Wednesday, December 22, 2004

*HIV/AIDS in Singapore*

I think it is safe to say that AIDS is a problem of sufficient magnitude that we need to do something about it. Granting of course that some would consider other issues as more pressing etc.

What I want to do is to focus this issue in Singapore for a couple of reasons: 1. It's my homeland after all 2. While no longer in its nascent stage, it's not as widespread as certain parts of Sub-Saharan Africa 3. Whatever policy considered has a fair chance of actually working considering the strong Executive/Legislature and the relative small size of this sunny island. 4. The worthy luminaries can worry about the rest of the world

Before I begin, let me state what this problem is not. 1. Cost, Singapore does subsidise AIDS drugs if I'm not wrong. 2. Distribution, small island, literate population. If it works in Uganda, it's bound to work here. 3. Acknowledgement of problem. We realise we have a problem...I think... 4. Blood. It's almost entirely about sex. We screen our blood, we don't have the sale of blood/blood bank scandals like in China.

So, the basic problem in Singapore is fundamentally one of education. See the whole debate on whether Condoms work or do not work...I blame Focus on the Family for their ideological stance getting in the way of proper sex education and their infantile idea that an abstinence only policy works. But others would claim either the moral degeneration of aping Western Liberal Ideas, promiscuity, the homosexual community etc. And with all the ideological egos at stake we could have a serious problem here. But ultimately, I suppose we're all on the same side so to speak.

The more pressing issue is the extent to which certain civil liberties, particularly those of privacy, should be infringed. Theoratically, we could institute mandatory AIDS testing and let nature run its course and theoratically it would 'burn out' by itself. Of course, practically speaking it (being Murphy's Law) would ensure that this would never happen but we've already taken the first step of screening mothers for AIDS with the provision of antenatal drugs to prevent transmission of the virus.

But even if we do a full blown mandatory testing, of which the next step would be to test the yearly intake of NSF regularly and then extending to the rest of the population etc., it then arises the question of whether the test results ought to be made know in a public fashion. On one hand, you've got the public good. On the other, do we trust our society to be mature enough not to discriminate and abuse such people? After all, while there are those who voluntarily took the risk, others had the risk forced upon them e.g. spouses.

However, while keeping the data private (or on a need to know basis) would protect the privacy of patients, it would require people with knowledge of their condition not to willfully infect others (see the recent Thai case). With the stakes so high, can we afford the risk?


*NTU Pre-Worlds*

1. This house would put humpty dumpty together: OG (3), we ran that we would overturn the Eu Anti-Trust Ruling and allow Microsoft to bundle whatever proprietry software that they wished with Windows.

2. This house would choose love over money: OO (1), OG ran abolishing of Capital Punishment. Relatively straightforward case.

3. This house would pave paradise and put up a parking lot: CG (2), OG ran very tight case on why US should put its bases out of Japan. Our extension was that this would be good for both US and Japan because it would prevent the anti-US, right wing, pro-militarisation side from hijacking the LDp's military and foreign policy by making Koizumi more por-active rather than react to their demands. Unfortunately that wasn't persuasive as compared to our 'other' extension that this would reduce the stretch that the US was currently facing.

4. This house believes that Malaysia is truely Asia. CO (3), OG ran why Malaysia should remove its ringett peg. Bah humbug.

5. Frankly my dear this house doesn't give a damn. OG (3), we ran gay marriages. *Sigh*, not a good setup on my part unfortunately, too much 'noise' (fillers) apparently according to Amit.

So with a grand total of 7 points and average speaker scores, we broke into the quarter finals. Unfortunate, being Swing A (we were there just to make up the numbers), we got kick out automatically...=P


Monday, December 13, 2004

BBC NEWS | Health | Call to legalise live organ trade

Personally I don't buy the ethical arguments against it and I'm sure my moral arguments for legalisation will probably fall on flat ears so nevermind this set of arguments.

So let's take it purely on a CBA on the basis of a harm reduction policy. The basic arguments for and against such a move have pretty much been dealt with in the BBC link above but here are a couple more that might be useful.

Would it create a situation whereby on the rich would be able to afford it? This situation might be execerbated if no one is willing to donate his or her kidneys unless there is some monetary gain to be gotten from it. But as the situation stands, most organ transplants are done when the doner is dead (for obvious reasons, the kidneys being one of the few organs which a person can survive with one or partially, another being the liver), so that shouldn't be a major issue (especially in conjunction with opt out programmes).

So the likelihood of such a problem cropping up would be for such transplants such as kidneys and livers amongst others. And while it is probably very likely that such transplants would go to the rich, we have to face the fact that already money is important in the kind, type, quality and extend of medical treatment that can be gotten. Even if one wants to consider equity, at least this frees up dialysis machines and beds and waiting lists so why not?
The trade apparently is flourishing so regulation would be useful to minimise the harm and prevent abuses already occuring today.

Saturday, December 04, 2004

BBC NEWS Americas Abortion battle rages on in US

Gee whiz...

I finally managed to finish reading Roe v Wade yesterday and it didn't so much as legalise abortions but decide when the state would have a compelling interest in overriding the mother's right to privacy (and hence bodily autonomy...please don't ask me how they link, the Justices weren't clear on it. Justice Renquist dissenting).

Point to note, that the Texan abortion laws which Roe was against had not been changed since 1877. But more importantly, it did permit for abortions in the cases where the mother's life was at stake or when it was due to sexual violence.

What is interesting is that the Supreme Court basically determined that much of the then legislated abortion statutes in the various states (and their history) were not so much as to protect the unborn fetus but in the interest of the mother's health and safety because of the high mortality rates these operations entailed in the 19th Century.

Hence, the ratio decidendi (ruling of the Court), is actually very narrow. "A state criminal abortion statute of the current Texas type, that excepts from criminality only a life-saving procedure on behalf of the mother, without regard to pregnancy stage and without recognition of the other interests involved, is violative of the Due Process Clause of the Fourteenth Amendment." Hence, a) Abortion laws would be deemed unconstitutional if they barred abortions in the first trimester. b) Past that, State may regulate such operations in a manner reasonable to maternal health. c) Past viability, abortions may be banned, subject to the state's determination of the preservation of the mother's life and health (Legal jargon: Best interests). Hence the Texan abortion statutes were unconstitutional.

Interesting point to note is the state in which it places the physician. He can do anything he judges to be in his professional best interests subject to compelling state interets (see current ho haa over the so called Conscience Laws).

Reasoning was rather simple. They weighed the rights of the mother to that of the state and found that the state had two compelling interests. One would be that of the mother and the other, the fetus i.e. ball of cells or unborn child.

With regards to the State's interest to the mother's health, the compelling point is that post first trimester because the mortality and complication rate of such operations in this period would be lower than that of pregnancy.

With regards to the State's interest to 'potential life', it boils down to 'viability' in that the fetus would be capable of meaningful life outside of the mother. Currently, the average is 24 weeks i.e. second trimester, but has been going down due to the advances in medical science.

Personally, I feel the last bit was put in to prevent a situation whereby advances in medical science would render abortions so safe that there would be no basis for the state to legislate against it short of the fetus actually being born and hence having citizenship rights. To be fair, I doubt any Court or Legislature would have accepted such a carte blanc ruling (Singapore prohibits abortions post 24 weeks. Britain's Common law and statutes do recognise certain fetus rights, see Re S cf. St George's NHS Trust v S, as well as Congenital Disabilities (Civil Liability) Act 1976.)

*Sigh*...and now to formulate a case that would call for the overruling of Roe v Wade to establish abortion in US on a firmer basis.