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Dr Brendan Nelson MP
The Sir Herbert Maitland Oration
Sydney University
26 October 1999
Dr. Jim Ellis, President of the Sydney Hospitallers, members of its Council, Mr Brian Buggy, founder and Musical Director of the Knox Abbotsleigh Youth Orchestra, its outstanding members, distinguished guests from the endeavours of health, church, academia and politics, ladies and gentlemen.
I am both humbled and honoured that the Council should bestow upon me the privilege of delivering the thirteenth Sir Herbert Maitland Oration, not only because it honours the life and values of such an extraordinary man, but also for the genre and quality of its previous orators.
Tonight I will endeavour to do justice to Herbert Maitland, but I can assure you that I am not now - nor ever will, match the intellect and conviction of previous speakers who have each made a remarkable contribution to making Australia what it is today.
In preparing for tonight, I discussed with Jim Ellis the life of Herbert Maitland to discover what remarkable qualities so endeared this man to so many that he should be knighted and have this oration named in his honour. In searching for an adequate description, Jim described him as a "thinking surgeon". That one distinguished contemporary surgeon should see this as a uniquely outstanding quality in one if his professional forebears, confirms what many suspect - and physicians have known, since their respective disciplines emerged from the trade guilds in early modern England.
Herbert Maitland had an extraordinary gift - one that is impossible to define, but which you know when you see it. He so inspired those whom he taught, that students voluntarily attended his lectures and tutorials from other hospitals. An athlete who was both liked and respected, he had arguably more impact on the pursuit and achievement of excellence in the field of Surgery than any of his contemporaries.
Tonight, a century later, we turn to consider "Health in the Ideal World: Medicine in Valhalla".
We generally regard Valhalla as 'heavenly paradise'. It might also be a place assigned to people worthy of 'special honour'.
For the purpose of tonight's address, Valhalla as heaven may be preferable to the place of Norse Mythology where it was regarded as the home of 'slain heroes'. All the slain heroes were kept at Valhalla awaiting the day they will join the Gods to fight the giants at Ragnarok, at the end of the world. A modern analogy might be that of past Presidents of the Australian Medical Association (AMA) gathering at Valhalla awaiting the call to arms needed to destroy the twin evils of government and corporate intervention in the affairs of the medical profession.
For those who are the product of more contemporary culture in search of medical Valhalla, Bart and Lisa Simpson might ask, "are we there yet?"
Ideal World Health Care
But from whose perspective do we seek health care in an ideal world and how will we know when utopia has arrived?
It depends on your perspective.
When Herbert Maitland removed a retrosternal goitre from a patient seated upright under local anaesthetic, I doubt that either surgeon or patient thought they were in heaven - although possibly one step closer to it!
Doctors might consider Valhalla to be Australia prior to the advent of the 'Common Fee' and subsequently the advent of universal public health insurance; immunity from civil conscription; freedom to practice without government interference but with access the latest technologies and drugs.
Patients might instead seek a modern, fully equipped hospital, well staffed and immediately accessible at no cost to them personally. Medical practitioners should be attentive to their every complaint and be as available in a community setting as TAB agencies and alcohol retailers.
For we policy makers, Valhalla might be compliant doctors and empty hospitals to facilitate the implementation of good policy and programs.
There is no 'ideal' world in which health care can be delivered, and the practice of medicine undertaken, as long as we human beings search for longer lives, innovative ways of treating ourselves and resent resources being consumed by others whose needs we see as being inferior to our own.
As we mourn the recent passing of Morris West, the search for medical Valhalla evokes the wisdom of his 1996 biography, A View from the Ridge,
"I learned to be silent and to wait. I learned the futility of argument with the deaf. I learned never to confuse the truth with the person who preached or perverted it, to suspect always the wild evangelist who cried - Heaven is this way. Stop, follow me and I'll get you there".
If we are to know when we have arrived, we must first ask ourselves where we want to be, why we want to get there and then what we might do once we have arrived. In effect what is our vision?
Like a campfire around which we sit, reflecting on where we have been, the relationship we have to one another, where it is we dream of being as we contemplate the challenges required to get there, without vision we have little to guide us.
Health Care in Context
So too health care, as critically important as it is, must be seen in a broader economic, cultural and political context. Concern for the practice of medicine or the Sydney Hospital itself is an exercise in futility if we fail to appreciate what changes are being worked into our society generally.
In 1993 The United Nations Children's Fund defined, "The Progress of Nations" as its vision for nations and their children:
"The day will come when the Progress of Nations will be judged not by their economic or military strength, nor by the splendour of their capital cities and buildings, but the well being of their peoples; by their levels of health, nutrition and education; by their ability to participate in the decisions that affect their lives; by the respect that is shown for their civil and political liberties; by the provision that is made for those who are vulnerable and disadvantaged; and the protection that is afforded to the growing minds and bodies of their children".
Let us first pause to reflect on some of the changes gripping this country as it stands on the threshold of both a new century and a new millennium. It is a time when Australians are considering what we will leave in this century and that we take into the next.
Few things are more difficult, nor more painful than - change. As the economist, John Kenneth Gailbraith observed, given the option of change or proving it unnecessary, most people get working on the proof.
Yet it is change more than anything else which characterises the society and world in which we live. But change for its own sake, change that is unprincipled, has the potential to do enormous damage.
Australia faces a "moment of truth" in the coming year. As with any one of us in our individual lives, we are travelling through a period that challenges our survival. It is also one that will redefine our values. We are at an economic and cultural turning point that may make us a stronger, more resilient nation. But if we have neither the wisdom to reflect on what is happening nor the intelligence to understand it, this is a period - whatever our considerable achievements, that may do us lasting damage.
Though we are propelled into an uncertain future, it is no less stable than the period of Herbert Maitland's life.
Hawke Keating Governments
Whatever the good things it had done, particularly in its first two terms, the Hawke/Keating Governments failed us in two ways.
The first was that it allowed us as a nation to spend more than we earn, using debt and asset sales to prop up consumption to build and maintain social infrastructure of which hospitals are such a critical part. Our subsequent exposure to constant exchange rate depreciations, an intractable balance of payments problem rooted in abysmal national savings and the use of higher interest rates to limit growth funded by off shore borrowing, was driven by the creation of an unsustainable expectation of what governments can, and will provide.
But there was a deeper malaise from which we are only just beginning to emerge. We became a selfish country. My generation in particular became more concerned with rights than responsibilities; value transcended values and technique triumphed over substance. From individuals to governments, the here and now became more important than respectful understanding of the past and meaningful, inclusive planning for the future.
The German philosopher and physicist, Bernhard Philberth in his theological treatise on Change entitled Revelation, put it best when he said;
"Progress leads to chaos, if not anchored in tradition.
Tradition becomes rigid, if it does not prepare the way for progress.
But a perverted traditionalism and a misguided progressivism, propel each other toward a deadly excess - hardly leaving any ground between them".
Change - Misunderstood
From our own "deadly excess" - our past colliding with the future, emerged a lightning rod for the grief and anger many Australians feel for changes they neither understand nor want. It took the form of Pauline Hanson.
Philberth's traditionalists question with an impatient urgency whether the values and sacrifices upon which this country has been built will be the foundation for a future they fear. At the same time, "progressivists" seemingly want change - whether economic or cultural, for its own sake - neither understanding nor respecting that so important to those wedded to our past.
Mrs Hanson was not ever to be ignored. The issues she raised in her own inarticulate way go to the very heart - of not only why, so decisively there was a change of government in 1996, but also the people we see ourselves as being - and the kind of nation we want to become.
Indigenous Australians
Why, despite impropriety, greed and nepotism in some programs, do we consider the circumstances of indigenous Australians so unique as to move contemporary Australian governments to establish and fund programs specific to their needs? If any of us believe aborigines are getting such a good deal, who is prepared to go to Lightning Ridge, Arukun or Docker River and return to say, "I wish I had been born there?"
Simple though it may be to argue Australia withdraw from the United Nations on the basis that "we don't get anything out of its overblown bureaucracy", surely we strive to live in a country prepared to contribute to its humanitarian and peace keeping work.
Many Australians rallied under the One Nation banner to argue we should cease Foreign Aid on the basis "we should fix our own problems first". The next generation must know that the strength of human beings and of nations may be measured in the care, concern and compassion that is shown to those whose needs are greater than our own. Who would refuse to give to the Salvation Army on the basis that, "I'm not getting anything out of it this year?"
Similarly, in a year that heralded the six billionth person on earth, the question is not the content and nature of our immigration program but rather, how many people do we believe our continent can reasonably carry based on our ecological and economic carrying capacity.
Trading Policies
Concern for Australia's trade and protection policies has taken on a life and death dimension in many parts of regional and rural Australia. As we contemplate the role of Sydney Hospital in a vibrant cosmopolitan city, for other Australians each day brings further evidence of change over which they have little control, the beneficiaries of which are leaving them in the wake of a technology and services driven boom.
BHP has announced the closure or sale of its steel works. Berlei Australia, James Hardie and Coca Cola Amatil have relocated offshore along with other icon companies. Those that remain are exposed to foreign acquisition as we suck up their savings in preference to building our own. At the same time timber workers, citrus growers and milk producers struggle to adjust to a vortex of environmental activism, changing international demand, falling commodity prices and exposure to the rigours of competition.
At the end of World War Two there were over one hundred segmented markets throughout the world. Now they are coalescing into three major trading blocs. As only 0.3 per cent of world population, 1 per cent of world trade and barely 6 per cent of APEC, we experience the pain and anguish of a market-driven world vastly different from that of Sir Herbert Maitland's. In no small way our economic and cultural past is leaving us. And it hurts. In many parts of this country, it "bloody hurts".
Mining, manufacturing, commodities and primary industries so critical to our past are instead being usurped in importance by a booming services sector. Though the former will continue to be important, my children are more likely to be working in bio and information technologies, financial services, health, education or any one of a number of knowledge based industries than digging resources from the ground.
As rural Australians experience a paradigm shift in the economic foundation of the communities within which they live, vital reform in transport, communications, energy, finance, industrial relations and social services adds to the bewildered grief of many Australians losing services considered the backbone of the towns in which they live.
While rural and regional Australia is at the epicentre of these changes, those who suffer its consequences also live on the margins and outer suburbs of our cities caught in a cycle of poverty and debt. When we celebrate the nation's plunge into share ownership, worship at the alter of digital technology or marvel developments in medical science, a painful reminder prompts other Australians to doubt there may be a place for them in the world we envisage will be inherited by the next generation.
Native Title Tensions
There is also another section of society which I am privileged to represent in the federal parliament. Like all Australians they aspire to live in a prosperous and free country. Many - but not all, are individually prosperous but they are concerned for what their prosperity delivers those with neither power nor influence.
I was reminded at the peak of the Native Title debate of how much we in the cities assume and take for granted. As I was being deluged by letters from constituents concerned that the rights of indigenous people were in some way being unfairly denied, I heard an Anglican Parish priest from Charleville, Rev Peter Wales on radio seeking to put an alternative view to a cacophony of city based protest. He subsequently wrote to me:
"There is real tension here. On the one hand we need to do all that we can to stand with the indigenous people as they continue to seek the rights and self-determination we take for granted. On the other hand we cannot resolve the crimes of the past by creating new injustices now. Some religious leaders and politicians seem content to draw the line in a way that protects their own properties and those of their constituents, while leaving people on the land in a quagmire of uncertainty and confusion".
"Australians who make their living on the land face tremendous insecurity and hardship. People in my parish have faced fires, two major floods and possibly the worst drought in living memory, all within the last seven years. This marginalised and frequently impoverished group is being asked to carry the burden of reconciliation in a way that most Church leaders, politicians and city people would find intolerable."
His final observation summarises what I consider to be the political environment that will shape not only health care, but also policies critical to the development of this nation.
"Such an attitude of self interest", he said, "asking a marginalised minority to accept a burden they will not carry themselves, is unjust and unAustralian. Whatever the solution to the present crisis may be - and our response should be both swift and generous - it will not involve asking families in the country to bear alone a cost owed by every Australian".
Colliding Ideologies
What, you may well ask, does this have to do with "health in the ideal world", let alone the challenges facing Sydney Hospital and the community it serves? It has everything to do with its problems, solutions and the milieu in which policy makers will make decisions critical to its future.
Something which eludes a number of my political colleagues, but which seems quietly understood by a footsore electorate weary of change on the rocky road of reform, is that the emerging political battles in this country are not between the traditional left and right. Nor are they struggles between Labor and Liberal. Instead there is a growing political divide between those who on the one hand have a community, values based perspective to life's problems, and then on the other, materialists who see little other than the primacy of markets as an end unto themselves.
The push for a President - and a popular one at that, has as much to do with a deep sense of alienation from confrontationist political institutions, as it does with a repudiation of the Crown. An army of exasperated Australians aches for someone "above the fray" - above the political process.
Valhalla, it seems, at least for many Australians remains an illusory mirage.
You can open a newspaper, turn on a television or radio in any part of the country on any day of the week and confront evidence in support of such a view.
To complete the scenario, are the problems besetting Australia's public hospitals.
In rural areas, hospitals have lost their boards, endured changes in role delineation, been forced to reduce services and in many other cases - simply close. These resources have been distributed to regions and cities following population flows to feed an insatiable appetite for new health technologies demanded by an urban electorate.
In cities, whatever the rhetoric of State health ministers, public hospitals are not coping. Every day rationing takes the form of not only waiting lists for elective surgery, but also decisions taken by clinicians as to who will be removed from intensive care units so that an even more urgent case be admitted. While the battle against euthanasia may have been momentarily won, a lack of resources to meet escalating demand is forcing clinicians to take life and death decisions that are no less important to both individual patients and the values we uphold as a society.
At the other end of hospitals, outpatient services disappear to undermine the traditional roles of teaching, research and the fulfilment of social obligations to the communities in which they are based. Though not glamorous, anyone who doubts this should endeavour to find out what medical and allied health services are available to children with chronic illnesses, developmental delay or adolescents in crisis.
The Melbourne Age of 28 July 1998 reported the case of Dr Stephen Vaughan, a cancer specialist whose discipline, by training and nature is not a hotbed of industrial militancy. After 23 years serving public hospitals he resigned, disillusioned and dispirited. He resigned because he felt the system no longer allowed him to do what he valued most - to care.
"The personal dimension of care is regarded in the public sector as an optional extra - but it should not be optional. It is essential", he said.
"Public hospitals used to be the holder of the values of community and personal caring, irrespective of ability to pay .... but now they are just another organisation chasing the buck, and if you don't get paid you don't do it."
Whilst much of this is cause for gloom, Australians now enjoy record levels of life expectancy, a non indigenous boy born today could expect to live to 75 and a girl 81 years. In the twenties, perhaps when doctors had the time to 'care' and hospitals had boards, an Australian would struggle to see the age of 60.
Our economy is growing at record rates, interest rates are at a thirty-year low and inflation remains barely a blip on the nation's financial balance sheet. Industrial disputation is at an eighty year low while productivity has trebled in a decade. As a former Prime Minister might have said, "What are you on about....this is as good as it gets".
Community Needs
The point is this:
If all the economic and scientific problems were ever solved, all important questions would remain unanswered. In many ways, what Victorians have recently done in rejecting a government which saved them from financial ruin, is to say, "thanks for fixing our economic problems. Now we'd like someone who cares about us and our communities, even if it has all the risks associated with an inexperienced and potentially disastrous Labor government".
The threshold problems we face in health are these.
The demands and expectations of Australians for health services, generated by the profligate eighties, are outstripping the capacity of governments to deliver.
Population growth, the impact of aging and a drift to more expensive services and procedures fuel hospital demand. The decline in private health insurance coverage only recently arrested by the Howard Government further compounded the problem.
To look at aging alone, The Retirement Incomes Modelling Taskforce for the 1996 National Commission of Audit found that:
Australia will spend some $43 billion on health care this year. About 70 per cent will be derived from public resources. Half will be funded directly by the Commonwealth where health and social security outlays now consume almost 60 per cent of all its outlays.
Australia's health care system has evolved from powerful egalitarian principles, the vehicle for which has been a strong health insurance ethic. For over thirty years now it has taken the form of a universal health insurance and hospital financing program, the cotemporary and popular form of which is Medicare. Half funds our needs in the form of public hospitals in conjunction with the states - and is rationed. In some cases, severely so. The other half finances what John Patterson described as our "endless wants".
The Medicare levy is paid by 6.6 million Australians whose average contribution (1996/7) is $527. The money raised is less than 18 per cent of Commonwealth outlays and has not ever funded more than 9 per cent of the nation's health expenditure.
Further, recent (and understandable) publicity given to rationing of over-stretched resources in the public sector and uninsurable gaps in the private system have ignored one critical point.
The 1993-94 Household Expenditure Survey found that the average Australian household spent $1411.28 on health and medical care. In contrast that year, each household spent $1655 on gambling, alcohol and tobacco. The Productivity Commission's July 1999 report on gambling now puts gambling expenditure per person at $800.
Future Options
What then are our options? There are four.
We need to have the courage and national maturity to do a number of things.
Firstly there should be a 'State of the Nation Address' specifically for health of the genre of the Prime Minister's Headland speeches in 1995. It should embrace the principles and foundations upon which the health care system was built, how it evolved to its present form, detail our contemporary problems and then, lay out policy options for national debate of future direction.
My experience in health and other complex issues is that people will not only accept, but embrace change if they are convinced of a number of things. The problem described must reconcile with their own experiences, the solution offered must be fair, the motive of the proponent is to do "the right thing" and, most importantly, the key beneficiary of reform will be the next generation.
In the same way that Stan Wallis conducted an inquiry into Australia's prudential and financial regulation sector or detailed inquiries into Australia's complex and inequitable tax system led to much needed reform, so too there is a place for a review of our entire health financing arrangements.
Health remains the last major area of economic and social activity in need of review. That is not to say that this is not the best country in the world in which to have the misfortune to be sick. Instead, you and I both know that not only was Dr Stephen Vaughan correct about his ability to care, but so too the everyday Australian finds it difficult to reconcile statements made by politicians with the reality they meet in trying to access hospital services.
Real Progress
Our new tax system represents the most significant step in reform of State/Commonwealth relations this century in committing entirely to the states a GST growth tax. But real progress in hospital financing will not be made without reform of our constitutional arrangements that presently has one tier of government constantly seeking to shift both cost and political responsibility onto the other.
The real constitutional issues that face this nation are not whether we have a Governor General or a President, important though it may be. The real challenge for us is instead, how best can we govern ourselves as a federation in a world vastly different from that of Herbert Maitland and Henry Parkes?
There is a debate that must be had about the cost of duplicating State/Commonwealth bureaucracy in terms of resources and clinical care denied to people in need at the cost of administration.
But if Australia is to eventually embark on such a course -, as it should, the medical profession has new and emerging obligations to meet. It must be actively involved, individually and collectively in resource allocation.
No government will do what must be done while inefficiencies remain in the system - in the administration of resources, funding mechanisms and utilisation at a hospital level.
Doctor - Patient Relationship
In 1993 Time Magazine ran a story which well illustrates the rationing dilemma.
In Philadelphia, female Siamese twins were born to Reitha and Ken Lakenberg. They had a fused liver and a shared heart. If one were to be sacrificed, the other would still have less than a 1 per cent chance of survival.
America was drawn into a searing ethical debate, central to which was the question I put to you tonight. Does it make sense to spend hundreds of thousands of dollars in one exercise of likely futility while many others go without the basics of care as governments preach the gospel of cost containment?
Deciding to operate, the Philadelphia team went ahead, Mr Lakenberg justifying the procedure on the basis that "people win the lottery every week, why shouldn't we?"
The surgeon, Dr James O'Neill Jr said, "If someone is going to ration care because of money - it is not going to be us".
Doctors have a relationship to three critical groups. Firstly the individual patient for whom the doctor must always act in the 'utmost good faith'. There is a second responsibility to colleagues, to share skills and knowledge. But the third and equally important relationship is to society itself.
If doctors focus only on the doctor/patient relationship, refusing to participate in decisions of resource allocation - or worse still are desensitised to the agony of the process, then you abrogate your responsibility to those who will miss out. In refusing to participate, doctors are in fact deciding. Resource allocations will then be made by the worst of all possible people - politicians and our public servants.
Should we require those people who choose not to provide for their own health care, to make a greater contribution to Medicare than the base levy? Any comprehensive review must consider whether a progressive - as distinct from a flat levy for those who do not hold private health insurance might serve the dual purpose of raising more resources for public hospitals whilst reducing the demand placed upon them.
How much longer can we afford to provide 'free' medical services at any time, whatever the cost to every Australian irrespective of his/her financial circumstances? Would the every day Australian accept a co-payment for those not in receipt of social security benefits if all savings were redirected into areas such as mental health, disability support and regional health services?
As public officials and consumer advocates echo the 19th century writings of George Bernard Shaw by attacking the conspiratorial profit motives of doctors, they should remember that it is the indiscriminate application of competition policy to the medical profession that most threatens the fiduciary behaviour we expect and need of doctors? No access to a doctor is bad. An under-employed surgeon is a potential disaster.
Welfare & Indigenous Australians
In recognition of the fact that it is welfare that is killing indigenous Australians, why are we incapable of thinking outside the square and pool total indigenous community resources for management by them on behalf of their members. It is the cheque in the mail that does most harm. If an Aid Development project can prevent disease and death in the developing world, why can't we try it here? Whatever else we achieve as a nation, without a deficit reduction strategy on indigenous disease and premature death - we will have achieved little of substantial value.
Sydney Hospital
So what of Maitland's beloved Sydney Hospital?
What absurdity is it that sees ambulances having to drive past the hospital in emergencies because it does not have an Intensive Care Unit? Yet when other hospitals are on "by-pass" because they are full, Sydney has to take them. Six modern operating theatres and 380 car parking spaces sounds impressive, but would the expectations of the 25,000 CBD residents and almost a quarter of a million city workers not reasonably extend to state of the art tertiary care facilities?
Perhaps there is a place for Sydney City Council combining with the CBD's considerable corporate wealth to finance the establishment and maintenance of an ICU. Sydney Hospital would also ideally lend itself under such circumstances to the trial of management by a board comprising municipal, business and community representation. Irrespective of what may be said by political representatives, most people yearn for more local and less regional management of their hospitals. But with that should also go a responsibility to contribute financially.
The hospital could also, consistent with the Prime Ministers objectives for a "social contract" between business and government, take up the challenge of improving the standard of medical care provided to residents in the city's nursing homes. The appointment of a medical director, regular clinical audits and teaching rounds would do much to enhance the care provided to this most vulnerable group whilst elevating the "community" credentials of the great Sydney Hospital.
There is also the opportunity for a hospital more focused on its corporate community, to explore the possibility of exporting health expertise to our region, generating income for the care of Australians.
Given also that both this University and Sydney Hospital stand on what was once aboriginal land, could the hospital not, with the corporate sector, explore the possibility of philanthropic medical and surgical assistance to remote indigenous communities as a "living" symbol of reconciliation? If David David can bring kids from the developing world for craniofacial surgery, what can our Macquarie Street surgeons, physicians and business people do for indigenous people suffering diseases some have forgotten even existed.
Drugs - Self Injecting Rooms
Before concluding, there is another issue unfolding not far from your hospital about which all of us would harbour fearful concern.
The NSW Government has agreed to trial Australia's first legally sanctioned injecting room under the auspices of the Sisters of Charity.
While in one sense injecting rooms may be seen as an indictment of the kind of society we have become and the demand which drives it, in another it may be that so moved are we by this problem that we are prepared to put aside our instinctive revulsion.
Ironically I was in Zurich inspecting injecting rooms the day Premier Bob Carr announced this measure.
What I saw were facilities strategically placed around drug "hotspots". A board including local government, community, police and health care representatives administers each.
A security guard ensures that only Swiss nationals who are neither intoxicated nor aggressive may enter. The café-style rooms are clean, sell coffee and tea, and offer a clothing exchange, showers, laundry facilities and medical care. Injecting is done under nursing supervision and is forbidden into neck veins and other unsafe sites. Drug counselling is available and no one can leave until considered safe to do so.
Only 800 metres from one facility were two police cars on the verge of a pedestrian tunnel - arresting a dealer, " policing around injecting rooms is no different from anywhere else. We track and arrest dealers. It requires some discretion though".
What I did not see - on the streets, in the gutters or even in the parks frequented by drug users, were discarded needles and syringes. It may say something about their emphasis on needle exchange. My thoughts were of Reverend Ray Richmond at the Wayside Chapel retrieving up 120 needles a day from the small front yard and a further 60 from their toilets.
Nauseated is how I felt. The sight of human beings engaged in that to which I have committed much of my life fighting was - sickening. But the waves of nausea there will never match the sense of desperate futility that enveloped me when I attended my first fatal overdose as a young medical graduate. The young body still warm in the basement of an abandoned house.
While Swiss heroin deaths have halved in nine years - from 419 in 1992 to 209 last year, Australia's are headed in the opposite direction with one every ten hours and rising. Ambulances from April to September last year attended a non-fatal drug overdose every hour of the day in metropolitan Sydney, The Blue Mountains and the Central Coast. Sydney deaths have increased 134 per cent in the last five years alone. A third of NSW drug deaths last year were in a 2-kilometre radius of Kings Cross and 4 kilometres of Cabramatta. Of those, a third of the Kings Cross deaths, and two thirds of those in Cabramatta were in open spaces.
Tony Trimmingham lost his son, Damien to heroin in the stairwell of a tenement building behind St Margaret's Hospital. Had he not used heroin he would not be dead. But Damien, like many others, died because he used an unknown dose of heroin in a lonely isolated place. Had an injecting room been available and had he chosen to use it, would he still be alive?
Some parents may not ever be haunted by such questions if this facility goes ahead. But has the Government set the nuns up for failure? Will it be adequately resourced and accessible? If the Government supports a trial, as I do, why isn't it prepared to take a greater role? Have scientifically rigorous research studies been developed and funded to examine the health, social and legal impacts of the trial so that eighteen months from now protagonists are not able to make unsubstantiated claims about its impact?
Everything governments are doing to prevent the use of drugs and treat their consequences deserves our strong support - from sniffer dogs, Royal Commissions and Customs to education, treatment, rehabilitation and research. But so too we must appreciate that we cannot save the life of a person who is already dead. We cannot protect drug users from stupidity, but we can endeavour to keep them alive until they are ready to assume a drug-free life.
Whilst Valhalla may be an unattainable dream, we ignore dreams at our peril.
Wealth & Human Values
Amongst the critical measures of a caring society, few rate more highly than the extent to which we nurture the idealism of young people and protect their vulnerable transition to adulthood.
Australians are now five times richer in real terms than we were when Herbert Maitland made his mark on our profession and on Sydney. We expect to live longer, we consume more energy and enjoy technologies of which even he could not dream. With the mapping of the human genome, we also stand on the cusp of a revolution in the prevention and treatment of disease.
But are we any happier? If we sustain 4 per cent economic growth per annum for the next twenty years, my children will notionally be twice as rich. I suspect though, they may not be twice as happy.
Values do matter. They matter especially for the medical profession, because the commitment to an ethic of service to other human beings whose interests are placed ahead of your own, is what this country needs more than at any time in its history. Our destiny will be determined ultimately not by the economic indices with which we are so understandably obsessed, but by our values and beliefs, the way we relate to one another and see our place in the world.
Tethered still to the values of my generation - that hard work will meet the reasonable expectation of a higher standard of living than that of their parents, young Australians face this daunting task finding life cruelly short changing them. The yawning gulf between the ideal they seek and the reality they face has lowered their threshold of resistance to despair.
In marginalising ethics based organisations and churches from public policy debate; in diminishing the importance of parenting as a full time occupation; in trivialising the value of unpaid and voluntary work; in pushing young people into the education system - frequently beyond their natural abilities and inclinations to pursue education as a utilitarian objective for jobs they doubt will exist; in allowing the difference between right and wrong to be a matter of personal opinion free of external evaluation; and in diminishing respect for institutions including hospitals - we have created a culture in which many young Australians feel they have little more than themselves in which to believe.
The problem is not that young people have not learned our values. It is that they have.
John Kennedy defined the struggles for his generation as being against tyranny, disease, poverty and war. What are ours? Towards what do we strive to make progress? What kind of country do we want to become, upon what values will it be based and do young people really believe that the future is really theirs to shape and that the values they acquire can change the world?
Perhaps our greatest challenge, in a world of fundamentalist intolerance, unprecedented technological change and economic uncertainty, when we live in vast ignorance of the consequences of our actions - is not to connect the next generation to the Internet. It is instead, to connect them to one another.
Let us endeavour to become a country in which we value the health and integrity of human life as much as we do achieving our economic objectives.
That barriers to the creation of wealth are seen as the enemy of effective and equitable social policy.
That the idealism of young people is nurtured.
That Australians live in a society in which their opinions are both solicited and heard.
That every Australian, irrespective of their circumstances,
Knows they will be cared for - but in return, each is expected to make a contribution to the society from which they derive a benefit.
That we see ourselves as an outward looking country, reconciled with its indigenous people, compassionate yet competitive,
Imbued with the values of hard work, self-sacrifice, tolerance and courage.
BRENDAN NELSON
References
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Australian Doctors Fund |