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Wednesday 28 May 2008
Letters: Palliative medicine
Surge in palliative medicine still not enough for the terminally ill
Sir: It is devastating when a 47-year-old dies leaving a wife and family, as Sue Royal movingly described the death of her husband, (20 May). All the support and skill of the modern hospice movement is required to support both patient and family through such an ordeal.
We too accept that palliative care outside hospices is not yet as it should be. But we want readers to know that much has changed and has been achieved for better patient care through the work and dedication of the "Hospice Movement", both voluntary and statutory.
Most terminally ill patients would prefer to die at home if possible. Only a small minority can ever be catered for as in-patients in a hospice. Most will inevitably die in a general hospital. In 1977, there was an increasing effort to bring hospice philosophy into mainstream medical care, particularly the hospitals.
Palliative medicine was recognised as a specialty in the United Kingdom in 1987. Since then has come development of community palliative care services, hospital palliative care teams and day-hospice units; it has been a revolution in medical education.
All medical and nursing schools in the UK now have dedicated palliative care teaching; there is government endorsement of the Liverpool Care Pathway for dying patients, and the forthcoming End of Life Care Strategy will be announced shortly by the Department of Health. But we agree with Sue Royal that there is still a long way to go.
Dr Andrew Hoy, Dr Bill Noble, Dr John Wiles, Dr Richard Hillier, Baroness Professor Ilora Finlay, Dr Anne Naysmith, Dr Graham Thorpe, Dr Derek Doyle
Past and current chairs of the Association for Palliative Medicine of Great Britain and Ireland, Epsom, Surrey
Brown must realise he is not wanted
Sir: So Gordon Brown has received another clear message from the people of England that he is not wanted. When is he going to wake up and smell the coffee? He claims that he is going to listen to the people. By this, he really means he is going to listen only when he likes what he hears. He will be waiting a long time.
As usual, the media have failed to notice the most salient fact about this by-election as they did in relation to the local elections. After Scottish devolution (which Brown more than anyone worked to bring into effect), he has no mandate to govern England.
Last week, he had the cheek to say that free social care for the elderly is unaffordable in England and Wales, although it is freely available to his own constituents (courtesy of English and Welsh taxpayers). Brown's policies have no impact on the people who elected him, only on the English who did not elect him and cannot remove him.
Most English people see Labour as a Scottish-led anti-English party, and this result confirms this. Brown has no right to be the de-facto first minister of England and his attempt to cling on to power will not help him or his party. It is time for a referendum on an English Parliament, which is what opinion polls show the majority want. It is time this farce came to an end.
Southend on Sea, Essex
Sir: The removal of Gordon Brown as Prime Minister will not solve the Labour Party's problems. The root cause of the Government's unpopularity stems from their mismanagement of the economy.
There are several causes, staring with purchase by British banks of US sub-prime mortgage debt. This was not the Government's fault but it is their responsibility to work with the banking community to remedy the problem. It should be the shareholders and management, not customers, who bear the pain.
Add to that the expansion of debt, corporate and personal, which has led to asset values rising to artificial heights and families cutting normal spending. Consequently, individuals and companies are more vulnerable to international economic turbulence.
Then house prices were allowed to rise out of proportion to incomes, thus producing a false "feelgood" factor. The readjustment of prices inevitably creates a "feelbad" factor.
It should be a prime object of economic policy to maintain stable house prices at a fixed and reasonable ratio to incomes. The political party that can achieve this, working with policies that reduce the level of debt in the economy and restore the health of the banking system, will win the support of the electorate. Whether Mr Brown is Prime Minister or not is irrelevant. It could be done under his lead-ership or not done under new leadership.
Sir: Gordon Brown's big mistake was not calling a general election after he became leader. A man with his reputation should have had the strength to say, "I could carry on for the next three years but I want my own mandate". It's almost certain he would have got it. But he funked it and the public perception of him changed from one of strength to one of weakness. This, sadly, will never change, and almost anything he does will strengthen the perception of weakness.
A leader perceived as strong – Thatcher, Blair – can get away with almost anything. Fly in the face of public opinion and he is being firm; respond to public opinion and he is showing willing to listen. A weak leader in similar situations will be seen on the one hand as pigheaded and on the other as having no moral courage.
Gordon has brought the worst of all worlds on his own head and that of his party. I fear a spell in opposition under a new leader is what lies ahead.
Sir: Bruce Anderson's opinion piece ("Gordon Brown is doomed... ", 26 May) lists "Gulf War I, the Maastricht Treaty and its opt-outs, the conquest of inflation [and] the Northern Ireland peace process" as "achievements" of John Major's premiership. Rather an odd list, given that Anderson begins his column by chastising historians who misrepresent the past.
The first Gulf War was a shabby oil conflict, protecting one vile dictatorship against another, then leaving Saddam free to put down the ensuing Shia uprising; the Maastricht Treaty was best remembered for the large Tory rebellion that severely weakened Major's authority; the end of inflation was more a result of Black Wednesday than any carefully-planned "conquest"; and Major's best efforts at diplomacy in Northern Ireland ended with 39 casualties in the 1996 Canary Wharf bombing.
Sir: Gordon Brown must surely realise now that he does not have the support of the English people. He can argue that our worries about prices, fuel cost, etc are the cause and to some extent this is probably true. But his performance in the past does not give us any confidence in him being able to get us through the forecast economic problems. Apart from that, he has alienated the English electorate with his refusal to even discuss the matter of an English Parliament.
Let's hear it for the Duke
Sir: Terence Blacker ("What's the point of a Royal you can't talk to? 23 May) condemns Prince Philip's behaviour with reference to "the normal world of social interaction". Prince Philip is deaf. He cannot ever be in the normal world. With difficulty, he may be able to catch the whole of short sentences. Longer explanations including proper names, or worse still, Latin ones, are a nightmare for a deaf person.
Cold or indifferent responses, ignoring people, even moving off in the middle of someone's sentence, are standard signs of deafness. The unimaginative call this snootiness. Bravely, Prince Philip came out about his deafness some years ago in the RNID magazine. Nevertheless, he continues to do his best to talk to strangers in noisy public environments. He is a hero.
Scientists, the new global exterminator
Sir: Given acceptance of the geologists' explanation of earthquakes as readjustments in the earth's crust, perhaps Bruce Homes (letters, 22 May) would see the sense of attributing them to acts of science rather than acts of God.
Such an attribution would dovetail effortlessly into an emerging perspective which acknowledges the role of science as the primary destructive influence facing mankind, without which there would be no maintenance of luxury lifestyles, nor any supporting industrialisation and its attendant pollution, over- exploitation of earth's resources or general habitat degradation.
Scientists have become the new priestly caste for modern, consumeristic man, the world's only truly global exterminator species.
Child risk higher in one-parent families
Sir: According to Dr Kirkham (letters, 23 May), family structure bears little relationship to the wellbeing of children, and poverty is a greater predictor of negative outcomes than the absence of a father in the home.
Last year's Unicef report on child wellbeing found growing up in a single-parent family was associated with greater risk to wellbeing, including a greater risk of dropping out of school, leaving home early, poorer health, low skills, and low pay.
In the UK, a report from the Institute for Public Policy Research, called Freedom's Child-ren, reluctantly reached a similar conclusion, when it reported that the British evidence supported the consistent overarching finding in American research that "children who grow up in an 'intact, two-parent family' with both biological parents do better on a wide range of outcomes than children who grow up in a single-parent family".
Whether we like it or not, the evidence overwhelmingly dem-onstrates that family structure does matter. We don't do anyone any favours by reducing fathers to the level of sperm donors and pretending that they have no unique contribution to make to their child's upbringing.
Director, Family Education Trust, Twickenham, Middlesex
Shining a light on EC blackouts
Sir: I want to set the record straight in response to the article (21 May) suggesting, among other things, that the European Commission proposal to reduce industrial pollution could lead to blackouts.
The proposal, issued in December 2007, would further reduce harmful emissions across Europe by strengthening the pollution controls already in force. The insinuations that the proposal is a case of "bad regulation" could not be further from the truth. The proposal is based on the results of a two-year review of the current legislation that involved all stakeholders, including the energy sector. It will also reduce the administrative burden on industry: the review showed that seven pieces of European legislation need to be updated.
The proposal would give electricity operators a full 10 years to meet the most basic requirements. The proposal retains the flexibility for the energy sector to meet peaks in electricity demand, preventing blackouts.
Without the further reduction in pollution we are proposing, the UK would incur significant damage to the environment and human health, including at least 1,400 premature deaths each year. These costs far outweigh the cost of our proposal to UK energy producers.
Environment Spokeswoman, European Commission, Brussels
Good night, Dick
Sir: Tom Vallance reminds us in Dick Martin's obituary (26 May) of some catch-phrases in Laugh-In. My favourite, belated because it dawned on me only years later, was the character who introduced a poem by "Henry Gibson" in a southern accent; I assume now this was a homophone of Henrik Ibsen.
Thames Ditton, Surrey
Young pay for old
Sir: If there is indeed a dramatic rise in the financial clout of some of today's over-60s, as suggested by Chris Green (27 May), and financial support from grandparents for the young, why are benefits such as fuel allowances, free bus travel etc handed out, regardless of means, to the over-60s? Someone has to pay for these benefits, and that's the generation who has had to face the loss of final-salary pensions, ensuring they will have to work well past the usual retirement age, with no guarantee of financial security.
Rights and a wrong
Sir: Terence Blacker (May 27) says Cherie Blair has been too normal, open and obviously flawed, like the rest of us. She is frequently referred to as a leading human rights lawyer yet she lives with and backed a man who flaunted his policies on illegally invading Iraq and backing the illegal racism of Israel. Did her loyalty overcome her principles, or with what principles did she function as a leading human rights lawyer? Laudable human rights lawyer one moment and accomplice in the greatest of crimes the next?
Dr Chris Burns-Cox
Sir: Oscar Wilde called democracy "the bludgeoning of the people by the people for the people". But where is Nick Clegg's agonising intellectual analysis about why our politics are so dysfunctional ("Democracy? What a good idea...", 20 May)? Democracies are only as wise as their voters and rulers. Edmund Burke's point that MPs are representatives using conscience (judgement), and not errand-boys of the electorate, depends on society being educated in moral reasoning, perception and thinking. What hope otherwise?
Sir: Thank you for your calm, balanced article on the "emo cult" (23 May). It is high time the right-wing media were disabused of the notion that music is a destructive influence. In fact, bands such as My Chemical Romance, notable for speaking out against misogyny and homophobia, should be lauded as a positive influence on young people.
L M Payne
Sir: Bernard Ward's mention of the Idle Working Men's Club (letters, 26 May) reminded me of an equally unfortunate village name. The vice principal of my college lived in Loose, near Maidstone. His wife was in the Loose Women's Institute.
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