How doctors choose to die

Modern medicine almost refuses to let a patient die. Elaborate operations are performed on him, he  is connected to all kinds of machines which do the job of failed organs, tubes are inserted into him  to feed, to give blood and to remove wastes, and newer and evermore potent medicines are poured into him to keep him alive. Most specialist doctors who deal with terminally ill patients prescribe these interventions and drugs. But do these expert doctors want the same life-prolonging treatment when they themselves are terminally ill?  

A recent article "How Doctors Choose To Die" written by Dr. Ken Murray, a professor of medicine at the University of Southern California, published first in and then reprinted in many newspapers worldwide gives the surprising answer "No" to this question. Doctors across the US and UK have responded to his provocative article and most seem to agree with him that the best death is the least medicated. They generally feel that the quality of life is more important than the quantity. But they seem to be uncomfortable with the dichotomy in their thinking.  

Dr. Murray poses the interesting question "How has it come to this, that doctors administer so much care that they wouldn't want for themselves?" and answers it by holding the patients, the doctors and the system responsible, the patients because they expect too much from medical science, the doctors because they fail to present only reasonable options to the patient or his family, and the system because it threatens doctors for doing too little and never for doing too much.  

The stress of facing constantly the dichotomy of administering expensive medical care which is ultimately futile and which makes people suffer and being against such treatment if they themselves were the patients is, according to Dr. Murray, one of the reasons why physicians have higher rates of alcohol abuse and depression than professionals in most other fields.

B.V. Shenoy, Mysore Grahakara Parishat 

Rational Method of Determining Water Rates

The recent steep hike in water rates by Mysore City Corporation and the subsequent partial rollback in the face of heavy public opposition raises many questions on the capacity of MCC to come to rational conclusions about important matters concerning the city. MCC's first decision to effect a steep hike seems a shot in the dark and the decision to soften the blow a knee-jerk reaction to public outcry. Neither decision appears to be based on a sound analysis of the actual economics of water supply in Mysore.

Everyone agrees that the rates were fixed in an irrational way on both occasions, but many may not know how rates are fixed in a rational manner. Here we indicate the ingredients of a rational determination of water rates. They are:   
1. Conduct a detailed survey and find out how many illegal connections there are. Disconnect them or regularize them for a fee. This will give the total number of water connections. This will also give the number of domestic, commercial and industrial connections.
2. Based on the consumption pattern of domestic, commercial and industrial connections, estimate the total consumption by each of these categories.
3. Determine the total annual expenditure on water supply. This will include:
i. Salary to personnel connected with water supply 
ii. Electricity charges
iii. Maintenance expenditure
iv. Expenditure on servicing loans (such as ADB loan) taken to improve water supply
v. Depreciation of assets.
4. Analyze and incorporate ways to minimize each of these expenditures. Some ways are as follows.If there are too many staff, reassign them to other departments. Replace old pumps with new energy-efficient pumps so that electric charges are reduced. Monitor the inventory so that needless equipment is not purchased. Use chemicals at the right strength, too little may not do the job and too much is wasteful. Restructure loans to get the benefit  of advantageous interest rates.
5. The expenditure figure after the previous step is completed is the minimum possible expenditure. If water supply is to be run as a self-sustaining venture, one has to generate this much revenue from the consumers. Normally, a reasonable profit needs to be earned for upgrading the system and making it better and this profit should be added to obtain the revenue which needs to be generated. There will always be defaulters and the revenue to be generated should also be increased to compensate for the defaulters.
6. Estimate the fixed charge which has to be levied on a consumer even when he does not use any water. Ideally, this should be be just the cost of the meter reader making a trip to take the reading and administrative costs of maintaining and updating the consumer account and should not be more than 10-20 rupees. Its present value of Rs. 125 is too much.
7. Divide the revenue to be raised among domestic, commercial and industrial users, using the data obtained in step 2. Fix slabs and the corresponding water rates so that according to existing consumption patterns, the requisite revenues will be generated. It has been past practice that domestic consumers are levied the lowest tariff and industrial users levied the highest tariff. So industrial and commercial users are subsidizing domestic consumers. Such cross-subsidization also exists in electricity supply, but a law has been passed to reduce and eliminate it. It has also been past practice that rates in each class are higher, the higher the slab, to discourage excessive consumption of water. Whether the rates should be increased even more steeply for higher slabs needs to be debated.

This is an outline of the scientific and rational method to determine water tariffs. Steps such as publication of all the above data, improving the efficiency of revenue collection, reducing loss by leakage, etc. will go a long way in making the process transparent and increasing public support to the tariffs. Setting up a water regulatory commission on the lines of electricity regulatory commission will take care of all these issues and hence is highly desirable.

Maj.Gen. (Rtd.) S.G. Vombatkere, Mysore Grahakara Parishat 

Attention, railway users

Mysore Grahakara Parishat has been appointed a member on the Divisional Railway Users Consultative Committee. The committee meets once in a quarter. The next meeting is scheduled to be held on the 20th July at Mysore.

A preliminary meeting is being held at MGP office, 6/1, Vivekananda Road, Yadavagiri, Mysore 570 020 (opp. SBI, near Hotel Dasaprakash Paradise), Ph: 2515150, at 4 p.m. on Saturday, 7-7-12 to collect problems faced by railway users for presenting them to the authorities. If you have a problem with the railways, write a brief description of the problem and bring it to the preliminary meeting. If you can not attend the meeting, send it by post to the above address or e-mail it to mygrapa[@]gmail[dot]com or bsshankara[@]yahoo[dot]com.

V.Mahesha, Mysore Grahakara Parishat