Doctors strike back at BMJ editors over assisted suicide stance

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How would this translate to the UK?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Let’s not follow Oregon’s lead.

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

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

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

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

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

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

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

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

1. 18 years of age or older

2. A resident of Oregon

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Freedom of conscience in medicine is under sustained attack but is worth fighting for

I have previously highlighted the case of two Glasgow midwives who were disciplined by their NHS Trust for refusing to participate in abortion.

Their Trust was found to be in the wrong by the Scottish Court of Appeal and the case has been referred to the UK Supreme Court where a further hearing is still awaited.

A single act of physician refusal to abort a patient can evoke headlines around the world, especially in nations targeted by the pro-abortion industry.   

Conscientious objection on the part of Hippocratic physicians is a major obstacle now under concerted attack worldwide.

The Center for Reproductive Rights (CRR) has recently submitted its wish list to the UN to be incorporated in the Sustainable Development Goals  (SDG’s)  now under negotiation.

Especially interesting is the direct targeting of rights of conscience.  The CRR document encourages nations to track  ‘Rates of implementation of judicial or administrative decisions concerning violations of reproductive rights, including through the unregulated use of conscientious objection…’

Because many  physicians have stubbornly refused to kill their unborn patients,  the UNFPA (United Nations Fund for Population Affairs) has decided to recruit midwives to fill the void of abortion providers. 

The report states:  ‘The definition of “midwifery” used in this report is: the health services and health workforce needed to support and care for women and newborns, including sexual and reproductive health and especially pregnancy, labour and postnatal care. This includes a full package of sexual and reproductive health services, including preventing mother-to- child transmission of HIV, preventing and treating sexually transmitted infections and HIV, preventing pregnancy, dealing with the consequences of unsafe abortion and providing safe abortion in circumstances where it is not against the law.’ (emphasis mine)

In biblical thinking, the conscience is one of the most fundamental aspects of what it means to be a human being. The conscience is part of our created humanity and it is present in all, not just those who are believers. The conscience is seen as, in some sense, an internal reflection of God's law for all mankind. The Apostle Paul, writing of the Gentiles who did not receive the Mosaic law, states that 'what the law requires is written on their hearts' 

Freedom of conscience is not a minor or peripheral issue. It goes to the heart of medical practice as a moral activity. Current UK law and professional guidelines respect the right of doctors to refuse to engage in certain procedures to which they have a conscientious objection.

The right of conscience helps to preserve the moral integrity of the individual clinician, preserves the distinctive characteristics and reputation of medicine as a profession, acts as a safeguard against coercive state power, and provides protection from discrimination for those with minority ethical beliefs.

It is worth fighting for.

Sources – AAPLOG and CMF Files 

Might the large disparity in premature birth rates between black and white women be partly explained by abortion?

Prematurity is associated with a wide variety of health risks. In the UK, 7.8% of babies are born prematurely (60,000 per year) and this number is on the rise. 

The total cost of preterm birth to NHS is £2.9 billion a year, equivalent to that of smoking, alcohol and obesity. 

Reducing the rate of preterm birth even by a small amount will therefore have a significant impact on reducing this cost.

It is a well-established fact that, both in the US and the UK, black women have preterm birth rates of 15–18%, more than double than that of the white population. But although we know a lot about the causes of prematurity this specific disparity is as yet unexplained.

If you search on pub med you will find a whole host of articles looking at possible explanations. But research attributing the link to factors as diverse as infection, inter-pregnancy interval, nutrient deficiency and inequality remains inconclusive.

Might abortion perhaps play a role?

According the 2013 abortion statistics for England and Wales, published just last week, ‘Black or black British people’ only make up 3.3 per cent of the population but accounted for 9 per cent of abortions.

Furthermore, the percentage of women having an abortion in 2013 who had one or more previous abortions also varied by ethnic group. 49% of Black women having abortions in 2013 had previously had an abortion compared with 36% of White women.

The link between abortion and premature birth is well established but largely underplayed or denied by British authorities including the Royal College of Obstetricians and Gynaecologists (RCOG).

Most doctors and women are therefore not aware of it.

I have previously summarised the medical evidence for the link on this blog and have also highlighted major Finnish, Danish and Scottish studies confirming it.

Last year I drew attention to a paper from North Carolina which has reviewed all the available data on the association between abortion and preterm birth.

In fact there are now over 130 scientific articles reporting on the link between abortion and preterm birth in the subsequent pregnancy and two well-designed meta-analyses now demonstrate that just one prior abortion increases by 36% the risk for a future ‘preterm’ birth and by 64% for a ‘very preterm’ birth. Two or more abortions increase the risk for a future ‘preterm’ birth by 93%.

So might the large disparity in preterm birth rates between black and white women be partly explained by the fact that black women have more abortions?

One would have thought it was an obvious avenue of research. So why isn’t anyone looking into it?

Now there’s a question. 

Scotland Yard apologises for wrongfully threatening to arrest women in prayer vigil at London abortion facility

The Metropolitan police have apologised for wrongfully threatening to arrest pro-life campaigners for holding a prayer vigil outside a London abortion facility.

Police used a draconian ‘riot law’ legislation usually employed to disperse rioters and football hooligans to force the three women to move away from the BPAS clinic in Twickenham.

Officers issued the group with Section 14 Public Order Act notices on grounds that they posed a ‘serious risk of disruption to the life of the community’.

But the Metropolitan Police later admitted its officers had made a mistake and said the ‘riot law’ should not have been used.

The protesters, members of the Good Counsel Network (GCN), said they were acting within the law and only spoke to women who are willing to talk.

Justyna Pasek, 33, said she felt like a criminal when her small team was stopped by the police.

‘We hand out leaflets to pregnant women and speak to women who want to speak to us,’ she said, adding: ‘We don’t chase after women, we don’t stop anyone from going into the clinic and we never block the gates.

 ‘We just pray all the time and hand out leaflets. But we were made to feel like criminals when the police forced us to move away from the clinic. The officers were very aggressive and I felt very harassed and mistreated by them.’

‘I thought this was a free country, but this reminds me of the communist rule I used to live under when I was a little girl in Poland.’

A Scotland Yard spokesman said: ‘We have acknowledged the concerns raised by those affected by our actions. Following a review of the decisions taken on those days, we now acknowledge that the implementation of Section 14 notices under the Public Order Act 1986 was incorrect.’

It is bitterly ironic, at a time when doctors involved in sex selection abortions or illegal pre-signing are not being prosecuted, that police are instead misusing the law to intimidate peaceful protesters.

It is reminder that police can themselves be affected by societal prejudice in their judgements and of how commonplace abortion has become.

It seems not matter what the law says. Whilst those who blatantly disregard the Abortion Act get off scot-free, those who protest about the injustice risk police intimidation and arrest.

There have been over eight million abortions in Britain since the passing of the Abortion Act in 1967. 

But during this time there has been only one successful prosecution for illegal abortion, in spite of the fact that 98% of abortions are technically illegal.

This latest incident poses a challenge for Christians to get more involved in prayer over this matter, even in the face of the threat of wrongful arrest.

‘Rescue those being led away to death; hold back those staggering toward slaughter.’ (Proverbs 24:11)