LAW AND ETHICS NEEDED IN ORGAN TRANSPLANTATION (PART 3)

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Recently I have addressed many an issue on the whole question of ethics and the law needed in organ transplants!

And I thank those of you practitioners from the US, UK, Spain, Germany, Australia, India, Korea and Japan who have contacted me on the same and for your kind feedbacks and assistance in this issue.

I have also pursued vigorously an argument that there should never be the commercialization of organ transplants and Malaysia must never be a state where organ transplants are conducted purely for commercial purposes and for the financial and personal gratification of individuals, professionals or even certain foundations in and out of the country!

I am aware that there are many groupings out there not interested to take a punitive stand against rogue physicians, hospitals or foundations but I must differ and state here categorically that it is important that both organ transplants and practitioners are monitored to uphold the highest ethical principles and not be a stooge for the wild and abusive commercialization of organ transplants!

In some geographical locations organ transplants are a commercialized trade listed in the stock exchange!

This to me is vulgar!

Having discussed this matter with many friends in and out of the country, individuals who are a classic example of ethics and dedication I am today outlying guidance so that those involved in the practice of medicine, directly, indirectly or through NGO’s, organizations, medical foundations bear in mind these principles and ethical conduct in conducting organ transplants!

Let us call these the MAGNIFICENT 8 GUIDELINES!

(1)         First, that in all professional relationships between a physician and a patient, the physician’s primary concern must be the health of the patient. It is certainly not rocket science that the physician owes the patient primary allegiance.  This concern and allegiance must be preserved in all medical procedures, including those which involve the transplantation of an organ from one person to another where both donor and recipient are patients.  Care must, therefore, be taken to protect the rights and interest of both the donor and the recipient, and no physician may assume a responsibility in organ transplantation unless the rights of both donor and recipient are equally protected.  A prospective organ transplant offers no justification for a relaxation of the usual standard of medical care for the potential donor.

(2)         When a vital, single organ is to be transplanted, the death of the donor shall have been determined by at least one physician other than the recipient’s physician.  Death shall be determined by the clinical judgment of the physician, who should rely on currently accepted and available scientific tests and principles involved!

(3)         As a Consumer Advocate I have always maintained that there should be full unadulterated disclosure, discussion of the proposed procedure with the donor and the recipient or their responsible relatives or representatives and that this is mandatory.  The physician should ensure that consent to the procedure is fully informed and voluntary, in accordance with the guidelines on informed consent.  I must mention here that the said physician’s interest in advancing scientific knowledge must always be secondary to his or her concern for the patient. In fact I do appeal for the involvement of a third party to be part and parcel of this deliberations,  a silent but involved individual – a patient advocate bearing witness that this entire is transparent, accountable and above board.

(4)         Transplant procedures of body organs should be undertaken (a) only by physicians who possess special medical knowledge and technical competence developed through special training, study, and laboratory experience and practice, and (b) in medical institutions with facilities adequate to protect the health and well-being of the parties to the procedure. I would go further and state that these operations and procedures should only be allowed in specific classification of hospitals and other medical centers approved for the scheme and under strict enforcement procedures.

(5)         The decision on who the recipients of organs for transplantation should be determined by the physicians and consultants rather than by politicians and third parties in view allocation of limited medical resources and the greater need.

(6)         It would be silly for policymakers and others involved in this matter not to consider organs as a national, rather than a local or regional, resource.  As such I call for geographical priorities in the allocation of organs. They should be prohibited except when transportation of organs would threaten their suitability for transplantation.

(7)         And there should be clarity and order and patients should not be placed on the waiting lists of multiple local transplant centers, but rather on a single waiting list for each type of organ and the final decision to be made by the surgeon in context!

(8)         Finally, it is very important that life donors should only be first degree relatives, direct relatives or with blood linkage! And I say this purely to discourage abuse and to monitor the motivation behind unrelated donors schemes! I am highly suspicious of these donor schemes and ask pertinent questions because there is a ‘suspicious element’ behind them and we do not need to create a scheme where the ‘rich use the poor’ as was the case recently in an island state with rich beneficiaries and where the donors were poor Indonesians! If this is not addressed then we can have even in Malaysia the following namely organ trading,  commercialization and kidnapping! This will be Malaysia’s healthcare system’s worst nightmare, which we must avoid!
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NO FAULT CLAIM SCHEME – SCRAP IT! (Part 5)


Dr Jacob George is president and legal adviser to the Consumers Association of Subang and Shah Alam (Cassa)

‘Cari lah kawan bukan lawan!’

There are so many things that need fixing by Bank Negara!

And among them numerous complaints against many banks over the years over indiscriminate chargers and other ‘shady issues’ but Bank Negara as far as I am concerned have never come out addressing these real issues!

They forget whether it is issues pertaining to the banks behavior, their chargers, the manner they support certain ‘developers’ and the many construction schemes that have gone bust – it is essential that rules, regulations and chargers are made transparent and pertinent questions surrounding many a behavior whether related to the Hire Purchase Act, the numerous foreclosures or ‘suspect auctions’ the come after – people in the street – us CONSUMERS expect clarity, consistency and clarification but sad this has never come!

As such banks have become really powerful imposing chargers and counter-chargers which all make no sense!

Even the vary act of withdrawing our own money at the ATM has a charge!

Why?

Should this not be a service the bank provides to a client?

So with all these issues still unresolved – and – others – I cannot but wonder why is it so pertinent for Bank Negara to try to ride into the sunset another wild horse?

I am referring to the ‘controversial and clandestine’ attempt at introducing a ‘no fault claims scheme’ in Malaysian when we do not need it because our system presently is working alright!

I am advised certain ‘little Napoleons’ at Bank Negara are really ‘pissed off’ with me at ‘this one man crusade’ and pre-emptive strike against the Bank Negara proposed – ‘No Fault Insurance Scheme?’

Honestly, I am not bothered at what Bank Negara feels but I am aware that if this scheme is adopted it will make our already financially cash rich insurance industry financially vulgarly rich!

And the collateral damage – MALAYSIAN CONSUMERS – who will be totally and royally screwed – all 27 million of them and perhaps, with a few million other illegal from Bangladesh, Indonesia, the Philippines and Africa thrown in?

Yes, I am told a minority are so pissed off with me because I am behaving ‘like a trade unionist’ – they scream!

They are unhappy with my blog and Malaysiakini statements, my appearance on TV and Radio talk shows ‘royally screwing’ this scheme for what it really is – an instrument to hurt Malaysian consumers at the interests of the ‘cigar smoking fat cats’ of the insurance industry!

Hello – first, my dear friends at various Malaysian Trade Unions are far better person than I am!

Second, remember one thing – I have been in this scheme of things for over 37 years!

I am not a difficult person and those who know me personally can vouch for that!

And – I am also willing to talk – provided it is undertaken in a manner that serves the rights and interests of all stakeholders in the Malaysian demography and in an atmosphere of cordiality!

Yes, over a ‘cuppa tea’ and if situation provides perhaps, some red wine – good for the heart they say!

For the record, after reading my blog, several senior ministers recently asked me on the ‘No Fault Insurance Scheme’ and its implication.

I was shocked that these individuals were actually not aware that such a scheme was in the process?

Now another senior Minister tells me that the Malaysian cabinet is unaware of this scheme?

Perhaps, these individuals at Bank Negara are upset with what I had to say and my own minister will also be briefed with the policy division as to the expected backlash if this scheme becomes a reality will be expected to be contained by us!

As far as I am concerned – Bank Negara – you are walking a consumer minefield!

We do not need more fire fighting!

There is enough with issues from political coups and counter coups, the embarrassing childish pranks our self serving politicians dish out to one another making a mockery of the law, transparency, good governance and accountability, political etiquette to the quality of life issues from escalation of prices on essential goods, tolls, and services, to the fear of fuel price hike to the pending resurrection of the Goods and Services Act (GST)!

I have already provided my ministerial friends and others the negative implications of this scheme and the possibility of a nationwide  consumer backlash if this scheme is launched!

But I also know that the Najib administration will not tolerate any scheme that will upset Malaysian consumers and grassroots!

We have already seen it in recent government responses!

I am aware that Premier Najib Tun Razak – is aware that we are in the business of winning the hearts and minds of Malaysians!

We have neither a political, personal, private agenda nor obsession and as long as policy changes are done in the spirit of cooperation, openness and with consultation with the stakeholders – we are happy!

Policy issues must be deliberated among stakeholders without any hidden agenda or black hand operatives manipulating the scheme for private industry interest!

So today – March 19th 2010 – I want to tell these ‘little Napoleons’ at Bank Negara stop behaving like political warlords and pursue a course of positive engagement!

Even my beloved Prime Minister has done away with political protocols in his ‘open door policy’ and ‘turun padang’ deliberations so why should not Bank Negara officials!

This much I tell the ‘little Napoleons’ – you will not win this one!

Public opinion is already against you!

Do the right thing Bank Negara – Scrap this scheme and address more pertinent issues like the ones I have addressed at the start of this blog!

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THOUGHTS FOR REFLECTIONS THIS LENT!


Dr Jacob George is president and legal adviser to the Consumers Association of Subang and Shah Alam (Cassa)

Nothing heavy this morning – no sermonizing about public and consumer policy or advocacy!

Perhaps, what is needed TODAY – is a pause to pray and reflect!

And this story says it quite well indeed!

One day a woman’s husband died, and on that clear, cold morning, in the warmth of their bedroom, the wife was struck with the pain of learning that sometimes there isn’t “anymore”.

She found out that there were no more hugs, no more special moments to celebrate together, no more phone calls just to chat, no more “just one minute.”

There are no more ‘chances’ for those silly, petty and childish fights between spouses!

Sometimes, what we care about the most gets all used up and goes away, never to return before we can say good-bye, or say “I am sorry or I love you!”

So while we have it, it is best we love it, care for it, fix it when it’s broken and heal it when it’s sick.

This is true for relationship…..And old cars… and children with bad report cards, and dogs with bad hips, and aging parents and grandparents.

We keep them because they are worth it, because we are worth it.

Yes, indeed – some things we keep, like a best friend who moved away or a relative who has changed.

These are just some things that make us happy, no matter what.

Life is important, like people we know who are special.

And so, we keep them close!

I share this because this dear friend knew I was a ‘keeper’! Then I sent it to the people I think of in the same way.

Now it is your turn if you feel the same way to send this to all those people who are “keepers” in your life, including the person who sent it, if you feel that way.

It helps if one morning you never wake up and do all our friends and loved ones know we love them?

I was thinking.

I could die today, tomorrow or next week, and I wondered if I had any wounds needing to be healed, friendships that needed rekindling or three words needing to be said.

It could be – ‘I love you!’ or ‘I am sorry!’ or ‘I miss you!’ or that ‘I was wrong!’
The important thing is – let every one of your friends and loved ones know you love them.

Even if you think they do not love you back, you would be amazed at what those three little words and a smile can do.

And just in case even I am gone tomorrow.

I LOVE each and every one of you … all the same and yet different!

Live today because tomorrow is not promised!

May these words and thoughts help you during this important season of Lent!
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GST PAUSE SHOWS PM NAJIB’S SINCERITY!


Dr Jacob George is president and legal adviser to the Consumers Association of Subang and Shah Alam (Cassa)

The interesting thing is there is a desire on the part of Prime Minister Najib Tun Razak to pause and re-look at things provided there is positive engagement!

An engagement without a political agenda, trickery and high powered back stabbing!- Dr Jacob George

 

 

It is strange that certain political demographs are already claiming the sudden reversal on government’s decision to table the Goods and Services Tax (GST) bill for the second reading as ‘their victory!’

Talk about fat, obese obsessive egos!

They also claim the pause is yet again another of the many government’s incompetence, a ‘flip flop’ instead that the government taking cognizance of feedbacks given them ‘behind the scene maneuvers’ by various individuals, representatives and pivot groups like CASSA and the Federation of Malaysian Manufacturers to seek more time to address the many issues of the GST!

And it was the same with Real Property Gains Tax (RPGT), the petrol subsidy which was supposed to be implement in May this year.

The interesting thing is there is a desire on the part of the Najib government to pause and re-look at things PROVIDED there is positive engagement and discussion!

An engagement without a political agenda!

I was at parliament yesterday and had the privilege to say thank you for the pause!

So instead of lauding the move, we seem to be more involved in creating a ‘political storm and claiming credit!’

And it is sad that there is far too much politicking in the country and we are all to blame for this state of affairs!

Can we all say – ‘tak nak politiking’ for the next 12 months to steer the nation back on its feet in structural, economic and political reforms!

I sincerely believe the government is trying to create a select committee to look at the many issues that will spearhead holistic political, structural and economic reforms and if that is also our desire also what is important is for the various stakeholders to also join in the chorus to assist in this deliberation abandoning private and personal political agendas!

I am certain that the Najib government would welcome the coming together of the various political parties in Malaysian in a ‘political ceasefire’ to work on a joint platform to spearhead the economic growth of the nation at a time it is most needed!

All we need is a ‘political ceasefire’, an end to the ‘tit for tats’, the undermining and political backlash ‘to and fro’ should all cease – with the setting up a cross party economic forum to work together!

With sincerity, dedication and commitment this will work!

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H1N1 IS NOT BUT DENGUE IS A THREAT!


Dr Jacob George is president and legal adviser to the Consumers Association of Subang and Shah Alam (Cassa)

So I cannot but concur that the WHO must have been suffering from four decades of amnesia because ordinary seasonal flu, which sweeps the world annually and which is far more lethal than the currently circulating low-virulence H1N1 swine flu certainly meets the organization’s definition of a pandemic: infections over a wide geographic area that affect a large proportion of the population?

 In the dengue case – strange that human life has suddenly become very cheap and our policymakers high threshold of tolerance and apathy to dengue deaths, to the extent that a death from dengue is just regarded as a statistic to be hidden from public knowledge instead of a human tragedy compounded by its totally unnecessary and avoidable character! – Dr Jacob George

H1N1 IS NOT BUT DENGUE IS A THREAT!

So has the H1N1 swine flu outbreak ended?

I have rightly felt that from the onset the World Health Organization’s actions have ranged from the dubious to the flagrantly incompetent.

Inexplicable that last year WHO boosted the pandemic alert to the highest level, Phase 6.

Which to the learned mind means a pandemic was under way and for the record that the WHO in 41 years had made such a declaration.

So I cannot but concur that the WHO must have been suffering from four decades of amnesia because ordinary seasonal flu, which sweeps the world annually and which is far more lethal than the currently circulating low-virulence H1N1 swine flu certainly meets the organization’s definition of a pandemic: infections over a wide geographic area that affect a large proportion of the population?

God help us and ironically, one might even consider the emergence of the H1N1 flu during the past year a net public health benefit, since it appears to have suppressed, or at least supplanted, the far more virulent and lethal seasonal flu strains.

I am advised for example that during the second week of January, 3.7% of Americans tested positive for the seasonal flu, compared with 11.5% during the same week last year.

The death toll in the U.S. from H1N1 is estimated by the Centers for Disease Control and Prevention (CDC) to be around 3,900, while in an average year seasonal flu kills about 36,000!

Someone is failed to look at the statistics!

Intentionally or otherwise?

So I am justified to say that the WHO’s April 2009 decision to raise the pandemic flu threat to the penultimate level, Phase 5, “Pandemic Imminent,” was unwarranted and far outpaced the data accumulated.

Worst, that the June declaration that a pandemic was under way, which exposed the WHO’s flawed fundamental paradigm.

A warning system based solely on how widely a virus has spread, but that does not consider the nature, severity and impact of the illness it causes, is prone to false positives; it would classify not only seasonal flu but also the frequent but largely inconsequential outbreaks of virus-caused colds and gastroenteritis as “pandemics.”

The truth remains that WHO has never offered any explanation for why these examples that seem to fit its definition of a pandemic do not meet its criteria.

But I am only citing the above in showing how misplaced the priorities of our policymakers and others expected to watch over our health needs are!

So this morning, we will move away from this ‘H1N1 thingy’ and concentrate on a more dangerous threat that seems to have got the authorities underwear all soiled up for the wrong reasons!

I am really saddened that more and more people are falling victim or have contracted dengue.

For the record, we have also had fatalities, including a Subang Jaya resident and a former Universiti Hospital eye specialist and associate professor who was a very close family friend!

For this reason alone, I cannot but be angry and upset that the information — that dengue fever continue to claim victims – 54 lives in 2002, with 10,753 confirmed cases reported nationwide then and still the figures rising is pathetic!

It is easy to give stupid statements like one given by an official who stated to a foreign wire that Malaysia is urging people to take precautions against dengue fever after a rise in deaths from the mosquito-borne virus.

The last time I checked, I was told that 31 people have died after catching the disease in the first two months of the year, compared with 28 deaths in the same period last year.

More than 8,000 people caught dengue fever in January and February, the peak time for infection after monsoon rains.

Last week alone, six people died.

And instead of addressing a great plan of action we see the same of stupid reasoning and advisory asking people to keep their surroundings clean and destroy mosquito breeding grounds, such as stagnant pools of water.

That they should seek treatment if they have such symptoms as high fever, joint pains and nausea.

It does not take a rocket scientist to say that the current dengue epidemic, the worst in the history of the nation deserves urgent government and public response and attention like it is abroad in countries like Taiwan, Singapore, Hong Kong and Indonesia!

But here strange that human life has suddenly become very cheap and our policymakers high threshold of tolerance and apathy to dengue deaths, to the extent that a death from dengue is just regarded as a statistic to be hidden from public knowledge instead of a human tragedy compounded by its totally unnecessary and avoidable character!

To add salt to the wound, neither was there a concerted nationwide effort to combat this outbreak nor action taken against those who allow this situation to exist, be they individuals, developers or the local council.

As a consumer advocate, may I ask the Ministry of Housing and Local Government and the Ministry of Health, how many “body bags” must we fill before it is classified “an epidemic” and worthy of a national alert and effort?

In 2001, Malaysia posted 50 deaths and reported 8,669 dengue cases.

I am also aware that the World Health Organization had issued an alert warning all tropical countries, including Malaysia, to be prepared for an increase in the number of dengue cases. It is a pity that our local authorities have not adequately responded to the alert.

Ironically, the problem is not in some unreachable corner but in several cities.

Time here is of the essence and it is of utmost importance that the Housing and Local Government Ministry and the Health Ministry put away their petty squabbles and ministerial tussles and address the outbreak.

The present situation calls for a high powered inter-ministerial effort support by NGO’s like CASSA not excuses and childish pranks!

It is also important that the Ministry of Information, instead of spending too much time on “political propaganda”, goes on a media blitz, using private television stations too, to reach the public about the dengue problem.

Here time is of the essence!

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