Saturday 29 June 2013

The question that the police have not asked and Nitschke has not answered

Australia's ‘Dr Death’ Philip Nitschke (pictured left) visited the UK this week and held a ‘workshop’ at Dragon Hall in London providing instruction in how to commit suicide. About 150 people attended.

Not understandably the event evoked protests (see picture below) and some publicity.

In the week before Nitschke arrived I wrote to both the Home Secretary Theresa May and the London Metropolitan Police Commissioner Sir Bernard Hogan-Howe to advise them about his visit and to inform them that I believed his workshop would be in breach of the Suicide Act 1961, under which it is an offence to ‘encourage or assist’ suicide.

The Act does not require that a suicide is actually carried out in order to for a prosecution to take place.

Quite possibly as a result Nitschke was briefly detained at Gatwick airport but was eventually let in, presumably with the permission of the Home Secretary.

The police did not attend the workshop but referred the matter to the Crown Prosecution Service who decided that an investigation was not necessary.

At his workshop last Tuesday Nitschke, who is on public record as supporting suicide for ‘the depressed, the elderly bereaved, (and) the troubled teen’, gave advice on the sourcing, supply and use of barbiturates, nitrogen and other means that people could use to kill themselves.

2010 report demonstrated that coroners were aware of 51 Australians who had died from an overdose of Nembutal, a lethal barbiturate that Nitschke has promoted since the late 1990’s as ‘a peaceful way to die’.

But this fact seems to leave Nistchke unperturbed.

When previously confronted with the fact that 14 of the 51 were Australians in their 20’s and 30’s and only 11 of 38 investigated were known to have suffered chronic physical pain or a terminal illness he responded that ‘there will be some casualties’.

Currently Nitschke is the subject of an inquiry by the Australian Health Practitioners Agency (AHPA) in connection with an entity called 'Max Dog Brewing' which he has set up in order to sell nitrogen cylinders via his ‘Exit International’ website to people who wish to end their lives.

‘Max Dog Brewing’ is a business name for the company Northern Analytics Pty Ltd which has ‘Philip Haig Nitschke’ as its sole director.

Its website claims that nitrogen cylinders can be used for home brewing (nitrogen produces the bubbles in stout) but Nitschke has admitted on Australian national media that they can equally be used to commit suicide and there are much cheaper sources of the gas available for brewers.

I asked Nitschke on twitter this week how many nitrogen cylinders he has so far sold to members of the British public but thus far he has not responded.

However according to the Newstalk ZB in New Zealand 'Max Dog Brewing' has already sent shipments to both New Zealand and the UK.

So here we have a man who travels the world running ‘workshops’ in order to give information to people in order that they can commit suicide.

He tells them where they can obtain barbiturate drugs and sells kits for storage of the drugs and for measuring their concentration.

And he sells nitrogen cylinders via a company he has set up for the purpose along with the necessary kit to deliver the gas.

Quite why this does not amount to ‘encouraging and assisting’ suicide is a mystery to me.

What will it take, I wonder for the authorities - including the Home Secretary, the police and the Crown Prosecution Service - to do something about it?

I hope it is not the first barbiturate or nitrogen suicide of someone in the UK making use of his information and equipment. But I am not holding my breath. 

Friday 28 June 2013

Three parent embryos for mitochondrial disease – unsafe, unethical and unnecessary

Britain is planning to become the first country in the world to offer controversial ‘three-parent’ fertility treatments to families who want to avoid passing on mitochondrial diseases to their children.

The BBC reports this morning on the new techniques which it is claimed will children born through 'three-person IVF' who would carry genetic material from each of three different people.

There are about 50 known mitochondrial diseases (MCDs), which are passed on in genes coded by mitochondrial (as opposed to nuclear) DNA. They range hugely in severity, but for most there is presently no cure and little other than supportive treatment.

It is therefore understandable that scientists and affected families want research into these two related ‘three-parent embryo’ techniques (pronuclear transfer and maternal spindle transfer) to go ahead. But there are good reasons for caution.

This is not about finding a cure. It is about preventing people with MCD being born. We need first to be clear that these new technologies, even if they are eventually shown to work, will do nothing for the thousands of people already suffering from mitochondrial disease or for those who will be born with it in the future.

There are also already some alternative solutions available for affected couples including adoption and egg donation.

But apart from this I’m left with four big questions.

Is it safe? This is far from established. Each technique involves experimental reproductive cloning techniques and germline genetic engineering, both highly controversial and potentially very dangerous. Cloning by nuclear transfer has so far proved ineffective in humans and unsafe in other mammals with a large number of cloned individuals spontaneously aborting and many others suffering from physical abnormalities or limited lifespans. Also, any changes, or unpredicted genetic problems (mutations) will be passed to future generations. In general, the more manipulation needed, the higher the severity and frequency of problems in resulting embryos and fetuses.

Will it work? I am sceptical. This technology uses similar ‘nuclear transfer’ techniques to those used in ‘therapeutic cloning’ for embryonic stem cells (which has thus far failed to deliver) and animal-human cytoplasmic hybrids (‘cybrids’). The wild claims made about the therapeutic properties of ‘cybrids’ by the biotechnology industry, research scientists, patient interest groups and science journalists duped parliament into legalising and licensing animal human hybrid research in 2008. Few now will remember Gordon Brown’s empty promises in the Guardian on 18 May that year of ‘cybrids’ offering 'a profound opportunity to save and transform millions of lives' and his commitment to this research as 'an inherently moral endeavour that can save and improve the lives of thousands and over time millions of people'. That measure was supported in a heavily whipped vote as part of the Human Fertilisation and Embryology Bill, now the HFE Act. But ‘cybrids’ are now a farcical footnote in history. They have not worked and investors have voted with their feet. Ironically, it was in that same Act of Parliament, that provision for this new research was also made.

Is it ethical? No, there are huge ethical issues. A large number of human eggs will be needed for the research, involving ‘harvesting’ that is both risky and invasive for women donors. How many debt-laden students or desperate infertile women will be exploited and incentivised by being offered money or free IVF treatment in return for their eggs? How many thousands of human embryos will be destroyed? If it ever works, what issues of identity confusion will arise in children with effectively three biological parents? What does preventing those with mitochondrial disease being born say about how we value people already living with the condition? Where will this selection end? Some mitochondrial diseases are much less serious than others. Once we have judged some affected babies not worthy of being conceived, where do we draw the line, and who should draw it?

Is the debate being handled responsibly? No. The research scientists involved have huge financial and research-based vested interests and getting the regulatory changes and research grants to continue and extend their work is dependent on them being able to sell their case to funders, the public and decision-makers. Hence their desire for attention-grabbing media headlines and heart rending (but highly extreme and unusual) human interest stories that are often selective about what facts they present.

It must be tempting for politicians to make promises of ‘miracle cures’ in years to come which no one may remember. But I suspect it is much more about media hype than real hope.

This new push is being driven as much by prestige for government, research grants for scientists and profits for biotechnology company shareholders as anything else.

Let’s keep a cool head and instead concentrate on finding real treatments and providing better support for affected individuals and their families rather than spending limited health resources on unethical, risky and highly uncertain high tech solutions that will most likely never deliver. 

 (See BBCGuardianTimes(£), IndependentDaily Mail and Telegraph).

Three-parent embryos for mitochondrial disease? Twelve reasons for caution

The media is buzzing today with the news that Britain is planning to become the first country in the world to offer controversial ‘three-parent’ fertility treatments to families who want to avoid passing on mitochondrial diseases to their children (See BBC, Guardian, Times (£), Independent, Daily Mail and Telegraph).

The Department of Health announced yesterday that it would draw up draft guidelines to allow fertility clinics to offer the technique. The proposed guidelines would be released for public comment later this year, and Parliament would vote on a final version in 2014.

Scientists are currently researching two main three-parent IVF techniques. The first, being developed at Britain's Newcastle University and known as pronuclear transfer (PNT), swaps DNA between two fertilised human eggs. Another, called maternal spindle transfer (MST), swaps material between the mother's egg and a donor egg before fertilisation.

The BBC is heralding it as a ‘ground-breaking technique for preventing serious genetic disease’ and a ‘bold step for science and society’. Media reports are full today of reassurances that that mitochondrial DNA only accounts for 37 out of our 20,000 human genes and that this therefore is a small step that will be undertaken only under ‘strict safeguards’.

Most people accessing broadcast media will hear heart-rending accounts of affected families and will get the message that those opposing the move are Luddites and religious fundamentalists on the lunatic fringe.

But there are actually very good reasons we should not be going down this route. Here are just twelve for starters:

1. Even were this new technology to work (and there are huge questions about that) it would help only a very small handful of families and only a tiny fraction of those with mitochondrial disorders. One in 6,500 babies is born with mitochondrial disorder, about 200 per year in Britain. But only five to ten of these have conditions serious enough to merit this intervention.  The technology will not help the other 190 or the 12,000 people in the UK already living with mitochondrial disease.

2. Babies with serious mitochondrial disease will still be born as many families are not aware they are even carrying the abnormal genes until after the birth of at least one affected child. So this will largely be relevant only in preventing the birth of subsequent affected children to these families.

3. There are already alternative routes for these families to have unaffected children either through adoption or egg donation (although I personally have serious ethical misgivings about the latter).

4. Both techniques above involve cell nuclear replacement ‘cloning’ technology which has not yet been shown to work in humans. Whilst it appears to be effective in lower mammals like mice (see here) use of cloning techniques in higher mammals has resulted in huge numbers of miscarriages and the birth of large numbers of abnormal offspring. It took 273 attempts to produce Dolly the Sheep and she herself was abnormal dying early. There is a strong possibility that we may simply be trading mitochondrial disease for other abnormalities if babies are ever born after use of the technique.

5. It is likely that thousands of embryos will need to be produced and experimented upon in developing these techniques. Many, like me, who believe that human embryos are worthy of the utmost respect and protection as early individual human lives will argue that the end of producing an unaffected baby does not justify these means.

6. Tens of thousands of eggs will be required for this research. It is virtually certain that donated excess eggs from those undergoing fertility treatment will not be adequate to meet this demand and that egg harvesting from paid donors will be necessary leading to exploitation of  vulnerable women and exposure to  at times high-risk egg-harvesting procedures.

7. If successful, this research will cross an ethical and safety rubicon by allowing human germline genetic therapy for the first time in human history. The genes from the third parent will be passed on down the generations and will be impossible to remove from the family.

8. Any babies resulting from this therapy will have a third genetic parent whose details will not be on the birth certificate. This raises issues of personal and family identity for children born as a result of the technique and will inevitably lead to litigation involving parents wanting to assert maternity rights and children wanting information about all their genetic parents. Behind these cases will be the hugely emotive issues of custody and inheritance.

9. Allowing the technique will lead to further demands for extension in two ways. It will be argued that if we have accepted germ line therapy for mitochondrial disease then we should also accept it for genetic disorders transmitted by nuclear DNA and for less serious mitochondrial disorders. This will lead to pressure to extend the use of these techniques to other diseases. By backing germ line therapy even in these limited circumstances the UK is crossing a line that every other country which has considered the matter has concluded is too dangerous.

10. These techniques do not offer support or treatment to people affected with mitochondrial disease but rather are aimed at identifying these individuals at the embryo stage and genetically engineering them. There is more than an element of eugenic thinking here. Is it right for us to decide that lives with serious disability are not worth living to the extent that such people must be prevented being born or genetically altered to make them acceptable? This is a very dangerous slippery slope indeed.

11. In addition to genuine compassionate concerns about affected families there are very powerful ideological and financial vested interests in this field including research grants for scientists, profits for biotechnology companies and prestige for the British government. 

12. Hard cases do not necessarily make good law or policy. I remain deeply suspicious of the way this 'breakthrough' that will potentially help only a tiny number of people with a very limited number of conditions is being  foisted on the British public using emotive personal stories by an incredibly well-organised coalition of politicians, biotechnology companies, journalists, research scientists and patient interest groups without full consideration of the concerns like those above which many have expressed. I suspect there are much bigger agendas here that are not yet being fully disclosed. Are we, for example, seeing reproductive cloning and germ line therapy being deliberately smuggled in under the back door under the guise of compassion? The moving boundaries and mission creep we have seen with other IVF-related technologies should sound a huge note of caution for us. 

I have written previously on mitochondrial disease here, here, here and here. Also see CMF’s official submissions to the HFEA and Nuffield consultations on this issue and  a recent blog post where we argue that these techniques are unsafe, unnecessary and unethical.  

Update on Gay marriage Bill in House of Lords - what happens next?

Colin Hart, Campaign Director of the Coalition for Marriage (C4M), has this week issued a very useful summary on the current status of the Marriage (Same Sex Couples) Bill, which is now moving to Report Stage in the House of Lords.  

It outlines the main concerns with the bill and the way it undermines civil liberties and changes the meaningsof words like ‘husband’ and ‘wife’.

I have reproduced it below:

The Bill has now completed its Committee Stage. As is usual, there have been no votes during Committee Stage. The Bill now moves to Report Stage, scheduled to take place on 8 and 10 July, when we expect there will be votes on key amendments.

During Committee Stage, many Peers have been pressing for a long list of protections for people who believe in traditional marriage, including:

• Protecting people at work from being disciplined just because they voice support for traditional marriage.

• Stopping local authorities using the Public Sector Equality Duty to ban a church from hiring public facilities just because the church disagrees with same-sex marriage.

• Protecting foster carers from being blacklisted by social workers just because they believe marriage is the union of a man and woman.

• Giving couples the option of marrying according to the real definition of marriage, rather than being forced to marry according to the new genderless definition.

• Protecting the right of teachers to express support for traditional marriage without risking their careers.

• Making clear that freedom of speech about marriage should not be restricted by equality laws.

There have been some passionate and excellent speeches from Peers who support these protections, including from a number of the country’s top legal experts. A former Lord Chancellor and two former senior judges lent their voices to the call for civil liberty safeguards.

The Government has promised to change the criminal law so that criticism of same-sex marriage won’t be, of itself, a hate-crime. We welcome that reassurance, but our primary concern lies with civil, not criminal, law. For example, employment law and discrimination law – where the problems are most likely to arise – are part of civil law. Here, the Government has stubbornly refused to give an inch on safeguarding the freedom of people who believe in traditional marriage.

They even went as far as saying people who work in the private sector – let alone public sector – should be fired if they refuse to provide services for a same-sex wedding. As far as the Government is concerned, there should be no liberty of conscience in those circumstances.

That shows what we’re up against, but we have no intention of backing down. We will be working hard to call for safeguards for people – like you – who support traditional marriage.

This is important work, but we haven’t stopped defending the principle of real marriage. We always said the Government would tie itself in knots trying to redefine marriage, and here is just one example: in the official Explanatory Notes which accompany the Bill, the Government says:

The terms “husband” and “wife” here refer to a person who is married for the purposes of paragraph 1(2)(c) of Schedule 3. This means that “husband” here will include a man or a woman in a same sex marriage, as well as a man married to a woman. In a similar way, “wife” will include a woman married to another woman or a man married to a man. The result is that this section is to be construed as including both male and female same sex marriage. 

In other words, under this Bill, a woman can be a “husband” and a man can be “wife”. It just shows that words lose all meaning when politicians meddle with marriage.

Thursday 27 June 2013

21st century Britain - a dying rose severed from its cultural roots

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, it is culture rather than economics which has now become the defining political divide. The 21st Century is characterised by cultural, social and ethical fault lines between liberals and conservatives.
The main vehicles of British culture - parliament, the institutions, judiciary, universities, media, arts and entertainment- are increasingly now populated and dominated by a liberal elite which embraces an atheist worldview and the ethics of secular humanism. People who were in their teens and twenties in the 1960s are now running the country, 150 years after the start of decline of British Christendom in 1860.

Liberal elite values are characterised by sexual permissiveness, easy divorce, cohabitation, liberal abortion, drug legalisation, government interference, higher taxes, increased welfare spending and more recently by political correctness, embryo research, same sex marriage, euthanasia and the marginalisation of, and discrimination against, those with conservative values.

Social conservative values I see as including sexual purity, marital faithfulness, family and community loyalty, upholding the sanctity of life, respect for king and country, accountability, responsibility, integrity, stewardship, simplicity, sacrificial service, self-control, a strong work ethic and both charitable provision and legal protection for the most vulnerable.

In Britain these social conservative values are essentially Christian values – which have their roots in the Bible and were revived by the 16th century reformation, by the 17th century puritanism that drove the Pilgrim fathers and the non-conformist movement, and by the 18th century evangelical revival under Wesley and Whitefield (and  parallel Great Awakening in America) which led both to the 19th century social reform catalysed by the likes of Wilberforce and the Clapham sect and also to the 19th missionary movement, beginning with Carey in 1793, which profoundly shaped the Christian culture of the British Empire.

Christian social conservative values are a strange mixture of right and left wing political concerns – combining traditionally left wing concerns for the poor, disabled people, ethnic minorities and concerns about developing world trade, aid and debt with a more traditionally right wing opposition to abortion, euthanasia, divorce, sexual immorality and substance abuse.

David Cameron fails to understand this because he understands Christianity primarily in terms of its influence on Britain’s architecture, language, constitutional monarchy and parliamentary democracy but without really grasping Christianity’s fundamental world view and ethics except in very vague terms.

His recent speech on the 400th anniversary of the KJV illustrates this well – where he talked about ‘responsibility, hard work, charity, compassion, humility, self-sacrifice, love…pride in working for the common good and honouring the social obligations we have to one another, to our families and our communities…’ but tellingly left out any reference to the sanctity of life, sexual purity, respect for conscience or most importantly any reference to the mission of Christ or his incarnation, crucifixion, resurrection, ascension or return in judgement – concepts which by contrast the Queen does actually seem to understand.

Iain Duncan Smith in his 2006 analysis of ‘Breakdown Britain’ I believe attributed accurately the decline to the ‘five pathways to poverty’: family breakdown, educational failure, economic dependence, indebtedness, and addiction which he calculated costs us £102 billion per annum.  He listed 191 policies aimed at reversing the breakdown, with which I have much sympathy, but I see the underlying solutions as predominantly spiritual rather than political.

This is because at a deeper level I see the breakdown of Britain and its five 'drivers' as symptoms of a more general spiritual malaise – a loss of Christian faith and values – of Christian belief and behaviour. What is missing is the sense of accountability, responsibility, human dignity and empathy that has its roots in a Christian world view.

The problem with Britain is that like a dying rose it has been severed from the very roots which were responsible for its, now fading, bloom. 

Wednesday 26 June 2013

Scottish government committee recommends making free leather gloves available to teenage burglars

Colin McGregor (not his real name) is unlikely to forget his 15th birthday.

‘The night I cut my hand, I was celebrating my birthday,’ he says. ‘I told my friend I was going to burgle a house down the street because I wanted a television set. He said I should be careful that I didn’t cut myself smashing a window but I didn’t take proper precautions and came back bleeding. I was scared about people’s reactions but a bit excited at the same time. But then when I told my parents they didn’t take it well at all. All hell broke loose.’

‘Anyway this big cut in my hand needed suturing and then got infected which meant that I was grounded and couldn’t go out with my mates until it was properly healed. I missed out on a lot of fun having to stay at home when they were all out having a good time. And it stopped me playing tennis too.’

Unplanned lacerations are inevitably traumatic for the individuals concerned but they also have a negative impact on wider society. A report from Holyrood’s health and sport committee, published last week, calls for a national strategy to reduce injuries from burglaries.

Controversially, it recommends starting burglary education ‘as early as possible - pre-school even’ and making free protective leather gloves widely available to teenagers as young as 13.

Scotland has one of the highest teenage burglary rates in Western Europe and while teenage burglary levels are lower in Scotland than for Britain as a whole, Scottish government targets on reducing teenage burglary have yet to be met.

Dundee has the highest rate of teenage burglaries and those in the most deprived areas are almost five times more likely to suffer injuries than those in the least deprived.

While the report took care not to stigmatise teenage burglary, it highlighted the danger of injury and the cost to the general public. Teenagers who burgle are less likely to complete their education, more likely to live on benefits or in poverty and more likely to experience family conflict.

Andrew Houston, chief executive of Teenagers 1st, a charity which is broadly in favour of the report’s recommendations, says that injured burglars fall into three groups.

‘Some injuries are completely accidental and there is an issue with knowledge and information and access to leather gloves but there is also an issue with doing burglaries when they are drunk and which they regret afterwards,’ says Houston. ‘The second group are proactive and want to injure themselves or are ambivalent but wouldn’t mind if it happened.’

‘Often those are teenagers who live in poverty and deprivation. They don’t have aspirations and ambitions and they don’t feel part of anything. A scar following injury while carrying out a burglary is often seen as something desirable. It gives them an identity. Then there is a third group where they get injured after being led on by abusive people.’

‘It has ever been that teenagers will experiment with burglary,’ says Houston. ‘It is unlikely we will ever be able to stop that entirely. We then have a choice. If young people are going to burgle is it our preference to say, “You must not,” or do we talk about it, explain it is not the best time to do this, support them and help them to protect themselves?’

Note: This report was adapted from a Sunday Times report (£). This was not originally about burglary and injuries but another illegal activity, having sex with someone under sixteen, which runs the risk of an unplanned pregnancy.  The names have been changed but the same government committee did actually recommend making free protective condoms available to teenagers as young as 13. 

Sunday 23 June 2013

Why did the Home Secretary let this man into the UK?

Last week I wrote to the Home Secretary Theresa May advising her about the visit of Australian assisted suicide enthusiast Philip Nitschke (pictured) and urging her to prevent him entering Britain to conduct a seminar on methods people can use to kill themselves.

Today Nitschke was detained at Gatwick airport, but eventually let into the country several hours later after having some ‘items’ temporarily confiscated by border police.

Nitschke (aka Dr Death) is an extremist and self-publicist whose presence in the UK puts the lives of vulnerable elderly, depressed and disabled people at grave risk.

His workshop in London on Tuesday under the auspices of ‘EXIT International’ now looks likely to go ahead and will advise on the sourcing, supply and use of barbiturates, helium, nitrogen and other means to commit suicide. 

In 2001, Nitschke said that his so-called ‘peaceful pill’ should be ‘available in the supermarket so that those old enough to understand death could obtain death peacefully at the time of their choosing’.

Asked who would qualify for access he replied that ‘all people qualify, not just those with the training, knowledge or resources to find out how to “give away” their life and someone needs to provide this knowledge training or resource necessary to anyone who wants it, including the depressed, the elderly bereaved, (and) the troubled teen’. 

A 2010 report demonstrated that coroners were aware of 51 Australians who had died from an overdose of Nembutal, a lethal barbiturate that Nitschke has promoted since the late 1990’s as ‘a peaceful way to die’.

Of the 38 cases fully investigated by coroners, only 11 people were known to have suffered chronic physical pain or a terminal illness before their deaths. Of the 51, 14 were Australians in their 20’s and 30’s.

Journalist Michael Cook put it to Nitschke in 2011 that ‘nearly two-thirds of the Australians who died after quaffing Nembutal... were under 60, and quite a few were in their 20s and 30s... [suggesting that] that mental illness or depression, not unbearable pain, was the reason for the suicide.’

Nitschke responded, ‘There will be some casualties... but this has to be balanced with the growing pool of older people who feel immense well-being from having access to this information, [about suicide drugs].’

In the past, Nitschke's workshops have focused on the use of drugs and gas to commit suicide, with around half the time being used to explain how Nembutal, a veterinary sedative, can be used to end life.  

He has explained to attendees the best way to administer drugs and gas in order to bring about death, and has advertised test kits for Nembutal.

Currently he is the subject of an inquiry by the Australian Health Practitioners Agency (AHPA) in connection with a company called 'Max Dog Brewing' which he has set up in order to sell nitrogen cylinders to the public. Its website claims that they can be used for home brewing (nitrogen produces the bubbles in stout) but Nitschke has admitted on Australian national media that they can equally be used to commit suicide.

The Suicide Act, as amended in 2009, states that ‘an act capable of encouraging or assisting the suicide or an attempted suicide of another person’ is illegal, ‘whether or not a suicide, or an attempt at suicide, occurs’; the emphasis is on whether the accused ‘intended to encourage or assist suicide or an attempt at suicide’.

I believe that what Nitschke has done at previous workshops falls within the scope of these offences, because the information shared was capable of encouraging or assisting an attendee to commit suicide and the workshop was intended to encourage or assist people to commit suicide by offering them advice about the ‘best way’ of doing it.

Nitschke’s activities present a real and present risk to vulnerable members of the British public.

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

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

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

Quite why the Home Secretary allowed him into the UK remains a mystery but Britain deserves an explanation.

Thursday 20 June 2013

US House of Representatives vote for 20 week abortion limit raises the issue again for the UK

The Republican-controlled US House of Representatives has passed a bill that would reduce late abortions.

The plan to restrict terminations to the first 20 weeks after conception was approved by 228 votes to 196, largely along party lines.

The Pain-Capable Unborn Child Protection Act, which was based on research showing that the unborn child can experience pain by at least 20 weeks gestation, marks the first time that the United States’ Congress have voted to give affirmative protection to unborn children.

The debate followed polls showing that 64% of the American public would support legislation prohibiting abortion after 20 weeks (more detail is in Parliamentary Network for Critical Issues article).  

But the bill has no chance of becoming law as Democrats control the Senate and the White House has threatened a veto.

Most US states allow abortions to when a baby becomes viable outside the womb, considered to be some 24 weeks.

The Republican leadership pressed ahead with the abortion bill after the case of Kermit Gosnell, a Philadelphia abortion doctor who was recently sentenced to life in prison after being convicted of killing three babies delivered alive.

There has also been a lot of support for lowering the upper limit amongst UK politicians.

Health Secretary Jeremy Hunt came in for criticism last year  for saying that he believes the upper abortion limit should be lowered from 24 to 12 weeks. 

However he is not alone. Of the 16 Conservative MPs in Cabinet, 13 actually voted for a decrease in the abortion upper limit during the passage of the Human Fertilisation and Embryology Bill in 2008. 

Of these, three, including Mr Hunt, 
voted for 12 weeks, two voted for 16 weeks, seven voted for 20 weeks and one, the Prime Minister David Cameron, voted for 22 weeks. 

They are not alone in this conviction.

Nearly two thirds of the British public and more than three-quarters of women support a reduction in the 24-week upper age limit. 76% of the public think that aborting a baby at six months is cruel. Furthermore a 2007 poll by Marie Stopes International found that two thirds of GPs wanted a reduction from 24 weeks.

Why has public opinion changed on late abortion? There are five main reasons: 4D ultrasound, babies surviving below 24 weeks, stories of babies born alive after abortion, fetal sentience, and European precedent.

We have all seen Professor Stuart Campbell's high resolution 4D ultrasound images of babies 'walking’, swallowing, coughing, hiccupping from 12 weeks gestation and experienced how mothers bond emotionally to their babies as a result of these scans. We have also seen photographs of babies alive in the womb at 20 weeks (left).

The public also know about individual high profile cases like Manchester'sMillie McDonagh, born after a 22-week pregnancy and the world's most premature baby, Amillia Taylor, who was born a week younger in the US. Experts may argue about survival figures and about comparisons between population-based studies like EPICure and those from top neonatal units but the fact remains that some babies do actually survive below 24 weeks.

Stories of babies born alive after failed abortions are also not uncommon. In a 2007 West Midlands study of 3,189 cases of termination for fetal anomaly, 102 (3.2%) babies were born alive. This included 65.7% of those between 20 and 24 weeks. Accounts such as these understandably upset people.

And then there is the question of whether fetuses feel pain. The general public intuitively concludes that they do when they hear that from 16 weeks babies will recoil from a noxious stimulus in the womb and that premature babies born earlier than 24 weeks, if stabbed in the heel with a needle, will withdraw and cry. The RCOG wheels out its experts to tell us that babies below 24 weeks do not have the neurological apparatus to sense pain but fail to tell us that this is a controversial view not shared by other experts who regard it as being based on an outdated understanding of physiology.

Which of us, honestly, can imagine telling the mother who feels her baby kick at 20 weeks that it is not a sentient being?

Finally, Britain is out of touch with most of Europe in this matter. Most countries in the EU, 16 out of 27, have a gestational limit of 12 weeks or less. These include Germany, France, Spain, Portugal, Italy, Belgium and Austria plus most countries in Eastern and Central Europe who once had far more liberal laws. At 24 weeks Britain is up there with former Soviet States Lithuania and Latvia.

In 2010 there were 792 disabled babies and 1,936 able-bodied babies aborted in Britain between 20 and 24 weeks. Every single one of the latter group was aborted under ground C of the Abortion Act, which in 98% of cases means protecting the mental health of the mother.

Lowering the abortion limit to 20 weeks for able-bodied babies (as Miller and many other MPs would support) would give more legal protection to about 2,000 babies a year; just 1% of the total. It would put clear blue water between the upper abortion limit and the lower threshold of viability and it also would show that parliament is beginning to listen.

Of course it would also raise the question of whether we should be doing the same for disabled babies, who can currently be aborted up until the moment of birth, a question evaluated by a recent parliamentary inquiry which is due to report soon. 

Wednesday 19 June 2013

All the latest news on euthanasia and assisted suicide

Here is the latest update from the Care Not Killing Alliance about recent developments with euthanasia and assisted suicide.

Care Not Killing is a mainstream UK-based alliance of over 40 organisations and thousands of individuals which campaigns for better care and support for those who are sick, disabled and dying and against any weakening of the law to allow euthanasia or assisted suicide. The Alliance works in Parliament and in the courts and with health professionals, carers, general public and media.

Court of Appeal

From 13-15 May, three of England's top judges heard the appeals of Nicklinson, Lamb and 'Martin'; Paul Lamb joined the case after the death of Tony Nicklinson, whose widow Jane remains a party to the case. The Lord Chief Justice told the appellants that 'we are acutely aware of the desperate situation in which the appellants find themselves and we are very sympathetic. But we know, and they surely know, that we cannot decide this case as a matter of personal sympathy. We have to decide it as a point of law'.

Media interest in the case has allowed many members of the general public to hear from disability rights campaigners Katherine Araniello, Dr Kevin Fitzpatrick and Dr Colin Harte, who spoke eloquently about the risks posed to vulnerable people - notably disabled people - by a change in the law. Media coverage allowed our spokespeople to confront advocates with the unsettling facts of what legalisation would mean - summed up by discussion of the Groningen Protocol, which allows disabled babies in the Netherlands to be euthanised, in a heated Radio Fivelive exchange. It is crucially important that the dangerous reality of incremental extension not be allowed to be swept under the carpet, but exposed to public view.

Falconer Bill

On the final day of the Court of Appeal hearing, Lord Falconer tabled his 'Assisted Dying Bill' in the House of Lords. The first reading received virtually no press attention, and there is no date yet scheduled for second reading. The bill is the successor to Lord Joffe's failed attempt in 2006 and Lord Falconer's own failed previous attempt in 2009, and the Labour Peer is now seeking to use the findings of his stacked 'commission' to justify a third attempt, despite the continued opposition of those who would be directly affected by such legislation - doctors and disabled people - as well as his democratically elected colleagues in the House of Commons.

Legislation around the world

Evidence of how dangerous euthanasia and assisted suicide laws are for those who are most vulnerable continues to pour out of countries like Belgium - where euthanasia deaths increased by 25% in just one year - and Oregon - where suicide contagion has been proven by the daunting escalation in non physician assisted suicide rates since legalisation.

New South Wales in Australia and the US state of Maine have both decidedly rejected bills that would have permitted (respectively) euthanasia and assisted suicide in recent weeks, and Irish Taoiseach Enda Kenny has ruled out assisted suicide legislation in the light of the Fleming Supreme Court ruling. The US state of Vermont has, however, passed a law permitting physician assisted suicide, and becomes the first US state to pass such a law through its legislature. The law is based on that of Oregon, but with fewer 'safeguards' which will in any case expire after three years to be replaced by codes developed by doctors themselves. Quebec, meanwhile, has announced a euthanasia bill for the Canadian province, and Belgium has also moved one step closer to extending euthanasia to children.


The majority of the professional medical bodies have been strongly opposed to any change in the law which would change the nature of medicine, and the vast majority of individual medics across the board support this stance. The Royal College of General Practitioners (RCGP) has announced a consultation on assisted suicide, having last opened up the issue six years ago, and while we remain assured that the daily experience of GPs leaves them firmly opposed to any weakening of the law, we welcome an opportunity for practitioners to publicly reaffirm their stance. The consultation is restricted to members of the RCGP, who we would be delighted to hear from and to discuss the recent developments with.

The British Medical Association (BMA) saw attempts by advocates for change to press a neutral stance at last year's Annual Representative Meeting which was decisively rejected, and while we are glad that emerging end of life issues such as the Liverpool Care Pathway have been given priority at this year's ARM, we are pleased that the other important issues for the practice of medicine are unlikely to be sidelined due to further efforts by a determined minority so soon after the BMA last upheld its stance.

Liverpool Care Pathway

Lady Neuberger and her panel of experts have concluded oral evidence sessions, and are now considering the input from these, alongside written submissions and the findings of parallel inquiries. Care Minister Norman Lamb has announced that the Neuberger Inquiry will report in July, and we await its findings, hopeful that these will reflect the recommendations of our own submission.

Tuesday 18 June 2013

My letter to the General Medical Council over its guidance to doctors on conscientious objection to abortion

When two Glasgow midwives won the right to opt out of supervising abortions last April I suggested that the General Medical Council (GMC) needed to revise its professional guidance on the matter which now seemed to be at odds with the law.

At the time Niall Dickson (pictured), the GMC's chief executive, actually told the Guardian that the GMC would need to consider the implications of the judges' decision on its guidance. He is quoted as saying:

‘We will study the outcome of this ruling, which has just come out, to see if there are any implications for our guidance. We already have clear guidance which says that doctors should be open with employers and colleagues so they can practise in accordance with their beliefs without compromising patient care.’ 

As I have heard nothing further from the GMC about the matter, and almost two months have passed, I have today written to Mr Dickson to ask what is happening. My letter is below:

Dear Mr Dickson,

I’m writing to enquire whether the General Medical Council intends to revise its guidance on ‘Personal Beliefs and Medical Practice’ in the light of the recent Glasgow appeal court ruling on participation in abortion and, if so, what the timescales for the revision are.

You will be aware that two Roman Catholic midwives won a landmark legal battle in April to avoid taking any part in abortion procedures.

Mary Doogan, 58, and Concepta Wood, 52, had lost a previous case against NHS Greater Glasgow and Clyde (GGC) when the court ruled that their human rights had not been violated as they were not directly involved in terminations.

However appeal judges ruled their right to conscientious objection means they can refuse to delegate, supervise or support staff involved in abortions.

The judgment is significant and has relevance also to doctors (full judgement here).

As you will know the Abortion Act 1967 gives healthcare professionals the right to conscientiously object to ‘participate’ in abortion but the scope of the word ‘participate’ has been the matter of some legal dispute.

But Lady Dorrian, who heard the recent challenge with Lord Mackay of Drumadoon and Lord McEwan, said: ‘In our view the right of conscientious objection extends not only to the actual medical or surgical termination but to the whole process of treatment given for that purpose.’

She said the conscientious objection in the legislation is given ‘not because the acts in question were previously, or may have been, illegal’ but ‘because it is recognised that the process of abortion is felt by many people to be morally repugnant’.

She added: ‘It is in keeping with the reason for the exemption that the wide interpretation which we favour should be given to it. It is consistent with the reasoning which allowed such an objection in the first place that it should extend to any involvement in the process of treatment, the object of which is to terminate a pregnancy.’

In the earlier judgement Lady Smith had said that since the midwives were not covered by the conscience clause as ‘they (were) not being asked to play any direct role in bringing about terminations of pregnancy’.

But this has now been overturned.

The GMC guidance, which interestingly came into force earlier in the very week of the judgement, is at odds with this ruling. It currently reads:

‘In England, Wales and Scotland the right to refuse to participate in terminations of pregnancy (other than where the termination is necessary to save the life of, or prevent grave injury to, the pregnant woman), is protected by law under section 4(1) of the Act. This right is limited to refusal to participate in the procedure(s) itself and not to pre- or post-treatment care, advice or management, see the Janaway case: Janaway v Salford Area Health Authority [1989] 1AC 537′

In para 33 of the Judgment the court makes clear that professional guidelines can be legally wrong and cannot overrule statute, it says:

‘Great respect should be given to the advice provided hitherto by the professional bodies, but prior practice does not necessarily dictate interpretation. Moreover, when the subject of the advice concerns a matter of law, there is always the possibility that the advice from the professional body is incorrect’.

Because this Judgment is from a Scottish Court (and Scotland is a different jurisdiction to England and Wales) it is not strictly binding on an English Court. However it will nonetheless have significant persuasive force in England.

The Abortion Act 1967 applies in England, Wales and Scotland (but not in Northern Ireland) and when Scottish Courts have adjudicated on such ‘cross border’ legislation in the past their decisions have been taken very seriously in England and Wales and vice versa.

We have been concerned for some time that the GMC was over-interpreting the law in a grey area in issuing its guidance. But this latest judgement has clarified the law in a way that now makes that virtually certain.

Christian Medical Fellowship has over 4,000 doctors and 1,000 medical students as members and the vast majority would have a moral objection to participation in abortion. Many other doctors share these views and will want to know where they now stand with the GMC.

As I said above I would most grateful for an indication of your plans for review of your guidance along with timescales so that I can keep our members informed about this important development which has practical implications for many of them.

Yours sincerely

Monday 17 June 2013

Belgium and the Netherlands escalate their children’s euthanasia programmes

In this last week both Belgium and the Netherlands have taken major steps towards euthanasia for children.

A consensus among members of the Belgian Federal Parliament has reportedly formed in support of legislation to allow children to choose to undergo euthanasia in certain dire cases, according to a report in the Belgian daily newspaper Der Morgen, as translated by the Paris-based news agency Presseurop.

If child euthanasia is legalized in Belgium, the country would become the first in the developed world to have a law on the books formally allowing the practice.

Belgium became the second country in the world after the Netherlands to legalize euthanasia in 2002, but the statute currently extends only to people 18 or older.

The bill, introduced by the Socialist party last December, lays out guidelines for doctors to decide on a case-by-case basis whether or not a child is mature enough to make the decision to end his or her own life, as well as whether a child's health is grave and hopeless enough to warrant euthanasia.

‘The idea is to update the law to take better account of dramatic situations and extremely harrowing cases we must find a response to,’ Socialist party leader Thierry Giet said shortly after the bill was introduced, according to Agence France-Presse.

‘On both sides of the linguistic border, liberals and socialists appear to agree on the fact that age should not be regarded as a decisive criterion in the event of a request for euthanasia,’ Der Morgen wrote last week.

The decision to consider the bill follows months of testimony by medical experts, doctors, clergy members and others, and it marks a turning point in the nation's approach to the rights of young people, some of whom would be able to choose to die if the law were to pass, even while still being legally barred from driving, marrying, voting or drinking liquor until they turned 18.

The bill would also likely allow euthanasia for patients suffering from Alzheimer's and other diseases leading to advanced dementia, who may otherwise be deemed incompetent to make the decision to die. There were 1,133 cases of euthanasia recorded in Belgium in 2011, accounting for about 1 percent of the country's deaths that year, according to AFP.

Peter Deconinck, president of the Belgian medical ethics organization Reflectiegroep Biomedische Ethiek, has come out in support of expanding the practice to minors, as has the head of the intensive care unit of Fabiola Hospital in Brussels, who testified before a Belgian Senate committee.

‘We all know that euthanasia is already practiced on children,’ he told the committee. ‘Yes, active euthanasia.’

A majority of members of the Belgian Parliament are reportedly ready to pass the child euthanasia bill.  

In a separate move the Royal Dutch Medical Association (KNMG), which represents doctors in the Netherlands, has said that distress felt by parents can justify euthanasia of a dying newborn.

The Netherlands has since 2005 not prosecuted doctors who perform euthanasia on some minors as long as the doctors act in accordance with a set of medical guidelines dubbed the Groningen Protocol, drafted by Dr Eduard Verhagen in 2004.

Verhagen reported in the New England Journal of Medicine (NEJM) in 2005 on 22 babies with spina bifida who were given lethal injections under the protocol over a seven year period.

However, in a new policy document, ‘Medical decisions about the lives of newborns with severe abnormalities’ (in Dutch only) the KNMG now explains why it is acceptable, and perhaps even necessary, to euthanase children.

What is new about this statement is that it says that the parents’ suffering may be a reason to kill the newborn.

Amongst other conditions, the policy states that a lethal injection of muscle relaxant is ethically possible when ‘the period of gasping and dying persists and the inevitable death is prolonged, in spite of good preparation, and it causes severe suffering for the parents.’

Dr Verhagen, who is also one of the authors of the recent KNMG report, explained to Volkskrant, a leading Dutch newspaper, why parental anguish is relevant.

Doctors should spare parents the ‘abomination’ of seeing their child die in distress, he argues.  It is part of good palliative care.

The criteria for euthanasing newborns are as follows (from page 54 of the report): if the child is suffering, if it cannot express its own wishes, if death is inevitable and if the dying process is prolonged, then the child may be euthanased and spare the parents further severe suffering.

Of the 175,000 babies born every year in The Netherlands, the KNMG suggests that about 650 might be cases which would be worthy of euthanasia.

‘These babies, despite very intensive treatment, will certainly die in the short term. They have a poor prognosis and a very bleak life perspective. They may not be dependent on intensive care but they face a life of serious and hopeless suffering. Doctors and parents face the exceedingly profound question of whether to start or continue treatment or even whether a good action may actually be a harm, in view of the suffering and disability that may result from the poor health of the child.’ 

These disturbing latest developments in the two countries which were the first to legalise euthanasia in Europe demonstrate graphically the incremental extension that takes place once the door is opened and the public conscience begins to change.

The acceptance of two key concepts is what makes this extension inevitable – first it is accepted that there is such a thing as a life not worth living and second that the active ending of a person’s life is justified in order to lessen the suffering of others.

It was these two principles that were used to justify the killing an infant with limb abnormalities and congenital blindness (named Knauer) with parental consent by Dr Karl Brandt in neighbouring Germany in 1939.

This 'test-case' paved the way for the registration of all children under three years of age with 'serious hereditary diseases'. This information was then used by a panel of 'experts', including three medical professors (who never saw the patients), to authorise death by injection or starvation of some 6,000 children by the end of the Second World War.

The euthanasia programme in Nazi Germany, later headed by the same Karl Brandt, did not begin in prison camps like Auschwitz and Treblinka. It began far more subtly with doctors in hospitals and its very first victims were children who were killed on supposedly compassionate grounds.

It is bitterly ironic that child euthanasia is happening again seventy years later on the very same grounds in two countries that share a common border with Germany. 

This post has been republished on Life News and LifeSite News 

For ten year report on Euthanasia in Belgium see here.