The House of Lords decision in Bolitho (Bolitho

The House of Lords decision in Bolitho (Bolitho The House of Lords decision in Bolitho (Bolitho v City and Hackney HA [1998] AC 232) is a belated and welcome departure from judicial deference to medical opinion but there is still too much deference and more has to be done. Critically comment on the above statement. In any negligence claim, in order to succeed the claimant must show that he was owed a duty of care by the defendant, that the duty of care was breached, and that the breach of duty caused the damage complained of.[1] Kennedy and Grubb comment that the duty of care arises ‘from a request for medical services by an individual and a consequent undertaking by a doctor [or other health care professional] to provide these services.[2] Margaret Brazier has observed: ‘[a] patient claiming against his doctor †¦ usually has little difficulty in establishing that the defendant owes him a duty of care’.[3] The second stage of a clinical negligence action is to show that the doctor has breached his standard of care. In any negligence claim, the standard of care is set by law and is an objective standard.[4] Words such as reasonable or responsible are normally attributed to such a standard. Such adjectives are not normally equated with a practice that is ‘common’ or ‘accepted’. With respect to medical negligence claims however, the law has not taken such a view. The case of Bolam v Friern Hospital Management Committee[5] has established that ‘a doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art’. The Bolam case was a decision at first instance, but was later approved by the House of Lords in Whitehouse v Jordan.[6] The courts have continuously taken a protectionist view of the medical profession in clinical negligence claims. Jackson acknowledges that this could be due to the complexity of medical evidence, but it could also be explained by a sense of professional solidarity.[7] The medical profession has been highly regarded in society, and the courts have also expressed their respect. In Wilsher v Essex AHA,[8] Mustill LJ comments: â€Å"For all we know, [The doctors in this case] far surpassed on numerous occasions the standard of reasonable care. Yet it is said that for one lapse they (and not just their employers) are to be held liable in damages. Nobody could criticise the mother for doing her best to secure her son’s financial future. But has not the law taken a wrong turning if an action of this kind is to succeed?† It is interesting to note the difference in policy in cases involving medical professionals. In other negligence cases, the courts have commented that the function of the law of negligence (and the law of torts in general), is to compensate injured parties for loss. The judiciary have had no moral objections to awarding damages in cases where they can apply the ‘deepest pocket’ principle. Thus, in Nettleship v Weston,[9] Lord Denning had no problems in asserting that a learner driver would be held to the same standard of a competent driver (competent would be ascertained on an objective basis by the court), as the driver would be insured and thus, the law will award damages from the deepest pocket. Yet, there has been considerable hesitation in holding doctors negligent for public policy reasons, despite the fact that doctors will be also be insured. Furthermore, doctors working in the NHS will generally not be personally held accountable for the negligence – the action is brought against the Trust vicariously and NHS Trusts in England and Wales are part of an ‘insurance like’ scheme, the Clinical Negligence Scheme for Trusts (CNST) administered by the NHS Litigation Authority. The Bolam principle may be formulated as a rule that a doctor is not negligent if he acts in accordance with a practice accepted at the time as proper by a responsible body of medical opinion even though other doctors may adopt a different practice. ‘In short, the law imposes the duty of care; but the standard of care is a matter of medical judgment.’[10] In Maynard v West Midlands RHA,[11] Lord Scarman seemed to favour an approach that a doctor will not be negligent if there are other reasonably held approaches that are the same as the defendant doctor’s approach: â€Å"I have to say that a judge’s ‘preference’ for one body of distinguished professional opinion to another also professionally distinguished is not sufficient to establish negligence in a practitioner whose actions have received the seal of approval of those whose opinions, truthfully expressed, honestly held, were not preferred †¦ For in the realm of diagnosis and treatment negligence is not established by preferring one respectable body of professional opinion to another.† The pure Bolam approach is the subject of scathing academic criticism. Kennedy and Grubb comment: â€Å"It may seem curious that the law would defer to the medical profession in setting the content of the duty in negligence.†[12] Despite the deference to the medical profession in the courts, there have been some exceptions and one example is the case of Hucks v Cole.[13] The case involved a pregnant woman with a septic finger whose doctor failed to prescribe her penicillin. The patient suffered puerperal fever as a result and a number of witnesses gave evidence stating that they would not have prescribed penicillin in the same situation. However, the Court of Appeal held that even if there are relatively small risks involved, the fact that it would have been easy to avoid such risks so easily and inexpensively, is clearly not reasonable. Sachs LJ comments: â€Å"On such occasions the fact that other practitioners would have done the same thing as the defendant practitioner is a very weighty matter to be put on the scales on his behalf; but it is not †¦ conclusive. †¦ Despite the fact that the risk could have been avoided by adopting a course that was easy, efficient and inexpensive, and which would have entailed only minimal chances of disadvantages to the patient, the evidence of the four defence experts to the effect that they and other responsible members of the medical profession would have taken the same risk in the same circumstances has naturally caused me to hesitate †¦ The reasons given by the four experts do not to my mind stand up to analysis †¦Ã¢â‚¬  The approach taken in Hucks v Cole was also adopted by the House of Lords in Bolitho v City and Hackney HA,[14] in which the traditional Bolam approach was departed from. Lord Browne-Wilkinson comments: â€Å"In the vast majority of cases the fact that distinguished experts in the field are of a particular opinion will demonstrate the reasonableness of that opinion. In particular, where there are questions of assessment of the relative risks and benefits of adopting a particular medical practice, a reasonable view necessarily presupposes that the relative risks and benefits have been weighed by the experts in forming their opinions. But if, in a rare case, it can be demonstrated that the professional opinion is not capable of withstanding logical analysis, the judge is entitled to hold that the body of opinion is not reasonable or responsible.† The relevance of the Bolitho decision was initially regarded as a major shift from the pure Bolam approach. Following the decision, Kennedy and Grubb comment that ‘the law has been put back on its proper course’.[15] Lord Browne-Wilkinson was suggesting that medical approach must be defensible and capable of withstanding logical analysis. However, he qualified this by stating that this would only occur in ‘rare’ cases. Hucks v Cole was certainly one of those rare cases, but it is arguable whether there has been a significant shift in approach by the courts. In Wisniewski v Central Manchester Health Authority,[16] the defendant did not follow a procedure that would have detected that a baby’s umbilical cord was wrapped around his neck during birth and the medical opinion differed over the reasonableness of such. Brooke LJ comments that: â€Å"Hucks v Cole itself was unquestionably one of the rare cases which Lord Browne-Wilkinson had in mind †¦ In my judgment the present case falls unquestionably on the other side of the line, and it is quite impossible for a court to hold that the views sincerely held by [the experts supporting the actions of the defendant] cannot logically be supported at all †¦ the views expressed by [those experts] were views which could be logically supported and held by responsible doctors.† There have been a small number of ‘rare’ cases where the courts have gone as far as questioning the logic and defensibility of medical authority. The case of Reynolds v North Tyneside Health Authority,[17] is one such example. Thus, Gross J comments that it is one of those ‘rare cases where the Court could and should conclude that such body of opinion was unreasonable, irresponsible, illogical and indefensible.’ Similarly, in Marriott v West Midlands RHA,[18] the Court of Appeal stated that the expert evidence given by the witnesses defending the doctor’s conduct could not be logically supported. The Court of Appeal also affirmed that the trial judge was entitled to question whether an opinion was reasonably held and Mason and Laurie comment that ‘[o]n the face of things, then, Marriott moves the Bolitho test from one of logic to one of reasonableness, which is much more akin to the reasoning applied in other, non-medical standard of care decisi ons.’[19] The approach taken by the courts post Bolitho seems to suggest that the courts are only prepared to examine the credibility of witnesses and not the content of their evidence. So long as the evidence given is ‘truthfully held’ and ‘honestly expressed’ then the court is reluctant to question the evidence.[20] Furthermore, there have been a number of post-Bolitho decisions and it seems as though there is still a constant reluctance to question medical experts, and if there has been any departure from the traditional Bolam approach, this certainly seems to have been on the basis of the credibility of expert witnesses, and not on the reasonableness of their opinion. Thus, the subsequent case law suggests a somewhat restrictive approach on the modification of the Bolam principle in its new Bolitho interpretation.[21] Writing extra judicially, Lord Woolf comments that there have been a number of reasons for a shift away from the traditional approach in Bolam.[22] The courts apparently now have a less deferential approach to those in authority.[23] The courts have also apparently recognised the difficulties that genuine claimants have in successfully bringing a clinical negligence claim. At the same time, there has been a raise in the number of clinical negligence claims in England and Wales over the last number of years.[24] Furthermore, with an increasing awareness of patient rights, an increasing loss of faith in the public health service following various health ‘scandals’ such as Bristol and Alder Hey, a judicial deference to the medical profession certainly has its days numbered. Also, as Woolf acknowledges, ‘our courts were aware that courts at the highest level of other Commonwealth jurisdictions, particularly Canada and Australia, were rejecting the approach of the Engli sh Courts. They were subjecting the actions of the medical profession to a closer scrutiny that the English Courts †¦Ã¢â‚¬â„¢[25] Other commentators have also noted the way in which lawyers approach the issue of using expert witnesses. Teff comments: â€Å"Reassertion at the highest level of the court’s role in scrutinizing professional practice is welcome, not least because of current concerns about the dynamics of providing expert evidence for the purposes of adversarial litigation. Some law firms’ choice of experts is apt to depend too much on perceived presentational skills and acuity in advancing the client’s case, and too little on detached expertise†¦ †¦ One prominent medicolegal authority has bluntly declared that ‘Bolam will only work fairly if the use of hired hands as defence medical experts is eliminated. It would then be possible to talk of a responsible body of medical opinion’.†[26] Teff has thus outlined some of the practices that demonstrate how the Bolam principle is deferential in practice. Lawyers tend to look for an expert who will make their case stronger, and a survey of 500 expert witnesses revealed that about a quarter noted comments that in some instances, witnesses were requested to change comments that were alteration of their opinions.[27] The problems associated with the Bolam test have not only presented themselves in clinical negligence cases. The traditional Bolam approach was also questioned under the scope of ‘informed consent’ cases, which involve a claim of negligence for failing to warn of risks inherent in treatment. The leading case on the issue of disclosure of risks in treatment is Sidaway v Board of Governors of the Bethlem Royal Hospital.[28] Discussion of the Bolam test was present in practically all of the judgments delivered. Lord Bridge asserted that the law should reject the ‘reasonable patient’ test and follow a modified version of the Bolam test. Accordingly, disclosure of information is ‘primarily a matter of clinical judgment’, but this does not mean that the profession is entitled to set its own standard in such cases. Thus, a judge would be entitled to hold that a clinician should have disclosed a risk where there was a procedure that involved a ‘substantial risk of grave adverse consequences’, giving the example of a 10 per cent risk of stroke as substantial, but a 1 or 2 per cent risk of spinal cord damage was not substantial. Similarly, Lord Templeman also suggested that a modified Bolam approach should be taken. Subsequent interpretation of the Sidaway case has not been straightforward. The reasoning of the judges in the case is far from consistent, and furthermore, according to Lord Browne-Wilkinson, the modified test put forward to Bolitho did not apply to such cases. The Court of Appeal in Gold v Haringey HA,[29] merely referred to the judgment of Lord Diplock and therefore applying the Bolam principle in its purest form, an approach not generally followed by the House of Lords in Sidaway. The Australian High Court on the other hand decided the issue differently in the case of Rogers v Whitaker.[30] In that case, the shortcomings of the Bolam test were identified by the High Court: â€Å"One consequence of the application of the Bolam principle to cases involving the provision of advice or information is that, even if a patient asks a direct question about the possible risks or complications, the making of that inquiry would logically be of little or no significance; medical opinion determines whether the risk should or should not be disclosed and the express desire of a particular patient for information or advice does not alter that opinion or the legal significance of that opinion. The fact that the various majority opinions in Sidaway †¦ for example, suggest that, over and above the opinion of a respectable body of medical practitioners, the questions of a patient should truthfully be answered (subject to the therapeutic privilege) indicates a shortcoming in the Bolam approach.† The Australian High Court specifically chose not to follow the Bolam test in information disclosure cases, commenting: â€Å"In Australia, it has been accepted that the standard of care to be observed by a person with some special skill or competence is that of the ordinary skilled person exercising and professing to have that special skill †¦ But, that standard is not determined solely or even primarily by reference to the practice followed or supported by a responsible body of opinion in the relevant profession or trade †¦ Even in the sphere of diagnosis and treatment, the heartland of the skilled medical practitioner, the Bolam principle has not always been applied †¦ Further, and more importantly, particularly in the field of non-disclosure of risk and the provision of advice and information, the Bolam principle has been discarded and, instead, the courts have adopted the principle that, while evidence of acceptable medical practice is a useful guide for the courts, it is for the courts to adjudicate on what is the appropriate standard of care after giving weight to the paramount consideration that a person is entitled to make his own decisions about his life.† The comments made by Lord Woolf[31] in his paper are clearly justified when examining the decision in Rogers v Whittaker. Commonwealth decisions have been far more willing to examine and scrutinize medical evidence and it may not always be a question of what is more preferential for the judge to follow, but it is instead what the judge feels is reasonable. This does not involve the judge merely accepting that two courses of treatment may have both been reasonable in the circumstances in the opinion of medical experts. The judge’s actual role is to establish the reasonableness of each on the basis of the evidence presented to him and that does not necessarily mean that both have to be right. Mason and Laurie comment: â€Å"[W]hile the courts are increasingly determined to see that the Bolam principle is not extended [into areas such as judging ‘best interests’], they still have an innate reluctance to abandon it in respect of medical opinion; there is a sense that Bolitho, although welcome, is being used mainly in a ‘back-up’ position. What is certain is that Bolam can no longer be regarded as impregnable.† Thus, on the basis of the above comment, the post-Bolitho meaning of Bolam is that it is merely a back up for when the case faced by the court suits a change in approach. Furthermore, while the courts have been apparently reluctant to extending the Bolam principle into the best interests test,[32] the principle has already been incorporated into the concept of best interests. Airedale NHS Trust v Bland[33] required an analysis of what was in the best interests of a patient in a persistent vegetative state, who was being kept alive by artificial nutrition and hydration. In an analysis of whether such nutrition and hydration should be withdrawn (resulting in the death of the patient), the Law Lords turned to analyse the patient’s best interests. The treatment was apparently not in the patient’s best interests. This was because it was regarded as futile. In Lord Goff’s words[34], ‘the patient is unconscious and there is no prospect of any improvement in his condition’. In deciding whether the treatment was futile, the doctor had to act in accordance with a responsible body of medical opinion. More precisely the doctor had to satisfy the Bolam test. It is difficult to comprehend how it is relevant in deciding what is in the best interests of a patient –conflicting views of doctors will always be Bolam reasonable as long as one other doctor supports that view. In conclusion, the courts have established a completely different system of establishing the standard of care for medical professionals to that of other professionals. The Bolam approach has traditionally been interpreted as a principle that a doctor will not be negligent if other professional opinion holds his actions as reasonable, even if that opinion is a minority. The courts have been deferential to the profession, and the apparent move away from such approach in Bolitho is a disappointment of this deference. Lord Browne-Wilkinson’s words were read quite literally, the emphasis being placed upon the words, ‘but if in a rare case’ – the courts have only questioned ‘reasonable and responsible’ medical opinion in a very small amount of cases and it seems as though the Bolitho approach is, as Mason and Laurie commented, a mere ‘back up’ if the judge wishes to find for the claimant. Whilst the courts have slowly begun to depart fro m the traditional approach, more needs to be done before there is any comparison with the approach of other Commonwealth jurisdictions, such as Australia. Furthermore, the courts should be more clear in their reasoning, as it is also important to be able to ascertain objectively how cases should be decided on grounds of precedent. The majority of clinical negligence claims that are commenced, are settled by the NHS Litigation Authority before they even reach court and would it not be more economic for the NHS to be able to ascertain with greater certainty when a doctor has been negligent? Finally, the decision in Bolitho is far from a departure of judicial deference to the medical profession, it is a mere spin on the language originally used in Bolam. The courts now have ground to make in establishing a more fair, predictable and objective approach in line with other negligence actions. Bibliography Brazier, M. ‘Medicine, Patients and the Law’ (2003, 3rd edn) Penguin Books, London Davies, M. ‘Textbook on Medical Law’ (2001, 2nd edn) Blackstone Press, London Jaskson, E., ‘Medical Law – Text, Cases and Materials’ (2006) Oxford University Press, Oxford Kennedy, I. Grubb, A. ‘Medical Law’ (2000, 3rd edn) Butterworths, London Mason, JK et al, ‘Law and Medical Ethics’ (2002, 6th edn) Butterworths, London Montgomery, J. ‘Health Care Law’ (2003, 2nd edn) Oxford University Press, Oxford National Audit Office, Handling Clinical Negligence Claims in England, 2001 Singer, P., ‘Rethinking Life and Death: The Collapse of our Traditional Ethics’ (OUP Oxford 1994) Journal Articles Brazier, M., Miola, J., ‘Bye-Bye Bolam: A Medical Litigation Revolution?’ (2000) 8 Med L Rev 85 Keown, J., ‘Reining In the Bolam Test’ (1998) 57 CLJ 248 Teff, H., ‘The Standard of Care in Medical Negligence – Moving on from Bolam?’ (1998) 19 Oxford Journal of Legal Studies 473-84 Woolf, Lord., ‘Are the Courts Excessively Deferential to the Medical Profession?’ (2001) 9 Medical Law Review 1-16. 1 Footnotes [1] The establishment of negligence is a common law creation – see Donoghue v Stevenson [1932] All ER Rep 1 [2] Kennedy and Grubb, ‘Medical Law’ (3rd edn, 2000) at pp 278 [3] Medicine, Patients and the Law, (3rd Edn, 2003) at pp 141 [4] See for example, Nettleship v. Weston [1971] 2 QB 691 [5][1957] 2 All ER 118 [6] (1981) unreported, and Maynard v. West Midlands Regional Health Authority [1985] 1 All ER 635 [7] Jackson, E., ‘Medical Law – Text, Cases and Materials’, (2006, OUP), Oxford at page 123 [8] [1987] 1 QB 730 [9] above, n 4. [10] Lord Scarman in Sidaway v Board of Governors of the Bethlem Royal Hospital [1985] 1 All ER 643 [11] [1985] 1 All ER 635 [12] Kennedy and Grubb, ‘Medical Law’ (3rd edn, 2000) at pp 418 [13] [1993] 4 Med LR 393. Despite the fact that the case was reported in 1994, the decision was actually made in 1960 [14] [1997] 4 All ER 771 [15] Kennedy and Grubb, ‘Medical Law’ (3rd edn, 2000) at pp 445 [16] [1998] Lloyd’s Rep Med 223 CA [17] Unreported, 30 May 2002 [18] [1999] Lloyds Rep Med 23 [19] Mason, J.K., Laurie, G.T., ‘Mason McCall Smith’s Law and Medical Ethics’, (2006, 7th Edn) Oxford University Press, Oxford. [20] See for example, De Freitas v O’Brien [1995] 6 Med LR 108 [21] see for example, Briody v St Helen’s Knowsley AHA [1999] Lloyd’s Rep. Med. 185, Hallatt v NW Anglia HA [1998] Lloyd’s Rep. Med. 197, and Rhodes v W Surrey NE Hampshire HA [1998] Lloyd’s Rep. Med.. 256 [22] ‘Are the Courts Excessively Deferential to the Medical Profession?’ (2001) 9 Medical Law Review 1-16. [23] Ibid [24] Ibid. Also see, National Audit Office, Handling Clinical Negligence Claims in England, 2001 [25] Lord Woolf, above n 22 [26] ‘The Standard of Care in Medical Negligence – Moving on from Bolam?’ (1998) 19 Oxford Journal of Legal Studies 473-84 [27] Ibid [28] [1985] 1 All ER 643 [29] [1988] QB 481 [30] (1992) 67 ALJR 47 [31] above, n 22 [32] See for example Re S (adult patient: sterilisation) [2001] Fam 15, [2000] 3 WLR 1288. [33] [1993] 1 All ER 821 [34] [1993] AC 789 at 869

Bloodlines Chapter Twenty

I ALMOST ASKED, â€Å"Are you serious?† But let's face it: that probably wasn't the kind of thing she would joke about, especially considering how grave her face looked. Other questions popped into my head, but I held back on those as well. They weren't that weird, but I didn't want to draw attention to myself by showing unusual interest in a grisly murder. Instead, I simply thanked Mrs. Dawson for her help with the letter and returned to East Campus. Mrs. Weathers was at her desk when I entered the dorm. I brought her the letter, which she read over twice before tucking it away in her filing cabinet. â€Å"All right,† she said. â€Å"Just make sure your sister signs in and out each time.† â€Å"I will, ma'am. Thank you.† I hesitated, torn over whether to go or ask the questions Mrs. Dawson's information had triggered. I decided to stay. â€Å"Mrs. Weathers†¦ ever since Jill disappeared, I just keep thinking about that girl you told me about. The one who died. I keep thinking that could've been Jill.† Mrs. Dawson's face softened. â€Å"Jill's fine. I shouldn't have told you that. I didn't mean to scare you.† â€Å"Is it true that girl's throat was slit?† â€Å"Yes.† She shook her head sadly. â€Å"Terrible. Simply terrible. I don't know who does that kind of thing.† â€Å"Did they ever find out why it happened? I mean, was there anything unusual about her?† â€Å"Unusual? No, not really. I mean, she was a lovely girl. Smart, pretty, popular. A good – no, great – athlete. Had friends, a boyfriend. But nothing that would especially make her stand out as a target. Of course, people who do awful things like that probably don't need a reason.† â€Å"True,† I murmured. I walked up to my room, wishing Mrs. Weathers had elaborated a little more on how pretty Kelly was. What I really wanted to know was if Kelly had been Moroi. If she had, I'd hoped Mrs. Weathers might comment on how tall or pale she was. By both Clarence's and the Alchemists' accounts, no Moroi on record had lived in the Palm Springs area. That didn't mean someone couldn't slip through the cracks, however. I'd have to find the answer myself. If Kelly had been Moroi, then we had three young Moroi women killed in the same way in southern California within a relatively short time span. Clarence might argue for his vampire hunter theory, but to me, this pattern screamed Strigoi. Jill was in our room, serving out her house arrest. The more time passed, the less angry I felt toward her. Having the feeding issue fixed helped. I would've been a lot more upset if we'd been unable to get her off campus. â€Å"What's wrong?† she asked me, looking up from her laptop. â€Å"Why do you think anything's wrong?† She smiled. â€Å"You've got that look. It's this tiny frown you get between your eyebrows when you're trying to figure something out.† I shook my head. â€Å"It's nothing.† â€Å"You know,† she said, â€Å"maybe all these responsibilities you have wouldn't be as bad if you talked them out and got help from other people.† â€Å"It's not quite like that. It's just something I'm trying to puzzle out.† â€Å"Tell me,† she entreated. â€Å"You can trust me.† It wasn't a matter of trust. It was a matter of unnecessarily worrying Jill. Mrs. Weathers had feared she would scare me, but if someone was killing Moroi girls, I wasn't in danger. Looking at Jill and her unwavering gaze, I decided if she could handle living with the knowledge that her own people were trying to kill her, she could handle this. I gave her a brief summary of what I knew. â€Å"You don't know if Kelly was Moroi, though,† she said, once I'd finished. â€Å"No. That's the crucial piece here.† I sat cross-legged on my bed with my own laptop. â€Å"I'm going to check our records and local newspapers to see if I can find a picture of her. All I learned from Mrs. Weathers is that Kelly was a star athlete.† â€Å"Which may mean she's not Moroi,† said Jill. â€Å"I mean, look at how terrible I perform in this sun. What happens if she's not? You've got a lot of theories hinging on her being Moroi. But what if she was human? What then? Can we ignore it? It could still be the same person†¦ but what would it mean if the murderer had killed two Moroi and one human?† Jill had a point. â€Å"I don't know,† I said. My search didn't take long. The Alchemists had no record of the murder, but then, they wouldn't if Kelly had been human. Lots of newspapers had stories about her, but I couldn't find any pictures. â€Å"What about a yearbook?† asked Jill. â€Å"Someone must keep them around.† â€Å"That's actually pretty brilliant,† I said. â€Å"See? I told you I'm useful.† I smiled at her and then remembered something. â€Å"Oh, I've got good news for you. Maybe.† I briefly recapped Kristin and Julia's â€Å"plan† about Jill joining the sewing club. Jill brightened but was still cautious. â€Å"You really think that would work?† â€Å"Only one way to find out.† â€Å"I've never touched a sewing machine in my life,† she said. â€Å"I guess this is your chance to learn,† I told her. â€Å"Or maybe the other girls will be happy to just keep you around as their in-class model.† Jill smirked. â€Å"How do you know only girls sign up for that?† â€Å"I don't,† I admitted. â€Å"Just playing off gender stereotypes, I guess.† My cell phone rang, and Ms. Terwilliger's number flashed on the display. I answered, bracing for a coffee run. â€Å"Miss Melbourne?† she said. â€Å"If you and your brother can be at Carlton within an hour, you can speak to someone in the registrar's office before they close. Can you manage that?† I looked at the time and took it on faith Adrian wasn't doing anything important. â€Å"Um, yes. Yes, of course, ma'am. Thank you. Thank you very much.† â€Å"The man you'll want to talk to is named Wes Regan.† She paused. â€Å"And could you bring me a cappuccino on your way back?† I assured her I could and then called Adrian with instructions to be ready for me. Quickly, I changed out of my uniform and into a blouse and twill skirt. Glancing at my reflection, I realized he was right. There really wasn't a lot of difference between Amberwood attire and my normal wardrobe. â€Å"I wish I could go,† said Jill wistfully. â€Å"I'd like to see Adrian again.† â€Å"Don't you kind of see him every day in a way?† â€Å"True,† she said. â€Å"Although I can't always get into his head when I want to yet. It just happens randomly. And anyway, it's not the same. He can't talk back to me through the bond.† I nearly replied that it sounded better than being around him in person but figured that wouldn't be helpful. Adrian was ready to go when I reached Clarence's, excited and eager for action. â€Å"You just missed your friend,† he said as he got into Latte. â€Å"Who?† â€Å"Keith.† I made a face. â€Å"He's not really my friend.† â€Å"Oh, you think? Most of us figured that out on day one, Sage.† I felt a little bad about that. Some part of me knew that I shouldn't let my personal feelings for Keith mix with business. We were co-workers of sorts and should've been presenting a united, professional front. At the same time, I was kind of glad these people – even if they were vampires and dhampirs – didn't think I was friendly with Keith. I didn't want them thinking he and I had much in common. I certainly didn't want to have a lot in common with him. The full meaning of Adrian's words suddenly hit me. â€Å"Wait. He was just here?† â€Å"A half hour ago.† He must have come straight from the school. I was lucky to have missed him. Something told me he wouldn't approve of me furthering Adrian's education. â€Å"What was he here for?† â€Å"Dunno. I think he was checking on Clarence. The old guy hasn't been feeling well.† Adrian pulled a pack of cigarettes out of his pocket. â€Å"Do you mind?† â€Å"Yes,† I replied. â€Å"What's wrong with Clarence?† â€Å"I don't know, but he's been resting a lot, which makes things even more boring. I mean, he wasn't the greatest conversationalist, but some of his crazy stories were interesting.† Adrian turned wistful. â€Å"Especially with scotch.† â€Å"Keep me updated on how he's doing,† I murmured. I wondered if perhaps that was why Keith had been in such a hurry earlier. If Clarence was seriously ill, we were going to have to make arrangements with a Moroi doctor. That would complicate our setup here in Palm Springs because we'd either have to move Clarence or bring in someone. If Keith was working on it, then I shouldn't have concerned myself†¦ but I just didn't trust him to do a good job with anything. â€Å"I don't know how you put up with him,† said Adrian. â€Å"I used to think you were weak and just didn't fight back†¦ but now, honestly, I think you're actually pretty tough. It takes a hell of a lot of strength to not complain and lash out. I don't have that self-control.† â€Å"You've got more than you think,† I said, a little flustered by the compliment. I was down on myself so much for what I saw as not pushing back sometimes that it had never occurred to me that took its own strength. I was even more surprised that it would take Adrian to point this out to me. â€Å"I'm always walking a line. My dad – and the Alchemists – are really big on obedience and following the directions of your superiors. I'm kind of in a double bind because I'm on shaky ground with them, so it's extra important for me to not make a fuss.† â€Å"Because of Rose?† His tone was carefully controlled. I nodded. â€Å"Yup. What I did was tantamount to treason in their eyes.† â€Å"I don't know what ‘tantamount' means, but it sounds pretty serious.† I could see him studying me out of the corner of his eye. â€Å"Was it worth it?† â€Å"So far.† It was easy to say that since Zoe had no tattoo yet and I hadn't seen a re-education center. If those things changed, so might my answers. â€Å"It was the right thing to do. I guess that justified dramatic action.† â€Å"I broke a lot of rules to help Rose too,† he said, a troubled tone in his voice. â€Å"I did it out of love. Misguided love, but love nonetheless. I don't know if that's as noble as your reasons, particularly since she was in love with someone else. Most of my ‘dramatic actions' haven't been for any cause. Most of them have been to annoy my parents.† I actually found myself a little jealous of that. I couldn't fathom purposely trying to get a reaction from my dad – though I'd certainly wanted to. â€Å"I think love's a noble reason,† I told him. I was speaking objectively, of course. I'd never been in love and had no point of reference to really judge. Based on what I'd observed in others, I assumed it was an amazing thing†¦ but for now, I was too busy with my job to notice its absence. I wondered if I should be disappointed by that. â€Å"And I think you have plenty of time to do other noble things.† He chuckled. â€Å"Never thought my biggest cheerleader would be someone who thought I was evil and unnatural.† That made two of us. Hesitantly, I managed to ask a question that had been burning inside me. â€Å"Do you still love her? Rose?† Along with not knowing what it felt like to be in love, I also didn't know how long it took to recover from love. Adrian's smile faded. His gaze turned inward. â€Å"Yes. No. It's hard to get over someone like that. She had a huge effect on me, both good and bad. That's hard to move past. I try not to think about her much in terms of love and hate. Mostly I'm trying to get on with my life. With mixed results, unfortunately.† We soon reached the college. Wes Regan was a big man with a salt-and-pepper beard who worked in Carlton's registration office. Ms. Terwilliger had tutored Wes's niece for free one summer, and Wes felt he owed her a favor. â€Å"Here's the deal,† he said once we were seated across from him. Adrian was wearing khaki pants and a sage-colored button-down shirt that would've been great for job interviews. A little too late. â€Å"I can't just enroll you. College applications are long and require transcripts, and there's no way you can swing one in two days. What I can do is get you in as an auditor.† â€Å"Like with the IRS?† asked Adrian. â€Å"No. Auditing means you're attending the class and doing the work but not getting a grade for it.† Adrian opened his mouth to speak, and I could only imagine what comment he had about doing work for no credit. I quickly interrupted him. â€Å"And then what?† â€Å"Then, if you can throw together an application in, oh, a week or two – and are accepted – I can retroactively change you to student status.† â€Å"What about financial aid?† asked Adrian, leaning forward. â€Å"Can I get some money for this?† â€Å"If you qualify,† said Wes. â€Å"But you can't really file for it until you've been accepted.† Adrian slumped back, and I was able to guess his thoughts. If getting enrolled would take a couple of weeks, there'd undoubtedly be a delay with the financial aid filing too. Adrian was looking at a month or more of living with Clarence, and that was probably optimistic. I half-expected Adrian to get up and nix everything. Instead, a resolute expression crossed his face. He nodded. â€Å"Okay. Let's get started with this auditing thing.† I was impressed. I was also jealous when Wes brought out the course catalog. I'd been able to lull myself into contentment with Amberwood's classes, but looking at real college offerings showed me the two schools were worlds away. The history classes were more focused and in depth than anything I could have imagined. Adrian had no interest in those, however. He immediately honed in on the art department. He ended up signing up for two introductory courses in oil painting and in watercolors. They met three times a week and were conveniently back-toback. â€Å"That'll make it easier if I'm busing in,† he explained as we were leaving. I gave him a startled look. â€Å"You're taking the bus?† He seemed amused by my astonishment. â€Å"What else? Classes are in the daytime. You can't take me.† I thought about Clarence's remote house. â€Å"Where on earth would you catch the bus?† â€Å"There's a stop about a half mile away. It transfers to another bus that goes to Carlton. The whole trip takes about an hour.† I confess, it left me speechless. I was amazed that Adrian had researched that much, let alone was willing to go to all that trouble. Yet on the ride back, he never uttered one word of complaint about how inconvenient it would be or how long he'd have to wait to move out of Clarence's. When I arrived back at Amberwood, I was excited to tell Jill the news about Adrian's collegiate success – not that she needed me to tell her. With the bond, she would probably know more than I did. Still, she always worried about him and would undoubtedly be pleased to see something go well for him. Jill wasn't in our room when I returned, but a note informed me she was studying elsewhere in the dorm. The only bright part of her punishment was that it limited where she could be at any time. I decided to use this opportunity to go make Ms. Terwilliger's crazy amulet. I'd accrued most of the necessary ingredients, and along with compliance from the biology teacher, Ms. Terwilliger had secured me access to one of the chemistry labs. No one was there this time of night, and it gave me plenty of space and quiet to mix up the concoction. As we'd noted, the instructions were extremely detailed and – in my opinion – superfluous. It wasn't enough to just measure out the nettle leaves. The instructions called for them â€Å"to rest for an hour,† during which time I was supposed to say to them, â€Å"into thee, flame I imbue† every ten minutes. I also had to boil the agate stone â€Å"to infuse it with heat.† The rest of the instructions were similar, and I knew there was no way Ms. Terwilliger would actually know if I followed everything to the letter – particularly the chants. Still, the whole purpose of this stunt was to report on what it was like to be an ancient practitioner. So, I followed everything dutifully and concentrated so hard on performing every step perfectly that I soon fell into a lull where nothing existed except the spell. I finished over two hours later and was surprised at how exhausted I felt. The final result certainly didn't seem to justify all the energy I'd expended. I was left with a leather cord from which hung a silk pouch filled with leaves and rocks. I carted it and my notes back to my dorm room, intending to write up my report for Ms. Terwilliger so that I could put this assignment behind me. When I reached my room, I gasped when I saw the door. Someone had taken red paint and drawn bats and fanged faces all over it. Scrawled across the front, in big blocky letters, were the words VAMP GIRL Full of panic, I burst into the room. Jill was there – along with Mrs. Weathers and another teacher I didn't know. They were going through all of our things. I stared in disbelief. â€Å"What's going on?† I asked. Jill shook her head, face mortified, and couldn't answer. I'd apparently arrived at the end of the search because Mrs. Weathers and her associate soon finished up and walked to the door. I was glad I'd taken my Alchemist supplies with me to the lab tonight. The kit contained a few measuring tools I had thought I might need. I certainly didn't want to explain why I owned a collection of chemicals to dorm authorities. â€Å"Well,† said Mrs. Weathers sternly. â€Å"There doesn't appear to be anything here, but I may do another spot check later – so don't get any ideas. You're already in enough trouble without adding yet another charge to it.† She sighed and shook her head at Jill. â€Å"I'm very disappointed in you, Miss Melrose.† Jill blanched. â€Å"I'm telling you, it's all a mistake!† â€Å"Let's hope so,† said Mrs. Weathers ominously. â€Å"Let's hope so. I've half a mind to make you clean up that vandalism outside, but in light of no hard proof†¦ well, we'll have the janitors take care of it tomorrow.† Once our visitors were gone, I immediately demanded, â€Å"What happened?† Jill collapsed backward onto her bed and groaned. â€Å"Laurel happened.† I sat down. â€Å"Explain.† â€Å"Well, I called the library to see if they had those yearbooks in – the ones about Kelly Hayes? Turns out they do normally have them, but they've all been checked out by the newspaper staff for some Amberwood anniversary edition. And you'll never believe who's heading that project: Laurel.† â€Å"You're right,† I said. â€Å"I never would have guessed that. Isn't she in Freshman English?† Laurel was a senior. â€Å"Yup.† â€Å"I guess everyone needs an activity,† I muttered. Jill nodded. â€Å"Anyway, Miss Yamani was in the building, so I went to ask her about joining the sewing club and working for Lia. She was really excited and said she'd make it happen.† â€Å"Well, that's something,† I said cautiously, still unsure how this was leading up to vandalism and a search of our room. â€Å"As I was coming back, I passed Laurel in the hall. I decided to take a chance†¦ I approached her and said look, I know we've had our differences but I could really use some help. Then I explained that I needed the yearbooks and asked if I could borrow them just for the night and that I'd get them back to her right away.† To this, I said nothing. It was certainly a noble and brave thing for Jill to do, particularly after I'd encouraged her to be better than Laurel. Unfortunately, I didn't think Laurel would reciprocate the adult behavior. I was right. â€Å"She told me in†¦ well, very explicit terms that I'd never get those yearbooks.† Jill scowled. â€Å"She told me a few other things too. Then I, um, called her a raving bitch. I probably shouldn't have, but, well, she deserved it! Anyway, she went to Mrs. Weathers with a bottle of†¦ I don't know. I think it was raspberry schnapps. She claimed I sold it to her and had more in my room. Mrs. Weathers couldn't punish me without harder evidence, but after Ms. Chang's hangover accusation on the first day, Mrs. Weathers decided that was enough for a room search.† I shook my head in disbelief, anger growing within my chest. â€Å"For such an elite, prestigious place, this school sure is quick to jump on any accusations that come up! I mean, they believe anything anyone says about you. And where did the paint outside come from?† Tears of frustration glinted in her eyes. â€Å"Oh, Laurel, of course. Or, well, one of her friends. It happened while Laurel was talking to Mrs. Weathers, so of course she's got an alibi. You don't think†¦ you don't think anyone's on to anything, do you? You said before it's just a mean joke†¦ and humans don't even believe in us†¦ right?† â€Å"Right,† I said automatically. But I was beginning to wonder. Ever since that phone call with my father, when he'd mentioned that there were humans who suspected and wouldn't be silenced, I'd wondered if I'd been too quick to dismiss Laurel's teasing. Had she simply found a cruel joke to run with? Or was she one of those humans who suspected about the vampire world and might make a lot of noise about it? I doubted anyone would believe her, but we couldn't risk attracting attention from someone who would. Is it possible she really thinks Jill is a vampire? Jill's forlorn expression turned angry. â€Å"Maybe I should do something about Laurel. There are other ways to get back at her besides freezing water.† â€Å"No,† I said quickly. â€Å"Don't lower yourself to that. Revenge is petty, and you're better than that.† Plus, I thought, any more supernatural activity, and Laurel might realize her taunts have more backing than she originally thought. Jill gave me a sad smile. â€Å"You keep saying that. But don't you think something needs to be done about Laurel?† Oh yes. I definitely did. This had gone too far, and I'd been wrong to let it slide. Jill was right that there were other ways to get back at someone. And I was right that revenge was petty and nothing that Jill should sully herself with. That was why I was going to do it. â€Å"I'll take care of it,† I told her. â€Å"I – I'll have the Alchemists issue a complaint from our parents.† She looked dubious. â€Å"You think that'll fix things?† â€Å"Positive,† I said. Because that complaint was going to pack an extra punch. A glance at the time told me it was too late to go back to the lab. No problem. I simply set my alarm extra early, with the intent to get up and head back there before classes started. I had one more experiment in my future, and Laurel was going to be my guinea pig.

Plato’s Theory of Forms Essay

Qu.1. A] Explain Plato’s concept of the Forms. B] Evaluate carefully Forms as a way of understanding the world. Plato, Socrates’ famous pupil, created the Theory of Forms. This essay will explore the ideas of Plato’s theory, the strengths and weaknesses of his thoughts, and how they affect our understanding of the world. The Theory of Forms states that everything has a Form- whether it is a chair, a bed, an animal etc; absolutely everything has a Form. Plato also states that ‘Forms are perfection’. Plato says there are four Forms for ethical values; these are Truth, Justice, Beauty, and Goodness. Plato believes there is a hierarchy of Forms, with the Form of Goodness being at the top. Plato believes that True Knowledge comes from knowing the four values, and using them to achieve Ultimate Reality. The way to achieve True Knowledge is ‘Only through the mind’ according to Plato. You have to separate body and soul, and concentrate on mind, to accomplish Ultimate Reality. Plato says we are born with the knowledge of Form, and through education, we recollect this knowledge. For example, we say ‘that is a beautiful flower’, but what is beauty? As we grow up, we are told what objects are beautiful; Plato states that we learn of Forms through experience and learning. Plato uses the ‘Analogy of the Cave’ to explain his Theory. The sun in the analogy represents the Form of Goodness; it gives life to everything, and is the source of all. In Christianity, the Form of Goodness is God, as He is the creator and leader. Plato believes to become a true philosopher you must attain knowledge of Forms, and to accomplish true enlightenment you must have true awareness of the Form of Goodness. Plato’s ‘Analogy of the Cave’ also shows that Forms are in a world beyond shadows and beyond appearance, they are the truth within our souls. Saint- Exupery agrees with this by saying ‘What is essential is invisible to the eye’. Plato suggests there is another reality, a reality that is invisible and beyond our senses. Plato says that facts (sight, touch, smell etc) assist in Forms, for example, we look at things to see if they are good. However, Plato says senses are unreliable and relative, and do not give an absolute view on anything. Plato’s ‘Analogy of the Cave’ also explains that although everyone knows the Forms, many refuse to accept them as it can take away the security of illusions, and the world as you know it. Plato believes Forms cannot be taught, only valued, and utilized. Plato’s Theory of Forms has had many criticisms, one being that it is not really a theory. It relies on the ‘Analogy of the Cave’ to support and explain its’ details. This suggests that Plato is unsure of Forms himself, or at least how to explain them. It is suggested that the Theory is unsure of the extent of the Forms, for example, is there a Form for humanity or each individual? This is important as the answer could change the concept of Form, and alter how the concept is used to understand the world. Another criticism is that Plato states that each Form is unique, but does not explain why this is. Plato also tells us about the Forms but does not say what they actually are. This suggests he has little evidence behind his assumptions, and perhaps does not fully understand Forms himself. Plato’s Theory also has many strong points. It is true that we know Forms- such as beauty etc, and learn about them throughout our lives. This suggests that we are born with knowledge of Forms within our minds, and understand the world using these Forms. It is also true that our senses are unreliable and ever-changing, for example we say something is ‘big’ but compared to something else it may be ‘small’. The way we believe things are true, is by using our senses. This suggests that the way we understand the world is untrustworthy and false, as it is based on unreliable sources. Another strong point is how many of us are secure in our world, and do not want to believe another world exists. We are comfortable in believing what surrounds us is true, and do not want our reality to be shattered. Overall, Plato’s theory is complicated and based on the fact that everything has a Form, and we all have an innate knowledge of Forms. Plato’s theory is criticised because it is unclear and imprecise, with little evidence to back it up. Nevertheless, it offers us a different way of thinking and a new light to see things. We have no idea whether it is true- how can we really know anything? Plato’s Theory of Forms is comprehendible and definitely possible and allows us to broaden our mind and consider another reality.

Essay Sustainability of the Intersection in Ontario, Canada

The signalized intersection between Highway 12 and Pine Street in Ontario, Canada has been facing some challenges in its current design. Therefore, future analysis and design of the intersection should incorporate a suitable sustainability indicator to ensure that the intersection remains functional as a long-term solution. Perhaps the most important sustainability indicators for the intersection’s future analysis or evaluation should be traffic demand together with the future population (Litman 12). These sustainability indicators will ensure that the intersection remains safe and performs at an optimum level for the future based on how it is designed today. The most significant challenge that the intersection has been facing is the†¦show more content†¦This has led to loss of fuel, energy and time when vehicles, especially trucks, wait for their chance to clear the intersection. This is because drivers have to keep their vehicle engines on unnecessarily at the intersection. In addition, this challenge has led to increased travel costs due to reduced accessibility of vehicles to their destinations in time. The vehicular delays are even high during peak hours in this intersection. Therefore, future evaluation of the intersection should consider congestion and mobility as the most important design challenge. However, in the evaluation of congestion-reducing design strategies, civil engineers should adopt sustainable mechanisms. For example, design mechanisms that increase diversity in the transport system such as transit improvement will increase sustainability. On the other hand, those designs that increase the population of tra ffic such as expansion of the intersection may reduce sustainability. To increase sustainability, civil engineers should consider reliability and transport expenditures in the new design. The current design of the intersection is unsustainable due to improper timing of the traffic signals. 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