It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way. i

Charles Dickens’ opening to A Tale of Two Cities is still an apt description of modern life more than a century and a half after its publication.

Today, as nations struggle to contain the delta variant that is driving a new wave of the COVID19 pandemic, stock markets are at record highs, property prices are soaring and Bitcoin has burst through the $50,000 mark.

Indeed, the ‘best and worst of times’ epithet is writ large everywhere:

There is political inaction on climate change as floods, wildfires and droughts cause untold destruction and death across the world;

Billionaires Jeff Bezos and Richard Branson vie for bragging rights over who took the first joy ride into space;

News reports tell us that pedophile Jeffery Epstein was best pals with a who’s who of the rich and powerful, including Prince Andrew, Bill Gates, Donald Trump, Bill Clinton, and Harvey Weinstein;

A violent mob incited by Donald Trump killed and injured dozens of police officers as they stormed the US Capitol Building in a bid to deny confirmation of the US election result;

More than 1000 Australian aged care residents were infected or died from COVID due to its spread by unvaccinated aged care staff;

A toxic male culture in the Australian parliament was exposed after an avalanche of stories from women concerning sexist comments, unwanted sexual advances, alleged rape, being sidelined, and being criticised for their weight, their looks, and their clothes;

A Royal Commission into Aged Care Quality and Safety revealed genocidal abuse of people in Australia’s aged care facilities;

Anti-lockdown protesters marched through Australian capitals, causing mayhem, destruction and further spread of deadly COVID.

What drives these disparities? And why are some enjoying the best of times while others suffer the worst?

Put simply, modern times reflect the tribalism that has been a feature of human society since its inception.

One feature of tribalism is competition between competing mobs and factions, each jostling for dominance, each vying for power, money and resources. And as the headlines show, it is the rich and powerful who get the best end of the contest.

These tribes exist in every sphere of society: in politics, the arts, sport, and business, and in every sociodemographic echelon — sex, age, race, religion, class, career, income level, and geographic aggregation.

Take the Australian example.

Despite a persuasive narrative that Australians are a laid back lot with broadly similar hopes and dreams, there is ample evidence for a counter narrative — that the pursuit of sectarian interests is alive and well and is having a corroding effect on nationhood by attacking the collectivity and mutual respect at its foundation.

The factions and power blocs that pursue sectarian goals use overt and covert means to seek and exert power. The use of political lobbying, for example, is just one tactic that tribes use to exert pressure for their demands.

In Australia, as in other democracies, factional interests lobby politicians to garner support for their proposals and promise their electoral support and cultural endorsement in return. This isn’t a new thing, of course: political lobbying is as old as politics itself.

The usual price to access an MP is to make a political donation, ‘though astute politicians have always sought the ear of business leaders and other important lobbies, like the farmers, doctors, bankers, miners, property developers and the gaming industry, to name a few.

A more overt form of lobbying happens in the news media where opinion leaders and lobby groups push their interests and exert pressure for their demands in return for their political patronage.

News media — be it opinion-making via digital and print articles, free to air tv, streaming tv on digital platforms, old fashioned wireless radio, and podcasts of course — are forums for pushing agendas and manufacturing consent.

Twitter, Facebook, Instagram and Youtube are also powerful platforms for professional media and anyone with a big online following to speak to billions.

History shows that influence-peddling, be it through political donations, political patronage, lobbying, news and social media — or a free ski pass and a tee-off with Greg Norman, corrupt the democratic process and damage collective good will — the glue of nationhood. Here’s three brief examples.

The Crown Resorts Inquiry

A recent media story revealed that Helen Coonan, who is Chairman of Crown Resorts, wrote to the Victorian gaming minister in a bid to neutralise the findings of royal commissioner, Ray Finkelstein QC.

Commissioner Finkelstein is holding an inquiry to assess whether Crown is fit to operate its flagship casino in Melbourne.

Ms Coonan’s letter to Minister Melissa Horne sought an “urgent meeting” with her, warning of a “huge problem for the government” if Finkelstein’s inquiry were to makes adverse findings against Crown’s Melbourne licence. The letter alsoc warned of “severe consequences” for Crown shareholders, thousands of employees and Victoria’s state coffers if the casino giant were allowed to fail.

Put simply, Ms Coonan went behind the back of the Royal Commissioner to kill the prospect of adverse findings by the Royal Commission.

After Coonan’s letter was made public by the government, Commissioner Finkelstein said a “plain” English reading of the letter to the gaming minister was that Crown was seeking to interfere.

“It [the letter] seems to have one stated, rather than unstated, purpose, which is to avoid a particular finding that the Commission might make, which will have the consequences that you set out in the letter,” he said.

“And it seems, on its face, plain old ordinary English language meaning, to mean ‘make sure that the commission doesn’t make a particular finding’.

“How the government goes about that I don’t know, [but] it’s that dangerous. That’s what this letter is about, in simple English,” he said.

Ms Coonan was unrepentant, despite her admonishment. In response, she issued a media statement saying, “Crown has an obligation to deal with all of its stakeholders, including the government, and this is in no way intended to be disrespectful to the commission.”

The fallout over the letter came as the commission learned, on its last day of hearings, that there were indications of money laundering through Crown in accounts excluded by an external review commissioned by the casino giant.

Crown Resorts Limited is Australia’s largest gaming and entertainment group. It owns and operates three of Australia’s leading gambling and entertainment complexes, Crown Melbourne, Crown Perth, and Crown Sydney. It makes hundreds of millions of dollars each year off the back of gamblers.

Coonan’s letter to the gaming minister was written just as the commissioner was casting doubt over the casino’s ability to overhaul its toxic corporate culture: a culture marked by a disregard for the law and regulators, despite the company pledging to be on a pathway of reform following a damning NSW inquiry that found Crown was unfit to open its Sydney casino.

Ms Coonan, who was a federal minister in the Howard government, is expected to step down from Crown’s board due to her culpable oversight of the company and her extraordinary attempt to neutralise the findings of the Commission. Hers is just one of several scalps that Crown is likely to offer up given the risk that Crown will be found unfit to operate its flagship Melbourne casino.

What could have motivated Coonan’s extraordinary behaviour? Clearly, she couldn’t have expected the government to interfere in the imminent findings of the Royal Commission, nor could she have expected the government to stay silent about her letter to the minister.

The only plausible answer is that Ms Coonan had decided to ‘take one for the team’ — her mob, her tribe — in the expectation that she would be taken care of in the wash up.

‘States at war over NSW outbreak’

This was the headline over a story in the July 23 edition of The Australian Financial Review describing a breakdown in relations between state and territory leaders following a plea from NSW Premier, Gladys Berejiklian for other states and territories to assist NSW with extra vaccine supplies to aid its losing battle with a coronavirus outbreak.

The story also described how Prime Minister Scott Morrison “vetoed a fallback proposal by Ms Berejiklian to redirect vaccines from COVID-19-free areas in her state.”

Morrison’s veto was a stunning political blow to Berejiklian. Having already declared a state of emergency granting her additional powers, the PM blocked the premier’s ability to redirect vaccine supplies from regional NSW to Sydney.

Following a meeting of national Cabinet comprising the PM and State premiers, Morrison said the Commonwealth would seek extra vaccines for NSW, but not at the expense of the other states and not at the expense of regional NSW.

Morrison’s rationale was that this would leave other areas of the NSW exposed. But his political calculation was evident. Rural NSW is where the PM’s coalition partner, The Nationals, hold a Senate spot and eight federal seats, including seats held by its federal leader, deputy leader and five Ministers. With a federal election to be held early in 2022, the idea of taking vaccines from eight federal MPs, a Senator, and their constituents would have been political suicide.

The was just the latest display of tribalism by the state leaders and the PM since the coronavirus pandemic came to Australian shores early last year. State and territory have been swiping at one another and grandstanding about their successes in taming COVID since the start of the outbreak.

Indeed, it’s fair to say that State of Origin isn’t just a rugby league contest between NSW and Queensland, it’s a full on blood sport between the states and territories dating back to federation.

Black and white Australia

The first schism to surface in Australia was between black and white. It was grounded in the profound racism that British colonisers exhibited to the land’s indigenous people soon after their arrival at Sydney Cove on January 26, 1788.

In his epic account of the early years of Britain’s colonisation of Australia, and the history of its convict transportation system, Robert Hughes describes many non indigenous Australians view Indigenous Australians:

“A static culture, frozen by its immemorial primitivism, unchanged in an unchanging landscape — such until quite recently was, and for many people still is, the common idea of the Australian Aborigines.

“It grows from several roots: myths about the Noble Savage, misreadings of aboriginal technology, traditional racism and ignorance of Australian prehistory. It is, in fact, quite false; but in the experience of white city-dwellers there is little to contradict it.” ii

Britain’s legal right to establish a penal colony at Sydney Cove was based on British navigator James Cook unprecedented claim to the entire eastern coastline of Australia in 1770. iii

The claim to owning the land that would become known as Australia was a unique event in British colonial history.

“In stark contrast to other British colonies,” writes historian Mark Mckenna, “the continent was conquered without negotiation with its Indigenous people.

“As Henry Reynolds explained, ‘the whole venture was premised on the belief … that the Aborigines had no legitimate claim on the land.’ ” iv

Britain’s claim to ownership was based on the idea of terra nullius, meaning the land was unoccupied and that its indigenous people had no claim to the land they had lived on for tens of thousands of years. v

Among the attributes assigned to Australian Aborigines by the British were ideas that they were uncivilised, primitive, ignorant and had no form of political organisation and therefore had no leaders with the authority to sign treaties.

This profouns racism sanctioned a host of policies that were favourable to the colonisers and deeply unfavourable to the indigenous people. vi They included the right to steal the land, to take children from their families, to poison food supplies, to disrupt cultural practices, to prohibit the speaking of native language, and most controversially, to kill and massacre indigenous Australians — a practice that persisted for 150 years from 1788 into the 1930s. Australian historical records have only begun to record these atrocities in the last 50 years or so.

As an example, McKenna’s contemporaries, Henry Reynolds, Lyndall Ryan, and Ray Evans have provided overwhelming evidence of the role that state-sanctioned and privately conducted violence played in Australia’s foundation.

Dr Ryan, is pursuing a long running research project “to create an interactive online map of massacre sites across Australia — places where six or more people were killed in frontier conflict between 1788 and 1960 — has already attracted widespread national and international attention. The first stage, mapping over 150 massacre sites in eastern Australia, was released in June 2017.” vii

By the time the map is completed, Dr Ryan believes that her research team will have verified more than 500 massacre sites nationwide.

Systemic racism has pervaded every aspect of black and white relations in Australia for the past 250 years. Today its effects can be measured by a range of social and health indicators. The Closing the Gap Initiative, for example, reveals that Indigenous Australians are far more likely to be jailed, to die in custody, to be unemployed, to suffer poor mental and physical health, and to live shorter lifespans than white Australians.

White racism and its progeny — discrimination, subjugation, rape, violence, frontier wars — have decimated indigenous Australians.

But Indigenous Australians are pushing back, not with violences towards their white oppressors, but with proposals for “truth telling” that could ultimately help to heal the rift between black and white Australia.

Beginning in 2016 and culminating in the Urulu Statement of the Heart in May 2017, a Referendum Council conducted twelve dialogues with more than a thousand people in Indigenous communities across Australia. These were deliberately termed ‘dialogues’ rather than ‘consultations’, to overcome the cynicism of Indigenous groups who feel they had often been consulted but rarely listened to.

A common message arising from these dialogues was a demand for truth-telling.

The subsequent Uluru Statement from the Heart is a statement of Aboriginal and Torres Strait Islander desires for substantive reform to the Australian Constitution. It proposes a permanent first nations Voice to Parliament, and a Makarrata Commission to engage in agreement-making and to sponsor truth-telling about the past.

Maybe one day, when the truth is told and acknowledged by all, Australians can become one mob, not a nation divided.

Dan Gaffney is the author of Journey Home: Essays on Living and Dying. His next book is about the factions and tribes that divide Australia and how it might become one nation of the heart.

i Charles Dickens, A Tale of Two Cities, p 3 Amazon Classics. Kindle Edition

ii Robert HUghes, The Fatal Shore, Random House 1986

iii James Cook, Journal of the HMS Endeavour, 1768–1771, National Library of Australia, Manuscripts Collection, MS 1, 22 August 1770

iv Quarterly Essay 69: Moment of Truth, Mark McKenna, March 2018, p138

v Terra nullius was eventually overturned in 1992 by the High Court of Australia in the Mabo case №2, which introduced the principle of native title into the Australian legal system. In recognising the traditional rights of the Meriam people to their land, the court also held that native title existed for all Indigenous people.

vi Race is a social construct that divides humans into an “us and them” based on differences in physical, linguistic and social attributes. It is not intrinsic to humans but an identity, often created by a socially dominant group, whereby the dominant group assigns negative qualities to a less dominant group. The assigning of negative attributes to another group is known as racism.

vii Quarterly Essay 69: Moment of Truth, Mark McKenna, March 2018, p155–156.

As Australians, we like to think of ourselves as an easy-going, laid back lot who take life’s ups and down in our stride, but the truth is we have become a nation of critics and whingers, all too ready to complain and critique our leaders (and each other) for our perceived shortcomings.

The latest outbreak of whinging started soon after the COVID19 virus came to our shores in 2020. Since then, our political leaders and public health experts have been pilloried by journalists, political opponents and armchair experts who carp and criticise everything from the vaccine rollout, quarantine arrangements, and the dreaded lockdowns that have upended our way of life.

The decision by NSW Premier Gladys Berejiklian to lockdown greater Sydney is a case in point. Her decision has been widely criticised for being too late by MPs, commentators, journalists and other assorted ‘experts’.

This is a first for the NSW Premier who, until recently, had been cast by media, business and public health experts as one of Australia’s best leaders at managing the unprecedented complexities of the COVID19 pandemic.

While Victorian Premier Dan Andrews has been criticised for invoking shutdowns prematurely, with consequent impacts on business, the economy and people’s mental health, Ms Berejiklian has been hailed as a leader better able to balance public health advice against the disruptions brought by ‘hard lockdowns’ that curtail freedom of movement.

The Australian Industry Group, for example, has said the Berejiklian government is “to be congratulated for holding the line with its successful, proportionate and targeted approach to dealing with COVID”.

On June 24, Australian Business Council chief executive Jennifer Westacott said the BCA supported the NSW government’s “proportionate and risk-based response”.

“This type of commonsense approach means that where possible people can still get on with their lives and businesses can keep their doors open,” Ms Westacott said.

Westacott’s comments were echoed by Business NSW chief executive Daniel Hunter, who said Sydney could avoid a lockdown if it could get on top of the outbreak quickly. “Businesses of all sizes are grateful they can still welcome customers during this period,” he said.

While business leaders have broadly supported the NSW government’s approach, armchair critics have been breeding like the plagues of mice now infesting large parts of Queensland and NSW.

Critics with no expertise offer advice

Research epidemiologist Mary-Louise McLaws has been a vocal critic of the decision by NSW Chief Health Officer, Kerry Chant and Premier Gladys Berejiklian not to send Sydney, or at least parts of it, into a lockdown sooner than she did.

Her specific expertise is in hospital acquired infections. She has never been an adviser to government at the sharp end of balancing the daily complexities of balancing health advice against the impacts of lockdowns on business and the wider community.

Another armchair critic is Bill Bowtell, an adjunct professor at UNSW’s Kirby Institute. He’s been a frequent critic of the federal government’s COVID19 advertising campaign (an easy target, admittedly) and its bungled vaccine rollout.

Mr Bowtell has lately joined Professor McLaws in critiquing the NSW Premier’s reluctance to call a hard lockdown in Sydney.

His biography describes him as a “strategic political analyst and consultant with long experience in social and political marketing and polling, as senior adviser to the Australian health minister between 1983–87, Bill was an architect of Australia’s response to HIV/AIDS.”

He is not a medical doctor, a virologist or an epidemiologist, and he has no postgraduate qualifications in public health or any other field. He earned a BA (Hons) from the University of Tasmania in 1975. He is not a faculty member at UNSW and the term ‘adjunct professor’ is an honorary title. But this hasn’t stopped his ability to generate media interest in his opinions.

Media, of course, thrive on conflict, so armchair critics with fancy titles can often garner media attention, despite having little to no hands-on experience.

Another high profile critic of governments, both state and federal, is the ABC’s health reporter, Dr Norman Swan. Dr Swan (a doctor with postgraduate training in paediatrics) is a persuasive media commentator who’s comments carry weight in community and government circles.

On the eve of the NSW Premier’s decision to put Sydney into an initial two-week lockdown, he issued a series of tweets that accused the government of ignoring best available public health advice.

“This cannot be described as an epidemiologically sound approach and given there are many competent epidemiologists NSW you have to assume they’ve been given the right advice but the politics are working against it or slowing it down,” he said in one tweet.

“Just listen to the new venues. Makes absolutely no sense that they’re not going city wide. They knew that yesterday. This is politics not public health,” he said in another.

More predicably, Western Australia’s Labor Premier Mark McGowan took a swipe at his NSW counterpart over the timing of her decision. He said, “the lesson from all of this is that we need to act quickly … delay is a problem.

“We have a different approach to NSW. We act quickly and we act with force and we don’t let it linger. Once you let it linger and it gets away from you it’s very hard to put the genie back in the bottle. The lesson out of this is to act with haste … to crush the virus.”

The day before the Sydney lockdown, the Australian Medical Association gave the Premier its own unsolicited advice by calling for an immediate lockdown of metropolitan Sydney to tackle the new Delta COVID strain.

“A lockdown of Metropolitan Sydney would be the right move,” said AMA President Dr Omar Khorshid. “The rules need to apply equally to the whole of Sydney to allow us to get ahead of this virus, and give the contact tracers a chance to catch up and try to avoid months and months of restrictions in Sydney.

“The economic consequences of lockdown are significant. But the economic consequences of getting this wrong are catastrophic, not just for Sydney but for all of Australia.”

Talkshow panellists with 2020 hindsight

Even further from the day to day management of COVID outbreaks were the talking heads that appeared on the July 8 episode ABC’s talkshow Q+A. The panel contained three journalists, a philosopher, two MPs and a filmaker — and no real world experts.

A full two weeks after greater Sydney went into lockdown several panelists told viewers that the NSW Premier should have locked down earlier than she did.

Mind you, this advice can with the benefit of two weeks’ hindsight that has seen the virus continue to spread across the city.

“Would it not have been more effective to have locked down Sydney sooner?” asked solicitor, Karen Tam.

“I think it’s clear the Victorian lockdowns, which were much tougher and went earlier, have worked better than what the NSW government has been doing,” offered philosopher, Peter Singer. “I think they have been too soft and too slow. Now they’re getting the consequences of it.”

Commentators are creating uncertainty, says Public Health Association

In March last year, the Australian Public Health Association’s chief executive wrote to its members backing Dr Brendan Murphy, who was then Australia’s chief health officer advising the federal government on the coronavirus pandemic.

Mr Slevin said conflicting advice from some medical commentators about managing COVID was contributing to public uncertainty about the government’s approach.

The letter asked its members, many of whom are public health experts with high media profiles, to consider the difficult task of Professor Murphy and his state-based colleagues in an environment of misinformation being advanced by alternative sources claiming authority on managing COVID.

In a Sydney Morning Herald report, Mr Slevin said he was not “suggesting there aren’t varying opinions” among experts. “There is legitimate debate about ways forward in the health community, but they need to be conducted in a calm and professional manner by experts,” he said.

In the same article, Norman Swan, Bill Bowtell and Medical Journal of Australia editor-in-chief Nick Talley were named as critics whose comments were at odds with government’s advice concerning issues such as lockdowns and school closures.

The SMH also quoted Tania Sorrell, director of the Marie Bashir Institute for Infectious Diseases and Biosecurity, who said high-profile commentators were well-intentioned but should be careful with their comments.

“I think everybody is trying to do the right thing and trying to persuade the authorities to do what they believe is in the best interests of the country,” Professor Sorrell said.

“But it’s difficult if groups of individuals want to convey a different message than what is the consensus message that is being supported by various professional societies and ministries of health at state and Commonwealth level.”

Professor Sorrell, in contrast to many armchair critics, is eminently qualified to comment on the management of pandemics — and to her credit, she has studiously avoided doing so.

Let Public Health Officers lead

Dr Tony Bartone, the immediate past president of the AMA, agrees that “evidence-based information led by the Chief Medical Officer is the way to go”.

“There’s so much information and material that goes into their decision making, that [you can’t] have a situation where you’re trying to make comment on only part of it,” he said.

“Everyone wants to be an expert. Let the evidence and the leaders speak for themselves. We need a single source of truth.

“The public want leadership, information and reassurance.”

Dan Gaffney MPH is the author of Journey Home: Essays on Living and Dying. His next book is about the culture of complaint that is turning Australians into a nation of whingers.

Medical experts have convinced me to avoid the AstraZeneca jab. This is unfortunate because widespread hesitancy about taking the AstraZeneca vaccine means that millions of Australians continue to be at risk of being infected with coronavirus (COVID19).

Concerns about side-effects top the list of reasons for vaccine hesitancy according to a recent survey by research company Resolve Strategic. Almost one-third of adult Australians surveyed say they are unlikely to be vaccinated.

The finding poses a major roadblock to the reopening of the economy and a path back to the way we lived before the pandemic.

Questions about the efficacy of the AstraZeneneca vaccine undermine confidence

Questions about the efficacy of the AstraZeneneca vaccine, which is the cornerstone of Australia’s vaccine rollout, have also undermined public confidence.

In March US health officials said AstraZeneca may have included ‘outdated information’ in a coronavirus vaccine trial.

In an extraordinary rebuke, just hours after AstraZeneca announced its vaccine worked well in a US study, an independent panel overseeing the study scolded the company for cherry-picking data.

The panel wrote to AstraZeneca and US health leaders that it was concerned the company chose to use data that was outdated and potentially misleading instead of the most recent and complete findings, according a panel member.

Despite some concerns over the strength of scientific data on the AstraZeneca vaccine, many experts backed its approval by the Therapeutic Goods Administration (TGA), Australia’s medical regulator.

In its detailed analysis, the TGA said AstraZeneca was shown to be safe and prevent COVID-19, the disease caused by the coronavirus, but it was not clear whether it prevented transmission or asymptomatic disease.

Despite the green light, there were other issues raised by the TGA.

In its report, the regulator raised “significant concerns” about the robustness of the data used in the company’s trials and said there was “insufficient data” about the dosing of the vaccine.

Vaccine expert Tony Cunningham, from Sydney’s Westmead Institute, said he was “pleased” the TGA had raised those concerns.

Professor Cunningham said while it was abundantly clear the vaccine was safe and provided a “strong immune response”, he said the number of trials running in tandem across different countries had provided “bitsy data” from different places.

The AstraZeneca vaccine first came under the spotlight last year after a mistake in its dosing regime showed different efficacy rates — ranging from 62 per cent to 90 per cent — depending on the trial and the dose given.

Despite this AstraZeneca announced that its COVID-19 vaccine was “highly effective” in preventing disease.

Researchers found that if people were given a half dose followed by a full dose of the vaccine, rather than two full doses, about 90 per cent of people were protected.

Where two full doses were given at least one month apart it showed 62 per cent efficacy.

The combined average across different dosing regimes, which had a total of 11,636 trial participants, was 70 per cent effective.

At first glance the results were lauded. The Australian Government declared it a “very good result” that will help create a “fully safe Australia”.

But Geoff Porges wasn’t convinced. Dr Porges, is a vaccine expert of 25 years and a director of therapeutics research at one of the world’s leading healthcare investment banks.

Dr Porges said he thought AstraZeneca had “embellished the data”. Pressure quickly mounted on the company when a stream of other scientists and researchers across the world agreed with Dr Porges’ initial assessment.

Some labelled it “shaky science”, while others questioned the legitimacy of the data released by the company.

By contrast, the coronavirus vaccines made by Moderna and Pfizer-BioNTech have proven to be highly effective at preventing symptomatic and asymptomatic infections under real-world conditions.

Consistent with clinical trial data, a two-dose regimen prevented 90 percent of infections by two weeks after the second shot. One dose prevented 80 percent of infections two weeks after vaccination.

Rare blood clotting syndrome linked to the AstraZeneca vaccine

Then, in early March, news came that the AstraZeneca vaccine rollout was being suspended in Germany, Italy, France and Spain amid blood clot concerns.

The World Health Organization appealed to countries not to suspend vaccinations against COVID, which had caused more than 2.7 million deaths worldwide to that point.

“As of today, there is no evidence that the incidents are caused by the vaccine and it is important that vaccination campaigns continue so that we can save lives and stem severe disease from the virus,” WHO spokesman Christian Lindmeier said.

Australia’s medical regulator had approved the AstraZeneca coronavirus vaccine for use in Australia on February 17 and by mid March Australia had secured 53.8 million doses of the AstraZeneca vaccine, 50 million of which were to be made in Australia by medical giant CSL.

On March 12 Prime Minister Scott Morrison said Australian health authorities had not raised any concerns about using the AstraZeneca vaccine and that there was no advice to pause Australia’s rollout.

On the same day news came that Denmark, Norway and Iceland had suspended the use of the AstraZeneca vaccine, following reports that people who received it went on to form blood clots.

Deputy Prime Minister Michael McCormack also sought to assure Australians the vaccine remained safe to use.

“We’re getting on with the vaccine, we’re getting on with the rollout, and Australians should be assured our TGA — which is world class — they’ve said it’s OK,” he said.

In a statement, Chief Medical Officer Paul Kelly said there was no evidence to suggest the vaccine caused blood clots.

“Safety is our first priority and in a large vaccine rollout like this, we need to monitor carefully for any unusual events so we will find them,” he said.

“This does not mean that every event following a vaccination is caused by the vaccine. But we do take them seriously and investigate — and that’s what Denmark is currently doing.”

On April 3 Queensland’s Chief Health Officer Jeannette Young said, “all vaccines have some very, very rare side effects”.

“At this point in time, people shouldn’t be concerned and we expect rare side effects,” Dr Young said. “We just need to be aware of them and individuals need to be aware of them.”

Her comments followed the case of a 44-year-old man who was being treated at Melbourne’s Box Hill Hospital after being admitted with serious thrombosis and a low platelet count.

The man had received a dose of the AstraZeneca vaccine nearly two weeks earlier. His symptoms appeared to fit the diagnostic criteria for vaccine-induced pro-thrombotic thrombocytopenia.

The case was being investigated by the Therapeutic Goods Administration (TGA), the Australian Technical Advisory Group on Immunisation (ATAGI) and the Australian Health Protection Principal Committee (AHPPC).

Commenting on the case of the 44-year-old man, Dr Nada Hamad, a member of the Haematology Society of Australia and New Zealand, said while information was still being gathered it had “intrigued the medical community enough to want to understand this process, and to try and figure out how to minimise it”.

“I think what’s important is that people not panic,” Dr Hamad said.

Then, on April 29, it was reported that two men had died days after receiving the AstraZeneca vaccine in New South Wales, with reviews underway to determine whether the jab contributed to their deaths.

One man, reportedly in his 50s, died at a hospital in Tamworth in the state’s northwest. The other man, believed to be in his 70s, had died in Sydney.

AstraZeneca COVID vaccine no longer recommended for people under 50

Three weeks later, on April 8, Prime Minister Scott Morrison announced that the AstraZeneca COVID vaccine would no longer be recommended for people under 50 based on the risk of developing the rare clots.

Instead, Pfizer was now the preferred vaccine for people under 50 in Australia. This change was based on advice from the Australian Technical Advisory Group on Immunisation (ATAGI).

Professor Allen Cheng, who co-chairs ATAGI said his committee, and others, had to weigh up the risks.

“We think the risk in younger people is probably around the order of two to four per 100,000,” he said. “That’s a pretty small risk still but it’s starting to get into the territory where we think that is starting to outweigh the benefit.”

On May 6 five new cases of the clotting disorder were confirmed by the Therapeutic Goods Administration (TGA): two cases were women, aged 51 and 64, and three were men aged 66, 70 and 74.

By that stage 11 Australian cases of the rare blood clotting phenomenon known as thrombosis with thrombocytopenia syndrome (TTS) had occurred in people following vaccination with the AstraZeneca vaccine.

The 66-year-old man was in intensive care in Townsville with thrombosis after receiving his first AstraZeneca dose on March 30, and the 70-year-old man was in a stable condition in hospital in Tasmania.

TGA head Adjunct Professor John Skerritt said he was “not surprised” that five new cases of a rare blood clotting syndrome linked to the AstraZeneca COVID-19 vaccine had been identified in Australia.

“This is a rare adverse event but we believe it’s staying at the expected frequency and at the frequency that we’re seeing internationally,” he said.

Like other talking heads, Professor Skerritt was trying to assure Australians that while the AstraZeneca vaccine was recommended as safe for people over 50, the sometimes fatal clotting reaction was not unheard of in people in that age group in trials and elsewhere around the world.

But in seeking to reassure us that the odds of suffering a potentially fatal clotting reaction are rare, Professor Skerritt only convinced me not to get the AstraZeneca shot.

“If you step back and think about who is now getting the AstraZeneca vaccine, it is, with a few rare exceptions, only people over 50,” he said.

“So it is obvious that future cases will be in the over 50s.

“The early results globally showed that the prevalence of this rare side effect was much more common in people under 50, but it wasn’t unknown in people over 50.

“So we’re not surprised with the results.”

Whether Skerritt realised his own-goal isn’t clear but when I looked into his credentials, I was even less assured by his pontifications about the safety of AstraZeneca.

Skerritt is not a medical doctor. He is not a haematologist. He is not a public health expert or epidemiologist. He’s not a virologist. Indeed, he’s not a practising clinician or researcher of any kind. He’s a PhD in pharmacology who has spent decades on government boards and committees.

Another chap who gave me pause is the Royal Australian College of General Practitioners Rural Chair and Townsville GP, Dr Michael Clements.

Dr Clements spoke to the ABC about the clotting complication in a 66-year-old Townsville man, one of the five newer cases of blood clotting believed to be linked to the AstraZeneca vaccine.

The Townsville man received the first dose of the vaccine on March 30 and developed abdominal pain before presenting to the Townsville University Hospital.

He was later admitted to the Intensive Care Unit with thrombosis.

Dr Clements said the case was saddening.

“I’m sure this person and their family didn’t want this to happen,” he said. “Nobody wants to go to ICU after doing what has been recommended by the public health.”

Dr Clements said he was concerned the Townsville case would prevent people over the age of 50, who were now eligible for the AstraZeneca vaccine, from getting the jab.

“From a science point of view, we knew this would happen,” he said.

“If we vaccinate enough people, the evidence tells us that there’ll be a number of them who do get this reaction.

Another own-goal, this time from a medico, although like Dr Skerritt, Dr Clements has no training or expertise in public health or epidemiology and no specialist medical training in virology or haematology.

Despite these deficits, Dr Clements does have a nose for which way the wind is blowing.

“Sadly, I think, for those who were hesitant to start with, this case is going to be something that they’re going to add into their list of reasons why not to have the vaccine.”

Dead right.

Given the almost zero prevalence of COVID19 in the Australian community, I am not going to put myself in harm’s way, no matter how rare such an event may be. I have one life and it is too precious.

Pfizer to the rescue for over 50s

On May 19 the federal government made a muted concession that the COVID vaccine rollout was being impeded by vaccine hesitancy, particularly in regard to AstraZeneca.

Health Minister Greg Hunt said people over the age of 50 who were currently eligible for the AstraZeneca vaccine could instead wait for Pfizer or Moderna doses.

On May 25, the federal government promised that two million Pfizer doses each week would be available from the start of October, although Health Minister Greg Hunt reiterated “people should not wait” and should get vaccinated now.

Amid reports some over 50s are waiting to receive a different vaccine, Mr Hunt has urged all people eligible for a vaccine to get a jab as soon as possible.

“If you are in a qualifying group, if you are in the over 50s, please come forward now,” he said. “Vaccination will save lives and protect lives, and if you aren’t vaccinated and you do catch COVID you could die. It’s as simple as that.”

This echoed comments from the vice-president of the Australian Medical Association, Chris Moy, who said he was worried too many Australians felt safe from the virus to the point where they were not motivated to get their vaccine when they became eligible.

He’s half right. I feel relatively safe (not complacently so) but mostly I am scared of the potentially fatal clotting complications linked with AstraZeneca. Messaging from experts and MPs that ignores these legitimate fears will only fall on deaf ears.

Why so? Two reasons.

First, most patients accept that medicines have side effects and that this is the trade of between being sick and getting better. However, this trade off doesn’t work in the same way when healthy people are asked to take a medicine (AstraZeneca vaccine) that has rare and fatal side effects in return for preventing a rare and fatal infection (COVID).

Now that the government has promised a failsafe alternative in the form of the Pfizer vaccine, can cautious people like me be blamed for saying no to AstraZeneca and waiting until October?

Second, despite comments from some experts that unvaccinated Australians are “sitting ducks” (only four per cent of Australians are fully vaccinated), the prevalence of coronavirus in Australia is virtually zero at the time of writing.

This is because the federal government is keeping Australia’s international borders firmly shut, despite calls to begin reopening the border and our globally-linked economy.

Prime Minister Scott Morrison won’t be opening the border until after the next federal election, which could be held as late as May 2022. The PM has seen the polling that shows Australians largely approve of tight border controls, which make us feel safe from the ravages of the COVID pandemic. He has also seen thumping victories by incumbent state governments in Western Australia and Queensland — governments that have been tough on border control.

As to the alarmist claim that unvaccinated people are “sitting ducks”, let’s not forget that Australia has achieved low community transmission because it has employed standard public health measures in response to the pandemic — namely social distancing, hand washing, mask-wearing, contact tracing, quarantining, and periodic shut downs — all this long before the arrival of vaccines.

Indeed, modelling provided to National Cabinet on 3 August this year revealed that it will be public health measures that do the heavy lifting of keeping the delta variant and its mutants at bay.

The graphic below shows that as effective as vaccinations will be, at best they will contribute only 40 per cent of the national defence against the contagious delta variant.

Experts suggest raising age limit for AZ to 60+

On June 10, The TGA revealed Australia’s second death from TTS due to the AstraZeneca vaccine. The death occurred in a 52 year old woman who suffered a catastrophic stroke. As of early June there have been 35 definite TTS cases and 13 probable ones linked to the vaccine. Most are recovering but 15 are still in hospital, including one in intensive care.

The incidence of TTS linked to AstraZeneca remains low: in people under 50 it is 3.2 cases per 100,000 and in people over 50 it is 1.8 per 100,000. The death rate among people who suffer TTS linked to AstraZeneca is 3–4 per cent. The majority of cases in Australia are of a less serious and more treatable type.

Of the total 48 cases about 30 percent fall into the severe end of the condition, and this is where age becomes a factor. According to overseas data, the younger the person receiving AZ, the more likely they are to develop TTS and the more likely they are to develop a serious disease, and this severity risk appears to extend into the 50 to 59 age bracket.

Some Australian experts are now arguing for a change, given the latest data. “Personally, I do have concerns about looking very carefully at needing to move the age up to 60,” said Professor Huyan Tran, a respected haematologist at the Royal Prince Alfred Hospital in Melbourne.

His concerns are echoed by Associate Professor Margie Dancin, a paediatrician from the Royal Children’s Hospital who researches people’s perception of vaccine risk. “It may be time to consider now that we do offer the Pfizer vaccine for the 50 to 59 age group,” she said.

Age limit for AZ raised from 50 to 60 in Australia

On June 17, Australian health authories raised the age limit for people given the AZ COVID-19 vaccine to 60 years and older. The decision followed an additional 12 cases of the clotting syndrome in early June.

Pfizer will be made available for anyone aged 40 to 59 at federally run vaccination clinics. The latest advice affects 2.1 million additionL people aged between 50 and 59.

This change will further slow the rollout, add pressure on the delivery of Pfizer doses from overseas, and cause further vaccine hesitancy related to side effects of COVID vaccines.

This second policy shift on AstraZeneca in the past two months confirms increasing evidence that the AstraZeneca vaccine is not the safe and effective shield against COVID that it was promised to be, despite initial and continuing claims that it is.

It also sends mixed messages to different segments of the community. Older Australians — those aged 60 and over — are being asked to have a vaccine (AstraZeneca) that is not as good as the Pfizer vaccine so that younger people can have it instead.

The problem is that the federal government is not saying this, which leaves a communication vacuum to be filled with misinformation and rumour. The nation’s pubic health cannot afford this at a time when so many people are still unvaccinated and the threat of the Delta variant is a daily threat to the status quo.

Also, the fact that a further two million Pfizer doses each week will be available from October means that many Australians will wait for that option, further delaying the prospect of herd immunity. This is a dangerous mix that implies no urgency.

PM creates chaos by saying anyone under 40 can approach their GP and request the AstraZeneca

By far the most contentious advice to be issued about the AstraZeneca vaccine came when Prime Minister Scott Morrison announced a massive change to Australia’s coronavirus vaccination program, advising that anyone under the age of 40 could approach their GP and request the AstraZeneca vaccine.

The advice of the nation’s peak advisory group to government on COVID vaccines is The Australian Technical Advisory Group, which says Pfizer is the recommended vaccine for Australians under the age of 60 due to the risk of rare blood clotting disorders linked to the vaccine in younger people.

The unilateral announcement by the PM was met with howls of condemnation by state premiers and their chief health officers and widespread confusion in the community. It also added new demand for dwindling supplies of the Pfizer vaccine at a time when 12 million Australians have been locked down to protect them from new outbreaks of the virus across the nation.

The new advice caught GPs unprepared and unable to advise patients about their individual risks since there are no known risk factors for blood clotting condition beyond age. This is because researchers have not been able to identify the mechanism(s) of action that produce thrombosis with thrombocytopenia syndrome (TTS).

Bungled and disingenuous messaging by the federal government about the safety, efficacy and availability of vaccines has cemented my decision not to be vaccinated with AstraZeneca, which has rare but serious side effects. No amount of positive spin from talking heads in government can convince me otherwise.

Instead, I’ve been guided by the scientific evidence presented by relevant experts that the AZ vaccine is linked to serious adverse health outcomes. As an immunocompromised 58 year old this puts me and others in a precarious situation. Fortunately, I am now due to get the Pfizer jab on July 1 and a second jab three weeks later. Meanwhile, 2021 is still the year of living dangerously.

Dan Gaffney MPH is a teacher and author. His book and podcast series, Journey Home — Essays on Living and Dying was published in 2019.

The universal right to a self-determined death affirms the view that peo­ple are capable of autonomous choices concerning the desire for a rational suicide, and that this right is beyond the claims and restrictions of any law or institution.

The Swiss Criminal Code of 1937 comes closest to enshrining this right in law. It allows assisted suicide, also known as assisted dying or medical aid in dying, which is a suicide that’s done with the aid of another person.

Assisted dying usually refers to physician-assisted suicide, which is a death that is assisted by a doctor or other healthcare provider. However, there is no requirement in Swiss law that doctors need to play a role in assisted suicide.

Further, unlike the long list of requirements and ‘safeguards’ that apply to assisted suicide laws in other jurisdictions, Switzerland has just two requirements/safeguards: (i) mental capacity (ii) and that the action(s) of ending one’s life are performed by oneself, and no one else.

Swiss law specifically outlaws “incitement or assistance to suicide from selfish motives” (Art. 115). Any active role in voluntary euthanasia (“manslaughter on request”) is also outlawed, even if committed from “respectable motives” such as mercy killings (Art. 114).

So, lethal drugs can be prescribed so long as the recipient takes an active role in a drug’s administration, but active euthanasia (such as administering a lethal injection) is not legal.

Swiss law allows providing the means to commit suicide but the reasons for doing so mustn’t be based on self-interest (such as monetary gain). Based on this legal situation, non-profit organisations administering life-ending medicine were first established in Switzerland in the 1980s.

Under Swiss law, the basis for an assisted suicide need not be a terminal diagnosis. Assistance that is driven by altruistic motivations is lawful.

Physician-assisted suicide, also known as voluntary assisted dying (VAD), is legal in some countries, under certain circumstances, including Canada, Belgium, the Netherlands, Luxembourg, Spain, Switzerland, Germany, parts of the United States (California, Colorado, Hawaii, Maine, Montana, New Jersey, Oregon, Vermont, Washington and Washington, D.C.) and Australia (Tasmania, Victoria and Western Australia).

To qualify for legal assistance in most of these jurisdictions, individuals who want a physician-assisted suicide need to meet certain criteria, including: having a terminal illness, proving they’re of sound mind, voluntarily and repeatedly expressing their wish to die, and taking the specified, lethal dose by their own hand.

In the three Australian states where physician-assisted suicide is legal, there are more than 60 conditions and ’safeguards’ that must be met in order for people to qualify for a legally sanctioned exit. It is only available to those suffering from an incurable, advanced and progressive disease, illness or medical condition, and who are experiencing intolerable suffering. The condition must be assessed by two medical practitioners to be expected to cause death within six months.

These conditions and safeguards are so narrow, however, that many people who might want access to physician-assisted suicide are denied it. For example, those aged less than 18 years cannot access this law. Having a disability alone, such as quadriplegia, blindness or MS, is not a sufficient reason to access this law. Similarly, mental illnesses alone, such as depression or bipolar disorder is not a sufficient ground to access voluntary assisted dying.

Each of these caveats and restrictions on people’s right to end their life ignore the fundamental human right to self-determination and autonomous decision-making concerning the desire for rational suicide.

Philip Nitschke argues that people’s reasons for wanting choice at the end of life is about more than wanting to avert dying from a terminal disease and being spared the (all too common) indignities of poorly administered palliative care.

“Choice at the end of life is much more fundamental,” he says. “It is about taking back control of one’s existential existence from the world we all live in. This is not a choice that can or should be delegated to a bunch of doctors.” [i]

People have a host of reasons for wanting to die before death claims them. For example, some old people lose the will to live because their spouses and friends have died, they are physically diminished, living with pain, and have lost much of their autonomy, especially if they are living in an aged care facility.

Even without these restrictions and vicissitudes, some older people feel they have a lived a full life and have no desire to live another ten or 20 years of inexorable decline. Many people living with chronic depression feel that suicide is a desirable and rational choice because their lives are intolerable and there is little prospect of any improvement.

For people living with chronic or life limiting or terminal conditions their leading motives for wanting a quick, assisted (or unassisted) exit include loss of autonomy, a dwindling ability to engage in activities that make life enjoyable, loss of dignity, intolerable pain from their disease or medication, loss of sense of self, and a fear of burdening others.

Other common reasons include long-standing beliefs in favour of hastened death, a desire for control, and people’s fears about their future quality of life and dying.

Further, anyone with knowledge or experience of palliative care will probably want to avoid being palliated at the end of their life, if they can avoid it. Dozens of reports confirm that palliative care in Australia, at least, is inadequately funded, understaffed, poorly planned, administered and monitored. [ii]

For these and a host of other reasons, many people are seeking ways to secure a quick and painless death outside of the restrictions and prohibitions imposed by law.

Exit International is an international non-profit organisation that informs and assists people who want control over how and when they die. It is engaged in several activities, including advocating the legalisation of voluntary euthanasia and assisted suicide, publishing material providing information on assisted suicide and voluntary euthanasia, and research and development of non-medical ways of achieving a quick and painless death.

For example, the Sarco machine is a euthanasia device resembling a small spaceship. It was invented in 2017 by euthanasia campaigner Philip Nitschke. It comprises a 3D-printed detachable capsule mounted on a stand that contains a canister of liquid nitrogen to commit suicide through inert gas asphyxiation. The device can be made from biodegradable material and the detachable capsule can be used as a coffin.

The main reasons that some people are opposed to assisted dying and suicide coalesce around issues of vulnerability, access and concerns about eroding the value of human life.

Once we let doctors kill patients, or enable ways for people procure fast, pain free ways of suiciding, there will be pressure, some argue, to extend the range of circumstances where euthanasia is permissible.

This is sometimes called a ‘slippery slope argument’ because it’s argued that it’s easier to amend or liberalise existing laws that permit euthanasia than getting it approved in the first place.

Once active euthanasia is legalised, opponents say that frail, chronically ill or terminal people will be vulnerable to an ever-expanding set of circumstances where doctors could kill patients, or where they could help people kill themselves.

Therefore, patients who don’t really want to end their lives might feel pressure to end their lives when this isn’t what they really want.

Another rationale used by some opposed to euthanasia is that pain isn’t a sufficiently good reason for anyone to want to die. Pain is simply part of dying and can be adequately managed, they say.

Another view is that passive euthanasia is a better alternative — such as withholding life-saving treatment like chemotherapy or turning off life-support systems.

Embedded in this argument is a view that the difference between active and passive euthanasia is morally significant. That letting nature takes its course (passive euthanasia) is morally defensible, while taking a life (active euthanasia) — even with patient consent under legally defined circumstances — is not.

Judeo-Christian religions oppose euthanasia and assisted suicide on moral grounds. The Catholic Church considers active euthanasia to be a ‘crime against life’ and a ‘crime against God’. [iii]

Catholicism says euthanasia is a sin because life is ‘holy’ and ‘sacred’, and human actions that cause death, or that intend to, are effectively ‘playing God’. Implicit in this view is the idea that God created life and that human actions to end it go against God’s dominion and what Catholics regard as the inviolability or ‘sanctity of life’. The Jewish, Islamic and Hindu faiths also look gravely on active euthanasia.

Euthanasia is divisive. And like other issues that divide us, like immigration policy or same-sex marriage, I’m guessing that people with little to no experience of euthanasia have more strident and negative views than those with personal and professional experience of it. [iv]

I say this because there’s good evidence, for example, that people with racially and ethnically diverse social networks are less likely to support racist views than people with monocultural networks.

It turns out that education and life experience breed tolerance and compassion.

Tolerance says, I am willing to accept difference. I still have my opinions but as a mark of respect, I am willing to say live and let live. Each to her own. I can agree to disagree and leave it at that.

Compassion goes deeper than tolerance because it walks in the shoes of another without judgment or opinion. Compassion is a matter of heart, not head, and bridges the divide between us.

Compassion says, I feel what you feel. And even if I thought you were making a ‘mistake’ by choosing to die as a way to end your fear and suffering, who am I to judge?

We all face death. Can we be so certain, so confident in our views that we feel ordained to tell others how to face theirs? What gives any of us the right to tell another that they don’t have the right to die?

If we lay aside our arguments and religions and moral precepts, maybe we can let others face these end-of-life choices in their own way.

Dan Gaffney is a teacher and author. He leads workshops and educational events and hosts a men’s group in the Blue Mountains. His book and podcast series, Journey Home — Essays on Living and Dying was published in 2019.

[i] Philip Nitschke, e-deliverence, Exit International newsletter, p3, December 2020

[ii] NSW Auditor-General’s Report to Parliament: Planning and evaluating palliative care services in NSW, NSW Audit Office, August 2017

[iii] Sacred Congregation for the Doctrine of the Faith (May 5, 1980). Declaration on Euthanasia

[iv] Maria Sacchetti, M and Guskin, E (2017). In rural America, fewer immigrants and less tolerance, The Washington Post, June 17

At the first glance there’s a paradox in the stories of people with terminal conditions who do all they can to live longer through medical interventions only to change their mind, stop therapy, and allow themselves to die.

Why not fight to the end? some ask. Why waste all the effort that you and your doctors have put into extending your life only to throw it away?

Anyone who has signed up for life-preserving therapies, as I have, knows the cost of living longer with a terminal disease.

Endless treatment. Mounting side-effects. The emotional rollercoaster we ride as the disease rises and falls (and rises and falls). The pain and indignities we endure from recurrent surgery, radiation and medications. The way our diaries have morphed from a vast array of work and social and recreational entries down to interminable medical appointments.

I’ve had many painful things done to me in the name of treating recurrent, refractory myeloma. I will not bore you with the details but suffice to say that now, after nearly seven years in treatment, the holy grail of remission has arrived. The graph below shows four years’ of data and is typical of the ups and downs of “successfully” treating an incurable disease.

For the first time, cancer has been brought to its knees, but so have I.

Whether it’s the impact of the new experimental immunotherapy drug (Belantamab), the cumulative effect of seven years of chemotherapy, the myriad effects of persistent myeloma in the body, simply growing older, or some/all of the above, I feel I can’t go on living this way much longer.

Despite being in remission thanks to Belantamab, I’m still in treatment as part of a clinical trial that gives me access to the drug. Under the terms of the trial, treatment will continue until one of the following occurs: myeloma progresses because the drug becomes ineffective; the side effects become too harmful or unacceptable; patient death; or I decide for whatever reason to cease treatment.

For people with terminal and life-shortening illnesses, the allure of cadging more time through medical treatment often involves a fantasy of a life that’s barely interrupted by therapy. Many imagine that life-extending or curative therapies will simply involve a benign and temporary change in circumstances. This is rarely the case.

Too often, the side effects of surgery, radiotherapy and other aggressive interventions diminish a person’s ability to resume their former life, to say nothing of fulfilling their hopes for a better, longer life.

For five years, Stephen Jenkinson was program director of a palliative care outreach program at a major teaching hospital in Canada. In that role, he witnessed the often-devastating impacts that medical interventions had on terminally ill people.

He also saw people who were wholly unprepared for the existential crisis triggered by living longer in the face of a delayed death.

“More time, when it finally kicks in, is the rest of a dying person’s life, and the rest of that life will be lived in the never-before-known shadow of the inevitability of their dying. For the first time in their lives they will live knowing that they will die from what afflicts them. More time means more time to live their dying.

“It means more symptoms, more drugs for the symptoms, more drugs for the side effects of the first drugs, more weakness and diminishment and dependence to go along with more time with the kids or grandkids or walks in the park with the dog.

“That’s not all it means, not necessarily, but more time almost always means more dying. No one is born, no one walks in the park or sits looking out the window knowing how to die like that, slowly and visibly and knowingly. Very few here on these shores, where death phobia rules, learn how, or want to.”

Stopping treatment would allow the dormant myeloma to surge again and, in the absence of any other treatment, I would die of the disease and its complications. That was always going to be the case but now it feels like I’ve reached the crossroads. I got seven more years of life and I’m grateful for the unique and exquisite experiences it afforded. But as Stevenson suggests, there comes a time when the existential and physical toll of living this kind of life becomes unsustainable. Unacceptable. Unliveable.

Ceasing treatment and dying from myeloma is likely to be painful and protracted. It’s not the kind of death I want even with access to enlightened palliative care, which is rarely the case for most people. I do not want to die in a hospital or a hospice, gasping for air, filled with pain, begging for morphine. In practical terms, that leaves physician assisted suicide (voluntary assisted suicide) or taking one’s own life.

Individuals who want an assisted suicide that’s approved by the state need to qualify by satisfying many criteria, such as having a terminal illness, proving they’re of sound mind, voluntarily expressing their wish to die, and taking a specified, lethal dose of drugs themselves. A doctor’s assistance is usually limited to writing a prescription for lethal drugs. Voluntary assisted suicide is not available where I live.

Exit International is an organisation that advocates for the legalisation of voluntary assisted suicide. Because this is legal in just a handful of countries, Exit International supports people who want to kill themselves by providing information about how to procure lethal substances and procedures that cause a quick, painless, peaceful death.

The organisation was founded by Dr Philip Nitschke, who was the first doctor in the world to administer a legal, lethal voluntary injection under the short-lived Rights of the Terminally Ill Act in Australia’s Northern Territory.

Avril Henry was an English activist who campaigned for the legalisation of voluntary euthanasia and a former professor of English medieval culture at the University of Exeter. She was 81 years old when she died at her home in the UK. She died of a Nembutal overdose.

She had planned her suicide for some time, telling friends and extended family that she had had a wonderful life but now was the time to go. At the time of her death, she was confined to a wheelchair, living alone, with a rapidly deteriorating quality of life. She’d decided that a trip to Switzerland for an assisted suicide was too difficult and besides, she wanted to die at home and be buried in her orchard.

Being the organised person that she was, Avril took matters into her own hands. She got a copy of the Peaceful Pill Handbook through Exit International and imported the same drug that she would have been given in Switzerland, sodium pentobarbital (Nembutal).

With her funeral and burial pre-paid, she was buried soon after her death in her beloved orchard, just as she had wanted. She left a lengthy suicide note explaining her actions.

You can hear her full story at The Longreads podcast program.

Would I take my life if I had no other alternative? I’ll wait and see. If dying is bearable, the pain can be well managed and I’m not stripped of my dignity and self-control, then I’m open to dying naturally. If not, I will make a quick exit.

Dan Gaffney is a teacher and author. He leads workshops and educational events and hosts a men’s group in the Blue Mountains. His book and podcast series, Journey Home — Essays on Living and Dying was published in November 2019.

The NSW Health Minister is denying equity to dying people in the Nepean Blue Mountains region

The lack of a palliative care unit in the Nepean Blue Mountains local health district worsened the end-of-life care for a local motor mechanic and caused frustration and anger for his family.

This wasn’t what mechanic Joe Bartolo or his close-knit family wanted but the steadfast refusal of the NSW Health Minister, Brad Hazzard and the Berejiklian government to fund a palliative care unit in the Nepean Blue Mountains local health district means that thousands of people like Mr Bartolo are receiving sub-standard end of life and palliative care.

Nepean Blue Mountains local health district is the only health service in greater Sydney without a dedicated palliative care unit. Most other health districts have either two or three dedicated palliative care units.

Motor mechanic Joe Bartolo died last September at Mt Druitt Palliative Care Unit after being transferred from Nepean Blue Mountains LHD because none of its 11 palliative care beds were available.

He had been under the care of Nepean Blue Mountains Palliative Care service for six months before his death from a rare, aggressive cancer called sinonasal undifferentiated carcinoma.

In early September, Mr Bartolo had to return to hospital for treatment but there were no available palliative care beds at Nepean Hospital.

“We were told a bed was available at the Mt Druitt Palliative Care Unit, just 20 minutes from Nepean and closer to the family home,” said Ms Bartolo.

“After some discussion about the services there, Joe was transferred.”

Mt Druitt Palliative Care Centre is operated by a different local health district (Western Sydney), and Mr Bartolo was not known by staff there.

“That’s when the problems started and I feel now that all this might have been avoidable if Nepean Blue Mountains LHD had adequate palliative care resources,” said Ms Bartolo.

“There was no continuity of care after Joe was transferred to Mt Druitt Palliative Care Unit,” said Ms Bartolo.

Transferring to another health service meant getting to know a new team of doctors, nurses and allied health staff.

“The nurses there didn’t seem to fully appreciate his symptoms or how to accommodate him.”

Mr Bartolo became deaf shortly after his diagnosis and he had increasing difficulty swallowing and communicating in his last two weeks of life in the Mt Druitt Palliative Care Unit.

“Joe’s ability to communicate was severely limited by his deafness,” said Ms Bartolo, “but we made use of an iPad and Etch-A-Sketch device but as his symptoms worsened, it was nearly impossible for him to write messages or understand the messages we wrote to him. This was heartbreaking.”

The lack of continuity of care meant Ms Bartolo felt she had to act as his de facto carer and nurse instead of simply being able to be his grieving wife.

“I feel angry, confused and sad about this,” Ms Bartolo said.

“I felt like we needed a guide or advocate about Joe’s treatment at Mt Druitt. Someone who could tell us our options and what Joe’s remaining time there might be like. However, this didn’t happen and I made it clear to the nursing staff and the nursing unit manager that we weren’t happy with Joe’s care.”

Ms Bartolo said her husband received good care at Nepean Hospital, where he was admitted three times during his six-month illness. He also received at home visits from Nepean’s palliative care team.

“The doctors and nurses at Nepean Hospital and Palliative Care team knew him, understood his illness and there was good rapport and continuity of care,” said Ms Bartolo. He also received physiotherapy and occupational visits at home organised by the Nepean palliative care team, which aided his symptoms.

The palliative care service in the Nepean Blue Mountains local health district (NBMLHD) is at a breaking point and it is the only health service in the greater Sydney region without a dedicated palliative care unit.

Every other local health district in greater Sydney, including in NSW Health Minister Brad Hazzard’s electorate, has a dedicated, properly staffed, multidisciplinary palliative care unit, excepting the central coast, where the government announced a commitment last year to build a 10 bed unit at Gosford Hospital.

Northern Sydney local health district, which encompasses the Minister’s electorate has three specialist palliative care units, as do the South Western Sydney and Central Sydney local health districts.

These are purpose-built facilities that offer a comprehensive array of palliative and end of life services. They are staffed by trained palliative care nurses and doctors, together with an array of allied health carers, such as physiotherapists, pharmacists, dieticians, music and art therapists, and counsellors. They have kitchens where family and friends can prepare meals for loved ones, accommodation for family members, and they often have large verandas opening onto gardens and play areas for children.

How the NSW Health Minister is denying equity to dying people in Nepean, Hawkesbury, Mountains

NSW Health Minister, Brad Hazzard says 3 doctors, 7 nurses and 11 beds is enough to meet the unmet needs of dying people in the Nepean Blue Mountains Local Health District (LHD).

This is despite a briefing he received in August 2020 confirming an urgent need for more specialist doctors, nurses and palliative care beds to for the 390,000 people living in the four local government areas served by the Nepean Blue Mountains LHD. It also called for the establishment of a “dedicated multidisciplinary palliative care centre at Nepean Hospital.”

The briefing, developed by local palliative care staff and concerned citizens, was sent to the Minister by Trish Doyle MP for state member for The Blue Mountains and Brad Park MP, Shadow Minister for Health.

It said the Local Health District needs 8 doctors, 48 nurses and 26 specialist palliative care beds to meet the complex needs of dying people and to comply with national palliative care guidelines.

The briefing revealed that demand for palliative care in the Nepean Blue Mountains is overwhelming capacity: 70 per cent of potential patients in the region never receive supportive or palliative care.

It also described a range of other impacts of inadequate staffing and facilities, including:

Inadequate and poorly co-ordinated services that don’t meet the needs of vulnerable patients;

Increased healthcare costs due to admissions via Emergency Departments and delayed discharges;

Poorer symptom control;

Poor support for families and carers;

An inability to provide best practice specialist palliative care in dedicated settings.

Mr Hazzard didn’t reply to the letter. Instead, the Labor MPs received a short four paragraph letter from junior minister Natasha Maclaren-Jones MLC saying nothing beyond “consideration” being given to a specialist palliative care unit in “future clinical services planning”.

Lack of palliative care staff and infrastructure in Nepean Blue Mountains local health district

The Nepean Blue Mountains region has 11 hospital beds nominally assigned to palliative care but these are scattered across different wards in three hospitals spread across the vast geography of four local government areas. Palliative care patients can be admitted to any ward, or hospital, depending on bed availability among patients with conditions and needs far different to palliative care patients. Most admissions are via the emergency department.

According to national palliative care guidelines Nepean Blue Mountains LHD should have eight palliative care doctors, 48 specialist palliative care nurses and 26 specialist palliative care beds to meet the complex needs of people like Joe Bartolo.

Dozens of reports and enquiries have noted that just a tiny fraction of dying Australians get proper palliative care. In May 2020, a report by KPMG and Palliative Care Australia put that figure at just two per cent.

In Nepean Blue Mountains region just 700 people each year get any form of palliative care; far fewer get seen by specialist care staff while none have access to a dedicated palliative care unit.

Nepean hospital is undergoing a $1 billion redevelopment to upgrade a range of services, including an expanded emergency department, birthing suites, a new neonatal intensive care unit, new community health services, 200 hospital beds in new accommodation, and a multi-story car park.

But despite years of advocacy by Nepean’s small cadre of palliative care staff, there is no money and no commitment to upgrade palliative care staffing or infrastructure within the billion-dollar redevelopment.

Further reading

Penrith Press April 7, 2021: Nepean Local Health: calls for specialised palliative care unit

Prime Minister Scott Morrison is ill-equipped to lead the cultural changes being demanded by Australian women.

There are many reasons for this but foremost is the fact that Mr Morrison is, like many other men leading major institutions, a product and beneficiary of a male culture that trains and rewards misogyny in boys and men.

This means he is blind to the power and prejudice that ground men’s dominance over women and which lie at the heart of women’s mistreatment.

Further, it means he is clueless and incapable of leading the root and branch changes needed in every sector of our society, including within the federal parliament, workplaces, every sector of government and the private sector, and most urgently in domestic settings, where misogyny in the form of male aggression, violence, homicide, and sexual predation is widespread.

For the past six weeks or so, Australians have had almost daily updates revealing the toxic male culture that pervades the Australian Parliament. Women inside and outside the building are finally having their “me too” moment.

An avalanche of stories concerning sexist comments, unwanted sexual advances, alleged rape, being ignored and sidelined, and being criticised for their weight, their looks, and their clothes are the stuff of daily headlines. Many of these stories involve MPs and male staffers in the Liberal Party and government headed by Prime Minister Morrison.

The PM has studiously ignored these stories until now. ABC journalist Patricia Karvelis put it like this:

“Morrison has spent the last month failing to read the national mood when it comes to the treatment of women.

“Convinced the issues around rape, sexual assault and sexual harassment were boutique feminist issues that didn’t have cut through in Australian suburbs, the Coalition has belatedly realised that sexism knows no class, race or political persuasion.

“It lives where male power festers unchallenged and manifests in the degrading treatment of women.

“Story after miserable story has exposed the toxicity of this culture.”

This doesn’t mean changing Australian culture is a lost cause; it means the colossal task should be led by others better equipped for the job.

The sooner the PM understands and accepts this, the sooner he can lend the vast resources of his office to endorse and enable cultural changes to be led by others in our society.

The PM now says he “gets it” when it comes to understanding women’s experience of mistreatment and misogyny, although the latter is not a term that has passed his lips.

He says he understands women’s intergenerational trauma, the relentlessness of the subordination, the lack of respect, the fear, the repetitive reality of being talked over, objectified, sexualised, marginalised, trivialised, harassed and assaulted.

He says he is shocked and disgusted by the almost daily examples of prejudice, aggression, and sexual misconduct exhibited by men in the federal parliament.

And that he has ordered no less than four inquiries into a rape allegation raised by former Liberal Party staffer, Brittany Higgins.

Men’s ignorance and shame

Men’s mistreatment of women has its foundations in power, privilege and prejudice. At an emotional level, it is rooted in ignorance and shame.

Too many men are emotionally illiterate, meaning they have little ability to feel or name their emotions, a deficit that makes them incapable of emotional empathy — understanding and responding appropriately to emotions in others, including women.

A case in point.

On March 15, former Liberal Party staffer, Brittany Higgins told news media that she had asked police to reactivate a complaint about an alleged sexual assault by a colleague in the parliamentary office of her then boss, defence minister Linda Reynolds in March of 2019.

Although Ms Higgins first raised the complaint with police days after the alleged incident, she paused it a few weeks later because she was concerned that pursuing it might lead to her losing her job as a parliamentary adviser.

Ms Higgins confirmed this during an interview with Network Ten on 15 March this year. “I realised my job was on the line,” she said. “I didn’t feel like I had a choice.”

During the same interview, Ms Higgins said the handling of her complaint by Minister Reynolds and senior staff, including some in Scott Morrison’s office, made her feel as though she had created a political problem for the government.

“There is a strange culture of silence in the parties and you just don’t … the idea of sort of speaking out on these sorts of issues, especially around [an election] campaign, is just like letting the team down, you are not a team player,” Higgins told Ten.

The next day, Mr Morrison announced a review into workplace culture in Parliament House and apologised to Ms Higgins for what she experienced following the alleged incident and conceded the government had mishandled its response.

Mr Morrison said the announcement followed a discussion with his wife Jenny the previous night and after he considered how he, as a father, would want his daughters to be treated.

“Jenny and I spoke last night and she said to me, you have to think about this as a father. What would you want to happen if it were our girls?” he told reporters.

“Jenny has a way of clarifying things. Always has. And so, as I’ve reflected on that overnight and listened to Brittany and what she had to say.”

In other words, Mr Morrison needed his wife to tell him what he should have been feeling and how to respond empathically as a human being.

Emotional literacy lacking in men

Emotional literacy, which the American psychotherapist Claude Steiner defined as ‘the ability to understand your emotions, the ability to listen to others and empathise with their emotions, and the ability to express emotions productively’, seems to come naturally to females. [i]

What’s more accurate is to say is that girls and women are encouraged to feel and express their emotions and to recognise and respond appropriately to them in others.

Sitting in a café this morning, I overheard a conversation between women. A new baby boy had just been born to the daughter of one of the women.

Congratulations were given and received, but what characterised most of the conversation was their empathy. “Thank goodness it’s now over for your daughter,” said one women. “I’m glad her ordeal is over.” Another said: “I’m so happy to hear that everyone is healthy and well,” while a third added: “Now she can rest for a few days and start to enjoy her baby boy.”

Can you imagine the same conversation ever occuring among men?

By contrast, male conditioning teaches boys to suppress many of their feelings, especially ones that leave them prey to male criticism, such as fear, shame and sadness. “Boys don’t cry,” is a trope as old as time.

As feeling and expressing the full range of human emotions is beaten or shamed out of them, boys eventually become insensitive to their emotions and the emotions of others.

When they experience events that should stir feelings of fear or sadness, they often feel nothing. More often they feel angry, a derivative emotion that is a safer and more acceptable in male culture.

Their anger is also born of frustration and denial: they live in bodies roiling with emotions with no outlet until they boil over into anger, self-harm and violence towards others, including women.

Another case in point.

A few days ago, Mr Morrison lashed out angrily at journalist at a Parliament House news conference in which he had addressed media about the latest example of sexual misconduct in the building.

The night before the news conference another example had emerged about a Liberal Party staffer’s conduct in Parliament House. The incident involved a staffer sacked after he had allegedly taking photos of a lewd act on the desk of a female Liberal MP.

Sky News reporter Andrew Clennell put it to the Prime Minister that the situation made it look like he had lost control of ministerial staff.

“Right now,” Mr Morrison responded, “you’d be aware in your own organisation, that there is a person who has had a complaint made against them for harassment of a woman in a women’s toilet and that matter is being pursued by your own HR department.

“Let’s not, all of us who sit in glass houses here, start getting into that.”

Morrison’s inappropriate accusation turned out to be false and he was forced to apologise later that day.

We don’t know how the PM felt about being asked a legitimate question about his leadership on an issue that demands sensitivity, wisdom and compassion. What we witnessed instead was an angry and baseless attack on a representative of a news organisation.

Men’s shame

When we behave in ways that fall short of our own or society’s standards, we realise there is a gap between the standard and our behaviour. As a result, some people feel guilt while others experience shame.

Brené Brown has made a distinction between the two emotions that is critical in explaining some of men’s behaviour towards themselves and others, including women.

While guilt has a focus on behaviour — “I did something bad” — shame has a focus on self — “I am bad.”

As we grow up, we experience hundreds of shaming messages from influential adults and peers: who do you think you are? You’re not good enough. You’re a failure. You’re stupid. Arrogant. Violent. Criminal. Sinful.

When we internalise a shaming message from a powerful adult or peer, we make the mistake of focusing on our identity or self instead of our behaviour.

Internalising shaming messages, according to Brown, is highly correlated with addiction, depression, violence, aggression, bullying, suicide, and eating disorders.

By contrast, guilt is inversely correlated with these pathologies. The ability to hold something we have done up against something we want to be able to do is adaptive, she argues. Uncomfortable but adaptive.

It’s adaptive because admitting we’ve behaved badly or in a way that is sub-standard — being honest and accountable — and making a new commitment to behave differently in future is positive, learnable and measurable. Unlearning internalised shaming messages is far harder.

For men, the biggest shaming message is “you are weak.” So, suppressing one’s natural ability to feel and express one’s more tender emotions is the safest way to avoid accusations of weakness.

This is precisely what a toxic male culture does: it rewards men for suppressing most of their feelings; for being emotionally numb and illiterate.

Moreover, it turns men into emotional time bombs: ready to explode in violent and catastrophic ways that violate themselves, strangers and loved ones.

Rape. Murder. Mass shootings. Domestic violence. Sexual harassment. Sexual exploitation. These are the consequences of men’s emotional ignorance and internalised shame.

Shame needs three things to fester and grow: secrecy, silence and judgment, all of which are created and reinforced by a socialising male culture. Sadly, most men have no clue about how to begin talking about their fears, their sadness, or their shame. And even if they did, are there men who would know how to listen to them?

Empathy is the antidote to shame

Empathy is the antidote to shame, so the most powerful words we need to hear when we are struggling with internalised shaming messages is “me too”.

This is why cracking men’s silence and suffering requires courage and vulnerability, not perfection.

Part of what we need in male leaders in every sector of society is men who are willing to show and teach emotional vulnerability by telling the truth about themselves.

We need male leaders who can feel and demonstrate the full range of human emotions, which is the proving ground for emotional literacy and empathy.

We need male leaders willing to demonstrate authentic accountability, not a scripted or half-hearted apology given in the hope that this is enough to answer for their actions.

We need men who are willing to investigate the origins of their bad behaviour so that they can consciously begin to learn how to change their lives, and therefore the lives of women and children for the better.

We need safe, evolved, conscious men — elders — who are willing to teach boys and men the requisite emotional and leadership skills of how to be a balanced, conscious human being.

Who can teach boys and men these skills?

There are a few Australian organisations that have been running effective educational programs for men, boys and girls that could be part of a wider set of policies and solutions to the problems now crying out for attention.

In Australia, the Pathways Foundation has many programs for boys and girls who are growing into adulthood. In particular it runs multiday rites of passage camps for boys and girls run by skilled, emotionally literate leaders. It has been operating for 20 years and the Governor General the Hon David Hurley AC and her excellency Mrs Linda Hurley are its joint patrons.

“As a values-based organisation our framework is that of Respect, Responsibility and Awareness for self, others and the environment,” says the Foundation. “Pathways Programs assist with the prevention of risk-taking behaviours, self-harm, anxiety, substance abuse, under achievement, bullying, body image and disconnection with themselves, families, peers and their community.”

The Mankind Project Australia has been running men’s rites of passage in Australia since 2002 and has centres operating in NSW, Victoria, Queensland and Western Australia. Perhaps more importantly, it operates men’s groups where men can learn the soft skills of humanness that they often miss out on during boyhood and as they move into adulthood.

These skills include abilities such as emotional literacy and include abilities such as deep listening, feeling and expressing emotions, speaking honestly from the heart, taking responsibility for the impacts of one’s words and actions, and learning life-purpose and leadership skills.

Learning and developing these skills in the company of other men has many benefits but foremost is that men can bring these newfound skills to the way they conduct relationships between themselves and the wider world.

Research and anecdote suggest that well-run men’s groups are training grounds for these skills because they provide an antidote to many of the shaming messages boys and men learn in the absence of emotionally literate male role models during their developing years. They are not a panacea for misogyny or stopping men’s mistreatment of women. The solution to this deep cultural issue requires a raft of educational and other policy responses that will take generations to take effect.

Resources

The benefits of men’s groups

How To Start And Run A Men’s Group Successfully

Starting & Running a Successful Men’s Group Starting a Men’s Group

Brené Brown — Listening to shame

Brené Brown — The power of vulnerability

About the author

Dan Gaffney is a teacher and author. He leads workshops and educational events and hosts a men’s group in the Blue Mountains. His book and podcast series, Journey Home — Essays on Living and Dying was published in November 2019.

[i] Steiner, C and Perry, P. (1997) Achieving Emotional Literacy. London: Bloomsbury

In the six short months since I said I’d opened myself to healing, many remarkable things have happened. Cancer has vanished. I have more vitality, more joy de vivre. Happy, healthy choices are easier and more desirable, and a flood of heart-opening, life affirming people and experiences have come my way.

‘There are no accidents’ goes the saying, and whether one believes this dictum or not, the fact is our choices have consequences, and, so, making different choices leads to different consequences. More of which, later.

What does it mean to open oneself to healing? For me, it means (in part) changing what I give attention to, who I spend time with, what I say and do, what I eat and drink — all practical, observable, learnable choices that are easy to describe and teach, if it comes to that.

But let’s unpack the the headlines.

Cancer has vanished

I’m in a clinical trial (DREAMM 7) that is evaluating two forms of immunotherapy to treat multiple myeloma. The decision to join the trial five months ago of an experimental therapy was guided by a larger call to healing more than a singular desire for a cancer cure. I had no expectations of a positive impact and elsewhere I have described why participating in a clinical trial is really a gift to future generations, not something one should do in the expectation of a cure or reprieve from a serious health condition.

By mid January 2021 the results had been positive and spectacular. By early February and after 6 doses of Belantamab combined with Bortezomib and Dexamethasone, blood tests had plummeted 99 per cent to the point that these results suggested I might be cancer-free. For myeloma, the gold standard evidence of being in remission (meaning that cancer is indetectable) is confirmed by a bone marrow biopsy.

I had a biopsy in early February and got the results on 22 February. The biopsy confirmed the blood tests: I’m in remission for the first time in six plus years. Cancer is now indetectable in my body. I feel like I’ve conquered Everest but as anyone knows conquering a peak only happens with the aid of many, many people. I’m now sharing the good news and calling the dozens and dozens and dozens of people who have supported my recovery.

More vitality, more joy de vivre

As the cancer load has continued to drop it feels like a 500-pound gorilla has climbed off my back. Before now I had felt like I was wading through treacle and loaded down with lead weights. Now I feel like I’m walking on the moon. This physical release has come with more joy, more lightness, a more buoyant spirit. I can’t properly describe this newfound freedom but slowly I’m regaining my strength, my delight, and the feeling of being flooded with gratitude. I can breathe more deeply. I can feel blood coursing warmly through my blood vessels. The incessant pain that accompanied cancer in my bone marrow has vanished.

Happy, healthy choices easier, more desirable

In his remarkable documentary On Yoga: The Architecture of Peace, film-maker Heitor Dhalia explores the depths of yoga through photography, stream-of-consciousness video footage and extensive interviews with yoga masters from India, Tibet and New York.

Perhaps the central message of the film is this pearl, spoken by one devotee of yoga: “Nothing can bring you lasting happiness, but you have it already. The real thesis of yoga is not that you get your health, your well-being, your inner peace comes from outside yourself, which is what our culture often teaches us, but rather, we have it already. And then the question becomes, ‘what am I doing that’s disturbing that, as opposed to how can I get something that I don’t already have?’”.

This is the core of healing: nothing can give you lasting happiness, but you have it already. So I’ve stopped disturbing the bliss that’s present by simply residing in being. Any thought or action aimed at chasing another state (like feeling happy or high) disturbs our native state by manipulating external events in the hope of changing our internal state.

A better word than happiness might be ‘peace’. Meaning that when we abide in being still, in letting go of distracting thoughts and pent-up feelings, resting in this moment instead of indulging mental schemes about the future (or replaying the past), we find we already reside in the bliss we’ve been seeking to create.

As the cliché goes, “less is more”. The fact that peace is here now obliterates the desire for anything that disturbs this natural state of being. Our bodies and minds are wired for pleasure and yet abiding in the truth that peace is our native state makes pleasure-seeking a secondary concern because all efforts aimed at gaining pleasure (or peace or happiness) beg the question, “what am I doing or seeking that’s disturbing inner peace?”

The yamas and niyamas were first described by Patañjali in The Yoga Sūtras, which is a set of books containing 196 aphorisms describing the lessons and virtues of yoga. [i]

The second yama is Satya, meaning truthfulness. In The Yoga Sūtras (2:36), the Sanskrit text says: Satya pratiṣṭhāyām kriyāphalāśrayatvam, which translates as, “to one established in truthfulness, actions and their results become subservient.” [ii]

This is the truth at the heart of opening ourselves to healing. Manipulating external events to engineer happiness is not only misguided but ignores the truth of being: that peace is here if we let ourselves notice and experience it.

This is in contrast to a prevailing attitude that says contentment lies outside ourselves rather than within. “When we expect the world to meet our needs, we turn outside ourselves to find sustenance and completion,” writes Deborah Adele. “We expect our partners to fulfill us, our jobs to meet our needs, and success to solve all our problems. As long as we think satisfaction comes from an external source, we can never be content.

“True freedom and contentment begin to find their way to us when we can see things as they are, (rather than) spend(ing) so much energy manipulating things according to our preferences.” [iv]

As a consequence, I’m spending more time doing yoga, taking long walks in nature, cultivating and eating organic, nutrient-dense foods, reading and watching educative books and films, and hanging out with people who are living lives similarly inspired by a desire to cultivate and allow their native peace and happiness.

Heart-opening, life affirming people and experiences

It’s axiomatic that changing our choices leads to different experiences, both internally and externally. And as I said above, the recognition that one already resides in peace means the desire to make choices aimed at manufacturing ‘happiness’ or ‘bliss’ have dropped away. This choice means new, life affirming people and experiences have come my way. Without trying to explain this phenomenon, I can only say these people and experiences have brought more opportunities for healing — meaning that they reinforce my opening to the truth that “nothing can bring you lasting happiness, but you have it already.”

Healing sickness, healing wounds

I’m told that multiple myeloma is an incurable cancer. The best that can be expected, even from a “deep, positive response” to treatment is less severe symptoms, less complications, a higher quality of life and a longer life expectancy. These are profound and welcome treatment outcomes. But healing is a different kettle of fish and while it may not encompass a cure for cancer, it is both a noble and necessary way to live. Why? Healing is necessary for cauterizing and sealing the wounds inflicted by countless others, including the accumulated wounds bestowed by the untold, unhealed, generations who came before us. God love our ancestors!

Healing our wounds bestows peace in our hearts by ending the war we wage on ourselves and others and thereby ends intergenerational wounding. In Buddhist terms, healing frees us from the karmic wheel of samsara so that we become self-authoring peacemakers. [v] In other words, we realise our Buddhahood, our inherent nobility, our innate divinity.

The Call of the Reed Warbler

Then consider the healing that has unfolded in the Australian landscape (and others) over the past 30–40 years through the practice of biodynamic farming. In his seminal book, The Call of the Reed Warbler, Charles Massy explains how “less is more” — that working with nature instead of against it, allows the dynamic interplay of the five elements of ‘landscape function’ to restore dead, diseased, unproductive farms and landscapes to their natural ecological health. [vi]

His book reveals in detail how farming methods beginning in the eighteenth century took a mechanistic view of nature that views landscape and its elements as inert substrates that farmers had to manipulate in order to reap a decent harvest. Over the following 250 years this view and its practices have persisted and produced untold damage to the land and its productivity, to its plants and animals, and to the humans who have perpetrated this misguided approach to farming.

Some of the tenets of this approach include the massive use of pesticides and herbicides, monocultural (single species) farming, wholescale removal of trees and ‘non-farmable’ perennial grasses and plants, long term set-stocking of animals such as sheep and cattle, and the almost exclusive sewing and cultivation of shallow-rooted annual cereal crops.

The consequences include loss of biodiversity, mass erosion and soil loss, rising soil salinity, falling water tables, the devastation of monoculture crops by pests (insects, birds, funguses and viruses), the declining ability of farms to naturally support the growing of crops and the feeding of animals, and the widespread financial ruin of farming families and businesses — to name a few.

In Australia and across the globe, these devastating effects have been exacerbated by the effects of global warming, especially through increasing exposure to droughts, bushfires and floods. Globally, more and more land has become ‘marginal’ and unviable for farming at all scale levels — from small scale farmers feeding families, to mid-sized farmers supporting local and regional markets and communities, through to massive agribusinesses and factory-farming behemoths.

However, over the past 40 years or so, both necessity and a deeper consideration of landscape ecology, which originated from biodynamic movements in Europe during the 1930s, have led to experimentation and innovations that have seen farmers who employ this thinking enjoy massive bounties: landscapes and farmlands have been restored to health; crop yields have climbed without need of pesticides or the use of superphosphate, farmed animals are happier, heavier and healthier; soils have deepened and their ability to hold and store water have increased, and farms are more resilient to pests and the scourges of drought and the other incursions of climate change.

Not least, the increasing supply and consumption of healthy organic produce means less people are being exposed to the toxic plant and meat products that are baked into modern food supplies. Said another way, the increasing adoption of biodynamic farming methods means the land, its harvest, and those who consume its produce are healing. Massy and others steeped in these practices explain that these benefits are a function of ‘farming without farming” — working with nature and not against her.

Here it’s worth re-citing Deborah Adelle, who I quoted earlier: “True freedom and contentment begin to find their way to us when we can see things as they are, (rather than) spend(ing) so much energy manipulating things according to our preferences.” Adelle is talking about the path to healing. Like the farmers who are adopting the tenets of biodynamic “do less” farming, our ability to observe and notice the deeper currents of reality — meaning the nurturing underpinnings of life — and to live in accord with them, means we too can enjoy the bounties of health, healing, vitality and peace.

Dan Gaffney is a teacher and author. His book and podcast series, ‘Journey Home — Essays on Living and Dying’ was published in 2019

[i] Over the past century or so, dozens of commentaries on The Yoga Sutras have been written by teachers and academics seeking to clarify variations and interpretations of the Sutras, which were first written in Sanskrit. These interpretations and translation are a matter longstanding discussion and debate.

[ii] Jack Utermoehl, The Eight Limbs of Yoga For The American Yogi, Bhakti House, Kindle, 2nd edition, 2019, pp161–163

[iii] Jack Utermoehl, 2009, ibid, pp 418–419

[iv] Deborah Adele, The Yamas and Niyamas: Exploring Yoga’s Ethical Practice, On Word Bound Books, LLC, Minnesota, 2009, p121

[v] Samsara refers to the cycles of birth and death; the cycling of all things in the universe. For more information see A Path With Heart by Jack Kornfield, 2002 by Rider, an imprint of Ebury Publishing

[vi] The five key landscape functions described by Massy are water, soil, sunshine, biodiversity and humans. For more, see Charles Massy, The Call of the Reed Warbler: a new agriculture, a new earth, 2018, White River Junction, Vermont: Chelsea Green Publishing.

Telling loved ones your end-of-life preferences lightens the load for everyone

End-of-life conversations offer a host of benefits to people facing death, and to their families and friends. They provide opportunities to explore and define the kind of care we want as we approach our last days and moments. These conversations mean confronting the limits of medical and palliative care and the reality that life is finite — facts that can trigger mental and emotional alarm for some.[i]

So it’s no surprise that some doctors and their patients are cautious when it comes to discussing death, and that many people avoid or delay these conversations till the last minute, or until it’s too late.

In a large, often-cited study named Coping with Cancer, the authors reported that nearly two-thirds of terminally ill patients said they’d never had a conversation with their doctors about their end-of-life care, despite having just four months to live.[ii]

The study also found that the one in three patients who did have end-of-life conversations with doctors were more likely to accept that their illness was terminal. These patients also voiced a preference for treatments that focused on relieving their pain and discomfort in preference to choosing life-extending therapies.

There were other benefits, too. Patients who had end-of-life conversations with doctors were less likely to be resuscitated, had less depression and worry, and were less likely to end up in an intensive care unit or to have aggressive medical interventions near death, such as intubation and mechanical ventilation.

Also, six months after these patients died, their families were less likely to be depressed and felt more prepared for their loved one’s death than families of patients who didn’t have end-of-life conversations and who endured aggressive medical interventions near death.

Said another way, people who have practical conversations with doctors about their preferences for their end-of-life care seem more likely to die a ‘good death’ while sparing their families a lot of heartache and distress.

While these findings mightn’t be surprising, they’re not well known or discussed either in healthcare circles or the wider community. Even if they were, it’s still likely that they’d be unwelcome. Our compulsion for finding a fix for death means we’re ignorant and afraid to talk about what we might want until it’s too late.

Beyond specialties like palliative care, there’s almost no discussion about end-of-life conversations. But the costs are heartbreaking. If you have any doubts, watch Extremis — a documentary that shows the devastation experienced by three dying patients and their families because they didn’t speak up sooner about their life and death choices.

The question is, when your days are numbered, do you want to have serious medical interventions that you didn’t choose yourself?

Do you want your kids and loved ones forced to make life and death choices for you, because you didn’t speak up sooner?

Do you want them to have to live with the consequences?

Stories about families burdened by making life and death decisions for their loved ones are far too common. So are stories of doctors taking matters into their own hands — sometimes against the wishes of patients and families.

The tragic case of Marlise Munoz, a pregnant 33-year-old woman, is a case in point. A day after she collapsed at home, Munoz was declared brain dead by doctors. But against her family’s wishes, doctors kept her body on ventilators because they said they had a legal duty of care to her unborn 14-week-old baby.

In 2014, teenager Jahi McMath was declared brain dead after complications from what should have been a routine tonsillectomy. Authorities at the Children’s Hospital in Oakland wanted to turn off the 13-year old’s artificial life support, but her family resisted and transferred her to another facility where her body was maintained by a mechanical respirator.

These examples are just two of many such cases that add to the debate and controversy about defining death, including brain death.[iii] [iv] They also highlight the catastrophic cost of prolonging life beyond its limits despite the high emotional and financial cost to families, health carers and health insurers.

It’s estimated that 30 per cent of all healthcare dollars are spent on medical efforts to prolong people’s lives — with 80 per cent of that money spent in the final month of life. A lot of this heartbreak and expense happens because most of us haven’t made a living will and told someone about it.

Now is your opportunity to speak up about what you want and don’t want before it happens. Some people want the full treatment, no expense spared, intervention at all costs. Others want a quiet dignity that spares them from the prolonged pain and trauma that can accompany medical interventions intended to extend people’s lives.

The internet makes it easy to create and register a living will (also called an advance care directive) and to appoint a healthcare proxy — someone authorised to make decisions about your medical and end-of-life care if you can’t make these decisions yourself.

Advance care directives are meant to advise doctors about what you do and don’t want but they are not legally binding in all circumstances or legal jurisdictions.

For example, In the Australian state of New South Wales, the NSW Supreme Court has said that valid advance care directives must be followed. This is because they are a part of a person’s right to make decisions about their health.

If an advance care directive is valid, it must be followed. Health professionals and healthcare proxies have no authority to override a valid advance care directive.

In New South Wales, a treating doctor will consider your advance care directive to be valid if three conditions are met: you had mental capacity when you wrote it; it has clear and specific details about treatments that you would accept or refuse; and, it applies to the situation you are in at the time.[v]

Advance Care Planning Australia has a multi-language online resource library containing information, forms, case studies, articles, videos and fact sheets to assist advance care planning.

If we all talked to our family about our choices and completed advance care directives, we could lighten the load for everyone — not least for ourselves, but especially for our loved ones.

[i] Puri, S (2019). The Lesson of Impermanence, The New York Times, March 9

[ii] Wright AA et al (2008). Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA, 300(14), pp 1665–1673

[iii] Gostin LO (2014). Legal and Ethical Responsibilities Following Brain Death: The McMath and Muñoz Cases. JAMA, 311(9), pp 903–904

[iv] Juahar, S (2019). What is Death? The New York Times, 16 February

[v] NSW Ministry of Health (November 2018). Making an Advance Care Directive, ISBN 978–1–76000–996–0

One of the unique and troubling challenges of being human is our separation from nature. We harbour this separation in our heads, hearts and souls — a quandary that has rendered us homeless in a most profound way.

Many of us have been physically separated too. For millennia, we’ve fled our families and homelands due to war, slavery, persecution, migration, disasters and the search for a better life. These experiences are rooted somewhere in our collective memory, and recorded examples go back as far as the Old Testament of the Bible.[i]

By contrast, people with a long intergenerational history of living securely in the land feel deeply at home.[ii]Crucially, these people know where the bones of their ancestors lie, and they have a profound sense of belonging to their forebears, to the plants and animals, and to the land, skies and waterways.[iii]

Before their culture was disrupted 250 years ago, scholars say Indigenous Australians lived this way for as long as 60,000 years. Their Dreaming mythology infused everything with sacred meaning.

When life is lived mythologically, there’s no separation between what we might see as mundane — chores, study, work, commuting, food preparation — and what we call sacred — prayer, sacrifice and worship.

For many indigenous people, mythology mirrors their deep feeling of belonging to nature: everything is sacred, especially hunting, gathering, storytelling, celebration and the initiations that inform their spiritual journey from birth to death.

Among the many tragedies perpetrated by disruption to indigenous cultures, perhaps the greatest was stealing and removing people from their homelands through the practice of slavery.

Of course, slavery inflicts many more wrongs — it denies people their liberty, their customs, their gods and their language, but its chief injury is to violate people’s feeling of belonging by stealing their sense of spiritual and cultural belonging.[iv]

Similar wounding has befallen people who’ve been forcibly removed from their land or who have fled in fear of persecution and death. Some immigrants and their descendants feel a similar deprivation even though they and their forebears weren’t stolen or fleeing from calamity.

In the United States, the southern and westward expansions of the frontier that began with the British colonial settlements of the early 17th century created opportunities for immigrants and pioneering settlers to stake their claim for a new home and a better life.

But going west didn’t mean they had any idea of how to be at home in their new environment. With their ancestors behind them in Europe or back in the newer colonial settlements to the east, these pioneering immigrants quickly became cultural orphans. They had no lineage, no elders and no mythology to ground them in the land.

What’s more, their loss was bought at the expense of indigenous people. Encouraged by a belief in ‘manifest destiny’ and the passing of laws such as the Indian Removal Act of 1830 and the Indian Appropriations Act of 1851, the US Congress extinguished native title to land that enabled the forcible removal of Native Americans from their ancestral homelands to accommodate the European-American expansion west of the Mississippi River.

Indigenous people who agreed to assimilate into the new white culture were allowed to stay on their lands rather than being moved to reservations. But assimilation meant abandoning long-held stories and practices that ruptured their cultural identity. [v]

Anthropologists who study the impacts of human dislocation and ethnic cleansing say it takes just two generations to break the bonds that bind people to their ancestry and their sense of being at home.

‘The grandchildren, with no lived or recounted memory of any ancestral home, know nothing of Home — nor do they know that about themselves,’ writes Stephen Jenkinson. ‘They don’t know what the elders are talking about, if they are still talking about what was left behind, and they don’t often know much of the language the elders are speaking when they do. What the grandchildren know is flight.’[vi]

But those of us with the good fortune to have a house, a passport and citizenship of a nation-state are still cultural orphans with nothing and nobody to fill our longing for a spiritual home.

Yet home isn’t a place or psychologised state of being, even though the real estate and home decorating industries have convinced many that feeling homely signals the bliss of a spiritual home.

Nomadic people have no settled location. They move from place to place as a way of obtaining food, finding pasture for livestock and making a living. Their shelters are temporary, and their movement is guided by the seasons and the availability of plants, game and water. Today, some 30 to 40 million people are classed as nomads, drawing on traditions dating back as far as 8,500 BC.

With no fixed address, nomadic people bear their children and bury their dead by the trail. No headstones or cemeteries mark the whereabouts of their fallen ancestors.

But how is it possible to be at home with no fixed address? One clue lies in the relationship that nomads and some surviving indigenous peoples share with their ancestors. In these cultures, the dead feed the living. When grandpa dies, the tribe honours the old man with days of grieving and stories and songs and feasting.

The old man is present at his wake, propped in a makeshift chair or throne to hear the stories of his life — his achievements and failures. Everyone feasts on the marrow of his life and when the ceremonies are done, they put him in the ground and move on.

But he’s not gone or forsaken. Soon after he’s in the ground, the old man’s body starts to rot through the action of microbes in his body and the bacteria, fungi and worms in the soil. Within three years, his remains have put large quantities of carbon and nutrients into the soil, resulting in lush plant growth.[vii] [viii]

Meanwhile, the old man’s tribe continues its journey, always following the herd from pasture to pasture until they stop to settle on the best-eating grasslands, nourished by their fallen elders. All are fed by ancestry and all are nourished by the countless accretions of the dead: the soil, the pasture, the livestock and the tribe.

The wisdom here is that death doesn’t rupture relations between the living and the dead but, rather, affirms its necessity for life’s continuance and sustenance.[ix]

The dead aren’t gone, they’re present to the living through stories and customs and, most emphatically, as nourishment if we can appreciate and embrace the cycle of life and death. For those fortunate enough to know and hold their ancestors closely, the dead are never lost — they are destiny — and the living are always at home.

But for most of us there’s no balm for our loss and no liniment for our fear of dying and death. Without a spiritual home or a cultural context, we seem to be tearing at the world in a frenzied pursuit of what we’ve forgotten. And all the while we are turning the Earth into a smoking ruin — a stark reminder of our inner landscape.

We belong nowhere. We have no tribe, no elders and no ancestral story to bring us home. No wonder the news of our death has become an existential horror to us. But it wasn’t always so, and in some parts of the world it’s never been so.

Dan Gaffney is a teacher and author. His book and podcast series, ‘Journey Home — Essays on Living and Dying’ was published in 2019

[i] Thorpe, L (2012). A Study of Modern Day Slavery. International Disciples of Women’s Ministries of the Christian Church

[ii] Clarkson, L et al (1992). Our Responsibility to The Seventh Generation: Indigenous Peoples and Sustainable Development. International Institute for Sustainable Development, Winnipeg

[iii] Jenkinson, S (2018), Come of Age: The Case for Elderhood in a Time of Trouble, North Atlantic Books. Kindle Edition, pp 204–205

[iv] Australian Human Rights Commission (1997). Bringing Them Home: Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families

[v] T Egan, After Five Centuries, a Native American With Real Power, New York Times, 1 January 2021

[vi] Jenkinson, S (2014). Die Wise: A Manifesto for Sanity and Soul. North Atlantic Books, Berkeley, California, p250

[vii] Vass, A et al (1992). Time since death determinations of human cadavers using soil solution. Journal of Forensic Sciences, 37 (5), pp 1236–1253

[viii] Anderson B (2013). Dynamics of ninhydrin-reactive nitrogen and pH in grave soil during the extended postmortem interval. Journal of Forensic Science, Sept 58(5)

[ix] Oliver, M (2013). A Thousand Mornings, Penguin Books, pp27–28