In Opposition to Suicide, Assisted or Otherwise

Deputy Gino Kenny

Deputy Gino Kenny’s Dying with Dignity Bill is due to go before the Dáil this week. It should be opposed for two reasons – the floodgate effect, and what such a bill says about the very nature of life itself.

The Floodgate Effect

Most conservative objections to liberal social legislation are based on floodgate effects. This is because all legislation has a floodgate effect. If it didn’t, what would be the point of it?

The Dying with Dignity Bill contains a number of provisions to limit this floodgate effect. A “qualifying person” must be diagnosed as suffering from a terminal disease with no hope of a cure by two separate medical professionals. There must be a treatment paper trail. A qualifying person must be judged mentally capable of making the decision to die. There will be provision made for conscientious objection by medical professionals. And so on.

Immense cultural taboos towards taking life before its natural end currently exist. For all the horrors of death – and they are many – very few people step forward to put a pillow on the face of the dying and hurry things along.

We all tell each other how we’ll eat a bullet before suffering the indignity of being a bedridden, senile incontinent in a nursing home. Everyone nods their head when that comes up in discussion. And yet the western world has this year shut itself down to protect the lives, among others, of those same bedridden, senile incontinents. Isn’t there a certain inconsistency in that? Are we really sure we know what we’re doing here?

If this bill, or a bill like it, were passed and a similar pandemic were to arrive a generation or two later, there wouldn’t be any debate at all about what to do with the nursing homes. Once the taboo is broken and the years go by, the constraints are lifted, one by one, because their original impulse, the deep-seated taboo, no long exists.

Succeeding generations will be puzzled to know what all these obstacles are doing in what should have been perfectly straight-forward legislation. Look at this ridiculous two-doctor rule. If I need a tooth pulled, I don’t know two dentists to tell me, do I? What about the qualified person being in full awareness of the decision? For goodness sake, surely if you’ve lost your marbles, you’re more or less dead already, aren’t you? What were these people thinking in 2020?

The Fundamental Irrationality of Life

The current age – which has been the current age since Pierre Beaumarchais staged the Marriage of Figaro at the Comédie-Française in Paris in 1778, for what that’s worth – sees itself as the age of science. There are no ghosts in the machine. There is, and there ain’t. With apologies to Wittgenstein, what is, is, and what ain’t, ain’t. It is unfortunate to take so unsubtle a position with regard to so messy a proposition as life, and society, and humanity. It can lead down strange paths.

Some of the great scientific minds of the first half of the Twentieth Century were eugenicists. Two of the founding fathers of modern statistics, Sir Francis Galton and Sir Ronald Fisher, were eugenicists. They had read their Darwin (Galton and Darwin were related) and done their sums. What was the point in human progress being held back by, to borrow a phrase from a movie, too many goofy bastards in the herd?

The eugenics movement never recovered from the Allies’ entry into the Ohrdruf concentration camp in April 6th, 1945. It’s one thing to talk about eugenics and tidying up the race while enjoying a glass of port after a five-course dinner. It’s quite another to see that race-tidying process industrialised as the Germans, that nation of engineers, had done.

Science favours controlled breeding. How could it not? There are no rational arguments against it. Only the sentimental. And yet it is sentiment that makes us human in the first place, is it not? Just how rational is the human animal anyway?

Our only certainty in life is death. Whoever you are, where-ever you are, whether you are a man or a woman, rich or poor, tall or short, you will die. It’s only a question of when.

What, then, is the point of living? What is the point in knowing that all you have will be left behind you, in knowing that every day brings the end closer, that every day after your peak you have declined by that little bit more, until that poor bastard in the nursing home wearing the diaper is your own sweet self? The very act of living exists in defiance of rationality itself.

It’s the easiest thing in the world to get dead. People die all the time. They’re here, and then they’re not, and they are never coming back, ever, not even for a glimpse on the side of a hill in the distance. Gone.

And yet, for reasons that are not rational, that do not balance on both sides of the equation, people fight for life with tooth and claw. All the damned in the war zones of the world, in Yemen, in Syria, in South Sudan – why do they cling to life as they do? Where is the kindness in allowing them to suffer so when their end is inevitable? Wouldn’t it be kinder for the West to come along and assist them into the Undiscovered Country?

Cultural taboos are to the social sciences what Schrödinger's cat is to physics. All very explicable in theory but when you go looking for the actual thing itself it proves very damned hard to pin down. Physicists have been searching for that damn cat for ninety-five years, and have yet to find a single whisker. We change what we do not understand at our absolute peril.

FOCAL SCOIR. Some people do not need assistance to commit suicide. Some people are every day aware that the means of their escape is in their own hands. The big thing to remember here, and the point I think that’s being missed by this bill, is that suicide only looks like an escape. It’s not really. An exit door is only ever an exit door. It’s always better to stay in the ring, because it can’t rain every day. It just can’t. If life is hanging heavy with you these days, it’s no harm to give the Samaritans (https://www.samaritans.org/ireland/samaritans-ireland/) a shout. You can call them at 116 123 twenty-four hours a day, whenever suits. They’d love to hear from you.

Members of the Oireachtas Have Nothing to Feel Smug About

It was around about the same time that UK prime minister Theresa May was in front of a baying House of Common. The contrast between this respectful celebration of 100 years of unbroken parliamentary democracy here [sic] and the shambles in London was not lost on the Dublin audience.

Irish Times, Tue, Jan 22, 2019.

It is the nature of the politician to be blessed with an above-average amount of self-regard. An adamantine hide is necessary in a life where you submit yourself to public judgement at least once every five years. However; the notion of the current members of the Oireachtas stiffening with pride at the thought that they are the finest of parliamentarians, not like those knuckle-dragging Tans across the way, is too much for even the most ravenous of goats to stomach.

One hundred years after the first sitting of Dáil Éireann, Ireland is a state where the Gardaí have merrily ignored 7,900 crimes, some of them very serious, over the past seven years. Nobody knows why these crimes have been ignored, but the GRA, the Garda Representative Association, has made it quite clear that however it happened it wasn't their boys' fault. It may turn out that dog ate each and every one of their notebooks. It’s what Mr S Holmes used to refer to as a three-pipe problem.

This is the same police force who were discovered to have made up breathalyser tests, bullied whistleblowers out of the force and saw the last two Garda Commissioners and the last two Ministers for Justice resign under never-really-fully-explained circumstances. The police exist to enforce the law; what does the law currently mean to the police? It seems to them as a midge on a summer’s evening on the mountain; bothersome, but not really to be taken seriously.

The situation is so worrying a man could end up in hospital as a result. Except that were he foolish enough to do so he might be better of going straight to the graveyard with his wooden overcoat on, such is the state of the Health Service.

The current Minister for Health is - nominally, theoretically - in charge of a Health Service that is unable to diagnose cervical cancer and over-estimates the price of the new children's hospital by one billion Euro, and counting. That's not the price of the thing, remember; that's how much the original estimate differs from the current estimate, and it's gone up, rather than down.

How much is a billion Euro? It's enough to buy every single residential house in the town of Ballina, with about half of those in Castlebar thrown in as well. It's a lot of money, and yet the current Minister for Health, famously "mad as hell" about the cervical crisis, seems completely content to sign off on this bill, no matter how many more billions it goes up to. Don't forget either that this new hospital will not deliver one extra bed compared to the number of children’s beds currently available. Details!

One wonders what the Minister for Finance, Paschal Donohoe, thinks of all this. Paschal is one of the leading politicians in the country. He had enough nous to know that, as he himself could never become leader, his allying himself closely with Leo Varadkar once Varadkar made his run would make him the next-best thing. When appointed Minister for Finance, the cognoscenti thought of those many media performances where he smothered criticism of Fine Gael in the manner of a conscientious huntsman drowning surplus beagles, and thought: here is the man to keep an iron grip on the public finances.

If only. The Irish Fiscal Advisory Council responded to last year's budget by accusing the government of repeating the mistakes of the past - over-heating an already-overheated economy, thus guaranteeing that the country will be once again on its uppers when the tide goes out again, as it inevitably must.

There is an irony in this as the Irish Fiscal Advisory Council was set specifically to perform this very task. One of the reasons identified for the crash of 2008 was that a "support the green jersey" policy blinded officials to their duty of telling the economic truth as it is, rather than as people wanted it to be. Thus when things went splat!!, there was no rainy-day money at all. Not behind the couch, not under the bed, not buried in the garden in a biscuit tin.

And now, ten years later, we're doing it all again. The ambulance drivers struck yesterday. A nurses' strike is guaranteed. The teachers can't be far away from having the Art class studying Placarding 101. There's that monstrous, growing bill for the Children's Hospital collapsing into the weight of its own gravity like a fiscal black hole, set to swallow every single thing around it. And that's not even counting the six hundred million lids that the Health department was over budget last year, and for which money was found from .. well. We never do find out where this miracle money comes from, do we?

And how does the political class respond to these triplicate impending disasters, to say nothing of Brexit itself, homelessness, the narrow tax base, the flight from rural Ireland? By poncing about the Mansion House telling each other how well they would have done at Soloheadbeg or Kilmichael had Fate not decided they would be born too late, and then off to Buswells, Kehoe's, Doheny's and sundry other houses to pint the night away.

Brexit is a nightmare, but at least the British can see that there's a dirty big iceberg off the starboard bow and it could sink the whole ship. The first our politicians - and we the people, God help us, because it is us, after all, who are the ones who elect the donkeys in the first place – the first any of us will know about the iceberg is when we're clinging to a spar in the freezing Atlantic, watching the state go under once more, and asking ourselves: how the **** did that happen? It's a mystery alright, Paddy. Who could ever have seen that coming?

What is the Point in Watching the Budget?

Pascal O'Donoghue, TD, Minister for Finance

Do you plan to watch the budget today, Reader? Will you listen to the Minister, thrill to the analysis, and carefully ponder the responses to the budget from the parties’ various spokespersons on finance when they, too, address Dáil Éireann?

And are you entirely sure that’s wise? All things considered, would you not be better off beating yourself unconscious with a brick instead?

You say that’s crazy talk. No, it’s not. Beating yourself unconscious with a brick is every bit as sensible as listening to the budget and expecting the government to exercise any control over the public finances – insofar as they government can figure out what the public finances are in the first place, of course.

The one reason the country hasn’t sunk beneath the waves – and I thank almighty God for it – is that we must have our budgets signed off in Berlin anymore, even since that time we went crazy buying two-bed apartments with one parking space and thinking they were little goldmines. The majority of the spending is already spent before the Minister got out of bed this morning. What the Minister will actually be talking about is what he’s allowed to spend from the change discovered at the back of the couch, as the big money is only handled by the big boys any more.

And even then, the unhappy man will still make a bags of it. His is an impossible task.

Professor Séamus Coffey, head of the Fiscal Advisory Council, was interviewed on This Week on RTÉ Radio One on Sunday. Professor Coffey noted that every year for the past fifteen years the Department of Health has been unable to calculate its spending correctly.

This is phenomenally bad practice, and what makes it worse is that every time the Department manages to underestimate spending. It’s not that the Department of Health gets its sums wrong, as such. It’s that it always gets them wrong in the same way.

For fifteen years the Department has tried to calculate how much it needs, and each year it’s underestimated its budget and had to be dug out. This is despite always going higher than last year for each of the fifteen years.

This isn’t bad maths. If it were bad maths, they’d have over-estimated at least once. This is something else.

Let’s put that in perspective. Let’s say you’re saving for a mortgage, and you decide to cut down on the pints. You budget yourself a fifty-Euro-a-fortnight pinting allowance, and swear never to break it.

At the end of the fortnight, you do your sums and you find that instead of blowing fifty Euro on porter, you’ve blown eighty. OK. You were unrealistic in your initial calculation. There are few places in Dublin city centre where you can get a pint for less than a fiver, and five pints a week isn’t even half the weekly limit as set out by the killjoy Department of Health. OK. So you recalibrate, and your new fortnightly pinting budget is now eighty Euro.

You examine your spend after this second fortnight and find out you’ve spent one hundred Euro.

This isn’t great. Not only are you still over budget, but you’ve doubled your initial estimate. This is bad. You feel bad. You’re not looking forward to telling your girlfriend, who’s counting on you pulling your weight for this mortgage. But at least you know now what the price of booze is. You budget for a hundred bucks this time, and go again.

That’s three budgets reader. The Department of Health have got this wrong for fifteen budgets in a row. If that were the case where you were saving for your mortgage, it’s safe to say that you could forget about the mortgage. You could forget about the girlfriend too, as she’d long ago have walked out. But you yourself are not bothered about a mortgage now, of course. Why would you need a mortgage when you now live under a bridge, off your cake on a cocktail of Buckfast and dry sherry all the livelong day?

Minister Harris, a man borne down by the sense of his own dignity, is inclined to respond that there is no discretionary spend in Health. If some invalid, some wretched soul, were to call to a hospital, how could the hospital send him or her away?

Such an unfortunate should not be sent away, of course. But your faithful correspondent can tell you who should be sent away. The genius who agreed to pay €6.5 million per year in rent for the new Department of Health offices eighteen months before anybody actually moves into the place could do with sending away.

The only reason whoever is monitoring how well hospital consultants are maintaining their working division between private and public patients while working in public hospitals can’t be sent away because it seems that person doesn’t exist in the first place.

According to last week’s report of the Comptroller and Auditor General, no more than 20% of beds in public hospitals are meant to be set aside for private patients. However, beds are considered plain beds, not public beds or private beds, and “the HSE does not draw comparisons on activity levels between hospitals or individual consultants in order to monitor trends in activity over time.” So that’s bound to be going well.

You may think your faithful correspondent is picking on the Department of Health. Not at all. Consider this shaggy dog story, as reported in yesterday’s Times Ireland:

The Irish Greyhound Board had their old stadium in Harold’s Cross valued in March of last year. Savills' reckoned it was worth twelve million Euro if developed, six million if it remained a dog track.

A few weeks later, the Department of Education asked the Valuation Office to survey the dog track at Harold’s Cross, and see how much it was worth. Harold’s Cross could do with a new school, you see.

Where Savills' considered the site worth €12 million, the Valuation Office thought it worth more €23 million. The Department of Education bought the site for €23 million in May of last year. Did the site more than double in value in two months? What exactly are we missing here? Other than our shirts, of course - we lost those long ago.

Now. Suppose you’re some sort of nut who thinks maybe the country would be in better shape if we spent money wisely, instead of finding new and, frankly, quite astonishing ways to waste it? For whom exactly should you vote in the coming election? Whom can you trust to get a start on that task?

I’ll give you a minute, dear Reader. Then you can go off and find yourself a brick.

a brick.

Irish Politics Summed Up in Seventy-Seven Words

"The hospital was proposed in 2002/2003. One of my daughters was going into secondary school at the time. At the same time, there was a hospital proposed in Perth. That daughter of mine went through secondary school, went through medical school, went through internship and, two years ago, went out to Perth to work in the hospital. By the time she was working in the hospital, not a block had yet been laid for the Irish hospital."

Gerald Flynn, speaking about the projected cost overrun for the National Children's Hospital on RTÉ Radio One's Late Debate last Thursday, February 23, 2017.

What the Election Should Have Been About

From the Irish Examiner

The final leaders’ debate is on tomorrow. Miriam O’Callaghan will doubtless introduce it as a debate about the issues. But these things are never about the issues. Not around here.

The Irish nation doesn’t do thinking in generalities. Whether that’s the media’s fault or the politicians’ fault is a chicken-and-egg situation – we would have a higher level of political debate if the media would report it, politicians would frame issues in a different way if they thought the media would report it that way. Who knows?

The only thing we do know is that one leader saying that, if elected, he or she will hire 500 new guards, and the next seeing the five hundred guards and raising 300 teachers, is rubbish. Rubbish. Here are the questions that should be asked during tomorrow night’s leaders’ debate, but won’t.

The Economy
As an open economy that does not control its own currency, what would different parties do to exert control on the economy? If inflation is rising, for instance, a government will usually raise interest rates to make it harder to borrow. This lessons the money in the economy and means that prices don’t go up quite as high.

But if inflation is rising in Ireland but flat in the Eurozone, that’s not an option for Ireland. One of the reasons the crash happened was that interest rates were too low relative to the money available, and this created a bubble. What has the current government done to protect the state from that happening again, or from recession in China? What will an alternative government do to protect the state from those and other external economic threats?

The Electoral System Itself
Irish politics is engineered to favour clientelism at every step. To survive, a TD must put local interest ahead of the national interest, even though TDs are elected to govern the nation, not the local area. This is partly why it will be so very difficult to form a government after this election. What steps has the current government taken to address this systemic failure? What steps will the alternative governments take to address this issue?

Education
One of the reasons for Ireland’s current economic prosperity is that the reputation of Ireland’s workforce as being well-educated is very good. But grade inflation has become more and more obvious in STEM subjects at secondary level, and it’s only a matter of time before the tech firms realise the educational system isn’t quite as advertised. What steps has the current government taken to address this issue? What steps will the alternative governments take?

The Distribution of the Recovery
Although elected to govern for the entire state, and by aspiration the entire island, successive governments have favoured the development of Dublin at the expense of the rest of country. A spatial developmental strategy was proposed as far back as 1969, yet nothing has been done about this issue. There are number of reasons for this, bribery, corruption and plain stupidity among them. What steps has the current government taken to address this issue? What steps will the alternative governments take?

Health
Hard case stories are terrible, but governments have to look at big pictures. When it comes to patients on trollies, there are questions not being asked. Are patients on trollies localized – do some hospitals regularly have more patients on trollies than others? Which ones? Why? Are patients on trollies seasonal – are there more patients on trollies in winter than in summer? On Saturdays rather than Wednesdays? This isn’t a medical issue. A medical issue is finding a cure for cancer. The vast majority of issues in the health service come down to poor management. What steps has the current government taken to address this issue? What steps will the alternative governments take?

Crime
We have a Special Criminal Court in this state. We have abolished trial by jury in certain circumstances, an extraordinarily totalitarian situation about which the normally vocal liberal lobby are strangely quiet. Why not use these extraordinary powers to break up Irish gangland, rather than seeing them being glamorized in the gutter press and in TV dramas? What is the Government’s position on this? What are the alternative governments’ positions?

Media Ownership
There can be no real democracy without a free press. A free press keeps the people informed on what their leaders are doing. Without a free press, how can the people know how they’re being governed. Recent technological and business changes have turned the Irish media landscape on its head, to the extent that whether or not a free and independent indigenous media is now under question. What is the Government’s position on this? What are the alternative governments’ positions?

Priorities in the Health Service

July 1, 2015
HSE management 'clearly incapable', say Portlaoise parents
http://www.irishtimes.com/news/health/hse-management-clearly-incapable-say-portlaoise-parents-1.2218094
Families who lost children told to 'go away and have more children', health committee hears
The HSE refused to advertise a helpline for patients on the night of the Prime Time programme, as requested by Patient Focus, because it didn't believe it would attract many calls, Cathriona Molloy of the patient organisation told the committee. The organisation was forced to use its own phone number for a helpline, which attracted hundreds of calls in the days after the programme, she said.

July 1, 2015
Hiqa to review Tusla over concern for at-risk children
http://www.irishtimes.com/news/social-affairs/hiqa-to-review-tusla-over-concern-for-at-risk-children-1.2259121
Records obtained by The Irish Times earlier this year showed thousands of reports of abuse, neglect and welfare concerns over children at risk were waiting to be allocated a social worker. An internal report presented to the board of Tusla said backlogs were so acute in some areas that hundreds of extra staff are needed to bring numbers back to 'manageable' levels.

June 22, 2015
HSE orders review into nine maternity cases
http://utv.ie/News/2015/06/22/HSE-orders-review-into-nine-maternity-cases-39584
The HSE has recommended a full review into nine maternity cases at three separate hospitals. A team examined 23 cases from the Midland Regional Hospital in Portlaoise, three from the Midland Regional Hospital in Mullingar and two from the University Maternity Hospital in Limerick between 1985 and 2013. It found that nine cases should be subjected to a full systems analysis review.

June 15, 2015
'Cloak of secrecy' around abuse of intellectually disabled
http://www.irishexaminer.com/ireland/cloak-of-secrecy-around-abuse-of-intellectually-disabled-336948.html
Fine Gael's Fergus O'Dowd made the claim after the Irish Examiner revealed 21 HSE workers have been sacked or suspended for alleged sexual, physical, and financial abuse of residents at care facilities for adults with severe intellectual disabilities since January 2014. Details published on Saturday show that, over the past 18 months, HSE management has been aware of serious incidents at seven such facilities.

June 12, 2015
What the hospital scandals teach us about management
http://www.independent.ie/opinion/comment/what-the-hospital-scandals-teach-us-about-management-31296032.html
HR policies are such that managers will tell you they are powerless to deal with people who ought to be sanctioned even for quite serious reasons.
It can take six months to replace a nurse through the shared HR services centre in Manorhamilton.
There is no effective performance management system for managers. Management structures are in a state of constant flux; many managers don't have the delegated authority they need to do their job; and some support functions are too centralised.
Compared to the HSE, the hospitality industry in Ireland has a better system for the training and cultural formation of hotel managers, sending them to the best hotels around the world on a carefully structured development programme. The results speak for themselves.

March 5, 2015
HSE 'Gave Contracts to Former Staff' Without Tender
http://www.todayfm.com/HSE-gave-contracts-to-former-staff-without-tender
The claims are understood to mostly centre around cases where contracts were awarded to companies led by former HSE staff, or where ex-HSE workers are now on the payroll. They include cases where the HSE has paid former staff members for spaces in care homes, without first investigating whether better deals could be found elsewhere. Committee chairman John McGuinness says some former HSE staff members have made huge money from unadvertised contracts.


These are just some of the reasons that the HSE has been in the news lately. And what is the Government doing about all this? Why, it's providing free healthcare for children less than six years old WHO AREN'T EVEN SICK IN THE FIRST PLACE. This isn't just an inefficient use of resources. This is immoral in every way and I don't know one politician who's had the stones to come out and say that, for fear they'd lose votes in leafy suburbs or roasted by a "Mums Outraged .." headline in the Indo or the Daily Mail.

Banana Republic. Will anything ever change in this godforsaken country?

Owning the News Cycle

Yesterday’s news was dominated by stories about patients on trolleys in Irish hospitals. Why?

Nobody doubts that having patients on trolleys is a bad thing. But that doesn’t make patients-on-trolleys news. For instance, the famed NHS of Great Britain has an A&E overcrowding problem right now and, bad and all as the HSE are, they aren’t responsible for events in Britain.

When asked once about the scandal of patients on trolleys, a medical doctor and Minister for Health once remarked that there is, actually, very little difference between a hospital bed and a hospital trolley, per se. You can lie on both, they both have wheels, and so on. But that doctor and Minister wasn’t Leo Varadkar, the current incumbent at Hawkins House. That was John O’Connell, twenty years ago.

So. Patients on trolleys because of hospital over-crowding isn’t unique to Ireland or unique to this year. Our current over-crowding is mirrored by over-crowding in the British NHS, and the issue of patients on trolleys has been an issue in Irish politics for a quarter of a century.

Why, then, did it get such intensive coverage yesterday?

Sometimes, something makes the news because there’s nothing else going on. It’s like all the foreign news that leads the bulletins over Christmas. An election in Azerbaijan is below the page 2 fold in the Irish Times 51 weeks of the year. Christmas week, hold the front page for the word from Baku.

But that isn’t the case this week, where there are lots of other things happening. Your correspondent's own favourite was Aodhán Ó Ríordáin’s extraordinary attack on his fellow Government members as reported in yesterday's Examiner. Ó Ríordáin went on the record to say none of the Government’s mistakes have been Labour’s fault. That buck, thinks Ó Ríordáin, rests with Fine Gael.

You can imagine what the backbenchers in Fine Gael, already plenty jittery, made of them onions. You can equally imagine what sort of repercussions that might have on those same backbenchers' enthusiasm, watery to begin with, for the same-sex marriage referendum – a same-sex marriage referendum for which Ó Ríordáin himself is to lead the Yes side for the Government. Will the backbench Blueshirts forgive and forget? What do you think?

That’s a juicy story. Was it covered by the National Broadcaster? Nope. Not a sausage.

For the four days prior yesterday, Lucinda Creighton's was the only story in town. Fergus Finlay in the Examiner was so sure that #rebootireland amounted to less-than-nothing that he wrote a column about it, as one does about things that aren’t important.

Of course, it hasn’t been easy to figure out just what Lucinda is up to, other than to note that when it comes to media appearances the woman is as sure-footed as a tightrope walker. Your correspondent has long hoped that Creighton would be the leader to finally consign civil war politics to the history books (and, for civil war politics to end, both civil war parties have to go – an important point that is hardly ever mentioned), but unless people rally to her flag and soon, that chance is gone.

But while the chance of ending civil war politics will be gone, Ms Creighton herself will be anything but. Her time is only beginning. For instance, consider the following picture tweeted by Lucinda just before Christmas:

Isn’t it extraordinary? For those who aren’t good at dates, it was December 17th when Leo Varadkar told the Dáil that Ireland’s abortion laws were too restrictive. And then he goes off and has a lovely dinner with his old friend and former party colleague Lucinda Creighton on December 19th, that same L Creighton who happens to be the current face of the anti-abortion movement in Ireland.

So. On Christmas week the Twitterati learned that Lucinda Creighton isn’t such a bigot after all, and is more than willing to dine with those who oppose her beliefs. And they learned that Leo Varadkar isn’t a bigot either, and remains loyal to his old friend. We can gather from this that, were Enda Kenny no longer the leader of Fine Gael, there would be very few bars to Lucinda’s return to Fine Gael should she choose that path.

Then, the first week after Christmas, Lucinda flexed her muscles before the general public by dominating the media with a press conference at which she said the absolute bare minimum to make renting the room worthwhile. Four days’ publicity from an hour-long presser.

As they saw Lucinda at every hands’ turn over the weekend, did Fine Gael backbenchers wonder if it was their own seats that were most vulnerable to the rise of a Creightonista faction?

Not that anybody is talking about Lucinda now. Oh no. On Monday, we had Simon Coveney - a contender to replace Enda Kenny as Fine Gael leader with, funnily enough, Leo Varadkar - announce that the lucrative American market is now open to Irish beef for the first time in fourteen weeks. Then yesterday the trolley scandal broke – just when Leo Varadkar happened to be on holidays and unable to act to defuse the situation.

Man. How unlucky is that for Leo?

Some commentators have said that it’s difficult to see what exactly Lucinda is up to with all this media activity. Reader, there’s a lot of it about.

The Demon Drink

First published in the Western People on Monday.

A dangerous quantity of black porter
in the Palace Bar. Allegedly.

Ireland’s relationship with alcohol is dysfunctional, dangerous and destructive. It makes us overlook the inexcusable and give a pass to behaviour that should be completely unacceptable in every circumstance.

But for all that, using statistics that don’t add up does the alcohol moderation lobby no favours. Once one of their propositions is holed, a shadow of doubt is cast over all of them and their entire argument is on shakier ground than it should be. The latest survey figures from the Health Research Board are just such doubtful statistics.

The Health Research Board survey tells us two things that are very difficult to believe. The first is that a frightening seventy-five per cent of all alcohol consumed in Ireland was consumed as part of binge drinking, rather than the moderated sup that we like think of ourselves as indulging in.

We think that we like a little drop of the craythur to keep the cold winter away, rather than slugging the stuff back like men caught on just as the Guards were battering down the door, horsing it back because they need to destroy the evidence but can’t bear to pour the good drop away.

However, the Health Research Board’s definition of a “binge drinking session” is “the consumption of six standard drinks” in a single sitting. Six standard drinks works out at three pints of beer.

If, as an adult of mature years, you drink three pints of beer you will be aware that you are no longer sober. But to say that you have binged on the stuff is ludicrous. Ludicrous. If three pints is a binge, what word do we use to describe the amount of alcohol consumed by many people – not everybody, of course, but many people – at Christmas? On St Stephen’s night, when everybody is home? On St Patrick’s Day? Have the Health Research Board ever been at the Galway Races or the All-Ireland Final? What do they call that level of consumption?

It could be that, as far as Science is concerned, once you’ve gone past the three-pint mark, it doesn’t matter how much more you drink. By this definition, binge drinking is like being pregnant – once you’re pregnant, you can’t get more pregnant. You’ll never be pregnant-er.

But this flies is the face of both common sense and experience. For instance, many years ago, a friend of this column was stuck in London with some friends for Christmas, looking at the prospect of a lonesome Christmas dinner of cheese sandwiches on dry bread. He did what Paddy often does when he’s lonely – he went to the pub, to drink the pain away.

Unfortunately, while in the pub, he choose to mix his drinks. The next day, this young man did not have cheese sandwiches on dry bread for Christmas dinner. He spent Christmas Day being walked up and down the living room by his friends, in the hope of returning his own powers of locomotion to him.

The Health Research Board survey tells me that man did as much damage to himself as a man who drank three pints in his local on Christmas Eve, because they both went on binges. I say phooey to the Health Research Board survey.

We are told that the three-pint limit is the European Commission standard, at which news we’re supposed to – I don’t know, cheer, I suppose. But the definition is far from agreed, as a 2009 paper in the Oxford Journals’ Social History of Medicine discusses.

The definition of binge drinking used to be what we generally understand as a binge – Richard Harris going out for a pint of milk in London and waking up slaughtered in some bar in New York three days later. The authors of the paper posit that the definition of binge drinking changed as society and politics’ reaction to drinking changed.

In the original definition, binge drinking was a sign of weakness. It showed a chap had no grit, would be read out from the altar and die drunk in an alley. This was a moral judgment.

There are have been two moves away from this definition. Firstly, alcoholism is  now seen as a disease, meaning moral approbation of the old school is no longer appropriate. Secondly, the drinkers about whom society is concerned has changed.

One hundred years ago, society was concerned about layabouts who would rather drink than work. Now, society is concerned about young people drinking, especially young women. These are not the same groups, and should not be addressed in the same language.

But where Aughrim is lost is that the terminology has not changed with the public health policy. It would not have been hard to come up with a word to describe the drinking patterns of at-risk groups like young people who have more money than sense. By not inventing a new terminology, the definition appears ridiculous.

Three pints of an evening is not a session – never was, never will be. At risk young people know this from watching adults. So they know they’re being fed a line if they’re told that three pints is dangerous drinking, and automatically switch off when they should be paying attention. The Health Research Board is doing more harm than good in releasing surveys that are fine in a lab but that have no bearing whatsoever in reality.

As evidenced by the other howler in the Health Research Board survey, the definition of a “standard drink.” A standard drink, by this Health Research Board’s definition, is half a pint of beer, a small glass of wine or pub measure of spirits.

I know more or less nothing about the grape, but beer and whiskey I’ve met before. That standard drink definition tells me that three pints of beer are the same as six glasses of whiskey. Reader, they are not.

I wrote earlier that after drinking three pints of beer you are no longer sober. After drinking six glasses of whiskey you may not know that you are no longer sober, but everyone in your company is fully sure that you are drunk and are now in need of minding if things are not to get out of hand.

Whiskey is a beautiful drink, but it should only be drunk on special occasions, one glass at a time. It’s a fine toast at a birth, and a lovely tribute after a death – I seem to remember a tradition of men going for a solemn whiskey after the opening of a grave in the ancient long ago. But more than one is almost always a mistake.

The Politics of Healthcare

I diagnose - money. Lots
and lots of money.

First published in the Western People on Monday.

The politics of healthcare are always difficult. You can only ever build so many hospitals and employ so many doctors. There will always be a gap between what people think they need and what a service can provide. Not every health care story will be good news, by the very nature of the business.

For all that, the politics of healthcare have taken an unedifying dip in recent years that reflects badly on all concerned. In arguing over budgets in the media instead of in their offices, where they belong, those involved in running the Irish health service are terrifying ordinary people who have enough to worry about as the nights continue to lengthen and the cold winter bites.

The most recent instance of this is the dispute over pay to the Chief Executive Officers of different hospitals in the State. It started some weeks ago, when the CEOs of the Mater, St James’s, Our Lady’s Hospital for Sick Children, Crumlin, and Tallaght Hospital published a letter they had written to the HSE, predicting all sorts of calamity should funding to those four hospitals be cut any further.

This letter was covered on Prime Time and made the main story on Morning Ireland the next day. Further calamity in the health service, doctors and nurses working 23-hour-days, what are the people to do?

At no stage did anyone stop and stay: wait a minute. Has anyone done the sums on this? Do these people have a point?

The wheel has come full circle now, as someone – goodness knows who – has leaked the salaries of certain hospitals CEOs to the media, and the shoe is now on the other foot. The salaries of the hospital CEOs who dare not cut one cent further are now in the news and, to the surprise of no-one, they are both big and fat.

This is what happens when amateurs play politics. They get your hands dirty. By entering the political arena, the CEOs have found themselves out of their depth, and are being outspun and outleaked at every turn.

And this would all be very funny if it weren’t for the fact that we’re talking about health spending. The story itself is now dead – the CEOs will be keeping their beaks tightly shut after this, while the HSE now says that the bonus money paid to the CEOs will be taken out of the relative hospitals’ grants. And that closes the book on the hospital CEOs’ shot across the HSE’s bows – the game ends in a score draw.

But while the story is dead, the smell of it lingers on. Pat Leahy noted in his recent book about the first two years of the present Government, The Path to Power, that the Government got blamed for the ideas that were floated but not implemented in their first budget.

The prospect of real cuts was fixed more firmly in people’s minds because they could relate to them. People don’t remember details of different budgets – how could they? But hearing that they’re losing their medical card or that a particular benefit was being cut – that’s very real and easy to relate to.

People will have forgotten the details of this storm in a teacup by Christmas – who got paid what and by whom. What they will remember is the chills that ran through them, in these times of austerity, when they first heard the details of the CEOs’ letter.

Future reductions in spending could “seriously threaten the quality and safety of patient services,” we were told, and that there are “unacceptable delays for treatment of certain cancer patients due to overwhelming demand.”  That’s what lasts in people’s heads, even though we don’t know if it’s right or wrong. The media has moved on, but the fear remains with ordinary people. And ordinary people have enough on their plates without being terrified out of their wits the next time they turn on the news.

Very few people on this island could estimate how much the CEO of a hospital should be paid. If you have to ring a man to come out and fix a gutter that got blown away in a storm, you’ll have your head well scratched figuring out how deep you’ll have to reach into the pocket to pay him. You haven’t a hope of having a correct option as to what Doctor O’Mahony of the Rotunda is worth.

When Liam Doran of the Irish Nurses Union comes on TV with his latest (long) list of grievances, you naturally sympathise with the nurses. But can you really make a call on whether or not their grievance is fair and just? How could you? The matters involved in health administration are so complex you’re lost as soon as you begin.

Better, then, for the media to be a little more judicious in how they report health stories, and not go for the terror angle. They ought to keep the narrative within certain bounds, and settle for that. For instance, here’s one way to go about it:

The British Government spends about seven hundred billion pounds sterling a year, give or take. One hundred billion of that spending is spent on the National Health Service – one pound in every seven.

The Irish Government spends about fifty billion Euro a year, give or take. Fourteen billion of that spending is spent on the health service – one Euro in every three.

Ireland is paying twice as much for half the service. How can that be? Where is the money going? Is it being wasted? Why is it being wasted? What’s being done to stop the waste? Who’s responsible? Who’s going to fix it?

Everyone can relate to those questions. It would be nice to hear the answer to even a few of them. Nice, but not at all likely.

Will the Electronic Cigarette Save the Tobacco Industry?

First published in the Western People on Monday.

Electronic cigarettes are the best thing to have happened the cigarette industry since the invention of the filter tip. The Government should act quickly to ban then, before the turn the tide and make smoking fashionable again.

Electronic cigarettes, for those who might not have come across them, are ostensibly another aid to quit smoking, like chewing gum, patches or inhalers. The difference between electronic cigarettes and their antecedents is that they’re a little more sophisticated and, proponents say, they work that much better.

The problem with patches or gum is that none of them feel like smoking. Electronic cigarettes come as near as possible, releasing a nicotine vapour, getting hot, having to be ignited, and so on.

Paul Kehoe, the Government Chief Whip, caused a small stir a few weeks when he suggested that the Government regulate electronic cigarettes just as they regulate any other medicine. People couldn’t see where he was coming from. Surely if they help people kick the demon weed, they should be available on every street corner?

Yes, they should, if that were all electronic cigarettes do. The problem with electronic cigarettes is that their advertising gives actual cigarettes something that they haven’t been able to advertise in nearly half-a-century – glamour, and lots of it.

The next time you flick through a magazine or are shopping and spot a poster, look out for the electronic cigarette ads. Those slinky, sophisticated women, those rugged and fearless men, puffing away – do they look like they’re selling a health aid? Or do they look like cigarette advertisers have always looked, like sellers of a lifestyle?

Once you start advertising a message that electronic smoking is cool and sophisticated, it isn’t a great jump to start to wonder what actual smoking is like. Is that cool and sophisticated too?

If electronic cigarettes were selling only to those who are trying to give up smoking, they certainly make a very slight effort to get that point across. The weight of their message seems to be that if smoke (electronically, wink, wink), you instantly become as chic as Audrey Hepburn or as cool as Humphrey Bogart. You’d be a while trying to make Milk of Magnesia look that cool.

And this is the danger. The nicotine in cigarettes is addictive, certainly, but a nicotine craving leaves your body within twenty days. There’s no trace of the stuff left in the system, and it’s not natural to crave it if you’ve never been introduced to it. Cigarettes’ real attraction is their transformative power, to make any ordinary Joe or Jane into a Hollywood star. You might be in Swinford but once you light up you’re on Sunset Boulevard.

The Government’s current campaign to fight smoking by making manufacturers package cigarettes in plain packaging may be completely pointless, such is the additive nature of the cigarette. Martin Lindstrom details an experiment conducted on smokers in his book Buy-ology, where a group of smokers were connected up to a brain scanner and shown various anti-smoking ads – the blackened lungs, the rotting teeth, and so on. In theory, the areas of the brain that register revulsion should have lit up. Instead, it was the areas of the brain that register cravings that rang the bells.

Meaning that when smokers were shown pictures of the scientifically proven consequences of their smoking, the rational part of their brains were completely by-passed. All that registered was: “man, I could sure use a smoke once this experiment is over.”

That’s how addictive they are. It is hard work to smoke now, in comparison to years ago. You have to go outside in the pub, and leave the company. You are in the rain and, if you are in the capital, you are liable to be hassled by all manner of ne-er-do-wells. But still the people carry on, even people who are too young to remember a time when you could smoke in bars.

The smoking ban is ten years old this year – anyone in their mid-twenties or younger is too young to remember being in a old-style bar, when the air was so thick with smoke that you couldn’t see the end of the room. And still they want to smoke, even though they have only ever been discouraged to do so for all their sentient lives.

Why would they do that? They do that because cigarettes are the most glamorous and addictive things humanity has managed to invent in five hundred years, and the most dangerous since the atomic bomb. By the time it was realised just how bad for public health they are, cigarettes were already an essential part of adult life for a huge, huge section of the population. It’s taken generations to row that back to where we are now, and all those advance are in danger of being lost by the glamorous way that electronic cigarettes are allowed to advertise.

The easy thing to do with cigarettes would be to ban them outright, but the lesson of history tells us that prohibition is always a disaster. And the Government can’t price them to the hilt because that will make them even more glamorous, and associate smoking with sunbathing in Monaco and skiing in Saint-Moritz.

Funnily enough, the Government is currently doing as good a job as can be done with cigarettes – heavily regulating where they can be sold, and to whom. Penalizing advertising and lumping on as much tax is as feasible. Ideally, the habit will get a long, slow death and by the time it finally dies off people will have forgotten it was ever widespread in the first place.

Unless the industry gets a boost from the electronic cigarette industry, and is able to ride the coattails of that advertising. If, as may happen tomorrow or next week, a model arrives who becomes the poster girl for electronic cigarettes, and she’s all over the papers, looking chic with her electronic cigarette. And all her adoring followers will wonder: why should I always eat spam? I wonder what actual bacon is like?

Ban the things now, and cut them off at the pass.

The Nine Lives of Reilly

James Reilly may be thick, but he’s very, very far from being dense. There is an understanding abroad that a lack of previous political experience has stood against Doctor Reilly in his career as a politician. Rather than being a life-long party member, working his way through the ranks, Reilly was was a high profile candidate head-hunted by Fine Gael, just as George Lee was.

But this perception is not the reality. Of his current Fine Gael generation, Reilly may be the most cunning, the most devious, the most brilliant of them all.

The Minister for Health did a radio interview with Pat Kenny yesterday that is instructive of just how commanding a political presence James Reilly is. One of the distinctive features of a Pat Kenny interview is that Pat himself is seldom shy about showing his own grasp of a subject.

If he’s interviewing lovely Clodagh McKenna, Pat may comment that finds a cheeky glass of Chateauneuf-du-Pape goes particularly well with fish fingers, or complement Denis Lehane on Lehane's excellent grasp of Boston vernacular. Pat can seldom resist interrupting the sports reports to remark that Sir Alex ought to play Rooney in the hole behind the strikers, or that Padraig Harrington has been putting too much weight on the back foot while executing his putting stroke.

It’s how the guy is. In every gang he was ever in at school, Pat almost certainly played the role of Brains.

Yesterday though, Reilly blew Pat away with a fusillade of facts that not even RTÉ’s great savant could keep up with. Pat was naïve at the start in not carefully corralling Reilly at the start – Pat’s first question to the Minister was “what do you have to say about that story on the front page of the Independent today?”

Reilly saw open country, and romped into its wide open spaces. He gave Pat and the people of Ireland chapter and verse on Irish health policy, far more than non-experts can keep up with. Over half an hour the Minister discussed

• the contrast between public private partnership and direct provision,
• the personal cost to him of his involvement in politics,
• the fluid nature of the criteria by which things are judged,
• Roscommon Hospital,
• the differences in hospital standards across the country,
• the importance of metrics in patient outcomes,
• his personal financial losses due to his service to the state,
• the cuts in the Health budget since 2009,
• his relationship with Róisín Shortall,
• a defence of the people of Balbriggan against insult,
• improvements in the Health service since his took charge,
• the Health service frontline staff who have taken ownership,
• and his own managerial style.

Half an hour of radio, with enough material for a book on the Health service. Pat Kenny and the listeners got swept away in the tide while Reilly remained dry on the shore.

Two questions remained unaddressed – did the Minister pull a stroke for his buddy, and what exactly are these criteria by which these sites are judged? All the rest are issues for other days.

If Minister Reilly didn’t bump Balbriggan and Swords onto the list it’s entirely possible that they are the only two locations on the list that are not there as a result of stroking. This is Ireland. We don't do “criteria.”

The only reason things happen here is because someone has made a better deal than someone else. We’re Irish, not German. We sell horses to each other as darkness falls on the fair and hope the horse we bought is less lame than the one we sold. We score that as a win.

But let’s take the Minister at his word, and take it that he didn’t pull the stroke and that criteria for judging these sites do exist, no matter how fluid they are. The sad fact for Reilly now is that none of that matters anymore. Events have overtaken them.

Eighteen years ago a situation developed between Labour and their then coalition partners, Fianna Fáil, where Labour got sick of being pushed around by Fianna Fáil. That situation is now developing again. The backbench anxiety has been added to by two MEPs, Phil Prendergast and Nessa Childers, publically calling on Minister Reilly to resign. This means it’s now a game of chicken.

Eamon Gilmore has to call for Reilly’s head, or else be exposed as the grand old duke of York. Enda Kenny owes his entire premiership to James Reilly and Phil Hogan, who were the only major party figures to support him during Bruton Minor’s ill-fated heave two years ago. So the question now is: who’s going to blink first?

Labour can’t back down from this. Sauce for the goose has to be sauce for the gander, or else Labour can’t preach to anyone ever again. And it goes without saying that not being able to preach would be a fate worse than death for that particular party.

Will Enda give Labour Reilly’s head? Or will he call Gilmore's bluff on collapsing the Government? Who fears the doorsteps most? Labour, or Fine Gael?