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Just as the NHS is the darling of the British people, it will come as no surprise that its failures are increasingly covered by the tabloids, who have found that the crisis in health provision is a concern to those who have to rely on the state through no fault of their own. High taxes and expensive private health care denies choice to the majority of the population.
One of the latest (and incredible) stories to emerge is a lack of mops in Victoria Infirmary in Glasgow:
PATIENTS spent two days in “grotty” wards – after a hospital ran out of mops.
Cleaners at the Victoria Infirmary in Glasgow were left stunned after bosses told them of the shortage. And it took two working days for the hospital to replace all the mops.
A source at the closure-threatened hospital said: “We knew things were bad here but this takes the biscuit. Cleaners went to work on Wednesday and were told there were no mops and nothing could be done about it
Only scenes such as these could be caused by a state monopoly of health:
After replacement mops arrived on Thursday, a source revealed that hospital staff celebrated.
The insider revealed: “People were dancing around the boxes, singing and chanting, ‘We have mops.’ ” The source added: “No wonder our hospitals are riddled with MRSA superbugs and such like if they can’t get something as simple as this right.”
Only the NHS could ration health and mops!
“Organic farming has been put forward as one of the major pillars of a new, more-sustainable human society that would be “kinder to the earth”. Unfortunately, organic farming cannot deliver on that promise. In fact, organic farming is an imminent danger to the world’s wildlife and hazard to the health of its own consumers.”
Dennis Avery, quoted in Fearing Food, (page 3) by Roger Bate and Julian Morris.
Something for George Moonbat to ponder, I reckon.
Last summer, I went on very public record with my opinon that the überhyped and screechingly hysterical ‘obesity epidemic’ was nothing but a crock of shit, cooked up (in this country at least) by grasping public sector vested interests and amplified by their MSM handmaidens.
While I will continue to do whatever is in my power to undermine this whole wicked, mendacious plot over here, I am pleased to note that there is also some serious fightback going on over on the gun-toting side of the Atlantic:
One would be forgiven for thinking CDC stands for Center for Damage Control. Just a year after its widely-publicized and exceedingly controversial announcement that excess weight kills 400,000 Americans annually, the agency is rumbling, bumbling, stumbling toward an explanation for a new study that says the real figure is just 26,000.
Unfortunately, trial lawyers who see dollar signs where the rest of us see dinner have seized on the CDC’s 400,000 deaths number to justify their frivolous crusades.
Now word comes from experts within the CDC that excess weight is about one-fifteenth as dangerous as previously thought, and has a lower death toll than diseases like septicemia and nephritis. Each death is of course tragic. But has anyone heard of the septicemia “epidemic” or the nephritis “tsunami”?
It’s said that a lie can travel halfway round the world while the truth is putting on its shoes. Well, the truth about obesity is finally lacing up. And that’s bad news for trial lawyers pursuing obesity lawsuits against food and beverage companies as well as the self-appointed diet dictators seeking extra taxes on foods they don’t like.
Not that that will stop them, mind. Truth has little currency when compared to the value of a well-forged career-path or the tantalising lure of brimming public coffers. (By the way, the link above is to the website of an American organisation called the ‘Center for Consumer Freedom’. Not only do they appear to be on the side of the Angels but their website looks like an excellent activist resource that is well worth a bookmark).
Still, the backlash has to begin somewhere, somehow and debunking the fraudulently inflated statistics is an important part of that process. However, it is equally important to maintain the principle that, even if all the har’em-scar’em statistics were true (which they clearly are not) then the responsibility for and solution to the problem of obesity lies with the obese themselves and not with judicial system or the apparatus of tax-collection.
[My thanks to Dr.Chris Tame who posted this link to the Libertarian Alliance Forum].
Story here that says that far from being a bad thing, sitting outside in the sun for at least 15 minutes a day is good for you, latest medical findings suggest. It certainly is a bit of a change from the period, I well recall, in the 1990s, when it appeared to be the case that any exposure to sun was fraught with danger as a result of the supposed hole in the ozone layer. I recall the constant worries, fuelled in the press and elsewhere, about skin cancer and the dangers of overdoing the sunshine.
Sometimes you have to just laugh. Of course being exposed to the sun is good for you in moderation! Mankind was not meant to sit indoors or conceal every aspect of the body all the time. Anyone I know who spends the vast majority of his or her time indoors looks, well, unwell, in my opinion. I always make the effort to break out of my office at lunchtime to get what passes for sunshine in this damp country of ours. It is not rocket science.
Coming next: medical experts reveal that regular exercise, eating vegetables and playing sports can do you some good.
The steady advances in cloning technology holds a great deal of hope the future of the species and the news from Korea and Britain has been pretty damn encouraging over the last few years. It now looks like we could be on the brink of being able to mass produce stem cells and that, boys and girls, could be the gateway to a new era of medical possibilities.
It takes some nerve to announce this on the day of a General Election. Mind you, I doubt very much that it would at all influence the outcome:
Patients should be refused treatment because of their age in some cases, government advisers have proposed.
Where age can affect the benefits or risks of treatment, discrimination is appropriate, the National Institute for Health and Clinical Excellence said.
Charities representing older people said the recommendations were outrageous and sent out mixed messages.
Wrong. The message is quite clear and will gradually become more acceptable. Within five years, people over 75 will be offered euthanasia when they get sick. Within 10 years it will be mandatory.
The fine U.S. blogger and libertarian scholar, Tyler Cowen, who’s blog Marginal Revolution is well worth a visit (as if I did not have enough things to read, aarrgghh, Ed) has started a specialist blog devoted to tracking developments and medical research surrounding avian flu. Tyler is clearly worried about the spread of new and more powerful viruses and the threat this poses to the health to millions of people around the world.
Rather interesting, I think, that the Internet, which helps to spread ideas with the speed of a virus, is now spawning blogs which are devoted to actual, existing viruses.
Terri Schiavo died this morning.
I hope that her husband and family can find some peace, if not with each other, than at least within themselves.
Now that the emotional flash point of the debate is gone, I hope that we can have a more considered policy discussion over who should make medical decisions for non-decisional patients, and under what restrictions.
Nobody is willing to take the position (at least in public) that a person should not be able to refuse medical care in person, on their own behalf. However, many of those now engaged in the struggle over end-of-life health care are, wittingly or not, arguing that some health care decisions should be removed from private hands and made by the state.
The current baseline rule is that your personal autonomy with respect to consenting to or refusing to consent to medical care is pretty much absolute (I am discussing medical care, not mental health care, which operates in a parallel universe on these issues). I note that there are some second-order restrictions on what kind of care is actually available to you, arising from various licensing and regulatory regimes, but leave those aside for now. You can refuse any and all kinds of care, ranging from the most extreme life support to the most mundane blood transfusion, and people do all the time, even when the refusal puts their life at risk.
Things get more complicated when you are unable to decide for yourself (or, what amounts to the same thing, unable to communicate your decision). Someone has to decide what care you will be given. Your ability to make such decisions in advance will, sooner or later, be outrun by the unforeseeable complexities and irreducible detail of your medical care. If nothing else, someone will have to interpret your written instructions and apply them to the messy clinical realities. At the end of the day, if you are not “decisional” you will have a surrogate decision-maker. That decision-maker will either be a private individual or the state.
The current system very rarely results in the state directly taking custody of a medical patient who is not decisional, and is very heavily biased toward leaving health care decisions in private hands, with a fairly limited “reserved” power in the state to hear disputes about who the private decision-maker should be. So far, so good.
Although reasonable people can disagree on whether, for example, Michael Schiavo should be Terri Schiavo’s surrogate or one of her parents should be, this dispute is over the proper issue of which private party should make decisions. It is very difficult, I think, to argue that this issue hasn’t been fairly and adequately processed by the courts.
However, we are seeing increasing pressure to restrict the decisions that the surrogate can make. This is where it gets tricky, because legal restrictions on the decisions that a private decision-maker can make mean that the state is making that decision. If there is a law on the books that prohibits your surrogate from consenting to experimental treatments, then the state is making the decision that you will not receive that treatment. If there is a law on the books that prohibits your surrogate from withdrawing a feeding tube, then the state is making the decision that you will be fed through a feeding tube.
The current mantra that “if there is any doubt, err on the side of life” is a TV-friendly sound-bite in the service of expanding the control that the state has over your medical care, because this “principle” removes from your surrogate the ability to make health care decisions, and is functionally equivalent to the state ordering that medical care be provided regardless of your wishes. For your own good, of course.
Similarly, the endless agitation for more appeals amounts to agitation for more state review and oversight of a nominally private decision. For your own good, naturally.
In short, to the extent any coherent public policy is being advanced by the people who want the feeding tube re-inserted into Ms. Schiavo, it is a public policy that shrinks the decision-making powers of private decision-makers, and necessarily transfers those decisions from private hands to those of the state.
The over-riding principle that is cited in favor of this transfer of power to the state is the protection of life. However, the protection of life is not an absolute trump card; indeed, when it comes to medical care, personal autonomy overrides protection of life; otherwise, the law would require that life-saving health care be provided to you over your objections.
Nobody is willing to take that step, so advocates for the transfer of power to the state are left in the position of arguing that some decisions that you can make for yourself should never be made by your surrogate, but should be made by the state instead. Those are the only two choices on offer – either the state makes decisions about your end-of-life medical care by prohibiting your surrogate from deciding, or your surrogate decision-maker does.
I think you know where my instincts are when faced with a choice between preserving the private sphere and expanding state control.
On The Voice of Reason (slogan: “A penny saved is a government oversight”), there is a pretty clear headed little essay of what I think is most the reasonable position on this absurdly emotive case.
For an excellent overview of the Schiavo case, written by someone with a better work ethic than me (she links to her sources, I just kind of remember their gist), go to Majikthise.
Out of the morass of purely case-specific issues in this case, perhaps the most legitimate policy argument raised by the Schiavo trainwreck has to do with the withdrawal of food and water.
Let’s be clear on Schiavo’s condition and treatment here: she is being fed and hydrated through a tube in her stomach. She is not feeding herself, and is presumably not capable of taking food and water orally, or the tube would never have been inserted. This kind of feeding and hydration is just as much a medical treatment as having a glucose or saline IV inserted into your arm.
No one attempts to deny that Terri (or anyone else) would be permitted to refuse this treatment for themselves; a law mandating that you receive a given medical treatment against your will would be widely regarded as an abomination.
Similarly, no one seems to be seriously arguing that if Terri were on a ventilator or some other form of artificial “life support”, that her guardian should be permitted to withdraw the life support, even though there is no written evidence of what Terri’s wishes were in that regard.
This leaves many of the folks who are now arguing for federal intervention into Terri Schiavo’s medical treatment in the rather uncomfortable position admitting that (a) she could refuse to consent to being fed through a tube in her stomach, and (b) that her guardian could withdraw other forms of life support, but nonetheless that (c) her guardian cannot refuse consent to her being fed through a tube in her stomach.
Thus, the policy question being posed by this case seems to be whether a surrogate decisionmaker should be compelled by law to “consent” to their ward being fed through a tube in her stomach, unless he can produce written evidence that is what the patient would have wanted.
The case against such a legal mandate boils down to the argument that denying the right to consent or refuse consent to the surrogate is the same as denying it to the patient herself. Of course, the surrogate is not, in fact, the patient, and there may be legitimate boundaries placed on the decisions the guardian can make on behalf of their ward. The question is whether withdrawal of nutrition and hydration is outside of those boundaries, and if so why.
The case for a legal mandate that nutrition and hydration be given over the objections of the legal guardian rests comes down to the argument that, where there is any doubt as to what the patient would want, we should err on the side of keeping them alive. This argument, however, founders on a couple of points. Logically, it cannot be limited to nutrition and hydration, and thus requires that we keep all life support, no matter how extraordinary, in place. Further, it begs the question of how much certainty is enough. Even where a written living will exists, the question can be raised about whether the patient changed her mind.
Because we cold-hearted libertarians care about such things, Terri Schiavo’s care is being paid for by taxpayer money through the Medicaid program. Even though her parents have noisily pledged to take all financial responsibility for her care, they have not yet done so, even though the trust fund established out of the proceeds of her malpractice case to pay for her care is nearly exhausted. The annual cost is probably around $80,000 per year.
Various precincts of the US body politic are obsessed with Terri Schiavo, a young woman who has been at the center of an ongoing familial, legal, and now, sadly, political dogfight.
In very broad terms, Terri Schiavo is unable to make decisions for herself. She is apparently brain damaged, and has been in some degree of coma or “persistent vegetative state” for years. Her husband wants to withdraw artificial life support and let nature take its course. Her parents want her kept on life support indefinitely in the hopes that some day she will make some degree of recovery. As ever, you can find a medical expert to present just about any side of this that you want. This situation is, sadly, all too common.
The uproar around Terri Schiavo illustrates rather nicely the key distinction between libertarians and, well, everyone else. For libertarians, the critical question is “who decides?”, based on their belief that you should be able to make your own decisions in life. Most other folks, it seems, don’t care “who decides” nearly as much as they care about “what decision is made,” and particularly, “whatever decision is made, it damn will better be one I approve of.”
In Terri’s case, this means that all sorts of folks who you think would know better than to invite the state to participate in medical decision-making are doing exactly that, because Terri’s husband has made a decision that they do not approve of.
So, not only have we been treated the spectacle of the Governor of Florida, Jeb Bush, trying to elbow his way to Terri’s bedside so he can dictate what care she will receive, we also have various Florida legislators trying to insert the State of Florida into the mix. Now the US Congress, apparently not satisfied with embarrassing itself* in its ongoing investigation into steroid use in major league baseball, is preparing to abuse its subpoena power to block the decision made by Terri’s husband.
A fundamental principle of health care law, and one dear to the hearts of libertarians, is that you must give informed consent to any treatment before it is administered to you (with an exception in cases of emergency when you are unable to communicate, in which case the caregivers are allowed to assume you want life-saving treatment). A doctor who treats you without your consent has committed assault and battery. It is your right to refuse any treatment at all, even if it will mean your death, and so long as you are a competent adult no court or legislature can intervene to force treatment on you.
When the patient is not a decisional adult, someone who will make decisions on their behalf must be located. You can appoint your own surrogate decision-maker, via a health care power of attorney (which I strongly recommend). Some states have lists of “deemed” surrogate decision-makers on the statute books, such as spouses, parents, siblings, etc., in rank order so everyone knows who has authority in a given case. As a last resort, a court will appoint a guardian.
The whole process is focused on the proper issue of identifying “who will decide.” Once the decision-maker is identified/appointed, they stand in the shoes of the patient. The state retains (or should retain) only the most limited role, to ensure that the decision-maker does not abuse their power. Clearly, the decision to withdraw life support is a decision that Terri Schiavo could make for herself. Indeed, my wife has told me that if she were in Terri’s position, that is exactly what she would want. Her husband’s decision to make it in her stead is by no means an abuse of his power as her surrogate decision-maker – such decisions are made routinely, every single day, across the country by people charged with the heavy burden of making health care decisions for someone else.
What we have in the Schaivo case, then, is the legally appointed and recognized decision-maker making a choice that is well within his purview. Multiple court reviews have concluded that he is the right person to make the call, and his decision should be honored. To this libertarian, that is the end of the matter, because the very essence of being a libertarian is respecting the decisions of others even when you might decide otherwise. To a broad spectrum of conservatives, however, the fact that medical decision-making should be private is of no concern when the decisions made are decisions they disagree with.
*While at the gym yesterday, I caught a few minutes of the steroid hearings. It was painfully embarassing to see the solons of American governance earnestly seeking noted idiot Jose Canseco’s advice on public policy. A quick survey of the fellows in the locker room revealed that this latest Congressional exercise in nannying competent adults and chasing headlines is not being well-received by the public. The universal sentiment was, “Don’t they have anything better to do?”
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Who Are We? The Samizdata people are a bunch of sinister and heavily armed globalist illuminati who seek to infect the entire world with the values of personal liberty and several property. Amongst our many crimes is a sense of humour and the intermittent use of British spelling.
We are also a varied group made up of social individualists, classical liberals, whigs, libertarians, extropians, futurists, ‘Porcupines’, Karl Popper fetishists, recovering neo-conservatives, crazed Ayn Rand worshipers, over-caffeinated Virginia Postrel devotees, witty Frédéric Bastiat wannabes, cypherpunks, minarchists, kritarchists and wild-eyed anarcho-capitalists from Britain, North America, Australia and Europe.
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