The vast majority of the members of Lord Falconer’s new commission on assisted dying are well-known names in the pro-legalisation lobby

Today I went by invitation to the launch of Lord Falconer’s Commission on ‘Assisted Dying’ at the London headquarters of think-tank Demos.

He confirmed that the commission has been set up with funding provided by Bernard Lewis and celebrity novelist Terry Pratchett (pictured), a Patron of Dignity in Dying and advocate of legalizing assisted suicide for people with dementia. He also confirmed that Dignity in Dying itself (formerly the Voluntary Euthanasia Society) had made the arrangements for its formation.

He insisted however that his inquiry into assisted dying in the UK would be ‘an objective, dispassionate and authoritative analysis of the issues’.

The aims of the commission are to consider ‘what system, if any, should exist to allow people to be helped to die and whether changes in the law should be introduced’. He confirmed at the meeting, in answer to a question, that the commission would deal only with assisted suicide and not with euthanasia.

In an attempt to answer critics (including me) who have raised concerns over the commission's transparency, independence and objectivity, he said: ‘We will evaluate all the evidence we hear on a fair basis, judge us at the end by the quality of our report.’

Today we learnt the names of all twelve members of the commission. It was no surprise to learn that the majority (nine) are known already by those who work in this field to support a change in the law to allow assisted suicide. Most have actively worked towards this end in the past. None of the remaining three are known to oppose it.

I asked the Demos Director about how the members of the commission were selected and she confirmed that they had been effectively handpicked by Lord Falconer himself. She didn't go as far as saying they had been interviewed by DID CEO Sarah Wootton and Terry Pratchett himself (and I didn't ask), but that might be a good line of questioning for journalists.

Falconer has included people who are prominent in their respective professions and have impressive sounding titles that bring a degree of gravitas to the proceedings but he has kept very quiet about their personal views. This will effectively fool most casual observers and media people not that familiar with the broader cast in this whole debate.

He has, for the same reason, avoided using any of DID's official patrons, seemingly in order to create the impression that this is a group of 'independent' people not linked with DID (when in fact most of them are), or who at very least, in the main, share Falconer's own views.

So who are the twelve members of this grand jury?

All four Parliamentarians on the commission have either made their pro-assisted dying views public or voted for legalisation in the Houses of Parliament.

Lord Falconer himself, who will chair the commission, has campaigned long and hard on this issue and attempted to legalise assisted suicide via an amendment to the Coroners and Justice Bill in 2009.

Baroness Elaine Murphy of Aldgate and Baroness Young of Old Scone share Falconer’s views – Young supporting Falconer’s amendment on 7 July 2009 and Murphy voting for Lord Joffe’s Assisted Dying Bill on 12 May 2006. Penny Mordaunt MP has not had an opportunity to vote on the issue but recently made her own support for legalisation very clear.

While all the major disability rights organisations in the UK (RADAR, UKDPC, NCIL, SCOPE, Not Dead Yet) oppose a change in the law Stephen Duckworth, Chief Executive of Disability Matters Limited, is one of those rare disabled people actually to back legalisation. 'Disability Matters' sounds grandiose but it is in reality just a private business - and judging by the current accessibility of its website, may not be doing that much at present. Duckworth happens to be disabled (hence his usefulness to Falconer) but he seems not to represent anyone but himself. Hardly surprising then that he is included on this panel.

Whilst 95% of Palliative Medicine Specialists are opposed to a change in the law Lord Falconer has managed again to find two who buck that trend in Professor Sam Ahmedzai, Professor of Palliative Medicine in Sheffield, and Dr Carole Dacombe, Medical Director, St Peter’s Hospice.

Earlier this year I was involved in a two hour dialogue in Oxford (over dinner) with Lord Ian Blair of Boughton, former Commissioner of the Metropolitan Police, and I can assure you that he too firmly supports a change in the law.

Sir Graeme Catto, former President of the General Medical Council, recently spoke in support of the new organisation seeking to promote the legalisation of ‘assisted dying’, Health Professionals for Change.

So who does that leave? Just three whose views we (or at least I) do not already know but may be able to guess: Dame Denise Platt, Member of the Committee on Standards in Public Life; Celia Grandison-Markey, Management Consultant for Health and Social Care in the public sector; and the Revd Canon Dr James Woodward, Anglican Priest and Canon of St George’s Chapel, Windsor.

Any information of any of these would incidentally be most welcome.

So is this an independent committee? I think not! In fact I am astounded that Demos, which is to act as secretariat, providing administrative and research support, has agreed to work with such an unbalanced group.

But I suspect that like most of the British Public, Demos was simply not aware of where these illustrious people’s personal convictions lay.

Lord Falconer, of course, is perfectly free to set up an ad hoc committee to take evidence and make recommendations to Parliament. It is a free country and he has every right to try and influence public policy.

But it is a trifle disingenuous of him to pretend that a group with such clearly settled prior convictions, might bring any impartiality or objectivity to bear on these important issues.

Further disclosures about Lord Falconer’s Commission on Assisted Dying raise more questions about transparency and independence

The Commission on 'Assisted Dying', due to be launched on Tuesday 30 November, has attracted some more attention in the press today and we are given additional information about the identities of some of the members of Lord Falconer’s ‘independent’ panel.

The Observer has today run a piece with the intriguing title ‘Assisted Suicide Law to be reviewed by Lords’. This creates the misleading impression that this commission is somehow part of the parliamentary process when it is nothing of the sort.

Instead, as we have already learnt, it is a privately organised enquiry which was the idea of campaign group ‘Dignity in Dying’ (formerly the Voluntary Euthanasia Society) and is being funded by celebrity novelist Terry Pratchett (who like Baroness Warnock backs legalising assisted suicide for people with Alzheimer’s disease).

It is true that the Commission intends to publish a report in October 2011 which it hopes will be discussed in Parliament but we need to be clear that the pro-euthanasia lobby has decided to take this ‘independent’ route because their attempts to legalise assisted suicide through the standard parliamentary processes have failed by large margins at the last two attempts (148-100 and 194-141 in the House of Lords in 2006 and 2009 respectively).

So what do we know thus far of those involved?

As noted previously, Lord Falconer, who attempted to amend the Coroners and Justice Bill in 2009 to decriminalise taking 'loved ones' to Zurich so that they could end their lives at Ludwig Minelli’s suicide facility, will chair the commission.

Another member of this 12-person ‘independent’ team is revealed today to be Penny Mordaunt MP (pictured), who ten days ago laid her cards on the table as a supporter of so-called ‘assisted dying’.

Further members include Baroness Barbara Young, the former chair of the government's health watchdog, Canon James Woodward of St George's Chapel, Windsor and Stephen Duckworth, who has campaigned on disability issues.

Baroness Young of Old Scone supported Lord Falconer’s move to decriminalise assisting with suicide in 2009 and also spoke in support of Lord Joffe's Bill in 2006. So the two ‘Lords’ on the panel who are to review the law are both already committed to legalisation.

Stephen Duckworth also supports 'assisted dying' according to a statement on the DID website and seems to have no link with any of the main disability rights organisations who oppose any change in the law such as RADAR, Not Dead Yet, UKDPC, NCIL or SCOPE.

We wait with interest to see who the other seven members are but it will be even more interesting to learn how they were selected. Were they nominated or appointed and if so by whom? Did they apply to be included and if so how did they learn about the commission’s existence and what was the selection process? Was there an interview? If so who was on the panel and how ‘independent’ were they?

I do hope that on Tuesday, when the commission is launched there will be full transparency on these questions along with full disclosure about the commission’s funding and any possible financial and ideological vested interests of those selected.

I was interested to read today in the Observer that Lord Falconer felt his 2009 amendment failed because it didn’t contain enough safeguards against abuse. It would be interesting to hear from him more specifically about which safeguards he felt were inadequate and why.

Lord Joffe’s ‘Assisted Dying for the Terminally Ill Bill’ also failed on grounds of inadequate safeguards and serious questions have been raised about whether the key safeguards currently being campaigned by Dignity in Dying are adequate (ie. ‘mentally competent’, ‘terminally ill’, ‘persistent well-informed voluntary request’, ‘suffering unbearably’). In fact whereas Joffe used a definition of 'six months to live' for 'terminally ill', Sarah Wootton, the Chief Executive of Dignity Dying, extends this to twelve months.

Baroness Young's comment on Joffe's Bill in 2006, when she supported it in her speech, is most enlightening in this context. She said, 'The Bill is a very carefully crafted set of proposals. I very much admire the thoughtful way in which the noble Lord, Lord Joffe, has conducted the drafting and his commitment to amend it to best meet the widest possible range of views. It contains multiple safeguards against misuse. It deserves our and, indeed, the Government's support.'

I note that Health Professionals for Change spokesperson Ray Tallis was heavily defeated in a debate on assisted suicide this last week in Liverpool by Lord Alton who simply outlined the deficiencies in so-called safeguards mentioned to date.

I see also that Baroness Finlay, Professor of Palliative Medicine in Cardiff, has now joined John Pring and George Pitcher in expressing misgivings about the independent nature of the commission. She says, ‘I have been told by someone close to this that they are not looking at whether (to legalise ‘assisted dying) but how. It can't be independent?’

I wonder who the ‘someone close to this’ was and what else they said. There are lots of interesting leads here for enquiring journalists to chase.

It’s going to be a fascinating week.

By focussing exclusively on HIV/AIDS, malaria and TB, Western governments and NGOs have neglected other easily treatable and curable diseases

Micah Challenge is a global coalition of Christians holding governments to account for their promise to halve extreme poverty by 2015.

It is establishing a global movement to encourage deeper Christian commitment to the poor, and to speak out to leaders to act with justice and its specific focus is the Millennium Development Goals.

The Millennium Development Goals (MDGs) are eight international development goals that all 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015.

They include eradicating extreme poverty, reducing child mortality rates, fighting disease epidemics such as AIDS, and developing a global partnership for development.

The aim of the MDGs is to encourage development by improving social and economic conditions in the world's poorest countries.

The eight MDGs were developed out of the eight chapters of the United Nations Millennium Declaration, signed in September 2000. There are eight goals with 21 targets, and a series of measurable indicators for each target.

Goal 6 is to ‘Combat HIV/AIDS, malaria, and other diseases’ and its three associated targets are as follows:

Target 6A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Target 6B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it
Target 6C: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

There are five measurable indicators for target 6C but every single one of them relates to tuberculosis and malaria and none to ‘other diseases’.

So in other words, whilst MDG 6 aims to ‘combat HIV/AIDS, malaria, and other diseases’ the exclusive focus of its associated ‘targets’ and ‘measurable indicators’ is actually HIV/AIDS, malaria and TB. To emphasise the point the United Nations webpage on the MDGs highlights just these three diseases.

The Global Fund to Fight AIDS, Tuberculosis and Malaria is an international financing institution that invests the world’s money to save lives. To date, it has committed US$19.3 billion in 144 countries to support large-scale prevention, treatment and care programs against the three diseases.

It claims as a result, through Global Fund-supported programs, to have saved 5.7 million lives, and put over 2.8 million people on AIDS treatment, 7 million people on anti TUBERCULOSIS treatment, and distributed 122 million insecticide-treated nets for MALARIA prevention.

This is perhaps not at all surprising given the support of wealthy donors and celebrities like Bill and Melinda Gates, Warren Buffet and Carla Bruni. But at the same time virtually no progress has been made on ‘other diseases’. If you don’t identify your target there is little chance of hitting it.

So what are these other diseases? And who is championing their cause?

You, like me, may have missed a series of articles in the Guardian highlighting research that is answering just this question, and giving a platform to the British doctor who has been almost a lone voice in trying to attract the world’s attention to this issue.

In 2005 David Molyneux of the Liverpool School of Tropical Medicine said ‘We urge policy makers and health economists to recognise that although HIV, TB and malaria are the most serious problems facing health planners, other diseases exist that can be addressed at realistic cost with effective interventions. Controlling Africa's neglected diseases is one of the more convincing ways to make poverty history.’

As it seems that no one has listened he has now said it again.

The neglected diseases, which include schistosomiasis, river blindness, ascariasis, elephantiasis and trachoma, affect more than 750 million people and kill at least 500,000 every year.

Treating all of these illnesses with a cocktail of four readily available drugs would cost less than 50 cents (28p) a person a year. Furthermore dealing with the forgotten diseases would reduce susceptibility to malaria and help to make socio-economic improvements for those in poverty, as well as save lives.

Molyneux and his fellow researchers are not saying that we should turn our back on HIV/AIDS, TB and Malaria. Far from it! What he is saying is that they must not be our exclusive focus:

‘We urge policy makers and health economists to recognise that although HIV, TB and malaria are the most serious problems facing health planners, other diseases exist that can be addressed at realistic cost with effective interventions. Controlling Africa's neglected diseases is one of the more convincing ways to make poverty history.’

Reaching everyone in Africa who needed treating would cost $200m a year, a mere fraction of the $15bn a year being spent on malaria, HIV and TB.

However, the plight of these people is being neglected because resources are being monopolised in developing countries by HIV, malaria and TB – even though these diseases infect a much smaller fraction of their populations.

These ‘other diseases’ are being missed because of distorted health policy goals.

‘This is not the fault of pharmaceutical companies,’ says Molyneux. ‘They have made available billions of doses of key drugs. Our problem is that we are not providing the impetus or the means for getting these drugs to disease sufferers. People at policy level think that only malaria, TB and HIV exist in the third world. This is not true. Neglected tropical diseases as a whole – like sleeping sickness or bilharzia – cause more of a burden than these big-name diseases but are being ignored.’

Most major pharmaceutical companies have pledged to provide, at no cost, billions of doses of the drugs needed to combat these diseases. But many G8 governments have failed to provide the means or impetus to get those drugs to the people who need them, a failure which Molyneux says is a major one.

‘If we can't deliver free drugs to poor people, I don't think there is much else we can do in international health’, he said.

Matthew’s Gospel tells (4:23) us that ‘Jesus went throughout Galilee, teaching in their synagogues, proclaiming the good news of the kingdom, and healing every disease and sickness among the people.’

Surely if Jesus himself didn’t focus on just some diseases, but dealt with all, then as his people we must do the same.

I pray that it will not be said of us as a generation of Christian doctors, that whilst making an impact on HIV/AIDS, TB and Malaria we turned a blind eye to ‘other diseases’ like schistosomiasis, river blindness, ascariasis, elephantiasis and trachoma.

The neglected diseases (with numbers affected in sub-Saharan Africa)

Ascariasis Most common human worm infection (173 million)
Schistosomiasis Also called bilharzia. Flatworm infection (166 million)
Elephantiasis Worm infection of lymph system (46 million)
Trachoma Leading infectious cause of preventable blindness (33 million)
River blindness Parasite. Symptoms include eye lesions (18 million)

Serious questions raised about status and independence of new Commission on ‘Assisted Dying’

The British Medical Journal (BMJ) last week ran a story about a new Commission on ‘Assisted Dying’ that is due to launch officially on Tuesday 30 November in London.

Demos, which is hosting the commission, describes itself on its website as ‘a think-tank focused on power and politics’ and gives the following information about the launch

‘Lord Falconer (pictured), Chair of the Commission, will make a keynote speech setting out the aims of the Commission on Assisted Dying and launching a public call for evidence.

Lord Falconer's speech will be followed by a Q&A chaired by Kitty Ussher, Director of Demos. Attendees will have the opportunity to meet members of the Commission and refreshments will be provided.

The Commission will look at the issue of assisted dying. It will consider what system, if any, should exist to allow people to be assisted to die, and whether any changes in the law should be introduced.

The Commission will run from 30 November 2010 to September 2011, with a report launched in October 2011. The Commission will act entirely independently and will be solely responsible for its conclusions.’

The BMJ reports that the commission will consist of twelve people and says that the other eleven include ‘ethicists, doctors, lawyers, and law enforcement professionals’. Their names will not be announced until the commission is launched.

Lord Falconer told the BMJ that the idea came from Dignity in Dying (formerly the Voluntary Euthanasia Society), which raised the money for the commission from the best selling novelist Terry Pratchett, who has Alzheimer’s disease, and from businessman Bernard Lewis.

The fact that an ‘independent’ commission on ‘assisted dying’ is to be chaired by a peer who just last year tried to relax the law on assisted suicide, is being funded by a celebrity novelist who is passionately pushing for a change in the law and was dreamt up by a leading campaign group will certainly raise eyebrows.

The Commission has understandably already attracted international media interest along with critical comment.

Both George Pitcher writing in the Daily Telegraph and and John Pring of the Disability News Service writing for the Federation of Disabled People have raised questions about both its status and independence.

Pring quotes Baroness [Jane] Campbell, a leading disabled campaigner against legalising assisted suicide, who said that at this stage – before the full make-up of the commission was known – it ‘does not look in the least independent’.

She added: ‘Demos may make all the claims of independence it likes, but if the commissioners and funders are heavily weighted towards those who support assisted suicide then the manner with which they will look at the evidence will be seen through this prism.’

Baroness Campbell said she was particularly keen to discover whether the commission would involve ‘knowledgeable disabled people with the experience of severe impairment’.

These are all serious questions which require serious answers. One hopes that these answers will be forthcoming next Tuesday amidst the media hype that will almost certainly accompany the launch.

Larry Norman's nightmare - No contemporary Christian artist writes lyrics like this

Just found Larry Norman's Nightmare on You Tube - astonishingly prophetic from the 1970s.

I've pasted the lyrics here for you. Enjoy!

last night i had that same old dream it rocked me in my sleep
and left me the impression that the sandman plays for keeps
i dreamed i was in concert on the middle of a cloud
john wayne and billy graham were giving breath mints to the crowd
i fell through a hole in heaven i left the stage for good
and when i landed on the earth i was back in hollywood

the california earthquake it tore the land in half
while san andreas cleared her throat i heard tsunami laugh
the ground began to tremble the land began to sway
and people in the other states they were glad they'd moved away
when suddenly california just floated in the breeze
while every thing that wasn't sank down into the seas

and soon i saw atlantis rumble and rise high
and the great egg of euphrates came down out of the sky
out stepped shirley temple with guy kibbee who was dead
and that communist bill robinson whom shirley called black red
they had a marionette of harpo marx they said it was a inside joke
but when i honked his horn he came alive and these were the words he spoke

"with the continents adrift and the sun about to shift
will the ice caps drown us all or will we burn
we've polluted what we own will we reap what we have sown?
are we headed for the end or can we turn?
we've paved the forest killed the streams
burned the bridges to our dreams
the earth is bursting at the seams
and in pain of childbirth screams
as it gives life to what seems
to either be an age that gleams
or simply lays there dying
if this goes on will life survive how can it
out of the grave oh who will save our planet?"

i said i'm pleased to meet you i always thought you were a scream
he said "had you ever thought of having helen keller in your dreams?"
i said errol flynn dropped by but he tried to steal my girl
then she ran off with ronald colman said something about a new world
now i'm stuck with my own cooking hell i'm lonely can't you see
well he grabbed my leg he said exactly eighty nine words to me
count 'em

"let the proud but dying nation kiss the last generation
it's the year of the pill, age of the gland
we have landed on the moon but we'll clutter that up soon
our sense of freedom's gotten out of hand
we kill our children swap our wives
we've learned to greet a man with knives
we swallow pills in fours and fives
our cities look like crumbling hives
man does not live he just survives
we sleep till he arrives
love is a corpse we sit and watch it harden
we left it oh so long ago the garden"

the strings snapped briskly then went slack the marionette lay dead
while hoover played with the motorcade the body slumped and bled
the man who held the camera disappeared into the crowd
i said the hope of youth, fictitious truth, lays covered in a shroud
then up walked elmo lincoln and he said i beg your pardon
but we left it oh so long ago, the garden

Thomas Sydenham's advice to medical students in 1668 deserves more attention today

Thomas Sydenham, a man of deep Christian faith who many regard as the father of English medicine, said the following in his advice to medical students in 1668:

‘Whoever applies himself to medicine should seriously weigh the following considerations:

First, that he will one day have to render an account to the supreme Judge of the lives of sick persons committed to his care.

Next, whatever skill or knowledge he may, by divine favour, become possessed of, should be devoted above all things to the glory of God and the welfare of the human race.

Thirdly, he must remember that is no mean or ignoble creature that he deals with. We may ascertaining the worth of the human race since for its sake Gods’ only begotten Son became man and thereby ennobled the nature that he took upon him.

Finally the physician should bear in mind that he himself is not exempt from the common lot but is subject to the same laws of mortality and disease as his fellows and he will care for the sick with more diligence and tenderness if he remembers that he himself is their fellow sufferer’.

Death of a tea lady - the unforeseen effects of a bad management decision

When I was a general surgical registrar in Auckland, New Zealand the 'management era' was just beginning. Someone, who I expect had never worn greens and didn't know one end of a retractor from another, was examining the operating theatre budget in some office remote from the front line.

About $15,000 needed to be saved and the deed was done by one stroke in the expenditure column. The theatre tea lady was sacked. The next day a metal and glass substitute arrived and took its place in the corner of the theatre tearoom.

If a committee had studied the theatre environment for a decade in order to determine how to deal the worst blow possible to productivity, morale and efficiency for the minimal possible cost they could not have done better; because in value for money terms the theatre tea lady was the most important staff member in the department.

I expect she graduated into her low-paid, low prestige role in the health service through managing to flunk her school exams and close the door to other possible career paths. Perhaps she chose her path willingly and cheerfully.

Regardless, she loved her job and considered it a privilege and pleasure to be part of the team - and in many ways her fussing, appreciation, smiles and sheer human warmth as she dispensed cake, sandwiches and cups of tea made to personal order were part of the glue that kept morale up.

Despite her low status she had a gift for making everyone feel they were appreciated and valued. And I think that helped us in doing the best possible job. By contrast her sudden unannounced departure without a scrap of consultation just fuelled the resentment.

What the faceless bureaucrats failed to understand is that people perform best when they feel they are recognised and appreciated for the work that they do. The sacking of the tea lady was the first step in a long series of management blunders by people who in Oscar Wilde's words 'knew the price of everything and the value of nothing'.

Little things like clean on-call rooms, after hours meals for hard working staff, rubbish bins you don't have to empty yourself and tea ladies who smile and make you feel important make a huge difference to morale, self-worth and performance.

But you have to rub shoulders with those on the clinical front line to appreciate it. And that takes a special sort of manager - regrettably seen rarely in the administrative corridors of the NHS.

Jesus was that special sort of manager - entering our world at the lowest level, taking the form of servant, and bearing our burdens. We desperately need more of him.