Wednesday 29 September 2010

Christianity provides medicine with a whole person perspective

When I was medical student I was required to write an essay on the nature of man.

The secular world has developed many different models for human beings. There are psychoanalytical models like that of Sigmund Freud who saw man as the product of a complex reaction between superego, ego and id. Then there are the behaviourists like B F Skinner who see human beings as complex stimulus-response machines. Then there are the physical anthropologists who see man as simply a clever monkey, and finally the biochemists who see man as nothing other than a complex chemical reaction, the product of matter, chance and time in a universe without meaning or purpose.

All these views are 'reductionist' in that they reduce man to simply the sum of his individual parts.

As doctors we know that the biochemical, anthropological, behaviourist and psychoanalytical models are all useful in understanding how human beings function. We learn our biochemistry, physiology and anatomy because we know that human beings are physical entities. We learn our psychology, social anthropology and sociology because we know that human beings are more than just physical entities - they need to be understood also as thinking entities existing in relationship. We learn our philosophy and religion because we know that human beings ask deep questions about morality, purpose and destiny. Human beings are also spiritual.

Biblical Christianity teaches that human beings are a complex unity of spirit, soul and body; and that these elements together form an inseparable whole. We can be understood in physical terms because we are made from physical elements, but we are more than just physical beings. We have souls and spirits too, and these three parts of our natures – body, soul and spirit - interact in a complex fashion.

We know that our physical health has profound effects on the way that we think, and that illness causes us to ask questions about meaning and purpose. We know that the mind can also affect physical health in the case of psychosomatic illness. We know that major life events like bereavement or divorce can have profound effects on our health.

If we treat our patients simply as physical bodies we will be doing them a gross disservice. It is true that they have physical bodies and that they may need their biochemistry corrected, their physiology normalised and their anatomy realigned.

However they are also souls enmeshed in a complex set of relationships and spirits asking serious questions about hope, meaning and destiny. These factors have profound implications for health and need to be addressed too.

Jesus Christ healed physical illness but he also restored broken relationships, forgave sin and reintroduced people to their creator.

Saturday 25 September 2010

What can St Paul teach us about evangelism to Muslims?

Christians and Muslims agree… on the reality of God, revelation, scripture, angels and judgment. But they also disagree; about Christ’s identity, death and resurrection and the authority of the Bible. Given these similarities and differences, what evangelistic approach should we adopt? Should we ‘build bridges’ or attack false teaching? Should we contextualise or confront?

Contextualisers claim that confrontation alienates unbelievers. Muslims must be gently coaxed. A horse led unwillingly will not drink. Argument doesn’t convert.

On the other hand confronters reply that contextualisation dilutes the gospel. Strongholds must be demolished. False teaching must be exposed.

What were Paul’s methods? On one hand he was a contextualiser, using a different approach for each audience. In the synagogue he established common ground by appealing to Jewish history and Old Testament Scripture (Acts 13:13-51); with the farmers at Lystra he spoke of God’s control of the seasons (14:14-18); with the philosophers in Athens he quoted their own poetry (17:22-31). He took the truth they already knew to establish rapport.

On the other hand he ‘reasoned’ (17:17), ‘discussed’ (19:9), ‘argued persuasively’ (19:8) and confronted (13:46). He summed up his ministry by saying ‘...we try to persuade’, (2 Cor 5:11), ‘... we demolish arguments and every pretension’ (2 Cor 10:5).

Contextualisation lays a foundation for debate. But if we do not move on to challenge the wrong beliefs of our listeners we are not telling the whole truth. On the other hand if we merely confront Muslims without establishing common ground our arguments will fall on deaf ears. Just as contextualisation can become the refuge of the cowardly, so confrontation can be the defence of the uncaring.

However, Paul did more than just contextualise and confront. He preached the gospel: Christ’s divinity, incarnation, death, resurrection and coming in judgment. This resulted in one of two responses. Some ‘received the message with great eagerness’ (Acts 17:11), ‘were persuaded’ (17:4) and ‘believed’ (17:34). Others ‘sneered’ (17:32), ‘became abusive’ (18:6) and ‘stirred up persecution’ (13:49).

If we build bridges or attack false teaching without preaching the gospel, then we are failing in our witness. Paul’s primary concern was neither to build friendships nor win arguments. Rather, his heart’s desire and prayer was that people be saved (Rom 10:1) through hearing the gospel (1:16). His priority was to win people to Christ. His strategy involved both contextualisation and confrontation; but always with the aim of preaching Christ crucified.

We are wise to follow his example.

Thursday 23 September 2010

Dignity in Dying (formerly the Voluntary Euthanasia Society) extends its definition of ‘terminally ill’ to twelve months

The campaign group Dignity in Dying (formerly the Voluntary Euthanasia Society) prides itself on being more modest in the scope of its taste for medical killing that other more radical groups like SOARS, FATE, Exit International or Dignitas.
But careful listeners to Radio Four’s ‘Exit Strategy: Choosing a Time to Die’ at 8 o’clock on Monday 20 September will have been intrigued to learn that DID Chief Executive Sarah Wootton (pictured) has just extended her definition of ‘terminally ill’ by another six months. Yes, if you are within twelve months of death you now fall within DID’s widening net of people who will qualify for a ‘lethal drug-assisted’ death under their proposals.

DID tells us on their website that they ‘only advocate assisted dying - not assisted suicide, voluntary euthanasia or euthanasia’.

This supposedly makes them more modest in their aims that Belgium and the Netherlands (where voluntary euthanasia is legal) or Switzerland (where assisted suicide is legal). The law they want, we are told, is ‘similar to that in place in Oregon and Washington’.

DID support only ‘assisted dying’ – or more specifically ‘allowing ‘terminally ill, mentally competent adults’ after meeting ‘strict legal safeguards’ to ‘self administer’ lethal drugs.

The language is skilfully crafted to disguise its real meaning. But what does it actually mean?

Voluntary euthanasia is where a doctor ends a patient’s life by administering lethal drugs. Assisted suicide is where the patient is helped to administer the drugs herself. ‘Assisted dying’ is actually assisted suicide for the ‘terminally ill’, but calling it ‘assisted dying’ makes it sound like something altogether different. The aim, like that of any euphemism, is to make it more acceptable to the public.

But who is actually terminally ill? What an interesting question! I have on several occasions in debates and on media asked DID spokespeople to define what they actually mean by ‘terminally ill’ but until last Monday had never been able to elicit a specific answer.

However on Radio Four Ms Wootton actually defined it for us. She said, ‘What we do say is that they are dying, that they should be terminally ill and the GMC guidelines define terminally ill as someone who is likely to die in the next 12 months.’

Aha! So she’s going for the GMC guidelines definition of twelve months.

Lord Joffe’s Assisted Dying for the Terminally Ill Bill, which was defeated in the House of Lords by 148-100 in May 2006, specified six months. So also do the laws in both Oregon and Washington on which DID’s policy is supposedly based. But DID now wants twelve months as one of their so-called ‘robust safeguards’ aimed at limiting abuse.

How robust is this safeguard? Joffe’s Bill was rejected largely on the basis of the findings of a Parliamentary select committee report written after consultation with a wide range of experts. The references that follow, unless otherwise indicated, are to House of Lords Report HL 86 (Session 2004-05).

Medical experts were asked how accurate a prognosis of 'six months or less' was? Here is what they said:

'It is possible to make reasonably accurate prognoses of death within minutes, hours or a few days. When this stretches to months, then the scope for error can extend into years' (Royal College of General Practitioners, HL 86 Vol II, Page 80)

'Prognostication may be better when somebody is within the last two or three weeks of their life. I have to say that, when they are six or eight months away from it, it is actually pretty desperately hopeless' (Professor John Saunders, speaking for the Royal College of Physicians, HL 86 Vol I, Paragraph 118)

'A simple bit of practical evidence is one of the benefit forms that are filled in for patients assigned to a doctor thinking that the patient has six months to live. I would not like to count how many of these forms I have signed in my life for patients still living after a year, eighteen months or even longer' (Dr David Jeffery, speaking for the Association for Palliative Medicine, HL 86 Vol I, Paragraph 119)

The select committee suggested that any 'assisted dying' bill should define terminal illness 'in such a way as to reflect the realities of clinical practice'. This was ignored in the Lord Joffe's 2005 bill, and there is no indication that it has been taken on board by the pro-euthanasia lobby since Parliament's rejection of that bill in 2006.

In fact, after a period of failing to define terminally ill at all, DID is now daring to go twice as far as Joffe!

Wednesday 22 September 2010

It is imperative that the police now fully and promptly investigate the circumstances of this tragic joint suicide

A couple found dead in a car on an industrial estate in Braintree, Essex on Monday, are believed to have been involved in a suicide pact.

Police now believe that Steve Lumb (35) and Joanne Lee (34) had met only hours before after initially making contact on an internet suicide forum.

Miss Lee is understood to have posted a message on the forum begging someone to join her in taking her own life. According to report in the Sun newspaper, she wrote. ‘I haven't the strength to do this alone. I'm not a cop, a cannibal or a murderer, just desperate. I have all the ingredients and want to do it ASAP’.

Her plea was answered by Mr Lumb, a lorry driver, who apparently drove 200 miles from his home town of Sowerby, West Yorks, to join her. Their bodies were found in his fume-filled Vauxhall Astra in Miss Lee's home town. Police believe they died after mixing chemicals in a bucket to make a lethal gas.

Distraught parents Jill and Brian Lee apparently had no idea that their daughter was planning to kill herself and Mr Lumb’s father Melvin, who lived with his son, said he had never shown signs of being depressed.

Following a number of high-profile internet-related suicides over recent years, among them the tragic cases of Nadia Kajouji and Mark Drybrough, parliament changed the law last year in an attempt to prevent similar events occurring in the future.

The Suicide Act was amended by the Coroners and Justice Act last year in order to deal specifically with cases such as these. The law now reads:

‘Under section 2(1) of the Suicide Act 1961 (as amended by section 59 of the Coroners and Justice Act 2009) it is an offence to do an act capable of encouraging or assisting the suicide or attempted suicide of another person with the intention to so encourage or assist… The person committing the offence need not know the other person or even be able to identify them.'

It is important to note that even if no suicide attempts take place as a result of information given via websites that might encourage or assist suicide, internet authors can still be found guilty of an offence.

On the surface it certainly seems as though the law has been breached, and on the basis of reports thus far, that other individuals (still living) could have been involved in assisting or encouraging a suicide.

It is of course impossible to know exactly what went on between Steve Lumb and Joanne Lee in the hours immediately preceding their deaths, and in particular whether any coercion was involved by either party. Both of the key witnesses are now dead and nothing can bring them back. But other vulnerable people may also be in danger.

It is therefore imperative that the police now fully and promptly investigate the circumstances of this case to assess whether any crime has been committed and, in particular, whether others were involved.

Should there be evidence sufficient to bring charges, all eyes will be upon the Director of Public Prosecutions to see whether he considers it to be in the public interest to do so.

On the basis of what has been reported it seems highly likely that, had these two people not met on an internet forum, they would both still be alive today.

Suicides like this can be prevented but it will require the joint commitment of parliament, prosecutors, police and communities if internet sites are to be properly regulated and the encouragement of suicide significantly curbed.

Tuesday 21 September 2010

As UK Christian doctors, are we as radically different from non-Christians in our attitudes and actions as our Indian colleagues are?

I paid for my trip to India in stress and sweat. Not out there, but in the mad rush to clear my desk before departure, and in the bulging in-tray and looming deadlines on return. However the blessing I received in ten autumn days, through being involved in the EMFI national conference and in visiting hospitals and health projects in the northwest, was well worth it. There is much to tell, but let me share the three things that struck me most.

The first was a sense of thanks for the blessings Christianity has brought in Britain. We easily forget that we have clean drinking water, low infant mortality, few street children, minimal corruption, good health and education, a functioning legal system and a good standard of living largely as the legacy of Christian revival in the18th and 19th centuries. What Wesley and Whitefield sparked in the 1700s led ultimately to profound social reform through notables like Wilberforce, Barnardo and the Clapham sect. Our medical system too is indebted to the foundation laid by Christian doctors like Lister, Jenner and Sydenham and most of our present difficulties are because we have forgotten as a society what once made us great. By contrast, India’s principle problem is a suffocating ideology which stratifies people into castes, values cows more than children and promotes spirituality without morality. Hinduism has two main failings: it isn’t true and it doesn’t work.

The second thing that struck me was a sense of wonder at what God is doing today in India. There are now over 40 million Christians, and 44,000 Indian missionaries serve cross-culturally within its borders. Past missionary efforts have led to the Syriac church in Kerala, the Catholic Church around Goa and the Protestant churches in the northeast and south-east tip, in the 1st, 15th and 19th centuries respectively. In some states Christians now make up over 80% of the population. But all these past incursions of God’s spirit are being dwarfed by the current wave of new converts, from all backgrounds, but especially amongst the poor. I met new Christians who were formerly Jain, Animist, Sikh and high-caste Hindu and visited areas where Buddhist and Muslims are coming to Christ. There is a real sense of expectancy amongst the churches and doors are wide open.

But third, I was most challenged by the way many of our Christian doctor colleagues integrated their faith and lifestyle, particularly in their concern for the poor. The Evangelical Fellowship of India (EMFI), our sister organisation, is growing rapidly, and has been built on a firm foundation of sacrificial and compassionate service to those in most need. There are still over 1,200 church hospitals in India largely staffed by Indian Christian doctors, many of whom trained at one of two Christian hospitals, Vellore and Ludhiana. Most are in areas where Christians are fewest in number, and through associated urban and rural community health, literacy and development projects, are empowering marginalised people and transforming communities. One team of 70 healthcare professionals, in ten years, had helped transform the lives of 200,000 of Delhi’s slum dwellers to the extent where child mortality had fallen 80% and there was 95% immunisation, almost full employment and minimal malnutrition or TB. Pregnant women received antenatal care of almost UK standards (including ultrasound) and in one site I visited most of the houses had metered electricity, many with electric fans and televisions. What the Christians do provides the opening for what they say. In the same way, in the aftermath of the Orissa floods and the Gujerati earthquake, Christian compassion through healthcare has opened up to the gospel those regions most antagonistic to Christianity.

I wonder if, as Christian doctors in the UK, we are as radically different from non-Christians in our attitudes and actions as our Indian brothers and sisters are. And if not, what effect it has on how the gospel is received by our patients and colleagues.

Monday 20 September 2010

Current sexual health strategies are based on three false presuppositions

Can we imagine training young people how to drive without also instructing them in the laws of the road? Or teaching trainee surgeons how to remove an appendix without also training them in the proper indications for the procedure?

And yet when it comes to sex, an activity which, like driving and surgery, carries high risks in the wrong context, the prevailing wisdom is that education focusing primarily on the access and use of contraception will be sufficient.

We learn this week of a new GCSE sex course which allegedly will be available to children as young as 11. Nine secondary schools have apparently adopted the qualification – ‘Level One Award in Sexual Health Awareness’ – since it became available earlier this month. Another 30 are expected to follow in the coming weeks.

Topics covered include accessing advice on contraception and other sexual health services without the knowledge or consent of parents. Pupils are also told where to obtain free contraception and how to quickly obtain the morning-after pill.

A second story graphically illustrates just how good teenagers are at actually taking precautions. The headline ‘One in four young people have sex without contraception’ refers to a recent study by Marie Stopes International. 16 per cent of UK young people who admitted to unprotected sex said they did not use contraception with a new partner as they forgot, 13 per cent said their partner preferred not to use contraception and 19 per cent said they had been drunk and forgot.

Current sexual health strategies are based on three false presuppositions – that contraception is safe, that young people will actually use it and that abstinence is impossible. Perhaps this explains Britain’s burgeoning epidemic of sexually transmitted disease, unplanned pregnancy and abortion amongst young people.

By contrast the Creator’s model for sex is simple, safe and effective – save it for marriage.

Sunday 19 September 2010

William Wilberforce was an extraordinary reformer but what was the secret of his motivation and perseverance?

John Piper’s Christian biographies are a must if you enjoy inspirational MP3s. I listened to his masterly treatment of William Wilberforce for the third time today on an eight mile run and still found it profoundly refreshing.

William Wilberforce was the British Parliamentarian who led the campaign to abolish the slave trade and just three years ago we celebrated the bicentenary of his success in 1807. He has inspired many social reformers and those who desire to shape public policy today can still learn a great deal from studying his methods.

But Piper’s account goes right to the heart of understanding where Wilberforce’s motivation, inspiration and dogged perseverance actually came from. As always Piper draws on original sources and in particular Wilberforce’s own book, A Practical View of Christianity, which was first published in 1797.

‘What made Wilberforce tick’, says Piper, ‘was a profound biblical allegiance to what he called the "peculiar doctrines" of Christianity. These, he said, give rise, in turn, to true affections – what we might call "passion" or "emotions" – for spiritual things, which, in turn, break the power of pride and greed and fear, and then lead to transformed morals which, in turn, lead to the political welfare of the nation.’

In other words Wilberforce’s political ambitions - and principally his lifelong commitment to abolishing slavery - were the direct product of his evangelical Christian faith. He said, ‘If . . . a principle of true Religion [i.e., true Christianity] should . . . gain ground, there is no estimating the effects on public morals, and the consequent influence on our political welfare.’

Piper goes on to explain that Wilberforce ‘believed with all his heart that new affections for God were the key to new morals and lasting political reformation. And these new affections and this reformation did not come from mere ethical systems. They came from what he called the "peculiar doctrines" of Christianity. For Wilberforce, practical deeds were born in "peculiar doctrines." By that term he simply meant the central distinguishing doctrines of human depravity, divine judgment, the substitutionary work of Christ on the cross, justification by faith alone, regeneration by the Holy Spirit, and the practical necessity of fruit in a life devoted to good deeds.’

Wilberforce in fact felt so strongly about the real root of his commitment to abolishing slavery that he called the practice of ‘considering Christian morals as distinct from Christian doctrines’ a ‘fatal habit’.

However don’t let me spoil it for you. If you want a brilliant introduction to the life of Wilberforce based on his own writings which goes far deeper than the 2006 movie ‘Amazing Grace’ to describe his early life and conversion, his relationship with John Newton, the story of slavery’s abolition, the identity of his other main lifetime ambition, his family life, mystery illness and the secret to his amazing perseverance then you can’t do much better than John Piper’s MP3 (or, if you prefer, the online transcript).

Thursday 16 September 2010

The Ray Gosling saga raises serious questions about both governance and ethics at the BBC

When former television journalist Ray Gosling confessed on BBC’s Inside Out programme on 15 February that he had taken a pillow and smothered a gay lover with AIDS who was in ‘terrible, terrible pain’ it very quickly became an international phenomenon.

Pro-euthanasia groups, such as Dignity in Dying, not surprisingly jumped on the bandwagon to further their cause claiming that the case provided further grounds for a change in the law.

It has now transpired, after a police investigation involving 32 officers, lasting six months and taking 1,800 hours at a cost of over £45,000 in taxpayers money, that Goslings’ ‘confession’ was simply made up. He did not kill his lover and in fact was not even in the country at the time he died. Furthermore the man did not die in pain.

Gosling has now been given a 90-day suspended prison sentence at Nottingham Magistrates' Court after pleading guilty to wasting police time. The judge in passing sentence has branded him as ‘a sheer liar and fantasist’ guilty of ‘creating and maintaining this cruel fabrication’.

It was very clear at the time the story broke that the BBC intended it to have maximum impact. The Care Not Killing Alliance (CNK) started getting media calls hours before the programme was originally broadcast regarding a ‘new euthanasia story’ involving a ‘prominent BBC employee’ but we were not allowed to know any of the details. Meanwhile every regional and national BBC news outlet was lining up interviews for the ensuing 24 hours.

We now learn that Gosling had made his original confession to BBC colleagues four months earlier over a ‘beery lunch’. And the programme itself was filmed some months before it was shown and eventually screened just one week before the Director of Public Prosecutions published his prosecution policy for cases of assisted suicide. Why did the BBC not inform the police during this time or more carefully investigate what was effectively a confession of murder? How many BBC employees actually knew about it? Was this actually a cynical attempt to influence public and judicial opinion at a critical point in time?

In the days that followed the screening, as well as giving a spate of national and regional broadcasts in the UK (including Five Live and BBC breakfast), I was interviewed by a host of international outlets covering the story – including Italian and Spanish newspaper journalists, Russian, Bolivian, Brazilian and Indian television and the BBC world service. The international interest was huge.

The very same week, both the Daily Mail and Daily Telegraph carried the story of Lord Carlile, CNK Chairman, writing to the BBC Director General to allege media bias and to accuse the corporation of adopting an ‘incredibly zealous’ ‘campaigning stance’ on assisted suicide.

The whole Gosling saga raises serious questions about both governance and ethics at the BBC.

I do hope that the BBC board will be carrying out a careful investigation to see whether its guidelines relating to fair and impartial broadcasting have been breached in this matter. Furthermore, I trust also that the corporation will take more care in future to check its facts and be more transparent with the police rather than being a party to the sensational proliferation of partisan propaganda or, in this case, downright lies.

Sunday 12 September 2010

Armenia is a country with a remarkable Christian past and future

Last month, during a visit to Armenia, I had the opportunity to visit the historic church of Khor Virap (pictured), situated on the Turkish border immediately adjacent to Mount Ararat.

Khor Virap was the site where ‘Gregory the Illuminator’ had been placed in a pit in the ground for thirteen years in the late third century by the King of Armenia (T’rdat) because his father had assassinated the King’s father. Both had been in exile in different parts of the Roman Empire during which time Gregory, who was not actually Armenian, was converted to the Christian faith. He was kept alive by the King’s sister lowering food down to him and was eventually let out by the King after his sister had a dream indicating that there would be serious repercussions were he to be kept imprisoned. On being released he led the King to the Christian faith and apparently also healed him of a mental illness. As a result he was given the freedom of Armenia to preach the Gospel and establish churches. In this way Armenia was officially declared the first Christian country in the world in AD 301, twenty years before the conversion of Constantine.

Just over a century later in 405 AD the unique Armenian script (the language was previously written in Greek script) was revealed in a dream, written down and the language transcribed into it. This move effectively protected the Armenians from cultural assimilation over the following centuries and helped to ensure that Armenia remains 97% Christian today.

Although Christian faith for many Armenians is now simply nominal there is nonetheless a rich Christian cultural heritage which goes right back to the first century when two of Jesus’ twelve disciples, Bartholomew and Thaddeus, visited and established churches in 40 AD. Bartholomew was later martyred in the country.

Armenia currently has a population of three million but over ten million Armenians live in over one hundred countries worldwide in communities which preserve their language and culture. Almost all are at least bilingual and they therefore constitute a potentially strong missionary force. Armenia’s location within the 10:40 window, surrounded by Muslim nations is also clearly very strategic.

The borders to Turkey and Azerbaijan on the west and east respectively remain closed but those to Georgia in the north and Iran in the south are open. Armenians believe that both the Garden of Eden and Noah’s Ark were located in ‘Greater Armenia’. Mount Ararat, where the Ark settled, is now within Turkey and therefore much less accessible. The Garden of Eden, which is described in Genesis as being at the source of four rivers (Tigris, Euphrates, Gihon and Pishon) was, they believe, located in northern Iran just west of modern day Tabriz. The Gihon and the Pishon they recognise as two rivers which have been subsequently renamed and which drain into the west and south coasts of the Caspian Sea respectively.

Armenia has been through a lot of hardship throughout the centuries and especially in the last hundred years. A key defining event was the Armenian genocide of 1915 when allegedly over a million Armenians lost their lives at the hands of the Turks. The country was then for 70 years part of the former Soviet Union and a further 30 to 50 thousand died in Stalin’s purges. Just before independence the Spitak earthquake killed thirty thousand in 1988 and after independence in 1991 the war with Azerbaijan over the disputed Armenian enclave of Nagorno-Karabakh accounted for a further 30,000 lives. These events were in large part responsible for the mass emigration of Armenians at different points over the last century.

Whilst the Apostolic church is characterised by somewhat archaic ritual, ceremony and liturgy in ancient Armenian which few understand, there is vibrant new life in the evangelical churches and particularly in the Baptist and Pentecostal denominations.

The rich Christian history, strategic location, wide diaspora and biculturalism of Armenians make this country very important in world mission in the 21st century.