Saturday, 2 May 2015

What would a hung parliament really mean for the UK’s constitutional future?

With only four days left to go, who is likely to be governing us after the UK general election on 7 May, and what are the implications for the UK’s constitutional future?

There are 650 seats in the British parliament but only 194 marginal seats (those that would require less that a 5% swing to change hands). 

The current standing is Conservative (302), Labour (256), Lib Dem (56), DUP (9), SNP (6), Sinn Fein (5), Independent (5), Plaid Cymru (3), SDLP (3), UKIP (2), Green (1) Alliance (1), Respect (1).

Given that one Conservative MP (currently John Bercow) must serve as speaker, and that Sinn Fein do not take up their seats in the House of Commons, any party or coalition needs 323 seats to govern.

Nate Silver, the pollster who correctly predicted the last two US presidential elections has forecast the following 2015 election result on the basis of the latest opinion polls, historical elections results and census data:

Conservative (278), Labour (271), SNP (50), Lib Dem (28), DUP (9), Sinn Fein (5), Plaid Cymru (4), SDLP (2), UKIP (1), Green (1), UUP (1).

What is most striking here is how different the make-up might be if the UK used a system of proportional representation. The latest opinion polls have Conservatives (34%), Labour (33%), UKIP (14%), Lib Dem (8%), Green (5%).

So whilst UKIP has 14% of popular support, almost twice that of the Lib Dems, they are predicted to win only one seat against the Lib Dem’s 28. 'Is that really fair?', some might ask.

But, that aside, the most notable changes between 2010 and now, apart from the rise of Labour and the fall of the Conservatives, are the dramatic rise of the SNP, the latter mainly at the expense of Labour (see interactive map of constituencies) and the equally dramatic fall of the Lib Dems.

Clearly, if this result is repeated on Election Day, no one party will be able to form a majority government. But also, if the SNP does not go into coalition, then no party will be able to form a majority coalition government either.

A right of centre coalition of Conservative, Lib Dem, DUP and UKIP would have only 316 seats, 7 short of that needed. 

But a left of centre coalition of Labour, Lib Dem, Plaid Cymru, SDLP and Green would have only 306, a shortfall of 17.

But Plaid Cymru, DUP and UKIP have already signalled they will not be entering coalition and the Lib Dems are suggesting that they will drive a much harder bargain than last time. This makes the possibility of a majority coalition even more remote. 

This would mean that it would only be possible for either the Conservatives or Labour to pass the Queen’s speech on 27 May with the support of the SNP.

But the SNP has already ruled out a coalition (or any other arrangement) with the Tories, and Labour has ruled out a coalition or a ‘confidence and supply’ arrangement (ie. support in vote of confidence and for budget) with the SNP.

So, the only possibility of Labour continuing in government would be by some kind of vote by vote agreement with the SNP. This would leave Labour at the mercy of the SNP over specific policies like defence (especially Trident which the SNP wants to scrap), the economy and the constitution.

The SNP is strongly opposed to austerity and would push Labour to tax, borrow and spend much more than it would otherwise. It would undoubtedly also push for an early second referendum on Scottish independence.

So it appears that we may have a serious constitutional crisis.

Charles Moore suggested two weeks ago that the Scottish National Party (SNP) is seeking to engineer a reverse take-over of the Labour Party. In reality, they are intent on staging the Scots’ first attempt to capture their bigger neighbour since Bonnie Prince Charlie led his Jacobite army as far as Derby in 1745. 

So what will Cameron do with this result?

He remains Prime Minister until he stands down, just as Gordon Brown did in 2010 when he stayed put for five days with far fewer seats than the Tories.

Mr Cameron could challenge the Commons to vote him down (in a vote of no confidence) when it next meets on 27 May or go to the Queen and tender his resignation (which would be curtains for him personally).

This would leave Ed Miliband trying to form a government which he will only be able to do with the support of the SNP. But a minority government does not need a formal pact to sustain it in office, just the votes, and Nicola Sturgeon has all but guaranteed them to Labour.

The Telegraph’s Phillip Johnston has argued that if neither Mr Cameron nor Mr Miliband were able to put together a viable government, a second election would normally follow; but the Fixed-Term Parliaments Act 2011 complicates matters.

‘It provides for a dissolution of Parliament only when there is a specific vote of no confidence in the government or if two thirds of all MPs vote for an election. This makes the prospect of another early general election less likely. In any case, the parties may have little appetite for one given the expense and the prospect of losing support in a fresh contest.

Without a dissolution we would have a legislature but no government, a bit like Belgium, where the prime minister resigned in April 2010 and no new parliamentary majority could be established for almost two years. The country was run by a former prime minister brought out of retirement and a caretaker administration.’

As Johnston concludes, ‘One thing is clear: a minority Labour government, with fewer seats than the Tories, running the country while in thrall to a nationalist party that has only 2 or 3 per cent of the total UK vote, would test our constitutional structures to breaking point, and maybe beyond. More than that, it could test our creaking, centuries-old Union to destruction.’

One thing is abundantly clear. The UK’s days as a two party state where one party has an absolute majority are over. In the 1950s 97% of people voted Tory or Labour. Now barely 67% do.

This is a new era of coalition and shared power. But coalitions in a multi-party democracy can only rule effectively when they have an overall majority. And that may not happen without a shift to some form of proportional representation – like that or Italy, Israel or Greece.

Perhaps that is the direction in which we are inexorably drifting; either that, or Scottish independence, or both.

Thursday, 30 April 2015

Deeply flawed assisted suicide bill must be rejected by Scottish Parliament at the earliest opportunity

A report by MSPs criticising the proposed assisted suicide Bill before Holyrood has been welcomed by campaigners opposing the legislation. 

The Assisted Suicide (Scotland) Bill, introduced by Green Party MSP Patrick Harvie, is due to have its first stage debate in the Scottish Parliament by the end of May.

On a raft of crucial matters the committee has revealed the Bill to be lacking and deeply flawed.

And while stopping short of recommending MSPs to throw out the Bill they have made their view clear that the majority of the Health and Sport Committee, which has been scrutinising the Bill, oppose it.

Dr Gordon Macdonald of Care Not Killing (pictured giving evidence to the committee), said, ‘This report confirms what we have said along. The Bill is poorly thought out, ill-conceived, badly-drafted and effectively not fit for purpose. We are delighted that the committee agrees with us that the Bill contains significant flaws which are likely to prevent it from being enacted. It is gratifying to note a majority of the committee is against the Bill although they have not made a formal recommendation to the Parliament to reject the Bill.’

Catherine Garrod, Edinburgh Disability Rights Campaigner speaking on behalf of Not Dead Yet, another campaign group opposing the Bill, said: ‘Disabled people oppose assisted suicide because it gives the message that our lives are not worth living. Disabled people want assistance to live, investment in health and social care, good palliative care, support for independent living and the right to equality not assisted suicide.’

Care Not Killing is strongly opposed to legalising assisted suicide and firmly believes life should be protected and palliative care prioritised. It represents more than 40 professional groups, faith groups, human rights groups, medical professionals, palliative care specialists and legal experts who are convinced it would be dangerous and unnecessary to decriminalise the existing law on homicide.

Dr Macdonald said. ‘We do not want the state-sanctioned killing of old, ill and disabled people of all impairment.

‘We want support for people to live - not to die. In recent weeks as the Bill has been scrutinised we have witnessed repeated and sustained criticism  from a variety of sources and for a range of reasons because it is so badly drafted - leading experts in medicine and palliative care, senior lawyers and experienced ethicists who all express serious and genuine concerns. And more than 15,000 members of the public have signed our petition.

‘We have always maintained that assisted suicide is unnecessary, unethical and uncontrollable. This is compounded by the fact that this is a weakly thought-out and poorly-written Bill. The numbers of people who have criticised whole parts of it, quite aside from any moral or ethical objections, highlight the problems with the legislation.’

The Bill calls for the creation of  ‘licensed facilitators’ - aged as young as 16 - who would assist individuals end their life and would remain close by until such times and even film the scene as the individual dies or decides not to proceed with the assisted suicide.

In effect, the Scottish Government is being asked to fund and train licensed killers to preside over the suicide deaths of teenagers as young as 16.

Dr Macdonald added: ‘We believe the public needs to be fully aware of all the arguments and not just be influenced by the knee-jerk emotional arguments about so-called dignity in death from those who back the Bill.

‘People change their minds quickly on this issue when they are told about the possible impact on the vulnerable, those near the end of life, the sick, elderly, disabled and depressed who may consider themselves in some way a burden and through fear of becoming a financial, emotional or care burden find themselves pressured in some way to opt for assisted suicide.

‘The proposed safeguards contained in the Bill are simply not robust enough to prevent abuse from occurring. Many people, including leading doctors, spokespeople for disability groups and representatives of Scotland's churches, have criticised this Bill . And it must be rejected by MSPs and the Scottish Parliament at the soonest opportunity.

‘Countries which have enacted assisted suicide laws have seen the eligibility criteria expand and widen putting intolerable pressure on the ill, the elderly and the infirm. Recently a bill was introduced in Oregon seeking to widen the eligibility criteria for assisted suicide. This is a perfect example of the incremental and insidious widening which would inevitably follow here were the bill to be passed - Oregon is not an example we want to follow and that is the model upon which the Bill before Holyrood is based.’

Dr Macdonald added, ‘I am delighted the First Minister and other party leaders including Jim Murphy (Labour) and Willie Rennie (Liberal Democrats) have expressed their opposition to the legalisation of assisted suicide. They clearly understand it would bring pressure on vulnerable people to end their lives and put the elderly and disabled at risk of abuse as well as very ill young children.

‘The First Minister summed it up well when she said:  ‘I believe we should support people to live and I am therefore  in favour of good quality palliative care. There also remains a major stumbling block to assisted suicide: How could you have sufficient safeguards?’

‘The new Bill follows very closely the 2010 End of Life Assistance Bill proposals which MSPs comprehensively rejected in Holyrood by 85-16. MSPs are likely to again have a free vote on this Bill. The First Minister and other leaders have one vote each and we hope the vast majority of MSPs will  follow their example after examining all the evidence.’

Dr Macdonald highlighted a number of key conclusions of the committee criticising the Bill including:

*The Committee is not persuaded by the argument that the lack of certainty in the existing law on assisted suicide makes it desirable to legislate to permit assisted suicide;

*Members have also acknowledged that there are ways of responding to suffering (such as increased focus on palliative care and on supporting those with disabilities), which do not raise the kind of concerns about crossing a legal and ethical ‘Rubicon’ that are raised by assisted suicide.

*The Committee considers that a requirement for mandatory psychiatric assessment would be desirable in relation to any request for assisted suicide by a person who was terminally ill, under the age of 25, and/or with a history of mental disorder. The Committee also acknowledges the argument that given the magnitude of the decision to commit suicide, assessment by a psychiatrist ought to be routine in all cases.

*The Committee considers that legislation to permit assisted suicide seems discordant with a wider policy of suicide prevention by ‘normalising’ suicide and seeming to endorse it.

What you can do

Wednesday, 29 April 2015

New DNA editing technique for mitochondrial disease may render three parent embryos redundant

A new technique for removing harmful genes from strands of DNA could potentially obviate the need for three parent embryos for preventing mitochondrial disease.

Researchers from the Salk Institute for Biological Studies in La Jolla, California, have reported success for the first time in using gene-editing technology to prevent mitochondrial diseases being passed from female mice to their offspring.

Mitochondrial diseases are inherited maternally and cause a variety of severe conditions that currently have no cure. The UK government has recently legalised the controversial use of embryos carrying DNA from three genetic parents to prevent their transmission, but the proposed techniques have been criticised on both ethical and safety grounds (see my previous review).

This new research, published in the 23 April edition of Cell magazine, involves injecting affected embryos with RNA which leads to the production of enzymes which specifically target and remove faulty genes.

It is reported on this week in Nature, Popular Science, Medical News Today, Tech Times, and (amazingly) has even come to the attention of the BBC. Ted Morrow's blog gives a useful overview.

Authors Alejandro Ocampo and Juan Carlos Izpisua Belmonte realised that reducing the amount of mutant mitochondrial DNA in an egg or fertilised embryo could reduce the chance of mitochondrial disease developing.

They achieved this by injecting mouse embryos with a segment of RNA designed to produce a DNA-cutting enzymes called restriction endonucleases and transcription activator-like effector nucleases (TALENs).

These enzymes then sought out mitochondria with mutated DNA and removed it while leaving the normal mitochondrial DNA intact.

The treated embryos were then transferred to female mice where they developed normally and resulted in healthy pups with low levels of the targeted mitochondrial DNA.

These pups later went on to give birth to healthy offspring themselves, demonstrating that this is a viable approach for preventing transgenerational transmission of mitochondrial diseases.

The researchers then trialled the TALENs using mouse eggs that contained genetic material from human patients mitochondrial DNA mutations known to cause two disorders - Leber's hereditary optic neuropathy and dystonia (LHOND) and neurogenic muscle weakness, ataxia, and retinitis pigmentosa (NARP).

Again, the technique resulted in a significant reduction of the mutated DNA.

It is early days with this new technique which will need thorough testing in mice and non-human primates before being ready for testing in humans.

However it has several obvious advantages over controversial three parent embryo techniques.

First, it does not require DNA donation and so avoids the health risks to donors (such as OHSS) associated with egg harvesting.

Second, it does not involve cell nuclear replacement (cloning) technology with all its safety concerns.

Third, it can be tested on eggs as well as embryos and does not involve the destruction of existing embryos.

Fourth, it is technically much easier to perform than the mitochondrial (or more accurately cytoplasmic) replacement used in three parent techniques. RNA injection is a technique that can be carried out relatively easily in IVF clinics.

Fifth, it appears to be a far more finely targeted technique, eliminating faulty genes rather than replacing the whole cytoplasm with all of it mitochondrial and other organelles. More like a sniper than a blunderbuss or carpet bomber.

Finally it does not produce offspring with three genetic parents.

However, we are still left with three concerns.

First, this new technique does still involve genetic medication of the germline, and the possibility that any ‘mistakes’ in editing would be passed on down the generations. This has already led David King of Human Genetics Alert to reject it outright.

Second, we cannot be sure, without a lot of further research, just how finely tuned it is as an editing tool. How much damage might be done to other genes in the vicinity and what effect might this have? 

Third, once this tool is more widely available, might it then be used by unscrupulous researchers or scientists to edit DNA in more dangerous contexts?

However, were it to work as well as some are hoping, it could potentially reduce the three parent technique, over which so much time, money and sweat has been expended, to a tiny historical footnote.

It will be intriguing to see how this research progresses and how long it takes for those British science journalists and parliamentarians who have been pushing three parent embryos so aggressively to take notice. 

Monday, 27 April 2015

DPP faces new legal challenge for ‘clarifying’ guidelines on prosecutions for assisted suicide

Perhaps surprisingly, the Sunday Times has been the only broadsheet newspaper to cover a landmark case (£) which challenges the powers of the crown prosecution service.

The CPS head Alison Saunders (pictured), Director of public prosecutions (DPP), is already in considerable hot water over her failure to prosecute Lord Janner for alleged sex abuse, an action she justified on grounds of him not being capable of standing trial because of dementia. This new development may add considerably to those difficulties. 

Sadly this latest case lies behind the Sunday Times paywall which has somewhat restricted it coming to the wider public attention that it deserves, so I will quote some of the article in this post. 

‘A woman who was once so paralysed she could only wink her right eye will this week launch a High Court challenge against “liberal” guidelines on assisted suicide brought in by Alison Saunders, the embattled director of public prosecutions (DPP).

Nikki Kenward, 62, will on Tuesday seek a judicial review after doctors and nurses who help severely disabled or terminally ill people to take their own lives were told that they are now less likely to face criminal charges.’

Kenward, a former theatre manager, was struck down by Guillian-Barre syndrome in 1990, aged 37.

She was initially fully paralysed for more than five months, and has been in a wheelchair since. She cannot tie her laces or hold a needle, but had a play staged last year and campaigns against euthanasia and assisted suicide through the Distant Voices pressure group. Her case is backed by the Christian Legal Centre.

Lawyers for Kenward will argue that Saunders exceeded her powers with a what she called a ‘clarification’ to the guidelines on prosecution for assisted suicide which she made last October (see my previous article here).

They will argue that she has entered a policy realm that should properly be a matter not for her but for parliament. They will also say that the attorney-general has failed in his duty to ‘superintend’ the DPP. In other words they will claim that she has gone beyond her remit which is to uphold the law and not to make the law.

To quote the Sunday Times again:

‘They are expected to argue Saunders’s guidance will “enable healthcare professionals operating on an ideological or other premise to offer their services to a person wishing to commit suicide . . . this is crossing the Rubicon”. They will add: it will “make any prohibition on a Dignitas-style of assisted suicide difficult to resist”.

“[It] weakens the protection given by parliament to people . . . coming under pressure to commit assisted suicide.”’

The fuller background to this case deserves unpacking.

Back in 2009, as a result of the Supreme Court judgement in the Debbie Purdy case, the DPP was required to make public the criteria by which he (then Keir Starmer) decided whether a prosecution in a given case of assisted suicide was in the public interest.

He published an interim policy and put it out to public consultation. After the consultation was completed he modified this interim policy and published his definitive policy in February 2010.

The summary of responses received and the responses themselves are still in the public domain.

The interim policy did not contain a paragraph about the role of medical professionals but as a result of the consultation one was included in the definitive policy.

It now says that a prosecution is more likely to be required if…

14. ‘the suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer [whether for payment or not], or as a person in authority, such as a prison officer, and the victim was in his or her care;’

Keir Starmer gave his reasons for including the new clause here.

Saunders, Starmer’s successor, subsequently ‘clarified’ the words in bold last October as follows:

‘For the avoidance of doubt the words "and the victim was in his or her care" qualify all of the preceding parts of this paragraph [43.14]. This factor does not apply merely because someone was acting in a capacity described within it: it applies only where there was, in addition, a relationship of care between the suspect and the victims such that it will be necessary to consider whether the suspect may have exerted some influence on the victim.’

The key questions raised by Kenward’s case are whether this amounts to a change in the policy or merely a clarification and whether the DPP should have made the change without consulting anybody.  

My own view is that DPP has actually crossed the line in both instances.

The relevant factors as I see it are as follows:

1. The ‘clarification’ makes it clear that doctors who do not have ‘a relationship of care between the suspect and the victims such that it will be necessary to consider whether the suspect may have exerted some influence on the victim’ are now not within the scope of this clause. This surely means that people like Philip Nitschke and Michael Irwin, who have made a name for themselves by assisting suicides in various ways whilst not being the patient’s primary care giver, are less likely to be prosecuted. This is real change in my view.  Irwin, who welcomed it as ‘a wonderful softening’ agrees with me. I think it is also clear from the current General Medical Council (GMC) guidance and Medical Defence Union (MDU) guidance (see also here) that these bodies did not understand the guidance in the way that Alison Saunders has now re-interpreted it. See below

2. Assisted suicide is contrary to all historical codes of medical ethics including the Hippocratic Oath, the Declaration of Geneva, the International code of medical ethics and the Statement of Marbella – which was reaffirmed by the World Medical association (WMA) as recently as 2013. The latter reads, ‘Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically.’ So a strong argument could be made that this new ‘clarification’ is morally corrupting for the medical profession  as it makes possible their direct involvement in an unethical practice with far less possibility of prosecution.

3. Assisted Suicide is opposed by the British Medical Association, the World Medical Association, the Association for Palliative Medicine, the British Geriatric Society and virtually every Royal Medical College including the RCGP and the RCP.

4. The GMC makes it clear in its guidance on assisted suicide that ‘encouraging or assisted suicide’ is against the law. It makes no mention of any mitigating factors and warns doctors strongly against any involvement. It certainly does not convey the impression that doctors like Irwin, Nitschke etc are exempt. It is precisely this understanding of the law which led to Tony Nicklinson  and  Paul Lamb trying unsuccessfully to change it through the courts. Saunders seems now effectively to have done that at the mere stroke of a pen.

5. It is precisely people like Nitschke and Irwin who will push the envelope rather than ordinary GPs in a relationship of care with patients, although the ‘clarification’ does also give scope to GPs to do a little assisted suicide on the side with patients who are not ‘in their immediate care’. This clarification appears to give them free rein. 

6. The phrase ‘In their care’ can be interpreted in several different ways. One might argue that any doctor using his skill and expertise to help a patient kill themselves is actually involved in ‘care’ even if he is not their primary doctor.

7. The reason people responding to the original consultation pushed for the inclusion of the doctor clause in the first place was because of concerns about the unique position of doctors. Doctors possess the sort of knowledge and power that could easily be abused.  We have seen already how they push legal boundaries with abortion and how prosecutors are very unwilling to hold them accountable. This is why doctors need strong guidance and laws in place to ensure that some of them do not end up becoming the most dangerous people in the state. It is also why they should not be involved in assisted suicide.

8. As the doctor phrase (clause 14 quoted above) was introduced into the DPP guidance after, and as a direct result of, a lengthy public consultation (34% of respondents supported its inclusion) surely it should not be changed, or redefined, at a whim by the DPP without a similar public consultation. Simply asking medical bodies for their opinion would be inappropriate and inadequate – rather like asking the police about guidance on prosecuting policemen. This is why the GMC now has a strong lay membership because as a result of the Shipman case and others it was decided that doctors were not  capable of regulating themselves.

It seems to me that the DPP has not merely ‘clarified’, but actually changed the meaning and scope of the guidance. Furthermore she has made the change without apparently consulting anybody at all. 

I await the result of Kenward’s legal challenge with great interest.


Thursday, 23 April 2015

Lessons from Daniel – God is sovereign over the rise and fall of nations

When Jerusalem fell to the Babylonians in 587 BC, the nation of Judah was taken to Babylon in an exile that would last 70 years. As God's people in a foreign land that was hostile to their faith and values, they faced the challenge of living and serving as ‘aliens and strangers’.

There was great pressure to close ranks or to forget who they were. There was also great hand-wringing and lament.

Their emotions are beautifully described in Psalm 137, in words given popular currency by the pop band Boney M – a German based but ethnically Jamaican foursome – who achieved popularity during the disco era of the late 1970s.

In King James English: ‘By the rivers of Babylon, there we sat down, yea, we wept, when we remembered Zion.’(Psalm 137:1)

The psalm goes on to describe in graphic detail how they were tormented by their captors, unable to sing the songs of their homeland, pining for Jerusalem and longing for vengeance against those who had mistreated them.

They were forcibly displaced people - not even asylum seekers or refugees let alone economic migrants - but rather captives – prisoners of war in a country utterly different from their own in language, culture, values, religion and worldview.

God’s people – but made to serve in an evil empire, Babylon.

In the New Testament the symbolism of ‘Babylon’ is used by the apostles to describe Christian’s position in the world.

The apostle Peter talks of ‘living in Babylon’ and describes God's elect (Christians) as 'strangers in the world' (1 Peter 1:1), and 'aliens' (1 Peter 2:11).

We are called to 'be holy' – to be set apart – because we are 'a chosen people, a royal priesthood' and 'a holy nation' (1 Peter 2:9).

One of the key themes of the book of Daniel is that God is sovereign over all physical, spiritual, social and political processes (Daniel 2:21, 4:17, 5:21).

In other words, fire can’t burn, lions can’t bite and kings can’t rule unless God allows them to.

God’s rescue of Daniel from the lion’s den in Daniel 6 along with that of his friends Shadrach, Meshach and Abednego from the fiery furnace in Daniel 3, are well familiar to anyone who has attended Sunday school. 

But less appreciated and believed in – even in the church - is God’s control over political events and his sovereign rule over the rise and fall of nations.

‘He changes times and seasons; he deposes kings and raises up others.’ (Daniel 2:21)

‘The Most High is sovereign over all kingdoms on earth and gives them to anyone he wishes’ (Daniel 4:32). This same verse is repeated in Daniel 4:17, 25 and  5:21, 35.

Daniel’s two great dreams – in chapters 2 and 7 of this book – illustrate this.

First there is the great statue in chapter 2 with its head of gold, chest of silver, loins of bronze and legs of iron – representing the empire of Babylon and three more empires – usually identified by commentators as Medo-Persia, Greece and Rome - which will follow it.

Then there are the four great beasts of chapter 7 – representing probably the same four kingdoms – each falling to be replaced by the next.

Each dream ends in a similar way with these temporary earthly Kingdoms being destroyed to be replaced by a heavenly kingdom that will never end.

The statue made from four metals is smashed by a rock which grows to fill the whole world – a direct reference to Christ’s Kingdom.

The four beasts are superseded by one, we are told, like a ‘Son of Man’ (Daniel 7:13) coming with the clouds of heaven. He approaches the Ancient of Days (God the father) and is led into his presence. 

Then this Son of man ‘is given authority, glory and sovereign power; all nations and peoples of every language worship(ed) him. His dominion is an everlasting dominion that will not pass away, and his kingdom is one that will never be destroyed.’

‘Son of Man’ was of course Jesus’ favourite term for himself. It is Jesus who through his death and resurrection rules over all the kingdoms of men.

I live in St Albans – named after Britain’s first Christian martyr, a Roman nobleman called Alban - who was converted through the ministry of a priest fleeing persecution in the early 3rd century. When he refused to recant the Roman officials chopped his head off.

But centuries later when the Roman town of Verulamium where he lived lay in ruins they took the bricks and used them to build a cathedral on the very spot where he had given his life.

It’s a beautiful picture of what has, and is, happening in history – through the shedding of Jesus own blood at the hands of Roman Empire – God is building a living temple of his own people – the church.
 ‘The sovereignty, power and greatness of all the kingdoms under heaven will be handed over to the holy people of the Most High. His kingdom will be an everlasting kingdom, and all rulers will worship and obey him.’ (Daniel 7:27)

Of course what is true of the ancient world empires is equally true of the empires of today – the American, British and Soviet Empires – and equally the Empires of post-war western capitalism and Islam.

God has raised them all up and God will bring them all down.

Wednesday, 22 April 2015

Bruce Forsyth's recent pronouncements on assisted suicide are seriously misguided

Celebrity entertainer Sir Bruce Forsyth (pictured) has called for the legalisation of assisted suicide after watching his ex-wife succumb to dementia.

His first wife, Penny Calvert spent her last years in a care home, dying last year. Bruce was married to Penny from 1953 to 1973 and they had three daughters. He later remarried twice.

'It bothers me an awful lot that people are just left to suffer,’ he said. ‘If I had Alzheimer’s or dementia I would do something about it. The law should be changed and if people want to die with a bit of dignity left they should be able to do so.’

Forsyth is not the first celebrity to back a change in the law.

‘Moral’ philosopher Baroness Warnock 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.

Warnock added that she hoped people will soon be ‘licensed to put others down’ if they are unable to look after themselves.

A recent survey suggests that a significant proportion of doctors in the Netherlands, where euthanasia is legal, are prepared to carry out assisted suicide for people with mental illness.

Of the 1,456 physicians responding to the survey, 34% found euthanasia and assisted suicide conceivable in patients with psychiatric disease, 40% in early-stage dementia, 29-33% in advanced dementia and 27% in circumstances where the patient was ‘tired of living’. 

According to the Alzheimer’s Society there are currently 850,000 people with dementia in the UK.  But the number forecast to increase to over one million by 2025 and over two million by 2051.

The total cost of dementia in the UK is £26.3 billion. The NHS picks up £4.3 billion of the costs and social care £10.3 billion. Of the £10.3 billion in social care costs, £4.5 billion is attributed to local authority social services for state funded care.

Two thirds of the cost of dementia (£17.4 billion) is paid by people with dementia and their families, either in unpaid care (11.6 billion) or in paying for private social care.

The overwhelming majority of people with dementia do not actually want to die. But one can see that, were the law to change, there would be many families struggling to make ends meet and health administrators trying to balance the books in a cash-strapped NHS who would in fact have a financial interest in their deaths.

A law removing legal protection from people with dementia in an environment of economic recession would be a very lethal cocktail indeed.

This is why it is so important that the current law, which makes both euthanasia and assisted suicide illegal, does not change. It would be impossible to police and far too easy to abuse.

In the Netherlands plenty of doctors are willing to push the boundaries of the current law which does not currently allow euthanasia or assisted suicide for people who are not mentally competent.

The very same thing would inevitably happen here.

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

It deeply concerns me when misguided celebrities use the language of autonomy, choice and compassion to justify taking another person’s life through euthanasia or assisted suicide.

Caring for people with mental illness or dementia can be deeply harrowing and costly. But it is far better to do this than to remove their legal protection and place them at the mercy of those with something to gain, financially or emotionally, from their deaths.

Bruce Forsyth may be a gifted and popular entertainer. But his misguided pronouncements on this crucial issue of public policy are very dangerous indeed.

Tuesday, 21 April 2015

New study confirms that making morning-after pill free without prescription increases sexually transmitted infections and fails to reduce pregnancy rates

Half of all pregnancies in the United States are unintended.

One might therefore assume that making the morning-after pill (MAP) more widely accessible would cut the unplanned pregnancy rate.

Not so.

A new recent US study is the first to estimate the impact of making the morning-after pill available over the counter without prescription on abortions and risky sexual behaviour as measured by sexually transmitted infection (STI) rates.

Dr Karen Mulligan, associate professor of economics and finance at Middle Tennessee State University, found that providing individuals with over-the-counter access to emergency contraception (EC) leads to increased STI rates and has no effect on abortion rates.

Moreover, risky sexual behaviour such as engaging in unprotected sex and number of sexual encounters increases as a result of over-the-counter access to EC.

Mulligan’s analysis estimated that over the counter access increases STI rates by approximately 12% for women aged 15-44 and 9% for teenagers; these numbers are also consistent with the 12-17% increase in gonorrhea rates found in Washington as a result of expanded access.

She concluded that switching EC to over the counter status has three main effects on behaviour: individuals are more likely to have sex, they have a higher number of sexual encounters, and are less likely to use condoms.

The FDA approved access to emergency contraception, or Plan B (equivalent to Levonelle in the UK), through US pharmacies without a prescription in 2012 nationally. This followed pilot programmes in several states starting with Washington in 1998. 

But the US’s persistence with this unproven strategy is apparently driven more by ideology than evidence.

In the light of Mulligan’s research, Dr David Paton, professor of industrial economics at Nottingham University Business School, today called on local and national governments in the UK to review their current policy of aggressive promotion of emergency contraception (EC) to young people in schools, pharmacies and sexual health centres.

‘It is very interesting to see further confirmation that access to emergency birth control (EBC) does not seem to reduce abortions but leads to higher rates of STIs. This paper is one of the first to explore the mechanisms whereby EBC affects STIs, finding that both rates of 'unprotected' sex and numbers of partners increase in response to over-the-counter EBC. Although this paper uses US data, it is consistent with evidence from the UK’, he said.

A previous 2012 American study showed that making emergency contraception available free over the counter without prescription leads to an increase in rates of sexually transmitted infections and does not decrease pregnancy or abortion rates. 

Christine Durrance, Assistant Professor of Public Policy at the University of North Carolina, Chapel Hill, used county-level data as well as specific timing of changes in pharmacy access to consider the intended and unintended consequences of pharmacy access to emergency contraception in Washington. 

The results were almost identical to those of a British study published in the Journal of Health Economics (full text) in December 2010 and reported in the Daily Telegraph in January 2011.

This research, by professors Sourafel  Girma and David Paton of Nottingham University, compared areas of England where the scheme was introduced with others that declined to provide emergency contraception free from chemists (See my previous blogs on this here and here).

The academics found that rates of pregnancy among girls under 16 remained the same, but that rates of sexually transmitted infections increased by 12%.

In fact, in a systematic review published in 2007, twenty-three studies published between 1998 and 2006, and analyzed by James Trussell’s team at Princeton University, measured the effect of increased EC access on EC use, unintended pregnancy, and abortion. Not a single study among the 23 found a reduction in unintended pregnancies or abortions following increased access to emergency contraception (see also fact sheet here).

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

The term has been applied to the fact that the wearing of seatbelts does not decrease the level of some forms of road traffic injuries since drivers are thereby encouraged to drive more recklessly.

In the same way it has been argued that making condoms readily available actually increases rather than decreases rates of pregnancy and sexually transmitted infections because condoms encourage teenagers to take more sexual risks in the false belief that they will not suffer harm.

Whilst condoms offer some protection against sexually transmitted infections the morning-after pill offers none.

Britain has the highest rate of teenage pregnancy in Western Europe.  But international research has consistently failed to find any evidence that emergency birth control schemes achieve a reduction in teenage conception and abortion rates.

Now there is growing evidence showing that not only are such schemes failing to do any good, but they may in fact be doing harm.

Making the emergency contraceptive pill available over the counter free, without prescription, is sadly an ill-conceived knee-jerk response to Britain’s spiralling epidemic of unplanned pregnancy, abortion and sexually transmitted disease amongst teenagers. It is also not evidence-based.

The best way to counter the epidemic of unplanned pregnancy and sexually transmitted disease is to promote real behaviour change. The government would be well advised to enter into dialogue with leaders of communities in Britain where rates of sexually transmitted diseases and unplanned pregnancy are low, especially Christian faith communities, to learn about what actually works.