Friday, 5 August 2016

How should Christians respond to new biotechnologies?

In recent years we have seen an explosion of new biotechnologies bursting on the scene, with promise (or threat) of much more.

In vitro fertilisation (IVF) has opened the door to embryo experimentation, egg and sperm donation, surrogacy, embryo selection, pre-implantation genetic diagnosis, embryonic cloning, animal human hybrids, mitochondrial replacement and now gene editing.

Nanotechnology opens the possibility of ‘engineering’ minute biochemical systems at an atomic level.

Cybernetics merges human tissue with mechanical or electrical devices in order to restore lost function or enhance human abilities. With retinal implants, cyborgs – part human, part machine – may be just around the corner.

New drug treatments and enhancements are taking human performance to new levels: viagra to enhance sexual performance and modafanil to heighten concentration and memory.  

Humanoid Japanese robots can blink, smile, walk, talk, express anger, sing and provide healthcare.

Most of these so-called ‘advances’ have been justified on the grounds that they will prevent human suffering or lead to new treatments. Undoubtedly many will. But what biblical principles should we use to evaluate these diverse new biotechnologies from a Christian perspective?

First, as Christians, we must pray to be like the ‘Men of Issachar’ (1 Chronicles 12:32) who both ‘understood the times’ and ‘knew what to do’. John Stott popularised the principle of double-listening saying that as Christians we must approach the world with the Bible in one hand and the newspaper in the other – listening both to God’s Word and God’s World.

Second, we must realise that ethical approaches based on a secular worldview are inadequate for dealing with these dilemmas. We cannot simply rely on uncritically accepting the world’s principles. It’s not enough, as some moral philosophers are saying today, to say that we should just do good, respect choice and act fairly. How are we to define ‘good’, ‘bad’ or justice without any agreed moral framework? What do when choice and justice conflict? And what is it that defines a person to whom we owe these responsibilities? Are humans with severe dementia ‘persons’ with right? Are fetuses? Are embryos? These key questions need to be answered from a biblical perspective first.

Third, we need to embrace a biblical view of humanity.  Thomas Sydenham taught that human beings have dignity because they are created in the image of God and because the Son of God became a man. We are not just the product of matter, chance and time in a godless and purposeless universe, but the product of intelligent divine design. We are godlike beings made for the purpose of knowing, loving and serving our creator forever.

Fourth we need to understand that there are limits to what we can legitimately do technologically to human beings. Professor of Neonatology John Wyatt has described human beings as ‘flawed masterpieces’. On the one hand, we are masterpieces made in the image of almighty God – analogous to the creation of a great painter or sculptor. On the other hand, we have become cracked and flawed over time – needing restoration and ultimately re-creation. In attempting to restore the human body we must be guided by the creator’s intentions. There is a difference between restoration and enhancement and there are also limits to our powers of restoration.

Fifth, we must keep an eternal perspective. The ultimate goal of the secular transhumanists is immortality and the elimination of disease. The most extreme amongst them believe that perfect health and unlimited lifespans are within our grasp using some of these new tools.  But as Christians, whilst we value the blessings of medicine, we look forward ultimately to the resurrection rather than the genetic revolution or cybernetics for our restored bodies. We need to be good stewards of technology but we should not seek to ‘build heaven on earth’.

Sixth, we must learn to embrace a wider love. Jesus told the parable of the Good Samaritan in response to the question ‘Who is my neighbour?’ In telling the parable he taught the expert in the law who asked it what was he needed to do actually to be a neighbour even to those with whom he felt no human bond, regardless of age, size or degree of deformity.  The baby with special needs trapped inside a non-functioning and dying body is as valuable as the greatest athlete. The embryo in the petri dish is as important as the colleague in the laboratory who lends us a pencil. The child scraping an existence on a rubbish heap is as important as a world famous scientist.

Seventh, we must keep ends and means in balance. In God’s economy, the end never justifies the means – we must do God’s work God’s way. It can be very tempting to dispense with biblical principles such as the sanctity of life or the purity of the marriage bond in finding solutions to some of the vexing challenges in medicine and society. But we can’t justify breaking God’s commands in pursuit of some perceived greater good. This principle has profound implications for what we do with fetuses and embryos in particular.

Finally, in all this, we must keep the cross of Christ central – being prepared to follow in the footsteps that Jesus himself walked. Carrying the cross means two things. First, it calls us to stand up for the truth whatever the world may throw at us – to risk reputation, credibility and career if the situation calls for it. But carrying the cross also involves being part of the solution. Jesus did not live in blissful disengagement from the world, like the Buddha. By contrast, his life was one of painful engagement and involvement. He became part of the solution – and this must surely mean that we must be committed as his followers to fulfilling our role as God’s stewards, to use our God-govern gifts and abilities in God’s way to help provide just and compassionate solutions for human suffering whatever it may cost. That is our mission. 

Tuesday, 2 August 2016

High Court rules in favour of NHS providing 'HIV prevention drug' but big questions remain

The High Court has today ruled that the NHS in England can fund a drug that can reduce the chance of people catching HIV whilst engaging in high-risk sexual activities.

NHS England had previously argued that local councils should provide PrEP ('pre-exposure prophylaxis') as 'health prevention' is their responsibility.

But Mr Justice Green said that NHS England had ‘erred’ and that both it and the local authorities were able to fund the drugs. Summing up, he said:

‘No one doubts that preventative medicine makes powerful sense. But one governmental body says it has no power to provide the service and the local authorities say that they have no money. The clamant [the National Aids Trust] is caught between the two and the potential victims of this disagreement are those who will contract HIV/Aids but who would not were the preventative policy to be fully implemented.’

The ruling has understandably evoked praise from gay rights campaigners and AIDS charities but consternation from NHS England which intends to appeal the decision. They are concerned about the effectiveness of the strategy, the precedent it creates for funding other 'disease prevention' measures and the way resources might be drawn from other health priorities were it to get the go-ahead.

The once a day pill known as PrEP, trade-named Truvada, consists of two antiretroviral medications used for the treatment of HIV/AIDS (tenofovir and emtricitabine or TDF-FTC) and costs £400 a month per person. The total cost to the health service could be in the order of £10-20m.

It is currently used in the US, Canada, Australia and France to help protect the most at-risk gay men.

According to the CDC (Centers for Disease Control) PrEP is for people who do not have HIV but who are at substantial risk of getting it.  It should be used in combination with other 'HIV prevention' methods, such as condoms, but even in these circumstances is not foolproof.

The CDC reports studies have shown PrEP reduces the risk of getting HIV from sex by more than 90% when used consistently. Among people who inject drugs, PrEP reduces the risk of getting HIV by more than 70% when used consistently.

But these figures are what is achievable with good adherence (consistent use), and many of those most at risk are very likely not to adhere with taking the pills regularly.

An authoritative Cochrane review is far less reassuring. Overall, results from four trials (Baeten 2012Van Damme 2012Grant 2010Thigpen 2012) that compared TDF-FTC versus placebo showed a reduction in the risk of acquiring HIV infection by about 51%.

Marked differences between the studies were attributed to differences in levels of adherence.

As one major review has concluded:

‘The efficacy of PrEP is dependent on adherence, and adherence to PrEP medications in efficacy studies has been variable, raising questions about whether persons who are prescribed PrEP in clinical settings will be adherent enough to derive protection.’

Furthermore the drug’s use may in fact lead to a paradoxical increase in other sexually transmitted infections (gonorrhoea, chlamydia etc) by encouraging more high risk behaviour from those who have been lulled into a false sense of security.

This well-known phenomenon whereby applying a prevention measure results in an increase in the very thing it is trying to prevent is known as ‘risk compensation’.

I have previously blogged on the fact, surprising to some, that morning-after pills don’t actually cut teen pregnancy rates and instead increase the incidence of sexually transmitted infections (see also here). 

The term ‘risk compensation’ has also been applied to the fact that the wearing of seatbelts does not decrease the level of some forms of road traffic injuries since drivers, feeling more secure, are thereby encouraged to drive more recklessly.

In the same way making PrEP freely available to already promiscuous homosexuals could well encourage more sexual risk-taking and more sexually transmitted disease as a result. Any effect on decreasing HIV transmission rates is then cancelled out by rising levels of promiscuity.

Many will be shocked at the levels of promiscuity reported in these high-risk groups. In one study in the Cochrane database, during screening, participants reported an average of 12 coital acts per week with an average of 21 sexual partners in the previous 30 days.

It is only when these facts are known that the highly addictive nature of high-risk sexual activity, especially amongst male homosexuals, becomes evident. PrEP is not a prevention strategy at all. It is rather a harm reduction strategy aimed at lessening the damage that people addicted to high-risk sexual behaviours are doing to themselves. More akin to clean needles for drug addicts, filter cigarettes for smokers, protective gloves for compulsive burglars or seatbelts for habitual joy-riders.

As has been recently argued with respect to PrEP for drug addicts, 'PrEP is not ready for our community and our community is not ready for PrEP'. We need instead to address the underlying structural drivers and social context of the HIV epidemic and ask what it is that actually leads people to behave in this way. 

PrEP may reduce the risk of HIV transmission significantly but it does not eradicate it. That is because it is not actually a 'prevention' strategy at all but a 'harm reduction' strategy. And lack of adherence and ‘risk displacement’ simply add to the problem. This means that those who rely on PrEP for protection against HIV are still effectively playing Russian roulette, with the willing assistance and collaboration of health professionals.

NHS England is right to challenge this judgement. We will need much more evidence that PrEP is truly effective in practice before embarking on this strategy, which brings us back to the bottom line in all this: The only way of preventing HIV infections, as opposed to reducing the chance of catching them, is by avoiding the high-risk sexual behaviours that lead to them.

Friday, 22 July 2016

New parliamentary report on conscientious objection to abortion calls for widespread changes

A new parliamentary report has found that there is ‘widespread and increasing pressure’ on healthcare professionals to participate in abortions which is ‘in large part due to inadequate observance of the current legislation’.

‘Freedom of Conscience in Abortion Provision’, which was published on 21 July, is the culmination of a four-week consultation and makes nine key recommendations. In total 150 witnesses contributed to the inquiry, of whom nearly a third were current or former healthcare professionals or healthcare bodies.

Notable amongst these was the British Medical Association (BMA), the doctors’ trade union, which spoke of doctors ‘being harassed and discriminated against because of their conscientious objection to abortion’.

The inquiry, carried out by the All Party Parliamentary Prolife Group (APPG), sought to assess the extent to which the Conscience Clause provides adequate protection for doctors and other health professionals who do not wish to participate in abortion, directly or indirectly, and to examine how freedom of conscience in the law and professional guidance can be developed. It is the first parliamentary inquiry into this subject and is long overdue.

The 37 page report, calls on both Government and NHS governing bodies to ensure that the legal right of healthcare professionals to conscientious objection is properly protected and makes specific practical suggestions about how this can be achieved.

AGGP chair Fiona Bruce MP (pictured with five other MPs from the APPG)  concluded, ‘Freedom of conscience is a key part of living in a diverse and democratic society. It is vital that conscientious health professionals who do not wish to participate in abortion can be confident in their right to opt-out of doing so without fear of censure, discrimination or abuse. It is essential that our hardworking doctors, nurses and midwives are given the protection the law requires if they do not want to participate in abortions.’

She said that while the Inquiry received some examples of good practice, it also received accounts from nurses, midwives and doctors who had been pressured and discriminated against despite their right to conscientious objection, often seeing their career or training options limited.

The report makes clear that, whilst there is legal protection for healthcare professionals who have a conscientious objection to participating in abortion, this is not being properly observed in practise.

Section 4 of the Abortion Act (1967) requires that ‘no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection’.

Commonly known as the ‘Conscience Clause’, the purpose of this section of the 1967 legislation was to enable men and women with conscientious objections to abortion to remain fully engaged in providing healthcare without being compelled to participate in the provision of abortion.

The report, which is well worth reading in its entirety, expresses deep concern about the way the conscience clause has been both interpreted and applied and reserves specific criticism for the Royal College of Obstetricians and Gynaecologists, which refused to give evidence to the inquiry, and the Vice President of the Supreme Court, Lady Hale, who in a recent judgement, narrowed the scope of the conscience clause so that it applied only to staff directly involved in abortion provision.

It also recommends that the Government conduct a review into the training of medical students, and calls for the principle of ‘reasonable accommodation’ to be introduced into legislation in this country. The report calls specifically on the Royal College of Obstetrics and Gynaecologists to publish a statement clarifying its position on this issue.

‘Freedom of Conscience in Abortion Provision’ makes nine practical recommendations to strengthen provision of the protection which Parliament intended for healthcare professionals with a conscientious objection to abortion:

1.      A cross-party Parliamentary Commission should be established to examine the role of conscience in the context of ‘British Values’ and any new ‘British Bill of Rights’.

2.      The Government should commission a full review into the training given to healthcare students to ensure that they are given full information about their right to conscientiously object.

3.      The General Medical Council should maintain their current guidelines ensuring that no doctor who has a conscientious objection to abortion should be required to refer a patient to another practitioner.

4.      All professional healthcare bodies should adopt the wording of the current GMC guidelines ensuring that no healthcare professional who has a conscientious objection to abortion is required to refer a patient to another practitioner (Recent Royal College of Midwives (RCM) guidance makes referral mandatory).

5.      The Royal College of Obstetricians and Gynaecologists (RCOG) is requested to publish a statement in response to this Inquiry to clarify their view on career progression for healthcare professionals who conscientiously object to abortion.

6.      Government and NHS governing bodies should ensure that an appropriate appeal system for those who believe they have been discriminated against because of their conscientious objection is set up.

7.      New guidelines for managers must state how those with a conscientious objection to a procedure should be fairly and respectfully treated and also propose solutions for how employers can accommodate practitioners with a conscientious objection.

8.      The Government should consider the feasibility of extending conscientious objection to indirect participation in abortion by authorising trials in several hospital departments and clinics across the country.

9.      Consideration be given to the introduction of the principle of ‘Reasonable Accommodation’ into legislation in this country, in the form of an amendment to the Equality Act 2010.

This inquiry has done a great service to the healthcare professions and NHS, not simply in its detailed and helpful analysis of current practice, but also in making specific achievable suggestions about how the problems with the conscience clause can be addressed. Doctors and other health professionals must now press the relevant authorities, not least parliament itself, to implement its recommendations.

It is particularly striking that all the witnesses who submitted evidence to the inquiry stressed the importance of conscience, regardless of their beliefs on the substantive issue of abortion. 

As the report concludes, ‘Conscience plays a crucial part in the dignity and morality of each individual. Any downplaying of conscience in public life is to the great detriment of society and individuals.’

Further Reading

Sunday, 3 July 2016

When the foundations are being destroyed – Christian reflections on Broken Britain

'When the foundations are being destroyed what can the righteous do?’[i]

We live in times when the very foundations of our civilisation are being destroyed: the NHS with its burgeoning needs and shrinking budgets, mounting national debt, political and economic uncertainty following ‘Brexit’, the threat of Islamic fundamentalism, creeping atheism and secular humanism.

The mountains of our culture, those institutions which shape its trajectory: our parliaments, courts, universities, medical institutions and the worlds of art, media and entertainment, seem increasingly to be run by people who do not share our Christian beliefs and values.

Daily in our GP surgeries and hospitals we see the fruit of a society which has turned its back on God: family breakdown, educational failure, economic dependence, indebtedness and drug and alcohol addiction. Marriage and the family are threatened by same-sex unions, ‘gender fluidity’, internet pornography, gene editing, abortion and euthanasia.

Broken families, broken communities, broken institutions, a broken country. 

The Psalmist, seeing the foundations being destroyed, is taunted by his accusers: ‘Flee like a bird to your mountain. For look, the wicked bend their bows; they set their arrows against the strings to shoot from the shadows at the upright in heart.’[ii]

But instead of succumbing to the very real threats about him and withdrawing to safety he declares: ‘In the Lord I take refuge…. The Lord is in his holy temple; the Lord is on his heavenly throne.’[iii]

He takes himself in hand and remembers that he serves the ruler of the universe, the judge before whom every knee shall one day bow, who ’is righteous’, ‘loves justice’ and ‘observes everyone on earth’. He reminds himself that ‘the upright’, those who he has justified by faith, will one day ‘see his face’.[iv]

Jesus who announced the coming of his Kingdom in the Nazareth synagogue as coming with preaching, healing, deliverance and justice[v] later commissioned his disciples with the words, ‘as the Father has sent me, I am sending you.’[vi] But he also promised them his power, presence and the gift of prayer. ‘Come to me, all you who are weary and burdened, and I will give you rest….  For my yoke is easy and my burden is light’.[vii] ‘Ask the Lord of the harvest, therefore, to send out workers into his harvest field.’[viii] ‘You will receive power when the Holy Spirit comes on you; and you will be my witnesses’.[ix]  ‘Surely I am with you always, to the very end of the age’.[x]

We are not called to escapism, retreating to our Christian ghettos. Nor are we called to assimilation, merely blending in with the world around us.

Instead we are called, like Babylon’s exiles, both to moral distinctiveness – ‘shining like stars’[xi] - and to courageous and compassionate engagement with society – ‘seeking the peace and prosperity of the city’.[xii] We are to be ‘in the world’ but ‘not of the world’.[xiii]

The social reformer William Wilberforce, whom God used to end the British slave trade in the early 19th century, spoke of his Christian calling in this way: ‘God almighty set before me two great objects, the suppression of the slave trade and the reformation of morals and manners.’

But in reforming ‘moral and manners’ he was not advocating a mere fleshly legalism. He understood that it was the ‘peculiar doctrines’ of Christianity (salvation by grace through faith in Christ’s death and resurrection) which led to ‘true affections’ (a changed heart), then to personal transformation’ (an obedient life) and ultimately ‘political reformation’ (a renewed society).[xiv]  

UK Prime Minister David Cameron resigned after the Brexit vote on 24 June without ever fulfilling his dream of a ‘big society’. And yet, since he first came to power in 2010, we have ironically seen an explosion of Christian social initiatives in Britain – food banks, debt counselling, street pastors, drug and alcohol rehabilitation, parenting classes, crisis pregnancy counselling. Churches are touching the heart of our broken society’s need.

But what if churches were to think even bigger like Wilberforce and his fellow Christian professionals from the ‘Clapham Sect’: Christian GP surgeries and hospitals, socially responsible businesses, legal advice and advocacy, schools and universities, serving in the political corridors of power? 

Might we, by God’s grace, take Britain back? That is our challenge.  

‘If my people, who are called by my name, will humble themselves and pray and seek my face and turn from their wicked ways, then I will hear from heaven, and I will forgive their sin and will heal their land.’[xv]



[i] Psalm 11:3
[ii] Psalm 11:2
[iii] Psalm 11:1,4
[iv] Psalm 11:4-7
[v] Luke 4:18,19
[vi] John 20:21
[vii] Matthew 11:28-30
[viii] Matthew 9:38
[ix] Acts 1:8
[x] Matthew 28:20
[xi] Philippians 2:15
[xii] Jeremiah 29:7
[xiii] John 17:14,15
[xv] 2 Chronicles 7:14

Tuesday, 21 June 2016

BMA rejects attempt to push it neutral on assisted suicide by 2 to 1 majority

Today the Annual Representative Meeting (ARM) of the British Medical Association (BMA) in Belfast voted against going neutral on assisted suicide by a two to one majority (see detail here).

Delegates rejected motion 80, ‘that this meeting believes that the BMA should adopt a neutral stance on assisted dying’, by 198 to 115 (63% to 37%).

The debate took place after a previous motion affirming that ‘it is not appropriate at this time to debate whether or not to change existing BMA policy’ was defeated by 164 to 160.

The BMA, the UK doctors’ trade union, has been opposed to the legalisation of assisted suicide and euthanasia for every year of its history with the exception of 2005-6 when it was neutral for just twelve months.

Fifteen doctors spoke during an impassioned debate on the two motions but the final vote was decisive, and reflected the 65% opposition to legalising assisted suicide shown in most opinion polls.

Dr Mark Porter, the Chair of BMA Council, noted that the debate marked the eighth time in 13 years that the BMA had considered the matter, and stated that ‘nobody can credibly say this issue has been suppressed or obfuscated’. Dr Andrew Mowat, who moved Motion 79, went further, describing the constant returns to the issue as a ‘neverendum’; Dr Gary Wannan simply mused, ‘we’ve been here before...’

The Royal College of Physicians, Royal College of General Practitioners and British Geriatrics Society are all officially opposed to a change in the law along with 82% of Association for Palliative Medicine members.  Amongst all doctors, this latter group carries the greatest weight in this debate due to their understanding of the vulnerability of dying patients and their knowledge of treatments to alleviate their symptoms.

British parliaments have consistently resisted any move to legalise any form of assisted suicide or euthanasia. There have been a dozen unsuccessful attempts in the last twelve years. Last year the Marris Bill in the House of Commons and the Harvie Bill in the Scottish Parliament were defeated by 330-118 and 82-36 respectively.

Assisted suicide and euthanasia are contrary to all historic codes of medical ethics, including the Hippocratic Oath, the Declaration of Geneva, the International Code of Medical Ethics and the Statement of Marbella.

Neutrality on this particular issue would have given assisted suicide a status that no other issue enjoys. Doctors, quite understandably, are strongly opinionated and also have a responsibility to lead. The BMA is a democratic body which takes clear positions on a whole variety of health and health-related issues.

Furthermore, to drop medical opposition to the legalisation of assisted suicide and euthanasia at a time of economic austerity would have been highly dangerous. Many families and the NHS itself are under huge financial strain and the pressure vulnerable people might face to end their lives so as not to be a financial (or emotional) burden on others is potentially immense.

In rejecting an attempt to move it neutral at its ARM in 2012 the BMA said that neutrality was the worst of all positions. This was based on bitter experience. When the BMA took a neutral position for a year in 2005/2006 we saw huge pressure to change the law by way of the Joffe Bill. Throughout that crucial debate, which had the potential of changing the shape of medicine in this country, the BMA was forced to remain silent and took no part in the debate. Were it to go neutral again it would be similarly gagged and doctors would have no collective voice.

Going neutral would also have played into the hands of 
a longstanding campaign led by a small pressure group with a strong political agenda. 

Healthcare Professionals for Assisted Dying (HPAD), which is affiliated to the pressure group ‘Dignity in Dying’ (formerly the Voluntary Euthanasia Society), at last count had just over 500 supporters, representing fewer than 0.25% of Britain’s 240,000 doctors.

Instead the BMA ARM wisely gave short shrift to this latest neutrality proposal and signalled by the margin of defeat that this matter should now be settled for the foreseeable future. 

Monday, 20 June 2016

New parliamentary inquiry launched to review freedom of conscience in abortion

A new parliamentary inquiry into freedom of conscience over abortion has just been launched.

Commissioned by Fiona Bruce MP, it seeks to examine whether the Conscience Clause in the 1967 Abortion Act provides adequate protection for doctors and other healthcare professionals who do not wish to be involved, directly or indirectly, in termination of pregnancy.

The closing date for written submissions (online, by email or by letter) is 5pm on Monday 11 July

There are seven questions and a maximum limit of 500 words per question.

They include: Why is freedom of conscience important? Do doctors and other health professionals have enough protection? Can you give examples of good or bad practice? Do you know of good precedents from elsewhere in the UK or abroad? What legal or regulatory changes would you suggest?

Section 4 of the Abortion Act (1967), the ‘conscience clause’, requires that ‘no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection’.

Its purpose is to ensure that people with a conscientious objection to abortion are not put under coercive pressure to take part.

The application of the clause has been the subject of much legal and ethical debate and has also been tested in the courts. Most of the debate centres around the meaning and scope of the two words ‘participate’ and ‘treatment’.

There is general agreement that the clause protects doctors or nurses from being forced against their consciences to be directly involved in carrying out abortions – for example by performing or assisting an operative procedure or administering abortifacient drugs.

But what about preparing a patient for surgery, attending them afterwards, supervising others doing abortions, typing a referral letter or being part of the referral process? Here the application is less clear.

The problem is that legal precedent and professional guidelines vary in how they interpret and apply the conscience clause.

The recent Glasgow Midwives case (Doogan and Wood) narrowed its scope. The Scottish Court of Appeal (Lady Dorrian) had ruled that the two nurses involved could refuse to delegate, supervise or support staff involved in abortions:

‘In our view the right of conscientious objection extends not only to the actual medical or surgical termination but to the whole process of treatment given for that purpose.’

But this was later overturned by the Supreme Court. Lady Hale ruled that:

‘The conscience clause does not cover making bookings or aftercare for patients who have undergone a termination. Nor does it cover fetching the drug before it is administered. “Participating” is limited to direct participation in the treatment involved. It does not cover administrative and managerial tasks.’

Furthermore Hale added that any medical professional who refuses to provide an abortion ‘must arrange for a referral to someone else who will do so’.

This legal ruling conflicted with 2013 General Medical Council (GMC) guidance that doctors are not obliged to refer patients seeking abortion to other doctors who will do it but must ‘make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection’.

What about nurses?

Clause 4.4 of the Nursing and Midwifery Council (NMC) Code allows for conscientious objection in only limited circumstances. But a new position statement on abortion from the Royal College of Midwives (RCM) narrows this protection even further and states that midwives should be involved in all care of a woman undergoing a termination.

They have the right to opt out on the basis of conscience only from those clinical procedures directly involved in the abortion. Furthermore, both the NMC and RCM make referral to another competent practitioner mandatory. 

Many would consider that a referral for abortion is actually participating in abortion. If I do not physically take part in an immoral act but knowingly provide others with the means to do so, am I not equally culpable?

In fact doctors in New Zealand felt so strongly about this that they took their regulatory body, the NZMC, to court for suggesting referral was an obligation, and won! The NZMC subsequently dropped its appeal of the ruling.

The European Convention of Human Rights (ECHR) and the Equality Act 2010 are also relevant here. The Equality Act 2010 prohibits discrimination on the grounds of religion and belief and Article 9 of the ECHR guarantees freedom of thought, conscience and religion. There is a duty under the Equality Act to make 'reasonable accommodation' for those who have a disability and the argument is that there should be similar provision for religious beliefs.

As Professor John Wyatt has argued in a useful CMF File, 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.

Current UK law and professional guidelines respect the right of doctors to refuse to engage in certain procedures to which they have a conscientious objection. This applies not just to abortion but to other activities as diverse as artificial reproduction and gender reassignment.

Christians are called to show respect for governing authorities (Romans 13:1-7), but this is not a call for unquestioning obedience. Ultimately we obey God and not men (Acts 5:29).When the King of Egypt ordered the Hebrew midwives to kill all male Hebrew children they refused to do so and God commended and rewarded them (Exodus 1:15-22).

This new consultation is timely. It provides a great opportunity for anyone with strong feelings on this issue, and especially those with experience of how the conscience clause works in practice, to provide input which may help to shape future law and regulations.

It’s an opportunity well worth taking – especially for doctors and nurses.

Please visit the Inquiry website www.conscienceinquiry.uk where you will find more information. 

The BMA should reject this latest attempt to push it neutral on assisted suicide and euthanasia

Tomorrow, 21 June, the Annual Representative Meeting (ARM) of the British Medical Association (BMA) will consider two motions on assisted suicide.

The BMA is the UK’s professional association and registered trade union for doctors and currently has 170,000 members.

It has been opposed to the legalisation of assisted suicide and euthanasia for every year of its history with the exception of 2005-6 when it was neutral for just twelve months.

The first motion (79 on the agenda) affirms that ‘it is not appropriate at this time to debate whether or not to change existing BMA policy’.

Only if this is not passed will debate take place on the second motion (80): ‘that this meeting believes that the BMA should adopt a neutral stance on assisted dying’.

A total of 29 motions were put forward on this issue – of which 21 upheld current BMA policy and only 8 opposed it; 27 motions did not make the cut of the agenda committee.

The use of the term ‘assisted dying’ is especially interesting as it is a form of words developed by the pro-euthanasia lobby that is vaguely defined and has no meaning in law. So it raises the question as to what the BMA would actually be going neutral on?

British parliaments have consistently resisted any move to legalise any form of assisted suicide or euthanasia. There have been a dozen unsuccessful attempts in the last twelve years. Last year the Marris Bill in the House of Commons and the Harvie Bill in the Scottish Parliament were defeated by 330-118 and 82-36 respectively.

The majority of doctors are opposed to a change in the law. Opinion polls show an average of 65% doctors opposing the legalisation of assisted suicide and/or euthanasia with the remainder undecided or in favour. The Royal College of Physicians, Royal College of General Practitioners and British Geriatrics Society are officially opposed.

82% of Association for Palliative Medicine members oppose a change in the law, with 72% saying a bill allowing assisted suicide even for imminently dying people would have an adverse effect on the delivery of palliative care. Amongst all doctors, these voices carry the greatest weight in this debate due to their understanding of the vulnerability of dying patients and their knowledge of treatments to alleviate their symptoms.

Assisted suicide and euthanasia are contrary to all historic codes of medical ethics, including the Hippocratic Oath, the Declaration of Geneva, the International Code of Medical Ethics and the Statement of Marbella. Neutrality would be a quantum change for the profession and against the international tide.

Furthermore, neutrality on this particular issue would give assisted suicide a status that no other issue enjoys. Doctors, quite understandably, are strongly opinionated and also have a responsibility to lead. The BMA is a democratic body which takes clear positions on a whole variety of health and health-related issues. Why should assisted suicide and euthanasia enjoy a position which no other issue shares, especially when doctors will actually be the ones carrying it out?

Furthermore, to drop medical opposition to the legalisation of assisted suicide and euthanasia at a time of economic austerity could be highly dangerous. Many families and the NHS itself are under huge financial strain and the pressure vulnerable people might face to end their lives so as not to be a financial (or emotional) burden on others is potentially immense.

Were the BMA to drop its opposition, and as a consequence a law were to be passed, it would also leave the medical profession hugely divided at a time when, perhaps, more than any other time in British history, we need to be united as advocates for our patients and for the highest priorities in a struggling health service.

The British Medical Association (BMA) rejected an attempt to move it neutral at its ARM in 2012 saying that neutrality was the worst of all positions. This was based on bitter experience. When the BMA took a neutral position for a year in 2005/2006 we saw huge pressure to change the law by way of the Joffe Bill. Throughout that crucial debate, which had the potential of changing the shape of medicine in this country, the BMA was forced to remain silent and took no part in the debate. Were it to go neutral again it would be similarly gagged and doctors would have no collective voice.

Going neutral would instead play into the hands of 
a longstanding campaign led by a small pressure group with a strong political agenda. Healthcare Professionals for Assisted Dying (HPAD), which is affiliated to the pressure group ‘Dignity in Dying’ (formerly the Voluntary Euthanasia Society), at last count had just over 500 supporters, representing fewer than 0.25% of Britain’s 240,000 doctors.

The BMA has been historically opposed to a change in the law on assisted suicide and euthanasia for good reasons. These reasons have not changed.

Going neutral would be inappropriate, undemocratic and potentially highly dangerous. It would also be playing into the hands of a small unrepresentative pressure group and giving an advantage to only one side of the debate. Furthermore it would communicate confused messages to the public at a critical time and divide the profession at a time when a united doctors’ voice is needed more than ever.

The BMA ARM would be wise to give short shrift to this latest neutrality proposal. The issue has been debated to death in recent years and the views of parliament and the medical profession in this country are settled.

There are many more pressing and crucial matters on the ARM agenda. It is time to give this one a well-deserved rest.