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Well, it looks like we're jumping right back into the euthanasia debate. The Straits Times carried a Saturday special report on the issue, and Sandra Davie posted something in her blog...
The debate is important to have....but sadly it is beginning to sound tired,...kinda like a broken record that does not go anywhere.
People's positions get hardened around extreme and unrealistic positions. There are deliberate obfuscations so that it seems like everyone is playing in their own soccer fields. There is a general confusion about the AMD which is unfortunate as it is in a totally different playing field. Then there is the almost deliberate blurring of the line between murder and euthanasia, as if it is something done with the patient's full and informed consent. Sadly, after a protracted period of these confused meandering, the government will step in and proclaim that there is enough public debate, and that adequate public opinion has been sought, then proceed to implement its agenda.
How sad. How tragic.
I believe, if the discussions are to be meaningful:
a] The topics and definitions need to be carefully and clearly circumscribed. We need to deal with each problem clearly and specifically.
b] The main points of contention must be clearly identified and dealt with. In this regard, I see one of the major sticking points is the apprehension that the essentially noble idea, will eventually be abused, and extended to less noble ends. In the ST report, bioethicist Margaret Sommerville pointed out this 'slippery slope'. She says, "Once euthanasia is legalized, its availability expands.". She is right.
The government, and proponents of euthanasia must therefore spell out how this creeping availability, and extensions of the application of the euthanasia principle, can be managed and controlled.
c] The government must make more effort to manage the perception that this is somehow linked with the commercialization of health care. Why now?? It didn't help that this was brought up almost in the same breath as the organ trade issue. The public should be rightly concerned that euthanasia is only being surfaced now as an alternative medical option, just when there is this massive national push to establish Singapore as a 'grandmother of all medical hubs'.
If legalized, euthanasia should never ever be part of any activity associated with commercialized medicine. And it should never be offered to anyone who is a non citizen.
There is a bunch of funny picorna viruses which tend to infect babies and young children. They produce a febrile illness accompanied headaches and characteristic rashes over the body with ulcers on the palms, soles and the insides of the mouth. Although usually mild and self limiting, the illness does rarely affect the brain and produce fatalities. Locally apparently the virulent and more dangerous EV71 virus is quite prevalent.
I became interested because there was a recent apparent fatality due to Hand Foot and Mouth Disease (HFMD). He was only 12 years of age. This was apparently only our second HFMD death since 2001.
The incidence of HFMD in Singapore has been increasing. The figures in 2008 are alarmingly higher than 2007. There was a large spike earlier in April-May this year, and another smallish one extending from November through into December. Both these periods had numbers which brought the disease into epidemic proportions
.
Graph from MOH site. Click picture for a larger view.
Although understandng the Ministry of Health's reluctance to create any sort of public panic about what essentially is a relatively mild childhood disease, the single reported death last Sunday is a cause of concern.
I tried to find out more from the MOH website but couldn't get much other than the figures displayed here.
Some missing information which should be of public interest include:
a] How many of these numbers reported were actually HFMD? Were they all lab diagnosed with specific HFMD serlogical tests? Were they specifically examined for the virus type...were they all EV71?
b] What is the frequency of EV71 infections as compared to other milder versions of the picorna virus.
c] Was the recent death examined for EV71? Was it clear that this was HFMD? Why does it take so long to do a PCR virus analysis.
For an infectious disease of this sort, I found it quite discomforting that these info were not readily available to the public. For parents to be reassured, and for them to be able to make sensible and rational decisions about their children, the Ministry of Health really needs to be more upfront about telling us what's going on.
Just like the AVA, the people in MOH tend to treat the public as if they were morons or immature children who cannot deal with information other than highly sanitized ones, and are totally incapable of making rational decisions.
Bacteria are not necessarily our enemies. The TB bug (Mycobacteria tuberculosis) has been around for a very long time and has co-evolved with us. For the most it is quite content to grow slowly and hide in our tissues without much fanfare...flaring up only when our immunity is down. You would consider that a smart bug will not try and kill its host.
Another smart bug began collaborating with us from our very origins. The earliest cells enveloped them into their internal environment, and outsourced their energy requirements to them. In time they got incorporated into the energy functions of every living cell, and even insinuated themselves into our reproductive cycles. These bugs, now called mitochondria (singular, mitochondrion) gets transmitted with our mother's eggs.
Many scientists believe that the health of these mitochondria may underlie much of human health and disease.
We still do not know what is the ancestral bug that gave rise to the mitochondria, but we are all agreed, this is one very smart bug.
The other colourful event on the roads that never fails to lift my spirits every evening on my drive home, is the florid coloration of that line of shrubs alongside the Bukit Timah canal directly opposite Hwa Chong Jr College.
It took me quite a bit of effort to track down the identity of this beautiful shrub, but I finally found it!! It is apparently the Syzygium campanulatum (variously known as Eugenia oleina and Kelat paya)
The shrub is particularly beautiful as its new leaves are orangey red. The National Parks people did a fantastic job in planting a dense row of these lovely shrubs opposite HCJC. The new leaves are all out and that short drive is so delightful because there is this tall wall of autumny colours flanking you. It's one of the rare occasions that I actually enjoy being caught in the traffic there!
There is a nice blog post about this shrub here...go check it out.
It was easy to contemplate reimbursing kidney donors. It just made sense to do so. Just as it did legitimizing the process.
Now when the discussion and dialogues begin it is starting to look pretty scary.
Minister Khaw Boon Wan was reported in today's Straits Times, as having said at the first HOTA dialogue session with some 300 grassroot leaders, that Singaporeans and foreigners should receive the same reimbursements. Far'nuff, I thought. Except that this is probably the first clear indication that we were clearly going to be purchasing organs from overseas, that we were not going to limit this reimbusement for organ donors thing to just a Singapore activity. Viva la Singapore Medical Hub!!
What was also worrying for me was the almost unanimous voice that supported the organ trade lobby. The reimbursements, far from originally proposed that it was only to cover costs of medical procedures and associated costs for time etc, would be in the tune of $50,000-$100,000.
Whoa....!
This was human organ trade getting into full swing. Let's not bother about those airy-fairy ideas of inducements and exploitation. If we need those organs, just go ahead and buy them off those poor sods for whom $100,000 would represent several lifetimes of income.
I hope that Minister Khaw will consider (and I trust he will because I believe he is at the core, a good and ethical person) that the opinios solicited at his dialogue do not represent the universe of opinions and are heavily biased towards the recipients position as many of those represented there will have friends, relatives and constituents who are potentially recipients of the donated kidney. There are no voices there that effectively represent the potential donors, and the populations from whom the potential donors will come from if the great kidney sale extends to the international community.
One of the very pleasant surprises on our roads these days is the sudden flowering of the Yellow Flame (Peltophorum pterocarpum). 
Sometimes they are called the Yellow poinciana, and contrasted to the Red Poinciana (Flame of the Forest). These bright yellow blooms have brightened up some of my long drives on the expressways. If you want to catch a nice display, there is a beautiful scattering of these trees around the Moulmein exit of the northbound CTE (Central Expressway). Go catch it before it disappears.
Dr Lee Wei Ling has jumped back into the fray once again with respect to the kidney trade issue. Today's Straits Times carried carried half a page of her rants about this much debated issue.
I have great respect for Dr Lee. At other times she has given voice to segments of society that have been marginalized, and otherwise voiceless. But on this issue, I believe she is way off course. There is no doubting her passion in wanting to save the lives of patients who are dying of kidney failure. But her passion is misplaced, when she chooses to dismiss the exploitation problem. In doing so, she has chosen to take the side of the wealthy sick against the poor. Is the life of a wealthy Singaporean worth so much more than the welfare of the poor that she should so readily brush off any suggestion that they may be exploited in this transaction?
She makes the point that "If the seller makes an autonomous decision and, in return, receives a substantial payment that may improve his and his family's quality of life, why should that constitute exploitation?" I would find nothing objectionable in that statement, other than the fact that in a dependent and vulnerable position, the donor is not likely to be able to make a fully autonomous decision. Yes, he/she remains lucid, and rational. Yet we know that given a real choice in the matter he/she would rather not have to sell his/her kidney, whatever the price. She herself acknowledges: "Let's get real: Who would willingly donate his kidney to a stranger without profiting from that act?" She herself would not. She should therefore ask herself why a poor man/woman would go under a knife and 'donate' his kidney to a stranger unless the financial reasons were so compelling. This is the very nature of an 'inducement'. A fully autonomous decision needs to be free of inducements. It is true however, that in life, our decisions are always compounded by some element of inducement, but taken to the extreme, inducements compromise our autonomy. And in the situation of reimbursing kidney donors, the greater the payout, the greater the financial need of the donor, the greater the inducement will be, and the greater the likelihood that the decision was not made with full autonomy.
Much as we may be motivated to save the life of a dying patient, this must not be at the expense of another individual. Therein lies the dilemma in regulating organ trade. Our wealth must not be an instrument of exploitation of the poor.
But perhaps I am too idealistic. (See my other comments on this and related issues...)
I take further offense with respect to her comment : "Why the rigid insistence that the remuneration for the seller should not be so high as to be an inducement to part with a kidey? To be blunt, the main reason is because there is not enough independent thinking here."
Errmmm... 'not enough independent thinking'? Does she imagine that the only independent thinkers are those who agree with her? Legitimizing the organ trade is really a no brainer...and the far easier path to trod. Afterall, who doesn't want to save lives? Standing the moral high ground is a far more difficult choice to make. Wealth empowers. But it takes a stronger (and a more independent minded) person to exercise wisdom and forego that power in defense of the weak and poor.
C'mon Wei Ling....who is more deserving of your support?
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