Thursday 30 May 2013

The police and GMC should be investigating the London psychiatrist that Michael Irwin is protecting

The papers are full today of a report (initially carried by the Daily Mirror) about the first British man with dementia to have an assisted suicide at the Dignitas facility in Zurich, Switzerland.

The BBC is now running the story which will give it even wider coverage but it has also been reported by the Telegraph, Independent and Daily Mail. I have personally been asked to comment by the BBC, Mirror, Times (£) and Telegraph.

This story (on which I originally commented in March) is in the news because Michael Irwin (pictured), who heads up the campaign group SOARS (Society for Old Age Rational Suicide),  gave an exclusive interview to the Daily Mirror reporting that an 83 year old man with early dementia had killed himself at Dignitas seven weeks ago. The Mirror then splashed it on their front page. Now other news outlets are playing catch up in the usual feeding frenzy.

Irwin claims to have ‘helped’ the (unnamed) man in question by referring him to a London psychiatrist (currently also unnamed) who provided him with a medical certificate to say that he was mentally competent enough to make an informed decision about being helped to kill himself.

Irwin believes that assisted suicide should be available to elderly people on demand and seems determined to make himself a martyr for the pro-euthanasia cause by progressively pushing the legal boundaries so this case was very helpful to his cause.

According to the Daily Mirror he now claims to have helped at least 25 people to die at Dignitas.

In 2005 the General Medical Council found him guilty of serious professional misconduct and struck him off the medical register after he admitted supplying sleeping pills to help a friend die although you will seldom see this reported.

Ever since, ironically and curiously, he seems to have escaped prosecution by virtue of the fact that he is no longer a registered medical practitioner. This is in spite of the fact that encouraging or assisting a suicide remains a crime carrying up to a 14 year prison sentence under the Suicide Act 1961.

This is because the Director of Public Prosecutions has decided that he hasn’t yet fulfilled his prosecution criteria. The problem this has created is that Irwin will go on annexing the Sudetenland until he provokes a reaction from the DPP or police because he sees that any reaction will give even more publicity to his cause.

However there is now a new twist to the tale. In deliberately concealing the identity of the London psychiatrist who issued the certificate of mental capacity to this patient Irwin may well now be obstructing the course of justice.

The Director of Public Prosecutions makes it clear that doctors acting in a professional capacity to assist a suicide are likely to be prosecuted and the General Medical Council (GMC) has warned that such doctors risk censure, including being struck off the medical register (see details of DPP and GMC guidelines here). 

That would seem to place the unnamed psychiatrist at risk of both being prosecuted and also losing his licence to practice.

So at very least it would seem that this case should be fully investigated by the police and the GMC.

However on past form I would expect that Irwin will make it extremely difficult for them. He has cleverly, with the media’s full cooperation, created an unsolved mystery that will run and run and ensure that he himself stays in the media spotlight.

The reason for this is that Irwin is actually a campaigner who craves publicity. So he will talk to the media when it suits him but will also withhold incriminating information when it best suits his cause. 

He is playing ‘catch me if you can’.

I suspect he would quite like to be prosecuted to give his cause even more of the oxygen of publicity and will continue to push the envelope more and more until he elicits a response.

Those selling newspapers are of course only too happy to oblige but in the process they risk fuelling more anxiety and suicide contagion amongst the worried well.

What we learn from Irwin is that pro-euthanasia campaigners will always push the boundaries. This is because once you accept the argument that there is such a thing as a life not worth living it is not possible to draft a law to encompass all who would like to fall within its remit without eventually opening it up to everyone.

The minute assisted suicide is allowed for anyone at all others will come using the same arguments of  compassion and autonomy with allegedly equally deserving cases that fall just outside the existing legal boundaries. And they will claim that in the interests of equality they should have access to it too.

And so we see in any jurisdiction where euthanasia or assisted suicide has been legalised that incremental extension steadily takes place (eg Oregon, Belgium, Netherlands).

First there is a year by year increase in numbers and then, accompanying this, a widening of the categories of people to be included.

First we have mentally competent, adults with less than six months to live (as Dignity in Dying and Lord Falconer are pushing for here). Then there are those who are ‘suffering unbearably’ (in mind or body) but not terminally ill; then minors who are judged capable of making up their own minds; then the mentally incompetent who ‘would have wanted it’ had they been able to say.  

Irwin wants assisted suicide to be available not just for those who have early dementia, but for any elderly people who feel that their time has come.

The problem is that one cannot grant the legal right to assisted suicide to any group without at the same time removing legal protection from other similar people.

If the law ever were to change in this country vulnerable people would feel constrained to end their lives for fear of being a burden upon loved ones. Or alternatively loved ones would feel constrained to help their determined elderly relatives.  

This pressure would be felt with real intensity at this time of economic recession when many families are struggling to make ends meet.

Given the number of people and organisations who stand to gain financially from the deaths of elderly people it would be a certain recipe for personal and institutional elder abuse.

People with dementia and their families need the best possible care and support, not campaigns for the removal of their legal protection.

Our current law provides the right balance. 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 discretion to prosecutors and judges in dealing with hard cases. It does not need changing.

The odd thing about this whole drama is why this 83 year old man, given his obvious mental capability, did not simply take his own life without requiring assistance.

But then, had he done that, it would not have been an international news story and would not have helped Michael Irwin’s campaign.

Tuesday 28 May 2013

Christians should prepare for further job discrimination following today’s European Court ruling

Two British Christians who refused to act contrary to conscience have lost their legal battle at the European court of human rights in a move that demonstrates that ‘gay rights’ trump ‘conscience rights’ when the two conflict.

Gary McFarlane and Lillian Ladele (pictured) had their appeals to the Strasbourg court rejected in January and had sought to resolve the matter in the court's grand chamber, its final arbiter. However, judges at the court have rejected the request, in effect ending the legal battle.

Ladele, 52, a local authority registrar, was disciplined by Islington council in London for refusing to conduct civil partnership ceremonies, while McFarlane, 51, a Bristol relationship counsellor, was dismissed by the charity Relate for saying he might object to assisting same-sex couples with their sex lives.

The court had previously ruled that both employers' actions were justified, given their obligations to prevent discrimination against people using their services.

In 2003 Miss Ladele, who was being defended by the Christian Institute, told her managers at Islington Council that, should civil partnerships ever become law, she would have a conflict of conscience based upon her Christian beliefs about marriage.

Following the introduction of civil partnerships, she wrote to her employer in 2006 asking for a reasonable accommodation of her religious objection to same-sex civil partnerships.

Islington accepted that it had enough registrars to provide a civil partnership service to the public without requiring Miss Ladele’s involvement. But managers at the council refused her request, and demanded that she carry out civil partnership registrations against her will.

McFarlane, who was being defended by the Christian Legal Centre, had practised as a relationships counsellor for a number of years. Then, during a training course for a new skill, he was prompted to indicate that if the situation ever arose he might have a conscientious objection to providing sex therapy to a same-sex couple on account of his Christian faith.

He was dismissed for gross misconduct for discrimination on the grounds of sexual orientation, despite the fact that (i) the issue involved a hypothetical scenario and (ii) there was never a risk of anyone being denied a service to which they were entitled (since there were many other counsellors who were willing and able to provide it). 

The dismissal by Relate (his employer) was on principle and it was irrelevant whether he could have been accommodated.  A dismissal for gross misconduct is the most severe sanction available to an employer. 

The two rulings demonstrate that under British law gay rights now trump conscience rights and that reasonable accommodation need not be made for employees. At a stroke this puts at risk the job of any employee objecting to helping gay couples in activities they believe to be wrong (eg. Celebrating a civil partnership, adopting a baby, having sexual counselling etc).

The decision of the Grand Chamber has understandably prompted calls for more robust protections to be put in place for Christians in the Government's Marriage (Same Sex Couples) Bill. The House of Lords is due to vote on the Bill at Second Reading next Monday 3 June.

It has been argued that if this latter bill goes through those who refuse to endorse gay marriage (eg. Teachers, Council workers, healthcare workers) could similarly find their jobs to be at risk.

Amidst the rulings however there were some rays of hope for conscience rights.

The European Court decided that decisions of the UK Courts were within the 'margin of appreciation' (discretion) that it allows to national Courts - but in so doing it challenged many of the principles adopted by UK Courts and asserted by the British government. 

So for example, the UK Courts had held that beliefs about marriage as between a man and a woman was not a core component of Christian belief and so not protected. The European Court said that these beliefs were part of Gary and Lillian's Christian identity and so were in principle protected!

The British Government also suggested that because the individuals were free to resign and find other jobs, there had been no infringement of their freedom of religion - in other words, 'your freedom to resign secures your freedom of religion'.  But the European Court ruled that 'freedom to resign and find another job' is not sufficient to guarantee religious freedom.

These are significant breakthroughs and will be a great help in contending for Christian freedoms in the UK Courts in the future. 

Last month the Council of Europe passed a resolution calling on all member states to respect conscience and accommodate religious beliefs in the public sphere. The situation facing UK Christians was recorded in the report that was prepared for the debate that took place before the vote. This shows how the cases have influenced Council of Europe opinion and consequent policy.

This month, a member of the EU Delegation to the International Organisations in Vienna wrote:

‘We are concerned about rising anti-Christian intolerance and violence... a trend which often remains unnoticed.’

Christians and others, living in a free democratic society, should not be forced, at fear of losing their jobs, to do things they believe are profoundly wrong. Instead reasonable accommodation should be made for them.

In both these cases it could have been, but the respective employers decided instead, backed by the law, to put these two employees in an impossible situation.

Whilst neither Ladele nor McFarlane were healthcare workers the same principles will apply to doctors, nurses and others who find themselves in similar moral dilemmas (I have previously commented on the way that British law and employment regulations are marginalising Christian health professionals). 

Whilst we must not give up the fight these cases should not surprise us given Britain’s progressive slide into secularism.

The Bible tells us that ‘everyone who wants to live a godly life in Christ Jesus will be persecuted’ (2 Timothy 3:12). It is part and parcel of following Christ, so best to prepare for it now.

Christians contemplating these circumstances need to draw a line in the sand and not be intimidated. In so doing they stand by biblical precedent.

The Hebrew midwives when ordered by the king of Egypt to kill all male Hebrew children refused to do so and as a result we are told that God commended and rewarded them (Ex 1:15-22).

Rahab the harlot similarly refused to co-operate with the king of Jericho in handing over the innocent Israelite spies (Jos 2:1-14). She is later praised for her faith in so doing (Heb 11:31; Jas 2:25).

Even the prospect of death as a consequence of disobedience to state law did not stop Shadrach, Meshach and Abednego refusing to bow down to the image (Dan 4:6-8), or Daniel persisting with public prayer (Dan 6:1-10).

In the New Testament when Peter and John were commanded by the Jewish authorities not to preach the Gospel they replied 'We must obey God rather than men' and went right on doing it (Acts 5:29). 

We need to do the same and leave the eventual outcome in God's hands. Whether we are vindicated or condemned he will be glorified. 

Monday 27 May 2013

Theresa May needs to look beyond al-Mihajiroun for the real cause of the Woolwich murder

The search for what radicalised Michael Adebolajo (pictured) and Michael Adebowale to kill soldier Lee Rigby in Woolwich last week is leading increasingly to the influence of al-Muhajiroun leaders like Anjem Choudary and Omar Bakri Mohammed.

Al-Muhajiroun is an Islamist group fronted by the radical Luton-based cleric Anjem Choudary, which has been rebadged under a multitude of brands since being proscribed by the previous government.

Its founder, Omar Bakri Mohammed, a Lebanon-based preacher, who was banned from Britain and once ran courses in fighting jihad at a disused nunnery in Sussex, claimed last week that he had converted Adebolajo.

If Theresa May is to stop thousands being radicalised in Britain however she needs to look beyond al-Mihajiroun to the text that is radicalising that movement, the Qur’an itself.

As Jay Smith points out in a Pfander Films video published this week, Adebolajo and Adebowale were in fact just taking the Qur’an literally (See also Answering Islam here which makes the same point).

Smith asks why these two men killed this soldier, attempted to decapitate him, pulled him into the street and then, without attacking anyone else, waited around for the police to arrive before running into their guns.

It’s all in the Qur’an, he says.

Sura 5:32, which was ironically quoted this week by Nick Clegg in support of peace, was the very verse that Adebolajo quoted to the cameras to justify his action:

‘whoever kills a soul unless for a soul or for corruption [done] in the land - it is as if he had slain mankind entirely’

Rigby was a British soldier in Afghanistan and some British soldiers have killed Muslims. But killing one Muslim is like killing all Muslims. It was British soldiers who killed Muslims so a British soldier and not British civilians had to pay the price.

So what should a Muslim fighting jihad do with such people? The answer in is Sura 47:4:

‘So when you meet those who disbelieve [in battle], strike [their] necks until, when you have inflicted slaughter upon them’

And the reward for losing one’s life in carrying out such activity? Well, it’s Paradise, as explained in Sura 47:4, 5 & 6:

‘And those who are killed in the cause of Allah - never will He waste their deeds… He will guide them and amend their condition. And admit them to Paradise, which He has made known to them.’

By shooting them without killing them the police denied these two Muslims their actual aim, promotion to Paradise under the sight of the world’s media cameras.

Theresa May and Nick Clegg cannot of course ban the Qur’an, which is why they must seek instead to reinterpret it to claim that it is not saying what these men believed it was actually saying.

But if we don’t like what happened on the streets of Woolwich, it is perhaps the Qur’an itself, and not just al-Mihajiroun, that we should be calling into question.

Adebolajo justified his actions as ‘an eye for an eye and a tooth for a tooth’.

By contrast Jesus, when one his disciples (Peter) took up the sword urged him to place it back in its sheath:

‘Put your sword back in its place,’ Jesus said to him, ‘for all who draw the sword will die by the sword’ (Matthew 26:52)

And he urged them not to follow the ‘eye for an eye’ directive but rather to ‘turn the other cheek’:

‘You have heard that it was said, “Eye for eye, and tooth for tooth.” But I tell you, do not resist an evil person. If anyone slaps you on the right cheek, turn to them the other cheek also.’ (Matthew 5:38, 39) 

The history of Islam began with bloody military conquest by Muhammad and his followers.

But Christianity began with the death of Jesus (on our behalf) and of his twelve disciples eleven gave their lives as martyrs in his service because they preached the word of God rather than taking up the sword. It was a peaceful revolution that conquered the Roman Empire through spreading love and the good news of Jesus' death and resurrection.

This is the same love and good news that Christians are called to spread today to all people whatever their age, sex, race, ideology or creed. And it is for this reason that I join many in condemning without reservation not only the Woolwich atrocity itself but also any violent reprisals against Muslims by any British citizens. 

It is true that since the first century others have taken up arms in the name of Christ. But this was never part of Jesus’ teaching. It was however, according to the Qur'an, part of Muhammad’s.

Sunday 26 May 2013

Great Female vocalists from a very long time ago – 19 of the best

Here (in no particular order) are some of my favourite female vocalists from the 60s, 70s and 80s and one even earlier, each with a link to one of their best songs (imho).

Each song was first recorded more than 25 years old.

Yes of course there are many other great female voices from more recent years but if you don't know these then they are worth a listen.

If you do, enjoy a little nostalgia.

Susannah Hoffs - Manic Monday  

Stevie Nicks - Gypsy   

Karen Carpenter - Rainy Days and Mondays  

Cyndi Lauper - Time after time  

Aretha Franklin - Think

Annie Lennox - When tomorrow comes  

Barbara Streisand - Woman in Love

Tina Turner - Simply the Best

Dolly Parton - Jolene 

Bette Midler - The Rose

Pat Benatar - Heartbreaker  

Kirsty MacColl - Fairytale of New York

Maggie Reilly - Moonlight Shadow 

Judy Garland - Over the Rainbow

Mary Travers - Blowin in the Wind  

Debbie Harry - Call me

Chrissie Hynde - I got you babe

Sunday 19 May 2013

Twenty reasons not to feel too down about NZ losing the first cricket test

OK. It was a pretty dismal batting display. Granted. How could we be bowled out for 68 at Lords when we needed only 239 runs to win?

But as Kiwis and Black Caps supporters we need to pick ourselves up, dust ourselves down and look for the positives.

And for that we need to indulge in a little cognitive behavioural therapy (CBT) to help us believe that things could actually have been a lot worse.

So here are twenty things about the game to be thankful for (in no particular order but the second to last is definitely the most satisfying!) J

Yes of course I concede that this is really scraping the barrel and that not all relate to cricket, but hey, so what!

The key thing is that if you are a Kiwi you will feel better after reading this list.

1. We were still in the game after three days until we starting batting this morning

2. This was not our worst test performance this year. We only scored 45 in the first innings of the first test in South Africa in January.

3. Tim Southee (pictured) bowled well and became only the second New Zealander (after Dion Nash) to claim a ten-wicket haul in a Test at Lord's. 

4. None of the England eleven could score a century against us and they could only manage a total of 445 runs in two innings.

5. After Joe Root’s 71, Taylor’s 66 and Williamson’s 60 in the first innings were the second and third highest scores in the match.

6. Our 68 in the fourth innings was more than twice our worst ever test total of 26 (also against England) in Auckland in 1954-5.

7. We managed to take 20 wickets for the first time in a test since playing Sri Lanka last year.

8. We have scored lower totals at Lord’s against England on three previous occasions (47 in 1958 and 67 in 1958 and 1978).

9. We did not score fewer runs than the highest ever total by a Kiwi number 11 batsman (Collinge’s 68no against Pakistan in 1972-3 in Auckland which I personally witnessed).

10. No Kiwi batsman scored a pair in the match (unlike Prior). OK I concede that Boult didn’t score any runs but he was not out in the second innings.

11. Anderson in the first innings and Broad in the second were in scintillating form and would have given anyone trouble. English captain Alistair Cook called it the best fast bowling he had ever seen and Broad said it was his best bowling ever. Kiwi skipper Brendon McCullum called it 'an hour of madness'.

12. England had to bat twice to beat us which South Africa did not have to do in either test in January.

13. We still drew with England in a three match series down under earlier this year so this is the first time they have managed to beat us in four attempts.

14.  It’s not like cricket is our premier sport – we are 8th in the world rankings whilst England are 2nd so they should rightfully thrash us.

15. We beat them by 189 runs in the Hamilton test in the 2007-8 season in New Zealand so a 170 run victory is nothing to brag about.

16. There are three New Zealand teams in the top six of the super fifteen after this weekend’s matches and we are still the rugby world cup champions.

17. We have just won the 2013 IRB rugby sevens for the 11th time in 14 attempts with one tournament to spare.

18. We were the only football team to come home from the last world cup unbeaten. Not even the eventual winners Spain could match that.

19. We bowled England out for 64 in the final innings of the 1978 test in the Basin reserve when they only needed 137 to win the game. On that occasion Richard Hadlee took 6 for 26 against a team that included Boycott, Botham and Willis.

20. It’s only cricket!

Saturday 18 May 2013

Lord Falconer is seeking to overturn the Hippocratic Oath and change 2,400 years of history

'I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect.'

So reads the Hippocratic Oath, which until recently used to be taken by all graduating doctors. 

Hippocrates of Cos (c. 460 BC – c. 370 BC) was an ancient Greek physician of the Age of Pericles (Classical Greece), and is considered one of the most outstanding figures in the history of medicine.

His oath at the time it was drafted was revolutionary.

Previously doctors had had the power to prescribe both remedies and poisons. But Hippocrates, recognising their great power and the potential for abuse, demanded that they should dedicate themselves solely to healing. 

Along with the Judeo-Christian ethic the Hippocratic Oath has formed the basis of every code of medical ethics since 400 BC; that is until now.

Lord Falconer, who has just introduced his ‘Assisted Dying Bill’ into parliament this week (see timetable here), is seeking to change 2,400 years of history.

His bill would make it legal for doctors to help mentally competent adults with less than six months to live to kill themselves. Two doctors would need to agree that a patient met the criteria and the option would not be open to minors, people without mental capacity or those who are not terminally ill.

The final step would involve a doctor (or nurse) hand-delivering lethal drugs to the patient at a time and place of their choosing and staying with them while they took the drugs and until they were dead.

Falconer has some supporters within the medical profession.

Twelve retired senior doctors have today send a letter to the Times (£) backing his bill. And in the last few years a new organisation, Health Professionals for Assisted Dying (HPAD), has set itself up under the auspices of the Dignity in Dying (formerly the Voluntary Euthanasia Society).

But as an article in the Times (£) accompanying the above letter notes, the British Medical Association and almost all Royal Colleges are opposed to a change in the law. In fact about two thirds of doctors are opposed.

Interestingly, the Times newspaper, is in agreement with them.

In its editorial (£) today it says it would be ‘wrong to legislate’ and that ‘the law that Lord Falconer now wants is a step too far’.

The current blanket prohibition on assisted suicide keeps the numbers low, as evidenced by the very low numbers of people travelling to Dignitas facility in Switzerland to kill themselves.

Furthermore the Director of Public Prosecutions (DPP) already has discretion not to prosecute in hard cases and the authority to temper justice with mercy. But he is particularly tough on doctors, because of the power they have, as recognised by Hippocrates.

‘There is a danger’, argues the Times, ‘that a codified law that attempted to replace such difficult and nuanced judgments with statute would produce two problems.’

‘The first is a large increase in assisted suicides as it becomes more legally straightforward. This is the reason why many lobbyists for the disabled oppose the Bill, concerned that people will be put under pressure to end their lives.’

‘The second danger is, oddly, an increase in prosecutions for assisting suicide, as the discretion of the old system is replaced by a more formulaic approach. This may be the reason why doctors are, in general, against a new law. And why they are right to be.’

It is significant that the Times, which backed a change in the law at the time of Falconer’s last attempt to alter it in 2009 has now changed its position.

But it has done so on the basis of good evidence.

Jurisdictions which have legalised either assisted suicide or euthanasia, have seen a steady increase in case over subsequent years and the widening of criteria to include categories of people for whom it was never intended.

This pattern of incremental extension is seen in the NetherlandsSwitzerland, Oregon and Belgium and extension beyond mentally competent adults has been clearly seen in both the Netherlands and Belgium.

Our current UK law is clear and right and does not need changing. The penalties it holds in reserve act as a powerful disincentive to exploitation and abuse, whilst giving both prosecutors and judges discretion to temper justice with mercy in had cases.

It may not be perfect, but we tamper with it at our peril.

And Hippocrates was right about doctors too. They are too powerful and too human to be given the power and authority to kill.

Friday 17 May 2013

Time lapse imaging of embryos – exciting breakthrough or just eugenics by another name?

Various media outlets (including The Times (£), The TelegraphBBC, The Independent and The Guardian) have published articles reporting on how fertility specialists from Nottingham have developed a radical technique that will ‘dramatically improve’ the chances of IVF couples having a baby.

The original research appears in Reproductive BioMedicine Online.

About one in eight couples have trouble having children through natural conception and around 48,000 women currently undergo IVF treatment each year resulting in about 12,200 IVF births, an overall success rate of 25%.

This failure rate of 75% causes immense emotional upset to affected couples, many of whom have paid between £5,000 and £10,000 for each treatment cycle.

However the new  procedure, which uses ‘time-lapse imaging’ to monitor the health of embryos by taking thousands of digital pictures to identify ones that are developing well, could raise the chance of a live birth to 78%, about three times the national average.

The new technique identifies the ‘best embryos’ to be implanted into the womb based on the time it has taken to develop between two key stages in the early life-cycle of the embryo.

Thousands of time-lapse pictures taken during the first few days of an IVF embryo's life are used to identify the time between the first appearance of the fluid-filled cavity, called the blastula (normally 97 hours), and the full blastocyst (122 hours).

In embryos at high risk of aneuploidy (extra chromosomes) these steps occurred about 6 hours later on average. Aneuploidy is the single biggest cause of IVF failure.

To test the system, the doctors ran the program on time-lapse images of 88 embryos that had been recorded previously for 69 couples at the clinic. Some 61% of the embryos ranked as low risk for abnormal chromosomes led to live births, compared with none of those ranked as high risk.

Around a dozen private and NHS clinics are currently using time-lapse embryo imaging. It costs around £750 in addition to about £3,000 for IVF.

The £750 cost compares favourably with the current cost of £2,500 for Pre-implantation Genetic Screening, an invasive test which removes cells from the early embryo for analysis.

If the new imaging test proves to be effective in larger trials it seems likely that it will be used much more widely.

What is singularly lacking from any media coverage of this research however is any discussion of the ethics.

Not only does it seem to be taken for granted that the improved success rates override any ethical objection. There is simply no ethical objection even considered.

But let’s think about what is actually happening here.

Embryos are being created in a laboratory and those with aneuploidy are being identified and discarded.

Some of these will have the commoner trisomies (three rather than two copies of a particular chromosome) – Down’s syndrome (trisomy 21), Edward’s syndrome (18) and Patau’s syndrome (13) – where affected babies are often born alive.

Some will have other trisomies (like trisomy 15, 16 and 22) and inevitably will either fail to implant or result in miscarriages.

So is it right to implant those embryos more likely to survive and throw away the others?

Well that surely depends on what these tiny organisms actually are.

They are undoubtedly individual human lives, but what status do they have? Are they potential human beings or are they human beings with potential?

Philosophers like Singer, Glover and Harris will tell you that they are alive but non-persons because they do not yet have functioning nervous systems.

But others, who would argue that human life from the time of fertilisation should be shown the utmost respect and afforded protection would say that every living human organism – no matter how young, old or disabled and regardless of its intellectual capacity – is also a human person with rights.

I know what I think, but what do you think and why? They are either persons or not persons. Which is it?

Is this new technique the 'most exciting breakthrough in IVF treatment in 30 years'? Or is it just eugenics by another name?

It makes all the difference in the world.

Thursday 16 May 2013

Embryonic stem cells from cloned human embryos – six reasons for caution

The newspapers are full today of the news that scientists in the US state of Oregon have produced embryonic stem cells (ESCs) using the same cloning technology (somatic cell nuclear transfer (SCNT)) that created Dolly the sheep.

The original paper was published in the scientific journal Cell (Reuters and Nature give helpful reviews).

Shoukhrat Mitalipov and his colleagues took skin cells and transplanted their nuclei into eggs from paid donors from which the nuclei had been removed. Some resulting embryos were grown to the blastocyst stage (about 150 cells) at which point embryonic stem cells were harvested and developed into stem cells lines from which a range of more specialised body cells were derived.

Some are claiming that this might be the first step in producing stem cells that can be used to treat conditions in which there is cell loss like Parkinson’s, diabetes and spinal cord damage.

The huge media coverage this story has generated is due to the obsession of the British media with embryonic stem cell technology, the fact that this is the first time embryonic stem cell lines have been derived from cloned human embryos and the emotion generated by conditions for which there is currently no cure.

Amidst the hype let me register six reasons for caution.

First, what many news outlets do not make clear is that these embryonic stem cells have been produced by the cannibalising of cloned human embryos, a process that results in their destruction. This is a huge ethical barrier to the technology for those who believe, as I do, that human life begins at conception.

Second, the paper discloses that ten women were paid to ‘donate’ more than 120 eggs in the course of the research. The primary means by which these eggs are procured is ovarian hyperstimulation which is associated with serious health risks in both the short and long term. Egg donors for the experiment received US$3,000–7,000 in compensation. This is expensive and risks creating an organ trade that preys on the poor, especially students. Jennifer Lahl’s excellent book ‘Eggsploitation’ spotlights the booming business of human eggs told through the tragic and revealing stories of real women who became involved in selling their eggs.

Third, the method used to create these embryos is identical to that used to create cloned adults. If someone were to implant one of these embryos in a woman it could theoretically be grown into a cloned baby. Such portakabin technology is extremely difficult to police and some like Dr David King, from the campaign group Human Genetics Alert, are saying for this reason that it should not be done at all.  

Fourth, we know already that cloned mammalian embryos are not normal because they do not grow into normal adults. It took 277 attempts to create Dolly the sheep and she was abnormal and died early. This raises the strong possibility that stem cells derived from cloned embryos may not be normal either. This means that they are very unlikely ever to be used in treatments but only in research. It is adult stem cells derived from sources like umbilical cord blood and bone marrow that hold the real promise, are involved in the overwhelming majority of clinical trials and are already being widely used in treatment of a wide range of conditions.

Fifth, there is already alternative stem cell technology available for research. Induced pluripotent stem cells (iPS) (which can be made from reprogrammed adult cells without the need to create and destroy embryos) and for which Japanese researcher Shinya Yamanaka won a Nobel prize in 2012, have already led many researchers to abandon research using cloning methods. Although this research is still at an early stage iPS cells appear to have most of the properties of embryonic stem cells and their production does not involve the same ethical barriers.

Finally, this new research is at a very early stage and we need to beware of the huge media hype that will be generated around it by biotechnology companies and scientists who have financial and personal vested interests and a hotline to the media. We need to be wary that we are not being given an exaggerated account which is high on hype and plays down the real risks. 

Monday 13 May 2013

The ‘Groningen protocol’ for euthanasia of disabled babies in the Netherlands

In an interview this morning on BBC Five Live (at 0705) on the Paul Lamb case (listen here) I was asked by the presenter Nicky Campbell about evidence for a slippery slope following the legalisation of euthanasia in other jurisdictions.

In my answer I mentioned the steady escalation in numbers of cases in Belgium and the Netherlands (see here and here) and said that one third of nurses had carried out euthanasia illegally in Belgium and that one third of cases in some parts of Belgium had been involuntary although the law did not allow this.

I also mentioned the ‘Groningen Protocol’ under which disabled babies had been given lethal injections in the Netherlands.

Campbell appeared not to know about this and asked me on air to email him information about it to which I agreed. Another BBC journalist phoned me after the interview to check my sources.

I sent her a link to the original paper on the ‘Groningen Protocol’ from the New England Medical Journal in 2005.

It says that ‘Twenty-two cases of euthanasia in newborns have been reported to district attorneys' offices in the Netherlands during the past seven years’ but also highlights underreporting:

‘Given that the national survey indicated that such procedures are performed in 15 to 20 newborns per year, the fact that an average of three cases were reported annually suggests that most cases are simply not being reported.’

The 22 babies killed all had spina bifida and/or hydrocephalus – conditions which many disabled people live with in Britain today (Here is another report on the protocol from CBHD citing the 22 documented cases).

Under the ‘Groningen Protocol’ the termination of a child's life (under age 12) is acceptable if four requirements were properly fulfilled:

  1. The presence of hopeless and unbearable suffering
  2. The consent of the parents to termination of life
  3. Medical consultation having taken place
  4. Careful execution of the termination
A more recent report suggests there has been a reduction in cases of direct newborn euthanasia in the Netherlands since 2005 because of 1. More efficient prenatal detection and late abortion 2. More use of ‘terminal sedation’ not recorded officially as euthanasia 3. Continued underreporting

Other issues I mentioned to the BBC in my email included:

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.

4. According to a recent report Belgium is now the ‘world leader’ in organ removal after euthanasia with at least nine cases since 2005 but suggestions are that there would have been many more had more euthanasia patients had transplantable organs.

6. Summary of recent developments in Netherlands documenting a 15-20% increase in euthanasia cases per year since 2006 (gives good overview of overall situation).

7. The latest Lancet paper on the subject giving 12.3% as the figure for terminal sedation deaths in the Netherlands and summarising other past papers in NEJM/Lancet

I gather that Nicky Campbell has since agreed on twitter with my opponent in the interview (Andrew Copson of the British Humanist Association) that I was ‘a past master in extreme and irrelevant claims’ (I'd be interested to hear his evidence for that btw) but at least he will be able to verify the truth of my claims about euthanasia in Belgium and the Netherlands from the links given above.

For ten year report on Euthanasia in Belgium see here.

Saturday 11 May 2013

Culture Wars – the old right/left divide has gone

The 20th Century was defined by economic and class-based divisions between socialists and capitalists. But with the main political parties now increasingly embracing free market capitalism and in the absence of an argument about economic management, culture rather than economics will be the future's defining political divide. The 21st Century will be defined by cultural and social divides, between liberals and conservatives.

American culture wars are already being fought. Liberals embrace abortion, gay marriage, drug legalisation, sexual permissiveness, embryo research, euthanasia, easy divorce, cohabitation, political correctness, positive discrimination, government interference, and higher taxes and spending to pay for welfare; Conservatives most likely go to church and oppose all of the above. The best predictor of whether a white American voted Republican in 2000 was church attendance more than once a week – 79 percent of this group voted Bush.

By contrast, British liberalism reigns largely unchallenged. Small victories are won – the government defeat over the Racial and Religious Hatred Bill, and the rejection of the Joffe Bill – but the general policy thrust, both Conservative and Labour, is liberal. Daily, the headlines are dominated by yet another liberal triumph. Cohabiting couples are to have equal rights as the married; churches and mosques are to be forced to rent out their premises to homosexuals; under-age sex is actively encouraged by the media; single parent families are to be admired as much as married families; drug-taking celebs are condoned; Christian teaching is thought freakish and extreme; and the Human Rights Act makes a mockery of the criminal justice system to the point of virtual collapse of law and order.

The British liberal establishment is now so powerful that it is a wonder we keep winning the euthanasia vote. Government departments, institutions, the media, and even medical journals and organisations like the BMA are increasingly influenced by powerful liberals. As a result, Christians are increasingly marginalised, left without a voice, by the new establishment.

Many UK Christians will have reservations about some of the issues supported by our brethren in the US. Christian morality is in some ways a strange mixture of right and left wing politics – mixing traditionally left wing concerns for the poor, disabled, ethnic minority groups and developing world with a more traditionally right wing opposition to abortion, euthanasia and sexual immorality. The common factors we would want to emphasise are a concern for the vulnerable and marginalised, and recognition that those most easily exploited need to be both strengthened and protected.

But following in the footsteps of Christ in these days involves both the willingness to speak out on behalf of the voiceless, and the willingness to suffer and expend energy on their behalf. And to do that effectively, we need to be involved at every level of society, not only at the grassroots, but also in the media and institutions.

Reproduced from Triple Helix

Wednesday 8 May 2013

Don’t be fooled by Lord Falconer’s ‘modest’ assisted suicide proposals

Lord Falconer has finally announced that his long awaited assisted suicide bill will be tabled in the House of Lords next week on Wednesday 15 May.

It is then that we will finally see the full text of the bill which will then proceed to second reading (debate stage) sometime in June, or possibly in the autumn.

According to the BBC and Telegraph the bill will be based on the Oregon model – assisted suicide for mentally competent adults who have less than six months to live.

The timing has been carefully planned. On 13 and 14 May the Court of Appeal will be hearing the case of Paul Lamb, a 57 year old man with quadriplegia, who is seeking permission for a doctor to kill him by means of a lethal injection.

Off the back of media coverage of this case, Falconer, who is being backed by Dignity in Dying (the former Voluntary Euthanasia Society), will argue that his proposal is modest in comparison.

Lamb is not terminally ill and wants a doctor to give him a lethal injection (euthanasia).  Falconer however is only asking for people who are terminally ill to have the right to receive help to kill themselves (assisted suicide).

This model, he will argue, will be safer for vulnerable people and will have ‘upfront safeguards’ to stop abuse.  

According to House of Lords calculations in 2005 a Dutch-type law (such as Lamb is seeking) would mean 13,000 euthanasia deaths a year in Britain, but an Oregon-type law (like Falconer’s) would mean only 650.

Falconer is thereby attempting to position himself as the reasonable middle ground between those who wish to keep euthanasia and assisted suicide illegal and those who want extensive decriminalisation.

We should not be fooled by this ploy and the situation in Oregon is already ringing loud alarm bells.

Members of the House of Lords should note that statistics released just earlier this year (full report here) show that the number of assisted suicide prescriptions and deaths in Oregon, once again, increased in 2012 and has now reached an all-time high. 

There were 59 assisted suicide deaths in Oregon in 2009, 65 in 2010, 71 in 2011 and 77 in 2012; a 30% increase overall in just four years. 

The number of prescriptions for assisted suicide was 95 in 2009, 97 in 2010, 114 in 2011 and 115 in 2012; 115 in 2012; a 21% increase since 2009.

Overall assisted suicides have gone from 16 in 1998 to 77 in 2012, an overall increase of 381% (see chart above).

This pattern of incremental extension is similar to that seen in 
the NetherlandsSwitzerland and Belgium, other countries that have changed the law.

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

The Oregon numbers may not seem large but we need to remember that Oregon has a very small population relative to the UK and that they may well be an 
underestimate as they are based on physicians' self-reporting. 

But for argument's sake let's simply take them at face value. How would they then translate to Britain?

Back in 2006, and based on Oregon’s total of 38 assisted suicide deaths in 2005, 
the House of Lords calculated that with an Oregon-type law we would have about 650 cases of assisted suicide a year in Britain. 

But as the numbers in Oregon have since doubled to 77 the UK equivalent would now be 1,300.

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

Any change in the law to allow assisted suicide (a form of euthanasia) would inevitably place pressure on vulnerable people to end their lives so as not to be a burden on others and these pressures would be particularly acutely felt at a time of economic recession when many families are struggling to make ends meet and health budgets are being slashed. Especially when fears about the NHS are actually fuelling support for assisted suicide. The so-called right to die can so easily become the duty to die.

And once legalised there will inevitably be incremental extension as we have seen in Oregon, Switzerland, Belgium and the Netherlands. Legalisation leads to normalisation. New hard cases will brought to bring pressure to widen the existing criteria to allow extension to ‘Gillick competent’ minors, people without mental capacity who ‘would have wanted it’ and those who are ‘suffering unbearably’ but are not terminally ill.

I have previously blogged about 
the shroud of secrecy which surrounds assisted suicide practice in Oregon, the worrying trends in neighbouring Washington state, which enacted a similar law more recently and the way the Oregon law steers people toward suicide. 

Also deeply concerning are reports of 
depressed patients being killed without being treated, doctor shopping, deaths taking place without witnesses present (raising questions about elder abuse) and the fact that 44 of the 77 who died last year (57%) said that they were concerned about being a burden on family, friends and caregivers. 

The lessons are clear. Let’s not go there.

The best system is what we have already – a blanket ban on both assisted suicide and euthanasia which provides a strong deterrent to exploitation and abuse whilst giving discretion to both prosecutors and judges to temper justice with mercy in hard cases.

Under this the number of people going to the Dignitas facility in Switzerland to end their lives remains a trickle of about 15-20 per year.

So let’s keep that system in place and concentrate on providing the best possible care to people who are dying. Let’s major instead on killing pain without killing the patient.