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

Secretary of State for Health, Jeremy Hunt (pictured), yesterday hailed the controversial Liverpool Care Pathway (LCP) for patients who are dying as ‘a fantastic step forward’ in the way hospitals support the terminally ill.

I agree that the LCP is a useful clinical tool that has helped many thousands of people experience better care in the last hours or days of life, but like any tool it must be used with the proper indications and by properly trained staff.

Every airline accident should make our next air trip safer; in the same way every abuse or misuse of the LCP should mean that the same mistake never occurs again.

CMF has recently called on the government to consider nine key points in its recently announced review of the LCP which is currently used with around 130,000 people a year, about a third of annual deaths in the UK.

To iron out the abuses that have been reported, several key measures need to be implemented:

1.It should be made absolutely clear that no one who is not imminently dying within hours, or at most two or three days, should be placed on the LCP and anyone placed on it who shows improvement should be taken off it. These assessments should be made by senior clinicians.

2.No one should be placed on the LCP without it being discussed with the relative or carer (although the latter do not need to give consent).

3.Every patient placed on the LCP must be regularly monitored and reassessed by a multidisciplinary team.

4.The present documentation is far too complex and needs to be simplified and standardised so that those implementing it can easily follow the guidelines and supervisors can easily tell what is going on with each patient.

5.Training and supervision of those using the pathway needs to be standardised and improved and formal training should be required before any healthcare professional is able to use it.

6.An annual audit needs to be carried out and all suboptimal use identified promptly acted upon.

7.Non-clinical priorities in the use of the pathway, especially financial priorities, must be eradicated and every patient treated solely according to their need. In this connection it would be far better to link CQUIN payments to staff training in the use of the pathway rather than numbers of patients placed on the pathway.

8.Communication to relatives both by health professionals and organisations involved in LCP implementation needs to be substantially improved.

9.Those misusing the LCP should be quickly identified and in the case of abuse reported to the appropriate authorities (General Medical Council, Nurses and Midwifery Council or Health and Care Professions Council).

Writing in a recent review for CMF’s journal Triple Helix, Dr Jeff Stephenson, a Devon-based consultant in palliative care has said:

‘The LCP represents a pragmatic and effective response to some of the suffering experienced by many in the last days of life. It remains, however, a tool and it is only as good as those who use it. There is always potential for misuse and abuse and there are undoubtedly instances where this occurs. Where these arise by intention then those involved should be held to account, but more often they occur through poor understanding and inadequate training. We owe it to patients to not only furnish the means to better care, but also to equip adequately those who provide it.’

Stephenson’s whole article is well worthy of study.

Won’t a good moral life get me to heaven?

Peter Ustinov, the famous actor, was asked in a television interview for his 'doctrine of man'. He gave the reply 'Man is essentially good!' and was rewarded with sustained applause from the audience.

Even among those who believe in the reality of heaven and hell, the popular conception is that the latter must be reserved only for arch villains like Stalin, Hitler or Genghis Khan - perhaps along with a handful of gang rapists and serial killers.

Most people, however, are thought good enough to pass the test. This sort of thinking is widespread but totally at odds with the Christian Gospel.

Our acceptance by God does not depend on our goodness, but rather on his mercy (Lk 18:9-14; Tit 3:5). In answering the question 'Won't a good moral life get me to heaven?' we need to bear in mind the following:

1.The Reality of Judgment

The Bible teaches that death leads not to extinction of perception, not to reincarnation, not to a disembodied existence of the soul - but rather to judgement (Heb 9:27). At this point there is a separation between those who are consigned to Hell, and those who are to receive resurrected bodies (Phil 13:2; 1 Cor 15:35-56; 2 Cor 5:1-9) and join Christ as his subjects in a new heaven and earth (Is 65:17-25; Is 66:22-24; Rev 21:1-5). Any who doubt the reality of Heaven and Hell should be reminded that this is the teaching of Jesus Christ himself and his apostles (Mt 10:28, 11:20-24, 13:37-43, 47-50; 25:31-46; Jn 5:22-30; 2 Thes 1:7-10; Rev 20:11-15).

2.The Pass-Mark of Perfection

God's standard is not that we be better than others, but rather that we be perfect (Mt 5:48). To stumble at just one point is to fail completely (Jas 2:10). Furthermore in God's eyes bad thoughts are no less evil than bad actions - lust is equivalent to adultery (Mt 5:27,28) and anger to murder (Mt 5:21,22). As we become conscious of God's real standards, it becomes apparent that even the morally upright fall short of them (Rom 3:20) - as the examples of the apostle Paul (Phil 3:4-7) and the Rich Young Ruler (Mt 19:16-30; Mk 10:17-30; Lk 18:18-30) clearly demonstrate.

3.The Universality of Sin

With this standard in mind it is clear that there is no-one 'who does what is right and never sins' (Ec 7:20). To the contrary all have fallen short (Rom 3:9-12, 23; Ps 14:2-3, 53:2-3). Even our good deeds are bad in God's sight (Is 64:6). Since we cannot save ourselves it follows that our only hope is to be rescued by God (Mt 19:25-26).

4.The Perfection of Christ

By contrast with man, the sinlessness of Christ is taught in the Bible as an established fact (Is 53:9; 2 Cor 5:21; Heb 4:15; 1 Pet 2:22; 1 Jn 3:5). He can confidently challenge his accusers to find fault 'can any of you prove me guilty of sin?' (Jn 8:46). He is therefore the only way to God (Jn 14:6; Acts 4:12; 1 Tim 2:5).

5.Salvation only by faith

Eternal life therefore cannot be gained by our own efforts. It is a free gift of God which must be received by faith (trusting belief) in Christ (Rom 1:17; 3:22; 6:23; Gal 2:16; Eph 2:8,9; Phil 3:9; Tit 3:3-6; Heb 11:6). If we could achieve it by our own efforts, it would not have been necessary for Christ to give his perfect life on our behalf (Gal 2:21). It is Jesus’ death on the cross on our behalf for our sins which is what makes it possible for us to be saved from what would otherwise be inevitable judgement (Jn 3:16; 1 Cor 15:3; Gal 1:4; 1 Jn 3:16).

Sometimes the question is put around the other way. If God is good then surely he would not send people to Hell? But this is to misunderstand the sinfulness of man and the holiness and moral purity of God. Sinful man simply cannot stand in God’s presence so could never exist in heaven.

On earth we are sheltered from the reality of judgement in order to give us a chance to come to God willingly to receive his forgiveness. He has furthermore, through Jesus Christ, done everything necessary for that to happen. But if we refuse that and thereby shake our fists at him in defiance then there is no other offer on the table. It is his universe not ours and there is only one other possible destination.

A good moral life cannot get us to heaven. It is not good people who go to heaven, for no-one is good enough. Good people (those who think they are good enough) go to hell. Bad people (those who realise they fall short of God's standards and look to his grace and mercy) go to heaven if they put their faith in Christ (Jn 3:16, 5:24).

A bit of New Year nostalgia - Twelve favourite songs from my childhood

Time for a little nostalgia. The songs of our childhood are precious to us not just because of their words and melodies but because of the memories of times, places and people that we associate with them.

The following list includes some of my favourites from the 1960s when I was growing up in New Zealand and before I became a teenager.

I’ve included just one from each artist or group that has special significance for me but not necessarily the most well-known or best loved.

Of the following I have only ever seen the Seekers perform live – in the Auckland Town Hall in (I think) 1968.

I went with my cousins and our parents managed to secure seats in the front row for was an unforgettable experience. Like many ten year-olds of the time, I had a crush on Judith Durham (pictured) and felt that she was singing just to us.

Some of these songs will be familiar because they were big hits but others you may not have heard.

All however have great melodies so if you haven’t heard any of them before do click the links and enjoy.

Where possible I have tried to include links to live recordings:

1. All that I remember (1967) – The Seekers

2. My boomerang won’t come back (1961) – Charlie Drake

3. A whiter shade of pale (1967) – Procul Harem

4. Proud Mary (1969) – Creedence Clearwater Revival

5. California dreamin’ (1965) – Mamas and the Papas

6. Witchita Lineman (1968) – Glen Campbell

7. House of the Rising Sun (1964) – The Animals

8. The Boxer (1968) - Simon and Garfunkel

9. Daydream Believer (1967) – The Monkees

10. A day in the life (1967) – The Beatles

11. Nights in White Satin (1967) - Moody Blues

12. In the year 2525 (1969) - Zager and Evans

Why cross-cultural communication can be so difficult

Have you ever wondered why cross-cultural communication can be so difficult?

Recently a world-wide survey was conducted by the UN.

The only question asked was:

“Would you please give your honest opinion about solutions to the food shortage in the rest of the world?"

The survey was a failure because:



•In South America they didn't know what "please" meant.
•In Eastern Europe they didn't know what "honest" meant.
•In China they didn't know what "opinion" meant.
•In the Middle East they didn't know what "solution" meant.
•In Africa they didn't know what "food" meant.
•In Western Europe they didn't know what "shortage" meant.
•In the US they didn't know what "the rest of the world" meant.
•In Australia, they hung up, because they couldn't understand the Indian accent.

The Queen once again points her subjects to Jesus Christ

While the Pope, the Archbishop of Canterbury and the Archbishop of Westminster addressed Syria, women bishops and gay marriage respectively the Queen kept her Christmas message short, direct and simple.

Building on the spirit of togetherness and friendship captured in 2012 by the London Olympics and Diamond Jubilee celebrations she then praised the spirit of service displayed by the armed forces, emergency services and health workers before saying that all of us should reach out beyond ‘familiar relationships’ to serve others.

But then she really cut to the chase (see full text here).

'At Christmas I am always struck by how the spirit of togetherness lies also at the heart of the Christmas story. A young mother and a dutiful father with their baby were joined by poor shepherds and visitors from afar. They came with their gifts to worship the Christ child. From that day on he has inspired people to commit themselves to the best interests of others.

This is the time of year when we remember that God sent his only son "to serve, not to be served". He restored love and service to the centre of our lives in the person of Jesus Christ.

It is my prayer this Christmas Day that his example and teaching will continue to bring people together to give the best of themselves in the service of others.'

Not content to point to Jesus simply as an example to follow, she drove home the point of responding personally to him:

'The carol, In The Bleak Midwinter, ends by asking a question of all of us who know the Christmas story, of how God gave himself to us in humble service: "What can I give him, poor as I am? If I were a shepherd, I would bring a lamb; if I were a wise man, I would do my part". The carol gives the answer "Yet what I can I give him - give my heart".'

Last year the Queen similarly pointed people to Jesus Christ by using another familiar hymn:

‘Finding hope in adversity is one of the themes of Christmas. Jesus was born into a world full of fear. The angels came to frightened shepherds with hope in their voices: “Fear not”, they urged, “we bring you tidings of great joy, which shall be to all people.”

“For unto you is born this day in the City of David a Saviour who is Christ the Lord.”

Although we are capable of great acts of kindness, history teaches us that we sometimes need saving from ourselves - from our recklessness or our greed.

God sent into the world a unique person - neither a philosopher nor a general, important though they are, but a Saviour, with the power to forgive.

Forgiveness lies at the heart of the Christian faith. It can heal broken families, it can restore friendships and it can reconcile divided communities. It is in forgiveness that we feel the power of God's love.

In the last verse of this beautiful carol, O Little Town Of Bethlehem, there's a prayer:

O Holy Child of Bethlehem,
Descend to us we pray.
Cast out our sin
And enter in.
Be born in us today.

It is my prayer that on this Christmas day we might all find room in our lives for the message of the angels and for the love of God through Christ our Lord.’

At a time when so many use authority to exercise power over others, we are truly blessed to have a monarch who knows where true power lies.

And in an age when even many Christian leaders seem to find it difficult to be faithful to the Gospel, we can be thankful that our sovereign does not hesitate to tell it like it is, and graciously points people to Jesus Christ, the King of Kings and Lord of Lords, as the one with the power to forgive, to whom we owe our very hearts.

End of year update on euthanasia, assisted suicide and palliative care

As 2012 draws to a close, we look back over a busy twelve months, and ahead to the challenges that 2013 holds in store.

Lord Falconer's 'Commission on Assisted Dying'

The Falconer Commission reported on 5 January, predictably recommending a change in the law to permit assisted suicide (not euthanasia) for mentally competent adults with less than twelve months to live. The general media coverage was very balanced, and the divisions within the pro-euthanasia movement became clear, with some arguing that the Commission had not gone nearly far enough. CNK played a prominent role in discrediting the Commission, with 40 media interviews in 24 hours (seehere, here, here, here, here and here).

Whitehall & Westminster

The Government promised £1.5m for research exploring suicide prevention among those most at risk of taking their own lives, as part of a new suicide prevention strategy aimed at cutting the suicide rate and providing more support to bereaved families.

This summer's Government reshuffle produced two new junior health ministers, Anna Soubry and Norman Lamb, who have since spoken out in favour of relaxing the law on assisted suicide, but a poll commissioned by CNK (covered by outlets including ConservativeHome, the Telegraph and Press Association) has shown that just 29% of MPs back moves to introduce assisted suicide (59% were opposed) and indeed, it has been a positive year for our cause in Westminster.

CNK held a mass lobby of Parliament on 3 July, ahead of the publication of Lord Falconer's new bill and the Dignity in Dying (DiD) AGM & lobby. Brian Iddon and Peter Saunders spoke, alongside notable Westminster figures including Lord Alton, Ann Widdecombe, Fiona Bruce MP, Jim Dobbin MP and Ian McColl MP.

David Burrowes MP led a Westminster Hall debate in January at which MPs in attendance signalled a desire for the debate about end of life issues to be based upon providing excellent palliative care rather than any measure to introduce assisted suicide.

Director of Public Prosecutions' guidelines

27th March saw one of the year's most impassioned debates on the floor of the House of Commons, as Members debated whether or not to put the Director of Public Prosecutions' (DPP) guidelines regarding assisted suicide on a statutory footing. This had been a goal of DiD and their Parliamentary allies, with the aims of obtaining assurances of no prosecution ahead of time for specific cases of assisted suicide, and creating an exemption for healthcare workers. The Government told the Lords in February that the DPP should remain 'unfettered', and MPs concluded that improved palliative care should be the priority, Richard Ottaway MP having withdrawn his original motion. Debate was respectful, but Members were clear: care, not killing.

BMA

The British Medical Association's annual representative meeting in June saw 14 of 20 motions regarding euthanasia or assisted suicide seek to relax the BMA's policy on the subject. One of these, Motion 332seeking to move the British Medical Association to a neutral position on 'Assisted Dying', was debated and defeated by a large majority despite having substantial support from the British Medical Journal. The BMA vote was the most serious threat since 2005, and the vote clearly demonstrates that the medical profession remains overwhelmingly 'on side'.

Nicklinson & Martin

On 19-22 June, three High Court Judges heard the joined cases of two men with conditions resembling locked-in syndrome, seeking to challenge the 1965 Murder Act. Tony Nicklinson argued that the principle of necessity should allow a doctor to end his life without fear of prosecution for murder, and that the current laws interfere with his Article 8 right to his private life. 'AM' ('Martin') additionally wants the DPP, the Solicitor's Regulatory Authority and the General Medical Council to make clear in advance the extent to which solicitors and doctors could assist his suicide. CNK was granted permission to intervene in both cases, and Justices Toulson, Royce & Macur rejected both applications in August, saying that it was a 'matter for Parliament.'

Nicklinson's death six days later attracted extensive media interest & coverage. His wife unsuccessfully sought to intervene on his behalf, but she is now appealing that decision, while 'Martin' has been granted leave to take his case to the Court of Appeal.

First European Symposium on Euthanasia and Assisted Suicide

The first European Congress on Euthanasia Prevention in Edinburgh (6-8 September) was a great success, with around 100 delegates and attendees from a dozen countries being addressed by "passionate and committed speakers". Those assembled discussed ongoing threats across Western Europe and North America, with experiences shared and relationships developed, and contributions from disability rights campaigners were singled out for particular praise.

Liverpool Care Pathway

Controversy has built over the latter half of this year regarding the Liverpool Care Pathway (LCP), a framework for the care of those in the final hours or days of life. The press has helped to bring to light numerous cases of its misapplication, and the ensuing level of concern has drawn both condemnation and support from the highest levels of the Government, the medical & care sector and patients' groups.

On 26 November, Care Minister Norman Lamb MP convened roundtable talks with parliamentarians, doctors and patients' representatives to discuss the LCP. During the meeting, at which CNK was represented, the Minister announced a far-reaching review to consider the various issues raised, with an independent chair. The review will consider the findings of three existing reviews being conducted by the Association of Palliative Medicine ('on the implementation of the pathway and the experience of professionals'), Dying Matters ('on the experience of the patient and their loved ones') and the End of Life Care Strategy ('on complaints surrounding the LCP and end of life care in hospitals'). The announcement received widespread media attention (BBC, Telegraph, Guardian, Mail).

CNK has been an active part of this debate throughout, and our basic position has been that the LCP is a useful clinical tool when used correctly- with many thousands of people benefiting from it- but that there is clearly a need for change, and we have already published a number of recommendations.

Massachusetts

The US state of Massachusetts voted 51%-49% in a referendum on 6 November to reject the legalisation of physician-assisted suicide for the terminally ill. The measure was defeated after a strong campaign by a diverse coalition called 'No on Question 2', comprised of disability rights organisations, doctors, nurses, community leaders, faith based groups and patients' rights advocates.

NEXT YEAR: Holyrood legislation

Two years since her last attempt was defeated in Edinburgh by a massive 85-16, Margo MacDonald MSP is gearing up to introduce her new Assisted Suicide (Scotland) Bill in the spring, and has promised a'tougher fight'. Her proposals are based loosely on the Oregon model, and despite the fact that 65% of responses to her own consultation were opposed to any change in the law, she intends to press ahead, supported by DiD and with the backing of the required 18 MSPs.

NEXT YEAR: Westminster legislation

Although two APPGCEL MPs came 2nd and 4th in the private members' ballot, neither opted to bring forward relevant legislation, so a new attempt to introduce legislation to Westminster will most likely be by Lord Falconer in the upper chamber. DiD and the 'Choice at the End of Life' All-Party Group (APPGCEL) published a new bill 'for consultation' along the lines of the Falconer Commission recommendations (i.e. assisted suicide for mentally competent adults with less than twelve months to live, with essentially the same 'Joffe' safeguards). The 'consultation' closed on 20 November and we await its report and the timescale for the bill.

NEXT YEAR: Courts

Here in Britain, Jane Nicklinson and 'Martin' are set to appeal the judgement handed down at the High Court in August. Our counterparts abroad face similarly significant legal challenges, and as we were conscious of ahead of the Massachusetts vote, foreign precedents impact here.

Ireland's High Court will rule on 10 January in the landmark case of Marie Fleming, a terminally ill MS patient (and partner of Exit International's European leader, Tom Curran) seeking the right to be assisted in taking her own life. In Canada, the Euthanasia Prevention Coalition has been granted permission to intervene in the appeal of a British Columbia assisted suicide ruling (set for March), while the Canadian Supreme Court continues to hear evidence in the Rasouli case, in which a family is battling doctors to maintain life support for their husband and father.

NEXT YEAR: RCGP

Royal College of General Practitioners Council Chair Clare Gerada's November newsletter devoted four paragraphs to the issue of assisted suicide, while in the December edition of the British Journal of General Practice (£), she argued that: 'all Royal Colleges and Medical, Nursing, and other, umbrella medical organisations should… take a neutral stance on the issue of assisted dying...' Following the fall of similar motions at the BMA this year, General Practice is set to be the new frontline for attempts to neutralise medical opinion.

Send a gift this Christmas that will really transform lives in the developing world

Do you feel you are just going through the motions this Christmas spending money on unneeded gifts?

Some friends told me recently that they had given each of their children a £50 allowance to buy Christmas gifts for people living in developing countries.

Their kids had grasped the opportunity with both hands, putting careful thought into their purchases, and even adding some of their own savings in an effort to make a real difference in the lives of those they were seeking to help.

The idea of 'buying a goat for Christmas' is not new but it is amazing to see the huge variety of other gifts that are now available on line. And for not much outlay at all.

On the Christian Aid you can buy a beehive for £43, a goat for £19, 20 fruit trees for £16, three mosquito nets for £15, and a 'wormery' for £7.

Samaritan's Purse is offering four chickens for £12, gardening tools for £14 and a hygiene kit for £12.

From CBM £26 will provide enough Mectizan tablets to help 40 families for an entire year - stopping the progression of River Blindness (Onchocerciasis) and freeing them from the associated, debilitating symptoms. £30 will buy a child a hearing aid.

World Vision is offering sets of pots and pans (£13), six water containers (£14) and vaccination kits (£20).

These are just a few of the hundreds of imaginative options on these sites and others like Oxfam and Save the Children.

Why not make someone you have never met feel special this Christmas?

Jesus Christ said,'Sell your possessions and give to the poor. Provide purses for yourselves that will not wear out, a treasure in heaven that will never fail, where no thief comes near and no moth destroys.'(Luke 12:33)

Ten People Punished for Believing in Traditional Marriage

Freedom to disagree and the right to private conscience are fundamental liberties in any truly open society. Yet, the Government has utterly failed to consider the impact on civil liberty of its plans to redefine marriage (See their proposals here).

I have already given ten ways in which these new proposals will undermine civil liberties.

The Coalition for Marriage has just released a new leaflet outlining ten case histories of people who have already been punished in various ways for standing for traditional marriage.

In it they argue that redefining marriage is sold as a permissive measure, but it will quickly become coercive. In fact, they say, it already has. Too many people have already been punished for expressing their sincere beliefs about marriage. If marriage is redefined, it will get much worse. The ten examples they quote are as follows. In each case I have added links to the relevant news coverage.

1. Adrian Smith (pictured) was demoted and had his salary cut by 40 per cent, all because he said gay weddings in churches would be ‘an equality too far’. He wrote those four words outside work time on his personal Facebook page which was not visible to the general public.

2. Peter and Hazelmary Bull were ordered to pay £3,600 in damages because their B&B had a policy of only allowing married couples to share a double bed.

3. David Burrowes MP received a death threat after he said redefining marriage is unnecessary because civil partnerships already give same-sex couples legal equality with married couples.

4. Archbishop of York, Dr John Sentamu, received hate mail – some of a racist nature – after he spoke out against the Government’s plans to redefine marriage. North Yorkshire Police investigated the correspondence as hate crimes.

5. Rhys & Esther Curnow are young newly-weds who delivered a 500,000-strong petition against redefining marriage to Number 10 Downing Street. They were targeted online with threatening and hate-filled messages, sparking a police investigation.

6. World Congress of Families had a conference about redefining marriage banned by the Law Society and the Queen Elizabeth II Conference Centre because just discussing the subject would be a breach of ‘diversity policies’.

7. Arthur McGeorge is a bus driver who faced disciplinary action by his bosses just because he shared a petition backing traditional marriage at work during his break time.

8. Dr Bill Beales, a respected headmaster, faced calls for his suspension after he said in a school assembly that people were being ‘placed on trial’ for holding traditional beliefs about marriage.

9. Lillian Ladele, a registrar at Islington Council, was pushed out of her job because she asked her managers to accommodate her belief that marriage is the union of one man to one woman.

10. Dr Angela McCaskill is a deaf diversity officer at a university in America. She was suspended because she signed a petition saying voters should decide whether marriage should be redefined.

‘He’s on His Way!’ – what Christmas is all about

‘He’s on His Way!’ The image of the ultrasound ‘Christ’ in his mother’s womb that was launched on thousands of billboards and other advertising venues in the UK and in other countries around the globe just two years ago, subtly showcases the fact that Jesus Christ was once an unborn child in need of protection to ensure his birth and ultimate mission in his life on earth.

John 1:14, puts this truth in the starkest possible terms. 'The Word became flesh and made his dwelling among us. We have seen his glory, the glory of the One and Only, who came from the Father, full of grace and truth'

Jesus the Son of God, the Word who was God (John 1:1), who was with God (1:2) and who created the world (1:3), literally put on human flesh, and took on our human existence in all its frailty.

Jesus was an unborn baby, confined by the boundaries of the womb, going through the trauma of a normal birth, needing to be wrapped up. As the writer of Hebrews tells us he was made like us in every respect (2:17).

So what does the incarnation mean for us personally?

First, it reminds us that Jesus understands us. He knows what it is like to be a human being. He knows hunger and thirst, pain and sorrow. He knows bereavement and loss. He knows rejection and betrayal. As Hebrews tells us he can sympathise with our weaknesses because he has been tempted in every way as we are, and much more (4:15).

Second, it reminds us that Jesus can help us. Again the writer of Hebrews tells us, 'Because he has suffered and been tempted he is able to help those who are tempted' (2:18). What are our areas of weakness? What do we despair over? What is it that is stopping us growing as Christians? What is it we are fighting that perhaps no-one else sees or knows about? He is able to help us.

Third, the incarnation is a model for us in our own Christian lives. We are called to follow in Jesus’ footsteps. The cross is the means by which God put us right with him, but it also a pattern to follow. We too are to carry the cross, to take our share of suffering, to bear the burdens of others.

Fourth, the incarnation helps us in our evangelism. It challenges us to cross social barriers as Jesus did, to make ourselves accessible and vulnerable, in the way that Jesus was, to be, in the words of Paul, 'all things to all men'.

But finally, and most importantly the incarnation reminds us of why Jesus came, because Christmas is the prelude to Easter. The same Jesus who grew in the womb and lay in the manger was sent to die on a cross and rise from the dead in order to reconcile us to God.

‘Christmas Starts With Christ’. ‘He’s on His Way’. Let’s keep Jesus’ birth and all that means at the centre this Christmas.

Ten ways redefining marriage would damage civil liberty

Freedom to disagree and the right to private conscience are fundamental liberties in any truly open society. Yet, the Government has utterly failed to consider the impact on civil liberty of its plans to redefine marriage (See their proposals here).

The Coalition for Marriage has just released a new leaflet outlining ten ways redefining marriage would damage civil liberty.

If the meaning of marriage changes in law, they argue, based on expert legal opinion that:

1.Teachers in state schools will be forced to endorse the new definition of marriage. Those that refuse could be disciplined or even dismissed. Such action would be legal.

2.Parents will ultimately have no legal right to withdraw their children from lessons which endorse the new definition of marriage across the curriculum.

3.NHS/University/Armed forces chaplains could be lawfully fired by their employers if they express, even outside work time, the belief that marriage is between one man and one woman.

4.Foster carers could be legally rejected by local authorities on the basis that they fail to embrace the new definition of marriage.

5.Public sector workers could be demoted or dismissed for expressing support for marriage between one man and one woman.

6.Registrars who have a conscientious objection to the new definition of marriage will be dismissed unless they are prepared to act against their beliefs.

7.Churches/mosques/synagogues could ultimately be forced to perform same-sex weddings if a Government ban on such weddings in religious premises is overturned by the European courts.

8.The Church of England may have to disestablish or face the prospect of court action because, as the established church, it must provide a wedding to any person who is legally eligible to get married.

9.Faith-based charities could be banned from hiring public facilities if they refuse to endorse the new definition of marriage.

10.Clergy who disagree with same-sex marriage, but who are in a denomination which has no such objection, could be taken to court if the Government allows religious same sex weddings.

The scenarios above are based upon a legal opinion written by Aidan O’Neill QC, a leading human rights lawyer. A summary of the legal opinion is available from the C4M website

See also (on this blog site) - Same-sex marriage - 24 articles on all aspects of the UK debate

I'm happy to publish links to longer responses to this post on this page on request:

Responses

1. Dan Abrahmsen

Health professionals and organisations misusing LCP should be reported to regulators, says CQC

The Liverpool Care Pathway was developed at the Royal Liverpool University Hospital and the city's Marie Curie hospice to relieve suffering in dying patients, setting out principles for their treatment in their final days and hours.

But it has been dogged by controversy with claims that patients who were not imminently dying have been placed on it and that patients’ families were not fully consulted and informed.

Health Minister Norman Lamb is currently heading up an investigation into its use but in the meantime there are moves to counter its inappropriate use.

The Care Quality Commission (CQC) has this week agreed a statement with other health and care regulators about each organisation’s role and responsibilities in relation to the Liverpool Care Pathway (LCP).

The CQC regulates all health and adult social care services in England, including those provided by the NHS, local authorities, private companies or voluntary organisations.

The statement has had surprisingly little coverage in the media with only the Daily Telegraph noting it.

It says that ‘it is the duty of those professionals involved in the care of the dying to work together as a team to determine, in association with the person and those close to them, when it is appropriate to implement the LCP. The relevant regulators need to be informed if any person believes the implementation of the LCP to be inappropriate.’

The statement also makes it clear that clinical and other staff working in regulated services have a responsibility to bring it ‘to the attention of the relevant professional regulator’ should they ‘witness malpractice or unprofessional conduct in their work place’.

Nurses and midwives should be reported to the Nursing and Midwifery Council and other health professionals to the Health and Care Professions Council. Organisations should be reported directly to the CQC itself.

The Liverpool Care Pathway is a useful clinical tool that has helped many thousands of people experience better care in the last hours or days of life but like any tool must be used with the proper indications and by properly trained staff.

There have been disturbing case reports in the media about it being used inappropriately with patients who are not imminently dying and it is right that these cases are properly investigated by the appropriate authorities.

This clarification by the CQC about the proper procedures to be followed by clinical and other staff if they witness malpractice or unprofessional conduct in their work place is most welcome.

Meanwhile the people behind the pathway have recently spoken out in its defence and the CMF has published an excellent review article looking at it from a Christian perspective. It concludes:

‘The LCP represents a pragmatic and effective response to some of the suffering experienced by many in the last days of life. It remains, however, a tool and it is only as good as those who use it. There is always potential for misuse and abuse and there are undoubtedly instances where this occurs. Where these arise by intention then those involved should be held to account, but more often they occur through poor understanding and inadequate training. Successful roll out of the LCP needs much education, both initial and ongoing, and this may sometimes be underestimated or under-resourced. We owe it to patients to not only furnish the means to better care, but also to equip adequately those who provide it.’

I have previously outlined a list of issues that need to be addressed in the enquiry.

Christian Medical Comment – 500,000 page views

Christian Medical Comment (CMC) was launched in December 2009 (so is three years old this month) but I started blogging regularly in September 2010.

Overall there have been 556 individual posts and just over 500,000 page-views – at an average of about 900 views per post.

CMC has been ranked in the 20 top UK blogs in the Religion and Belief category in the e-buzzing rankings for all but one of the last 18 months. It peaked at 3rd in March 2012 and currently stands at 13th. It ranks 397th overall amongst e-buzzing’s over 210,000 registered blogs.

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

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

50% of readers come from the UK, 22% from the US and 9% from Canada, Australia, Germany, Russia, France and Ireland combined with the remaining 19% coming from other countries around the world.

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

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

My ten most viewed all time posts are as follows:

1. Twenty questions atheists struggle to answer
2. Hospital kills ‘wrong’ twin in selective abortion – both babies now dead
3. Ten reasons not to legalise same-sex marriage in Britain
4. Response to Daily Mail article on abortion of IVF babies for Down’s syndrome reveals frightening attitudes to disability
5. Twenty questions atheists struggle to answer: How theism does better on the first six
6. Fantastic interview! Rev Cooper, chaplain to Chile’s president, gives glory to God on Radio Five Live about God’s hand in rescue of Chilean miners
7. Twenty facts we did not learn from Terry Pratchett’s BBC ‘documentary’ on assisted suicide in Europe
8. Do you object to being labelled 'homophobic' when you are actually just 'homosceptic'?
9. Ireland victory makes North-South rugby world cup final look a near certainty
10. Powerful arguments advanced in UK parliament for a change in the law to ensure properly informed consent for abortion

New study shows free emergency contraception increases rates of sexually transmitted infections

A new American study published this week has shown that making emergency contraception available free over the counter without prescription leads to an increase in rates of sexually transmitted infections and does not decrease pregnancy or abortion rates.

The FDA recently approved access to emergency contraception, or Plan B, through US pharmacies without a prescription. While this change is only now occurring nationally, several states had previously allowed pharmacy access to emergency contraception. In particular, Washington State was the first state to implement such a program in 1998.

In the new study, Christine Durrance, Assistant Professor of Public Policy at the University of North Carolina, Chapel Hill, used county-level data as well as specific timing of changes in pharmacy access to consider the intended and unintended consequences of pharmacy access to emergency contraception in Washington.

The results indicated that while county-level access to emergency contraception was unrelated to trends in STIs and abortions before access changed, access afterwards caused a statistically significant increase in STI rates (specifically gonorrhea rates), both overall and for females, and statistically significant decreases in abortion rates for some ages. These results were robust to several specification tests and falsification tests.

The results are almost identical to those of a British study published in the Journal of Health Economics (full text) in December 2010 and reported in the Daily Telegraph in January 2011.

This research, by professors Sourafel Girma and David Paton of Nottingham University, compared areas of England where the scheme was introduced with others that declined to provide emergency contraception free from chemists (See my previous blogs on this here and here).

The academics found that rates of pregnancy among girls under 16 remained the same, but that rates of sexually transmitted infections increased by 12%.

In fact, in a systematic review published in 2007, twenty-three studies published between 1998 and 2006, and analyzed by James Trussell’s team at Princeton University, measured the effect of increased EC access on EC use, unintended pregnancy, and abortion. Not a single study among the 23 found a reduction in unintended pregnancies or abortions following increased access to emergency contraception (see also fact sheet here).

The phenomenon whereby applying a prevention measure results in an increase in the very thing it is trying to prevent is known as ‘risk compensation’.

The term has been applied to the fact that the wearing of seatbelts does not decrease the level of some forms of road traffic injuries since drivers are thereby encouraged to drive more recklessly.

In the same way it has been argued that making condoms readily available actually increases rather than decreases rates of pregnancy and sexually transmitted infections because condoms encourage teenagers to take more sexual risks in the false belief that they will not suffer harm.

Whilst condoms offer some protection against sexually transmitted infections the morning-after pill offers none.

Britain has the highest rate of teenage pregnancy in Western Europe. In 2008, the latest year for which figures are available, more than 7,500 girls in England and Wales became pregnant. Nearly two thirds of these pregnancies ended in abortion.

Rates of sexually transmitted diseases are also rising. In 2009 there were 12,000 more cases than the previous year, when 470,701 cases were reported. The number of infections in 16-to 19 year-olds seen at genito-urinary medicine clinics rose from 46,856 in 2003 to 58,133 in 2007.

International research has consistently failed to find any evidence that emergency birth control schemes achieve a reduction in teenage conception and abortion rates. But now there is growing evidence showing that not only are such schemes failing to do any good, but they may in fact be doing harm.

Making the emergency contraceptive pill available over the counter free, without prescription, is sadly an ill-conceived knee-jerk response to Britain’s spiralling epidemic of unplanned pregnancy, abortion and sexually transmitted disease amongst teenagers. It is also not evidence-based.

The best way to counter the epidemic of unplanned pregnancy and sexually transmitted disease is to promote real behaviour change. The government would be well advised to enter into dialogue with leaders of communities in Britain where rates of sexually transmitted diseases and unplanned pregnancy are low, especially Christian faith communities, to learn about what actually works.

Church-based programmes such as Love for Life (Northern Ireland), Love2last (Sheffield), Challenge Team, Romance Academy or Lovewise (Newcastle) are getting great results and have much wisdom to pass on. How about financing some serious research into examining them in more depth?

Euthanasia is out of control in Belgium – new ten year review

Belgium has already often been in the news over euthanasia.

I have previously drawn attention on this blog to the fact that using organs from euthanasia victims for transplant is now an established procedure there.

In a previous post, 'Twenty things Terry Pratchett did not tell us about euthanasia in Europe', I also drew attention (with links) to the following facts:

1. Almost half of Belgium’s euthanasia nurses have admitted to killing without consent, despite the fact that involuntary euthanasia is illegal in Belgium and that nurses are not allowed to perform even voluntary euthanasia.

2. In Belgium, nearly half of all cases of euthanasia are not reported to the Federal Control and Evaluation Committee. Legal requirements were more frequently not met in unreported cases than in reported cases and a written request for euthanasia was absent in 88%.

3. A recent study found that in the Flemish part of Belgium, 66 of 208 cases of ‘euthanasia’ (32%) occurred in the absence of request or consent.

But to build on all this Bioedge and Life News have both run stories in the last week about a recent report into the first ten years of legalised euthanasia in Belgium.

Belgium legalised euthanasia in 2002, with a law containing strict controls to protect the vulnerable. (Here is a review of events and the text of the law in English )

The Belgium-based European Institute of Bioethics has just released a study (link to English and Dutch translations) of the experience of ten years of euthanasia. It claims that the results are far from encouraging.

Michael Cook at Bioedge gives his assessment as follows:

‘The central theme of the reportis the ineffectiveness and bias of the body established by the legislation to allay the misgivings of the public by monitoring and controlling euthanasia. After 10 years and about 5,500 cases, not one case has ever been referred to the police. It is illusory, says the IEB, to expect doctors to denounce their own failings.

Furthermore, nearly half of the statutory 16-member Commission for Control and Assessment are members or associates of the leading Belgian right-to-die society. This is sufficient to explain, according to the IEB, ‘the absence of any effective control and the ever‐widening interpretation which the Commission intends to give the law’.

A law which permits euthanasia is bad enough, the IEB suggests, but the government is not even enforcing its application.

‘As is the case in all penal laws, this law has to be strictly interpreted lest it be of seeing it stripped of any substance. It is not for the Commission, appointed to control and assess the law, to provide an ever‐widening interpretation of its terms, with this going so far as to negate the initial spirit of the text and of doing away with the control of decisive legal criteria.’

As a result, there are on-going abuses in several areas. Here are a few of those which the EIB singles out for criticism:

•A written declaration of a desire for euthanasia is required, either by the patient or a surrogate. However, the Commission often waives this obligation.

•Initially patients had to have a life‐threatening and incurable illness. Nowadays, the illness need only be serious and debilitating.

•The pain is supposed to be unbearable, unremitting and unrelievable. However, a patient can refuse medication to relieve the pain. The Commission, says the IEB, has ‘decided not to carry out its mission ‐ so central to the law ‐ of verifying the unbearable and unrelievable nature of the suffering’.

•The ambit of ‘psychological suffering’ is ever-expanding.

•Doctor-assisted suicide is not authorised by 2002 legislation. However, the Commission has ignored this and regularly signs off on such cases.

•If a patient is to be euthanised at home, the doctor himself is supposed to fetch the lethal medications at a pharmacy from a registered pharmacist and to return left-over drugs. In practice, family members often get the drugs; unqualified personnel hand them over; and no checks have ever been made about surplus drugs.’

Wesley Smith at Life News makes the point that once doctor-administered death is legal, any assurances about so-called ‘safeguards’ become inoperative. Instead the categories of the killable continually expand. He quotes from the report as follows:

'Initially legalized under very strict conditions, euthanasia has gradually become a very normal and even ordinary act to which patients are deemed ‘to have a right’. In the face of certain high profile cases, the evident relaxation of the very strict conditions has caused many reactions but also a total absence of any sanctions on the part of the Commission and a very conciliatory silence from the political establishment has given rise to a feeling of impunity on the part of some concerned medical practitioners, and to a feeling of powerlessness in those worried about where things are leading.'

He then argues that things are looking to get worse, with Belgium poised to follow the Netherlands into infanticide and quotes a further chilling section of the report:

'Several neonatologists have drawn up a procedure which enables euthanasia of premature newborn infants or those presenting a handicap in one of the three following instances: either the infant has no chance of survival, or it is deemed to only have a very mediocre quality of life, or the outlook is poor and it is felt that the infant will suffer unbearable pain.

The Groningen Protocol [Dutch infanticide protocol] caused quite a stir in Belgium and a great many medical practitioners are of the opinion that since a ‘therapeutic’ abortion is possible right up to the day before birth in the event of the child being handicapped, euthanasia of newborns ought also to be allowed under the same conditions.'

I have never been convinced by the term ‘slippery slope’ which implies passive change over time. What we are seeing in Belgium is more accurately termed 'incremental extension', the steady intentional escalation of numbers with a gradual widening of the categories of patients to be included.

Documented cases of euthanasia in Belgium have increased 500% since 2003. since I recently described the similar steep increase of cases of assisted suicide in Oregon (450% since 1998) and Switzerland (700% over the same period). In the Netherlands since 2006 the number of official cases of (lethal injection) euthanasia has doubled since 2006, although many other people (possibly up to 12.3% of all deaths) are having their lives actively ended through the process of ‘continuous deep sedation’ whereby doctors deeply sedate patients and then withhold fluids with the explicit intention that they will die.

The lessons are clear. Once you relax the law on euthanasia or assisted suicide steady extension will follow as night follows day.

More on Guttmacher’s gross distortion of worldwide abortion statistics

I have recently reviewed a landmark paper by Koch and colleagues critically examining the methodology used by the Alan Guttmacher Institute (AGI) to estimate abortions in Mexico.

The AGI has long been looked to by decision-makers to provide statistics on abortion and by pro-abortion activists to argue that making abortion ‘legal and safe' all over the world will actually reduce the overall number of abortions.

It is now evident, however, that their methodology is profoundly flawed.

It may well be that there are not 42 million abortions worldwide annually, as AGI claims, but much closer to half this number.

As William Johnston has convincingly argued (see my previous review) whilst there is little dispute about abortion numbers from developed countries, AGI has misled the international community for years about abortion numbers in developing countries.

The upshot of this is that their estimates of abortion in developing countries are astonishingly wayward and a major plank of their argument for legalisation is thereby kicked away (I have previously exposed the way in which inaccurate figures about deaths from illegal abortion have been similarly distorted by pro-abortion activists).

Here is the full press release of 6 December from Koch and Colleagues about their recent paper.

MEXICAN PARADOX: WHILE SURVEYS OVERESTIMATE ABORTIONS 10-FOLD, ABORTION MORTALITY CLEARLY DECREASES

Abortion figures estimated through opinion surveys in Mexico are inconsistent with the significant decrease in abortion mortality in the country, study finds

Summary: There seems to be a paradox between estimated abortion figures and the significant decrease in abortion deaths in Mexico. A multinational collaborative study shows up to 10-fold overestimation of the actual induced abortion figures in Mexico DF when opinion surveys were used. Moreover, the report shows that 98% of maternal death causes are unrelated to induced abortion, highlighting the importance of increasing emergency and specialized obstetric care in Mexico to improve maternal health.

A collaborative study conducted in Mexico by researchers from the West Virginia University-Charleston (US), Universidad Popular Autónoma del Estado de Puebla (México), Universidad de Chile and the Institute of Molecular Epidemiology of the Universidad Católica de la Santísima Concepción (Chile), revealed that opinion surveys used by researchers from the Guttmacher Institute overestimated figures of induced abortion in the Federal District of Mexico (Mexico DF) up to 10-fold. The research recently published in the International Journal of Women’s Health highlights that the actual figure of induced abortion in Mexico DF has not surpassed 15,000 per year according to the official registry. “During 2009, the number of induced abortions in Mexico DF was 12,221, which directly contradicts the figure of 122,355 induced abortions estimated by opinion surveys for the same year, resulting in a 1000% overestimation” pointed out Elard Koch, the Chilean epidemiologist leading the research.

The research group directly compared the estimations of induced abortion reported by the Guttmacher Institute and the actual figures reported by the GIRE (from the Spanish acronym Grupo de Información en Reproducción Electiva), institution that maintains epidemiological surveillance of abortion in Mexico DF since its decriminalization in 2007. The researchers detected that discrepancies found between estimated and actual figures are likely due to the subjective and potentially biased nature of opinion surveys, which have estimated figures as large as 1,024,424 induced abortions per year for the entire Mexican country. “This is a perfect example demonstrating that methodologies used for estimating figures of induced abortion and related indicators, such as abortion mortality rates, need constant re-evaluation and scrutiny by the scientific community in order to provide the best epidemiological data to be used for public policies of any region” explained Byron Calhoun, specialist in Obstetrics and Gynecology from the West Virginia University-Charleston and co-author of the study.

Paradoxically, the study also shows that abortion mortality in the whole Mexican country has decreased to the point that approximately 98% of total maternal deaths are related to hemorrhage during childbirth, hypertension and eclampsia, indirect causes and other pathological conditions. Koch explained that “given the low figures of abortion deaths observed in Mexico and previous results observed in the Chilean natural experiment published in May of this year in PLoS ONE, it is very improbable that changes in the legal status of abortion can elicit significant effects to decrease maternal mortality in these Latin American countries.” For instance, out of the 1207 total maternal deaths registered in Mexico during 2009, only 25 could be attributable to induced abortion, resulting in a mortality rate of 0.97 per 100,000 live births. In the case of Chile, out of a total 43 maternal deaths observed during 2009, only 1 could be attributable to induced abortion, with a mortality rate of 0.39 per 100,000 live births. “To evaluate what are the main causes of maternal death is crucial to promote adequate Public Health policies and allocation of resources in developing countries.” Koch and Calhoun agreed.

A fact that concerned the researchers is that part of maternal deaths due to induced abortion in Mexico may be related to violence against women during pregnancy, whose prevalence has increased alarmingly in the country. Surveys of violence against women (Encuesta Nacional sobre Violencia contra las Mujeres, ENVIM) conducted in 2003 and 2006 show an increase in the prevalence of intimate partner violence from 9.8% to 33.3% and of physical violence during pregnancy from 5.3% to 9.4%. “In addition to some deaths due to spontaneous miscarriages rapidly complicated by sepsis, membrane rupture and subsequent abortion are often observed in pregnant women suffering episodes of excessive physical violence, falls or accidents. If these women do not receive prompt medical attention, they may die from clinical complications. It is important to remark, that any of these deaths cannot be avoided by promoting changes in abortion legislations simply because they are the result of other causes, especially septic shock resistant to antibiotic treatment” said Koch.

The researchers stated that implementation of emergency obstetric units and timely access to specialized medical care for high-risk pregnancies, especially in the most vulnerable regions, are key to further reduce maternal mortality in Mexico. “Hundreds of Mexican women continue to die due to hemorrhage, eclampsia and indirect causes; this suggests very concrete strategies that clearly are unrelated to the legal status of abortion” Koch and Calhoun concluded.

Koch E, Aracena P, Gatica S, Bravo M, Huerta-Zepeda A, Calchoun BC (2012) Fundamental discrepancies in abortion estimates and abortion related mortality: A reevaluation of recent studies in Mexico with special reference to the International Classification of Diseases. Int J Women Health 4: 613-623. Available here.

Koch E, Thorp J, Bravo M, Gatica S, Romero CX, et al. (2012) Women's Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007. PLoS ONE 7(5): e36613. doi:10.1371/journal.pone.0036613. Available here.

See also 'Evidence on abortion figures overestimated in Mexico fuels scientific debate in medical journal'

Ireland and abortion – a review of recent events and the current legislative predicament

The international spotlight is now on Ireland in the wake of the case of Savita Halappanavar who, it is alleged, died after being denied an abortion (the facts of the case are still subject to an investigation and are hotly disputed).

Abortion remains illegal in Ireland under statute law but two court cases have established precedent which has to some extent led to loss of clarity.

The ‘X case’ (in 1992) (Attorney General v. X, [1992] IESC 1; [1992] 1 IR 1) was a landmark Irish Supreme Court case which established the right of Irish women to an abortion if a pregnant woman's life was at risk because of pregnancy, including the risk of suicide.

The ‘ABC case’ ( A, B and C v Ireland [2010] ECHR 2032) was a landmark case of the European Court of Human Rights on the right to privacy under article 8 ECHR. It held there is no right for women to an abortion, although it also found that Ireland had violated the Convention by failing to provide an accessible and effective procedure by which a woman can have established whether she qualifies for a legal abortion under current Irish law.

An ‘expert group’ has now produced a report on the Judgement in A, B and C v Ireland which has put forward four options for the Irish government to consider. The Irish government is not obliged by the judgement of the European Court of Human Rights to legislate for abortion. However there is a lot of international pressure for it to do so.

Pat Buckley (pictured) of the European Life network has put up some very useful posts on the current dilemma faced by the Irish government.

Buckley draws attention to a report from the European Life network (ELN) on the expert recommendations and links to the full critique.

ELN essentially questions the entire basis on which the report is premised and rejects many of the assertions set out in it.

It concludes as follows:

By defining abortion as necessary medical treatment, and by undermining the absolute prohibition on abortion in the Irish Constitution and Irish statute law, the expert report sets the scene for legislation which will lead to ever-wider permissions for abortion.

The history of abortion law in Great Britain shows that, over time, court judgments, new statutes, regulations and professional guidelines form a trend towards de facto abortion on demand.

The Oireachtas must reject the expert group if it wishes to avoid this scenario. It must find a way to overturn the X case judgment and any other element of law or public policy in Ireland which fails to apply Ireland’s constitutional and statutory ban on intentionally ending the lives of unborn children from the point of conception onwards. This will also protect the lives and dignity of women, in a country whose maternal health record is one of the best in the world.

In another post Buckley reports on the statement of the Irish Catholic Bishops' Conference on 4 December who have issued their initial response to the Report of the Expert Group on the Judgement in A,B and C v Ireland.

I have quoted some key excerpts below but a fuller summary is available on Patrick Buckley’s blog.

A society that believes the right to life is the most fundamental of all rights cannot ignore the fact that abortion is first and foremost a moral issue.

As a society we have a particular responsibility to ensure this right is upheld on behalf of those who are defenceless, voiceless or vulnerable. This includes our duty as a society to defend and promote the equal right to life of a pregnant mother and the innocent and defenceless child in her womb when the life of either of these persons is at risk.

By virtue of their common humanity the life of a mother and her unborn baby are both sacred. They have an equal right to life. The Catholic Church has never taught that the life of a child in the womb should be preferred to that of a mother. Where a seriously ill pregnant woman needs medical treatment which may put the life of her baby at risk, such treatments are morally permissible provided every effort has been made to save the life of both the mother and her baby.

Abortion, understood as the direct and intentional destruction of an unborn baby, is gravely immoral in all circumstances. This is different from medical treatments which do not directly and intentionally seek to end the life of the unborn baby.

Current law and medical guidelines in Ireland allow nurses and doctors in Irish hospitals to apply this vital distinction in practice. This has been an important factor in ensuring that Irish hospitals are among the safest and best in the world in terms of medical care for both a mother and her unborn baby during pregnancy. As a country this is something we should cherish, promote and protect.

The Report of the Expert Group on the Judgement in A, B and C v Ireland has put forward options that could end the practice of making this vital ethical distinction in Irish hospitals. Of the four options presented by the Report, three involve abortion – the direct and intentional killing of an unborn child. This can never be morally justified. The judgement of the European Court of Human Rights does not oblige the Irish Government to legislate for abortion.

The Report takes no account of the risks involved in trying to legislate for so-called ‘limited abortion’ within the context of the ‘X-case’ judgement. The ‘X-case’ judgement includes the threat of suicide as grounds for an abortion. International experience shows that allowing abortion on the grounds of mental health effectively opens the floodgates for abortion.

The Report also identifies Guidelines as an option. It notes that Guidelines can help to ensure consistency in the delivery of medical treatment. If Guidelines can provide greater clarity as to when life-saving treatment may be provided to a pregnant mother or her unborn child within the existing legislative framework, and where the direct and intentional killing of either person continues to be excluded, then such ethically sound Guidelines may offer a way forward.

A matter of this importance deserves sufficient time for a calm, rational and informed debate to take place before any decision about the options offered by the Expert Group Report are taken.

I have previously argued, with reference to the Savita case, that Ireland should not be changing its law on abortion.

However, I agree with the Irish Bishops that ethically sound guidelines which clarify when life-saving treatment may be provided to a pregnant mother or her unborn child within the existing legislative framework may offer a way forward.

I have written more on the subject of abortion to save the life of the mother both here and here.

I would also urge medical professionals to sign the Dublin Declaration.

The point of this declaration is to make clear that there is a vast difference between

1.Separating the mother and fetus for purposes of saving the life of the mother, and
2.Intentional destruction of the life of the fetus for the purpose of producing a dead fetus

It is essential that we as medical professionals communicate now that pre-viable delivery to save the life of the mother is not the same as direct abortion, even if the preterm fetus cannot survive the process.

And direct abortion (a procedure performed with the primary intent to produce a dead fetus) is never medically indicated.

In this connection the Association of American Prolife Obstetricians and Gynaecologists (AAPLOG) statement on ‘Maternal mortality in Ireland’ is also well worthy of study.