The real meaning of the tarot – 'The High Priestess'

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 because this wisdom tells us how to make sense of the world and live in it.

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

I have already explained the rich symbolism behind the ‘Wheel of Fortune’ card and ‘The Lovers’ and move now to the ‘High Priestess’.

In this card we see a robed female figure sitting with a rolled scroll in front of a curtain slung between two pillars.

In order to identify the true identity of the woman, the scroll she is holding, the significance of her clothing and the curtain we need to start with the two pillars which bear the English letters J and B.

As with the wheel of fortune card, in order to understand the symbolism we need to go to the symbolism in the Old and New Testaments of the Bible.

In 1 Kings 7:13-22 (read the whole account here) we read about the construction of the Israelite King Solomon’s Temple in Jerusalem in about 830 BC.

‘King Solomon sent to Tyre and brought Huram, a skilled craftsman in bronze...He cast two bronze pillars, each eighteen cubits high and twelve cubits in circumference. He also made two capitals of cast bronze to set on the tops of the pillars... He erected the pillars at the portico of the temple. The pillar to the south he named Jakin and the one to the north Boaz.’

So the letters J and B identify the pillars as Jakin and Boaz and the structure as Solomon’s Temple.

The scroll the woman is holding bears the four letters TORA but the word is actually TORAH, the H being hidden by a fold of the woman’s garment.

TORAH, or law, refers to the Pentateuch or the first five books of the Old Testament – Genesis, Exodus, Leviticus, Numbers and Deuteronomy.

And it is the second of these books, Exodus which gives us the explanation of the curtain slung between the two pillars.

Exodus 26:31-34 describes this curtain as follows:

‘Make a curtain…Hang the curtain from the clasps and place the ark of the covenant law behind the curtain. The curtain will separate the Holy Place from the Most Holy Place. Put the atonement cover on the ark of the covenant law in the Most Holy Place.’

Exodus 30:6-10 describes the curtain’s significance:

‘Put the altar in front of the curtain that shields the ark of the covenant law—before the atonement cover that is over the tablets of the covenant law—where I will meet with you… Once a year Aaron shall make atonement on its horns. This annual atonement must be made with the blood of the atoning sin offering for the generations to come. It is most holy to the Lord.’

The High Priest Aaron was only able to enter the Holy Place within the temple once a year to make a sacrifice for the sins of his people. He did this by shedding the blood of an animal. The curtain tells us that there is a barrier preventing human beings meeting with God because of their sin.

So what then of the woman? The fact that she is sitting outside the curtain in the temple and holding the Torah suggests that she is the nation of Israel, and this is confirmed by the presence of a sickle moon at her feet.

Again the Bible holds the key to this interpretation Revelation 12 in the New Testament of the Bible:

‘A great sign appeared in heaven: a woman clothed with the sun, with the moon under her feet… She gave birth to a son, a male child, who “will rule all the nations with an iron scepter.” And her child was snatched up to God and to his throne….The woman was given the two wings of a great eagle, so that she might fly to the place prepared for her in the wilderness…’

The reference to the two eagles’ wings identifies the woman with the moon at her feet as the nation of Israel. The clue is in Exodus 19:3,4 where God tells the Israelite leader Moses:

‘This is what you are to say to the descendants of Jacob and what you are to tell the people of Israel: “You yourselves have seen what I did to Egypt, and how I carried you on eagles’ wings and brought you to myself.”’

Israel was delivered out of slavery in Egypt into a desert or wilderness on the way to Canaan (Palestine) in about 1446 BC.

Revelation 12 goes on to tell us that ‘the dragon’ who is identified in verse 9 of that chapter is ‘that ancient serpent called the devil, or Satan, who leads the whole world astray’.

You may recall that this serpent, who appears in the Garden of Eden in Genesis 3 in the Old Testament, is also depicted in two cards I have already reviewed – ‘The Wheel of Fortune’ and ‘The Lovers’.

So who is the male child of the woman? The cross on her breast identifies this as Jesus Christ, descended from Israel, who died on a cross.

And it is the cross that is the real key to bringing all the items in the card together.

Hebrews 9:3-8 in the New Testament tells us that:

‘Behind the second curtain was a room called the Most Holy Place which had the golden altar of incense and the gold-covered ark of the covenant. This ark contained the gold jar of manna, Aaron’s staff that had budded, and the stone tablets of the covenant… But only the high priest entered the inner room, and that only once a year, and never without blood, which he offered for himself and for the sins the people had committed in ignorance. The Holy Spirit was showing by this that the way into the Most Holy Place had not yet been disclosed…’

Jesus Christ’s significance is described in verses 11 & 12:

‘But when Christ came as high priest… he entered the Most Holy Place once for all by his own blood, thus obtaining eternal redemption.’

Jesus Christ’s entry beyond the curtain surpassed that of the High Priest in three ways: he shed his own blood not that of an animal; this action dealt with the sins of all people once and for all not just the people of Israel at a particular time in history; the redemption (or rescue) that was won was eternal (for ever) and not temporary.

When Jesus Christ died on a Roman cross in about AD 29 the curtain in the temple was torn from top to bottom by a supernatural force (See Matthew 27:51, Mark 15:38 & Luke 23:45) showing that through Jesus’ death on the cross all human beings now had access to a restored relationship with God.

It is up to us to make a response to God’s completed offer of reconciliation.

Ethically derived stem cells offer more therapeutic promise – exciting new breakthroughs

Shinya Yamanaka (pictured) of Kyoto University won the Nobel Prize in medicine this year for his pioneering work in producing induced pluripotent stem cells (iPS) from adult skin cells in mice.

In so doing he laid the framework for an ethical alternative to using embryonic stem cells (which involve the destruction of an embryo) to provide treatments for conditions including diabetes, Parkinson’s disease, spinal injury and ischaemic heart disease.

Since his initial breakthrough in 2006 there have been progressive refinements of his technique (see here and here) and just last week, in a new breakthrough, a team at the University of Cambridge used cells from a patient's own blood (‘late outgrowth endothelial progenitor cells’) to make personalised stem cells from which they will be able to grow blood vessels. The first use will be to test drugs on those vessels.

This latest study was published in the journal Stem Cells: Translational Medicine.

Dr Amer Rana, leading the team, said this method was better than taking samples from skin or other tissues because of the relative ease of obtaining a blood sample.

The British Heart Foundation added that these cells had ‘great potential’ and The Medical Research Council talked of ‘rapid progress’ being made in the field.

Whilst therapies derived from iPS cells are still some way off, the advances have been so dramatic that a review by Matt Ridley in the Wall Street Journal this week concludes:

‘It's not far-fetched to conclude that, thanks to induced pluripotent stem cells, the embryonic stem-cell debate is fading fast into history. If stem cells derived from the patient's own blood are to offer the same therapeutic benefits as embryonic stem cells, without the immunological complication of coming from another individual, then there would be no need to use cells derived from embryos.’

Ridley says that the chief medical ambition of those who study stem cells has always been that the cells would be used to repair and regenerate damaged tissue. But, he adds, there's another, less well known application of stem cells that is already delivering results: disease modeling.

It might soon be routine to test drug treatments on personalised tissue created from your own stem cells in order to work out which drugs might best benefit your condition.

Ridley reports of a study doing just this. A team at Johns Hopkins University and the Sloan-Kettering Institute for Cancer Research, using a version of Dr Yamanaka's technique, successfully grew nerve cells from a patient suffering from a rare disease called Riley-Day syndrome, which is linked to early mortality, seizures and other symptoms and caused by a fault in one gene.

The scientists then tested 6,912 chemical compounds on the cells to see if they could find one that ‘rescued’ the ‘expression’ of the gene: that is to say, caused it to produce the protein it is supposed to produce. One of the compounds worked, inducing the gene to be actively transcribed by the cell. Ridley concludes:

‘The hope is that in the not-very-distant future, when something is going wrong in one of your organs, one treatment may be to create some stem cells from your body in the laboratory, turn them into cells of that organ, or even rudimentary structures, and then subject them to experimental treatments to see if something cures the problem. The goal of personalized medicine, in other words, may be reached by stem-cell researchers before it's reached by geneticists.’

In a further development this week along the same lines ten international drug companies are to team up with scientists from 11 European countries to create a bank of stem cells for a project aimed at speeding up the development of new medicines.

‘StemBANCC, coordinated by Swiss drugmaker Roche and managed by scientists at Oxford University, aims to use human-induced pluripotent stem cells (iPS) derived from people with hard-to-treat conditions - as research tools.

Martin Graf from Roche, who is coordinating the project, said the goal was to generate 1,500 induced pluripotent stem cell lines derived from 500 patients that can then be used by researchers around the world to study a range of diseases, including diabetes and dementia.

Graf and Zameel Cader of Oxford University, who announced the project in London, said the raw material for the project would be largely skin and blood samples taken from patients with diseases such as Alzheimer's and diabetes.

The research will focus mainly on these conditions as well as peripheral nervous system disorders such as chronic and neuropathic pain, central nervous system disorders such as dementia, and neurodysfunctional conditions such as autism, schizophrenia and bipolar disorder.

One of Dr Yamanaka's original motivations when he set out to induce pluripotency in adult cells was to discover ethical avenues of research. He once said:‘I thought, we can't keep destroying embryos for our research. There must be another way.’

Even Julian Savulescu, the controversial and liberal bioethicist at Oxford University, recognises that Yamanaka has achieved great scientific advances within an ethical framework:

‘Yamanaka has taken people’s ethical concerns seriously about embryo research…he deserves not only a Nobel Prize for Medicine but a Nobel Prize for Ethics’.

The best and most effective treatments are also ethical treatments. Maybe that is the most important lesson to learn from all this.

Perhaps the last word belongs to leading US stem cell scientist James Sherley: 'For those trained in the science, this is not news, but instead a completed fate that was known from the beginning' – a timely reminder that in good science the end does not justify the means (Romans 3:8).

'Lies, damned lies and statistics' from the Alan Guttmacher Institute

One of the principal techniques used by the pro-abortion lobby to advance their agenda of legalising abortion in developing world countries is to argue that ‘safe, legal abortion’ will decrease overall maternal mortality whilst not appreciably increasing the overall number of abortions.

In order to make this case they obviously have to establish first that there are already lots of illegal abortions happening and that many women are dying from them.

To achieve this end lobbyists need statistics about levels of illegal abortions and this where the Alan Guttmacher Institute (AGI) comes in.

For many years AGI’s astronomical figures of illegal abortions from developing countries have gone virtually unchallenged by both prolife and prochoice campaigners alike.

But this is about to change now that more rigorous research is being published.

Jacqueline Harvey this week writes about a new study published in the International Journal of Women’s Health showing that AGI’s figures for illegal abortions in Mexico in 2006 and 2009 were grossly overestimated.

The study titled, ‘Fundamental Discrepancies In Abortion Estimates And Abortion-Related Mortality: A Reevaluation Of Recent Studies In Mexico With Special Reference To The International Classification Of Diseases’ was conducted by a panel of six epidemiologists at four universities in the U.S., Mexico and Chile and examines the actual figures produced by the Federal District of Mexico and confirmed by an independent, non-governmental agency that supports legal abortion.

AGI’s estimate for illegal abortions in Mexico in 2006 was 725,070-1,024,424. But the actual number of abortions in 2007 after abortion was legalised (which typically increases rather than decreases the numbers), was only 10,137! So AGI’s estimate was 70-100 times the actual figure.

After legalisation the AGI estimate for legal abortions in Mexico in 2009 was 122,455. But the actual number was 12,221. This is a 10 fold overestimation.

These gross disparities discredit not only AGI figures for illegal abortions and abortion-related mortality in Mexico, but in all countries where they apply their flawed methodologies to create these bogus estimates.

The researchers also discovered that AGI purposefully includes women who died from ectopic pregnancies, miscarriage and assault in their calculations of illegal abortion-related mortality, a case of intentional deception. This leads them to over-estimate abortion-related mortality rate by almost 35%. I have previously blogged about gross overestimates of maternal deaths in the US and UK abortions before legalisation here.

Harvey concludes:

‘Nonetheless, AGI uses these false calculations and deceptive figures about illegal abortion deaths to push for decriminalization of abortion around the world. This new study authoritatively discredits the Alan Guttmacher Institute and its findings.’

This new study adds hard evidence to suspicions I have had for some time. Last July I was speaking at an ICMDA (International Christian Medical and Dental Association uniting over 70 national bodies of which CMF is one) conference in Nigeria where there were 1,700 Christian doctors and medical students from all over Africa.

A leading obstetrician in Kenya told me then that she thought the AGI stats for death from abortion for Kenya were grossly inflated and based on small urban samples along which included miscarriages and other gynaecological diagnoses.

And another doctor who was working in the main teaching hospital in Lagos, Nigeria had done a research project on abortion deaths and said that the actual number of illegal abortions was very small relative to AGI estimates.

This strategy used in Kenya and other developing countries is similar to that used by US abortion supporters in their efforts to legalize abortion in the late 1960s and early 1970s. Dr Bernard Nathanson, a leading supporter of abortion rights and an abortionist himself, later admitted to deception:

‘We aroused enough sympathy to sell our program of permissive abortion by fabricating the number of illegal abortions done annually in the U.S. The actual figure was approaching 100,000 but the figure we gave to the media repeatedly was 1,000,000. Repeating the big lie often enough convinces the public. The number of women dying from illegal abortions was around 200-250 annually. The figure we constantly fed to the media was 10,000.’

The most impressive catalogue of known abortion statistics on line is that of William Johnston whose latest totals of abortions worldwide (last updated in August 2012) are listed here.

What struck me about these numbers was how much lower they were than AGI figures for all developing countries.

When I raised this discrepancy with Johnston he answered as follows (reprinted with permission):

'(My) figures for worldwide abortions differ because AGI includes estimates of unreported illegal abortions, estimates which are inflated by bad methodology (in my opinion).

My figures cover only reported abortions (with limited use of estimates, eg. interpolation for missing years) thus, while they are incomplete they are well documented. They are also limited to countries with legal abortion and where statistics are compiled. Some of the higher AGI/WHO figures involve estimated underreporting from countries with legal abortions, but most of the difference is from their estimates for developing countries where abortion is illegal or legal under very limited circumstances.

These latter estimates are generally based on hospitalisation samples, household surveys, and a variety of assumptions. This process yields illegal abortion rates that are as high as legal abortion rates in the developed world, coincidentally supporting the AGI thesis that abortion should be unrestricted everywhere because laws have no effect on occurrence rates.

The key here is of course the set of assumptions that turn small sample sizes into multi-national estimates of abortion rates. Some obvious issues I see include: surveys of urban populations on abortion, and treating results as applicable to the general population; bias by basing results on surveys of people willing to talk to these survey takers; the validity of the assumptions used for underreporting, for deciding what fraction of hospital miscarriage cases are illegal abortions, or for turning such “detected" abortions into figures including "undetected" abortions.

I do not dispute that many illegal abortions take place in developing countries but I suspect that the actual numbers are significantly below the AGI/WHO estimates, because the methodology of their estimates involves assumptions biased by their policy position. I have little evidence to produce an estimate of total worldwide abortions, but I'm inclined to suspect that the AGI/WHO figures (of 42 million per year) are high by about a factor of two.

A few years ago Laura Antkowiak and Randall O'Bannon analyzed the AGI methodology in an article series in the National Right to Life newsletter. They indicate, for example, that some of the sample sizes involved are only a few dozen. Here are links to their articles.

1. WHO Claims of Unsafe Abortions and Deaths
2. World Abortion Estimates: An Audit (Part 1)
3. World Abortion Estimates: An Audit (Part 2)
4. World Abortion Estimates: An Audit (Part 3)
5. World Abortion Estimates: An Audit (Part 4)

Here are figures for comparison: AGI/WHO estimate worldwide abortions at 45.6 million in 1995, 41.6 million in 2003, and 43.8 million in 2008. (This is from the jointly AGI-WHO-authored article Sedgh et al., 2012, The Lancet, 379(9816):625+) For those three years what I can document are 18.1, 15.1, and 16.0 million. The drop to my current figure of ~12 million/year is mostly due to fluctuations in reported figures from China.

Some perspective on using AGI as a source: for current abortions in the US, their data is better than official data because the abortion providers provide statistics to AGI that they withhold from state health departments. In contrast, AGI survey-based statistics (based on estimates) tend to be biased.

Another point: the above Lancet article claims: ‘The abortion rate was lower in sub-regions where more women live under liberal abortion laws’ - a counter-intuitive claim to anyone but an abortion proponent, one that rests entirely on methodological assumptions, and one that is refuted by regional-level data in the US and Europe.'

Harvey and Johnston’s work needs much wider circulation to counter the 'lies, damned lies and statistics' that pro-abortion campaigners and population control advocates are using to advance their case. More research is also needed.

Please spread the word.

The fact that abortions in developing countries have been overestimated does not in any way of course alter the fact that abortion remains the number one cause of human death worldwide.

Even when one takes Johnston’s ‘revised-down’ figures the total number of abortions is utterly staggering. Johnston has documented almost 1 billion abortions worldwide from figures gleaned for the 90 years between 1922 and 2012, a figure equivalent to one seventh of the world’s current population.

Given the timespan the vast majority of these babies, had they not been aborted, would still be alive today.

Pro-euthanasia lobby rounds up tiny maverick group of religious leaders in preparation for new assault on parliament

I see that Dignity in Dying (the former Voluntary Euthanasia Society), which campaigns for the legalisation of assisted suicide for mentally competent people with less than a year to live, has set up a new group with the innovative title ‘Interfaith Leaders for Dignity in Dying’.

The arrival of the group was announced earlier this week in a small article in the Times (£) as follows:

‘An alliance of Jewish and Christian leaders who favour changing the law to allow assisted dying in particular circumstances was formed last week. The InterFaith Leaders for Dignity in Dying (IFDiD) group plans to specify the situations in which assisted dying might be justified, to devise rituals for those opting for an assisted death, and to compose guidelines for the before-and after-death pastoral care of those who have an assisted death and for the care of their families.’

Well, the ‘after-death pastoral care of those who have an assisted death’ is certainly an innovative concept!

According to the Huffington Post, the new group wants ‘to change the portrayal of religion as being anti-assisted suicide’.

Rabbi Jonathan Romain (pictured), of Maidenhead Reform Synagogue and co-ordinator, says that they are arguing for a position on assisted suicide that is ‘a bit more nuanced’.

Currently the group boasts 52 members, mainly Christian and Jewish ministers, but Romain said they are ‘actively seeking ordained members of other faiths, including imams’.

Given that there are 47,000 churches, 1,700 mosques and over 400 synagogues in the UK they have a fair way to go.

But I suspect that will not stop them obtaining column inches to propagate their views in vehicles like the Times, Huffington Post, Guardian and Independent.

The group plans to publish ‘a compilation of religious texts on assisted dying’ and provide ‘theological guidelines’ for looking after those suffering and their families before and after death.

In 2010 DiD was also instrumental in setting up Healthcare Professionals for Assisted Dying (HPAD) (see here) to push similarly for the legalisation of assisted suicide. This group has about 520 members (a figure representing about 0.25% of the country’s estimated 200,000 doctors).

DiD seem to be resorting to increasingly desperate measures in the face of flagging support for a change in the law. The response to their highly trumpeted recent ‘consultation’ on Lord Falconer’s new proposed bill on assisted suicide was dismal with a total of only 411 groups and individuals making submissions.

Lord Falconer’s so-called ‘Independent Commission on Assisted Dying’, which was set up to pave the way for a new bill, was stacked full of euthanasia sympathisers, and received a similarly muted response when it held its ‘consultation’ last year.

About 46 individuals and 40 organisations who were invited to give evidence to this commission refused to do so largely due to concerns about bias.

As a result the commission ran out of ‘witnesses’ half way through last year after DID had encouraged its members to send in their own ‘evidence’.

It is not unlikely that a substantial proportion of those giving evidence to this most recent private consultation were similarly ‘encouraged’.

By contrast a balanced House of Lords Select Committee carried out an official parliamentary Inquiry into assisted suicide in 2005. This covered some 246 Hansard columns and two volumes of 744 pages and 116 pages respectively; 2,460 questions were asked and the committee received 14,000 letters.

These two recent enquiries, in comparison, were not only unbalanced but miniscule.

Romain’s new group of ‘religious leaders’ may well attract some interest from the liberal press, but they are unlikely to convince anyone who does not already share their views.

In 2005 nine prominent leaders of the six main world faith groups (Christians, Muslims, Jews, Sikhs, Buddhists and Hindus) signed an open letter to all MPs and Peers in which they opposed the legalisation of euthanasia and assisted suicide.

Their letter, which represents what the vast majority of faith leaders actually believe about these issues, is far more worthy of study than the maverick theology of IFDiD.

Amour – an award winning film with a sting in the tail

Amour (literally, ‘Love’) is a 2012 French-language film written and directed by Michael Haneke which won the Palme d’Or (top prize) at the 2012 Cannes Flim Festival.

It is now screening in Britain.

The narrative focuses on an elderly couple, Anne and Georges, retired music teachers with a daughter living abroad.

Anne suffers a turn, from which she recovers and is then found to have a blocked carotid artery, but the surgery goes wrong leaving her partially paralysed and confined to a wheelchair.

She makes Georges promise not to send her back to the hospital or go into a nursing home but suffers a further stroke and her condition worsens.

Georges continues to look after Anne, despite the strain it puts on him to do so.

Their daughter Eva (Isabelle Huppert) wants her mother to go into care, but Georges says that would break the promise he made to Anne.

One day, Georges sits next to Anne's bedside after she has been crying out, apparently in pain. He tells her a story and as it reaches the conclusion, he grabs the pillow on the bed and smothers her with it.

The narrative is powerful in portraying the deep bond between the characters and understandably evokes a huge amount of sympathy for them.

This naturally leads the viewer to be drawn to see Georges’ ending of his wife’s life as an act of love and compassion rather than one of desperation.

I was particularly struck by the strong similarity between this film and another made in Europe just over 70 years ago.

Ich klage an (Eng: I Accuse) is a 1941 film, directed by Wolfgang Liebeneiner, which depicts a woman with multiple sclerosis who asks her husband, a doctor, to relieve her of her suffering permanently. He agrees to give her a lethal injection of morphine while his friend (who is also a doctor) plays tranquil music on the piano.

The husband is put on trial, where arguments are put forth that prolonging life is sometimes contrary to nature, and that death is a right as well as a duty. It culminates in the husband's declaration that he is accusing them of cruelty for trying to prevent such death.

Ich klage an was actually commissioned by Goebbels at the suggestion of Karl Brandt to make the public more supportive of the Reich's T4 euthanasia program, and presented simultaneously with the practice of euthanasia in Nazi Germany.

Along with similar propaganda films it greatly influenced German public opinion, and it is therefore perhaps not surprising, then, that the first phase of the Nazi euthanasia program (titled Operation T4) actually began with parental requests for the ‘merciful deaths’ of their severely disabled or ill children.

As they say, ‘the rest is history’.

The film was banned by Allied powers after the war.

In a recent blog Wesley Smith catalogues a few other examples in which movie makers and actors were nominated or won awards in pro euthanasia movies:

‘Million Dollar Baby: Boxing coach kills his student when she becomes quadriplegic; You Don’t Know Jack: Hagiography of Jack Kevorkian; How to Die in Oregon: Rose glasses documentary of Oregon’s law; The Sea Inside: Paralysed man fights for right to be euthanized; Johnny Got His Gun: Anti war movie in which grievously wounded soldier is euthanized by his nurse; One True Thing: A beloved mother with cancer commits suicide. Then add in the pro euthanasia movies and television programs that have pushed the meme; Law and Order, Star Trek, and on and on and on.’

From this side of the Atlantic I could add The English Patient and A Short Stay in Switzerland, the latter produced by the BBC.

Smith concludes, ‘Popular culture is one of the most powerful promoters of the culture of death.’

Quite!

Investigation into the Liverpool Care Pathway – an update

On Monday 26 November, Care Minister Norman Lamb MP (pictured) convened roundtable talks with parliamentarians, doctors and patients' representatives to discuss the controversial Liverpool Care Pathway (LCP).

During the meeting, which I attended, the Minister announced a far-reaching review to consider the various issues raised, with an independent chair.

The review will consider the findings of three existing reviews being conducted by the Association of Palliative Medicine ('on the implementation of the pathway and the experience of professionals'), Dying Matters ('on the experience of the patient and their loved ones') and the End of Life Care Strategy ('on complaints surrounding the LCP and end of life care in hospitals').

The announcement has understandably received widespread media attention (BBC, Telegraph, Guardian, Mail).

The LCP has been the subject of criticism but has been defended by over twenty leading healthcare organisations and a group of more than 1,000 doctors. One testimony that has drawn a lot of attention is that of Dr Kate Granger, who as a terminally ill cancer patient and geriatric consultant has knowledge of both ends of this issue.

I have previously blogged extensively on the LCP and welcomed the investigation.

Currently about 80,000 patients per year have been supported by the LCP and there is no doubt that it has hugely improved the care of many thousands of patients in the last hours and days of life.

Furthermore the fact that most patients are dying within 33 hours of being placed upon it tells us that they are dying not from dehydration but from their underlying conditions. People usually take 10-20 days to die from dehydration and patients in the last hours or days of life often do not utilise fluids well and have no desire to drink.

However, the LCP has also come under justified criticism for its inappropriate use in some patients who are not imminently dying, its use by junior staff who have not been adequately trained or supervised and the fact that some relatives have not been informed that their loved ones have been placed on it.

Case reports of patients being on the pathway for up to two weeks before dying, or recovering and living for months after being taken off it after protests by relatives have been particularly disturbing and two doctors at the meeting actually called for the withdrawal of the pathway altogether.

If everyone followed the very clear guidelines issued by those overseeing the LCP’s implementation I doubt that we would be having the current discussion.

However it is clear that in some care homes and district hospitals implementation has been sub-optimal.

In order to iron out the abuses several measures need to be implemented:

1.It should be made absolutely clear that no one who is not imminently dying within hours, or at most two or three days, should be placed on the LCP and anyone placed on it who shows improvement should be taken off it. These assessments should be made by senior clinicians.

2.No one should be placed on the LCP without it being discussed with the relative or carer (although the latter do not need to give consent)

3.Every patient placed on the LCP must be regularly monitored and reassessed by a multidisciplinary team.

4.The present documentation is far too complex and needs to be simplified and standardised so that those implementing it can easily follow the guidelines and supervisors can easily tell what is going on with each patient.

5.Training and supervision of those using the pathway needs to be standardised and improved and formal training should be required before any healthcare professional is able to use it.

6.An annual audit needs to be carried out and all suboptimal use identified promptly acted upon.

7.Non-clinical priorities in the use of the pathway, especially financial priorities, must be eradicated and every patient treated solely according to their need. In this connection it would be far better to link CQUIN payments to staff training in the use of the pathway rather than numbers of patients placed on the pathway.

8.Communication to relatives both by health professionals and organisations involved in LCP implementation needs to be substantially improved.

9.Those misusing the LCP should be quickly identified and in the case of abuse reported to the appropriate authorities (General Medical Council or Nurses and Midwifery Council).

Every airline accident should make our next air trip safer. In the same way every abuse or misuse of the LCP should mean that the same mistake never occurs again.

We await the result of the investigation with great interest.

Journalists told to stop using the term ‘homophobia’

The Associated Press has nixed the term ‘homophobia’ from its Style Book.

The online Style Book now says that ‘-phobia’, ‘an irrational, uncontrollable fear, often a form of mental illness’ should not be used ‘in political or social contexts’, including ‘homophobia’ because ‘a phobia is a psychiatric or medical term for a severe mental disorder’.

AP Deputy Standards Editor Dave Minthorn said that ‘Homophobia especially is just off the mark. It's ascribing a mental disability to someone, and suggests a knowledge that we don't have. It seems inaccurate. Instead, we would use something more neutral: anti-gay, or some such, if we had reason to believe that was the case.’

‘We want to be precise and accurate and neutral in our phrasing,’ he said.

Wikipedia currently defines ‘homophobia’ as ‘a range of negative attitudes and feelings towards homosexuality and people identified or perceived as being homosexual’.

In keeping with this view, author, activist, and civil rights leader Coretta Scott King in a 1998 address, equated homophobia to ‘racism and anti-Semitism and other forms of bigotry’ on the grounds that ‘it seeks to dehumanize a large group of people, to deny their humanity, their dignity and personhood’.

However when the term was first used it actually meant something quite different.

The word homophobia first appeared in print in an article written for the 23 May 1969 edition of the American tabloid Screw, in which it was used to refer to heterosexual men's fear that others might think they are gay. It has also been used to describe a fear of people who ‘come out’ as homosexual.

These definitions are much more in keeping with the literal meaning. After all, a phobia is a fear: claustrophobia, arachnophobia and acrophobia being fears of closed spaces, spiders and heights respectively.

But more recently the term has been almost exclusively used to describe anyone who publicly opposes the demands of the gay rights lobby. The aim has generally been to silence and marginalise opposition and to close down rational debate. By labelling opponents as 'homophobic' campaigners are able to demonise opponents by implying their views are purely the product of prejudice, thereby avoiding having to engage seriously with their arguments.

For people who don’t hate, dislike or fear gay people, but simply believe that sex between people who are not married (including all sex between those of the same sex) is morally wrong, journalists clearly now need a new term.

I’d like to propose that the media start using the term ‘homosceptic’ – which the Urban dictionary defines as ‘a member of society who does not hate homosexuals, but generally does not agree with the principle of homosexuality in moral and ethical terms’.

As I’ve previously argued this term could be broadened to include ‘being sceptical about the key presuppositions of the gay rights movement’ such as the beliefs that:

• Homosexuality is genetically determined
• Homosexual orientation is always fixed
• Sexual orientation is a biological characteristic like race, sex or skin colour
• Feelings of same sex attraction should be welcomed and acted upon
• Offering help to those who wish to resist or eradicate these feelings is always wrong