At The Song Said – The Times, They Are A’Changing. We Need To Face The Future More Alone.

This appeared last week:

Australia is trying to pretend the world hasn’t changed

Trump’s revolution has upended politics in the US, Canada, Germany and the UK. Neither Labor nor the Coalition has seriously confronted the difficult policy responses required.

Michael Stutchbury Editor-at-large

Mar 15, 2025 – 5.00am

Donald Trump’s new world disorder is gate-crashing Australia’s now-prolonged election campaign just as it is upending politics on both sides of the Atlantic. But will Labor and the Coalition face up to what this means?

Wall Street has been spooked into a correction-sized sell-off over Trump’s preparedness to let an escalating global trade war trip the American economy into recession. For Australia, that’s just the start of it.

The Queensland and NSW floods have forced Anthony Albanese to delay a pencilled-in April 12 election to May. Treasurer Jim Chalmers will now hand down a March 25 election budget that wasn’t supposed to happen.

That will give Labor an opportunity to set an election narrative. But a decade of looming budget deficits amid stalled productivity will expose the old assumptions that have underwritten Australia’s envied prosperity.

First, that Chinese demand for Australia’s iron ore, coal and gas will readily finance the politicians’ elect-me promises, such as Albanese’s Medicare bulk-billing policy costing $8.5 billion over the next four years.

And, second, that Australia can keep free riding on the American alliance that has kept the peace in the Asia-Pacific.

Neither Labor nor the Coalition has seriously confronted the dismantling of these foundations of Australia’s modern prosperity.

A probable post-election minority government would lack the stability to take the difficult policy responses required.

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Trump’s willingness to favour authoritarian Russia over democratic Ukraine and to risk the NATO-led Western alliance signals Australia’s need to ratchet up defence spending amid the forecast decade of fiscal deficits.

UK Labour Prime Minister Keir Starmer has announced a sizeable increase in defence spending, financed by cuts to foreign aid.

In Berlin, new centre-right Chancellor Friedrich Merz seeks to exempt Germany’s military budget from the nation’s constitutional debt limit. It would be a historic development.

Germany’s centre-left-led coalition collapsed hours after Trump’s November 5 election and amid the rise of the anti-immigrant far-right Alternative for Germany party.

Shortly after Germany’s February 23 election, Merz said his absolute priority would be to strengthen Europe so that it could “really achieve independence from the USA”.

“I never thought I would have to say something like this on a television program,” he said.

While Germany is surrounded by like-minded European states, the circling of Australia by Chinese warships exposes the nation’s vulnerability in the absence of the American security blanket.

The popular backlash against Trump is testing the Albanese government’s support for the American alliance and the Coalition-inked AUKUS nuclear-powered submarine deal opposed by a broad progressive front from the Greens to Paul Keating and Bob Carr, to Malcolm Turnbull.

The global cost-of-living squeeze is prompting pro-growth deregulation and smaller government, such as through Elon Musk’s controversial Department of Government Efficiency.

Push to smaller government

In the UK, Starmer vows to cut the cost of business by 25 per cent and trim the “flabby” British state.

“We’ve created a watchdog state completely out of whack with the priorities of the British people and that is unfit for the volatile and insecure world we live in,” he said overnight Thursday AEDT.

This includes abolishing NHS England, the “bloated” bureaucracy that runs the National Health Service, at the cost of 13,000 jobs. Imagine the Mediscare if the Coalition proposed that in Australia.

Australia’s government spending blowout has been driven more by in-kind programs such as the NDIS, childcare and Medicare than by means-tested transfer payments.

That has left the government spending less targeted on lower income earners, according to a report this week from the e-61 economic research institute and the University of NSW.

US Treasury Secretary Scott Bessent says America’s biggest banks are being weighed down by “unduly burdensome regulatory requirements” and “backward looking policies in response to an undercapitalised system predating the global financial crisis almost two decades ago”.

Starmer announced plans to axe the UK Payments System Regulator by folding most of its functions into the Financial Conduct Authority. UK Chancellor of the Exchequer Rachel Reeves says that post-financial crisis banking regulations have “gone too far”.

Threats by the New Zealand government to wind back increased post-GFC capital requirements to help revive economic growth were a factor in Kiwi central bank governor Adrian Orr’s sudden and unexplained exit last week.

There is no such push from Australian Labor, which forced the previous Coalition government to set up the pro-regulation Hayne royal commission into banking misconduct.

Shadow treasurer Angus Taylor vows to attack “excessive regulation and compliance costs” exceeding $1 billion annually for some big financial firms.

That would include requiring the Australian Prudential and Regulatory Authority to emphasise competitive access to finance as well as financial system stability.

“Over-regulation has left Australians under-insured, under-advised, and under-banked,” Taylor said last month. But the Coalition’s commitment is undermined by Peter Dutton’s populist threats to wield the big stick on insurance companies.

Pro-growth deregulation

Trump’s “drill, baby, drill” withdrawal from the Paris climate accord is mirrored by new Canadian Prime Minister Mark Carney’s immediate dumping this week of a consumer carbon tax on petrol, diesel and gas scheduled to rise to $C170 ($187) per tonne of carbon emissions by 2030.

Australia’s still-rising energy costs were confirmed by this week’s Australian Energy Regulator’s ruling that benchmark household power bills could increase by up to almost 9 per cent because of a more-expensive and renewables-driven electricity network.

Labor’s political response in the March 25 pre-election budget is set to be a Band-Aid debt-financed repeat of its $300 energy bill rebate to households and small businesses.

Australia’s clean energy transition is more costly than promised, undercutting the cheap energy advantage needed for Albanese’s Future Made In Australia hopes to become a so-called green energy superpower. The Coalition’s ambitious nuclear energy policy lacks a mechanism to bring down energy costs in the next decade.

While energy costs remain high, increased green, red and black tape is closing down parts of Australia’s industrial processing base and eating away at the nation’s comparative advantage in resource development. Trump’s America is overtaking Australia as an LNG exporter.

Labor’s empowering of trade unions and increased workplace regulation is undermining workplace-level productivity.

In his prime ministerial acceptance speech this week, Canada’s Carney vowed to “win” the trade war with Trump. “These are dark, dark days brought on by a country we can no longer trust,” he said.

Even though not even in parliament, the former Bank of England governor won the Liberal Party ballot to replace the unpopular Justin Trudeau as leader of Canada’s ruling centre-left government.

Like in Germany, Canada’s leadership change was Trump-induced. Trudeau resigned on January 6 in the face of looming defeat by populist Trump-lite Conservative Opposition Leader Pierre Poilievre.

Since Trump launched his trade war on Canada, however, the government’s patriotic tariff counter punches have clawed their support back to level-pegging with the Conservatives.

Unlike in Canada, though, Albanese rightly rules out tit-for-tat trade retaliation against Trump’s refusal to exempt Australia from his 25 per cent global aluminium and steel tariffs. That would be self-defeating for a medium-sized commodity-exporting economy at the foot of Asia.

But there is more to come, including Trump tariffs on beef and pharmaceutical imports. And, from April 2, the big one of global “reciprocal” tariffs.

Trump’s new global disorder will require Australia to compete more sharply. If the election campaign does not recognise this, the next government will lack the mandate needed to deal with the world in which we live.

Here is the link:

https://www.afr.com/policy/economy/australia-is-trying-to-pretend-the-world-hasn-t-changed-20250311-p5lil1

All I can say is that we look to be in for a pretty rocky ride while ever Trump is in the White House so we need to get used to living “on the edge”!

We would do well to watch Mark Carney in Canada and learn what we can from him as he also manages Trump.

Stand by for fireworks and instability!

David.

Australia Needs To Get Out From Under The US Hegemon And Its Warped Trumpian Strategies And World View!

There is a better way!

CANZUK: An idea whose time has come

Daniel Hannan

Mar 16, 2025 – 9.39am

Within hours of Britain’s declaration of war on September 3, 1939, Michael Joseph Savage, New Zealand’s first Labour prime minister, made a statement from his hospital bed (he was to die seven months later).

“Both with gratitude for the past and confidence in the future, we range ourselves without fear beside Britain. Where she goes, we go. Where she stands, we stand.”

With how many nations does the UK have such a bond, an alliance so instinctive and automatic that it needs no explanation? The list is a short one, but it surely includes the three countries with whom we truly do have a special relationship, namely Australia, Canada and New Zealand.

We are linked by language, culture and kinship. We share a legal system, drawing on one another’s precedents. We have similar parliamentary forms, complete with maces, state openings, green benches, the works. We salute the same king.

The modern campaign to knit the four chief realms into a closer association was launched in British Columbia in 2015, and goes under the acronym CANZUK, a term first coined by UN officials because the four nations almost always voted en bloc.

CANZUK campaigners want closer diplomatic and defence collaboration, an automatic right to work in each other’s countries and a common market based on mutual recognition of standards in goods, services and professional qualifications.

For a decade, CANZUK was treated by politicians as a worthy idea, but not an urgent one. Then came the second Trump term, the tariff wars and the upending of US foreign policy. Both main Canadian parties have warmed to a CANZUK-type deal, as have all three coalition parties in New Zealand. In Britain, too, the idea is gaining in popularity. And you can see why.

To grasp the extent to which the world has tilted on its axis, try the following thought experiment. Suppose that Donald Trump was secretly working for Vladimir Putin. What would he be doing differently?

It is one thing to halt weapons shipments to Ukraine, including those batches already in transit, and to cut off intelligence sharing. But Trump is going well beyond such measures. He has repeated Putin’s propaganda claims, calling Volodymyr Zelensky a dictator and accusing him of having started the war. He has told his cybersecurity agency to deprioritise the threat from Russia. He has relieved pro-Ukrainian US generals of their commands. He has voted in the UN with Russia, Belarus and North Korea against a motion condemning the invasion of Ukraine from which even China abstained.

Most seriously, he has picked fights with NATO countries, threatening to annex Greenland and is waging economic war against Canada.

The leaders of the other Anglosphere democracies have been left stranded, like governors of outlying Roman provinces when the Eternal City was sacked. Consider, if nothing else, the impact on Britain’s defence procurement.

Since the 1950s, Britain has assumed that, in a big war, we would be fighting alongside our American allies. Yes, we could manage smaller wars on our own: Aden, the Falklands, Sierra Leone. But, if things turned truly nasty, we’d be in a US-led coalition.

Like other Western allies, we therefore specialised rather than developing full-spectrum defence capacity. We relied on the US for heavy lift, advanced satellites and intelligence. More seriously, we depended on it for the development and maintenance of our nuclear missiles.

Our current deterrent, Trident II, will last until 2040. And then? Can we be sure that the US will be a dependable ally? I think it likely; but, after the past two months, I can no longer be certain.

What of Europe? Again, I like to think that we will still be on the same side – the side of freedom and democracy – but it was not long ago that the EU planned to close the Irish border out of pique because our vaccine roll-out had been faster than its own.

In the run-up to Brexit, Jeremy Hunt, as foreign secretary, was astonished to find that Britain’s investment in the defence of Europe – armoured regiments in Estonia and Poland, the RAF effectively acting as Romania’s air force and much else – generated no bankable goodwill. Even now, when you might think the EU would be falling over itself to draw Britain into a closer defence arrangement, it sticks doggedly to the position that it won’t talk to us about anything else until we give its vessels the right to fish in our waters.

No, there is only one set of countries with whom it is unthinkable that we would fall out 40 years from now: the other CANZUK nations. This matters, among other things, because we need to make decisions soon about our next-generation deterrent.

If we decide to build a fully autonomous nuclear capability – one that needs no US storage or spare parts, like France’s – we will need our own rocket-making capacity. That will cost around twice as much as buying the off-the-shelf US alternative. On our own, we couldn’t afford it; as part of a CANZUK consortium, we could.

CANZUK has consistently polled at around two-thirds support in the four putative constituent nations, making it by far the most popular policy that governments could feasibly implement but haven’t.

Why haven’t they? Partly because enthusiasm, until recently, came largely from parties of the right: Conservatives in the UK and Canada, Liberals in Australia, and all three right-wing parties (National, New Zealand First and ACT) in New Zealand.

Some leftists reflexively opposed anything that looked like imperial nostalgia or, worse, a pining for the White Commonwealth (though, in reality, all four nations have larger non-white populations, proportionately, than the EU has). In Britain, Euro-nostalgics were upset to see Leavers proposing free movement with distant countries, on grounds that British people could more easily imagine themselves working in Australia or Canada than Finland or Slovakia.

But all that was before Trump began menacing Canada with annexation – and, indeed, roughing up other US allies. When Australia signed its trade agreement with the US in 2005, it specifically exempted its steel exports from any tariffs decreed in the name of national security. Trump has imposed them anyway.

Suddenly, CANZUK is beginning to look both inevitable and urgent. At Canada’s Liberal leadership debate last month, the candidates were falling over each other to demand closer economic links with the other great English-speaking monarchies – despite it being the French-language debate.

When I suggested CANZUK in the House of Lords this week, the level-headed minister, Baroness Chapman, replied that the government would listen sympathetically to any proposal.

I don’t, from first principles, prefer a CANZUK pact to a US-led one. I would rather keep the US-UK Mutual Defence Agreement, NATO, AUKUS and all the rest of the apparatus we have built since the 1941 Atlantic Charter. I am delighted to see New Zealand, under its impressive defence minister Judith Collins, lining up with AUKUS.

If the American alliance can be salvaged, CANZUK will complement it. But if not, it is a comfortable fall-back, constituting, as it would, the third most powerful military force on the planet.

How quickly can we put it in place? Well, October of next year is the centenary of the 1926 Imperial Conference which began the formal transformation of the British Empire into a voluntary association, a Commonwealth.

As King George V hosted his various premiers on that occasion, so his great-grandson, Charles III, should invite the prime ministers of his four chief realms – who by then, with a bit of luck, might include Peter Dutton in Australia and Pierre Poilievre in Canada as well as Christopher Luxon in New Zealand. That meeting should announce the formal creation of a CANZUK secretariat, based, for time-zone reasons, in Vancouver, and tasked with ensuring free movement of labour, market reciprocity and a common defence among the four kindred nations.

It would give every participating premier a massive electoral boost. And you know what? If Sir Keir Starmer can pull it off, he’ll deserve it.

Daniel Hannan is a former Conservative MEP, a House of Lords member and a founder of Vote Leave.

Here is the link:

https://www.afr.com/politics/federal/canzuk-an-idea-whose-time-has-come-20250316-p5ljw2

I could not agree more. The Trumpian experiment has failed and we need to get out from under.

I sure do not want to be led by a nation which has a man with the morals of an alley-cat as its leader. We are a good deal better than that, and we should takes steps to maximize our distance until such time as more sensible rulers emerge in the US. JD Vance is equally repugnant IMVHO….

We have our own values and interests and should follow them! Let the Americans fester until they can put true decent American values back into action and kick these bounders out!

David.

This Is An Epidemic We Have Brought on Ourselves. Silly Us!

This very alarming article appeared last week:

Our children are rapidly losing their sight. What can be done?

The sudden rise of short-sightedness worldwide, particularly among kids, has experts alarmed and rushing for answers before a myopia epidemic takes hold.

Richard Godwin

The global myopia rate tripled between 1990 and 2023. Why?

12:00 AM March 15, 2025

The Weekend Australian Magazine

Every morning – shortly after checking my phone and shortly before brushing my teeth – I pull down my lower eyelids in turn and smush a contact lens on to each of my eyeballs. I’m pretty good at this by now and can do it without a mirror. After a heartbreaking diagnosis when I was 12 – and a genuinely tragic first pair of glasses – my vision declined throughout my teenage years, finally stabilising at -4.5 dioptres, which means that objects come into focus at 22.22cm (ie one metre divided by 4.5) in front of my face.

My eyeballs are the wrong shape. They grew into eggs instead of perfect spheres. My increased axial length – that’s the distance from my corneas in the front to my retinas at the back – means that objects come into focus in the wrong place. Without contacts or glasses, everything is underwater.

Like most of my fellow myopes (shortsighted people), I have come to view this as a mild hindrance but a manageable one. It hadn’t occurred to me until I began speaking to the world’s leading myopia experts that I suffer from a disease. Least of all a preventable ­disease. Least of all a disease that if left to spread at its current rate will result in millions of people going blind.

It sounds alarmist and yet when you look at the numbers, alarm feels appropriate. Necessary, even. The global myopia rate tripled between 1990 and 2023, according to a recent study in the British Journal of Ophthalmology. The World Health Organisation predicts that by 2050, half of the world will need glasses and 10 per cent will be high myopic (a -6 dioptre prescription or higher), which carries severe risks of complications and even blindness.

“Myopia should absolutely be viewed less as an inconvenience and should take its proper place as a disease,” says Dr Donald Mutti, professor in optometry at Ohio State University.

“Not all myopic eyes have the pathologies that threaten vision,” he explains. “But it’s ­absolutely the case that myopia increases risk for ocular disease.”

Ocular diseases include cataracts, glaucoma, and the two that cause the experts most concern. One is retinal detachment, which is when vitreous fluid – the jelly inside your eyeballs – begins to leak and pushes the retina away at the back, “a bit like a bubble in wallpaper” as a leaflet from Moorfields Eye Hospital in London helpfully puts it. Moorfields has been handing out a lot of such leaflets recently. Amid a ­“substantial” increase in retinal detachment surgery, the hospital recently reported a sharp increase in the proportion of myopes undergoing the treatment, with the steepest rise among younger patients.

“If your retina detaches, you lose vision,” ­explains Dr Annegret Dahlmann-Noor, the ophthalmologist who led the Moorfields study. “It starts in the periphery and moves towards the centre and if it gets to the point where it affects your central vision, then usually recovery is not complete. We’ve seen teenagers and people in their early ­twenties present with retinal detachments. It’s a trend we can see.”

The other condition that “really destroys” your vision, as she puts it, is macular degeneration. This is now the leading cause of blindness in working age people in China, explains Dr Jan Roelof Polling, who is part of the myopia working group at the Erasmus University Medical Centre in Rotterdam. “As your eyeballs grow longer, it puts the tissues under strain,” he says. “The stretching is OK when you’re young. But when you’re older you lose collagen – and there’s lots of collagen in the eye. So now the eye is stretched but it has holes in it.”

Again, this is a condition that once mainly affected older people but is now hitting ever-younger patients. Unlike retinal detachment, there’s not a lot that can be done about it. “You can have injections into the eyeball to take the bleed away but that’s about it,” says Polling. “One third of all high myopes develop myopic macular degeneration, which almost always ­results in visual impairment or blindness.”

One third of all “high myopes” … if you scale that up you begin to see the cause for alarm. The world population is expected to be 10 billion by 2050. One-tenth of that is one billion; one-third of that is 333 million. That’s a USA of blindness.

“That’s why we’re starting to worry now,” says Polling. “You only have to look at China, where 80-90 per cent of people have myopia and a significant proportion become blind or visually impaired within their working careers. It’s a huge worry and a huge expense for families. This will become a much bigger problem.”

At this point, you’re probably wondering why. Why has the world’s eyesight deteriorated so badly? The current estimate is that 15-20 per cent of British teenagers are myopic, but our data gathering isn’t nearly as good as it is in East Asia and Singapore, where this is already recognised as a dire catastrophe. In Singapore, the “myopia capital of the world”, around 80 per cent of adults are myopic. In Seoul, South Korea, the condition affects 96.5 per cent of 19-year-old males.

This is where we are heading, stresses Dahlmann-Noor. “We analysed hundreds of data sets last year. We used to have a rigid algorithm to find out what the underlying problem was when a five-year-old already had myopia. We would do our diagnostic tests and we would ­reliably be able to find something wrong – ­genetically, metabolically, whatever.

“Now? If we do the same tests as before, we find children with myopia who don’t have a thing wrong with them. They only have myopia. So there is a trend for the onset of myopia to be earlier. And there is a trend for children with simple myopia coming into our NHS [National Health Service] clinics at an earlier age.”

There is a strong genetic component to ­myopia. If both of your parents need glasses, you probably will too; rates of myopia are also higher in certain Asian and Afro-Caribbean populations than in white people. Still, none of this explains the rapid increase in recent years. It isn’t the gene pool that has changed, says Dahlmann-Noor: “What has changed very ­dramatically are our lifestyles.”

There are two factors of particular concern. One is that children are not spending nearly as much time in daylight as they need to. Daylight is thought to stimulate the release of dopamine in the retina, which inhibits eyeball growth. Given that we evolved as an outdoor species but now spend around 90 per cent of our lives indoors, the idea that our eyes are struggling to cope with our low-light interiors isn’t so ­surprising. The other factor is that children are spending too long engaged in “near-work”, i.e. concentrating on things too close to their face and thus squeezing their eyeballs into the wrong shape from an early age.

Since myopia develops while the eyeball is still growing, the crucial window is in childhood. Hence the standard advice for children is known as the 20/20/2 rule: for every 20 minutes of near-work, spend 20 seconds focusing on something in the distance; and most importantly, spend two hours outside each day. Also, go and get your eyes tested.

So, environment plays a crucial role. Much of the blame for the shockingly high rates of myopia in East Asia (notably in urban areas) seems to come down to the highly competitive education system. East Asian children start school earlier in life, work longer days, receive far more homework, and spend very little time outdoors. Similarly, in Singapore, children spend as little as half an hour a day outside.

One of the few East Asian countries to have seen a decline in myopia rates in recent years is Taiwan, which in 2010 introduced a policy known as Tian-Tian 120, which encourages schools to incorporate 120 minutes of time outdoors into their daily schedules.

You would think that “less homework, morebreaks” is a message that most schoolchildren could get behind. But it’s not solely schoolwork that’s to blame – children’s leisure time has shifted too. China also tops the global chart of hours spent playing video games each week (12.4 hours on average, compared to the UK’s 7.2). And one of the things that Polling has noticed from studying Dutch teenagers is that it’s no longer principally the academic children who need glasses – it’s everyone. “There has long been an association with education and myopia,” he says. “It used to be that the kids with glasses were the ones who went on to study at university – and the kids who played soccer stayed without glasses. That’s changed with people born after 2000. Everyone is on their phone now.”

Dahlmann-Noor is reluctant to draw conclusions before the link between early eyeball development and devices has been more rigorously researched. However, she does stress that if children only had access to phones when they were 16 or 17, the effects on their eyesight wouldn’t be nearly as bad. “That’s when the eyeball has reached its final state. But I have families coming into the consultation rooms who clip a smartphone on to their child’s ­pushchair and have Peppa Pig running. Why does a one-year-old need to have Peppa Pig on a smartphone? But these things have invaded everyone’s private space and we don’t even ­notice them any more.”

We are by now fairly used to the idea that phones have made a generation of teenagers anxious, depressed, sleep-deprived, narcissistic, susceptible to terrible influencers – and the rest. US social psychologist Jonathan Haidt lays out the evidence in grim detail in his bestseller The Anxious Generation, and if you’re on any parental WhatsApp groups you’ll be aware of his thesis: the wide adoption of the smartphone since 2010 plus a gradual erosion of unstructured outdoor play has prompted a teenage mental health catastrophe, resulting in higher rates of suicide and self-harm, particularly among teenage girls. Nonetheless, the idea that these same forces might literally be destroying our children’s ability to see things clearly – might even eventually blind them – is not one that I’ve seen discussed, even in the most tech-phobic parental forums. And yet: one Danish study found double the risk of myopia in 16- to 17-year-olds who used electronic devices for more than six hours a day. Chinese studies have correlated axial length with time spent on both computers and phones and found that yes, there is a link.

It should be stressed, however, that experts are cautious about pushing the thesis too hard. Dahlmann-Noor points out that the myopia trend long predates smartphones. Concentrating on anything close to your face can be bad for your eyesight. Your child could be copying out The Book of Common Prayer, she could be performing a mindful colouring exercise, she could be playing Tetris on a Game Boy in 1992 or she could be doomscrolling TikTok. The eyeball would be under the same strain.

Moreover, it’s generally agreed that near-work is secondary to time outdoors as a determining factor. “If you’re looking at school-age kids from six or seven or so, we have not found that near-work has the influence that people often think it does,” says Mutti. “It just doesn’t show up as that significant a factor in cohort or longitudinal studies.”

Mutti has been collecting data on ­behavioural patterns and myopia since 1989 and is convinced that time outdoors is the ­significant factor. “It’s pretty clear that kids are spending less time outdoors than they used to,” he says. “When I was a kid, my mum would ­encourage us to get out of the house: ‘Come back when it’s dinner time’. But indoors is just a lot more entertaining than it used to be. And parents have more concerns about unsupervised kids running wild on the streets.”

Many of these are perfectly rational, I’d add. I’d love my children to play outside more. But my immediate urban environment is designed for cars, not children. There are few activities for children to safely do outdoors that don’t ­require parental supervision and/or cash.

And it’s not as if time spent on screens and time spent outdoors are unrelated. If my eldest is playing football with his mates, he is, perforce, not playing Roblox. If my youngest is watching Bluey while I get some work done, this is almost certainly happening indoors. And it’s the youngest I should be most worried about, says Mutti. Even as a “near-work ­sceptic”, he is extremely concerned about the effect of screens on the very young. “To me, the preponderance of evidence is not in favour of near-work being so important in school-age kids,” he says. “But could near-work influence a young child’s eyes? A preschooler’s eyes? That’s a valuable question to ask. In my ­research on refractive development, there are strong effects of near-focusing on the ­development of infants’ eyes – maybe into the toddler years.”

He demonstrates this to his students with balloons. “The focusing muscles act as a ­mechanical force, tensing force at the front of the eye. If you put a squeeze around the balloon in the front, it elongates at the back. So it’s not hard to see how near-focusing could change the shape of an infant’s eye. That makes me very concerned about how toddlers are spending their time.”

And here is an “absolute difference” brought on by technology. “You no longer have to be able to read to be an intense near-worker as a toddler,” he says. “If you watch small children, they love their iPads. They’re very adept at swiping and scrolling and finding their next video even at age two. I’m concerned about the intense use of electronic devices among toddlers.”

Polling adds that just because it’s harder to find a direct link between myopia and screens, it doesn’t mean it doesn’t exist. “It’s relatively straightforward to measure light exposure or even simply how much time a child is outside. It’s much harder to measure focal distance.”

But either way, it hardly seems surprising that myopia rates rapidly accelerated during the Covid-19 pandemic, during which children were both locked up indoors and forced to look at screens. Neither I nor my 11-year-old have forgotten the torture of his Year 1 Zoom lessons. Indeed, the pandemic period of 2020 to 2023 saw a “notable” increase in myopia rates. One recent Scottish study found a 42 per cent rise in the incidence of myopia. And a recent study in Hong Kong found that myopia rates in six to eight-year-olds had doubled during the Covid-19 pandemic: 25 per cent of six-year-olds and 46 per cent of eight-year-olds were myopic.

It’s worth stressing again that the earlier ­myopia presents itself, the worse it will be. “It’s difficult because you don’t see immediate ­effects,” says Polling. “You need a lot of ­exposure from a very young age and then, at the age of eight, you finally become myopic.” Some parents with mild myopia aren’t too ­concerned if their child is diagnosed with a similar prescription, he says. But if you’re -3D at eight you are basically certain to be -6D or above at 18. And macular degeneration might arrive in your forties or fifties. “These windows are precious and fleeting,” says Polling. “If we can delay the onset of myopia until 12 instead of 10, that’s a huge difference.”

What’s interesting – OK, what’s maddening – is that when you bring this sort of thing up with parents, they will often treat screens as a symptom of myopia as opposed to a cause. As in: “Oh yes, I’ve noticed that Rosa always holds the phone up close to her face when she’s watching cartoons in bed.” Here is an account from an online myopia community from a ­parent panicking about the results of their three-year-old’s first eye examination: “He would watch TV up close (but most kids seem to) and also watch the phone up close with his head tilted to one eye …” It’s almost as if we ­accept it as inevitable. A bit of genetic bad luck. As opposed to a situation we might ­actually do something about.

The difficulty for ophthalmologists comes with framing a condition that will be perfectly manageable for most people and may not present any complications as a matter of urgency until decades down the line. The costs involved in requiring contact lenses might focus minds. As might the risks. A few years ago, I contracted acute keratitis from dirty contact lenses. This is an infection of the cornea that can lead to blindness – and honestly, the pain was ­unbelievable. It was like having sandpaper and chilli alternately rubbed into my right eye and the cure was almost as torturous. I had to apply eye drops every 30 minutes for 48 hours. I have been scrupulous about contact lens hygiene ever since.

But that’s the thing about eyes. You take them for granted until you don’t. “I speak to people who have macular degeneration in their forties and fifties,” says Dahlmann-Noor. “They are incredibly bitter. They say, ‘I just wish someone had warned me that this was on the cards’.” It’s certainly enough to be a serious long-term worry for the NHS.

Still, Dahlmann-Noor expresses some optimism. “For all my life, there was nothing you could do about the growth of the eyeball,” she says. “You’d go and have your eyes measured, you’d get your new glasses, and that was it. But now myopia has become such a problem that there has been a lot of research and there are ­finally treatments.”

It is not possible to stop or reverse the onset of myopia. But it is possible to slow it down. Corrective glasses and contact lenses work by creating a second image shell in front of the retina, which pulls the image forward and counteracts the elongation of the eyeball. These have been shown to slow the progression of myopia by 40-50 per cent.

Then there are atropine eye drops, which are already widely prescribed in Asia (sometimes to pre-myopic infants) and are likely to become available in the UK this year.

There are factors that are beyond the control of medics. “These Big Tech companies need to start taking care of kids’ health,” says Polling. “They need to make their apps less addictive. And to warn parents not to give children phones before the age of six, and keep them to a minimum after that.”

Given the extreme indifference tech ­companies have so far displayed towards the welfare of children, you’d have to say they are extremely unlikely to do that without being ­legally obliged to do so. “Now, I’m sorry, that’s not very optimistic!” he laughs.

“But there is something children can do,” he stresses. “Just play outdoors.”

I suspect that would do most of us adults some good too.

Here is the link:

https://www.theaustralian.com.au/weekend-australian-magazine/our-children-are-rapidly-losing-their-sight-what-can-be-done/news-story/83b93c845b07f3404f5fd775c7743070

We need to get these little mites out and in the broad daylight for a decent spell each day,

Just how that fits with school, music and so on I have no idea but they need to get out there somehow! 

I suspect the harm is done after 15 or so but before then its all hands to the pumps of glasses by the time 15 rolls around!

David.

It’s Wonderful To Read A Real Expert When They Show Us What A Mess We Are In.

This revelatory article appeared last week:

We wasted a $400b windfall, and now we’ll all have to pay

An audit of federal finances finds Australia has never seen rivers of gold like this, but the hangover will be brutal.

Chris Richardson Economist

Mar 16, 2025 – 12.59pm

Paul Keating famously declared that you change the country when you change the government. Yet, while that might have been true when he fought Fightback! a third of a century ago, these days elections are solely about style rather than substance: our politicians stopped challenging us decades ago.

Our oppositions complain loudly but only pretend to oppose, essentially adopting the policies of the government of the day and relying on its unpopularity to win power.

The proof? Follow the money. Although dollars aren’t a perfect yardstick of policy differences, they are an arms’ length one. Australia has budgeted $6 trillion across the next four years: half as spending going out, and the other half as taxes coming in.

Yet, with big-ticket items such as nuclear power plants and extra fighter jets sitting mostly some years away, the difference between government and opposition policies in this election will be comfortably less than 1 per cent of the amounts we’re set to tax and to spend in the next four years.

And yes, that’s typical. For decades now our oppositions have promised their taxing and spending to be more than 99 per cent matching those of the government they’re campaigning to replace.

In the election campaign both sides are therefore promising Australians that they’ll remain mediocre.

I believe them, and you should too. This article spells out why.

Our national social compact

We tax workers and businesses so we can spend that money – more than a quarter of all national income – on the young, the old, the sick, the poor and a defence force.

That makes the federal budget our national social compact. It’s marvellous when we get it right, disastrous when we get it wrong.

The good news is there’s lots to like about our Australian federal finances: debts and deficits here are a fraction of those in many nations.

The bad news is we’ve done well thanks to luck rather than good management. And the worse news is that, despite the luck that’s come our way, our social compact isn’t delivering prosperity: Australian living standards stood still over the past decade.

What’s that about luck?

Budgets move because of two things – the decisions of politicians, and “everything else”. The latter category – luck – often plays a bigger role than policy.

And recent times saw our biggest ever surge of budgetary luck. Wars pushed up the price of what Australia sells to the world, and we got tax windfalls from that. Many migrants meant more people to tax. And inflation took money from families and handed it to the taxman.

Politicians who live through a phase of budgetary luck tend to claim that their budgetary success was due to their superb management. Yes, Peter Costello, I’m looking at you.

Yet the windfalls of the current government dwarf those Costello benefited from. And as the noted budget economist Cyndi Lauper points out, Money changes everything.

The government’s own figures estimate that, since its election, revenue revisions dropped an extra $85 billion into the taxman’s pocket in 2022-23, followed by another $102 billion last year.

Adding my own estimates of yet more luck of late (including commodity price strength and a weaker Aussie dollar), that windfall eases to a still remarkable $89 billion next year and $85 billion the year after.

Remember, those revisions weren’t due to any policy change by any politician. Rather, they came via the combined impact of war and migration adding to the size of the pie we tax, plus inflation giving the taxman a bigger slice of that pie.

That surge in luck is unprecedented. Last year’s windfall more than paid for nine of the 20 largest federal programs – more than all of the cost of unemployment benefits, plus childcare subsidies, the capabilities of each of the army, navy and air force, federal subsidies to state schools, as well as our support for carers, fuel tax credits, plus spending on public sector superannuation.

Please read that last sentence again. And marvel. Australia has never seen rivers of gold like this. Never. Yet although luck’s a fortune, it isn’t a strategy. The glory years of luck are fading, and the challenges are rising.

The key challenge is that we took our luck to town. Spending was 24.4 per cent of national income in 2022-23, but it’ll be 27.2 per cent next year. That’s the fastest and largest increase in the size of the federal government since Whitlam’s expansion half a century ago.

Luckily, that lurch coincided with our luck, so we still saw surpluses. Yet luck is temporary, whereas the promises we’re making to ourselves are permanent.

Why has spending gone up so much?

The government didn’t plan to drive a major expansion in the size of government. Yet that’s what’s happened.

The key driver wasn’t pre-election promises. It was Australia’s fight against inflation.

The Reserve Bank’s famous “narrow path” saw them reduce inflation with a much smaller increase in the ranks of the unemployed than earlier such fights. But the winners in a slow fight against inflation – those who don’t become unemployed – don’t realise their good fortune. So they don’t thank either the government or the RBA.

Yet a slow fight against inflation is one in which wage earners and borrowers and taxpayers all lose out for longer. And they sure as hell know they’re hurting.

Although overall living standards in Australia have stood still for a decade, that hides the recent pump-and-dump. Living standards were making modest progress before hitting an artificial peak as the then government handed us money during COVID.

As of today, however, they’re down 9.9 per cent from that peak. That’s why polls have narrowed and the punters are cranky: with its small number of ungrateful winners and its many losers (wage earners, borrowers and taxpayers), the RBA’s fight against inflation was an economic success but a political minefield.

No wonder, then, that state and federal governments have spent a fortune. And the federal surplus made it harder to ignore those insistent calls for more spending – after all, the punters could see that they didn’t have money, so how come the government wouldn’t hand over its surplus?

What next?

But you needn’t worry: the government is promising to go on a diet in the next three years, with its spending growing just 1.8 per cent faster than inflation. Even better, federal spending in a decade is promised to be a smaller share of national income than next year.

Phew ... Except there’s no actual details of that diet. Worse still, those official forecasts of a diet pre-dated the phoney war election campaign now under way, where the pace of new promises has accelerated towards an extra half a billion dollars of spending every single day.

So we’re promising to go on an unspecified diet while busily still stuffing our face with Doritos.

A promise to spend is a promise to tax

Even those vague promises of a switch to a harsh spending diet aren’t enough to generate official projections of an eventual narrowing in deficits. To get back close to a balanced budget in a decade, the official forecasts also have to assume the tax take reaches its highest recorded share of national income.

Yes, you read that right: the official figures say the tax take will leap, and they do so by assuming there won’t be another personal tax cut in the next decade. That means bracket creep will get decidedly creepy, with average full-time wages busting into the 37 cent tax bracket halfway through the coming decade.

Mistakes – we’ve made a few

Can we do better? You bet. Much of our spending is stupid, much of our taxing is terrible.

Let’s start with the WA GST deal. The federal budget tries to deliver fairness across states, but the WA GST deal works to neatly undo those, meaning we spend $5 billion a year to worsen fairness.

And while there may be dumber things you could do with taxpayer money, they’d probably involve smoking $100 notes.

Or what about the NDIS? It should be a triumph of targeted support for those who need it, but it was littered with poor incentives from the get go. The upshot is that one in every seven (14.2 per cent) boys aged six in this nation are in the NDIS, and 69 per cent of those entering it are aged under 15.

To its credit, the current government – having blocked the modest reform efforts of the previous government – realised the need for change. But although Australia needed leadership, most of what we got was creative accounting: moves that pushed more NDIS costs on to the states and set up a new scheme specifically for kids.

Yet that came at the cost of further bribes to the states, reducing federal NDIS spending but at the cost of raising a bunch of other federal spending.

Or how about student debt? The government recently announced some good changes, but threw in a $20 billion clanger – forgiving student debt.

Why is that bad? Because students end up earning more than the average, meaning that forgiving student debt means lower taxes on those who’ll eventually be better off. That comes at the cost of everyone, including those who aren’t well off.

Worse still, our budget accounting standards are so broken that, because student debt is off budget, that debt forgiveness magically costs nothing in terms of bigger deficits.

I could go on. Whyalla … why? Or fossil fuel subsidies masquerading as electricity cost-of-living relief. Also why? Or bulk billing incentives that put three dollars in the pockets of doctors for every dollar they put in the pocket of patients. (You’d have a bigger impact on our health – and definitely on fairness – if we followed the recommendations of the Economic Inclusion Committee.)

And tax? I’m sad you asked

Australia may be a first-world nation, but we increasingly have a third-rate tax system. It last got a spit and polish a quarter of a century ago, with the subsequent neglect leaving it ever more reliant on a handful of increasingly damaging taxes.

In the meantime, we’ve built a system with:

• Superannuation taxes that raise next to nothing (less than the sector takes in fees) while busily shovelling money from poorer Australians to richer Australians.
• Taxes on our gasfields that also raise next to nothing – we built that tax with oilfields in mind, and it’s been an epic disaster when applied to gasfields.
• A fringe benefits tax that began as a force for good but is now so riddled with loopholes that it has become a force for evil.
• A levy on banks that massively undercharges them for their “too big to fail” insurance.
• Perhaps most spectacularly, we raised cigarette taxes through the roof, but didn’t match that with better enforcement. That blew a huge hole in the tax take, while simultaneously making smoking cheaper for most Australians and underwriting the rise of the most lucrative (and least risky) market that organised crime in this nation has ever had.

This isn’t the Deep State. It’s the Dumb State.

Then there are the taxes we don’t have but should, including everything from a carbon tax through to a wealth tax. Hate me.

And the poster child for tax reform in the current election campaign? If you wait two years, a pint in a pub will cost five cents less than otherwise. Here’s cheers to that shattering reform …

A more dangerous world is a more expensive world

As Lenin said, “There are decades where nothing happens; and there are weeks where decades happen”.

Recent weeks saw decades happen, as the Trump administration beat a retreat from the world stage rivalling that of Milli Vanilli.

Key nations are now run by old men with big agendas and poor impulse control. And, like it or not, that says Australia will need to spend more on defence. Worse still, the reliability of the US as a defence supplier also took a hit in recent weeks, as Ukraine can attest.

That backdrop says a whole bunch of budget trends are not our friend:

• We’ve wasted a blinding burst of budgetary luck, making permanent promises to ourselves off the back of temporary gains, generating a worsening structural budget deficit;
• That’s left our budget absolutely covered in barnacles – terrible taxing meets stupid spending;
• Yet a bunch of expensive challenges are rising fast, not least on the geopolitical stage; while
• There’s a looming hung parliament, suggesting we will struggle as a nation to take the rapid and decisive action we need.

Poor fellow my country.

Here is the link:

https://www.afr.com/policy/economy/we-wasted-a-400b-windfall-and-now-we-ll-all-have-to-pay-20250314-p5ljjv

This really is a terrifying condemnation of Governmental waste and a total real lack on insight on just how things work!

This litany of errors and mistakes identified here is both epic and shameful. There is great and penetrating insight here!!!

I will follow up Mr Richardson’s finale with one of my own…

“God help us all”!

David.

I Feel This Is A Topic We Need To Think About Every Few Years….

This appeared last week and reminded me of the importance of having a thought through view on the topic:

‘We’re going to talk about death today – your death’: a doctor on what it’s like to end a life rather than extend one

I used to focus on maternity and newborn care, but when Canada legalised assisted dying in 2016, I began helping people with a different transition

By Dr Stefanie Green

Sat 15 Mar 2025 22.00 AEDT

The patient referral comes through my reliable old fax machine on a single sheet of paper. “Thanks for seeing this 74-year-old gentleman with end-stage liver failure. He’s been following the news carefully and is eager to make a request for an assisted death. I hear you’ll be providing this service here in Victoria – courageous! I look forward to your assessment. Summary of his file is below.” I read it twice to myself before sharing it with Karen, my office manager. We look at each other for a short moment before I break the silence. “His name is Harvey. I’m going to need a chart.”

While Karen makes a chart for Harvey – demographics on the front sheet, blank request forms in the back – I dial his number. His wife, Norma, answers. As Harvey isn’t mobile, I agree to meet them at their home.

Three days later, I stand in my bathroom brushing my teeth and practising what I will say, the tone I want to set. If Harvey meets all the criteria, he will be the first patient to whom I will offer medical assistance in dying (MAiD), following its legalisation in Canada just a few days earlier, in June 2016.

At the time I had been practising medicine for more than 20 years, trained as a family physician, and focused on maternity and newborn care, preparing women and their families for the profound transition a new baby would bring to their lives. But when it became clear the law was about to change to allow MAiD, I changed course with it, learning everything I could about this newly emerging field so that I could support people with their final wishes and their transition at the other end of life.

When I arrive at Harvey’s home for the assessment, a man in his 70s with a bushy grey moustache opens the door and smiles sadly as he extends his hand. “Hi, thanks for coming. I’m Rod, Harvey’s brother-in-law.”

I cross the threshold and am ushered upstairs, where I see a man in a bathrobe and a woman sitting close together on a couch. “Hello, Doctor, thank you for coming,” she says, smiling. “I’m Norma.” Her hands fidgeting, she appears slightly nervous, or maybe just awkward. I recognise the same feeling within myself.

Dressed in grey pyjamas and covered with a warm blanket, Harvey looks years older than Norma. I notice his protuberant, fluid-filled abdomen and papery, yellowed skin, signs that his liver failure is advanced. I see his frail hands and gaunt, unshaved face. He likely has only weeks left to live.

“Good to meet you,” I say as I give his hand a squeeze. It is cool and bony, mottled with purple, and has little musculature left, but he holds on a little tighter and just a moment longer than I expect, slowly shifting his gaze to look me straight in the eye before letting go. I sit down in front of Harvey and ready myself to begin what I have been practising all morning. “I’d like to start by breaking the first rule of medical school.”

Harvey musters a sly grin, intrigued, but doesn’t say anything, which I take as an invitation to continue.

“In medical school, they taught me that when I meet a new patient, I should let them speak first … But I want to start by telling you something about myself. I want to tell you that I am pretty direct,” I say.

Harvey is egging me on with a slow, wobbly nod.

“We’re going to talk about death today, and we’re going to talk about dying,” I continue. “We’re going to talk about your death, and we’re going to talk about assisted dying. We’re also going to talk about what’s important to you. I’m going to talk about these things frankly. I’m not going to use euphemisms or talk about ‘passing over meadows’.” I pause and lower my voice, addressing Harvey directly. “You OK with that?”

I am relieved to see he is smiling. “Yes, that’s exactly what I hoped for,” he says. “No more bullshit.” His voice is a bit gravelly, but this last word comes out strong, emphatic. “We’re going to get along just fine,” he adds.

What to wear? All black seems morbid, bright colours too festive. I want to look professional but not cold, casual but no jeans

I get down to the essentials. “Why do you want to die?”

Harvey smirks. “I don’t! I’d rather live. I’ve had a great life. But it seems I no longer have much say in the matter.”

It’s my turn to nod.

“I’ve got great friends, great kids, we’re blessed with family all around us. I know I’m lucky. I’ve been married to this gal here for 52 years … ” He trails off, holds Norma’s hand, shakes it at me a bit and swallows some emotion before continuing. “I really wanted to make it to 52 years, and I did.” He’s quieter now, his energy already drained. “Now I’m ready.”

Harvey is straightforward with me. He knows he is dying, that it will not be long, but he wants to control the how and the when.

“I want Norma and the kids with me at the end,” he says with a flash of spirit, “here, in my home, in my own bedroom … I want to do it my way. I want to have my friends over this weekend, have one last bash, maybe even sneak a sip of a beer.” He smiles at the thought. “I’ve seen friends linger on at the end … in bed … out of their minds. I’m not interested in putting myself or my family through that.”

Harvey ticks every box of eligibility. He is capable of making his own decisions, he is making a voluntary request, and he has a grievous and irremediable condition. He will need to sign an official request form, and Norma assures me it will be completed by the end of the day, witnessed by two independent people. After that, a mandatory 10-day reflective period can begin. The law also requires a second clinical opinion, so I will call a local colleague to see if he is available.

The next few days are busy. As is expected with his liver failure, Harvey continues to decline cognitively. If he declines too much, too quickly, he won’t be able to give his final consent immediately before the procedure, which is required. Because the second doctor and I agree this risk is imminent, we are allowed to shorten the waiting period. Harvey chooses a date three days out.

True to his word, two days before his scheduled death, Harvey and Norma host an open house for friends and neighbours to celebrate his life and say goodbye. Meanwhile, I review all the practicalities and guidelines. I am keenly aware that if I get anything wrong, I could be liable for criminal charges. The words “up to 14 years in prison” keep flashing in the back of my mind. No one yet has a sense of the mood of the prosecutors. Are they waiting to meticulously comb through each case and make an example of a clinician who makes a mistake? I’m not willing to leave anything to chance. Harvey isn’t just my first assisted death. His is the first on Vancouver Island and among the first in Canada. I am aware that I need to get this right – for myself, for the MAiD programme but, most important, for Harvey.

---

It’s 16 June 2016, the day Harvey has chosen to die. This is all about him, but it’s momentous for everyone involved. This morning I stood in my bedroom, staring into my closet, considering choices and discarding them immediately. What does one wear to a scheduled death? All black seemed morbid, bright colours too festive. I wanted to look professional but not cold, casual but no jeans. How could this be the hardest part of my day? I’ll  be picking up the medication at 10am, I’m expected at Harvey’s by 11 and I suspect he’ll be dead before noon.

I pull up outside, close enough to have arrived, far enough that no one from inside can tell I’m here yet. I take a deep breath. In medical school, the saying was “see one, do one, teach one”. But in this case, there has been no way for me to “see one”. The law changed only a few days ago. I am about to take a big, blind step.

I leave the car and stride to the door. Once inside, I head upstairs. I catch Norma’s eye from across the room, but before I can get over to greet her, I meet Jessica, the nurse practitioner who will assist me, standing at the top of the stairs in her scrubs and stocking feet. All I can think of is that I do not want the family to suspect we have never actually met. I don’t want to do anything that might remind them I have never done this before.

There are eight close family members in the house. I ask to speak privately with Harvey for a few minutes and am told he’s in his bedroom, so I head there. Sitting in the chair by the bed, I begin, “How was your night?”

“It was what it was,” he replies. “I’m ready to go. I need this to be over today.”

The official purpose of this talk is for me to verify that Harvey is still clear of mind, that he still wishes to proceed and, if so, to obtain his final consent.

“Are you having any second thoughts?”

“No, none at all.”

Harvey reassures me that his affairs are all in order; his funeral plans have been made, the names of his lawyer and his accountant have been written out for the family. He expresses some concern about those he will be leaving behind. I try to reassure him I will provide them with some resources.

“Thank you for making this possible.”

I don’t recall who reached out first or when we began holding hands, but, once again, he is holding mine a little longer and a little tighter than expected.

“You know, I’m a little scared.”

“Of course you are … that’s OK.”

We talk, take the time we need. No one is in a rush.

“What do you think comes next, Dr Green?”

“I really don’t know, Harvey. What do you think?”

“I’m not a religious man, not even very spiritual. But I do not believe this is the end. It just can’t be.”

‘I join the family in the living room, explain the order of events, the number of syringes.’ Photograph: Rachel Pick/The Guardian

“OK. But what if it were, Harvey?” I ask. “What would you change, do differently?”

He continues to hold my hand. I hear his regrets – there are few – and of what he is most proud. I learn so much from Harvey. I am already grateful that he is my first MAiD patient.

At some point we both fall silent. I explain that I will go speak with his family about what to expect. By now I’ve reassured myself that he is still capable of making this choice. I hand him the required form and watch as he scratches out an unsteady version of his signature, then I join the family in the living room. I explain the order of events, the number of syringes – Harvey has chosen the intravenous option for his final medications – and the time for last words. I ask if there is any ritual or ceremony they’d like to incorporate, then I get down to the details. “The first medication is an anti-anxiety drug. It will make Harvey relax, feel pretty good, pretty sleepy. He’s already quite weak, so I expect he’ll fall quickly into a nice light sleep. We might hear him snore; that’s one way you’ll know he’s truly comfortable.”

I am trying to be as transparent and informative as I can.

“The second medication is a local anaesthetic to numb the vein. It may not be necessary if he is sleeping already, but some of the other medications can sting a bit, so I’ll use this to be sure he won’t feel any discomfort.”

I notice involuntary nodding from Harvey’s brother, his son. I recognise relief on Norma’s face and see blank stares on the others’ … the reality is starting to sink in.

“The third medication is the stuff we would normally give someone for an operation, except it’s a much larger dose. With this, Harvey will go into a much deeper sleep, down into a coma over the course of a couple minutes. If you’re looking carefully, you might notice his breathing begins to space out with this medication.”

I am using my hands now to gesture what is going to happen. “His breathing will become more shallow and will most likely stop.”

I am looking around, trying to judge reactions.

“Even though I expect Harvey will die with this third medication, I will go ahead and use the fourth in our protocol, which ensures there is no muscular movement in the body. I will let you know when his heart has stopped. This whole process is likely to last between eight and 10 minutes.” I lower my voice a little. “I do not expect you will see any gasping or twitching or anything unsettling. My goal is to make this as comfortable and as dignified as possible. But there is a real possibility his breathing will stop before his heart does. If that’s the case, you will likely see a paling of his face, maybe a bit of yellowing. His mouth might drop open slightly. His lips may turn a bit blue. If you find yourself uncomfortable at any time, please feel free to step back, sit down or step out. There is no medal for staying in the room. I will be focused on what I am doing, so I’ll need you to take care of yourselves in those few moments, if necessary. OK?”

Muted nods. A few people breathe out as if they hadn’t realised they were holding their breath.

“That’s the nuts and bolts of it. I expect it’s all feeling a bit real right now. Any questions?”

There’s a pregnant pause, then a previously quiet man in his mid-70s asks, “You got any extra of that anti-anxiety stuff, Doc? I could use a dose myself right now.”

Harvey’s wife tells him to let go. As on most nights of his life, hers are the last words he hears as he falls asleep

Back in Harvey’s room, he is calm, he is smiling, and he appears certain. His love for family has been evident from the start and they are all here with him now. We are huddled in closely around his bed. I ask if anyone has anything left unsaid. Harvey’s son reaches out from beside me and places his open palm directly on Harvey’s chest. He repeats that he loves Harvey and thanks him for being such a great dad. Harvey reminds them all that this is what he wants and asks them not to be sad.

I take hold of Harvey’s left arm. Only after he looks me in the eye and thanks me one last time do I think to begin. When I announce I will start, I sense Jessica reach out from behind me. I didn’t realise how tense I was until she put her hand on my back. I feel myself relax as I push the first medication through the syringe.

“Maybe now is a good time to think of a great memory,” I begin, “doing something you loved, with someone you loved … Go to that place now, feel that moment again … If you feel sleepy, go ahead and close your eyes, you’ve earned it. We’re all here with you.”

Then Harvey dies exactly as he wished: being held by his children and gazing into the eyes of his wife as he begins to feel sleepy. They connect, forehead to forehead, whispering to each other as I continue. She holds his face in her hands, strokes his head and tells him it’s OK. She tells him she loves him, that she will miss him, but that she is all right. She whispers inaudible words, evoking private memories, and he smiles. The intimacy of this moment is so absorbing that I struggle to focus on what I’m doing. She tells him to let go, that she is here with him, and as on most nights of his life, hers are the last words he hears as he falls asleep.

Harvey musters a light snore. Norma recognises the sound and dabs at her eyes. I continue with my protocol, and Harvey soon stops breathing; no one says anything, but I am certain we all take notice. I understand in that moment that I am witnessing this event as much as I am orchestrating it. I continue on to the final medication and immediately notice it doesn’t flow as smoothly as the others did. I have an instant of panic, wondering if my IV line is blocked, but it takes only a moment for me to understand it’s because Harvey’s blood is no longer circulating. I am certain his heart has stopped, but I continue nonetheless. Only after the last medication is delivered do I cap and lock the IV. Only after the empty syringes are resealed within the plastic container do I reach for my stethoscope. And only after I listen for a complete 60 seconds do I announce, “He’s gone.”

Only then do his family members allow themselves to be overcome by their loss. There are sobs, tight-clenched hugs and flowing tears. To my utter astonishment, there is also an immediate outpouring of gratitude for what I have just done, and for this, I’ll admit, I was unprepared.

---

By February 2017 I’d gone from being a beginner in a new field of medicine to feeling more certain of what I was doing. I was becoming known among local family practitioners and specialists for my work in assisted dying, and the number of referrals to my office continued to climb. The latest concerned a patient called Edna, whose worsening multiple system atrophy was affecting every aspect of her life. Two weeks earlier, her palliative care physician, Dr Vass, had been visiting when she’d asked him for MAiD by scratching out letters on a whiteboard. It was one week after her 77th birthday, just after she’d returned home from a hospitalisation, and she had repeated her plea several times since.

Edna managed a slight smile upon my arrival at her home a few days later, but her eyes seemed locked in a blank gaze. I noticed her frail body was strapped into her padded chair to stay upright. Before I even began, Edna was already scratching on the whiteboard. I waited for her to finish, three letters that said it all: “D-i-E”.

I was surprised and thankful she was still able to write. She looked up and I thought she was done. She uttered a sound I didn’t understand, then brought the marker down forcefully, drawing my attention to her message. “D-i-E P-L-S-!”

Request received.

Edna was close to her sister, Mindy, from whom I learned that Edna had been a pioneer for most of her life, one of only two women to graduate with a bachelor’s degree in biology from her college back in 1960. She taught high school science for two decades, did a few stints as the principal of two schools, then retired from her post as superintendent of the school district at 68. An avid hiker and a supporter of women’s rights, Edna had remained active and involved in various volunteer positions until her diagnosis overwhelmed her.

Edna was now unable to walk or talk, and had become dependent on others for care. Recently, she’d been losing the ability to swallow, and had landed in hospital last month after aspirating food into her lungs. There was talk of inserting a feeding tube into her stomach. She didn’t want that. She saw no reason to prolong her life as it was, but did not wish to starve to death.

I spoke again to Dr Vass and two weeks later I returned to Edna’s bedside with the news that I was convinced she was eligible, and I was willing to help her. She drew a happy face … no eyes, just a smile. We then turned to practical matters. Edna had been raised in a religious home and still had family who were deeply faithful. She’d been worried about their reaction, so she’d kept much of the decision-making to herself. Now she would share her choice, and hoped they’d be willing to join her on the day of her death. With Mindy’s help, we discussed some of the obstacles she foresaw, and I arranged for a hospice counsellor to facilitate what everyone expected would be a difficult conversation.

It didn’t go well. The counsellor said she had encouraged people to express their feelings and listen to others’ points of view, but much of the meeting had felt like a sermon: “As her brother was talking, she took the time to write out ‘CHRiStN ANtAgONiSM’. I’d say she’s determined to proceed.” When I returned to talk about choreographing the day of her death, Edna informed me that her relatives would not be joining us.

On the afternoon of Edna’s scheduled death, I arrived at her home expecting it would be a quiet affair. Instead, I walked into a chaotic scene. I could hear a man’s voice yelling as I opened the front door. Edna’s nephew Andrew and his wife were standing at the foot of her bed, pleading with her to reconsider.

“They have poisoned your mind!” Andrew thundered. “The church will never condone this. Your soul will never rest.” His anger was mounting. “We will never condone this!”

“Good afternoon,” I announced loudly. The yelling stopped immediately. “I’m Dr Green.”

Edna looked calm, but her face was hard to read. I asked Andrew and his wife if we might talk in another room. I told them I respected their position, but it really didn’t matter what they wanted or believed: “This decision is Edna’s and Edna’s alone.”

Andrew lapsed into silence. He stood up abruptly, then sat back down. “How can it be possible that, as a close family member, my arguments won’t be taken into account?” he asked.

I assured him his arguments were important but only in relation to his own healthcare and no one else’s. “This is unconscionable!” he began ramping up again. “If you proceed, I’ll call the police. In fact, I’ll call them anyway. This must be stopped. You cannot just kill my aunt.”

I was concerned to see him so upset, but Edna’s diagnosis was clear and she had made a voluntary, formal request. I felt sorry for her family, I understood they would need support, but I would not be bullied out of my responsibilities, nor would I let them bully Edna.

“You can call,” I said. “I suspect they will be helpful in enforcing the law and escorting you out of this house.” Then I checked my tone and took a breath. “It would be a shame if that were Edna’s final memory of you.” We stared at each other in silence.

“I see,” he said, and stood up once more. “Alice, we are leaving. We’ve done what we could. Aunt Edna will pay the price. I will not attend her murder.”

And with that, they walked out. Mindy was just arriving, but they did not stop to talk. I was saddened to see them go, but I was also relieved.

In an odd twist of fate, I was alone at this procedure. There had been a conflict in scheduling, so Jessica had come by earlier to start the IV, then left. In the end there was just Edna, Mindy and me in the bedroom, and Edna used the whiteboard to provide her consent. When I asked if she was ready to begin, she grunted and nodded slightly, then grabbed my hand and squeezed firmly, three times. I didn’t really know what her hand squeezes meant, but they felt like a thank you to me. For a woman who couldn’t speak any more, I thought she’d communicated beautifully. I began.

Later, alone in my car, I ran over the events in my mind. Andrew referring to Edna’s death as a murder had been upsetting, even though I knew it was purposeful hyperbole. I had to remind myself it was Edna’s disease that was killing her and my role was only to facilitate her free will. Afterwards I asked colleagues if they’d ever encountered such resistance, and I’m sorry to say I wasn’t alone. Much more common, though, were friends or family members who declined to attend, citing differences in values, but remained respectful of their loved one’s right to do as they pleased.

I spent several weeks worrying about whether Edna’s event might lead to a complaint to the professional licensing body. I was confident of the outcome, but dreaded having to go through the process. I took comfort in the fact that, in the end, Edna died with dignity, holding the hand of a person who loved her, confident in her decision and empowered by a rights-based legal system. I’m happy to report no complaint was made.

This is an edited extract from This Is Assisted Dying: A Doctor’s Story of Empowering Patients at the End of Life by Stefanie Green, published by Simon & Schuster on 27 March at £20. To support the Guardian and Observer, order your copy at guardianbookshop.com

Here is the link:

https://www.theguardian.com/society/2025/mar/15/were-going-to-talk-about-death-today-your-death-a-doctor-on-what-its-like-to-end-a-life-rather-than-extend-one

I thought this was an excellent discussion of a topic which I still find somewhat unsettling. At an intellectual level I am comfortable in easing severe unending suffering when it is needed but I still have a concern about the mechanics and actuality of the process and think careful reflection upon actions in this domain is vital.

Despite knowing this is a desired outcome by a clearly well supported and genuinely requesting patient at the practical end of their life one still has to take careful pause….

I am not at all sure I could be an active participant in delivering such care, although I am sure knowing the patient, their circumstances and the degree of their suffering would make such action far easier

How do you feel about personal involvement in such processes?

David.