Don’t be fooled by Lord Falconer’s ‘modest’ assisted suicide proposals

Lord Falconer has finally announced that his long awaited assisted suicide bill will be tabled in the House of Lords next week on Wednesday 15 May.

It is then that we will finally see the full text of the bill which will then proceed to second reading (debate stage) sometime in June, or possibly in the autumn.

According to the BBC and Telegraph the bill will be based on the Oregon model – assisted suicide for mentally competent adults who have less than six months to live.

The timing has been carefully planned. On 13 and 14 May the Court of Appeal will be hearing the case of Paul Lamb, a 57 year old man with quadriplegia, who is seeking permission for a doctor to kill him by means of a lethal injection.

Off the back of media coverage of this case, Falconer, who is being backed by Dignity in Dying (the former Voluntary Euthanasia Society), will argue that his proposal is modest in comparison.

Lamb is not terminally ill and wants a doctor to give him a lethal injection (euthanasia).  Falconer however is only asking for people who are terminally ill to have the right to receive help to kill themselves (assisted suicide).

This model, he will argue, will be safer for vulnerable people and will have ‘upfront safeguards’ to stop abuse.  

According to House of Lords calculations in 2005 a Dutch-type law (such as Lamb is seeking) would mean 13,000 euthanasia deaths a year in Britain, but an Oregon-type law (like Falconer’s) would mean only 650.

Falconer is thereby attempting to position himself as the reasonable middle ground between those who wish to keep euthanasia and assisted suicide illegal and those who want extensive decriminalisation.

We should not be fooled by this ploy and the situation in Oregon is already ringing loud alarm bells.

Members of the House of Lords should note that statistics released just earlier this year (full report here) show that the number of assisted suicide prescriptions and deaths in Oregon, once again, increased in 2012 and has now reached an all-time high. 

There were 59 assisted suicide deaths in Oregon in 2009, 65 in 2010, 71 in 2011 and 77 in 2012; a 30% increase overall in just four years. 

The number of prescriptions for assisted suicide was 95 in 2009, 97 in 2010, 114 in 2011 and 115 in 2012; 115 in 2012; a 21% increase since 2009.

Overall assisted suicides have gone from 16 in 1998 to 77 in 2012, an overall increase of 381% (see chart above).

This pattern of incremental extension is similar to that seen in the Netherlands, Switzerland and Belgium, other countries that have changed the law.

A major factor fuelling this increase is suicide contagion - the so-called Werther effect. This is particularly dangerous when assisted suicides are backed by celebrities as they are here and given high media profile as they are frequently by the BBC. 

The Oregon numbers may not seem large but we need to remember that Oregon has a very small population relative to the UK and that they may well be an underestimate as they are based on physicians' self-reporting. 

But for argument's sake let's simply take them at face value. How would they then translate to Britain?

Back in 2006, and based on Oregon’s total of 38 assisted suicide deaths in 2005, the House of Lords calculated that with an Oregon-type law we would have about 650 cases of assisted suicide a year in Britain. 

But as the numbers in Oregon have since doubled to 77 the UK equivalent would now be 1,300.

We should learn from the Oregon experience and be resisting these moves. 

Any change in the law to allow assisted suicide (a form of euthanasia) would inevitably place pressure on vulnerable people to end their lives so as not to be a burden on others and these pressures would be particularly acutely felt at a time of economic recession when many families are struggling to make ends meet and health budgets are being slashed. Especially when fears about the NHS are actually fuelling support for assisted suicide. The so-called right to die can so easily become the duty to die.

And once legalised there will inevitably be incremental extension as we have seen in Oregon, Switzerland, Belgium and the Netherlands. Legalisation leads to normalisation. New hard cases will brought to bring pressure to widen the existing criteria to allow extension to ‘Gillick competent’ minors, people without mental capacity who ‘would have wanted it’ and those who are ‘suffering unbearably’ but are not terminally ill.

I have previously blogged about the shroud of secrecy which surrounds assisted suicide practice in Oregon, the worrying trends in neighbouring Washington state, which enacted a similar law more recently and the way the Oregon law steers people toward suicide. 

Also deeply concerning are reports of depressed patients being killed without being treated, doctor shopping, deaths taking place without witnesses present (raising questions about elder abuse) and the fact that 44 of the 77 who died last year (57%) said that they were concerned about being a burden on family, friends and caregivers. 

The lessons are clear. Let’s not go there.

The best system is what we have already – a blanket ban on both assisted suicide and euthanasia which provides a strong deterrent to exploitation and abuse whilst giving discretion to both prosecutors and judges to temper justice with mercy in hard cases.

Under this the number of people going to the Dignitas facility in Switzerland to end their lives remains a trickle of about 15-20 per year.

So let’s keep that system in place and concentrate on providing the best possible care to people who are dying. Let’s major instead on killing pain without killing the patient.

How Cate Faehrmann misled the NSW parliament in order to promote her euthanasia bill

Cate Faehrmann (pictured) is a member of the New South Wales state parliament in Australia who earlier this week introduced a euthanasia bill.

In her speech she made the mistake of attacking a blog I had written about euthanasia in Belgium which had been reproduced on the website of LifeSite News.

She quoted from my blog in order ‘to demonstrate to members the type of tactics used to discredit voluntary assisted dying schemes in operation overseas’ and said that it was ‘a great lesson in lies, damn lies, and statistics’ ( I think she meant ‘lies, damned lies and statistics’ just as she meant to say ‘Philip Nitschke’ and not ‘Philip Nietzsche’)

In order to put the record straight I have reproduced the statements she made in her speech here along with my rebuttals so that it is apparent who was really distorting the truth. The quotes from her speech are in italics.

‘The material circulated was an article headed “Stunning 4,620% increase in Belgian euthanasia cases in ten years since legislation” by Peter Saunders… As Saunders says, the number of euthanasia deaths in Belgium has increased from 24 in 2002 to 918 in 2011.  However, he has miscalculated the percentage increase.  The increase in the ten years is 918-24, which is 894.  So firstly the percentage increase is 3,725% not 4,620%.’

Faehrmann has here confused the figures. The graph in my article (reproduced above from the recent FCEE report for 2010 and 2011) has three lines, one representing euthanasia cases in Flemish-speaking Belgium, one for French-speaking Belgium and an overall total. The figures I gave were the overall total for 2002 (24) and 2011 (1,133). This is actually an increase of 4,620% as I said. Faehrmann has taken the overall total figure for 2002 (24) but the Flemish figure for 2011 (918) to derive her incorrect percentage increase of 3,725%.

Additionally, Belgian euthanasia laws weren’t passed by parliament until late September 2002, which means the 24 deaths that year were in the last 3 months. That’s why the figure is relatively low. But the following year was 235, so arguably that should be the base line number. So that’s more like a four-fold increase from 2003 to 2011.

This is a fair point but does not alter the fact that the annual figures in the Belgian report did actually increase 4,620%. However if we multiply the first 3 month figure of 24 by 4 to get 96 then the increase over ten years to 1,133 is still 1,080%. Even if we take the total for the first full year (2003) as she suggests (235) and include the figure for 2012 (1,432) then the ten year increase was 509.4%. Is she really suggesting that this level of increase is acceptable?

‘Of course, this percentage increase still seems large. But presenting the figures in this way is misleading.  It stands to reason that in the first few years after the introduction of the legislation the number of euthanasia deaths would be low since the system took some time to be understood by both the medical profession and the public.  Once it was more established annual deaths under the scheme began to increase by about 100 a year to the present level of 918, but that figure comprises only 1% of total annual deaths in Belgium according to Saunders' own source.’

Since 2007 the annual rises have been 209, 118, 131, 180 and 299 – much bigger than ‘about 100 a year’ - with each annual rise (but one) greater than the last.

‘Another way of expressing the increase in Belgium is to say that between 2002 and 2011 the percentage of deaths for euthanasia increased from 0.026% of total deaths to 1% of total deaths – hardly “opening the floodgates”!’

Or you could say that the annual number of deaths went from 235 to 1,432 per year in ten years. If this fivefold increase does not ring alarm bells with her then we do have a problem. Although she has placed the words ‘opening the floodgates’ in quote marks I didn’t actually use these words. Instead I said that ‘once euthanasia is legalised steady escalation follows along with a change in the social conscience so that it rapidly becomes accepted as normal’.  I have previously highlighted the similar escalation of euthanasia and assisted suicide cases in the Netherlands, Oregon and Switzerland in recent years.

‘Saunders’ other unsupported assertion is that the FCEC is now considering “extending the right to citizens who suffer from degenerative mental illnesses like Alzheimer’s and also to children”.’

In fact this assertion was not unsupported at all. The full facts and references to the original Belgian source documents can be found here along with previously documented reports from Belgium showing that half of cases go unreported, half of Belgian euthanasia nurses have killed people without request, one third of euthanasia cases in at least one region are involuntary and that euthanasia cases are now being used as organ donors.

A report published late last year by the Brussels-based European Institute of Bioethics claimed that euthanasia was being ‘trivialized’ and that the law was being monitored by a toothless watchdog. After ten years of legalised euthanasia and about 5,500 cases, not one case had ever been referred to the police.

Cate Faehrmann may be passionate about euthanasia but it is a very serious thing for an MP to mislead parliament, especially in introducing a bill.

I am asking her to retract her accusation of ‘lies, damned lies and statistics’, to issue an apology and to correct the errors and omissions in her published speech. 

Doctors should not be forced to provide emergency contraception if they have an ethical objection to it

The Independent has run the story of a ‘Christian-run NHS GP surgery’ which has apparently ‘attracted criticism for posting a notice warning that some of its doctors refuse to prescribe the morning-after pill to patients on grounds of conscience’.

The message on the door of The Links Medical Practice in Mottingham, south London advises patients that if ‘a consenting doctor is not available’ to prescribe contraception they should contact a local clinic or chemist.

One of the practice’s patients was apparently so outraged by this that she opted to leave the practice and Audrey Simpson, chief executive of the Family Planning Association, has said that other women should also think about leaving the surgery in response to the notice.

She is reported as saying: ‘Leaving will send out a message to them that women have the right to access emergency contraception.’

Women can of course legally access ‘emergency contraception’ in the UK and can buy the ‘morning-after pill’ levonelle over the counter without prescription from most pharmacies as well as accessing it free on prescription, from sexual health clinics and from NHS walk in centres.

But according to General Medical Council guidelines published just recently (see my full review of them here), doctors can also refuse to prescribe certain treatments as a matter of conscience.

The Guidance ‘Personal Beliefs and Medical Practice’ states:

‘You may choose to opt out of providing a particular procedure because of your personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients.’

It goes on to describe how this is to be done:

‘If, having taken account of your legal and ethical obligations, you wish to exercise a conscientious objection to particular services or procedures, you must do your best to make sure that patients who may consult you about it are aware of your objection in advance. You can do this by making sure that any printed material about your practice and the services you provide explains if there are any services you will not normally provide because of a conscientious objection.’

This seems to be exactly what these doctors have done.

The guidance adds that doctors who do not provide a certain treatment should ‘tell the patient’, tell them ‘that they have a right to discuss their condition and the options for treatment with another practitioner’ and ‘make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection as you’.

Why might doctors have an objection to prescribing ‘emergency contraception’?

There are three main reasons.

Some doctors may have an objection to prescribing contraception in principle. Many Catholics take this view.

Some doctors object to prescribing a drug which might in some circumstances act by preventing an early embryo from implanting in the womb as they see this as an early form of abortion. Although there is not firm proof that levonelle acts in this way there is at very least a degree of uncertainty and no absolute proof that it does not (more on this here – note levonelle in the UK is the same drug as Plan B in the US).

Finally some object because they are unconvinced that levonelle is an effective intervention. Its success rate is relatively low (95% within 24 hours of sexual intercourse, 85% from 25-48 hours and 58% from 49-72 hours).  Also in clinical trials its ready availability has been shown not to reduce pregnancy rates in a population and actually to raise rates of sexually transmitted diseases. 

This is thought to be due to the phenomenon of ‘risk compensation’ – people taking more risks because they believe there is a safety net.

But regardless of the reasons for a given doctor’s objection to prescribing ‘emergency contraception’, the fact that a patient can legally access it does not mean that every doctor thereby has a legal or ethical duty to supply it.

Doctors should not be forced to provide treatments or interventions that they believe are unethical, ineffective or inappropriate. To force them to do so would be to undermine their professional integrity. They are not simply rubber stamps.

Instead reasonable accommodation should be made. And thankfully both the law and the GMC guidance currently allow for that. 

As the recent CMF File on the doctor's conscience concludes: 

The right of conscientious objection is not a minor or peripheral issue. It goes to the heart of medical practice as a moral activity....  The right of conscience helps to preserve the moral integrity of the individual clinician, preserves the distinctive characteristics and reputation of medicine as a profession, acts as a safeguard against coercive state power, and provides protection from discrimination for those with minority ethical beliefs.

(Listen to my BBC London Interview with Vanessa Phelps here)

Man in active homosexual relationship who wants to become priest takes bishop to human rights tribunal for ‘discrimination’

New Zealand became the 13^th country to legalise same sex marriage two weeks ago.

This week the Anglican Bishop of Auckland is being taken to the Human Rights Tribunal over allegations he is discriminating against a gay man who wants to become a priest.

Right Reverend Ross Bay (pictured) has been accused of preventing a gay man entering the Anglican Church's training or discernment programme for priests because he is unmarried and in a sexual relationship with his male partner.

Bay denies the allegation.

The complainant, who cannot be named for legal reasons, said he had been signalling his desire to train for the priesthood since 2006, but had never been accepted into the programme (but see follow up here).

Bay, who approves entrants to the Anglican Church's clergy training programme, has been the Bishop of Auckland since 2010.

The Human Rights Act 1993 allows exceptions to some discrimination laws, including where organised religions are following their doctrine.

The Bishop said, ultimately, church rules determine who can be ordained, and he refused the man entry ‘by reason of the defendant not being chaste in terms of canons of the Anglican Church’.

He added that anyone in a sexual relationship outside of marriage would not be accepted to train as a priest.

The case is illustrative of the sort of litigation that will become commonplace once same sex marriage is legalised.

At the end of the day this is not about ‘legal equality’ – already granted by civil partnerships – or ‘love’ – nothing currently stands in the way of such relationships.

It is largely about the desire for affirmation and recognition.

What infuriates and drives some sections of the gay rights lobby is the fact that some other members of society - in this case leaders in the Anglican church - refuse to accept, affirm and celebrate their sexual relationships.

And so in complete disregard of the directive of Jesus and Paul not to take fellow Christians to court (Matthew 18:15-17; 1 Corinthians 6:5-7) they end up doing just that – thus underlining the key issue at stake in this debate – a disregard for biblical authority.

The Bible is very clear that the only context for sexual intercourse is within a lifelong heterosexual marriage relationship.

If this aspiring priest wishes to be ordained he needs to acknowledge and respect that by giving up his claim to ordination or by becoming celibate. He can't have it both ways. 

Even if he is successful in challenging the rules in a human court he will not be successful when he attempts to justify himself before God who set the rules in the first place. 

See also 'New Zealand anti-gay marriage group to lose charity status')

NB: The Human Rights Tribunal later dismissed this case in October 2013

58 premature babies in England and Wales every year develop cerebral palsy because their mothers had previous abortions

Almost 60 premature babies are born with cerebral palsy in England and Wales every year because their mothers had previous abortions. 

This is because 15% of babies born before 28 weeks develop cerebral palsy and 400 premature births before 28 weeks each year are attributable to abortion. 15% of 400 is 60.  This calculation is based on the studies below.

It is well known that women who have abortions are more likely to suffer from pre-term births in subsequent pregnancies.

I have blogged previously  on the scientific evidence for this link. There are now at least 119 articles in the world literature attesting to the association, and very few indeed that contest it (see review).

A new Finnish study published just last month has further confirmed the link.  It showed that prior induced abortions (IAs) result in a 28% higher risk of an extremely preterm birth (< 28 weeks' gestation).

Another landmark study from Finland last year analysed data from 300,858 first-time mothers between 1996 and 2008. It showed that women were three times more likely to have a very premature baby, born before 28 weeks, if they had had three or more abortions.

Overall the paper showed three babies born before 28 weeks for every 1,000 women who had never had an abortion, four per 1,000 who had had one abortion, six in those who had had two abortions and 11 if the woman had had three or more abortions.

One of the more serious consequences of premature birth is cerebral palsy.

A major meta-analysis (study of studies) by Eveline Himpens et al published in 2008 quantified this risk (See ‘Prevalence, type, distribution, and severity of cerebral palsy in relation to gestational age: a meta-analytic review’). Twenty-six articles met the inclusion criteria.

The prevalence of cerebral palsy was found to decrease significantly with increasing gestational age as follows: 14.6% at 22 to 27 weeks' gestation, 6.2% at 28 to 31 weeks, 0.7% at 32 to 36 weeks, and 0.1% in term infants.

In other words babies born before 28 weeks have 146 times the chance of having cerebral palsy of those born at term.

So how much cerebral palsy in very preterm babies can be attributed to previous abortions?

There are about 4,000 babies under 28 weeks born in England and Wales each year (there were 4,150 in 2005/6).

On the basis of the Finnish study quoted above I have previously calculated that 10% of these premature births - about 400 - are attributable to abortion.

If 14.6% of these 400 babies had cerebral palsy (Himpens’ figures), that would make 58 babies born each year in Britain who have cerebral palsy attributable to premature birth as a result of abortion. 

A report last year showed that the NHS paid out £3.1bn in damages over a decade to babies and mothers injured as a result of staff errors during childbirth.  Of this £3.1bn a total of 542 claims for cerebral palsy cost the NHS some £1.3bn alone.

But what about injuries which happen as a result of premature births which in turn have occurred as a result of abortion?

I wonder if those women who have a baby with cerebral palsy as a result of a premature birth attributable to a previous abortion might have a claim against those doctors who performed those abortions.

It’s an interesting question. 

Several leading bioethicists defend the practice of infanticide this week in leading medical journal

In February 2012 two bioethicists provoked international outrage with an article advocating infanticide.

Writing in the Journal of Medical Ethics (JME), Alberto Giubilini and Francesca Minerva argued in ‘After-birth abortion: why should the baby live?’,   that foetuses and newborns ‘do not have the same moral status as actual persons’.

They concluded that ‘after birth abortion (killing a newborn) should be permissible in all the cases where abortion is, including cases where the newborn is not disabled’.

The same journal (JME) has this week responded to the crisis with a special issue containing 31 commentaries from a range of ethicists, some of whom have argued for years that infanticide can be a moral action; others who believe that even suggesting it is a vile stain on academic integrity.

Editor Julian Savulescu introduces the issue with these words:

‘Infanticide is an important issue and one worthy of scholarly attention because it touches on an area of concern that few societies have had the courage to tackle honestly and openly: euthanasia. We hope that the papers in this issue will stimulate ethical reflection on practices of euthanasia that are occurring and its proper justification and limits.’

Savulescu claims to be ‘strongly opposed to the legalisation of infanticide along the lines discussed by Giubilini and Minerva’ but says that they are not alone in advocating it.

Infanticide is already practised openly and legally in the Netherlands under the ‘Groningen Protocol’ which allows doctors to end the life of neonates at the request of their parents if the infant is experiencing ‘hopeless and unbearable suffering’.

In addition some of the world's most famous living philosophers have written about its merits and justification over the last 40 years, including Michael Tooley, Jonathan Glover, Peter Singer, Jeff McMahan and John Harris.

Four of these five have contributed to this issue of JME and the full text of their articles is currently available on line.

McMahan argues that the permissibility of infanticide in some circumstances is not only implied by certain theories, but by beliefs that are widely held and difficult to reject.

Michael Tooley's book is entitled Abortion and infanticide.

Peter Singer wrote a book in 1985 with Helga Kuhse called Should the baby live?

Jonathan Glover's landmark Causing death and saving lives notes that ‘Dr Francis Crick (the Nobel Laureate who discovered DNA with Jim Watson in 1956) once proposed a two-day period for detecting abnormalities, after which infanticide would not be permissible’.

Many will be shocked by what these philosophers are saying but Savulescu argues that the issue throws up a broad range of ethical questions fundamental to medical ethics.

What constitutes a person with rights? Is there a moral difference between killing a baby of the same gestation inside and outside the womb? Is there a moral difference between euthanasia and withdrawal of treatment and/or sedation with the explicit intention that the baby will die? In what circumstance is ‘letting die’ morally different from killing?

These are all serious questions which many people, including many doctors, have not carefully thought through.

As I have previously argued these bioethicists have actually done us a service. If we don’t like their conclusions, then it should actually lead us to question the premises from which they logically flow.

Philosophers like Peter Singer believe that it is the qualities of rationality, self-consciousness and communication that make human beings special. What follows from this is those humans with less of these qualities are of less value and can, in some circumstances, be disposed of.

By contrast this Christian view of the sanctity of life, which Singer and others reject, is that human beings have value not because of any ‘intrinsic’ qualities, but for two main ‘extrinsic’ reasons. First, that they are made in the image of God for an eternal relationship with him, and second because God himself became a human being in the person of Jesus Christ and thereby bestowed unique dignity on the human race.

If we follow that view through to its logical conclusion it leads us to say that any human being, regardless of its age, appearance, degree of deformity or mental capacity, is worthy of the highest possible degree of protection, empathy, wonder and respect.

These bioethicists are arguing that infanticide is morally no different to abortion.

But we can draw one of two conclusions from that – either we should embrace infanticide or stop doing abortions.

But whatever view we opt for, we should have the courage of our convictions to draw out its full practical implications as these bioethicists have done.

Most people are just not that consistent. 

How to ask your MP to support a referendum on same sex marriage

Anne Main (also see here) (pictured) is my local MP. She has an excellent voting record on social issues (you can find out your own MP’s voting record here).

She voted against the redefinition of marriage in February and I have just asked her to co-sign an amendment (New Clause 9) to David Cameron’s same-sex marriage bill calling for a referendum on the issue.

My local Tory candidate for the local elections, Salih Gaygusuz, did not bother replying when I asked him his view on the issue, so I gave my vote to the UKIP candidate Philip Singleton who opposed the measure instead.

I have told my MP this and also that I will (reluctantly) vote for UKIP again in 2015 if the Tory Party continues to drift in its current direction.  

If you wish to write to your own local MP urging them to co-sign new clause 9 (which will increase its chance of being debated) you can do so very easily via the write to them website.

The more MPs who co-sign an amendment the more chance it has of being debated.

My letter to Anne is below.

My letter to Anne Main MP

Dear Anne,

As you will know MPs vote soon on amendments to the government's Marriage (Same Sex Couples) Bill.   

I am writing to urge you to co-sign the proposed amendment 'New Clause 9' to the bill which calls for a referendum on the issue.

It is not the government's job to redefine marriage and there is no mandate for this bill.

It didn't feature in any major party's manifesto and there is no public consensus for redefining marriage - many people are opposed to it.

Furthermore the government's consultation ignored half a million responses opposing the redefinition of marriage.

I'm deeply concerned about the bill and what it more widely represents - that the Tory Party leadership is no longer listening to social conservatives.

As a result for the first time I voted for UKIP in this week's local elections. 

Despite my longstanding personal support for you I will do so again, with considerable regret, in the next general election in 2015 if the Conservative party continues to drift in this direction.

Yours sincerely,

Peter