Thursday 30 April 2015

Deeply flawed assisted suicide bill must be rejected by Scottish Parliament at the earliest opportunity

A report by MSPs criticising the proposed assisted suicide Bill before Holyrood has been welcomed by campaigners opposing the legislation. 

The Assisted Suicide (Scotland) Bill, introduced by Green Party MSP Patrick Harvie, is due to have its first stage debate in the Scottish Parliament by the end of May.

On a raft of crucial matters the committee has revealed the Bill to be lacking and deeply flawed.

And while stopping short of recommending MSPs to throw out the Bill they have made their view clear that the majority of the Health and Sport Committee, which has been scrutinising the Bill, oppose it.

Dr Gordon Macdonald of Care Not Killing (pictured giving evidence to the committee), said, ‘This report confirms what we have said along. The Bill is poorly thought out, ill-conceived, badly-drafted and effectively not fit for purpose. We are delighted that the committee agrees with us that the Bill contains significant flaws which are likely to prevent it from being enacted. It is gratifying to note a majority of the committee is against the Bill although they have not made a formal recommendation to the Parliament to reject the Bill.’

Catherine Garrod, Edinburgh Disability Rights Campaigner speaking on behalf of Not Dead Yet, another campaign group opposing the Bill, said: ‘Disabled people oppose assisted suicide because it gives the message that our lives are not worth living. Disabled people want assistance to live, investment in health and social care, good palliative care, support for independent living and the right to equality not assisted suicide.’

Care Not Killing is strongly opposed to legalising assisted suicide and firmly believes life should be protected and palliative care prioritised. It represents more than 40 professional groups, faith groups, human rights groups, medical professionals, palliative care specialists and legal experts who are convinced it would be dangerous and unnecessary to decriminalise the existing law on homicide.

Dr Macdonald said. ‘We do not want the state-sanctioned killing of old, ill and disabled people of all impairment.

‘We want support for people to live - not to die. In recent weeks as the Bill has been scrutinised we have witnessed repeated and sustained criticism  from a variety of sources and for a range of reasons because it is so badly drafted - leading experts in medicine and palliative care, senior lawyers and experienced ethicists who all express serious and genuine concerns. And more than 15,000 members of the public have signed our petition.

‘We have always maintained that assisted suicide is unnecessary, unethical and uncontrollable. This is compounded by the fact that this is a weakly thought-out and poorly-written Bill. The numbers of people who have criticised whole parts of it, quite aside from any moral or ethical objections, highlight the problems with the legislation.’

The Bill calls for the creation of  ‘licensed facilitators’ - aged as young as 16 - who would assist individuals end their life and would remain close by until such times and even film the scene as the individual dies or decides not to proceed with the assisted suicide.

In effect, the Scottish Government is being asked to fund and train licensed killers to preside over the suicide deaths of teenagers as young as 16.

Dr Macdonald added: ‘We believe the public needs to be fully aware of all the arguments and not just be influenced by the knee-jerk emotional arguments about so-called dignity in death from those who back the Bill.

‘People change their minds quickly on this issue when they are told about the possible impact on the vulnerable, those near the end of life, the sick, elderly, disabled and depressed who may consider themselves in some way a burden and through fear of becoming a financial, emotional or care burden find themselves pressured in some way to opt for assisted suicide.

‘The proposed safeguards contained in the Bill are simply not robust enough to prevent abuse from occurring. Many people, including leading doctors, spokespeople for disability groups and representatives of Scotland's churches, have criticised this Bill . And it must be rejected by MSPs and the Scottish Parliament at the soonest opportunity.

‘Countries which have enacted assisted suicide laws have seen the eligibility criteria expand and widen putting intolerable pressure on the ill, the elderly and the infirm. Recently a bill was introduced in Oregon seeking to widen the eligibility criteria for assisted suicide. This is a perfect example of the incremental and insidious widening which would inevitably follow here were the bill to be passed - Oregon is not an example we want to follow and that is the model upon which the Bill before Holyrood is based.’

Dr Macdonald added, ‘I am delighted the First Minister and other party leaders including Jim Murphy (Labour) and Willie Rennie (Liberal Democrats) have expressed their opposition to the legalisation of assisted suicide. They clearly understand it would bring pressure on vulnerable people to end their lives and put the elderly and disabled at risk of abuse as well as very ill young children.

‘The First Minister summed it up well when she said:  ‘I believe we should support people to live and I am therefore  in favour of good quality palliative care. There also remains a major stumbling block to assisted suicide: How could you have sufficient safeguards?’

‘The new Bill follows very closely the 2010 End of Life Assistance Bill proposals which MSPs comprehensively rejected in Holyrood by 85-16. MSPs are likely to again have a free vote on this Bill. The First Minister and other leaders have one vote each and we hope the vast majority of MSPs will  follow their example after examining all the evidence.’

Dr Macdonald highlighted a number of key conclusions of the committee criticising the Bill including:

*The Committee is not persuaded by the argument that the lack of certainty in the existing law on assisted suicide makes it desirable to legislate to permit assisted suicide;

*Members have also acknowledged that there are ways of responding to suffering (such as increased focus on palliative care and on supporting those with disabilities), which do not raise the kind of concerns about crossing a legal and ethical ‘Rubicon’ that are raised by assisted suicide.

*The Committee considers that a requirement for mandatory psychiatric assessment would be desirable in relation to any request for assisted suicide by a person who was terminally ill, under the age of 25, and/or with a history of mental disorder. The Committee also acknowledges the argument that given the magnitude of the decision to commit suicide, assessment by a psychiatrist ought to be routine in all cases.

*The Committee considers that legislation to permit assisted suicide seems discordant with a wider policy of suicide prevention by ‘normalising’ suicide and seeming to endorse it.

What you can do

Wednesday 29 April 2015

New DNA editing technique for mitochondrial disease may render three parent embryos redundant

A new technique for removing harmful genes from strands of DNA could potentially obviate the need for three-parent embryos for preventing mitochondrial disease.

Researchers from the Salk Institute for Biological Studies in La Jolla, California, have reported success for the first time in using gene-editing technology to prevent mitochondrial diseases being passed from female mice to their offspring.

Mitochondrial diseases are inherited maternally and cause a variety of severe conditions that currently have no cure. The UK government has recently legalised the controversial use of embryos carrying DNA from three genetic parents to prevent their transmission, but the proposed techniques have been criticised on both ethical and safety grounds (see my previous review).

This new research, published in the 23 April edition of Cell magazine, involves injecting affected embryos with RNA which leads to the production of enzymes which specifically target and remove faulty genes.

It is reported on this week in Nature, Popular Science, Medical News Today, Tech Times, and (amazingly) has even come to the attention of the BBC. Ted Morrow's blog gives a useful overview.

Authors Alejandro Ocampo and Juan Carlos Izpisua Belmonte realised that reducing the amount of mutant mitochondrial DNA in an egg or fertilised embryo could reduce the chance of mitochondrial disease developing.

They achieved this by injecting mouse embryos with a segment of RNA designed to produce DNA-cutting enzymes called restriction endonucleases and transcription activator-like effector nucleases (TALENs).

These enzymes then sought out mitochondria with mutated DNA and removed it while leaving the normal mitochondrial DNA intact.

The treated embryos were then transferred to female mice where they developed normally and resulted in healthy pups with low levels of the targeted mitochondrial DNA.

These pups later went on to give birth to healthy offspring themselves, demonstrating that this is a viable approach for preventing transgenerational transmission of mitochondrial diseases.

The researchers then trialled the TALENs using mouse eggs that contained genetic material from human patients mitochondrial DNA mutations known to cause two disorders - Leber's hereditary optic neuropathy and dystonia (LHOND) and neurogenic muscle weakness, ataxia, and retinitis pigmentosa (NARP).

Again, the technique resulted in a significant reduction of the mutated DNA.

It is early days with this new technique which will need thorough testing in mice and non-human primates before being ready for testing in humans.

However it has several obvious advantages over controversial three parent embryo techniques.

First, it does not require DNA donation and so avoids the health risks to donors (such as OHSS) associated with egg harvesting.

Second, it does not involve cell nuclear replacement (cloning) technology with all its safety concerns.

Third, it can be tested on eggs as well as embryos and does not involve the destruction of existing embryos.

Fourth, it is technically much easier to perform than the mitochondrial (or more accurately cytoplasmic) replacement used in three parent techniques. RNA injection is a technique that can be carried out relatively easily in IVF clinics.

Fifth, it appears to be a far more finely targeted technique, eliminating faulty genes rather than replacing the whole cytoplasm with all of it mitochondrial and other organelles. More like a sniper than a blunderbuss or carpet bomber.

Finally it does not produce offspring with three genetic parents.

However, we are still left with three concerns.

First, this new technique does still involve genetic medication of the germline, and the possibility that any ‘mistakes’ in editing would be passed on down the generations. This has already led David King of Human Genetics Alert to reject it outright.

Second, we cannot be sure, without a lot of further research, just how finely tuned it is as an editing tool. How much damage might be done to other genes in the vicinity and what effect might this have? 

Third, once this tool is more widely available, might it then be used by unscrupulous researchers or scientists to edit DNA in more dangerous contexts?

However, were it to work as well as some are hoping, it could potentially reduce the three parent technique, over which so much time, money and sweat has been expended, to a tiny historical footnote.

It will be intriguing to see how this research progresses and how long it takes for those British science journalists and parliamentarians who have been pushing three parent embryos so aggressively to take notice. 

Monday 27 April 2015

DPP faces new legal challenge for ‘clarifying’ guidelines on prosecutions for assisted suicide

Perhaps surprisingly, the Sunday Times has been the only broadsheet newspaper to cover a landmark case (£) which challenges the powers of the crown prosecution service.

The CPS head Alison Saunders (pictured), Director of public prosecutions (DPP), is already in considerable hot water over her failure to prosecute Lord Janner for alleged sex abuse, an action she justified on grounds of him not being capable of standing trial because of dementia. This new development may add considerably to those difficulties. 

Sadly this latest case lies behind the Sunday Times paywall which has somewhat restricted it coming to the wider public attention that it deserves, so I will quote some of the article in this post. 

‘A woman who was once so paralysed she could only wink her right eye will this week launch a High Court challenge against “liberal” guidelines on assisted suicide brought in by Alison Saunders, the embattled director of public prosecutions (DPP).

Nikki Kenward, 62, will on Tuesday seek a judicial review after doctors and nurses who help severely disabled or terminally ill people to take their own lives were told that they are now less likely to face criminal charges.’

Kenward, a former theatre manager, was struck down by Guillian-Barre syndrome in 1990, aged 37.

She was initially fully paralysed for more than five months, and has been in a wheelchair since. She cannot tie her laces or hold a needle, but had a play staged last year and campaigns against euthanasia and assisted suicide through the Distant Voices pressure group. Her case is backed by the Christian Legal Centre.

Lawyers for Kenward will argue that Saunders exceeded her powers with a what she called a ‘clarification’ to the guidelines on prosecution for assisted suicide which she made last October (see my previous article here).

They will argue that she has entered a policy realm that should properly be a matter not for her but for parliament. They will also say that the attorney-general has failed in his duty to ‘superintend’ the DPP. In other words they will claim that she has gone beyond her remit which is to uphold the law and not to make the law.

To quote the Sunday Times again:

‘They are expected to argue Saunders’s guidance will “enable healthcare professionals operating on an ideological or other premise to offer their services to a person wishing to commit suicide . . . this is crossing the Rubicon”. They will add: it will “make any prohibition on a Dignitas-style of assisted suicide difficult to resist”.

“[It] weakens the protection given by parliament to people . . . coming under pressure to commit assisted suicide.”’

The fuller background to this case deserves unpacking.

Back in 2009, as a result of the Supreme Court judgement in the Debbie Purdy case, the DPP was required to make public the criteria by which he (then Keir Starmer) decided whether a prosecution in a given case of assisted suicide was in the public interest.

He published an interim policy and put it out to public consultation. After the consultation was completed he modified this interim policy and published his definitive policy in February 2010.

The summary of responses received and the responses themselves are still in the public domain.

The interim policy did not contain a paragraph about the role of medical professionals but as a result of the consultation one was included in the definitive policy.

It now says that a prosecution is more likely to be required if…

14. ‘the suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer [whether for payment or not], or as a person in authority, such as a prison officer, and the victim was in his or her care;’

Keir Starmer gave his reasons for including the new clause here.

Saunders, Starmer’s successor, subsequently ‘clarified’ the words in bold last October as follows:

‘For the avoidance of doubt the words "and the victim was in his or her care" qualify all of the preceding parts of this paragraph [43.14]. This factor does not apply merely because someone was acting in a capacity described within it: it applies only where there was, in addition, a relationship of care between the suspect and the victims such that it will be necessary to consider whether the suspect may have exerted some influence on the victim.’

The key questions raised by Kenward’s case are whether this amounts to a change in the policy or merely a clarification and whether the DPP should have made the change without consulting anybody.  

My own view is that DPP has actually crossed the line in both instances.

The relevant factors as I see it are as follows:

1. The ‘clarification’ makes it clear that doctors who do not have ‘a relationship of care between the suspect and the victims such that it will be necessary to consider whether the suspect may have exerted some influence on the victim’ are now not within the scope of this clause. This surely means that people like Philip Nitschke and Michael Irwin, who have made a name for themselves by assisting suicides in various ways whilst not being the patient’s primary care giver, are less likely to be prosecuted. This is real change in my view.  Irwin, who welcomed it as ‘a wonderful softening’ agrees with me. I think it is also clear from the current General Medical Council (GMC) guidance and Medical Defence Union (MDU) guidance (see also here) that these bodies did not understand the guidance in the way that Alison Saunders has now re-interpreted it. See below

2. Assisted suicide is contrary to all historical codes of medical ethics including the Hippocratic Oath, the Declaration of Geneva, the International code of medical ethics and the Statement of Marbella – which was reaffirmed by the World Medical association (WMA) as recently as 2013. The latter reads, ‘Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically.’ So a strong argument could be made that this new ‘clarification’ is morally corrupting for the medical profession  as it makes possible their direct involvement in an unethical practice with far less possibility of prosecution.

3. Assisted Suicide is opposed by the British Medical Association, the World Medical Association, the Association for Palliative Medicine, the British Geriatric Society and virtually every Royal Medical College including the RCGP and the RCP.

4. The GMC makes it clear in its guidance on assisted suicide that ‘encouraging or assisted suicide’ is against the law. It makes no mention of any mitigating factors and warns doctors strongly against any involvement. It certainly does not convey the impression that doctors like Irwin, Nitschke etc are exempt. It is precisely this understanding of the law which led to Tony Nicklinson  and  Paul Lamb trying unsuccessfully to change it through the courts. Saunders seems now effectively to have done that at the mere stroke of a pen.

5. It is precisely people like Nitschke and Irwin who will push the envelope rather than ordinary GPs in a relationship of care with patients, although the ‘clarification’ does also give scope to GPs to do a little assisted suicide on the side with patients who are not ‘in their immediate care’. This clarification appears to give them free rein. 

6. The phrase ‘In their care’ can be interpreted in several different ways. One might argue that any doctor using his skill and expertise to help a patient kill themselves is actually involved in ‘care’ even if he is not their primary doctor.

7. The reason people responding to the original consultation pushed for the inclusion of the doctor clause in the first place was because of concerns about the unique position of doctors. Doctors possess the sort of knowledge and power that could easily be abused.  We have seen already how they push legal boundaries with abortion and how prosecutors are very unwilling to hold them accountable. This is why doctors need strong guidance and laws in place to ensure that some of them do not end up becoming the most dangerous people in the state. It is also why they should not be involved in assisted suicide.

8. As the doctor phrase (clause 14 quoted above) was introduced into the DPP guidance after, and as a direct result of, a lengthy public consultation (34% of respondents supported its inclusion) surely it should not be changed, or redefined, at a whim by the DPP without a similar public consultation. Simply asking medical bodies for their opinion would be inappropriate and inadequate – rather like asking the police about guidance on prosecuting policemen. This is why the GMC now has a strong lay membership because as a result of the Shipman case and others it was decided that doctors were not  capable of regulating themselves.

It seems to me that the DPP has not merely ‘clarified’, but actually changed the meaning and scope of the guidance. Furthermore she has made the change without apparently consulting anybody at all. 

I await the result of Kenward’s legal challenge with great interest.


Thursday 23 April 2015

Lessons from Daniel – God is sovereign over the rise and fall of nations

When Jerusalem fell to the Babylonians in 587 BC, the nation of Judah was taken to Babylon in an exile that would last 70 years. As God's people in a foreign land that was hostile to their faith and values, they faced the challenge of living and serving as ‘aliens and strangers’.

There was great pressure to close ranks or to forget who they were. There was also great hand-wringing and lament.

Their emotions are beautifully described in Psalm 137, in words given popular currency by the pop band Boney M – a German based but ethnically Jamaican foursome – who achieved popularity during the disco era of the late 1970s.

In King James English: ‘By the rivers of Babylon, there we sat down, yea, we wept, when we remembered Zion.’(Psalm 137:1)

The psalm goes on to describe in graphic detail how they were tormented by their captors, unable to sing the songs of their homeland, pining for Jerusalem and longing for vengeance against those who had mistreated them.

They were forcibly displaced people - not even asylum seekers or refugees let alone economic migrants - but rather captives – prisoners of war in a country utterly different from their own in language, culture, values, religion and worldview.

God’s people – but made to serve in an evil empire, Babylon.

In the New Testament the symbolism of ‘Babylon’ is used by the apostles to describe Christian’s position in the world.

The apostle Peter talks of ‘living in Babylon’ and describes God's elect (Christians) as 'strangers in the world' (1 Peter 1:1), and 'aliens' (1 Peter 2:11).

We are called to 'be holy' – to be set apart – because we are 'a chosen people, a royal priesthood' and 'a holy nation' (1 Peter 2:9).

One of the key themes of the book of Daniel is that God is sovereign over all physical, spiritual, social and political processes (Daniel 2:21, 4:17, 5:21).

In other words, fire can’t burn, lions can’t bite and kings can’t rule unless God allows them to.

God’s rescue of Daniel from the lion’s den in Daniel 6 along with that of his friends Shadrach, Meshach and Abednego from the fiery furnace in Daniel 3, are well familiar to anyone who has attended Sunday school. 

But less appreciated and believed in – even in the church - is God’s control over political events and his sovereign rule over the rise and fall of nations.

‘He changes times and seasons; he deposes kings and raises up others.’ (Daniel 2:21)

‘The Most High is sovereign over all kingdoms on earth and gives them to anyone he wishes’ (Daniel 4:32). This same verse is repeated in Daniel 4:17, 25 and  5:21, 35.

Daniel’s two great dreams – in chapters 2 and 7 of this book – illustrate this.

First there is the great statue in chapter 2 with its head of gold, chest of silver, loins of bronze and legs of iron – representing the empire of Babylon and three more empires – usually identified by commentators as Medo-Persia, Greece and Rome - which will follow it.

Then there are the four great beasts of chapter 7 – representing probably the same four kingdoms – each falling to be replaced by the next.

Each dream ends in a similar way with these temporary earthly Kingdoms being destroyed to be replaced by a heavenly kingdom that will never end.

The statue made from four metals is smashed by a rock which grows to fill the whole world – a direct reference to Christ’s Kingdom.

The four beasts are superseded by one, we are told, like a ‘Son of Man’ (Daniel 7:13) coming with the clouds of heaven. He approaches the Ancient of Days (God the father) and is led into his presence. 

Then this Son of man ‘is given authority, glory and sovereign power; all nations and peoples of every language worship(ed) him. His dominion is an everlasting dominion that will not pass away, and his kingdom is one that will never be destroyed.’

‘Son of Man’ was of course Jesus’ favourite term for himself. It is Jesus who through his death and resurrection rules over all the kingdoms of men.

I live in St Albans – named after Britain’s first Christian martyr, a Roman nobleman called Alban - who was converted through the ministry of a priest fleeing persecution in the early 3rd century. When he refused to recant the Roman officials chopped his head off.

But centuries later when the Roman town of Verulamium where he lived lay in ruins they took the bricks and used them to build a cathedral on the very spot where he had given his life.

It’s a beautiful picture of what has, and is, happening in history – through the shedding of Jesus own blood at the hands of Roman Empire – God is building a living temple of his own people – the church.
 ‘The sovereignty, power and greatness of all the kingdoms under heaven will be handed over to the holy people of the Most High. His kingdom will be an everlasting kingdom, and all rulers will worship and obey him.’ (Daniel 7:27)

Of course what is true of the ancient world empires is equally true of the empires of today – the American, British and Soviet Empires – and equally the Empires of post-war western capitalism and Islam.

God has raised them all up and God will bring them all down.

Wednesday 22 April 2015

Bruce Forsyth's recent pronouncements on assisted suicide are seriously misguided

Celebrity entertainer Sir Bruce Forsyth (pictured) has called for the legalisation of assisted suicide after watching his ex-wife succumb to dementia.

His first wife, Penny Calvert spent her last years in a care home, dying last year. Bruce was married to Penny from 1953 to 1973 and they had three daughters. He later remarried twice.

'It bothers me an awful lot that people are just left to suffer,’ he said. ‘If I had Alzheimer’s or dementia I would do something about it. The law should be changed and if people want to die with a bit of dignity left they should be able to do so.’

Forsyth is not the first celebrity to back a change in the law.

‘Moral’ philosopher Baroness Warnock believes that elderly people suffering from dementia should consider ending their lives because they are a burden on the NHS and their families.

She said in 2008 that pensioners in mental decline are ‘wasting people's lives’ because of the care they require and insisted there was ‘nothing wrong’ with people being helped to die for the sake of their loved ones or society.

Warnock added that she hoped people will soon be ‘licensed to put others down’ if they are unable to look after themselves.

A recent survey suggests that a significant proportion of doctors in the Netherlands, where euthanasia is legal, are prepared to carry out assisted suicide for people with mental illness.

Of the 1,456 physicians responding to the survey, 34% found euthanasia and assisted suicide conceivable in patients with psychiatric disease, 40% in early-stage dementia, 29-33% in advanced dementia and 27% in circumstances where the patient was ‘tired of living’. 

According to the Alzheimer’s Society there are currently 850,000 people with dementia in the UK.  But the number forecast to increase to over one million by 2025 and over two million by 2051.

The total cost of dementia in the UK is £26.3 billion. The NHS picks up £4.3 billion of the costs and social care £10.3 billion. Of the £10.3 billion in social care costs, £4.5 billion is attributed to local authority social services for state funded care.

Two thirds of the cost of dementia (£17.4 billion) is paid by people with dementia and their families, either in unpaid care (11.6 billion) or in paying for private social care.

The overwhelming majority of people with dementia do not actually want to die. But one can see that, were the law to change, there would be many families struggling to make ends meet and health administrators trying to balance the books in a cash-strapped NHS who would in fact have a financial interest in their deaths.

A law removing legal protection from people with dementia in an environment of economic recession would be a very lethal cocktail indeed.

This is why it is so important that the current law, which makes both euthanasia and assisted suicide illegal, does not change. It would be impossible to police and far too easy to abuse.

In the Netherlands plenty of doctors are willing to push the boundaries of the current law which does not currently allow euthanasia or assisted suicide for people who are not mentally competent.

The very same thing would inevitably happen here.

The real heart of a society is revealed in the way it treats vulnerable people – especially the elderly, sick or disabled. Does it make sacrifices for vulnerable people or does it choose rather to sacrifice them?

It deeply concerns me when misguided celebrities use the language of autonomy, choice and compassion to justify taking another person’s life through euthanasia or assisted suicide.

Caring for people with mental illness or dementia can be deeply harrowing and costly. But it is far better to do this than to remove their legal protection and place them at the mercy of those with something to gain, financially or emotionally, from their deaths.

Bruce Forsyth may be a gifted and popular entertainer. But his misguided pronouncements on this crucial issue of public policy are very dangerous indeed.

Tuesday 21 April 2015

New study confirms that making morning-after pill free without prescription increases sexually transmitted infections and fails to reduce pregnancy rates

Half of all pregnancies in the United States are unintended.

One might therefore assume that making the morning-after pill (MAP) more widely accessible would cut the unplanned pregnancy rate.

Not so.

A new recent US study is the first to estimate the impact of making the morning-after pill available over the counter without prescription on abortions and risky sexual behaviour as measured by sexually transmitted infection (STI) rates.

Dr Karen Mulligan, associate professor of economics and finance at Middle Tennessee State University, found that providing individuals with over-the-counter access to emergency contraception (EC) leads to increased STI rates and has no effect on abortion rates.

Moreover, risky sexual behaviour such as engaging in unprotected sex and number of sexual encounters increases as a result of over-the-counter access to EC.

Mulligan’s analysis estimated that over the counter access increases STI rates by approximately 12% for women aged 15-44 and 9% for teenagers; these numbers are also consistent with the 12-17% increase in gonorrhea rates found in Washington as a result of expanded access.

She concluded that switching EC to over the counter status has three main effects on behaviour: individuals are more likely to have sex, they have a higher number of sexual encounters, and are less likely to use condoms.

The FDA approved access to emergency contraception, or Plan B (equivalent to Levonelle in the UK), through US pharmacies without a prescription in 2012 nationally. This followed pilot programmes in several states starting with Washington in 1998. 

But the US’s persistence with this unproven strategy is apparently driven more by ideology than evidence.

In the light of Mulligan’s research, Dr David Paton, professor of industrial economics at Nottingham University Business School, today called on local and national governments in the UK to review their current policy of aggressive promotion of emergency contraception (EC) to young people in schools, pharmacies and sexual health centres.

‘It is very interesting to see further confirmation that access to emergency birth control (EBC) does not seem to reduce abortions but leads to higher rates of STIs. This paper is one of the first to explore the mechanisms whereby EBC affects STIs, finding that both rates of 'unprotected' sex and numbers of partners increase in response to over-the-counter EBC. Although this paper uses US data, it is consistent with evidence from the UK’, he said.

A previous 2012 American study showed that making emergency contraception available free over the counter without prescription leads to an increase in rates of sexually transmitted infections and does not decrease pregnancy or abortion rates. 

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

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

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

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

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

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

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

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

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

Britain has the highest rate of teenage pregnancy in Western Europe.  But international research has consistently failed to find any evidence that emergency birth control schemes achieve a reduction in teenage conception and abortion rates.

Now there is growing evidence showing that not only are such schemes failing to do any good, but they may in fact be doing harm.

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

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

Monday 20 April 2015

Four blood moons coinciding with major Jewish festivals in 2014-5 – does it have any significance?

In my experience British Christians are either deeply suspicious or profoundly disinterested in eschatology (the theology of the last things). Meeting Christ after death therefore features far more in their thinking than his ‘second coming’.

Many British atheists and secular humanists find the idea of the return of Christ frankly risible.

And so I’m guessing it is unlikely, if you are a British Christian, that you will have read much at all about the significance of the four ‘blood moons’ this year and last.

The Blood Moon Prophecy, recently popularised by Christian authors John Hagee and Mark Biltz, states that an ongoing tetrad (a series of four consecutive lunar eclipses—coinciding on Jewish Holidays—with six full moons in between, and no intervening partial lunar eclipses) is a sign of the end times as described in the Bible.

The latest such tetrad occurs in 2014 and 2015. The ‘blood moon’ comes from the New Testament and is referred to by two of Jesus’ closest disciples: Peter, who preached the first Christian sermon at Pentecost, and John, who wrote Revelation, the last book in the Bible.

‘The sun will be turned to darkness and the moon to blood before the coming of the great and glorious day of the Lord.‘ (Acts 2:20)

‘I watched as he opened the sixth seal. There was a great earthquake. The sun turned black like sackcloth made of goat hair, the whole moon turned blood red.’ (Revelation 6:12)

The prophecy has its origin in the Old Testament book of Joel which describes both a total solar eclipse and a total lunar eclipse.  

‘The sun will be turned to darkness and the moon to blood before the coming of the great and dreadful day of the Lord.’ (Joel 2:31)

The event is also alluded to by Jesus Christ himself in the Olivet discourse, spoken just prior to his arrest and crucifixion:

‘There will be signs in the sun, moon and stars.’ (Luke 21:25)

 ‘But in those days, following that distress, “the sun will be darkened, and the moon will not give its light”.’ (Matthew 24:29 & Mark 13:24)

Jesus immediately follows these words with a reference to his own return:

'Then will appear the sign of the Son of Man in heaven. And then all the peoples of the earth will mourn when they see the Son of Man coming on the clouds of heaven, with power and great glory. And he will send his angels with a loud trumpet call, and they will gather his elect from the four winds, from one end of the heavens to the other.’ (Matthew 24:30-31)

This passage echoes the prophecy of Zechariah over 400 years earlier, which suggests that the Jewish people would recognise the crucified Christ as Messiah and turn to him en masse.

'And I will pour out on the House of  David and the inhabitants of Jerusalem a spirit of grace and supplication. They will look upon me, the one they have pierced, and they will mourn for him as one mourns for an only child, and grieve bitterly for him as one grieves for a first-born son' (Zechariah 12:10)

This same theme of Jews recognising Jesus as the Messiah also features in Paul’s letter to the Romans in the mid first century.

‘I do not want you to be ignorant of this mystery, brothers and sisters, so that you may not be conceited: Israel has experienced a hardening in part until the full number of the Gentiles has come in, and in this way all Israel will be saved.’ (Romans 11:25-26)

Many Christians see this as a reference to Jewish people turning to Christ just prior to his return. They therefore see the current rapid growth of messianic (Christ- believing)  Jewish congregations as the start of this process. There are now estimated to be over 20,000 messianic Jews in Israel alone in over 200 congregations.

Jesus himself suggested that the return of Jews to Israel, after an almost 2,000 year diaspora following the destruction of Jerusalem by the Romans in AD 70, as a marker of the ‘time of gentiles’ coming to an end.

They will fall by the sword and will be taken as prisoners to all the nations. Jerusalem will be trampled on by the Gentiles until the times of the Gentiles are fulfilled. ‘(Luke 21:24)

Jews began returning to Israel in the mid 19th century, leading to the Balfour Declaration in 1917, the establishment of the State of Israel in 1949 and the capture of Jerusalem during the six day war in 1967.

So what of the blood moons?

From the first century until now there have been a total of 62 tetrads of blood moons. However, only eight of these have fallen on Jewish feasts of Passover and Tabernacles (Sukkot). Several of these eight occurrences have coincided with important events in Jewish and Christian history.

The last two of these have been in the years 1949-50 and 1967-68 coinciding with the birth of the state of Israel and the capture of Jerusalem.

The latest tetrad of total lunar eclipses falls on 15 April and 8 October 2014 and 15 April and 28 September 2015.

This eighteen month period has been characterised by the rise of Islamic State, a rising tide of anti-semitism in Europe , a hardening of Western political attitudes to Israel and an escalation of persecution of Christians in the Middle East.

What further might happen this year remains to be seen but to all Christians these astronomic events are a poignant reminder to ‘keep watch’ by turning daily to Christ and being earnest in evangelism and active in his service. (Matthew 24:4, 42, 25:13)

There are those who mock the prospect of Christ’s return, pointing to 2,000 years passing since he first appeared.

But the Apostle Peter reminds us that God delays in calling history to an end precisely in order that people may have a chance to turn to him and receive forgiveness whilst there is still time to do so. (2 Peter 3:9)

For when the author of the story of the universe walks back on to the stage of history it will be too late to change sides.

For an explanation of the significance of Christ’s death and resurrection see, ‘The real meaning of Easter: why did Christ have to die? 

For a fascinating account of how the Babylonian Saros Cycle can be used to date Jesus' crucifixion, which also occurred at a lunar eclipse, see here.

Sunday 19 April 2015

Today's aggressive LGBT rights movement takes no prisoners – and it’s not finished yet

I suspect that few reading this blog will have heard of the ILGA but will equally not be surprised to learn that it exists.

The International lesbian, gay, bisexual, trans and intersex association (ILGA) is a worldwide federation of 1,100 member organisations from 110 countries campaigning for lesbian, gay, bisexual, trans and intersex rights.

Its European wing maps the LGBT status of every European country and from this portal you can easily access the legal summary for the UK.

The latter lists the legislative objectives achieved and those still sought in these islands – in great detail.

You may be surprised that LGBT activists believe that there still are legal battles to fight. Northern Ireland still does not recognise hate crime on grounds of gender identity and has not yet legalised same sex marriage. Scotland has not yet criminalised hate speech on grounds of sexual orientation.

But overall the UK bridges not yet crossed are very few.

The ILGA is building a similar legal analysis for every nation on earth and its member organisations are working collaboratively to achieve every legislative objective.

Some may say ‘so what?’ Why shouldn’t LGBT people have the freedom to have what they are asking for?

But the problem is that legal rights for some constitute legal duties for others. Gay rights were once a concession. They then became an expectation. Now it seems they are a requirement.

What began as ‘accept me’ quickly became ‘affirm me’ and then ‘celebrate me… or else’.

Those who resist being coerced to deliver on the LGBT agenda pay a heavy price – not just ridicule and marginalisation, but legal sanctions - dismissal, fines, imprisonment, gagging and being driven from the public square.

These activists will not tolerate disagreement or dissent. Every knee must be made to bow, to recite the mantras and creeds and to grease the LGBT machinery.

The Coalition for Marriage has this week published a leaflet outlining 30 cases involving individuals or groups who have been ‘punished’ for ‘believing in traditional marriage’.

Each case is documented and carefully referenced and although coming from all over the world the vast majority come from the UK. Some examples:

Ashers Baking Company, owned by the McArthur family, was taken to court by the Equality Commission for Northern Ireland for declining to produce a pro-gay marriage campaign cake.

Lillian Ladele was pushed out of her job as a registrar at Islington Council for asking her managers to accommodate her belief that marriage is the union of one man and one woman.

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

Andrew McClintock was forced to resign as a magistrate in Sheffield because he didn’t believe placing children with same-sex couples was in their best interests. He lost his discrimination case at an employment appeal tribunal.

All Roman Catholic adoption agencies in England have been forced to close or abandon their religious ethos because of their policy of only placing children with traditionally married couples.

That’s five. There are 25 more. And so it goes on and on. I’m informed that these 30 cases are a small minority of those that have occurred. A mere tip of the iceberg.

Now it appears that we are in for more of the same with the three main political parties all pledging in their election manifestos to do more for LGBT ‘rights’. They are full of specious euphemisms which cleverly disguise the realities for those will not play ball.

The Conservative Manifesto trumpets its pride in legalising same-sex marriage and promises more: 

‘Our historic introduction of gay marriage has helped drive forward equality and strengthened the institution of marriage. But there is still more to do, and we will continue to champion equality for Lesbian, Gay, Bisexual and Transgender people. We will build on the posthumous pardon of ... Alan Turing ... with a broader measure to lift the blight of outdated convictions of this nature’ (p46).  

The Labour Manifesto speaks of combatting ‘homophobia’:

We will also build on our history of championing LGBT rights, tackling homophobia with tougher laws at home and greater engagement abroad (p67) ...Labour will ...appoint an International LGBT Rights Envoy and a Global Envoy for Religious Freedom’ (p81).

The Liberal Democrat Manifesto boasts about further ‘marriage liberalisation’:

We will ... permit humanist weddings and opposite sex civil partnerships, and liberalise the rules about the location, timing and content of wedding ceremonies ... promote international recognition of same sex marriages and civil partnerships as part of a comprehensive International LGBT Rights Strategy’ (p107). 

It is clear that whoever gets to form a government after the general election on 7 May will be actively advancing the LGBT agenda.

Those who believe, teach and practise traditional Christian teaching on marriage, relationships and sexuality are therefore going to find themselves increasingly on the wrong side of the law as this new political correctness is taught is schools, enforced by the constabulary and judiciary and promulgated by the media, in parliament, through celebrity culture and inevitably in our churches.

Our first priority in opposing its pernicious influence must be to ensure that our congregations – and especially our children and young people – are firmly grounded in biblical teaching and also well briefed in how to argue against the new agenda. It is a task that will require clarity, compassion and, above all, courage.

The enemy’s goal is to undermine real marriage and the family. We must resist him with every fibre of our being – through speaking up for the truth and by faithfully upholding God’s model in our personal lives and Christian communities. 

Saturday 18 April 2015

Assisted Suicide – In the face of two major threats the price of freedom is eternal vigilance

Lord Falconer's Assisted Dying Bill sought to legalise assisted suicide (but not euthanasia) for mentally competent adults (aged over 18) with less than six months to live, subject to 'safeguards' under a two doctors' signature model similar to the Abortion Act 1967.

The Bill had an unopposed second reading in the House of Lords on 18 July 2014 and Committee stage debates took place on 7 November and 16 January 2015. Over 175 amendments were tabled and three votes held. Lord Pannick’s amendment (to delegate the final decision in any specific case to the courts) was ‘accepted’ and attempts to change the bill’s wording throughout from ‘assisted dying’ to ‘assisted suicide’ and to require two doctors to carry out examinations  were defeated by 179-106 and 119-61 respectively. 

The bill has now fallen with the approach of the general election on 7 May and will not enter the House of Commons in this parliament. However it is expected to be reintroduced, possibly in the Commons, later this year. Its progress then will depend very much on the post-election composition of parliament.

It is clear that the mood of the House of Lords is now sympathetic to Falconer but the lower house is another matter altogether. Both Prime Minister David Cameron and Liberal Democrat Leader Nick Clegg remain opposed to it although Labour leader Ed Miliband is neutral.

There are excellent reviews of the debate and analyses of the deficiencies of the Bill on the Care Not Killing website.

Patrick Harvie’s ‘Assisted Suicide (Scotland) Bill’, however, remains very much alive in the Scottish Parliament. The MSP (pictured above) took over the bill following the death of Margo Macdonald MSP in April 2014. It proposes an ‘Oregon type system’ with trained ‘licensed facilitators’ but with a wide scope for mentally competent adults (>16) with a ‘terminal or life-shortening illness’ or a ‘progressive and terminal or life-shortening condition’ who have concluded that the ‘quality of their life is unacceptable’.

The bill has even more holes than Falconer’s including relativistic definitions, poor reporting provisions, minimal penalties, a ‘saving’ clause protecting doctors acting in ‘good faith’, no specification of ‘means’ of suicide and the absence of a conscience clause.

Oral evidence sessions took place in January and February this year and a first stage debate considering the general principles of the bill must take place in the Scottish parliament before 28 May. Scottish First Minister and SNP leader Nicola Sturgeon has already signalled that she will not support the bill and over 15,000 Scottish people have signed a petition against it.  

The voices of Scottish Christian doctors and lawyers will be particularly crucial in the lead up to this first stage debate, where we hope the bill will be soundly defeated. Again, there are many resources available about the bill on the CNK Website.

We need to speak out for those voiceless vulnerable people who will be exploited and abused by this ill-conceived draft legislation (Proverbs 31:8,9).