Cross Listing Coursework Example | Topics and Well Written Essays - 500 words

Cross Listing - Coursework Example The company obtains benefits by the economic activities of that foreign country especially from the financial market’s ability to provide greater strength to the market value of that domestic company. Cross listing is also one of the methods of diversifying the investors’ risk profile. By investing in a company which is not a domestic company, allows much more diversification to the local investors as they are now subject to different sorts of risk exposures as compared to their other counterparts. These investors are subject to the risk of the economy of that cross listed company’s country. In short, cross listing provides another avenue of financial resources to the domestic company as well as provides a safeguard from a likely hostile takeover. It also provides a greater opportunity and flexibility to the foreign investors in managing and maintaining their portfolio of investments in a diversified manner. Essar Energy plc is one of the best private groups of India which have substantial investments in both the oil & gas sector as well as the in the power sector. Established in 1989 with petroleum sector only, the company has made remarkable achievements such that the company remained highly successful even in diversifying its operations by investing in refinery and later on, in the power generation and distribution sector. In June 2010, the company cross listed itself in London Stock Exchange after already having a presence in the local stock exchanges in India. The company managed to raise net proceeds of around $1.8 billion from the UK investor. This had been the largest IPO subscription in London Stock Exchange after 2007 by any company. Currently, the company is a constituent of FTSE 100 index of London Stock Exchange. After a tremendous turnaround and interest of the foreign investors in the stakes of the Essar Energy plc, the company

Cognitive Behavior Therapy: Palliative Care

Cognitive Behavior Therapy: Palliative Care Individuals that have been deemed by their medical team to have serious diseases that are resistant, nonresponsive or have failed reasonable treatments are often referred to specialists for comfort measures only. According to the World Health Organization, Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is the achievement of the best possible quality of life for patients and their families (WHO, 1990). The National Center for Health Statistics (1996) estimated that 20% of all deaths and 30% of the deaths of elderly individuals occurred in extended care facilities. Extended care facilities are but one place where end-of-life issues are a common fact of daily life. However, regardless of the setting, each individual faces the end of life with his or her own view of life, death and the dying process. The estimated number of patients in palliative care varies due to the difficulty in capturing the actual numbers from hospitals, primary care practitioners, families and emergency rooms. The estimate of patients receiving the Medicare benefit for hospice and palliative care is approximately  ½ million, and it is estimated that, in 2000, approximately 20% of patients dying in the United States received hospice or palliative care services. It should be noted that although many, if not most, individuals in hospice/palliative care settings are age 85 or older, this level of care is not limited to older adults. Motor vehicle accidents, post-traumatic incidents, drug overdoses and other physiologically devastating disorders may result in permanent damage to the younger body as well as the older body. Mortality rates at a young age for those with mental illnesses is decreasing therefore it is estimated that by 2030 there will be 15 million individuals with mental illness residing in long term care facilities (SAMHSA, 2004). This chapter will focus on the reduction or modification of autonomic, psychiatric, or sensory symptom experience of these individuals through use of cognitive behavioral therapy. Cognitive behavior therapy (CBT) uses a structured and collaborative approach while helping individuals to recognize, evaluate and restructure the relationships between their thoughts, feelings and behaviors. Through a process of targeted interventions, the therapist assists individuals to identify, monitor and cognitively restructure the dysfunctional thoughts and/or to modify behaviors that are maladaptive, useless or even harmful (Beck, 1976; Turk, Meichenbaum, Genest, 1987; Freeman Freeman, 2005). CBT includes a range of both cognitive and behavioral techniques such as relaxation, guided imagery/visualization, biofeedback, behavioral experiments, guided discovery, stress management, training in pain or stress management strategies, and cognitive restructuring for dysfunctional thinking and many others . Although there is a paucity of research on the use of CBT in palliative care settings, CBT is effective for many of the psychological issues that are prevalent in palliative care including, depression, anxiety, pain management, and insomnia. The purpose of this chapter is to provide an overview on the use of CBT for assessment and treatment of psychological distress in palliative care settings. Assessment of Emotional Functioning in Palliative Care There are many challenges to the assessment of mood disorders in palliative care settings. An initial challenge is the myth that psychological distress is a normal reaction to end of life. Despite expectations, most individuals in palliative care settings do not have symptoms of anxiety, depression or dementia. Many individuals arrive at this stage of their lives or illnesses with a sense of calm resignation, if not expectations of relief and of going home to God, heaven or family members waiting for them in the hereafter. Therefore those individuals that are experiencing symptoms that require intervention may achieve significant benefit from the interventions. The most common presentations are those of depression, anxiety, pain management failures with exhaustion and anguish, and sleep disorders. The healthcare provider requires tools necessary to differentiate major depression from anger, sadness, and anxiety associated with the symptoms of an untreatable or chronic illness. Assessment of preparatory grief and depression. Another obstacle to the assessment process is simply overcoming the challenges of differentiating symptoms from normal grief of the illness itself. Differentiating between preparatory grief and depression is a key component to the proper assessment of depression in palliative care and has important treatment implications. Preparatory grief can be defined as what an individual must undergo in order to prepare himself for his final separation from this world (Kubler-Ross, 1997). Symptoms of preparatory grief include 1) Mood waxes and wanes with time, 2) Normal self-esteem, 3) Occasional fleeting thoughts of suicide, and 4) Worries about separations from loved ones (Periyakoil and Hallenbeck, 2002). Preparatory grief is a normal, not pathological, life cycle event (Axtell, 2008; Periyakoil and Hallenbeck, 2002). Major depression is defined as five or more of the following symptoms during the same two week period: depressed mood, marked diminish in pleasure, weight loss or gain, insomnia or hypersomnia, psychomotor agitation/retardation, fatigue/loss of energy, feelings of worthlessness or inappropriate guilt, lack of concentration/indecisiveness, and recurrent thoughts of death and suicidal thoughts or plans (APA, 1994). Table 1 provides a symptom list. The list is not intended to be all inclusive however it gives the clinician an overall view of symptoms that may be observed in the individual dealing with depression in a palliative care setting. Although some symptoms of grief and depression overlap, there are ways to distinguish between grief and depression. Table 2 summarizes the ways to differentiate symptoms of grief versus depression according to temporal variation, self-image, hope, anheonia, response to support, and active desire for an early death (Periyakoil Hallenbeck, 2002). The first step to proper recognition of depression involves the identification of possible risk factors (Wilson, Chochinov, de Faye, and Breitbart, 2000). Certain demographic characteristics, such as younger age, poor social support, limited financial resources and family history of a mood disorder, as well as a personal history of previous mood disorders place individuals at a greater risk for developing depression or anxiety in end of life situations. Risk for developing a mood disorder also is elevated with certain types of diagnoses, including pancreatic cancer and brain tumors, and particular medical interventions such as radiation therapy (Hirschfeld, 2000). Symptoms of the illness, including poor symptom control, physical disability, and malnutrition also place individuals at higher risk. The second step to the proper assessment of depression includes utilization of appropriate assessment tools. Many times it is the degree and persistence of symptoms that provide the information necessary when considering major depression. Major depression, which is estimated to occur in fewer than 25% of patients in end of life care, may be best screened with targeted questions such as: How much of the time do you feel depressed? In addition, for those individuals that have a difficult time describing their symptoms or history, asking family members to provide information about a previous history of depression or a family history can be very useful. Although studies validating assessment tools vary greatly, many of the self-report measures have been shown to be effective in palliative care patients. The most common utilized tools in palliative care settings frequently omit physical symptoms of depression. Many symptoms of depression overlap with the terminal disease process (Noorani Montagnini, 2007). Examples of self-report measures that omit somatic symptoms include the Beck Depression Inventory II (Beck, Steer, and Brown, 1996), Hospital Anxiety and Depression Inventory (Zigmond Snaith, 1983), and the Geriatric Depression Scale (Yesavage et al., 1983). The Hayes and Lohse Non-Verbal Depression Scale (Hayes, Lohse, and Bernstein, 1991) is a third party observational measure that can be completed by staff, family, or friends to assist with the diagnostic process. Terminally Ill Grief or Depression Scale (TIGDS), comprising of grief and depression subscales, is the first self-report measure designed and validated to differenti ate between preparatory grief and depression in adult inpatients (Periyakoil et al., 2005). Assessment of anxiety. The symptoms of anxiety may differ in individuals in the palliative care environment. Many times symptoms of anxiety have a physiologic component. For example in those individuals with chronic obstructive pulmonary diseases difficulty breathing, low oxygen levels and overall compromised respiratory function causes air hunger which is experienced as anxiety and even panic. Table 3 lists some of the common anxiety symptoms seen in this population. Family members are often at a loss as to what they can do to assist their loved one that is experiencing anxiety, and especially fearfulness. It is often useful to provide significant others with a checklist of items that are important to report to the healthcare provider. Involving the family has the benefit of giving them a structured guide for response which reduces their own anxiety in response to the patient. In addition the patient may relax more knowing that a family member is involved with their care in an approved, helpful manner. An example of a list of items for family members to watch for and report to the healthcare team is listed in Appendix 1. Cognitive Behavioral Interventions in Palliative Care Psychological intervention in the palliative care setting includes those aspects of treatment that would provide relief from emotional distress while an individual is dying. Often this time period includes depression, anxiety, grief and organic brain dysfunctions such as dementia and/or cerebral vascular diseases. Individuals and their family members are both considered the patient during these times. Many of these individuals are suffering from chronic, unremitting pain conditions which negatively impact their emotional health. Treatments for pain and chronic conditions also play a part in the individuals mental status. The use of Cognitive Behavior Therapy (CBT) is extremely useful for these individuals. Cognitive Behavioral Therapy has the strongest empirical support of any psychological intervention for the management of symptoms typically seen in a palliative care setting. The most common presentations of psychological distress in the dying patient include anxiety, depression, hopelessness, guilt over perceived life failures and remorse. Persistence of these thoughts and feelings interfere with functioning, makes the person generally miserable as well as those around them and can severely affect his/her quality of life. Medical treatments, such as antidepressants, anxiolytics and cholinesterase inhibitors, exist for these problems however supportive psychotherapy such as relaxation training, imagery, distraction, skill training, and negative thought restructuring improves the possibility of remission. CBT can also improve the symptoms of spiritual distress that may include feelings of disappointment, guilt, loss of hope, remorse, and loss of identity. CBT for depression. Symptoms of depression are common in end of life care. It can be one of the most distressing groups of symptoms an individual can experience and may interfere significantly with daily tasks of life. Some experts have estimated that up to 75% of patients with terminal illnesses experience symptoms of depression. Amelioration of some of the symptoms of depression can increase the amount of pleasure and meaning in life, as well as add hope and peace. Treatment for depression can reduce the experience of physical pain as well as general misery and suffering. In addition, reduction of the symptoms of depression may improve the treatment of coexisting illnesses more effective. Most importantly, given that one of the most serious symptoms of depression is suicidal ideation, it makes sense to treat depression in order to prevent successful suicidal outcomes. There is a paucity of literature in the area of the use of CBT with depression in Palliative Care, due to the high attrition rate resulting from physical morbidity and mortality (Moorey et al., 2009). Therefore, these factors pose significant barriers to conducting randomized clinical trials in Palliative Care to address these components. The following is a review of the sparse literature on CBT in Palliative Care with depression. In an attempt to address this problem, Moorey et al., conducted a cluster randomized controlled trial in order to determine if it was possible to teach nurses CBT techniques in order to reduce anxiety and depression symptoms in patients with advanced cancer (2009). Eight nurses were trained in CBT by attending several 1- and 2-day workshops and then were rated on the Cognitive Therapy First Aid Rating Scale (CTFARS) for CBT competence. Seven nurses did not receive training and served in the control group. A total of 80 home care patients entered the trial; however most of these participants were excluded due to being too ill to participate. A total of 16 patients were in the CBT group and 18 patients were in the control group. The participants received home care nursing visits in which assessments were conducted at 6-, 10-, and 16-week intervals. The individuals who received CBT reported lower anxiety scores over time, but no effect of the training was found regarding depression. It was noted that both groups experienced lower rates of depression over the course of the study. The authors noted the heterogeneity of the sample and the high attrition rate due to physical morbidity and mortality presented several barriers to conducting the study and may have played in a role in the findings (Moorey et al., 2009). Cole and Vaughan (2005), in their review on the feasibility of using CBT for depression associated with Parkinsons disease (PD), found that it is a promising option. The authors noted that depressed inviduals with comorbid PD experienced a significant reduction in depressive symptoms and negative cognitions. In addition they experienced an increased perception of social support over the course of treatment (Cole Vaughan, 2005). The recommended course of action for individuals in this setting included: stress management training, relaxation training, behavioral modification techniques for sleep hygiene, and cognitive restructuring. Modification of life stressors contributing to depressed mood should be identified and plans made to minimize stress and maximize quality of life. The use of thought restructuring is recommended in order to maintain a sense of purpose and fulfillment through meaningful activity and to adjust expectations of self and others. Individuals are also encouraged to return to previously enjoyed activities in order to maximize feelings of pleasure and happiness. Through systematic defocusing on physical conditions the person is able to experience more pleasant activities, which are also encouraged. Similarly, Dobkin et al, conducted a study which explored the effects of modified CBT for depressed patients with PD, in conjunction with a separate social support intervention for caregivers (2007). The patients received 10-14 sessions of modified CBT, while caregivers attended three to four separate psychoeducational classes. The modified CBT sessions were comprised of the same components of the previous Cole Vaughan, (2005) study, such as, stress management training, behavioral modification techniques for sleep hygiene, relaxation training, cognitive restructuring, modification of life stressors, and increasing engagement in pleasurable activities. The classes were targeted at providing caregivers with ways to respond to the patients negative thoughts and beliefs, as well as, strategies to offer appropriate support. As in the previous study, the modified CBT sessions were comprised of training in stress management, behavioral modification, sleep hygiene, relaxation techniques, an d cognitive restructuring. Participants reported a significant reduction in their depressive symptoms and cognitions and increased perception of social support at treatment termination and one-month post-treatment. CBT for anxiety. Along with depression, anxiety is a common mental health problem in palliative care settings and also appears to be alleviated with CBT interventions. In a small feasibility study examining the use of cognitive behavioral therapy techniques for mild to moderate anxiety and depression in hospice patients, four sessions of CBT techniques was found to significantly reduce anxiety and depression in a majority of patients (Anderson, Watson, Davidson, and Davidson, 2008). Overall, participants in the study found the CBT techniques acceptable, helpful, and qualitatively reported improved mood. A significant reduction in anxiety symptoms also was seen in a randomized controlled trial of CBT administered by home care nurses in patients with advanced cancer (Moorey et al., 2009). CBT techniques are particularly effective to assist with the management of anxiety related to breathing difficulties commonly seen with pulmonary diseases, such as chronic obstructive pulmonary disease (COPD). In a group of individuals with COPD, six sessions of guided imagery, a CBT relaxation technique, was found to significantly increase the partial percentage of oxygen saturation, which is a physiological indicator signaling more effective breathing (Louie, 2004). In another study, as little as 2 hours of CBT group therapy yielded a decrease in depression and anxiety among older patients with COPD, but there was no change in physical functioning (Kunik et al., 2001). CBT for pain management. Pain is not simply a biological response to unpleasant stimuli. It is a complex phenomenon that includes biological, psychological, behavioral and social factors that interact in complex ways to influence the pain experience. Some of the factors that can influence a persons experience of pain include: a) previous pain experiences, b) biologic and genetic predispositions, c) mood disorders such as anxiety and depression d) their beliefs about pain, e) fear about the pain experience, f) their individual pain threshold and pain tolerance level, and f) their skill with coping methods. Cognitive-Behavioral Therapy has the most empirical support for the management of chronic pain, especially when used as part of an interdisciplinary treatment approach to manage pain symptoms (Turk, Swanson, Tunks, 2008). Cognitive behavioral techniques can be used independently to assist with pain management or integrated into a comprehensive cognitive-behavioral case conceptualization framework to address pain (Turk, Swanson, Tunks, 2008). The three components to CBT for pain management are 1) Education and rationale for the use of CBT, 2) Coping skills training, and 3) Application and maintenance of CBT skills (Keefe, 1996). Useful behavioral interventions to assist with pain management include goal setting, relaxation strategies, such as deep breathing and guided imagery, and activities scheduling. Cognitive interventions would include increasing problem-solving skills and addressing an individuals maladaptive thoughts related to pain management. Examples of maladaptive thoughts include: 1) Ive tried every pain management intervention with no success, 2) I cannot do any of the things that I used to do, 3) nothing will help manage my pain, and 4) no one can help me feel better. CBT for pain manage ment has demonstrated efficacy in various diagnoses often addressed in palliative care. CBT has been found to be efficacious in the management of cancer-related pain in single studies (Syrjala, Donaldson, Davis, et al., 1995) as well as in systematic reviews (Abernethy, Keefe, McCrory, Scipio, Matchar, 2006). CBT for sleep hygeine. Insomnia, sleep duration and quality are major concerns for people with pain disorders such as osteoarthritis (Vitiello, 2009). Approximately 60 percent of individuals with chronic pain disorders report frequent nighttime awakening due to pain during the night. Disrupted sleep patterns exacerbate chronic pain intensity and experience which in turn causes more disturbance of the sleep/wake cycle. Successful treatment of interrupted sleep may reduce the pain experience as well as improve the overall quality of life for these individuals. Psychotherapeutic techniques that target sleep disturbances are easily incorporated within behavioral and cognitive management of other co-occurring disorders as well. Sleep disorders are common in patients who suffer from Parkinsons disease (PD) (Stocchi, Barbato, Nordera, Berardelli and Ruggieri, (1998). Specifically, insomnia, nightmares, REM sleep behavior disorder, sleep attacks, sleep apnea syndrome, excessive daytime sleepiness, and periodic limb movement in sleep result from changes in sleep structure, movement disturbances in sleep, disturbances in neurotransmission and medications. Individuals who are sleep deprived are at risk to develop infections, cardiovascular disease, hypertension, diabetes, depression, and require increased time to recover from stress (Schutte-Rodin, Broch, Buysse, Dorsey, and Sateia, 2008). CBT improves sleep by addressing unhelpful beliefs regarding sleep and misperceptions about the amount of sleep that one obtains. Many misperceive the amount of time they are actually asleep. People who suffer from insomnia actually sleep more than they are aware of because they are only attentive of when they are awake. Furthe rmore, many people believe they require 8 hours of sleep in order to be able to function during the day and any amount of sleep that is less is insufficient and will result in reduced ability to function during the day. Therefore, these beliefs and misperceptions can increase ones stress level about sleep and a stress response may result when one thinks about going to sleep. Clearly, a heightened stress response is not conducive to sleeping. CBT increases ones control over their unhelpful and inaccurate beliefs and enables them to replace them with more helpful and accurate beliefs (Whitworth, Crownover, and Nichols, 2007). CBT also addresses the behavioral components of ones sleep routine or patterns that interfere with ones ability to obtain restful sleep. Exercising, smoking, or drinking caffeinated drinks just prior to bedtime can interfere with ones sleep. All of these activities are stimulants that energize the body. Also, not having a bedtime routine, a regular sleep-wake pattern, or taking naps may interfere with ones ability to get restful sleep. Increasing ones sleep hygiene by developing positive habits that influence sleep such as, having a bedtime routine to prepare ones mind and body for sleep, regular exercise several hours before one intends to prepare for sleep, and avoiding coffee, alcohol, and smoking in the evening, as well as, increasing activities that produce relaxation (e.g., taking a hot bath one to two hours before going to bed, meditation, deep breathing, or muscle relaxation) can increase the likelihood of obtaining restful sleep. Another behavioral strategy utilized in CBT i s sleep restriction. This technique attempts to match ones actual sleep requirement with the amount of time one spends in his/her bed. The theory behind this approach is that reducing the amount of time spent in bed without sleep will increase ones desire to sleep (Harvey, Ree, Sharpley, Stinson, and Clark, 2007). Results of a study by Vitiello showed that treatment improves both immediate and long-term self-reported sleep and pain in older patients with osteoarthritis and comorbid insomnia without directly addressing pain control (2009). This study included 23 patients with a mean age of 69 years were randomly assigned to CBT, while 28 patients with a mean age of 66.5 years were assigned to a stress management and wellness control group. Participants in the control group reported no significant improvements in any measure while Individuals treated with CBT reported significantly decreased sleep latency (onset of sleep) by an average of 16.9 minutes and 11 minutes a year after treatment. Interruptions in sleep after sleep onset decreased from an average of 47 minutes initially to an average of 21 minutes after one year. Pain symptoms improved by 9.7 points initially to 4.7 points. Sleep efficacy (how rested does the person feel upon awakening) initially increased by 13 percent and 8 percent a year after treatment. The improvements remained robust in 19 of 23 individuals at a one-year follow-up visit. Furthermore, while many older adults experience insomnia, it is reported that up to two-thirds of those who experience these symptoms have limited knowledge regarding available treatment options. Sivertsen (2006), conducted a randomized controlled trial to compare the efficacy of non-benzodiazepine sleep medications with CBT. This study included 46 patients with a mean age of 60.8 years who were diagnosed with chronic primary insomnia. Participants were randomly assigned to either the CBT intervention (information on sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and progressive relaxation), sleep medication (7.5 mg zopiclone each night), or placebo medication. Treatment lasted 6 weeks, and the CBT intervention and sleep medication treatments were followed up at 6 months. Data regarding total wake time, total sleep time, sleep efficiency, and slow-wave sleep was collected utilizing sleep diaries, and polysomnography (PSG; monitors physiological activity during sleep). Results revealed that total time spent awake improved significantly more for those in the CBT group compared to the placebo group at 6 weeks and the zopiclone group at both 6 weeks and 6 months. In comparison, the zopiclone group did not reveal significant results from the placebo group (Sivertsen, 2006). The CBT group experienced a 52 percent reduction in total wake time at 6 weeks compared with 4 percent and 16 percent in the zopiclone and placebo groups respectively. A statistically and clinically significant finding was that participants receiving CBT improved their PSG-registered sleep efficiency by 9 percent at posttreatment, opposed to a decline of 1 percent in the zopiclone group. Total sleep time increased significantly between 6 weeks and 6 months for the CBT group. The zopiclone group showed improvements at 6 weeks and maintained these improvements at 6 months, but did not show further improvements. The CBT group showed significant improvements compared to the zo piclone group in total wake time, sleep efficiency, and slow-wave sleep; total sleep was the only area that did not yield a significant difference (Sivertsen, 2006). ADAPTING CBT TO THE PALLIATIVE CARE SETTING Overview of CBT in Palliative Care Cognitive-behavioral therapy is effective for many of common mental health issues seen in palliative care and often augments the success of pharmacological interventions. In addition to the individual with the terminal illness, their family members, as well as multiple health providers are considered integral members to the success of the collaborative relationship. Use of a CBT case conceptualization framework and various components offer flexibility, which makes the CBT approach feasible to implement within a palliative care setting. The following section provides an overview of the components of cognitive-behavioral therapy and necessary adaptations to palliative care settings. Collaborative Relationship As mentioned in previous chapters in this book, a collaborative relationship is a core component of an effective cognitive-behavioral intervention. In a palliative care setting, the collaborative relationship often involves more than just the client and the therapist. The interdisciplinary treatment team works with the individual to develop an individualized treatment plan that is central to the case conceptualization and goal setting of CBT. A variety of disciplines, such as nursing and social work, use CBT techniques in palliative care settings. Individuals receiving palliative care often need assistance with CBT interventions as their illness progresses. Individuals receiving palliative care often need assistance from the treatment team with practicing skills, such as relaxation techniques, and adapting CBT interventions as goals of care change. Some individuals in the Palliative Care setting may not be facing death in the near future, and if they are facing impending death, they may not be aware of it. In these cases the primary patient may be the family member or significant other. It is also common practice for most individuals to seek help for mental health problems from their family practitioner even though the typical family practitioner has very little training in psychiatric/mental health assessment, diagnosis and treatment. In cases where the family is relying on an under-trained health care provider it may be incumbent upon the mental health provider to negotiate the gap between family and medical care. Case Conceptualization and Goal Setting Therapy with the dying person should begin with having the person identify, explore and determine outcome goals regarding the issues at hand. Similarly to the primary care setting, case conceptualization and goal setting need to occur almost immediately. The therapist uses the Socratic Dialogue to explore the persons concerns and worries. This gives the individual more of a sense of control over what will be happening in the therapy session. Once this sense of control is established it becomes easier to explore other, more emotion laden topics. Goals should be small, obtainable and proximal to the session to be most effective. For example, Mrs. Jones I will be back to see you tomorrow. One of the things you have decided to practice is your deep breathing at least twice tonight and again in the morning. When I return I will check with you to see how you are doing with the practice. In palliative care setting, it may be necessary to discuss how other people involved in care can assist with reaching goals. For example, nurses might remind individuals to practice relaxation strategies during wakeful periods, as well as talk an individual through the relaxation technique when experiencing a high level of pain. Behavioral Interventions Pleasant Events Scheduling. Activities scheduling is a useful intervention to assist with mood disorders, pain management, and sleep hygiene issues seen in a palliative care setting. Engaging in pleasant events distracts an individual from negative thoughts and provides experimental evidence to support more adaptive thinking styles. Often times in palliative care the first barrier to overcome is identifying pleasant events that can occur in a palliative care setting due to health limitations. Pleasant events need to be person-centered, meaningful, and feasible activities that can be built into a daily routine. Meaningful pleasant events can be identified through both clinical interview and self-report methods. Clinical interview queries should include taking a history of an individuals daily schedule and identify activities the individual enjoyed engaging in on a routine basis prior to their illness. From the generated list of previously enjoyed pleasant events it needs to be determined which activities the individual can continue to enga

Macbeths Numerous Atmospheres :: Free Macbeth Essays

Macbeth's Numerous Atmospheres       The atmospheres in William Shakespeare's Macbeth are numerous, but begin as one surrealistic atmosphere initially with the witches' appearance at the outset. From there the atmosphere is incrementally added to regularly.    Charles Lamb in On the Tragedies of Shakespeare comments on the atmosphere surrounding the play:    The state of sublime emotion into which we are elevated by those images of night and horror which Macbeth is made to utter, that solemn prelude with which he entertains the time till the bell shall strike which is to call him to murder Duncan, - when we no longer read it in a book, when we have given up that vantage-ground of abstraction which reading possesses over seing, and come to see a man in his bodily shape before our eyes actually preparing to commit a muder, if the acting be true and impressive as I have witnessed it in Mr. K's performance of that part, the painful anxiety about the act, the natural longing to prevent it while it yet seems unperpetrated, the too close pressing semblance of reality,give a pain and an uneasiness [. . .]. (134)    D. F. Bratchell in Shakespearean Tragedy record's Charles Lamb's consideration of   Macbeth's atmosphere as essential to the purpose of the play:    For Lamb the essence of the tragedy in Macbeth lies in the poetically suggested atmosphere of horror and evil impulse, readily seized upon by the imagination of the perceptive reader, whereas stage representation concentrates the mind on the action. (133-34) Roger Warren comments in Shakespeare Survey 30 , regarding Trervor Nunn's direction of Macbeth at Stratford-upon-Avon in 1974-75, on opposing imagery used to support the opposing atmospheres of purity and black magic:    Much of the approach and detail was carried over, particularly the clash between religious purity and black magic. Purity was embodied by Duncan, very infirm (in 1974 he was blind), dressed in white and accompanied by church organ music, set against the black magic of the witches, who even chanted 'Double, double to the Dies Irae. (283) L.C. Knights in the essay "Macbeth" mentions equivocation, unreality and unnaturalness in the play - contributors to an atmosphere that may not be very realistic:    The equivocal nature of temptation, the commerce with phantoms consequent upon false choice, the resulting sense of unreality ("nothing is, but what is not"), which

Ethical and Legal Systems of Health Care Organizations Essay

Aetna Incorporated, a health care plan company, is one of the American leading companies in diversified benefits of a range of traditional and consumer directed health care insurance services. It includes vast service offerings in health care insurance from mental and behavioral health to long-term care benefits and other health-related care and concerns . (Aetna, 2007a; Wikipedia, 2007) Moreover, it is the nation’s pioneer in full-service health insurer that proffers a consumer-oriented health plan. Aetna provides its members with the opportunity to reach out on suitable tools and comprehensible information for them to perform based decisions regarding health and financial interest (Aetna, 2007a). For over 150 years, Aetna has been committed to supporting people in attaining health and financial security. The company establishes information and necessary resources to work for its members and clients for them to execute â€Å"better-informed decisions about their health care. Currently, Aetna membership numbers up to 15. 7 million (M) medical members, around 13. 7 M dental members and around 10. 5 pharmacy members (Aetna, 2007a). In terms of health care networks, it holds on more than 783,000 health care professionals, 458,000 major care doctors and specialists, 4,681 hospitals and a network called AexcelSM, of specialist physicians. Aetna is also the provider of benefits through national employers of small, mid-sized and large multi-state scales in all 50 states, as well as individuals and Medicare recipients in certain markets. Aetna: Code of Conduct The company’s Code of Conduct contains a unique and consistent set of values and standards of integrity and business practices. It mediates in guiding the company in complying with the laws, regulations and ethical standards that controls Aetna’s business functions (Aetna, 2006). According to the preface message of Aetna’s Chairman and Chief Executive Officer (CEO) and President Dr. Ronald A. Williams, every company’s employee, officer, and director is expected to follow the Code of Conduct because: a) it is the expectations of the customers from the company; b) they have a vow to live b their values, and; c) they would be functioning with the utmost principles of fair and ethical business guidelines given that they follow the contained guidelines in all their business aspects. However, the Code cannot cover all situations and Dr. Williams encourages the assistance or guidance of The Aetna Way and their Ethical Decision-Making Framework (to be discussed later in this paper) to conduct sound decisions and take the right actions in performing Aetna business practices. Ethical System The Code of Conduct contains ten (10) specific areas of topics in which the company discusses some policies on specific matters. The first one or Statement 1 deals with Conflicts of Interest that in general regards with the company’s requirement that its employees, officers and directors to keep away form real or obvious conflicts of interest to protect Aetna’s reputation. There should be avoidance in ownership interests or participation in excluded activities that would create a conflict of interest or interference in performing of a job. This requires reporting to the manager and compliance officer for review and sanction of affiliations on hand or ownership concerns that involves him or her or a family member or even a close friend residing in a home such as any positions with any â€Å"business, nonprofit organization or government entity that is an Aetna competitor, customer, provider or supplier† or for other cause or motives that may induce conflict of interest, and; getting hold of a considerable amount of partnership in possession of interest in any business or even partnership. However, the determination of conflicts of interest might sometimes be blurry and hence, guidance of a compliance officer might come necessary. There are also guidelines in the affiliations and interest of the Director and are not far-related to what have been discussed previously, and the review by the Nominating and Corporate Governance Committee must also re regarded relevant. There are also guidelines and rules in accepting or giving gifts; travel, entertainment and honorarium; discounts and preferential treatment; and loans and guarantees of obligations. Statement 2 deals with record-keeping and use of the company’s property and resources which should be entirely legal and proper. This is so since Aetna and any other companies for that matter, is mandatory to submit relevant documents, reports and public communication to the Securities and Exchange Commission and other regulators that also includes disclosure in a manner that is whole, impartial, accurate, timely and comprehensible. All of the company’s resources and property such s e-mail, internet and other computing and communications systems should only be used for the company’s purpose. Bribes and other illegal payments are also strongly discouraged by the company. Statement 3 embarks on fraud, dishonesty and criminal conduct since these apparently affect Aetna’s reputation and continued success. Hence, all business functions must be performed with honesty and with compliance with applicable laws, regulations and ethics rules. Statement 4 is with regards with protecting member and other confidential information of members, employees and the company itself from any inappropriate access, use or disclosure. This is also in integration and compliance with federal and state privacy and security laws that is applicable to the company. Private company information refers to member information, the company’s professional interests, and other relevant information about its clients, subordinates and even suppliers that might be used against the company or for the benefit of its competitor. This is applicable in the course of being under Aetna or after the affiliation with the company. Statement 5 deals with the company’s business and trade practices which should be complied with honesty and integrity since Aetna has its own laws and regulations that apply to the company’s business which are under federal law. The company’s Record and Management Policy is also strongly encouraged to be followed. Statement 6 encourages the company’s subordinates to support Aetna to be a responsible and trustworthy government contractor since the company treasures winning and keeping government contracts. This can be achieved by following federal, state and local laws that regards with government contracting and procurement. Employment laws must be also strictly complied with. The Code is also concerned with proper employment practices and welfare as well as the appropriateness of its workplace (Statement 7). The company complies with policies and programs that ensure the inclusiveness and safety or the workplace for its employees and business partners, promote fairness and respect for all, and promote a working environment where diversity and inclusion are appreciated. Federal laws that discourage discrimination, harassment, special personal relationships, violence and vices are strongly administered by the company. Such laws that are complied with in the company are the Equal Employment Opportunity and the Affirmative Action, which takes away the basing of business decisions on individual’s characters (such as sex, race, color, nationality, age and others; and the company’s very own Alcohol and Drug Policy that prohibits distribution, possession, use, purchase or sell of alcoholic beverages and illegal or prescription substances and drugs. Statement 8 deals with Aetna’s securities transactions which prohibits trade securities if an individual has no material nonpublic information about particular securities. Under this code, all are expected to comply to all insider trading and securities federal laws and the company’s own relevant regulations. Also included dealing and transacting with securities matters and management and secrecy of private information. The company and a subordinate could face civil and criminal consequence for insider trading since insider trading is unethical and unlawful. The statement also discusses on â€Å"material information† relevant in decision-making that concerns any transactions on the company’s securities. Statement 9 deals with the company’s interaction whether private or public to any external institution such as media organizations and even with the federal government. Anyone in close relation to the company and even its subordinates should not speak in behalf of Aetna only there was consent or authorization from the Board of Directors to take such action. Personal views should also be kept separate from the company’s view. He funds of the company should not be also utilized to engage on a lobbyist or to make a political donation except authorized by the Government relations. These are for the protection of Aetna’s reputation and an individual as well, under compliance of laws. Finally, Statement 10 deals with Aetna’s intellectual property. Apparently valuable, such property must be protected from improper use or disclosure whether owned by the company or licensed from others. Intellectual properties of the company must be controlled the legal and proper way. Usage of such property must be under approval of an internal legal counsel and in accordance with the Aetna Intellectual Property Guide. Policies on Aetna’s intellectual properties are also extended to the websites, videos, music and publications. Aetna’s ethical system as contained in its own Code of Conduct presents a vast range of policies that protects the reputation, integrity, security and welfare of both the company itself and its subordinates and members. As discussed above there are specific policies or code of ethics from recordkeeping, employee’s equal opportunity and to intellectual property rights. According to the company, all policies are established in compliance with federal laws. The company’s policies regarding conflicts of interest and confidentiality have general basis as concluded by the study in a position paper from the Society for Health and Human Values and Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation (Aulisio, 2000). One of their conclusions is that, abuse of power and conflicts of interest must be avoided in health care companies. This is so since ethics consultants have the authority and power to influence clinical care and such power can be exploited. Since conflicts of interest can be partial to consultants’ recommendations, important personal or professional linkages with one or more parties should be disclosed and be get rid of. In addition, the personal concerns of the consultants may be affected by giving advice that could act against the company’s financial or public relations concerns. Policies that concern on recordkeeping and use of the company’s property and resources, and insider trading are all in accordance to federal laws specifically in the Securites Exchange Act of 1933 and 1934 (USSEC, 2007). The two basic objectives of the former it that to mandate investors or companies receive financial and other relevant information regarding securities being offered for public sale and forbid â€Å"deceit, misrepresentations, and other fraud† in the sale of securities. The latter states that insider trading is illegal when an individual trades a security while in ownership of nonpublic material information in disobedience of an obligation to withhold the said information or renouncement from trading. On the other hand, policies regarding the company’s employment practices are also observed in compliance with federal employment laws. Federal Equal Employment Opportunity (EEO) Laws prohibit job discrimination which covers almost all private employers, state and local governments, educational institutions and even the federal government (USEEOC, 2005). The said law is enforced by the US Equal Employment Opportunity Commission and also complies with the American College of Healthcare Executives or ACHE (ACHE, 2003). Overall, Aetna covers the essential and core ethic issues in accordance to federal laws.

Just War Theory

War is said to occur when one state declares hostility against another by which it places the people and resources under its authority to enmity against their adversaries as well as their resources (Gardam J, 1993). According to broadminded ed war historian and theorist Jeffrey Rodgers Hummel, there is an implication of the above definition.In placing its people as well s resources to hostilities, each state is in reality declaring war on three phases; first and foremost as to the other state; second as to the people of the other state; and thirdly as to its own dissenting citizens, should they fail to act in accordance with the State’s demand for manpower and resources (Gardam J, 1993).Going by the above definition offered by Jeffrey R. Hummel, just war would comprise that the war should have a just beginning. That is, it must be declared in reaction to violent behavior; the response has to be reasonable and according to the level of aggression, it has to be begun by an appro priate authority in opposition to appropriate enemy; it has to be conducted in proper manner that is justly†¦that is no harming of innocent people knowingly or intentionally (Gardam J, 1993). The war must have a just originThe just war theory asserts that war should originate only if there is violation of rights and only in self-defense. These rights should be individualistic rights as opposed to those that lead to war, for instance breach of a country’s sovereignty on a realistic altitude. Nevertheless, a difficulty arises at once. The fundamentals necessary to judge the justness of the war’s origin for instance, time and relevant information are not often available at the point war is declared.In deciding the idea of German Catholic participating in war during the Nazi period, it was once remarked by a publisher that â€Å"A scientific judgement concerning causes and origins of the war is absolutely impossible today because the pre-requisites for such a judgeme nt are not available to us. This must wait until a later time when the documents of both sides are available† (Allen C, 1966). The war must be a reasonable response As per the theory, it is grimacing for a provoker to be shot whether he acted on purpose or accidentally.While exercising self-defense the level of force utilized has to be proportional to the force used by the aggressor, while the aim of the responsive force should be articulated on the tenets of protection or restitution. Thus, a war with a just origin should have first exhausted all lesser force employment that could have consummated the desired objectives. It becomes crucial to elucidate one idea that the war should be left with the people with, that the state has consigned their rights of defense with.The question is whether States’ declaration of war places all its citizens to take part in hostilities even though a small proportion of them have been aggressed. Secondly, does aggression directed towards those consigned with the right of defense bind all others under declaration of war? If so, the contract appears to be calculated to enhance the level of violence of any differences as opposed to providing protection or restitution. The war has to be declared by a proper authority and against a proper enemy.Under this theory, the proper authority to exercise a right of self-defense against an aggressor is an agent or individual upon whose rights have been violated. Thus, under this heading a state is interpreted to be a proper authority. Here the assumption is that the war is declared against a state that is proper enemy. Just war should have a just ending On the ordinary observation, a just war (precisely since, it is not a campaign) should finish with the reinstatement of the status quo ante. The model case is a war of hostility, which ends justly when the provoker has been conquered, his attack repulsed, the old boundaries reinstated.Conceivably this is not quite enough for a jus t ending: the wounded state might merit compensations from the aggressor state, so that the damage the aggressor's forces meted out (Gardam J, 1993). In considering the atomic bombing of Japan, Was the bombing just? Was it moral? The use of atomic bombs was not meant to be confined to military targets, as these are obviously weapons mass destruction and could not fail to terrorize the civilians. From point of view of justice, discarding the rule that excludes civilians from deliberate attack represented a grave injustice from which the world requires to recover.If the aim was to end the war this could have been achieved without dropping those bombs on civilians (Gardam J, 1993). Appearing in the Nation, an article by Richard Falk titled â€Å"Defining a just war† in issue of Oct 29, he asserted that the war in Afghanistan qualified to be the first just war since World War II (Roberts A, 1993-1994). Although in the issue Falk went on to warn that the justice of the cause could be â€Å"negated by the injustice of improper means and excessive ends†, he did not relinquish his original affirmation.This utterance came from one of the prominent and respected advocates of international peace and justice. How true was his assertion about just war in Afghanistan (Roberts A, 1993-1994)? Interpreting Falk’s position as saying US war could be just, as long as it adhered to the ideologies he articulated, his argument nevertheless was manifestly wrong. First, on the ground that the principles were broken as of the start of the war and secondly, on the dismissal of alternative action that could have solved the impasse through the United Nations.How could this war be justified if the bombings lead to starvation of many millions of Afghanistan’s due inability of aid agencies to deliver their services to the civilians prior to the felling of the first bomb? On the other hand, prior knowledge of humanitarian crisis that could be occasioned by bombing serves to negate it from being construed as just war. First, the war did not meet the criteria of discrimination (not to harm civilians). Secondly, on the proportionality of the force (force should not be greater than the provoking cause), the force employed was greater compared to that of the aggressor (Roberts A, 1993-1994).The war in Afghanistan largely did not meet the criterion of necessity that calls upon force not to be applied if there are other non-violent means available. Before the onset of the bombing, Taliban Ambassador to Pakistan had proposed that they were ready to try Osama bin Laden if America provided evidence connecting him to the attacks in the New York and Washington. Going by the words of this ambassador, it is clear that this war could have been avoided if US offered the evidence they were demanding in order to prosecute the culprit (Mintz A, 1993).In addition, the ambassador had indicated that under Islamic law legal proceedings could begin. Thus, infact tri al could begin pertaining to the raised allegations followed by evidence being provided in court. However, what happened is that Washington refused to offer evidence, declared its demands were not subject to negotiation and started bombardment of Afghanistan (Mintz A, 1993). Whether Taliban’s offer was serious or not, Washington never bothered to follow, conversely going to war faced with such conditions eliminates the criterion of necessity.Vietnam War first assumed the aspect of political dimension with many at last being pressed towards moral arguments. Of course, the war was seen to be completely irresponsible, and one that could not be won. Its costs, even if the Americans were egoistic, were above the normal. The war was fought unjustly since it involved a lot of brutality by the Americans, a factor that was seen by many as the one that led to the defeat. In a war for â€Å"hearts and minds† as opposed to land and resources, justice stands out to be the main aspe cts to victory.Vietnam War served to educate states that there was a need for state to fight justly and to crown it all, justice has become military necessity. Vietnam was the first war that saw the need for emphasizing the jus in belle principle. It enumerated that Wars unpopular at home should not be fought in addition to wars whereby the state is unwilling to commit its resources. As mentioned earlier Vietnam War was based on doubtful justice and the war was fought unjustly, as it irritated the civilian population. By losing the hearts and minds of the civilians led to the loosing of the whole war.Modern warfare requires that there be support from different civilian populations, expanding past the population facing instantaneous risk. Nevertheless, moral regard for civilians at risk is crucial in winning great support of the war. America has in the past-confused just wars as crusades, as if a war can be just only where the forces of good outweigh those of evil. However, as for Ge orge Bush (elder) he appeared to understand that war, is properly a war of armies, a combat between combatants, through which the citizens should be protected.In good faith, there was nothing of a just war in Iraq bombing in 1991. The civilians there were not protected, since there was destruction of electricity networks as well as water purification plants (Mintz A, 1993). Demolition of infrastructure, that is, significant for civilian existence was rampant during the Gulf War. Nevertheless, American approach in Gulf War was due to compromise among what justice would have necessitated. There was no controlled bombing and collectively as opposed to Korea or Vietnam, targeting was far more unlimited and selective.Conclusion Many people acknowledge that we are faced with moral duty to avoid the evils of war. However, this realization poses many difficult questions, when as responsible individuals we witness tormenting injustices for instance, ‘ethnic cleansing’ (Gardam J, 1993). With millions of lives being risked by war, one is bound to consider if war should ever be justified and if so, for what purpose? In answering the above, it is first important to consider principles of just war theory and finally correlate these principles to historical as well as ongoing conflicts.On the just cause, figures like Ronald Reagan are seen to assert that whether in self-defense or defense for others, remain the only classified cause that justifies waging war. There is a need to justify military intervention in secessionist or revolutionary wars. The conduct of war should also be in accordance with the principles of discrimination and proportionality. Civilians should not be directly targeted ad costs of military action should be proportionate to the expected advantages of ruining military targets. ReferenceAllen C. Isbell, (1966). War and Conscience Abilene, Texas: Biblical Research Press, p. 82. Gardam, Judith Gail. (1993) Proportionality and Force in Internati onal Law. American Journal of International Law, Volume 87, Issue 3, 391-413. Mintz, Alex. (1993). The Decision to Attack Iraq: A Noncompensatory Theory of Decision Making. The Journal of Conflict Resolution, Volume 37, Issue 4, 595-618. Roberts, Adam. (Winter, 1993-1994). The Laws of War in the 1990-91 Gulf Conflict. International Security, Volume 18, Issue 3 134-181. Just War Theory The theory of just war is a military ethics doctrine tracing its origin from catholic and Roman philosophy. The Catholic Church in the United States of America was very vocal in the 1960s in asserting the theory of just war especially in their pastoral letter that were released in 1963 known as ‘The challenge of peace: God’s promise and our response. ’ Moral theologians, international makers and ethicists on just war theory maintain that for any conflict to qualify as just it should meet religious, philosophical and political justice criteria.When our eyes are cast back in the history of America, it is true that US has been involved in various wars for example the First World War, the Second World War and Afghanistan war. In the light of the just war theory, was United States ethically right to enter into these wars? This is what this research will mainly focus on. It will analyze the reasons that made US to enter into these wars from ethics point of view using th e theory of just war as the parameter. The paper starts with a short introduction then the main points and at the end there is a conclusion which is basically the summary of the key points.At the very end of this paper is a list of the resources that are used in this research, properly formatted in accordance with MLA formatting style. According to the United States Catholic Bishops, for any military action to be applied to a conflict it must meet four conditions for it to be legitimate. First of all they say that for any military action to be taken, the damage caused by the aggressor must be enormous, specific, grave and lasting. Secondly, it should be used as the last option that is, when all other means at disposal proves to be ineffective or impractical.Thirdly, the prospects of success before entering the war must be high. The fourth and the last criterion is that there should be lesser evils and disorders than the much that the aggressor(s) caused (Evans 4) Generally there are two sets of criteria for determining whether war is just or not. The first addresses the right to enter in the war while the second one is about the conduct of the military in the war. The former holds that the reason for joining the war must be just but should not for used for revenging or repossessing things captured in other words the cause must be just.In comparative justice principle, injustices suffered by one party must exceed that of the other. Again, war cannot be waged by anybody thus can only be waged by a legitimate authority. It is also argued that there must be high chances of winning the war for fighting a losing battle is wastage of resources. Also war should be used as the last resort or when all other methods have failed. Finally the gains of entering the war must be equal to the loss and harms incurred or in short, macro-proportionality must apply.After the war begins, the just war theory holds that any military action should only target specific places and indiv iduals especially the enemies and their strongholds and the condition of proportionality must apply or put in another way, the amount of force to be used must be gauged by the amount of harm caused and that only a minimum force must be put to task for the goal is not to destroy and harm civilians but to correct the mistakes that were done by the aggressor(s) (Evans, 5)According to the just war theory the entry of United States in the First World War in 1917 could be said to have been just this was because the decision to join the war was made by a legitimate body and not by a single individual. The then president Woodrow Wilson asked the congress to convene twice to determine the way forward. It was in order for US to declare war on Germany as it kept on violating all the agreements that had been made for example it violated the agreement that it would suspend all unrestricted submarine warfare.Germany had also tried to entice Mexico to join the war against US on condition that Germ any would help it to liberate itself from the United States. The other reason was that Germany attacked all neutral ships that neared what was referred to as zones irrespective of what they carried. This affected US in that its passengers were killed and the trade network was interrupted. (Coffman 25) In accordance with just war theory, if the harm is long lasting and grievous then the war is just. The same was the case in the First World War where the US was losing its people and property due to German’s malicious activities.Again as per this theory the war was just because it was used as the last option. At first the US never wanted to join the war and was following the policy of isolation. It used diplomatic talks and signing of agreements to shun war but this proved to be futile and the only option that was left was war. This war was geared towards stopping what Germany was doing and correcting the mistakes that were done and was not meant as a revenge but when the war da mage assessment is done, the damage caused by this war was more than what the aggressor had caused thus as per this theory’s principle the war could be said to have been unjust.(Coffman 26) The US entry on the world war II could also be said to be just according to the just war theory because it was declared by a legitimate body in 1941 after Japan attacked US spheres of interest in Pearl Harbor. Though the war was declared by a recognized legitimate body according to this theory it could be regarded as unjust because it was more of revenge than order restoration. The US wanted to challenge Japan which had proved to be a bother in the Pacific region.The harm that Japan had caused as per the just war theory was not grievous, lasting or that big enough to have merited the consequences that resulted. Just war theory holds that the harm caused by the war should not exceed the damage done by the aggressor but in the case of Japan, the war caused enormous damage in fact about 100,0 00 people perished when the US dropped atomic bombs in Nagasaki and Hiroshima. This is a clear indicator that US was not only targeting the combatants and their strategic positions but also targeted the civilians and thus in the light of the above the war was unjust.(Coffman 27) As per this theory the war could be said to have been just because the chances of US winning the Second World War were high although this was later proved to have been a miscalculation for it extended longer than expected and that was why the US was forced to resort to atomic bombs. This war could also be said to be unjust if it is judged the theory’s principle that argues that war should not be used as a means of achieving personal gains and in this case US used it as such.It wanted to protect its interests in the Western Europe nations because it had invested a lot in those countries in terms of loans and war materials and thus if they were to be defeated by Germany then this would have meant losing all that it had invested. (Gaido and Walters) The third war that will be analyzed using this theory is the US entry in the Afghanistan war in 2001. According to this theory, this war was justified in all ways. The war was declared by a legitimate institution that is the US government and was in response to terrorist activities of bombing the World Trade Center and the Pentagon.This was the height of terrorism and that was why the US was forced to act. The war was thus meant to control terrorism but not to avenge. When the issues of damages that were caused by these attacks are assessed, they were enormous that the amount of harm that resulted from this war and for this reason the war was just. As per the theory, the war should be used as the last resort and this is what happened in Afghanistan. The US had tried to use all other methods that were at its disposal and they proved to be ineffective. Terrorism continued to be on the increase despite the measures that were taken against it.The US had tried to hold talks with terrorists asking them to stop their terrorism activities. They kept attacking US citizens and other areas of interest and at this time it was pushed beyond limit and had to act. (Gareau 16) As per the just war theory, there is no need to engage yourself in a losing battle but here the US was confident enough that it would win this war and indeed it won thus on the light of the above, the war could be said to have been just. In conclusion, the just war theory is a theory that is used to determine whether the war is just or not.It holds that the war is just if is declared by a legitimately recognized body, if the chances of winning are clear, if it is for correcting the harms done as opposed to revenge and if it is used as the last option when all other methods have failed. Using it to determine whether US was just to enter in the First World War, Second World War and the Afghanistan war, it is right to justify US entry in the first world war an d the Afghanistan war but using the same criteria its entry on the second war could not be justified. Works Cited:Evans, M. Just War Theory: A Reappraisal. Edinburgh University Press, 2005 Coffman E. M. The War to End All Wars: The American Military Experience in First World War. University Press of Kentucky. 1998. Gaido, D. and Walters, D. Socialist Workers Party/Workers Party Split. The Second World War: What the War is About. 2005 http://marxists. catbull. com/history//etol/document/fi/1938-1949/swp- wpsplit/swpwp01. htm Gareau, F. H. State Terrorism and the United States: From Counterinsurgency to The War on Terrorism. Zed Books, 2004