Woman refuses $10,000 to abort surrogate baby with special needs

This is a bizarre story from the US state of Connecticut which appeared on CNN today but deserves far wider distribution. 

The original account titled ‘Surrogate offered $10,000 to abort baby’ runs to 3,500 words so I have cut it to 1,400 (see here). The story has now gone viral (see here).

I run the story here without comment, but it demonstrates just how complicated things can become in a world where IVF, commercial surrogacy and abortion come together. 

It is poignant that it has come to light the day before submissions close for Fiona Bruce’s parliamentary inquiry on abortion for disability.

Crystal Kelley, 29, who already had two daughters of her own, hired herself as a commercial surrogate for $22,000 to carry a couple’s two frozen embryos. The couple already had three children and desperately wanted a fourth child, but the mother couldn't conceive.

One embryo survived after implantation but the five month ultrasound scan showed the baby had a cleft lip and palate, a cyst in the brain, and a complex heart abnormality.

The doctors explained the baby would need several heart surgeries after she was born. She would likely survive the pregnancy, but had only about a 25% chance of having a ‘normal life’. The commissioning parents wanted an abortion but Kelley felt that all efforts should be made to 'give the baby a chance'.

The parents tried to convince Kelley to change her mind and said that they had pursued surrogacy in order to minimize the risk of pain and suffering for their baby.

The two sides were at a standoff. The doctor and the genetic counselor offered an amniocentesis in the hope that by analysing the baby's genes, they could learn more about her condition.

Kelley was amenable but the parents felt that the information gained from this testing would not influence their decision to opt for abortion. They were very upset and said that Kelley ‘should try to be God-like and have mercy on the child and let her go’.

Kelly told them that they had chosen her to carry and protect this child, and that was exactly what she was going to do. She told them it wasn't their decision to play God and walked out of the room.

She then received an e-mail from Rita Kron at Surrogacy International telling her that if she chose to have the baby, the couple wouldn't agree to be the baby's legal parents.

Kelley didn't want to be the baby's mother - she'd gotten pregnant to help another family, not to have a child of her own. She was then told that the parents would pay her $10,000 to have an abortion.

The offer tested Kelley's convictions. She'd always been against abortion for religious and moral reasons, but she really needed the money.

Kron took Kelley to lunch. Kelley said, ’She painted a picture of a life of a person who had a child with special needs. She told me how it would be painful, it would be taxing, it would be strenuous and stressful. She told me it would financially drain me, that my children would suffer because of it.’

Kelley made a counter offer. ‘In a weak moment I asked her to tell them that for $15,000 I would consider going forward with the termination’, she said. But as soon as she got in the car to go home, she regretted it.

Kron let Kelley know the parents had refused to pay $15,000 but by that point, it didn't matter to Kelley -- she'd decided against abortion no matter what.

On 22 February 22 2012, six days after the fateful ultrasound, she received a letter from the parents’ lawyer saying that she was obligated to terminate the pregnancy immediately. The lawyer informed her that she had  signed a contract, agreeing to ‘abortion in case of severe fetal abnormality’ and was in breach of contract.

If she did not abort, the parents would sue her to get back the fees they'd already paid her -- around $8,000 -- plus all of the medical expenses and legal fees.

Kelley found a lawyer who was willing to take on her case free of charge who  explained that no matter what the contract said, she couldn't be forced to have an abortion. She wrote back to the couple’s lawyer saying that ‘abortion is off the table and will not be considered under any circumstance’.

The couple’s lawyer then phoned telling Kelley’s lawyer that the parents had changed their minds and now planned to exercise their legal right to take custody of their child -- and then immediately after birth surrender her to the state of Connecticut. She would become a ward of the state.

Kelley couldn't stand the thought of the baby in foster care but was advised by her lawyer that under Connecticut law she'd likely lose in court.

Her only option was to move to another state where, under a different law, where she and not the genetic parents, would be considered the baby's legal mother. That place was 700 miles away.

On 11 April 11, in her seventh month of pregnancy, Kelley and her daughters left for Michigan.

She chose Michigan because of its laws, but also its medicine: she'd been doing research on the baby's condition, and concluded CS Mott Children's Hospital at the University of Michigan had one of the best pediatric heart programs in the country.

When she arrived, she found an inexpensive summer sublet from a University of Michigan student and applied for Michigan Medicaid. She made appointments with a high-risk pregnancy specialist and a pediatric cardiologist.

There was one thing left to do: She had to decide if she would keep the baby. She was a single mother with no job and no permanent place to live, but she'd grown emotionally attached to the life inside her, and some days she wanted to keep her. She finally decided she wasn't the right person to raise the child but through a support group found a couple who were willing to adopt.

But about one month before the baby's due date, the original parents filed in Connecticut Superior Court for parental rights. They wanted to be the legal parents with their names on the birth certificate. The legal papers included a stunning admission: the wife was not the baby's genetic mother -- they'd used an anonymous egg donor.

The case had now become very complicated. The lawyers were still negotiating about who would be the legal parents when the baby was born on 25 June.  Three weeks later, the two sides struck a deal: The father agreed to give up his paternal rights as long as he and his wife could keep in touch with the adoptive family about the baby's health.  Since then, the couple has visited the baby and the father has held her.

The baby's medical problems turned out to be much more extensive than the ultrasound at Hartford Hospital had revealed. She had a birth defect called holoprosencephaly, where the brain fails to completely divide into distinct hemispheres. She also has heterotaxy, which means many of her internal organs, such as her liver and stomach, are in the wrong places. She has at least two spleens, neither of which works properly. Her head is very small, her right ear is misshapen, she has a cleft lip and a cleft palate, and a long list of complex heart defects, among other problems.

‘Baby S’, now nine months old, has a long road in front of her. She's already had one open-heart surgery and surgery on her intestines, and in the next year she'll need one or two more cardiac surgeries in addition to procedures to repair her cleft lip and palate. Later in childhood she'll need surgeries on her jaw and ear and more heart surgeries.

Her adoptive parents, who asked to remain anonymous to protect their family's privacy, know Baby S  might not be with them for long. The cardiac procedures she needs are risky, and her heterotaxy and holoprosencephaly, though mild, carry a risk of early death, according to doctors. If Baby S. does survive, there's a 50% chance she won't be able to walk, talk or use her hands normally.

Her adoptive parents know some people look at her and see a baby born to suffer -- a baby who's suffering could have been prevented with an abortion. But that's not the way they see it. They see a little girl who's defied the odds, who constantly surprises her doctors with what she's able to do -- make eye contact, giggle at her siblings, grab toys, eye strangers warily.

Kelley says, ‘I can't tell you how many people told me that I was bad, that I was wrong, that I should go have an abortion, that I would be damned to hell.’

But in the end, she feels like she did the right thing. ‘No one else was feeling this pregnancy the way that I was. No one else could feel her kicking and moving around inside,’ she said. ‘I knew from the beginning that this little girl had an amazing fighting spirit, and whatever challenges were thrown at her, she would go at them with every ounce of spirit that she could possibly have. No matter what anybody told me, I became her mother.’

Speaking out for truth and justice – a Christian responsibility

Speaking out for truth and justice is just one of many responsibilities we have as Christians. But I suspect it is the one that we most willingly shirk, simply because it can be so costly. 

Being a Christian is costly in many ways. It is costly to live a life of obedience and service, costly to go on loving against the odds, costly to persevere when we are tempted to give up and costly to give generously of our energy, time and money. But when we speak out we pay a cost of a different kind, because speaking out makes us a target for attack.

John the Baptist lost his head for speaking out about vice and corruption – but he did not shrink from confronting individuals in power when it was appropriate to do so. The prophets and apostles were persecuted for what they said, rather than what they did. Jesus himself was crucified for his words, rather than his healing or his miracles.

And yet Christians are often reluctant to risk ridicule, attack or ‘loss of influence’ by putting their heads above the parapet. Karl Marx was particularly disdainful of Christian priorities, ‘You Christians have a vested interest in unjust structures which produce victims to whom then you can pour out your hearts in charity.’ And whilst we would not embrace his communist philosophy or solutions he did have a point. Real concern for the marginalised is evidenced both by charity and by speaking out.

Bishop Dom Header Camara of Recife, Brazil, who lived as a bishop among the poorest of the poor during the Brazilian dictatorship (post 1964), made this observation. ‘When I served the poor they called me a saint, when I asked why they were poor, they called me a communist.’ Camara understood the structural reasons for the deep poverty of so many of his fellow Brazilians. He challenged the obscene wealth of the rich, and the embarrassing linkage of the Church with the powerful in his country.

As Christian doctors we have a responsibility to speak out on behalf of the marginalised, the disempowered and those who have no voice– the poor, elderly or confused, those with head injuries, dementia or strokes, those suffering from chronic or psychiatric illness, the terminally ill, children, unborn children and human embryos.

We need to speak out in everyday conversation, through our NHS trusts and hospitals, through the BMA and Royal Colleges, through government and on the Christian, secular and medical media – both nationally and internationally. And we need to encourage one another to make and create opportunities and remember that we are not alone.

Mordecai’s words to Esther urging her to speak out when her own people were under threat are just as relevant to us today: ‘If you remain silent at this time, relief and deliverance… will arise from another place, but you and your father’s family will perish. And who knows but that you have come to royal position for such a time as this?’(Esther 4:13-14)

Speak up for those who cannot speak for themselves, for the rights of all who are destitute.

Speak up and judge fairly; defend the rights of the poor and needy… If you say, ‘But we knew nothing about this,’ does not he who weighs the heart perceive it? Does not he who guards your life know it? (Proverbs 31:8,9 and 24:12)

The duties of a physician - a Puritan's prescription

Richard Baxter (1615-1691), author of The Saint's Everlasting Rest and The Reformed Pastor, was known as 'an eminent curer of souls'. 

This advice for Christian Physicians (taken from his 1673 Christian Directory) gives interesting insights into the doctor-patient relationship in the 17th century and good guidance for us today.

Baxter did not want to 'intermeddle in the mysteries of (physicians') art' but wanted to tell 'the learned men of this noble profession... what God and conscience will expect from them'. His directives can be summarised as follows:

1. Put the patient first

We are to 'be sure that the saving of men's lives and health' is 'first and chiefly in (our) intention, before any gain or honour of (our) own'. This is the only way to ensure that 'it is God that (we) serve' rather than ourselves.

2. Serve the poor

We are to 'be ready to help the poor as well as the rich; differencing them no further than the public good requireth (us) to do'. Christian service honours the vulnerable.

3. Know your limits

We are to 'adventure not unnecessarily on things beyond (our) skill' but rather, in difficult cases, to be ready to 'persuade (our) patients to use the help of abler physicians'.

4. Depend on God

We are to 'depend on God for our direction and success' by earnestly 'craving his help and blessing in our undertakings'. God is the source of all our ability, knowledge and skill.

5. Prepare for eternity

We are to 'let (our) continual observation of the fragility of the flesh, and man's mortality, make (us) more spiritual than other men, and more industrious in preparing for the life to come'. Death and suffering should produce seriousness and not cynicism in us.

6. Share Christ

We should 'exercise (our) compassion and charity to men's souls, as well as to their bodies' by '(speaking) such words as tend to prepare them'. We are reminded that as doctors we 'have excellent opportunities, if (we) have hearts to take them'.

Fresh warning sounded to UK as euthanasia deaths increase by 25% in Belgium in just one year

Things are moving at a frightening pace in Belgium. 

Further to my recent ten year review in December and report on the twins’ euthanasia case that made international headlines in January Alex Schadenberg has just published the following review on Belgium’s 2012 figures just out. 

I’ve reproduced it here from his blog.

Recent studies concerning the Belgian euthanasia law found that: 32% of the assisted deaths are done without request and 47% of the assisted deaths go unreported in the Flanders region of Belgium. Another recent study found that even though nurses are prohibited from doing euthanasia, that in fact nurses are euthanizing their patients in Belgium. There has never been an attempted prosecution for abuses of the Belgian euthanasia law.

Confirming that euthanasia is out-of-control in Belgium the 2012 euthanasia statistics indicate that there was a 25% increase in the number of assisted deaths in Belgium.

Recent government statistics indicate that the number of reported assisted deaths increased from 1133 in 2011 to 1432 in 2012, representing 2% of all deaths in Belgium. The number of reported assisted deaths inBelgium in 2010 was 954. It is important to note that these statistics do not include the unreported assisted deaths.

The study that found that 32% of the assisted deaths are done without request, indicated that the people who died by euthanasia without request were usually: incompetent, did not have cancer, were over the age of 80, and living in a hospital. The same study indicated that these deaths represented "a vulnerable patient group."

Further to that doctors who admit to not reporting assisted deaths usually do not follow the guidelines of the Belgian law. A recent study found that 73.1 % of the reported assisted deaths followed the guidelines while only 12.3% of the unreported assisted deaths followed the euthanasia guidelines in the Belgian law.

The response by Belgian legislators to the abuses of the euthanasia law is to widen the definitions of the law to include children with disabilities and people with dementia. By widening the definitions in the law, fewer doctors will be abusing the law. It is also feared that the proposed changes to the euthanasia law may effect the freedom of conscience for health care workers in Belgium.

The proposed changes to the Belgium euthanasia law, combined with the lack of attempted prosecutions for abusing the Belgium euthanasia law, in conjunction with the massive increases in the number of euthanasia deaths, indicates that a slippery slope, also known as incremental extensions, has occurred in Belgium.

If you think that is bad enough, consider the fact that a woman with anorexia nervosarecently died by euthanasia, a man wrote that his depressed mother died by euthanasia, belgian twins who were born deaf were euthanized out of fear of blindness, and Belgium is experimenting with euthanasia/organ donation.

A recent 10 year report of the Belgian euthanasia law that was done by the European Institute of Bioethics found:

• A written declaration of a desire for euthanasia is required, either by the patient or a surrogate. However, the Commission often waives this obligation. 

• Initially patients had to have a life‐threatening and incurable illness. Nowadays, the illness need only be serious and debilitating. 

• The pain is supposed to be unbearable, unremitting and unrelievable. However, a patient can refuse medication to relieve the pain. The Commission, says the IEB, has ‘decided not to carry out its mission ‐ so central to the law ‐ of verifying the unbearable and unrelievable nature of the suffering’. 

• The ambit of ‘psychological suffering’ is ever-expanding. 

• Doctor-assisted suicide is not authorised by 2002 legislation. However, the Commission has ignored this and regularly signs off on such cases. 

• If a patient is to be euthanised at home, the doctor himself is supposed to fetch the lethal medications at a pharmacy from a registered pharmacist and to return left-over drugs. In practice, family members often get the drugs; unqualified personnel hand them over; and no checks have ever been made about surplus drugs.’ 

To learn more about the current practice and abuses of the Belgian and Netherlands euthanasia laws, by ordering the book, by Alex Schadenberg ($20 includes shipping): Exposing Vulnerable People to Euthanasia and Assisted Suicide. Exposing Vulnerable People will prepare you to oppose the legalization of euthanasia and assisted suicide.

The Euthanasia Prevention Coalition (EPC) hopes that Belgian legislators will open their eyes to the reality of their euthanasia experiment and reverse their direction. If not, we hope that the rest of the world will recognize how dangerous legalized euthanasia and assisted suicide is and how it threatens the lives of their citizens.

‘Amour’ is a dangerously seductive piece of pro-euthanasia propaganda

Margaret Morganroth Gullette (pictured) is Resident Scholar of the Women's Studies Research Center, Brandeis University and author of ‘Agewise: Fighting the New Ageism in America’.

She has just written a brilliant review of the award winning film ‘Amour’ for the Guardian Film blog which is well worth reading.

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 Film Festival and 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, until one day 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. 

Gullette argues, ‘For a film in which a husband murders his wife, Amour has been shown a lot of love. It was nominated for five Oscars, including best actress for Emmanuelle Riva, and best foreign language film, which it won.’

‘But the manner in which the movie ends, and the apparent inevitability of such an ending,’ she says,  ‘have gone largely unexamined’.

She then artfully probes and exposes the films unstated presuppositions that, by going unchallenged, subtly prepare the viewer to embrace euthanasia uncritically as a solution to irreversible disability:

‘One of the implicit convictions of the film is that a carer – even one as assiduous as Jean-Louis Trintignant's Georges – will crack under the strain of caring for a stroke victim… yet the circumstances shown in Amour are highly unusual. Money is no object for this couple. The carer has no pressing health issues of his own. He is also a man. And, though highly educated, he is a man who apparently has never received any advice about caregiving.’

This set of circumstances, she argues, is rather contrived:

‘ Carers are now advised to arrange respite care: to get out, eat properly, enjoy a social life. It's understood that their own health and mental wellbeing is at stake. As well as this, Georges could easily have secured more help from other agencies…  a daughter better educated about disability might have said words of love to her mother, and persuaded her – while it was still possible – to go out for tea, out in her wheelchair, to visit a friend. The family doctor, who makes house calls, could certainly have provided adequate pain medication for Anne; morphine could have eased her passing. Georges had more compassionate alternatives available to him than smothering his wife with a pillow.’

Gullette makes the point that the ’film's largely adulatory reception has implications for people with no knowledge of living with disability’ and ‘raises cultural risks in a western world that is already ageist, and in which stretched medical resources are meted out to older patients much less generously than to the young’.

The film is constructed in such a way that ‘it becomes hard to disagree with Georges' masochistic choices, or even notice that he has broken down’, whereas the reality is that ‘many seriously ill people find the “morbid phase” of their lives well worth prolonging’.

By presenting ‘a nonconsensual termination of life as a solution for the carer: it justifies euthanasia’ and in the fact that it has been ‘ so widely acclaimed while remaining so ill-examined’ is,  she concludes, ‘a dangerous thing’.

‘Amour’, as I previously argued, is a dangerously seductive piece of pro-euthanasia propaganda which will help fuel and justify elder abuse and will further erode the public conscience.

I have been particularly struck by its strong similarity with 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.

Our current generation sadly is a long way from possessing the same courage or powers of discernment. 

Landmark Irish ‘right to die’ case is based on flawed assumption

Marie Fleming (pictured) is a 59 year old former Irish lecturer who has multiple sclerosis and wants her partner to be able to help kill herself without risk of prosecution (See Irish Times and BBC Europe reports).

Her landmark case in Ireland is very similar to that of Debbie Purdy in Britain, who won a case in 2009 forcing the Director of Public Prosecutions (DPP) to make public the criteria he used in deciding to bring a prosecution for assisting suicide. These criteria were published in February 2010 and have been the subject of some controversy.

Fleming has thus far, however, had far less success than Purdy.

What makes the Fleming case particularly interesting is that her partner who wishes to avoid prosecution is none other than Tom Curran, the Coordinator for Exit International Europe (EIE), a pro-euthanasia lobby group (EIE is part of Exit International, which is headed by controversial Australian euthanasia campaigner Philip Nitschke). 

Fleming’s case is currently before seven judges at the Irish Supreme Court, and although the hearing of evidence is expected to conclude on Tuesday, the judgement may not come out for some time.

Suicide was decriminalised in Ireland in 1993, but Section 2.2 of the Criminal Law Suicide Act 1993 makes it an offence to ‘aid, abet, counsel or procure’ a suicide. Those convicted under this law still face a custodial sentence of up to 14 years.

The Irish Act is almost identical to the Suicide Act 1961of England and Wales, with the exception that in the latter the words ‘aid, abet, counsel or procure’ were amended to ‘encourage or assist’ by the Coroners and Justice Act in 2009 in an attempt to make it easier to secure convictions in cases of internet suicide promotion where the guilty party did not personally know the victim.

In her case against Ireland, the Attorney General and Director of Public Prosecutions (DPP), Fleming claims section 2.2 of the Criminal Law (Suicide) Act, which renders it an offence to aid, abet, counsel or procure the suicide of another, is unconstitutional on grounds that it breaches her personal autonomy rights under the Constitution and European Convention on Human Rights (See more here)

Fleming argues that the absolute ban should and must be relaxed to meet her particular circumstances as a terminally ill person in severe pain who is mentally competent to decide when and how she wants to end her life but cannot do so without assistance. She is claiming that the law discriminates against her as a disabled person who needs assistance to kill herself.

A three judge High Court ruled last month the absolute ban does not disproportionately infringe Ms Fleming's personal rights under the Constitution and is wholly justified in the public interest to protect vulnerable people.

The High Court also ruled that the Director of Public Prosecutions has no power to issue guidelines setting out what factors she would consider in deciding whether to prosecute cases of assisted suicide. However, the court was however ‘sure’ the Director would adopt a humane and sensitive approach to Ms Fleming's plight, Mr Justice Nicholas Kearns said.

Ms Fleming is not appealing against that aspect of the court's decision. Her appeal focusses on arguments that the absolute ban on assisted suicide breaches her personal autonomy rights under the Constitution and European Convention on Human Rights and that, in her particular circumstances, this ban is not justified on public interest grounds but is disproportionate and discriminatory.

Fleming’s case rests on the flawed assumption that, since suicide itself is not illegal, there is thereby a right to suicide. It is on this basis that she claims that as a seriously disabled person she is being discriminated against for not being able to exercise that right, when able-bodied people can.

Dignity in Dying (the former British Voluntary Euthanasia Society) has used a similar line of argument.

However this is to misunderstand the basis and intention of the law.

When the British Parliament passed the Suicide Act in 1961 it was assured that the decriminalisation of suicide did not indicate any reduction of the seriousness with which either (a) suicide or (b) assisting suicide were viewed.

The Joint Under-Secretary of State for the Home Department, moving the Suicide Bill's Third Reading, said:

'Because we have taken the view, as Parliament and the Government have taken, that the treatment of people who attempt to commit suicide should no longer be through the criminal courts, it in no way lessens, nor should it lessen, the respect for the sanctity of life which we all share. It must not be thought that because we are changing the method of treatment for those unfortunate people, we seek to depreciate the gravity of the action of anyone who tries to commit suicide…..' (Hansard: HC Deb 28 July 1961 vol 645: 1961(a): Cols 822-823)

He went on:

'I should like to state as solemnly as I can….that we wish to give no encouragement whatever to suicide…..I hope that nothing that I have said will give the impression that the act of self-murder, of self-destruction, is regarded at all lightly by the Home Office or the Government.' (Hansard: HC Deb 19 July 1961 vol 644: Cols 1425-1426)

Fleming and others wish to argue that in some cases suicide is not serious and is in fact a morally good course of action. That is a position that needs to be strongly resisted at all costs.

It is one thing to argue that people who attempt suicide should be treated with mercy and compassion by the courts. But it is quite another to argue that committing suicide, taking one’s own life, is a moral good and thereby a right.

That would be a very dangerous precedent indeed, which once established would be used as a legal lever for more and more incremental extension.

Brief update of UK news about euthanasia and assisted suicide

Care Not Killing’s latest news roundup of news at the end of life from its January/February 2013 newsletter

Legislation

Lord Falconer (pictured) has announced that he will seek to introduce his DiD-backed assisted suicide bill in the House of Lords in May. In line with the recommendations of his sham 'Commission on Assisted Dying', Falconer will push for doctors to be empowered to help mentally competent adults with less than one year to live to kill themselves. New figures from Oregon, whose laws are Falconer's inspiration, serve as a grave warning of the consequences of enacting such legislation - especially given that Oregon's laws are based on a more limited six-month prognosis.

The vast range of different agendas within the pro-euthanasia movement would almost certainly prompt incremental extension once the principle of assisted suicide is established, and Falconer's so-called 'safeguards' are very similar to those in the Joffe Bill which the Lords rejected in 2006.

As politicians begin to consider the upcoming debate, Lib Dem peer Lord Carlile corrected misconceptions regarding legalisation of assisted suicide - which the Liberal Democrats support - as espoused by a party activist. The stakes could hardly be higher.

Liverpool Care Pathway

In the opening weeks of 2013, so-called 'financial incentives' again became a focus for considerable concern. One of our member organisations made a much publicised call* for these to be scrapped and shortly afterwards, Care Minister Norman Lamb pledged* that payments would 'only be made if it could be demonstrated that it improved the care of dying patients'.

MPs had the chance to debate concerns surrounding the LCP in an 8 January Westminster Hall debate secured by Glyn Davies MP* (video, transcript). A number of notable contributions* were made, especially from Fiona Bruce MP*, and training and communication emerged as key focuses for improvement.

On 15 January, the Department of Health announced* Baroness Neuberger as chair of Care Minister Norman Lamb's 'wide-ranging' review of the LCP. Lady Neuberger, previously Liberal Democrat health spokesperson in the House of Lords but a Crossbencher since becoming a senior Rabbi, has worked with the King's Fund, and will be assisted by a panel of experts. The review's work has begun, and they are accepting submissions until 5 April. 

GMC

The General Medical Council released long awaited guidance on assisted suicide on 31 January, clarifying that doctors may not assist, encourage or advise assisted suicide. Despite attempts by DiD to 'spin' aspects of the documents, this was undoubtedly a good day for patients and for the medical profession.

 Belgian twins

The news* that 45-year old Belgian twins Marc and Eddy Verbessem were euthanised after discovering that they were going blind - having been deaf since birth - reverberated* around the world in January. What this says about a legal mindset which continues to move further away from talk of 'death with dignity' for the terminally ill is deeply disturbing.

Euthanasia Road Trip

Seeking answers to 'why a country passes such a law, how they work in practise and whether my worries and concerns are justified', actress and comedienne Liz Carr set out to visit the five nations where euthanasia and assisted suicide are legal for a BBC World Service series. Meeting with practitioners, patients, families and campaigners, she gained a unique insight - but remained convinced that euthanasia and assisted suicide are not right for the UK. Read her introduction to When Assisted Death is Legal, or listen again.

Way to Go

On 16 January, BBC3 aired the first episode of its newly commissioned comedy*, Way to Go. Starring Inbetweeners favourite Blake Harrison, the series attracted controversy* for its subject matter: two brothers, in financial straits, decide to set up an 'assisted suicide' business. The show's creators described the black comedy as sensitive*, but initial reviews claimed the show 'may prove that some things just aren't funny'*. We at CNK wanted to give the series a fair chance, initially publishing only criteria for review. Having seen the six episodes, we were glad that the series highlighted key dangers of assisted suicide, but overall concurred with initial reviews: assisted suicide is not a source for comedy. Thank you to all those who contacted us regarding the series.

Amour

Michael Haneke's Amour, which caused concern for its sympathetic portrayal of euthanasia, has enjoyed considerable success* during the ongoing awards season, culminating in winning Best Foreign Language Film at the Oscars. The film had, unusually for a foreign language film, been nominated in a number of key Academy Award categories*. What does this say about opinion formers in the world of creative arts?

Jane Nicklinson

Jane Nicklinson, whose husband Tony died last year after losing his high profile High Court bid, has been granted permission* to challenge the ruling which refused those seeking to end their lives to do so with medical assistance. 'Martin', whose case was heard in tandem with Nicklinson's, is also appealing. We expect the cases to be heard in early May.