MacDoctor

The MacDoctor received an interesting survey today from Auckland University. It purported to be a survey about end of life issues but it was clearly structured to ascertain whether doctors were covertly euthanising their patients, either with excessive doses of medication, or by withholding the necessities of life. Readers of this blog will know that I have an interest in palliative care and take a dim view of the idea of euthanasia, passive or active. I find it interesting that researchers want to concentrate on euthanasia to the exclusion of the rest of the complex issue of end-of-life. To my mind, euthanasia cannot be debated until we have properly addressed all the issues that hinder the provision of adequate terminal care in New Zealand. These issues include:

• inadequate funding of terminal care
• inadequate training of doctors in palliative care, especially GPs
• The inadequate legal position of living wills
• The inadequate provision of backup care facilities (hospice, hospital hospice beds and trained caregivers) for terminal patients

Until these issues are properly and thoroughly tackled, any debate on euthanasia will be driven by the horrors of poor palliative medicine rather than the ethics and appropriateness of doctors and the state being permitted to kill their patients. Terminal care is hard work for both doctors and caregivers and expensive work from the point of view of government. But it is work that affirms the value and dignity of human life and it should not be allowed to be subverted by the “quick fix” of euthanasia.

There may well be a valid argument for euthanasia in a select few cases but let us not allow this extremely final solution to paper over the glaring cracks in the care of the terminally ill.

Mrs MacDoctor and I have just had a relaxing week in Vanuatu, celebrating our 30th wedding anniversary. Internet access was painfully slow, so there has been no blogging for more than a week and not much news about New Zealand. I see that I have not missed much, just another unexciting budget from Bill English. Still, he and John Key can rightly pat themselves on the back for not being stampeded into orgies of “stimulus” spending and endless printing of increasingly worthless banknotes à la Messers Obama and Bernanke. They deserve the thumbs up they received from the IMF and from Standard and Poor’s, despite the lack-luster nature of the budget.

Of more interest is the latest petition from the Greens on deep-sea drilling. When are the media going to wise up to the fact that the Greens use petitions not as a way of influencing government but as a way of generating free adverstising for themselves? Or if they are wise to it, when are they going to do their job and actually get the story, rather than the spin? While the media continue to give the greens uncritical support, they devalue the impact of all petitions as New Zealanders and the government both become increasingly weary of them.

Todays report is on the latest Green advertising stunt known as “Kiwi Bid” (are they going to offer the government and the people of New Zealand compensation for the loss of earnings and jobs from not exploring the sea bed? Nah). Much is made of the fact that two sports stars are lending their support, and there are quotes from Olympic Rower and ex-green candidate, Rob Hamill – whose sole marine expertise consists of large shoulder muscles – and Metiria Turei – whose marine expertise is considerably less.

Where is the quote from a Marine geologist? Where is the reassurance from the Government that proper measures will be taken to regulate this? Was the CEO of BP New Zealand not available for a quote on the lessons learned from the Deepwater Horizon disaster? While I realise that journalists have deadlines and often drip feed shorter articles to spin out the story into a series rather than a single item, there is no excuse for such a blatantly unbalanced article. It just gives unnecessary oxygen to a small flame of artificial outrage being generated by the Greens. Currently the attached poll would indicate that 75% of New Zealanders are quite comfortable with deep sea drilling as long as it is properly overseen.

The Green, of course, have not even a modicum of understanding of the nature of drilling as this quote from Turei shows:

“There is no guarantee of safety with deep-sea drilling so we shouldn’t be doing it.”

Of course there is no guarantee of safety – that would be impossible. The real question is – does the level of reward reflect the risk? To answer that, one requires some marine expertise and careful reasoned consideration, not fact-free bluster from the ignorant and blatantly partisan scare-mongering from the press.

The word charity was derived from the Latin word caritas (precious, costly), an attempt to translate the Greek word agape in the New Testament (1 Corinthians 13:13), a word that is hard to translate, but the phrase “extravagant selfless love” gets the flavour of it. It is a far cry from the simple alms-giving that we normally associate with the word charity.

It strikes me that the polarisation of the reactions to Family First (and Greenpeace earlier this year) losing their charitable status, is due to this slow degradation of meaning of charity. If we still saw charity as a giving of ourselves to others in need, we would not be confused about the status of organisations such as Family First  and Greenpeace who provide strong advocacy, but little in the way of support of personal need.

To be charitable in any meaningful way, an organisation (or person for that matter) must be involved directly in supplying personal needs. It is not sufficient to claim that you are bettering mankind by lobbying for government action – you have to be bettering mankind directly yourself to be charitable. Anything less than this is merely a monetary donation to a “cause” – possibly worthy, but a far cry from truly loving your fellow man.

Any government, of course, likes to foster charity by providing tax incentives to the donors. So long as the organisation involved is truly charitable (i.e. provides a service) then that is one less service that the government does not have to provide. Allowing advocacy groups charitable status, provides no benefit to the government financially and leads to lobbying groups being partially funded with taxpayer dollars taken from people who vehemently disagree with the lobby in question. This is manifestly unfair.

A cause should only be backed by those who believe in it. If I like Greenpeace’s advocacy for the environment, I am at perfect liberty to sponsor them. If I agree with Family First and their take on the world, I can support them. Those who say that removing charitable status from advocacy groups deters free speech are drawing a very long bow. If a cause has support in the community, it will find backers.

It comes as no surprise that the Greens are producing a bill to change the definition of charity to include advocacy. These are, after all, the same people who want to force me to fund their election campaign (with tax dollars) despite the fact that I disagree with almost all the policy they have ever produced. Including advocacy in the definition of charitable status will soon have political organisations, unions and political parties trying to take advantage of tax deductibility.

Not all advocacy should be denied charitable status. Many organisations who are clearly charities provide a great deal of advocacy. Barnardos and The Salvation Army spring to mind immediately. These are organisation whose purpose is charitable works but who find themselves, from time to time, forced into advocacy for their charges. This is perfectly acceptable. But groups whose charitable works form a minor part of their activities should be viewed with suspicion.

Family First are an advocacy group, not a charity. There is nothing wrong with this but people donating to it should not be having their donations subsidised by the taxpayer.

Apropos of the state supplying food to poor children in schools. Everyone seems to assume that the reduction in learning ability seen in children who come to school without food is due to their being hungry. Thus, feeding them will improve their long-term ability to achieve academically. However, the MacDoctor has seen little or no decent research to back up this assertion. It seems to him that the drop-off in learning ability is just as easily explained by the simple fact that these children have, in general, lousy parents. It is a well-established fact that poor parenting skills and disengaged parents are powerfully correlated with poor academic achievement in children. One suspects that this is due to far more than the simple absence of breakfast.

It would be interesting to see any long-term research on supplying meals in schools, if there is any. Especially if we plan annually to drop $100 million of borrowed money on the problem …

Preserving Aaron Gilmore’s finest moments for posterity

Gilmore [gil-mawr] verb.

1. To bluster or bully someone from an imaginary power-base: When he was caught lying, Aaron tried to gilmore his way out, but nobody was intimidated.

2. To deposit bowel motions in an inappropriate place: The dog gilmored on the doorstep.

The MacDoctor is all for using protective devices, if they have been shown to be effective, but too often he sees over-reaction like this:

“Schools urged to insist on helmets for push-scooter riders after claims to ACC rocket 500 per cent.

“The number of children seriously hurt while riding push scooters has skyrocketed with their popularity. More than 6000 under-14s were injured last year.”

Nowhere are we told what the increase is in the number of children riding scooters. For all we know from this article, the rate of injury might be falling (if the increase in scooter use is up more than 500% over the 5 years). After all we are talking of an increase from around 150 accidents to about 750 accidents – not a huge increase considering there are over a million kids under 16 in New Zealand. Already you know that the article is going to be long on drama and short on fact.

A single glance at the impressive laceration pictured in the article confirms this. We are told that the 9-year-old Brent came by his accident by hitting a rock and flipping over. The MacDoctor suspects he was going down a hill at a considerable speed when he did it. We are given the impression that a helmet would have prevented this injury. Child safety group Safekids is campaigning for schools to introduce a “no helmet, no scooter” policy for children.

Yet when you look at the breakdown of accidents that ACC report only 2% of them record a diagnosis of concussion. While a small percentage of the lacerations may be head-related, all serious head injuries like Brent’s would also have the diagnosis of concussion in addition to the laceration. Given that the vast majority of “concussion” diagnoses are for very minor head injuries, the MacDoctor concludes that the number of serious head injuries we are talking about is very, very small. Possibly Brent is our only unfortunate.

More to the point, there is no evidence at all that wearing a helmet on a scooter is a worthwhile safety precaution. It is possible that any extra protection provided to the head is overtaken by an increased rate of serious neck injuries. It is not possible to simply extrapolate this data from bicycle riding. For one thing, the mechanisms of injury are quite different and, for another, the age groups are considerably more variable. Also the data on bicycle helmet safety is nowhere near as conclusive as we are normally lead to believe.

The MacDoctor sees mostly minor scrapes and the occasional arm fracture from scooters. He sees far more serious injuries from almost every other activity of children – monkey bars, slides, team sports of all kinds, horse riding and – the big daddy of them all – the dreaded trampoline. Even furniture causes more injuries than the lowly scooter – and don’t let’s start on kitchens…

Children damage themselves at play, sometimes seriously. Responsible parents will try to minimise this risk – as they should. But let us not bubble wrap our children like a crate of fragile eggs. Let us be realistic about risk, least we create risk-averse adults or, worse, discourage our children from physical activity completely. If you have a nine-year-old like Brent, you might want to insist he wears a helmet. But six-year-old Sally, riding to school, is likely to be fine and will not be helped by schools with restrictive policies or heavy-handed legislation.

Ahhh, politics! You are just getting some control of the political debate with the opposition making spoilsport Karl Marx mouthings that are playing your way, when, BANG, some complete drunken ass commits an utterly pointless and stupid mess right on your front doorstep. No wonder John Key always looks tired and harassed when on camera (of course, that could just be due to carefully selected lighting and editing).

The opposition now get to go on about how weak Key is and bay for the head of Aaron Gilmore like some sort of demented french revolutionary. Naturally, they conveniently forget the nature of our political system, where Gilmore would have to resign before a new list MP can take his place. To force that, one would need a damning amount of hard evidence to ensure that Gilmore had no other choice.

Unlike Winston First, Key cannot throw him out of the National party and that would, politically, be a very poor solution. Gilmore could stay on as an independent MP, if he felt aggrieved that he had not been treated fairly – just like Brendan Horan. Imagine the horror of letting Mr. Gilmore have a veto vote over government legislation when the vote is tight. It is bad enough having to ensure Mr Dunne and Mr. Banks are on board without adding a political zombie.

For a political zombie Aaron Gilmore is. He is politically dead in every way, even though he may remain in parliament. Like Phil Goff, David Cunliffe, Brendan Horan and John Banks (yes, John, you too), he joins the ranks of the political walking dead. While sometimes an astute politician can do a Lazarus act (Winston Peters), I believe Mr. Gilmore has neither the political nous or the previous track record to enable resurrection.

In fact, the only decent thing he can do now is to stop walking around parliament and give someone else a chance to do something useful. He should resign immediately. Anything less is just a self-indulgent fantasy that is hurting the party he purports to support.

The MacDoctor was wondering how many of the people who think that some forms of aggravated assault are too trivial to deserve 14 years imprisonment are the same people who think that a light smack for disciplinary purposes is child abuse?

Or perhaps they would like to find grades of offending in indecent assault?

I view the proposal to feed children in decile one and two schools with a great deal of trepidation. While I am certainly not opposed to feed starving children, I suspect the proposed bill is more likely to be just another form of creeping welfare. Just providing blanket feeding for all these children produces one obvious inequality and one hidden consequence.

The inequality lies in the fact that many children in decile one and two schools are, in fact, quite adequately fed. Providing these children with meals merely distributes more welfare onto people who do not need it. Most of these people will be paying tax, so this is merely “churn” and a waste of resources. There are also many children in higher decile schools who are not being fed properly – why are they excluded?

The hidden consequence is that delinquent parents, who would smoke/drink/party/gamble rather than feed their kids, are partially absolved from this behaviour. While no-one wants to see kids suffer from their parents neglect, one has to ensure that you are not endorsing this conduct.

MacDoctor proposes a simple two-part solution:

1. A voucher system enabling children to buy food at the school shop (you can make it healthy food, if you must). This enables you to target it towards only the truly deprived, rather than just “everyone who goes to a low decile school”.
2. The vouchers are obtainable only via a registered budget counselling service, who will determine need based on a realistic budget which the parents must follow.

The only disadvantage of this idea that I can see is that there are parents who simply don’t care that their children are starving and will not make the effort to collect the vouchers. Frankly, I consider that gross neglect and think that CYFS should be removing those kids from what is clearly an abusive situation.

Targeting is always fairer than blanket aid and many families would relish the opportunity to discuss budgets with someone other than WINZ. It would be a much better system than a partial middle-class welfare by stealth.

I see there is another phishing scam running; this time involving the IRD. There is something particularly scummy about this – sort of like conning someone out of money by pretending to be collecting for the local protection racket…

Anyway, in service to humanity, here are some quick tips on avoiding scams. I have kept them nice and simple, since this is an accurate description of most people taken in by a scam. Nice, simple. And a touch of greed…

MacDoctor’s Guide to Avoiding Scams

1. Assume any message with the words “Western Union” in it is a scam. This includes telephone conversations. Western Union exists to transfer money into the deep dark places of the world that don’t have electronic banking. Be warned.
2. If anyone (or anything) you have never heard of before offers you money, it is a scam. Trust me on this. It does not matter if it is a mysterious long lost relative who does not know your name or a wealthy Nigerian prince who wants to trust a perfect stranger with his money. It is a scam.
3. Assume all people asking you for your password or any other sensitive information (like credit card details) are bad people.  The sole exception to this is when you have navigated to a site you trust without using a link on an email, PDF file, advert or unfamiliar web site and you expected to give this information. Suspicion destroys phishin’.
4. Only download stuff from a reputable downloading site (Helpful hint: does not have a “Z” anywhere in it’s name, including WINZ). If you download unknown software at a stranger’s request you are a complete moron and deserve to lose everything they take. And, no, I don’t care if they were offering free porn…You are still a moron.
5. That nice Indian gentleman on the phone cannot possibly know what is on your computer, unless he is a malicious hacker. See points three and four.
6. If it is too good to be true – it is.

And remember, children, always let your paranoia be your guide…