PortableFirefox is magic

I had used PortableFirefox in one of its earlier in one of its earlier incarnations and although the concept was good, there was a questions of usefulness. Firstly, many of the plugins either didn't work, or didn't work well. Secondly, there was the problem of keeping a concurrent second list of bookmarks. When everything was done, it seemed more logical to simply use the default installed browser on the work computer.

Yesterday, I revisited PortableFirefox and I am now mightily impressed with how it has progressed. Firstly, Macromedia Flash and Shockwave work completely. Most extensions to PortableFirefox works just like to the standard installation of Firefox. Even more remarkably, updates to Firefox work perfectly for PortableFirefox as well.

I normally use Google Browser Sync to for bookmark and history management and I can happily report that it works perfectly with PortableFirefox as well! For me, this is quite important as I often do research on the web at home and would save a number of links on any browsing session for later review. With Google Browser Sync, when I load up PortableFirefox in almost any location, it is as if I have my browser on my home PC - all my internet history and bookmarks are immediately and completely available.

With regards to performance, PortableFirefox is inevitably slightly slower, being installed on a USB memory key rather than on the hard disk but nevertheless, it is still surprisingly snappy.

Written college examination finally over!

Last Saturday, I sat the Royal Australian College of General Practitioners (RACGP) written examination for the fellowship. Now, I have only the clinical examination in May 2007 and assuming that I pass both and gain my fellowship, I will technically be a GP.

Although I am glad that one hurdle is past, I can only say that the written examination was long and painful, and in my humble opinion, unduly so. It was in two parts; a three hour short answer paper in the morning, followed by a four hour multiple choice paper in the afternoon. One has to question whether a seven hour examination actually provides any more information than something that is shorter.

Then, there were the entirely stupid questions like the multiple choice question asking for the antibiotic of choice for Legionella pneumonia. Frankly, if one of my patients had Legionella, the local public health unit and infectious diseases department would be jumping on the patient, I would discuss with my local microbiologist first before commencing treatment, not to mention that they would probably be admitted into hospital. Insofar as the management of Legionella pneumonia in general practice, the choice of antibiotic is frankly one of the least important aspects.

Anyway, four weeks to go until the clinical examination and then FREEDOM!

Full-fee paying local university students

The Sydney Morning Herald published a colourful opinion piece by Lisa Pryor on full-fee paying local students in Australian universities (1). The gist of her article was that the full-fee paying option allowed students of lesser academic ranking (and by presumption, ability) to "bribe" their way into university. Pryor states and I quote:

"The problem with full-fee paying students is they are engaged in institutionalised bribery...

The real threat to values is the triumph of money over fairness, which full-fee payers represent. What is the point of drumming into kids an ethos of egalitarianism and the fair go at school, if we are going to teach them as soon as they leave that it is okay to bend the rules so long as you can afford it?"

On this point I agree fully with Pryor. If there is such as thing as "Australian" values, then egalitarianism and meritocracy are a key part. There is an intrinsic unfairness to the fact that for those students who cannot enter a program on academic merit alone, a large sum of cash will guarantee placement.

Nevertheless, I can see the reasoning of the universities in this regard. Unless there is a significant shift in public policy with increased funding to tertiary education, external sources of funding are required. An ideological position of "pure" meritocracy would either require a contraction in positions, and/or higher tuition fees for all students.

In the example of full-fee paying international students, we do not consider that these students are "taking local places". Not only do their tuition fees fully fund their course, but they also help subsidise the remainder of the university. This "export" of tertiary education has become an important sector in Australian trade with a 123% increase in the international student population between 1997 and 2002 (compared to an 20% increase of local students) (2).


A discussion of full-fee paying university positions

Let us assume that:

1. There will not be any substantial change in government funding for tertiary education;
2. and that some form of "privatised" tertiary education in public universities is a necessity for the economic viability of the universities (insofar as maintaining current standards).

Firstly, we must ask the question as to whether "private" tertiary education positions are acceptable at all. I believe that the answer is in the affirmative. Specifically, Australians accept "private" (i.e., non-government) schools for both primary and secondary education. Many "aspirational" families indeed have a preference for these schools.

Now, given that there is no intrinsic objection to non-publicly funded education, the second question is whether private positions are acceptable within a public institution. Given the paucity of "private" tertiary educational institutions in Australia, this would seem to be a necessity. Furthermore, the fact that the highest quality and most prestigious universities in Australia are public rather than private institutions (in comparison to the United States) should be a source of national pride.

There are no obvious examples in primary or secondary education that we can draw upon, but perhaps, an analogous situation can be taken from the health system. On the whole, most people do not find it objectionable that there are patients with private health insurance in public hospitals. Indeed, there are clear benefits to the system as privately funded patients (i.e., their insurer) not only fully pays for their stay, but the small profit that the public system makes reduces the public funding load for everyone else.

Extrapolating this into the tertiary education system, I believe that there are indeed benefits in having full-fee paying students in public universities.


What are the objections to full-fee paying students?

I can see a number of specific issues problems with public universities accepting full-fee paying students:


Entry by lesser academic merit / advantageous financial merit

The first is discussed in the aforementioned opinion piece by Pryor. The current system allows economically advantaged students a "bypass" into what is essentially the same position if they do not meet the entry criteria by academic standards alone. This is perhaps particularly odious when full-fee paying students change into a HECS-HELP (3) funded position after "getting their foot in the door". Clearly this is inequitable.

The stance of the universities, however, is represented by the following University of Melbourne 2003 Senate Inquiry Submission who reject this notion (4):

"The University rejects the idea that enrolling full-fee paying students undermines the merit principle. The ‘clearly in’ score required of HECS students reflects supply and demand for a limited number of places, not merit, or any minimum ability to required to complete a course. All full-fee paying students meet minimum entry requirements, as do other students admitted on lower than the ‘clearly in’ score, such as those in equity programs. Many students admitted under the full-fee program would be eligible for a HECS place at another course within the University, and all of them would be eligible for a wide range of courses at other universities. In 2002, the academic performance of the commencing students in domestic undergraduate full-fee places exceeded that of students in HECS-liable places. Australian full-fee students were more likely to pass all their subjects, and to receive a first class honours grade. The strong academic performance of full-fee students demonstrates that the selection process in no way compromises academic standards."

Here, I reject the University of Melbourne's "rejection". Specifically, they have avoided the point. It is clearly acknowledged that entrance into an Australian university is based on supply and demand. Arguable, this is the case for most human endeavours. However, the ranking of the potential university entrants is based on academic principles while the acceptance of full-fee paying positions is not the case. I would propose that it is a matter of common sense that there would be a clear positive correlation of socioeconomic advantage for those students who accept a full-fee paying position compared to those that don't.

With regards full-fee paying students doing well in their tertiary studies, the conclusion made by the University is spurious. I could equally claim it supports the notion that the University demonstrates academic favouritism to full-fee paying students.

The submission states further:

"The best solution is not to abolish the full-fee paying places, but to end the quota system that creates the original mismatch between supply and demand. This is what the University proposed in its submission to the 2002 Nelson review. A second best solution is to extend income-contingent loans to full-fee paying undergraduates, and we support the government’s proposal to do this. The Minister has suggested that the $50,000 limit on loans under the FEES-HELP program be increased, and we strongly support an upward revision."

I agree with the "best solution" in principle. The rigid quota system and inadequate tertiary education funding is what drives universities to seeking full-fee paying students in the first place.

However, the "second best solution" as detailed above is diametrically opposed to the "best solution". Moving down that pathway is a validation of the existing system. The University is trying to walk down both sides of the street; trotting out the best (but politically unpopular) solution and killing it in the same breath with a flawed but politically acquiescent position.


Government funding into privatised positions

This issue goes to the heart of social equality. It is not only an issue in tertiary education, but also primary and secondary education as well as health. When someone has the socioeconomic advantage to be able to choose the "non-standard" option, should public money be used to support that choice?

I believe that public money should not be used in this fashion. For example, we may give social benefits to someone who is unemployed but it would be ludicrous to give that same benefit to someone who is not only employed but wealthy. Nevertheless, the incumbent conservative Federal Government seems to not agree with a progressive increase in funding of non-government schools at the expense of government schools since the mid-1990s (5).

In the context of tertiary education, we have the FEE-HELP scheme (3). States the Government policy:

"Students paying full fees for an undergraduate course do not currently have access to an income contingent loan scheme. This means that a qualified student who is offered a full fee paying place but who does not have the means to pay up front or can not take out a commercial loan can not access a place. This is inequitable."

I reject this assessment that it is (i) inequitable, and that (ii) government assistance through a deferred "income contingent loan scheme" is the correct solution. The Federal Government is moving the goal posts and forcing the public and the universities into a new status quo.

What is unstated in their "support for students" section of the policy paper is that this so called "inequity" is of the government's making, by setting rigid HECS-HELP quotas and encouraging universities in offering more "full-fee" funded positions. It seems to me that a clearly better solution is that any funding that would have been given through the "FEE-HELP" scheme to be applied to the HECS-HELP, i.e., by either reducing the cost of publicly funded university positions or by increasing the number of publicly funded positions.

I believe that students accepting a full-fee paying university position should do exactly that; be full-fee paying and to do so up front.

A proposed "fair" model that includes full-fee paying students

I believe that I have demonstrated that there is nothing fundamentally wrong with a partial privatised system but that there are many inequities to the current system. The following are a list of suggestions that I believe will make the system more fair:

1. Separate the admissions pool for private vs. public students
You can apply for any one course either through the publicly-funded system (where you are ranked and compete with other students on the "public" list) or you you can apply through the full-fee paying system (where you are ranked and compete with other students on the "private" list). That is, if you apply and are not offered a publicly funded position, you cannot "weasel" into the course by giving the university a large sum of money.

2. Relax the strict quota system that the universities are placed under
Universities may offer "x" number of places to prospective students under the quota. Naturally, there will always be a shortfall. The current system is such that the universities cannot then offer further publicly-funded positions in subsequent rounds (this is the basis the universities use to claim that their full-fee funded positions are "fair"). Clearly, it would be much fairer if the system allowed the universities to fill their publicly-funded positions with publicly-funded students!

3. Full-fee paying students must not be able to "convert" partway into publicly-funded position
I believe that when you start a university course as a full-fee paying student, you are entering into a social contract with the nation. Arguably, if someone wants to change courses, they should have access into either a publicly-funded or a full-fee paying position. However, I think that it is clearly unfair for a full-fee paying student to then subsequent enter a publicly-funded position in the same degree.

4. Full-fee paying students must be just that
It seems illogical for a full-fee paying student to receive public funding for their studies. Surely, any such funding would be better spent on more publicly-funded positions.

References

1. Pryor L. First lesson at university: have the cash, can jump the queue [opinion]. The Sydney Morning Herald. 3 March 2007. [Link]
2. Lukic T., Broadbent A., Maclachlan M. International higher education students. Strategic Analysis and Evaluation Group, Research Note No. 2, May 2004. Australian Government, Department of Education, Science and Training. [Link]
3. "Support for students", Our Universities: Backing Australia's Future, Policy Paper. Australian Government, Department of Education, Science and Training. Last updated: 16 November 2006. [Link]
4. Submission to the Employment, Workplace Relations and Education References Committee. Inquiry into Higher Education Funding and Regulatory Legislation 2003. The University of Melbourne. Submitted: 14 August 2003. [Link]
5. Australian Government funding to public and private schools. Australian Education Union. April 2004. [Link]
   

A discussion on euthanasia

I have recently been participating in an Australian web forum for current and prospective Australian medical students known as "Paging Dr." The following article is mostly derived from a number of posts that I wrote on that forum.

I am gratified to see that euthanasia has come back into the social agenda, in the Sydney newspaper press in any case. On Australia Day (26 January 2007), The Sydney Morning Herald published a wonderfully human story on Dr John Ellison, a Sydney medical doctor dying from myeloma who travelled to Switzerland to "end his life with dignity"(1). He sought the assistance of a Swiss charity "Dignitas" who assist patients with suicide. About Dignitas (from the BBC)(2):

"Dignitas was founded in 1998 by Swiss lawyer, Ludwig Minelli, who runs it as a non-profit organisation.

It takes advantage of Switzerland's liberal laws on assisted suicide, which suggest that a person can only be prosecuted if they are acting out of self-interest...

...The law on suicide actually states:

"Whoever lures someone into suicide or provides assistance to commit suicide out of a self-interested motivation will, on completion of the suicide, be punished with up to five years' imprisonment".

Dignitas interprets this to mean that anyone who assists suicide altruistically cannot be punished.

Its specialist staff all work as volunteers to ensure there can be no conflict of interest..."

The reason why someone from Australia would travel to Switzerland for euthanasia, of course, is that euthanasia is illegal in Australia. There is clearly a demand for euthanasia services. Let us explore some of the issues regarding this contentious subject.


Do people have a right to death?

Firstly, consider the fundamental question, for the moment outside the boundaries of law and ethics: "do people have a right to choose the option of death?"

If the answer is in the negative, then obviously euthanasia cannot be condoned by any means.

However, I believe, that in some settings, the answer is clearly in the affirmative. It helps to consider a scenario; a captain who "falls onto a grenade" to save his men has clearly chosen to sacrifice himself for a particular (and noble) reason. In fact, he is considered heroic. I can think of any number of other scenarios but it is clear that there is no blanket ban for a person choosing to die.

Indeed, if we consider this from a civil liberties point of view, then surely if we have a right to chose the way we live, the logical conclusion is that we can chose to die given that the endpoint of life is universally death.


"In some settings"

Establishing that someone has a right to choose death, however, does not mean that as a society must accept that choice unconditionally. Death by its nature is irreversible and the tenacity for the will to live is so strong that in most settings we would consider the voluntary act to extinguish life to be contrary to the human condition. We, for example, almost always consider a victim of suicide to be a tragedy and would aim to prevent it if possible. Mosts survivors of attempted suicide retrospectively view those events of their life as extreme low points.

In what settings then would euthanasia be considered acceptable?

Let us first describe an unambiguous case. A person with terminal metastatic cancer with extreme pain who has an expected lifespan measured in hours to days. By giving a sufficiently high dose of analgesic to control symptoms, a hastened death would be likely. I think that most people would consider the ethical duty to treat the distressing symptoms to overwhelm the ethical duty to not harm the patient (indeed, what further harm can be done?)

I think it is important to recognise this case. The reason being is that this is clinical reality and it happens every day across the globe and has been the case for centuries. It is important to note at this stage that many people do not consider this to be "euthanasia" as the argument is that the aim of the active treatment is to treat symptoms rather than to hasten death. Nevertheless, I feel that this may be a case of intellectual sophistry as we are still knowingly hastening death.


The "real" public debate on euthanasia

The above scenario is not really debated except as a point of grounding. That is not the "real" debate on euthanasia. When someone is on the "cusp" of death for the most part the debate is rendered irrelevant.

The real debate is for someone like Dr John Elliot as described in the above article. I quote verbatim(1):

"It is minus 5 degrees outside in Zurich and she knots a white scarf around his neck. As he walks out the door he breathes and says faintly: "I'm free."

The taxi drives a few blocks to a snowy, suburban street. In the ground-floor flat of a plain, four-storey building they meet a male nurse and a female social worker.

They sign documents. Dr Elliott, from Rose Bay in Sydney, takes a preparation to prevent vomiting. The nurse, Arthur, mixes a drink containing the barbiturate sodium pentobarbital and water.

As they wait 30 minutes for the anti-emetic to take effect they drink a cognac and chat. Arthur says he is from Davos, in the mountains. Oh, Dr Elliott says. He and Angelika used to go to the nearby village of Clavedel. They had so many happy days there.

With a video tape rolling, for legal purposes, Arthur asks Dr Elliott whether he realises that if he takes the drink he will die. Dr Elliott says he does.

"You can opt out at any time," the nurse says, several times.

"No," says Dr Elliott, an American-born doctor who never practised in Australia.

"I just want to get going. Hurry up."

About 10.10, sitting in a chair, Angelika holding his hand, he drinks. "It's not bitter at all," he says, surprised.

He has another cognac. His wife hugs him for the last time in 34 years of marriage. He starts to look drowsy, then his head nods forward, like any person falling asleep. In 15 minutes he is dead.

Dr Elliott spent the last hour of his life as he spent his last three months, unflinchingly determined to die."

The real debate on euthanasia is someone who has a terminal illness who prefer death rather than face an expected adverse effect on their quality of life in the near future, and they are otherwise well enough such that they are at minimal risk of dying from natural causes in the short to medium term.


The criteria for allowing euthanasia

If we accept then that (i) people have a fundamental right to chose death in some settings, and (ii) there is at least one unambiguous scenario where euthanasia is considered a clinical norm, what then follows as the criteria we use to "allow" people to choose death?


1. "Personal choice and competence"
Although this is needed, it is clearly not enough. Many people with depression who attempt suicide also "choose" their actions but we rightly (i) try to prevent suicides and (ii) try to resuscitate people who have had a suicide.

So thus, we must establish that people who make this "personal choice" are competent to do so. This is not a trivial thing to do. It is essentially a contradiction to ask whether someone who wants to suicide is in the "right mind" to choose it.

An analogy: someone who is hypomanic often feels fantastic when they are unwell. If they are an intelligent hypomanic, then they can make the most convincing arguments against treatment. how it is their "choice" to remain this way. Indeed, "people with hypomania are generally perceived as being energetic, euphoric, overflowing with new ideas, and sometimes highly confident and charismatic."(3) This of course all falls down then either they are treated or the hypomania stops. When they are well, they have the insight to their illness, which is why for the most part, we still treat people with mild bipolar disorder.

Establishing whether someone is in the "right mind" to chose death is not an easy thing as the experience of suicidal thoughts are that they go away when the underlying affective disorder or social situation improves.

Thus, not only must it be the personal choice of the person, but it must be established that they are completely free from all mental illness; something that I believe to be difficult to establish in someone with a terminal malignancy.


2. Delegation of responsibility
Following on from personal choice and competence comes the question whether the responsibility of the choice can be delegated to others; for example, the family, the treating doctor, a carer/guarding, a public guardian, or even some form of advanced directive. This is highly relevant considering that many terminal illnesses may lead to a decline in cognitive function.

The answer to this is fraught with dilemma. There are practical considerations but at the same time, there are obvious inherent conflicts of interest:

• family (release from burden of care, potential financial payout);
• doctor/health system (release from burden of care / lower health costs);
• a public guardian (the shorter the lifespan of their client, the less work they have to do).

For a person with a terminal illness, there are many stakeholders apart from the ill person who would benefit from a hastened death. Where there is a legislated pathway, there would also be a huge potential for abuse, unless, it was strictly regulated.


3. "Terminal condition"
Must there be a "terminal condition" for a patient to choose euthanasia? This is a hard question. One must consider people with multiple sclerosis, motor neurone disease and degenerative neuromuscular diseases. In themselves they are not "terminal" in the way malignancies are.

In the follow on from this question is the time frame. Too short a time frame and it would exclude just about everyone. Too long a time frame and there will be a subset of patients who may not have had a terminal illness at all.

For example, let's say that an inclusion criteria is that your expected lifespan must be less than 6 months. A small percentage of these patients may live for years if they are not euthanised ("life expectancy" is firstly a grouped average and secondly is more art than science).

Thus, if we use "presence of a terminal condition" as an inclusion criteria, it necesitates a time frame and the time frame chosen will be purely arbitrary.


4. Quality of life
Must the patient have an expected deterioration in their quality of life? The answer would appear to be "yes", but, the devil is in the details. How much reduction?

Furthermore, can this even be competently determined on an a priori basis?

For example, requiring a colostomy bag may be the worst thing that a particular person can imagine. The reality of a colostomy bag, however, may be much less onerous. On the other hand, managing a colostomy may actually be a terrible imposition on that person if they had to do it.

Thus if we accept that we must take quality of life into account, we must not only gauge whether the expected reduction is real, but also whether the person has realistic expectations. Clearly, euthanasia should not have a place as a method of treating a person's fears of the future.


5. Other problems - refusal of standand therapy
If we permit euthanasia, could a patient be included if they refuse standard therapy?

Examples:
A person has an operable colon cancer but it would involve a colectomy (i.e., colostomy bag) with chemotherapy. They refuse treatment (clearly within a persons right to choose) but wants euthanasia (so not to have to experience cancer death).

A more subtle example:
A person has metastatic melanoma (i.e., inoperable) but targeted radiotherapy and chemotherapy / immunotherapy could lead to significant improvement in both quality and quantity of life. They refuse treatment (again clearly within their right) but wants euthanasia (so not to have to experience cancer death).

The significance of these questions is that they are realistic. Most patients in fact do have options other than euthanasia; treatment modalities that would either improve their symptom control and/or improve their lifespan.


Practical implications of legalised euthanasia

The point of the above discussed criteria is to highlight that if euthanasia were permitted, it would by necessity be rigidly regulated, and that any inclusion and exclusion criteria arbitrary and at some level, inconsistent. Many people who may "benefit" from euthanasia will still not have access to it. Some people who are euthanised will on retrospectively analysis be considered to have been a bad decision.

To a certain level, clinics like Dignitas as described in the Sydney Morning Herald article work because they are a rare and limited service and their clients are highly self-selected motivated individuals.

For a widely available and accessible service (which would be the implication of "legalised" euthanasia) a lot of money will need to go into the regulatory framework. From an economic point of view, one must consider whether the manpower, intellectual investment and money would be better spent elsewhere (e.g., palliative care).


"Passive" and "active" euthanasia - consideration of ethics

"Active" euthanasia is when "the medical professionals, or another person, deliberately does something that causes the patient to die"(4).

For the most part, "active" euthanasia is illegal in both Australia and worldwide (with a few exceptions).

"Passive" euthanasia occurs when "the patient dies because the medical professionals either don't do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive". Activities that would fit this definition is legal and in many places part of standard therapy. It is considered a practical necessity.

However, is there actually an ethical difference between the two?

Some people argue that there isn't. Giving someone a lethal cocktail to hasten death is an active process on the part of the health professional. Withdrawal of active therapy is also an active process. Even withholding therapy (e.g., not giving further blood transfusions) is at a cognitive level an active management choice.

Thus, it can be argued that given we accept withdrawal of therapy as a valid medical decision, and that there is no ethical distinction between this and so called "active euthanasia", the logical conclusion is that euthanasia should not only be legal but performed were clinically appropriate.

There is a lot of appeal to this argument but I believe that it suffers from a flaw.

• "Active" euthanasia leads to death due to the intervention given by the medical practitioner.
• "Passive" euthanasia leads to death due to the natural history of the disease.
  

If you believe that this makes a difference then it means that "passive" euthanasia cannot be lumped in the same class as "active" euthanasia.

If you don't believe that it makes a difference (i.e., planned active decision resulting in death in both cases) then it can even be argued that active euthanasia is morally superior as it results in less distress and discomfort for the patient.

I believe that it makes a difference (my personal opinion).

It is the duty of doctors to improve health and prolong life, but not prevent death by all means possible (which is impossible). Death is a part of life and part of being a doctor is to allow people to die. That is, I don't believe that there is any ethical principle against letting people die from "natural" reasons. Quotation from the 19th century poet Arthur Hugh Clough:

"Thou shalt not kill but needst not strive, officiously, to keep alive."

There is, however, the ethical principle of non-maleficence - i.e., we should refrain from something that harms a patient. Is providing active euthanasia to a patient who desires death it "harming them"? It can be argued either way.

Thus the conclusion is that "passive euthanasia" is okay but "active euthanasia" may or may not be okay on a medical ethics basis, and, that there is a distinction between the two. This is somewhat the status quo though there are strong differing points of view within bioethics.


Reference articles

1. Button, James. My name is Dr John Elliott and I'm about to die, with my head held high. The Sydney Morning Herald. 26 January 2007. [Link]
2. Dignitas: Swiss suicide helpers. BBC News. 20 January 2003. [Link]
3. Hypomania. Wikipedia. Accessed 4 February 2007 (last updated 23 January 2007). [Link]
4. Active and passive euthanasia. BBC - Religion & Ethics. Accessed 4 February 2007 (Last updated: 20 July 2006). [Link]
   

"The Creation of The Medicine Box" published

This book, “The Creation of The Medicine Box” is a comprehensive documentation of the design, goals, development and construction of this website. It contains a review and analysis of the state of the project after six months from its launch in April 2006.

This report was in addition written and designed as a guidebook to the development of online medical education resources.

“The Medicine Box” represents a significant body of work. We hope that you find both this book and the website worthwhile.

"The Creation of The Medicine Box" has been published as a hard cover publication through Lulu.com. It can be purchased here for $US 17.95.

It can also be downloaded as a PDF ebook [4.2 MB].

“Asymmetrical” warfare – Israel’s response

War crimes are not a valid response to terrorism

Israel has responded to border skirmishes and an abduction of two of its soldiers in Lebanese/Israeli border by Hezbollah militants with the unilateral declaring war on the Lebanese government and launching a devastating bombing campaign into Southern Lebanon.

In essence, it has responded to terrorism with what can only be described as flagrant war crimes.

Regardless of Israel’s claim of only targeting “Hezbollah” facilities and installations, the truth on the ground is clear. Israel has systematically targeted civilian facilities. Roads, entire neighbourhoods have been flattened by the air strikes. Over 350 Lebanese have been killed, the majority being civilians. At least a half of a million people in southern Lebanon have been displaced. Recently reported today, Israel has started targeting television and radio transmission towers within Lebanon, even those unrelated with Hezbollah.

States UN High Commissioner for Human Rights Louise Arbour:

“Indiscriminate shelling of cities constitutes a foreseeable and unacceptable targeting of civilians… Similarly, the bombardment of sites with alleged military significance, but resulting invariably in the killing of innocent civilians, is unjustifiable.”

Although Arbour did not specify individuals, she suggested that leaders could bear personal responsibility. It is universally acknowledged that the actions of Hezbollah militants toward rocket attacks on civilians constitute terrorism. The action of the Israeli military and government should be measured by the same standards. Again, Ms Arbour:

“There is an obligation on all parties to respect the principle of proportionality.”

As a point of comparison, a total of 35 Israelis have died in the recent conflicts, 15 of them civilians. That is, the Lebanese casualties are over an order of magnitude worse.

This disproportionate warfare has hardly been lost to the people of Western Europe or the United States. There have been extensive anti-war protests in London as well as significant diplomatic disquiet. Nevertheless, both the United Kingdom and United States have resisted official condemnation of the Israeli action or calls for a ceasefire. The United Kingdom, nevertheless expressed its displeasure unofficially through the comments of Mr Kim Howells, the Foreign Office minister who stated:

“I very much hope that the Americans understand what’s happening to Lebanon. The destruction of the infrastructure, the death of so many children and so many people. These have not been surgical strikes. And it’s very difficult, I think, to understand the kind of military tactics that have been used. You know, if they’re chasing Hezbollah, then go for Hezbollah. You don’t go for the entire Lebanese nation.”

British Prime Minister Tony Blair official spokesperson has supported Howells statement.

It is interesting to read the United States position on the conflict. The United States has by large given explicit consent for the Israeli military campaign and has placed the “blame” solely on Hezbollah. Lebanese civilian casualties, just like those of the Gazans have been ignored behind the glib “Israel has a right to defend itself”. Syria and Iran are the usual bogeymen with their arms support for Hezbollah. The hypocrisy is breathtaking.

Rather than condemning the Israel’s bombing strategy, the United States, Israel’s main weapons supplier, has expedited a shipment of munitions to Israel. Far from simply “looking the other way”, the United States is complicit in this slaughter of civilians.

Even more ludicrous is the suggestion by Australia’s feckless Foreign Minister Alexander Downer who claimed in the 7:30 report:

“Hezbollah should immediately withdraw from southern Lebanon and leave Israel alone, and the sooner they do that, the better.”

I can fully agree that Hezbollah should “leave Israel alone”, but our esteemed foreign minister needs to explain why the Lebanese should “withdraw” from their own country for the sake of the Israelis. Of course, parroting US foreign policy dogma seems to be the standard path for the Howard Government.

The international effort for peace must be pursued. Violence begets only violence.

Source articles
Perry T. Israel and Lebanon under fire. Reuters. 23 July 2006.

Tostevin M. Diplomatic flurry in Israel over Lebanon war. Yahoo! News (Reuters). 23 July 2006.

Long G. Thousands march in protest against Israeli attacks. Yahoo! News (Reuters). 22 July 2006.

Noueihed L. Lebanese flee north raising white flags. Yahoo! News (Reuters). 22 July 2006.

Pickler N. Bush: Rice trip will focus on Hezbollah. Yahoo! News (Associated Press). 22 July 2006.

Minister condemns Israeli action. BBC News (International). 22 July 2006.

US rushes precision-guided bombs to Israel: NYTimes. Yahoo! News (Reuters). 22 July 2006.

Israel targets Lebanese television towers. Taipei Times. 23 July 2006.

UN warning on Mid-East war crimes. BBC News (International). 20 July 2006.

Downer defends embassy staff [transcript from TV program]. ABC 7:30 Report. Broadcast 19 July 2006.

Moving to Gilgandra

I am posted to the town of Gilgandra in rural NSW for the next six months for my Advanced General Practice term. As such, I am taking a short break from vitualis' Medical Rants for the next 3 weeks.

New articles will appear once internet access in the registrar house in Gilgandra has been set up.

Best regards,
Michael Tam

vitualis' Medical Rants - Volume 3 published

Following tradition since this blog was revitalised in October 2004, a biannual compendium of vitualis' Medical Rants is published in print form (what Wikipedia refers to as a "blook"). Just released is Volume 3: January to June 2006 - available in soft cover, hardcover and as an ebook in Adobe PDF format.

The printed version of vitualis' Medical Rants contains the full text of the original articles, but furthermore, also contains reprints of the original reference articles as well.

I will take this opportunity to thank all my readers for their kind support.

Best regards,
Michael Tam

Mutual terrorism

The Israeli-Palestinian disaster

Israel unleashed its military machine in the past few days, ignoring global calls for calm and restraint. For one captured and murdered soldier, Israel has accelerated the conflict to outright war. Launching night raids across the occupied West Bank and East Jerusalem, Israel captured and arrested the majority of the ministers and members of parliament of Hamas.

Hamas has stated that these raids were an act of “open war against the Palestinian Government and people” and it is hard to see how this is not so. States an Israeli Foreign Ministry official (Mark Regev):

“If the government of the Palestinian Authority says it’s okay to send rockets into Israel, to kidnap Israelis, to behave like terrorists, then they will be treated like terrorists.”

The hypocrisy of this statement is unfortunately lost on most people, and obviously, the Israelis. The Israeli Government has launched dozens of aerial attacks into Palestinian urban areas, killing an order of magnitude more civilians. It has routinely “kidnapped” Palestinians through its extrajudicial security sweeps.

As for behaving like “terrorists”, in the past two days, Israeli attacks targeted the Gaza Strip’s only power station and have left 700,000 Palestinians in the Gaza without power and with a threatened water supply. The Foreign Ministry has described civilian infrastructure as “legitimate targets”. Sorry Mr Regev, but targeting civilians and civilian infrastructure in such a manner is an act of state sponsored terrorism and a war crime.

As I have argued on numerous occasions the ethics and morality of action needs to be examined through the lens of “universality”. If we apply the reasoning that Israel uses to justify its attacks to Hamas, then surely Israeli “civilian infrastructure” would also be “legitimate targets”. Attacking and kidnapping of Israeli ministers and MPs would be justified.

This is obviously not the case. As such Israeli should be condemned in perpetrating this highly unethical, if not illegal military action against the Palestinian people.

In just six months since the Ariel Sharon broke away from Likud to form the centralist Kadima party, the hope that he created for a new peace between Israelis and Palestinians has faded like the man.

From: The Sydney Morning Herald

Acts of war: Middle East on edge (excerpt)
Ed O'Loughlin Herald Correspondent in Gaza and agencies
June 30, 2006

...In night raids across the occupied West Bank and East Jerusalem, Israeli troops rounded up most of the ministers and MPs representing the non-Gaza wing of the Palestinian ruling party, Hamas.

Hamas has described the raids as an act of "open war against the Palestinian Government and people" and said Israel would have to face the consequences...

...Israel's move against the Palestinian Authority in the West Bank is only the most serious of a number of grave developments threatening to escalate an already fraught situation into all-out war and humanitarian disaster...

...On Wednesday Israeli jets buzzed the summer palace of Syria's President, Bashar Assad, driving home Israel's threat to assassinate Hamas leaders at large in Gaza and in exile in Syria. Syria said its air defences fired on the aircraft without hitting them.

Early yesterday Israeli troops found the body of a murdered 18-year-old Jewish settler - Eliyahu Asheri, who is the son of an Australian immigrant - abducted by Palestinian militants in the West Bank on Sunday.

In Gaza, meanwhile, militants belonging to the mainstream Fatah military wing, the al-Aqsa Martyrs' Brigade, claim to have fired a chemical-tipped missile into Israel for the first time...

...Israel's Prime Minister, Ehud Olmert, has said that Israel will not negotiate to release Corporal Shalit and will take "extreme actions" if he is not freed.

"Our aim is not to mete out punishment but to apply pressure so the soldier will be freed," he said. "We want to create a new equation: freeing the abducted soldier in return for lessening the pressure on the Palestinians."

Over the past 48 hours, Israeli attacks - including artillery bombardments, tank incursions and the destruction of two bridges and the strip's only power station - have left 700,000 people without power and threaten to cut off water to 1.3 million Gazans.

The actions have been condemned as "collective punishment" by human rights groups and by the British Foreign Office...

Guantanamo Bay military tribunals ruled unconstitutional

In a stunning blow against the Bush Administration, the US Supreme Court has ruled in a five-to-three decision that the military tribunals held in Guantanamo Bay against the detainees were illegal.

Specifically, it stated that the Geneva Conventions covering prisoners of war had to be applied to proceedings against all the prisoners.

However, the court did rule that the administration had the authority to hold the prisoners and whether they should be held as prisoners of war did not appear to be within the scope of the ruling. Of the eight prisoners held who have had charges made against them (including Australian David Hicks), this is a major breakthrough. It has already been argued that the charges brought against Hicks are invalid under the Geneva Conventions.

The position that the Guantanamo Bay detainees should be released as has received a major boost. The camp should be closed with all haste.

From: The Sydney Morning Herald

Military tribunal for Hicks illegal (excerpt)
Michael Gawenda
June 30, 2006

...The US Supreme Court has ruled that the military commissions set up by the Bush Administration to try prisoners, including David Hicks, at Guantanamo Bay are illegal and must be abandoned.

In a major blow to the Administration the five-to-three decision of the court said the Geneva Conventions covering prisoners of war had to be applied to proceedings against all prisoners at Guantanamo...

...It means that at the very least, the Pentagon will have to set up standard courts martial for prisoners, with all the protections afforded them under US law.

It is not clear what the Administration's response will be or how long it will take for it to set up military courts martial to try prisoners, such as Hicks, who have already been charged with offences that may not be valid under Geneva rules...