Secrecy is Singapore’s ruling party’s first-resort in matters it considers sensitive. Take Singapore’s powerful sovereign wealth funds for example. These massive state-run investment agencies, Temasek Holdings and Investment Corporation of Singapore, only disclose select parts of their key financials and investment performance. Lee Kuan Yew’s explanation for this is revealing of the state’s penchant for secrecy.
In 2006, Mr Lee, Singapore’s Minister Mentor at that time, rebuffed critics of its secrecy amidst controversy over the Shin Corp deal:
We disclose what we think they need to know. This is our money, we are trustees, we know what we have to do and we’re going to do this .
We took this country from zero to here, and we’re not out to bring it back to zero. So I say, please put your mind at ease – Singaporeans do not worry, you need not worry for them.
Much the same may be said of the Prime Minister’s Office’s (PMO) updates on Mr Lee’s medical condition. The latest statement, issued on Wednesday afternoon, followed the trend of disclosing only what the government thinks Singaporeans need to know. It tersely states:
Mr Lee Kuan Yew remains critically ill in the ICU and has deteriorated further.
State-linked newspapers have failed to shed more light on Mr Lee’s condition and international news agencies have been none the wiser. Everyone is in the dark.
Understandably, responsible journalists have avoided speculating about Mr Lee’s condition. However, given the public interest in the medical condition of such an important national figure as Singapore’s longest serving Prime Minister, the mainstream media, with its vast resources, ought to at least investigate and not rely solely on the government for information. While this is not unexpected, it is also not responsible journalism. Readers are done a disservice by the “lazy parroting,” as Andrew Loh points out.
What we do know
Based on the reports from the PMO, and additional research, here’s what we do know.
Severe pneumonia. Pneumonia is an inflammatory condition of the lung that is usually caused by infection with viruses or bacteria. Mr Lee is most likely still receiving treatment for it. The PMO would have announced the good news if he had recovered from it.
Mechanical ventilation. Mechanical ventilation is required for patients who cannot breathe on their own and need the help of a machine. This is a form of life support and one of the conditions for executing the Advance Medical Directive. Mr Lee is most likely still on mechanical ventilation. He would require it if he is still suffering from pneumonia and the PMO would have announced the good news if he had been taken off it.
Treatment plan. Mr Lee was first hospitalised on Feb. 5 and started on his second course of antibiotics on Feb. 26, three weeks after. It’s almost been another three weeks and the second course of antibiotics hasn’t worked. He will most likely need a third course. This is certainly not a good sign.
Advance Medical Directive. There have been no changes to the Advance Medical Directive that Mr Lee signed in 2010. The directive requires caregivers to withdraw life support in the event that the patient’s death is imminent and if life support “would only serve to postpone the moment of death of the patient.” The more Mr Lee’s condition worsens, the more likely the AMD will come into effect. If he is conscious, the decision on whether to withdraw life support will rest with him. So far, reports have only indicated that he has been lightly sedated, probably because he is still on mechanical ventilation.
Effects of prolonged reliance on mechanical ventilation. Prolonged reliance can give rise to complications, worsening or causing acute lung injury. According to the US National Institutes of Health, “mechanical ventilation may increase the alveolar/capillary permeability by overdistension of the lungs (volutrauma), it can exacerbate lung damage due to the recruitment/derecruitment of collapsed alveoli (atelectrauma) and may cause subtle damages due to the activation of inflammatory processes (biotrauma).” Being on mechanical ventilation for a long time can also have adverse psychological effects as it prevents a person from communicating and can make a person feel helpless.
What we don’t know
And here’s what we don’t know.
Mr Lee’s condition is said to have worsened, and then most recently to have deteriorated. These are not medical terms so they don’t tell us very much.
We don’t know what he was infected with on Tuesday, Mar. 17.
We don’t know how he caught that infection in the ICU, which is supposed to protect patients from infections.
We don’t know what doctors think about his condition and what their prognosis is. What are his chances of recovery? How long more does he have? So far, these are questions that we do not have the answers to.
Why we need to know
Singaporeans deserve to know about Mr Lee’s medical condition, and not just so they can gossip about it. Mr Lee’s is an important public figure who still plays a stabilising role in the ruling party. His health is a matter of public concern for all Singaporeans.
On Feb. 24, the Economist Intelligence Unit (EIU) writes:
Reports of Mr Lee’s poor health in recent years ostensibly have not had an impact on the government, and the confirmation of his hospitalisation hardly created a ripple in financial markets. However, although he has not held a cabinet position since 2011, his track record, leadership style and legacy continue to exert a strong influence over current office-holders, including the present prime minister, his son, Lee Hsien Loong, whose recent successful lawsuit against blogger Roy Ngerng for defamation, for example, was strongly reminiscent of his father’s methods of dealing with dissent.
This year marks the 50th anniversary of Singapore’s independence and its ageing first prime minister continues to command tremendous respect among Singaporeans. However, his hospitalisation will not impact on our political stability forecasts. [emphasis mine]
In its special report on Singapore’s 50th year of independence, the EIU writes:
A new generation of leaders remains largely invisible. This continues to fuel longstanding concerns about Singapore’s post-Lee Kuan Yew future, with the primary fear being that Lee Hsien Loong’s leadership will be challenged once his father is not around. In the absence of a credible succession plan in a country where the media is largely state-controlled and democracy is flawed, this could potentially lead to political turmoil that could hamper the growth of the city state. Although the risk that the ruling People’s Action Party (PAP) will be unseated from power in the next election remains very low, policymaking targeted at quelling public resentment is not sustainable in the long run and takes away from Singapore’s reputation for efficiency. [emphasis mine]
The EIU thus suggests that the death of Lee Kuan Yew might spark an internal struggle for power in the PAP. Even though this will not make Singapore politically unstable, and is unlikely to cause the PAP to lose the next election, it is an invaluable opportunity for Singapore to remake its political culture.
There will be no better opportunity then this for Singapore to abandon its old ways of conducting politics. We can stop the counterproductive silencing of political opponents using legal means, stop suppressing the media, stop arbitrarily redrawing electoral districts, stop disadvantaging opposition town councils, stop assuming that big daddy knows best and re-examine dogmatic beliefs — such as the belief that the top one percent will leave the moment we raise taxes and that secrecy is always more important than accountability.
Feb 5: Mr Lee is hospitalised for severe pneumonia.
Feb 21: PMO makes first press release announcing Mr Lee’s hospitalisation. Mr Lee is reportedly on life support but his condition has stabilized.
Feb 26: Mr Lee remains sedated and on life support. His doctors have started him on a new course of antibiotics.
Feb 28: Mr Lee’s condition improves slightly, although he remains sedated and on life support in the ICU at Singapore General Hospital.
Mar 6: Condition remains largely unchanged.
Mar 13: Condition remains largely unchanged.
Mar 17: Condition worsens due to an infection.
Mar 18: Condition deteriorates further.