Heart Beat/Maurice Neligan: Wisdom excelleth folly as far as light excelleth darkness - Ecclesiastes ch.2, v.13. You can choose a definition of folly. Feeling charitable today, I will settle for "lack of good sense".
The Irish Council for Bioethics has just held a symposium concerning the ethical dilemmas posed by a pandemic. In this forum a worthy lawyer pointed out that the Constitution might have to be altered to allow an appropriate response to such an event. Dear Jesus, I thought; did I really read that?
Dr William Farr in postulating his eponymous law stated that "the curve of an epidemic at first ascends rapidly, then slopes up slowly to a maximum, to fall more rapidly than it mounted".
It's the first bit that concerns me. When it happens as it almost certainly will, let us then not talk about amending the Constitution. The contagion by then will have long passed, leaving a trail of death and morbidity behind before such change could be accomplished. If such is really necessary, which I profoundly doubt, let us do it now, as the good man was suggesting.
This is reducing a mountain to a molehill. The afflicted are not going to give a damn what the Constitution says. They are going to want to know if the health system of this country is capable of reacting to such an emergency.
The answer is a bald unequivocal: no. Let us face facts here. We cannot deal in our acute hospitals with those presenting with emergency conditions right now. It is not merely evasive, but mendacious to pretend that somehow we would cope if current numbers were multiplied by factors of several hundreds, even thousands.
We all know this. We must now stop pretending and actually do something. The responses must be measured and ready. They must be understood by the likely victims, ie us. We must have reasonable confidence in them.
It is not exactly reassuring that a sliding scale of dispensability is being mooted to develop priorities in vaccination. If this is indeed so, I would suggest that the officials of the Health Service Executive (HSE), the Department of Health and the political denizens of Leinster House be placed last. It might concentrate their powerful intellects to know that their own arses were on the line.
We will be told we cannot protect everybody. I don't accept that. Let us anticipate, vaccinate and have the facilities to treat as many of the afflicted as possible. It is obvious that public health doctors and primary care physicians are going to be in the front line of our response.
It is accordingly extremely disquieting to know that discussion between them and "the authorities" have been suspended due to a pay dispute in some other part of the service. As Prof Gerard Bury of UCD has pointed out, it is scandalous that an unrelated issue could delay such serious dialogue. It is our welfare they are talking about, and this is not a matter of "it'll be alright on the night". It won't.
Meanwhile, back at the medical ranch many problems preoccupy the doctors. I am not talking about that tired old red herring of the consultant contract. I say now without equivocation that whether reformed or not it will make no discernible difference in the delivery of the health service.
Of more concern to the profession are the draft heads of the Bill for the new Medical Practitioners Act. Under the Bill, the Medical Council must comply with general policy decisions by the Minister. The council must also co-operate and co-ordinate with other public authorities, in particular the HSE. How's that for an independent Medical Council?
The same council tells us that it exists to protect patients' interests. It must surely dawn upon them that the interest of the establishment and the patients are not necessarily the same.
They should be but they are not. It is a peculiar form of independence that would forgo its right of patient advocacy at ministerial behest. This proposes nothing less than total political control of the health service with the power to suppress dissent. It is bad enough as it is. However, thankfully we are not yet in a totalitarian society.
Incidentally, leading into the next problem is the odd fact that Canada shares with North Korea and Cuba the distinction of being a country that bans private health insurance. I raise this because the Canadian system is light years away from our own.
In our case more than 50 per cent of the population have such cover. In view of this, it is a little surprising that it was to Canada and indeed not all of Canada, rather to the state of Alberta and more recently Nova Scotia, that our Medical Council looked for the scheme of competence assurance that they are endeavouring to foist upon the profession here.
When I, among others, expressed grave doubts about this plan, we were told that we were in a minority and by intimation, a trouble-making minority. I have yet to meet a doctor in favour of the council's plan and it is clear that those dissenting are in fact an overwhelming majority. There is of course in our democracy, a sure way to find out.
Lastly I am sorry to hear about those two Swedish Ministers who relinquished office over their TV licences. Did they not have 25 friends to give them a "dig out"?
What's this word "resign?" It must be Swedish.
Maurice Neligan is a cardiac surgeon.