Tube Food for Thought

Today's papers reported the death of a British man who was devastated when the court in London rejected his request for assistance to end his life. The man was paralysed neck downwards since 2006 but was fully  cognitive. He died of natural cause (pnuemonia) 6 days after the court decision. The case reignited the debate on euthanasia.

Curious as to what constitutes euthanasia in Singapore I did some googling. Apparently the witholding of artificial means to sustain life when the patient is deemed terminally ill is legal and not considered as euthanasia. The patient or the family can make a decision to withold "Extraordinary Life Sustaining" procedures if the patient is deemed terminally ill and when such procedures only serve to prolong his dying process. So in Singapore any person can make an AMD (Advance Medical Directive) to direct that his life should not be sustained by artificial means if he is deemed terminally ill. However what is important to note is that palliative care cannot be witheld and this includes feeding by tube etc. Hence even if a person is dying from cancer he can not opt for tube feeding to be stopped.
I thought this is not very justifiable. If the world is not so medically advanced or if the patient has fallen ill in a country without such medical facilities he would have died naturally at home wouldn't he? How come people are trapped by legal constitution which seems rather unethical as in prolonging a person's sufferings? In my mind force feeding a person by tube against his wishes is unnatural because he would have died a natural death through malnutrition etc if he has not sought treatment from a hospital.

However when I google further I come across another big debate, that of whether witholding tube feeding from cognitively disabled patients makes them suffer a long and painful death. From the account of a lady who recovered from a coma,  she had suffered immense pain during a brief period when tube feeding was suspended. In the case of a dying person however,  it is believed that the body  has begun to shut down and to reject food. The dying person will thus not have a painful death from dehydration and starvation.

As such it can be seen that euthanasia even in its passive form is quite a complex and sensitive issue.  However I feel it is good to go back to basics. Medicine is about curing illnesses and saving life. In circumstances when nothing else can be done to save life, a person should have the choice to go home and refuse all types of medical treatment include unnatural procedures like tube feeding. Think of how our great grand fathers died of their illnesses at home without food forced upon them. They probably weakened and deteriorated quickly when eating became difficult. Haven't generations after generations perished in the same manner? This is really tube food for thought.

Antonio's Inexplicable melancholy

In the Merchant of Venice, Antonio was a hopelessly melancholic character who found it difficult to place a finger on the cause of his constant moodiness; thus his famous lament "I hold the world but as the world, A stage, where every man must play a part; And mine a sad one".

In Greco-Roman medical analysis of temperaments (psychology), there were 4 predominant temperaments in people known as the 4 "humors" that  being sanguine (pleasure-seeking, sociable, impulsive), choleric (ambitious, aggressive, leader-like), melancholic (introverted, over pondering, sad), and phlegmatic (calm, unemotional, sluggish). The 4 "humors" concept was based on the assumption that the body fluids (humors) within a person was responsible for his mood and personality . Thus Hippocrates described a melancholic person as having too much black bile thus the word "melan chole" in Greek, the phlegmatic person had much phlegm. Any excesses of a certain body fluid would cause some personality disorder. Treatment was in the form of medicine, diet or blood-letting using leeches.

I find myself a bit of an Antonio, as in sometimes I feel moody or anxious for no good reason. When I feel this way I will usually find a cause to justify my unease. It could be some situation not so desirable that I wish I could get rid of or something lacking which will make me happy. Very often melancholy arises out of boredom and anxiety out of existential angst perhaps.

Of late I have been trying my best to maintain a routine of meditating for about half an hour daily. During the first 15 minutes thoughts will come and go. Most thoughts that surface initially will be about jobs or chores that need to be done and little plans to carry them out. As these come and subside issues underlying the feeling of the day usually arise and I have to will myself to focus on my breath. So these thoughts come forth and retreat like the ebb of a tide. Sometime in the middle of the session with the aid of the regular and slow deep breathing the mind quietens down and the heart feels more at ease. In some snapshot moments I may come to some awareness that things around me are "Just what they are". There is nothing in the air or the cloudy sky or the trembling leaves to suggest gloom or nervousness. They are neutral and are just what they are, the environment and the situation; and whether I colour them gray or forlorn is all in my mind.

Studies have shown that meditation makes one less reactive to stress and pain. In fact MRI scans have found that with more hours of meditation, the meditator's emotional networks were less active during experimental distracting sounds, which meant it was easier for the meditator to focus. I strongly believe that it is not only being able to focus but also to have a clearer mind and shedding those tinted glass over one's eyes.

Surely meditation is also a more pleasant form of therapy than letting leeches feast on you.

Baby boomers' crushed dream?

It is an inherent biological instinct for parents not only to care and provide for their children but expect the lives of their children to improve over theirs. Our generation, the baby boomers have fulfilled such expectations of our parents in terms of being better educated, enjoying much more material comfort and healthcare and being more aware of the world at large. It is only natural for us to expect that our children should enjoy yet a higher level of these and it disturbs us when we realise they may instead  suffer a heavy set back as a result of our past excesses.

Leaving aside the huge deficit and the worn out infrastructure in far away US, we the baby boomers in this part of the world have our share in contributing to the aftermath of our excesses. We benefited from almost free education, rode on the economic growth and property boom in a relatively stress free and less competitive environment; and by sheer numbers redirected the use of limited natural resources to satisfy our needs. We fuel the rising housing prices and have insatiable demand for consumer goods. Now our children have to work all their lives to serve the house mortgage, suffer the consequence of global warming and will feel the impact of heavier government spending on elderly healthcare at the expense of say education. As a result of a growing income divide our next generation may also experience greater social immobility.

The next generation is sometimes described as a " generation screwed". Parents all the world over worry for their children's future and well being.  We worry about our children’s finances, relationship issues and problems in balancing work and family. Back home, Singapore is also facing a severe fertility crisis which if uncorrected will in the words of LKY see the country "fold up". The competitve environment and heavy job demands are named as contributing factors. Will our children be the last mohicans with no one to take care of them when they turn old after slogging a lifetime to survive? This is inconceivable in the minds of us baby boomers who ironically have worked hard to forge a better future for our children. Our predominant focus on economic growth and competitiveness seems now to have backfired leaving behind a world so messed up that our children see little meaning to bring yet another generation to endure. So our dreams like that of the predecessor of every generation in wishing a better life for their children waver and stand the risk of being crushed.

Beach Art

Make a quick guess who the artists of these 2 pictures are (click on picture for a larger view).
Krabi beckons and we were back. This time round we did not stay at Ao Nang but at a remote resort with a quiet beach. Around evening my husband and I took a stroll on the beach with only one other couple in the distance. We saw many many pictures on the sand, some looked like flora, some like butterfly, all lovely patterns. The pictures I displayed look like a coconut tree and a bird & a phoenix in another, don't they?

On closer scrutiny we discovered the pictures were moving as in they were in the midst of creation. Time was on our hands and we squatted there, quiet and motionless and watched with wonder tiny crabs (less than 1 cm in size) digging small trenches and moving forward. As they used their pincers to burrow, the sand was rolled into small bubbles or balls and gently tossed to one side of the small trench, forming lines and curves. Each picture is the work of one crab.

I then google to see what was actually happening and got this information:
"At low tide, the sand bubbler crabs emerge from their holes beneath the sand to gather microscopic food that the tide has brought along. They do this by collecting and sifting the sand, actually checking each grain, and rolling those parts devoid of anything useful for them into little balls (sand bubbles) that they toss behind.

So, the little sand balls are actually cleaned parts of sand, rolled into a ball so that the crab doesn’t check them again by mistake. Pretty clever, isn’t it? And we can’t even state that the waste we leave behind looks even half as pretty. Enjoy the following amazing crab art designs. "

Here is a close up from the web

I left the beach feeling rather mystical. My mind wondered about these tiny crabs going about their routines, their daily living (their 活着) , unaware of the beauty they created before the tide washes it away; and how they lay no claims to their artistic gift and how they bring  about delight to the beholder and draw the beholder closer to their soul. It makes me believe that  the same is true of every living creature. Too often we bash ourselves for our weaknesses and focus on our mistakes and misdeeds. I am sure each of us has brought joy and delight to some others at least sometimes.