthened, and particularly for those who are the most powerless: sick children and the very old, the mentally and mentally retarded, the disabled and the demented (p. 4). Newman (1991) also attacks the concept of the slippery slope itself. Arguing that just pointing out that one type of action could conceivably lead to another constitutes a very unpersuasive argument and that for the premise to hold true, it must be shown that pressure to allow further steps will be so strong that these steps will actually occur. He also reminds us that such arguments are frequently abused in legal and social policy debate (p. 169). Besides Kamisar, the risk of abuse argument has also been put forth by a host of other authors who variously claim that assisted suicides might result in flagrant murders that may be perpetrated by deliberately forcing or coercing self-destruction and that others may advance personal motives by aiding in suicide (Adams, et. al., p. 2031); that when the entire medical profession is involved in euthanasia, including the poorly trained, the insensitive, the less skilled, there becomes the danger that physicians might not do whatever they can to avoid euthanasia if possible (Newman, p. 177); and that some people who enjoy the exercise of power over others might become addicted to the process (Doerflinger, p. 19). It is this fear of abuse that leads the AMAs Council on Ethical and Judicial Affairs to argue that the ban on active euthanasia is a bright line distinction that deters this type of potential abuse. They state: Allowing physicians to perform euthanasia for a limited group of patients who may truly benefit from it will present difficult line-drawing problems for medicine and society. In specific cases it may be hard to distinguish which cases fit the criteria established for euthanasia. For example, if the existence of unbearable pain and suffering was a criterion for euthanasia, the definition of unbea rable pain and suffering could be subject to different interpretations, which might lead to abuse of the process in the case of certain practitioners. (CEJA, p. 2232). Proponents of euthanasia argue that the risk of abuse, while certainly present, is not really much of a threat. This is true first, because laws against homicide are severe enough to provide a strong deterrent (Newman, p. 178); second, because a clear set of guidelines prescribing when active euthanasia is allowed will prevent confusion (Adams, et. al., Gifford); third, because we already risk the practice of abuse by allowing passive euthanasia, and such abuse has not occurred (Newman, p. 178); and finally, that the current state of illegality promotes an absence of discussion and actually encourages the practice of clandestine euthanasia (Newman, p. 177). As Gifford (p. 1572) succinctly puts it, what slope could be more slippery than one with no guardrails whatsoever? Additionally, the balancing tests already in place by the legal system should serve to eliminate this problem. Adams, et. al., (p. 2034) explain: For example, some opponents of physician-assisted suicide argue that pe rmitting some assisted suicides may lead to the killing of patients who want to live. This slippery slope argument expresses a utilitarian rationale for prohibiting suicide assistance. Others argue that suicide and the assistance of suicide is intrinsically evil, and that sanctioning them will damage the fabric of social morality. These and other utilitarian and moral considerations are encompassed within the states interest in preserving the sanctity of all life and affect its weight in the balance against the patients interest in self-determination. Opponents of euthanasia contend that there is no guarantee that euthanasia will be strictly voluntary. The potential for sub

The Theme in The Lesson by Toni Cade Bambara Essay -- Toni Cade Bambar

The Theme in The Lesson by Toni Cade Bambara The theme in "The Lesson" by Toni Cade Bambara appears to be a lesson on Social Class and having a choice which society you choose to live in. Miss. Moore who takes on this responsibility to educate the young ones has more then a lesson to teach, but a challenging group of city kids to come by. Sylvia and Sugar which seems to be the leader of the group of neighborhood kids gives Miss. Moore that challenge and not give her the satisfaction. Sylvia's stubborn and stern attitude is sear towards Miss. Moore perhaps Sylvia got a bad impression of Miss. Moore from all that was said about her by the grown-ups. The narrator speaks as a second person and to me Sylvia is the narrator in the story. When the narrator speaks it is she would always say "I" and when Miss. Moore asked Sylvia she states "I'm mad, but I won't give her that satisfaction". The story takes place in what some people might call the projects, or the gutto but in this case it's called the slums by Miss, Moore. Miss. Moore star...

Marketing ans supplementary services

Inna bid to form a boding relationship with consumers and customers, many organizations through their marketing activities have engaged in giving supplementary services such as additional services to argument or facilitate the core service or core product sold by the organization, after sales services, continuous enlightenment and communication to consumers on how to effectively utilize their products or service, among others. The supplementary services provided by an organization in its marketing strategy this is a way of retaining the patronage of old customers and winning the trust of new ones. As the strategy of retaining old customers is more cost effective than sourcing for new ones this supplementary services provision is a good way of increasing the bond between the organization and its customers. According to Stern (1997), â€Å"Bonding is an increasingly popular marketing strategy in which services marketers seek to establish personal long- term bonds with consumers so that current ones may be retained. Retention is now considered a more cost- effective strategy than continual prospecting for new customers, and this is made manifest by a firm’s commitment to the relationship as an enduring one†. Thus, enduring commitment to an organization’s relationship to its customers, it is adequately expressed via the level of supplementary services made available for them. Thus, the role of supplementary services and goods provision by an organization to its customers would be looked upon. SUPPLEMENTARY SERVICES IN GOODS AAND SERVICES PROVIDING ORGANIZATION An organization provides core services and goods to its customers. This core services or products are the main organization’s operation which they render or sell to customers. According to Iacobucci (2001:323), â€Å"An organization that provides services, either as its central provision or in a   value-added capacity in a bundle of attributes included in a customer’s purchase of some goods, may find it useful to distinguish those elements of the services purchase experience that are ‘core’ from the supplemental†. Therefore core services or core product of an organization is that function that forms the business identity. For example, a car manufacturing company will have its core product as the finished cars sold to customers. On the other hand supplementary goods or services are those additional services that an organization gives to customers as a way to augment the core goods or services that was purchased or rendered by the organization. â€Å"The supplementary services are the components of the service delivery system that are intended to facilitate and enhance the customer’s experience† (ibid). using the car manufacturing organization again to illustrate, its supplementary services may be that it have a car servicing center, repairs to brakes, sells spare parts for its brand of cars, run a driver training school etc. Looking at the core and supplementary service of an organization that is service base, for example, an airline organization will have as its core service the transportation of passengers from one city to another. Its supplementary services would include the provision of movies and meals for passengers on board, the operating of a frequent flyer accounts (E.g. Air China gives its frequent flyer a Mileage Awards and run a club for its frequent flyers), conveniently located hubs etc. Also, a business center for data processing and photocopy services as its core may have supplementary services as sending of fax messages, sending of overnight express packages etc. The illustrated examples go to buttress the fact that supplementary services is applicable to both an organization that deals in  Ã‚   goods and services. THE ROLE OF SUPPLEMENTARY SERVICES Supplementary services plays a vital role in making customers satisfy with the core goods or services they derive from an organization. The supplementary goods facilitate and make the customer have a quick satisfying experience from the utilization of the core services or goods from an organization. According to Iacobucci (2001:321), â€Å"In an attempt to create distinct advantage managers often seek to provide added value to customers and enhance their corporate competitive advantage by offering better customer service†. Hence, the provision of supplementary services to customer is a way by which a firm can gain competitive advantage over its rivals. The extra supplementary services goes a long way in putting the organization ahead over its rivals, that is as customers derives additional services they would be made satisfied and this is an advantage to the organization. Proctor (20000, argues that â€Å"marketing is about satisfying customers wants and needs and in the course of doing so facilitating the achievement of an organization’s objectives by paying attention to customers wants and needs organizations are likely to achieve their objectives in the marketplace†¦they have to compete with each other and also have to satisfy customers wants and needs at least as well their competitors.† Supplementary services brings the customers into forming a bond with the organization and hence, creating continuous patronage from the customers. Patronage motives, according to Beckman & Davidson (1967:300), â€Å"stressed in industrial   purchasing include accessibility to seller, rapidity of delivery, terms of sale and reliability of repair services, history of satisfactory business relationships, and other similar rational consideration†. Supplementary services helps in winning the continuous patronage of customers. For example, when a customer who buys television sets for his retail sales from an organization that offers supplementary repairs services, the retailer would be rest assures that if there is problem with any of the set, he stays to get expert to repair them from the organization. Thus, his patronage of the organization product would continue, and that bond would be established between him and the organization. Supplementary services also play the role of giving customers the ability to assess the level of satisfaction they get from the  Ã‚   core services or utility derived in consuming an organization’s product. For example, patience in a hospital may base his satisfaction on what he derives while being admitted as an in-patient. This could come in   supplementary services as the meal served, how conducive the environment is in terms of facility provided, and a clean environment, question like was the television in the ward too loud or in a good state? All these supplementary services which are not the core service from the hospital would go a long way in making the patient form his judgment on how satisfied he is with the core service from the organization. HOW TO RELATE SUPPLEMENTARY SERVICES WITH AN ORGANIZATION’S MARKETING STRATEGY The supplementary services rendered by an organization should be established with a focus to helping the organization effectively market its core services or core products. Thus, it is germane that these supplementary services are a streamlined in the direction of how effectively the organization could attain its corporate objectives. According to Proctor (2000), â€Å"a strategy is a plan that integrates an organization’s major goals, policies, decisions and sequences of action into a cohesive whole†. Thus, it is germane that the provision of supplementary services is targeted towards enhancing the organization’s core functions in order to make it effectively meet its goals and objectives. The need to make vital decision on what to bring up as supplementary service sis important in meeting the significant that goes along with the service creation. According to Lazar (1971), an organization can derive good intelligent decision through information gotten from assessing marketing alternatives and adjust to  Ã‚  Ã‚   dynamic market conditions. Thus the provision of supplementary services should be done with the cognizance of change in the environment where the organization operates. CONCLUSION The provision of supplementary services is an effective way of satisfying the desires of customers. And this is applicable to organization operating in services provision and goods production. Continuous patronage and the formation of bond between customers and the organization is enhanced and facilitated through supplementary service provision. Hence, the establishment should align its supplementary services or goods to be intone with its core functions, so as to effectively meet the organization’s objectives and long term goals. REFRENCES Beckman, Theodore N & Davidson, William R. (1967), Marketing New York: Ronald Press Co. Iacobucci, Dawn (2001), â€Å"Services Marketing and Customers Service’ in Iacobucci, Dawn (ed.) Kellogg on Marketing. New York: Wiley Lazar, William (1971), Marketing management: A Systems Perspective. New York: John Wiley & Sons Proctor, Tony (2000), Strategic marketing: An Introduction. London: Routledge Stern, Barbara B. (1997), â€Å"Advertising Intimacy: relationship Marketing and the Service Consumer† in Journal of Advertising. Vol. 26, No. 4   

Best Vs. Worst Communicators - 967 Words

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Summary Although the October 16, 1995 legislative proposal purports to regulate computer pornography, the proposal contains fatal flaws which render the proposal at best counterproductive and at worst devastating to on-line communications. First, it prohibits, but fails to define, indecent speech to minors -- a dangerously vague, medium-specific, and, after decades of litigation, still undefined concept, which may include mereRead MoreThe History Of Social Psychology2266 Words   |  10 Pagesintervention. An example is not placing a small child in a car seat. Moderate neglect can sometimes involve child services if community help does not cause change. An example of moderate neglect is not providing warm clothes for a child during winter. The worst type, severe neglect, is when there is long-term harm to the child and has not been given needed medications over a long time period. Another type of child abuse that is not physical or mental is sexual. Sexual child abuse is forcing a child into sexualRead MoreDetection And Prevention Of Sinkhole Attack On Zone Routing Protocol3293 Words   |  14 Pagesthe early days among military, police, and rescue agencies in the use of such networks, especially under disorganized or hostile conditions, including isolated scenes of natural disaster or armed conflict. Soldiers equipped with multimode mobile communicators ca n now communicate in ad hoc manner without the need for fixed wireless base stations. A hybrid protocol is a combination of both reactive proactive routing protocols.ZRP is one of the hybrid protocol and it more efficient, and effective routingRead MoreDetection And Prevention Of Sinkhole Attack On Zone Routing Protocol3349 Words   |  14 Pagesthe early days among military, police, and rescue agencies in the use of such networks, especially under disorganized or hostile conditions, including isolated scenes of natural disaster or armed conflict. Soldiers equipped with multimode mobile communicators can now communicate in ad hoc manner without the need for fixed wireless base stations. A hybrid protocol is a combination of both reactive proactive routing protocols.ZRP is one of the hybrid protocol and it more efficient, and effective routingRead MoreDetection And Prevention Of Sinkhole Attack On Zone Routing Protocol3308 Words   |  14 Pagesthe early days among military, police, and rescue agencies in the use of such networks, especially under disorganized or hostile conditions, including isolated scenes of natural disaster or armed conflict. Soldiers equipped with multimode mobile communicators can now communicate in ad hoc manner without the need for fixed wireless base stations. MANET have three protocols, that is proactive, reactive and hybrid protocol. The hybrid protocol is a combination of both reactive proactive routing protocolsRead MoreMercedes Benz7662 Words   |  31 Pagesrating of the hotel and for the corporate companies two turnover segments are considered. The figures for companies are the figures of the turnover per year of the companies. BENEFIT STATEMENT Mercedes-benz philosophy: â€Å"We give the best for our people who expect the best† Technical buying influence: Your Mercedes-Benz M-class gives you the feel of throttle as it is designed amp; crafted with German engineering. User buying influence: Your Mercedes-Benz M-class gives you luxury, safety and sportinessRead MoreWhat Is Interpersonal Communication?2955 Words   |  12 Pagesassigned by others who are part of the process for realizing the knowledge and recognize. According to Dias (2001, p. 32), this aspect may lead to more or less credibility to the issuer and bring a statute of the score the performance of its role as a communicator. Some people, by deeply knowing a subject, do not like or bother to talk to someone who does not have the same subject domain and vice versa. 2. Appearance: how to dress and care can determine the way in which the people communicate with each other

Essay on Assessing Maths Assignment - 665 Words

Access Diploma in Adult Learning Assessing Maths Assignment Landscaping a Garden Ive been asked me to cost his landscaping project for him using the prices quoted by a local supplier, and to give him a full breakdown of the calculations required and how I arrived at the final cost. Plan I plan to do this firstly by breaking up the garden plan into 5 sections. 1. Decking and border. 2. Flowerbed and crazy paving 3. Fish pond, safety fence, bridge and rail 4. Perimeter fence 5. Grass. Decking and Border The decking area consists of two right angle triangle. The two edges around the decking are equal in length. I need to work out the length of the edges and the area of the decking, how much materials required and cost. In†¦show more content†¦the flowerbed using the equation, this will give me the service area of the flower bed Area + I then will work out the area of the larger semi-circle marked D using the above equation and subtract the area of the smaller circle (flowerbed). This will give me the area of the crazy paving I will then work out how much crazy paving required / m ². I will then work out the cost of the paving @  £3.50 + VAT per m ² I will work out how many bulbs required for the area in m ² for the flower bed, and the cost at  £6.40 per m ². Fish pond, safety fence, bridge and rail The fish pond has a depth of 75cm enclosed by a safety fence which has a 1m wide bridge over it in the shape of a quadrant. The bridge is fitted with a handrail on both sides. Firstly I need to decide what length the sides of the pond are going to be. (Pond marked E) To work out the amount of safety fence required, I will work out the perimeter of the square fish pond subtracting 2m (1m for each side of the bridge at 1m each side). Perimeter = 4 x sides – 2(1m) I will need to work out how many meters of safety fencing/ m required and then cost it at  £8.70 per m To work out the quadrant shape bridge marked F. As a quadrant is quarter of a circle I can work out the length of the outside edge of the bridge by using the circle theorem. I will calculate the circumference using the radius and dividing by 4. Equation to find Quadrant Circumference = When will then cost theShow MoreRelatedPart 1: Exemplars Math Rubric And Exemplars Reading Rubric.826 Words   |  4 PagesPart 1: Exemplars Math Rubric and Exemplars Reading Rubric How does the Exemplars criteria for both math and reading rubrics follow a top-down or bottom-up approach? How do you know? Exemplars scoring rubrics are excellent tools for assessing student work. One clear thing about the rubrics is that both math and reading rubrics follow a top-down approach in assessing students. In math, for instance, the strategy is chosen first (Brookhart, 2013). â€Å"Exemplars math material comprises standards-basedRead MoreAssessment And Evaluation Is Important Tool On Finding Out What Students Know And Their Experiences849 Words   |  4 Pagestheir skills and learning. Redesign The instructional design project chosen is from Technologies for Teaching and Learning EDU 649. The subject was math and Pre-K was the grade level for this lesson. Math skills are one of the most important skills for young learners to how to solve problems in which relates to real world connections. For this assignment students will identify how to create and extend patterns using technology. The learning outcome of each lesson, students will be expected to recognizeRead MoreStudents Learning Content And Achieve Progress Towards Their Individual Iep Goals843 Words   |  4 Pagesassessments. Daily assessments in my classroom usually consist of observation and completion of in class assignments. Weekly or bi-monthly assessments of students include observations, in class work and simple review assignments. For example, I may have the student’s play a quiz or trivia game based on previously taught skills or lessons, depending on the student, subject or data I am assessing for. T he assessment may be verbal, written or using some other form of communication, depending on the needsRead MoreGraduation Speech : Mathematics, Technology, Engineering And Mathematics1406 Words   |  6 Pages I want to teach math in New York City because I will be able to communicate the significance of math in everyday life. The math that adults use to pay bills, manage their budgets, tax preparations, as well as other things is significant. Using real-life situations would capture a students’ attention since it is aligned with their interests. Depending on the grade level, students start to question the relevance of a subject to their future. I love the gratitude and appreciation students show whenRead MoreThe Importance Of Instructional Improvements In College1517 Words   |  7 PagesWisconsin and Norfolk, Virginia raise overall achievement and close the achievement gap between student subgroups (2003). Some practices suggested by Reeves are not feasible for Fort Pierce Westwood, such as double-blocked periods for all English and Math classes. There are some best practices suggested by Reeves that can be used by improving upon structures that are already in place at the school. The first practice is carving out time for teachers to collaborate (Reeves, 2003). Reeves says that teacherRead MorePerformance Goals for a Child with Learning Disabilities Essays586 Words   |  3 PagesCarlos is 12 years old Hispanic American in grade 7th. He is fine-looking, polite, admired, and hardworking. His Math is good and he has good skills in auditory processing. Unfortunately, local committee and special education has classified him as Learning Disabled. Learning Disability encompasses numerous types of learning problems. Following are 3 main Learning Disabilities he carries. ol li value=1 Reading li value=2 Writing li value=3 Precision or awareness li value=1Read MoreGraduation Speech : Science, Technology, Engineering And Mathematics1172 Words   |  5 PagesI want to teach math in New York City because I will be able to communicate the significance of math in everyday life. The math that adults use to pay bills, manage their budgets, tax preparations, as well as other things are significant. Using real-life situations would capture a students’ attention since it is aligned with their interests. Depending on the grade level, students start to question the relevance of a subject to their future. I love the gratitude and appreciation students show whenRead MoreEssay about Princilples of Assessment Unit 12 Pttls1553 Words   |  7 Pagesidentifying if the learner has chosen the right course or programme of study. Initial assessments also ensure that the learner is not attempting a level above their current capabilities. â€Å"Diagnostic tests can be used to ascertain information regarding maths, English or ICT.† G ravells (2011:p41). They can also be used to help compile and individual learning plan (ILP) When planning assessments, it is essential that the trainer follows the awarding bodies’ guidelines and that suitable types and methodsRead MoreMy Vision For My Future Classroom989 Words   |  4 Pagesclassroom because it makes learning more efficient, increases student creativity, and creates endless learning possibilities by giving every student a customizable learning experience. Basic Information Splash Math is an app that helps kids review, improve, and refine their personal math skills.  The basic app month trail is free, but if parents and teachers wish to use the app longer they must pay a monthly or annual rate. Also a teacher or parent account must be created before the child is allowedRead MoreA Teacher s Assessment Tools823 Words   |  4 Pagesa) Teacher’s Assessment Tools: Writing: During the first week of school Mrs. Marks conducted teacher-student conferences as students worked on their writing assignment, during their writing workshops. She does this as a form of assessment, and to keep students on task. We also conducted a word study at the end of the week, in order to assess students’ use of blends, and their ability to identify long and short vowel sound. Mrs. Marks also plans to assess and score her students’ writing using the

Environment Prep Essay - 637 Words

nvw CU2652 - Prepare Environments and Resources for Use during Healthcare Activities 1. Explain how the environment is prepared, maintained and cleaned to ensure it is ready for the healthcare activity All areas that are being used for healthcare activities should be cleaned with either disinfectant wipes each morning and in between patients/procedures. Equipment should be all new out of the packets and clean. For things more major such as vasectomy’s, minor surgery or family planning clinics, areas should be cleaned everywhere with a disinfectant fluid and also with wipes, gloves should always be worn as well as other PPE such as aprons and hats. All equipment should be new from the packet and only touched by the person who is using†¦show more content†¦All healthcare workers are required to report anything that effects the environment. For example speaking to a senior staff member or manager straight away, explaining the problem so it can be dealt with properly. Reportable incidents: deaths, major injuries, some work-related diseases; dangerous occurrences – where something happens that does not result in an injury, but could have done; registered gas fitte rs must also report dangerous gas fittings they find, and gas conveyors/suppliers must report some flammable gas incidents. RIDDOR applies to all work activities but not all incidents are reportable 3. Describe the impact of environmental changes on resources including their storage and use Most consumables used in healthcare have a use by date and will need to be replaced, at haxby we check stock weekly to make sure it is all in date. some pieces of equipment/drugs can be ruined by temperature or sunlight. 3.1 Describe the importance of ensuring that environments are ready for their next use To make sure the area is sterile and ready for use and also that all needed equipment is available and also sterile. Preparing this makes it easier to prevent any cross infection. E.g procedures at haxby- we prepare couch and equipment while the patient is waiting so it is all ready and prepared for their procedure when they are called in, doing this helps as we have more time to make sure everythingShow MoreRelatedAnalysis Of Laura Palmer By Bastille / Running Away From Pencey Prep1329 Words   |  6 Pagesâ€Å"Laura Palmer† by Bastille// Running Away From Pencey Prep The song â€Å"Laura Palmer† by Bastille reminds me of the scene in Catcher in the Rye where Holden ran away from Pencey Prep, thoroughly finished with the â€Å"morons† there. Pencey, the last school Holden attended, was full of phonies according to Holden. Although he did not like the people at Pencey, the school provided a generally stable environment for Holden. 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Managerial Leadership Development

Question: Discuss about the Managerial Leadership Development. Answer: Introduction Leadership is an essentiality in the present organisational structure. A good leader can take the company to new heights. A leader should have all the qualities and capabilities in him to lead the company and his team. With time his managerial capabilities and skills should also be enhanced. McDonalds is one of the top most fast food companies in the world. It employees more than sixty thousand employees and to lead such a huge number and achieving the set goals of the company is a big task. How a company is lead to the success is the job of a capable leader. McDonalds has a aim to be the best fast food restaurant in the world and a good managerial leader can change this objective into a reality and provide success to the company. Managerial Leadership Development in McDonalds An effective and successful leader is the one who does the correct things. It is a leaders responsibility to effectively lead its team, earn their support and communicate them the vision of an organisations goals and make them achieve that goal. He needs to have managerial traits also to manage everything that comes in his way (Rast, Hogg and Giessner, 2013). The managerial leaders of McDonalds have adopted a style known as Team-Building to manage their team and make the outlets a fun place to work. Managerial leaders of McDonalds advance the social responsibility and accountability to culture and include these activities in their business operations (Miller and Buxton, 2012). The managerial leadership model followed by McDonalds is Adairs model of leadership also known as action-centred leadership. The leadership functions used in Adair model of leadership are:- Accomplishing the attained task Team maintenance Individual need of members of the team should be met Adair model of leadership believes that the leader that emerges has the quality to adopt any style of leadership as required by the situation (De Hoogh, Greer and Den Hartog, 2015). Certain characteristics that a leader needs to perform his role efficiently are as follows: - The high level of integrity and authenticity should be there in a team leaders behaviour, and he should build a trusted relationship with all his team mates His commitment should be towards the team development Along with communication skills, he should be a good listener too He should share his assumptions, perceptions, and views with his team members Work independence to team member should be given but in a self-organised way At McDonalds the controlling span of a managerial leader is narrow. The controlling span means the number of working subordinates under the leader (Campbell and Richardson, 2007). If the controlling span is narrow, it gives certain advantages to the leader, and that is: Tight control on the working subordinates Close supervision of the daily operations brings co-ordination. Leader gets time to think and plan Delegation gets reduced due to narrow span of control Manager can provide more of his initiative towards the organisation Critically analysing, the managerial leadership style of McDonalds is autocratic and thus, the employees or the subordinates are not included in any decision making. Also, the suggestions of crew members or subordinates are not welcomed even, as most of them are new in the company. On a general basis, the young and inexperienced work in these restaurants during their holidays and therefore their ideas are not valued enough. Young staff is always motivated when paid well with transportation and meal. Hence, they work enthusiastically even in autocratic leadership (Lyons and Schneider, 2009). This leadership style puts pressure on the team members who are already much pressurised with a workload. Even with the disadvantage of autocratic leadership style workers of McDonalds find their workplace a fun place to be. They do not mind being ordered and directed by their managers. In fact, they prefer working under the autocratic style of leadership. One reason may be that under stress they dont have to be creative for their job and just have to follow orders. It may be said that at McDonalds leadership cannot be the actual reason for workers performance but the environment they are working in. And it is the managements work to provide the working staff right environment to work in (Bhatti et al., 2012). Autocratic leadership style can only dictate employees but cant motivate them, but, McDonalds fears to adopt another style of leadership as it may lead to a backlash from the team members who want the most independent style of working. McDonalds seek standardisation across the globe, and that cannot happen if every outlet will have a self-starter. So, Autocratic leadership style will be the best type of managerial leadership for McDonalds (Boudrias et al., 2009). Processes and Methods for Developing Leaders Leader development expands the persons ability to make him effective in leadership processes and roles. These roles and processes which are expanded help the leader in direction setting, maintaining commitment, and creating alignment in a team for doing a common job. All the programs and educational researches of an organisational leadership focus on developing skills, abilities, and individual knowledge in connection with individuals formal leadership roles. Leader development is actually an investment in human capital (Velsor, Ruderman, McCauley, 2010) The process of leader development includes three main purposes, and they are: Performance Improvement- the first step of this process is to access the organisations need for an effective leader and how well it is being met. The second step is to find out the gaps of the system that is in need of addressing. The third step is to find out the current leaders qualities and the performance areas where improvement is required (Clifton, 2015). Succession Management- the first step of succession management is to see that a sufficient number of potential candidates is getting ready for higher management positions. The second step includes the identification of the successor of leadership positions The third and the final step of succession management are to check out the diversified pool of high potentials. Organisational change- for organisational changes the first steps of the process are to identify the leader abilities and skills which is an important thing for accomplishing the business strategy. The second step is to consider the extent of the importance of organisational values and beliefs for accomplishing the strategy (Velsor, Ruderman, McCauley, 2010) The methods of developing a leader are given as follows:- Rotate through the different type of jobs- exposure gained from different level and divisions will give a leader experience of various roles of a company. The challenge with unfamiliar jobs- different and unfamiliar jobs will give experience and growth to a leader. Even failure will also teach a lesson. Create mentoring programs- pairing the employee with a senior employee is a common approach to any business but some time should be given to them to build trust for each other before providing a specific job to them (Fulmer, Stumpf and Bleak, 2009). Frequent feedback and coaching are necessary-proper evaluation and feedback of work done should be given so that an employee can work to improve his performance. Tap veterans advice- mentoring programs from veterans to the future leader, will help them to learn from the experience of the old worker. After following the processes of developing a leader and later involving the methods to develop a leader an organisation will have a potential leader for running the business strategies of the company successfully (Grossberg, 2013). Strategy Plan for Improving the Leadership Capabilities of McDonalds One is not born with leadership qualities they can be developed in the person if given proper guidance and training. Now-a-days being a leader is not enough one has to have the managerial qualities also to run an organization and lead a team and set an example for them (Muchiri et al., 2011). The McDonalds is one of the top most fast food restaurants in the world, but it aims at being the best fast food restaurant across the globe. To attain this goal the leader of the company should have leadership and managerial skills which will help the organisation to be the best fast food restaurant in the world (Zhang, 2014). The strategic plan for developing the capabilities of a leader of McDonalds includes few steps, and they are as follows: - The first step to improve the leadership capabilities is to add few characteristics that a future leader will require:- A leader should have perception and insight of an extraordinary level of the practicality of the work and themselves. Motivation level should be high to attain the changes that will occur to be a successful leader. successful leader needs to be emotionally strong so he could manage the anxiety of oneself and of others. Update his skills for identifying functional, analysing cultural and dysfunctional assumptions which enlarge the culture by enhancing the functional elements and strength. A leader should willingly involve others when a task is too complex for him to solve or to attain (Jeavons, 2011). The second step to increase the capabilities of the leader is adding some behavioural skills and they are: - He should learn to have effective verbal communication which includes listening It is important to manage stress and time Individual decisions need to be managed He should be able to recognise, define and solve problems A leader has to motivate and influence others and for that, he has to be motivated himself A leader should know the process of delegating A leader should be able to express his vision and goals to his team A leader should be self-aware Team building is an important skill for a leader A leader should be able to manage conflicts (Kelly, 2006). If a leader has all the capabilities mentioned above, he will be able to run the company in a better way than before. For attaining any goal a leader has to face few challenges that will stop him in his way. It is necessary to find those challenges and issues. The challenges a leader may face are:- It is not a one day process, developing a leader needs time and patience Its looks easy but very difficult to develop all the capabilities and skills in one person Organisational politics may act as a hindrance in following the strategy. Too many things to be accomplished in little time create headaches. Employees may not want the change of leadership style they may be happy with the way things are going Many a times leader is developed, but authorities are not given to the leader to use his capabilities and skills (Miller and Buxton, 2012). Recommendations The processes and methods of developing a leader do not cover every area that is required by the leader to be successful leader, therefore, few recommendations for managerial leadership development for an organisation are given here and they as follows: - It is recommended that a leader should listen better for understanding new ideas, and context, etc. this is a foundation step to great leadership. A leader should always work to improve his perception because one single mistake can threaten the decades of good work A leader should how to reinforce, the values and beliefs of the company because once these values and beliefs are reinforced then it will affect the daily operations of the company (Robinson, 2010). A leader should learn to say only that what he commits to doing. It will improve his integrity in the eyes of subordinates A leader should be a talent generator. He should be able to help his subordinates in a constant growth which will improve his companys outcome A leader should know how to deal with failure and improve him by learning a lesson from it. A deep connection with his team members will help the leader to have a constant growth A leader should be a judge of his own strengths which he should use for his favour. A leader should always welcome feedback and suggestions as it will help in improving the working of the company and of his. A great leader always provides an example for his subordinates thus; he should maintain his working and values to be respectful. A leader should have a clear vision towards the organisation and its working that he should be able to convey to his team (Robinson-Walker, 2007). Another leadership style other than autocratic can be tried that may help the company improve. These are the suggested recommendations for improving the capabilities of a leader of McDonalds. It will help the company to attain its goal of being the worlds best fast food restaurant. Conclusion A person is not born leader, but one can develop leadership skills by following the path of leader development. Every organisation in todays time needs an effective leader who can take care of everything his subordinates, managing, planning, publicising, customer relations and problem handling and solving. A person can develop as a leader by learning from the experiences that he gains from working and from others also he should incorporate the skills and capabilities that a successful leader needs to effectively manage and lead his team. There would be many challenges that will hinder the leaders progress in the development, but a leader should be able to overcome all the hindrances and develop as a successful managerial leader (Vestal, 2009). References Bhatti, N., Maitlo, G., Shaikh, N., Hashmi, M. and Shaikh, F. (2012). 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