Tony Nicklinson deserves sympathy but hard cases make bad law

A severely disabled man from Wiltshire is to ask the High Court to allow a doctor to end his life.

Tony Nicklinson, 57, is paralysed from the neck down after suffering a stroke in 2005.

He cannot speak or move anything except his head and eyes and communicates through nodding his head at letters on a perspex board or by using a computer which responds to eye movements.

The Melksham man, who has been married for 25 years and has two daughters, sums up his life as 'dull, miserable, demeaning, undignified and intolerable'.

His lawyers want a doctor actively ending his life to have a ‘common law defence of necessity’ against any possible murder charge.

A spokesman for law firm Bindmans, which represents him, confirmed he had issued proceedings in the High Court asking for declarations that it is lawful for a doctor to terminate his life, with his consent and with him making the decision with full mental capacity.

Earlier this year Nicklinson’s legal team asked the Director of Public Prosecutions to clarify the law on so-called mercy killing but the DPP made it clear there was no flexibility on the law and anyone who deliberately took someone's life would be charged with murder.

They are therefore trying this new route.

In English law, the defence of necessity recognises that there may be situations of such overwhelming urgency that a person must be allowed to respond by breaking the law. There have been very few cases in which this defence has succeeded. However, the Crown Prosecution Service tends to choose not to prosecute those cases where it believes potential defendants have acted reasonably in all the circumstances.

This defence was used in the early trial of Regina v. Dudley & Stephens (1884) 14 QBD 273 DC, where four shipwrecked sailors were cast adrift in a small boat without provisions. To save themselves, the three strongest decided to eat the fourth, the 17 year-old cabin boy. The court ruled that cannibalising the boy was not urgently necessary. Even though the cabin boy would almost certainly have died of natural causes, the sailors killed the boy intentionally and were guilty of murder. There was some degree of necessity arising from the threat of starvation but, at any moment, a ship could have sailed over the horizon to save them as, indeed, the three were rescued. Since they could never be sure that the killing was actually necessary from one minute to the next, the defence was denied. Cannibalism itself is not an offence so long as the death occurs naturally.

Dudley and Stephens were convicted of murder and sentenced to be hanged, however their sentence was later reduced to just six months in prison. The fourth man, Brooks, was not tried, as he had not participated in the murder. The principles from this case form the basis of the defence of necessity not being available for murder.

In order for the defence of necessity to hold sway there must be an urgent and immediate threat to life which creates a situation in which the defendant reasonably believes that a proportionate response to that threat is to break the law.

It is difficult to see how this defence might help Nicklinson who is severely disabled, has a reasonable life expectancy and is not facing any imminent emergency.

However, it is thought that Nicklinson’s lawyers are likely to base their arguments on comments about necessity in the 2001 conjoined twins case where the court ruled that the life of a seriously disabled baby (Mary) could be sacrificed in order that her sister (Jodie) could survive. (A (Children) (Conjoined Twins: Medical Treatment) (No. 1) [2001] Fam 147).

In that case the Court of Appeal said that the doctrine of necessity was more elastic than it had been represented as being in the cabin boy case above.

The Human Rights Act also adds a new dimension.

Nicklinson has Article 8 rights under the European Convention on Human Rights (respect for his private life and family) which must be respected. His lawyers will no doubt argue that these rights cannot be respected unless he dies, and accordingly that the law of necessity needs to give a defence to a doctor who, in the act of respecting his rights, kills him.

However Article 8 also states that the right to respect for private life and family must in a democratic society be balanced with considerations of public safety, the prevention of crime, the protection of health and morals, and the protection of the rights and freedoms of others.

The Murder Act is there in part to protect vulnerable people from exploitation and abuse by those who might have an interest, financial or otherwise, in their deaths. Any further removal of legal protection by creating exceptions for bringing prosecutions would encourage unscrupulous people to take liberties and would place more vulnerable people – those who are elderly, disabled, sick or depressed – under pressure to end their lives so as not impose a burden on family, carers or society.

We also need to realise that cases like Nicklinson’s are extremely rare and that hard cases make bad law. The overwhelming majority of people with severe disability – even with ‘locked-in syndrome’ – do not wish to die but rather want support to live. I have previously highlighted inspiring stories on this blog of people who with good support have been able to get to a position where they can see meaning and purpose in lives even in the face of substantial suffering. It is assisted living most want, not assisted dying.

We all accept that there are limits to choice. Even in a free democratic society there are boundaries to our autonomy. We are not entitled to exercise ‘freedoms’ that will endanger the reasonable freedoms of others. That is why we have laws. Every law limits choice and stops some people doing what they might desperately wish to do. This is in order to maintain protection for others.

The current law is clear and right and does not need fixing or further weakening. On the one hand the penalties it holds in reserve act as a powerful deterrent to exploitation and abuse. On the other hand it gives judges some discretion to temper justice with mercy when sentencing in hard cases. We should not be meddling with it.

It was therefore refreshing to see a spokesperson for the British Medical Association saying yesterday: ‘The BMA is opposed to assisted suicide and to doctors taking a role in any form of assisted dying. We support the current law and are not seeking any change in UK legislation on this issue.’

Oregon Governor orders that some state-sanctioned killing must stop

Earlier this week, in an emotional declaration (£), the Governor of the US state of Oregon, John Kitzhaber, said he would refuse to sanction any further executions.

Today he was strongly criticised (£) by a condemned man who called him a ‘coward’.

Gary Haugen (pictured), a double murderer, wants to be executed to protest at weaknesses in the justice system. He told The Statesman Journal that Kitzhaber had acted on his personal beliefs instead of carrying out the will of Oregon voters who reinstated the death penalty in 1984.

‘I feel he’s a paper cowboy,’ Haugen said. ‘He couldn’t pull the trigger.’

Haugen, 49, was sentenced to death for stabbing a fellow prisoner in 2007 while serving a life sentence for killing a former girlfriend’s mother 30 years ago. He was to have been executed on 6 December until Mr Kitzhaber intervened.

Haugen says he is considering legal action to fight the reprieve which lasts until the governor leaves office.

Interestingly, Oregon is one of only two states in the US which have legalised assisted suicide, also in response to a referendum.

But the Governor isn’t showing any signs of repealing that law.

John Smeaton today draws attention to a letter from Charles J. Bentz, a physician practising medicine in Oregon, published by Times Colonist, an on-line Canadian journal.

In brief, Dr Bentz’s patient, being treated for cancer, became depressed. Dr Bentz’s letter concludes: ‘In most jurisdictions, suicidal ideation is interpreted as a cry for help. In Oregon, the only help my patient got was a lethal prescription intended to kill him. Don't make Oregon’s mistake.’

So Oregon is left in the curious position of endorsing ‘state-sanctioned killing on request’ in some circumstances (ie. for vulnerable sick people) but opposing it for others (ie. for those guilty of murder)

Wouldn’t it be better just to stop all state-sanctioned killing?

MDU warns that doctors who provide medical reports for patients seeking assisted suicide abroad could be prosecuted

The Medical Defence Union (MDU) in its latest advice to doctors (MDU Journal, Volume 27 issue 2 November 2011, Page 24) has published a case study to emphasise the point that doctors who supply medical records to patients who are intending to commit suicide could well be prosecuted.

In February 2010 the Director of Public Prosecutions (DPP) published his ‘Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide’

This lists 16 criteria which make prosecution more likely in any case of assisted suicide. One of these (14) is that ‘the suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer [whether for payment or not], or as a person in authority, such as a prison officer, and the victim was in his or her care’

Encouraging or assisting a suicide is a crime carrying a discretionary custodial sentence of up to 14 years. The MDU’s case study reproduced below is largely accurate in its conclusions except that it misquotes the Suicide Act 1961, which was actually amended in 2010 by section 59 the Coroners and Justice Act 2009.

The error is understandable given that the government hasn’t yet got around to amending the legislation on its own website even though the law was passed over two years ago!

In short, the words ‘aid, abet, procure or counsel’ have been updated to ‘encourage or assist’. The change was aimed at preventing the internet promotion of suicide.

Under the current law a person commits an offence ‘if (he/she) does an act capable of encouraging or assisting the suicide or attempted suicide of another person, and the act was intended to encourage or assist suicide or an attempt at suicide’.

Regardless of the unintentional error the MDU’s advice is very clear and should leave doctors in no doubt about any attempt to assist suicide even by simply providing documentation to a patient.

Here is the case study (which is not as far as I can see available on the internet)

The Scene

A consultant in palliative care received a request for medical records from a patient with multiple sclerosis. The patient had previously expressed her wish to arrange an assisted suicide and had approached her GP for a medical report and insertion of a cannula. The GP had refused to comply with her request. This consultant was in no doubt as to the patient’s motivation for requesting her records and rang the MDU advice line to find out what the repercussions might be if he complied and the patient later committed suicide.

The advice

The MDU adviser confirmed the consultant’s belief that if he knowingly assists a patient in committing suicide, he would be committing a criminal offence.

A doctor could face a criminal investigation if alleged to have assisted a patient with the act, even if the assistance is in the form of advice to the patient. Even if criminal proceedings do not follow, the GMC may still decide to investigate the doctor’s fitness to practise. The member was therefore advised not to engage in discussion about this matter with the patient.

Section 2(1) of the Suicide Act 1961 states: ‘A person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be liable on conviction on indictment to imprisonment for a term on exceeding 14 years.’

Although the Director of Public Prosecutions has decided in the past that it would not be in the public interest to prosecute those who have assisted, for example, patients travelling to Switzerland to commit suicide, the decisions have been case-specific and do not change the legal position for doctors caring for a patient.

It should also be noted that while healthcare professionals must follow an advance decision if it is valid and applies to the particular circumstances when a competent patient wishes to refuse treatment, this is not the same thing as taking active steps to kill a patient. Although the Mental Capacity Act 2005 provides for patients to make a written statement requesting certain treatment of expressing a preference, such statements will certainly not legally require doctors to take active steps to bring about a patient’s death and indeed Section 62 of the Act specifically states that nothing in the Act is to be taken to affect the law relating to murder, manslaughter or assisted suicide.

Assisted Suicide in the United States – overview of present position

Margaret Dore, a US attorney, has just published an excellent overview of the current status of assisted suicide laws in the United States on her blog ‘Choice is an Illusion’. I have reproduced the article below, but without the weblinks which are available on Dore’s site.

There are two states where physician-assisted suicide is legal: Oregon and Washington. In these states, statutes give criminal and civil immunity to doctors and others who participate in a qualified patient's suicide. Oregon's act was enacted via a ballot initiative in 1997. Washington's act was enacted via a ballot initiative in 2008 and went into effect in 2009. Washington's act is modeled on Oregon's act.

In Oregon and Washington, assisted-suicide laws apply to ‘terminal’ patients, defined in terms of having less than six months to live. Such persons are not necessarily dying. Consider, for example, Jeanette Hall, alive 11 years after her terminal diagnosis. More recent proposals to legalize assisted suicide have included people who are clearly not dying.

In Montana, Baxter v. State gives doctors who assist a patient's suicide a potential defense to prosecution for homicide. Baxter does not legalize assisted suicide by giving doctors or anyone else immunity from criminal and civil liability although proponents argue that this is the case. This year, a bill to reverse Baxter's potential defense was defeated. In Montana, the leading group against assisted suicide is Montanans Against Assisted Suicide & For Living with Dignity.

This year, Idaho enacted a statute strengthening its law against assisted suicide. This was after proponents falsely claimed that assisted suicide was already legal.

This year, bills to legalize physician-assisted suicide were defeated in Montana, Hawaii and New Hampshire. In Vermont, identical legalization bills were introduced in the House and Senate, but not put on for vote before the legislative session ended.

In Hawaii, where a bill to legalize assisted suicide was defeated this year as well as in prior years, proponents claim that assisted suicide is legal.

In Connecticut, a lawsuit to legalize physician-assisted suicide was dismissed in 2010.

In Massachusetts, there is a pending ballot initiative to enact an Oregon/Washington style act that applies to ‘terminal’ patients defined as having less than six months to live.

In the US, no assisted suicide/euthanasia law has ever made it through the scrutiny of a legislature despite more than 100 attempts.

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

Children with special needs can be a great challenge to care for but a tragic story from Australia this week demonstrates that the search for the perfect child can have devastating consequences.

Steven Ertelt in Melbourne relates the story on Life Site News (see also BBC)

A hospital in Australia is making news for having killed the ‘wrong’ twin in a selective abortion. The mother of the two babies had wanted to abort the baby who doctors said had little chance to live. But now, both babies are dead.

The Herald Sun newspaper reports that the unnamed woman from Victoria had already named her unborn children when doctors told her one of the unborn babies had a congenital heart defect that would require years of operations, assuming the baby survived long enough to have them.

The mother decided to have an abortion, terminating the life of one of her unborn children and allowing the other baby to live.

The newspaper indicates an ultrasound technician checked on the healthy baby before the abortion and determined that the child was in a separate amniotic sac from its sibling. However, the abortion, which took place last Tuesday afternoon, went awry and the wrong baby was injected with drugs meant to end his or her life.

After the mother was informed of the error, doctors did an emergency Cesarean section and the sick unborn baby was 'terminated' in a three-hour operation, the newspaper indicates.

A friend of the mother told the newspaper she is having a difficult time following the error.

“She went to the hospital with two babies and now she has none. And she had the heartache of giving birth to her sick baby. She’s traumatized,’ she said. ‘The hospital said it had followed correct procedure, but how could this happen? The ultrasound clinician said she checked three times before the termination because she didn’t want to make a mistake.’

The newspaper indicates the family is considering legal action.

Ertelt goes on to relate the stories of other similar cases around the world.

The story graphically illustrates the grim reality of the ‘search and destroy’ approach to unborn babies with special needs. Such procedures are now very common although very few involve twins.

It is interesting that the killing of an ‘unwanted’ child with special needs in the womb is regarded as ‘normal’ whilst the killing of a ‘wanted’ normal child is seen as a tragedy and worthy of international news coverage.

And yet if the ‘abnormal’ baby had actually been born, doctors would presumably have done everything possible to provide what treatment or care they could. After all the twins were at 32 weeks gestation, 8 weeks past the accepted threshold of viability. Instead however they ensured that it was not born alive by 'terminating it'.

Of course if the second ‘normal’ child had also been ‘unwanted’ then the story would not have warranted a mention. Abortion of ‘unwanted’ ‘normal’ babies takes place over 40 million times every year around the world.

The British Abortion Act 1967 currently allows abortion up until birth where there is a ‘substantial risk’ or a ‘serious handicap’ – so-called ground E - but this is currently interpreted very liberally indeed.

As I blogged previously, recently revealed statistics showed that between 2002 and 2010 there were 17,983 abortions in this category. The overwhelming majority of these were for conditions compatible with life outside the womb and 1,189 babies were aborted after 24 weeks, the accepted age of viability.

The 17,983 included 26 for babies with cleft lips or palates and another 27 with ‘congenital malformations of the ear, eye, face or neck’, which can include problems such as having glaucoma or being born with an ear missing.

Over the period 2002-2010 there were altogether 3,968 Down’s syndrome babies aborted and now 95% of all babies found to have Down’s syndrome before birth have their lives ended in this way.

Our society’s increasing obsession with celebrity status, physical perfection and high intelligence fuels the view that the lives of people with disabilities or genetic diseases are somehow less worth living.

By contrast the Christian view is that the life of every human individual, regardless of its intelligence, beauty, state of health or degree of disability is infinitely precious. A just and caring society is one where the strong make sacrifices for the weak, or in the words of the Apostle Paul, ‘bear one another’s burdens, and so fulfil the law of Christ’ (Galatians 6:2).

This story is a stark warning to recognise and resist the eugenic mindset. Our priorities should be to develop treatments and supportive measures for those with genetic disease; not to search them out and destroy them before birth.

Tragically, if this woman had not sought to intervene both her babies would probably still be alive, one needing further treatment and one not.

David Brainerd – Reflections on the life and ministry of this great inspirer of missionaries

On a run this morning I listened again to John Piper’s excellent biography on the life of David Brainerd, widely known as the missionary to the American Indians.

I love Piper’s missionary biographies and listen to them again and again always picking up something new.

In this one Piper particularly recommends Jonathan Edward’s ‘Life of Dave Brainerd’ which he says has never been out of print, but the only copies I could find on the web were several hundred dollars each so I will have to give that a miss. The biography though is an inspiration in itself and well worth the listen (or read).

Piper begins as follows:

‘David Brainerd was born on April 20, 1718 in Haddam, Connecticut. That year John Wesley and Jonathan Edwards turned 14. Benjamin Franklin turned 12 and George Whitefield 3. The Great Awakening was just over the horizon and Brainerd would live through both waves of it in the mid thirties and early forties, then die of tuberculosis in Jonathan Edwards' house at the age of 29 on October 9, 1747.’

He then outlines how he was present at Yale University at the beginning of the Great Awakening when Whitefield visited. Later he was thrown out of the university for his part in it, but God turned this disappointment into 'His appointment'.

‘Brainerd preached to the Indians at the Forks of the Delaware for one year. But on June 19, 1745 he made his first preaching tour to the Indians at Crossweeksung, New Jersey. This was the place where God moved in amazing power and brought awakening and blessing to the Indians. Within a year there were 130 persons in his growing assembly of believers.’

He then sums up the impact he has had upon other great missionaries who followed:

‘It was a short life: twenty-nine years, five months and nineteen days. Only eight of those years as a believer, and only four of those as a missionary. Why has Brainerd's life made the impact that it has? One obvious reason is that Jonathan Edwards took the Diaries and published them as a Life of Brainerd in 1749. But why has this book never been out of print?

Why did John Wesley say, "Let every preacher read carefully over the 'Life of Brainerd'"? Why was it written of Henry Martyn that "perusing the life of David Brainerd, his soul was filled with a holy emulation of that extraordinary man; and after deep consideration and fervent prayer, he was at length fixed in a resolution to imitate his example"? Why did William Carey regard Edwards' Life of Brainerd as a sacred text? Why did Robert Morrison and Robert McCheyne of Scotland and John Mills of America and Frederick Schwartz of Germany and David Livingston of England and Andrew Murray of South Africa and Jim Elliot of modern America look upon Brainerd with a kind of awe and draw power from him the way they and countless others did?

Gideon Hawley, another missionary protégé of Jonathan Edwards spoke for hundreds when he wrote about his struggles as a missionary in 1753, “I need, greatly need something more than human to support me. I read my Bible and Mr. Brainerd’s Life, the only books I brought with me, and from them have a little support.”’

Piper speculates as to why Brainerd’s life had such an impact and asks specifically why reading about Brainerd has encouraged him to press on in the ministry and to strive for holiness and divine power and fruitfulness in his life.

He concludes that Brainerd’s life ‘is a vivid, powerful testimony to the truth that God can and does use weak, sick, discouraged, beat-down, lonely, struggling saints, who cry to him day and night, to accomplish amazing things for his glory’.

He then outlines the struggles Brainerd faced as follows, expanding on each in turn:

1. Brainerd struggled with almost constant sickness.
2. Brainerd struggled with relentlessly recurring depression.
3. Brainerd struggled with loneliness.
4. Brainerd struggled with immense external hardships.
5. Brainerd struggled with a bleak outlook on nature.
6. Brainerd struggled to love the Indians.
7. Brainerd struggled to stay true to his calling.

Piper concludes as follows:

‘I think the reason Brainerd's life has such powerful effects on people is that in spite of all his struggles he never gave up his faith or his ministry. He was consumed with a passion to finish his race and honor his Master and spread the kingdom and advance in personal holiness. It was this unswerving allegiance to the cause of Christ that makes the bleakness of his life glow with glory so that we can understand Henry Martyn when he wrote, as a student in Cambridge in 1802, “I long to be like him!”

Brainerd called his passion for more holiness and more usefulness a kind of “pleasing pain.” “When I really enjoy God, I feel my desires of him the more insatiable, and my thirstings after holiness the more unquenchable; ... Oh, for holiness! Oh, for more of God in my soul! Oh, this pleasing pain! It makes my soul press after God ... Oh, that I might not loiter on my heavenly journey!”’

‘Care Not Killing’ - Update on end of life issues

The Care Not Killing Alliance (CNK), representing over 40 organisations which promote palliative care and oppose euthanasia, has just published its November 2011 update on end of life issues.

I have reproduced the highlights below.


Falconer Commission

The Falconer Commission on ‘Assisted Dying’ is due to report in late November. The Commission has been suggested by Dignity in Dying (Formerly the Voluntary Euthanasia Society), paid for by one of its patrons and stacked full of euthanasia sympathisers by Lord Falconer's own admission. It is expected to recommend the legalisation of assisted suicide within ‘strict safeguards’ for those who are terminally ill.

CNK has written why the law should not be changed on either physician-assisted suicide (PAS) or voluntary euthanasia and about the background and bias of the Falconer Commission. At the commission’s launch on 30 November 2010 it was revealed that nine of the twelve commissioners were well-known names in the pro-legalisation lobby. The BMA has passed a five part motion undermining the commission’s credibility.

Philip Nitschke’s visit to Britain

CNK wrote to the Home Secretary, Theresa May, asking her to exercise her powers to prevent Philip Nitschke entering the UK. Nitschke is running a series of seminars instructing people how to commit suicide. He is on public record as supporting suicide for depressed people and teenagers.

Addressing suicide contagion

CNK recently responded to the Department of Health suicide consultation. Our submission argued that the new suicide prevention strategy for England should further consider the phenomenon of media-induced suicide contagion.

Royal College of Nursing guidance on assisted suicide requests from patients

The RCN guidance gave practical advice about how to address the topic sensitively, within the law and supporting the patient. The guidance addresses the different legal issues and was surprisingly good.

Students change minds in debate about ‘right to die’

CNK debated at University College London against the vice chair of Dignity in Dying. CNK Campaign Director Dr Peter Saunders explained that a change in the law was unnecessary and dangerous and that the present law works well in deterring exploitation whilst giving discretion to prosecutors in hard cases. By the end of the debate, initial strong support for the ‘right to die’ was heavily reduced to less than half of those present.

Times launches ‘Silver manifesto’ for elderly people

The Times (£) has launched a fifty point plan (£) to improve the lives of elderly people. Some of the suggestions were to run care homes like homes not hospitals, give older people a role in schools and make text on menus bigger.

Doctors provide analysis of Palliative care article

Dr John Wiles, CNK Chair and retired NHS Consultant in Palliative Medicine, challenged an article in the BMJ by Clare Dyer that asserted that the legalisation of assisted dying does not harm palliative care. Dr Wiles argued that the recent article from the European Association for Palliative Care did not reach that conclusion.

New evidence that Patients in ‘Permanent Vegetative State’ may be consciously aware

The Lancet has reported that a method of communicating with brain damaged patients in a permanent vegetative state has been discovered by scientists in the UK and Belgium. Out of sixteen patients diagnosed in the vegetative state, three could repeatedly and reliably respond to two distinct commands.

Keep Breathing: A novel by Adam Grace

A new novel about campaigning and euthanasia has been written by Adam Grace. The powerful and imaginative story is about Howard Mitchell, a pensioner who leads a national campaign against a government keen to introduce stringent euthanasia law.

Adult stem cell research goes forward in leaps and bounds whilst embryonic stem cell work grinds to a halt

It has been an amazing week in the field of stem cell technology with five big stories hitting the news all at once. New doors of therapeutic promise are opening whilst at the same time other doors are slamming shut.

I recently highlighted a New Scientist editorial, ‘In praise of stem-cell simplicity’, which gives a fantastic overview of exciting new avenues in ethical stem cell research which are opening up. But the speed of new developments has increased by leaps and bounds just in the last few days.

Stem cells are naturally occurring cells in the body which have the capacity to develop into a variety of specialist cells. They have been recognized for well over a decade as having huge potential in the treatment of diseases where is there is tissue or cell loss – such as diabetes, Parkinson’s disease, spinal injury and heart disease.

The reason stem cells are so controversial is that the harvesting of embryonic stem cells involves the destruction of existing embryos and yet some British scientists have for years maintained that they are essential for research.

On the other hand, other scientists have argued that stem cells derived from ethical sources (adult stem cells, umbilical stem cells and induced pluripotent stem (iPS) cells) are safer than embryonic stem cells and have greater therapeutic potential.

Both adult stem cells (from bone marrow and other body tissues) and umbilical stem cells are already used in treatment for a wide variety of haematological and other conditions. By contrast the first clinical trials using embryonic stem cells have only just recently begun.

In addition to this iPS cells, which appear to have all the characteristics of embryonic stem cells, can now be produced by stimulating ordinary body cells to revert to an earlier developmental stage without having to destroy embryos.

What has happened this week is that there have been some fantastic advances in using stem cells from ethical sources whilst at the same time a huge setback for embryonic stem cell technology. It appears that ethical stem cell research is opening more and more doors whilst unethical research using embryos is foundering. These developments are another nail in the coffin for the misinformation and hype that the British public have been fed by the British press on these issues for so long.

For the first time, adult stem cells from patients’ own hearts have been shown to improve heart failure.

In the research, carried out at the University of Louisville and published in the Lancet, the heart’s blood-pumping efficiency in 14 patients who responded to the stem cell treatment, increased from 30.3% to 38.5% whilst at the same time the amount of dead heart muscle tissue decreased by 24% percent over four months. Seven control patients who did not receive the stem cell treatment showed no improvement.

Second, the doctors behind the world’s first transplant of an artificial windpipe made from a patient’s own stem cells are to begin clinical trials next year on a stem-cell ‘bandage’ for mending torn knee cartilage.

Professor Anthony Hollander of the University of Bristol, who helped save the life of a Colombian woman, Claudia Castillo, with the transplant of a tissue-engineered windpipe, will lead a team treating patients with torn knee cartilages, a common problem among sportspeople. The doctors aim to transplant stem cells derived from a patient’s bone marrow on to a damaged knee joint, where it is hoped the cells will act like a repairing bandage to mend the tissue.

Third, Embryonic-like stem cells have been isolated from breast milk in large numbers. The discovery raises the possibility of sourcing embryonic stem cells for regenerative medicine, without the need to destroy embryos.

Peter Hartmann at the University of Western Australia in Crawley and his colleagues first announced the discovery of stem cells in breast milk in 2008. Now they have grown them in the lab and shown that they can turn into cells representative of all three embryonic germ layers, called the endoderm, mesoderm and ectoderm – a defining property of embryonic stem cells (ESC).

Embryonic-like stem cells have previously been discovered in amniotic fluid and in the umbilical cord, but this is the first time they have been discovered in an adult. Chris Mason of University College London has said, ‘If they are truly embryonic, this would be another way of getting stem cells that would not raise ethical concerns.’

Fourth, Scientists at the Mount Sinai School of Medicine have demonstrated that baby mice in utero can heal their mothers’ heart disease (See 'Foetal stem cells "can repair mother’s heart"'). They found that foetal stem cells from the placenta, which they had marked with green fluorescent protein, travelled to the pregnant mother’s heart and were transformed into a variety of cells to repair cardiac damage. This may help to explain a phenomenon seen in previous studies where one in two women with peripartum cardiomyopathy spontaneously recovered after pregnancy.

The director of cardiovascular regenerative medicine at the institution, Dr Hina Chaudhry, has described it as ‘an exciting development that has far-reaching therapeutic potential’. The findings, which are published in the American Heart Association’s journal Circulation Research, could help researchers find a stem cell treatment for heart disease.

Finally, the company doing the much-heralded first trial on embryonic stem cell therapy is discontinuing further stem cell work.

Geron, a pioneer in stem cell research that has been testing a potential spinal cord injury treatment, said late Monday that it’s halting development of its stem cell programs to conserve funds. It is seeking partners to take on the programs’ assets and is laying off 66 staff, 38% of its entire workforce.

Those scientists who have been singing the praises of embryonic stem cells most loudly are, perhaps predictably, expressing their disappointment. The firm is claiming that its decision is ‘purely financial’ but John Martin, Professor of Cardiovascular Medicine at University College London has said: ‘The Geron trial had no real chance of success because of the design and the disease targeted. It was an intrinsically flawed study… The first trials of stem cell that will give an answer are our own in the heart. The heart is an organ that can give quantitative data of quality.’

Josephine Quintavalle from the group CORE (Comment on Reproductive Ethics) was rather more frank: ‘At long last after 10 years of unremitting hype, reality has caught up with embryonic stem cell claims. If Geron is abandoning this project it is because it is simply not working, despite the millions of dollars and hot air that has been invested in the promotion of this research.’

So in summary, this has been a week where ethical stem cell research has marched on whilst embryonic stem cell work has ground to a halt. What were perhaps always blind alleys are now closing but new highways of promise are opening ever and ever wider.

The best and most effective treatments are also ethical treatments. Maybe that is the most important lesson to learn from all this.

A sonnet from CS Lewis - but what does it mean?

I was intending to blog on all this week's amazing stem cell stories tonight but have run out of time. It will have to wait.

Anyway for something completely different here is one of my favourite poems (a sonnet) from CS Lewis from one of my favourite books 'The Pilgrim's Regress'

The book is obviously based on Bunyan's 'Pilgrim's Progress' but the chief character, instead of meeting people who represent different vices and virtues encounters characters embodying different philosophies.

See if you you can work out what it means and whether or not you approve of the theology?

A clue - it's titled 'The footnote to all prayers'

It's an earlier version - the later one in the Regress is tidied up and a bit tighter in the wording. Lewis obviously went back to it.

He whom I bow to only knows to whom I bow
When I attempt the ineffable Name, murmuring Thou,
And dream of Pheidian fancies and embrace in heart
Symbols (I know) which cannot be the thing Thou art.
Thus always, taken at their word, all prayers blaspheme
Worshipping with frail images a folk-lore dream,
And all men in their praying, self-deceived, address
The coinage of their own unquiet thoughts, unless

Thou in magnetic mercy to Thyself divert
Our arrows, aimed unskilfully, beyond desert;
And all men are idolators, crying unheard
To a deaf idol, if Thou take them at their word.
Take not, O Lord, our literal sense. Lord, in thy great
Unbroken speech our limping metaphor translate.

Why legalising assisted suicide inevitably also legalises euthanasia

The Falconer Commission on ‘Assisted Dying’ is about to be put out of its misery when it reports later this month.

Having been suggested by Dignity in Dying (formerly the Voluntary Euthanasia Society), paid for by one of its patrons and stacked full of euthanasia sympathisers by Lord Falconer’s own admission (and also for these reasons discredited by the BMA) the Commission is expected to recommend that assisted suicide for mentally competent terminally people be legalised with so-called ‘strict safeguards’.

The arguments that will be used to support this proposal however (compassion and choice) apply to many people outside this seemingly narrow category and if euthanasia is ever legalised, given DID’s support for legally binding advance directives, you can be sure they will later be pushing for mentally incompetent people (including dementia patients) to have euthanasia on the grounds that they have previously signed a directive and it is ‘what they would have wanted’.

This is probably why Falconer has said he is planning a ‘gradualist’ approach – legalizing assisted suicide for a small group and then incrementally broadening the criteria once people have got used to it.

But another practical reason why assisted suicide leads inevitably to euthanasia, even without activists’ encouragement, is that it often doesn’t work, leaving doctors to wade in with a lethal injection to ‘finish off’ a comatose patient who has vomited or for some other reason is not yet dead after self-administering a cocktail of lethal drugs.

The following is excerpted from an article appearing at ‘True Dignity Vermont :Vermont Citizens Against Assisted Suicide’

In 2000, the New England Journal of Medicine featured an article on the clinical problems of assisted suicide and euthanasia. The article, titled Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands, is still available on line.

This study analyzed data from 649 cases and found that complications (such as myoclonus or vomiting) occurred in 7% of the assisted suicide cases, and that problems with ‘completion’ (such as a longer-than-expected time to death, failure to induce coma, or induction of coma followed by awakening of the patient) occurred in 16% of assisted suicide cases.

According to the results of the study, ‘The physician decided to administer a lethal medication in 21 of the cases of assisted suicide (18 percent), which thus became cases of euthanasia. The reasons for this decision included problems with completion (in twelve cases) and the inability of the patient to take all the medications (in five).’

This study shows how the legalisation of assisted suicide will inevitably lead to euthanasia because a significant number of assisted suicides fail. In Holland those failed assisted suicides have been completed by lethal injection (ie. euthanasia) which is also legal there.

Of course we know that patients who have experienced a failure of an assisted suicide sometimes change their minds, because, of the three people in Oregon who took the poison and did not die in 2010, none decided to attempt suicide again.

We wonder if the other people, those whose relatives may have finished them off with a plastic bag or whose doctor, if present, may have finished them off with a lethal injection, would have also changed their minds, if given a chance. We will never know how many of these people there were. The dead tell no tales.

Adult Stem Cells: the power of placenta

You are unlikely to learn this from any UK news source but an international conference was held in Rome on 9-11 November devoted to medical applications of adult stem cells.

The Vatican Pontifical Council had earlier announced a 5-year, $1 million partnership with adult stem cell biopharmaceutical firm NeoStem and its educational foundation to research adult stem cells, examine their use and promote the cells as medical treatments.

Adult stem cells, which unlike embryonic stem cells can be obtained ethically without destroying human embryos, are already used in the treatment of hundreds of diseases. Great strides are also being made in developing the alternative ethical sources – umbilical stem cells and iPS (induced pluripotent stem cells).

I have recently highlighted some exciting new advances on this blog.

Some interesting papers have come out of the conference. Here is one on another promising ethical source of stem cells – the human placenta. I reproduce the article from the Vatican radio site here in full with some added links.

Adult Stem Cells: the power of placenta

A leading pioneer in the use of adult stem cells to treat life-threatening diseases is calling the Vatican ‘a very powerful and supportive ally to helping advance this technology.’

Dr Robert J Hariri, founder and chief executive officer of Celgene Cellular Therapeutics is a US neurosurgeon and trauma specialist recognized for his discovery of pluripotent stem cells (cells that can differentiate to become nearly any cell of the body) from placenta.

Dr. Hariri spoke to Vatican Radio after delivering a speech on his research on adult stem cells in the treatment of autoimmune diseases at a three day Vatican sponsored conference this week entitled ‘Adult Stem Cells: Science and the Future of Man and Culture.’

Recipient of the Thomas Alva Edison Award for his discovery of placental stem cells in 2007 and for engineering tissues and organs from stem cells in 2011, Dr Hariri says he was first drawn to investigate the placenta as a therapeutic source of stem cells after seeing an ultrasound of his daughter while she was an embryo growing in the womb. He marvelled at how the placenta developed more rapidly than the embryo and at its nutrient-giving and protective properties.

He explains that placental cells are ‘one size fits all.’ They can mature into all kinds of cells without an embryo, and do not present problems of rejection by the patient-recipient. ‘The placenta is nature’s perfect graft material. It’s accepted between recipients and donors without having the two be matched.’

Using adult stem cells obtained from human placenta, Hariri says he and his team of researchers have had ‘compelling results’ in the treatment of autoimmune and inflammatory diseases.

‘We’re able to down-regulate the auto-reactive response of diseased immune system and correct things like Crohn’s Disease, Rheumatoid Arthritis and Multiple Sclerosis. And we find this exciting enough to continue to invest in exploring this as a potent, therapeutic use of these cells.’

And the supplies of these stem cells are apparently limitless. Dr Hariri told participants at the Vatican conference that one donor can provide cells for millions of recipients.

‘The placenta is an abundant resource,’ that can be easily recovered when a woman gives birth to a child he notes. ‘It’s readily available, it can be procured or recovered under very rigorous or tight controls. It’s a good, high quality source of material. From a single placenta we can mass produce, expand, manufacture those cells into huge numbers, quantities that allow us to treat hundreds of thousands, and potentially millions of patients.’

When asked what he thinks about the Vatican’s decision to host this week’s stem cell conference, Dr Hariri told Vatican Radio’s Tracey McClure: ‘It’s important for people to realize that the Vatican is a powerful, powerful advocate for science and technology. It is not interfering or impeding progress in this space and I think that the position in supporting non-embryonic stem cells happens to be a logical one because the tools at our disposal today don’t violate anyone’s personal, moral or ethical standards…these stem cells which can be derived from bone marrow, adipose (fat) tissue or from placenta are readily available, high quality, and can meet the needs of the clinical future.’

But is there enough public support in his country, the United States, for research into adult stem cell research? ‘I think there’s confusion…considerable confusion,’ reflects Dr Hariri. ‘There are underlying political and media agendas which sometimes distort the reality. Simply enough, I think that every scientist, every physician, every politician wants to see people have access to new breakthrough medicines that change the way diseases are treated and this is just one new tool.’

Should ‘gay’ Christians be true to their feelings?

Last Wednesday’s Metro (p35) ran the story of ‘a burly rugby player’ who ‘suffered a stroke in training and woke up to find he was gay’ (See ‘Different strokes - 19st rugby player now gay hairdresser’)

Mr Birch (pictured) was ‘straight’ and engaged to be married when he suffered a freak accident in the gym. The 26-year-old tried to impress his friends with a back flip but broke his neck and suffered the stroke. When he woke up, he underwent a drastic personality change that included an attraction to men.

Claiming that he ‘had to be true to (his) feelings’ he broke off his engagement and found a boyfriend.

The article speculates that ‘the personality change could have been caused by the stroke opening up a different part of his brain’ and quotes Stroke association spokesman Joe Korner as saying, ‘During recovery, the brain makes new neural connections, which can trigger things people weren’t aware of such as accent, language or perhaps a different sexuality.’

The case raises several interesting questions for Christians, not least ‘to what extent should we be “true to our feelings”?’

To answer it we have to appreciate that the issue of homosexuality needs to be understood at a number of levels.

1.Homosexual attraction – feelings of erotic attraction to people of the same sex
2.Homosexual orientation – predominant erotic attraction to people of the same sex
3.Homosexual behaviour – having sexual relations with people of the same sex or engaging in same-sex sexual fantasy, pornography or seduction
4.Homosexual identity – identifying oneself publically as ‘gay’ or lesbian’

In Mr Birch’s case above, it appears a change of sexual orientation occurred as a result of a brain injury. But in the vast majority of cases it arises as a result of a complex interaction between genetics, environment and lifestyle choice. But often there is little or no choice involved.

There is some overlap but also a lot of distinctiveness in these four categories. For example, in certain circumstances (eg prisons, boarding schools), people who have neither a homosexual orientation or identity may participate in homosexual behaviour.

Alternatively people of homosexual orientation might engage secretly in homosexual behaviour but never assume a homosexual identity. Or people who would describe themselves as heterosexual may occasionally experience same sex erotic attraction.

An ONS survey last year suggested that almost three-quarters of a million UK adults in Britain say they are gay, lesbian or bisexual - equivalent to 1.5% of the population.

People aged 16 and over were questioned about their self-perceived sexual identity, and asked to respond with one of four options: heterosexual/straight, gay/lesbian, bisexual or other.

The data showed that 95% said they were heterosexual, 1% gay or lesbian, 0.5% bisexual, 0.5% other, and the remaining 3% either did not know or did not answer.

The Office for National Statistics (ONS) said that on this basis 480,000 (1%) consider themselves gay or lesbian, and 245,000 (0.5%) bisexual.

The Kinsey scale (pictured) classifies people along a six point spectrum from exclusively heterosexual (0) to exclusively homosexual (6).

There are, by this reckoning, many people in church congregations who experience some feelings of same-sex attraction or recognize themselves as having a homosexual orientation. In fact, given that nine million people (15% of Britain’s population) go to church at least once a month, then that may mean that there are 72,000 gay and lesbian and 36,000 bisexual churchgoers in Britain (15% of above figures).

So if this describes us should we ‘be true to our feelings’ by having same-sex sexual relations or indulging in same-sex fantasy?

The Bible is very clear that all sexual relations outside marriage (a life-long exclusive monogamous heterosexual public covenant relationship) are morally wrong (Leviticus 18:6-23, 20:10-21; Romans 1:26, 27; 1 Corinthians 6:9,10; Colossians 3:5; 1 Thessalonians 4:3; 1 Timothy 1:9,10; Revelation 22:15). This includes fornication, adultery, same-sex relations and all other sorts of sex imaginable, even if you are deeply in love with the other person.

Claiming that we are just ‘being true to our feelings’ in this area is just as wrong as claiming that our feelings justify any other form of sin. As Jeremiah put it ‘the heart is deceitful above all things and beyond cure’ (17:9) It is God’s Word that must guide us, not our feelings.

So people who become Christians, who recognize that they experience same-sex feelings or have a homosexual orientation and/or identity, are in the same category as anyone who has opposite-sex feelings but is unmarried, divorced, widowed or in a marriage relationship where, for physical or psychosexual reasons, sex is not possible.

They must accept that not having sex is their only option. And for those who recognize themselves to be exclusively of homosexual orientation this may well mean that the only course open to them is staying single. Sometimes sexual orientation may change over time, but often it doesn’t.

Jesus of course was unmarried and never had sex yet we know that he ‘was tempted in all ways as we are – yet was without sin’. This must surely have included the temptation to sexual sin.

Is it possible to live a full life without having sex? Well Jesus did just that. And he is able to help any Christian to do the same. Marriage is a great calling but so is singleness, and sex is neither compulsory, nor necessary, in order to live a fulfilled and fruitful life.

Sex is a wonderful gift but like any gift it is not granted to all. If for any reason you can’t have sex, then ask what other good gifts God has given you, and enjoy those instead.

‘For this reason he had to be made like his brothers in every way, in order that he might become a merciful and faithful high priest in service to God, and that he might make atonement for the sins of the people. Because he himself suffered when he was tempted, he is able to help those who are being tempted.’ (Hebrews 2:17, 18)

‘For we do not have a high priest who is unable to sympathise with our weaknesses, but we have one who has been tempted in every way, just as we are — yet was without sin. Let us then approach the throne of grace with confidence, so that we may receive mercy and find grace to help us in our time of need’ (Hebrews 4:15, 16)

‘No temptation has seized you except what is common to man. And God is faithful; he will not let you be tempted beyond what you can bear. But when you are tempted, he will also provide a way out so that you can stand up under it’ (1 Corinthians 10:13)

Why is the Home Secretary allowing Philip Nitschke back into Britain?

The front page of last Wednesday’s Metro carried the story of an army veteran and his wife who committed suicide after becoming destitute (see ‘Driven to kill themselves by utter poverty’)

Mark and Helen Mullins are thought to have killed themselves at their rundown home after being reduced to despair as they struggled to live off just £57.50 a week. The couple had suffered a series of health and benefit setbacks and had had their 12-year-old daughter taken into care.

This tragic story is an extreme example of how some vulnerable families are feeling the economic pressure as the recession bites and living costs and unemployment rise.

Such people can be pushed by circumstances to take desperate measures and this sad case should heighten calls for more support and better protection for people living on the edge.

It is perhaps bitterly ironic therefore that Philip Nitschke (pictured) is entering Britain again this week to run a series of seminars instructing people how to commit suicide.

Nitshcke is an extremist and self-publicist who is on public record as supporting suicide for people including (in his own words) ‘the depressed, the elderly bereaved, the troubled teen’.

Between 12 and 21 November he will run a series of seminars in London, Eastbourne, Edinburgh and York in which he will give ‘practical information for end of life decision-making’.

I personally believe that these actions run contrary to the Suicide Act 1961 which prohibits the ‘encouraging or assisting’ of suicide.

I therefore wrote to Home Secretary Theresa May on 25 October asking her to exercise her powers to exclude Dr Nitschke on grounds of public policy and because his presence in the United Kingdom threatens a fundamental interest (namely the maintenance of the ‘rule of law’ and the maintenance of a law abiding community).

I urged her to take immediate action and, if no Exclusion Order was made, to provide me with full details surrounding the reason for the decision.

I have had no reply from the Home Secretary’s Office and to my knowledge no attempt has been made to detain Nitschke who is due to arrive this week.

The Home Secretary is, as we know, currently under pressure defending a decision to relax immigration controls. Nitschke’s arrival could well add to those difficulties.

With the growing elderly population, failure of the care system and worsening economic situation a growing number of frail, disabled, ill and depressed people in Britain, like the Mullins, will be feeling under even greater pressure to end their lives, either for fear that they will not cope, or so as to be less of a burden to relatives.

They deserve better protection from suicide predators like Nitschke than they are currently getting.

Let’s hope that no vulnerable person is ‘helped’ over the edge by attending one of his seminars or as a result of the inevitable media hype that will accompany his visit.

Euthanasia of woman with advanced dementia in Netherlands sounds loud warning to Britain

A 64-year-old woman suffering severe senile dementia has been euthanised in the Netherlands – even though she was no longer able to express her wish to die.

The unnamed woman was a long-term supporter of euthanasia and had made a written statement when she was still well, saying how she wished to die.

But the pensioner, who died in March, had been unable to reiterate her instructions as the disease progressed, Volkskrant reported.

Euthanasia is legal in the Netherlands provided the doctor believes the patient is making an informed choice and is suffering from unbearable pain. But once dementia has set in, it’s too late: even a living will made prior to the decline cannot be taken into account. The ‘solution’ that is being proposed, therefore, is to step out of life before the disease runs its course.

Cases of euthanasia in the Netherlands have risen from 2,500 in 2009 to 2,700 in 2010; but even more shocking, last year 21 persons suffering from the early stages of dementia, but who were otherwise in good health, were euthanized. All of these 21 ‘mercy killings’ were subsequently approved by the official euthanasia follow-up commission.

63-year-old Guusje de Koning was one of the ‘beneficiaries’ of euthanasia last year. In a video shot by her husband four days before her death, and aired on the television station, she explained her choice to be killed to her two children.

Her image is now being used to support the notion that killing of people in the first phase of dementia is a good way to avoid both suffering and the excessive cost of healthcare for elderly Netherlanders.

The number of reported euthanasia deaths in the Netherlands has grown significantly over recent years since being legalized in 2002. In 2008 there were 2331 reported deaths, 2120 in 2007, 1923 in 2006 and 1815 in 2003. But these are only the voluntary euthanasia figures.

The 2005 official study of euthanasia in the Netherlands indicated that 7.1% of all deaths were by intentional sedation and dehydration. By 2007 this had grown to 10%.

Just last month it was reported that the Dutch Medical Association was seeking to expand the practice of Euthanasia in the Netherlands to include more people under the ‘unbearable suffering’ that allows physicians to kill patients and the elderly.

Dutch Radio Worldwide reported: ‘Until now, factors such as income or a patient’s social life played almost no role when physicians were considering a euthanasia request. However, the new guidelines will certainly change that. After almost a year of discussions, the KNMG has published a paper which says a combination of social factors and diseases and ailments that are not terminal may also qualify as unbearable and lasting suffering under the Euthanasia Act.’

In other words the scope of those now qualifying now includes those who are lonely. The situation in the Netherlands gives a stark warning about the incremental extension that inevitably accompanies a change in the law to allow euthanasia. It extends from voluntary to involuntary, from adults to minors and from those with terminal illness to those with chronic illness and disability.

In 2006 a House of Lords Committee calculated that a Dutch-type law in the UK would lead to 13,000 cases of euthanasia per year here – a huge increase on the 20 or so Brits who travel abroad to end their lives at the Dignitas facility in Switzerland each year. These estimates would be even higher now.

Britain is about to be greeted over the next few months by a rigged commission recommending a change in our law and three new bills – in the Isle of Man, Scotland and Westminster – seeking to decriminalize assisting suicide.

But legalising assisted suicide or euthanasia in Britain would be a recipe for the abuse and exploitation of elderly, dying and disabled people. Combine that with economic recession, growing unemployment and rising cost of living – with many families feeling the pinch – and you have a very lethal cocktail indeed.

There are currently 750,000 people with dementia in the UK but by 2021 this will have increased to over a million. There are many people who have a financial or emotional interest in their deaths. Let’s not give them any encouragement.

Any move to weaken the law must be roundly rejected. Better care and more legal protection is the right way forward.

Allowing sexually active gay men to donate blood is not worth the risk

Gay men will now be able to give blood as Government restrictions are officially lifted, the Department of Health (DoH) has said.

A lifetime ban on blood donation by men who had had sex with another man was put in place in the UK in the 1980s as a response to the spread of Aids and HIV.

But following a review by the Advisory Committee on the Safety of Blood, Tissues and Organs (Sabto), men who have not had homosexual sex within a year will be able to donate if they meet certain other criteria.

The move will be implemented in England, Scotland and Wales.

Men who have had anal or oral sex with another man in the past 12 months, with or without a condom, will still not be eligible to donate blood, the DoH said. They said this was to reduce the risk of infections being missed by testing and then being passed on to a patient.

Sabto’s advisory panel, comprising leading experts and patient groups, carried out its review based on the latest available evidence and found it could no longer support the permanent exclusion of men who have had sex with men. They considered the risk of infection being transmitted in blood, attitudes of potential donors in complying with the selection criteria and improvements in testing of donated blood.

Dr Lorna Williamson, NHS Blood and Transplant's medical and research director, said: ‘The Sabto review concluded that the safety of the blood supply would not be affected by the change and we would like to reassure patients receiving transfusions that the blood supply is as safe as it reasonably can be and amongst the safest in the world. There has been no documented transmission of a blood-borne virus in the UK since 2005, with no HIV transmission since 2002.’

I have just listened to a BBC interview (still on line) where a bisexual man called John said that there was still not ‘equality’ and that there should not be even a twelve month waiting time. It was explained to him that this waiting time would still be in place because the incubation period for hepatitis B, which is carried in blood, is six months – and that the twelve month ban was there for reasons of patient safety. I might add that the time for sero-conversion for HIV (during which you can infect others but do not have detectable antibodies) is 20-90 days and can also be as long as six months.

Why am I unhappy about this new policy? I simply believe that allowing gay men who have been sexually active to donate blood is just not worth the risk.

First, the conclusion of the latest research is that over 10% of men who have sex with men (MSM) already knowingly defy the current lifelong ban. This suggests that many will also knowingly defy the twelve month ban and this will increase the risk of transmission, especially if John’s reaction above is in any way representative.

Second, the number of new donors this policy will produce will be very small. According to the Wellings’ survey only 2.6% of men report ever having had sex with men and the vast majority of these will have been active in the last year. Also two thirds of gay men participate in anal sex. So it will be only a very small fraction of an already small starting percentage who will even be eligible.

Third, the risks of HIV transmission with anal sex are very high indeed, 18 times higher than in vaginal sex. The risk of an HIV positive person passing the virus on in the course of a relationship involving anal sex is around 40% explaining why gay men are such a high risk group (see also original source).

Fourth, a subset of gay men are extremely promiscuous and the risk of HIV transmission goes up with the number of partners one has. Despite the popular media image of homosexual monogamy, several large early studies from the 1970s revealed that less than ten percent of homosexual men or women had ever experienced a relationship of greater than ten years duration. In one large early study, 74% of male homosexuals reported having more than one hundred partners in a lifetime, and 28% more than 1,000; 75% reported that over half of their partners were strangers. A more recent review of six studies showed that 87% of gay men displayed levels of promiscuity parallel to those of unmarried straight men with an average of five or six sexual partners in the last five years. But a significant minority were promiscuous to an extent seen rarely in straight men. 14.4% had 20-100 sexual partners in the previous five years and 4% had over 100!

So in summary – most gay men engage in high risk anal sex, some are extremely promiscuous, and a significant proportion lie about it. It’s simply not worth the risk allowing them to give blood given the small number of gay men who would actually qualify under the new guidelines.

If one person gets HIV from blood donated by a gay man it will be a tragedy. Banning all gay people giving blood donations may debar some who would very much like to help in this way. But safety should be the overriding priority. In a free society we accept, for reasons of public safety, that some people are not able to do what they very much would like to do – in all sorts of contexts other than blood donation.

In a much-quoted editorial published in Vox Sanguinis in 2004 J P Brooks argued that ‘The rights of blood recipients should supersede any asserted rights of blood donors’

The abstract of his review summarised the arguments as follows:

‘Some gay men have argued that the laboratory testing of blood is so accurate that continued deferrals based upon sexual activity are unnecessary and unjust. They also assert that they have a right to donate blood. There has been much debate over altering the rule barring donation from men who have had sex with other men since 1977, with blood organizations disagreeing over the best course of action. Two studies have indicated that changing the rule would increase the risk of human immunodeficiency virus (HIV) transmission. This dilemma is part of a broader issue, namely: what are the responsibilities of blood services to blood donors and recipients? Blood services should base decisions regarding donor suitability on science rather than on their donors’ desires. Blood services must recognize that the rights of blood recipients should supersede any asserted rights of blood donors.’

Quite!

But the final word goes to Andrew Marsh of Christian Concern who was interviewed on Radio Five Live breakfast show this morning.

He made the point that the safest donors, with respect to HIV, are those who have only had sex within the context of marriage, and that if there was no sex outside marriage there would be no HIV. Well now, there’s a radical idea!

New study highlights positive benefits of marriage

The Family Education Trust has just highlighted a report from the Institute of American values which is of huge relevance here given that the government intends to undermine the distinctiveness of marriage by legalizing same-sex marriage.

Based on a survey of over 250 peer-reviewed journal articles on marriage and family life from around the world, a team of 18 leading American family scholars chaired by Professor W Bradford Wilcox of the University of Virginia has drawn 30 conclusions about the positive benefits associated with marriage under five headings.

Each of the conclusions is substantiated in the report and 20 pages of supporting references can be downloaded from the website of the Institute of American Values.

Here is a snapshot of the conclusions:

Family

1. Marriage increases the likelihood that fathers and mothers have good relationships with their children.

2. Children are most likely to enjoy family stability when they are born into a married family.

3. Children are less likely to thrive in complex households.

4. Cohabitiation is not the functional equivalent of marriage.

5. Growing up outside an intact marriage increases the likelihood that children will themselves divorce or become unwed parents.

6. Marriage is a virtually universal human institution.

7. Marriage, and a normative commitment to marriage, foster high-quality relationships between adults, as well as between parents and children.

8. Marriage has important biosocial consequences for adults and children.

Economics

9. Divorce and unmarried childbearing increase poverty for both children and mothers, cohabitation is less likely to alleviate poverty than is marriage.

10. Married couples seem to build more wealth on average than singles or cohabiting couples.

11. Marriage reduces poverty and material hardship for disadvantaged women and their children.

12. Minorities benefit economically from marriage also.

13. Married men earn more money than do single men with similar education and job histories.

14. Parental divorce (or failure to marry) appears to increase children’s risk of school failure.

15. Parental divorce reduces the likelihood that children will graduate from college and achieve high-status jobs.

Physical Health and Longevity

16. Children who live with their own two married parents enjoy better physical health, on average, than do children in other family forms.

17. Parental marriage is associated with a sharply lower risk of infant mortality.

18. Marriage is associated with reduced rates of alcohol and substance abuse for both adults and teens.

19. Married people, especially married men, have longer life expectancies than do otherwise similar singles.

20. Marriage is associated with better health and lower rates of injury, illness, and disability for both men and women.

21. Marriage seems to be associated with better health among minorities and the poor.

Mental Health and Emotional Well-Being

22. Children whose parents divorce have higher rates of psychological distress and mental illness.

23. Cohabitation is associated with higher levels of psychological problems among children.

24. Family breakdown appears to increase significantly the risk of suicide.

25. Married mothers have lower rates of depression than do single or cohabiting.

Crime and Domestic Violence

26. Boys raised in non-intact families are more likely to engage in delinquent and criminal behaviour.

27. Marriage appears to reduce the risk that adults will be either perpetrators or victims of crime.

28. Married women appear to have a lower risk of experiencing domestic violence than do cohabiting or dating women.

29. A child who is not living with his or her own two married parents is at greater risk of child abuse.

30. There is a growing marriage gap between college-educated Americans and less-educated Americans.

Why Marriage Matters: Thirty conclusions from the social sciences, Institute for American Values and National Marriage Project, 2011.

Family Education Trust Report

Over half of British Christians would not back Tories if they push for same-sex marriage

Earlier this week I argued that Prime Minister David Cameron’s promotion of the gay rights agenda was based on a false presupposition – that homosexuality is biologically determined.

This was in the wake of government plans to allow same-sex civil partnership ceremonies to take place in churches.

Today I learnt from Stuart James about a new poll which shows that the Conservative Party risks losing Christian votes if it goes ahead with legalizing same-sex marriage.

In February the government expressed its intention to begin a consultation to allow both religious same-sex ceremonies and civil marriage for same-sex couples.

In September, at the Party’s recent conference in Manchester, David Cameron announced his intention to introduce same-sex civil marriage by the next general election.

The survey, published on 4 November, was undertaken on behalf of Premier Christian Media Trust among the ComRes CPanel of UK churchgoing Christians aged 18 and over.
544 were interviewed online between 25 and 31 October 2011. Results are available on line.

‘British Religion in Numbers’ reports it as follows:

Asked how they viewed the Conservative proposal to legalise same-sex marriages, only 11% of Christians supported it, while 83% were opposed (three-quarters of them strongly).

Hostility was particularly concentrated among the over-65s (90%), compared with 26% support in the 18-34 cohort. Denominationally, Independents, Pentecostals and Roman Catholics were most critical.

Overwhelmingly, these churchgoers foresaw negative consequences in the event of the law being changed in respect of same-sex marriage:

•85% were concerned that the value of marriage would be further undermined
•78% that it would be harder to argue against ‘other novel types of relationship’ such as polygamy
•88% that schools would be required to teach the equal validity of same-sex and heterosexual relationships
•93% that clergy would have to conduct same-sex marriages against their consciences

Absolutely nobody claimed that Cameron’s commitment to legalizing same-sex marriages would make them more likely to vote Conservative. 37% said that it would make no difference to their political behaviour.

But 57% were clear that they would be less disposed to back the Tories in future, this being especially true of Pentecostals (69%) and Roman Catholics (75%).

I have outlined previously how it appears no longer acceptable in David Cameron’s Britain to express the view that homosexual acts are in any way unnatural or immoral. But in fact the orthodox Christian position, upheld by the Bible itself, is that they are both.

The Prime Minister does not hold these views and in fact sacked a Conservative Party candidate just before last year’s national election for expressing them, although they are held by a significant proportion of the population.

It has been suggested that David Cameron is supporting same-sex marriage and promoting the gay rights agenda because he believes that the Gay rights lobby in this country is stronger than the Christian lobby.

I guess the jury is still out on that one.

But regardless, whether he holds his personal beliefs out of political expedience or personal conviction, it appears that they may soon be seriously tested.

On the fewness of those who love the cross of Christ – a challenge from Thomas a Kempis

‘Jesus has always many who love His heavenly kingdom, but few who bear His cross; many who desire consolation, but few who care for trial; many to share His table, but few to take part in His fasting. All desire to be happy with Him; few wish to suffer anything for Him. Many follow Him to the breaking of bread, but few to the drinking of the chalice of His passion. Many revere His miracles; few approach the shame of the Cross. Many love Him as long as they encounter no hardship; many praise and bless Him as long as they receive some comfort from Him. But if Jesus hides Himself and leaves them for a while, they fall either into complaints or into deep dejection…

If a man gives all his wealth, it is nothing; if he does great penance, it is little; if he gains all knowledge, he is still far afield; if he has great virtue and much ardent devotion, he still lacks a great deal, and especially, the one thing that is most necessary. What is this one thing? That leaving all, he forsake himself, completely renounce himself, and give up all private affections. Then, when he has done all that he knows ought to be done, let him consider it as nothing, let him make little of what may be considered great; let him in all honesty call himself an unprofitable servant…

No one, however, is more wealthy than such a man; no one is more powerful, no one freer than he who knows how to leave all things and think of himself as the least of all.'

I first read this passage titled ‘Of the fewness of those who love the cross of Christ’ when I was a fourth year medical student. It comes from Thomas à Kempis’ Imitation of Christ, and was written in 1427 in the late middle ages, a time characterised by general moral and ethical decline and of widespread secularisation. The book survives in 700 manuscripts and 2,000 printings and has been translated into 90 languages, and is the most popular book in history outside the Bible.

I was deeply moved by it because I recognised that the person being described – the mercenary, the fair weather Christian, the one who loved miracles and God’s heavenly Kingdom but actually wasn’t willing to carry Jesus’ cross… was me.

The term ‘radical discipleship’ is a tautology, because Christian discipleship is radical by its very nature. Jesus is a radical King who calls us to follow him in his radical footsteps. ‘Christian disciple’ actually means ‘follower of Jesus’. Acts 11:28 tells us that the disciples were first called Christians in Antioch – many years after Pentecost. Before that they were called disciples. Christian and disciple are one and the same.

The Gospel is not some kind of therapy to make our lives easier. Discipleship is costly. It involves suffering, persecution and hardship because it involves following in the footsteps of Jesus. Becoming a Christian does not insulate us from suffering. If anything it makes us targets.

Jesus pulled no punches with his disciples:

If anyone comes to me and does not hate his father and mother, his wife and children, his brothers and sisters—yes, even his own life—he cannot be my disciple. Anyone who does not carry his cross and follow me cannot be my disciple. Any of you who does not give up everything he has cannot be my disciple. If they persecuted me, they will persecute you also.

John understood what it meant to follow Jesus: ‘This is how we know we are in him: Whoever claims to live in him must walk as Jesus did.

We can be greatly blessed by God and not be his disciples; countless people were healed by Jesus who never became his disciples because they never repented and became his followers. We can be greatly used by God and not be his disciples – Judas was. The parable of the houses on rock and sand make it clear that those who build their houses on the rock are those who both hear God’s word and obey it. Scripture teaches us that there were many who thought they were out who were actually in, and many who thought they were in who were actually out. We cannot have Jesus as Saviour without also having him as Lord – being a disciple means following in his footsteps.

Are we serious about following Jesus in this day and age knowing that it will cost us, that there is suffering and hardship, that there is a price to pay? Do we think Jesus is worth it? That depends on whether we really understand who he is and what he has done for us.

Jesus is God himself who came to this earth to be rejected, humiliated, abused, murdered and nailed to a cross in order to rescue us from the hell and judgement we rightly deserve; in order to call us to be partners with him in his work of redemption and then to spend all eternity with him.

If we really understand what we have been saved from and what we have been saved to then we will also recognise that we don’t have any choice but to respond to his call to follow and say like Peter did in John 6:68-9: ‘Lord, to whom shall we go? You have the words of eternal life. We believe and know that you are the Holy One of God.’