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REPORT: U.S. IS UNCARING PLACE TO DIE

From Reuters

WASHINGTON (11/18/2002)--The United States is a cold and uncaring place to die, offering little relief from pain or even sympathy to people in their last weeks and months, according to a report issued Monday.

"Dying patients and their families today suffer more than they should," said Judith Peres, deputy director of the nonprofit consumer coalition Last Acts, which wrote the report.

"We still have a long way to go to improve health care and policy for this segment of the American population," Peres said.

Although more than 70 percent of Americans say they would like to die at home, only 25 percent of them do. The rest are often hooked up to machines in intensive care units, the report says.

About half of all deaths occur in hospitals, but fewer than 60 percent of hospitals offer specialized end-of-life services. Only 14 percent offer palliative care, which means special care to make sure a dying person is comfortable without working to extend a doomed life.

Hospitals concentrate on extending a patient's life, even if staff know the patient is dying, the report says. It may be kinder, Last Acts says, to allow the patient to gently slip away in as much comfort as possible.

Just 23 percent of hospitals offer hospice care, which is designed to do just this.

"Most states have only fair hospice use, with about 12 to 25 percent of deaths including a hospice stay," the report says.

Most dying people get only a week in a hospice, when 60 days would be much better, the group found.

And fewer than half, 42 percent, offer specialized pain management services.

"In any given state, at least one in four nursing-home residents is experiencing pain for at least two months without appropriate pain management," the report says.

"A study of cancer patients in the ICU found that 55 to 75 percent had moderate to severe pain, discomfort, anxiety, sleep disturbance or unsatisfied hunger or thirst."

A survey of 1,000 adults, done by Lake, Snell Perry and Associates for the group, found that 75 percent had lost a loved on in the past five years. Sixty percent of those surveyed gave the U.S. health care system a rating of fair or lower, and 25 percent said it was poor.

It found that 93 percent believed improving end-of-life care was important.

See the original article at CNN.

 

SYDNEY SUMMIT A STEP BACK FOR ACCESS TO MEDICINES, BUT IT'S NOT THE END OF THE STORY

A joint press release from Doctors Without Borders and Oxfam

SYDNEY, Australia (11/15/2002)--Trade ministers meeting in Sydney today proposed a reform to World Trade Organization (WTO) patent rules which supposedly allows poor countries to import cheap generic medicines but which in practice could be unworkable. "This is a setback in the fight to put public health before corporate profit, but the battle is not over," said Jeff Atkinson, a spokesperson for Oxfam International.

The major problem is that the country supplying cheap generic copies of drugs needed to combat AIDS, TB, and any other disease, would have to agree to override the relevant patent. This makes the needy importing country unacceptably dependent on the political will of another government, and increases the administrative burden. Potential suppliers would also be under enormous pressure from industrialised countries such as the US and EU not to help out.

If this proposal is accepted by the wider WTO membership, an insurmountable barrier to getting cheaper medicines is replaced by numerous lower ones, argue the international aid agencies Oxfam and Doctors Without Borders/Medecins Sans Frontieres (MSF). But this 25-nation summit is informal - the real decision will be taken by all 144 WTO member states over the coming month in Geneva.

"The irony is that while developing-country delegates in Sydney have been pressured to back down, world opinion is swinging in their favor," says Kathryn Dinh, spokesperson for MSF. "The proposition from the European Commission that won the day in Sydney has been unravelling at home, with the French, Belgium, Dutch, and European Parliaments supporting the proposals favored by many developing countries. And leading US newspapers are now vocal critics of US policy on this issue."

"Many people in the Third World and aid agencies such as Oxfam and MSF were hoping that Sydney would act in the spirit of WTO commitments made at Doha. As it is, they have been disappointed to see their trade ministers pressured by powerful countries into accepting a political fudge in a behind-closed-doors meeting," said Mr. Atkinson, "but the needs of millions of sick and needy people will not be set aside so easily."

See also documents related to the Sydney meeting, which are also available here. A playback of yesterday's MSF press teleconference on Sydney WTO Informal Ministerial is now available by calling: 1-800-615-3210 (in US), 1-703-326-3020 (outside US), passcode #6317329.

 

WHAT HAPPENED IN QUITO
The nitty gritty on recent FTAA talks

By Timi Gerson, Public Citizen's Global Trade Watch

QUITO, Ecuador (11/2002)--Two weeks ago I joined thousands of people to protest the 7th FTAA Ministerial Meeting in Quito, Ecuador. Indigenous people, women, workers, environmentalists, farmers, and students talked, marched, and protested while the CEOs of the Americas Business Forum and the national trade ministers holed up in their hotels. At the protestsí height, a police platoon rebelled and insisted that the trade ministers actually meet with the people. The result was a face-off with US Trade Representative (USTR) Robert Zoellick. See eyewitness accounts.

This time the people in the streets weren't alone. Many Latin American governments are also questioning the NAFTA-free trade model. They resisted Washington's agenda, and Quito barely moved the FTAA process forward. Agriculture was the biggest point of contention, with Latin American ministers especially angry about huge corporate farm subsidies in the recently passed US Farm Bill. Even Latin American countries with conservative governments are apparently holding out for concessions in agriculture before they give US negotiators what they want in services and other sectors.

With agriculture talks stalemated, other issues barely inched forward. USTR Zoellick is trying to cover this failure by saying that it doesn't matter -- all the agricultural issues will be dealt with at the next WTO Ministerial (scheduled for September of 2003 in Cancun, Mexico).

However, Brazil and other developing countries are playing the same game in the WTO, holding out for agricultural market access and 'special and differential treatment.'

The trade ministers in Quito also disagreed about the FTAA process and timeline. Venezuelan negotiators tried to push the FTAA implementation deadline back to 2010, but in the end were not able to. And according to the New York Times, the new Brazilian government insisted that Cuba be included in the FTAA talks, much to the chagrin of the U.S.

Brazil's new president, Luis Ignacio da Silva, campaigned on the theme that the FTAA was a 'policy of annexation, not integration.' Though Lula is unlikely to pull out of the FTAA process entirely, his hard-line negotiating strategy may slow down the talks--especially since the U.S. and Brazil will now co-chair the FTAA negotiations until their 2005 deadline.

Perhaps as a sign of impasse, the Quito talks ended two hours early, with the final press conference being held at 4:30 instead of the planned 6:30 pm. The USTR is touting his 'victories' in Quito, but a quick look at the seven objectives he 'achieved' shows that they are mainly things that had already been agreed upon.

Here's an analysis of the results, at Trade Observatory.

Post-Quito, international momentum is clearly in our favor. Perhaps thatís why the next FTAA Ministerial will be on "safe" ground in Miami. It is our unique responsibility to take the massive resistance the FTAA has encountered in the South and bring it home in the North. It is our job this year to build public awareness, political accountability, and strong local campaigns.

See you in Miami!

Questions and answers about the Quito Ministerial

Didn't they agree on anything?

The various countries' negotiators do seem to agree that they don't want enforceable environmental or labor standards. The Quito Ministerial Declaration's article 11 states that negotiators 'reject the use of labor or environmental standards for protectionist purposes. Most Ministers recognize that environmental and labor issues should not be utilized as conditionalities nor subject to disciplines, the non-compliance of which can be subject to trade restrictions or sanctions.' (Source)

In other words, all requirements to uphold the International Labour Organization's core labor rights or compliance with any Multinational Environmental Agreements (MEAs) as conditions for trade agreements will be non-binding. Any kind of enforcement (specifically sanctions, which are used to enforce the FTAA's commercial provisions) would be prohibited.

See the Hemispheric Social Alliance's take on the Declaration.

When's the next trade ministers' meeting?

In Miami next fall, most likely after the September WTO summit.

Did they release a new draft text?

Yes. The 2nd FTAA draft text is available on the official FTAA website, but, like the draft released in 2001, it is a 'scrubbed' version that doesn't tell us which countries support which positions. The text is heavily bracketed (brackets denote disagreements between negotiators), but there is no way to know which countries are disagreeing or what their positions are.

The Hemispheric Social Alliance and other groups are analyzing this 'new' draft; see the analysis at Hemispheric Social Alliance by the end of January 2003.

Essential Action and Doctors Without Borders quickly analyzed the Intellectual Property Rights (IPR) chapters and access to medicines and found that these are no substantive differences from their earlier analysis on the IPR chapter. See the IPR analysis.

What's next?

The negotiators set timelines for making secret 'requests and offers' for market access in each of the nine negotiating group areas (agriculture, services, government procurement, etc). In other words, government A makes a request ('we'd like you to put your education sector on the chopping block'), and government B responds with its offer ('we'll put higher ed on the block, but not primary education'). The 'request' phase lasts from December 15. 2002 to February 15, 2003 and the offer phase from February 15-June 15, 2003. This timeline would clear these very contentious issues out of the way before the fall 2003 Miami Ministerial.

The 'requests and offers' for the services agreement in the WTO (GATS) is taking place on a parallel track, with final offers due in March of 2003. See our GATS page. Both 'requests' and 'offers' in the FTAA and the WTO are highly secretive processes so that the populace doesn't actually know what their government is giving up until it's too late.

You may also want to visit Public Citizen's Global Trade Watch, if you haven't already.

 

'THERE SHALL BE NO POOR AMONG YOU'
A Bible study on Deuteronomy 15:4-15

From Christian Aid

Christian Aid’s purpose is to ‘expose the scandal of poverty’. This text contains some of the most famous Biblical teachings about poverty. It is also part of the ‘jubilee’ teaching which inspired the Jubilee 2000 debt campaign.

The Old Testament describes something which could be called ‘God’s economy’. Poverty is not inevitable--‘there will be no poor among you’. But sometimes we may need to take action to bring this about. Christian Aid believes that it is not God’s will that some people live in crushing poverty.

Read the passage from Deuteronomy together. Allow time to reflect on the passage, then invite people to share any immediate thoughts or questions that it raises for them.

For discussion

• How do you reconcile the apparent contradiction between verse 4 ‘There will be no-one in need among you’ and verse 11 ‘there will never cease to be some in need’?
• How do you make sense of the fact that there is and always has been poverty in our world?

Read these quotes

• ‘The question to be asked is not what we should give to the poor but when we will stop taking from the poor? ... Charged to be stewards, we have instead become exploiters. Rather than treating the bounty of the earth as a gift for all God’s children, we have wasted its resources to profit a few.’
  --Jim Wallis, contemporary scholar and founder of the Sojourners’ community in Washington DC (Call to Conversion, Lion Publishing, 1986)
• ‘The poor, just by the fact that they are poor, without saying anything to us, tell us ‘The way the world is organised is wrong, because there is no place for us. We are equal to you.’ When a tiny part of humanity lives well, and ninety percent don’t live well, something is wrong in God’s world.’
  --Salome Costas, community worker from Brazil

For discussion

How do you think this ancient text can inform trade rules agreed by governments in the 21st century?

See the original study at Christian Aid.

 

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