Secretary-General Ban Ki-moon pointed to the many positive steps made in tackling HIV/AIDS, including increased government support for universal access to prevention, treatment, care and support. But he cautioned that “this is just the beginning,” adding that “AIDS will not go away any time soon.”

In his message for the Day – which is marking its 20th anniversary this year – Mr. Ban called for sustained leadership and bolstered resources. “The need to lead, empower and deliver on AIDS is as real and urgent as ever,” he said, noting the need to stamp out discrimination that prevents people from seeking treatment.

Echoing the Secretary-General’s call for an end to intolerance, Navi Pillay, High Commissioner for Human Rights, pointed out that “27 years after AIDS was first identified, stigma against people living with HIV is as strong as it ever was.”

She said people are driven underground by a combination of punitive laws on the disclosure of HIV status, the criminalization of HIV transmission, and travel bans for people with the disease, among others.

“Like all people, these groups are entitled to the right to health and the full enjoyment of their human rights even though they may engage in activities that are criminalized in some countries,” Ms. Pillay said in a statement. “AIDS thrives on injustice and inequality,” she said, urging a human rights-based response to prevent infections and mitigate the impact of HIV.

Viewing the issue through the lens of women’s rights, Inés Alberdi, Executive Director of the UN Development Fund for Women (UNIFEM), appealed for equal treatment for every woman.

“Imagine a world where every woman, young and old, lives without fear or violence, stigma or dispossession if she decides to seek an HIV test, or treat, or support or information,” she said.

To make such a world a reality, women’s equal access to prevention and care must be ensured, Ms. Alberdi said.

General Assembly President Miguel D’Escoto added his voice to those marking the Day, noting that the simple facts that 2.5 million people were infected with HIV last year, and another 2.1 million died of AIDs around the world underscore the huge amount of work that remains to be done.

“Let us draw on the deep reservoirs of compassion that are within each of us to sustain our determination to conquer this disease and to care for its many victims. Let us stand together in this determination and in solidarity,” he declared.

In a related development, the UN-backed Global Fund to Fight AIDS, Tuberculosis and Malaria today announced that 2 million people living with HIV have received life-saving anti-retroviral treatment, surging over 40 per cent over last year’s results.

The Fund provides almost one quarter of all global resources to fight the disease, and it reported today that 62 million HIV counselling and testing sessions have been delivered to people, while 3.2 million AIDS orphans and vulnerable children have received basic care and support.

It also reported successes in its fight against TB and malaria, with the number of people being treated for these two diseased having increased by nearly 40 per cent and over 50 per cent, respectively.-UN News Service

Ambassador of Japan to Pakistan, Chihiro Atsumi and Executive Director, Rural Community Development Society, Mohammad Murtaza signed the agreement for the project at Japanese Ambassador’s residence here. The grant equivalent to Rs.2.3 million will be utilized for the procurement of six medical equipments including two X Ray Machines, two Ultrasound Machines and two ECG Machines for the existing two community health centers.

Through this project, the function of the community health centers will be enhanced and 11,000 people will be able to access affordable and high quality medical services for better health conditions. At the signing ceremony, Ambassador Atsumi said the Government of Japan gives priority to the health sector and has been extending Japanese Official Development Assistance to help Pakistani people receive affordable and high quality medical services such as the Children Hospital and Mother and Child Health Care Centre at PIMS.

Ambassador Atsumi also expressed hope that this project would contribute to improvement of health conditions of people of Pakistan and further strengthen the already existing friendly ties between Japan and Pakistan.-SANA

The Prime Minister said government is determined not to let resource crunch stand ion the way of march towards healthier Pakistan. He expressed his satisfaction that the Ministry of Health is working on the national policy on the fast track to re-orient health services to enable us to keep pace with the changing time.

Syed Yousuf Raza Gilani said with the rise of the population we have to improve the quality of health care. He said under the Prime Minister’s health programme more doctors, lady doctors, medicines and X-Ray machines would be provided to the all basic health units throughout the country.

He said government has initiated a number of health care programmes including immunization, lady health workers, mother and new born child heath for the prevention of ailments would ensure Pakistan’s success in achieving the Millennium Development Goals in unison with International Community.

He said health system and its different tiers are taking the services right to the door steps of every citizen. In this regard lady health workers programme as a land mile initiative conceived and launched by our Shaheed leader Benazir Bhutto.

Syed Yousaf Raza Gilani said the Expanded Immunization Programme is another programme apart from Hepatitis. He said it was the cornerstone of the welfare oriented policies of Shaheed Zulfiqar Ali Bhutto and Shaheed Montarma Benazir Bhutto to improve access of the impoverished, the powerless and underserved people.

He expressed concern over the reports of polio cases in different parts of the country. He urged the need to work on war footing to plug the gaps on the administrative and management front as identified by national experts. He also called on the Health Ministry, provincial health departments, district administration and the communities to join hands and make sure that no eligible child is missed out in the immunization campaign.

The Prime Minister also appealed to the parents, community leaders and public representatives to come forward and make this polio and vitamin A administration campaign, a success.-SANA

He said polio has been eradicated in the 121 countries and expressed the hope that people of Pakistan will also hear such news soon. He said cases of polio have been reported in some parts of the Pakistan as these areas were not accessible due to security reasons.

Dr. Khalif Bile Mohamud said WHO is working with the government of Pakistan to vaccinate each and every child of the country. To a question he said there is no shortcut to eradicate polio from the country adding, ” We have to reach each and every child to their doorstep to save them from the polio virus.”-SANA

The Ministry would be re?structuring its strategy to counter Dengue fever by placing more emphasis on the media communication component. The meeting discussed the agenda for the Health Ministry at the upcoming ECNEC meeting.

She stressed forming linkages with the Radio Pakistan as apart of the Ministry’s awareness raising drive. Radio Pakistan has an extensive outreach across Pakistan.

“A permanent space for Health Programmes on the Radio would go a long way in serving the objectives of our preventive healthcare strategy,” she added.

The Minister was also given a comprehensive briefing on “Current Status of Dengue in Pakistan” by the Directorate of Malaria Control.

Sherry Rehman was informed Dengue is a self?remitting disease in over 98% of the cases and the patient can recover in a week’s time if provided treatment.

The Dengue Hemorrhagic Fever, which is a serious threat, is seen in those who suffer a second spell of infection with different stereotype of virus. Therefore, it is important that the patient avails the facility of medical assistance as soon as there is fear of Dengue attack.

The Minister said Dengue as a disease can best be countered by individuals and households as no macro?level Programme can address its causes.

“The Dengue mosquito thrives in home environment and prefers clean water. It is important for households to adopt precautionary measures since they can guard themselves most effectively against the virus,” she added.

Emphasizing the significance of vector control initiatives, Ms Rehman said the preventive steps could be augmented by public’s use of mosquito repellents, including coils and sprays.

“According to our information, repellents work effectively against mosquitoes and insects. They could be used by households to minimize the risk of dengue mosquito attack,” the Minister said.

Ms Rehman said public’s approach to the epidemic is shaped by its perception of the disease and added there are gaps on information front.

While the fear factor that stems from lack ofknowledge can play a positive role compelling people to seek medical help in case of a Dengue risk, one cannot downplay the cost of ignorance, she said, adding that it is important the public has access to accurate information on Dengue so that we could avoid mortality, as well as any misconception regarding the disease.

Sherry Rehman informed that the mortality figure from Dengue has come down substantially over the past two years.

She said there were 6,056 Dengue cases reported in 2006, and there were 52 deaths.

“Compared to this, we have 1,488 cases this year, out of this, 661 cases were reported positive and there were 26 deaths. The difference between the admissions and the positive cases indicate that people take Dengue symptoms seriously. Our objective for the coming year is to minimize the mortality rate, while also ensuring the availability of adequate information on the disease at every level,” she added.-APP

It added that as families cut back on spending, there are also grave risks for the educational performance of poor children. “While people in the developed world are focused on the financial crisis, many forget that a human crisis is rapidly unfolding in developing countries,” said World Bank Group President Robert B. Zoellick. “The financial crisis will only make it more difficult for developing countries to protect their most vulnerable people from the impact of rising good and fuel costs,” added Mr. Zoellick.

The report, slated for presentation this weekend at the annual meeting of the World Bank and its sister institution the International Monetary Fund (IMF), sets out a series of priority measures aimed at reducing the impact of the food and fuel price crises on the poor.

These include making existing cash transfer programmes more generous, providing nutrition for infants and pregnant women, expanding food distribution programmes, using targeted subsidies for poor consumers, and implementing additional measures to prevent children from dropping out of school.

“Malnourished children cannot develop into healthy adults and become productive members of society who can contribute to the growth needed to lift themselves and their country out of poverty,” the Bank stated in a press release issued yesterday.

In May the Bank launched a $1.2 billion rapid financing facility to help poor countries cope with the food crisis. Since them, around $850 million has been committed to finance seeds, plantings and feeding programmes. In April Mr. Zoellick called for a “New Deal for Global Food Policy” that included a variety of measures providing immediate help to poor people and farmers while increasing food production.-UN News Service

Government may miss target by one million tonnes
Government is already in process of revising wheat production target of 23.5 million tonnes for 2008-09 by .5 million tonnes due to around 40 per cent water shortage. The scarcity of fertilizer and other input costs is also a major concern. But, President of Pakistan Economy Watch, Dr. Murtaza Mughal said that a ban on the movement of seed by government of Punjab may hit the targets badly.

Growers in Sindh start cultivation in the first half of October. Farmers in Mirpur Khas and Sanghar etc have already started sowing sub-standard seed due to non-availability of certified one. All the provinces rely on certified seed from Punjab. Some growers will use retained seeds which is not advisable.

The ban by Punjab is helping making of a crisis as some 65 to 70 percent growers rely on seed from Punjab and the ban should be lifted soon. The ban may push many to opt for other crops frustrating federal government efforts to become self-reliant as far as the staple is concerned.

861,000 hectare area assumed to be cultivated in the Rabi season may not be achieved, warned Dr. Murtaza Mughal. There was no ban before the government of Shahbaz Sharif and now a number of agencies including Food Department, Police and Special Branch are barring any movement. Government of Punjab has decided to issue permits for seed movement by so far no permit has been issued yet. Also, confusion prevails as to who will be issuing these permits, he said.

Frustrated growers can switch to other crops
He said that Pakistan requires a million tonnes of wheat seed per annum. Presently country is facing 50 per cent shortage. Federal Seed Certification and Registration Department is able to provide almost three lakh tonnes of certified seed. The same department is providing 34000 tonnes of cottonseed, 13000 tonnes of rice seed, 8000 tonnes of maize seed, 1000 tonnes of oilseed and seed for pulses etc. “The budget of this department should be enhanced to ensure green revolution,” said Dr. Murtaza Mughal.

A group of dentists at the King Saud University (KSU) have studied the medicinal properties of the miswak (teeth cleaning sticks) commonly used in Arab and Asian countries, and have concluded that “the beneficial effects of miswak for oral hygiene and dental health of a person using miswak are equal to, if not greater than, those who use toothbrush and paste.

The research identified 19 natural substances found in miswak that benefit dental health. According to the research, the miswak contains a number of natural antiseptics that kill harmful microorganisms in the mouth; tannic acids that protect the gums from disease; and aromatic oils that increase salivation.

The study said that “the miswak’s bristles are parallel to the handle rather than perpendicular, and it can reach more easily between the teeth, where a conventional toothbrush often fails to reach.” The study has termed miswak as “an oral hygiene tool” for one and all. According to the study, “the miswak has many medicinal properties and can fight plaque, gum line recession, tooth wear, gingivitis, and periodontal pocket depths.”

The study also concluded that the miswak releases fresh sap and silica that acts as an abrasive material for the removal of stains and buildup.

The KSU’s research has been supported and substantiated by another research work done by Abdul Al-Shareif of the Ministry of Agriculture. According to Al-Shareif, miswaks contain anti-mouth ulcer substances and antiseptics. “In addition to the substances that prevent teeth carries, gum bleeding, mouth cancer and putrefaction, miswak has another ingredient that strengthens the gum and prevents teeth from coloring.”

Al-Shareif said that a number of Saudi farmers have been planting miswaks for business.

The two studies have proved that the miswaks also release a substance that soothes toothaches.

He said that the use of miswaks might also improve appetite and regulate peristaltic movements of the gastrointestinal tract. “In fact, the World Health Organization (WHO) recommended the use of miswak way back in 1986, but stated that further research was needed to document the effects,” said Aziza Al-Mubarik, a KSU dentist, while referring to the widespread use of miswak, which is more common during Ramadan in Saudi Arabia and many other Arab and Muslim countries.

Asked why one should prefer miswak, Dr. Rahi Al-Badr, a local physician, said miswaks have many medicinal properties including scents, painkiller substances and sodium bicarbonate, which are widely used in the production of different kinds of toothpastes.

On the growing sales of miswak especially during Ramadan, Mubarak Al-Arifi, a miswak seller in Riyadh, said: “Miswak sales has gone up in Ramadan, especially in Makkah and Madinah, where the sales have increased up by nearly 300 to 500 percent.”

“Miswaks have a big market in Saudi Arabia and users can find these sticks nowadays in every nook and corner of the city, on roadsides, on pavements, or even in stores that sell Islamic books and cassettes,” said Al-Arifi, 65, who has always used miswak and has never visited dentists all his life.

On miswak sales, Karim Bandhu, a Bangladeshi salesman, who sits in front of a mosque in Rawdah district of Riyadh, said: “This is our season and we do brisk business in Ramadan. For me, it is fun, praying and talking to people, while selling miswaks.”

The best source of miswak is the root of arak tree, which is called Salvadora persica in botanical terms. The arak trees are grown in Saudi Arabia, Sudan, Southern Egypt, Chad and eastern parts of India.

In other parts of the Muslim world, where the arak tree is not found, other trees are used for the same purpose. Strips of bark are used in Morocco and branches of the neem tree are often used in India.

Two kinds of miswak are sold in Yemen, spicy and bland ones, said miswak seller, Mohammed Al-Hassan, a Yemeni national. Many Muslims use the miswak to follow the recommendations of Prophet Muhammad, (peace be upon him), who said, “Siwak cleanses the mouth and pleases Allah”.

Asked about the use of miswak among women in Saudi Arabia, Zurwa Jameel, a young Pakistani girl, said, “I use miswak during Ramadan because the use of toothpaste during Ramadan nullifies fasting.” “I have seen Saudi and non-Saudi Muslim women using miswaks more commonly than Asians or European Muslims,” she said.

Advantages of miswak

• The reward of Salaah (prayers) is multiplied 70 times, when miswak is used before prayers.

• Miswak strengthens gums and prevents tooth decay.

• Miswak assists in eliminating toothaches and prevents further increase of decay which has already set in.

• Miswak creates a fragrance in the mouth, keeping it fresh.

• Miswak is a cure for illness.

• Miswak eliminates bad odors and improves sense of taste.

• Miswak sharpens memory.

• Miswak is a cure for headaches.

• Miswak creates luster (noor) on the face of the one who continuously uses it.

• Miswak causes teeth to glow.

• Miswak strengthens eyesight.

• Miswak assists in digestion.

• Miswak clears the voice.

Times when usage of miswak is Sunnah:

1. For the recitation of the Qur’an.

2. For the recitation of Hadith.

3. When the mouth emits an odor.

4. For the learning or teaching of virtues of Islam.

5. For making Dhikrullah (Remembrance of Allah, meditation).

6. After entering ones home.

7. Before entering any good gathering.

8. When experiencing pangs of hunger and thirst.

9. After the signs of death are evident.

10. At the time of Sahur

11. Before meals.

12. Before undertaking a journey.

13. On returning from a journey.

14. Before sleeping.

15. After leaving the bed in morning.

Courtesy Arab News

According to sources, the child belonged to Atai Khan Banglani, a village of Tooje Union Council in Thall Taluka. The P-1 virus of polio was found in the child and the EPI has confirmed this new case. Meanwhile, deputy project director EPI Dr Noor Ahmed Sheikh said that the number of polio cases in the province has so far reached 15.

He said that three cases each in Karachi and Jacobabad while two cases in Khairpur have so far been reported and one case each has been reported in Nawabshah, Hyderabad, Shikarpur, Mirpur Khas, Dadu, Sanghar and Nowshehro Feroze.-SANA

On the other hand, flour price jumped to all time high of Rs750 per 20-kilogram bag in Peshawar. Half of the shops in Peshawar Flour Market were closed down in addition to the 150 flourmills. Around 1300 bags are being supplied to Fair Price shops on daily basis, however, people complained about poor quality of flour available at Fair price shops.-SANA

Contributing to this growth is soaring food, fuel and fertilizer prices, FAO said. Food prices rose 52 per cent between 2007 and 2008, and fertilizer prices have nearly doubled over the past year. The hardest hit have been the poorest, the landless and female-headed households.

“The devastating effects of high food prices on the number of hungry people compound already worrisome long-term trends,” said Hafez Ghanem, FAO Assistant Director-General for Economic and Social Development. “Hunger increased as the world grew richer and produced more food than ever during the last decade.”

Not only does this development impact efforts to achieve the hunger-related MDG, but it also affects progress towards many of the Goals, said Mr. Ghanem. Hunger negatively impacts labour productivity, health and education, all factors for economic growth. “Reducing the number of hungry people by 500 million in the remaining seven years to 2015 will require an enormous and resolute global effort and concrete actions,” he added.

FAO stressed the need for action on two fronts – making food accessible to the most vulnerable, and helping small producers raise their output and earn more. In December 2007 the agency launched its Initiative on Soaring Food Prices to help vulnerable countries boost food supplies and improve access to food. Measures include the distribution of seeds, fertilizer, animal feed and other farming tools and supplies to smallholder farmers.

“Urgent, broad-based and large-scale investments are needed to address in a sustainable manner the growing food insecurity problems affecting the poor and hungry,” said Mr. Ghanem. “No single country or institution will be able to resolve this crisis on its own.”- UN News Service

Asia, with its large population and increasing prosperity, is fueling demand, says UNODC, whose 2008 Global Assessment reveals that the worldwide market for amphetamine-type stimulants (ATS) is an estimated $65 billion. Annually, its use surpasses that of cocaine and heroin combined.

ATS is being used as “a cheap and available tonic for our fast and competitive times – for entertainment in discos (mostly in the West), and for greater stamina in assembly lines and behind a steering wheel (in the East),” UNODC Executive Director Antonio Maria Costa said at the launch of the report in Bangkok. The Assessment shows that while the use of synthetic drugs has stabilized and even decreased in North America and Europe, the problem has shifted to new markets over the past few years.

In 2006, almost half of Asian countries reported an increase in methamphetamine use. That same year, Saudi Arabia seized more than 12 tonnes of amphetamine – one quarter of all ATS seized globally. In 2007 the amount increased to almost 14 tonnes. Meanwhile, the number of seized methamphetamine laboratories in South Africa has gone up consistently for the past five years while domestic consumption has increased. Recently, the single largest seizure of ecstasy ever recorded, 4.4 tonnes, originating in Western Europe, was made in Australia, which is still struggling with a major synthetic drugs problem.

UNODC notes that the production of synthetic drugs is hard to trace since the ingredients are readily available for legitimate industrial purposes. Methamphetamine, for instance, can be cooked up in the kitchen, and pills can be pressed in a garage.

“Suppliers quickly adapt to the latest trends, and cater to local markets. When one lab is shut, another opens. When one type of precursor chemical is unavailable, producers switch to an alternative,” said Mr. Costa. “This presents a challenge to law enforcement since production is so close to retail outlets. Therefore, greater emphasis should be put on prevention.”

He added that the countries facing the brunt of the problem are also the least prepared to deal with it. To assist countries, UNODC has launched the SMART programme (Synthetics Monitoring: Analyses, Reporting and Trends), through which it will work with governments to improve their capacity to gather, analyse and share information on ATS products, their use, and on trafficking routes. “This should give us a better sense of how big the problem of synthetic drugs really is, and what more can be done to deal with it in terms of prevention, treatment and law enforcement,” Mr. Costa said.-UN News Service

Cut vegetables into small to medium pieces and cover with water. Boil fast for ten minutes. Reduce to simmer and continue cooking until veggies are tender. Eat as much as you want whenever you want and at any time of the day. This soup will not add calories. The more you eat, the more you lose. If eaten alone for indefinite period, you would suffer malnutrition. Fill a thermos in the morning if you will be away from home during the day.

DAY ONE: All fruits EXCEPT BANANAS. Your first day will consist of all the fruits you want. Cantaloupes and water melon are lower in calories than most fruit. Eat only your soup and fruit the first day. For drinks unsweetened teas, cranberry juice and water.

DAY TWO: All vegetables eat until you are stuffed with all fresh, raw or cooked vegetables of your choice. Try to eat leafy green veggies, and stay away from dry beans, peas and corn. Eat all the veggies you want along with your soup. At dinner this day, reward yourself with a big baked potato and butter. Eat all the soup you want this day but do not eat your fruit.

DAY THREE: Mix day1 and day2.Eat all the soup, fruits and veggies you want. You can’t have a baked potato this day.

DAY FOUR: Bananas and skimmed milk. Eat as many as 8 bananas and drink as many glasses of skimmed milk as you can on this day along with your soup. Bananas are high in calories and carbohydrates and so is the milk but on this particular day of your diet, your body will need potassium and carbohydrates. Protein and calcium will lessen your cravings for sweets.

DAY FIVE: Beef and tomatoes. You may have 10 to 20 ounces of beef and a can of tomatoes or as many as 6 fresh tomatoes this day. Try to drink at least 6-8 glasses of water this day to wash the uric acid from the body. Eat your soup at least once this day.

DAY SIX: Beef and veggies. Eat to your heart’s content beef and veggies this day. You can have two or three steaks if you like, with, if you like leafy green veggies. But NO BAKED POTATO. Be sure to eat your soup at least once.

DAY SEVEN: Brown rice, unsweetened fruit juices and veggies. Again stuff yourself. Be sure to eat your soup at least once this day.

AT THE END OF SEVENTH DAY: If you have not cheated on this diet, you will have lost 10-17 pounds. If you have lost more than 15 pounds stay off the diet for 2 days before resuming again from day one.

The seven day eating plan can be used as you like if correctly followed. It will clean your system of impurities and give you a feeling of well being as never before. After only a few days of this process, you will feel lighter by at least 10-17 pounds and have an abundance of energy. Continue on this plan on as long as you wish and feel the difference. This diet is a fast fat burning diet and the secret is that you will burn more calories than you take in. It will flush your system of impurities and give you a feeling of well being. This diet does not lend itself to drinking. Any alcohol beverages at any time, because of the removal of fat built up in your system. Go off the diet at least 24 hours before any intake of alcohol.

Because everyone’s digestive system is different, this diet will affect everyone differently. After day three, you will have more energy than when you began if you do not cheat. If after being on the diet, for several days, you find bowel movement has changed, eat a cup of bran and fiber. Although you can have black coffee on this diet, you may find you won’t need the caffeine after the third day.

DEFINITELY NO SUBSTITUTIONS. No bread, alcoholic beverages, no carbonated beverages, not even tab or other diet soda soft drinks. Stick with water, unsweetened fruit juices, cranberry juice and skimmed milk. (on the day it is allowed). No fried foods or breads. You may eat boiled or baked chicken instead of beef (absolutely no skin on the chicken). If you prefer, you can substitute boiled fish for the beef only on the beef days. You will need the protein in the beef on the other day.

The basic burning soup can be eaten at any time you feel hungry in the day. You can eat as much as you wish, as often as you like. This soup will not add calories. Eat all you want. The more you eat, the more you lose.

Any prescribed medications will not hurt you on this diet. Continue this plan as long as you wish and feel the difference in both physical and mental dispositions.

Definition of Euthanasia
Euthanasia is defined as the act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy. Euthanasia is also defined as “mercy killing”. There are two forms of euthanasia: voluntary and involuntary active euthanasia. Involuntary active euthanasia refers to ending a patient’s life without their informed consent; whereas voluntary active euthanasia involves a request by a competent patient to another person to administer medication, usually via lethal injection, to cause death. Another term that is synonymous to euthanasia is physician-assisted-suicide, or active euthanasia. Assisted suicide refers to ending a person’s life, with an assistance of a physician. Physician-assisted suicide refers to a physician prescribing medication or other types of interventions to hasten a patient’s death (Jasper 39). There are obvious differences between the act of euthanasia and suicide. Both acts seek to end a person’s suffering; however, in most cases of euthanasia, one only wants to end the physical pain for which there is no other treatment. Euthanasia generally reflects an acceptance or willingness to face the inevitable. To the terminally ill patient, death is the last hope of maintaining any remnants of dignity in a life where there is no longer any control. Euthanasia appears to be the only escape from a life where pain rules this person’s existence.

Ethical Principals
On both sides of the issue, one must keep the ethical principles in mind. These principles endorse the right of the individual to make health care decisions based on personal values and quality of life considerations, and the responsibility of clinicians to provide humane and compassionate care that is consistent with professional and societal norms. These principles guide end-of-life decision making.

The Principle of Autonomy
This principle asserts that competent individuals have the right to make their own decisions regarding their healthcare, such as refusing medical treatments, whether that choice results in the individual’s life or death. Autonomy should not be restricted by the limitations through other’s values and standards (Kleepsies 29). In the realm of healthcare, healthcare professionals may act paternalistically and ignore a competent patient’s choice. In the U.S. health care system, autonomy is viewed as a patient’s right, if he or she wishes to exercise it.

Informed consent is an ongoing process which helps the patient understand what he or she needs to know in order to make a treatment decision and the health care professional understand the patient’s needs and concerns which might influence such a decision. Ideally, the patient makes a voluntary, informed decision regarding care.

It requires information presented at a level that the patient can understand, in an environment that supports good decision making. It also requires active support of and respect for the patient’s right to make that decision. Informed consent promotes and protects patient autonomy.

The Principle of Beneficence
Beneficence is the action to do well; a moral obligation to act for the benefit of others (Kleepsies 30). When a treatment provider enters into contract to provide services to a patient, a commitment and obligation meets the health care needs of the patient, and to promote their well-being (Kleepsies 30). Fidelity is defined as loyalty and/or promise-keeping. In some cases this term is used to describe a duty to be loyal. In other instances it is used to refer to the duty to keep one’s promises. With managed care contracts and the increase in institutional affiliations, more health care professionals are finding themselves in situations where they have to choose between honoring a contractual obligation or doing what they believe is in the patient’s best interests. They may also find that their obligations to different third parties conflict.

The Principle of Mercy and Nonmaleficence
Primum non nocere or above all do no harm. This directive stems from the Hippocratic Oath. Nonmalificence warns the health care provider to abstain from procedures that may inflict suffering or pain (Kleepsies 32). This principle is also seen as a component of the principle of mercy as it warns us not to inflict harm or suffering needlessly.

Where possible, one ought to relieve the pain or suffering of another person, when it does not contravene that person’s wishes, where one can do so without undue costs to oneself, where one will not violate other moral obligations, where the pain or suffering itself is not necessary for the sufferer’s attainment of some overriding good, and where the pain or suffering can be relieved without precluding the sufferer’s attainment of some overriding good (Kleepsies, 2004, p. 31).

The Principle of Justice
This principle refers to “fair, equitable, and appropriate treatment in light of what is due or owed to persons” (Kleepsies, 2004, p.32). In the realm of end-of-life care (and health care in general), distributive justice plays a key role. This refers to the fair distribution of services and resources (Kleepsies 2004). With scarcity of services and resources increased competition exists for them. Life-threatening illnesses put these resources to the test, and decisions about who is treated versus who is not treated, quickly becomes a question of who will live and who will not live (Kleepsies 2004).

These ethical principles play a key role in the iron triangle of cost, access, quality of healthcare and how the health care system will aid the Baby Booming population, who are heading down the steep hill of chronic illness, questioning their mortality. The debate is about the limits of individual freedoms and the political power of the Baby Boomers, now at the age when they are beginning to contemplate their mortality. It’s about an ageing population and a limited health dollar. It’s about an increasingly educated population losing its awe of the medical profession (Magnusson, 2002, p. 36).

Pro-Euthanasia
“Death with dignity” has become a catch phrase used by euthanasia activists, who believe euthanasia respects a terminally ill patient’s dignity, and meets ethical principles of autonomy and beneficence.

The correlation between increasing support for legalization of euthanasia and a growing fear of becoming trapped in unacceptable position of dependency brought by medicine’s ability to prolong dying (Manning 27). Terminally ill patients request euthanasia for a variety of reasons. Out of the five most common reasons, 80% of those reasons fell under “psychosocial factors” (Rosenfeld 2004). Fifty-seven percent of patients cited “loss of dignity” as their prime reason. Other reasons included “unworthy dying” by 46% of the patients. Thirty-three percent of the patients claimed being dependent on others and 23% said tiredness of life. Forty-six percent of the patients cited the only physical symptom on top of their list was pain (Rosenfeld 2004). Depression was listed as a factor in 55% of these cases. Patients would commonly request that physicians prescribe them anti-depressant or anti-anxiety medication (65% of these cases). Only 19% of those patients who suffered from depression requested assisted suicide but 39% of those cases, lethal injection was sought (Rosenfeld 2004)

Assisted Suicide in Oregon
In November 1994, the state of Oregon voted in favor of the Death with Dignity Act, also known as Measure 16, which legalized physician-assisted suicide but did not authorize active euthanasia (Magnusson 2002). The law came into effect on October 27, 1997. In November 1997, sixty-percent of Oregon voters passed legislation verifying their support for this act a second time. In October 1999, the United States House of Representatives passed the Pain Relief Promotion Bill, which made it an offense for doctors to prescribe barbiturates, specifically for purposes of assisted-suicide (Magnusson 64).

The Oregon Dying with Dignity Act or ODDA allows any adult with specific-met conditions to be prescribed medication to terminate his or her life. These conditions include: (a) over 18 years old, (b) an Oregon resident, (c) diagnosed with a terminal illness with a life expectancy of less than 6 months, and (d) capable of making a sound decision (Rosenfeld 148). Assuming that the patient meets these conditions, he or she must make two verbal requests to his or her physician 15 days apart as well as provide the physician with a written request no less than 48 hours before the prescription is provided and must be witnessed by a non-relative (Rosenfeld 148). A disturbing fact is that patients that utilized ODDA were young, Caucasian, well-educated people with a diagnosis with cancer or ALS (Rosenfeld 156). Loss of autonomy leads the main reason for lethal injection request, followed by poor quality of life, loss of dignity, and pain or fear of pain (Rosenfeld 2004)

Self Determination
The right to control the course of one’s medical treatment has become increasingly accepted as a general ethical principle in health care. Whether the desire to determine the course of one’s illness and treatment reflects a psychological need for control or an American focused on value we place on privacy and autonomy or some combination of these and other factors, patient autonomy has consistently grown over the last century. This movement gave birth to the Patient Self-Determination Act of 1990. This legislation requires Medicare-reimbursed institutions to inform the patients of their right to participate in medical decisions and advance directives. Some conditions institutions must adhere to are providing information concerning an individual’s statutory right to make decisions concerning medical care. This includes the right to accept or deny treatment and to prepare an advance directive, (b) provide a copy of the institution’s written policies with respect to implementation of such rights, and (c) obtain documentation of patient’s signature of the advanced directive in their medical record (Rosenfeld 44).

Media Support
In more recent cases, Lord Joel Joffe- a retired human rights lawyer who defended Nelson Mandela, requested the right to assisted suicide enshrined on the statute book (Bid to Legalise Assisted Suicide). Other alternatives to assisted suicide included hospice and palliative care. Here, the patient would have to make a written statement to declare their wish to die. This Patient Assisted Dying Bill consists of safeguards to ensure that the vulnerability of the society is protected.
Health care Cost in Supporting Euthanasia

The principle of common good goes beyond the utilitarian argument for placing limits on self-determination, and calls us to consider the impact that allowing euthanasia might have on our general attitude toward preserving life and the taking of life. Will euthanasia be used as a cost-saving measure to avoid expensive long-term disability care? Or as an easy fix to the complex problems of aging and disability?

Euthanasia or physician-assisted suicide can help reduce the high cost of health care for terminally ill patients and possibly make new financial resources available to serve for the common good. Chronically ill and terminally ill patients contribute the most to the rise of health care. Perhaps one of the most important developments in recent years is the increasing emphasis placed on health care providers to contain costs. In such a climate, euthanasia certainly could become a means of cost containment. In the United States, thousands of people have no medical insurance; studies have shown that the poor and minorities generally fall victim to lack of accessibility for available pain control, and managed-care facilities offer physicians cash bonuses if they don’t provide care for patients. With greater and greater emphasis being placed on managed care, many doctors are at financial risk when they provide treatment for their patients. Legalized euthanasia raises the potential for a profoundly dangerous situation in which doctors could find themselves far better off financially if a seriously ill or disabled person “chooses” to die rather than receive long-term care. Savings to the government may also become a consideration. This could take place if governments cut back on paying for individual patient treatment and care and forced patients into treatments causing death.

Anti-Euthanasia
Death is a foregone decision. Euthanasia is a topic that provokes as much controversy as capital punishment, primarily because it is irreversible. For most people in Western society, death is an issue that most prefer be hidden behind the closed doors of a hospital. This fear is best left unspoken and many find it uncomfortable and disturbing. This fear of a ‘thing’ that nobody has any control over is very much apart of our society. In the health care realm, a health care professional’s primary concern is the preservation of medical resources and cost containment, as opposed to the betterment of human life.

Cost of Euthanasia
Financial pressures may also lead to incentives for active killing by limiting funding for terminal care (Wekesser 1995). Legislators consider the cost of terminal care with Medicare and Medicaid along with private insurers may take it as an obligation to encourage more cost effective ways of dying. Cost pressures will force future adoption of practice protocols based on a patient’s condition, likely outcome and cost of alternative treatments. If euthanasia is added to this economic pressure, the freedom to choose well set the stage for unsubtle financial coercions that will determine how many of us die, especially the indigent, uninsured, and underinsured populations (Wekesser 1995).

Hospice and Palliative Care
Until the early 1990’s, ‘palliative care’ was described as taking care of dying patients, especially dying cancer patients. Demographic and technological changes such as the aging population, along with advances in pharmacological and surgical techniques have shaped the historical view of palliative care (Meghani 2004). World Health Organization (WHO) defines palliative care as

an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual

(Meghani 2004, p.155).

The concept of palliative care in the U.S. has evolved to address the needs of a wide range of patient population to alleviate suffering and improve their quality of life. The four attributes of palliative care are total, active and individualized patient care; support for the family; interdisciplinary team approach; and effective communication (Meghani 2004, p. 157). The hospice approach to the treatment of terminally ill focuses on relieving the physical symptoms of patients provides psychological and social support for both patient and family.

The National Hospice Organization defines hospice as:

Hospice affirms life. Hospice exists to provide support and care for persons in the last phases of incurable disease so that they might live as fully and comfortably as possible. Hospice recognizes dying as normal process whether or not resulting from disease. Hospice neither hastens nor postpones death. Hospice exists in the hope and belief that, through appropriate care and the promotion of the caring community sensitive to their needs, patients and families may be free to attain a degree of mental and spiritual preparation for death that is satisfactory to them

(Wekesser 1995 p.119).

Legalized killing would create a new ethical reality by sanctioning these killings through removal of ventilators and feeding tubes (Wekesser 1995). Part of the opposition to pro-euthanasia is the assertion that palliative care, or comfort care, can adequately relieve pain and distress, thereby avoiding the escape route for euthanasia. Palliative care specialists are keen on drawing attention to the success of their specialty in providing comfort care and regard support for euthanasia as a sign of lack of information and ignorance by doctors and patients (Magnusson 2002). Some see the push for euthanasia primary as a symptom of the failures of doctors to communicate to their patients, failure to respect a patient’s choice by discontinuing treatment when it is futile, and their failure to practice good palliative care (Magnusson 2002).

Health care Cost
While U.S. heads the list of top countries regarding per capita health care expenditure, recent reports indicate that the existing health care structure is in much needed care of patients diagnosed with potential or actual chronic illnesses (Meghani 2004). Medicare is the prime insurance provider of hospice care in the United States for people age 65 and over. Unlike many developed countries that operate under a centrally administered health system such as United Kingdom, and Canada, the health care system in the United States mainly operates based on market-forces. Therefore, cost-containment has remained central to most public policies. The effect of this market place system is evident among Medicare beneficiaries, where hospice enrollment varies by the insurance type (Meghani 2004).

Presently, aside from hospice care, no other third-party reimbursement is available to support non-traditional palliative care. The lack of adequate reimbursement has resulted in an improvised partnership and research projects such as independent hospice entity into a contractual relationship with hospital(s) or integration of a hospice program within a hospital or health care system. This is a prime example of vertical integration (Meghani 2004).

It is important to bear in mind that the key element of the debate of legalizing euthanasia is to reduce the cost of health care. One danger of this is that euthanasia would be seen as a “convenient” solution to the heavy demands on care made by certain types of patients. The kind of humane impulses which have sustained the development of hospice medicine and care would be undermined because too many would think euthanasia is a cheaper and less personable demanding solution. With managed care, the quality of care is paramount. But that quality of care is compromised when cutting cost is a factor. Therefore, those patients requiring quality care are overshadowed by reduction of care (Smith 1997).

As providers of managed death, many physicians will be sincerely motivated by respect for patient autonomy, but the cost factor will always lurk silently in the background. This will be especially true if they are providing managed death in a setting of managed care. A perilous line of argument might then emerge:…1) Too much money is spent on health care; 2) certain patients are expensive to take care of (i.e., those with physical disabilities and the elderly); 3) these patients appear to suffer a great deal, lead lives of diminished dignity and are a burden to others;…4) recognizing the diminished dignity and suffering and burdens borne by these persons and those around them, their right to euthanasia or assisted suicide should be legally recognized; and 5) the happy side effect will be health care cost savings (Smith 1997, p.154).

Media Support
The Patient Assisted Dying Bill may not be helpful if a patient is in a vegetative state and cannot express his or her wishes due to their condition. A prime example of this is the ongoing 10-year saga of the Terri Schiavo case. The controversy lies in which to let Terry die, a decision rendered by her husband Michael, or to keep her alive and offer some sort of intense therapy to improve her health, a decision rendered by Terry’s parents. President Bush allowed the federal courts to review state court decisions in the case (Franken 2005).

My Position
After thoroughly researching both sides to this sensitive issue, I believe that legalization of voluntary euthanasia will reduce the cost of health care but at a cost of a patient’s life. If a patient makes a decision to terminate its own life an advanced directive must be prepared. The advanced directive will provide more autonomy to individuals in order to ensure the fulfillment their medical wishes. This directive will also foster fidelity between the doctor and the patient. One powerful drive is the demand for people to make their own decisions. This call for autonomy says that, while a doctor may have a better understanding of the patient’s medical needs and the likelihood of success of any particular treatment, individuals have primary responsibility for their health and must live with the consequences of any decisions. The previous paternalistic mentality of ‘the doctor knows best’, has been replaced with the notion of ‘informed consent’ - the idea that clinicians give information so that patients can make sound choices.

In the example of the Terry Schiavo case, this 10-year battle would not have been dragged if not for an advanced directive by Terry Schiavo herself, expressing her last wishes. The $1 million medical malpractice award that Michael Schiavo won in his wife’s case quickly diminished due to the vast medical expenditures to keep her alive (CNN 2005). Legalizing voluntary euthanasia compromises the ethical principle of benevolence, justice and nonmalificence.

Legalization of voluntary euthanasia will reduce the quality of care by physicians to patients who lack insurance, or are impoverished. The surplus of chronic diseases in this country belongs to the underserved, underinsured, and uninsured population. As their quality of life diminishes, patients will opt for voluntary euthanasia which will start a vicious cycle to the reduction of cost of health care.

Legalization of voluntary euthanasia would create a profound change in medicine, a change that could bring many other unforeseen changes and social consequences for the profession and the public it serves. Persons can be best served by adopting measures that make the process of dying more respectable, humane, and dignified by for all (Wekesser 1995). In essence, this means adopting a hospice inspired strategy of accepting death when it is inevitable, by providing support to ease suffering and using every method to control pain. It is a doctor’s prerogative to inform patients of the alternative of palliative care and/or hospice care. Improved hospice services can improve the quality of care and reduce its cost. Educating patients and health care providers on hospice care will render the issue of euthanasia essentially moot (Wekesser 1995).
Conclusion

In the end, legalizing voluntary euthanasia can cause a conflict of interest between physicians and patients. Hospitals may be predisposed to encourage physicians to gain consent of some patients as cost-control measures. Patients should be cognizant of alternatives to voluntary euthanasia such as hospice and palliative care. These alternatives will aid in cost-saving measures along with provide quality care to patients in their end-of-life care. Patients should also be cognizant of obtaining an advanced directive to avoid hasty decisions in one’s death. Every life is a worthy life; cost of legalizing euthanasia should not play a factor in the termination of life.

Karim said that during the current year the disease has affected 11 children in the province. He said as soon as the law and order situation improves in Bajaur and Kurram Agency a polio campaign would be launched in these areas. He said that 160,000 children would be administered polio drops in Swat.-SANA

Recent studies have revealed that HIV prevalence among IDUs in Kabul is three percent. So far 435 HIV positive cases have been reported from different sources, but it is estimated that there are 2000-2500 HIV positive cases nationwide, the ministry added. A press release from the ministry quoted the public health minister as saying: As you are aware that the World Bank has granted $10 million for the successful implementation of National AIDS Control Program and out of that amount, $3,744,955 is allocated for harm reduction services.

Dr. Amin Fatimie added: It is indeed a great pleasure that today MoPH with financial help of the World Bank signs the contracts that include the delivery of harm reduction services, with five non-governmental organizations. HIV preventive services, harm reduction, case finding and treatment of TB in prisons would be improved, Fatimie promised while signing the seven contracts, including two with the Organization for Technical and Community Development (OTCD) for Kabul and Nangarhar respectively. Two contracts will be inked with the Solidarity Afghan Families (SAF) for Kabul and Balkh, one each with Shahamat Rehabilitation Organization (SHRO) for Herat, Sanayee Development Organization (SDO) and ActionAid-SANA

Thirty patients were discharge after the initial treatment and seventy patients were admitted to Nowshara-Kala and Pabi hospitals, while serious patients were shifted to hospital in Peshawar. Health department said that medicines would be provided on emergency bases in the affected areas. Doctors considers the recent devastating rains and the resulting floods as a main reason of the epidemic in the affected areas and suggested drinking boiled water.-SANA

“The Ministry of Health is fully prepared to respond to the floods and we have already sent our mobile teams, and necessary medicines to deal with the post flood challenges,” said Ms Rehman. “We are vigorously pursuing a preventive strategy incorporating efforts for clean drinking water, vaccination and a comprehensive communication plan. In order to prevent the outbreak of water-related epidemic, the Ministry has dispatched over 10,000 water purification tablets and more could be provided to ensure their adequate supply in the flood-hit areas. As soon as the floods recede, we will initiate a vaccination exercise against measles, cholera, and meningitides. We have already formulated a communication strategy to augment our preventive efforts. We will be utilizing all channels of communication to inform and educate public about health-related challenges in the backdrop of the floods. The Lady Health Workers will also carry out the task of delivering door-to-door messages on preventive measures.”

Ms Rehman informed the Health Ministry has devised a strategy to enable the LHWs to make an effective contribution to the medical and emergency relief measures. These include organizing camps to provide medications and vaccinations, and extend preventive health services at doorsteps. The LHW Programme will also offer logistics support to the Executive District Offices while it would continue to work as the distribution channel for health interventions.”

The Federal Minister clarified that there is no immediate threat of floods, since the major rivers and reservoirs were maintaining their normal levels. “We are experiencing flash floods as heavy rains have caused inundation of some parts of the country. The Government is actively monitoring the situation in all four provinces, and the Health Ministry is working in close coordination with the provincial governments, the National Disaster Management Authority and the Emergency Relief Cell of the Cabinet Division, with the objective of supporting and augmenting their efforts.” -SANA

The Members of the Sub-Committee were of the view that well coordinated efforts were required to root out the menace of spurious drugs as it is a crime against the society. They underlined the need for establishment of a coordination cell at federal and provincial levels comprising of the representatives of health department, law enforcement agencies and other stakeholders to check such incidents and take quick action against those involved in the spurious drugs business.

It was pointed out that the performance of the drug inspectors was not up to the mark and there was a dire need to revamp the whole system and adopt a zero tolerance policy while taking action against the persons involved in the unethical business. It observed that a crack down is required to unearth those elements who play with the lives of the innocent people and that rigorous punishment should be awarded to those involved in this nefarious business.

The Committee also called for making the drug courts fully functional to expedite the process of conviction. Senator Sardar Jamal Khan Laghari said that the blame game should be stopped and all of us should feel the responsibility to curb the menace. He said that people were facing threats to their lives due to availability of fake drugs in the market which can only be checked properly when coordinated efforts were made.

He assured his all out support to the federal and provincial health departments, law enforcement agencies and all the other stake holders to chalk out such policies which could help check the crime appropriately. Earlier, the representatives of the federal and provincial health departments, law enforcement agencies gave their view point on the issue of spurious drugs. Secretary Ministry of Health Mr. Khushnood Lashari stated that the Committee which has been constituted by the Sub-Committee on Interior has held various meetings.

He said that the Ministry of Health have held in depth discussions, with representatives from the four provincial health departments, FIA, Chemists and manufacturers on the issue of spurious drugs and soon a comprehensive report would be submitted to the Sub-Committee for further necessary action. The meeting was attended by Senators Sardar Muhammad Jamal Khan Leghari and Bibi Yasmeen Shah. Secretary Ministry of Health, DG, FIA and senior officers of the provincial health departments, Law and Justice Division etc. were also present.-SANA