Ethical Health Care Issues Essay

Healthcare ethics involves making well researched and considerate decisions about medical treatments, while taking into consideration a patient’s beliefs and wishes regarding all aspects of their health. The healthcare industry, above any other, has a high regard for the issues surrounding the welfare of their patients. This power over a patient’s wellbeing creates a mandatory need for all healthcare organizations to develop an ethics committee. The committee’s goal is to establish a written code of ethics that details the policies and procedures that determine proper conduct for all employees. There are many ethical issues that may arise in regards to a patient’s healthcare. Treating patients with certain religious beliefs pose important ethical issues in the field of healthcare. This paper will describe an ethical health care issue concerning refusal of care, such as a blood transfusion. It will cover the four ethical principles as they apply to healthcare providers and patients’ rights. It is important that health care workers have a rudimentary understanding of Jehovah’s Witnesses philosophy about blood transfusion so that as professionals we can be proactive in their management. Ethical Health Care Issue In all areas of practice, physicians come into contact with Jehovah’s Witnesses and their refusal to accept blood transfusion, even when it means saving their lives. The Jehovah’s Witness faith creates some challenges for physicians caring for its members. The ethical principles of autonomy versus beneficence come into conflict when a physician believes a transfusion is in the best interest of the patient, but the patient refuses. Legal precedence provides a backdrop. In addition, Panico, Jenq, & Brewster (2011) article states, there was a case involving a woman who had consented for examination of a fibroid tumor under anesthesia, but withheld consent for removal of the  tumor. While sedated, she underwent resection of the tumor that led to complications. She sued and the judge ruled in her favor, establishing the notion that every human being should have the right to decide what is done with his or her own body. Moreover, this premise gave any individual the right t o refuse treatment if he or she understands the risks; a Jehovah’s Witness has the right to refuse a blood transfusion. This ruling set a precedent for informed consent. In 1990, the Canadian case of Malette v Shulman described an emergency department physician who gave a blood transfusion to an unconscious patient who was in hypovolemic shock. Per report, the patient had a signed wallet card that identified her as a Jehovah’s Witness, although it was undated and unwitnessed. The wallet card, is considered a legal document which, stated that she did not want to receive a blood transfusion under any circumstances (Lantos, Matlock, & Wendler, 2011). Furthermore, when the patient’s daughter arrived and asked that the transfusion be stopped, the physician did not comply. The physician argued that there was no way of knowing if the patient had changed her mind in the minutes before the car accident and thus he was duty bound to save her life (Lantos, Matlock, & Wendler, 2011). The court found the physician guilty of battery. Although it is easy to draw on emotion to argue against the ruling in this case, the verdict has not been overturned. This case illustrates the current teaching to today’s physicians, who are taught to respect patient’s autonomy and preferences for their own bodies (Lantos, Matlock, & Wendler, 2011). Jehovah’s Witness have been known to refuse transfusions with packed red blood cells to treat their life-threatening diseases. Medical professionals must consider patient has autonomy of thought, intention, and action when making decisions regarding health care procedures. To comply with patient’s wishes medical professionals could offer fresh frozen plasma and platelets as an alternative. Furthermore, Jehovah’s Witnesses number over one million in the United States and at least six million worldwide. Witnesses believe in strict and literal interpretation of the Bible, which leads them to reject some aspects of modern medical care (Doyle, 2002). Medical professionals have discussed in open forums ethical decisions they are required to make while taking care of a dying patient who refused to accept a blood transfusion. Data suggests they struggled to relate to someone who would take some blood products, but  not others, and who are willing to risk death over a red blood cell transfusion. Refusal of blood transfusions became common practice only after a 1945 church decision (Mann, Votto, & Kambe, 1992). Indeed, Jehovah’s Witnesses interpret these sections of the Bible differently and if a member accepts blood into their veins, they are shunned and forfeit their membership in the faith community and eternal life. The society had enforced shunning and social isolation by Witnesses’ own family members, relatives, and friends, ultimately leading to expulsion from the religion (Doyle, 2002). Similarly, research suggest that the health care provider must consider four main areas when evaluating justice and the four areas are fair distribution of scarce resources, competing needs, rights and obligations, and potential conflicts with established legislation (Gillon, 1994). In considering the many ethical dilemmas associated with Jehovah’s Witnesses and their refusal to accept blood transfusion have medical professionals focusing on the ways in which treatments or interventions violates accepted norms of conduct of social science research. Physicians must be aware of the growing diversity of values and beliefs among Jehovah’s Witnesses. Some of the most intractable ethical problems arise from conflicts among principles and the necessity of trading one off against the other. The balancing of such principles in concrete situations is the ultimate ethical act (House, 1993, p. 168). Evaluation involves at least four levels of social-political interaction- with government and other agency policy makers who commission evaluation. Evaluation has to operate in this multilayered context of different interests, providing information to inform decisions while remaining independent of the policies and programs themselves (House, 1993, p. 170). More importantly, the weight of ethical judgment is thus put on experimental research to justify meeting ethical standards (Panico, Jenq, & Brewster, 2011). Resource allocation is a major issue that physicians are confronted with when dealing with Jehovah’s Witness allocation. Beneficence requires that the procedure be provided with the intent of doing good for the patient involved. As described above if a patient refuses a blood transfusion and opt for an alternative procedure that costs more it can prove problematic (Panico, Jenq, & Brewster, 2011). When society thinks of the greater good, this argument poses a challenge to the principles of patient autonomy that we also value. In a society in which medical resources  are costly, benefits will always need to be weighed against the potential cost to both the patient and society thus creating ethical challenges. Finally, the care of a Jehovah’s Witness with life threatening illnesses requires a multidisciplinary and planned approach. These patients suffer with certain diseases and are often anemic and must be prepared to deal with this issue in both outpatient settings and during an acute crisis. Clinicians must view each patient as an individual who may have varying thoughts about transfusions of the multiple different blood products that are available. Therefore, medical practices today need to continue to open early lines of communication with these patients. Providing adequate information and educating the patient about realities and obtaining informed consent before subjecting a patient to any test, procedure, or surgery is very essential. It is vital to the optimal care of a Jehovah’s Witness patient. It is necessary that dialysis unit nurses and social workers have conversations with patients about their beliefs on blood products. Discussing a patient’s wishes, understanding their basis for these decisions, and discussing risks, benefits, and alternatives that can be used in both emergent and non-emergent situations is crucial to preparing for more urgent situations, when these conversations often are not possible. Conclusions To many Jehovah’s Witnesses, the consequences of accepting a blood transfusion can be worse than death itself. Not every Jehovah’s Witness patient abides by the same beliefs regarding the acceptance of blood products. These patients can be managed through careful planning and open lines of communication between physicians and patients. Understanding the premise behind the beliefs of patients who are Jehovah’s Witnesses is critical to beginning conversations and truly understanding the patient. Ultimately, when a patient establishes what they will accept, as clinicians, ethically we must optimize the care we provide within their wishes about blood products. Frequent and open dialogue is essential for enhancing care for a Jehovah’s Witness. As an alternative to violating a patient’s autonomy some physicians and some hospitals are more comfortable with bloodless procedures and patients can be referred to these centers if necessary for specialty care. Overall, health care professionals should be able to provide  ethical health care to patients who are Jehovah’s Witnesses at any hospital or community office, but must continue to be educated and aware of their beliefs and respect their wishes and the impact these may have on organizing and providing their care. If these considerations are neglected one can surely expect ethical breaches or dilemmas as inevitable. References Doyle D. Blood transfusions and the Jehovah’s Witness patient. Am J Ther. 2002;9(5):417–424. Gillon, R. (1994). Informed consent: an ethical obligation or legal compulsion. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840885/ House, R. (1993). Ethics in evaluation. Retrieved from http://www.uk.sagepub.com/gray3e/study/chapter12/Book%20chapters/Ethics_in_Evaluation.pdf:168-170. Lantos J, Matlock A, Wendler D. Clinician integrity and limits to patient autonomy. JAMA.2011;305(5):495–499. (Lantos, Matlock, & Wendler, 2011). Mann M, Votto J, Kambe J, McNamee M. Management of the severely anemic patient who refuses transfusion: lessons learned during the care of the Jehovah’s Witness. Ann Intern Med. 1992;117(12):1042–1048. Panico, M. L., Jenq, G. Y., & Brewster, U. C. (2011). When a patient refuses life-saving care. American Journal of Kidney Diseases, 58(4), 647-653.

Criminal justice Essay

Luqman Rohaizat (5 Omega 2009) At first thought, caning may seem like an inhumane punishment for students, who are not yet fully matured in their thinking, and are still learning along the way. â€Å"It just hurts them, physically and emotionally, without doing anything else† I hear concerned parents say. But then again, is there a more effective way to punish and control students? Moreover, nowadays there seems to be a noticeable rise in disciplinary problems involving students in schools nationwide. We need to find an explanation for this rise in disciplinary problems, in order to find the ideal solution for the problem. By my knowledge, we can clearly relate the rise in disciplinary problems with the withdrawal of caning, or any sort of physically inflicted pain, as a punishment for students. What I mean is, when students don’t get punished, they will get into more trouble in the future. Based on this, I fully agree that caning is an effective way to punish students. This is where caning can be part of the solution. Please, let me explain. Students get into trouble because it is their nature to make lots of mistakes and learn through them. Yes, they learn new and important things in life through mistakes. It is okay to make one or two mistakes once in a while, but when a student gets into trouble, or keeps repeating the same mistakes one too many times, this indicates a problem. Maybe the student does not realize that he is causing trouble, or hurting other people. For all we know he might even be enjoying causing trouble. If this student is not punished, he is certain to do more harm again, and this is not good for everybody. As a solution, caning will make the student realize that what he is doing is wrong, and that he should never make this mistake again. As you can see, caning becomes part of the long-term solution to shape a student’s thinking pattern, for the benefit of himself. Another thing to consider is that because of the withdrawal of caning as a punishment for students, our students’ respect for their teachers and their school has dwindled. Respect is an important virtue for every student, and if the student does not develop the value of respect within himself, he will never succeed in life. Nowadays, students are becoming more and more outrageous, with cases ranging from stealing and smoking to doing drugs, or even sexual crimes. It seems that this younger generation has lost respect and fear of their teachers, parents, and has no sort of shame at all for that matter. The only way to instill fear and respect in these students for their teachers is by giving teachers the responsibility of caning troubled students. Through caning, these students will learn the consequences of their crimes and avoid negative behavior. Hurting the students a little bit is for their own good, and is a low price to pay compared to a jeopardized future. Nonetheless, caning is an effective tool to improve students’ discipline, if and only if it is done the right way, taking the necessary precautions and steps. Caning will not achieve the desired results, if done without thought and order. Teacher cannot cane students just because they feel like doing so. What is the benefit in that? In my opinion, only certain teachers should uphold the responsibility of caning students. It would be best if the responsibility is given to the disciplinary teachers of the school. It is in their field to punish students, and disciplinary teachers are the best people for the job. If a student gets into serious trouble, he or she would be sent to the disciplinary teacher’s office, for a session of caning. May I add that even though students are fully matured in their thinking and behaviour, they are still fully able to think rationally. Thus, teachers must deal with students in a professional manner, and not treat them like little children. They should be told the troubles they have caused, and why they deserve to be caned for them. We should make the student understand the punishment they have received, so they will not repeat it. Public caning, especially during assemblies, is strictly prohibited, as humiliation will not do any good to students. Caning can be a solution, if done correctly and with reason. In short, I think that caning should be fully allowed in schools, with the necessary precautions applied, for the benefit of everybody. Caning, as a punishment, is effective, keeps troubles away, and is for the students’ long term benefit. Besides, getting the cane once or twice never hurt our parents. You’ll feel like a hero, stepping out of the Discipline teacher’s office. Catatan Web Admin: Esei ini merupakan sumbangan penulis untuk Majalah Darulaman. Terima kasih kepada Cikgu Osmadosnani Mat Lazim (Setiausaha JK Penerbitan KSAH) yang mengusahakan sehingga esei ini dapat dimuat naik di laman web KSAH. (upload : 05/06/12).

Government responsibility Vs Individual responsibilty Essay

Government responsibility Vs Individual responsibilty - Essay Example This is quite evident in George Orwell's short story, A Hanging (first published in 1931 and reprinted in James and Merickel, 2001), the author describes a European's experience of watching a Hindu man's execution in Burma. As he acknowledges, he has never known what it feels like to destroy a perfectly healthy human body. Throughout the story, there is no inkling that the executioners know what the prisoner is accused of or why he is being hanged. It is simply the Europeans' duty to carry out orders in the name of the law. They go about doing their duty mechanically and go for their drink after the execution is over, quite oblivious of what the dead man could have felt like in his last minutes. The executioner, in his role as the government's representative, is simply carrying out his assigned role even when personally, the act is disgusting to him. In Things They Carried (reprinted in James and Merickel, 2001), Tim O'Brien describes the things that a group of soldiers carried with them when they went to the World War II. While most of them carried things of utter necessities, like can openers, pocket knives, wrist watches, mosquito repellants and so on, some also carried letters of their loved ones, diaries and books. None of the soldiers knew whether they would return home alive. Neither were they necessarily aware of the real reasons of the war. They simply knew that they had to fulfill their responsibilities as soldiers. Each one of the soldiers remembered their loves, the mistakes that they have committed in their personal lives and wished that they had behaved differently. Yet, there was no way to go back from their official responsibility and had to march on. Typically, authoritative show of power is exerted by states in order to maintain peace and individuals are nothing but pawns in the state machinery. In The Prince, a most commanding and widely read discourse on government, Niccolo Machiavelli prescribes the government's social and political stance on power and authority. Even in situations, when the individual sense of responsibility may come in the way, the government may need to adopt strategies that curtail free will. In an advisory tone, Machiavelli recommends policies that would dissuade mass political upheaval, directing subjects' energies into personal quests so that that the monarch could best protect his power. He advises sensible use of violence, reverence to private possessions and the traditions of his subjects without being politically rigid as being dictated by a fixed set of moral or religious standards. The monarch, from his perspective, may now and then be forgiven for taking resort to violence and dishonest deeds albeit morally unforgivable behind closed doors (lucidcafe.com). A new prince can get a principality: by his own arms, by the arms of others, by immoral ways, and by civil approaches. A principality won by a prince by his own arms is most safe. Citing the examples of Moses, Cyrus, Romulus, and Theseus, those princes who prevailed to power through their own skills ruling well, he points out that they were all armed, unlike Savaronola, who lost his command as he did not take resort to arms. According to him, a principality acquired by the arms of others requires a prince with both luck and high merit. Cesare Borgia was lucky to have

Ways of Knowing Assignment Example | Topics and Well Written Essays - 1750 words

Ways of Knowing - Assignment Example Nevertheless, enlightenment cannot be exactly known without discussing it in the context of ignorance. When one is ignorant, one is pictured as extremely sensitive and vehemently opposing something without even realizing why. For example, one is into anarchism, or the condition where one is â€Å"unrestricted by man-made law† and believes that â€Å"all forms of government rest on violence† (Goldman 583). This is actually such a negative standpoint from which to proceed. Nevertheless, the ignorant are relentless in believing that â€Å"God, the State, and society are non-existent† (584). This they proclaim while contending that â€Å"the individual is the heart of the society† and that â€Å"society is the lungs which†¦keep the life essence† (584). How then can society be the â€Å"lungs† that keep the individual alive when in fact it had previously been declared that the society is â€Å"non-existent†? Thus, the ignorant do not realize that their principles are actually contradictory. Moreover, if the great French anarchist Proud hon states that â€Å"Property is robbery,† then I am not even entitled to own my physical body lest I be called a robber (584). Why then should anarchism be the solution to all the ills of the world when anarchism can in fact totally annihilate everything? The ignorant stops here and cannot answer such a question. This is the problem of having contradictions. Such contradictions may have only been a theory by Goldman but they made up the entire philosophy of Marx and Engels – the philosophy of communism, which was loosely based on opposition. Judging only from their own limited or ignorant points of view, the authors contend that opposition exists among the social classes: â€Å"†¦every form of society has been based†¦on the antagonism of oppressing and oppressed classes† (Marx & Engels 487). If such oppression did exist in

Without positive freedom, it is impossible to lead a valuable life. Do Essay

Without positive freedom, it is impossible to lead a valuable life. Do you agree - Essay Example Therefore, it is true that valuable life might not be achieved in absence of positive freedom, people need to choose the course of their life and destiny without restrictions, freedom is essential also where individual potential is harnessed for the benefit of the whole society although in the process of enjoying this freedom care should be taken to make sure that other peoples liberty is not violated. In the process of enjoying positive freedom equity in opportunity must be regulated or observed, state may intervene to enforce equity and root out other social evils due to positive freedom (Raz, 1988). In a nutshell, complete absence of positive freedom leads to bad and impossible valuable life because every individual wants to operate in an environment which they feel free not intimidating surroundings, this will increase their productivity that in return improve the living condition and life at large for the whole society. A society that feels able to function without interruption although certain aspects must be observed as mentioned above (MacCallum, 1967). Positive freedom acts as an inner driving force in individuals. This equates and augers well autonomy. At the same time, autonomy many a time equates with several aspects that include individuality, integrity, and freedom of the will, responsibility, and critical reflection. In the same way, factors like self-knowledge, independence, freedom from compulsion, lack of external causation and self assertion play vital roles in perpetuating positive freedom. Different people have got varied notions about the steps that others should take to shape their lives. This is because individuals get involved in activities that portray absence of good morals. It has forced researchers to attempt to identify standing reasons that lie behind dissimilar nature of crimes that individuals commit. Even for all their attempts, the researchers are not able to impose their findings about criminology and its associated

Gentrifying Gay Heaven Research Paper Example | Topics and Well Written Essays - 750 words

Gentrifying Gay Heaven - Research Paper Example This has led them to face social, economic and political problems for the gay in San-Francisco. Gentrification is a process of re-constructing or regeneration of a society due to inflow of high- income people in an under-developed country. Gentrification was mostly seen in the cases of gay community that possesses high income shifting to low income country in-habituated by black people. For example San-Francisco which constitutes about 17% of population as gay-community. This is done mainly to develop a Gay community with a gay neighbourhood having access to all political, social and economic rights. Due to high income and new big buildings, they had to get huge property rights. This leads to cultural development of the society, lesser crime and reduction in the sexuality differences between the â€Å"actual† men and LGBT people causing lesser crime and confusion between people about their identity (Castells 138). In the urban society the gay community set up their own organizations or institutional places for their benefits in every section of life. The gay community also improved their quality of life by having good buildings, property rights, renovation of old houses and so on. They were also provided with job offers in their area and also leisure time in their livelihood. These people enjoyed freedom of rights, protection and identification in the social class or society. Moreover the development of gay community has given them a safe life without harassment and embarrassment where same gender people can roam around with hand in hand or can openly kiss in the streets. This has helped them to like other normal human beings who are stated as â€Å"actual† men by some researchers. The gay community is restricted in their area had been enjoying life and also can express their thoughts. (Sibalis). Moreover, gentrification has helped the gay and lesbian community gain freedom, rights and identification. They should be provided with sexuality and sexual

I am going back to my school and giving a speech to the senior class Essay

I am going back to my school and giving a speech to the senior class. I must either Motivate, Inspire, or Entertain them - Essay Example As the senior class of this school, you are grown and mature. In the outside world, you will not have the luxury of delaying your responsibilities. You can’t be late for job, bills have to be payed on time. It is a decision you have to make today; whether to change for the better and look ahead to the future, or be conformable with the idea that we are a slacker generation. You should be the difference since you are the most senior in the school and the role models to the rest. When the time will come that you will have to leave this place; the world should know that your class will not hold back since you will be the once making the difference out there. It is important that at this point you have come to appreciate the fact there is a solution for every problem, no matter how big or small it may be. For every solution that is provided, someone or something will always be gaining and by doing this, you will be making the school a better place than you found it. All of you may not end up in college, and success does not come at an instance. But what I can assure you is that if you use your time in school wisely, you will succeed in the long run. Don’t waste your time in school, you have a very little time left to make things

Cold War Essay Example | Topics and Well Written Essays - 1250 words - 3

Cold War - Essay Example A major characteristic of the Cold War was the prevalent of a division of the world into two distinct regions trending on varying paths of â€Å"political modernity and economic development†1. Amidst this war, the Soviet Union and the United States engaged in a contest-of-power, thereby marginalizing the relation-of-domination causing complex bifurcation in the area of modernity for both nations and their communities. The origin and cause of the phrase â€Å"Cold War† cannot be oversimplified given the implications present to date. In this paper evaluates the validity of the phrase â€Å"cold war’ through the evaluation of the global perspective on the cold war, and its impacts on the first, second, and third world? Today, the Cold War, despite taking place years ago, symbolizes the establishment of conflicting political forces and powers that left the world characterized with wounds induced by war, given the violent ways used for the â€Å"manifestation of bipolar global order..†.2 Though global bipolarity could have existed prior to the Second World War, the end of this war and the end of the alliance between the Soviet Union and the United States deepened the drift between the two sides. The implication that the cold war began before the end of World War II implies that the contest for global supremacy commenced in as early as the beginning of the 19th century. In their perspective, the Soviet Union nations opposed the sole progressive and benevolent powers of the US and were not in terms with the market-oriented liberal world progressed by the United States. Conversely, opponents agree that Russia and the Soviet Union were insecure and fear that the US would cause a world that was mo re competitive, powerful, and more organized. This then led to the Union’s strategy to seek security through destruction of rival powers that is not compliant to or that compromised it. The insecurity of the Soviet Union does not cover-up America’s denial of

Victims and Legislative Solutions Essay Example for Free

Victims and Legislative Solutions Essay â€Å"knowing production, use or trafficking in counterfeit or unauthorized access devices such as any card, plate code, account number, electronic serial number personal identification number, that can be used to obtain money, goods, services, or any other thing of value, or that can be used to initiate a transfer of funds† (Cybercrime Public and Private Entities, 2007). Despite these measures in place, cybercrime is still a massive problem. This is due to the fact that hiring and retaining skilled investigators is a daunting task because private companies offer a higher salary and better benefits than the federal government (Cybercrime Public and Private Entities, 2007). Also, â€Å"staff rotation policies in place at certain law enforcement organizations† make it difficult for law enforcers to fully attend and address the situation properly (Cybercrime Public and Private Entities, 2007). Besides, it takes a year to train an investigator to be competent enough to handle his own case (Cybercrime Public and Private Entities, 2007). Individuals have to be trained because federal agencies lack resources to employ professional investigators (Cybercrime Public and Private Entities, 2007). In addition, multiple jurisdictions in place makes the matter even more complicated to handle (Cybercrime Public and Private Entities, 2007). â€Å"Law[s] used to address cybercrime differ across states and nations. For example, not all US states have anti-spam laws or anti-spyware laws Further, jurisdictional boundaries can limit the actions that federal, state, and local law enforcement can take to investigate cybercrime that crosses local, regional and national borders† (Cybercrime Public and Private Entities, 2007). Lastly, the complex nature of tracking an identify theft also poses a problem. â€Å"[C]ybercriminals can take steps to remain anonymous, making it difficult, if not impossible, to attribute a crime to them [this is because] [c]ybercriminals can be physically located in one nation or state, direct their crime through computers in multiple nations or states and store evidence for the crime on computers in yet another nation or state† (Cybercrime Public and Private Entities, 2007). Hence, cybercriminals are rarely caught and if they are apprehended, the â€Å"penalties are minimal Community service and parole are the usual sentence† (Identity Theft: How it Happens, 2000). Cybercriminals exist because engaging in identity theft enables them to acquire money and benefits such as material assets, medical insurance and tax returns without working conventionally to obtain them. Also, they are rarely caught because the system in place is disorganized and ineffective; that is why identity theft remains a big problem. A national and specialized agency should be set up to handle this situation. Resources should be allocated to this agency so that skilled investigators can be employed. This will speed the investigation process because individuals in the force do not have to be trained for a year to be able to effectively deal with cases. References: Privacy Rights Clearinghouse. (2000, July 12). Identity Theft: How it Happens, Its Impact on Victims and Legislative Solutions. Retrieved January 20, 2008, from http://www.gao.gov/

Summery of Two Gentlemen of Verona Essay Example for Free

Summery of Two Gentlemen of Verona Essay Bosom buddies Valentine and Proteus bid a tearful farewell on a street in Verona. Valentine is off to improve himself, venturing out to see the world, while Proteus stays home in Verona, tied by his love for Julia. After Valentine departs, his servant, Speed, enters. Proteus inquires whether or not Speed delivered a letter to Julia, to which Speed replies affirmatively. Julia, meanwhile, asks her maid, Lucetta, with which man she should fall in love, and Lucetta recommends Proteus. Lucetta admits that she has a letter for Julia from Proteus. After much bickering, Julia tears up the letter, only to regret this act an instant later. Antonio decides to send Proteus, his son, to the Dukes court in Milan, a decision with which neither Proteus nor Julia is particularly happy. They exchange rings and promises to keep loving each other. Meanwhile, Valentine has fallen in love with the Dukes feisty daughter, Silvia. When Proteus arrives at court, he too falls in love with Silvia, and vows to do anything he can to win her away from Valentine. When Valentine confesses that he and Silvia plan to elope, Proteus notifies the Duke of their plans, gaining favor for himself and effecting Valentines banishment from court. Back in Verona, Julia has hatched a plan to disguise herself as a man so that she can journey to Milan to be reunited with Proteus. Upon arriving at court, she witnesses Proteus and Thurio wooing Silvia. The banished Valentine, while traveling to Mantua, is apprehended by a group of outlaws. The outlaws, all of whom are banished gentlemen as well, demand Valentine to become their king. Since they threaten to kill him if he refuses, Valentine accepts. Silvia and Julia, who is disguised as the page Sebastian, meet when Julia delivers the ring Proteus had given her to Silvia on behalf of Proteus. Julia does not reveal her identity. Silvia calls on her friend Sir Eglamour to help her escape her fathers oppressive will (he wants her to marry Thurio) and to find Valentine. However, while traveling through the forest, she and Eglamour are overtaken by a band of outlaws. Eglamour runs away, leaving Silvia to fend for herself against the outlaws. By this time, the Duke, Proteus, and Thurio, with Sebastian/Julia in tow, have organized a search party for Silvia. Proteus wrests Silvia away from the outlaws. Valentine watches the interaction unseen. Proteus demands that Silvia give him some sign f her favor for freeing her, but she refuses. He tries to rape her for her resistance, but Valentine jumps out and stops him. Proteus immediately apologizes, and Valentine offers to give him Silvia as a token of their friendship. At this moment, Sebastian faints and his true identity becomes clear. Proteus decides that he really loves Julia better than Silvia, and takes her instead. The Duke realizes that Thurio is a thug and says that Valentine is far nobler and can marry Silvia. Valentine asks for clemency for the outlaws, and suggests that his marriage to Silvia and Proteus marriage to Julia should take place on the same day.