Gemologists essays

Gemologists essays Gemologists have a duty to carefully examine each gem and test them before it can be appraised. Gemologists cannot identify or appraise gemstones based on sight alone; one of the first things a gemologist is taught to do is not to identify gemstones without a few simple tests. Gemologists must constantly be aware of stone treatments or enhancements such as heating, irradiation, impregnation, stabilization, dying, bleaching and using lasers. For example, if a gem appears red, green or blue, it does not necessarily mean it is a ruby, emerald or sapphire respectively. The lack of proper testing procedures can often lead to substantial dollar amount differences on the appraisal line. Simply put, a gemologist studies the quality, characteristics and value of gem stones. They grade gemstones on the basis of their color, clarity, and the presence or absence of flaws. Gemologist can go two routes in their profession; some specialize in cutting gemstones, while others specialize in matching gemstones with jewelry settings. Often, gemologists sell jewelry and provide appraisal services. Several gemologist are even hired by insurance companies offer their own appraisal services for those customers who wish to insure certain pieces of jewelry. Years of specialized training is required in order to become a prestigious gemologist. Gemologists must learn about the many different gemstones and their chemical composition. Also, they learn the crystal structures of gemstones and must understand how it enhances a gem. Gemologists will undergo training in gem appraisal and cutting in order to become qualified in their field. This involves examining different gemstones in order to become familiar with identifying their original characteristics of each gem. They learn the tricks of the trade through vocational or technical schools. Colleges and art and design schools also offer programs that can lead to a Bachelor of Fine Arts or Master of Fine A ...

How to Write a Short Story 9 Steps from a Best Selling Author

How to Write a Short Story 9 Steps from a Best Selling Author How to Write a Short Story That Captivates Your Reader Why? Because it reveals many of the obstacles, dilemmas, and questions you’ll face when creating fiction of any length. If you find these things knotty in a short story, imagine how profound they would be in a book-length tale. Most writers need to get a quarter million clichà ©s out of their systems before they hope to sell something. And they need to learn the difference between imitating their favorite writers and emulating their best techniques. Mastering even a few of the elements of fiction while learning the craft will prove to be quick wins for you as you gain momentum as a writer. I don’t mean to imply that learning how to write a short story is easier than learning how to write a novel- only that as a neophyte you might find the process more manageable in smaller bites. So let’s start at the beginning. Need help fine-tuning your writing?Click here to download my free self-editing checklist. What Is a Short Story? Don’t make the mistake of referring to short nonfiction articles as short stories. In the publishing world, short story always refers to fiction. And short stories come varying shapes and sizes: Traditional: 1,500-5000 words Flash Fiction: 500-1,000 words Micro Fiction: 5 to 350 words Is there really a market for a short story of 5,000 words (roughly 20 double-spaced manuscript pages)? Some publications and contests accept entries that long, but it’s easier and more common to sell a short story in the 1,500- to 3,000-word range. And on the other end of the spectrum, you may wonder if I’m serious about short stories of fewer than 10 words (Micro Fiction). Well, sort of. They are really more gimmicks, but they exist. The most famous was Ernest Hemingway’s response to a bet that he couldn’t write fiction that short. He wrote: For sale: baby shoes. Never worn. That implied a vast backstory and deep emotion. Writing a compelling short story is an art, despite that they are so much more concise than novels. Which is why I created this complete guide: 9 Steps to Writing a Great Short Story Read as Many Great Short Stories as You Can Find Aim for the Heart Narrow Your Scope Make Your Title Sing Use the Classic Story Structure Suggest Backstory, Dont Elaborate When in Doubt, Leave it Out Ensure a Satisfying Ending Cut Like Your Storys Life Depends on It Step 1. Read as Many Great Short Stories as You Can Find Read hundreds of them- especially the classics. You learn this genre by familiarizing yourself with the best. See yourself as an apprentice. Watch, evaluate, analyze the experts, then try to emulate their work. Soon you’ll learn enough about how to write a short story that you can start developing your own style. A lot of the skills you need can be learned through osmosis. Where to start? Read Bret Lott, a modern-day master. (He chose one of my short stories for one of his collections.) Reading two or three dozen short stories should give you an idea of their structure and style. That should spur you to try one of your own while continuing to read dozens more. Remember, you won’t likely start with something sensational, but what you’ve learned through your reading- as well as what you’ll learn from your own writing- should give you confidence. You’ll be on your way. Step 2. Aim for the Heart The most effective short stories evoke deep emotions in the reader. What will move them? The same things that probably move you: Love Redemption Justice Freedom Heroic sacrifice What else? Step 3. Narrow Your Scope It should go without saying that there’s a drastic difference between a 450-page, 100,000-word novel and a 10-page, 2000-word short story. One can accommodate an epic sweep of a story and cover decades with an extensive cast of characters. The other must pack an emotional wallop and tell a compelling story with a beginning, a middle, and an end- with about 2% of the number of words. Naturally, that dramatically restricts your number of characters, scenes, and even plot points. The best short stories usually encompass only a short slice of the main character’s life- often only one scene or incident that must also bear the weight of your Deeper Question, your theme or what it is you’re really trying to say. Tightening Tips If your main character needs a cohort or a sounding board, don’t give her two. Combine characters where you can. Avoid long blocks of description; rather, write just enough to trigger the theater of your reader’s mind. Eliminate scenes that merely get your characters from one place to another. The reader doesn’t care how they got there, so you can simply write: Late that afternoon, Jim met Sharon at a coffee shop†¦ Your goal is to get to a resounding ending by portraying a poignant incident that tell a story in itself and represents a bigger picture. Step 4. Make Your Title Sing Work hard on what to call your short story. Yes, it might get changed by editors, but it must grab their attention first. They’ll want it to stand out to readers among a wide range of competing stories, and so do you. Step 5. Use the Classic Story Structure Once your title has pulled the reader in, how do you hold his interest? As you might imagine, this is as crucial in a short story as it is in a novel. So use the same basic approach: Plunge your character into terrible trouble from the get-go. Of course, terrible trouble means something different for different genres. In a thriller, your character might find himself in physical danger, a life or death situation. In a love story, the trouble might be emotional, a heroine torn between two lovers. In a mystery, your main character might witness a crime, and then be accused of it. Don’t waste time setting up the story. Get on with it. Tell your reader just enough to make her care about your main character, then get to the the problem, the quest, the challenge, the danger- whatever it is that drives your story. Step 6. Suggest Backstory, Don’t Elaborate You don’t have the space or time to flash back or cover a character’s entire backstory. Rather than recite how a Frenchman got to America, merely mention the accent he had hoped to leave behind when he emigrated to the U.S. from Paris. Don’t spend a paragraph describing a winter morning. Layer that bit of sensory detail into the narrativeby showing your character covering her face with her scarf against the frigid wind. Step 7. When in Doubt, Leave it Out Short stories are, by definition, short. Every sentence must count. If even one word seems extraneous, it has to go. Step 8. Ensure a Satisfying Ending This is a must. Bring down the curtain with a satisfying thud. In a short story this can often be accomplished quickly, as long as it resounds with the reader and makes her nod. It can’t seem forced or contrived or feel as if the story has ended too soon. In a modern day version of the Prodigal Son, a character calls from a taxi and leaves a message that if he’s allowed to come home, his father should leave the front porch light on. Otherwise, he’ll understand and just move on. The rest of the story is him telling the cabbie how deeply his life choices have hurt his family. The story ends with the taxi pulling into view of his childhood home, only to find not only the porch light on, but also every light in the house and more out in the yard. That ending needed no elaboration. We don’t even need to be shown the reunion, the embrace, the tears, the talk. The lights say it all. Step 9. Cut Like Your Story’s Life Depends on It Because it does. When you’ve finished your story, the real work has just begun. It’s time for you to become a ferocious self-editor. Once you’re happy with the flow of the story, every other element should be examined for perfection: spelling, grammar, punctuation, sentence construction, word choice, elimination of clichà ©s, redundancies, you name it. Also, pour over the manuscript looking for ways to engage your reader’s senses and emotions. All writing is rewriting. And remember, tightening nearly always adds power. Omit needless words. Examples: She shrugged her shoulders. He blinked his eyes. Jim walked in through the open door and sat down in a chair. The crowd clapped their hands and stomped their feet. Learn to tighten and give yourself the best chance to write short stories that captivate your reader. Where to Sell Your Short Stories Need help fine-tuning your writing?Click here to download my free self-editing checklist. 1. Contests Writing contests are great because the winners usually get published in either a magazine or online- which means instant visibility for your name. Many pay cash prizes up to $5,000. But even those that don’t offer cash give you awards that lend credibility to your next short story pitch. 2. Genre-Specific Periodicals Such publications cater to audiences who love stories written in their particular literary category. If you can score with one of these, the editor will likely come back to you for more. Any time you can work with an editor, you’re developing a skill that will well serve your writing. 3. Popular Magazines Plenty of print and online magazines still buy and publish short stories. A few examples: The Atlantic Harper’s Magazine Alfred Hitchcock’s Mystery Magazine The New Yorker Ellery Queen’s Mystery Magazine Woman’s World 4. Literary Magazines While, admittedly, this market calls for a more intellectual than mass market approach to writing, getting published in one is still a win. Here’s a list of literary magazine short story markets. 5. Short Story Books Yes, some publishers still publish these. They might consist entirely of short stories from one author, or they might contain the work of several, but usually tied together by theme. Regardless which style you’re interested in, remember that while each story should fit the whole, it must also work on its own, complete and satisfying in itself. What’s Your Short Story Idea? You’ll know yours has potential when you can distill its idea to a single sentence. You’ll find that this will keep you on track during the writing stage. Here’s mine for a piece I titled Midnight Clear(which became a movie starring Stephen Baldwin): An estranged son visits his lonely mother on Christmas Eve before his planned suicide, unaware she is planning the same, and the encounter gives them each reasons to go on. Need help fine-tuning your writing?Click here to download my free self-editing checklist. In the comments below, write the one-sentence essence of your short story.

Invictus Essay Example | Topics and Well Written Essays - 500 words

Invictus - Essay Example The feeling that this is a real person overcoming real problems lends â€Å"Invictus† great emotive power. The second theme is that of opposition. The author establishes this in the opening lines of the poem where we read, â€Å"Out of the night that covers me/Black as the Pit from pole to pole,† (1-2). No source of this darkness that covers the author is ever identified. The third theme introduced in the first stanza is that of the â€Å"unconquerable soul† (4). This theme recurs at the end of each four line stanza as a beacon of hope for the reader of the poem, and perhaps it did for the author as well when he wrote it. Each stanza following the first returns to these three important themes. Henley stays firmly in the first-person throughout the poem. But the themes of opposition and triumph over that opposition are nuanced and expounded upon in the final three stanzas. The author alludes to the, â€Å"fell clutch of circumstance† (5) at the beginning of the second stanza. This adds emotional weight to the opposition mentioned at the beginning of the poem by suggesting that the adverse situation the author finds himself in is not of his own doing. Chance has intervened in his life in the most horrible way. By clearing the subject of the poem from wrongdoing or negligence, the reader of the poem is enticed to have greater empathy for the subject. Everyone can relate to having bad things happen in their lives that were beyond their control. This acquittal from fault for the subject of the poem also enhances the achievements the unconquerable soul. Overcoming and defying despair in the face of obstacles you have created for yourself is expected behavior for a mature, well-adjusted member of society. The admirable behavior is recognized when one defies the misfortune life hands to you that are not of your own

Things i dont like Essay Example | Topics and Well Written Essays - 500 words

Things i dont like - Essay Example The dislike of presenting, as far as I can tell from my particular perspective, is rooted in a fear of public speaking. Since this issue is commonly discussed in school, I had expected it to be well covered in literature. This was a correct assumption, but an initial glance at the research and theories of this condition presented a bit of a shock. For some reason, I hadnt considered that the problem might be linked to an anxiety disorder. To make it clear, I was well aware that I felt extremely anxious about presentations, but I did not ever think of it as a health concern. However, it does cause me distress and sometimes impedes my regular life, so an official assessment might tell a different story. This revelation strengthened my resolve, and gave meaning to the new goal of reducing my anxiety in public speaking situations. The next logical step in the process was to determine the factors that underlie the anxious response. A 2010 study (Nelson 282) suggests that biased processing in the brain is associated with anxiety disorders. Their study found that someone with public speaking anxiety is more likely to overestimate the risk of negative social interactions in both frequency and impact. This makes sense from an outside perspective, but I still feel stubborn to admit any exaggeration on my part. This is the kind of information I will need to become more open to, so that I may benefit in the future. Public speaking and presentations are a part of life for students, and so I can only make it easier on myself by letting my guard down and addressing these potential biases in my own cognitive processing. This assignment was to address multiple objects of distain in my life, and it turns out that public speaking anxiety is the perfect segue to the second item I had intended to address . I hate embarrassing situations. In fact, I now understand that the fear of being publically embarrassed is probably the root

Women’s Bodies in Taoism Essay -- Religion Religious Essays

Women’s Bodies in Taoism â€Å"I would rather live in a world where my life is surrounded by mystery than live in a world so small that my mind could comprehend it.† This powerful statement by Henry Emerson Fosdick so simply defines the concept of a common Chinese religion. Taoism is a religion practiced by many Asians and by people around the world. It is a religion that is so beautifully complex and yet based on principle as simple as breathing in and out. This paper will outline some basic information on the Taoist tradition, examine the views of the female body in Taoism as presented by Barbara Reed and my own critique of the tradition will be provided. A brief history of Taoism is required in order for us to pursue these goals. To begin with, Taoism originated from a man named Lao Tzu. He wanted to deeply come to an understanding of how one could induce human beings to live together. Tradition says that he developed such a theory but there was no one around to listen to him. In turn, he hopped on his water buffalo and rode to Tibet. When he arrived, he found a border guard and Lao Tzu taught the guard his philosophy. The guard agreed with all Lao Tzu stated and he encouraged Lao Tzu to write his teachings down. The word Tao means â€Å"The way†. This is the entire basis of the Taoist tradition, finding harmony, living peaceably and being creative during the flow of nature. Taoists have a goal as living life for â€Å"the way†and achieving immortality. The Taoist tradition has two sacred texts. Both of these texts â€Å"extol the way of nature as the path of happiness.† says Barbara Reed in Women in World Religions.(161) The Tao te ching is the basic text for Taoism. It has been translated to mean â€Å"The Way an... ... History, University of Chicago Press, Chicago and London, 1970. Reed, Barbara, â€Å"Taoism†, Sharma, Arvind, eds. Women in World Religions, State University of New York Press, Albany, NY, 1987. Schipper, Kristofer, The Taoist Body, University of California: Berkley and Los Angeles, CA, 1993. Smith, Houston, The World’s Religions, HarperCollins, San Francisco, CA, 1991. Tortchinov, Evgueni A., The Doctrine of the â€Å"Mysterious Female† in Taoism: a Transpersonalist View, Department of Philosophy, St. Petersburg State University, Russia, reprinted from, Everything is According to the Way: Voices of Russian Transpersonalism, Bolda-Lok Publishing & Educational Enterprises, Brisbane, Australia, 1997. http://etor.h1.ru/mystfem.html Young, Serinity, eds. An Anthology of Sacred Texts By And About Women, The Crossroad Publishing Company, New York, NY, 1993.

Ethical Challenges in the Era If Health Care Reform

Ethics, Law, and Policy Vicki D. Lachman Ethical Challenges in the Era Of Health Care Reform n truth, the United States is at the beginning of a long overdue and a much needed health care reform. We have seen the dismal statistics about our high cost health care system and some of the less than stellar outcomes (e. g. , infant mortality) (Callahan, 2011; World Health Organization [WHO], 2011)). The purpose of this article is not to complain about the current health care system, but instead to focus on existing reform efforts — The Patient Protection and he Affordable Care Act (ACA), the ethical justifications for its creation, and ethical challenges it brings. I Key Features of the Law ACA offers new ways for consumers and providers to hold insurance companies accountable. The most important parts of the law are features described in the following discussion. Because of space limitation, I will highlight some elements of the law that are enacted through 2014 and clearly impact nursing. These selected features include insurance choices, insurance costs, rights and protection, and people age 65 and older. Insurance ChoicesThe intention of the law is to expand health care coverage to most U. S. citizens and permanent residents by requiring most people to have or purchase health insurance (HealthCare. gov, 2012a). Citizens will have a choice of private insurance, employer-paid insurance, Medicaid, Medicare, or state-based insurance exchanges. Affordable Insurance Exchanges. Individuals and small businesses can purchase coverage through these exchanges, with premium and cost-sharing credits available to individuals and families with income between 133%-400% of the federal poverty guideline (in 2011, the overty guideline was $18,530 for a family of three) (Werhane & Tieman, 2011). Businesses with 50 or more employees need to make coverage available, and businesses with less than 25 employees will qualify for tax credits to offset their cost (Kaiser Family Foun dation, 2011). Consumer Operated and Oriented Plan (CO-OP). The ACA produces a new kind of non-profit health insurer, called a Consumer Operated and Oriented Plan (CO-OP). CO-OPs are meant to offer consumer-friendly, affordable health insurance options to individuals and small businesses. By January 1, 2014, individuals will be able to buy a CO-OPVicki D. Lachman, PhD, APRN, MBE, FAAN, is Clinical Professor, and Director, Innovation and Intra/Entrepreneurship in Advanced Practice Nursing, Drexel University, College of Nursing and Health Professions, Philadelphia, PA. 248 health plan through the Affordable Insurance Exchanges. Pre-existing condition insurance plan. All covered benefits are available to individuals, even to treat a pre-existing condition. This program offers temporary protection for people with pre-existing conditions until 2014, when insurance companies can no longer deny individuals coverage based on their health status.Young adult coverage. Individuals can add or k eep their children on their health insurance policy until they reach age 26. The law makes it easier and more affordable for young adults to get health insurance coverage. Insurance Costs ACA holds insurance companies accountable. It also helps individuals keep their costs down. Value for individual’s premium dollar. ACA requires insurers selling policies to individuals or small groups to spend at least 80% of premiums on direct medical care and efforts to improve the quality of care. Unfortunately, this does not apply to self-insured plans.Lifetime and annual limits. ACA restricts and phases out the annual dollar limits a health plan can place on most of its benefits. Furthermore, ACA eliminates these limits completely in 2014. Rate review. Insurance companies must now justify proposed rate increases for health insurance. Insurance companies cannot raise rates by 10% or more without first explaining the reasons to the state or federal rate review program. Rights and Protecti ons The ACA puts consumers in charge of their health care, not insurance companies. The following rights and consumer protections are available. Preventive care.Individuals may not have to pay a copayment, co-insurance, or deductible to receive recommended preventive health services, such as screenings (e. g. , mammograms and colonoscopies), vaccinations (e. g. measles, polio, or meningitis), and counseling (e. g. , smoking cessation, weight loss, healthy eating). Doctor choice and ER access. Individuals can choose any available participating primary care provider and they can access out-of-network emergency rooms without prior approval. ACA prohibits health plans from requiring a referral from a primary care provider before women can seek coverage for obstetrical or ynecological (OBGYN) care. People 65 and older. ACA offers eligible elders a range of preventive services with no cost-sharing. ACA also provides discounts on drugs when older adults are in the coverage gap known as the â€Å"donut hole. † July-August 2012 †¢ Vol. 21/No. 4 Ethical Challenges in the Era of Health Care Reform TABLE 1. Views of Liberal Egalitarians vs. Libertarians and Free-Market Advocates Liberal Egalitarians Libertarians and Free-Market Advocates Health care is a fundamental good and access to this good Role of government is confined to protecting the freedom of all allows us to become full members of society. ersons to choose their own goals and means to pursue them. This right to health care must be exercised by removing all People have a right to non-interference. barriers to access. Justice, equality, and community are values. Freedom and personal responsibility are values. Health care is a right. Health care is a commodity. Single-payer system is the solution. Decentralized market mechanisms with personal payment are the solution. Preventive services. The list is significant and begins with an annual wellness visit. Other important preventive services include bone mass measurement; cervical cancer creening, including Pap smear tests and pelvic exams; colorectal, prostate, and diabetes screening; influenza, pneumonia, and hepatitis B immunizations; and many other services. There are other services and features in the ACA that could be discussed, but we will now move to discuss the ethical justifications for the ACA. The controversy it has created in the eyes of individuals with a free-market or libertarian view will be compared to those with a liberalegalitarian outlook. Ethical Justifications for the ACA Since 1986, the Emergency Treatment and Labor Act has prohibited hospitals from refusing acute care to any ndividual who could not afford to pay (CMS. gov, 2012). â€Å"Consequently, $100 billion of care annually is ‘costshifted’ onto patients who can pay, almost all whom are insured. This shift raises the average annual health insurance premium roughly $1,000 for every insured family† (Crowley, 2009, p. 10). This lack of distributive justice for the insured is one reason why insurance is being mandated in ACA. It is equally unfair to mandate that all citizens have insurance if insurance is not affordable, as this could cause significant harm to individuals and families already struggling financially.Therefore, the ethical principles of beneficence and nonmaleficence are supported by the features of Affordable Insurance Exchanges and the development of Consumer Operated and Oriented Plans. Ethical reasoning for health care reform has relied primarily on distributive justice as justification for change, specifically due to lack of access to care for the underinsured and uninsured (Lachman, 2009). According to the U. S. Census Bureau, 46. 3 million people in the United States were uninsured in 2008 (ProCon. org, 2012). The United States is the only developed nation in the world hat does not guarantee health coverage. Table 1 offers a comparison of views of persons who support distributive justice, see health care as a right, and therefore want a single-payer system with those individuals who want to continue the free-market system. â€Å"To single-payer advocates, the primary goal of health policy is ensuring that everyone can obtain some minimal level July-August 2012 †¢ Vol. 21/No. 4 of health care† (Sade, 2007, p. 1429). Making access to health care widely available permits individuals to be fully functioning members of society and the moral ommunity (a group of people drawn together by a common interest in living according to a particular moral philosophy). On the other hand, Americans who are libertarians and free-market advocates mostly look beyond the natural (genetic) and social (upbringing) lottery that places some at a disadvantage and instead look to the individual’s free will and personal responsibility for actions (Callahan, 2011; Pariser, 2012; Trotter, 2011). They believe health care is one of the many options from which to choose to improve the ir lot in life. Their belief in personal responsibility can make them unsympathetic o people with unhealthy lifestyles for whom they would ultimately have to spend their insurance dollars. They also resent having to fund treatments they personally would not choose (e. g. , transplants, mechanical ventilation for person in persistent vegetative state). Though many wealthy individuals support health care reform out of benevolence, they do fear the loss of freedom which is central to their value system. However, two additional factors drive change for health care reform — significant cost and quality problems. In 2007, health care expenditures totaled $2. 2 trillion, 16. 2% of the U.S. economy. Health care employs more than 14 million people and is the largest industry in the United States. Of the 193 WHO member states, the United States is ranked first in per capita health care expenditures ($6,719) (ProCon. org, 2012). The present health care system is not giving the utility f or the dollars spent. This cost problem is a reason that ACA has a focus on physicians counseling individuals on end-of-life options. It found that about 30 percent of Medicare dollars are spent during the last year of life, and half of that is spent during the last 60 days. In 2009 dollars, Dr.Gordon calculated, that amounts to $70 billion a year, much of it spent on futile care that prolongs suffering (Brody, 2009, para 20). Unfortunately, politics initially got in the way in 2009 with the â€Å"death panel† jargon and this counseling was dropped from ACA; however, this end-of-life options counseling was incorporated into 2011 Medicare reimbursement for health care providers (HealthCare. gov, 2012b). 249 Ethics, Law, and Policy WHO (2011) statistics also indicate the money spent is not putting us at the top of the list in quality outcomes. The infant mortality rate for the United States in 2009 was even deaths per 1,000 live births, ranking the United States 43rd among WHO nations. Rates for Sweden, Spain, Italy, Germany, France, Czech Republic, Slovenia, and Iceland are all half of the United States rate. Quality is a focus of ACA in the preventive realm and with quality measurement. Two essential principles of the ACA are that: 1. Provider reimbursement for health services is based, in part, on the relative quality and patient experience of the care provided. 2. Information about that comparative quality and patient experience will be publicly accessible. Quality and patient satisfaction will be rewarded by ata from hospital comparison required by the Hospital Consumer Assessment of Healthcare Providers and Systems for Medicare patients. â€Å"The implications of Value-Based Purchasing (VBP) regulations for hospitals are clear — FY2013 implementation at 1% of base DRG payments, rising to 2% by FY2017† (Acton, 2012, para 2). Hospitals will have to earn it back by achieving and maintaining high quality and positive patient experiences. T his consequential focus in the patient care experience supports the autonomous choice of the patient for hospitals and physicians. Ethical Challenges of ACA Legal ChallengeBefore discussing three key ethical challenges health care providers will face, the legal challenge before the Supreme Court needs to be addressed. This challenge determined if the ACA requirement to purchase health insurance violates Article 1, Section 8, Clause 3 of the U. S. Constitution: Congress shall have the Power To lay and collect Taxes, Duties, Imposts, and Excises, to pay the Debts and provide for the common Defence and the general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States†¦ (Werhane & Tieman, 2011, p. 83)The argument against this mandate is that the government has never required people to buy any good or service as a condition of lawful residence in the United States. However, every working person is required to pay into Social Security and Medicare. The counter argument is that these are government-mandated and governmentrun programs. This argument ultimately could support a Supreme Court decision of only a government-run singlepayer system, an action libertarians and free-market advocates oppose. Second, there are requirements for car insurance for drivers, and flood insurance for persons ho live within authorized distance from a possible flood plain. Because all people will need health care at some point in their lives, the argument could be made that insurance should be a requirement so as not to burden the moral community with the costs of those who do pay for insurance (Hamel & Nairn, 2011). 250 On June 28, 2012, the U. S. Supreme Court endorsed most of the Patient Protection and Affordable Care Act, including the contentious individual mandate that requires most Americans to obtain health insurance. In a 5-4 decision, the court said the federal government has he power to fine Americans who do not ac quire insurance because it is considered a tax (Jaslow, 2012). Electronic Medical Records The requirement for electronic records could generate a significant ethical challenge for privacy and confidentiality. Unfortunately, the $20 billion for health information technology from the American Recovery and Reinvestment Act (ARRA) did little to change the current HIPPA privacy paradigm (Crowley, 2009). Furthermore, it is likely patients will carry their personal health records in their own electronic devices or retrieve them through the Internet.A transformation in rural health care is likely through telehealth and telehomecare. These innovations will bring expertise to patients to facilitate the best choice in their treatment decisions. The challenge will be to assure informed consent and confidentiality in this expanded digital age. Chronic Disease Management Individuals with chronic illness benefit significantly from palliative care services, not just at end-of-life care but througho ut the disease progression. The ACA focus on chronic disease management is best exemplified by this phrase: â€Å"An integrated care approach to managing illness hich includes screenings, check-ups, monitoring and coordinating treatment, and patient education† (HealthCare. gov, 2012b, para 1). Feministic ethics, with its focus on managing the particulars of any person’s situation, celebrates this personalized service to individuals who must manage illnesses often for many years. In her book, Caring: A Feminine Approach to Ethics and Moral Education, Nell Noddings (2003) argued that a morality based on rules is inadequate. She contended this approach loses the richness of the moral dilemmas people face, and nly situational and contextual knowledge of the individual can help resolve the moral quandaries of life. Shaping Health Care Policy According to the Code of Ethics for Nurses, provision 9 (American Nurses Association [ANA], 2001), nurses have an obligation to  "work individually as citizens or collectively through political action to bring about social change† (p. 25). This responsibility to shape social (health care) policy calls for nurses to voice concerns about the meaning of the rejection of the individual mandate for society. The libertarians and free-market advocates reinforce a caricature of American individualism and weaken a sense of responsibility for oneself and fellow citizens†¦It neglects one side of the equation, forgetting that we are not only individuals with the freedom to choose, but also members of society called to uphold a common good. (Hamel & Nairn, 2011, p. 94) continued on page 245 July-August 2012 †¢ Vol. 21/No. 4 Ethics, Law, and Policy REFERENCES continued from page 250 Therefore, nurses and nursing associations have the ethical challenge to stand firm for patients and ensure the long-term sustainability of our health care system.Nurses need to advocate for the people without a voice — t hose discriminated against because of health status and lack of insurance. Conclusion ACA has provided a forum for debate about not only health care insurance, mechanisms to maintain financial stability of its systems, and strategies to ensure access to millions of people, but also has contributed to defining American society’s values. It is easy to argue against the individual mandate impingement on choice and freedom. However, other provisions provide children, adults, and elders with coverage and services that will help keep hem healthy and support them in their management of chronic diseases, while quelling the fear of bankruptcy. The Supreme Court will decide the legal matters in ACA, but it will not resolve the ethical matters. Can Americans continue to allow the self-protective practices of insurance companies in excluding high-risk individuals (e. g. , pre-existing conditions, lifetime caps on benefits)? The principle of autonomy was never meant to abandon the moral r elationships that continue to be necessary for the human good. â€Å"The nurse respects the worth, dignity and rights of all human eings irrespective of the nature of the health problem† (ANA, 2001, p. 7). July-August 2012 †¢ Vol. 21/No. 4 Acton, A. (2012). The hidden risk (or reward) of HCAHPS. Retrieved from http://blog. healthstream. com/blog/bid/103384/The-Hidden-Risk-orReward-of-HCAHPS American Nurses Association (ANA). 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(2012). Medical groups laud Supreme Court’s decision on Affordable Care Act. Retrieved from http://www. cbsnews. com/8301504763_162-57462837-10391704/medical-groups-laud-supremecourts-decision-on-affordable-care-act/ Kaiser Family Foundation. (2011). Summary of new health reform law. Retrieved from www. kff. org/healthreform/8061. cfm Lachman, V. D. (2009). Ethical challenges in healthcare: Developing your moral compass. New York, NY: Springer. Noddings, N. (2003). Caring: A feminine approach to ethics and moral education.Berkeley, CA: Universit y of California Press. Pariser, D. M. (2012). Ethical considerations in health care reform: Pros and cons of the affordable care act. Clinics in Dermatology, 30(2), 151-155. ProCon. org. (2012). Right to healthcare: Did you know? Retrieved from http://healthcare. procon. org/ Sade, R. M. (2007). Ethical foundations of health care system reform. Annuals of Thoracic Surgery, 84(5), 1429-1431. Trotter, G. (2011). The moral basis for healthcare reform in the United States. Cambridge Quarterly of Healthcare Ethics, 20(1), 102-107. Werhane, P. , & Tieman, J. 2011). Clearing the brush: Myths surround the Affordable Care Act. Health Progress, 92(4), 82-84, 86-87. World Health Organization (WHO). (2011). World health statistics 2011. Retrieved from http://www. who. int/whosis/indicators/WHS2011_ IndicatorCompendium_20110530. pdf 245 Copyright of MEDSURG Nursing is the property of Jannetti Publications, Inc. and its content may not be copied or emailed to multiple sites or posted to a listser v without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

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