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Is health insurance a scam? August 14, 2014

Posted by Tomboktu in Business, Health, Medical Issues.
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Is health insurance a scam?

I discovered today VHI has been including home-birth cover in my plan for some years. Gay male, late 40s, and I will so need that! More fundamentally, I’ve been paying for healh insurance for over 15 years, but as I have been approaching 50 in the last few years, the cost has been rocketing. Is it a case of reasonable rates when you’re young(er) and healthy (healthier), but push them up when you get to the age you’ll begin to need insurance, not matter how long you’ve been paying without drawing down?

This year, the price has to the point where I looked at it and wondered “why pay this?”

This morning, as I was discussing the options on the phone with the rep, I kept coming back to “If I’m so ill that I need insurance, my concern is to get the treatment, not to be in a first class hotel-standard room.”

The State’s position on the rights in the kind of situation before Savita Halappanava’s death November 17, 2012

Posted by Tomboktu in Bunreacht na hÉireann, Ethics, Feminism, Health, Human Rights, Ireland, Medical Issues.
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Here is what the government says is the official procedure to be followed in the kind of situation that preceeded Savita Halappanava’s death, as explained by the Government to the European Court of Human Rights in 2009, and summarised by that Court in September 2010. [I have added the emphasis. Here they are dicussing the case of “C”.]

189. As regards the third applicant specifically, the Government made the following submissions.

In the first place, they maintained in response to a question from the Court, that the procedure for obtaining a lawful abortion in Ireland was clear. The decision was made, like any other major medical matter, by a patient in consultation with her doctor. On the rare occasion there was a possibility of a risk to the life of a woman, there was “a very clear and bright line rule provided by Irish law which is neither difficult to understand or to apply because it is the same law that has been applied under Section 58 of the 1861 Act, under Article 40.3.3 of the Irish Constitution and under the legislative provisions of every country which permits a pregnancy to be terminated on that ground”. As to the precise procedures to be followed by a pregnant woman and her doctor where an issue arose as to such a possible risk, it was the responsibility of the doctor and a termination could occur when the risk was real and substantial. If the patient did not agree with that advice, she was free to seek another medical opinion and, in the last resort, she could make an emergency application to the High Court (as outlined above). The grounds for lawful abortion in Ireland were well known and applied. Referring to the Medical Council Guidelines, the CPA Guidelines and the evidence of practitioners to the Committee on the Constitution, the Government considered it clear that, while there were issues regarding the characterisation of medical treatment essential to protect the life of the mother, medical intervention occurred when a mother’s life was threatened, the refusal of treatment on grounds of moral disapproval was prohibited and a patient was entitled to a second opinion. While the Irish Institute of Obstetricians and Gynaecologists had no published guidelines concerning a pregnant woman presenting with life threatening conditions, that Institute would be in agreement with the Guidelines of the United Kingdom Royal College of Obstetricians and Gynaecologists concerning the management of ectopic pregnancies and it was probable that Irish gynaecologists would “by and large” follow the latter Guidelines with or without minor amendments or additions. This clear process of how a decision to terminate a pregnancy was taken in Ireland by the patient in consultation with the doctor was regularly followed in the case of ectopic pregnancies./blockquote>

[You may wish to know that Ireland was found by the European Court of Human Rights to have breached the human rights of “C”.]

The 90-page PDF is available here.

Ministers and gender reassignment August 24, 2010

Posted by Tomboktu in Gender Issues, Human Rights, Medical Issues, Ministers, Social Policy.
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I would guess that only a few people have given any more thought to the proposals about legally recognising a change of gender in Ireland than an instinctive reaction along the lines that it is a good move or that it is a bad move. However, even if you have no interest in the substantive issues — legal, medical, social, or even concerning public finances — that gender reassignment raises, there is one aspect of the consultation document that is simply crazy. That document is short — 999 words — and was published earlier this month by the Gender Recognition Advisory Group, which was set up by the Minister for Social Protection. Although the membership of the Group does not seem to have been published, it is an interdepartmental group, and I am told that it consists entirely of civil servants.

The public consultation document sets out three main sets of issues:

  • (a) it outlines options for a legal process for having a new gender legally registered and recognised,
  • (b) it invites submissions on what level of evidence will be needed before a change of gender will be recognised, and
  • (c) it sets out a few proposals on some specific issues (for example, that a birth certificate in the new gender should be indistinguishable from an original one).
  • On the second item in that list, the Group says simply that

    a level of evidence [will be required] to the effect that the applicant has made, or is making a genuine transition from the original gender to the opposite preferred gender.

    The Group invites submissions as to the evidence that should be required of the person making the application.

    and, elsewhere in the document, that

    [t]he criteria should be capable of being interpreted in a consistent and objective manner.

    (Experienced bureaucrats among the readers of CLR will note that ‘criteria’ is not the same as ‘level of evidence’, but it would be unfair not to recognise that that reference to the criteria must encompass the level of evidence.)

    It appears that the Group has not looked to other jurisdictions to establish any parameters that the level of evidence should meet. Nor does the group indicate that it is deliberately leaving the question open, although that may be the situation. That is not surprising. A group of civil servants is unlikely to have any of the psychiatric, endocrinological, or surgical expertise to be able to deal with that.

    What civil servants do have, in abundance, is expertise in bureaucracy and deferring to ministers, and they appear to have applied that with gusto. Here is what they say:

    The Group’s initial view is that the basic outline of the scheme should be as follows:

    1. The person seeking recognition of his/her changed gender makes an application to the Minister, or a decision making body designated under the Act, seeking to have the new gender recognised.
    2. The applicant submits evidence in support of the application.
    3. The Minister, or the decision making body, examines the application and the evidence and makes a decision to either accept or reject the application.
    4. The Minister or the decision making body, issues a formal statement to the successful applicant recognising the new gender.
    5. There will be an appeal process for unsuccessful applicants.

    The Group invites submissions on the proposed process.

    The most shocking piece of the consultation document, I believe, is the fact that in three of a total of five steps, the Group countenances a role for ‘the Minister’ in making decisions in individual cases. And this thinking appears in two other places in the document when the Group says:

    In making its decision the Minister or official decision making body will require a level of evidence to the effect that the applicant has made, or is making a genuine transition from the original gender to the opposite preferred gender

    and

    The Minister or the decision making body will issue a gender recognition certificate to the successful applicant

    Yes, each of those references is immediately followed with a parenthical ‘or the decision making body’, but what kind of thinking leads anybody to believe that there is any justification for suggesting a minister would be given that kind of role, even if the detailed procedures reduce that to a final sign-off of a decision made elsewhere? I truly hope that the source is not the civil servants and that the references to a minister appear in the document because some minister — junior or Cabinet, pre- or post-reshuffle — insisted on it. And, in that vein, I hope the Group’s true view is reflected in the two options they offer two possibilities under the heading ‘Decision Making Process’:

    The Group invites submissions on the type of decision making process which should be established. Options could include:
    Judicial or Court — model whereby applicants would apply to a designated existing court;
    Statutory Panel — model whereby an expert independent panel would be appointed under the legislation to make the gender recognition decisions.

    I hope that submissions — the deadline is 17 September — support one of those options and make it untenable for the suggestion of a ministerial role to remain on the table.

    John Waters, depression and sadness: Reactionary times… August 20, 2007

    Posted by WorldbyStorm in media, Media and Journalism, Medical Issues, Other Stuff.
    26 comments

    Another week, another column from John Waters [sub req’d]. Now, I don’t intend to make a habit of parsing his thoughts. I’ve got a few of my own on a range of other issues, from the bizarre introduction by Ed Moloney to the biography of Ruairí Ó Brádaigh to puritanism on the Left. But today’s is well worth at least a slight consideration.

    Under the heading “Depressing new take on sadness” John, for it is he, steps fearlessly into debates on depression…

    An Australian psychiatrist, writing in the British Medical Journal , has said something many of us think but are nervous about expressing out loud.. .

    ‘Nervous’? Surely not. And who is this ‘us’?

    Prof Gordon Parker believes that the concept of “depression” has got out of hand. Doctors are diagnosing as depressed people who are merely “unhappy”. A low threshold for diagnosing clinical depression risks treating normal emotional states as “illness”, he argued. Prof Parker was challenged in the same edition of the publication by a fellow Australian, Prof Hickie, who said that diagnosis and treatment of depression had led to a reduction in suicides.

    Okay.

    But it must be obvious to most 10-year-olds that Prof Parker is talking sense and Prof Hickie talking through his hat. The number of prescriptions issued for anti-depressants is growing in the UK at the rate of about 6 per cent per annum, while suicide rates have remained static at a high level for at least a decade. The same is undoubtedly true of this country.

    Unfortunately, this very day, figures released show that it is not true of this country. In a disturbing article in the Irish Times new research suggests that the suicide rate is probably higher than hitherto thought due to methodologies used in categorising them, and that:

    These latest figures show suicide rates in the State have risen from nine per 100,000 people in the five-year period 1980- 1984, to 15 per 100,000 in the five years 2000-2004.

    and that:

    The researchers found that in 30 of the 47 cases the victim had experienced depression at some time in their lives. And fewer than half of suicide deaths could be attributed to alcohol.

    In any case, there is, to my mind, something a tad distasteful about making a judgement on ‘depression’ from the suicide figures. The pressures and dynamics involved in suicide are radically different – albeit parallel on some axis – to depression in the population. This doesn’t deter Waters, and as we shall see arguing from the extreme to make a point about the general society is a tack he will take again…

    Virtually every newspaper report about suicide nowadays cites depression as a major cause, implying that those who take their own lives do so because they suffer from some perhaps unrecognised clinical condition.

    Some years ago, the leading Irish psychiatrist and then chairman of Aware, Dr Patrick McKeon, spoke about the nature of what is called depression. “Human beings, to live with themselves,” he said, “actually have a natural infusion of positive perspectives on things, and that enables us to keep going in life. When that’s taken away, that’s actually called depression . . . if anyone is really involved in life they are going to get depressed at some stage or other in their life. To anybody who says they don’t get depressed . . . I say, are you really that switched off.”

    But McKeon is not saying that there is no such thing as depression. He’s saying that people do get depressed and that people must expect that in a life. And if one is willing to accept the likelihood of depression then one must also be open to the idea that there are means through counseling or medication that can alleviate that depression. What Waters is doing is subtly different as he continues…

    Life can be tough. Bad things happen. We feel let down, sad. Sometimes we feel sad for no apparent reason. St Thomas Aquinas defined sadness as “the desire for an absent good”. In a society that persistently seeks to deny a higher meaning, it is not surprising that more people feel more and more sad, but we dispose of the evidence of our vacuity by defining them as “depressed”.

    Waters is saying that depression isn’t depression, it’s merely sadness.

    This is astounding stuff. Waters appears to be trying now to diminish depression as an aspect of our society and rework it as ‘sadness’, and a sadness which is the result of not having a ‘higher meaning’. And those who eschew ‘higher meaning’ are… the guru has spoken… vacuous. Look, I’m all for politics, but it’s not for everyone. Most people prefer to knock along doing their thing, and while that may put the project back I’m not given to whinging about their fecklessness.

    Problem is that there is such a thing as clinical depression. To be honest I suspect much larger numbers of people are prey to it than the statistics demonstrate. I’m not really surprised. It’s not that ‘life can be tough’, it is that life is tough. It’s a struggle in this society or any society.

    (Incidentally, on a slight tangent, the evidence seems to lean towards those who have convictions – whether atheistic, or theistic – as being those who, for example when facing death are best capable of dealing with it. Those like myself in the agnostic, not entirely sure, mode, are the ones who get it worst – natch)

    But, as so often in the discourse presented by our centre right media the point is not the supposed primary issue of depression or the treatment of same, but instead a means of getting a good lash in against…why post-modernism of course!

    There may be a moral dimension also, which again I require to cite an expert in order to outline. In The Frivolity of Evil, one of the superb essays in his collection, Our Culture? What’s Left of It, Theodore Dalrymple addressed the matter of what our societies term depression, which he argues has eliminated “the word and even the concept of unhappiness from modern life”. Dr Dalrymple worked for 14 years as a psychiatrist in British prisons and mental institutions, retiring in 2004.

    “Of the thousands of patients I have seen,” he wrote, “only two or three have ever claimed to be unhappy: all the rest have said they were depressed.”

    Get out of here! They’re in prison and they ‘claim’ to be depressed? Who knew?

    This semantic shift is deeply significant, for it implies that dissatisfaction with life is itself pathological, a medical condition, which it is the responsibility of the doctor to alleviate by medical means. Everyone has a right to health; depression is unhealthy; therefore everyone has a right to be happy (the opposite of being depressed). This idea in turn implies that one’s state of mind, or one’s mood, is or should be independent of the way one lives one’s life, a belief that must deprive human existence of all meaning, radically disconnecting reward from conduct.

    Okay, even noting that Dr. Dalrymple worked ‘as psychiatrist in British prisons and mental institutions’ it seems to me that that environment might not necessarily give the most complete picture of depression as it relates to the broader society, nor might the environment lead one to be – shall we say – as sympathetic as one might otherwise be.

    Moreover, the semantic shift is irrelevant. If a patient presents saying that they are ‘unhappy’, or ‘depressed’ the function of the doctor isn’t to beat them rhetorically around the head for their temerity in not accepting that life is a vale of tears and in this instance most specifically a corrective institution, but instead to determine the severity of the depression and whether the person is suffering from clinical depression, a recognised disorder or from a more transitory depression of mood and do something about it. These are real and potentially serious conditions and disorders that blight lives.

    And incidentally, for anyone who has any actual – as distinct from rhetorical – experience of depression of either flavour or those who have had depression it will be well known that the goal is not actually to be ‘happy’ but to achieve some balance where by ‘unhappiness’ doesn’t flood the day to day experience. That balance may not actually include ‘happiness’ to any significant degree. This has nothing to do with a ‘right to be happy’, nor is it about being the ‘opposite’ of depressed. There are many intermediate stops on that journey. But hey, why allow the complexity of the situation spoil the reality?

    It gets worse.

    He wrote about one patient, a woman who had lived a life of, to any objective assessment, outright misery. Having been raped as a child by her mother’s boyfriend “with the mother’s full knowledge”, she had herself chosen as lovers a succession of highly violent men, who had left her with three children. As a psychiatrist, he met many such women, who had chosen men “who had their evil written all over them, sometimes quite literally in the form of tattoos saying F*** Off or Mad Dog”.

    So… these are ‘choices’ made as easily as I go into the canteen at work and choose between the Innocent smoothie or the unpleasant “Summer fruit” fizzy juice drink?

    The woman is most likely in a prison or mental institution, John. That suggests that her problems are greater than the question of whether we concern ourselves if the unhappiness/depression she experiences is unhappiness or depression.

    Incidentally, there are a host of potential reasons why a woman in such a position might indeed be attracted to an individual who was seemingly ‘strong’ or ‘impervious’. I know it’s a bad choice, but it is an understandable one. And I want to move onto a different aspect of this because Water’s argument flies very very close to the idea that those within abusive relationships are somehow to ‘blame’.

    There is a glibness here that is quite – well reactionary actually.

    Such horrors, according to Dalrymple, are the inevitable consequence of a culture of ideas in which the notion of personal responsibility has been eliminated. An “unholy alliance” between left-wing liberals and right-wing free-marketeers has made “a long march though the minds of the young”, elevating non-judgmentalism to the highest value and dispensing with ideas of personal responsibility in favour of total “freedom to choose”. When the individual chooses badly and encounters unhappiness, we decide she has become ill. Dalrymple’s only cause for optimism “has been the fact that my patients, with a few exceptions, can be brought to see the truth of what I say: they are not depressed; they are unhappy and they are unhappy because they have chosen to live in a way that they ought not to live, and in which it is impossible to be happy”.

    So, by examining the extreme – a prison population – it is possible to build up a seamless theory of the broader society? Doesn’t seem like the best way to move forward – as well consider that the human dynamics in the Apollo 13 capsule as it fought its way back from the moon give a good insight into school organisation

    And one has to ask, what is this ‘culture of ideas’? Where is this non-judgementalism? If any thing I see much the opposite. Unlike some around here I’m no fan of Big Brother. But one thing that it appears to promote, apart from a nebulous infantilism, is a sense that there are indeed red lines of personal responsibilities, that one must try to get along, not to upset others, etc, etc. Big Brother is explicitly judgemental when it comes to those who criticise core attributes of individuals, such as gender, race or sexuality. It just so happens that Waters doesn’t want to recognise that judgementalism may not be his judgementalism. And that’s at, as it were, one end of the market.

    Yet again the straw man of non-judgementalism is dragged kicking and screaming out of the place where straw men are kept. One can ask, with all due respect, what on earth is Dalrymple talking about when he suggests that ‘they are not depressed; they are unhappy and they are unhappy because they have chosen to live in a way that they ought not to live, and in which it is impossible to be happy’ ? Without context such a statement is essentially meaningless. Taking the woman who was attracted to violent men. The social linkages created by the children would be such as to permanently embed her within a matrix that would make movement beyond it difficult, if not impossible. Educational, social and other issues would also impact. And she is, I reiterate, most likely in a prison or mental institution.

    Of course she’s made bad choices, and of course it is broadly speaking impossible to be ‘happy’ in such a context, although institutionalisation brings for some a degree of acceptance, in itself a serious problem. But what on earth has that to do with people outside prison whose life choices have been circumscribed by many other factors which have left them depressed? What relevance does this column have to them? Because one very significant distinction between someone in prison and having their life experience and someone outside of it who has suffered catastrophic distress comes down to ‘meaning’.

    For those who commit crimes the possibility of prison is at least an element of their mental horizon. But for someone in the broader society where ‘life is tough’ events can unfold with appalling rapidity, events that are entirely beyond personal control. Yeah, that might just lead to depression above and beyond how “they have chosen to live in a way they ought not to live”… But then we’d need a whole different column, making entirely different points and coming to a significantly different conclusion.

    And here the argument is almost a mirror image of something that Michael Shermer of Scientific American has noted in a recent column on self-help manual The Secret by Rhonda Byrne. The Secret is, as Shermer writes:

    … the so-called law of attraction. Like attracts like. Positive thoughts sally forth from your body as magnetic energy, then return in the form of whatever it was you were thinking about. Such as money. “The only reason any person does not have enough money is because they are blocking money from coming to them with their thoughts,” we are told. Damn those poor Kenyans. If only they weren’t such pessimistic sourpusses. The film’s promotional trailer is filled with such vainglorious money mantras as “Everything I touch turns to gold,” “I am a money magnet,” and, my favorite, “There is more money being printed for me right now.” Where? Kinko’s?

    The advocates of the Secret argue that:

    “Thoughts are sending out that magnetic signal that is drawing the parallel back to you.” But in magnets, opposites attract–positive is attracted to negative. “Every thought has a frequency…. If you are thinking that thought over and over again you are emitting that frequency.”

    But as Shermer points out:

    The brain does produce electrical activity from the ion currents flowing among neurons during synaptic transmission, and in accordance with Maxwell’s equations any electric current produces a magnetic field…The brain’s magnetic field… quickly dissipates from the skull and is promptly swamped by other magnetic sources, not to mention the earth’s magnetic field … which overpowers it by 10 orders of magnitude!

    And Shermer notes that:

    Ceteris paribus, it is undoubtedly better to think positive thoughts than negative ones. But in the real world, all other things are never equal, no matter how sanguine your outlook. Just ask the survivors of Auschwitz. If the law of attraction is true, then the Jews–along with the butchered Turkish-Armenians, the raped Nanking Chinese, the massacred Native Americans and the enslaved African-Americans–had it coming.

    And they didn’t have it coming, anymore than someone who is suffering from depression, or clinical depression or whatever has it coming – even for the sake of a newspaper article.

    So what’s the difference? Self-help gurus suggesting that positive thoughts will get you everything your heart desires or journalists suggesting that depression is really ‘sadness’ because that slots neatly into a discourse about responsibility and how those who say they’re depressed are really unhappy because of some existential angst caused by lack of responsibility and the inability to judge.

    There is no real difference because each is built upon an avoidance of fact or knowledge in favour of ‘something many of us think ‘.

    Think again.

    Abortion debate takes to the streets. July 4, 2007

    Posted by franklittle in Bioethics, Feminism, Gender Issues, Irish Politics, Medical Issues, Religion, The Left.
    5 comments

    There have been a number of good discussions on the Cedar Lounge about issues around abortion and the strength or weakness of the pro-choice lobby in Ireland. The latest contribution to the debate was WBS’s piece at the start of the week going through some of the contributions to the letters debate in the Irish Times.

    But the last couple of weeks have seen the debate emerge from the sterile corridors of the Times and back onto the streets again to an extent not seen since the last abortion referendum, motivated no doubt on both sides by the Ms D case.

    Last Saturday I went along to the pro-choice rally organised by Choice Ireland in Dublin’s city centre where a good crowd of a little under 200 heard Senator David Norris and likely Senator Ivana Bacik call for a the introduction of a woman’s right to choose in Ireland. Some pictures on Indymedia available here. Interestingly, there was a complete absence of party banners, with the exception of the Connolly Youth Movement of the Communist Party. I saw Labour, SWP, SP and Sinn Féin people but unusually for a city centre demo where everyone is normally fighting to get their banner to the front of the march, party badges were kept under wraps.

    Pleased though I was to see the pro-choice movement back out on the streets, and as well as the demo Choice Ireland had a very successful couple of media interventions over the week, it needs to be seen in the context of the strength of the anti-choice forces in Ireland.

    Youth Defence is currently concluding a ‘pro-life roadshow’ that has seen them hold a range of leaflet drops, demos, stalls and public meetings in 16 towns and cities across the country, culminating in a rally at the GPO in Dublin this Saturday with a public meeting in the evening ‘after Mass’ (Of course). Bear in mind too that this is merely one part of the anti-choice movement in Ireland, and not necessarily the strongest, though certainly the most prominent.

    The roadshow has not been without controversy. Gardaí in Galway City shut down one of their information stalls and a Youth Defence demonstration outside a family planning clinic in Limerick was the subject of a peaceful counter-demonstration.

    As Smiffy pointed out in a previous post on the subject there is some evidence of an emerging pro-choice majority in Irish society, certainly among 18-25 year olds according to a recent MRBI poll. Yet the growth in support for the pro-choice position has had little, if any, effect on the positions taken by the major political parties. Nor has it seen the emergence of a campaigning organisation that can match Youth Defence on the streets.

    Choice Ireland holds out the possibility of being just such an organisation even if it is still very much in the first phase of growth. But the other problem is neatly summed up by Yeats. “The best lack all conviction while the worst are full of passionate intensity.”

    Whatever about the rights and wrongs of the abortion argument, one cannot question the near fanatical determination of the anti-choice movement motivated in large part, though not entirely, by religious belief. And at one level, you have to admire their determination and commitment to what they see as saving lives.

    Against this, the pro-choice movement relies less on emotional or faith based appeals but on what we would perceive as political concepts such as equality, feminism, rights and so on. All very correct, but it makes it harder perhaps to appeal to voters to back your cause and activists to get stuck in than something that gets to people in their gut.

    How is the pro-choice movement to attract activists, most of whom if taken from the traditional left in Ireland have party or organisational commitments elsewhere? To compete with the likes of Youth Defence, does the pro-choice movement needs it’s own fanatics?

    A mad world, my masters May 30, 2007

    Posted by franklittle in Bioethics, Culture, European Politics, Film and Television, Freedom of speech, media, Media and Journalism, Medical Issues, Television Shows.
    6 comments

    I have stolen the title for this post from the BBC’s John Simpson who used it for one of the volumes of his auto-biography though in fairness, he stole it from the playwright Thomas Middleton. Note also, the absence of ellipses.

    It was the phrase that popped into my head when I heard about the new Dutch TV show to air on the first of June where a terminally ill 37 year old woman will choose from one of three candidates for a kidney transplant with the aid of text messages from the viewing public.

    Entitled ‘The Big Donor Show’ it has justifiably drawn harsh criticism from Dutch political parties, the medical community, donor organisations and even the EU Commission has thrown it’s two cents into the pot.

    Bizarrely, the defence from the programme makers at BNN that it will stimulate discussion about the problems of organ donation where 40,000 people are on waiting lists across the EU with 15-30% of them expected to die while waiting, can claim to have some validity.

    In what is either a gigantic coincidence or a direct response to the show, the EU Observer reports that the EU Health Commissioner has unveiled a set of proposals to ‘promote donations from living donors’ and to crate an EU-wide organ donor card.

    All very worthy, but the programme still leaves a bad taste in one’s mouth.

    ADDENDUM:

    In further EU related news, there might be some interest in the latest wheeze from the boys and girls in the EU Commission to tighten their grip and extend their propaganda for a neo-liberal federal European state. The Commission is next month to announce plans to fund political foundations on an EU level that will be attached to European Parliament groupings. This is, they say, to ‘spice up’ political discourse.

    While I’m all for more debate, and better informed at that, about European issues, I’ve generally seen the EU Commission more as the source of the problem, rather than part of the solution. Worth noting as well that since the funding will be based on the number of MEPs in each Group, it means the EU Commission has found a way to channel yet more money to the slavishly pro-EU Constitution Groups like the Christian Democrats, the Liberals and the ‘Socialists’.

    As Tobey Maguire might have observed, my Spidey sense is tingling.

    To refer or not to refer: abortion prohibition won’t go down without a fight May 5, 2007

    Posted by joemomma in Bioethics, Irish Politics, Medical Issues, Social Policy.
    6 comments

    I hope that our readers would acknowledge that this recent post by smiffy on the ‘D’ case would be an ornament to any national newspaper’s opinion page. I find myself agreeing with him almost entirely on a logical level, however in my gut I can’t help but harbour reservations. I started to put these into a comment on his post, but it grew unwieldy so I have decided to convert it into a post of my own. As it started out as a comment, I couldn’t think of a decent title so I’ve decided to rather lamely pursue smiffy’s Shakespearean motif.

    My principal reservation is this: I must say I find it hard to believe that, even now, a pro-choice referendum would have a chance of passing. My impression is that Irish people generally have a default anti-abortion position, which is only varied through personal or family experience of crisis pregnancy, or development of political consciousness. In other words, left to their own devices, and dealing with the concept purely in the abstract, the tendency is to come down on the anti-abortion side. I don’t have any empirical evidence of this, of course, but perhaps you’ll indulge me in a little trip down memory lane to illustrate the point.

    I would reckon that until the age of 20 or so, there was an anti-abortion consensus amongst my peer group. Nobody had given it much thought, we just went along with the received wisdom that abortion was wrong and also unnecessary. I even remember a classmate who was already a fervent leftie and feminist expressing an extremely strong anti-abortion viewpoint. She has since been all around the world protesting at WTO talks and such, although we’ve lost touch so I can’t say if her position on abortion has changed.

    Speaking personally, at that age I was quite an idealistic leftie, and it’s possible that this idealism actually served to prop up my anti-abortion viewpoint. Abortion being a bad thing, naturally it had no place in the utopian society towards which I felt I had to work. If other evils could be eradicated, why not abortion?

    Of course this position was based on a completely abstract concept of abortion, derived largely from church and school propaganda. It was certainly not based on any consideration given to the realities of women faced with crisis pregnancy, to any of the “hard cases” such as the current Miss D, to the reproductive rights of women generally, or even to any coherent liberal ethics.

    All the same, even with a maturing political outlook and a less sheltered experience of life, I did not let go of this position without an internal battle. I’ve never liked too much fuzziness in my moral reckoning, and the “life begins at conception” slogan had a power over me in this respect. Even though a cluster of embryonic cells is clearly not the same thing as an implanted foetus, which is not the same thing as a viable baby (despite what Youth Defence might think), the lack of an absolute dividing line between these categories troubled me.

    So although I continued to believe that abortion was a moral evil, and that the Irish people were entitled to prohibit it on this basis, I did moderate my position to allow that it was not for me or anyone else to judge women who felt they had to go through with it. Such a position, of course, requires that abortion actually be available to such women despite prohibition, and in this respect the Irish solution of the boat to England was an indispensable crutch for this crippled ethical outlook.

    So experience of the real world was enough to shift me from the default attitude inculcated at school, but actually moving from my agnostic and ultimately hypocritical position to being actively “pro-choice” involved a great deal of soul-searching, and a reconsideration of the rights of persons within a more coherent liberal ethics. In other words, it required me to devote more thought to ethics, politics, and rights than most people probably bother with. I’m not saying I’m any kind of moral philosopher — in fact I’m quite sure I’m still hopelessly mixed up on all sorts of issues — just that if I hadn’t become politically active I might never have given up the views I held when I was younger.

    In case you’re starting to wonder, this is not in fact an extract from my memoirs, and all this personal reflection is merely to illustrate the point that the anti-abortion attitudes which have dominated Irish society are not likely to go away without a fight. smiffy argues persuasively that the Irish political class is running scared from the issue, but I would caution that a further referendum at this point might not move the debate forward in a desirable direction. The survey by the Crisis Pregnancy Agency which he cites appears to offer encouragement to the pro-choice lobby, but I must say I find it hard to credit that such figures would be born out in an actual referendum. I could simply be a slave to the received wisdom, but my perception is that the anti-abortion side could probably still call on a 55% – 60% majority to defeat any proposal to liberalise our abortion laws.

    I feel the pro-choice lobby may need to engage in a little more “softening up” of the Irish electorate before it presses its political representatives to propose a referendum. We may need to see the debate more in terms of inculcating liberal ethics in society, to replace the received, largely Catholic, ethics which still apparently pervade it. I feel that many Irish people, even though they may ostensibly have left Catholic morality behind them, do not yet have anything to put in its place when it comes to issues such as abortion. Even though they do not consider themselves religious, and even though they may have actively rejected the religious line on any number of issues, they are apt to revert to the default position received from school and parents unless they’re forced to think rather hard about it.

    In short, I’m suggesting that what is required is a reasoned debate on the moral and ethical issues involved in abortion and its prohibition. I’m further suggesting that such a debate is unlikely to occur in any useful form in the context of a referendum campaign.

    The Banquo’s Ghost of Irish Politics May 2, 2007

    Posted by smiffy in Bioethics, Health, Ireland, Irish Election 2007, Irish Politics, Judiciary, Medical Issues, Social Policy.
    13 comments

    Well, as the long-awaited puppet contest finally gets started, something rather bizarre has happened. Politics, real politics, the kind of politics that seriously impacts on people’s lives has made a reappearance, in the form of abortion: the spectre which has been haunting Irish political life for the last quarter of a century. While the parties tie themselves in knots over stamp duty, the cost of home improvements in 1994 and early morning trips to the Phoenix Park, and unsuccesfully attempt to demonstrate any significant difference between their view and the views of their opponents, it’s almost comical watching them run for cover to avoid dealing with the one issue of substance that’s arisen all week.

    We have a seventeen-year old woman who’s faced with the appalling prospect of carrying, against her will, an anencephalic pregnancy for five more months, in the full knowledge that she will give birth to a child without a brain which will live for a couple of days at most, if it lives at all.

    We have Health Services Executive which not only refuses her permission to travel to the UK for a termination (for reasons which still remain unclear) but which also goes to the Gardaí in order to ensure that she doesn’t travel without their knowledge; this is the same HSE, remember, which we’re now told has previously funded women in the same situation to travel for termination in the past.

    We have an Attorney General’s Office which states that the HSE and Gardaí have no power to prevent her from travelling, but which also appoints a counsel for the ‘unborn’ (despite the fact that, in presenting a defence to a recent case taken against the state in the European Court of Human Rights, it argued that a foetus with a serious abnormality incompatible with life might not constitute an ‘unborn’ at all).

    And, perhaps most stomach-churning of all, we have a political class which, with a few honorable exceptions, refuses to take the responsibility of government and of the role of legislators seriously and address a tragedy with afflict thousands of women each year in this country.

    The issue of abortion has dogged Irish politics for 25 years, ever since Haughey and Fitzgerald capitulated to a bunch of fanatical religious extremists and unwittingly enshrined a right to abortion in the Constitution. Since then, and particularly since the ‘X’ case in 1992, all political parties have adopted an ostrich-like approach to the problem: sticking their heads in the ground and waving their arses in the face of those Irish women faced with crisis pregnancy.

    In the 15 years since ‘X’ there has been little or no serious attempt to get to grips with this hidden national crisis, and to regularise the confused and ambiguous legal situation. While the Supreme Court established the right to an abortion in cases where a woman’s life was at risk, this has never been legislated for, thus the judgement and the right are effectively ignored by Irish lawmakers. After the ‘C’ case, involving another minor in the care of the State, there was no attempt to draw up a code of conduct or best practice in dealing with such situations, and no attempt to preemptively address what the legal position should be in respect of the current ‘D’, where the risk to the life of the mother isn’t apparent (it’s not like such a situation couldn’t have been predicted). We’ve had a refusal even to define in law what the ‘unborn’ actually is, meaning that, at present, the state recognises the right to life of an adjective, impacting not just on abrotion but also on the recent dispute over the ownership/right to life to frozen embryos. And finally, after the other ‘D’ case in the ECHR, the coincidence of letters mirroring the coincidence in circumstances of the women involved, there was no thought given to the possibility that perhaps it was going to arise again, and that maybe, just maybe, it might be worth addressing the legal position before it turned into a another crisis.

    Why don’t our TDs take their role as legislators seriously and tackle this complex issue? We hear the usual lines trotted out about how personal the issue is (which is why we have a Whip system in the Dáil) and how it’s not possible to gain consensus on it (as if a government which included Michael McDowell ever worried about getting cross-party support on anything else). My recent favourite is Mary Harney’s comment yesterday:

    “We had a referendum a number of years ago in relation to abortion, where we put forward a very balanced approach, and that was rejected by the people,” Ms Harney said. “Therefore I am not certain that people are ready to determine in relation to these issues again.”

    Remind anyone of Brecht’s poem about the East German Workers’ Strike of 1953?

    The truth is that they’re scared and stupid. They buy the received wisdom which is repeated over and over that the Irish people oppose abortion (although this is contradicted by the most comprehensive research on the subject, the Crisis Pregnancy Agency’s Irish Contraception and Crisis Pregnancy Study: A Survey of the General Population, which shows a pro-choice majority and only a small minority ruling abortion out in all circumstances); that the Irish people don’t want another referendum on it (which assumes that all previous referenda were responses to the pleas of the electorate and that people prefer regular Court challenges to the abortion laws to dealing with this issue once and for all); and that the idiotic phrase ‘abortion on demand’ actually means something. They also realise, quite cynically, that there are no votes to be won on abortion, and would prefer to avoid the attentions of the screamers. Even though there are several pro-choice politicians in the Dáil, I know of none who would describe themselves as such in public (possibly Joe Higgins), while the so-called ‘pro-lifers’ smugly parade their piety. On no other issue are Yeats’ words more true: ‘The best lack all conviction, while the worst/Are full of passionate intensity’.

    The case is due to be heard in the High Court tomorrow, and one can only hope that Miss ‘D’ is granted permission to travel. Regardless of the outcome, however, one thing is sure: the next government, of whichever combination of parties, will not take a serious stance of abortion, or do anything of substance to eliminate the trauma of having to travel abroad faced by the thousands of Irish women dealing with crisis pregnancy every year. Unfortunately for the women, and luckily for the parties, this really is an issue that will go away if you ignore it. The government will follow the familiar path of keeping their heads down on the subject (in the sure knowledge that the opposition will do likewise), weather the storm if and when another teenager has to go to court to vindicate her rights, and once the particular case stops being talked about on Joe Duffy, it’s back to business as usual.It’s entirely apt that this case should have come to attention on the first day of the electoral campaign. It reminds us that without politicians of principle, who will show leadership and will make the right choices, regardless of how superficially popular or unpopular they might be, the entire process is a pointless farce. The kind of pusillanimity shown by countless Irish politicians on the issue of abortion – leaving the hard decisions to be decided by the courts on a case by case basis, rather than debated in the Dáil chamber, represents a complete abnegation of the duties of the elected legislator. But as long as we keep voting for them, I suppose we deserve nothing better.

    Edit: Thanks to jjcarroll over on Semper Idem who has highlighted an important flaw in the post above. The CPA study cited only queried people in the 18 to 45 age group, rather than the electorate as a whole, as I had thought for some reason. While the figures are still striking, they’re obviously limited, therefore, in determining how people might vote on the issue in the future. It would be interesting, though, to see quite how different the figures would be if the population surveyed had been wider, as I don’t know of any serious research which has ever attempted this.

    I don’t think this impacts too heavily on the overall argument, but that’s for the readers to decide for themselves.

    Harney beware. The nurses are coming January 17, 2007

    Posted by franklittle in Fianna Fáil, Greens, Health, Irish Election 2007, Irish Labour Party, Irish Politics, Medical Issues, Progressive Democrats, Sinn Féin, Trade Unions.
    5 comments

    Last Monday’s Questions and Answers was unusual for a couple of reasons. Firstly, I watched it, having been lured away many moons ago by the higher standard of political discussion on The Panel, and Podge and Rodge. But what was also a little puzzling was what was not discussed during a debate on health issues.

    Minister Harney, Sinn Féin’s Health spokesperson Caoimhghín Ó Caoláin TD and Dr Orla Hardiman of the newly founded Doctor’s Alliance went around the houses on the issue for some time. Harney chose to blame the problems in the health crisis on consultants and, basically, anyone but her, in the standard PD habit of blaming someone else. McDowell and the judiciary for gangland crime is another example.

    What interested me the most was no-one said a word about the nurses. For the month of January the Irish Nursing Organisation and the Psychiatric Nurses Association have been holding regional meetings of their members while balloting for industrial action. Reports that found their way to the Little household indicate packed meetings with standing room only and a very, very militant attitude.

    And they have much to be militant about. It is over 25 years since the Labour Court said nurses and midwives should be the first to benefit from a reduction in the working week. Yet they are the only health professionals to work a 39 hour week today, everyone else at what no doubt IBEC would see as a slothful 35. They are also the lowest paid of all graduate health professionals, to such a degree that 70%, almost three in four, nurses and midwives have left the country within 18 months of graduating.

    As well as industrial balloting, members at these meetings are being given powerpoint presentations outlining their demands, and the arguments in favour, and instructed to besiege all candidates and elected representatives in their clinics until further notice. The INO/PNA leaderships have also met with all the parties except the Greens and Labour curiously enough, though I suspect scheduling differences other than Labour not taking the nurses seriously. That said, the Shinners were the first to meet them. Eyes firmly on the ball it seems.

    The core of the nurses’ demands is the reduction in the working week, a 10% increase in pay with a cost of living increase of 3%. These increases would bring them in line with other personnel working in the healthcare sector and address a number of pay anomalies. In comparison to other workers for example, a nurse earns 7,000 Euros per annum less than a play therapist on graduation. Social Care Workers, who in many cases have to report to nurses, earn 3,000 euro per annum more than the nurses, and although the gap narrows after the sixth pay increment, always earn more.

    The 3% cost of living increase, by the way, is due to the nurses under the new Towards 2016 pay agreement but the HSE before Christmas embarked on a campaign of trade union intimidation, circulating a form asking workers to identify what union, if any, they are a member of and threatening to refuse the increase to INO or PNA members. William martin Murphy’s play book has been dusted off in the HSE bunker it seems.

    At this point, with the Health Service Executive sticking to it’s guns if they’re set on pursuing this union intimidation tactic, a massive vote in favour of industrial action by the 40,000 workers affected is likely to be announced at the start of February. This will authorise limited forms of strike action, lunchtime protests, work to rule etc. As Liam Doran of the INO has said, “The strategy will be to maximise pressure on management while minimising the impact on patients and members.”

    And then it might get interesting for Harney. The nurses are one of the very few groups of workers Irish society is sympathetic to. If anyone else goes on strike, especially transport workers or taxi drivers, they are lucky not to be run over by Liveline inspired Fianna Fáil voters trying to stamp out the Red Menace. But nurses, and to a lesser extent firefighters and teachers, get a pass. Anyone who has listened to people complaining about the health service on radio or television often hears the complainant signal the nurses out for praise. Nurses are, rightly, not held responsible for the failures of the health service.

    In other words, industrial action by the nurses less than four months before a general election, especially when linked to the problems in the health service, has the potential to receive massive public support and do serious damage to Harney. The nurses are refusing to go through Benchmarking, so if the Government backs down, they undermine Benchmarking and, to a lesser extent, Towards 2016. If they hold firm, it will be Mary Harney versus the nurses. If I was her, I wouldn’t have wanted it mentioned on Q&A either.

    Brokeback confusions January 6, 2007

    Posted by smiffy in Bioethics, Ethics, Medical Issues, Science.
    5 comments

    Johann Hari (someone I’ve linked to so much on here he should probably have his own category to the side) had an interesting piece in yesterday’s Independent, throwing up quite a few difficult moral and philosophical questions.He notes that recent research into the sexual behaviour of sheep at Oregon State University points to not only a biological basis for homosexuality but also suggests that it may be possible to alter sexuality using hormone injections. The article itself deals with most of the immediate implications this discovery, if true, would yield: both how it might undermine the basis of much anti-gay prejudice (particularly the religious kind) and the possible negative consequences of believing that homosexuality might be amenable to some kind of ‘cure’, an idea which has resulted in a lot of pain and tragedy in the past. Hari is far more eloquent on the subject than I could be, so there’s no point in my rehashing the arguments; read the piece for yourself. However, there’s a particular aspect of the question which isn’t addressed in much detail but which I think merits further consideration.

    In a post-script to the article, where he addresses some of the responses he’s received, Hari writes:

    A few readers have e-mailed asking how I can square my support for allowing mothers to abort foetuses with severe disabilities with my opposition to allowing mothers to abort gay foetuses. It’s fairly simple: homosexuality isn’t a disability. If you are deaf, dumb and blind, you are missing out on some of the greatest dimensions of life, not due to social prejudice, but due to inherent and tragic malfunctioning within your body. If you are gay, the only dimensions of life you miss out on are those that bigots choose to lock you out of. It’s not homosexuality that’s the disability it’s homophobia.

    While it’s hard to disagree, on one level, I don’t think the issue is quite as straightfoward as is made out there. Certainly I think that several activists for the rights of people with deafness might have serious difficulties with it. An argument I’ve heard several times is that by allowing abortion in specific cases such as, say, Downs Syndrome, Spina Bifida or the situation suggested above “deaf, dumb and blind”, you’re implying that the lives of those people who have those conditions and who are alive are somehow inferior to those of unaffected by them. There’s quite a provocative article by someone who takes this position against Peter Singer (another inspirer of my little pieces) here. Now, this isn’t a view I’d hold with, but only because I don’t believe that a foetus should be considered a person in the same way as an adult with deafness, for example, would be. Choosing not to proceed with a pregnancy where the foetus, when born, will have or will develop one of the ‘abnormalities’ above is not the same as saying that persons with those conditions shouldn’t have been born in the first place.

    In a trickier way, though, I think something similar applies when it comes of homosexuality. Now, I absolutely concur with the sentiment above that homosexuality isn’t a disability. However, I don’t think allowing parents of ‘gay foetuses’ (actually, I’m not sure about that term – I think the expression ‘foetuses which, if the pregnancy continued to term and the child developed to maturity would become a gay person’ but that’s a bit of a mouthful) to terminate the pregnancy is necessarily the equivalent suggesting that gay people should be cured, or shouldn’t be born in the first place.

    Let’s look at it from a different angle, for a moment. Supposing, instead of talking about terminating a pregnancy where the foetus is ‘gay’ (see above), we were talking about a pre-natal treatment which allowed parents to choose the sexuality of the person the foetus would become (indeed, a similar thought experiment might involve sex rather than sexuality but I think the issues involved are broadly similar). Is this morally acceptable? Certainly, it could well lead to many people choosing against having gay children. Similarly, it might lead to some couples actively choosing to raise a gay child. While it could, of course, lead to less gay people being born, I don’t believe that it impacts in any way on the actual child in question. While gay people have as much right to be gay as straight people have to be straight, a foetus which isn’t a person in the first place doesn’t have any ‘rights’ at all so altering their prospective sexuality while still in-utero isn’t a violation of any rights in the first place.

    Is choosing the sexuality of a child distasteful? Certainly, and it’s not a choice I’d want for myself. Would gay people find it offensive if people were given that choice? Again, almost certainly and probably rightly so. However (and this is the big question) is the potential offence it could cause sufficient to deny people the right to make that choice in the first place? On this point, I’m far from sure.

    If the difference between choosing a child without deafness and choosing a straight child, rather than a gay one, is that we should be allowed to avoid ‘disability’, then are we saying that intervention should only occur in such cases, and no others? Should, for example, choosing other, broadly non-contentious, characteristics such as height or hair colour, be prohibited?

    I don’t know the answer. On the one hand, I think the choice should be left with the parents, and them alone, and I’m uneasy with the idea that people shouldn’t be entitled to particular information because of how they might act on it (whether that’s Downs Syndrome, homosexuality or just brown eyes). On the other hand, I’m very uncomfortable with the idea of people making those choices, as they do now in many places if the foetus is female. Anyone who’s got a convincing way of settling the dispute, please jump in in the comments.

    On a lighter note, it seems that Doctor Moreau is screwed. Shame. Centaurs are cool.

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