Sunday, March 27, 2011
Saturday, March 26, 2011
Broken promises are primarily about trust. Each promise that is not kept erodes at the base of the relationship we share. It is a challenge faced regularly by parents in the negotiating space which young children bring to the family environment. As a parent, I was always careful in answering children’s questions not to breach that trust. This can be quite tricky at times. “Is there a Santa?” is but one of those questions which places the parent in a difficult position. I preferred to be honest with my children. “Of course there’s a Santa!” I would reply, “…I’m Santa!” Delivered with the appropriate sense of irony and robustness, the children would laugh and decry my claim. When the truth dawned on them and the challenge of integrity was raised, I was able to remind them of my honesty. At other times it was better to reflect back the question with another, or offer an explanation of an apparent injustice, seeking to help the child grow in understanding and maturity. To admit that I blew it, and explain why I haven’t delivered on a promise might not make all things right, but often serves to strengthen the relationship.
However, keeping promises isn’t always easy, or even possible. There are times when circumstances have intervened to stymie the keeping of a promise to a family member. And then there were some promises which should never have been made – those blanket, romantic assertions which are beyond the capability of anyone to deliver. “I’ll never let anything happen to you…” “I’ll always be here to protect you…” It is part of the growth of parents and children that the discovery of human limitations reveals the fallacy on which such promises are made. As idealistic as it might be to believe that all promises must be kept, we recognise that there are times when promises need to be broken, and even that there are times when promises are made in order to be broken. While we might readily debate the ethical principles at work, we all operate at some level or another in complicity with such an understanding.
In any case, it would deeply disturb me if we simply elected leaders to be automatons who simply and only implemented the promises they made during an election campaign. We elect our leaders on the strength of their promises and for their ability to lead. These two often exist in creative tension. Ought we have expected the Rudd government to maintain budget surpluses when the Global Financial Crisis hit? To do so would have been an abrogation of leadership, sacrificing responsible leadership on the altar of purity, and we all would have been losers. And how would we have expected leaders to respond in the wake of September 11, given that no promise had been made at the previous election about such an event. We simply cannot afford to restrict leaders to do that and only that which they had promised at the last election. Our representatives owe us their judgment, and we ought to not only expect it of them, but demand it. An opportunity to deliver our assessment will follow at the next election. Arguably the electorate did so in 2010, turning on a government lead by a person who declared climate change to be “the greatest moral challenge of our time,” and then backing away from acting. But the electorate at the time did not embrace the alternate position either.
I can appreciate those who protest the government’s commitment to a price of carbon when they argue the merits of the approach, but not on the basis of some confabulated sense of broken promises. The question at hand is not whether the promise delivered at the time of the election was broken – a debate which could last for years without resolution or agreement – but whether the approach adopted towards the delivery of an ETS is both needed and appropriate. The former response is at best unproductive and at worst potentially divisive. The latter allows all to air their perspective and concern and allow the community to reach some form of agreement or acceptance about the way forward. Banners of the ilk represented at yesterday’s Canberra gathering are neither witty nor constructive, serving only to demean the spirit and integrity of their protest rather than to further debate or understanding, and are ill-befitting those who seek to claim the high moral ground.
Friday, March 25, 2011
THERE was a moment during the last national debate on euthanasia that deserves to be revisited by a new generation of legislators, a moment that crystallised fears that the so-called right to die would come to be felt by the frailest among us more as a "duty to die".
It was 1995 and our then governor-general, Bill Hayden, was addressing the College of Physicians during debate on the Northern Territory's euthanasia laws. The scene was significant, since the dual concern with euthanasia is the corruption of the relationship between the state and its most vulnerable citizens, and between doctors and their most vulnerable patients.
Our head of state urged doctors to support euthanasia not only as a right, but also as a positive duty towards society. He reflected on past cultures where the elderly would take their lives when their usefulness had passed, and declared of our own culture: "There is a point when the succeeding generations deserve to be disencumbered of some unproductive burdens."
The next day a retired state governor, Mark Oliphant, publicly supported Hayden's astonishing message to "unproductive burdens" that they should do the right thing by society. This is the callousing of social attitudes, the insidious pressure on the frail and demoralised, that we could expect within a culture of mercy-killing.
A year earlier in Britain, a House of Lords select committee on medical ethics completed the most thorough enquiry into euthanasia ever undertaken, and concluded in stark contrast to Hayden: "The message which society sends to vulnerable and disadvantaged people should not, however obliquely, encourage them to seek death, but should assure them of our care and support in life."
This committee began with a majority in favour of euthanasia, but ended by rejecting it as unsafe and corrupting public policy:
"It would be next to impossible to ensure that every act of euthanasia was truly voluntary. We are concerned that vulnerable people - the elderly, lonely, sick or distressed - would feel pressure, whether real or imagined, to seek early death."
Doctors have no illusions about the pressures that can be felt by vulnerable people.
One patient of mine, a woman with disabilities and minimal self-confidence, received a cruel letter from a close relative effectively telling her she should be dead, and demanding certain arrangements in her will. She then developed cancer.
Consider such family dynamics in a setting of legalised euthanasia, and ask what the "right to die" would mean to a cancer patient so isolated and intimidated.
And the public should have no illusions about the corruptibility of doctors if they are given authority to take life.
According to the Dutch government's own data, doctors in The Netherlands put to death several hundred patients a year without any explicit request, even where the patient is competent to give or withhold consent.
The Dutch officially legalised voluntary euthanasia in 2002 and some claimed that bringing euthanasia "out into the open" in this way would reduce such abuses. Not at all. The Netherlands' 2007 report on euthanasia states that the rate of patients killed "without explicit request" since legalisation in 2002 is "not significantly different from those in previous years".
And why would we expect a reduction?
Doctors who treated the law with contempt when euthanasia was illegal would be even more comfortable and relaxed about abusing the practice once it was socially approved.
Professors of psychiatry in Brisbane, Frank Varghese and Brian Kelly, warned of the impossibility of protecting patients from "the doctor's unconscious and indeed sometimes conscious wishes for the patient to die" once doctors run the state machinery of mercy-killing.
Even the assertion by euthanasia advocates that psychiatric assessment will protect patients by detecting any depression that might be marring the patient's judgment is shown to be a sham, on the available evidence from the US State of Oregon and the Northern Territory.
In Oregon, for instance, of the 49 patients who died by physician-assisted suicide in 2007 not a single patient was referred for psychiatric assessment prior to taking their lethal drug. In the NT during the period of legal euthanasia (July 1996 to March 1997) there were four deaths, all presided over by euthanasia advocate Philip Nitschke.
Psychiatrist and palliative care specialist David Kissane reviewed Nitschke's cases and made this assessment of the so-called "safeguard" of compulsory psychiatric assessment:
"Nitschke reported that all patients saw this step as a hurdle to be overcome. Alarmingly, these patients went untreated by a system preoccupied with meeting the requirements of the act's schedules rather than delivering competent medical care to depressed patients."
More than once I have urged Nitschke to study palliative medicine, to broaden his awareness of what can be done for people with advanced disease. When we look after such patients well, thoughts of euthanasia often fade. Then, in the words of one hospice patient who had asked me for euthanasia only the day before, but was now pain-free, "It's a different world, doc."
However, I would not use the argument against euthanasia that "palliative care can ease all suffering". We cannot ease all suffering in dying any more than we can ease all suffering in childbirth, even though we have made enormous progress.
Rejection of euthanasia is not dependent on perfecting palliative care for all patients.
Its rejection is on the grounds of injustice to the weak, as Kevin Andrews made clear on presenting his Euthanasia Laws Bill 1996, which overturned the NT's legislation: "The people who are most at risk are the most vulnerable, and a law which fails to protect vulnerable people will always be a bad law."
We must reject euthanasia both as a corruption of the doctor-patient relationship and as an insidious oppression of society's "unproductive burdens".
And parliament must reject the Greens' trivialisation of such a momentous issue, their proposal that five politicians on Norfolk Island or nine in the ACT assembly should have authority to transform national culture on a matter of life and death.
David van Gend is a Toowoomba GP and a senior lecturer in palliative medicine at the University of Queensland. (This article does not purport to represent the view, if any, of the university.)
Wednesday, March 23, 2011
While residents on the north coast of Japan watch and wait as the environmental impacts of the damage to its Fukushima nuclear power generators in the wake of the devastating earthquake and tsunami, and communities along the Gulf of Mexico continue their cleaning efforts after the sustained release of oil energy from the disabled drilling platform, Melburnians today are being warned of a major energy disaster engulfing the city. Energy many times the capacity of either the reactors in Japan or the oil wells in the Gulf of Mexico is being released across the city in an unrestrained way, impacting the lives of every resident of and visitor to the city. Daily reports of this leak fill our news media, with papers regularly reporting the times in which its release begins and ends, often indicating when the peak impact will occur during the day. Radio programs punctuate the hour with updates, often reinforced across the hour. Yet in their typically laconic Aussie style, Melbourne’s residents seem to take it in their stride.
Far from being concerned about this release of energy into the atmosphere, Melbourne’s citizens seem to revel in it. Though extreme circumstances can cause severe damage to the skin, and often lead to a significant reduction in productivity, marked by a surge in residents leaving the city and heading to the shores, shedding work responsibilities and, incredibly, soaking up its rays, for the most part the atmospheric presence of this unrestrained energy source is taken for granted, with little pressure being exerted upon governments and industry to take action to curb this waste.
A variety of symptoms of exposure have been reported, including in its mild forms, increased consumption of liquids, and the shedding of external clothing by humans, and at extreme levels increased risk of skin cancers. But its release can also lift sombre moods, stimulate the playful twitter of bird life, and the encourage the blossoming of flowers and flourishing of gardens. Oddly enough, a common response when this energy release is at its peak is for Melburnians to increase demand for and consumption of coal and gas-fired energy sources which have even more adverse effects on the atmosphere and the broader environment, intensifying its impact in the atmosphere. Some of Melbourne’s citizens have consequently been pressing for investment in the nuclear generation technology which has Japanese residents presently in a heightened state of alert. In spite of the abundance of this energy source, few Melburnians seem concerned enough to harness and utilise solar resources in the overall generation of power through its infrastructure. This terrible and unconstrained wastage passes daily with little concern by the average citizen, save to occasionally retreat when at its most intense or, paradoxically, also when it is at its least intensity. In stark contrast to the citizens of Japan and the Gulf Coast, Melburnians seems strangely relaxed about this unconstrained release into the environment and the accompanying wasted opportunity, yet at the same time apparently concerned that we move to harness and deploythe very sources of energy which have paralyses these other places for extended periods.
Interestingly, were such unconstrained release of energy of the kind we see each day be of any other form of energy being consumed around the world, the death toll would be enormous and the environment damaged to the extent that it would be uninhabitable. Conversely, harnessing this power source for our daily conduct of life will do nothing to diminish the enjoyment of it in other ways by others, and may even provide benefits in other ways to our communal well-being, without the risks which most alternatives bring. It almost beggars belief.
So every time you hear a weather report today and revel in the sun’s rays, take a moment to remember and perhaps pray for our sisters and brothers in Japan, and contemplate the waste we tolerate every day.
Monday, March 21, 2011
The intervention of the United Nations into the Libyan struggle, while welcome at one level, and a game-changer at another, will also change the nature of any victory which ensues. The struggle for change in Libya commenced as an internal struggle, not unlike others seen in recent weeks in the Middle East, most recently Egypt, where the victory was won by non-violent revolution within the powers of the people. True democratic reform has taken place because it was the voice – and actions – of the people which prevailed. Libyan citizens, encouraged by what they had seen in the neighbouring country, took up the struggle for change. The time seemed right to bring the long rule of Colonel Gaddafi to an end. However, Gaddafi not only resisted the voices, he responded with force against his people, and the people were threatened.
At one level the response of the United Nations to sanction military intervention by other nations is understandable. Gaddafi was not going to go quietly, if at all, and the cost in terms of lives was set to escalate. Having stood by and watched such brutality in other countries unfold without intervention, and with an escalating and tragic cost in lives – both in terms of number of deaths and in the number of refugees created, the argument for intervention was made, and accepted. But in so doing, the nature of the struggle has changed.
The use of such a powerful force against the Gaddafi regime, nominally in enforcement of a “no-fly zone” changed the game significantly. No longer is this simply a battle for political transformation rooted in the power of the Libyan people, it has become a battle of forces far greater. Any victory is no longer an ideological victory based in arguments for a freer and fairer Libyan society, it has been shifted into a battle based on who can unleash the greatest force for the longest time. Paradoxically, an act taken to empower the Libyan people may well undermine the very case they are trying to make – that true political power is rooted in the voice of the people, not in the tyrannical exercise of force.
If Gaddafi manages to survive this assault, his position will be strengthened, and an argument can be made that the coalition has effectively undermined the moral authority of the arguments made by the Libyan people in their rebellion. If the UN coalition succeeds in removing Gaddafi from power, there consequently exists a moral claim upon whoever assumes power in his stead, one which has laid a foundation of power which still rests upon violence. The game will have been won, but a far different game than envisaged at the outset. It is no longer only the struggle of the Libyan people, it is now a battle between Gaddafi and the world. Any victory will thus create a power vacuum, echoing problems we have seen in Iraq and Afghanistan. And with the additional factor in the equation – Libya’s oil reserves – at the heart of Western interests, a new power struggle emerges in the wake of any regime collapse.
We may well ask about the alternatives. Should we have let this struggle play itself out as an internal struggle, just as the world allowed to happen in Cairo? Do we not believe in the power of the people’s voice – democracy – enough to let this struggle continue? Is the presence of oil the real catalyst for action, or a genuine and altruistic commitment to protect the Libyan people who began this uprising and were struggling to see it through? These are complex questions. But it is of concern that we turn so readily to the use of force to solve such problems… if such actions really do solve them at all. Is the ultimate answer to all tyrants only that we have the bigger weapons? What happens if they manage to gain this upper hand?
Wednesday, March 16, 2011
Tuesday, March 15, 2011
The first part of 2011 has been remarkable for the number of catastrophic events which have been on our screens and in our newspapers. Floods, cyclones, bushfires, earthquakes, and tsunamis have appeared almost in sequence within this region of the world, prompting many to pause and ask “what is going on?” The ever-present and continuous news presentations providing blanket coverage of these events has, to some extent, heightened awareness and – possibly – the sense of trauma being felt within the community. The distance from our lounge-room chairs to the flood-devastated residents of Brisbane and North Queensland, to the bushfire threatened residents of Perth, to the shaken and shattered residents of Christchurch or to the inundated residents of Japan has been greatly reduced by the wonders of telecommunication technology and the conspicuous presence of 24-hour news coverage. It is hard to avoid being drawn into these dramatic events. It is equally difficult to escape their presence. The trauma being experienced by the residents is encroaching upon our daily lives.
At one level, the sense of disaster we feel is heightened by our proximity to the events, both in vision and experience. Who can but help to be shaken by the images of waves destroying everything in their path which have saturated our screens in recent nights? How can we not be shaken to the core as we witness first-hand the distress of residents standing outside collapsed buildings wondering whether friends and loved ones are trapped inside? We experience these things in their raw state, entering ever more deeply into the experience of the residents. Not for us any longer the capacity to wait for news to reach us, often processed with the benefit of passing time. It is raw. It is filled with anguish. And the very screen which brings us into this drama also cuts us off from resources to help us process it. Aid and support workers are on the ground helping residents deal with their shock and grief, but not in our lounge rooms. We find ourselves either immersed in the trauma, or conceptually reducing it to a form of entertainment. (Remember the reminders during the events of September 11? Newscasters had to remind audiences that this was real. Note that we no longer find the need to do so.)
At another level, we seem to have been hit by an uninterrupted sequence of catastrophic events of an extreme nature. This sequence also gives rise to the question – is there something unusual about this sequence? Have we tripped off events by human action? While I resonate with Boris Johnson’s decrying of those who search for simplistic answers to this situation, I hesitate to rule out the need to ask ourselves whether our actions have somehow disturbed the delicate balance in creation to a point where the frequency of events has been accelerated and their ferocity intensified. Is it realistic to assume that we can extract billions of litres of crude oil from below the earth’s crust and replace it with seawater without upsetting the balance? Is it naïve to believe that setting off nuclear explosions beneath the earth’s surface has no impact on the stability of the tectonic plates? We are already pondering the impact of our carbon emissions on the planet… ought we not extend our considerations to other aspects below the surface? Of course the earth is not a person who “exacts revenge.” It is, however, a system in balance – an ever-shifting balance with tremendous capacity to adapt to changes – but one which does have limits to its flexibility. We can no longer presume on human capacity to treat creation as its plaything without some consideration of the potential consequences. Whilst I would agree that it is only human stupidity which seeks to ascribe simple or singular causes to such events, I would also suggest that it is only human arrogance that can allow us to continue as though these things were entirely matters of chance.
Yet when we hear the question, “What is going on?” echoing through ordinary conversation, we recognise the conversation being turned towards discussion of meta-narratives – is there a bigger picture of which this is part? The search for meaning is a basic human trait – that sense of purpose in life which explains who we are and why we live in a certain way. Although some might suggest that the idea of the meta-narrative has gone the way of the dodo, its resurrection at times such as this (and not only at this time) indicates that questions of meaning are still very much alive. This is why some find it irresistible to offer simplistic explanations: “It’s the judgment of God,” or “It’s the earth fighting back.” These are as helpful as Johnson’s suggestion that “we don't have to treat this as any kind of verdict on mankind's activities,” or to borrow a phrase from another politician, “shit happens.” An inappropriate response – at either end – does not invalidate the question. There is a middle ground where some thoughtful reflection needs to be undertaken about the impact of our lifestyle on the planet while we pour our efforts and resources into aid and support for the devastated regions (and not just those in the West!)
We do need to contemplate where our lifestyle is leading us, and whether these events are indicators, or simply isolated episodes consistent with the inherent volatility of our planet. Failure to even ask the question might allow us to journey into even deeper troubles.