Monday, 29 October 2012

Peter Singer backs abortion for curbing population growth

Peter Singer is an Australian moral philosopher and currently Professor of Bioethics at Princeton University. He is former editor of the Bioethics journal and one of the most influential thinkers in bioethics today.

Singer espouses utilitarianism, a system of ethics that seeks to minimize suffering and maximize wellbeing. The New Yorker has called him ‘the most influential living philosopher’.

One of the clearest expositions of Singer’s position, and interestingly the first thing I read of anything he wrote, is a seminal article titled ‘Sanctity of Life or Quality of Life?’, published in the American Journal ‘Paediatics’ in 1983. In it he argues as follows:

'We can no longer base our ethics on the idea that human beings are a special form of creation, made in the image of God...Once the religious mumbo-jumbo surrounding the term 'human' has been stripped away, we may continue to see normal members of our species as possessing greater qualities of rationality, self-consciousness, communication and so on than members of any other species, but we will not regard as sacrosanct the life of every member of our species, no matter how limited its capacity for intelligent or even conscious life may be... If we can put aside the obsolete and erroneous notion of the sanctity of all human life, we may start to look at human life as it really is, at the quality of human life that each human being has or can achieve.'

To Singer and many influential thinkers like him, man is nothing but the product of matter, chance and time in a godless universe; merely a highly specialised animal. The value of an individual human being is determined by his level of rationality, self-consciousness, physical attributes or capacity for relationships. Human life that has fewer of these qualities is of less value and can be disposed of.

This Darwinian ethic with its aim of 'survival of the fittest', once popularised and politicised, places the demented, mentally handicapped, brain-injured, unborn and disabled newborn in great danger.

Dave Andrusko, writing for Life Site News this week, reviews a blog that science writer John Horgan has written about Singer for the Scientific American after the latter paid a visit to Stevens Institute where Horgan is Director of the Center for Science Writing.

‘(Singer) has a knack for pushing people out of their moral comfort zone,’ Horgan writes. ‘Although his positions—especially on mercy killing of severely disabled infants and adults–have sparked public protests both in the US and abroad, (he) is disarmingly cool on the page and in person, even when talking about the hottest topics.’

Singer has tip-toed around some of his most infamous statements, but still adheres to the position that a child does not attain ‘full moral status’ until somewhere between one and two, which makes infanticide in some cases (actually many cases) acceptable.

To Singer the unborn is a member of the species Homo sapiens but not a ‘person’ because ‘the idea of a person involves the capacity to see oneself as existing over time’.

Says Horgan, ‘Singer nonetheless believes that abortion is ethical, because even a viable fetus is not a rational, self-aware person with desires and plans, which would be cut short by death; hence it should not have the same right as humans who have such qualities. Abortion is also justified, Singer added, both as a female right and as a method for curbing overpopulation’.

In his support for abortion as a means of controlling world population Singer is interestingly in good company with some notable Western politicians and policy-makers.

In 2009 Jonathon Porritt former chairman of the UK Government’s Sustainable Development Commission, said that curbing population growth through contraception and abortion must be at the heart of efforts to combat global warming, and that couples who had more than two children were irresponsible.

In the tradition of Malthus and Ehrlich, Porritt warned of ecological and environmental disaster ahead unless we do something rapidly to curb population growth (I have previously argued against this view here)

Former International development secretary (and until recently Chief Whip) Andrew Mitchell is another supporting abortion (subsumed within ‘family planning’) for population control. He argued recently in the Metro as follows:

‘The British government is working to improve access to contraception and family planning education for 10 million women in the developing world. This will prevent five million unintended pregnancies, save the lives of 50,000 women and avoid the deaths of 250,000 newborns by 2015.’

And the source of the information on which Mitchell based his policy? Well not surprisingly it is a report by the UN Population Fund (UNFPA), a key supporter of China’s population control programme, which is in large part responsible for 160 million missing women (as a result of sex selection abortion) in Asia.

Mitchell’s policy is consistent with a report by UN Special Rapporteur for Health, Anand Grover, which linked unrestricted abortion with the right to the highest attainable standard of physical and mental health. Grover adamantly affirmed his intention to redefine the ‘right to health’ in UN conventions and treaties to include abortion.

Peter Singer, like most philosophers, will never personally carry out his plans. To him they are just ideas. But ideas that are whispered in the ivory towers of universities in one generation get shouted in the streets in the next and become the basis of future public policy.

Let’s therefore keep a close eye on Singer and also, perhaps even more carefully, those policy makers who share his worldview and seek to put it into practice.

School contraceptive jabs to 13 year-olds without parental consent - a dangerous and ill-informed strategy

School nurses have given implants or jabs to girls aged between 13 and 16 more than 900 times in the past two years, a survey by The Daily Telegraph has found.

Girls aged 13 have been given contraceptive jabs and implants on more than 20 occasions.

A further 7,400 girls aged 15 and under have been given contraceptive injections or implants at family planning clinics.

Under the patient confidentiality rules, nurses are banned from seeking the permission of parents beforehand, or even informing them afterwards, without the pupil’s permission.

The implants, which prevent pregnancy for up to three years by releasing hormones into the blood, are inserted into girls’ arms. The injections are effective for up to three months.

Using Freedom of Information laws The Daily Telegraph has discovered that these implants and contraceptive injections are being offered in schools in Bristol, Northumbria, Peterborough, Co Durham, the West Midlands and Berkshire. They give much more detail about individual trusts in their article today.

The number of girls given implants and jabs is likely to be higher as many trusts claimed they did not keep records or said releasing information would breach patient confidentiality.

I was phoned by the Telegraph yesterday about this and they have just used one sentence of a fairly lengthy quote I gave them so I’m giving a more lengthy response here.

Why should we be concerned about this?

First, sex under 16 is not only illegal, it can also be profoundly damaging – physically, emotionally and spiritually. To facilitate such behaviour behind parents’ backs is unprofessional, irresponsible and morally wrong.

When this story first came to light earlier this year there were understandably a lot of angry parents who felt that their responsibility for their own children had been undermined and that their children were being exposed to risk and encouraged to experiment.

Children under 16 cannot drink in a pub, drive, vote or watch certain films and parental consent is required for any other medical or surgical procedure. Why is this issue so different, especially when contraceptive implants pose health risks – in particular the danger of them ‘going missing’ and damaging later fertility.

Second, young people who feel that they are secure and protected by contraception will take more risks sexually. The phenomenon whereby applying a prevention measure results in an increase in the very thing it is trying to prevent is known as ‘risk compensation’. The term has been applied to the fact that the wearing of seatbelts does not decrease the level of some forms of road traffic injuries since drivers are thereby encouraged to drive more recklessly. In the same way it has been convincingly argued that making contraception readily available to vulnerable people can actually increase rather than decrease rates of pregnancy and sexually transmitted infections because teenagers are thereby encouraged to take more sexual risks in the false belief that they will not suffer harm.

Third, there are other real risks to the health and well-being of young people in this strategy. A contraceptive implant or jab will protect you to some degree against unplanned pregnancy but it will not protect you against sexually transmitted infections or sexual exploitation. If a young teenage girl is in an abusive relationship or has pressure put on her to have sex then she can be very easily manipulated especially if she is emotionally involved with the boy or man who is trying to coerce her. I am concerned that this contraceptive provision has been moved from the safety of the doctor-patient relationship. Who is taking a detailed history from these girls to ensure that they are not being exploited, coerced or absued?

Fourth, this new strategy is not evidence-based – it is effectively an untested strategy paid for by tax payers’ money and promoted by the government. There is, by contrast, real evidence that making contraceptives more widely available does not reduce unplanned pregnancy rates in a population and may actually increase the incidence of sexually transmitted infections.

The current government teenage sex strategy is not working. Although teenage pregnancy rates in Britain have fallen to their lowest level since 1969, they are around twice as high as those in France and Germany and five times the rate in the Netherlands. That is because the strategy is based on two false premises – that contraceptives are 100% effective and that abstinence is impossible.

Contraceptive provision alone will never address Britain’s epidemic of promiscuity and its consequences. More needs to be doing more to dissuade young people from having sex and promoting abstinence as a good lifestyle choice. The government also needs to be upholding the law about sex with girls under 16 and doing more to curb easy access to pornography. In a pornography-saturated culture many young people have very unrealistic ideas and expectations about sex and will end up making decisions they later regret.

There are communities in the UK – both ethnic and faith communities – which have very low levels of promiscuity and accordingly very low levels of unplanned pregnancy and sexually transmitted disease, divorce and broken relationships. These groups are getting it right and the government should be learning from them rather than basing their strategy on a non-evidence-based ideology involving more and more contraceptives to younger and younger people.

Sunday, 28 October 2012

Government ministers and MPs wade in on Liverpool Care Pathway

The controversial Liverpool care pathway (LCP), a framework used to manage patients who are imminently dying, has not unexpectedly now come to the attention of government ministers and MPs.

Earlier this year, the Daily Mail newspaper claimed in a headline that the NHS was killing off 130,000 patients a year via the LCP.

On the other hand a group of over 20 leading organisations have defended the LCP but at the same time emphasised that it must be used by trained people under expert supervision.

Like any clinical tool, if used on the wrong people for the wrong indications the LCP may well do more harm than good.

It now appears that things may be starting to move toward a long-awaited resolution where the LCP's appropriate use will be affirmed and its misuse will be identified and stamped out.

An article in today’s Express strikes a good balance on this.

Government ministers and MPs are now speaking out about the problem and investigations are being launched.

According to the Daily Mail Health Secretary Jeremy Hunt has hit out at the ‘unforgivable failure’ of some doctors to inform relatives that their loved one has been put on an ‘end of life’ programme.

‘People in the last days of their life deserve to be treated with dignity and respect, which at a minimum means involving individuals and their family in any decision regarding their care. I would expect any trust accused of such an unforgivable failure to investigate fully and learn lessons.’

Similarly Stephen Dorrell, chairman of the Commons health select committee, said there were clearly problems at some hospitals with the way the pathway was being used.

‘The idea that a person can be cared for at the end of life without the family being involved – that is not high-quality care as anyone would understand it.’

The Daily Mail also reports that ministers last week officially launched a wide-ranging investigation into the Liverpool Care Pathway after accusations it hastens the deaths of some patients.

Care Minister Norman Lamb said: ‘We need to know how patients and families feel about the care they receive. We need to make sure that health professionals have the best tools to help them with this sensitive work.’

Julian Brazier, Tory MP for Canterbury, said: ‘There should be an independent inquiry and not one run by the practitioners.’

The investigation will be run by a Heath Department organisation, the National End of Life Care Programme, and medical organisations which have been deeply involved in promoting and operating the Pathway.

It will have two elements. In the first, the £300 million NELCP will look into complaints about end of life care, including the Liverpool method. A group called Dying Matters will also talk to families.

The second element will involve consulting medical professionals about their views on the Liverpool pathway and other similar methods.

It will be led by the Association for Palliative Medicine, which represents 1,000 doctors.

The inquiry findings will be sent to the Department of Health but there is no pledge currently to make them public.

I suspect these inquiries, although welcome, will be too slow for critics.

My hope is that specialists in palliative medicine will in the meantime move swiftly to respond to the five key concerns that have been raised.

If they don’t the present controversy may well rage for some time yet.

The demographic time bomb is most marked in Japan

The demographic time bomb – whereby the elderly population assumes a greater and greater proportion of the total population - is no more marked than in Japan.

Falling birth rates (as a result of abortion, contraception and delaying childbirth) and increasing longevity as a result of better medical care have created this situation.

If we look at the population age structure in Japan (see graph above) we can see how dramatically its shape has changed since 1950 and how much more it will change by 2050.

The same trends are spelt out numerically in the table below where different countries are compared.

The population pyramid of 1950 shows that Japan had a standard-shaped pyramid marked by a broad base. The shape of the pyramid, however, has changed dramatically as both the birth rate and death rate have declined.

In 1950 the population of elderly citizens (65 years and over) accounted for just 4.9% of the total population. This had risen to 21.5% by 2007 and will rise to 39.6% by 2050.

This growth in numbers of older people has been matched by a shrinking of the younger population. In 1950 those under 15 made up 35.4% of the total population but this had fallen to 13.5% by 2007 and will fall further to 8.6% by 2050.

Note also that those of working age (15-65) constituted 65% of the population in 2007 (two thirds) but will account for only 51% (half) by 2050.

They could well account for much less given that many of those in the 15-65 age group, as of now, might be in education, or alternatively not in education, employment or training.

The speed of aging of Japan's population is much faster than in advanced Western European countries or the USA but the trends are similar throughout the industrialised world.

Add in increasing debt and rising unemployment and you have a very toxic cocktail indeed.

Unless something is done to reverse the demographic trends, ‘economic necessity’, together with the ‘culture of death’ ideology which is becoming more openly accepted, may well mean that the generation that killed its children through abortion will in turn be killed by its own children through euthanasia.

Some European politicians and economists have been chillingly open about the economic incentives for euthanasia.

Jacques Attali, the former president of the European Bank for Reconstruction and Development, said in 1981 in an article in L’Avenir de la vie:

‘As soon as he gets beyond 60-65 years of age, man lives beyond his capacity to produce, and he costs society a lot of money... euthanasia will be one of the essential instruments of our future societies.’

The real answer is not euthanasia. The real answer is in our grasp, but it requires a completely different mind-set to that which has led us, in our reckless pursuit of affluence and personal peace to mortgage our present, bankrupt our futures, and see those who rely on us as a burden rather than a privileged responsibility.

We need instead, as a society, to stop killing our children, build up our families, live more simply, give more generously and focus our priorities on providing for our dependents, especially the older generation which fought for our freedom in two world wars, provided for our health, education and welfare, and left us the legacy of wealth, comfort, peace and security which we have squandered and taken for granted.

Data on Japan obtained from online ‘Statistical Handbook of Japan’

Saturday, 27 October 2012

Ten questions you never hear asked on the media

I was on the Radio Four Today programme earlier this week debating Lord Falconer (listen here for Radio Four and here for Radio Five Live and ) on whether or not assisted suicide should be legalised in the light of ten years of British people going to the Dignitas facility in Switzerland to end their lives.

Prior to our debate the programme ran a prime time recorded interview with Win Crew, wife of one of the first Britons to die there which I listened to in the taxi on the way in.

It was typical of such interviews. The usually robust Evan Davies
(pictured), rather than giving her a challenging and searching cross-examination, instead reverted to slow underarm bowling in the apparent hope that she might hit each question over the boundary in the cause of legalisation.

She, not understandably, made the most of being given an international media platform to propagate her views effectively unchallenged.

The BBC later gave the interview huge prominence in keeping with their ‘assisted suicide cheerleader’ policy whilst our debate was relegated to the graveyard slot just prior to 9am.

In the light of this not atypical experience I was interested to see this post on Life Site News on the not unrelated issue of abortion – another where the liberal elite who dominate the media do what they can to ensure that really searching questions are never asked.

I have virtually never heard these ten questions asked (or answered) on media but invite anyone with a prochoice position to attempt to answer them either here or elsewhere.

They come from over the pond in the lead up to the US presidential election but apply equally well here.

Here’s some food for thought then from Trevin Wax at blog — ‘Ten questions you never hear a pro-choice candidate asked by the media’.

1. You say you support a woman’s right to make her own reproductive choices in regards to abortion and contraception. Are there any restrictions you would approve of?

2. In 2010, The Economist featured a cover story on “the war on girls” and the growth of “gendercide” in the world – abortion based solely on the sex of the baby. Does this phenomenon pose a problem for you or do you believe in the absolute right of a woman to terminate a pregnancy because the unborn fetus is female?

3. In many states, a teenager can have an abortion without her parents’ consent or knowledge but cannot get an aspirin from the school nurse without parental authorization. Do you support any restrictions or parental notification regarding abortion access for minors?

4. If you do not believe that human life begins at conception, when do you believe it begins? At what stage of development should an unborn child have human rights?

5. Currently, when genetic testing reveals an unborn child has Down’s Syndrome, most women choose to abort. How do you answer the charge that this phenomenon resembles the “eugenics” movement a century ago – the slow, but deliberate “weeding out” of those our society would deem “unfit” to live?

6. Do you believe an employer should be forced to violate his or her religious conscience by providing access to abortifacient drugs and contraception to employees?

7. Alveda King, niece of Martin Luther King, Jr. has said that “abortion is the white supremacist’s best friend,” pointing to the fact that Black and Latinos represent 25% of our population but account for 59% of all abortions. How do you respond to the charge that the majority of abortion clinics are found in inner-city areas with large numbers of minorities?

8. You describe abortion as a “tragic choice.” If abortion is not morally objectionable, then why is it tragic? Does this mean there is something about abortion that is different than other standard surgical procedures?

9. Do you believe abortion should be legal once the unborn fetus is viable – able to survive outside the womb?

10. If a pregnant woman and her unborn child are murdered, do you believe the criminal should face two counts of murder and serve a harsher sentence?

Thursday, 25 October 2012

Specialists in Palliative Medicine need to act swiftly to respond to these five key concerns about the LCP

Yesterday I mentioned that the Association for Palliative Medicine (APM) had announced plans to launch an investigation into the controversial Liverpool Care pathway.

Today both the Daily Telegraph and the Daily Mail have run the story.

In addition a Daily Mail editorial today welcomes the investigation and outlines the major concerns that have been expressed by people contacting them as follows:

1. People have been put on the LCP without the knowledge or consent of their families

2. It is cruel to deny fluids to sentient beings

3. Doctors cannot accurately predict that someone is dying within hours or days

4. When doctors withdraw all treatment and nourishment, believing their patients have only days left, the prediction becomes self-fulfilling

5. When well over 100,000 are dying on the LCP each year, the suspicion inevitably arises that the pathway is being used to hasten death and free up beds

The editorial concludes that these are the fears the profession must address and allay if the LCP is to remain official practice.

These questions I would have thought are not difficult to answer and should be able to be addressed easily by any specialist in palliative medicine.

I would gladly attempt it myself but it would be much better if a specialist were to do it. It should not take more than 800-1,000 words.

I gladly offer this blog to anyone prepared to do so and will do all I can to draw it to media attention or to get the story placed in a major paper as an op ed piece.

Ideally it needs a named author but if you wish to remain anonymous that is fine.

Please contact me via this blog or DT me on twitter at @drpetersaunders

I see that the APM has today issued a fresh statement to the media as follows:

‘Our president’s blog has reported that we have recognised there is ongoing debate around Integrated Care Pathways, and the work we are proposing will identify and explore any concerns properly, and find ways of addressing those concerns and improving practice. The APM intends to join others in undertaking this piece of work. We would be very concerned if this proposal was conveyed in any other way. The members of the Association for Palliative Medicine continue to deliver, and support the delivery of, high quality palliative care, including listening and responding to concerns and anxieties experienced by our patients and their families about many different aspects of their illness and treatment, as part our holistic approach to their care.’

I understand that the National End of Life Strategy has also announced that they are going to carry out ‘a short snapshot review of complaints relating to end of life care within acute hospitals' with partnership organisations.

This will 'include complaints relating to the use of the Liverpool Care Pathway and any communication or perceived communication issues’.

It has invited specialists in palliative medicine to take part.

This are helpful and admirable statements and plans but the real priority now is to address the unanswered questions outlined above.

That is what is required to defuse the current controversy and to stop the Daily Telegraph and the Daily Mail continuing their criticism of the LCP.

Wednesday, 24 October 2012

Ten years of assisted suicide at Dignitas – another excuse for an international news story

Now that the Tony Nicklinson case is over and the next assisted suicide bills (from Falconer in the House of Lords and Macdonald in Scotland) are not to be debated until next year one could be forgiven for thinking that the relentless media pressure for the legalisation of euthanasia might relent for a few weeks.

But no – first we have the pronouncements of junior health ministers Norman Lamb and Anna Soubry giving their support for the legalisation of assisted suicide and now the BBC, in its role as cheerleader for assisted suicide, is making an international news story about the fact that it is ten years since the first Briton went to the Dignitas suicide facility in Zurich to kill himself.

This is actually a non-story. The on-going sad procession of desperate Britons on the Swiss suicide trail is in reality a tiny trickle but every new case is seized upon by sections of the British media, and especially the BBC, in an attempt to create the impression that there is a huge ‘unmet need’ and as a further opportunity to say again that we must have the debate that we have actually not stopped having constantly for the last six years.

In fact, given that the BBC repeatedly breaches international suicide prevention guidelines in its coverage, it is not beyond the realms of possibility that a significant number of those travelling abroad have been encouraged to do so by seeing others doing it on television with full media and celebrity support.

The carefully orchestrated and well-funded celebrity driven campaign run by Dignity in Dying, the former Voluntary Euthanasia Society, is skilled at getting hugely disproportionate coverage for every new case it can find and the BBC, in particular, is only too willing to provide them with an international media platform.

Today's story is in the news because DID obtained some new figures from Dignitas and sent out a press release to sympathetic media outlets including the BBC. The BBC have also given prominence to an emotive hard case in a prime time slot on Radio four whilst relegating a more serious examination of the issues to a time when far fewer people were listening.

The reality is that between 2002 and 2011 a total of 182 Britons – on average 18 per year – have killed themselves at Dignitas. Numbers per year since 2006 have been relatively constant between 20 and 30 per year.

These numbers are a tiny fraction of the 550,000 natural deaths that occur in Britain each year and a very small trickle compared with the 650 and 13,000 who, on the basis of the 2005 Lords Select Committee report, it was estimated would die in Britain annually under an Oregon or Dutch-type law respectively.

The 700% increase in assisted suicides amongst Swiss nationals since 1998, along with the disturbing 18% annual increase in euthanasia in the Netherlands over the last year will sound strong alarms to legislators in Britain that we should not be contemplating going down this route.

Reports from the Netherlands of psychiatric and dementia patients being euthanized and mobile euthanasia clinics along with Belgian accounts of organs being harvested from euthanasia patients and 32% of all euthanasia deaths being ‘without consent’ understandably fuel this concern.

Public opinion polls supporting a change in the law can be easily manipulated when high media profile (and often celebrity-driven) ‘hard cases’ are used to elicit emotional reflex responses without consideration of the strong arguments against legalisation.

But when these arguments are heard decision-makers have consistently voted against. There have been over 120 attempts to legalise assisted suicide through US state parliaments all of which have failed in the last fifteen years.

British parliaments have also rejected any loosening of the law here three times over the last five years – in 2006, 2009 and 2010 - on the basis that any change would place pressure on vulnerable people (those who are elderly, disabled, sick or depressed) to end their lives for fear of being a financial or emotional burden on others.

More than seven out of ten MPs refuse to back calls to legalise assisted suicide as shown in a recent ComRes poll.

The vast majority of UK doctors remain opposed to legalisation along with the British Medical Association, the Royal College of Physicians, the Association for Palliative Medicine and the British Geriatric Society.

Similarly all major disability rights groups in Britain have resisted any change in the law believing it will lead to increased prejudice towards them and increased pressure ‘to seek help to die’.

The first duty of Parliament is to protect its citizens. Elder abuse and neglect by families, carers and institutions is real and dangerous and a law allowing the active ending of life could be so easily exploited and abused. This is why strong laws are necessary.

The British Suicide Act is thereby shown to remain fit for purpose. Through its blanket prohibition on all assistance with suicide, it continues to provide a strong deterrent to the exploitation and abuse of vulnerable people whilst giving both prosecutors and judges’ discretion in hard cases. It strikes the right balance, is clear and fair and does not need changing.

Ten years of Dignitas and ongoing media pressure should actually change nothing.

Tuesday, 23 October 2012

Palliative Medicine specialists to investigate Liverpool Care Pathway

The Association for Palliative Medicine, representing over 1,000 doctors working in hospices and specialist palliative care units throughout the UK, is going to carry out new research into the use of the controversial Liverpool Care Pathway (LCP).

The LCP was developed to assist in the care of patients entering the last hours and days of life but there have been claims that it has been used to end the lives of people who were not imminently dying (but also see balancing comments here).

Understandably this has led to a large amount of adverse media coverage and investigations into individual cases of alleged abuse are currently on-going.

Responding to the media attention given to the clinical pathway over recent months the APM President, Dr Bee Wee, acknowledged for the first time this week on her blog that there are ‘some controversies about the strength of the evidence-base’ supporting the use of integrated pathways like the LCP and also ‘some very real anxieties amongst the public and some professionals’ about its use.

Instead of ‘simply defending the concept or reiterating that if only it were used properly it would be OK’ she suggested that ‘it might be more helpful to stand back a bit, identify and explore the concerns properly, and find ways of addressing those concerns and improve practice’.

The APM intends to announce details of this new work, which will be carried out in collaboration with other organisations, soon.

The Liverpool Care pathway has come under sustained attack by certain sections of the media in recent months prompting the recent publication of a Consensus Statement by 22 organisations, including the APM, supporting its appropriate use.

Both Dr Bee Wee and the Care and Support Minister Norman Lamb have written to the Daily Mail in the last week to express their concerns about media coverage. The letters are difficult to find on the Daily Mail website so I have reproduced them below.

It is good to see the APM now contributing to this important debate and the fact that they have clearly acknowledged that there are real concerns that need to be addressed will hopefully move us towards some resolution of the current controversies.

Letter to Daily Mail from Drs Bee Wee (President) and David Brooks (Vice-President) of the Association for Palliative Medicine (22 October)

Dear Editor

We are concerned about the irresponsible journalism of recent scare stories in this paper about care of patients who are approaching their last days of life.

Care pathways for patients in the last days of life and Electronic Palliative Care Coordinating System (previously known as end of life care registers) are both designed to ensure that patients get the quality of care they need in their last days, weeks and months of life.

When properly used neither should deny anybody treatment or care that may benefit them, including food and fluids, and neither should lead to hastening death. Both should ensure that patients and carers are more informed about the current state of the person’s illness and life expectancy, and that their views are taken into account.

We accept that use of any pathway or care tool requires adequate training and in some areas there are inadequate specialist palliative physicians and nurses to provide the training needed by the non-specialists who provide the majority of this care.

There may be individual cases where the tools intended to promote good care have been poorly applied leading to concerns for relatives and carers but these individual stories should not be blown out of proportion. There is a risk that scaremongering due to individual examples of bad use of good tools leads to depriving the silent majority of patients the care they should expect in their last days of life. What the Mail and other media need to highlight is the need for adequate specialist palliative care and training resources to ensure that care is delivered well and appropriately at the end of life so that patients die in comfort and dignity.

Yours sincerely

Letter to Daily Mail from Care and Support Minister, Norman Lamb (19 October)

Dear Editor

Your headline, '3,000 doctors putting patients on 'death lists'' (Thursday 18 October) is wilfully misleading.

The GP End of Life Care register is no more sinister than other lists of those with diabetes or heart failure who need additional care. It is a way of making sure that planning so the patient's wishes come first and ensuring that people are cared for with dignity and appropriately at the end of their life.

You also insist the Liverpool Care Pathway systematically denies treatment to those who are dying. Nothing could be further from the truth; it is simply about ensuring that patients receive whatever treatments are right for them in the final days and hours of their life. More than 20 leading organisations including the Royal College of GPs, Marie Curie Cancer Care, and Age UK have already jointly signed a statement supporting the Pathway and addressing your misrepresentation. I am copying this letter to them.

Almost three quarters of people say they would choose to be cared for at home, in their own bed. But just over half actually die in hospital. Your article was wrong to assert that NHS organisations are moving patients away from hospital in order to save money. By preparing an End of Life Care plan, patients have the best chance of having their wishes met – surely something everyone can agree is a good thing.

Despite the fact this work gives patients better care I am concerned about reports some doctors are not properly communicating with their patients. I cannot stress enough the importance of involving patients and families in their care. I have asked officials to look at how best we can ensure that this always happens. I will also be meeting patient groups to ensure that their interests are always paramount. I am very happy to discuss any of these issues directly with you.

Yours sincerely

Christian Medical Comment receives Christian New Media Award

‘Christian Medical Comment’(CMC) was runner up in the People’s Choice category at the Christian New Media Awards in London last week.

The full listing of awards is available here.

People’s Choice is decided on a popular vote so a big thank you for all who offered their support.

The category was won by ‘Free Bible Images’.

This result was an improvement on last year when CMC was a finalist in the Best Christian Blog category but not placed in the top two.

In 2010 it was listed in Jubilee Centre's seven best blogs giving a Christian perspective on social and political issues.

Monday, 22 October 2012

27% of all human deaths in England and Wales are due to abortion

A full listing of ‘all’ deaths in England and Wales in 2010 is available on the Guardian website in an interesting article titled ‘Mortality statistics: every cause of death in England and Wales, visualised’.

In all there were 493,242 deaths in England and Wales from ‘all causes’.

This includes 224 babies ‘dying before, during or after birth’. However this total of 224 does not include 189,574 human deaths in 2010 from abortion in England and Wales.

Abortion has for some years now been the leading cause of human death in Britain.

If we add the pre-born babies who died as a result of abortion in 2010 the total number of human deaths in England and Wales comes to 682,816.

In other words, 189,574 out of 682,816 deaths, or 27.76% were due to abortion.

The other main causes of human death in England and Wales in 2010 (apart from abortion) were as follows:

Circulatory diseases – 158,084 deaths
Cancers and Neoplasms – 141,446
Respiratory diseases - 67,276
Digestive diseases - 25,662
Mental disorders - 19,916
Diseases of the nervous system - 18,483
Accidents and external – 17,201
Genitourinary diseases – 12,406

Abortion is against the Hippocratic Oath, against the Declaration of Geneva, against the International Code of Medical Ethics and against the Judeo-Christian ethic on which the laws of our country were originally based.

In 1947 the British Medical Association called abortion 'the greatest crime'.

But it is now so commonplace in Britain that we don’t even bother to mention it as a cause of human death despite the fact that every abortion stops a human heart beating.

The fact that abortion deaths are excluded from official death statistics is a symptom of how far we have fallen since abortion was effectively legalised in Britain 45 years ago this week on 27 October 1967.

There is no one in Britain more innocent, more vulnerable and killed in greater numbers than the pre-born baby.

Sunday, 21 October 2012

Brilliant triathlon result for promising young contender

I woke up this morning to the news on Radio Five Live that Jonathan Brownlee had come second in the men’s elite World Triathlon Grand Final in Auckland New Zealand.

This leaves him first overall in the series.

What they neglected to mention is that my cousin Elise Salt, running for New Zealand, came 8th in the Junior Women’s race.

Elise couldn’t wait to represent NZ at the Junior Elite World Champs and it seems like she didn’t hang about in the race itself, finishing just 31 seconds behind the winner.

And at only 17 she has another year in the category.

We are all incredibly proud of her and looking forward to seeing her in London next year!

Redefining Marriage - The case for caution

The Jubilee Centre’s latest Cambridge paper ‘Redefining Marriage - The case for caution’ is well worthy of careful study.

The author, Julian Rivers, is Professor of Jurisprudence at the University of Bristol Law School, an editor-in-chief of the Oxford Journal of Law and Religion, and a member of the advisory board of the Ecclesiastical Law Journal.

He argues that the British government’s proposal to introduce same-sex marriage seems to rest on reasons of equality, stability and convenience. But on closer inspection, these are respectively incomplete, speculative and negligible.

With respect to equality, marriage already discriminates on grounds of age (children cannot marry), kindred and affinity (one cannot marry a parent, sibling or close relative). This discrimination is justified so equality alone does not constitute adequate grounds for redefinition. Nor is it clear where any new lines of equality should be drawn. If marriage is to be truly equal on grounds of ‘sexual orientation’ the law should not be restricted to just one type of sexually-intimate relationship.

The government argues that since marriage brings stability, same-sex marriage will bring further stability. But the truth is that we do not know the relative stability of traditional marriage and same-sex marriage. Same-sex marriage is an untested institution.

Similarly, with respect to convenience, the new definition will introduce new levels of complexity, especially with respect to transgender people.

The root of the problem is that the Government fails to address the fundamental question of what a marriage is, and thus it fails to identify and defend the boundaries of any new definition.

The proposal to change the current definition of marriage depends on a sense that the man-woman criterion confers no distinctive social goods and represents an arbitrary limitation. But this is not the case. Marriage affirms the equal value of men and women, and promotes the welfare of children.

By contrast, the new definition of marriage will unavoidably call into question its exclusivity, its permanence and even its sexual nature. Moreover, the logic of equal recognition and radical choice means that the boundaries of any new definition will be far more vulnerable.

Such an unravelling of marriage is too high a price to pay for a proposal which fulfils no practical legal need.

Marriage risks becoming any formalised domestic arrangement between any number of people for any length of time. On such a trajectory, marriage will eventually unravel altogether.

Rivers’ paper, which runs to 4,000 words and has 49 academic references, unpacks these arguments in some detail.

The full paper is available free on line

Today is Healthcare Sunday, a day to pray for those working in the NHS

Today, 21 October, is Healthcare Sunday.

Working in the medical and caring professions is hard work. Helping people to deal with distressing problems, and caring for people at the most difficult and traumatic moments in their lives has never been easy.

Currently health workers of all kinds face even more pressure: coping with cuts in services as funding for the National Health Service (NHS) becomes tighter; dealing with uncertainty in the face of legislative changes to the NHS; managing with pay freezes and changes to pension arrangements.

In the UK the NHS employs more than 1.5m people. The number of patients using it is equally mind-boggling.

On average, the NHS deals with one million patients every 36 hours - that’s 463 people a minute or almost 8 a second. Each GP in the nation’s 10,000-plus practices sees an average of 140 patients a week.

Many more people pass through our hospitals and GP surgeries than through our churches, and Christian doctors, nurses and other healthcare workers play a key role as Christ's hands and feet at the sharp end of society with the opportunity to touch people's lives at what can be their greatest time of need.

They also face big ethical and moral pressures in a workplace which is often hostile to Christian faith and values. As ordinary Christian disciples facing these challenges and with their own personal, spiritual and emotional needs, they need our prayer and encouragement.

There are estimated to be 100,000 Christians employed by the NHS.

Healthcare Sunday is a chance for churches to express their support for health workers in their congregations and the wider local community, to acknowledge the vital role that they play, and to support and pray for them in the midst of all these pressures.

The caring work they do is very close to God’s heart and Jesus always had special concern for the vulnerable and needy.

Short video presentation on Healthcare Sunday being shown in churches and small groups.

Resources available from CMF, including a prayer, and other videos.

Saturday, 20 October 2012

The real meaning of the tarot – ‘the Wheel of Fortune’

The Rider-Waite tarot deck is the most popular Tarot deck in use today in the English-speaking world.

It has been vastly influential in the development of later divinatory tarot decks to the extent that many are called 'Rider-Waite clones' because they closely follow its symbolism and imagery.

The cards were originally published in December 1909 by the publisher William Rider & Son of London.

While the images are deceptively simple, almost childlike, the details and backgrounds hold a wealth of symbolism.

Many people use tarot cards for divination, but this is to miss their true significance and meaning.

It is far better to seek to understand their symbolism and the ancient wisdom that lies behind it.

Now you may be familiar with tarot cards or you may not. But take a careful look at the ‘Wheel of Fortune’ above.

The most prominent feature of this card is the central wheel from which tarot cards get their name. If you follow the letters clockwise from the top and include the top letter ‘t’ twice you get TAROT.

But you can also read it from the bottom. The four letters then spell ROTA meaning wheel.

But even more important are the symbols between these letters (pictured left). These also are four letters but not in Latin script.

These letters are the key to the tarot’s true meaning.

They are actually four ancient Hebrew letters known as the ‘tetragrammaton’ – the Latin transliteration is YHWH – the ‘theonym’ or secret name of God – translated alternatively Yahweh or Jehovah (read them clockwise from bottom right).

That this refers to the God of the Old Testament of the Bible is further confirmed by the four winged creatures in each corner of the card.

These are a man, an eagle, a lion and a bull – the four features of the four living creatures which support the throne of God in the first chapter of Ezekiel.

The fifth creature atop the wheel is a lion – symbolising Judah, the fourth tribe of ancient Israel. We are told of Judah that ‘like a lion he crouches and lies down’(Genesis 49:9).

The next verse in Genesis (49:10) tells us that from Judah will come a descendant who will eventually rule over all the nations.

The Lion of Judah is Jesus Christ. Jesus was from the tribe of Judah and he is mentioned as the ‘Lion of Judah’ in Revelation 5:5.

The two-edged sword he holds is the word of God (Hebrews 4:12), the Bible, which all four of the creatures are reading.

The clouds surrounding the central image are a reference to the fact that Christ would come ‘with the clouds’ into the presence of God. Daniel 7:13 tells us that ‘he was given ‘authority, glory and sovereign power; all peoples, nations and men of every language worshipped him’.

The next verse (7:14) tells us that ‘his dominion is an everlasting dominion that will not pass away, and his kingdom is one that will never be destroyed’.

I’m sure you will also have noticed two other creatures in the picture. The red creature with two horns sliding under the wheel is the devil, the deceiver who tries to lead people astray and stop them from believing the truth.

He is the usurper who will attempt to wrest authority from the Lion of Judah. He makes his appearance first in human history as a serpent in the Garden of Eden – the yellow snake in the picture – who attempts to deceive human beings and get them to worship him rather than the true God. He will also one day appear as a man.

This is the real meaning of the tarot. It is revealing important truths about the world in which we live to all who are open to them.

This deeper meaning and purpose will be more fully revealed as we examine the other cards in subsequent posts.

Thursday, 18 October 2012

‘Death Lists’ – how unbalanced reporting can damage a well-intentioned initiative to improve care

In the last two days the Daily Mail has run two articles with the following alarmist headlines:

Put 1 in 100 patients on death list, GPs told: Frailest to be asked to choose 'end-of-life' care

3,000 doctors putting patients on 'death lists' that single them out to be allowed to die

The articles draw attention to a new campaign aimed at helping GPs to identify patients nearing the end of life in order to improve their care.

The ‘Find Your 1% campaign’ is funded by the Quality, Innovation, Productivity, and Prevention End of Life Care workstream (QIPP) and is being hosted by the Dying Matters Coalition.

It is supported by the Royal College of General Practitioners (RCGP) and the National End of Life Care Programme (NEoLCP).

‘Find your 1%’ is based on the idea that around 1% of a GP’s patients will die in any given year and it aims to help GPs identify those patients who have a year or less to live in order to improve their care.

Currently around 70% of people want to die at home, yet more than half of the 450,000 people who die each year in England do so in hospital.

As well as improving patient care the scheme, it is said, would also save the NHS money as there would be fewer inappropriate emergency hospital admissions.

Typically towards the end of life, each unplanned admission to hospital costs more than £3,000. In the last 12 months before death, patients average 3.5 admissions each, with estimates that at any one time 20% of all hospital beds are occupied by people who are dying. If each person had one less crisis admission, the NHS would save £1,350,000,000 (NHS QIPP EOL workstream 2010).

I was phoned by the Daily Mail yesterday and asked to comment on the campaign, which I did, but unfortunately I was quoted selectively in a way that made it look like I was criticising it, when I was not intending to do so at all.

The sentences they extracted from my interview, which I asked to see and approved, read as follows:

‘If GPs are being encouraged to identify those patients who are terminally ill in order that they can be provided with the best care that is to be applauded. However I think we have to be very careful with the process of quotas. It is essential that every single case is reviewed on its own merits and the decision is made in a fully evidence-based way.

‘We all know that doctors’ estimates of patients’ lifespans can be sometimes accurate but sometimes wildly inaccurate. Caution needs to be exercised in making predictions. We all remember the cases of Al Megrahi and Ronnie Biggs. A skilled doctor can in the great majority of cases assess when a patient is within a few hours or days of death. However, once we start to talk about weeks or months we know that we can often be right, but equally very badly wrong. That is why it is so important that any assessment like this is regularly reviewed in the light of new evidence.'

‘This also goes for the Liverpool Care Pathway, where we know that some people have been put on it inappropriately.’

When it ran the article however, the Daily Mail excluded my first sentence, where I applauded the general principle of identifying terminally ill patients with the purpose of providing better care, extracted only the word ‘quotas’ from my second sentence, ran the bulk of the sentences on the difficulties of assessing lifespans and reframed my comments about some patients being inappropriately being placed on the Liverpool Care Pathway to make it appear that I was criticising the pathway per se.

They were, in other words, attempting to make my comments support an editorial agenda.

Anyone who reads my blogs knows that I am firmly opposed to assisted suicide, euthanasia and legally binding advance refusals for food and fluids. Intentional killing by act or omission is always wrong.

I am also very wary of government-led agendas driven by the desire to cut costs as opposed to delivering better care. Patients should not be deprived of helpful treatments.

But equally, dying is actually a normal part of life and should not be over-medicalised.

Unnecessary emergency hospital admissions and intrusive burdensome interventions for dying patients who could be managed more effectively by GPs at home can be traumatic and damaging.

It is important that patients can access the care they need at the end of life and that they are helped to die comfortably in the place of their choosing. Any campaign that helps GPs provide better care for dying patients is therefore to be welcomed.

I see that Dying Matters Chief Executive Eve Richardson and National End of Life Care Programme Director Claire Henry have responded to the Daily Mail with the letter below, with which I concur.

Dear Sir,

Far from being placed on a ‘death list’ as your article misleadingly suggests ('Put 1 in 100 patients on death list, GPs told', 17 October 2012), it is crucially important that GPs talk sensitively to people in their practice who are coming towards the end of their life about their wishes, such as whether they want to be cared for in their own home rather than in hospital.

After all, half a million people in England die every year, but many people aren't getting the end of life care that they need, often because their wishes have not been discussed with them. After loved ones, people tell us it is their GPs they want to turn to for information and support about planning for their end of life wishes.

Eve Richardson, Chief Executive, Dying Matters Coalition
Claire Henry, Director, National End of Life Care Programme

Tuesday, 16 October 2012

The Liverpool Care Pathway – consensus statement from 22 organisations

Twenty two leading healthcare organisations last month published a statement about the Liverpool Care Pathway to counter adverse publicity in the mainstream press.

I have written extensively on this controversial end of life treatment protocol before and won’t rerun the arguments here except to say that this new statement is well overdue and hopefully will go some way to quelling concerns.

The full statement, which has had surprisingly little publicity, reads as follows:

Consensus Statement: Liverpool Care Pathway for the Dying Patient (LCP)

Published misconceptions and often inaccurate information about the Liverpool Care
Pathway risk detracting from the substantial benefits it can bring to people who are dying and to their families. In response to this we are publishing this consensus statement to provide clarity about what the Liverpool Care Pathway is - and what it is not.

The hospice movement in the UK is famous around the world for looking after dying people with dignity and skill. Since the late 1990s, the Liverpool Care Pathway has been helping to spread elements of the hospice model of care into other healthcare settings, such as hospitals, care homes and people’s own homes.

The Liverpool Care Pathway:

•Requires staff ensure all decisions to either continue or to stop a treatment are taken in the best interest of each patient. It is not always easy to tell whether someone is very close to death – a decision to consider using the Liverpool Care Pathway should always be made by the most senior doctor available, with help from all the other staff involved in a person’s care. It should be countersigned as soon as possible by the doctor responsible for the person’s care.

•Emphasises that people should be involved in decisions about their care if possible and that carers and families should always be included in the decision-making process. Of those who responded as part of the evaluation, 94% said that they had been involved (National Care of the Dying Audit – Hospitals, MCPCIL/RCP, 2011).

•Relies on staff being trained to have a thorough understanding of how to care for people who are in their last days or hours of life.

•Is continually evaluated in all the places where it is in use.

The Liverpool Care Pathway does not:

•Replace clinical judgement and is not a treatment, but a framework for good practice.

•Hasten or delay death, but ensures that the right type of care is available for people in the last days or hours of life when all of the possible reversible causes for their condition have been considered.

•Preclude the use of clinically assisted nutrition or hydration - it prompts clinicians to consider whether it is needed and is in the person’s best interest. GMC guidance (2010) provides specific information regarding this issue.

In response to a question asked in the House of Lords on 20th June 2012 the Parliamentary Under Secretary of State for Health, Earl Howe, said (see full parliamentary debate here):

“The Liverpool Care Pathway has sometimes been accused of being a way of withholding treatment, including hydration and nutrition. That is not the case. It is used to prevent dying patients from having the distress of receiving treatment or tests that are not beneficial and that may in fact cause harm rather than good.”

The Liverpool Care Pathway has been suggested as a model of good practice in the last hours and days of life by successive national policy frameworks (DH, 2003 and 2006), the national End of Life Care Strategy (DH, 2008), Quality Markers and Measures for End of Life Care (DH, 2009), General Medical Council guidance (2010) and the NICE quality standard for end of life care for adults (2011).

We support the appropriate use of the Liverpool Care Pathway and make clear that it is not in any way about ending life, but rather about supporting the delivery of excellent end of life care.

Age UK
Alzheimer’s Society
Association for Palliative Medicine of Great Britain and Ireland
Association of Directors of Adult Social Services
British Geriatrics Society
British Heart Foundation
English Community Care Association
Help the Hospices
Lindsey Lodge Hospice
Macmillan Cancer Support
Marie Curie Cancer Care
Motor Neurone Disease Association
Multiple Sclerosis Society
National Care Forum
National Council for Palliative Care
National End of Life Care Programme
National Nurse Consultant Group (Palliative Care)
Nuffield Trust
Royal College of General Practitioners
Royal College of Nursing
Royal College of Physicians
Sue Ryder

Monday, 15 October 2012

Ten myths about the redefinition of marriage

The Prime Minister David Cameron wants to redefine marriage to allow gay couples to marry.

Thus far over 600,000 people have signed a petition launched by the Coalition for Marriage(C4M) against these plans which reads simply as follows:

‘I support the legal definition of marriage which is the voluntary union for life of one man and one woman to the exclusion of all others. I oppose any attempt to redefine it.’

I have previously written on this issue and have published 24 articles on all aspects of the debate. One of these, ‘Ten reasons not to legalise same-sex marriage in Britain’, gives an overview of the main issues.

This week, however, the Coalition for Marriage has published a new leaflet titled ‘Ten reasons why the government is wrong to redefine marriage’ which is available in pdf format on the C4M website.

It outlines ten myths about the redefinition of marriage.

I have reproduced the text below.

Ten reasons why the government is wrong to redefine marriage

Myth 1 - It will promote marriage

Evidence shows that redefining marriage actually undermines support for marriage in wider society. Neither has it delivered the promised stability for same-sex couples. In Spain, after gay marriage was introduced, marriage rates across the whole population plummeted. In the Netherlands too there has been a significant fall in the marriage rate since marriage was redefined. Same-sex marriage does not promote marriage.

Myth 2 - Marriage has always evolved

Marriage between a man and a woman is not a recent social invention. Everyone knows that marriage predates law, nation and church. It goes back to the dawn of time. Yes, matrimonial law may have been tweaked over the years, but the law has never fundamentally altered the essential nature of marriage: a lifelong commitment between one man and one woman. Samesex marriage would rewrite hundreds of years of British legal tradition and thousands of years of cultural heritage.

Myth 3 - It’s all about equality

Same-sex couples already have equality. All the legal rights of marriage are already available to same-sex couples through civil partnerships. Equality doesn’t mean bland uniformity or state-imposed sameness. If the Government genuinely wants to pursue equality, why is it banning heterosexual couples from entering a civil partnership? Same-sex couples have equal rights through civil partnerships, but they don’t have the right to redefine marriage for everyone else.

Myth 4 - No impact on schools

The current law requires schools to teach children about the importance of marriage. If marriage is given a new definition, it will be endorsed in schools. According to expert legal advice, any teacher who fails to endorse same-sex marriage in the classroom could be dismissed. Parents will have no legal right to withdraw their children from lessons which endorse same-sex marriage across the curriculum. Already supporters of gay marriage are recommending books (see here and here) for use in schools which undermine traditional marriage, and call on schools to get children to act out gay weddings. The effect on schools will be polarising and divisive.

Myth 5 - It won’t be a slippery slope

If we redefine marriage once, what’s to stop marriage being redefined yet further? If marriage is solely about love and commitment between consenting adults, what’s to say we shouldn’t recognise threeway relationships? It’s already happened in nations that redefined marriage. In Brazil, a three-way relationship was given marriage-like rights by a judge because of civil partnership laws. A similar situation has existed in the Netherlands for several years. In Canada after marriage was redefined, a polygamist launched a legal action to have his relationship recognised in law. When politicians meddle with marriage it all starts to unravel.

Myth 6 - Opponents are just bigots

This slur is meant to shut down debate and stop people thinking for themselves. Nick Clegg landed in hot water over a draft speech which called opponents of redefining marriage ‘bigots’. He later retracted the word, but there’s no doubt that many who support this radical agenda think anyone who disagrees is not worthy of respect. However, support for traditional marriage has come from many respected academics, lawyers, politicians of all parties, and religious leaders. They all know that redefining marriage would have a profound impact.

Myth 7 - Gay couples want to marry

Polling shows that only a minority of gay people (39 per cent) believe gay marriage is a priority. And according to the Government only 3 per cent of gay people would enter a same-sex marriage. A number of gay celebrities and journalists are themselves opposed to gay marriage. Latest official data shows that only 0.7 per cent of households are headed by a same-sex couple. Not all of them want, or will enter, a same-sex marriage. So, why is such a monumental change being imposed throughout society?

Myth 8 - The public supports it

Seven in ten people want to keep marriage as it is. Other polling which purports to show public support for gay marriage fails to tell respondents that equal rights are already available through civil partnerships. When people are told this crucial fact, most people say keep marriage as it is. MPs say their postbags have been dominated by public opposition to redefining marriage. Ordinary people want the Government to concentrate on reviving the economy and providing better public services, not meddling with marriage.

Myth 9 - Just a modest change

Since we already have civil partnerships, isn’t same-sex marriage just a small logical next step? No. Rewriting the meaning of marriage will have a far-reaching impact on society. Over 3,000 laws make reference to marriage. The Government has already admitted that official documents will need to be rewritten to remove words like ‘husband’ and ‘wife’. In France the Government is eradicating the words ‘father’ and ‘mother’ from all official documents. The Church of England has warned that it could lead to disestablishment and a constitutional crisis.

Myth 10 - Conscience will be respected

It’s not even being respected now. A housing manager from Manchester was demoted and lost 40 per cent of his salary for stating, outside work time, that gay weddings in churches were ‘an equality too far’. Conferences and symposiums in support of traditional marriage have been thrown out of venues. Adverts in support of a 600,000-strong public petition in favour of traditional marriage have been investigated as ‘offensive’. And all this has taken place before any change to the law has taken place. What will it be like if the law does change? A leading human rights lawyer has outlined the devastating impact of redefining marriage on civil liberties.

Sunday, 14 October 2012

Matthew Parris’s attack on Michael Nazir-Ali lacks his usual rigour and clarity

Matthew Parris is a former Conservative MP and one of Britain’s most loved political journalists who regularly writes for the Times.

He has an established reputation as an iconoclast and, as an openly gay atheist, has surprised people by writing in defence of Christian missionaries and in support of the idea that homosexuality is in part a conscious choice.

However, his latest offering, ‘Religion does not belong in the small print’ (£), lacks his usual rigour and clarity.

Parris is arguing that people who have faith-based convictions should declare this to be the case when they speak publicly on issues where their faith might have some bearing.

On the surface, this seems a not unreasonable request. Public figures should not attempt to conceal their personal or worldview convictions, especially if these have an influence on their views about an important issue of public policy.

But Parris seems to be saying more than this and his argument is, on this occasion, flawed.

What appears to have inspired the piece is a debate he had with the former Bishop of Rochester, the Rt Rev Dr Michael Nazir-Ali at a fringe meeting organised by ResPublica, a think-tank, at the Conservative Party conference.

Nazir-Ali put forward a case against ‘gay marriage’, which Parris said ‘could have been made by an unreligious professor of sociology’.

His argument was ‘apparently based on the social and cultural value of marriage as presently defined, the importance of a stable upbringing for children, and the resistance people feel to attempts “to change the meaning of the word ‘marriage’ ” ’.

Parris then asked the former bishop if he believed that ‘homosexuality was a sin’ and accused him in the article of beating about the bush with his answer.

He goes on to say that Nazir-Ali was ‘being disingenuous’ because he ’plainly believes that homosexuality is a very considerable evil in the eyes of God’.

In Parris’ view ‘the rest of us have a right to know the source of (peoples’) opinions, and if they are faith-based those who hold them have a duty in all honesty to declare it.’

He argues that ‘it is slippery for people to couch objections that are really undeclared religious objections in the language of a secular argument.’

‘The reason’, he says, ‘is obvious. ‘The audience may not share the speaker’s religious faith, and if they knew his advice was faith-based might wish to discount it.’

In fact Parris seems to suggest that his own ‘mild support’ for ‘gay marriage’ only arose when he saw ‘who was massing on the other side’ of the argument.

Parris then relates the case of an MP arguing in support of a reduction of the abortion limit to twelve weeks who used arguments about the humanity of the preborn baby as revealed on ultrasound but neglected say that he was a devout Catholic.

He implies that this is another example of ‘concealment’.

As a Christian who often speaks about issues of public policy on the media, I find Parris’s argument disturbing for four reasons.

First, it is an example of a growing trend in media debates on public policy whereby those advocating a particular position try to advance their case, not by countering their opponents’ arguments, but rather by undermining their personal credibility. This is essentially avoiding the argument by launching an ad hominem attack. To say that someone only takes a certain position because they are a Christian or a Jew or a Sikh or a 'bigot' is just an excuse for not engaging in serious debate about the issue in hand. It is disingenuous, cowardly and disrespectful.

Everyone knows that Nazir-Ali, as an evangelical Christian, is opposed to homosexual practice per se, not least Nazir-Ali himself. This is a given. But on this occasion he is speaking not to Christians in a church who share his faith convictions but rather to a mixed group at a political conference. Naturally he is going to employ arguments against gay marriage that he thinks will appeal to his audience. This is not being disingenuous. It is what all good debaters do. It is in fact what Parris himself does. Nazir-Ali is simply choosing not to use all his arguments, but only those he feels will be convincing in this particular context.

Second, Parris seems to be trying to imply that Nazir-Ali’s only real objections to ‘gay marriage’ are religious. This is simply not true. The Coalition for Marriage, which has amassed 600,000 signatures in this country against a change in the law, does not actually use faith-based arguments and some of the strongest opponents of the proposed policy are actually secularists or gay people (Brendan O’Neill and Andrew Pierce are two notable examples).

President Sarkozy, another secularist, opposed gay marriage in France on the basis that civil partnerships already offered gay people all the rights of marriage and that legalising it would lead to disunity and unrest. The government of largely secular Australia recently rejected gay marriage by a large majority in both houses egged on by its left-wing atheist prime minister. Why should Nazir-Ali not be entitled to use non-religious arguments if they embody some of his objections to legalisation?

Third, Parris seems to imply that Nazir-Ali’s arguments on gay marriage should be rejected on the grounds that he also opposes civil partnerships and all same-sex sexual relations per se. But why should the fact that Nazir-Ali holds an absolute position on homosexuality (which he does) mean that he cannot argue against a specific legal change on gay marriage? Is he seriously suggesting that people who hold views at one end of a spectrum on a specific issue of public policy are not as entitled as everyone else to express those views in the public square? Parris expects his own arguments to be judged on their own merit. Why not extend the same courtesy to Nazir-Ali?

Finally, why does Nazir-Ali, as a Christian, have a duty to declare his faith position when in fact everyone who expresses an opinion in this debate is doing so from one world view perspective or another? There is an element of hypocrisy in Parris demanding that the former bishop declare his faith, whilst he himself is seemingly not under an equal obligation to confess that he is a practising homosexual or an atheist, when both almost certainly are informing his own views on the issue. Personally I don't think that either of them should be required to reveal their personal convictions. But if it is to be demanded then let's have a level playing field.

Parris is a good journalist but this latest piece falls short of his usual clarity and incisiveness. And as one who generally enjoys his writing, I am disappointed that he seems to have based his current ‘mild support’ for gay marriage more on the fact that those who have different world view convictions from him oppose it, rather than on a careful evaluation of the arguments.

Friday, 12 October 2012

My Newsnight interview on abortion upper limits

See full programme here

Last Monday I was invited onto the BBC current affairs programme Newsnight at the last minute to join a debate on abortion upper limits.

Three cabinet ministers had suggested in the previous week that the upper abortion limit for able-bodied babies of 24 weeks should come down (Abortion is legal up until birth for disabled babies).

Kathryn Attwood of the prolife group Abort67 was up against Patricia Lohr, Medical Director of BPAS, which carries out most of Britain’s private sector abortions, and Zoe Williams a pro-choice Guardian journalist.

Two to one didn’t seem fair so I was dragged in to even things up.

Jeremy Paxman (pictured) introduced the debate by saying that most people in Britain agreed that legal abortion was necessary and that the debate was largely about time limits.

We then saw a brief film put together by the BBC which discussed the science around the debate. I was pleasantly surprised at how balanced this was.

It was acknowledged that in the very best neonatal units over 50% of babies born at 23 weeks (17 weeks premature) survive. This admission, as far as I know, is a first for the BBC.

Significant viewing time was also given to Professor Stuart Campbell’s astounding 4D ultrasounds showing babies at twelve weeks gestation stretching and flexing in the womb. This was accompanied by a comment from Campbell arguing for a reduction to twelve weeks.

The only questionable claim in the piece was a claim that babies below 24 weeks were not sentient which went unchallenged.

This is the official position of the Royal College of Obstetricians and Gynaecologists (RCOG) but, as I have argued before, their report is very controversial and has been described as an ‘emperor with no clothes on’ by a leading neonatologist.

We then went into a four way debate.

Paxman seemed determined to paint all of us as extremists and, rather than examining the arguments in the debate, was more interested in pressing us on where exactly we thought the line should be drawn.

Kathryn and I said that we opposed abortion in principle and would not personally be satisfied with any specific time limit.

Lohr and Williams, by contrast, defended the status quo and argued that regardless of time limit abortion should be a woman’s choice.

All very predictable.

A spirited exchange followed with Paxman sitting back to enjoy the moment. Time precluded any in depth discussion.

The whole programme illustrated the real problem with this whole debate, and with time limits in general.

There are some MPs who hold consistent prochoice or prolife positions respectively but most, along with most members of the public, actually lie somewhere in the middle.

But a middle position is only tenable in this balancing act of mother’s and baby’s rights if you consider that the rights of the baby are dependent on its degree of neurological development; in other words that it is all right to kill babies below a certain level of cortical function.

So for example, if they lack sentience, cannot smile or swallow or fail to exhibit some other arbitrary function that older humans are capable of, then they don’t deserve legal protection.

But this approach is at very heart discriminatory. Conferring legal protection on the basis of age, size or intellectual capacity is something that we would not tolerate for any human being after birth so why should do so before birth?

The only two logically consistent approaches are either to offer protection to all preborn babies regardless of gestation, or to say that none are human beings with rights and allow abortion for any and every reason.

When people take the latter approach I usually ask them why it is all right to kill a baby in the womb at 39 weeks but not to kill a premature baby in the neonatal unit at 24 weeks. That is, if it is really about degree of development then, in order to be consistent, shouldn’t we have the same attitude to abortion as we do to infanticide if the two babies, inside and outside the womb, are the same age?

If abortion is right then infanticide must also be right and vice versa. Unless, that is, we are arguing that the woman is utterly sovereign over her body and can do whatever she likes with any baby still in the womb but nothing to one already born.

However politics, it seems, is usually about compromise and logical inconsistency.

Having said that, if someone introduced a measure solely aimed at reducing the upper limit I would support it, but only if the current law was not weakened in any other way.

Any lowering of the limit would save at least some babies.

However, many more babies' lives could be saved if parliament were to introduce properly informed consent for women with unplanned pregnancies or to insist that the current law was not abused by doctors authorising abortions on spurious mental health grounds (currently 98% of all abortions fall in this category as I have argued elsewhere).

The video can be viewed here.