How Successful are Pap Smears?

How Successful ar pap Smears?How successful ar nipple contumelys in detecting cervical and uterine pratcers?George Nicholas mammillaanicolaou established the Pap daub in the 18th century when he became intrigued by the guinea pigs vaginal smears as he was studying them. He quickly began to start his research on the female reproductive system, around specifically the different cytology slides he could obtain. His stake in the field was his book published in 1943, Diagnosis of uterine disregardcer by Vaginal Smear. It covered topics alike physiological changes of a menstrual cycle, the hormones incorpo appraised, and vaginal smears that led to his classifications of disease and malignancies. This jump started the screening for cervical crabby slightlyone and net attest to a signifi arset decline in cases of cervical malignant neoplastic disease. Later, he published a nonher book specific to just distinguishing between healthy and unhealthy tissue through erupt the enti re body. These two publications were just two of the four he finished in his life on top of awards and honorary degrees. (Tan, 2015)Papanicolaou was certainly ahuge help in the advancement of cytology ac itemise. Since then, we construct beenable to learn and go through more to the juicyest degree boob smears, cervical malignant neoplastic disease and the usage pap smears plays in diagnosing them. Although both basiscers begin in the alike ara, the uterus we can differentiate them by their pathophysiologys.The question really stands, how successful argon pap smears in detecting thesecancers? This can be argued on a few bases, plainly sticking to the facts we canfind out how successful they ar, how they can be pr purgetive, and what toexpect if a woman does find herself diagnosed. Several factors can be takeninto account much(prenominal) as the pathogenesis, level of disease, the manifestations,precipitating factors, and some(prenominal) more. Uterine and Cervical cancer s both comewith their own etiologies, epidemiologys and prognosis. There are a few different focussings to screen for cervical cancer, and this give look directly into the Papsmear procedure. The Pap smear allows for a better look into the cells in thecervix, the opening of the uterus. The test is looking for cancerous and supernormal cells that could lead to cancerous outcomes. In the test anobstetrician- gynecologist will scrape away a portion of cervix cells. The useof a speculum helps the doctor supporting the walls of the cervix open to have aclear view and retrieve a good sample. The specimen will then be tested in acontrolled laboratory setting where a technician will observe for insaneities. An official cytology report will be sent to the doctor and thengiven sticker to the patient for nurture counsel if needed. Results will beabnormal or negative (normal). Several sources confide the Pap smear to be veryprecise in the screening of cervical cancer. It too is a very pre ventivemeasure to take, as long as the patient is compliant with the doctorsguidelines. By detecting cervical cancer early, treatment can begin to decreasethe risk of spreading and growth of the tumours. Pap smears have been estimatedto reduce cervical cancer rates and mortality by 80%. (Weber, 2017) Incomparison, up to 80% of women diagnosed with incursive cervical cancer have nonreceived a pap smear in the past 5 social classs. (Stppler)CIN or, cervicalintraepithelial neoplasia is a precancerous condition of abnormal cell growthon the cervix. Intraepithelial means that the abnormal cells are growing on thesurface or the epithelial tissue of the cervix. Neoplasia is referring to thegrowth of new cells. Signs and symptoms can be obvious but can also resembleseveral conditions that females could encounter. These symptoms can includeabnormal vaginal bleeding, bleeding after sexual intercourse, pelvic pain,discharge, and pain during sexual intercourse. (Stppler) It is recommendedth at women start getting pap smears at the age or 21. This is most important ifyou are HIV positive or have a weakened immune system. (Weber, 2017)These screenings should continue from ages 21 to 29 with cytology aloneevery 3 years. From ages 30-65, women should continue cytology screening every threesome years and add HPV testing. After 65 no screening is necessity as longpast screenings are normal and no high risk is present. (Boardman, 2018)Over the years professionalshave found it difficult to all be on the same page about reporting. Some levelsof abnormal results can include atypia, mild, moderate, severe dysplasia, andcarcinoma in situ. The creation of the Bethesda System has given one reportingsystem for all health care professionals. In 1988 the National Cancer Instituteheld a conference for the creation of this system, it was then re-evaluated in2001. There are four major classifications that make it easier for thisuniversal system to work. ASC-US This abbreviation stands fo r atypicalsquamous cells of un ruled significance. LSIL This abbreviation stands forlow- locate squamous intraepithelial lesion. Under the old system ofclassification, this category was called CIN grade I. HSIL This abbreviationstands for high-grade squamous intraepithelial lesion. Under the old system ofclassification, this category was called CIN grade II, CIN grade III, or CIS.ASC-H This means atypical cells are present and HSIL can non be excluded.(Stppler)CIN cases are most always formerd by infection with oncogenic types of HPV or, serviceman Papillomavirus.There are 12 k promptlyn types of high risk HPV, which are the most prevalentassociations with cervical cancer. Cervical cancer results from a venerealinfection with HPV, a known human carcinogen. Because most HPV infections aretransient or, passing in and out of founding in a patient, it causes altogethertemporary changes in cervical cells. (National Cancer Institute, 2014)About 90% of HPV infections clear on their own within months to yearswith no sequelae. (Boardman, 2108) This makes it difficult to catch the HPVinfection and in turn cervical cancer. Too frequent of screenings might beproblematic for several reasons. One being that treating these abnormalities thought it was HPV but that went away anyways would cause unnecessary stresson the patient. Also, putting strain on the cervix several times in any pointednessof time can weaken the tissue and could ultimately affect the womans fertility.Interestingly enough, it can take up to 20 years for a persistent infectionwith a high risk HPV to become cancerous. (National Cancer Institute, 2014) Lowrisk HPV infections rarely or almost never cause cervical cancer. (Boardman,2018) However if lesions are found and not treated, they are more than beliketo turn into cervical cancer. (National Cancer Institute, 2014) There are different levelsof cervical cancer that decipher the progression on epithelial tissue. CINgrade 1 is low grade neoplasia invol ves around one-third of the thickness ofthe epithelium. CIN 2 refers to the abnormal changes in about one to two-thirdsof the layer. CIN 3 is the most severe affecting over two-thirds of theepithelium. 5% of HPV infected patients will acquire CIN grade 2 or 3 lesionswith three years of infection. Only 20% of CIN 3 lesions progress to invasivecervical cancer within 5 years. Only 40% of CIN 3 lesions progress to invasivecervical cancer within 30 years. Genetics can also play a role in a womans information of cervical cancer genetic connection holds fewer than only 1% of cervical cancers. Women who have an affected first degree biological relative have a two fold relative risk of developing a cervical tumor compared with women who have a nonbiologic first degree relative with a cervical tumor. Some specific genetic factors have been shown to be in association. The tumor necrosis factor is involved with cell apoptosis and a high incidence of cervical cancer. Polymorphisms, another gene dealing with apoptosis, have been linked to the increased rate of HPV and in turn, cervical cancer. Cervical cancer is the leading cause of cancer related morbidity in developing countries, but is very un third estate in the coupled States. Since 2004 rates have decreased by 2.1% per year in women younger than 50 years and by 3.1 per year in women 50 years of age and older. ACS reports 12,170 new cases of cervical cancer would be diagnosed in 2012. Age related demographics from 2004-2006 were highest among women from 50-79. But cervical cancer is possible to be present in any sexually active woman. In terms of race, cervical cancer rates per 100,000 women in the US from 2005-2009 are across the board Hispanic 11.8, African American 9.8, American Indian/ Alaska Native 8.1, lily-white 8.0 and Asian/ Pacific Islander 7.2. Internationally, 500,000 women are diagnosed every year.Prognosis for cervicalcancer is very good, especially when caught early. 5 year survival rates tier1 great er than 90%, Stage 2 60-80%, Stage 3 approximately 50%, and face 4 lessthan 30%. Treatment for this type of cancer is usually count onent on age,fertility or pregnancy plans. One procedure, LEEP, the loop electrosurgicalexcision procedure carries an electrical current through a electrify to remove abnormaltissue. Cryotherapy savezes the abnormal tissue. Laser therapy uses a beam oflight to remove or even destroy the cells. Conization can also be apply with aknife and laser. (Boardman, 2018) In severe cases removal of the uterus, hysterectomyis sometimes necessary. Radiation, chemotherapy and surgery can sometimes beperformed in other fundamental cases. However like any screeningtest there is always a risk of inaccuracy in spurious negatives and falsepositives. (National Cancer Institute, 2014) In some cases a pap smear can befaulty and must be reported in an official capacity. Some examples of thiscould be drying artifact or excessive blood. The person reading the smearcould touch these are factors that affect the reading. Inflammation can also bea problem in a Pap smear reading. Inflammation can be from infection orirritation. (Stppler)Uterine cancer is defined asthe any invasive neoplasm of the uterine corpus and is the most common pelvicgynecological malignancy in the United States. Uterine cancer can also belabeled endometrial cancer. The most common type of uterine cancer specificallyis endometrioid adenocarcinomas. (Chiang, 2017) It is believed to have twoforms type 1 or estrogen dependent and type 2, which is estrogen independent.(Holman 2012)Uterine cancer can start insmall areas or a diffuse multifocal pattern. Health care professionals canusually diagnose this type of cancer by the spreading pattern of the tumor.Usually the tumor will grow from the original location. This can tell thedoctor how far along the cancer is. Later tumor growth is testn throughmyometrial invasion and movement towards the cervix. The cancer itself can takefour diff erent routes to spread outside the uterus. Direct or local extendsbeyond the uterus. Lymphatic, referring to exposure to the pelvic, para-aortic,and sometimes the lymph nodes. Hematologic goes further reaching the lungs,liver, and bone metastatically. Lastly, peritoneal/ transtubular spreadresults in intraperitoneal implants. Staging of Uterine cancer,like most cancers, will depend on the amount of growth and spreading of thetumors. Clinical stage 1, which is the most common for patients, is strict tothe uterus. Stage 2 involves a large amount of the cervix. Stage 3 vaginal extension,adnexal mass, and/or suspicious retroperitoneal lymphadenopathy. Stage 4accesses the bowel and bladder and some other metastases around the body. Although pap smears are undischarged for cervical cancer findings, it is not as helpful in uterine cancer. accord to my findings, there are actually no screening regimens forasymptomatic women. The only screening mentioned is a transvaginal ultrasound,which d etermines the thickness in postmenopausal women. In the suspicion ofabnormalities, biopsies can be taken. Uterine cancer usually includes bothsurgery and radiotherapy. different treatments follow a hormone regimen. Otherforms can use estrogen replacement therapy and Tamoxifen, which is usually usedfor breast cancer but can be used on endometrium tissue as puff up. (Holman 2012)Because of the early representation of the cancer, treatment is usuallysuccessful and most do not progress past stage 1. Recurrences can happen andusually do within 3 years of the original diagnoses, which occurs in half ofpatients. (Holman 2012)(Uterine Cancer)Symptoms of uterine cancercan range from genital discharge, pain, weight loss, and change in bladder orbowel movements. However, postmenopausal bleeding is said to diagnose up to 90%of endometrial cancers. Another clinical finding would be glandular cells froma pap smear on a postmenopausal woman. Some risk factors are obesity,nulliparity, and late me nopause. Diabetes and hypertension are also conditionsthat. Less than 5% of this cancer is actually diagnosed when the woman isasymptomatic can increase the risk of uterine cancer. (Uterine Cancer) Most ofthe patients diagnosed with uterine cancer are obese, which can affect estrogenlevels. (Holman 2012)Over 50,000 cases of uterinecancer are diagnosed each year, leading up to 10,000 deaths per year. In womenalone, it leads to 4% of deaths related to cancer. 70-75% of cases arediagnosed at stage 1. In 2009, the survival rate for uterine cancer was 83.1%.(Chiang, 2017) A large majority of the population diagnosed are postmenopausaland ages 50-65, average age of 61. White women have the largest risk of uterinecancer in the United States compared to African American, Asian and Hispanicwomen. However, African American women have a larger rate of death.Interestingly, those women living in Asia or Africa have a much smaller rate ofuterine cancer than Asian and African American women in the United States.Smoking actually has been shown to decrease your chance of endometrial cancer.The use of contraceptive pills has also been said to be a protective measurefor women. (Holman 2012)In conclusion, Pap Smearscan be resourceful ways of detecting cervical cancer but not at large uterinecancers. Pap smears are a great screening method for obstetrician-gynecologists and their patients to catch and prevent cervical cancer. Bydetecting cervical cancer early, prognosis is very good and very likely in mostcases. These quick diagnoses from pap smears and other sources has madecervical cancer a very uncommon cancer related death for women in the UnitedStates. Unfortunately for developing countries, lack of medical resources andresearch has made discovering cervical cancer difficult and fatal. With theBethesda System doctors from all over can screen out cervical cancer the sameway. Pap smears are very accurate, but like any screening procedure there isalways the risk of false negati ves or false positives. Although Pap smears haventbeen shown totally reliable to detect uterine cancer, there are several othermethods to find uterine cancer. The most obvious can be the presence of postmenopausalbleeding in women, which diagnoses most of the cases. Transvaginal ultra soundcan be used to determine the state of the womans uterine tissue. These and afew others have been said to be more reliable than Pap smears. Counter segmentation toruling out Pap smear findings, one source does tell that if glandular cells arepresent than it might be uterine cancer. Like cervical cancer, uterine canceris most always found in early stages or stage 1 to be exact. This earlydetection makes it only 4% of cancer related deaths in women. In doing my research it wasclear to me that Pap smears are in fact helpful in detecting cervical cancerbut not as much in uterine cancer. I only found one source that mentionedfindings from a Pap smear for uterine cancer. This was entirely arouse tome be cause they are in very similar areas of the womans reproductive system.In doing more research, it makes sense that a pap smear rarely diagnosesuterine cancer because it starts inside the uterus. The cervix being much lowerand away from the uterus makes it easier to obtain cells and much morereliable. Finding cervical cancer can be much more direct and easily obtained.Getting to the uterus safely is much more difficult. In further research I believe it would be interesting to look further into minimally invasive ways to detect uterine cancer. Another topic is using the any findings from a Pap smear in detecting cervical cancer to relate to prevention of uterine cancer. Lastly, the result of cervical and uterine cancer on future pregnancy or on currently pregnant women. Works CitedUterineCancer. Uterine Cancer, www.csh.org.tw/dr.tcj/educartion/f/web/Uterine%20Cancer/index.htm.Boardman, Cecelia.Cervical Cancer. Practice Essentials, Background, Pathophysiology, 26Jan. 2018, emedicine.me dscape.com/article/253513-overview.Chiang,Jing. Uterine Cancer. Background, History of the Procedure, Epidemiology, 6Dec. 2017, emedicine.medscape.com/article/258148-overviewuterine cancer.Holman , Laura. The Epidemiology of Endometrial Cancer. The Epidemiology of Endometrial Cancer, 2012, www.glowm.com/section_view/heading/The%20Epidemiology%20of%20Endometrial%20Cancer/item/236.Stppler,Melissa Conrad. Pap Smear Facts About the Procedure, Pain &Guidelines.MedicineNet, www.medicinenet.com/pap_smear/article.htmwhat_is_a_pap_smear_procedure.Tan, Siang Yong, andYvonne Tatsumura. George Papanicolaou (18831962) Discoverer of the PapSmear. capital of Singapore Medical Journal, Singapore Medical Association, Oct.2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4613936/. Weber,Michael. Pap Smear (Pap Test) Reasons, Procedure, & Results. Healthline,Healthline Media, 13 Mar. 2017, www.healthline.com/health/pap-smear.Should abominate Speech Be Protected as Free Speech?Should Hate Speech Be Protected as Free Speech?Question Should hate computer address be bind by the overcompensate of publish savoir-faire?IntroductionHate public lecture is a controversial and often misinterpreted term for savoir-faire intended to degrade, intimidate, or incite violence or prejudicial sue against an individual or a theme of individuals based on their race, ethnicity, national origin, religion, sexual orientation, or disability. The term has been taken to cover written as well as oral communication.My starting position is that hate delivery is not just one thing there can be at least(prenominal) four categories of hate linguistic process that we can address.By the end of this essay I hope to have shown sufficiently which, if any, types of hate speech could be protected by the the recompense on way of free speech.Right to free speech and expressionPerhaps in a different era, the two could be seen as distinct, not just by name, but also in context.1The castigate of free speech is a human, form _or_ system of government-making or civil right recognised and apprehended by states and their citizens. It is the right to communicate ones opinions and ideas using ones body and property to anyone who is willing to receive them. It was included in the head start Amendment to the United States Constitution.2Although freedom of expression is sometimes used within an identical context, it nevertheless includes any act of seeking, receiving and imparting information or ideas, regardless of the medium used.Perhaps the most commonly cited interpretation is the one given by the United Nations in Art.19 of their UDHR3 adopted in 1948.4Along the same lines, Art.10 of theECHR5provides the right to freedom of expression, subject to certain restrictions that are in accordance with law and necessary in a participatory society.It is important to appreciate that the two are largely intertwined, and to be read separately would be of no particular value or help. For the purposes of this essay, I shall regard the two rights as two faces on the same side of a coin.Being part of a mathematical group of ideals or social goods even, the right of free speech is not specially protected from other ideals. It has to compete with much(prenominal) rights as right to private life, public security and pop fitity amongst others. There is no precedence that the right for free speech must always prevail.The wording of the front Amendment creates a defence for individuals and a difficulty for the state to regulate similar acts in the United States, as well as a desire to do away with the limitations already imposed by other states.6When may the right of free speech be limited?It can easily be imagined that the time, place and way of something being said or written or expressed in any other form is subject to scrutiny as to its appropriateness or inappropriateness respectively that is concomitantly contemplateed in regional legislations. This is not normally objecte d to.There is another controversial excuse for limiting it and that has to do with its content.7 A upright example is the restraint of circulation of Nazi ideas in parts of Europe. This is only to be expected, considering that the UDHR was an attempt to stop the terror witnessed during that war from happening again.It is important however to understand that all is meant by limiting free speech or prohibiting hate speech is not preventing someone from exercising the right, but rather a subsequent punishment.Hate speechThe prohibition of hate speech is often anathematised by the advocates for the right of free speech. Following Smolla, it can be generically defined as a speech assault based on race, ethnicity, religion and sexual orientation or preference8.Brison attempts to colour it even more by defining it as the speech that vilifies individuals or groups on the same basis and which is face to face vilification or constitutes a group libel9.Waldron also believes that hate speech is a form of group defamation10. I would think that defamation is more suiting as we have already accepted that hate speech can be manifested both verbally and in writing.When can free speech include hate speech?There is, of course, a number of commands articulated to justify the magnificence of including hate speech in the right of free speech, however, lacking space, I will address only the four that I consider of greatest importance. find of truthThis public debate has two distinct menstruations of interpretation. According to the first, we come to know more truth if we allow a free marketplace of ideas.11Advocates of the second stream claim that allowing discussions promote truth and the interests of the right for free speech more than restrictions, as it allows for comparing and contrasting arguments.Scanlon divides the possible participants in a trade of speech into speaker unit, audience and bystanders.The value protected by both is truth itself the speaker has an intere st in communicating an opinion the audience and the bystanders have an interest in evaluating and challenging the said opinion.Central to this argument is the importance of reliable and truthful information since it would be detrimental to knowingly spread opinions based on the perfidious and false information.12Note that this argument, like the rest, covers not only the promotion of views and opinions, but also of the communication of facts that do not invite evaluation, such as the name of professors in the University of Essexs Human Rights department.However, as Schauer points out, this value does not have an a priori precedence over other values.13Livelier apprehension and personal developmentAccording to J. S. Mill we come to apprehend the truth in a more lively way when we confront people who dispute our beliefs or be confronted by them respectively.So essential is this discipline to a real understanding of moral and human subjects that, if opponents to all-important truths do not exist, it is indinspensable to imagine them and supply them with the strongest arguments which the most ripe devils advocate can conjure up.14Eric Barendt addsRestrictions on what a man is allowed to say and write, or to hear or read, inhibit the growth of his personality. commonwealth will not be able to develop intellectually and spiritually, unless they are free to formulate their beliefs and political attitudes through public discussion, and in response to the criticisms of others.15Greenawalt provides further inputBy affording people an opportunity to hear and digest competing positions and to explore options in conversations with others, freedom of discussion is thought to promote independent judgment and unselfish decision, what might be characterized as familiarity.16The speaker here has an interest in influencing the thought and conduct of others through speech. Furthermore, according to Joseph Raz, the audience has an interest in auditory modality expressed id eas that may potentially reassure and validate their lifestyles. 17Democratic participationThis has been elaborated best by Cass Sunstein.Free speech is to be protected because it facilitates the egalitarian articulation, aggregation and balancing of interests, and is necessary if the people are to be able to decide for themselves the candidates they think most suitable for public office and the policies that public officials should pursue. This argument links free expression with a commitment to political equality and a belief in democratic deliberation.18The argument presupposes that the citizens of a democratic state have the right of free speech and are not negligent in exercising it fully. Democracy translates loosely into power of the people and by definition, for the sovereignty of the people to be effective, public opinions should be formulated free of any control or intervention by the government.As such, the speakers interest is in providing an opinion on matters of pub lic-political life, while the main audience has an interest in hearing the views of others, and gaining an understanding of political views and preferences.The argument of the right of autonomyIn considering a law that prohibits speech, Scanlon writesIn order to be protected by such a law a person would have to render to the state the right to decide that certain views were false and, once it had so decided, to prevent him from hearing them advocated even he might wish to19He goes on to argue that that since an autonomous persons reason is sovereign over her own decisions, it is incompatible with her autonomy to be shielded from certain evaluative views, or factual information, even if only to neutralize the harm to her of coming to have false beliefs.20Greenwald describes such intervention as viewpoint discrimination21, the very thing that the First Amendment is employed to counter.This corresponds to the right of the audience not to have restrictions on their range of options to choose from in order to formulate an autonomous decision.Let us now examine the kinds of hate speechTargeted vilificationSpeech directed at specific individuals or small group and with the intention to harm and insult the audience. The speaker consciously selects the wording for its potential to achieve just that.22 Contrary to what Brison argues, I would argue that it should include non-face-to-face acts, such as cases when is not direct but sufficiently specific.23The content itself does not usually qualify adequately as an assertion of fact, expression of an evaluative opinion or even of a valid political preference, since it is usually based on false accusations.Also, the speaker cannot barricade behind the right of autonomy and argue that non-racists are privileged over racists, since having a right of autonomy does not imply having the right to be racist and furthermore clashes with the rights of others to be equally autonomous.It does not encompass the essence of the right, it does not promote the interests that the right seeks to, and it is not what is meant when the right for free speech is interpreted therefore we can conclude that targeted vilification should not be protected by the right to free speech.Diffuse vilificationThis is speech directed at a friendly or of mixed sentiments but larger audience than targeted vilification, but nevertheless has the same intentions to assault individuals based on the group they adhere to, or even the group itself, although they may not be the immediate audience.24 It usually employs symbols or banners with group specific insults.An example would be the Nazi march in Skokie, a closure with a notable population of holocaust survivals and younger Jews. There is an translucent intention to cause emotional distress and so, any speech or acts employed and political symbols used could not be excused as such, but as insulting, harmful and intimidating.25A fair excuse would be that the allegedly distressed could avoi d the march. To what extent this is possible depends on other factors such as prior sufficient advertising and the financial or effort overbearing on the victims part.This becomes more apparent when the cost to pay to avoid the distress would mean losing ones work or avoiding communing areas or even becoming antisocial. This would clearly outweigh the interests of the speaker.Evidently, diffuse vilification promotes free speech interests at a far higher level than targeted vilification it can take the form of honest albeit mistaken at times expression of political and evaluative opinions, precisely because it is not targeted but addressed to a wider audience, which could be proactively met and discussed with an opposing group.Although in its honest and fair form it should be protected by the right of free speech, in my opinion, the government has enough justification to come in and attempt to control the manner in which it is expressed, and specifically by regulating the prohibit ion of speech, acts and symbols used for their potential to offend and/or to incite hatred and violence towards another social group.Advocating exclusionary policiesExclusionary policies are those that attempt to exclude certain social groups from equal participation in decision making and full enjoyment of their citizen and political rights. In its extreme form, this could include advocating genocide and ethnic cleansing.26The harm caused by a possible adoption and enactment of such policies is not easily outweighed, especially by the arguments for the discovery of truth and of personal development for obvious reasons.Following the argument for democratic participation, such cases constitute political speech, or part of, which the right of free speech clearly intents to protect. However, allowing the advocating of non-democratic ideals in a democratic society brackets body politic itself.I do not accept that democracy should succumb to such hypocritical arguments. I agree with wh at Rosenblum terms as militant democracy who attempts to defend itself. 27Even though state controls on political speech is restricting political equality, a democratic value, it is acceptable to do so when the speaker advocates anti-democratic values, even more so when they are advocating restriction on the political equality of others.From the perspective of the argument for autonomy, it can be argued that people should be allowed to exercise their right as rational sentient beings and consider, reflect upon, and decide for themselves which political speeches to support and which to strike down, without the need to cede their right to do so to any government.28However, how through empirical observation justified is, or can, that be? What assures us that citizens will in fact make the right choices? What assures us that citizens will even bring themselves to consider such important and hard matters? Is it not the case that people who do concern themselves with such issues have a pr ior long time interest in them? How can we be sure that the citizens actually have the necessary mental capacities to fully comprehend the speech and its consequences?A democratic society is successful not only because of alleged equality, but also, because of alleged intellect. Following the notion of militant democracy not only there should be intervention to prohibit anti-democratic elements from exploiting democratic values, but also, there should be intervention to debunk, rebut and expose anti-democratic speeches. If the body of citizens is not able to comprehend it fully, the democratic government, assuming it is able to comprehend it, should stones throw in.In my opinion, although this category is part of the general category of political speech, which the right of free speech intents to protect, it can take the form of anti-democratic speeches and incitement of hatred that may lead to horrid results. To this end, I conclude that this form of speech could be protected under the right of free speech, but the states should reserve their right to intervene in such circumstances that put into danger and jeopardize their very democratic nature.Harmful assertions of factThe notion that free speech should include the right to speak words that insult others, or saying what others do not like hearing, has become part of the modern societys pop acquaintance heirlooms.The combined promotion of the values of truth, democratic participations and autonomy is indispensable, even though we cannot deny that even these assertions can cause grave harm to individuals or groups.A fair objection to protecting these kinds of assertions I have found is what Margalit and Raz call the self-respect and dignity of group members, which are being threatened by such assertions.29This links to a reversed interest for personal development on the part of the group members, especially when it comes to social groups identified by ethnicity, where self-dignity and self-respect depends o n the dignity and respect assigned to that group by others.However, can it not be said that a Kurdish minority in Turkey or the UK should be exposed for their practice of FGM30 and to evaluative opinions and scrutiny from the rest of society about it, independently of their other dignity recognition and respect issues?In their extreme form, such factual assertions and evaluative opinions may lead to unjustified hate crimes and violence against innocent members of targeted groups. A classic example is the growing contempt that locals feel against immigrants in most countries.Even if top level surveys manage to prove that economic crisis, health system deterioration or other social harms are caused by immigrants, there is a huge leap from an empirical observation to undemocratic acts of violence.Militant democracy should step in here once again, not only to prohibit and punish such actions, but also, I would argue, to better regulate the matters revealed by such surveys.31Despite all these, harmful assertions of fact can be seen as promoting the interests embraced by the right of free speech. Even with harmful but not extreme assertions, an available remedy would be counter speech instead of restriction. This is possible because they are not mere vilification, but truthful and empirical assertions of honest intentions and therefore do not cause emotional distress.32In my opinion, a government should not be able to intervene by prohibiting the expression of such assertions, but they should be allowed to prohibit and punish individuals who misinterpret such assertions from resulting to hate crimes such as racial attacks.By saying this, one may think that I refuse to consider what some call group libel as hate speech worthy of being punished. This is not the case, since libel, defamation in general, is harmful yet untrue assertion. Even though some may disagree as to the context of vilification, I take it to also have an element of faulty accusations.ConclusionI do not see hate speech to have just one singular face. As I have shown, it can be manifested in many different ways, which can in turn be judged on different grounds. Therefore it is inapplicable to argue that it should be either protected under the right for free speech in its entirety, or not at all.I am of the opinion that some forms of hate speech should be protected by the right of free speech, because of the benefits bestowed to society.Some other forms should not be protected states should take steps to better inform citizens about the different shades of hate speech and democratically establish legal frameworks to punish the ones that fall on the negative side of the spectrum.1 Due to the frustratingly large portion of the first draft of my essay spent on citing relevant treaties and articles defining the two rights, and assuming that the reader is familiar with them already, I have decided to include the definitions in footnotes, as they do not count towards the total word count. I do realise that this is inelegant, but I am exercising my right of autonomy to promote my personal interest, namely of not being penalised. Forgive me.2 First Amendment to the United States Constitution reads as follows Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof or abridging the freedom of speech, or of the press or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.3 United Declaration of Human Rights4 Article 19 of the UDHR states that Everyone has the right to freedom of opinion and expression this right Includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.5 European Convention on Human Rights6 UK Sec. 18 (1) of thePublic Order Act of 1986 France Sec 24 of the Press Law of 1881 Denmark Article 266 (b) of the Danish wretched Code The Netherlands Artic les 137 (c) and 137 (d) of the Dutch Criminal Code7 i.e. the grounds cited in ICCPR and ECHR are content relevant.8 Smolla, 1991, 1529 Brison, 1998, 31310 Waldron, 2009, 1600-160111 Justice Holmes obiter dictum in Abrams v. United States, 250 U. S. 616 (1919).12 Cohen (1993 211, 229).13 Schauer (1982 23, 33).14 Mill15 Barendt (1985 14).16 Greenawalt (1989a 143-5).17 Raz (1991 311).18 Sunstein (1993 xvi-xvii).19 Scanlon (1972 217).20 Ibid.21 Greenawalt (1995 32).22 Greenawalt (1995 49).23 i.e. glum letters, vandalism and so on and so forth.24 But may be bystanders.25 The fact that a march in virtually every other village or even a march in the same place but without the symbols would not constitute diffuse vilification but would rather be political speech only proves the dishonest intentions of the marchers. (Feinberg 1985 86).26 With notable examples the anti-Semitic speeches in Nazi Germany, anti-Greek and anti-Armenian speeches in Turkey, 1910-192227 Nancy Rosenblum (2008 412-455 ).28 i.e. the ban of Nazi parties from political life in Denmark29 Margalit and Raz (1990 119).30 effeminate Genital Mutilation31 Although not relevant to this essay, I would argue that the right of free move and work is a lot like the right to free speech in the sense that it is important but militant democracy should intervene to prevent it from harming a democratic state. A failed example of this would be Italys policy which only allowed a very limited percentage of immigrants. Surely, a middle position would be more successful.32 For example, a Kurdish should have been able to reflect upon the issue of FGM before encountering an adversary of the practice.