Doctors who won't prescribe contraception to unmarried women or provide sex-change operations risk being struck off, says GMC

Doctors who refuse to prescribe contraceptives to unmarried women or refuse to provide sex-change operations risk being struck off the medical register according to new draft guidance issued by their regulatory body.

The new draft guidance from the General Medical Council, ‘Personal beliefs and medical practice’, has been issued today and is subject to consultation. It warns that ‘serious or persistent failure’ to follow it ‘will put your registration at risk’.

The guidance recognises that ‘in some areas the law specifically entitles doctors to exercise a conscientious objection’ and opt out of ‘particular treatments or procedures’. It cites as examples ‘the right to refuse to participate in terminations of pregnancy’ and ‘participating in any activity governed by the Human Fertilisation and Embryology Act 1990’.

It also allows doctors to opt out of providing other procedures or treatments provided that they ‘make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection as you’.

In other words, they can object, but have a duty to ensure that the patient sees another doctor who does not object.

However, the GMC makes two clear exceptions to this rule, with regard to contraception and sex-change operations.

If a doctor has a conscientious objection to providing contraception per se, then he/she can do so. But he/she ‘cannot be willing to provide married women with contraception but unwilling to provide it for unmarried women. This would be a breach of our guidance…’

Similarly although doctors ‘may choose to opt out of providing a particular procedure because of (their) personal beliefs and values’, the guidance says that ‘the exception to this is gender reassignment since this procedure is only sought by a particular group of patients and cannot therefore be subject to a conscientious objection’.

The guidance claims the support of the Equality Act 2010 for these two positions.

A recent parliamentary enquiry, ‘Clearing the Ground’, concluded that ‘Christians in the UK face problems in living out their faith and these problems have been mostly caused and exacerbated by social, cultural and legal changes over the past decade.’

I have previously highlighted the fact that recent legislation, and regulations claiming to be derived from it, are being used marginalise Christian health professionals in Britain.

This new GMC draft guidance is yet another example. It is essentially a clever piece of double-speak. On the one hand it says that 'doctors should be free to practise medicine in accordance with their beliefs', but if this involves 'denying patients access to appropriate medical treatment or services' then they must 'be prepared to set aside their personal beliefs'.

The problem is that 21st century British medicine now involves practices which many doctors regard as unethical. This latest guidance by the GMC will therefore be seen by a many as a further attack on the right to practise independently in accordance with one's conscience which lies at the heart of being a true health professional.

I suspect it will also further undermine the credibility of the GMC.

A significant number of doctors do not wish to be involved in sex-change operations or prescribing contraceptives to unmarried couples and will not want to be forced to make arrangements for patients to undergo procedures or 'treatments' which they regard as unethical.

But it appears that these doctors, if this guidance emerges from this consultation unchanged, will soon be at risk of losing their licences to practise medicine.

(See CMF submission to GMC on previous draft of 'Personal Beliefs and Medical Practice')

How to protect your kids from internet pornography

I have just posted a blog on the report from a committee of MPs which makes recommendations about new measures to protect children from internet pornography.

Most of these are targeted at the ISP industry (and not a moment too soon!) but the real need is for parents to take steps themselves.

If you are interested about how practically to do it here is some advice from a Christian medical colleague (and computer whizz!) that I have gleaned today.

How to protect your kids (and yourself!)

Because of the proliferation of connectable devices having software just on a PC is inadequate - the entire home network needs internet filtering.

The best way to achieve this is for the ISP to do it. Out of the 4 main British ISPs (Virginmedia, Talktalk, BT and Sky) only Talktalk can do this at present.

The main system I use is ‘Covenant Eyes’. This is accountability software that I use with a friend. It monitors internet use and alerts your accountability partner if you are accessing inappropriate websites. Once installed it cannot be removed without your accountability partner being alerted. You probably know about this already but the website gives full details. It would be a brilliant thing to do with teenagers. Although there is little need for this if the OpenDNS service is used (see below), it has the advantage of monitoring a device whether it is used at home or elsewhere - OpenDNS only covers your home network.

Second, most mobile phone networks have the ability to turn on web filtering for smartphone use at a network account level. So as long as your kids have mobile phones on your account you can block the inappropriate use of mobile devices through the 3G network.

Third, and this is the really clever way of doing it, a home user can achieve network-wide site filtering by using a service called OpenDNS. A brief, simple explanation of what a DNS Server does can be found at the end of this post.

To set this up you have to create an account on OpenDNS.com, tell OpenDNS about the IP address your ISP has given your ADSL or cable modem, and then edit the settings in your router so you use OpenDNS's DNS Servers rather than your ISP's. They provide good instructions on how to do this, but it's a little technical. The service is free. (There is a more feature-rich service that you have to pay for but for most home networks the free bit is all you need).

As long as you keep the usernames and passwords for both your router and your OpenDNS accounts completely secret there is generally no way past this, even for your bright computer-savvy kids.

Check out www.opendns.com.

What a DNS server does (the technical stuff!)

Every networked device has a unique numerical address - an "Internet Protocol" (IP) address. It is a set of 4 numbers (between 0 and 255) separated by dots. The PC I am typing this on has the IP address "10.0.0.106". My PC at work is "172.22.255.42". When devices communicate over the network they talk to each other using these numerical IP addresses - but they are not very human-friendly! So each device also has a name - my PC is called "Saturn". At some point the IP address and the name need linking, so when I look at my network and see a PC on it called "Saturn" the software knows "Saturn" = IP address 10.0.0.106, and vice versa. This name to IP address translation is done through a database called "DNS" - "Domain Name Service". Every device has to know the address of the computers on their network that hold the DNS database (there's usually 2 - one main one and one backup). A computer holding the DNS is known as a DNS Server. With me so far? Good!

Now, this is also true on the Internet, with the condition that every device connected directly to the internet has to have a worldwide unique IP address. So the computer called "microsoft.com" (that responds when you type"www.microsoft.com" into your web browser) has the IP address "207.46.232.182" - no other computer exposed on the Internet can ever have this address. When you type "www.microsoft.com" into your browser your Internet router that connects you to the Internet realises no device inside your home network has this name so it sends out a request to your ISP's DNS servers which will respond with "the IP address you need is 207.46.232.182". Your router can then find this address on the Internet and you can see the Microsoft website. Every ISP provides all their users with the IP addresses of two DNS server so your router knows were to send the request for name to IP address translation to. For example, VirginMedia provides a primary DNS Server IP address of 194.168.4.100, and a secondary IP address of 194.168.8.100. Everyone using VirginMedia as an ISP will have these 2 IP addresses in the setup of their router so the network knows how to change website names into IP addresses.

A DNS server contains a huge database of website names and IP addresses - billions probably. Every single request to view a website that comes out of any device connected to your home network will go through the DNS server. Here comes the clever bit...

You don't have to use the DNS servers provided by your ISP. For example Google has a couple of public ones that you can use - their IP addresses are 8.8.8.8 and 8.8.4.4. Program those IP addresses into your router instead of the ones provided by your ISP and all your IP address requests will go through Google's DNS servers.

A company called "OpenDNS" provides 2 DNS server addresses for public use. They have built into them the ability to block certain website addresses from being passed back to your network. There is a massive classification database available that classifies millions and millions of websites into certain categories - hate, racist, violence, porn etc. The OpenDNS servers use this classification to allow you to filter website requests. So if I type "www.playboy.com" into my browser, VirginMedia's DNS servers would return "67.215.65.130" and off I go into the Playboy website. OpenDNS (assuming I have an account with them and have set up the filtering to block porn) will refuse to return an address and say the site is blocked. As you will now understand, any device connected to my network (smartphone, PC, laptop, PS3, XBox etc be they mine or guests in my home) will get the same response - "blocked".

MPs call for better protection of children against porn

A cross-party parliamentary has concluded that the government and internet service providers need to do more to stop children accessing pornography and websites showing extreme violence.

The inquiry called on the government to back moves for stronger filters of adult content and also recommended that the government appoint an internet safety tsar.

Their report, according to the Daily Mail, said that six out of ten children download adult material because their parents have not installed filters. The use of protective filters in homes has fallen from 49 per cent to 39 per cent in the last three years.

They concluded that parents were often outsmarted by their web-savvy children and felt unconfident in updating and downloading content filters. Many parents were ‘oblivious’ to the type of material available on the internet and were often shocked when they realised the content that children were accessing.

Claire Perry, the Tory MP who chaired the Independent Parliamentary Inquiry on Online Child Protection, said: ‘While parents should be responsible for their children’s online safety, in practice, people find it difficult to put content filters on the plethora of internet-enabled devices in their homes.It’s time that Britain’s internet service providers, who make more than £3billion a year from selling internet access services, took on more of the responsibility to keep children safe.’

The inquiry called for internet service providers to offer ‘one-click filtering’ for all devices within a year. This would block out adult content for all domestic broadband users and stop them accessing pornography on mobiles and iPads as well as PCs and laptops.

All the big four UK ISPs, BT, Sky, TalkTalk and Virgin, have agreed to offer all new subscribers the option to install parental controls.

TalkTalk is the only major UK ISP so far to have implemented a network level filtering system which offers parental controls for all devices that are connected via the home broadband service.

For those who wish to protect their children from pornography I have posted some advice on the best way of doing it from a Christian doctor colleague friend on this blog.

There is also an excellent article on a Christian approach to the issue in CMF’s journal Triple Helix. The main points are as follows:

'The ready availability of sexual images on the internet has led to an explosion in pornography use and addiction and Christians are not immune from the pressures. By offering stimulation without consequences and intimacy without responsibility, pornography brings unreal and damaging expectations into relationships. Furthermore, by encouraging unfaithful thoughts, the use of porn clearly violates God's commandments and undermines marriage. Warnings from the Old Testament prophets are chillingly relevant today. Christians need to recognise the risks of pornography, seek God's forgiveness for involvement and embrace practical measures that will help them resist the temptation to get involved.'

I was surprised to learn at a church seminar last night that the biggest users of pornography are actually men in the 35-55 age group with salaries over £45,000.

In terms of practical advice (adapted from Christian Viewpoint for Men) I’d recommend the following:

•Place the highest level of filter on your internet.
•Only view the internet in an open place.
•Find an accountability partner to discuss your progress with honestly.
•Install a programme that sends your weekly website hits to your accountability partner (Covenant Eyes is particularly recommended)

The demographic time bomb and euthanasia

I have previously warned that unless something is done to reverse current demographic trends, economic necessity, together with the ‘culture of death’ ideology which is becoming more openly accepted, may well mean that the generation that killed its children will in turn be killed by its own children.

In other words legalised abortion will lead to legalised euthanasia as a cost-saving and population-control measure.

The Political blog ‘Turtle Bay and Beyond’ reported last week on an interview with CFAM’s Susan Yoshihara on the population crisis in China.

‘Demographic trends are poised to spoil Beijing’s plans for a Chinese century,’ said Yoshihara, co-editor (along with Douglas A. Sylvia) of the book, ‘Population Decline and the Remaking of Great Power Politics.’

‘The country is aging rapidly and it is facing a contraction in its workforce sooner than anticipated. More than a quarter of the Chinese population will be older than 65 by 2050, up from 8 percent today. And the very old — those over 80 — will increase more than five times. China will see absolute population decline by the end of the next decade.’

I have previously highlighted Sunday Times columnist Minette Marin’s proposed final solution(£) for Britain’s growing number of elderly people and another article in the same paper linking euthanasia with demographic trends.

Lois Rogers (£), reporting on a joint suicide of a British couple in Australia, wrote that ‘Assisted dying is becoming more commonplace with the rise in the number of elderly people. Projections by the government suggest 11m Britons alive today can expect to reach 100.’

In the West we have a growing elderly population supported by a smaller and smaller working population – fuelled by elderly people living longer and an epidemic of abortion, infertility and small families.

These demographic changes, together with economic pressure from growing public and personal debt, and increasing pressure for a change in the law to allow euthanasia, produce a toxic cocktail indeed.

Marin’s solution is euthanasia – ie. continue with our consumptive lifestyles and small families and kill off the elderly.

But there is an alternative.

Britain’s problem is debt. And we are in debt because as a nation and as individuals we have lived beyond our means. Our personal debt is £1,500 billion and our public debt will reach that figure by 2014 (yes its getting bigger in spite of the Coalition’s plan to ‘cut the deficit’. All we are doing is borrowing less each year than we did in the previous one)

So our total debt will be around £3,000 billion (£3 trillion) in just three years’ time.

Let’s put that figure in a global context.

The world’s poorest billion people earn less than £1 per day (£360 per year) and the next poorest two billion earn less than £2 (£720) so the total income for the poorest half of the world’s population is £1,800 billion per year – just over half our nation’s debt.

And yet ironically, it is rich people in the affluent West, rather than the poor in the Global South, who say they can’t afford to look after their dependents and are clamouring for euthanasia.

The real answer is not euthanasia. The real answer is in our grasp, but it requires a completely different mindset to that which has led us, in our reckless pursuit of affluence and personal peace to mortgage our present, bankrupt our futures, and see those who rely on us as a burden rather than a privileged responsibility.

We need instead, as a society, to stop killing our children, build up our families, live more simply, give more generously and focus our priorities on providing for our dependents, especially the older generation which fought for our freedom in two world wars, provided for our health, education and welfare, and left us the legacy of wealth, comfort, peace and security which we have squandered and taken for granted.

We are at a crossroads surveying two possible future societies.

In the first, the independence and autonomy of the individual rule absolute and the weak elderly take an ‘honorable exit’ so as not to burden the young and virile.

The other, by contrast, is an inter-dependent world, where each person, regardless of their level of infirmity or disability is loved, cherished, valued and given the very best level of care that money can buy; one where the strong make sacrifices for the weak, where resources are spent on those who most need them, where what I have is yours if you need it, and vice versa.

Which society would you prefer to live in?

The demographic time-bomb is a challenge but it does not lead me to despair.

Rather it makes me want to live more simply, give more, save more, serve more, love more, value those who are dependent, both old and young, more deeply and work harder to provide good care for all.

The solution is easily within our grasp, but we must have the will to embrace it.

Huge increase in assisted suicide cases in Oregon and Switzerland sounds strong warning to Britain

There has been a massive increase in cases of assisted suicide in both Oregon and Switzerland over recent years according to the latest figures.

The Oregon ‘Death with Dignity Act’ allows terminally-ill Oregonians ‘to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose’.

It 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.

The latest figures show that cases of assisted suicide have gone from 16 in 1998 to 71 in 2011, an increase of 450% (see chart).

The US state of Oregon legalised assisted suicide in 1997 following a referendum. Thus far over 100 attempts to get other US state parliaments to change their laws have failed and only the state of Washington has followed suit, again on the basis of a referendum.

Switzerland has seen a 700% increase in assisted suicides over the same period. Swiss authorities have recorded a steady rise of assisted suicides in recent years, from 43 in 1998 to 297 in 2009. Earlier figures are not available, even though assisted suicide has been legal in Switzerland since 1942.

These figures include only Swiss nationals and not the growing number of people from abroad who are making use of facilities like Dignitas.

The experience of both countries demonstrates that when assisted suicide is legalised there will inevitably be incremental extension.

A major factor fuelling this increase is suicide contagion - the so-called Werther effect. This is particularly dangerous when assisted suicides are backed by celebrities as they are here and given high media profile as they are frequently by the BBC.

The Oregon and Swiss numbers may not seem large to some but we need to remember that Oregon and Switzerland have small populations relative to the UK.

Back in 2006 the House of Lords calculated that with an Oregon-type law we would have about 650 cases of assisted suicide a year in Britain. But given the increase of numbers in Oregon the UK equivalent would now be well over 1,000. Currently assisted suicide is illegal here and we see only 15-20 Britons going to Dignitas in Switzerland to die each year.

However, later this year we will see renewed attempts to change the law in this country.

Margo Macdonald is planning to present a bill based on the Oregon model to the Scottish Parliament and the pressure group Dignity in Dying (formerly the Voluntary Euthanasia) is planning a mass lobby of the Westminster Parliament on 4 July in support of a new bill they plan to introduce by means of their parliamentary wing, the All Party Group on ‘Choice at the End of Life’.

We should learn from the Oregon and Swiss experience and be resisting these moves.

Any change in the law to allow assisted suicide (a form of euthanasia) would inevitably place pressure on vulnerable people to end their lives so as not to be a burden on others and these pressures would be particularly acutely felt at a time of economic recession when many families are struggling to make ends meet and health budgets are being slashed.

And once legalised there will inevitably be incremental extension as we have seen in Oregon and Switzerland. Legalisation leads to normalisation.

Let’s not go there.

How British society marginalises Christian health professionals

Earlier this year Christians in Parliament, an official All-Party Parliamentary Group (APPG), chaired by Gary Streeter MP, launched an inquiry called ‘Clearing the Ground’, which was tasked with considering the question: ‘Are Christians marginalised in the UK?’

The inquiry was facilitated by the Evangelical Alliance and the report was published in February 2012. (You can read the executive summary here)

The inquiry’s main conclusion was that ‘Christians in the UK face problems in living out their faith and these problems have been mostly caused and exacerbated by social, cultural and legal changes over the past decade.’

I gave both written and oral evidence to the inquiry and part of my oral evidence is quoted in the report. Unfortunately my written evidence was not acknowledged or included, I suspect due to an administrative error but it is available on the CMF website.

I have pasted below the answers I gave to two key questions in the report.

What key issues face Christians in public life today?

With the rise of the secular humanism and, in particular, the new atheism, there is in British society generally a loss of historically held belief in the existence of a transcendent communicating God incarnate in Jesus Christ, in biblical authority and in biblical ethics, which is combined with an active agenda to impose an alternative secular world view through our laws, institutions and media. This is leading to an erosion of laws that were based on a biblical worldview and to some loss of Christian freedoms.

For Christian doctors the major impact has been felt in the areas of sharing Christian faith (evangelism), expressing beliefs about Christian doctrine or ethics or manifesting Christian behaviour especially in the areas of prayer and/or sexual and life ethics.

Conflicts arise when Christians are:

1. Prevented from sharing, expressing or manifesting their beliefs
2. Required to perform tasks or conform in ways which go against their beliefs
3. Excluded from consultation or decision-making or advisory roles because of their beliefs.
4. Prevented from meeting on public or institutional premises for worship/prayer/teaching/events.

These are the key issues in public life not because they are more important than other areas of Christian faith and practice but because they are the specific areas where recent laws, or regulations/guidelines based on those laws, have impacted.

The main laws implicated are:

1. Employment Equality regulations on religion and belief and sexual orientation (2003)
2. Equality Acts 2006 and 2010
3. Section 5 of the Public Order Act (less applicable to Christian doctors)
4. The Abortion Act 1967 and Mental Capacity Act 2005 also have some influence through interpretation by official bodies about the scope and application of their provision for conscientious objection.

Guidelines based on these laws by the Department of Health, NHS trusts and professional bodies like the GMC and BMA also have an impact on how legal policy is interpreted and implemented. Examples of such guidelines include:

1. Religion or belief: a practical guide for the NHS (Department of Health, January 2009)
2. Sexual orientation: a practical guide for the NHS (Department of Health, February 2009)
3. Personal beliefs and medical practice - guidance for doctors (GMC, March 2008)
4. The law and ethics of abortion (BMA, November 2007)
5. Treatment and care towards the end of life: good practice in decision making (GMC, July 2010)

Which specific aspects of law, or its interpretation, do you consider unfair?

1. The Employment Equality regulations on religion and belief and sexual orientation (2003) and the Equality Acts 2006 and 2010
A. The requirement for Christian organisations with a Christian ethos to employ people who either do not hold to Christian faith
B. The definition of harassment is too broad and too open for misinterpretation or perverse action: ‘unwanted conduct which takes place with the purpose or effect of violating the dignity of a person and of creating an intimidating, hostile, degrading or humiliating environment.’

2. The Department of Health practical guides on ‘religion and belief’ and ‘sexual orientation’ over-interpret the law with respect to evangelism and expression of Christian belief about sexuality and have created an environment where normal Christian behaviour is inappropriately open to censure or discipline. These documents were not made open to full consultation or review when implemented but are being used by NHS employers. Both these documents should be reviewed and opened to consultation.Examples of problematic clauses are given below.

3. The implementation of the Abortion Act 1967 and Mental Capacity Act 2005 conscientious objection clauses needs to be kept under regular review to ensure that Christians are not being unlawfully discriminated against.

Examples of problematic clauses in Department of Health documents which can be used to discriminate against Christians:

Members of some religions... are expected to preach and to try to convert other people. In a workplace environment this can cause many problems, as non-religious people and those from other religions or beliefs could feel harassed and intimidated by this behaviour… To avoid misunderstandings and complaints on this issue, it should be made clear to everyone from the first day of training and/or employment, and regularly restated, that such behaviour, notwithstanding religious beliefs, could be construed as harassment under the disciplinary and grievance procedures.(Department of Health, Religion and Belief)

Any NHS employer faced with an employee who by virtue of religion or belief refuses to work with or treat a lesbian, gay or bisexual person, or who makes homophobic comments or preaches against being lesbian, gay or bisexual, should refer to its anti-discrimination and bullying and harassment policies and procedures, which should already be in place… If the conduct has the purpose or effect of violating a person’s dignity, or creating an intimidating environment, and it is reasonable for the complainant to take offence, then it is harassment. (People) should not be subjected to discrimination or harassment on any grounds whatsoever. It should be made clear that such behaviour is unlawful and could result in legal proceedings being brought. (Department of Health, Sexual Orientation)

Changing views about sexual orientation - 'A more fluid approach'

Many people believe that homosexual and heterosexual are distinct biological categories like race – unchangeable, biologically fixed and genetically determined. It is on the basis of this view that the gay rights lobby and sections of the media argue that 'homophobia' is a form of discrimination akin to racism.

But this view is being increasingly challenged, not least by gay rights activists themselves. In a recent Huffington Post article that has generated a huge amount of attention, 'Future Sex: Beyond Gay and Straight', (1) Peter Tatchell affirms both the spectrum and also the fluidity of sexual attraction.

Regarding bisexuality he says: 'We already know, thanks to a host of sex surveys, that bisexuality is a fact of life and that even in narrow-minded, homophobic cultures, many people have a sexuality that is, to varying degrees, capable of both heterosexual and homosexual attraction.'

Then he challenges the traditional view that gay and straight are distinct categories:

'Research by Dr Alfred Kinsey in the USA during the 1940s was the first major statistical evidence that gay and straight are not watertight, irreconcilable and mutually exclusive sexual orientations. He found that human sexuality is, in fact, a continuum of desires and behaviours, ranging from exclusive heterosexuality to exclusive homosexuality. A substantial proportion of the population shares an amalgam of same-sex and opposite-sex feelings - even if they do not act on them.'

Tatchell, however, grossly inflates the true incidence of exclusive homosexuality. The best evidence (2) (3) (4) suggests that only a very small percentage of men (1-2%) and women (0.5-1.5%) experience exclusive same-sex attraction throughout their life course. But bisexuality appears to be more prevalent than exclusive homosexuality.

What is the relative ratio of bisexuality to exclusive homosexuality? For each man who is 'completely homosexual' (Kinsey score 6) there are three with varying shades of bisexuality; but for women the ratio is 1:16. (5)

Sexual attractions are therefore best understood as lying on a spectrum rather than in terms of a simple dichotomous binary categorisation, and mixed patterns of sexual desire, including attraction to both sexes at the same time, appear to be more common than exclusive same sex attraction, especially among women.

But the concept of a spectrum of sexuality–known for decades, but often ignored–also calls into question simplistic analogies between sexual orientation and race.

Conflating sexual orientation and race is not really comparing like with like. It is what is called a 'category error'.

References

1. Huffington Post; 10 January 2012
2. Dickson N, et al. Same-Sex Attraction in a Birth Cohort: Prevalence and Persistence in Early Adulthood. Soc-Sci and Med 2003; 56 (8):1607-15.
3. Savin-Williams RC, and Ream GL. Prevalence and Stability of Sexual Orientation Components During Adolescence and Young Adulthood. Arch Sex Behav 2007;36:385-94.
4. Laumann EO, et al. The Social Organization of Sexuality: Sexual Practices in the United States. Chicago: University of Chicago Press, 1994.

From the Spring 2012 edition of Triple Helix