Wednesday 27 May 2015

Scottish Assisted Suicide Bill gets short shrift from MSPs

Patrick Harvie’s Assisted Suicide (Scotland) Bill has been defeated today in a free vote by 82 votes to 36 in the Scottish Parliament.

The MSP (pictured left) took over the bill following the death of Margo Macdonald MSP in April 2014.

It was proposing 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 been heavily criticized for its 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 earlier this year and Scottish First Minister and SNP leader Nicola Sturgeon had already signalled that she would not support the bill.

In addition over 15,000 Scottish people have signed a petition against it.  

The Health and Sport Committee which scrutinised the bill had already delivered a damning view of its shortcomings but left it up to MSPs to decide. They did, giving it short shrift today.

Care Not Killing (CNK), which fought a strong campaign against the Bill, brought together more than 40 professional groups, faith groups and human rights groups along with medical professionals, palliative care specialists and legal experts, all convinced it would be dangerous and unnecessary to decriminalise the existing law on homicide.

After the vote, Dr Gordon Macdonald (pictured right), convenor of CNK Scotland said:

‘MSPs have issued a ringing endorsement of our views with this comprehensive vote, taking a bold and critical step which marks a major victory for the vulnerable in our society who are most in need of protection. The present law making assisted suicide illegal is clear and right and does not need changing.’

‘In every free democratic society there are limits placed on human freedom in order to protect the common good and vulnerable people.  It is right that the law is not to be changed to accommodate the wishes of a small number of desperate and determined people at the expense of the rights of others.’

The controversial legislation would have made Scotland the first part of the UK to legalise assisted suicide if it had been successful.

But Dr Macdonald said the vote demonstrated the widespread support throughout the country for palliative care. He said: ‘Vulnerable people who are sick, elderly or disabled can so easily feel pressure, whether real or imagined, to end their lives so as not to be a burden on others. Parliament’s first responsibility is to protect the vulnerable and that is what has happened.’

And he added: ‘Experience in other jurisdictions, such as Belgium, the Netherlands and the American states of Oregon and Washington, shows that any change in the law leads to ‘incremental extension’ and ‘mission creep’ as some doctors actively extend the categories of those to be included (from mentally competent to incompetent, from terminal to chronic illness, from adults to children, from assisted suicide to euthanasia).’

Legalising assisted suicide is fraught with danger. This is a hugely welcome result and a vote for sanity, justice and common sense.

Sunday 24 May 2015

Thirteen ‘solutions’ to mitochondrial disease assessed

Mitochondrial disorders are passed on through a mother’s mitochondrial DNA. They are progressive and can be very disabling but are thankfully relatively rare. They can cause stillbirth, death in babies and children, or may onset with severe effects in adulthood, such as blindness or heart failure.

As there is currently no treatment for most of them the majority of ‘solutions’ are aimed at prevention.

1. Hitler’s solution would have been euthanasia. His chief physician, Karl Brandt, believed that killing disabled people not only relieved the burden their lives imposed on the state, but also released them from lives that were not worth living: 'My underlying motive was the desire to help individuals who could not help themselves...such considerations should not be regarded as inhuman.’

2. Infanticide would be the answer of Watson and Crick, the scientists who discovered the molecular structure of DNA. Along with eugenicist Margaret Sanger and bioethicist Michael Tooley they advocated killing disabled neonates on the grounds that they were not fully human. Dutch doctors do the same today under the Groningen Protocol.

3. Prenatal diagnosis and abortion is the choice of most British mothers carrying a disabled baby. The fetal DNA can be examined through chorionic villus biopsy or amniocentesis followed by induced intrauterine death. 91% of babies with Down’s syndrome detected prenatally have their lives ended this way. Whether you see killing a new-born baby in a hospital ward as any different from killing in the womb a few weeks earlier will depend on your view of the unborn child.

4. Pre-implantation genetic diagnosis (PGD) is favoured by those who believe that killing a human embryo is different from killing a fetus. Produce embryos by IVF, examine them in the laboratory, and discard or destroy those which are affected. Then implant only those without a disability.

5. Mitochondrial transplantation (ie. three parent embryo technique) was recently approved by the British parliament. Take an egg with faulty mitochondria before or after fertilisation, shell out the nucleus and then transplant it into a donor egg from which the nucleus has been removed. This is currently untested and may result in worse genetic defects than those one is trying to prevent. But then prenatal diagnosis and abortion can be used as a back-up.

6. Use IVF with an egg from an unaffected donor. The baby would not carry mitochondrial disease as it can only be picked up from the affected mother. But the baby would also not be biologically related to its mother. Also it introduces a third person into the marriage and family tree and in an unnatural way.     

7. DNA editing has been successfully employed in mice. Produce an embryo by IVF. Inject the embryo with a segment of RNA designed to produce DNA-cutting enzymes. Snip out the faulty gene and implant the embryo in its mother’s uterus. Grow to term. An elegant form of molecular microsurgery not yet tested in humans but which runs the risk of passing any introduced genetic errors down the generations. Not yet legal in Britain.

8. Contraception. An affected couple who didn’t feel comfortable with approaches 1-6 above might just choose not to have children and use contraception on every occasion.

9. If they wanted to be absolutely sure (as no method of contraception is 100% foolproof) they might opt for abstinence.

10. Alternatively a woman known to be a carrier of mitochondrial disease might choose to remain single.  

11. Another option might be to adopt a frozen embryo related to neither parent in order both to carry a child to term and to give it chance of life it might not otherwise have. There are over 600,000 embryos in the US alone for which embryo adoption is a possibility.

12. Then there is the possibility of baby or child adoption. This provides an affected couple with a child and a child with a home.

13. Finally, they may opt simply to go ahead and accept the child they are given, whether it has mitochondrial disease or not, and regardless of how badly it is affected. After all, isn’t every human being precious and worthy of the greatest protection, care, respect and the best treatment that is available.

So which of these thirteen options is the best? The answer to that question will depend on one’s fundamental world view including one’s view of the status of the human embryo and fetus and one’s view of the marriage bond.

Most, but by no means all, would be repulsed by options 1 and 2 – euthanasia and infanticide.
Those who do not see the fetus as a human being with rights would opt for 3 – prenatal screening and abortion. 

If they are squeamish about abortion but happy with embryo disposal they might opt for option 4 – pre-implantation genetic diagnosis (PGD).

If they are desperate to have a child genetically related to both parents they might risk 5 – the three parent embryo - or 7 – DNA editing. On the other hand if they are happy for the baby to be related just to the father they might opt for 6 – IVF with an egg donor.

Those who cannot contemplate 1-6 for whatever reasons have three options: choosing not to conceive either through contraception, abstinence or remaining single; adopting an embryo, baby or child; or going ahead and having the baby anyway.

What do I think myself?

For me three crucial ethical principles come to bear.

The first is the status of the human embryo. As I have previously argued I see the human embryo as a living person worthy of the utmost respect, empathy, protection and wonder. So that rules out options 1 to 4. The end of having an unaffected baby does not justify the means of taking human life, at any stage.

Second is the inviolability of the marriage bond (dealt with in more detail here). To me introducing a third person into the marriage bond violates the biblical principle of one man, one woman, for life. Although the lust and cheating elements of adultery may not be present, the use of donor gametes still constitutes a form of biological adultery. So option 6 is out. 

Third I don’t have an absolute objection to IVF per se (provided that the couple is married, all embryos are re-implanted and that there are no donor gametes) but I do think that the creator designed human reproduction to occur as a result of the union of egg and sperm. So, even apart from concerns about safety and germ-line manipulation, the act of cobbling together a human being using organelles from three different individuals (the three parent embryo) not only introduces a third person into the marriage bond but disrupts the divinely designed reproductive process. This, for me, rules out option 5.

Of the remainder DNA editing (7) is most interesting. I do not have an a priori objection to germ-line gene therapy but I do have serious concerns about its safety. Its attractiveness is that, unlike the three parent embryo solution, it offers the possibility of restoring a whole embryo to health. But it could only be considered if was shown to be absolutely safe and effective in non-human primate studies and this has not thus far been done.

So I am left with options 8-13. 8-10 are feasible but rule out parenthood unless accompanied by adoption. Embryo adoption (11) makes parenthood possible and saves a life. But only if that embryo is already in existence and would otherwise perish. I do not believe that it is right to create embryos that are not going to be implanted and I do not support surrogacy (which is what this essentially is) other than to save an existing embryo. Baby or child adoption (12) may not save a life but it does potentially give a child in care or in fostering a loving home.

Having a baby regardless knowing that it could be affected (13) will require a great degree of both courage and love, and is perhaps the costliest solution of all.

God shows his compassion toward us through loving care given at great personal cost. He adopts us into his family. He loves us in spite of the fact that we are disabled by sin. He seeks to bring us back into a loving relationship with himself. So for me, options 11-13 most closely resonate with the heart of God himself. 

Thursday 14 May 2015

Home Secretary surgically dissected on Today Programme over new extremism disruption orders

This week Prime Minister David Cameron unveiled plans for a new counter-terrorism bill he intends to include in the Queen’s speech on 27 May.

The bill will include provision for extremism disruption orders giving the police powers to apply to the high court to limit the ‘harmful activities’ of an ‘extremist’ individual.

The orders were proposed during the last parliament in March, but were largely vetoed by the Liberal Democrats on the grounds of free speech. They were subsequently revived in the Conservative manifesto.

The measures would include a ban on broadcasting and a requirement to submit to the police in advance any proposed publication on the web and social media or in print. The bill will also contain plans for banning orders for extremist organisations which seek to ‘undermine democracy’ or use hate speech in public places.

There would also be new powers to close premises where extremists seek to influence others.

Cameron told the National Security Council on Wednesday:

‘For too long, we have been a passively tolerant society, saying to our citizens: as long as you obey the law, we will leave you alone… This government will conclusively turn the page on this failed approach. As the party of one nation, we will govern as one nation and bring our country together. That means actively promoting certain values. “Freedom of speech. Freedom of worship. Democracy. The rule of law. Equal rights regardless of race, gender or sexuality.”’

But just how far would these new orders extend?

Home Secretary Theresa May (pictured) appeared on Radio Four’s ‘Today programme’ (listen here) to explain it to presenter John Humphrys.

What followed was a masterclass in broadcast interviewing with Humphrys surgically dissecting May and brutally exposing the lack of clarity behind the new proposals.

The Home Secretary started by explaining that the new bill would include ‘banning orders for groups and disruption orders for individuals’ who were  ‘trying to promote hatred and intolerance’ which  ‘undermines our British values’.

‘But isn’t freedom of speech, an essential prerequisite of a tolerant and decent society’, asked Humphrys.

May answered that the ‘extremism’ the government was trying to prevent was that which ‘promotes(s) hatred’, which seeks ‘to divide our society’ and ‘undermine the very values that make us…  a great pluralistic society’

But what if ‘a group of people put together a meeting at which they expressed views about homosexuality that you or I might, perhaps, find repugnant. Would they be dividing society?’, said Humphrys.

May evaded the question so Humphrys asked, ‘At what point does it qualify for being banned?’
May again refused to define what she meant by ‘extremism’ but said that the aim was ‘to ensure that we can promote British values, the values that unite us as a society’.

Humphrys replied that ‘promoting British values’ was a woolly phrase and asked if May was intending to send people who refused to do it to jail. He pressed her again and again to define ‘extremism ‘ and ‘British values’ until she eventually offered a definition.

Apparently British values are ‘values like democracy, a belief in democracy, a belief in the rule of law, a belief in tolerance for other people, equality, and acceptance of other peoples’ faiths and religions.’

Which of course begs a whole host of questions: What is democracy? What law are we talking about? What should be tolerated and what shouldn’t be? What does equality entail? What does accepting another person’ faith actually mean?

These questions are crucial as the bottom line is that people who don’t promote what May calls ‘British values’ could be banned from broadcasting, required to submit their publications to the police, and have their organisation shut down and their premises closed.

But as Ian Dunt has said in an astute analysis on

‘The details are still not clear and won't get much clearer until the Queen's Speech – or probably afterwards. But we do know three things: 1) that the definition of an extremist is being expanded 2) that the process for how someone is officially designated as an extremist is shrouded in mystery, and 3) that the list of restrictions which applies to them once they have been designated an extremist is now extremely broad and intrusive.’

This appears to be a case where the price of freedom will be eternal vigilance. Every group whose views are judged to run counter to these poorly defined ‘British values’ could be in danger and would be strongly advised to subject the proposals, when they eventually appear, to the utmost scrutiny.

We may think that as Christian doctors we would immune from this kind of scrutiny but terms like 'tolerance', 'equality' and 'acceptance of other people's faith' are so elastic that they could be interpreted in such a way that perfectly normal Christian behaviour could be criminalised.

Is it being 'intolerant' not to participate in abortion? Is refusing to refer for a sex change procedure or IVF for unmarried couples (heterosexual or homosexual) showing a lack of respect for equality? Is sharing one's faith with a Muslim colleague or patient displaying a 'lack of acceptance of other people's faith'?

We have no way of knowing and how these principles are interpreted by officials (or even police) on the ground may be very much a lottery and may go far beyond what might have been intended by legislators. 

Ironically the Home Secretary’s interview was followed immediately by an interview with author AN Wilson (listen from 2h 24m here) , author of ‘Dante in Love’, marking the 750th anniversary of the birth of Italian poet Dante Alighieri.

Dante’s most famous work, the Divine Comedy – often described as one of the greatest ever written – is more than just the story of his journey through Hell, Purgatory and Paradise. It is a portrait of medieval society and a profound study of human psychology.

‘Dante had firm views about what our values are’, said Wilson. ‘He said they were based on the Christian religion and Roman law which runs through the whole of European Society and that’s what defines Europe.’

He went on to relate how Primo Levi , after been taken to Auschwitz by the Nazis, would recite to himself daily Ulysses speech in Dante’s divine comedy:

‘Consider your roots, where are you coming from, we are not just brute beasts, we are striving after knowledge and virtue’.

‘And these things’, Wilson concluded ‘are from Roman Law and Christianity’.


Sadly the Home Secretary seems to have forgotten, or perhaps never to have known, what the real historic roots of British values actually are.

Friday 8 May 2015

BMA calls on new parliament to debate six priorities for NHS

The British Medical Association (BMA) has today called on the newly elected UK parliament for ‘an open and honest debate about the NHS, focused on six priorities’ as follows:  

1. Address the funding shortfall for health

UK investment in health has slipped proportionately behind France, Germany, Denmark and Austria, and should be restored to a comparative level of GDP.

Increases in NHS funding based on unrealistic assumptions will not meet patient need. For example, an extra £8bn a year by 2020-21 overlooks the fact that an annual £22bn of efficiency savings will need to have been made by that time in order to close the £30bn funding gap on current services predicted by NHS England. There is still no credible plan, or commitment to invest enough, to enable this unprecedented scale of efficiency savings to be made. A good start would be for the government to fund NHS capital projects directly and to renegotiate existing PFI contracts to ensure a better deal for the nation, bringing our hospitals back into public ownership.

2. Remove market competition in healthcare

The Health and Social Care Act 2012 was a wasteful distraction from the real challenges in delivering healthcare and should be repealed.

A truly national health service needs an accountable leader; the health secretary’s statutory responsibilities to secure and provide universal and comprehensive healthcare must be restored and explicitly stated. The bureaucracy of competitive markets in the NHS in England hinders integration and prevents providers working together around patients’ needs. The government should use the NHS as its default provider, and not allow it to be destabilised by rival commercial providers.

3. Increase, retain and value doctors

Doctors are voting with their feet in neglected areas and services; the government has to recognise the need to improve working conditions.

Increasing the numbers of doctors in understaffed specialties such as general practice, psychiatry and emergency medicine will be impossible without this. Fair pay awards require that the independence of the Doctors’ and Dentists’ Pay Review Body (DDRB) should be restored and respected. Efficiency savings targets in the NHS should no longer be met at the expense of staff pay.

4. Maintain safeguards for patients and doctors

We must not return to the age of exhausted doctors; safeguards for patients and doctors assured by the Working Time Regulations must remain in place.

Seven-day services across the NHS should only be developed in response to clear patient demand and need, most acutely in urgent hospital care. Any proposals that dramatically change ways of working must follow rigorous analysis, have clear funding plans, and have workforce arrangements that protect both patient safety and doctors’ welfare.

5. Restore investment in general practice

General practice is the bedrock of many NHS services and the gatekeeper to the rest; it plays a vital role in all communities.

Significant investment in the workforce and facilities is overdue in order to meet rising patient need, in particular, that from older patients and those living with multiple conditions. The government must work more effectively with the profession to attract motivated doctors to work in general practice, and must invest in upgrading practice premises, delivering the ambition of true community care.

6. Prioritise health and wellbeing and strengthen ill-health prevention

Unhealthy lifestyle behaviours, such as poor nutrition, smoking and alcohol consumption, have a significant impact on quality of life and life expectancy and also place a huge burden on health services.

The government must tackle these behaviours and the industries that drive them, taking effective action to reduce health inequalities across society, improve the medical and social care of children, and develop a generation-long commitment to improve the public’s health. Health and well-being must be prioritised in all policy areas across government.

Saturday 2 May 2015

What would a hung parliament really mean for the UK’s constitutional future?

With only four days left to go, who is likely to be governing us after the UK general election on 7 May, and what are the implications for the UK’s constitutional future?

There are 650 seats in the British parliament but only 194 marginal seats (those that would require less that a 5% swing to change hands). 

The current standing is Conservative (302), Labour (256), Lib Dem (56), DUP (9), SNP (6), Sinn Fein (5), Independent (5), Plaid Cymru (3), SDLP (3), UKIP (2), Green (1) Alliance (1), Respect (1).

Given that one Conservative MP (currently John Bercow) must serve as speaker, and that Sinn Fein do not take up their seats in the House of Commons, any party or coalition needs 323 seats to govern.

Nate Silver, the pollster who correctly predicted the last two US presidential elections has forecast the following 2015 election result on the basis of the latest opinion polls, historical elections results and census data:

Conservative (278), Labour (271), SNP (50), Lib Dem (28), DUP (9), Sinn Fein (5), Plaid Cymru (4), SDLP (2), UKIP (1), Green (1), UUP (1).

What is most striking here is how different the make-up might be if the UK used a system of proportional representation. The latest opinion polls have Conservatives (34%), Labour (33%), UKIP (14%), Lib Dem (8%), Green (5%).

So whilst UKIP has 14% of popular support, almost twice that of the Lib Dems, they are predicted to win only one seat against the Lib Dem’s 28. 'Is that really fair?', some might ask.

But, that aside, the most notable changes between 2010 and now, apart from the rise of Labour and the fall of the Conservatives, are the dramatic rise of the SNP, the latter mainly at the expense of Labour (see interactive map of constituencies) and the equally dramatic fall of the Lib Dems.

Clearly, if this result is repeated on Election Day, no one party will be able to form a majority government. But also, if the SNP does not go into coalition, then no party will be able to form a majority coalition government either.

A right of centre coalition of Conservative, Lib Dem, DUP and UKIP would have only 316 seats, 7 short of that needed. 

But a left of centre coalition of Labour, Lib Dem, Plaid Cymru, SDLP and Green would have only 306, a shortfall of 17.

But Plaid Cymru, DUP and UKIP have already signalled they will not be entering coalition and the Lib Dems are suggesting that they will drive a much harder bargain than last time. This makes the possibility of a majority coalition even more remote. 

This would mean that it would only be possible for either the Conservatives or Labour to pass the Queen’s speech on 27 May with the support of the SNP.

But the SNP has already ruled out a coalition (or any other arrangement) with the Tories, and Labour has ruled out a coalition or a ‘confidence and supply’ arrangement (ie. support in vote of confidence and for budget) with the SNP.

So, the only possibility of Labour continuing in government would be by some kind of vote by vote agreement with the SNP. This would leave Labour at the mercy of the SNP over specific policies like defence (especially Trident which the SNP wants to scrap), the economy and the constitution.

The SNP is strongly opposed to austerity and would push Labour to tax, borrow and spend much more than it would otherwise. It would undoubtedly also push for an early second referendum on Scottish independence.

So it appears that we may have a serious constitutional crisis.

Charles Moore suggested two weeks ago that the Scottish National Party (SNP) is seeking to engineer a reverse take-over of the Labour Party. In reality, they are intent on staging the Scots’ first attempt to capture their bigger neighbour since Bonnie Prince Charlie led his Jacobite army as far as Derby in 1745. 

So what will Cameron do with this result?

He remains Prime Minister until he stands down, just as Gordon Brown did in 2010 when he stayed put for five days with far fewer seats than the Tories.

Mr Cameron could challenge the Commons to vote him down (in a vote of no confidence) when it next meets on 27 May or go to the Queen and tender his resignation (which would be curtains for him personally).

This would leave Ed Miliband trying to form a government which he will only be able to do with the support of the SNP. But a minority government does not need a formal pact to sustain it in office, just the votes, and Nicola Sturgeon has all but guaranteed them to Labour.

The Telegraph’s Phillip Johnston has argued that if neither Mr Cameron nor Mr Miliband were able to put together a viable government, a second election would normally follow; but the Fixed-Term Parliaments Act 2011 complicates matters.

‘It provides for a dissolution of Parliament only when there is a specific vote of no confidence in the government or if two thirds of all MPs vote for an election. This makes the prospect of another early general election less likely. In any case, the parties may have little appetite for one given the expense and the prospect of losing support in a fresh contest.

Without a dissolution we would have a legislature but no government, a bit like Belgium, where the prime minister resigned in April 2010 and no new parliamentary majority could be established for almost two years. The country was run by a former prime minister brought out of retirement and a caretaker administration.’

As Johnston concludes, ‘One thing is clear: a minority Labour government, with fewer seats than the Tories, running the country while in thrall to a nationalist party that has only 2 or 3 per cent of the total UK vote, would test our constitutional structures to breaking point, and maybe beyond. More than that, it could test our creaking, centuries-old Union to destruction.’

One thing is abundantly clear. The UK’s days as a two party state where one party has an absolute majority are over. In the 1950s 97% of people voted Tory or Labour. Now barely 67% do.

This is a new era of coalition and shared power. But coalitions in a multi-party democracy can only rule effectively when they have an overall majority. And that may not happen without a shift to some form of proportional representation – like that or Italy, Israel or Greece.

Perhaps that is the direction in which we are inexorably drifting; either that, or Scottish independence, or both.