2015년 4월 1일  | By: eyesopen1  |  세계  |  2 Comments

내과의사인 댄 스완가드는 죽음이 어떤 것인지를 잘 알고 있습니다. 모르핀에 의지하며 불안감에 사로잡힌 채 서서히 죽어가는 환자들을 수도 없이 대했기 때문입니다. 그리고 2013년 희귀한 전이성 암 진단을 받은 후, 중환자들의 죽음은 그에게 더욱 개인적인 문제가 되었습니다. 췌장과 간의 일부, 비장과 쓸개를 전부 들어내는 대수술은 성공적으로 끝났지만, 스완가드는 암 재발 가능성이 높다는 사실을 잘 알고 있습니다. 그리고 암이 재발해 더 이상 치료가 어려운 상황이 되면, 스스로 죽는 방식을 선택할 수 있기를 바라고 있습니다. 그리고 그는 현재 캘리포니아에서 진행 중인 소원에 참여하고 있습니다. 죽음을 앞당기기를 바라는 불치병 환자에게 의사가 극약을 처방할 수 있도록 허용해달라는 내용의 소송입니다. 자신이 실제로 그런 죽음을 택하리라 장담할 수는 없지만 선택권을 갖길 원하기 때문입니다.

뇌종양으로 투병하던 29세 여성이 “존엄사법”이 발효된 오레건 주로 이사를 가 안락사를 택한 사건 이후, 미국 전역에서는 안락사 논의가 재점화되었습니다. 스완가드와 뜻을 함께하고 있는 이들은 캘리포니아에서 자살 방조가 범죄이지만, 자신의 의사를 밝힐 수 있는 불치병 환자가 죽음을 택하는 것은 자살이 아니며, 오히려 헌법이 보장하고 있는 자신의 몸에 대한 권리라고 주장합니다. 현재 미국에서 의사 조력자살을 허용하고 있는 주는 오레곤 주, 워싱턴 주, 그리고  버몬트 주입니다. 뉴멕시코 주와 몬타나 주에서도 안락사는 합법이라는 판결이 나온 바 있습니다. 캘리포니아 주를 비롯, 각지에서도 비슷한 내용의 소송이 판결을 기다리고 있죠.

의사들은 전통적으로 조력자살에 대해 반대 목소리를 높여온 집단입니다. 전미의사협회의 공식 입장은 여전히 조력 자살이 치료자로서의 의사의 역할과 상충된다는 것이고, 캘리포니아의사협회도 의사가 환자의죽음을 돕는 것은 “환자를 해하지 않는다”는 원칙에 위배된다고 말합니다. 그러나 최근 미국과 유럽에서 의사 2만 여 명의 의견을 물은 설문 조사 결과를 보면 의사들의 생각이 달라지고 있음을 알 수 있습니다. 54%가 의사 조력자살 허용에 찬성한다고 답했는데, 4년 전 46%에서 크게 늘어난 수치입니다.

스완가드는 의사로 살아온 세월 동안, 의사들이 그저 환자의 생명을 연장하는데 급급해 마지막 남은 시간 동안 환자가 무엇을 원하는지를 돌보지 않는 것을 보며 의료계가 죽음을 대하는 방식에 문제가 있다고 느꼈다고 말합니다. 그리고 자신이 앞날을 내다볼 수 없는 희귀암 환자가 된 후에는 환자들의 입장을 더욱 잘 이해하게 되었다고 말합니다. 그는 일을 줄이고 명상을 하며 마음을 다스리고 있습니다. 만일 죽음을 피할 수 없다면, 약물에 취한 상태로 죽기보다는 사랑하는 사람들에게 둘러싸여 작별 인사를 한 후 죽고싶다고 생각하고 있습니다. 스완가드와 함께 소송에 참여하고 있는 또 다른 암환자이자 의사인 로버트 라이너 역시 환자들에게 죽음의 방식을 선택할 수 있도록 허용하는 것이 남은 삶을 충만하게 살 수 있도록 해주는 길이라고 믿고 있습니다. 그 역시 선택의 순간이 닥쳤을 때 자신이 안락사를 선택하게 될지는 확신하지 못합니다. 그는 최근에 새로운 배우자를 맞아들였고, 연극을 집필하고 피아노를 배우겠다는 은퇴 계획도 갖고 있습니다. 그럼에도 불구하고 그는 죽음을 결정하는 것이 내 손에 달려있다는 사실만으로도 큰 위안이 될거라고 말합니다. (NPR)

* 이 글의 원문출처는 아래와 같습니다.

http://newspeppermint.com/2015/03/31/aided-death-doctors/

http://www.npr.org/blogs/health/2015/03/30/396319789/doctors-with-cancer-push-california-to-allow-aid-in-dying

‘안락사 약물 다썼다’ 돼지 생매장..2차오염 비상

연합뉴스 | 입력 2011.01.06 11:29 | 수정 2011.01.06 11:38

 
독점공급 제약사 “원료 수입중, 21일께 공급 재개”

지자체, Co2 주입.저류조 설치 ‘안간힘’..효과 별로 ‘고민’

(의정부=연합뉴스) 우영식 기자 = 구제역 살처분 대상 가축이 기하급수적으로 늘어나면서 안락사에 필요한 약품 공급이 끊겨 전국적으로 ‘돼지 생매장’ 사태가 빚어지고 있다.

특히 방역당국은 돼지에 Co2를 주입해 중독사시키거나 저류조를 조기 설치하고 침출수 누출 예찰활동을 강화하는 등 안간힘을 쓰고 있지만 인력 부족까지 더해져 ’2차 오염’ 피해가 확산될 우려가 높아지고 있다

6일 경기도 구제역 재난안전대책본부에 따르면 경기도에서 지난해 12월15일 양주와 연천에 구제역이 처음 발생한 뒤 이날 현재까지 도(道) 내 살처분 대상 가축은 16개 시.군 800농가 47만9천378마리(한.육우 2만4천568마리, 젖소 1만3천419마리, 돼지 44만1천49마리, 기타 342마리)에 달한다.

전국적으로 82만6천456마리로 지난 1일 64만3천776마리에 비해 1만8천여마리가 늘었다. 하루 4만5천여마리 꼴이다.

그러나 살처분을 위한 약물 공급은 지난해 12월29일부터 끊겼다. 이 약물을 독점공급하는 제약회사의 비축분은 물론 원료까지 바닥나 더 이상 생산하지 못하고 있기 때문이다.

이 때문에 전체 살처분 대상 가축의 88.9%에 해당하는 돼지를 사실상 전량 생매장하고 있다.

이 제약회사가 구제역 발생 이전에 갖고 있던 근이완제 석시콜린(Succicholine) 비축 물량은 2㎖짜리 앰플 12만개. 소 1마리를 안락사시키는데 1~3개의 앰플을 사용하고 돼지의 경우 내성이 강해 많게는 소의 5배까지 사용됐다.

제약사 관계자는 “14일까지 해외에서 원료를 들여와 약품 생산을 재개할 방침이지만 제조하는데만 1주일이 걸려 빨라야 21일께나 약품을 공급할 수 있다”고 밝혀 돼지 생매장은 당분간 불가피할 전망이다.

동물 학대 논란도 논란이지만 문제는 생매장이 2차 오염 우려를 확 높인다는 점이다.

살아있는 가축이 몸부림치는 과정에서 비닐이 찢겨 침출수가 새어나와 지하수와 토양을 오염시킬 가능성이 크다.

구제역 긴급방역지침에 따르면 살처분 방법에는 사살, 전살(전기충격), 타격, 약물주입 등 4가지를 제시하고 있다. 하지만 사살.타격은 특수한 장비가 필요하고 전기충격은 사람의 감전 위험성이 커 그동안 약물 주입 방법을 써왔다.

해당 지자체는 당연히 비상이 걸렸다.

어쩔 수 없는 상황에 몰리며 생매장을 해 왔지만 2차 오염 우려가 제기되면서 이마저 강행하기 어려운 형편이 됐다.

경기 파주시와 고양시는 매몰지에 비닐을 덮은 뒤 이산화탄소를 주입해 산 돼지를 중독사시키는 방법을 동원하고 있지만 이 역시 산 채 매장하는 것과 별로 다르지 않아 오염 우려를 줄이는데 한계가 있기 때문에 2002년 구제역 발생 때도 일시 사용했다 중단한 바 있는 ‘임시방편용’이다.

이에 따라 각 시.군은 매몰 즉시 저류조를 설치하고 매몰지 침출수 누출에 대한 예찰활동을 강화하는 등 사후관리에 안간힘을 쓰고 있지만 급증하는 매몰지에 턱없이 부족한 인력으로 이마저도 여의치 않다.

경기북부지역의 한 방역 담당자는 “하루 1만마리까지 살처분한 적이 있는데 안락사용 약품 공급이 원활하지 않아 소에 사용하기도 버거운 실정”이라며 “신속한 매몰처리와 인력 부족 때문에 어쩔 수 없이 돼지를 생매장을 하고 있지만 침출수 유출 등이 우려된다”고 말했다.

wyshik@yna.co.kr

(끝)

Europe’s foot and mouth disease outbreak was foreseeable and preventable

By Paul Mitchell
8 March 2001

출처 : http://www.wsws.org/articles/2001/mar2001/fmd-m08.shtml

New outbreaks of foot and mouth disease (FMD) continue to be recorded daily in Britain. From the first case on February 21, the total has now reached 81, with instances reported in all parts of the country. At least 80,000 animals have been earmarked for slaughter, nearly eight times the original estimates.

With suspected cases in several European countries, the European Union has extended its ban on imports of any livestock, meat and milk products from Britain. Farms in France, Belgium and Germany have been ordered to destroy animals imported from the UK, or which have come into contact with such animals.

The epidemic of foot and mouth disease (FMD) is another example of the re-emergence of a disease once largely confined to more economically backward areas in Latin America, Asia and Africa, and practically eradicated from the advanced countries. The last major epidemic in Britain was in 1967. But last year saw outbreaks of the disease in Japan for the first time since 1908 and in South Korea—disease free since 1934.

Recognised as one of the most highly contagious diseases in animals, the virus rarely affects humans, but causes painful blisters around the mouth, nose, feet and teats of pigs, cattle and sheep. Most animals recover from the disease and its major impact is economic, with reduced milk yields and weight gain, abortions and the death of young animals.

International animal health bodies have existed for decades, but it is has been left up to national governments to decide if, or how, to implement controls. The resulting piecemeal approach has hampered the global eradication of the disease and the anarchic operation of global markets in animals and food products have made matters worse. According to the United Nations Food and Agricultural Organisation (FAO) “the movement of people, animals and animal products for trade is leading to an increased spread of animal diseases across national borders”.

Where the disease has been controlled, individual governments have generally first quarantined the affected area, with any animals showing signs of the disease being destroyed, and carried out vaccination programs in a wider area. Measures are then put in place to prevent infected animals or meat products entering the area.

Although vaccines against FMD have existed for some 50 years, there are certain problems with relying purely on vaccination to combat the virus. The disease exists as seven different types, and immunity against one type does not guarantee immunity against another. Scientists have found that up to half of all vaccinated cattle can still carry the virus, and it is difficult to tell a vaccinated animal from one incubating the disease. The vaccine itself is sometimes unsafe and has caused outbreaks on occasions. Nevertheless, according to the FAO, in Europe, “the introduction of compulsory, mass, annual vaccination of cattle [during the 1950s and 1960s] dramatically reduced the incidence of the disease such that during 1990 no outbreaks were recorded.”

Within two years, however, the routine vaccination of animals against FMD in the European Union was banned. To understand why requires an understanding of FMD in Britain.

Whilst European countries have carried out extensive vaccination programmes, the UK has never done so. The measures employed to deal with FMD in Britain have changed little in 100 years. Until the end of the nineteenth century, because FMD was not fatal to adult animals, farmers put up with it. But then, under pressure from rich, aristocratic cattle breeders, the government brought in controls. At the time, Britain exported industrial goods and imported agricultural ones. The export of pedigree cattle for breeding purposes was one of Britain’s few agricultural exports until after the Second World War. The government first imposed a policy of slaughtering all infected cattle, but exempted breeding stock. The cattle breeders also pushed for bans on imports from infected countries that had to eradicate the disease or lose their export market to the UK.

After the war, Britain turned to a policy of agricultural self-sufficiency and exports, with countries importing British animals and meat demanding it be FMD free. Most European countries, where the disease was very widespread, started using vaccines in 1952 as an alternative to slaughtering their national herds. Britain continued to promote its mass slaughter policy through the European Commission for Foot and Mouth Disease (ECFMD) that it helped to set up in 1954.

In 1985, the European Union (EU) had issued a Directive relating to FMD control that was weighted in favour of compulsory vaccination, but it was amended significantly in 1990. In order to establish the Single European Market by 1993, the EU sought to introduce a uniform policy. Mass slaughter was regarded as preferable to vaccination because outbreaks of FMD were resulting from faulty vaccines that contained virus that had not been inactivated. Disease-free status was vital for international trade, and it has proved difficult to distinguish between vaccinated animals and those that are incubating the disease.

Paul Pilotte, a Belgian veterinary inspector says, “it was the English who pushed for abolishing Europe’s foot and mouth vaccination programme and look where we are now. The English only value their land in order to extract profit from it and agriculture there has become an industry.” The first half of this somewhat xenophobic statement is true, but the EU as a whole went along with Britain—with the new policy relying on import restrictions and border checks. An ECFMD report justified this decision, arguing that “By 1992 Europe was free of the disease and decided to stop the costly annual mass vaccination campaigns.”

The mood at that time, described by some observers as “self congratulatory,” was short lived.

In 1997 the EU reported that as a result of the move to mass slaughter rather than vaccination since 1991, “a fully susceptible farm animal population prevails at present in the EU countries, potentially threatened by border countries where the disease is enzootic [very widespread]. The disease currently represents a constant threat to Europe, as witnessed over the last 12 months in the Balkans, with the outbreaks in Italy (1993) and Greece (1994) supporting this concern about disease re-introduction in Europe.”

A European Commission visit to the Confederation of Independent States (CIS-the former USSR) in 1998 reported, “No one from the central competent authorities was able to accompany the mission due to lack of funds,” where staff had not been paid for months. The annual herd vaccination carried out in the USSR stopped in 1991 when the Soviet Union ceased to exist. Moreover, the collapse of the USSR, local wars in several of its constituent parts and privatisation of much of the state sector has decimated veterinary services across the massive landmass of the former Soviet Union. As a result, for example, Georgia had gone from virtually no FMD outbreaks in the 1980s to 32 outbreaks in 1997.

The US-led war against Iraq in 1991 also produced a rise in FMD, with several outbreaks recorded in 1999. As the FAO warned, “The animal disease situation in Iraq has been aggravated by the collapse of the veterinary infrastructure and disease investigation, surveillance and diagnostic services in the country. The government has been unable to adequately monitor and control the spread of these diseases, partly because of the difficulties it has in obtaining equipment and supplies, particularly vaccines.”

Within Europe, the FAO warns that the creation of a single market, where animals are often transported long distances, increases the risk of diseases spreading. Typically, pigs remain four weeks in a breeding unit, seven weeks in a rearing unit and ten weeks in a fattening unit, often hundreds of kilometres apart, before going for slaughter. As well as these increased risks, the “institutional coherence” of many veterinary services “is being destroyed by the drive to reduce [the] public sector … and the fragmentation of services caused by delegation of power from national to regional levels” says the FAO.

Cuts carried out in Britain’s state veterinary services over the last ten years mean there are only half the number of regional animal health offices, with a fifth fewer vets.

Some commentators have sought to put the blame for the spread of FMD and other animal diseases on “globalisation” and the increased application of science and technology in agriculture. In contrast, the FAO’s senior officer for emergency prevention and infectious diseases, Mark Rweyemamu, says, “In terms of technology, we should be able to avoid such a catastrophe. We have the tools. The system for quick response and containment is much improved, provided those concerned are sufficiently alerted.”

“In an increasingly globalised world veterinary surveillance systems and services are vital to detect these diseases early enough and to prepare contingency plans to contain those outbreaks. Veterinary services should not be considered as a luxury—they must be supported to avoid future disasters,” he continued.

Moreover, as Abigail Woods, a qualified vet currently undertaking a PhD study on the history of animal plagues, points out, “Changing farming practices have long been blamed for FMD introduction and spread, including the use of manufactured, non-organic feedstuffs. In addition, long distance transport of livestock is nothing new… The movement away from local breeding, rearing, fattening, slaughter and marketing of livestock began over 150 years ago with the industrial revolution.” (See WSWS interview with Abigail Woods)

The advances in agricultural productivity associated with the rise of capitalism were also necessary to provide a more reliable and abundant source of food for the mass of workers required in the factories and offices. However, like any other commodity, the production of food is subordinated to the profit interests of the corporate elite. Public safety and animal welfare come a poor second to the drive for rising profits and the intense competition this unleashes.

Faced with the collapse in Korea’s meat exports to Japan because of FMD, American agribusiness saw an opportunity to promote its own interests. “The longer it takes Korea to regain FMD free status the more time US pork suppliers will have to increase market share in Japan,” was the conclusion reached by the United States Department of Agriculture last year in its report entitled Bottom Line: Impact on US trade.

Implementing small-scale local agricultural production and wholly organic methods, as advocated by those like the Greens, would mean a return to pre-industrial population levels.

The real question is to release the potential benefits of globalisation and scientific farming methods from their present subordination to anarchic market forces and the narrow pursuit of profit.