Ethical Issues of Clinical Ethics in the Developing World

Ethical Issues of Clinical Ethics in the Developing World Ethical Issues of Clinical Ethics And Research Ethics In The Developing World And Pakistan: Is There Any Solution? Zoheb Rafique Abstract: Health research plays an important role in addressing the inequities in human development and health, but in order to achieve these objectives, research should be based on ethical principles and sound scientific knowledge. Although it is accepted fact that bioethics play a pivotal role in health related research in the developing countries, much of recent debate has focused on the controversies surrounding internationally sponsored research and it has taken place largely without the adequate participation of developing countries. The relationship between the ethical guidelines and regulations, and also indigenously/locally sponsored and public health research is not adequately explored and so needs further exploration. Discussion Globally, there are wide inequalities in the economic development, in health outcomes, in burden of diseases and it is certain that the accelerating course towards globalization, without requisite safeguards and the protection of human rights, will only worsen the health inequalities. The funding of research in the developing countries has been the subject and debate of much attention recently. The forum for global health research has indicated that less than 10 % of the world’s research resources are earmarked for 90 % of the health problems. Recently, there was considerable debate regarding ethical conduct and the reviewing of health related research, but this debate has mostly taken place among the bioethicists and researchers in the industrialized countries. The view points of public health researchers and practitioners from the developing countries have been underrepresented. Research needs to respond to the community needs and also national priorities, and development of a national research agenda in the developing countries must be firmly grounded in the process of priority setting. However a more difficult challenge is to involve communities themselves in the research questions and to link their research to their development. Pakistan, being a poor country, has very limited health care resources. Treatment options for individual patients and between patients for free and subsidized treatments are common ethical dilemmas. Thus, prioritizing illnesses and people is an enormous ethical challenge and a very common part of every day medical practice in Pakistan. A review of published discourse on ethics in Pakistan reveals several general trends. These include a focus on ‘medicine’ as defined by formal western medical practice, delivered by physicians only. There is no pursuit of ethics as a focus of the work of other health professionals. The physician-authors of papers, the types of journals where papers have been published, and the phy sician dominant mode of health care, especially curative health care, in Pakistan make this understandable. Research ethics have not been captured in the published papers in Pakistan. This is an area of great importance that has escaped notice of the national thinkers and policy-makers. The conduct of appropriate and ethical research in international settings has been the focus of recent international reports. Ethical review committees, institutional review boards, and other national mechanisms to protect human subjects need to be discussed and put into place in Pakistan, as may be the case in other developing countries. Additional work is required to explore this important area within the context of the developing world. (1). The vital links between clinical and research ethics and human rights are perhaps of even greater significance in developing countries, where human rights are frequently ignored and violated. Conducting research in hierarchical, traditional countries such as P akistan adds yet another dimension to the difficulties in assuring that it is done in an ethical manner; an â€Å"indigenous† layer of cultural norms makes it even more of an uphill task, but it is a task that we are morally bound to shoulder. The historical and social construct of the Pakistan culture, the socioeconomic realities (with similarities to other countries in this region) and some of the deeply rooted values and customs pose challenges that are specific to this part of the world. We who live here know them, and only we can address them. Perhaps the most important factor that places human subjects at risk in this part of the world is the magnification of â€Å"power differentials† inherent in hierarchical societies such as Pakistan. This difference is particularly pronounced in the interactions between physicians and scientists and those they take care of or enroll in research projects. In Pakistan, scientists and physicians constitute the â€Å"elite† section of society. They are by and large the â€Å"English-Speaking†, affluent, highly educated minority in a society where the majority of those they deal with in their professional lives are â€Å"Urdu-Speaking†, poor, generally illiterate or misinformed and disadvantaged in many other ways. (2). Local researchers trained within the country have no concept of research ethics. There is a growing awareness that research cannot progress without better research ethics systems in developing countries. At the close of the last century several of the international agencies involved in funding health research, including WHO, tried to seriously examine the role of health research as an important contributor to sustainable human development. They also attempted to assess how governance of research at national, regional and global levels be made more effective and efficient. Ethical practice in health care and research is not only needed to ensure equity in health care and r esearch, but also to project individuals and communities from unnecessary risks and harm. (3).We can make clinical research more ethical in Pakistan by following all the International guidelines regarding clinical research ethics. Health research can play a crucial role in improving national and global health by developing and evaluating interventions and by exploring strategies that can empower individuals to alter unhealthy behaviors. However, health research involves human subjects and such individuals might be harmed by their participation in research. Accordingly, a strong system of ethical review is needed to enhance the protections of the rights and welfare of human subjects. Also, to enhance the public trust in research activities, investigators need to subscribe to a strict code of ethics that equals the highest standard of respect for human rights. This framework thus places ethics at the very core of a country’s programs for health and development. (4). There are f ive key ethical principles of ethical research that appear across the ethical codes of research institutions and associations. These are a) informed and voluntary consent; b) confidentiality of information shared; c) anonymity of research participants; d) beneficence or no harm to participants; and e) reciprocity. Researchers are expected to obtain informed consent from all those who are directly involved in research or in the vicinity of research. This principle adheres to a larger issue of respect to the participants so that they are not coerced into participation and have access to relevant information prior to the consent. Usually consent is obtained through written consent forms, and necessary elements of consent are identified by the review committees. These usually include prior information on key elements of research such as purpose, procedures, time period, risks, benefits, and a clause stipulating that participation is voluntary and the participants have the right to withd raw from the study. The principles of confidentiality of information shared and Anonymity of Research participants is also concerned with offering respect and protection to research participants through assurance of confidentiality of information shared and anonymity by not revealing the identity of the individuals and institutions involved. Typically anonymity is provided through the use of pseudonyms. The principles of Nonmaleficence, Beneficence and Reciprocity bounds the researchers to provide the participants with an outline of the risks and benefits involved to the participants in the study. The principle of reciprocity requires that the researchers consider actively ways through which participants could be compensated for their time and effort. Typically information about risks and benefits are expected to be provided in summary in the consent form and/or in a brief write up attached with the consent form. These principles and procedures of an ethical engagement with a resear ch study are laid out with the best of intentions to protect participants from malpractices and breach of ethics. However, the approach is taken from a mainly clinical medical research perspective with a concomitant view of epistemology and ontology. Hence, it is assumed that there is a well stated hypothesis which is to be tested, the relationship between the researcher and researched is clearly divided and bounded, and it is possible to outline the potential risks and benefits in some detail prior to the study. (5).The two salient concerns of public-health ethics in our Pakistan case are social justice as a background motivation and accountability as the primary operational objective. The formation of Pakistan’s NBC resulted from PMRC’s active involvement in documenting the under-distribution of global health research benefits to populations in LMICs (low and middle income countries). While this disparity might be seen as a failure of social justice on a global scale , redressing the 10/90 gap is in part a matter of domestic social justice, i-e, of how the benefits and burdens of social cooperation are distributed within each Sovereign State. Closing the gap would require governments of LMICs, such as Pakistan, to participate in dramatically increasing the amount of health research undertaken for the benefit of their own populations. Ensuring accountability for the conduct of this research with human subjects requires that protocols undergo independent ethical review. (6). A systems perspective will enable research stakeholders to improve their understanding and implementation of a national health research system (HRS) in order to improve health outcomes and health equity. Knowledge produced by health research, if disseminated widely, is a global public good. Knowledge contributes to the policies, activities, and performance of health systems, and to the improvement of individual’s and population’s health. The process of conducting research ethics and utilizing knowledge is a highly complex one. One glaring symptom of the current weakness of HRS across countries is that the research process and the policy process tend to exist in different worlds, with the result that research often has a limited impact on policy. Researchers and decision-makers tend to interact only around the â€Å"products† of their processes-for example, the results of a study for the researchers and a set of priorities for the decision-maker. Clearly, more attention needs to be given to establishing and maintaining ongoing links between the two words and, as noted previously, taking stock of the non-linearity of the research-policy-practice processes. (7). Bleak and confusing as the field may be, the last few years have been a watershed in international bioethics and the heightened debate has pushed ethical issues surrounding health research in developing countries into the limelight. The challenge is to develop sound plan for exp anding this ethics debate to larger issues of the global justice and equity, and to make the process as participatory and democratic as possible. The main goal in all these activities should be reduction of the global inequalities in health. Most of public health related problems in South Asia and their immediate causes are related to distal factors such as illiteracy, poverty, societal and gender inequities. The underlying issues must be understood to develop meaningful and sustainable solutions. (8).This will take time, but this is the only way to bring about true change in ethics of international health research. References Adnan A. Hyder and Sarah Nadeem. Health Ethics in Pakistan: A Literature Review of Its Present State. J Health Popul Nutr. 2001, 19(1): 6-11. Farhat Moazam. Research and developing countries: hopes and hypes. East Mediterranean Health Journal. 2006, Vol. 12 (Supplement no. 1): 30-36. Mohammad Afzal. Health research in the World Health Organization Regional Office for the Eastern Mediterranean. East Mediterranean Health Journal. Vol. 14: 67-73. Mohammad Abdur Rab Et Al. Ethical Practices for Health Research in the Eastern Mediterranean Region of the World Health Organization: A Retrospective Data Analysis. Plos one. 2008, Vol. 3(5); e2094. Anjum Halai. Ethics in Qualitative Research: Issue and Challenges. Edqual Working Paper. 2006, Quality no. 5: 1-13. Adnan A. Hyder Et Al. Integrating ethics, health policy and health systems in low-and middle–income countries: case studies from Malaysia and Pakistan. Bulletin of the World Health Organization. 2008, 86(8): 606-611. Tikki Pang Et Al. Knowledge for better health-a conceptual framework and foundation for health research systems. Bulletin of the World Health Organization. 2003, 81(11): 815-820. Zulfiqar Ahmed Bhutta. Globalization, Structural Adjustments and Public Health in South Asia: What does it mean for International Networking in Health Research and Researcher Training? 2001, 1-23.

Personal Sacrifices for Career Success

A great career often means that you have to sacrifice. There is always a give and take that you have to go through in order to get to where you want to go. Whether you have to work with someone you don't like because they can get you a connection, or doing a Job you don't like because you will one day get promoted to something you do, a good career requires give and take. Say the boss asks you to work on a Saturday. Why would you do It? Why would you give up a day where you could sleep In, go see a movie In the afternoon and then go out at night?You do it because working on Saturday will Impress people. It will show that you have a team first attitude that you will come In when needed to help the company. You might not enjoy working with people you don't know all day. This especially holds true for those who don't have great hygiene or respect personal space. Why do you put up with them? Why not just tell them they smell bad and get it over with? You shut your mouth because you have to be a professional, and you have to get along in order to get ahead. Professional sacrifice is also why you don't yell and scream at people who don't do a DOD job.You don't want others to feel bad, but you don't want to look like you are short tempered. This doesn't help anyone, and you can get in trouble for it. Even If you are saying what others are thinking, it still requires you to restrain yourself and stay quiet. The betterment of your career is why you show up five minutes early to work. It's why you go to Buffalo for a job when you have been living in San Diego your whole life. No one wants to go across the country when it is much easier to stay where you are happy. No one wants to get to work early when we all know that work isn't fun.

Starbucks International

International Marketing Case1-1: Starbucks-Going Global Fast Q1) Identify the controllable & uncontrollable elements that Starbucks has encountered in entering global markets. A1) There are several controllable and uncontrollable elements that Starbucks has encountered in entering the global market. To begin with, some of the controllable elements are somewhat similar to them growing in the domestic market. Some of the factors include the 4 P’s (Product, Price, Placement and Promotion).Starbucks has the advantage of being a global brand-it is recognized by millions around the world and is thus able to market according to its value. In addition, Starbucks can easily adjust to the different cultural sets and shift their prices according to the competitors in the region (without making much of an impact to their profit). As a result of being a global brand, Starbucks can market themselves as they wish to as well. An appropriate example would be the coffee in Italy-which is relati vely cheaper than Starbucks regular coffee.An espresso in Northern Italy is around 67 cents whereas in the south it can fall close to 55 cents. Meanwhile, Americans pay around $1. 50 for their espresso-for such reason, Starbucks would have to lower the prices if they wish to enter the Italian market for the simple reason to be able to compete in such an environment-basically going back to the point of controlling their prices as their competitors do. Starbucks have faced uncontrollable elements as well-mostly to do with foreign markets.To begin with are the issues that the brand might face trying to balance between domestic and international markets. There are several different elements of risk that they face when entering a foreign market such as competitive forces, technology levels, distribution structures, the nation’s infrastructure and other forces that add in such a cultural, political and legal. All these elements tie in with how Starbucks runs its business in an inte rnational market.Moreover, as Starbucks continues to expand, it will have to be increasingly sensitive to cultural challenges. One example could be Starbucks facing grave challenges with Japan’s ‘chilled coffee’ market with many lookalikes rivalling with the corporate brand making it more difficult for them to compete overseas. Being a global brand, Starbucks has mastered their skills to expand to other international markets-as long as they keep in check their controllable elements and try and resolve the uncontrollable ones.Q2) What are the major sources of risk facing the company? Discuss potential solutions. A2) Being such a major international brand-Starbucks is likely to face certain risks. To begin with, Starbucks has managed to saturate most of its market in United States. According to sources, there is a Starbucks for every 9,400 people in Seattle. Blanketing areas with their stores is not necessarily an advantage for Starbucks, it has even led to consume rs being frustrated with the low level of choice and causing a great dislike towards the global brand all together.Another risk facing Starbucks is the new, younger generation. Today’s 20 and early thirty year old consumers are not ready to pay the high prices for their daily coffee. Due to the recession, much of this generation was brought up on less costly brands such as McDonald’s McCafe, and is unlikely to shift to Starbucks or any other major brand even once recession has worn off. Consumer risks are not the only ones troubling Starbucks-the global brand also faces internal issues with employee burn out rate increasing over the years.Dissatisfaction over being over worked and under paid is starting to become synonymous with the Starbucks name causing frustrated store managers and a higher percentage of employee turnover. An example of this internal risk was when a lawsuit caused Starbucks a good $18 million, leaving them with decreased profit share. Analysts state that Starbucks can only maintain about 15% square footage growth in the United States, for only about two more years. After that, it will have to depend aggressively on overseas growth to maintain their annual 20% revenue growth.Expansion and cannibalization risk is also another element. Expanding at such an extreme rate with a constant growth in stores around the world have seen to cause some major cultural issues as well, for example Italy being threatened from changing their lifestyles of drinking coffee all together. Solutions: Advertising campaigns and positive public awareness could help improve their global image. Starbucks should being focusing on International expansion rather than saturating their domestic market-the more people they reach out to, the more the brand is likely to survive and make a profit.Having such an international image can have a disadvantage as well-Starbucks could learn to adapt to more cultural differences & requirements rather than concentrating on promoting their domestic image internationally as well. Through promotion and advertising Starbucks should begin to shift their target audience; the younger generation is a key element to their product life cycle-but re-positioning their products and focusing on the Middle class of today, Starbucks could find a solution within and continue to grow for years to come.Market research could be another solution that Starbucks can look into. By creating Global Strategies, success can be achieved by moulding according to the country’s culture and belief and by introducing products that are more likely to be accepted by people from different areas of the world. A certain kind of marketing is unlikely to appeal to an audience from all over the world-Starbucks should be flexible enough to create their image according to a different culture each time.The feeling of dissatisfaction from the employees of Starbucks should be resolved. This solution can be achieved by offering over time pa yment or incentive for every employee-as long as Starbucks is willing to take care of its people, employee turnover will be likely to reduce and their internal mechanics will run smoothly-thus causing them clarity to look at other major issues, such as international marketing and expansion.Q3) Critique Starbucks overall Corporate Strategy A3) In the case of Starbucks, the corporate strategy that they have implemented is unique to their industry which has allowed them to stand apart from their major competitors. It can be summarized shortly-Starbucks aims to provide quality coffee wherever they go.One of their strategies would be vertical integration, by having a close relationship from the start to the finish of their product by having their own supply chain and roasting their own coffee-Quality is one key element that Starbucks has never compromised on ( and from the looks of it, will be unwilling to do so in the near future as well) Modification of their products is another way St arbucks handles it strategy, by aiming at partnering with other successful brands and going for products that they can also sell in stores apart from their chain’s and focusing on the other services they provide such as pre order, Wi-Fi and partnering with the movie and music industry. Even without spending a lot on international advertisement, Starbucks makes sure to stay in the limelight, by making the right decisions to partner with companies that are appealing to their overall consumer base.In addition, Starbucks has begun to target the younger generation (that is likely to stray from the higher priced quality coffee) by boosting other services they provide. Instead of succumbing to the lower price demand, Starbucks has upped their other services and began advertising accordingly and directly aiming at the new generation’s consumer base. It is probably also worth mentioning how Starbucks has still managed to follow the usual, normal expansion routine as well. They began by aiming at their domestic market aggressively and once this had been saturated and developed completely, the organization began increasing their presence internationally. According to the Starbucks annual report in 2009, their international market grew by a rapid 7. 7% in 2009.Overall, Starbucks aims at growing internationally, by using other sources apart from the regular stereotypes, but at the same time, Starbucks aims to keep its footing in their domestic market as strong as they have been since the inception itself. Q4) How might Starbucks improve profitability in Japan? A4) Due to the high level of competition that Starbucks faces in Japan, it should begin by reconsidering their pricing strategy. Most of Japan still believes that Starbucks is slightly overpriced, and since there are so many different competitors, it is an easy decision for the consumer in Japan to choose another brand-based simply on the lower price.They could begin by lowering their prices slightly, w here they would still make a profit, but would fall within the range of other competitors so more consumers would be likely to choose Starbucks-mainly due to the great quality of product (and now better price as well) Another method that Starbucks could use is repositioning their product and service in Japan. According to sources, Japanese youth is more likely to spend their time in a constructive manner. Due to Starbucks and the competitors in Japan providing similar fare, it is easy for the competitor to eat up the Starbucks share, thus it would be ideal for the global brand to increase their benefits (or reduce price further).One benefit could be introducing the online order system in Japan, so Japanese consumers could pre order online, saving them time and using this benefit over the other competitors. By advertising with the domestic brands in Japan, Starbucks could possibly make itself synonymous with Japan’s youth-where they feel inclined to have Starbucks instead if c ompetitor coffee because their other major brands/artists seem to be having Starbucks as well. Including customized products for its consumers in Japan is also helping Starbucks stay on top of their globalization plans. This strategy increased same store sales and overall profits. By adding the drive through service, Starbucks is targeting their Japanese audience the most fruitful and profitable way.

Figurative Language and the Canterbury Tales - 13472 Words

1. allegory: a literary work that has a second meaning beneath the surface, often relating to a fixed, corresponding idea or moral principle. 2. alliteration: repetition of initial consonant sounds. It serves to please the ear and bind verses together, to make lines more memorable, and for humorous effect. †¢ Already American vessels had been searched, seized, and sunk. -John F. Kennedy †¢ I should like to hear him fly with the high fields/ And wake to the farm forever fled from the childless land. -Dylan Thomas, â€Å"Fern Hill† 3. allusion: A casual reference in literature to a person, place, event, or another passage of literature, often without explicit identification. Allusions can originate in mythology, biblical references,†¦show more content†¦A literary ballad was a favorite form of the Romantic period. Coleridge’s â€Å"Ancient Mariner† is a good example, and â€Å"The Ballad of Birmingham† is an American example. â€Å"It is an ancient Mariner, And he stoppeth one of three. By thy long gray beard and glittering eye, Now wherefore stoppst thou me? 13. blank verse: poetry written in meter but containing no ending rhyme. Lines of verse contain forms closest to that of natural speaking, yet are flexible and adaptive. 14. characterization principles: characters should be 1) consistent in their behaviors, 2)their words and actions should spring from motivations the reader can understand, and 3) plausible and lifelike 15. cinquain: a five line stanza 16. conceit: in literature, fanciful or unusual image in which apparently dissimilar things are shown to have a relationship. The device was often used by the metaphysical poets, who fashioned conceits that were witty, complex, intellectual, and often startling, e.g., John Donnes comparison of two souls with two bullets in â€Å"The Dissolution.† 17. conflict: a struggle between two opposing forces in a short story, novel, play, or narrative poem. 18. connotation: all the emotions and associations that a word or phrase may arouse; what a word suggests beyond its basic definitions; a word’s overtones of meaning. 19. consonance: repetition of consonant sounds in the middle or at the end of words 20. continuous form: the form of a poem inShow MoreRelatedEssay on Summary and Analysis of The Pardoners Tale1346 Words   |  6 PagesSummary and Analysis of The Pardoners Tale (The Canterbury Tales) Prologue to the Pardoners Tale: The Host thinks that the cause of Virginias death in the previous tale was her beauty. To counter the sadness of the tale, the Host suggests that the Pardoner tell a lighter tale. 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