The Consent Dilemma

 

Image courtesy ICT works

Lately, gentle reader, we've been hearing a great deal about consent.

The discussion has generally been about consent for sex, against the background of a high profile incident in parliament house, the awarding of Australian of the Year to Grace Tame, and school students becoming active about the issue.

But consent operates in a range of other contexts, notable amongst them the use of personal data. How often have you given consent for your information to be shared online, and how much thought do you put into that question? Look at the image above to get a handle on the complications.

Now we're hearing about consent in relation to medical matters, specifically the AstraZeneca vaccine. I had the first dose back in mid-April, with no ill effects. The flu vaccine, on the other hand, left me with a very tender left arm for a few days. 

I needed no persuasion to have either, so consent was not an issue, but in the past, it has been.

Many years ago (1982) my bride and I lost our first baby (full-term) through stillbirth. A post mortem revealed the cause was a cerebral aneurism, the consequence of a minor malformation which meant the baby could not survive the rigours of birth.

We were asked by the obstetrician at a debriefing appointment after my bride's discharge from the hospital whether we were planning to have more children. When we answered in the affirmative, he suggested that future births should be cesareans.

We made no decisions at the time, but went home and discussed the suggestion at length. It was clear that my bride did not want to go down that path, so we went back to the doctor, and asked him to explain simply the dimensions of the risk we were managing. He said that there was an 80% likelihood of safe childbirth.

Put this way, it was easier to make a decision, which was to opt for normal delivery, and four healthy babies later, that worked out well. What the experience did for us, was to highlight the issue of consent, and which player (or players) in the scenario have the right to provide it.

I was reminded of consent again when completing my St John's CPR refresher the other day. The instructor reminded us that first aid cannot be provided to a conscious lucid individual who refuses it. 

I hope I'm never put in that situation.

Now we have National Cabinet deciding that the AstraZeneca vaccine can be provided to people under forty if they give informed consent. Again, that consent needs to be weighed against the background of a risk/benefit analysis. 

Sometimes I think that the medical profession has a problem with allowing consent to be the prerogative of the patient, and I'm sure I understand why. It must be mortifying to know that the decisions the patient makes may not be in his/her long-term interest. It must butt up against the "first do no harm" principle something fierce.

Consent is also a critical factor in any discussion about euthanasia, but maybe I'll look at that another time.

In summary, medicine, whilst a noble profession, runs the risk of assuming a power it does not have. I'm talking about the "playing God" cliche.

I hope my GP brother doesn't read this.

TGA

Picture courtesy ABC - Not my bride.

 June 22nd started up as a routine Tuesday. 

I went to the gym, and my bride headed out to meet a friend for coffee, something that happens most weeks. I got home first and emerged from the shower, got dressed, and heard the car draw up, but my bride didn't come into the house.

This was strange, so I went into the garage and found her standing beside the car with its back door open, looking with a puzzled expression at a bag of bits and pieces obviously bought from a nearby shopping centre. She asked me "Where did this stuff come from?".

I rummaged in the bag and found a docket that showed the items had been bought half an hour earlier at a shop that my bride frequents, but she was adamant that she hadn't bought them. 

We went inside, and she kept repeating questions like "Where have I been and how did I get here?" I phoned her friend who reported that they had parted company after a chat and a coffee, and a mention that she was going to do a bit of shopping on the way home. My bride had no recollection of any of this.

By this time I was very concerned, so sat her down and went through the stroke test that I'd learned when I did my first-aid certificate. All seemed normal, but I drove her to casualty at the hospital less than a kilometre away. There, the triage nurse put her through the same stroke test I had applied, and then when the emergency registrar tured up, he did the same. That made three stroke tests in one hour. The registrar ventured a diagnosis, (probably a bit premature at that stage) of TGA (Transient Global Amnesia). 

Then followed an admission after a bed had been found and the beginning of a series of tests across the next three days including an electroencephalogram, an MRI, a Carotid duplex, and a CT scan. She was discharged on Friday evening after an examination from a visiting Neurologist who came from the big smoke.

He endorsed the registrar's diagnosis.

My bride is back to her old self, after one day (Wednesday) when she said she felt a bit fuzzy, and all memory has returned with the exception of a gap lasting from about noon Tuesday until Wednesday morning. For her, the most frustrating consequence was being locked out of her phone because she kept punching in the wrong login sequence during her confusion on Tuesday. 

An hour on the phone with the helpful Glen from Apple online help fixed that.

It was certainly a great relief that recovery was so quick and complete, and also that there were no nasty migraines that apparently can accompany these episodes.

Typically, the origin is unknown, so we're left with a mystery. 

It was, whilst it lasted, pretty frightening.

 Comments Closed 

A Tale of Two Myths

Gymnastics can be verbal.

 

The origin and tenacity of long-held Australian myths is a fascinating study.

To name a few of the more well-known, Ned Kelly, (as the Australian Robin Hood), Lassiter's Reef, Drop Bears, and the Inland Sea - they abound and persist.

The ANZAC myth is one of the most enduring, and the Dark Emu narrative the most controversial.

The first of these has been around for a very long time and the second is a recent phenomenon.

I've personally been guilty of exploiting one of these myths. To my eternal shame, I used the Drop Bear narrative on a Sydney-based soldier when we were at Shoalwater Bay in November 1969. He had never spent time in Central Queensland and swallowed the story whole, avoiding setting up sleeping space directly under large trees.

For a short time, it was funny, but we were sternly told to desist by our platoon sergeant when he sussed out what was going on.

The ANZAC Myth (rugged volunteer soldiers fighting for king and country when we were under threat) persists, but it was a very poor fit with our Vietnam experience. Somehow the contradiction between that historical construct and the fact of conscripting twenty-year-olds to fight in peacetime on foreign soil spilled through to the keeper.

The "primitive savage" narrative which describes the indigenous inhabitants of the country at the time of colonisation as useless and incompetent nomadic hunters and gatherers, also persists but has been challenged recently by Bruce Pascoe.

Now, let's get this clear. I'm not challenging either of these two narratives. Rather, I'm looking at the reaction when they are challenged.

In the case of the first, when I challenged the "every National Serviceman who went to Vietnam" narrative (an integral part of the ANZAC myth when applied to Vietnam) I was first ignored, but eventually, in the face of overwhelming evidence to the contrary, the fact of history was grudgingly ceded, but not until there had been a great deal of ducking and weaving.

Some of that ducking and weaving was epic. 

There were those who maintained that young men, who had their birthdates drawn in the National Service ballot were somehow "volunteers" because they went along with a posting to Vietnam.

Others were convinced that anybody who didn't join the CMF to avoid the possibility of operational service was also a "volunteer".

The logical gymnastics involved would have made Nadia Comăneci look like a rank amateur.

In reference to Dark Emu, the reaction to Pascoe's thesis has been epic.

How dare the notion of the noble, but incompetent savage be challenged? Pascoe's work was condemned by shock jocks, culture warriors, and serious politicians who suddenly assumed the anthropological mantle. 

I've read Pascoe's book and found it engaging and interesting, but I believe he has crossed a bridge too far with many of his assumptions. Having said that, the elevation of the issue in the public consciousness has probably done the study of indigenous history a good turn, and schools all over the country are including a discussion of the issue in curricula.

Pascoe, in the meantime, is laughing all the way to the bank. 

Contrasting the reaction to the busting of two myths has revealed a great deal about us as Australians. There are two basic lessons.

The first is - be prepared to be savagely attacked if you have the temerity to put a challenge forward to a myth that has become institutionalised.

The second is - the facts of history will always play second fiddle to long-held prejudices and bigotry.

Comments closed.

Review: The Long Shadow

This book has been a long time coming.

 

It provides vindication for surviving Vietnam veterans, although a bit late for the 500 who didn't come back, and those who have died since.

It was commissioned by the Australian War Memorial under Brendan Nelson's sponsorship and offers a riposte to the Evatt Commission and its findings.

That Commission, which pitted volunteer Vietnam veterans against highly paid silks, came to a set of conclusions that treated veterans as disposable political collateral. That set of conclusions has been well and truly eviscerated by Yule's comprehensive and patient research.

 The health outcomes for Vietnam veterans post-conflict are stark.

Of the 60,000 troops who went to Vietnam, 74.7% are classified by the Department of Veterans Affairs as suffering from some form of service-related health impact. These include physical disability, health problems related to chemical exposure and varying degrees of psychological trauma. The 3,129 who were severely injured suffer the resulting long-term effects. Many more were subject to less severe but still debilitating injuries such as hearing loss, which affects around a third of all Vietnam Veterans today.

What made Vietnam different was that it was the first conflict that saw the widespread use of herbicides such as the defoliant Agent Orange. Exposure has been linked to cancers, fertility issues, and birth defects. An extensive 2005 study by the Department of Veteran Affairs found that male Vietnam veterans have an increased cancer rate overall, including significantly higher rates of Hodgkin’s disease – explicitly linked to herbicides – as well as prostate and various other cancers. 

A connection has also been established between service in Vietnam and higher rates of skin and lung cancer which can be put down to higher rates of sun exposure and smoking. 

The long-term impacts of non-combat chemicals such as DDT, now banned in Australia due to their potentially carcinogenic properties; and  the use of Dapsone as an anti-malarial drug, which has been linked to circulatory and digestive disorders are still not completely understood.

Also not yet well understood are the intergenerational impacts of Post Traumatic Stress Disorder, but it seems that the consequences of this conflict may be felt by generations to come.

The Evatt Commission plagiarised huge slices of the evidence of chemical companies and used them on the floor of the Commission. Veteran witnesses at the time believed they were deliberately intimidated and completely disadvantaged by the legal representation.

Phil Thompson will never be forgotten.

Dr Yule interviewed many veterans, and their voices can be heard through the pages of this book. His approach is compassionate, fearless, and meticulous. The extensive bibliography, notes, and indices are evidence of the work he put into his research and the deep understanding of veterans he developed in the course of this project.

It was gratifying to note the half dozen citations from my memoir. There's plenty out there, and Peter Yule has obviously read them all.

He contextualises the war in Vietnam across conflicts going back as far as the Romans, the Medieval wars, the Napoleonic era, and the American Civil War. He describes the impact of industrialised warfare on soldiers during the First World War, and the beginnings of the understandings of the effects of psychological trauma.

He outlines the institutionalisation of repatriation in Australia after the first World War and traces the development of policy and practice in the area. He compares and contrasts the Australian experience of war in Vietnam with other conflicts, and points out how factors such as exhaustion, sleep deprivation, and the lack of a front line were particularly impactful. The lack of a front line meant that there was no safe place, even for those behind the wire. For those outside the wire, there was simply no respite from deadly threat. Survival depended on hypervigilance. When living with this hypervigilance across a ten-week operation, it became an ingrained habit that persisted even when the threat was no longer a reality.

His description of the ten-plus years of relative silence post the Australian withdrawal in 1972, and the fall of Saigon in 1975 lead the reader into a very comprehensive treatment of the Agent Orange controversy and ultimately the Evatt Commission. Yule is especially critical of F.B. Smith's official history. Smith seems to have made up his mind that the veterans were simply in pursuit of financial benefit, and wrote his account with that notion as the only consideration. The fact that recent research, including a number of morbidity studies, have largely vindicated the claims of the veterans has exposed Smith's bias.

To quote the Vietnam Veterans' Federation Of Australia -

We are grateful to the War Memorial Council and to Dr. Brendan Nelson for this opportunity to correct this long-standing blight on the reputation of Phil Thompson and his team of campaigning Vietnam veterans and to correct the long-standing misinformation on the veterans’ case before the Agent Orange Royal Commission.

The title of the last chapter of Yule's book is War Without Purpose, War Without End.

He closes the book with a quote from veteran Graham Chandler -

I've nothing to hide. I'm proud of what I did. I'm proud of the mates I was with.

Most veterans would echo this, and it is this truth-telling about the war and its aftermath that is so important. 

Peter Yule has eloquently exposed the truth of the experience of Vietnam veterans during the last fifty years, and hopefully, this truth will be the last step to the final reconciliation of these men with the community that sent them to war, but initially rejected them when they came home.

Included in this review is the youtube video of the book's launch, which had to be conducted remotely because of the pandemic.

Buy the book, or search it out in the library, especially if you're a friend or family of a Vietnam veteran. It's a great read, and it may help you understand him better.

An Interesting Encounter

            Pic Courtesy The Guardian

Sunday was interesting.

It was my sister's 70th, and she was celebrating with extended family in a resort out of town.

So we could catch up with her, my bride and I arranged to meet her and BIL at a country pub for lunch on their way back from the resort.  It also meant we were able to take advantage of some interesting roads out that way. These things demand to be driven.

The pub was empty except for about half a dozen blokes with big lumpy and shiny bikes, tatts, and leather embossed with club insignia.

There was nobody else in the lounge except the four of us and these guys. They were obviously having some kind of semi-official club meeting.

It's ill-mannered to listen in to others' conversations, but on this occasion, we didn't have much choice. The beer flowed - the conversation at the other table (interspersed with lots of profanity and colourful descriptions) rumbled on and we ate our lunch as we listened. It was, to say the least, entertaining.

They were discussing ways of increasing and maintaining club membership, which, by the sound of it, was declining. I remember thinking that they were having much the same problems as were other enthusiasts' groups, as the demographic aged, and machines like bikes and sports cars are no longer seen as engaging by Millenials.

I did harbour some suggestions but decided to keep them to myself. Discretion, after all, is the better part of valour. Besides, my bride wasn't keen on getting involved. This may have had something to do with the fact that besides my sister and her, the only other female on the premises was the middle-aged woman behind the bar. 

What really surprised me was the continual references being made to "inclusion" and "participation". These terms are used more often by social justice warriors than bikies.

We left before they had resolved anything. The biggest issue seemed to be organising working bees to renovate the clubhouse. 

I was thinking that they should employ a stripper or two, and perhaps some jelly wrestling after a day's work on the renovations.

I shared that thought with my bride but she didn't think it was a good idea.

Comments closed.

Review - When America Stopped Being Great

 

Outsiders are often in a better position than resident nationals to understand trends in a nation's political culture. In the case of Nick Bryant, a Bristol-born Brit writing about the US political scene, this is clear to the reader. This is a revealing, frightening, and thought-provoking work. 

His 2020 account of the rise of Donald Trump explains and rationalises the most recent developments in the USA and plots the rise of a new kind of politics, a phenomenon that he claims originated in the Reagan era.

He ought to know what he is talking about. He has studied politics at both Cambridge and Oxford and has a doctorate in American politics from the latter.

His view of recent events in the USA is negative - almost dystopian. He sees the widening gap between rich and poor, the festering racial divide, and government incompetence at all levels as drivers of Trump's election, and recent violence.

He writes (convincingly in my book) that the beginning of this decline can be traced back to the way in which Ronald Reagan fundamentally changed American understanding of the office of President. He posits that Reagan dumbed the office down and transformed it into a celebrity performance rather than a leadership and governance role.

He writes that Reagan was very much a part-time president who relied on speechwriters and assistants to do the actual work of administration and made up memes that were usually based on a scripted narrative often separated a great distance from reality. Reagan then played his starring role.

One example of this was his use of the story of Martin Treptow, a soldier of Cherokee heritage who was killed in World War One on the Western Front. The whole point of Reagan's address, delivered at Arlington National Cemetery, was that it was delivered over Treptow's tomb. The fact that Treptow was actually buried in Wisconsin was not allowed to detract from the narrative. The script was what mattered, not the history. Pat Buchanan, White House Communications Director under Reagan, summed him up pretty well -

For Ronald Reagan, the world of legend and myth is the real world. He visits it regularly, and he's a happy man there.

In that, Trump resembles Reagan, in that he invented a narrative all of his own, anchored in reality TV, which he proceeded to sell to his audience. The problem in this, of course, is that the myth requires little encouragement to develop a life of its own, and we saw the culmination of this on January 6th, 2021 at the Capitol.

It is possible to fool some of the people some of the time using a fictional narrative, especially in the USA. Orson Welles' famous broadcast is historical evidence of this, as is the contemporary QAnon phenomenon.

Bryant walks the reader through the Bush Senior and Clinton eras, using his thesis about the underlying and developing malaise in American culture as the thread that ties the history of their administrations together. His explanation of Bush senior's one-term presidency is convincing. The reader begins to understand how a dignified and competent President loses out to a narrative spun by individuals like Buchanan, ultimately delivering a slick Southerner with a penchant for interns to the White House. The story becomes so strong that it crosses partisan lines. An important aspect of this progression is the separation between the scripted meme and the performance in office of the President, a trend that continued through the Obama era, and which made the election of a snake-oil merchant like Trump to the White House almost inevitable.

Bryant's writing style is journalistic, personal, anecdotal, and punchy, and this adds weight to his conclusions. He writes that if America was ever great, it was fleeting greatness. It has been hampered by confrontation, nihilism, and corroded by racial tension and inequality.

The last sentence of his last chapter is not encouraging -

Alas, I fear more American carnage, regardless of who occupies the White House.

I hope he's wrong.

Comments closed.

The Hitchhiker

 

Pic Courtesy The Sun. Not my hitchhiker.

Every now and again, something entirely unexpected and blessed happens.

This morning, as is my habit, I drove to my local Coffee shop for a takeaway. As I was getting back in the car, coffee in hand, I was addressed by an elderly woman who was looking quite agitated.

She asked me whether I was turning right or left when I left the car park.  It was left, which turned out to be the wrong option for her. She had missed her bus and was hoping I could get ahead of it on the route, which would have involved a right turn.

I asked her where she was going. She was on the way for an important appointment with her optometrist in the CBD. As I had nothing pressing to do, I offered to give her a lift, wondering whether she'd, first of all, be able to get into my car, and then get out of it at the destination. 

MX5s are AIF* vehicles, after all.

I must look pretty harmless as, after a small protest, she accepted my invitation, although I had to convince her that I actually enjoyed driving the car. It was only a few clics out of my way. 

And I had the top down, and it was pretty cool (-1, the coldest day so far this year).

 I put her walking frame in the boot. Fortunately, it folded, although it took me a minute or two to figure out how it worked. The MX5 has a very small boot. 

We set off for the CBD, and then followed an amazing conversation. This woman was 93, apparently in good health apart from cataracts (the reason for her appointment), and had lived a remarkable life.

She was the mother of three, had two postgraduate qualifications, had started her own successful business in partnership with her lawyer husband, and was a pioneer in the development of a very active Toowoomba charity.

Her husband died about ten years ago, and she had only retired from active work at age 92. That retirement was forced on her because her failing eyesight meant she had to hand her driver's licence in. The paucity of public transport in Toowoomba was an ongoing problem for her, and a barrier to an independent life, and it was quickly apparent to me that her independence was very important.

She had published two books and told me she was in the process of writing another.

We arrived at the optometrist, and after I had retrieved the frame from the boot and reassembled it on her instructions, she got herself out of the car without needing my help.

I told her I had also written a book which was on sale at Dymocks and she promised to buy it. I'm not sure that a memoir about national service would be all that interesting to a nonagenarian, but there you go.

I sincerely hope I'm as spry if I get to 93.

*Arse In First.

Comments closed.