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The United States Bill of Rights came into being as a result of a promise made by the Fathers of Confederation to the states during the struggle for ratification of the Constitution in 1787-88. A great number of the states made as a condition for their ratification, the addition of amendments, which would guarantee citizens protection of their rights against the central government. Thus, we have a rather interesting situation in which the entrenchment of a bill of rights in the American Constitution was done by the virtual demand of the states, they themselves fearing a central government which was not legally constrained and restricted as far as its powers were concerned.

The first 10 amendments to the Constitution make up the Bill of Rights. The Bill of Rights is another name for the ten amendments to the United States Constitution. It was created September 25,1789, by James Madison. Madison, a member of the U.S. House of Representatives, went through the Constitution itself, making changes where he thought were most appropriate. Several Representatives, led by Roger Sherman, objected that Congress had no authority to change the wording of the Constitution itself. Therefore, Madison’s changes were presented as a list of amendments.

“The Revenue Act of 1764 did not bring in enough money to help pay the cost of defending the colonies. The British looked for additional sources of taxation. Prime Minister Grenville supported the imposition of a stamp tax. Colonial representatives tried to convince Grenville that the tax was a bad idea. Grenville insisted in having the new taxes imposed and presented to the parliament. The parliament approved the tax in February 1765. The colonies responded with outrage. It was considered a “shocking act”.(2)

To further strengthen the rights of the people, The Bill of Rights was ratified on December 15, 1791. With only the first ten amendments, it is no accident that two amendments, 9 and 10, specifically define the Constitutions purpose to protect rights, given to the government from the people; and the powers of the government are “only those delegated to it by the Constitution on behalf of the people” (Spalding, Page 145).

The Bill of Rights was ratified together with the Constitution in 1791. The Bill Rights was incorporated with the Constitution to diminish the fear by the Anti-Federalists of a government

The right of the Legislature of Great-Britain to impose taxes on her American Colonies, and the

The Bill of Rights became a very important document in the United States Constitution in order to ensure United States citizens equal protection of their rights and liberties. The main objective of the Bill of rights was to place limits on the national government creating an understanding and dividing the powers between the states and the national government. Not all the powers were granted to the national government however not all the powers were prohibited to the states. As stated by Ginsberg, Lowi, Weir & Tolbert (2015) the bill of rights consists of 10 amendments incorporated in the U.S constitution. It is important to note that each amendment contains a legal court case in which the supreme court as well as the government have ruled and have ignored or have protected the rights of the individuals involved.

On September 28, 1787, after three days of bitter debate, the Confederation Congress sent the Constitution to the states with neither an endorsement nor a condemnation. This action, a compromise engineered by Federalist members, disposed of the argument that the convention had exceeded its mandate; in the tacit opinion of Congress, the Constitution was validly before the people. The state legislatures' decisions to hold ratifying conventions confirmed the Constitution's legitimacy.

Three fifths of slaves will be counted for that state’s representation and three fifths of a plantation owner’s slaves will be counted for the owner’s taxation

During the next few years the Bill of Rights began to be accepted by the

Firstly, the Bill of Rights has guaranteed the adoption of the Constitution. James Madison proposed the Bill of Rights to the First Federal Congress on June 8, 1789 (Primary Documents 1). The First Federal Congress then proposed the twelve amendments to the constitution to the state legislatures (Constitutional Politics in Ohio 1). The

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1. Describe three different forecasting applications at Hard Rock. Name three other areas in which you think Hard Rock could use forecasting models.

安寧緩和療護的道德研究與探討 中華民國一○一年六月 壹、摘要 本論文的寫作目的，主要是要探討安寧緩和療護的存在所引起道德方面上的爭議。雖然安寧病房之所以會存在，是不想讓那些得了絕症或治療過程極其痛苦的病患繼續受苦，因而放棄治療，讓他們能夠儘可能安詳的走完最後一程；但是從另一個觀點來看，安寧照護也可以被視為消極的間接殺人；若病人無法接受臨終事實，但醫護人員及家屬共同決定不告知臨終事實，依社會工作「案主自決」原則，顯有違專業倫理；當病患意願與醫療理性相左時，如何進行溝通等諸如此類議題，正相繼衝擊安寧緩和醫療團隊、臨終為不可逆事件，即使病人不願或不肯接受實情，但知的權利仍不應輕言剝奪；醫護人員及家屬應如何協商，讓病患有機會參與重大決策，不致覺得只能自己孤獨面對死亡？這些情形非常值得我們探討。 貳、何謂安寧緩和療護 根據世界衛生組織（WHO）的規範，安寧緩和醫療照顧提供罹患無法治癒疾病的病人，積極性的全方位照顧。緩和醫療照顧是肯定生命，視死亡為自然的過程，不提早也不延後死亡，積極提供疼痛及其他窘迫症狀的緩解，提供支持系統，幫助病人盡可能提升生命品質，幫助家人度過病人生病與其身後期間所遭遇的種種壓力。 叄、安寧療護的目的 安寧療護服務的目的是為生命走到末期病患及家屬提供專業團隊服務，經由完整的身、心、靈之關懷與醫療，減輕末期病患的身體疼痛、不適應症及心理壓力，對病患及家屬提供心靈扶持，輔導其接受臨終事實，陪伴病患安詳走完人生最後一程，協助家屬面對病患死亡，達到生死兩相安的境界。 安寧療護以維護末期病人的生活品質和尊嚴為主，大林慈院家醫科陳世琦醫師透露了一般醫院在診療時常常只著重結果，但是卻忽略了病人的感受。「從參與安寧療護以來，一直在學習，也深受感動。」大林慈院家醫科林名男主任表示，希望提供的安寧療護，能夠盡力改善病人的生活品質，讓病人了無遺憾地往生，而家屬也能安心。 「不是放棄，而是勇敢面對生命不可逆的進程。」長期在花蓮慈院心蓮病房服務的家醫科謝至鎠醫師，在花蓮慈院海報展上也說明了安寧療護的重要性，過去進「安寧病房」往往被誤解為「等死」，但事實上，安寧療護是藉由藥物的使用、芳香療法、中西醫照護、藝術治療等方式，用心傾聽患者的心聲，尊重每一個生命，不延長也不縮短患者的生命，讓病人在臨終的過程中帶著尊嚴。 肆、安寧照顧的重要措施 安寧照顧主要對象是末期病人，在國內僅用於癌末病人的使用； 在國外除了癌末患者之外，還包括了愛滋病的病人。這些病人除了 要面對死亡的問題之外，還必須面對身心痛苦的問題。這些問題安 寧照顧又是如何來解決。我們由前述緩和照護的定義，提供了六種措施來解決末期病人的各種問題。 (一)舒適的照護 現代醫療體糸中，無論是在手術、診斷及急救等，皆是重視病情的治癒或延續病人的生命。癌症患者在初期時，有些可以藉著手術及放射性治療而痊癒。但是，病患到了末期時，癌細胞轉移其他部位，不管醫護人員用多先進的醫療技術，也是沒辦法讓病人復原。所以對醫護人員來說容易產生極大的挫折感，而這些絕症的病人，很容易是被放棄的一群。當醫療對末期病人無效時，並不代表對他們的關懷也無效。安寧照顧重視對病人的關心及照顧，強調以照護（care）為主，並且是舒適的照護。另外，安寧照顧在硬體上有舒適的設備，備有洗澡機、休閒室、陽光室、祈禱室、佛堂、咖啡廳、意樂治療室及兒童遊樂區等設施。裏面的設備盡可能不讓病人有住在醫院的感覺，而讓病人感受像居家的環境。在軟體的設備中，安寧照顧有醫療團隊的關心，這些照護跟普痛的醫院不同。這個醫療團隊在面對病人的照護時，以非病人（nonpatient）的態度去照顧病人，尤其重視護理上翻身、洗澡、等細微照護（安寧照顧在照護上對病人有特殊的照護技巧）。所以，癌末病人在安寧照顧受到非常親切及舒適的照護。安寧照顧除了醫院的安寧病房之外，還有日間照護、居家照護（home care）等。這些照護皆是為了配合病人或是家屬的需要，而設置的。其中，居家照顧是由居家護理師安排醫師和護士，定期到病人的家中照顧。這樣的照護是為了想待在家中的病人，或是家屬照顧方便而設置的。 (二)疼痛及症狀的控制 癌症末期主要的症狀有疼痛、虛弱、嘔吐、呼吸困難、水腫、失眠及焦慮等。其中，最令人受不了的症狀是疼痛和虛弱（根據馬偕醫院的統計）。癌末的疼痛時常令病人難以忍受，癌痛痛起來會要命，他們寧可死，也不要痛。所以病人極度疼痛的問題，經常成為患者請求安樂死的重要因素之一。安寧照顧的理念並不支持安樂死結束生命來解決疼痛的問題。從事安寧照顧的醫護人員利用現代醫療技術所發明的新藥，來緩解病人疼痛的問題，大部分病人都能有效控制疼痛。他們除了使用藥物控制之外，還應用中醫的針炙、推拿、心理支持及音樂治療等各種方法，來幫助末期病人減輕他們的痛苦，期使他們在最後的生命能更平和的度過餘生。 (三)團隊的處理 安寧的醫療團隊包括醫生、護士、心理師、精神醫師、營養師、神職、社工及義工等。這個團隊照顧末期患者及家屬所碰到的問題，給他們最大的幫助。所以，病人的問題不止由醫生及護士作決定，還有、心理師、社工、義工及宗教人員輔助。醫療團隊不僅是關心病人的病情，也重視心理支持、人際關係、心靈的需要（宗教的寄託）及家屬情緒的問題。團隊的照護是「全人的照護」（whole person care），所謂全人的照護，即是考慮病人最佳利益為主，針對病人的身、心、靈的照護。身的照護是指身體的痛苦，大部分團隊的醫生護士來處理。心的照護是情緒的困擾，諸如恐懼、悲傷、煩惱、人際關係等問題，由團隊中的心理醫師、精神醫師、社工及義工等人員協助。靈的照護是指心靈的寄託及死後宗教的依歸，由團隊中的宗教人員服務。 (四)病人為中心的照護 安寧照顧重視病人的權利，強調以「病人為中心」的照顧理念，有效率的病人中心照護，需要健康照護團隊和病人兩者合作，圍繞在病人的四個要素是： １. 全體的策略（holistic practice）：全體的策略即是上述所提到對病人是以全人的照護，不僅針對病人身體的照護，還包括精神、情緒與人際關係的照護。 ２. 尊重病人的自主權（autonomy）：安寧照顧尊重人有自主的權利，而這基本權利的辨別，是這人有獨立行動和合理自由地判斷的能力。 ３. 溝通（communication）：醫護（團隊）人員與病人的互動要良好，在平常的照護中護士與病人接觸最多，從照護及對話中，了解病人的問題及需要，讓病人的意願及問題能及時得到幫助。 ４. 賦予權力（empowerment）：安寧照顧賦予五個權利給病人，這五個權利是幫助（facilitating）、鼓勵（encouraging）、消除危 險（defusing）、改善（mending）及告知病情（giving informant） 由以上說明，以病人為中心的照護是重視病人全人的照護，與病人良好的溝通互動，並尊重病人的自主權，給予病人幫助及鼓勵。所以，安寧照顧把病人當做中心，注重病人身心靈的照護，充分尊重病人各種權利，把病人的地位提高跟一般人一樣，甚至比一般人更優厚的待遇。 (五)