101 not out for pioneering plastic surgeon and missonary

A forward-thinking, retired Salvation Army officer, surgeon and CMF member – who spent a lifetime working overseas, transforming the lives of leprosy sufferers – celebrates his 101^st birthday in Hawick on Sunday 13 July 2014.

Commissioner (Dr) Harry Williams, who was born in 1913, will commence his celebrations on his birthday with a few friends and family in the village of Melrose. Celebrations will continue at Hawick Salvation Army hall on Sunday 13 July with a morning worship service led by Commissioner Robin Forsyth and the sharing of cake. The meeting will include a feature on the commissioner’s life and a gift presentation – although, Dr Williams was quick to remind people that donations to the Harry Williams Hospital in Bolivia would be much more appreciated than birthday gifts!

Harry was working in insurance in London at 19 years old when he decided to become a missionary surgeon. After qualifying at the London Hospital, he trained in plastic surgery under the pioneering surgeon Sir Archibald McIndoe. Later commissioned as a Salvation Army officer (minister), Harry was sent to India where he served more than 30 years as a surgeon and later chief medical officer.

During his ministry as an officer, Commissioner Williams used his expertise in reconstructive surgery – refashioning noses deformed by leprosy and working to change attitudes towards the disease. He also redesigned buildings, reorganised departments and devised new medical programmes. The commissioner was a Territorial Commander – the national leader in Southern India, New Zealand and Australia – and later the International Secretary responsible for the administration of The Salvation Army’s work in the Americas and Australasia. He oversaw the beginning of medical work in Bolivia and The Salvation Army named a hospital in his honour. 

In retirement, Commissioner Williams remained active as an officer, artist and author. He has written novels and Salvation Army history books – the most recent written well in to his nineties. He has also sold many of his paintings to raise funds for Salvation Army projects.

Hawick Salvation Army Corps (church) leader Lieutenant Caroline Brophy-Parkin said: ‘At 101, Commissioner Williams is still active and takes a keen interest in the life at the corps and especially loves the young families and children. He remains passionate about The Salvation Army’s health ministry.’

Major James Williams, who supports retired Salvation Army officers from the church’s national headquarters, said: ‘Retired officers are the backbone of The Salvation Army. They bring a wealth of experience and knowledge into the present day. Retired officers were once fully engaged in ministry work and, like Commissioner Williams, continue to fulfil the call of God in their lives and in their community even beyond active service.’

HPAD gets slapped down at the BMA ARM

The British Medical Association (BMA) has always been opposed to euthanasia and assisted suicide. That is, apart from just one year, 2005, when under the influence of then Ethics chief Michael Wilks, it temporarily went neutral.

The BMA’s opposition to a change in the law has long infuriated advocates of assisted suicide, not least a small but vocal group of doctors who believe that they should be able in some circumstances to help their patients kill themselves.

In fact, campaigning for the legalisation of assisted suicide seems to be a major preoccupation (obsession even) for high profile retired secular humanist doctors (more here). Quite why is another story. 

Every year at the BMA annual representative meeting, this small group of retired doctors, now assembled under the umbrella ‘Healthcare professionals for assisted dying’ (HPAD), the medical arm of the former voluntary euthanasia society, floods the BMA with motions calling for a change in the law. And almost every year the matter gets debated and the BMA policy remains unchanged.

This year was no exception. HPAD members sent in motions from all over the country calling for a referendum amongst BMA members on euthanasia neutrality.

But not surprisingly, the BMA’s agenda committee relegated them to the ‘grey’ part of the programme – ‘unlikely to be reached’ – and prioritised other ethical issues instead.

Not to be outdone HPAD did everything that it could behind (and in front of) the scenes to force a debate. The matter eventually came to a head when HPAD chair Ray Tallis (pictured) attempted to highjack the Chair of Council’s Q & A session. You can watch the video here but it went as follows:

Raymond Tallis: ‘(I am) Raymond Tallis, North West Division, Declaration of Interest, Chair of Heathcare Professions for Assisted Dying: I am deeply curious to know why when twelve motions at least were submitted to survey the views of the BMA on neutrality regarding the issue of assisted dying that this motion did not actually make the agenda.  Given that the motion is extremely timely we know that Lord Falconer’s bill is receiving its second reading in the House of Lords in a couple of weeks I can only conclude and this may be the conclusion of some people in the represented body that people were afraid of doing a survey on neutrality as they were worried about the findings’.

Chairman’s response: ‘Thank you Ray.  I believe I answered that question earlier on. That is not a question for the Chairman of Council as I believe you know very well.  You had the opportunity to ask the RB (representative body) to prioritise that motion, the RB chose to disagree with you through the democratic process.  I do not want to hear any more about this because the RB said no. Next question…’

Well that was short shrift. But I expect Tallis and HPAD will be back again next year. He murmured at the end that he remained ‘unchastened’.

Meanwhile we can be thankful that the BMA has again stood on the principle that doctors should not kill their patients.

In June 1947 the BMA published a statement on ‘War Crimes and Medicine’ which it later submitted to the General Assembly of the World Medical Association in September1947.

It concluded: ‘Although there have been many changes in Medicine, the spirit of the Hippocratic Oath cannot change and can be reaffirmed by the profession. It enjoins…The duty of curing, the greatest crime being co-operation in the destruction of life by murder, suicide and abortion.’ 

Well they’ve done an about face since 1947 on abortion, but at least for now, they are standing firm on ‘murder’ and suicide. All is not yet lost.

Might Miliband be brokering a manifesto deal with Falconer over assisted suicide?

Lord Falconer’s ‘Assisted Dying Bill’ will receive its second reading in the Lords on 18 July. The former Lord Chancellor wants to license doctors to dispense lethal drugs to mentally competent adults who have less than six months to live and a ‘settled wish’ to die.

According to the Sunday Times he is claiming that a majority of peers in the House of Lords now support a change in the law.

That seems rather unlikely given that there are over 760 peers – and that most of them have not yet declared a view - but I suspect Falconer fancies his chances of obtaining a majority at a poorly attended Friday evening sitting in late summer.

There are already 92 peers who have put their names down to speak in the debate which means we might be in for a late night finish.

We have also seen from other recent debates that there has been a significant change in the composition of the House of Lords since the last election in 2010. Large numbers of both new labour and conservative peers of a liberal social disposition have come in and things may not be as one sided as they were when Falconer last tried to change the law on this issue with an amendment to the Coroners and Justice Bill in 2009. Then he lost by 194 votes to 141.

The 200 or so new peers may outwardly look like establishment figures but we need to remember than many of them were in their teens and twenties during the 1960s and imbibed fully that generation’s values (!). They are rich and powerful and also strongly politically correct. And assisted suicide is seen as a popular liberal cause.

Even if Falconer manages to win a second reading for his bill it needs to go through committee and third reading stage in the Lords and through three readings in the Commons before going for royal assent and finally becoming law. And this is a private member's bill, not a government bill, so no one is going to be in a great hurry to get it onto the statute books.

And with a general election looming in May 2015 there is not going to be much time for it either. Nor will there be much appetite for anything so controversial with election campaigns in full swing.  

Or will there? David Cameron is on the record as being strongly opposed to changing the law to allow any form of euthanasia on public safety grounds. There is therefore little possibility, even given a conscience vote, of assisted suicide ever getting the nod under a Tory-led House of Commons. But a Labour or Lab-Lib government after the next election may be another prospect altogether.

Ed Miliband, however, has not yet revealed his hand on the matter. Labour sources apparently say the party regards the issue as one on which MPs and frontbenchers should be given a vote. But insiders, according to the Sunday Times, say that Miliband sympathises with Falconer’s efforts and that the party is considering a guarantee of government time to discuss it if it wins the next election.

Falconer was Tony Blair’s former flatmate and it’s no secret how he was elevated to the peerage: Tony Blair appointed him. Again from the Sunday Times:

'He built up a successful career as a barrister but failed to be adopted as a prospective Labour MP because he refused to take his children out of private schools. But Blair made him a peer in 1997 and a minister soon after that. Falconer rose quickly through the ranks — solicitor-general, minister for the Millennium Dome, housing, Home Office and then, in 2003, lord chancellor and later justice secretary.'

He is now in a powerful position to further his personal agenda of legalising assisted suicide.

Again according to the Sunday Times:

‘Falconer is just about the only member of the Blair inner circle to be close to Ed Miliband. He has been appointed “head of the transition”, a rather grand piece of American jargon for Ed’s hoped-for move into Downing Street. This means Falconer will have a central role in any coalition negotiations and in the appointment of ministers…. He is a skilled lawyer, a proven political operator…’

It is then not beyond the realms of possibility that Falconer could be using his power to seal a deal with Miliband for some parliamentary time for his bill after the 2015 election, should Miliband have the good fortune to win. Perhaps he might seek even to get it into the Labour manifesto?

It will be a difficult call for Miliband. On the one hand he will be concerned about gaining the support of the growing super wealthy liberal elite – the coterie of celebrities, politicians, sportsmen, actors and entertainers who are gagging for this legal change. See Dignity in Dying's patrons' page for a taster.

Based on the evidence from other jurisdictions where assisted suicide is legal such as the US states of Oregon and Washington, it is precisely this group, those who are most used to being ‘in control’ in life, who are also the most likely to seek 'control' over the one thing they most fear… dying and death. The main reasons given for seeking assistance to take ones own life in the US North-West are not pain and suffering but rather loss of autonomy, loss of dignity and loss of enjoyment of life. 

But on the other hand the poor, weak and vulnerable – those who are sick, elderly or disabled – are the very ones who will be most at risk from exploitation and abuse should assisted suicide be legalised.

In a Britain where there is a widening gap between rich and poor, many are still struggling financially and, given increasing pressure on the NHS, are also those who are most likely to be subtly steered towards suicide either for fear of being a financial or emotional burden on their families, or because a glass of barbiturate is much cheaper than the costs of a care home, palliative treatment or a cycle of chemotherapy. In other words they will 'choose' assisted suicide because they can't afford any other of the 'choices' on offer and don't have the range of healthcare choices the rich and famous have. 

The fundamental problem with offering assisted suicide as a ‘therapeutic option’, which Falconer is attempting to do, is that killing oneself ‘with assistance’ will be by far the cheapest ‘choice’ available. 

And this alone will make it hugely tempting to greedy relatives worried about an inheritance being spent on care or to health ministers looking for budgetary cuts whilst faced with the burgeoning healthcare needs of a growing elderly population. And the so called 'right' to die could then very easily become the duty to die - doing the decent thing.

So which route will Miliband go? Will he accede to the wishes of the wealthy liberal elite, the politically correct? Or will he make protection of the poor and vulnerable his key priority?

At present he seems, perhaps deliberately, to have chosen to keep all options open.

Doctors strike back at BMJ editors over assisted suicide stance

BMJ editors Fiona Godlee (pictured) and Tony Delamothe are long-time supporters of decriminalising assisted suicide and have frequently used their editorial position in Britain’s most widely read medical journal to advance their cause.

This week they have written an editorial in support of Lord Falconer’s Assisted Dying bill which has understandably received a lot of media coverage (see here, here and here) and has got the blogosphere buzzing (see here, here, here and here).

They argue that assisted dying should be legalised because respecting ‘choice’ (autonomy) is now a more important priority than preserving life.

The BMJ is editorially independent from the British Medical Association (BMA) but is paid for by the subscriptions of BMA members, most of whom do not support changing the law.

So it is not surprising that their editorial has generated a lot of correspondence, almost all of it opposing Godlee and Delamothe.

Dr Mark Porter, chairman of the BMA council has said:

‘There are strongly held views within the medical profession on both sides of this complex and emotive issue.

The BMA remains firmly opposed to legalising assisted dying. This issue has been regularly debated at the BMA's policy forming annual conference and recent calls for a change in the law have persistently been rejected.

The BMJ is a wholly owned subsidiary of the BMA, and quite rightly has editorial independence. Its position on assisted dying is an editorial decision and does not reflect the views of the BMA or the medical profession. Our focus must be on making sure every patient can access the very best of palliative care, which empowers patients to make decisions over their care.’

A letter in the same print edition (so received before the editorial was published) from RCGP Council Chair Maureen Baker makes clear that the recent RCGP consultation on ‘assisted dying’ was comprehensive and conclusively in favour of no change to the law.

‘Our recent consultation on assisted dying was one of the most comprehensive ever undertaken, with 1700 members responding from all four nations of the UK.

The result was conclusive—77% of members who submitted responses directly to the college indicated that the RCGP should maintain its opposition to a change in the law.

Of the 28 RCGP bodies and groups who responded, 20 reported a majority view in favour of maintaining the college’s opposition to a change in the law and three reported a majority view in favour of a “neutral” stance. None reported a majority view in favour of active support for a change in the law.’

There is also an excellent contribution, again the same print edition, from Rob George, professor of palliative care, Cicely Saunders Institute, King’s College London. 

In an article titled ‘We must not deprive dying people of the most important protection’ he argues that the safety of vulnerable people must take priority over the determined wishes of individuals. Hard cases are already dealt with mercifully under the law which does not need changing.

‘Elizabeth Butler-Sloss, former president of the High Court, said, “Laws, like nation states, are more secure when their boundaries rest on natural frontiers. The law that we have rests on just such a frontier . . . The law is there to protect us all. We tinker with it at our peril.”

For me the real question is this: “Which is worse: not to kill people who want to die or to kill people who might want still to live?” In my experience it is impossible to separate those who might want to die from those who believe they ought to die and whose view is pretty well never “settled.” No one can be sure that some people not now at risk will find themselves so were the law to change.

A full blooded expression of autonomy includes the responsibility at times to restrain oneself on behalf of another: when it comes to having our lives ended, let’s keep it that way. Once this line is crossed there is no going back.’

I was briefly quoted in the Telegraph making much the same point about the limits of autonomy:

‘While autonomy is important it has to be balanced against other principles including public safety.

None of us believes autonomy is absolute, if we did we would have to say that there was no place for law because every single law restricts personal autonomy.’

Godlee and Delamothe appear not to understand that autonomy has limits. They are also well out of step with medical opinion and do not speak for the medical profession.

About two thirds of doctors in most surveys are opposed to any change in the law along with all the major medical institutions including the BMA, RCGP, RCP, British Geriatric Society and the Association for Palliative Medicine.

In a free society choice is important, but it has its limits. The duty to protect life trumps the so-called ‘right to die’.

Bankrolling killing – how the rich and famous promote abortion and euthanasia

The world’s fourth richest person, Warren Buffett, ploughed $1.23 billion into abortion groups over eleven years, a media watchdog has found.

The Media Research Center (MRC), which analysed tax returns for Buffett’s foundation, labeled him the ‘king of abortion’.

The MRC says the money given ‘is enough to pay for the abortions of more than 2.7 million babies in the womb’ – which, it points out, equates to the entire city of Chicago.

MRC’s report lays out the money Buffett’s foundation gave between 2001 and 2012, saying it amounted to $1,230,585,161.

The money was given to groups which either ‘provided abortions themselves or advocated for abortion or access to abortion’.

Warren Buffett has made his money through investments, and is listed by Forbes as having a net worth of $65.4 billion.

According to Buffett biographer Roger Lowenstein, Buffett has a ‘Malthusian dread that overpopulation [will] aggravate problems in all other areas – such as food, housing, even human survival.’

This fear of an overcrowded planet is at least in part what gives him his enthusiasm for abortion. I guess he thinks that if there were more people on the planet his wealth might have to be shared.

Buffet is not alone amongst the mega-rich in having a record of funding population control. Also previously implicated are Ted Turner (founder of the Cable News Network), Bill Gates of Microsoft, David Packard, co-founder of Hewlett-Packard and financier George Soros.

In a similar way the pro-assisted suicide campaign in the UK has been bankrolled by wealthy businessmen.

Lord Falconer’s Assisted Dying Bill, which seeks to legalise assisted suicide for mentally competent adults with less than six month to live, follows on from his highly controversial Falconer Commission which laid its framework.

This was conceived by Dignity in Dying (DID), the former Voluntary Euthanasia Society, manned by euthanasia sympathisers and funded by DID patrons Terry Pratchett and Bernard Lewis.

Bernard Lewis is the English entrepreneur behind the River Island fashion brand and clothing chain and is estimated to be worth £1,030m (€1,484m).

Terry Pratchett is an English novelist who has a net worth of £42 million according to the Sunday Times Rich List.

They are small fry compared with Buffet and Gates but very well-endowed by UK standards.

Baroness Warnock is a moral philosopher who believes that elderly people suffering from dementia should consider ending their lives because they are a burden on the NHS and their families.

She said in 2008 that pensioners in mental decline are ‘wasting people's lives’ because of the care they require and insisted there was ‘nothing wrong’ with people being helped to die for the sake of their loved ones or society.

The 84-year-old added that she hoped people will soon be ‘licensed to put others down’ if they are unable to look after themselves.

It deeply troubles me when I hear of very wealthy and powerful people using their money to finance efforts to legalise medical killing through abortion, assisted suicide or euthanasia.

I wonder if part of the motivation is to protect their personal wealth from those who might have calls on it for care, support or treatment.

The real heart of a society is revealed in the way it treats vulnerable people – especially the unborn, elderly, sick or disabled. Does it make sacrifices for vulnerable people or does it choose rather to sacrifice them?

These rich men all use the language of autonomy, choice and compassion but taking another person’s life through abortion or euthanasia, or helping them to kill themselves through assisted suicide, is actually to eliminate all future choice.

In stark contrast stands the life of Jesus Christ, creator and sustainer of the universe, who gave himself for us when we were helpless and weak:

‘For you know the grace of our Lord Jesus Christ, that though he was rich, yet for your sake he became poor, so that you by his poverty might become rich.’ (2 Corinthians 8:9)

‘For while we were still weak, at the right time Christ died for the ungodly. ‘ (Romans 5:6)

Oregon – steady annual increase in assisted suicide cases sounds warning to UK

Lord Falconer wants to legalise assisted suicide for adults who are mentally competent and have less than six months to live based on the ‘Oregon model’.

Since assisted suicide was legalised in Oregon there has been a steady annual increase in the number of prescriptions written for lethal drugs and in numbers of people killing themselves.

In 1998 there were 24 prescriptions written and 16 assisted suicide deaths. By 2012 these numbers had risen to 116 and 85 respectively. This is a 380% increase in prescriptions and a 430% increase in assisted suicide deaths in 15 years.

In 2013 there were 71 deaths – an apparent fall. But this was number that had been reported by 22 January 2014 and there were still 31 patients for whom ‘ingestion status’ was unknown.

For 2012 it was initially reported in January 2013 that there were 77 deaths – but also 25 whose ‘ingestion status’ was unknown - this increased to 85 once all figures were in so we can expect the 2013 figures to go up by at least a similar level.     

How would this translate to the UK?

There were 56.6 million people in England and Wales in 2012 but only 3.9 million in Oregon. So 85 assisted suicide deaths in a year in Oregon would equate to 1,232 in England and Wales (14 times that of Oregon).

Overall since the Oregon Death with Dignity Act (DWDA) was passed in 1997, a total of 1,173 people have had DWDA prescriptions written and 752 patients have died from ingesting medications. 

So over a similar time period, all other things being equal, we would expect 10,528 assisted suicide deaths in England and Wales.

This pattern of steady annual increase in number is also evident in other jurisdictions which have legalised either assisted suicide or euthanasia.

The number of assisted suicide deaths in neighbouring Washington State, increased by at least 43% in 2013.

There were 119 known assisted suicide deaths in 2013, up from 83 in 2012, 70 in 2011, and 51 in 2010. Assisted suicide was legalized in March 2009, after a ballot measure.

According to Dutch media reports, euthanasia deaths in the Netherlands in 2012 increased by 13% to 4188.

In fact from 2006 to 2012 there has been a steady increase in numbers each year with successive annual deaths at 1923, 2120, 2331, 2636, 3136, 3695 and 4188 – an overall increase of 118% in just six years. 2013 figures are still awaited but expected to show similar trends.

The number of reported euthanasia deaths in Belgium increased by 26.8% in 2013 to 1816 reported deaths. Figures for 2012, 2011 and 2010 were 1432, 1133 and 954 respectively and the increase since the first full year in 2003 is over 600%.

There is also widespread evidence of under-reporting. The Lancet recently published a long awaited meta-analysis study which indicated that in 2010, 23% of all euthanasia deaths were not reported meaning that the total number of deaths last year may not have been 4,188 but rather 5,151. 

Could similar under-reporting be happening in Oregon? It is a virtual certainty.

Oregon officials in charge of formulating annual reports have conceded ‘there’s no way to know if additional deaths went unreported’ because Oregon DHS ‘has no regulatory authority or resources to ensure compliance with the law’.

The DHS has to rely on the word of doctors who prescribe the lethal drugs. Referring to physicians’ reports, the reporting division admitted: ‘For that matter the entire account [received from a prescribing doctor] could have been a cock-and bull story.  We assume, however, that physicians were their usual careful and accurate selves.’

So with an Oregon law we can expect to see steadily increasing numbers of assisted suicide cases year on year in England and Wales, along with an unknown level of underreporting.

But that’s just one disturbing fact about assisted suicide in Oregon. There’s much much more to come.

Let’s not follow Oregon’s lead.

Twelve reasons to think twice about going the Oregon route on assisted suicide

Lord Falconer’s Assisted Dying Bill, due for a second reading in the House of Lords on 18 July, is purportedly based on the US state of Oregon’s Death with Dignity Act (DWDA).

Dignity in Dying, the former Voluntary Euthanasia Society, who are backing Falconer, claim that everything is wonderful in Oregon. But is that really true?

Over the next few weeks in the lead up to the bill being debated I will examine in more detail what is happening in Oregon and show that, far from being reassuring, the Oregon experience sounds a loud warning to the UK not to follow suit.

On 27 October 1997, Oregon enacted the DWDA which allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal drugs, expressly prescribed by a physician for that purpose.

The Oregon DWDA also requires the Oregon Health Authority to collect information about the patients and physicians who participate in the Act, and publish an annual statistical report.

These annual reports are all available on the Oregon government website and there is plenty of other relevant information in the public domain to draw on.

In order to qualify under the Act, a patient must be:

1. 18 years of age or older

2. A resident of Oregon

3. Capable of making and communicating health care decisions for him/herself

4. Diagnosed with a terminal illness that will lead to death within six (6) months.

It is up to the attending physician to determine whether these criteria have been met.

I have many concerns about the Oregon law which I will unpack in subsequent blog posts. Here is a list of twelve for starters:

1. There has been a steady increase in annual numbers of people undergoing assisted suicide in Oregon

2. The Oregon health department is funding assisted suicide but not treatment for some cancer patients

3. Patients are living for many years after having been prescribed lethal drugs for ‘terminal illness’ showing that the eligibility criteria are being stretched

4. There is strong circumstantial evidence of suicide contagion in Oregon with a disproportionate number of (un)assisted suicides

5. The vast majority of those choosing to kill themselves are doing so for existential reasons rather than on the basis of real medical symptoms 

6. Fewer than three per cent of patients are being referred for formal psychiatric or psychological evaluation

7. More than ten per cent of patients dying under the Act do not have terminal illnesses

8. Some doctors know the patient for less than a week before prescribing the lethal drugs

9. The fact that almost a third of patients dying under the Act report inadequate pain control or concerns about pain shows that palliative care provision in Oregon is unsatisfactory

10. The presence of no independent witnesses in over 80% of cases is a recipe for elder abuse

11. The demographic of patients dying under the Act is that of those susceptible to financial and elder abuse – white, well-educated and wealthy

12. According to research 25% of cases of assisted suicide in Oregon involve people who are clinically depressed