Sunday, March 31, 2013

Chinese raise a stink over commuters' foul behaviour

Mar 31, 2013
LETTER FROM BEIJING

By Kor Kian Beng China Bureau Chief In Beijing


Two incidents made Chinese commuters cry foul recently - foul- smelling, that is.

People who boarded a Beijing subway train on March 17 were hit by the stink of excrement. Spotting the obnoxious pile on the floor of the train carriage, they pinched their noses and scrambled for seats as far away as possible. Photos swiftly made their way online.

One of those who posted photos was a commuter known only as Mr Dan, who got on the train at the Wangjing West station on the Line 13 route heading to the Dongzhimen interchange.

"The terrible smell hit me the moment I boarded the train. I thought it was odd that the seats were empty and there was a pile of poop on the floor," he recounted on his Sina Weibo microblog.

The commuters had to put up with the stink for another four stops until the train reached Dongzhimen.

A subway station employee told Beijing News daily: "As the trains stop for only a short while at each station, there is not enough time for our staff to clean up until the train reaches the interchange."

He added that there had been such incidents before and that children who could not control the call of nature were responsible.

In the other incident last month, a rubbish bin became an instant toilet for a teenage schoolboy in southern Guangzhou city.

Incredulous commuters took photos of the boy in school uniform relieving himself atop the bin as a train station worker tried to stop them.

[Note: The train station worker "tried to stop them", as in tried to stop the (incredulous) commuters from taking photos of the boy relieving himself. NOT tried to stop the schoolboy from relieving himself.]

Netizens were generally sympathetic. The boy was just doing what came naturally in an "urgent" situation, they said, blaming the train operator for not providing enough toilets. Some had some mock praise for train station staff.

"It means the rubbish bins are clean enough for the boy to want to sit on them," said one netizen.

[And that explains it. Even the train station staff was sympathetic.]

Many did not find the incidents amusing. They said they showed a lack of social etiquette despite decades of modernisation and growth that have turned China into the world's second-largest economy.

Complaints about poor social behaviour have been on the rise, in part because of rural migrants flocking to the cities, which in turn leads to crowded trains and raised tension.

In a poll by a Beijing subway operator last December, netizens listed their pet peeves in this order: fighting over seats, talking loudly, littering and eating on trains.

Accountant Li Bin, 39, recently witnessed a fight between two women who had knocked into each other. "I saw one grabbing the other's head and knocking it onto her kneecap," she said.

Technician Tang Qingning, 39, found himself seated next to a man who feasted on a bucket of fried chicken throughout their hour- long train journey last month. "To make it worse, another passenger was eating buns non-stop. Luckily they didn't litter," he said.

[Baby steps.]

Commuters say one reason for bad or inconsiderate behaviour is the lack of enforcement. Beijing train stations put up a list of don'ts for commuters but there are no penalties for those who ignore them.

The notice only says that "those flouting the rules will be dealt with on a case-by-case basis and may be referred to the policy and relevant departments".

Beijing hotel employee Chen Xiyang, 21, who commutes to work by train, believes the authorities should impose heavy fines to stop bad behaviour.

Others like Ms Li think good behaviour starts with education. "Schools should play a more pro-active role. We should scrap Math

Olympiad classes and hold more civic morality lessons instead," she suggested. "There is hope only if our young learn how not to be a nuisance to others."

Like learning when to hold it in, for a start.

Friday, March 29, 2013

Integrating foreigners isn’t a lost cause

Integrating foreigners isn’t a lost cause
TODAYonline

On a recent trip to present a research paper in Tokyo, I was surprised to not hear a single mobile phone ringing or a commuter talking loudly on the subway. Despite the train coach being notoriously crowded, the quiet was deafening.

27 March

On a recent trip to present a research paper in Tokyo, I was surprised to not hear a single mobile phone ringing or a commuter talking loudly on the subway. Despite the train coach being notoriously crowded, the quiet was deafening.

Just as I was starting to wonder why the Japanese were behaving so considerately towards others, I heard announcements, first in Japanese then in English, over the sound system that all mobile phones must be switched to silent mode inside the coach.

What can we learn from the Japanese subway management to help our foreign friends better integrate in Singapore? Our Government has in recent times been sounding the refrain that foreigners whom Singapore welcomes to its shores must do their part in learning and adapting to our culture. Will this be a call in vain?

From a behavioural economist’s view, I believe not. It is in one’s self-interest not to deviate from the social norms of the society we live in.

The assumption that man is rational and self-interested is Economics 101. Indeed, it is what distinguishes economics from other social sciences such as sociology. While social scientists have long frowned upon such a simplistic view, it is only recently that behavioural economists have also challenged the validity of this assumption.

THE GENEROUS DICTATOR?

A simple way to test this assumption is by running a dictator game experiment. In this game, one player, known as the dictator, is asked to allocate any amount of his money to an anonymous recipient. According to the common assumption, standard economic theory predicts that the dictator would give nothing to the recipient.

Over the past 30 years, researchers across the globe have conducted countless dictator game experiments. The outcome, as summarised by Professor Colin Camerer of the California Institute of Technology, showed that, contrary to expectations, the majority of dictators gave away between 20 per cent and 30 per cent of their money.

The finding puzzled many economists. Borrowing ideas from neighbouring sciences in particular psychology, behavioural economists like Professor James Andreoni of the University of California San Diego sought to offer the explanation that people gain a “warm glow” when they sacrificed their own material benefit for the benefit of others.

According to Professors Ernst Fehr and Urs Fischbacher of the University of Zurich, we feel compassionate towards those who are worse off and giving to them helps to manage this feeling and improve our own happiness. Fundamentally, therefore, even giving is still a selfish act.

Recently, competing explanations have also been proposed. One school of thought argues that giving meets people’s innate desire to avoid appearing selfish.

We conducted an experiment at SIM Global Education to prove or debunk the existence of this ‘negative image avoidance’. We asked recipients to write a message to dictators after having received a token sum of money from them.

By default, the message would be given to the dictators for free. However, the dictators could pay the experimenter to stop the message from being passed back to them.

One might argue that the recipients’ negative impressions probably did not matter much to those dictators who chose to give little in the first place. But this was not the case.

THE DISAPPROVAL OF OTHERS

The dictators spent about 43 per cent of their own money that could have been earned from participating in the experiment to prevent the expected negative messages from reaching them.

Even though they could simply get the messages for free and refrain from reading them, the mere thought of receiving something negative propelled them to give up about half of their money to ensure the messages did not get to them at all. In other words, the self-interested incentive to avoid knowing the disapproval of others was strong.

The recent unabated debate about “locals vs foreigners” hinges on the assumption that there exists a common set of social norms and culture unique to Singapore.

If to avoid being perceived negatively — or at least avoid knowing that one is being viewed negatively — is innate to human nature, then spelling out consistently and constantly what the expected and desired behaviours are could well help foreigners adjust and integrate in this country.

Even in a mature and homogenous society such as Japan, reminders of clearly defined expectations of behaviour are repeatedly given to people so as to induce the desired manners.

The Government and Singaporeans alike can do their part in defining what is considered “Singaporean”, and what is not, and roll out programmes to systematically communicate this message.

While this may not be an exact science, going by behavioural economics, there is a chance that Singapore might just be successful in its integration efforts.

ABOUT THE AUTHOR:

Zhang Jianlin is a Senior Lecturer in Economics at SIM Global Education.

The growth of a quality society

The growth of a quality society

TODAYonline

28 Mar 2013

Devadas Krishnadas

Firms which emphasise profits or market share are the most likely to perform poorly and suffer from short-term thinking, so British economist John Kay argues in his book, Obliquity.

As The Financial Times commented in its review: “Strange as it may seem, overcoming geographic obstacles, winning decisive battles or meeting global business targets are the type of goals often best achieved when pursued indirectly.

“This is the idea of Obliquity. Oblique approaches are most effective in difficult terrain, or where outcomes depend on interactions with other people.”

Kay argues that when it comes to complex problems, we often do not know about the nature of our problems to introduce effective direct action solutions. Indeed, we often misdiagnose causation, and this is not made better by simplification of reality in the developing of models or viewing problems through cultural frameworks.

I earlier made the case for an IES sector — Ideas, Entrepreneurs and Start-Ups. The challenge is that we cannot simply expect a random unit of labour to become an active IES participant. That process is a generational one — and is wrapped up within a spectrum of dimensions which have no easy answers, such as how to boost the total fertility rate to maximise each generation’s creative potentia.

In this final part of the series, I argue that to sustain quality growth over time, we must find ways to grow the quality of our society.

We should supplement short-term direct attacks to achieving economic success, with longer term indirect strategies to populate the IES sector with creative minds bursting with innovation, and enlightened risk takers to start future global brands here.

SOCIAL INVESTMENTS, NOT COSTS

Until fairly recently, the Government has seen social policies, other than education, as a cost and not an investment. This was probably for four reasons.

First has been a rigid adherence to the principles of self-reliance and the family as the first line of support. This meant that the individual and his or her family should bear the greater share of the burden to meet their social needs. The State did its best to be the source of last resort for assistance.

Second, the principle of meritocracy fed into a larger framework of belief that it was fair that the best accrued the most gains, and it was not fair to unduly socialise collective costs for the rest at the former’s expense. Over the past two decades, the top income tax rate has fallen almost by half, while regressive taxation such as the Goods and Services Tax has been introduced and increased over the same period.

Third has been the difficulty in showing a positive cause-and-effect correlation in social support systems. In other words, it was difficult to demonstrate that boosting social safety nets lead to positive results that out-sized dollar expenditure. This was very much due to a mindset that perceived social safety nets as welfare, rather than as a means to generate human capital.

Fourth, there was an over-dependency in the use of the price mechanism to achieve policy aims.

An example would be financial incentive-driven marriage and procreation packages, where the underlying assumption is that at some point, a clearing price would be reached where individuals would decide to get married and have babies. The evidence of unrelenting decline in TFR failed to deter this mode of thinking.

BUILD SOCIAL CAPITAL

However, if we were to switch mindsets to view the public finance of social policies and social safety nets as investments rather than costs, we could end up with different outcomes.

We have the examples of Finland and its neighbouring Scandinavian countries as examples. These have been exhaustively studied and discussed by our policy-makers so the lessons of investing in social capital are not unknown to us, nor are the dangers of fiscal irresponsibility of many Western European countries with welfare systems.

The mistake to make is that the one implies the other.

We must overcome the four impediments to switching mindsets and take the risk that achieving social outcomes, such as boosting marriage and fertility rates and generating innovation and creativity, are predicated first on putting in place conditions conducive for socialising and learning.

The process of doing so is neither direct nor simple.

Our labour force works some of the longest hours among developed countries. Our education system is one of the world’s most competitive. Our costs of housing are high and rising. The wages of the workforce, for most income deciles, have been growing slowly when at all. Inflation has been elevated and persistently so.

Competition makes the climb up the career ladder difficult and stressful. All of these characteristics work against conditions for socialising, which is the premise for the higher-order actions of marriage and fertility.

We cannot do something about everything — but there are several things we can do.

WORK TO LIVE, NOT LIVE TO WORK

First, regulation should be introduced to limit the hours worked by all occupations, including PMETS and non-union labour. Protect the private lives of workers so that they have time to live their lives. We must create a culture where workers work to live, and not live to work.

As was noted in Part 1 of this series, the poor wage share to gross domestic product (GDP) shows that firms already retain the lion’s share of GDP as profits. Firms are not therefore in a strong position to make the case that they would suffer competitively if workers worked to a limit of eight hours per day.

It is important to make it mandatory to compensate workers for overtime. This is to discourage the situation where employers, facing tightening labour conditions, pressure their workers to work longer rather than invest or reinvent to make their firms more productive.

‘US’ PLUS ‘I’

Second, we need to move from a mental model that individual gains are derived mostly from individual responsibility, to one where individual gains are best arrived at through collective responsibility supplementing individual effort.

We have shown that we are not averse to spending large sums on physical infrastructure for education at the State level, and large sums on tuition and enrichment at the household level. We must ask if our excessive emphasis on individual merit through hyper-competition is creating more harm than good.

Finland has a high rate of entrepreneurship and a strong knowledge industry base. It is arguable that this was made possible because people are more willing to take risks, knowing that failing need not imply financial ruin for themselves or their families. This is because of strong and comprehensive social safety nets and State-supported social support systems such as education.

We have to use legislation to restrain our impulse to indulge in “arms races” in education. In Finland there are no arms races in education not only because the standard of public education is so high, but also because State support for parents of either gender to take care of the family over a multi-year period helps create a balanced view of life.

Third, we should consider the benefits of national level risk pooling for healthcare. Our costs of healthcare, particularly for catastrophic health crisis, are high and rising. By risk pooling, we can lower the insurance premiums for every Singaporean and absorb the costs of covering those with pre-existing conditions.

As a First World country, we can provide peace of mind for all, especially for those considering having children, that they need not fear the unexpected onset of a catastrophic illness in their family or unforeseen condition in a newborn.

Together, through risk pooling, we are better off than insisting on the individual to assume the costs of his or her personalised risk.

FOR SUCCESS, CELEBRATE FAILURE

Fourth, we have to change our thinking about success and failure. We are addicted to the idea of success where success means not failing. This is a false and dangerous idea. Success is usually a function of iterated failure.

Our misguided notion of success gets in the way of learning, distorts life choices and induces risk aversion. It gets in the way of learning because it encourages students to study to score instead of studying to learn. The recent discussion on the decline in the study of literature in schools is instructive.

It distorts aggregate social outcomes as it affects how we individually prioritise choices in life. Work and career building are seen as nearly mutually exclusive and, in some cases, perhaps even substitutable for relationships and family.

It induces risk aversion because we do not want to fail. But to build the IES, we need to be comfortable with “failure” and even celebrate it.

As much as policy and legislation can accomplish, it will never be enough. The greater share of effort in growing in quality as a society must be made by ourselves, not the Government. Public policy merely reflects the priorities, values and aspirations of the society.

The future is malleable. If we decide to be a quality society, we can do it. The decision to do so must first be made within ourselves.

ABOUT THE AUTHOR:

Devadas Krishnadas, a social and political commentator, is the director of a foresight consultancy. This is the last of a three-part series.

The Singaporean core - two essays

Mar 28, 2013

Much has been said about retaining a Singaporean core. The term has been taken to mean a core of citizens in a workforce where one in three is a foreigner. Others take the term to refer to a core of Singapore values. Two writers share their experience of moving from the periphery of Singapore society to embracing its core in these essays.

Can the new Singapore blossom from its core?

By Susrut Ray For The Straits Times


MY FLIGHT lands at Changi Airport; a cab drives me to the city through Airport Boulevard which is beautiful as ever. It welcomes me, as it has done a hundred times before. The greenery, the pink bougainvillea-lined kerb, the magnificent exit ramps and overpasses make up a grand bouquet.

My mind turns 30 years back; I think of the time I first landed in Singapore, not at Changi but at the old airport in Paya Lebar.

Just as I did today, I had taken a cab to the city. The roads I passed through were no less inviting. I was taken by the exuberant greenery that seemed to connect directly the primeval rainforest that existed long before Singapura or even Temasek was founded.

It is different now, more "developed", my Singaporean friends would say. But the connection between the greenery and Mother Earth seems to have been lost.

Lines written by homesick English poet Rupert Brooke as he sat at a cafe in Berlin a hundred years back come to mind: "Here tulips bloom as they are told; Unkempt about those hedges blows/ An English unofficial rose."

In Singapore today do the hibiscus, the Bunga Raya, bloom as they are told? Nostalgia for days gone by leads me to reflect on the changes that have taken place.

Soon after I arrived in the 1980s, the airport shifted to Changi. I remember seeing the grandest, the most meticulous "house-moving" operation ever, as my flat was along the route.

Trying to sleep then, I heard trucks all through the night, moving people and equipment. Overnight, that task was completed with military precision. Paya Lebar received its last commercial flight at 11.30pm on June 31, 1981. Changi was ready to take its first by 7.10am the next day.

One aspect of Singapore that has remained unchanged over the years is its legendary efficiency, which amazed me through the 17 years that I made the sunny island my home; it does so till today.

The spirit of Singapore revealed itself to me in diverse ways, most so through my interaction with Singaporeans. I remember, for instance, my first glimpse of then Prime Minister Lee Kuan Yew addressing the nation on TV, presenting his seemingly iron-clad argument with facts, figures, even graphs.

What a contrast this was from my past experience of politicians who incessantly spewed emotionally charged rhetoric. The intensity of rational progression of thought, sullied neither by rhetoric nor by emotion, was over-powering. This, to me, was a hallmark of the governance of Singapore.


It seemed to me that the rationality and efficacy that was apparent in public enterprise sprung from the "grassroots" (to use a local phrase). I encountered it in the behaviour of ordinary people.

Take this. One day, when I had just bought my car and was driving through still unfamiliar roads, I grazed past an old van, leaving an ugly scratch on my car while the van remained unscathed.

Where I came from, even a minor road accident is invariably followed by mutual rage and outbursts. Both parties would ritually blame each other irrespective of what had actually happened.

I was in the wrong, but reflexes got the better of me. My adversary was a wizened old Chinese man in singlet and shorts. He watched bemused as I hurled my accusations till I had run out of steam. Then, in a voice as calm as his PM's, he said: "Why you shout? You want we go to police, also can. You want to pay me, also can. You don't want to pay, also can."

What impeccable logic! What a chastening I had that day.


The practical wisdom to be found in the grassroots affected the lives of people as they hauled themselves up by their own bootstraps. It took them from the roots upwards, to the tips of the grasses, the shrubbery above, even upper branches of trees.

I remember Kaliappan. Born in Madras (now Chennai) to an impoverished family, he was bundled off with a distant relative to Singapore when he was only 13 to make a living. He told me how he did odd jobs around the harbour for many years. When he was 20 or so, he found employment in a shipyard. He made the most of it, got selected for training in Japan, and then on he never looked back.

A supervisor at the shipyard when I first met him, he lived in his Housing Board flat bringing up two bright kids and spending whatever time he had working as a grassroots leader of the ruling party. Sadly, he is not around any more.

But his two sons have moved into a bungalow, acquired undreamt of wealth (two cars, Club Med holidays, the works). They have children of their own. The older one has even stepped into his father's shoes and is a grassroots leader in his own right.

That, to me, was the spirit of Singapore and it is one I see over and over again.

I remember Jenny whom I hired to start our electronics assembly line. She was only 20, had finished her A levels (the first to do so in her family of Cantonese immigrants), and had some work experience with a multinational company. Single-handedly and within weeks, she had put together the assembly operations, hiring and training operators, buying equipment, designing the workflow, and so on.

On the first day of the pilot run, her line was already producing three times what the shop I had come from did (even though the person in charge there was more qualified and experienced than she).

Then there was Sarah, our star salesperson; customers swore by her. Over a casual conversation she revealed the secret of her success. Her parents ran a chicken-rice stall. Through her days at school, junior college and university she spent time at the stall, helping out, taking orders from customers, talking to them in English and Mandarin - languages that her parents hardly spoke.

That's how Sarah became a master of the process of selling which, in its basics, is the same whatever the product sold: chicken-rice or electronics.

I have lost touch with Sarah and Jenny. I suspect they are very much around but transformed to such an extent that I will not recognise them. Middle-aged now, they must be there among the bejewelled, designer-clothed, women whom I see shopping in the elegant malls (that put the Lucky Plazas of my time to shame).

Their children - never having to hawk chicken rice - likely went through fancy kindergartens, primary schools, secondary schools and universities of hallowed names without learning the good old habits their parents had learnt at their age. The real education that Sarah went through has been denied to her children.
Hawker stalls today, I understand, find it difficult to hire assistants. So do shipyards. They have to hire "non-residents", a misnomer for the "foreigners" that Singapore would rather not have as permanent residents.

So the bedrock that gave rise to the Kaliappans, the Sarahs and the Jennies - an environment where you need to struggle to succeed - is no longer there.

Singapore seeks to replenish its core by letting in "foreign talent" at a different level - professionals, managers and executives (PMEs). These become the PRs, the immigrants who it is hoped will become citizens one day.

Can the population of "core Singaporeans" and PRs raise the Sarahs and Jennys of tomorrow?

I wonder.

One of the changes that have come about is depletion of the very roots that gave Singapore its youthful vitality 30 years back, when I first came here.

It was still a country without formal distinction between "core" and "periphery". Over the years the core became entrenched, with exclusive privileges. But it cannot sustain the vitality, not only because it produces fewer children, but also because it is not raising the equivalent of Kaliappan's sons.

My Singapore was rooted in the equatorial rain forest and the flow of immigrants from diverse sources.

Over the years, it seems, there has been too much "development" and over-engineering in all spheres. A mass of concrete separates the ground in which "hibiscus grow as they are told" and Mother Earth. So too is the case of people. When too much is sanitised and made easy, something, it seems, is irretrievably lost. Meanwhile, denizens of a more prosperous present start to turn their back on their immigrant roots.

Can the vitality that comes from diversity and struggle ever be regained? As a friend of Singapore, I hope so.

The writer is a 63-year-old Indian national who lived and worked in Singapore in the IT industry for 17 years from 1980 to 1997. He is back in Singapore for a prolonged period of medical treatment.


Lessons from an unpleasant cab ride


ALL sides in the Great Population Debate are resting their hopes
ultimately on the Singaporean core, an elusive community that will
preserve the national character amid immigration.

At its most restrictive, the core is visualised as consisting
exclusively of the native-born and native-bred. At its most capacious,
it includes new citizens drawn from the ranks of foreigners working
here.

But how can erstwhile foreigners enter the national core?

It is through integration, as I have learnt.

I came from India on an employment pass in 1984. I was a mercenary - I
wanted to make some money and leave
- but I suffered no pangs of
regret.

Time-servers were no worse than natives in an economy in search of a
country, as Singapore seemed to me. I was a mercenary but not a
parasite. I worked hard, I paid my taxes, and I hoped that this market
paradise would last at least as long as I inhabited it.


Then, about a year after my arrival, I took a taxi driven by a
cantankerous old man. As it reached its destination, he blew his
trumpet. The ghastly smell filled the captive air. The fare flew out of
my hands as I fled from the taxi faster than it had travelled.

Yes, it sounds funny now, but it was not then.

Scandalised by the driver's insolence, which I believed had occurred
on purpose, I took down the taxi's licence number. I would complain to
the authorities.

But when I mentioned the incident to a Singaporean colleague the following day, he advised me against vengeance.

"Asad, you have been here for a year. How much do you get out of this
system? At least enough to take a taxi, right?" he remonstrated with
me. "That old man has been here forever, and he drives a taxi for a
living. How much do you think he gets out of the system? Do you want to
take even that away? Don't complain."


There was no complaint.

That day, I learnt to see Singaporeans as fallible humans - like me -
and not as the dutiful angels of a perfect and immortal city.

The more I saw my wayward thoughts reflected in them, the easier it
was to ignore their little transgressions. I began to move from the
periphery of arrival to the core of belonging, a journey that took me
through permanent residence and brought me to citizenship in 1999.

To belong is to be implicated in the functioning of the whole.

I was not personally responsible for the chain of events which had obliged the man to be a dyspeptic taxi driver in his dotage.

He might well have gambled away his savings, lost a well-paying job because of alcoholism, or even gone to jail for theft.

However, I was responsible for my power to ignore his annoying act,
which must have originated somewhere in the tangled web of his
circumstances - or perhaps it was just his health.

I derived this power from my privileged place compared to his in the
Singapore system. It thus fell upon me to share some of the burden of
his improvident life because I was complicit in the workings of a whole
system that had made him what he was,
and me what I was.

Extrapolating from my admittedly extreme experience to today's public
debate on immigration, I would say that, to be a part of the national
core is to invest one's abilities and imagination in the civic
recognition of one another as equal fellow citizens of this Republic.

Recognition - whether for the Singapore-born or the Singapore-arrived
- means acknowledging that we are the same as citizens no matter how
different we are in every other way: in origin, gender, race, religion,
wealth or talent. Given differences of individual talent, our life
outcomes cannot be the same, but given our sameness, our opportunities
must be equal.

Not just that.

Even with unequal outcomes, the challenge lies, not in rationalising
inequality away by arguing that it is inherent in human nature, but in
ameliorating the effects of that inequality to the extent possible
through social action. What is important is what can be done, and not
what cannot be done, about society.

The national core is the arena in which the contestation over the
ends and means of society is the most intense. It is a messy and dirty -
and smelly! - place, full of discordant voices arguing over a hundred
incompatible ways to a single future.

The foreigner who gives it a wide berth will have a quieter and
easier time in Singapore, but only as a stranger passing through. The
foreigner who walks into that cacophonous agora would have taken his
first step towards belonging.

Citizenship is not an invitation to a garden party. It is a voyage
marked by the beautiful risk of ideological belief and daring. It is
about daring to care.

Occasionally, it means surviving a taxi ride.

The writer, a former Straits Times journalist, is an associate fellow at the Institute of Southeast Asian Studies.

Take the pain out of the death penalty

Mar 28, 2013
By Andy Ho Senior Writer

AS LONG as there is going to be capital punishment in Singapore, make it more humane, a retired doctor friend said to me recently, advocating death by lethal injection as used in the United States instead of hanging, which is used here.

The US Supreme Court in Furman v Georgia (1971) found death by hanging, gas chamber, electric chair, firing squad or decapitation to be "cruel and unusual" punishment.

By contrast, lethal injection would be more humane as it causes less pain and suffering. In the US, all 35 states with the death penalty use lethal injection as their primary mode of execution.

First practised in Texas in 1982, according to Jean Kellaway in The History Of Torture And Execution (2003), it is usually a cocktail of three different drugs delivered sequentially through two separate intravenous lines.

The first drug to be injected is sodium thiopental, a barbiturate that acts as an anaesthetic to eliminate all pain. The second is pancuronium bromide, an agent that paralyses all skeletal muscles, so the person stops breathing. The final agent to be injected is potassium chloride, a drug to stop cardiac function by disrupting electrical activity in the heart.

The first injection will knock out the prisoner for enough time to complete the execution. Once he is unconscious, he will not suffer the terror of suffocation, which the second drug causes, or the chest pain the third drug leads to.

Two different veins have to be used because the first drug will cause a precipitation reaction with the second drug if they were mixed together in a single syringe, or even if delivered one after another through the same intravenous line.

It is true that there is a risk of extreme suffering and excruciating pain if the anaesthetic has not taken effect before the second and third drugs are administered. But properly administered and monitored by appropriately trained physicians, the process would be efficient and virtually painless.

Sadly, the US experience has been tainted by the fact that doctors and nurses are not usually involved in executions by lethal injection.

The Code of Ethics of the American Medical Association (AMA), of which only 20 per cent of US physicians are members, does not permit physicians to administer lethal injections.

It is common to say that the AMA "prohibits" physicians from participating in lethal injections. But the US Department of Justice has declared that "the pronouncements of the AMA and other associations do not themselves bind physicians".

In the US, physicians are licensed by the medical boards of each state, not the AMA, which thus has no legal authority to enforce its guidelines. It can urge physicians not to participate but the decision is the individual physician's to make.

A 2008 study published in the Journal of American Association of Nurse Anesthetists recounts botched executions because of the use of non-medical personnel called "lethal-injection technicians" who may struggle to set up intravenous lines.

For this reason, some executions have gone on for 90 minutes. In cases where the condemned was a former drug addict who had used most of his veins to inject heroin - so that most of his visible veins had hardened - establishing the necessary intravenous lines became a very difficult task, even if skilled doctors and nurses had tried.

A physician's participation would prevent such farces. But some contend that the physician must only heal, not harm. They say that the ancient Hippocratic Oath requires the physician "not to give a lethal drug to anyone if... asked, nor... advise such a plan", but few physicians the world over take this archaic oath. Thus, the Singapore Medical Council (SMC) Physician's Pledge omits this clause.

In the context of administering the lethal injection to a legally condemned prisoner, the physician's role is neither one of healing nor harming.

The person has been legally sentenced to death by properly constituted courts, so he will die with or without the involvement of a physician, who can't legally preserve his life anyway.

So in this context, the physician has only one role - to alleviate the condemned person's suffering.

The SMC Ethical Code and Guidelines require the physician to "use (his) medical knowledge in accordance with the laws of humanity" and ensure his patients are "treated with courtesy, consideration, compassion and respect".

All this is quite consistent with a physician being involved to alleviate the condemned person's suffering and minimise his physical pain during the execution.

In this setting, the physician is not a tool of the state but is there simply to make sure the condemned person is treated as humanely as possible up to and at the very last moment of life.

Some physicians might indeed be quite willing to give such succour.

.

Tuesday, March 26, 2013

Tackling food, water and energy crunch

Mar 25, 2013
Govts face difficult task of balancing competing needs

By Grace Chua


THE world's scarce resources are going to get even more scarce - and pricier. Earlier this month, Environment and Water Resources Minister

Vivian Balakrishnan said in Parliament: "The era of cheap energy, cheap resources, cheap food is going to come to an end."

Why? Global demand for food, water and energy will only rise in the years ahead, driven by a growing, urbanising population. Issues surrounding food, water and energy are closely linked, and so are their solutions.

Indeed, overcoming one resource's scarcity can cause shortages in other areas. Farming can cause water pollution, food and biofuel crops can compete for the same scarce land, and turning seawater into clean, potable water takes energy. By United Nations estimates, the world will need a third more water, 45 per cent more energy, and 50 per cent more food by 2030.

Singapore, too, will need more resources. Its water demand is expected to double in the next 50 years, up from 380 million gallons a day, enough to fill 692 swimming pools. And as its economy grows, so will its energy use and carbon dioxide emissions. These are projected to be 77.2 million tonnes in 2020 if Singapore does nothing to mitigate them, up from 43.4 million tonnes in 2010.

Singapore wants to provide all of its own water by the time its second water agreement with Malaysia runs out in 2061.

Yet the technologies it must use to treat, reclaim and desalinate water all require energy - from fossil fuels it must import from elsewhere. In turn, extracting fossil fuels and cooling refineries use water, while power generation companies need water to produce the steam that turns turbines to generate electricity.

Nuclear power generation can help reduce carbon dioxide emissions. But it can take a toll on water resources, as water is used for cooling, for uranium mining and for storing fuel rods.

Both water and energy are also needed for food production. At the same time, unsustainable agricultural methods drain resources or pollute the very sources of water they rely on. For instance, Central Asia's Aral Sea, once so large you could fit a hundred Singapores into it, has shrunk to 10 per cent of its original size as it has been tapped for irrigation in the last few decades. Closer to home, thousands of dead pigs have been fished out of the Huangpu River near Shanghai, casualties of a mystery porcine epidemic.

The onus is on the world's governments to achieve the goal of food, water and energy security - that is, maintaining people's access to these during major shocks to the system, such as droughts, heatwaves and so on.

Technologies that point to future solutions treat food, water and energy as linked components of a system. They aim to cut consumption or wastage of these resources, reducing dependence on them by adapting their processes and incorporating advancements.

Gulf nation Qatar relies on desalination for most of its water. But its huge natural gas and chemicals industry requires water for cooling and steam. So plants like Shell's gas-to-liquids plant, which converts natural gas into synthetic fuels and lubricants, recycle almost all of their water so that they don't further strain the nation's resources.

Shell does this at its other water-scarce sites, too. At its fuel refinery in Geelung, Australia, it has a plant on-site to treat and recycle water from both the refinery and the local community.

To counter the strain on resources in the production of food and water, by-products of some parts of the process are being harnessed too.

Sustainable Energy Association of Singapore chairman Edwin Khew pointed out that there are new ways to tap waste. "We can produce energy and compost from the waste generated by the processes that produce water, waste water and food," he said.

Another way countries can ensure water and food security is through international trade.

Water-scarce Singapore and Malaysia import grains and meats that take a lot of water to produce, while at the same time exporting non-agricultural manufactured goods, wrote water policy expert Jenny Kehl in a Yale Global commentary last month.

Even so, producing its own food is one prong of Singapore's food security strategy. It wants to grow 10 per cent of the leafy vegetables it consumes, up from about 7 per cent now. One of the most efficient ways of delivering food and water, and meeting other human needs is well-planned urban development, said Dr Balakrishnan.

Ms Ruth Cairnie, Royal Dutch Shell's executive vice-president of strategy and planning, highlighted Singapore's compact design and focus on resource efficiency as an example of good planning when she spoke at Singapore International Energy Week last year.

With three-quarters of the world's population set to live in cities by 2050, that could take some stress off food, water and energy supplies for Singapore and for the world's growing billions.

Shift all gears, not just some

Shift all gears, not just some

TODAYonline

26 Mar 2013

Hitherto, the pronouncements by the Government on its economic plans, and what it will take to realise those goals, have been addressed to private sector firms and to private sector labour.

They are being encouraged to become more productive, more skilled and move into more valued-added activities.

Deputy Prime Minister Tharman Shanmugaratnam has spoken in terms of the need to “shift gears”. I make the case that such a shifting has to occur in both private and public sectors.

As argued in my first article yesterday, we should shift from an intense emphasis on value-added gains to an emphasis on value creation. Value creation is about human capital, since ideas come from people not machines. In a scarce labour environment, we need to allocate our limited human capital effectively to avoid a crowding-out effect or other distortions.

PRODUCTIVITY IN GOVERNMENT

The public sector is the largest employer of total labour in Singapore and of resident labour by far.

According to the Manpower Ministry, in 2011, the total size of the labour force was 3.327 million, while the size of the resident labour force was 2.08 million. The public service sector formed approximately 3.95 per cent of the total labour force but 6.3 per cent of the resident labour force. This is before including those serving in the military.

This figure is low compared to many other advanced countries which typically have public sectors exceeding 10 per cent (sometimes much more) of total employment.

However, we should not excuse ourselves from the need to urge more productivity in and of government just because of this favourable comparison.

The exceptionalism of our circumstances means that we have to squeeze our productivity gains at the system level of the economy.

To date, the Government has 16 ministries and more than 50 statutory boards. This is in addition to the uniformed services and organs of the State. In a scarce labour environment, it should be asked how we can make government more productive in line with its expectations of the private sector.

Even while some segments of the public sector need to grow to meet demands from driving forces such as ageing and healthcare, surely trade-offs can be made, and have been made, by re-prioritising other public policies.

It would be absurd if all public policies and programmes, historical, current and future, enjoyed similar labour prioritisation in a contemporary world where the Government acknowledges that the principal factor input limitation is labour.

A PROBLEMATIC DICHOTOMY

There is a stark dichotomy in the Singapore labour market.

First, the concentration of resident labour in the public sector could add to the challenge of hiring in the private sector market, where hiring supplementary foreign labour is indexed, through the Dependency Ratio model, to hiring of a base of residents.

Second, whereas the private labour market is risk-loaded for employees, given that it is exposed to the travails of competition, the public labour market is relatively risk-free for staff. This could create a wall of disgruntlement.

Third, even where it is judged absolutely necessary to add employment to the public sector, we should not fall into the trap of assuming the Government creates jobs in the same way the private sector does.

Government employment should be about meeting the needs of the citizen; more such employment reflects an expansion of needs. Private sector jobs are about fulfilling economic functions; more such employment reflects an expansion of growth.

Growth is the means to financing expansion in the public sector, and not the other way around.

RIGHT-SIZED AND SMARTER

A right-sized and smarter public sector footprint would be helpful in several ways.

First, it is important for the Government to set an example for what it expects of the private sector. It must also make trade-offs, find efficiencies, create more flexibility in its labour pool so that it can cross-flow from lower- to higher-priority functions over time, and even inflate and deflate as circumstances require.

This would help build a sense of labour solidarity between private and public sector employees that they are facing similar risks. It would also ensure that policymakers are not making labour and economic policy divorced from a visceral appreciation of the policy conditions.

Second, it would avoid crowding out the private sector in the competition for scarce labour. More particularly, we must avoid a situation where talented and highly educated young Singaporeans, uncomfortable with the vicariousness of the competitive private sector, seek shelter in the public sector where jobs are secure and wages (particularly in the starting grades) competitive.

If too much talent flows into the Government, it can stall value creation simply because there is no impetus.

Third, we have to restrain the sense that just because we have the fiscal means or that there are strong drivers of demand, we should expand the public sector. This can happen in specific pockets but, at the system level, we should keep an eye on total growth of the Public Service.

RETHINK SECTOR CHAMPIONS

The Government has a history of establishing sector champions to drive advancement of specific economic sectors which it deemed desirable for the larger economic success of Singapore.

However, it may be time to revisit the premise for some of these sector champions, in the light of the restructuring that needs to occur.

An example would be tourism. In the 1970s and 1980s, tourism was judged an important sector because it brought in hard currency, marketed us to the wider world and created employment. It also generated investment to build hotels and impetus for public investment in tourist features such as the zoo and bird park, which had spin-off benefits for Singaporeans. The Singapore Tourism Board was established to champion the sector and it has done, and continues to do, an excellent job.

However, we are now in an environment where tourism jobs are largely low- or semi-skilled, and the sector as a whole is low value-add compared with knowledge-based sectors such as finance and information technology.

In 2010, the Ministry of Trade and Industry released a paper which claimed that tourism generated over S$8 billion in nominal value added in 2010. It also noted that “tourism is an important component of Singapore’s economy, contributing towards both gross domestic product and job creation ... Beyond (value-added) and job creation, tourism also brings about intangible benefits.

“Specifically, by raising Singapore’s visibility and profile through iconic events and tourism infrastructure, Singapore could become a stronger magnet for global talent. With more global talent relocating to Singapore, our economy would become even more dynamic and be able to continue its move up the value chain.”

This could all be true. However, tourism also comes with a large land footprint for hotels and facilities. It also adds to loads on our infrastructure. And employment in the tourism industry, as should be clearly visible to anyone visiting hotels for weddings or to patronise the amenities, is mostly made up of foreign labour.

CHANGE IS HARD

Singapore is no longer a stranger to the wider world, and we have a surfeit of hard currency flows given our strong position as a financial centre. Such “intangible benefits” that may arise from any particular sector must be netted in a trade-off calculus at the economy level.

In short, to win at the total economy level, we need not win in every sector. We have to prioritise and that involves ensuring that bureaucratic and policy inertia is held in check.

We need to recalibrate our emphasis on boosting specific sectors with a wider and longer view at the economy level. This may mean performing the novel action of cutting back on niche success in order to succeed at the system level.

Given the non-trivial presence of the public sector as both an economic actor through its policy action and as an employer, shifting gears at the economy level requires the Government to play its part alongside the private economy, not just through the private economy.

As acknowledged in Budget 2013, change is hard. Harder still, is when it has to start from within.

ABOUT THE AUTHOR:

Devadas Krishnadas, a social and political commentator, is the director of a foresight consultancy. This is the second of a three-part series.

Tomorrow: The growth of a quality society

The Singapore romancing of quality growth

The Singapore romancing of quality growth

TODAYonline

In recent years the buzz word from the Government has been “inclusive growth”. In Budget 2013 this has been substituted with “quality growth”.

25 Mar 2013

In recent years the buzz word from the Government has been “inclusive growth”. In Budget 2013 this has been substituted with “quality growth”.

Deputy Prime Minister Tharman Shanmugaratnam has clarified that quality growth means growth that benefits workers through better jobs and higher wages. He also spoke of an inclusive society which would be, in part, achieved through redistribution.

We can impute that quality growth is also growth with a social purpose. In this sense, ‘’inclusive growth’’ can be treated as synonymous with quality growth.

Given that Budget 2013 envisages a multi-year commitment to wooing quality growth, it is useful to explore the concept more thoroughly. This is the object of a three-part series of articles.

Innovations in Budget, such as a three-year transition programme and the Wage Credit Scheme for the economy, are being introduced as affirmation of the Government’s commitment to boosting productivity and to securing higher wages for Singaporean workers.

These come on top of earlier largesse such as Productivity and Innovation Credit, the National Productivity Fund and the enhanced Workfare policy. This link between productivity improvements and rising wages is the central thesis of the economic thinking in recent Budgets — and as it is justification for the public expenditure of many billions in incentives from the public purse, it is important to review how we got to this point.

GROWTH 2000-2009: HEEDLESS, HEADLESS AND TAILLESS

The Singapore economy suffered a series of economic shocks in the first half of the last decade. We began the new century struggling to get over the Asian Dollar Crisis when in 2001, we were buffeted by the ripple effects of the Dot Com bust and then the impact of SARS in 2003.

By 2005, as the term of government neared its conclusion, it was clear that the preceding five years were effectively wasted years in terms of economic and wage performance.

At the time, global macroeconomic indicators began to show a positive turn suggestive of growth possibilities for us. We embarked on aggressive labour force augmentation to feed those possibilities.

However, undetected by most, including the policy makers, the supply-side tactic to take advantage of demand-side growth opportunities quickly turned into the demand side-strategy generating supply-side growth, as labour force addition — rather than productivity — began to be the primary driver of Gross Domestic Product (GDP) performance.

This supply-side growth created overheating effects in housing and transport and removed the impetus for capital investments in productivity, in favour of cheap labour injections.

It is arguable that the wage stagnation at the lower end and marginal improvements in the middle of the income ladder were a by-product of this. Most Singaporean workers therefore did not benefit much from the growth.

[I have to re-read the last three paragraphs several times. I think I understand what he means. It sounds like it should be right. But I'm still struggling. What I think he means is, that we tried to ride the Tiger, but the Tiger ended up taking us for a ride.]

The data shown in the table shows that almost all the GDP growth over 2005 to 2009 — the period prior to the Government committing to moderation in foreign labour intake — was a function of labour force change. Of this, the greater proportion, indeed almost all, came from foreign supply.

The data is admittedly cloudy because the Government was pursuing an aggressive programme to absorb new citizens. Citizens and permanent residents (PRs) together form the “residents” of the labour force. Hence, if it were possible to strip out the additions to the PR pool and allocate them as foreign labour — which they functionally were, being foreign-supplied injects into the labour force — we should logically expect to see that the foreign labour force change was even higher.

On reflection it is not hard to argue that this growth model came at longer term costs and negative externalities which outweigh the short term economic benefits. This is a reflection of search for growth which, however well-intentioned, did not think ahead to side effects nor consider the citizenry’s sentiments.

It was therefore heedless but also headless, because it was not calibrated well as the Government itself acknowledged; and tailless, because the benefits did not fully trickle down to most Singaporean workers.

SIGNIFICANT TRANSFERS TO BUSINESSES

Businesses have historically received favourable attention from the “pro-business” stance of the Government. Since the global financial crisis, this has been taken to a whole new level.

The Government has tried to wean businesses of an overreliance on labour by enhancing levies and changing the employment policies on foreign workers. It is doing so with the goal of getting the economy to be more productive. While using the price signal has imposed a cost burden on businesses, the Government has been generous with “flow-back” to encourage productivity improvements

In the 2009 Budget, businesses have benefited from the Jobs Credit Scheme, the Skills Programme for Upgrading and Resilience (SPUR) (together estimated at S$4.9 billion), cash-flow assistance (mostly tax concessions, S$2.6 billion), the Productivity and Innovation Credit, National Productivity Fund (S$2 billion) and a myriad targeted grants and schemes from SPRING Singapore.

All of these are essentially special transfers from the public account to firms in the form of cash. This reduces their costs and facilitates their “restructuring” and “productivity” and boosts their innovation efforts.

Yet, as we have heard in the Budget 2013 speech, productivity performance has been negligible in the years since 2009, save for 2010 which was due to the GDP bounce off a low base in combination with labour force reductions in 2009.

LET WEAK BE WEEDED OUT

The economic plan as conceived by the 2013 Budget is good, but it can be made even better.

As with the Jobs Credit Scheme, the new Wage Credit Scheme has good intentions but comes at the cost of dead weight and the risk of pushing on a string. This risk can be mitigated only if the Government makes clear that there will be no extensions and further transition assistance beyond the three-year plan — and sticks to this condition.

The costs are unavoidable and thus, we have to focus on justifying it on the basis on results.

The declared object of the three- year transition plan is to buy time while entrenching a deadline for firms to become productive. But in aggregate terms it is, correctly, designed to force a circumstance where scarce resources of land, capital and, most emphatically, labour are shifted to productive and higher value-added activities. This higher goal makes sense, but we should push our policy thinking even further.

The Government continues, year after year, to provide financial and non-financial assistance to small and medium enterprises (SMEs). We must be mindful that micro-economic level intervention does not inadvertently impede the macro-economic level goal of restructuring.

We should permit consolidation to occur in the SME sector as part and parcel of achieving the necessary economy of scale efficiencies and leaning-out of processes, thereby leading to productivity gains at the firm and sector levels. The Government should be mindful not to permit well-intentioned intervention by sector champions within its agencies to inadvertently impede competition from weeding out weak-performing SMEs. We should permit the market to find its way.

VALUE ADDED VS VALUE CREATING

At the economy level, we should ask fundamental questions about the relative importance of value-added versus value-creating. Both are needed but while the former can help us keep and improve existing jobs, the latter helps create whole new ones.

Value-added provides the difference in input and output that creates surplus value in the form of profits and wages. Value-added is about firm level activities in the form of more efficient processes and productive use factor inputs.

Value creation is about ideas and knowledge. It is about the invention of new ways of doing things or new products. Value creation is the best route to GDP growth with momentum despite the limits of factor input. Value creation uses the vehicles of innovation and entrepreneurship.

To underpin this, we should make a policy shift from supporting SMEs to nourishing ISEs — Ideas, Start-Ups and Entrepreneurs.

Ideas are the fuel, start-ups are the vehicles and entrepreneurs the pilots of value-creation. To give the emerging generations of highly educated and aspirational Singaporean workers jobs which give them both fulfilment and income, we need to create the underlying ideas and vehicles.

We should think of ways to create a strong presence of venture capitalists, to encourage risk-taking through entrepreneurship and to encourage crowding in of the innovation and entrepreneurship space.

The recent measures announced by the Ministry of Trade and Industry (MTI) are good steps in this direction. But the process of creating ISEs requires more than simple injections of capital.

GROWTH 2010-2020: HEEDFUL, HEAD-LED AND TAIL HEAVY?

If we can re-base the economy on value-added and value-creating activities, we can be certain that the goal of good jobs and higher wages will be secured. Our economic planning — head-led — will thus be serving a clear purpose — heedful.

But we also need to ensure that the benefits from this restructuring are shared with greater equity between firms and labour.

The MTI has asserted that wage share of GDP has gone up from an average of 41.8 per cent in the 1980s to an average of 42.5 per cent in 2000-2009. This is no cause for celebration. In most advanced economies, the wage share of GDP is greater than the share attributed to firms — often significantly so.

For “quality” growth to also be “inclusive”, more steps will be required to ensure that the “tail” of growth is heavy, with an equitable share of GDP flowing to Singaporean workers in terms of higher wages.

When we have achieved this, the economic romancing of quality growth will not only be completed but be requited with renewed political faith by Singaporean workers in the Government.

ABOUT THE AUTHOR:

Devadas Krishnadas, a social and political commentator, is the director of a foresight consultancy. This is the first of a three-part series of commentaries on quality growth.

Next: Shift all gears, not just some

Monday, March 25, 2013

Letting the terminally ill die with dignity

Mar 25, 2013
By Andy Ho Senior Writer

FOR many a terminally ill patient, the prospect of severe and unrelenting pain at the end of life may make him or her wish for a quick death as release.

The issue of euthanasia, or physician-assisted suicide (PAS), is never easy. It came up in Singapore recently, when Chief Justice Sundaresh Menon raised it in a lecture. His main point was that Parliament, not the courts, should be the one to decide on whether it should be permitted, and he urged public discussion of the matter.

He also noted that in Singapore, the Advance Medical Directive (AMD) Act allows people to state in advance that they do not want extraordinary life-sustaining measures when terminally ill. The AMD Act does not condone, authorise or approve euthanasia, mercy killing or assisted suicide, he noted. But he added that assisted dying should be a matter of "public debate, private conversations... and personal reflection". He also suggested that the experience in other countries might well be a guide to discussion here.

Experience elsewhere

CURRENTLY, PAS is legal in Switzerland, Belgium, the Netherlands, Luxembourg, Mexico and three US states. In Singapore, however, anyone who assists the suicide of an adult can be jailed up to 10 years and fined. It is time to consider repealing this law for an ageing population that will have more terminally ill patients.

Singapore began that conversation on dying with the AMD Act enforced from 1997, which allows a person aged 21 or over who is of sound mind to make an AMD instructing doctors not to use extraordinary life-sustaining treatment if he is terminally ill and no longer competent to say so.

But the scope of the AMD is limited and confined to pre-deciding to decline extraordinary life-sustaining treatment when one is no longer competent.

In contrast, PAS allows mentally competent adults with a terminal condition and under six months of life, say, to have a physician give them lethal drugs.

The physician usually prescribes secobarbital or pentobarbital, which are barbiturates that put you to sleep at normal doses, but depress the brain and respiration at large doses. The terminally ill person himself takes the pills at high dosages to end his own life.

This is distinct from active euthanasia, where the physician himself administers some lethal medication to the patient with his informed consent.

In active euthanasia, doctors intentionally and directly end another's life. Normally, only the state has legitimate power to take any human life. By contrast, PAS gives back that power to the patient who must take the final step himself in physically swallowing the lethal medication on his own.

But Singapore law criminalises anyone who might help others, doctors or not, commit suicide. It also criminalises suicide: If you don't die trying, you may be fined and/or jailed for up to one year.

This is because, in general, the state seeks to preserve life.

But it is arguable what the state's interest might be when it comes to a patient choosing treatment. Many countries recognise that patients must give consent to treatment, and have the right to refuse treatment. If so, the competent dying patient has the right to ask for medication to be halted, a feeding tube removed or respirator turned off, even if death is thereby hastened.

This, in fact, is the essence of the AMD, where a person who is still competent spells out these end-of-life care preferences when he is no longer competent.

The natural extension of this right to refuse treatment is that the competent patient should also be able to ask for treatment that hastens his death. And if the state recognises it has no business overturning a dying patient's decision to decline treatment that would save him, it should also have no reason to intrude if a person wants to choose death and to determine its timing and manner.

This should be considered part of the sphere of one's privacy, self-determination and personal autonomy, into which the state should not intrude.

While refusing further life-sustaining treatment in this manner may look distinct from swallowing barbiturates to take one's own life, the distinction is one with just one difference. Whereas the goal and end result are the same in either case, PAS leads to a more peaceful, serene and dignified death whereas dehydrating and starving to death entail weeks of severe and needless suffering.

One may argue that access to PAS gives the terminally ill control and comfort, thus preserving human dignity, contrary to claims that PAS violates human dignity.

Doctors who kill?

ANOTHER common objection to PAS is that it makes killers of doctors, violating the Hippocratic Oath, by which the physician had vowed "not to give a lethal drug to anyone if... asked, nor will (he) advise such a plan". But most physicians the world over do not take this outdated oath. This is also omitted from the Singapore Medical Council Physician's Pledge.

[I did not know that!]

Whether a doctor should be involved in PAS depends on his own convictions. The essence of medical practice is "to heal sometimes, to remedy often, to comfort always", so the doctor must decide whether to do so when only ending life affords that comfort.

But he must never drive that decision, which must always be the patient's to make, on his own free will and at his own initiative. The doctor is to be just witness, counsellor and prescription writer.

Yet others argue that legalising PAS may lead society down the slippery slope towards the active euthanasia of the elderly, disabled or poor, who may be coerced or influenced to request PAS.

But this effete argument only denies a right just in case some may abuse it. The answer to that is to regulate PAS to prevent abuse, as American states like Oregon do.

What about the notion that no one but the Almighty may take life? In fact, the state already does take life, wherever there is capital punishment. In any case, this is a religious argument to which the secular state may not give force of law. If access to PAS is legalised, the religious may give it a miss but may not deny others of it.

Without PAS, the terminally ill desperate to die may resort to anything from antifreeze to heroin. He may see multiple doctors to acquire multiple prescriptions of sleeping pills to try to overdose himself. Family and friends sympathetic to his plight may contribute their own stash of drugs.

Without PAS, some sympathetic doctors may covertly prescribe enough medication to hasten death to shorten suffering when medical futility sets in. Rather than such a clandestine system that only some may access, better to legalise PAS so physicians can help the terminally ill die with dignity, yet not be criminalised for doing so. Not doing so in effect means we are saying that people should suffer severe pain before dying if their disease leads to this.

While dying has become highly medicalised, PAS can change that for some, so they can say their last farewells at home, surrounded by close family as it used to and should always be.


US Senate approves first Budget since 2009

Mar 24, 2013
But showdown looms as GOP-led House adopts its own fiscal plan

Washington - The US Senate reached a milestone early yesterday when it overcame partisan gridlock to approve its first Budget resolution in four years, setting up a political duel with the Republican-held House.

The sweeping plan for fiscal year 2014, the first fiscal blueprint passed by the Democrat-led Senate under President Barack Obama since 2009, squeaked through by the narrowest of margins, 50-49.

"Doing this has been a Herculean feat," said Democratic Majority Leader Harry Reid, noting the 100 amendments that were voted on in a marathon, 13- hour session.

The plan, shepherded by Senate Budget Committee chair Patty Murray, aims to reduce deficits by US$1.85 trillion (S$2.3 trillion) over 10 years mostly through the closure of tax loopholes that favour the rich and an equal amount in government spending reductions.

The House of Representatives last Thursday adopted the Republican plan from House Budget Committee chairman Paul Ryan, which seeks US$4.6 trillion in savings over the same period without raising new taxes. It aims to reach a small surplus by 2023 through deep cuts to health-care and social programmes.

Neither of the non-binding plans has a chance of passage in the opposing chamber, leaving Congress no closer to resolving deep differences over how to shrink deficits and grow the economy. But they give each party a platform from which to tout their own fiscal visions.

Passage of a stop-gap government funding measure last Thursday lowered the temperature in the Budget debate by eliminating the threat of a government shutdown this week.

The Senate had not passed a Budget resolution since 2009 because of fiscal policy disputes with House Republicans that forced Congress to turn to numerous stop-gap spending measures to avoid government shutdowns.

But this year, under last month's debt limit increase law, members of both the House and Senate faced pay suspensions if their chamber failed to pass a budget by April 15.

Mrs Murray said after the vote that she would try to work with Mr Ryan on a path towards compromise but observers say there is little chance the two sides can work out differences between the two budgets.

"You would expect that if there were a chance of success, they wouldn't have planted flags on completely different planets," said Mr Sean West, US policy director at Eurasia Group, a political risk consultancy.

Ultimately, it may take another 11th-hour deal between Mr Obama and congressional Republicans to set a fiscal path forward as part of a deal to raise the debt ceiling, he said.

The US Treasury is expected to exhaust its borrowing capacity around late July or early August.

Reuters, AFP

[This report does not mean what you think it means.

No. The US still does not have a budget. The US Congress has not signed a budget into law since 1997.

This report is just telling us that the US Senate (upper house) has pass a non-binding budget resolution by simple majority. But it is only binding if the House concurs (with a similar resolution, or if the Senate passes a second resolution. So they are still in gridlock.]

Saturday, March 23, 2013

Treading between the painful and the popular

Treading between the painful and the popular

TODAYonline
22 March

When they turn on the tap, Singaporeans know there will be water. They know it will be clean and safe to drink. The tap symbolises Singapore’s progress from water rationing to water security over the past 50 years.

But Singapore faces risks in continuing its remarkable success story in handling water and flood issues, as more Singaporeans seek a say in national decisions.

S'pore's next challenge: 'Treating more seawater with less energy'

Mar 23, 2013
By David Ee

EVEN if Singapore realises its quest to supply all of its own water, it faces another challenge: acquiring the energy it takes to produce the water.

That was the point raised by Minister for the Environment and Water Resources Vivian Balakrishnan at yesterday's book launch of The Singapore Water Story, which chronicles the country's rise to becoming a world leader in water management.

"Singapore has to realise that, in fact, we have translated a dependence on water to a dependence on energy...as long as you've got energy, you've got water," said the minister at the National University of Singapore's Bukit Timah campus.

The technologies employed in water treatment here today, for example, reverse osmosis, require substantial amounts of energy.

The Minister explained that as the country becomes more water self-sufficient, this "simply substitutes one strategic vulnerability for another".

To meet its energy challenge, Singapore will have rely on the same things that worked in its water story - political resolve, a clear vision, the right pricing, and a commitment to technology.

Today, Singapore produces at least 40 per cent of its own water needs - with three quarters coming from reclaimed Newater, and the rest from treated seawater.

National water agency PUB wants this to double to 80 per cent by 2060.

Reverse osmosis, the most common method to treat seawater here, typically uses up to 4.5 kilowatt hours to produce 1,000 litres of desalinated water.

That is enough energy to power an HDB flat for several hours.

But PUB is seeking to reduce these levels with new technologies. For example, it is working with Keppel Seghers to develop Memstill technology, which uses waste heat to treat seawater. The process can reduce energy use by up to two-thirds.

It is also exploring longer term solutions such as bio-mimicry, which copies the way some plants and animals treat seawater for their survival, using negligible amounts of energy.

By 2060, Singapore's water usage could double to almost 800 million gallons a day, enough to fill more than 1,200 Olympic-size swimming pools each day.

[Singapore is so humid, we should try to see how we can use Hyflux's "Dragonfly" water extractor to extract water from the air, and run that partially on solar-power. Maybe have solar panels on HDB roofs to run the dragonfly units, that would channel the extracted water to the water tanks.]

Signs of turnaround in birth rates

Mar 23, 2013
New forecast shows rising trend in some developed nations like Britain and the US

By Cheong Poh Kwan

FALLING birth rates may go hand in hand with developed economies but there are signs of a turnaround in some of the world's largest economies in the English-speaking world, according to projections by Germany's Max Planck Institute for Demographic Research.

The study found that birth rates are rising in Australia, Britain, Canada, Ireland, New Zealand and the United States. But no such trend is apparent in developed East Asia, although Japan - "historically a demographic trend- setter for the region" - has seen a slight increase.

Birth rates are expected to decline, albeit at a slower rate, in places like Singapore, South Korea and Taiwan, where governments have voiced concerns over their ageing and shrinking workforce.

The observation was recorded using a new forecasting method of measuring fertility developed by demographers Mikko Myrskyla, Joshua Goldstein and Alice Cheng.

Their study, recently published in the Population and Development Review, examined fertility rates in 37 developed countries with a prolonged history of fertility below the replacement level of 2.1 children per woman.

The team drew the projection by looking at a specific cohort of women - those born from 1962 to 1979, instead of the women population as a whole.

The measure of "cohort fertility rate" was hence used in place of the traditional "period fertility rate".

[a.k.a. "TFR"]

Cohort fertility rate measures the total number of children a woman from a specific birth year will have until the end of her childbearing years, generally assumed to be at the age of 50.

Period fertility rate, on the other hand, is a more general indicator. It gives the average number of children all women aged 15 to 49 will have in a specific calendar year and, according to the study, it "does not take into account the fact that each cohort has children slightly later than the last".

As a result, the reported period fertility rate tends to be lower than the cohort fertility rate, especially so in developed economies, where childbearing is likely delayed by higher education and careers for more women.

The study concludes that "much of the very low fertility is the result of later, not less, childbearing", and suggests that "long-term fertility decline in the developed world has come to an end or at least stalled".

This is certainly comforting news for the developed world, with the results "signalling a turning point which makes some of the current long-term fertility forecasts, such as 1.3 for Japan and 1.4 for Germany, seem considerably less likely", said Mr Goldstein.

But fertility trends will remain "notoriously hard to forecast", he added.

[May be good news. BUT it is still better for a woman to have children before 35, and if you have your first child at say 40, you are less likely to have more children than a woman who has her first child at say 26. So the "turnaround" is obtained by changing the metrics. Without the new CFR, the TFR would probably go up as child-bearing is delayed and all the older women "catch up".

So likely, we will see TFR in SG go up mainly due to the delayed childbearing effect, and the govt will think that it is their baby bonus effect, and pour more money into it. ]

Sugar, not fat, is the deadly villain in obesity epidemic, scientist says

Sugar, not fat, is the deadly villain in obesity epidemic, scientist says
TODAYonline
Daily Focus›Health

LONDON — Sugar — given to children by adults, lacing our breakfast cereals and a major part of our fizzy drinks — is the real villain in the obesity epidemic, and not fat as people used to think, according to a leading US doctor who is taking on governments and the food industry.

21 March

LONDON — Sugar — given to children by adults, lacing our breakfast cereals and a major part of our fizzy drinks — is the real villain in the obesity epidemic, and not fat as people used to think, according to a leading US doctor who is taking on governments and the food industry.

Dr Robert Lustig, who was this month in London and Oxford for a series of talks about his research, likens sugar to controlled drugs. Cocaine and heroin are deadly because they are addictive and toxic – and so is sugar, he says. “We need to wean ourselves off. We need to de-sweeten our lives. We need to make sugar a treat, not a diet staple,” he said.

“The food industry has made it into a diet staple because they know when they do you buy more. This is their hook. If some unscrupulous cereal manufacturer went out and laced your breakfast cereal with morphine to get you to buy more, what would you think of that? They do it with sugar instead.”

Lustig’s book, Fat Chance: The Bitter Truth About Sugar, has made waves in America and has now been published in the UK by 4th Estate. As a paediatrician who specialises in treating overweight children in San Francisco, he has spent 16 years studying the effects of sugar on the central nervous system, metabolism and disease.

His conclusion is that the rivers of Coca-Cola and Pepsi consumed by young people today have as much to do with obesity as the mountains of burgers.

Cheap sugar is endangering lives, he says It has been added to your diet, “kids have access” to it, and it is there in all sorts of foods that don’t need it, he says. When high-fat foods were blamed for making us overweight, manufacturers tumbled over each other to produce low-fat products. But to make them palatable, they added sugar, causing much greater problems.

Cutting calories is not the answer because “a calorie is not a calorie”. The effect of a calorie in sugar is different from the effect of a calorie in lean grass-fed beef. And added sugar is often disguised in food labelling under carbohydrates and myriad different names, from glucose to diastatic malt and dextrose. Fructose — contained in many different types of sugar — is the biggest problem, and high-fructose corn syrup, used extensively by food manufacturers in the US, is the main source of it.

In a recent study in the open journal Plos One, of which he was one of the authors, it found that in countries where people had greater access to sugar, there were higher levels of diabetes. Rates of diabetes went up by about 1.1 per cent for every 150 kcal of sugar available for each person each day – about the amount in a can of Coke. Critics argued sugar availability was not the same as sugar consumed, but Lustig and his colleagues say it is the closest approximation they could get.

The government is also to blame, he said. “Government has tied its wagon to the food industry because, at least in America, 6 per cent of our exports are food. That includes the legislative and executive branches. So the White House is in bed with the food industry and Congress apologises for the food industry.”

Michelle Obama appeared to be onside when she launched her Let’s Move initiative in February 2010 with a speech to the Grocery Manufacturers Association of America. “She took it straight to them and said, ‘You’re the problem. You’re the solution.’ She hasn’t said it since. Now it’s all about exercise.

“Far be it from me to bad-mouth somebody who wants to do the right thing. But I’m telling you right now she’s been muzzled. No question of it.” In his book he tells of a private conversation with the White House chef, who he claims told him the administration agreed with him but did not want a fight with the food industry.

Some areas of the food industry have appeared to be willing to change. PepsiCo’s chief executive officer, Indra Nooyi, who is from India which has a serious diabetes epidemic, has been trying to steer the company towards healthier products. But it has lost money and she is said to be having problems with the board. “So here’s a woman who is trying to do the right thing and can’t,” he says.

It is not a case of eradicating sugar from the diet, just getting it down to levels that are not toxic, he says. The American Heart Association in 2009 published a statement, of which Lustig was a co-author, saying Americans consumed 22 teaspoons of it a day. That needs to come down to six for women and nine for men.

“That’s a reduction by two thirds to three quarters. Is that zero? No. But that’s a big reduction. That gets us below our toxic threshold. Our livers have a capacity to metabolise some fructose, they just can’t metabolise the glut that we’ve been exposed to by the food industry. And so the goal is to get sugar out of foods that don’t need it, like salad dressing, like bread, like barbecue sauce.” There is a simple way to do it. “Eat real food.”

Does he keep off the sweet stuff himself? “As much as I can. I don’t go out of my way. It finds me but I don’t find it. Caffeine on the other hand...”

GUARDIAN


True price of free benefits

Mar 23, 2013
POLITICS 360

Next generation will have to pay bill for anything that's given away now

By Jeremy Au Yong Assistant Political Editor


THIS month, we were all given a live demonstration of the difference between free and merely cheap - with the whole thing played out over meatballs and McMuffins.

It started on March 7, when furniture retailer Ikea announced the return of its Swedish meatballs after the horse meat scare by selling them at a heavily discounted price of 10 cents each.

Then on Monday, McDonald's went one better and gave away free Egg McMuffins as part of what it called "National Breakfast Day".

Both promotions predictably drew large crowds and typical kiasu behaviour, but it was clear that the crowd hankering for free burgers were a more motivated bunch. Lines built up right from the start of the giveaway at 5am, with some reportedly pulling all-nighters to make sure they were up in time to snag a free burger. At least one person zipped from outlet to outlet to try to get as many free ones as he could.

The craze at Ikea was relatively - only relatively - more subdued. The lines did not build up until a far more reasonable time of 11am, 11/2 hours after Ikea opened.

The two promotions showed not just the tremendous appetite Singaporeans have for a good deal but also how powerful the lure of "free" can be.

It also served to reinforce the argument that underpins the Government's long-held reluctance to give things away for free - that free things encourage over-consumption.

The special effect of the price of "zero" is well known. In a much-referenced 2007 paper titled "Zero as a Special Price", academics from Massachusetts Institute of Technology, the University of Toronto and Duke University showed that zero pricing doesn't just lower costs, it actually leads the consumer to perceive the benefits as larger.

They conducted several experiments, one of them involving selling Lindt truffles and Hershey's Kisses for 27 cents and two cents respectively. They then discount both by one cent over two rounds until the prices are 25 cents and free. Demand did not change even when Hershey's were sold for one cent but it shot up dramatically when the Kisses became free.

The researchers argue that a price of zero produces an emotional reaction from people that affects the way they normally conduct cost-benefit analysis. The price difference between the two chocolates never changed, but the way people reacted to them did when one became free.

This might explain why so many were willing to lose sleep for a free burger that would usually cost $2, and why the Government will always be fearful about treading into the realm of "free".

Yet between the cheap meatballs and free burgers, the Government did seem to step away from its aversion to "free".

Pasir Ris-Punggol GRC MP Janil Puthucheary was at the forefront of the charge, making a speech during the Budget debate that urged the Government to consider using "free" as a policy tool. His suggestion was to set aside certain periods of time for free travel on public transport as a means of easing peak-hour congestion.

Transport Minister Lui Tuck Yew did not dismiss it out of hand but he did not embrace it either, saying his ministry would need to carefully consider the plan.

Later in the debate, "free" came up again, this time with Acting Minister for Culture, Community and Youth Lawrence Wong announcing that all Singaporeans and permanent residents would be given free entry to museums from May. He said the move was to make those institutions - currently not well patronised - more accessible to the masses.

And while the foray of "free" has been limited in scope thus far, it does raise the question of whether there is room for it to play a bigger role in Singapore policy.

The answer is likely to be a qualified "yes".

Qualified, because there needs to be a line drawn above the types of things the Government would not be prepared to give for free.

Dr Puthucheary suggested this be done based on outcomes. He said that he was against free health care because studies have shown that it did not raise the quality of life and simply raised state spending.

I suspect the line will be drawn based on needs. That is, the Government might always be reluctant to give away those things that Singaporeans truly need.

That might seem like rich irony to some, but for the Government to give away something like health care or education is to cross a line between incentivising desirable behaviour and welfare.

One key difference between the two is the permanence of welfare. You can take away incentives and perks, but it is nearly always politically impossible to withdraw welfare.

If people get used to something like free health care, it would take a brave political party to try to introduce a charge.

There was no danger of welfarism when it came to giving free access to museums. Attendance at museums here has generally been lacklustre and overconsumption on exhibits about Singapore's history is not a terrible thing to have. Yet, no one really needs a museum visit like they do a doctor's visit.

In that sense, the prospects for free transport during the shoulder periods of peak hour look good. Travel during a small window can hardly be considered a necessity and such a change is unlikely to create any sort of dependency.

If it does not result in the sort of behavioural change sought, the scheme can be taken away with minimal public uproar.

That ministers believe they need to carefully consider this change could indicate a need to signal continued resistance to any sort of institutionalised freebies.

A team of leaders so conscious about slippery slopes might see this as yet another one.

Give away free rides on the train or free entry to museums, and it does not take too much a stretch of the imagination to see someone totting up the cost of those and then asking for something else free in that price range. As it is, some politicians have suggested free travel for senior citizens.

One way or another, it is almost inevitable that there will be more and more people putting pressure on the Government to start giving more away for free, all of it backed by good intentions and legitimate need.

At the heart of the problem is the fact that "free" does not mean the bill disappears. Anything we give away free to one generation will have to be invoiced to the next in some way, be it higher taxes or cutbacks in some other area.

There will be cases where such a move is justified, but there will be other cases where the provision of free benefits means spending limited resources on people who do not need them.

With the multiple warnings of how an ageing population will mean an even larger strain on the young, we need to be very careful about not loading our already large future social spending bill with unremovable freebies.

Even as we move to become a more inclusive society, we need to keep in mind that things which come for free can still incur a heavy price.