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Tsunami batters Japan
Hike in MPs’ fund |
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Politics at play
Impetus to democracy
Of dastans and qissahs
When to let go
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Tsunami batters Japan Vast areas in Japan have been devastated with over 1000 lives lost as a massive offshore earthquake led to a major tsunami in the northeast of the country on Friday. The quake, measuring 8.9 on the Richter scale, resulted in walls of water as high as 23 feet hitting hundreds of towns and villages in the country’s 2,100-km-long coastal belt.
It was the fifth biggest earthquake in the world’s history and the severest in Japan since it began to keep records of such natural calamities in the late 1800s. The tremors were only a little less powerful than what was recorded in the sea off Northern Sumatra — of magnitude 9.1 — in 2004 that spawned a tsunami claiming over 200,000 lives in the Indian Ocean region, including India. But the toll from the Japanese quake, fortunately, has been much lower. Why? There is no country better prepared to face natural calamities like a tsunami than Japan. It has a strict building code, which is scrupulously followed. The Japanese, for whom facing earthquakes is part of their life, have spent billions of dollars on creating infrastructure to meet any kind of natural calamity. The skycrapers in Tokyo and other cities have the capacity to withstand as powerful an earthquake as has never been experienced before. Japan’s long coastline has high concrete walls with an alarm system connected to every building, residential or commercial, to warn people of an impending disaster much in advance. There could have been devastation worse than what the Japanese suffered on Friday if they were not adequately prepared to face natural disasters. Even the nuclear power plants in the affected areas have been found to be safe. The people around the reactors, closed immediately after the disaster struck, have been asked to shift to safer places as the cooling system in one of the plants was not functioning properly. The Japanese, one can hope, will have far better arrangements in the future to withstand natural disasters. There is a lot to learn for other countries like India. Foolproof preparedness to meet such eventualities can save hundreds of lives as the world has seen in Japan.
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Hike in MPs’ fund Few schemes have evoked as much criticism as the Member of Parliament’s Local Area Development Scheme (MPLADS) for its various conceptual flaws and the manner in which it has been executed over the years. No wonder, the UPA government’s decision to raise the corpus for MPs from Rs 2 crore to Rs 5 crore under the scheme has come as a big surprise.
That the government decided to go ahead with the hefty raise despite the Planning Commission’s objection is surprising. The hike, effective from April 1, will result in an additional expenditure of Rs 2,370 crore a year. In May 2010, when Planning Commission Secretary Sudha Pillai presented an update to a Rajya Sabha committee on the scheme, members told her to consider pruning fund outlays of big ticket schemes to make available necessary funds for the scheme. In fact, members have been demanding an increase in the corpus since 1999 on the ground that Rs 2 crore was insufficient to undertake worthwhile projects in their respective constituencies. The scheme, introduced in 1993 when Dr Manmohan Singh was the Union Finance Minister with a budget of Rs 5 lakh for each MP, was raised to Rs 1 crore in 1994 and then to Rs 2 crore in 1998. Experts have questioned the constitutional validity of the scheme and called for its abolition on the ground that it blurred the demarcation between the executive and the legislature. However, on May 6, 2010, the Supreme Court ruled that the scheme did not violate the principle of separation of powers because MPs could only recommend projects and it was the district administration, municipalities or panchayats that implemented them. The government kept modifying the guidelines of the scheme from time to time and introduced measures to ensure transparency, accountability and effectiveness even as states like Bihar have scrapped a similar scheme for MLAs following complaints of lack of transparency. The government should address the concerns raised about the scheme. This is particularly important because in its latest review, the Comptroller and Auditor-General of India has raised the question of diversion of funds, use of funds for private and commercial purposes, inflated estimates and misreporting of work progress besides wrong selection of work. The scheme’s status report (1993-2010) shows encouraging trends with most states registering a whopping 90 per cent fund utilisation. But the government should come clean over reports about irregularities in its implementation. After all, it is the people’s money and the government — and the MPs — are accountable for every pie that they spend on development.
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Politics at play One can understand UP Chief Minister Mayawati’s support for the agitating Jats’ demand for reservation in Central jobs since her government has already granted them a quota in the state services.
Besides, she gains politically by embarrassing the UPA government at the Centre and scoring over the Rashtriya Lok Dal, which enjoys Jat support but is silent on the issue. Why should Haryana Chief Minister Bhupinder Singh Hooda pass the buck to the Centre when his own government has not acceded to the Jats’ demand? Of course, Mr Hooda cannot go against the interests of his own community, which constitutes 30 per cent of Haryana’s population. Politics apart, the two chief ministers have mishandled the agitation. The Mayawati government was rather brutal with the peacefully protesting Samajwadi Party workers. However, the police did not intervene when the Jats indulged in arson at the UP-Delhi border on Thursday. They ignored Mayawati’s appeal for peace and threatened to cut off all rail and road links to Delhi. The Haryana Jats’ agitation is spreading. The days of rail blockade has crippled coal supplies to power plants, hitting power supply in parts of the state. The Hooda government has quietly watched the frequent breakdown of law and order in the Jat land. Be it the road and rail blockades on the issue of reservations, violence against Dalits or khap panchayats ordering the killings of young lovers — the government has abdicated its primary duty of ensuring the rule of law. It is true the fruits of growth have not adequately reached the Jats. Their plight has worsened with agriculture languishing. Their access to education has remained limited, partly because of their ignorance and choice. This has denied them a fair representation in government jobs. The way forward is not through reservations alone. Good health, education and training for entrepreneurship and technical skills along with the adoption of modern farming and agri-business practices can lift their living standards. It is here the government has a vital role to play.
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Do what you can, with what you have, where you are. — Theodore Roosevelt
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Impetus to democracy
It
is heartening to note
that in the past two years there has been a renewed emphasis on
electoral reforms. This is perhaps for the first time that the Union
Ministry of Law and Justice and the Election Commission have jointly
taken up the responsibility of pursuing reforms to their logical
conclusion. As a first step, regional consultations were held at Bhopal, Mumbai, Kolkata, Lucknow, Chandigarh, Bangalore and Guwahati. A national consultation will be held in New Delhi next month in which Prime Minister Manmohan Singh will take active part. Later, a Vision Report, based on the feedback from the consultations, will be prepared for effective implementation. In addition, NGOs and civil society are also contributing their might. Of special mention are the Association for Democratic Reforms (ADR) and the National Election Watch (NEW) with which 1200 NGOs from all the states are associated. At the recent national seminar on electoral and political reforms held at the IIT, Chennai, ADR and NEW, in collaboration with the Election Commission, have come out with many meaningful proposals to rid the electoral system of various ills and shortcomings. A major reform that cries for urgent attention is the mushrooming of political parties. Do we need 1200 parties today most of which collect funds, enjoy income-tax rebate but don’t contest elections? The money is spent on shares, jewellery and furniture. There is no financial discipline, internal democracy and transparency in the functioning of these parties. True, multiplicity of parties is not confined to India alone. It is a common feature in most new democracies. Nepal boasts of 39 parties, Sri Lanka 53 and Pakistan 71. In the UK, of the 160 parties, less than 10 parties are active. In the 2009 Lok Sabha elections in India, only 390 parties joined the fray. But the problem here is that while small, regional and caste-oriented parties are exerting pressure on coalition governments at the Centre and in the states, national parties seem to be losing their pan-Indian identity. Today, registration of a political party by the Election Commission is very easy. All that one needs to do is to file a simple declaration under Section 29A (5) of the Representation of the People Act, 1951. This has led to system overload and a huge burden on electoral management. The tendency of non-serious individuals or parties to stay on the rolls of the Election commission as functioning political parties can be discouraged and curbed by empowering the commission to de-register them. A simple introduction of a clause to Section 29A will suffice. Given the political will, a comprehensive piece of legislation that would provide for the enforcement of inner-party democracy, succession, clear and transparent procedures regarding receipts and expenditure with periodic public disclosure of financial accounts will be in order. The legislation could also deal with issues such as periodic rotation of posts among party leaders, parties’ accountability to their manifestos through an annual statement, candidates’ selection and nomination for various constituencies (similar to the US primaries), disqualification of those with a criminal background, prohibition of hate speeches, settlement of party disputes, splits and dissolution. Of late, increasing criminalisation of politics has become a cause for major concern. The argument that criminals have been duly elected by the people is flawed fundamentally and structurally. If MPs or MLAs are to be the role models, what examples these criminals would set for the country? In the current Lok Sabha, criminal cases are pending against 153 MPs, 74 of them with serious charges such as murder and robbery. The BJP and the Congress with 42 and 41 MPs with criminal cases respectively lead the pack. The maxim that a person is innocent until proven guilty does not apply to criminals. Ideally, political parties should refuse to give tickets to history-sheeters at the entry level itself. However, as they have failed in this onerous task, the Centre should take recourse to statutory enactment. Currently, the law debars only those candidates who have been convicted and sentenced with imprisonment of at least two years. The Election Commission’s proposal for an interim ban on criminals is worthy of consideration. It has recommended to the Centre that if anyone is facing serious criminal charges like murder, rape and extortion for which the punishment on conviction is five years of imprisonment or more, he/she should be barred from contesting the election during the pendency of the trial. Undoubtedly, elections have ceased to become a level-playing field for all candidates because of the increasing role of money power. Even the latest increase in the ceiling on election expenditure — Rs 40 lakh for a Lok Sabha election and Rs 16 lakh for an Assembly seat — will not help matters. The laws regarding the accounting and regulation of collections and expenditure by political parties are also vague. Suitable legislation is needed to bring about clarity on this issue. State funding of political parties is a laudable idea. The Dinesh Goswami Committee, the Indrajit Gupta Committee, the Justice M.N. Venkatachalaiah Committee and the Law Commission of India have all recommended it. However, there are reasonable apprehensions that cash funding may be misused by parties because of their poor record of accountability. The question of state aid, even in kind, to all beneficiaries, including Independents, needs to be examined closely. Any criteria like the votes polled by a party or its strength in Parliament and state legislatures for the grant of state aid may disturb the level-playing field. Clearly, the menace of proliferation of political parties should be tackled first before state aid is considered. Otherwise, it will be a heavy burden on the national exchequer. Of late, the menace of paid news has been engaging the attention of both the Centre and the Election Commission. Self-regulation is the best remedy, but it may not work effectively. The Press Council of India needs to be given adequate teeth to tackle the problem. It is presently a court of ethics and not a court of law. Similarly, there is a need to make recalcitrant TV channels to fall in line. A Group of Ministers of the Union Cabinet is currently looking into the menace. Significantly, when the Election Commission issued notices to 86 candidates during the Bihar elections, they admitted that they paid for the news and included expenditure on paid news in their returns. The newly-created Expenditure and Monitoring Division in the Election Commission has decided to emulate the Bihar model in the ensuing elections to five states — West Bengal, Tamil Nadu, Kerala, Assam and Puducherry. Undoubtedly, the Election Commission of India commands great respect and credibility for conducting elections in a free and fair manner. The model code of conduct during elections, evolved by political parties themselves, is a unique concept, some aberrations notwithstanding. Interestingly, the commission has handled the controversy over the electronic voting machines (EVMs) deftly by holding an all-party meeting in December last. It is presently seized with the suggestion for paper trials to EVMs. A five-member committee will soon give its report on the feasibility of introducing an automatic system of providing acknowledgement to voters after they exercise their franchise. The reforms proposed during the various consultations need to be followed up and implemented by the government with a sense of urgency. Given the political will, it should not be difficult for the Centre to strive for an all-party consensus without which Parliament cannot enact some of |
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Of dastans and qissahs
I
was recently introduced to dastangoi,
the dramatic Urdu art of oral story-telling. Invited by a friend, one
of the handful of female dastango (story-tellers) involved in its
revival, my sister and I sat enthralled. The two angrakha-sporting
performers, sans props except gao-takiyas, presented lively moving
pictures of a fantastic world peopled by warriors, evil kings,
tricksters and sorcerers. It was the trusting innocence of childhood
revisited. The episode unfolding before us vividly brought to life the trials and triumphs of a warrior from the most famous of dastans (long stories), the 46-volume Dastan–e-Amir Hamza. It had Hamza’s grandson, Asad, setting out to conquer the enchanted kingdom of Hoshruba, ruled by Afrasiyaab, king of magicians. He is aided in this task by the clever trickster Aman who possesses magical artifacts such as a cloak of invisibility and a pouch that contains parallel worlds. They are beset by magical snares and seductive sorceresses at every step but finally succeed in defeating Afrasiyaab. A classic triumph, that of good over evil, regardless of the means. Dating back to the narrative genre of medieval Iran, this vastly popular form of rich story-telling entered the subcontinent with the Mughals. Emperor Akbar would become one of the most significant patrons of this art by commissioning the Hamzanma: canvas folios painted with scenes from the dastan on one side and poetic narration on the other. These paintings were then held up by two people for an audience to view while a narrator stood behind to read out the inscriptions. After reaching its zenith in mid-nineteenth century Lucknow, this splendid art form would be devoured by technology and ironically by that other “talkie” in the twentieth. The verbal depiction of epics and heroes was no competition for the allure of radio and cinema; the last known dastango, Mir Baqir dying in poverty, selling paan in Delhi to earn his livelihood. Culturally, the dastan or qissah had no religious or official purpose. They existed purely for the sheer pleasure of the story-telling experience. Created by the narrator’s artistry, they were sustained by the listener’s continual query: then what happened? A similar refrain I recall even an old retainer, Bhikam Shah, insisting upon while tucking us into bed as children. His never-ending tall tales, too, were prompted by a sleepily mumbled “pher ki hoya”? Silence from our comatose forms, an indication for him to stop conjuring up a perfect world for believing young ears. Could he have been our very own dastango? I am left wondering…n
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When to let go The choice between different alternatives in medical practice is hard. Often the points for or against an apparent decision are equally strong and weak. Moreover, the concerned individuals - the patient and/or the family members — are often ignorant of wider perspectives of the issues concerned. On the other hand, the physician, who may foresee the disease course and weigh the pros and cons is not the competent individual, either morally or legally to take a decision. The socio-economic factors are other compelling forces in the overall decision-making process. A survey of the national sample of 2314 bankruptcy filers in 2007 revealed that 62.1 per cent of all bankruptcies were medical - this had risen by 49.6 per cent (2.38 fold higher) in 2007 than in 2001. Let us take a topically important example which one faces in day-to-day life. The issues related to the continued care of a terminally ill patient with chronic end-stage disease are bothersome for all concerned. Each specific term included in this statement i.e. the chronic end-stage disease, the terminally ill condition and the continued care must be fully understood. Chronic end-stage disease is the most critical determinant of decision-making. Parameters for these terms or conditions are clearly defined in scientific medical literature. The dilemma of whether to continue care or to withdraw the treatment is not easy to solve. Prima facie, it is almost abhorrent to think that the treatment may be stopped in an irretrievable and hopeless situation. This act, even if futile, may also be considered as an immoral or unethical practice. Some may tend to equate it with euthanasia, which it is not by any stretch of imagination even in a wider sense. But there are several genuine fears in the minds of the kith and the kin of the patient who is lying in a kind of vegetative state. "What will the relatives and others in society say if I/we suggest to withdraw the treatment"? "Let us continue irrespective of the outcome, perhaps some miracle may happen". As an advocate of the patient who is unable to express his/her opinion, let me dare to question the need and the obligation to "prolong the death" and interfere with the natural process of dying? Why to employ artificial supports to extend the period of suffering in pain and agony? Why deny the dignity of death? The real objective of medicine is to heal and provide comfort - not the opposite. The bottomline remains that the condition is end stage and irretrievable and all possible methods of cure have been exhausted. The arguments for and against the withdrawal of continued care can go on without finding a final answer. This, like many other difficult dilemmas in medicine, remains debatable since the introduction of artificial life supports and aggressive management practices. Incidentally, it was mostly in the 19th century onwards that different medical dilemmas had actually cropped up. This had broadly corresponded with the developments in advanced technology and their consequent application in medical care. It is in the past two decades, that a real attempt has been made to solve such dilemmas. The era now belongs to the guidelines - the scientific principles to solve a complex problem. Practical guidelines are neither rules nor policies. They consist of carefully designed and documented suggestions for the resolution of a conflict. Being framed through a systematic approach by a larger group of experts without any conflict of interest, the guidelines may serve as the leading light to move out of a dark tunnel. The decisions made on the basis of defined guidelines are more acceptable, and also defendable, including in the courts of law in case of disputes. The trend to formulate guidelines for the management of diseases and disorders is a global phenomenon in modern clinical medicine. Previously, the guidelines were based on expert opinions and views. Then came the consensus guidelines made by groups of people, based on mutual consensus arrived at after discussions and consultations. Now, there is greater stress laid on the scientific evidence available from studies published in peer-reviewed journals on the particular subject. Such evidence-based guidelines also tend to classify the level of evidence from 'unequivocal' to 'doubtful' and 'none' based on the methodology, the size and the type of studies, which are available and analysed. The evidence-based guidelines, in spite of some limitations, are more wide-based and professionally analysed. However, one must be careful to look into the credibility and objectives of the people or the body associated with the formulation of such guidelines. It is not uncommon in this era of Internet information and commercial exploitation to find motivated guidelines disseminated for ulterior or selfish purposes. The guidelines with reference to terminal care cannot be considered as 'unequivocal' and universal, unlike other recommendations for management of diseases. The terminal-care issues involve a whole lot of personal, emotional, financial, legal and socio-religious concerns, which are not only region-specific, but also different in different cultures and ethnic groups. It is, therefore, important to allow a degree of flexibility and variation in the interpretation of these guidelines in individual cases. An important aspect of the guidelines for terminal care relates to the issue of "withdrawal of aggressive treatments" in case of prolonged and hopeless situations. This is especially so in case of treatments in intensive-care units for patients on assisted life-supports such as the tracheal intubation and mechanical ventilation. The British Medical Association Guidelines "Withholding and Withdrawing Life-prolonging Treatments" is a highly valuable document for decision-making. Such guidelines are also available from the American Academy of Critical Care Medicine, European Intensive Care Units (ETHICUS) Study and a few others. There had been also attempts by the Indian societies, in particular the Indian Society for Critical Care Medicine to formulate Indian guidelines. In the recent past, doctors at the Postgraduate Institute of Medical Education and Research, Chandigarh, in joint consultation with the legal fraternity, had framed the "Guidelines for Withdrawal of Treatment of Irreversibly Critically ill Patients on Assisted Respiratory Supports". The document, available on the Institute website clearly defines the need, the situations, the ethical principles and the recommendations. They help a patient's family as well as the medical personnel looking after the patient to resolve conflicts and take a decision. Some people advocate voluntary "withholding" of aggressive treatments i.e. not instituting a particular treatment, as a more humane act than withdrawing at a later stage. Several western countries allow the end-stage disease patient to voluntarily sign the "do-not resuscitate" and/or "do-not intubate" consents as clearly expressed advance directives. This, as yet is not a valid consent in the Indian set-up. "Withholding," therefore, is not a practical option to offer. The withdrawal of life supports, especially of the assisted respiration, in the presence of defined conditions in the presence of an end-stage terminal disease is allowing the God's natural process to take its own course without any external interference. It considers death as a normal and logical end of life - something which is known to man since time immemorial. Even in modern medicine, it is true today what was said over two-and-a-half centuries earlier by Morgagni: 'In the treatment of disease, often times to do nothing is to do everything' (The Seats and Causes of Diseases).
Case examples l KR, a 74-year-old male who suffered from progressive lung disease for over 15 years, was admitted to a hospital after he fell unconscious. He was resuscitated, intubated and put on mechanical ventilation. He remained unconscious, developed bedsores and swelling all over the body. The daily costs amounted to over Rs 30,000 per day. Finally, he died after about 5 weeks of suffering. l TS, a 48-year-old individual suffered from advanced lung cancer which spread to different parts of the body. He had been given several cycles of anti-cancer drugs without any significant response. He suffered from relentless pain and sleeplessness. One day, he threw a fit (due to spread in the brain) and became unconscious. The rest of the story was generally similar as in the first case. Question: In both the cases, could (or should) one have withdrawn (or withheld) mechanical ventilation earlier? Ethical principles involved l The Indian Medical Council (Professional Conduct, and Ethics) Regulations with regard to professional conduct, etiquette and ethics terms the practice of euthanasia as misconduct. The exception is withdrawal of supporting devices to sustain cardio-pulmonary function after brain death. Assisted suicide and abetment to suicide are legally proscribed and hence shall not be indulged in by a medical practitioner. l There is an important distinction between intentional killing and allowing a person to die under circumstances mentioned as 'brain death' and persistent vegetative state /deep coma in the presence of all of the following: i. Chronic, previously diagnosed and documented advanced, end-stage disease. ii. No recognisable and treatable or reversible cause of an exacerbation. iii. No concurrent administration of
a hypnotic/sedative/ opioid
overdose. iv. No hypothermia (body temperature more than 35 degree
celsius). v. All above (i to iv) are documented to be true by at least two specialist doctors. l Physicians have an obligation to make patients comfortable during dying. Withholding therapy to provide comfort is not intended to or equivalent to killing. The intentions are critically important in determining the moralities, decisions, liabilities and legalities. l These principles are not in any way contradictory to the existing social, religious and legal values or systems in India. The writer is Professor and
Head, Department of Pulmonary Medicine, PGI,Chandigarh
Euthanasia or mercy killing in its passive form has taken legal root in India. The Supreme Court recently broke new ground with a judgment in the Aruna Shanbaug case, sanctioning passive euthanasia — or withdrawal of life-support systems — on patients who are brain dead or in a permanent vegetative state
(PVS). The court clarified that active euthanasia, involving injecting a potent drug to advance the death of such a patient, was a crime under law and would continue to remain so. A Supreme Court Bench, comprising Justices Markandey Katju and Gyan Sudha Misra, laid down the guidelines for the high courts concerned alone to give a final go-ahead for passive euthanasia, involving withdrawal of life-sustaining drugs and/or life-support system, in a brain dead or PVS patient, after bona fide consent from the patient's relatives and the doctor's opinion. The procedure would hold good until Parliament enacted a law on this issue. While laying down the guidelines, the Bench rejected the euthanasia plea for Aruna Shanbaug, who is in a PVS for the past 37 years after sexual assault.
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