Outrage over failure to prosecute doctors for sex selection abortions reaches new heights

It has not been an easy two weeks for Keir Starmer (pictured), the Director of Public Prosecutions (DPP).

When it emerged on 4 September that the Crown Prosecution Service, which he heads, would not be bringing charges against two doctors who had been caught authorising abortions purely on grounds of gender, the outrage was immediate.

Within hours the Health Secretary Jeremy Hunt said that sex selection abortions were ‘completely unacceptable’ and called for the Attorney General Dominic Grieve to seek an ‘urgent clarification’ about the decision.

The following day Lord Macdonald, the former DPP, described the decision as ‘very dubious’ and amounted to letting doctors ‘avoid criminal action’ because of their professional status - undermining the basic principle that ‘everyone is equal under the law’.

The CPS then made the situation worse by arguing that it was down to doctors to ‘interpret the law’ and that they had ‘wide discretion’ to assess whether a termination is legal or not. Although there was enough evidence to bring a prosecution it was not in the public interest to do so, they claimed. The matter was more appropriately a matter for the General Medical Council (GMC).

This led the GMC to distance itself from the CPS’s decision, insisting that, as a professional regulator, it should not be seen as a ‘substitute’ for the criminal justice system and is not there to ‘punish doctors’.

Emily Thornberry, Labour shadow attorney general, then wrote to the DPP to request an urgent review of the decision. She cut right to the heart of the issues at stake (full text here):

‘The GMC is a regulator and cannot bring criminal proceedings. The provisions of the Abortion Act 1967 are crystal clear. The conduct of abortions for reasons not stated in that Act is a criminal offence, not just a regulatory one. To decide not prosecute because a regulator can hear the matter instead is to disapply the law and undermine the will of Parliament.’

David Burrowes, a Tory member of the all-party parliamentary Pro-Life Group, then raised the issue in the Commons. He said: ‘There is urgent need for a statement to clarify whether the restrictions on choice in the Abortion Act are now meaningless.’

This led to the Prime Minister expressing concern in response to a parliamentary question from Tory MP Nadine Dorries.

Mr Cameron praised The Daily Telegraph for highlighting ‘this important case’ and said it was ‘absolutely right’ that the doctors could face ‘professional’ consequences.

This weekend 50 MPs supported the Health Secretary’s call for the matter to be urgently investigated.

In a letter to the Daily Telegraph they called the decision a ‘step back in the fight for gender equality’ and accused the DPP of usurping parliament’s role:

‘The decision by the CPS could lead to the conclusion that gender-specific abortion is merely a matter of professional misconduct rather than illegal. This is clearly unconstitutional as it is for Parliament to legislate to change the law, and it has occurred without recourse to Parliament. Safeguards in the 1967 Abortion Act need to be properly applied and enforced. Doctors are not above the law and the General Medical Council cannot be a substitute for the courts.’

Other critics have accused the DPP of ‘double standards’ over abortion laws and operating a policy ‘worthy of Alice in Wonderland’.

Last Friday the Christian Legal Centre said it was preparing for a private prosecution against the two doctors.

‘We are preparing for a private prosecution or judicial review, but we may do both,’ said chief executive Andrea Williams. ‘We will not let the matter go.’

I was asked to comment and said to the Telegraph that if the CPS won’t do its job then concerned citizens will step in. The CPS was giving the message that people wanting sex-selective abortions should come to Britain and that if the law is not upheld it will be increasingly flouted by unscrupulous people.

By failing to act the DPP has signalled that Britain is open for business as far as sex selection abortions are concerned. 

I can’t ever recall any issue related to abortion uniting those across the political spectrum in the way this has done. It has brought prolife activists and prochoice feminist factions together in an extraordinary way resulting in Keir Starmer attracting the wrath of all sides.

Now all the heat is on the DPP to explain fully why he has not upheld the will of parliament. We are all waiting.

67% of American doctors oppose the legalisation of physician assisted suicide

An on-line poll of readers of the New England Journal of Medicine suggests that the majority of American doctors are against physician-assisted suicide (PAS).

Based on 5,205 respondents from 72 countries, the poll showed that 67% of US readers opposed legalising PAS and a majority supported the practice in only 18 US states. Interestingly, this did not include Washington or Oregon, where PAS is already legal. Overall, 1,712 readers cast votes in the US.

The main reasons provided for opposing the practice were that it violates a doctors' oath to do no harm and that it would likely lead to the legalisation of euthanasia, a far less palatable practice. 

The survey follows the World Medical Association (WMA) reiterating its strong opposition to euthanasia. The WMA similarly opposes assisted suicide.

A 2011 study showed that doctors in the UK have opposed both euthanasia and assisted consistently over the past two decades. Researchers from Limerick, Ireland, used 16 key studies into doctors' attitudes between 1990 and 2010. The findings appeared in the journal Palliative Medicine and further confirmed the fact that those doctors who favour a change in the law, constitute a small vocal minority.

Sir Richard Thompson, past President of the Royal College of Physicians, responded to the launch of the small pressure group Healthcare Professionals for Assisted Dying in 2010, by eloquently outlining the reasons why a clear majority of the College’s members still do not support a change in the law.

The Royal College of Physicians is in good company. Other official UK doctors’ bodies opposing any change in the law to allow assisted suicide or euthanasia are the British Medical Association (BMA), the Association for Palliative Medicine (APM), the British Geriatric Society (BGS) and the Royal College of General Practitioners (RCGP).

The British Geriatric Society in 2010 issued a strong statement on assisted suicide which outlined its concerns about how a change to the law would remove protection from vulnerable elderly people. The full statement is most worthy of study by all who take an interest in this debate. 

Britain would be wise to listen to doctors and to learn from this strong international precedent when Charles Falconer and Margo Macdonald bring their bills seeking decriminalisation of PAS later this year.

Oliver Barclay (1919-2013) made an immense contribution to evangelical Christianity worldwide

Oliver Barclay, the second General Secretary of what is now known as the Universities and Colleges Christian Fellowship (UCCF), was promoted to glory this week. 

Christian Medical Fellowship (CMF), for which I work, grew out of IVF/UCCF in 1949 and was founded by Oliver’s immediate predecessor Douglas Johnson (DJ), who features in this obituary abridged from the UCCF website.

Both Oliver and Douglas made an immense contribution to the growth of evangelical Christianity worldwide.

Oliver Barclay, a scion of the banking family and second General Secretary of IVF/UCCF, died at his home in Leicester yesterday, 12 September 2013, aged 94.

He was born in Kobe, Japan, on 22 February 1919, the son of Joseph Gurney Barclay (who served with what is now the Church Mission Society). His great grandfather was the MP Thomas Fowell Buxton who campaigned with William Wilberforce as part of the influential Clapham Sect.

Oliver first joined the small IVF team in 1945, having completed a doctorate in zoology.  His original hope was to teach in one of China’s newer universities, but Douglas Johnson, IVF founding General Secretary (always known as DJ), persuaded him to defer his departure by two years. It soon became clear that the universities of Britain and Ireland would instead be his life’s work.

Oliver Barclay served for two years as a wartime President of the Cambridge Inter-Collegiate Christian Union (CICCU) and as Chairman of the students’ national IVF Executive Committee.  From his days in Trinity College, Cambridge, he formed a lifelong friendship with John Stott, also at Trinity, and two years his junior. Both men would serve as lifetime Honorary Vice-Presidents of the CICCU.

As Chair of the student national IVF Executive, Oliver was privy to DJ’s plans that the IVF should found a Centre for Biblical Research in a university town, to strengthen the roots of the church in the then very liberal Theology faculties of the universities. What would soon become Tyndale House, Cambridge (secured in 1944 and opened in 1945) had originally belonged to a member of the Barclay family. It now hosts one of the finest libraries for biblical research in the world.

In 1953, Oliver became the first IVF Universities Secretary, supporting the IVF travelling secretaries [now UCCF staff workers] around the four nations. The liberal hold in the university theology faculties, and in the churches, created much opposition to evangelical influences among students.

In 1964 Oliver Barclay succeeded Douglas Johnson as IVF General Secretary. This was the same year his first wife, Dorothy, a consultant surgeon at the Royal Free Hospital (whom he had married in 1949) died of cancer, leaving four children. The following year, Oliver married Daisy Hickey, a family friend.

Oliver Barclay steered the Inter-Varsity Fellowship through its own significant expansion to engage with the times, as new universities and colleges were founded, and as a surge of change swept through societal norms.  In 1975 the movement’s name was changed to the Universities and Colleges Christian Fellowship (UCCF) to reflect the growing work in the polytechnics and colleges of education. Its publishing wing, by then known as Inter-Varsity Press (IVP), was the UK’s leading evangelical publishing house.

Oliver Barclay urged clear-thinking evangelical graduates to consider two major directions: to pursue an academic career; or if ordained to apply for vacant churches in university towns.  Gradually the tide of liberalism began to turn. Oliver was succeeded in 1980 by Robin Wells under whom from the mid-late 1980s the regional teams would be formed, opening the way for the appointment, under Bob Horn’s leadership, of the first relay workers.

In retirement, Dr Barclay continued to serve on the IVP long-range planning group, and was instrumental in the founding of the UCCF Research Council to oversee the work of Tyndale House in Cambridge and the new Whitefield Institute in Oxford. He was co-founder in 1989 of the journal Science and Christian Belief, joint organ of the Victoria Institute and of Christians in Science.

Oliver served on the Executive Committee of the International Fellowship of Evangelical Students (IFES) from 1959-1983, and as its chair from 1971-79. He served as an Honorary Vice-President from 1983-91, and was always particularly thrilled to see its pioneering work pass into the hands of national leaders. This global movement now has presence in over 150 nations.

Oliver Barclay wrote several books including Evangelicalism in Britain 1935-1995 (IVP, 1997) and in the 1980s he edited a book series entitled When Christians Disagree. He had no formal theological training but developed in himself – and cultivated in his staff – the ability to ‘think theologically’. He read through Calvin’s Institutes each year and prayed daily for a deeper understanding of the meaning of the death of Christ. He never lost sight of his dual task, to strengthen a witness to Christ both in the student world and among faculty.

We thank God for Oliver Barclay’s tenacity and far-sightedness, his shrewd judgment and his passion for the gospel; and we commend his widow Daisy and his four children to your prayers.

UK decision to trial three parent embryos for mitochondrial disease ‘both premature and ill-conceived’ (Nature Magazine)

Christian Medical Fellowship has recently published a paper on ‘three parent embryos for mitochondrial disease’ which was strongly critical of this new technology on both theological and scientific grounds. 

This followed submissions that we made on the issue to both the Human Fertilisation and Embryology Authority (HFEA) and the Nuffield Council.

I have also argued on this blog that the technique involved is unsafe, unethical and unnecessary (see here, here, here and here).

I was therefore most interested to see these same views expressed this week an article in Nature arguing that the UK’s decision to trial the technique is ‘both premature and ill-conceived’.

Marcy Darnovsky (pictured) is executive director of the Center for Genetics and Society in Berkeley, California. In an article titled ‘A slippery slope to germline modification’ she points out that ‘those opposed to green-lighting mitochondrial replacement have been described in some quarters as religious objectors, against all types of IVF’.

However, she says, ‘many secular and actively pro-choice scientists, bioethi­cists and women’s-health advocates have voiced grave and detailed concerns about the safety and utility of mitochondrial replacement, and about authorizing the intentional genetic modification of children and their descendants.’

Were the United Kingdom to grant a regulatory go-ahead later this year, she argues, it would unilaterally cross ‘a legal and ethical line’ observed by the entire international community that ‘genetic-engineering tools’ should not be used ‘to modify gametes or early embryos and so manipulate the characteristics of future children’.

Darnovsky is very clear that ‘mitochondrial-replacement procedures would constitute ger­mline modification’.

She calls claims that such therapy would not affect a person’s identity ‘scientifically dubious’  and warns that ‘the permissive record of the UK regulatory authorities’ raises the prospect that inheritable mitochondrial changes would be used as a ‘door-opening wedge towards full-out germline manipulation, putting a high-tech eugenic social dynamic into play’.

To the claim that mitochondrial techniques would save lives, she points out that ‘these women have much safer alternatives, including pre-implantation genetic diagnosis and the use of third-party eggs with conventional IVF’.

She questions the HFEA’s claims that 1 in 200 children is born each year with a form of mitochondrial disease and the media’s uncritical acceptance of this figure, pointing out that the number is ‘more like 1 in 5,000’ (R. H. Haas et al. Pediatrics 120;1326–1333; 2007).

In addition she notes that among that much smaller group, a significant majority of cases involve mutations in nuclear as well as in mito­chondrial DNA, and so could not be helped by mitochondrial replacement.

Safety, she adds is ‘unproven’ and the results of animal trials are ‘far from reassuring’. Her overall assessment?

‘The question raised by these proposals is whether a risky technique, which would at best benefit a small number of women, justifies shred­ding a global agreement with profound significance for the human future. We need a moratorium on procedures based on human germline modification while that question is widely and fairly considered.’

Genuine concerns about this new mitochondrial technology have been swept aside in Britain in the headlong rush to push the scientific boundaries. But in many countries around and the world, and by commentators from both secular and faith based scientific backgrounds, Britain is viewed as rogue state in this area of research.

Coronation Street must handle assisted suicide story with great sensitivity and care

The BBC has reported this week that the ITV Soap ‘Coronation Street’ is to run a story on assisted suicide centred on the character Hayley Cropper (pictured).

Hayley, the first transgender character in a British soap, has been diagnosed with inoperable pancreatic cancer and the show has revealed that as her health deteriorates she will decide she wants to take her own life.

Cancer of the pancreas is not uncommon:  7,065 people in England and Wales died from the disease in 2010.

However, the overwhelming majority of those with pancreatic cancer, or in fact any other physical disease or disability for that matter, do not want assisted suicide or euthanasia but rather good care and support.

So this in itself means that Coronation Street is in great danger of normalising an occurrence that is actually very rare indeed.

It is a widely held misconception that people with terminal illnesses or disabilities are more likely than those in the general population to want to end their lives.

In fact suicidal thinking is far more likely related to feelings of hopelessness or worthlessness - existential or spiritual factors that may accompany illness - rather than physical symptoms which can in the main be effectively controlled.

90% of those who commit suicide suffer from some form of mental illness including depression, bipolar disorder, borderline personality disorder and alcohol or drug misuse.

American psychologist Thomas Joiner, has said that the three main factors causing someone to turn to suicide are:

• a perception (usually mistaken) that they are alone in the world and that no one really cares about them
• a feeling (again, usually mistaken) that they are a burden on others and that people would be better off if they were dead
• fearlessness towards pain and death

It is when these factors accompany illness that people might begin to find the prospect of euthanasia or assisted suicide appealing. But then our response, as with any suicidal person, should be to address these issues, not to reach for the euthanasia needle.

It was for these reasons that when Emmerdale, another TV Soap, ran an assisted suicide plot in 2011, the programme was not surprisingly criticised by disability rights groups for misrepresenting the lives and attitudes of sick and disabled people. 

As I have previously commented however, Emmerdale did eventually take a realistic view about the huge ramifications for the lives and relationships of those left behind after an assisted suicide and showed something of the huge emotional and spiritual fall out for those involved.

The way the media handles suicide is incredibly important – as it may have the effect of either increasing suicides or preventing them – the Werther and Papageno effects respectively.

The ‘Werther effect’ refers to ‘suicide contagion’ or ‘copycat suicides’ resulting from inappropriate media coverage of suicide.

However a recent paper in the British Medical Journal, ‘Papageno vs Werther Effect’, has demonstrated that some media coverage of suicide actually leads to a decrease rather than an increase in suicide rates.

‘Newspaper items accounting for (a decrease) form a distinct non-sensationalist class of suicide reporting. They follow the recommendations of the World Health Organization in reporting suicide—for example, avoiding terms such as suicide epidemic. Our findings suggest that media reports on individual mastery of suicidal crises are highly relevant in preventing suicide.’

In other words, media stories about how people coped positively with suicidal feelings actually lead to a decrease in levels of suicide in the general population – the ‘Papageno effect’.

The BBC, which has been justifiably called a ‘cheerleader for assisted suicide’ for portraying assisted suicide in a positive light, could learn some lessons from Emmerdale.

Let’s hope that ITV will too and that this new story in Coronation Street will not act as a propaganda vehicle for the pro-euthanasia movement and in the process push more vulnerable people over the edge by making suicide seem like an attractive answer to life’s problems. 

While soaps should not avoid controversial subject matters, it is crucially important that this particular issue is presented in a sensitive way and handled with great care.

Irresponsible portrayal of suicide risks being a recipe for elder abuse and a threat to vulnerable people, many of whom already feel under pressure at a time of austerity and who are worried about being a financial or emotional burden on others.

Christian Medical Comment - one million page views

Christian Medical Comment (CMC) has finally notched up one million page views.

Thanks to all my readers for all your interest, engagement and support.

For those with an interest in such things here is an overview.

CMC was originally launched in December 2009 with a post titled 'Goats and kitchen sinks for Christmas' but I started blogging regularly three years ago this month in September 2010. 

Overall there have been 725 individual posts and just over 1,120,000 page-views – at an average of about 1,380 views per post.

CMC peaked at 3rd in March 2012 in the Religion and Belief category for UK blogs in the e-buzzing rankings and currently stands at 21st. It currently ranks 1,139^th amongst 210,000 registered UK blogs.

CMC is a specialist blog majoring on issues at the interface of Christianity and Medicine with specific focus on the beginning and end of life. But my broader aim is to bring issues to the attention of Christians that I believe they should be informed and concerned about.

I write mainly for a Christian readership but many of my readers hold strongly opposing views and frequently take issue with what I say.

35% of readers come from the UK, 30% from the US and 9% from Singapore, Canada, Australia, France and Germany combined with the remaining 26% coming from other countries around the world.

CMC was runner up in the People’s Choice category at the Christian New Media Awards in London in 2012. In 2011 it was a finalist in the Best Christian Blog category and in 2010 it was listed in Jubilee Centre's seven best blogs giving a Christian perspective on social and political issues.

I’m particularly grateful to those other blogs which republish some of my posts giving them wider distribution (especially Euthanasia Prevention Coalition, Mercatornet, Anglican Mainstream, Care Not Killing, LifeSite News, Life News, National Right to Life News and the Official CMF blog) and also to the Christian Institute, Westminster2010 and Christian Concern which frequently link to or quote from them.

My ten most viewed all time posts (accounting for a total of 264,000 page views) are as follows:

1. Do you know what happened to the girl in this iconic Pulitzer prize winning photo from the Vietnam War? 

2. Twenty questions atheists struggle to answer 

3. Max Pemberton’s Telegraph article on ‘Gay cures’ is replete with unsupported assertions and misleading statements

4. Ten reasons not to legalise same-sex marriage in Britain 

5. Hospital kills ‘wrong’ twin in selective abortion – both babies now dead 

6. Response to Daily Mail article on abortion of IVF babies for Down’s syndrome reveals frightening attitudes to disability 

7. Twenty questions atheists struggle to answer: How theism does better on the first six 

8. Why Christians may eat shellfish but may not have sex outside marriage

9. Springbok rugby hero Joost van der Westhuizen, dying from motor neurone disease, speaks of his Christian faith

10. The Guardian is now censoring comments I make on articles which mention me on its website – how liberal of them

Liverpool care pathway – next steps now clearer with setting up of new leadership alliance

The Liverpool Care Pathway (LCP) was developed by specialists in palliative care to improve the management of dying patients but its implementation was dogged by controversy leading to the establishment of an independent review.

The review, chaired by Crossbench Peer Baroness Neuberger, published its report in July.

It concluded that the LCP should be phased out ‘over the next 6 to 12 months’ and replaced by an individual end of life care plan, ‘backed up by good practice guidance specific to disease groups’.

The Government backed the recommendations and said it would ‘consider fully’ the committee’s recommendations over the coming months, to inform ‘a full system-wide response to the review’s recommendations in the autumn’.

The review highlighted a number of issues with the LCP, including, amongst others: specific gaps in evidence on the LCP; difficulty of diagnosing when a patient is actually going to die; issues with decision making and consent; lack of relatives’ involvement in the patient’s care plan; issues with hydration and nutrition; issues with sedation and pain management; a lack of clear accountability in decisions relating to the LCP; a lack of compassion in caring; scarce availability of staff at weekend or out-of-hours.

While acknowledging that prior to the introduction of the LCP ‘the care that patients received was variable and there were many examples of poor care’, the review panel made a number of recommendations for the introduction of an individual end of life care plan which should be developed by a coalition composed of various organisations.

The 44 recommendations made by the panel included the following:

• Patients should only be placed on the LCP or a similar approach by a senior responsible clinician in consultation with the healthcare team.
• Unless there is a very good reason, a decision to withdraw or not to start a life-prolonging treatment should not be taken during any ‘out of hours’ period.
• An urgent call for the NMC to issue guidance on end of life care.
• An end to incentive payments for use of the LCP and similar approaches.
• A new system-wide approach to improving the quality of care for the dying.

Along with the results of the review, the Department of Health published an Evidence briefing on pathways for the dying phase in end of life care, which formed part of the evidence base used by the independent review panel during its work.

Following the Government’s decision to implement the Review’s recommendations, Care Services Minister Norman Lamb sent a letter to the boards of all acute NHS Trusts asking them immediately to put into effect two actions:

• Undertake a clinical review, led by a senior clinician, of each patient who is currently being cared for using the LCP or a similar pathway for the final days and hours of life, to ensure that the care they are receiving is appropriate and that the patient, where possible, and their family is involved in decisions about end of life care; and
• Assure themselves that a senior clinician is assigned as the responsible clinician to be accountable for the care of every patient in the dying phase, now and in the future.

In addition, the Minister asked that all complaints about pathways for the dying should be ‘investigated properly’, with the appointment of an independent assessor if required. Trusts should also consider whether new evidence exists that would warrant a re-examination by the trust of past complaints about the LCP, in light of the findings of the Review. Finally, they should appoint a Board member with the responsibility for overseeing any complaints about end of life care and for reviewing how end of life care is provided.

On 30 August it was announced that a Leadership Alliance for the Care of Dying People (LACDP) was being set up under the chairmanship of Dr Bee Wee, National Clinical Director for End of Life Care at NHS England, to respond to the Independent Review.

NHS England, the Care Quality Commission (CQC), Department of Health (DH), General Medical Council (GMC), Health Education England (HEE), NHS Improving Quality (NHS IQ), Nursing and Midwifery Council (NMC) and the National Institute for  Health and Care Excellence (NICE) have already signed up to join the alliance in order to:

• support everyone involved in the care of people who are dying to respond to the findings of the review;
• be the focal point for the system’s response to the findings and recommendations of the LCP review;
• provide guidance on what needs to occur in place of the LCP;
• consider how best health and social sector can address the recommendations in the review about the accountability and responsibility of individual clinicians, out of hours decisions, nutrition and hydration and communication with the patient and their relatives or carers
• map existing guidance, training and development factors that might affect the adoption of good practice.

The new leadership alliance has a great challenge before it, but I hope that it is able to reach a strong evidence-based census about the next steps forward to ensure that dying patients in Britain are optimally cared for. 

It will need to move quickly if public confidence is to be effectively restored.

Previous reviews

CNK submission to official LCP review

Liverpool Care Pathway – nine points for the government to consider in its review