Act of omission kills medical migrant - Ami Sumani is dead

The case of Ama Sumani is far from unusual. The 39 year old widowed mother of two died on Wednesday in Accra of cancer. What is unusual is how her preventable death was brought about by British immigration authorities. Ms Sumani went initially to the UK to further her studies but eventually fell ill. A bone marrow transplant would have preserved her life and prevented her premature death. Instead the British Home Office removed her from her hospital bed in Cardiff after her visa had expired, and put her on a plane back to Ghana. Ms Sumani, unsuprisingly perhaps, was unable to afford continuing private medical care in Ghana and eventually died, about 2 months after her forced return to Africa.

It goes without saying that the British Home Affairs ministry is unequivocal that it has followed procedure. Her visa expired, and medical care for her condition was available in Ghana. The immigration bureaucrats omitted to mention that minor snag, namely that Ms Sumani needed to generate a huge amount of money to pay for such medical treatment, because unlike in the UK in Ghana such care is not available thru its national health service. Not unusual in a two-tiered health care system. Everything is available - for a price. Miserable basic care exists for the overwhelming number of poor Africans and first class care for the continent's wealthy elites. So, Ms Sumani found herself in a situation not unlike very many Africans dying preventable deaths due to the lack of resources in their countries' health care systems - well, if whatever is in existence deserves the label ' health care system' to begin with.

The interesting ethical question is, of course, whether Ms Sumani deserved to be given compassionate leave of stay in the UK, and with that the right to receive continuing free care in that country's public health care system. This question, it goes without saying, is relevant not only to the case of Ms Sumani and not only to the UK, but equally to Canada, Australia and many other countries at the receiving end of medical migrants from the developing world. Why should we pay for the health care of impoverishes migrants from developing countries?

Well, for starters, because we can. The reality today is that our health care systems are able to absorb the comparably small number of medical migrants from developing countries suffering life-threatening illnesses. We could comfortably afford to resource our health care systems such that these additional patients won't break the proverbial camel's back. It's not unreasonable to suggest that we are morally obliged to act to prevent harm from happening if it is within our means to do so, and if the costs we have to bear are comparably small.

There is a second good reason: Only about 18% of the world's doctors and nurses reside in developing countries. We developed world people continue to recruit health care professionals that were initially trained in the developing world. About one out of every five Africa-born medical doctors works today in the developed world. The rich, in other words, are free-riders depending to some extend on a continuing transfer of health care professionals from the developing to the developed world. Developing countries use their resources to train very many of our doctors and nurses. Ghana, the country of which Ms Sumani was a native citizen has only about 6 doctors for every 100,000 citizens. It lost 3 out of every 10 Ghana-educated doctors to the US, UK, Canada, and Australia.

Perhaps we should consider offering free care to medical migrants that make it to our shores as one possible means to compensate the developing world for our continuing complicity in the stripping of their fledgling health care systems of health care professionals.

UK moves closer to presumed consent for organ transplantation purposes

Every day people die unnecessary, preventable deaths because most of us are essentially lazy. Across the world we are suffering a serious shortage of organs available for transplantation purposes. This is not because there is a shortage of people dying premature deaths in car accidents and the like, but because these people have forgotten to sign the necessary forms permitting doctors to take their organs after they have died, in order to transplant them into people who are unable to survive without suitable transplant organs. Any survey that has ever been published on this issue shows time and again that many more people are prepared to donate their organs after their death in order to preserve a fellow human beings life. However, many of these very same people forget, don't know where or how to sign the necessary papers permitting them to become organ donors. The result is that their organs are inaccessible in case of their death, and the result is avoidable deaths of people in need of transplant organs.

Anglosaxon countries, traditionally preoccupied with individual rights and individual liberties have dragged their feet longest when it came to considering changes to this lamentable status quo. More community oriented societies such as France, Spain and Iran, have long implemented an op-out system whereby people who do not wish to see their organs removed for transplantation purposes after their death have to state explicitly that they do not want to see their organs utilized after their death to save others. The results have been astonishing, to say the least. Waiting lists are substantially shorter, and fewer lives are lost due to lack of transplant organs. For once, people's laziness to deal with this matter is deployed in favor of preserving lives instead of letting go of them.

The English Chief Medical Officer has started a campaign to change regulations in England toward such an opt-out system. Sir Liam Donaldson argues that some 1000 or more lives are lost each year in England alone, because people need to opt-in to be considered as organ donors after their deaths. Surely agreeing to an opt-out system is the least we can do to change the odds of survival for our fellow citizens in need of a transplant organ. Hundreds of lives could be saved by means of this change of policy. The health care system in the UK is a devolved one, so it is worth noting that the train has departed in a similar direction to the English in Scotland. In fact, the Scots have very much taken on the role of change agent in the UK in this context.

There can be no doubt that there is something distinctly uncomfortable about the idea that unless I object to someone taking something off (not to say, out of) me after my death, I am presumed to have consented. However, equally, one wonders what good reason anyone could have to deny in death someone else the gift of life? Surely it is only a small minority of people insisting to be buried with their whole set of organs included. Why should we as society not ask them to let us know that they wish to utilize their organs to feed worms in the cemetery instead of permitting another human being to continue to live? That the majority of people disagrees with the friends of cemetery worms, when asked, in survey after survey, gives us arguably some reason to presume consent.

Pro-life activists have already responded to this new 'threat' in their traditional disingenious ways. Here's a quote from lifenews.com: 'In what pro-life advocates see as a further scaling back of the respect government should have for patients and their right to life, British Prime Minister Gordon Brown has endorsed allowing hospitals to take organs from dead patients without their consent.' Patients' right to life is subverted by taking organs from DEAD people. Yeah, sure, the dead can't get up walking again after their liver is taken out to save someone else's life. Normally the dead would go straight from their hospital bed to soccer matches, or church or whatever else they fancy. But now that those nasty politicians propose to extract organs from dead people in order to save someone who is still alive, the dead people's participation in public life is seriously under threat. Thank goodness prolifers managed to alert us to this danger to the lives of dead people.

Canada would do well to follow the French, Spanish, and hopefully soon Scottish and English examples suit. That much is surely owed by society to those of its members dying preventable deaths due to a lack of transplant organs.

- post scriptum: a shortened version of this opinion appeared on Jan 17, 2008 in the OTTAWA CITIZEN, and the Windsor Star.

Scotland - hopefully - moving to presumed consent system for organ donations

I have been writing about this issue time and again. Many human lives are being lost because most countries operate a system whereby a deceased person's organs may only be extracted for transplant purposes if that person has given consent (ie joined some kind of organ donor registry). The thing is, most of us are simply too lazy to do so. A survey in the UK suggests that about 70% of people surveyed would be happy to see their organ utilised after their death to save someone else's life, yet only 25% of the same group of people was on the organ donor registry operated by the NHS. So, bravely a Scot MSP, George Foulkes, has suggested that Scotland introduces an opt-out regime. In opt-out regimes people must state explicitly that they do not wish their organs to be used for transplantation purposes, or else their consent is going to be presumed to exist. Reportedly, the Scottish health secretary Nicola Sturgeon supports the opt-out regime. Such a change would be great news for Scotland! Preventable deaths would actually be prevented as a result of a switch from an opt-in regime to an opt-out regime.

Flu vaccination

I'm sure, those of us who ever had the flu will know that it is quite desirable to undergo the annual vaccination routine. Depending on what country one lives in there's different rule re access to flu vaccines. For instance, in the UK the NHS limits access to vaccines. GPs are required to prioritize along the lines of age (people above 50 years of age, young kids as well - surprise, surprise - folks working in the NHS). Us teachers, even though we spend hours meeting oodles of people, or bus drivers and such workers, are not a priority according to the NHS.
'Priority' ... that's, of course a pseudo-allocation type of activity. The NHS has decided that it's not worth purchasing sufficient supplies of vaccine, hence the annual scramble to prioritize. In South Africa local pharmacies sell the vaccine to anyone capable of purchasing it. Of course, it would make perfectly sense to simply vaccinate everyone. The incidence of suffering and disease as well as the amount of a given society's productivity losses due to illness could be very significantly reduced. So, for essentially stingy governments to limit access is counter productive. They are failing their citizens health needs.

Equally, I never understood why people who know of themselves to have the flu venture
back to places populated by large numbers of people (school and university class, work places, that sort of thing). Given that the people they mingle with cannot protect themselves against the flu virus spread by people knowing to be infected, I think it's fair to say that a clear cut case can be made in support of the idea that such infected people actively harm their work colleagues, fellow students, fellow aircraft passengers, and so on and so forth. We might be well advised to establish policies that - at a minimum- permit such folks to stay at home (and so contain the spread of the infection).

The good news for me. While I was just about today to enter Daffy's (ever hunting for a bargain) on Broadway and 34th, some guy pushed a leaflet into my hand. Unlike many other folks I always grab such materials and briefly check them (just so I don't miss a bargain). Well, today it paid off. I got a leaflet inviting me to pick up free flu shots that were offered in Manhattan by the American Lung Association. So, instead of going to Daffy's (actually... to be honest ... I simply postponed by 30 min), I got my free flu shots. What a pleasant difference to the nonsense going on in the UK NHS. For once I didn't need to weasel my way into getting access to a flu vaccine that I should be receiving from the public health services or private medical aid schemes anyway. Long live the American Lung Association!