Jul 26 2014 : The Economic Times (Delhi)

poke me - Not Death Before Life

Harmala Gupta





Euthanasia is premature when most people have no access to end-of-life care

It surprises those of us who look after people with life-limiting conditions that we are not asked more often to end lives.We do, occasionally , receive requests but have found that they quickly dissipate once the precipitating crisis is dealt with: unaddressed physical pain, a feeling of guilt or loss of meaning. Why is this so?
By and large in India, it is families and not individuals who take decisions about their lives, including medical ones. Nowhere is this more evident than when the diagnosis is a lifelimiting one like cancer. The patient's diagnosis and prognosis, the details of the treatment to be followed, etc, are generally kept away from the patient and discussed by doctors with those who are perceived as the main decision-makers in the family .
Patients, too, seem to be happy to play along as not only do they believe that the family and the doctor will do what is in their best interest, but also because they feel that since the brunt of expenses and the burden of care will have to be borne by the family , it would be churlish for them to insist on their individual right to know.
In these circumstances, where the individual affected is not the decision-maker and is not in full control of information regarding his or her illness, legalising euthanasia is out of the question. It cannot be a decision taken by someone else on your behalf when you are up and able. Not all families are happy families and not all doctors are wedded to the Hippocratic oath.
The second reason why our patients, who are often at the end-of-life and of their tether, do not ask for euthanasia is because our teams of doctors, nurses and counsellors are skilled professionals who have the medicines and competence to bring immediate relief and alleviate unnecessary suffering. They are trained in a sub-speciality known as palliative care that is not confined to symptom control alone but includes hands-on nursing and training of caregivers in simple nursing tasks.
When Care is Aspirational
The counsellor on the team seeks to prioritise the most pressing psychosocial and economic concerns to help patients and their families feel less helpless and regain a sense of control over their lives. This care and support continues till the end-of-life for the patient and post-bereavement for the family . Unfortunately , however, our patients are the lucky few, for the vast majority , palliative care is a bridge too far.
Once again, the call for euthanasia is premature in a country where people with chronic, debilitating and life-limiting illnesses have no access to end-of-life care that is appropriate, affordable and can be delivered at their place of choice, usually the home. Instead, the reality is that if they live in a city , they are likely to be shunted into a critical care unit and at some stage, put on life support, which further compounds their misery as well as that of their families. For those who cannot afford such care, it is back to the village to die without any kind of supportive care to ease their pain and suffering.
Surely , the answer lies in increasing access to palliative care by train ing more personnel and providing them with the necessary wherewith al and backup? This is not expensive care as it does not require prolonged hospitalisation or sophisticated int erventions. All it needs is good symp tom-control and compassionate care that respects the dying process and the right of the patient to continue to live with dignity .
Life Cycle
For this to happen, society , including doctors, medical bodies and lawmak ers, must first accept that death is na tural and that there is something cal led the dying process. Efforts should focus on facilitating it in a manner that does not make it grotesque, dis tasteful and something to be feared.
Doctors must have the latitude to take decisions, such as removing life support, or refusing to initiate intru sive measures that they consider fu tile without fear of legal censure.
This is not physician-assisted eu thanasia as the intention is not to kill the patient but to do what doctors are sworn to do: to cause the least harm and do what will benefit the patient the most under the circumstances.
Missing Critical Care For this to happen seamlessly , a palliative care team trained in end-of-life care needs to be at hand to support the treating team and to counsel and prepare families. The Indian Critical Care Society and the Indian Association of Palliative Care have already jointly initiated this process and it is to be hoped that their recommendations will be considered seriously by the government.
The euthanasia debate is both premature and inappropriate for India.
A vast majority of our population does not, at present, has access to humane end-of-life care. Moreover, as long as families and doctors follow a “do-not-tell-the-patient“ policy , offering euthanasia as an option is simply a non-starter.
The writer is founder-president, CanSupport

Jul 26 2014 : The Economic Times (Delhi)

India Presses Food Security Button at WTO Meet

NEW DELHI OUR BUREAU





Won't back trade protocol unless concerns addressed

India stuck to its guns at the World Trade Organization in defiance of developed nations with a strongly worded statement at the general council meeting in Geneva on Friday that it will not agree to any accord on trade facilitation unless food security issue is also taken up, signalling its intent to take a hard stand on July 31, the deadline by which a decision has to be made.Instead, India has suggested a four-point action plan that seeks to deliver by December 31 a complete package on agreements reached at the Bali ministerial that includes trade facilitation, a package for least developed countries and public stocking for food security. The hardening of India's stand emerged after the new government took stock of the situation earlier this week.
Rattled rich countries have hit back at India, accusing it of going back on what was signed in December 2013 at Bali, a charge India has strongly countered.“The EU is not ready to renegotiate basic elements or timelines that were agreed as integral part of the Bali package,“ the European Union said, indicating a heightened risk of a stalemate or talks unravelling.
Another delay looms, an expert said.
“WTO goes by consensus and with India along with the other African, Latin American countries not agreeing to sign the trade facilitation protocol, it will have to get deferred,“ said Biswajit Dhar, professor at the Jawaharlal Nehru University.
It is by no means clear what will happen next, said a person present at the general council meeting, adding that the atmosphere was very tense.
“It will be suicidal, absolutely.
And that's not a threat, that's just a statement of fact,“ one Western diplomat was cited as saying by Reuters. “They say we're going to get what we want or we'll blow everything else up, but if they do that they won't even get what they want.“India said the concerns of poorer nations needed to be addressed.
“To fully understand and address the concerns of members on the TF (Trade Facilitation) Agreement, my delegation is of the view that the adoption of the TF Protocol be postponed till a permanent solution on public stockholding for food security is found,“ India said at the general council meeting, adding that that it was disappointed by the lack of similar urgency shown on issues of importance to the developing countries.The trade facilitation agreement seeks to cut down red tape in global trade that some studies say could add $ 1 trillion to the global economy.At the Bali ministerial in December, WTO members had agreed to pursue trade facilitation, a solution to the issue of public stock holding for food security and a package for least development countries.
India's food security law, which is based on massive government procurement from farmers and distribution to poor at subsidised prices, runs the risk of violating WTO rules that prescribe a limit on farm subsidies at 10% of output.
The country has budgeted Rs 1.15 lakh crore for food subsidies in the current year.
“India is of the view that the Trade Facilitation Agreement must be implemented only as part of a single undertaking including the permanent solution on food security,“ New Delhi said in its submission, accusing the developed world of not having the “will to engage in areas of interest“.
The G-33 countries, a group of developing nations, want a complete exclusion of subsidies given on account of public stockholding programmes from the category of actionable subsidies at the WTO. This will require amendment to the WTO Agreement on Agriculture to allow countries to procure food grain from poor farmers at minimum support prices and sell to poor people at subsidised rates through public distribution systems.
India said timelines were important but there cannot be undue haste.“The Bali outcomes were negotiated as a package and must be concluded as such,“ it said. “This is important so that the millions of farmers and the poor families who depend on domestic food stocks do not have to live in constant fear. To jeopardise the food security of millions at the altar of a mere anomaly in the rules is unacceptable.“At the same time, India said it was fully committed to the decisions taken at Bali.
“Having signed on to the ministerial decisions in Bali, let there be no doubt about India's commitment to those decisions including the Trade Facilitation Agreement. All we are asking is that the public stockholding issue as well as other decisions of Bali be taken forward in the same time frame as trade facilitation,“ India said.
An Indian commerce department official justified India's stand saying that any accord should not ignore the interests of the poor.“We can defer the time. Timelines are important, but they are not sacrosanct at the cost of the interest of a large (amount of) humanity which lives below the poverty line. We are not saying that we want to postpone it to eternity, no, not at all,“ the person said.
India sought immediate establishment of an institutional mechanism such as a dedicated Special Session of the Committee on Agriculture to find a permanent solution on public stockholding for food security.

Jul 26 2014 : The Times of India (Delhi)

Autonomous NAAC to finally come out of UGC shadow

Hemali.Chhapia @timesgroup.com

Mumbai:





Outfit To Be Revamped, `Sanitized'

After dilly-dallying for six months, the National Assessment and Accreditation Council (NAAC) has been pushed to start the process of autonomy .At NAAC's 66th executive council meeting, it was decided that the accreditation body for higher education institutions would snap ties with the University Grants Commission, thus ending UGC's two decade-long supremacy .
In the EC meeting that took place on Thursday , it was also decided that the HRD ministry will take NAAC under its wing. Currently , NAAC functions under UGC, but the ministry had, in a letter, bluntly asked the accreditation body and the regulator to keep each other at “an arm's length“. Despite that, there was enormous internal resistance from within NAAC.
The divorce will require NAAC to draw up new byelaws besides amending its memorandum of association. HRD ministry sources said that besides routine administrative changes, NAAC, whose inspections have been the subject of intense scrutiny and debate with allegations of favours taken and given, has to be revamped and “sanitized“. “After UGC made accred itation mandatory , the idea of making NAAC an independ ent body has been stressed up on in several meetings,“ an HRD ministry official said.
Across the world, such a sepa ration is the norm. “Yet, de spite several reminders, the ministry's suggestion was not being acted upon,“ he added.
Many in the HRD ministry blame UGC for NAAC's limited growth. Officials said the National Board of Accreditation, which grades technical courses, underwent a transformation “financially and functionally“ after it was sepa rated from the All India Coun cil for Technical Education.
For the full report, log on to http://www.timesofindia.com

Jul 25 2014 : Mirror (Pune)

In the name of God





Most of humanity thinks of God only when there is reason to fear the outcome of wrongdoing

We have witnessed a spate of swearingin ceremonies to constitutional offices in recent weeks – ranging from ministers to judges. Although the Indian Constitution has two options in the form of assuming office — “do swear in the name of God” and “solemnly affirm” — an overwhelming majority invoked God when entering office.In a society that does not set great store by affirmations in affidavits and is yet inextricably intertwined with religious practices, this is arguably a good trend. Yet, since most of humanity thinks of God only when there is reason to fear the outcome of wrongdoing, the trend in how public office is assumed, can be disheartening.
The Indian Constitution sets out the forms of the “oaths or affirmations” applicable to various situations. While an “oath” is a vow or promise, an “affirmation” is a positive declaration. The oath is a promise (a swearing in the name of God) to “bear true faith and allegiance” to the Constitution while the affirmation is a solemn declaration that person making it will indeed do so.
Does the form of promising or declaring one’s allegiance to the Indian Constitution at all matter? Or, can the manner of stating allegiance at all be treated as form rather than substance? The founding fathers of the Constitution discussed this at some length. A peek into their deliberations is interesting. Some of them had wanted the very Preamble to the Constitution to contain an invocation to God and lamented that God found place only in the oath of office. Others questioned with dripping sarcasm if the draftsmen of the oath had taken permission from God to be named in the Constitution since they seemed to claim to know God.
Providing the option came in as an intended solution for agnostics who do not believe in God.
Some members of the Constituent Assembly who were willing to accept provision of both options quibbled over whether the oath in the name of God should come first in sequence or if the solemn affirmation should — the phrase that
came first would be the first among equals in their view, indicating some form of superiority.An argument for removing the option of swearing in the name of God was that even providing for such a classification led to identification and indication of whether a person was a believer or an atheist, which would be contrary to the spirit of democracy. A member who firmly asserted his belief in the existence of God, quoted from the Irish Constitution to show that even in a Roman Catholic nation, the President takes an oath in the name of the people of his nation and submits to the severest punishment from the State for potentially breaking his oath, without invoking God.
It was only much later (in 1972) that Ireland would remove a reference to the primacy of the Roman Catholic faith from her Constitution, but the form of oath did not refer to God. The Constitution of the socially-diverse-but-politicallyChristian United States of America too does not have the invocation of God for the President’s oath. The words “So help me God” and the kissing of the Bible are customary practices that dif
ferent Presidents adopted on their own. Recently, Tulsi Goddard, a Hindu elected to the US Congress (incidentally, not of Indian origin) took her oath with her hand placed on the Bhagavad Gita.B R Ambedkar, who had introduced the reference to God into the oath of office with his drafting, has clearly been proven wrong today in one respect. He had argued: “It is only Christians, Anglo-Indians and Muslims who swear [in the name of God]. The Hindus do not like to utter the name of God.” He defended bringing God into the secular constitution to enable invocation of “the governing force of the Universe as well as individual lives” as a sanctioning force for adherence to constitutional provisions that did not entail specific punishments for violations.
There was one member who seems to have been prescient about how the Republic would turn out. Tajamul Husain found the oath quite unnecessary. His argument: “… 99 per cent of the witnesses who go into the witness box and take an oath or affirmation mentioning Almighty God, go to tell the untruth.”

Jul 25 2014 : The Economic Times (Delhi)

POINTS TO PONDER - Let There Be Light

Bibek Debroy





Being lit-up may be the brightest index for measuring development

Unless your general know ledge is particularly good, you may not have heard of Gbadolite, as opposed to Kinshasa, capital of the Democratic Republic of the Congo (DRC). Gbadolite is the capital of the country's Nord-Ubangi district.More importantly , it was the ancestral home and residence of ex-President Mobutu Sese Seko, president of Zaire (DRC's former name), between 1965 and 1997.
Mobutu wanted to change Gbadolite into a “Versailles“ in the jungle.
For years, economists have sought measures of economic development, per-capita GDP not being the only option. GDP is market value of goods and services produced in a year and per-capita GDP needn't be the same as per-capita income (income includes net factor payments). For instance, for Indian states too, if remittance income is significant, per-capita state gross domestic product (GSDP) can deviate significantly from a state's per-capita income.
`Gross' Domestic Product As a measure, GDP is often criticised. The thrust of that criticism is an inability to quantify variables that don't have markets andor prices.
None of that criticism is really new.
People who point to these warts often don't know that Simon Kuznets, father of national income measurement, wrote one of the best critiques of GDP in 1934. However, income is, at best, a means. It isn't an end. We must have some other measure of human development and deprivation.
Consequently , we went through stuff like quality-of-life indices and the most robust of measures now is UNDP's human development index (HDI, based on purchasing power parity , per-capita income, health and education). Every once in a while, someone comes up with a new measure, incorporating new ideas and variables. But in considering development or deprivation, several variables are correlated with several others.
The Cows Come Home Idon't see much point in adding to complexity . Taken a bit out of context, this is a bit like Occam's Razor: “Pluralitas non est ponenda sine necessitate.“ Simplified and paraphrased: don't complicate without reason.
Down the years, Laveesh Bhandari and I have done some work on interstate comparisons.
Once fishing through livestock census data, we found some rather unexpected correlations. Whenever a state's agriculture did well, there seemed to be reverse gender preference. Usually , the ratio of cowsbulls was 50:50. However, whenever agriculture did well, the ratio became more like 70:30. Once you think about it, the finding makes sense.
Agriculture doing well means mechanisation (less bulls needed) or diversification into dairying (less bulls wanted). Ditto for dogs, where the state of data is much more unsatisfactory . Whenever a state does well, “pet“ dogs increase relative to “non-pets“, a phenomenon also linked to urbanisation. Had data permitted, one would probably have found a male dog preference, correlated with urbanisation. We could, thus, have developed cow and dog indices for development.
We didn't do that because we didn't want to become the butt of jokes.
But there is one other thing we fou nd. Through Nasa, we got hold of pic tures of India taken at night. There was a very visible correlation bet ween darkness and states known to be backward, and illumination and states known to be more advanced.
For instance, central and eastern In dia was shrouded in relative dark ness. You could see that pattern glob ally too, with highways lighting up parts of the US.
Enlightened Development Our exercise was largely fun. Now, there is a serious paper by Paul Ras chky (Monash University) and Ro land Hodler (University of St Gallen) published in The Quarterly Journal of Economics, illuminating the dism al science. What's remarkable is the quality of satellite data they have col lected: 38,427 sub-national regions, between 1992 and 2009. Therefore, you not only have a light shot at one point in time, you also have a time se ries. One hypothesis is obvious, such as North Korea versus South Korea, or the Nile region in Egypt. Deve lopment means light, deprivation means darkness.
However, because of time series, the fascinating story lies elsewhere.
Which is where Gbadolite comes in.
When a political leader comes to power, his favoured geographical re gion lights up, such as Gbadolite un der Mobuto. To make the story plausible, after Mobuto's exile and death, Gbadolite faded again.
There is a similar story -without the fade-out bit -for Hambantota in Sri Lanka under President Mahinda Rajapaksa. Subject to quantification and estimation problems, here are some figures.
If literacy is high and democracy mature, light intensity doesn't alter with change in political leadership.
But if these indicators are “medium“, night-time light intensity in the leader's birthplace (or favoured region) increases by 4% and regional GDP by 1%. If these indicators are “poor“, those numbers change to a light intensity increase of 11% and regional GDP increase of 3%.
It isn't obvious from the paper whether these consequences follow from new resources or diversion of resources from other regions. Nevertheless, it is a novel study. Lenin had a definition of communism as Soviet power plus electrification. If one can ensure 24×7 electricity to all households -not just token connections at the village-level and villages that are off-grid -socioeconomic development becomes a given. Clearly, we picked up the wrong kind of “power“ from Lenin's definition.
The writer is consulting editor, ET
Night pictures taken by Nasa show a visible correlation between darkness and states known to be backward: central and eastern India was under relative darkness

Jul 25 2014 : The Economic Times (Delhi)

Sensible Proposals on Labour Reform





The Apprenticeship Act calls for change

The government plans to amend three labour laws: on minimum wages, apprenticeship and child labour. This is welcome. India's labour laws must be aligned with the needs of the 21st century . These laws must protect workers' interests, sure, but also give employers the leeway to adjust to market needs. The outdated apprenticeship law is one reason why India has only 3,00,000 formal apprentices, while Germany has six million. Arbitrary rules on how many apprentices and in what ratio to the workforce, etc, hamper skill acquisition by young people rather than protect them. The licence raj on nationwide permissions for national employers makes no sense and should also be scrapped.Apprenticeships are not jobs. The government should desist from any change in the law that will force employers to absorb apprentices. A pragmatic way is for employers to formulate their own hiring policies. The training period varies from six months to four years now. A maxi mum training period of three years, as proposed by an inter-ministerial group, seems sound, for both employe rs and apprentices. Employers who vi olate the law should face fines rather than prison terms. Stipends for appre ntices are too low, and should be rais ed. However, the entire cost need not be borne by the employer: the state can chip in, if it is serious about skill development and job creation. The point is to have a robust law that will help greatly expand formal apprenticeship as part of a flexible market for skills.
Amendments proposed to the Minimum Wages Act -such as setting a floor for minimum wages across professions, revision every five years based on NSSO's Consumption Expenditure Survey -will raise salaries of workers in the unorganised sector and is, therefore, welcome. The amendment to the Child Labour Act to bar children between 14 and 18 years from taking up hazardous occupations is in order. But at a more fundamental level, the political class should intervene at the grassroots to change the socioeconomic foundations to send children to school, rather than to work.

Jul 24 2014 : Mirror (Pune)

Till human voices wake us

EUNICE de SOUZA





T S Eliot was a significant poet who wrote wonderful lines, but led poetry into a dead end

I taught T S Eliot's poetry for several years, but have only just begun to wonder if he is the great poet I thought he was. Obvious ly he was a significant poet, and wrote some wonderful lines, but I also think he led poetry into a kind of dead end, as Joyce did with his Ulysses and Finnegan's Wake. Startling as writing, but where could one go from there?
He seemed to be intent on going against the grain by publishing a poem such as The Love Song of J. Alfred Prufrock, in 1917 during the World War. In contrast to the war poems of Wilfred Owen, Isaac Rosenberg, Edward Thomas and others, Prufrock is entirely an “internal“ poem, in which a diffident middle-aged man, spends his time mumbling and grumbling to himself about his inadequacies, the inadequacies of the high society to which he belongs.Prufrock, despite his stodgy name, feels immersed in his life of fantasy, lyrical longings, until the voices of ordinary society make him feel as if he is drowning in the banal. He hears the magic voices of mermaids till ordinary human voices with their mundane preoccupations make him “drown.“
“I have measured out my life in coffee spoons,“ he says memorably on one occasion. It seems oddly self-indulgent for a writer who denounced the Romantics, and felt that poetry should be “impersonal.“ This word “impersonal“ has been used as a stick with which to beat women writers, for their apparently “bare all “ writing, while many male writers have been read differently from women writers talking about the same thing. Think of Nissim Ezekiel who wrote about a failed marriage and other such without any critic commenting on the fact.
It is easy to fault Prufrock. On the other hand, what is one supposed to do when the world appears to be falling apart? It's an endless debate. Is there something one can do, or is it best to concentrate on playing chess, writing poems, avoiding news on TV and in newspapers? Friends who work in foreign-funded NGOs are often frustrated by the insolence of the donors, and give up their jobs despite their very high salaries. Best to concentrate on coffee spoons?
Prufock is a poem more relevant to our experience than the much-touted The Wasteland.
The Wasteland is a significant poem, full of cultural references. But these are references to which the average person has no access. Not that a poet has to tailor his references to the average person. An academic can certainly work out the puzzles, but what is the point if a poem becomes a chore for the reader? Would anyone want to buckle down and read it for the good of one's soul?
The pity is that such work has overshad owed truly memorable and accessible poems such as Auden's Shield of Achilles, in which, he talks about the state of the world, and laments the fact that we have never learned to weep when others wept. The second-last stanza reads A ragged urchin, aimless and alone,Loitered about that vacancy; a birdFlew up to safety from his well-aimed stone.That girls are raped, that two boys knife a third,Were axioms to him who'd never heardOf any world where promises were kept,Or one could weep because another wept.
That's a poem worth treasuring, not just reading as a culturally significant chore.