Thursday, 28 February 2013

How do we know the NT documents were written in the first century?

Almost invariably these days sceptics come up with the argument that the New Testament (NT) documents are unreliable because they were written long after the events they purport to describe took place.

In my experience this claim is almost never backed up with any evidence other than hearsay.

So on what do I base my confidence that the NT documents were written in the lifespan of the eyewitnesses to Jesus’ death and resurrection?

Let me summarise the arguments (although there is more detail here and a good summary here from which much of the following is gleaned)

The NT contains 27 separate books which have been gathered together in one volume. There are four Gospel accounts of the life of Jesus (Matthew, Mark, Luke and John), the book of Acts (which describes the history of the early church), thirteen letters by Paul , three by John, two by Peter, one by each of Jude and James, the letter to the Hebrews (disputed authorship) and the book of Revelation. 

The best way of dating these books is to begin with the book of Acts as it makes reference to two key historical events, the dates of which are established by archeological evidence independent of it.

The first of these is Claudius’ edict expelling the Jews from Rome in AD 50, which sent Aquila and Priscilla to Corinth (Acts 18:2).

The second is an inscription at Delphi, in central Greece, that contains a proclamation of the Emperor Claudius referring to Gallio as the Roman Proconsul of Greece dated to AD 52 (Acts 18:12).

These two events correspond in Acts to Paul’s arrival in Corinth and his ensuing trial.

So Acts was written after AD 52 and most scholars date it to AD 62 on the following basis as argued by Roman historian Colin Hemer:

1. There is no mention in Acts of the crucial event of the fall of Jerusalem in 70.
2. There is no hint of the outbreak of the Jewish War in 66 or of serious deterioration of relations between Romans and Jews before that time.
3. There is no hint of the deterioration of Christian relations with Rome during the Neronian persecution of the late 60s.
4. There is no hint of the death of James at the hands of the Sanhedrin in ca. 62, which is recorded by Josephus in Antiquities of the Jews (
5. Acts seems to antedate the arrival of Peter in Rome and implies that Peter (who was martyred in the late 60s) and John were alive at the time of the writing.
6. The action ends very early in the 60s, yet the description in Acts 27 and 28 is written with a vivid immediacy. It is also an odd place to end the book if years have passed since the pre-62 events transpired.

The Gospel of Luke was written by the same author as the Acts of the Apostles, who refers to Luke as the 'former account' of 'all that Jesus began to do and teach' (Acts 1:1). The destiny ('Theophilus'), style, and vocabulary of the two books betray a common author. 

The author of Luke and Acts was a companion of Paul on his journeys (the 'we' passages in Acts) and is attested by 2nd century church fathers, many of whom would have been alive at the time Luke and Acts were written, to be Luke the Physician.

If Acts was written in 62 or before, and Luke was written before Acts (say 60), then Luke was written less than thirty years of the death of Jesus. This is contemporary to the generation who witnessed the events of Jesus' life, death, and resurrection. This is precisely what Luke claims in the prologue to his Gospel:

Many have undertaken to draw up a record of the things that have been fulfilled among us, just as they were handed down to us by those who were eye-witnesses and servants of the word. Therefore, since I myself have carefully investigated everything from the beginning, it seemed good also to me to write an orderly account for you, most excellent Theophilus, so that you may know the certainty of the things you have been taught. [Luke 1:1-4]

Luke presents the same information about who Jesus is, what he taught, and his death and resurrection as do the other Gospels. Thus, there is not a reason to reject their historical accuracy either. Most scholars would hold to the view, on the basis of shared material, that Mark was written first, followed by Matthew, then Luke which puts the earlier gospels back into the 50s at the latest.

It is widely accepted by critical and conservative scholars that 1 Corinthians was written by 55 or 56. This is less than a quarter century after the crucifixion in 33.

Further, Paul speaks of more than 500 eyewitnesses to the resurrection who were still alive when he wrote (15:6). Specifically mentioned are the twelve apostles and James the brother of Jesus. Internal evidence is strong for this early date:

1. The book repeatedly claims to be written by Paul (1:1, 12-17; 3:4, 6, 22; 16:21).
2. There are parallels with the book of Acts.
3. Paul mentions 500 who had seen Christ, most of whom were still alive.
4. The contents harmonize with what has been learned about Corinth during that era.

There is also external evidence:

1. Clement of Rome refers to it in his own Epistle to the Corinthians (chap. 47.)
2. The Epistle of Barnabas alludes to it (chap. 4).
3. Shepherd of Hermas mentions it (chap. 4).
4. There are nearly 600 quotations of 1 Corinthians in Irenaeus, Clement of Alexandria, and Tertullian alone (Theissen, 201). It is one of the best attested books of any kind from the ancient world.

Along with 1 Corinthians, 2 Corinthians and Galatians are well attested and early. All three reveal a historical interest in the events of Jesus' life and give facts that agree with the Gospels. Paul speaks of Jesus' virgin birth (Gal. 4:4), sinless life (2 Cor. 5:21), death on the cross (1 Cor. 15:3; Gal. 3:13); resurrection on the third day (1 Cor. 15:4), and post-resurrection appearances (1 Cor. 15:5-8). He mentions the hundreds of eyewitnesses who could verify the resurrection (1 Cor. 15:6).

Paul rests the truth of Christianity on the historicity of the resurrection (1 Cor. 15:12-19). Paul also gives historical details about Jesus' contemporaries, the apostles (1 Cor. 15:5-8), including his private encounters with Peter and the apostles (Gal. 1:18-2:14).

Paul's other books can be dated around events described in the book of Acts. He wrote Romans during his three month stay in Greece in AD 57. Ephesians, Philippians, Colossians and Philemon were written whilst he was in prison in Rome between AD 60-62.  1 Timothy was written after Paul's release from prison in AD 62 and 2 Timothy just before his martyrdom in AD 64. 

Surrounding persons, places, and events of Christ's birth were all historical. Luke goes to great pains to note that Jesus was born during the days of Caesar Augustus (Luke 2:1) and was baptised in the fifteenth year of Tiberius. Pontius Pilate was governor of Judea and Herod was tetrarch of Galilee. Annas and Caiaphas were high priests (Luke 3:1-2).

Of the four Gospels alone there are 19,368 citations by the church fathers from the late first century on. This includes 268 by Justin Martyr (100-165), 1038 by Irenaeus (active in the late second century), 1017 by Clement of Alexandria (ca. 155-ca. 220), 9231 by Origen (ca. 185-ca. 254), 3822 by Tertullian (ca. 160s-ca. 220), (ca. 160s-ca. 220), 734 by Hippolytus (d. ca. 236), and 3258 by Eusebius (ca. 265-ca.339; Geisler, 431).

Earlier, Clement of Rome cited Matthew, John, and 1 Corinthians, in 95 to 97. Ignatius referred to six Pauline epistles in about 110, and between 110 and 150 Polycarp quoted from all four gospels, Acts, and most of Paul's epistles.

Shepherd of Hermas (115-140) cited Matthew, Mark, Acts, 1 Corinthians, and other books. Didache (120-150) referred to Matthew, Luke, 1 Corinthians, and other books. Papias, companion of Polycarp, who was a disciple of the apostle John, quoted John. This argues powerfully that the gospels were in existence before the end of the first century, while some eyewitnesses (including John) were still alive.

The earliest undisputed manuscript of a New Testament book is the John Rylands papyrus (p52) (pictured above), dated from 117 to 138. This fragment of John's gospel survives from within a generation of composition. Since the book was composed in Asia Minor and this fragment was found in Egypt, some circulation time is demanded, surely placing composition of John within the first century. Whole books (Bodmer Papyri) are available from 200.

Most of the New Testament, including all the gospels, is available in the Chester Beatty Papyri manuscript from 150 years after the New Testament was finished (ca. 250). No other book from the ancient world has as small a time gap between composition and earliest manuscript copies as the New Testament.

Wednesday, 27 February 2013

Libel on twitter: the legal boundaries are clear and should be respected

Christians who express their beliefs on twitter come in for a lot of flak (See here and here).

Some of this is simply light-hearted ribbing and some frankly abusive.

I have been called all manner of things on line and do not mind being insulted. People are perfectly entitled to express their heartfelt opinions.

However, an internet pseudonym grants a cloak of anonymity which removes some tweeters’ inhibitions to such an extent that they say things they would never contemplate saying in open court. 

There are of course limits to free speech, lines which even in a free society should not be crossed.

Libel and threats for example are illegal and a total of 653 people faced criminal charges in England and Wales last year in connection with comments on Twitter or Facebook.

These divided into offences committed on the two sites, such as posting abusive messages, and those which had been provoked by messages, including violent attacks.

I personally draw the line at being misrepresented.

Recently, for the first time, I asked a Dr David Jones ( @welsh_gas_doc ) to retract a potentially damaging false statement he made about me. He eventually did, but only after it had been retweeted by 52 people to tens of thousands of twitter users.

I have since learnt that his tweets previously came to the attention of the national media (see here and here) after a medical colleague posted a complaint.

Whether he has learnt his lesson remains to be seen but a tweet he sent me a couple of days ago about Cardinal O’Brien (see below) raises serious questions. Dr Jones seems not to be aware of the principle ‘innocent until proven guilty’ and may well have crossed a legal line here.  

‘Idiot Immolater’ (I am assuming she is female), who goes under the twitter name @msgrumpy, describes herself as an atheist who is opinionated, passionate and loves an argument. Amongst other things she dislikes organised religion and evangelicals.

Ms Grumpy is a prolific ‘tweeter’ who has posted over 86,000 times and spends much of her time attacking Christians.

Last night she sent me a series of tweets, some merely insulting but several making quite extraordinary and frankly risible personal allegations.

First she accused me driving a Mercedes financed by my employer.

Then she claimed I was being financed by my church to stay in five star hotels.

She followed this up by saying that I was a closet homosexual who was paid to support my ‘penchant for the lady boys’.

Others then joined in. 

It is Ms Grumpy's comments that have led me to post this blog to draw attention to the legal boundaries, especially with respect to libel.

According to a recent ComRes poll 46% of 18- to 24-year-olds and 17% of over-65s are unaware they can be sued for defamation if they tweet an unsubstantiated rumour about someone.  

The BBC has recently published a useful article titled ‘Twitter users: A guide to the law’ which outlines the categories of law on which social media users in England and Wales are coming unstuck.

Essentially there are seven: libel, reporting sex offences, breaking a court order, other contempt of court, threats, offensive comments and injunctions/superinjunctions.

The libel law has been recently highlighted by the case of Lord McAlpine and Commons speaker’s wife Sally Bercow.

In November, Conservative peer Lord McAlpine announced his intention to seek libel damages from Twitter users over incorrect and defamatory insinuations linking him to child sex abuse.

The law concerning Twitter is clear - if you make a defamatory allegation about someone you can be sued for libel. It is the same as publishing a false and damaging report in a newspaper.

But until the McAlpine case, no one had seriously attempted to exercise that right in the UK.

Lord McAlpine has dropped threatened legal action against Twitter users with fewer than 500 followers and instructed his lawyers to concentrate their efforts on seeking £50,000 in damages from Mrs Bercow, the wife of Commons speaker Bercow, in what is expected to be the first High Court Twitter libel trial.

At the height of the Twitter frenzy, Mrs Bercow tweeted to her 56,000 followers: ‘Why is Lord McAlpine trending? *innocent face*’

A tweet is potentially libellous in England and Wales if it damages someone's reputation ‘in the estimation of right thinking members of society’. It can do this by exposing them to ‘hatred, ridicule or contempt’. It is a civil offence so you won't be jailed but you could end up with a large damages bill. The rules also apply to re-tweets.

The best defence is if you can prove the contents of the tweet are true.

The only way to be completely safe is to avoid tweeting gossip unless you know for a fact that it is true.

Under the Defamation Bill, due to become law later this year, litigants in England and Wales will have to show that the words they are complaining about caused ‘substantial harm’ rather than simply ‘harm’ to their reputations.

Website operators may also be forced to remove potentially libellous comments by anonymous ‘trolls’ or hand over their names and addresses to the authorities. Scotland is expected to adopt its own version of the changes.

Twitter is a useful forum which is a great information source and also allows people who might not otherwise meet to exchange views on important issues.

But there are boundaries in free speech that should not be crossed. 

Sunday, 24 February 2013

Homosexuality is only one symptom of the real sin of Sodom

Most people have heard of Sodom and Gomorrah, the cities we are told were destroyed for their sexual immorality in the 19th chapter of Genesis (See John Martin’s famous 1852 painting left).

Sodom and Gomorrah have become synonymous with impenitent sin, and their fall with a proverbial manifestation of God's wrath. 

The story has given rise to the English word ‘sodomy’ to  describe a sexual ‘crime against nature’ and specifically homosexuality. 

Recently I was on a tour of the British Library with Jay Smith when he mentioned that a tablet discovered in the library of the ancient city of Ebla, in modern day Syria, had listed the five ‘cities of the plain’ (Sodom, Gomorrah, Admah, Zeboim, and Bela) in the same order as in Genesis 14:1-3, 8-10.

William Shea pointed out in 1983 that on the 'Eblaite Geographical Atlas' [TM.75.G.2231], ad-mu-ut and sa-dam correspond to Admah and Sodom, and are contained in a list of cities that traces a route along the shores of the Dead Sea.

Rabbi Leibel Reznick, a senior lecturer in Talmudic studies in New York, makes a strong and highly plausible case for these cities being the five cities of Bab Edh-Dhra, Numeira, Safi, Feifa and Khanazir which are located at the southern end of the Dead Sea in modern day Jordan. This view is shared by Michael Sanders on the ‘Mysteries of the Bible’ website.

Reznick summarises the evidence as follows (but his whole article is well worth reading):

1. The Bible refers to a metropolis of five cities in the Dead Sea area. Five, and only five cities, have been found there (see map).

2. The Bible refers to a conquest by the Mesopotamians and the artifacts found in the Dead Sea area show a Mesopotamian influence.

3. The Midrash describes the metropolis as a thriving population. The enormous number of burials in the large cemeteries (over 1.5 million in three cities alone) attests to a great population.

4. The Talmud and the Midrash describe the area as an agricultural wonderland. The great diversity of agricultural products found in the ruins verify the lush produce enjoyed by the area's inhabitants.

5. According to the Talmud, there was a span of only 26 years between a war in the area and the ultimate destruction. Devastation levels found in Numeira (Sodom) are consistent with the Talmud's assertion.

6. The Talmud states that Sodom, unlike other cities in the area, only existed for 52 years. The ruins in Numeira (Sodom) indicate that the city lasted less than 100 years.

7. The Bible attributes the destruction of the cities to a fiery storm that rained down from above and thick layers of burnt material covering the remains of the cities in the area bear this out.

Whether or not Numeira will indeed turn out to be the biblical Sodom is yet to be finally confirmed, but Sodom nonetheless remains crucially important in biblical history and theology.

The cities of Sodom and Gomorrah, according to the Bible (Genesis 18 and 19), were destroyed by fire and brimstone for their immorality.

Abraham’s nephew Lot escaped the devastation and later, by his daughters (!), became the father of the ancient nations of Ammon and Moab, which engaged in centuries of conflict with the Israelites.

Sodom is mentioned 46 times in the Bible: 20 in Genesis, 17 in the rest of the Old Testament, and 9 in the New Testament, including five mentions by Jesus himself.

The prophet Isaiah (Isaiah 1:9-10, 3:9 and 13:19-22) accuses the people of Israel as being like Sodom and Gomorrah in their sinning and warns that Babylon will end like Sodom and Gomorrah.

Jeremiah (Jeremiah 23:14, 49:17-18, 50:39-40 and Lamentations 4:6) associates Sodom and Gomorrah with adultery and lies and prophesies the fate of Edom and Babylon using Sodom as a comparison.

In Ezekiel 16:48-50 God compares Jerusalem to Sodom, saying that Jerusalem was worse:

‘Now this was the sin of your sister Sodom: She and her daughters were arrogant, overfed and unconcerned; they did not help the poor and needy. They were haughty and did detestable things before me. Therefore I did away with them as you have seen.’

In Amos 4:1-11 God tells the Israelites he had warned them and treated them like Sodom and Gomorrah and yet still they did not repent. And in Zephaniah 2:9 the prophet tells Moab and Ammon, southeast and northeast of the Dead Sea, that they will end up like Sodom and Gomorrah.

Jesus continues the same theme. In Matthew 10:1-15, and Luke 10:1-12, he declares certain cities more damnable than Sodom and Gomorrah, due to their response to Jesus' disciples.

‘And if anyone will not receive you or listen to your words, shake off the dust from your feet as you leave that house or town. Truly, I say to you, it shall be more tolerable on the day of judgment for the land of Sodom and Gomorrah than for that town.’

In Matthew 11:20-24 he prophesies the fate of some cities where he did some of his works (RSV):

‘And you, Caperna-um, will you be exalted to heaven? You shall be brought down to Hades. For if the mighty works done in you had been done in Sodom, it would have remained until this day. But I tell you that it shall be more tolerable on the day of judgment for the land of Sodom than for you.’

In Luke 17:28-30 Jesus compares his second-coming to the judgment of Sodom and Gomorrah:

‘Likewise as it was in the days of Lot—they ate, they drank, they bought, they sold, they planted, they built, but on the day when Lot went out from Sodom fire and sulphur rained from heaven and destroyed them all—so will it be on the day when the Son of man is revealed.’

In 2 Peter 2:4-10 Peter, in his description of the time of the second coming of Jesus, says that God ‘condemned the cities of Sodom and Gomorrah by burning them to ashes and made them an example of what is going to happen to the ungodly’.

Jude 1:7 records that both Sodom and Gomorrah and the surrounding towns ‘gave themselves up to sexual immorality and perversion’ and ‘serve as an example of those who suffer the punishment of eternal fire’.

So Sodom is intended to be a strong reminder to us and a call to repentance and faith.

But whilst sexual immorality (and specifically homosexuality) was undoubtedly one manifestation of Sodom’s sin, it was far broader than that.

According to Isaiah (Isaiah 1:10-17) Sodom’s sin also included meaningless religious ritual, injustice, neglect of widows and orphans and the shedding of innocent blood. Ezekiel (Ezekiel 16:48-50) mentions arrogance, self-indulgence and neglect of the poor.

I am currently reading Rosaria Butterfield’s new book ‘The Secret Thoughts of an Unlikely Convert’.

Butterfield was a lesbian English Professor who came to Christ and has described Romans 1:24-28 (which addresses homosexuality) as one of the scariest passages in the Bible.

But in an intriguing chapter titled ‘Repentance and The Sin of Sodom’ she argues that ‘homosexuality – like all sin – is symptomatic and not causal’ and points out that the Ezekiel passage quoted above highlights ‘pride, wealth, entertainment-driven focus, lack of mercy and lack of modesty’ amongst the city’s sins.

‘Pride is the root of all sin’ she declares, in words reminiscent of CS Lewis in ‘Mere Christianity’. ‘Proud people always feel that they can live independently from God’ and ‘feel entitled to do what they want when they want to’.

These passages, she said, ‘forced me to see pride and not sexual orientation as the root sin’. ‘The truth is that outside Christ, I am a manipulator, liar, power-monger and controller… I learned that sin roots not in outward behaviours, but in patterns of thinking.’

By contrast she testifies, ‘Conversion overhauled my soul and personality. It was arduous and intense. I experience with great depth the power and authority of God in my life. In it I learned – and am still learning – how to love God with all my heart, soul, strength and mind.’

Romans 1:18-32 takes up the same theme. Sin starts with ‘suppressing the truth’ (18) about God, failing to glorify or give thanks to him (21), denying his ‘eternal power and divine nature’ (20) and exchanging ‘the glory of the immortal God for images’ (22).

Sin’s later fruit includes ‘shameful lusts’ in which ‘women exchanged natural relations for unnatural ones’ and ‘men also abandoned natural relations with women and were inflamed with lust for each other’ (26, 27).

But those who reject God also ‘became filled with every kind of wickedness, evil, greed and depravity’ (29) including ‘envy, murder, strife, deceit and malice’ (29). They are ‘gossips, slanderers, God-haters, insolent, arrogant and boastful… senseless, faithless, heartless, ruthless’ (30-31) and ‘approve of those who practise’ these things (32).

The destruction of Sodom was a real historical event which Scripture teaches serves as a warning of the much greater destruction and devastation which is coming after death to those who refuse to repent and believe – the eternal fire of Hell.

But the sin of Sodom was far more than sexual immorality which is only a symptom of its real root - a proud and arrogant dismissal of God’s existence and authority and a deliberate choice to live our own way rather than God’s way. 

Saturday, 23 February 2013

How historic codes of medical ethics have ‘evolved’ to endorse abortion

I’ve just come back from a trip to Derry and Donegal where I was doing a radio phone in and an evening meeting on abortion.

Abortion remains illegal in both Ireland and Northern Ireland under the Offences against the Person Act 1861. 

This Act also remains in force in England, Wales and Scotland although doctors can avoid being prosecuted under it by abiding by the provisions of the Abortion Act 1967.

The Offences against the Person Act, like many of our country’s laws, was originally based on the Judeo-Christian ethic which forbids the taking of innocent human life on the basis that all human lives are made in the image of God.  It treats abortion in the same way as murder - that is, as a crime punishable by life imprisonment.

Not many people know that abortion is also against historic codes of ethics like the Hippocratic Oath, the Declaration of Geneva (1948) and the International Code of Medical Ethics (1949) or that in1947 the British Medical Association called abortion 'the greatest crime'.

The Hippocratic Oath is an oath historically taken by physicians swearing to practise medicine ethically and honestly. It is widely believed to have been written either by Hippocrates (pictured), often regarded as the father of western medicine, or by one of his students.

The Oath, which dates from the 5th century BC, is one of the most widely known of Greek medical texts.

The Declaration of Geneva and the International Code of Medical Ethics are modern restatements of the Hippocratic Oath which were developed in response to the unethical actions of Nazi doctors during the Second World War.

I was surprised to learn that not even Clare Gerada, the Chairman of the Royal College of General Practitioners (RCGP), seemed to be aware of the contents of the Hippocratic Oath.  

In a twitter exchange last week (see below) she agreed with another doctor (of the same name but not I think related) that ‘good GPs must be neutral/secular on the abortion issue’.

When I said to her that doctors doing abortions were actually breaking the Hippocratic Oath she told me it was ‘rubbish’ to say that the Hippocratic Oath forbade abortion (see below).

When I linked her to a modern translation of the Oath on Wikipedia demonstrating that it did another doctor said that if I relied on Wikipedia for a source it was no wonder I had to ‘bow out of medicine’

Someone else then implied, that the Oath was no longer valid because it forbade the crushing of bladder stones (see below) although in fact it simply suggests that bladder stones should be referred to those with the necessary skills.

‘I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.’

Judging by her reaction Dr Gerada didn't seem to be aware of this either. In fact this clause upholds proper referral and the necessity of experience and training for those undertaking surgical procedures. 

These views are not at all unusual amongst doctors today.

Most medics are not aware that the dramatic increase in abortion worldwide last century ran completely counter to all historically accepted codes of medical ethics.

The Hippocratic Oath includes the resolution ‘I will not give to a woman a pessary to  produce abortion’.

The Declaration of Geneva (1948)  states  ‘I  will maintain  the utmost  respect for human life from the time of conception even against threat...’ and the International Code of Medical  Ethics (1949) affirms that ‘a doctor must always bear  in mind  the importance of preserving human life from the time of conception until death’.

In the same spirit the UN Declaration of Human Life (1948) asserts that ‘everyone has the right to life’ and the UN Declaration of the Rights of the Child (1959) that the child deserves legal protection before as well as after birth.

When the legal abortion rate soared world-wide in the second half of last century – with almost all abortions performed by doctors - the World Medical Association was left with a choice of changing either its behaviour or rewriting its ethics. It opted for the latter.

In 1970 it adopted the Declarationof Oslo. This allowed ‘therapeutic’ abortion in circumstances ‘where the vital interests of the mother conflict with those of the unborn child’. Although the ‘utmost respect for human life from the time of conception’ as laid out in the Declaration of Geneva was affirmed, it was recognised that there was a ‘diversity of attitudes towards the life of the unborn child’.

The Declaration of Oslo went on to say that ‘where the law allows therapeutic abortion to be performed... and this is not against the policy of the national medical association’ then ‘abortion should be performed’ under certain provisos.

The Oslo declaration thus laid the framework for doctors to perform abortions if their ‘individual conviction and conscience’ allowed it and the law and the national medical association were not in disagreement.

The change appeared minor at the time but it represented a fundamental shift in the whole framework of medical ethics.

The Judeo-Christian ethic with its concept of absolute right and wrong was discarded and ‘individual conscience’ enthroned as absolute in its place. ‘Individual conviction and conscience’ which ‘must be respected’ has replaced God as the arbiter of truth.

The doctor was no longer obliged not to kill. Instead by a strange twist he or she was now obliged not to stop other doctors killing if their ‘consciences’ dictated that they should. 

As the abortion rate rocketed world-wide in this new ethical environment (there now over 42 million abortions per year) consistency of belief and practice were achieved by further amending other ethical codes.  At the 35th World Medical Assembly held in Venice in October 1983 the WMA amended the words ‘from the time of conception’ in the Declaration of Geneva to ‘from its beginning’.

At the same time the words ‘from the time of conception until death’ were excised from the International Code of Medical Ethics.

The change in the medical profession’s attitudes and practice on abortion are the main reason these oaths and declarations are no longer used today in their original form.

In fact, we are now reaching the stage, it seems, where those who still wish to abide by the spirit of these historic oaths are thought by some to better out of medicine altogether. As RCGP Council Chair Dr Gerada says above, good GPs should be neutral/secular on abortion and if they are not then they should leave the profession.

The evolution of medical ethics codes is a fact unknown by most doctors. All the more important therefore for us to keep drawing it to their attention. 

Another unworkable proposal from NHS ‘experts’ on morning-after pill

An influential group of NHS experts is urging the Scottish Government to allow the morning-after pill to be handed out in schools (See reports by BBC, Scotsman and Scottish Herald)

But the push has faced criticism from the Roman Catholic Church in Scotland for being irresponsible. The parliamentary officer John Dieghan said it ‘pours more fuel on the flames.

In a written submission to a Holyrood committee, the Scottish Sexual Health Lead Clinicians Group (SSHLCG) accused ministers of ‘running scared’ of its critics over contraception in schools.

The group said: ‘Why is emergency contraception not available in schools? Why are condoms and contraception not accessible? Why can’t pregnancy and other STIs be prevented?’

The Scottish parliament’s Health and Sport Committee are looking into the high rate of teenage pregnancy in the country, which is one of the highest in Western Europe.

Ministers had hoped to cut the pregnancy rate for under 16s to 6.8 pregnancies per 1,000 girls by 2010 but the pregnancy rate for that year was 7.1 per 1,000.

But according to the evidence John Dieghan is quite right.

An American study which I highlighted last December 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. 

These 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 latter research, by professors Sourafel Girma and David Paton of Nottingham University (See my previous blogs on this here and here) 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 seat-belts 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. In 2008, the latest year for which figures are available, more than 7,500 girls in England and Wales became pregnant. Nearly two thirds of these pregnancies ended in abortion.

Rates of sexually transmitted diseases are also rising. In 2009 there were 12,000 more cases than the previous year, when 470,701 cases were reported. The number of infections in 16-to 19 year-olds seen at genito-urinary medicine clinics rose from 46,856 in 2003 to 58,133 in 2007.

International research has consistently failed to find any evidence that emergency birth control schemes achieve a reduction in teenage conception and abortion rates. But 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 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.

Church-based programmes such as Love for Life (Northern Ireland), Love2last (Sheffield), Challenge Team, Romance Academy or Lovewise (Newcastle) are getting great results and have much wisdom to pass on. How about financing some serious research into examining them in more depth?

Saturday, 16 February 2013

Women who keep their disabled babies face coercion, discrimination and disdain

Last Monday I attended the second oral evidence session of the Parliamentary ‘Inquiry into Abortion on the Grounds of Disability’ (more background here)

The current law permits an abortion to take place up to birth (40 weeks) if prenatal tests indicate that the child may be disabled when born. There is a legal limit of 24 weeks for abortions on other grounds. 

Abortions are currently permitted at any time up to and including birth if there is a ‘substantial risk’ that the child might be born ‘seriously handicapped’. The law does not define these criteria and they are broadly interpreted.

This ground for abortion is known as Ground E in practice and, according to Department of Health statistics, 2,307 ‘Ground E’ abortions were carried out in 2011.

The Equality Act 2010 protects disabled people from discrimination. The Act prohibits discrimination arising from a disability by preventing one person from treating another less favourably because of their disability. 

The current abortion law thereby discriminates against disabled babies in two ways.

First, it has a different upper limit for disabled babies and babies without disability (40 and 24 weeks respectively). Second, it allows for some disabled babies to be aborted under ground E (those who will be born with a ‘serious’ handicap) but not others.

Last Monday we heard evidence at the inquiry from disability rights activists, parents of children born with disabilities and support groups for affected families.

There were several strong themes that emerged.

First, there seemed to be very little support or information available for families who wanted to keep their babies, as opposed to having them aborted.

Second, there was a strong presumption from doctors that parents with disabled children would choose to have them aborted.

Third, there was a huge amount of subtle or direct pressure placed on parents who decided not to abort. They were repeatedly asked to reconsider their decisions and treated like pariahs – in short they were discriminated against.

It is just this sort of pressure that has led some commentators to talk about abortion for disability as a ‘coercive offer’. And there is a growing literature of personal testimonies around this issue.

‘Defiant Birth’ tells the personal stories of women who have resisted ‘medical eugenics’ and dared to challenge the utilitarian medical model/mindset - women who were told they shouldn't have babies because of perceived disability in themselves, or shouldn't have babies because of some imperfection in the child. 

'They have confronted the stigma of disability and in the face of silent disapproval and even open hostility, had their babies anyway, in the belief that all life is valuable and that some are not more worthy of it than others.

Disparaged and treated as pariahs for departing from accepted medical wisdom they have chosen non-compliance with medical/social prejudice and defiantly said yes to their babies, and no to the cult of bodily perfection.'

This is a controversial book that looks critically at the way in which medical eugenics is being used as a contemporary form of social engineering. Reist has written a strongly argued and trenchant introduction setting out the issues, among them the idea that having children is about ‘quality control and the paradigm of perfection.’

‘Defiant Birth’ explores what is means to have ‘less-than-perfect pregnancies’ and ‘genetically different babies.’ People with disabilities have been raising these issues for many years, but on the whole they remain silent and marginalised in the media.

Several parents recount the joy and love they have experienced with their 'abnormal' babies, including children with Down syndrome and achondroplasia ('dwarfism'). The book also has inspiring stories told by parents with their own significant illnesses and disabilities, including cerebral palsy.

Many write of the pressure, and even blame, from family, friends and professionals, to choose termination, justified as saving their children from suffering. This perspective is challenged by words of those with disabilities. Abortion is also justified to save the community from future costs, which is the fundamental (and profoundly concerning) reason for prenatal testing for abnormalities.

The stories also challenge the idea that allowing a baby with a fatal abnormality to survive to birth will be intolerably traumatic for the family. As mother Teresa Streckfuss poignantly writes about her son, who died 24 hours after birth from anencephaly:

‘Someone asked us after Benedict died, was it worth it? Oh yes! For the chance to hold him and see him and to love him before letting him go. For the chance for our children to see that we would never stop loving them, regardless of their imperfections. Children are always a blessing, even if they don't stay very long.’

The question of babies with disabilities incompatible with life outside the womb is explored more fully in ‘A Gift of Time’. The author Amy Kuebelbeck is a former reporter and editor for the Associated Press and previously wrote about her experience losing a child in ‘Waiting with Gabriel: A Story of Cherishing a Baby’s Brief Life’.

The book is a gentle and practical guide for parents who decide to continue their pregnancy knowing that their baby's life will be brief.

When prenatal testing reveals that an unborn child is expected to die before or shortly after birth, some parents will choose to proceed with the pregnancy and to welcome their child into the world. With compassion and support, ‘A Gift of Time’ walks them step-by-step through this challenging and emotional experience—from the infant's life-limiting prenatal diagnosis and the decision to have the baby to coping with the pregnancy and making plans for the baby’s birth and death.

The book also offers inspiration and reassurance through the memories of numerous parents who have loved a child who did not survive. Their moving experiences are stories of grief—and of hope. Their anguish over the prenatal diagnosis turns to joy and love during the birth of their child and to gratitude and peace when reflecting on their baby’s short life.

‘A gift of life’ is also featured on the ‘Perinatal Hospice’ website, which provides resources and support for those having to care for a dying baby.

CMF previously published a powerful testimony of a Christian psychiatrist who faced just this situation under the title ‘A life Precious to God’ and I have blogged previously about a similar more recent story.

Dame Cicely Saunders, founder of the modern hospice movement said, ‘You matter because you are you, and you matter until the last moment of your life.’

I pray that the testimonies in these two books and this parliamentary inquiry will help lead us to a point as a society where we are prepared to treat disabled babies, these most vulnerable of human beings, with the honour, respect, love and protection that they deserve and to give more information and support to their parents and families.

IVF for gay couples financed by the tax payer is actually the next logical step

The Telegraph this morning reports that more gay couples and women over the age of 40 are to be given fertility treatment on the NHS, despite claims that the health service cannot afford it (See BBC report here)

According to the Telegraph, under an expansion of NHS-funded fertility treatment, the National Institute for Health and Clinical Excellence (NICE) will recommend that lesbian couples be offered six cycles of artificial insemination and, if that fails, IVF.

There were just over 1,000 cycles of insemination performed for women in same-sex relationships in 2010, resulting in 152 babies. The number of cycles of IVF for this group rose from under 100 in 2009 to 561 in 2010, resulting in 215 babies. Most of these couples however paid for treatment privately, where a cycle of IVF can cost them £8,000.

Given that the NHS is having to find £20 billion of efficiency savings over four years because flat-rate budget increases are not enough to cope with increasing demand, this means that local clinical commissioning groups, which make the final decision on fertility provision in hospitals, will be unable to afford the extra treatment without making drastic cuts to other services.

Does it strike you as odd that in a time of economic recession NICE is recommending that our tax money through the National Health Service, pays for a lesbian woman, who is suffering from no illness, is not infertile and wants to become pregnant but does not wish to have sex with a man, to have artificial insemination or IVF?

This latest move has, perhaps understandably, generated a lot of controversy, but in fact is the next logical step following from presuppositions that we have already accepted as a society.

Having turned our backs on the Judeo-Christian worldview and ethical framework, decisions in healthcare are increasingly now taking place in an ethical vacuum where the principle drivers are autonomy, technology, commerce and relativism.

Autonomy says ‘we want it’. Technology says ‘we can do it’. Commerce says ‘there are purchasers and providers’ and relativism says ‘why not?’

The Human Fertilisation and Embryology Act 1990 started from two ethical presuppositions.

First there was the assumption that human embryos are not human beings and so can be used as a means to an end – meaning that they can be experimented upon, frozen or destroyed.

Second was the belief that gametes (egg and sperm) need not be used only within the marriage bond but can be bought, sold, shared with and given to others.

If we combine these ethical starting points with the beliefs that marriage, gender and reproduction are simply arbitrary social constructs which can be reshaped and redefined by social consensus then human demand, economics and technology become the only limitations on what can be done in human reproduction.

Equality law will then ensure that everyone who wants a given technology, regardless of marital status, gender or even degree of infertility, must be treated equally.

If married women whose husbands are infertile can use donated sperm then why can’t single women or lesbians? If married women who can’t produce their own eggs (for whatever reason) can used donated eggs then why can’t single women or lesbians? Similarly why can’t gay men use both donated eggs and a surrogate to carry the baby? 

And if lesbian women, who are fertile, choose to use donated eggs and IVF, then what is to stop single and married women, who wish to avoid either sex or pregnancy from dong the same? And if married couples can have a certain ‘treatment’ funded by the taxpayer, isn’t it discriminatory to bar others, whether gay or straight?

As technology develops further, and egg and sperm can be artificially manufactured from ordinary body cells, it will be possible for lesbian couples to generate their own sperm and eggs and produce babies that are genetically related to their parents. And gay couples will be able to do the same with the help of a surrogate, or perhaps even transplanted, uterus. We should expect these extensions of practice now and not be surprised when they occur.

If these things alarm us, then rather than simply reacting to the latest developments we should be going back to examine the set of presuppositions that brought us to this point and examining those.

In this connection I have previously put forward a Christian framework for infertility treatment which I believe respects both the sanctity of human life and the integrity of the marriage bond.

But the other real questions we should be asking are about the real drivers of this new technology. 

Why are levels of infertility increasing so dramatically and why there are so few babies available to adopt? It's not rocket science.

Friday, 15 February 2013

The RCGP Council should reject Clare Gerada’s attempt to push it neutral on assisted suicide and euthanasia

Next Friday, 22 February, the Council of the Royal College of General Practitioners (RCGP) will consider its Chairman’s suggestion to go neutral on assisted suicide and euthanasia.

The RCGP is the largest membership organisation in the UK solely for GPs and currently has over 42,000 members.

The papers for the meeting have not been made public but RCGP Council Chair Clare Gerada (pictured) is expected to put a similar case to that she made last year in a letter to members  and in an article in the British Journal of General Practice.

Gerada’s move seems deliberately planned to coincide with the tabling of two new parliamentary bills aimed at legalising assisted suicide. Lord Falconer is introducing a bill into the House of Lords in May and Margo Macdonald MSP is bringing a bill to the Scottish Parliament later this year.

In addition to this two high profile court cases involving patients with ‘locked in syndrome’ return to the Court of Appeal also in May.

The RCGP adopted its current strong opposition to a change in the law in 2005 after substantial discussion and consultation with its Faculties and Members.

It formulated its current policy then as follows:

‘The RCGP believes that, with current improvement in palliative care, good clinical care can be provided within the existing legislation and that patients can die with dignity. A change in legislation is not required.’

It restated this position in 2011 saying that ‘nothing has occurred since 2005 to alter or change the ethical issues around assisted dying’.

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. Palliative Medicine Physicians are 95% opposed and the Royal College of Physicians and British Geriatrics Society are officially opposed.

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.

Neutrality on this particular issue would give it a status that no other issue enjoys. Doctors, quite understandably, are strongly opinionated and also have a responsibility to lead. The RCGP 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 recession 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 RCGP 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 last year’s annual representative meeting 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 the RCGP to go neutral it would be similarly gagged and GPs would have no collective voice.

Going neutral would instead play into the hands of  a 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) has only 520 supporters, representing fewer than 0.25% of Britain’s 240,000 doctors. But last year they flooded the BMA ARM with no less than nine motions calling for the association to go neutral in an attempt to silence medical opposition ahead of new bills being introduced to parliament this year.

The RCGP 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 RCGP Council would be wise to give short shrift to its chairman’s proposal.