The Battin study does not prove that vulnerable people are not at risk from legalised assisted suicide

This report has been reproduced with permission from the Euthanasia-Free New Zealand Website

The Battin study is often quoted by pro-euthanasia advocates to support their claim that legal assisted suicide does not pose a risk to vulnerable people. The absolute claim that “vulnerable people are not at risk” is not supported by this study, because it identified a heightened risk to one vulnerable group: people with AIDS.

Subsequent research has also invalidated the study’s conclusion that other vulnerable groups are not at risk. 

For example, studies published in 2009 and 2010 show that vulnerable groups, such as the elderly and mentally incompetent, are indeed at a higher risk of being killed by euthanasia without their consent.

The Battin study was based on wrong assumptions and there are several issues with its scope and methodology. The case is not proven.

What is the Battin study about?

Margaret Battin and others analysed data up to 2005 from Oregon and The Netherlands to find out whether there is evidence that the lives of people identified as vulnerable are more frequently ended with assistance from a physician than those of the background population.

“These groups were analysed and compared with background populations: the elderly, women, the uninsured (Oregon only), people with low educational status, the poor, the physically disabled or chronically ill, people with sometimes stigmatised illnesses like AIDS, minors, people with psychiatric illnesses including depression, and racial or ethnic minorities.

“The study found that the only group with a heightened risk was people with AIDS. Where assisted dying is already legal, there is no current evidence [emphasis ours] for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician‐assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.”

The Battin study is based on wrong assumptions

• It assumed the elderly consist only of people aged 85 and older. No mention was made of people aged 65 to 84.

• It assumed women are more vulnerable than men when it comes to suicide and assisted suicide.

• It assumed depressed people are not vulnerable to assisted suicide.

• It assumed vulnerability is limited to physical characteristics and conditions.

• It assumed the poor are more vulnerable to physician-assisted suicide than the rich.

• It assumed only terminally ill people receive physician-assisted suicide in Oregon.

• It assumed a person cannot belong to more than one vulnerable group, i.e. be both elderly and disabled.  Battin et al treated vulnerable groups as separate and mutually exclusive.

Other limitations and issues with the Battin study

• Three vulnerable groups, who feature in statistics and studies on assisted suicide and euthanasia, were ignored in the Battin study: Those who suffer from depression, the mentally incompetent, and the unconscious or comatose.

• The study is based on data only up to 2005, when the Dutch euthanasia situation was relatively stable. According to Prof Theo Boer, a former member of a Dutch Regional Euthanasia Committee who has reviewed 4000 cases over 9 years, there has been a dramatic increase in euthanasia deaths since 2008. He recommends that the cause of this surge be investigated.  He was in favour of euthanasia, but has changed his mind. 

In July 2014 he warned the UK against legalising assisted suicide:

“I was wrong, terribly wrong in fact, to believe that regulated euthanasia would work.”

“In hindsight, the stabilization in the numbers was just a temporary pause. Beginning in 2008, the numbers of these deaths show an increase of 15% annually, year after year.”

“Other developments include a shift in the type of patients who receive these treatments. Whereas in the first years after 2002 hardly any patients with psychiatric illnesses or dementia appear in reports, these numbers are now sharply on the rise. Cases have been reported in which a large part of the suffering of those given euthanasia or assisted suicide consisted in being aged, lonely or bereaved. Some of these patients could have lived for years or decades.

• It’s limited to data from only two jurisdictions, and jurisdictions with very different social, cultural and legal environments as well as assisted-suicide reporting requirements. The study should not be used to make generalisations about the effect of legal euthanasia and assisted suicide in other parts of the world.
  
  

“We recognize that substantial differences in the methodologies of the source studies make it impossible to determine with certainty [emphasis ours] the actual incidence of assisted dying in several of the vulnerable groups studied. Our question is whether the available data show evidence of heightened risk to persons in vulnerable groups.”

• The source data didn’t include data on disability.

In reference to the group “people with chronic physical or mental disabilities or chronic non-terminal illnesses”, the authors stated “no data to calculate denominator; probably 10 cases or fewer per year.”  The word “probably” is hardly conclusive!

Expert critiques of the Battin study

The Battin study has been criticized by Prof Ilora G. Finlay and Rob George in the Journal of Medical Ethics, as well as by Dr George Seber, a statistician and counsellor.

Based on these expert opinions, as well as subsequent studies, Euthanasia-Free NZ concludes that the Battin study is unreliable and inconclusive.

Discredited by a statistician

Prof George Seber, an internationally-respected statistician, as well as an experienced counsellor, is of the opinion that “the case is not proven”.

He wrote an email to Euthanasia-Free NZ stating,

“The Battin et al. paper has some unresolved problems that may invalidate its findings.

“In endeavouring to look for differences between pairs of groups it is important to look at the numbers in overlapping groups, for example the numbers in two-group overlaps like gender and age, and those in three-group overlaps like gender, age, and vulnerability (e.g. with disabilities), etc. If there is “interaction” between groups it is not valid to compare groups in pairs without taking into account any interactions. Are there interactions? It seems likely that  the following might have an effect: (1) women live longer than men, (2) men may be more disabled than women in a certain age groups, (3) women network better than men and networks of friends are very important when it comes to psychological health.

“A major problem is how to compare suicide-assisted deaths with deaths in the population at large. It could be a case of comparing apples and oranges! For example, some people may die by accident or after a short illness and are not relevant to the comparison. We need to compare the numbers of people in both populations who have similar ages and are in similar situations (e.g. similar vulnerability).

“Another concern I have is about the fact that there is no mention of the  methods used to compare proportions. Some methods are still commonly used these days that are not  appropriate (cf. Seber , 2013a).

“Another worrying feature is the confusion over the role of depression and the so-called right of euthanasia. As a trained counsellor I can say  that depression is the most treatable of all mental illnesses and it is strongly linked to suicide without assistance (Seber, 2013b). I don’t believe it is grounds for assisted suicide or euthanasia.  It is known, for example, that women seem to be about twice as prone to depression than men, and the elderly are more prone as the life-span has been significantly increased so there is an age factor relating to depression as well.

“In summary, the case is not proven. Further research and statistical analysis is needed.”

George  A. F.  Seber, PhD, FRSNZ, Dip. Counsel., MNZCCA.

Emeritus Professor of Statistics, University of Auckland, New Zealand

Discredited by peers in the same journal

Finlay and George state that they disagree with the conclusions of the Battin study on four grounds:

• Battin limits vulnerability to physical characteristics such as race, gender and socioeconomic status only. Finlay and George argue,

“Vulnerability to PAS cannot be categorised simply by reference to race, gender or other socioeconomic status and that the impetus to seek PAS derives from factors, including emotional state, reactions to loss, personality type and situation and possibly to PAS contagion, all factors that apply across the social spectrum. Contrary to the conclusions drawn by Battin et al, the highest resort to PAS in Oregon is among the elderly and, on the basis of research published since Battin et alreported, that there is reason to believe that some terminally ill patients in Oregon are taking their own lives with lethal drugs supplied by doctors despite having had depression at the time when they were assessed and cleared for PAS.”

• Battin defines the elderly as people over 85 and finds that those people are not at heightened risk as compared to people aged 18-64.  Finley and George point out that people over 65 are generally defined as elderly in our society and note that Battin’s study does not mention at all the age group between 65 and 85.  Finlay and George also quarrel with Battin’s comparison of natural death rates of people 85 and older with assisted suicide rates in that age cohort, pointing out that, “Since the death rates from non-PAS causes among persons aged 85 years or over are naturally very high, it follows that almost any rate of PAS in this age bracket is likely to show up as proportionately less than the rate of death from other causes.”  In fact, they write, 68% of PAS deaths are among people over 65.  The elderly do seem to be vulnerable to PAS.

• Finlay and George quarrel with Battin’s choice of which groups to investigate for vulnerability.  For example, she investigates whether women are more vulnerable to PAS than men and finds that they are not.  Finlay and George find her discovery unimpressive, since studies done all over the world have shown men are more likely to commit suicide than women.   Battin cites the affluence and high educational level of PAS users as proof that the poor are not vulnerable. Finlay and George ask whether Battin has overlooked the possibility that there is a particular vulnerability among the affluent and educated, a vulnerability marked by an aversion to suffering, an isolating individualism seen as “dignity”, and a need for control.  They believe Battin’s work may have been distorted by her seeing “the concept of vulnerability from one perspective only, as something to which only less educated or less wealthy persons might succumb.”  They also suggest the possibility that Compassion and Dying, now Compassion and Choices, represented at the hearings by George Eighmey, may exert an unintended coercion on individuals they guide through the PAS process.  Finally, they point to the coercive influence among the affluent of fashion and political correctness.

• Finlay and George question Battin’s conclusion that only the terminally ill are receiving PAS in Oregon, pointing out, as Dr. Bentz did in his testimony to Health and Welfare, that the Oregon reports are based on “voluntary” reporting by doctors who are motivated to state that they acted within the law; those same doctors label their patients as terminal.  They note that one patient lived for three years after getting a PAS prescription; he was clearly not terminally ill when he got it.  They point to the difficulty of prognosticating and also to the blurring, purposeful or not, of the boundaries between chronic illness and terminal illness; for example they note that “…illnesses such as multiple sclerosis, Parkinson’s disease and cardiopulmonary disease pretty well universally have a chronic and disabling prelude before they become predictably terminal as defined by less than 6 months to live.”  Battin , they point out, discusses chronic and disabling terminal illness in a way that blurs the lines, if they can be drawn at all.

• Lastly, Finlay and George do point out, as Battin said, that some depressed patients seem to have received PAS.

References

Battin, M. P., Van der Heide, A. and Ganzini, L.  et al. Legal physician-assisted dying in Oregon and The Netherlands: Evidence concerning the impact on patients in ‘vulnerable’ groups. J Med Ethics 2007(37):591-97.

Finlay, I. G. and George, R. Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on patients in vulnerable groups – another perspective on Oregon’s data. J Med Ethics 2011(37):171-174   doi:10.1136/jme.2010.037044  http://jme.bmj.com/content/37/3/171.abstract

Seber, G. A. F. (2013a). Statistical models for proportions and probabilities. Springer Briefs in Statistics: Berlin.

Seber, G. A. F.  (2013b). Counseling Issues: A handbook for counselors and psychotherapists. Xlibris Publishing.

Defeat of the Marris Assisted Dying Bill – some reflections on how MPs voted

The Assisted Dying (No 2) Bill of Labour MP Rob Marris was the eleventh attempt in twelve years to legalise assisted suicide through British Parliaments.

But its overwhelming defeat yesterday (11 September 2015) by a margin of 212 votes (330 to 118) should settle this matter for a decade.

It is striking (and indeed fitting) that this happened the very day after World Suicide Prevention Day. The bill now cannot proceed further. It is dead.

There is clearly no chance at all of a similar bill passing through the Commons in the current parliament and even in the (now) unlikely event of a Labour victory in 2020 it is virtually inconceivable that the views of MPs will change enough to make it likely in the next parliament either.

MPs dealt the bill a resounding defeat largely driven by concerns about the risks it posed to vulnerable people who would have felt under pressure to end their lives so as not to be a burden to family, relatives, caregivers or a society short of resources. Six in ten who die under a similar law in Washington State US give this reason.

Overall 74% of MPs voted against the bill, a proportion almost identical to the 72% who opposed the last bill of its kind in the House of Commons in 1997. So there has been essentially no shift in parliamentary opinion in the last 20 years.

Rob Marris conceded in a BBC interview after the debate that he did not foresee another attempt in the Commons in this parliament and in fact called on the government to invest more in palliative care, a move which I would strongly support. Patients whose symptoms are properly controlled do not generally want help to kill themselves. 

You can read the full four hour parliamentary debate on Hansard and see reaction to the result on you tube along with my comments on what it means.

The Daily Mail has also given a full list of how MPs voted by party which I have reproduced below.

Overall out of 650 MPs, a total of 448 took part in the vote.

118 MPs supported the bill (27 Conservative, 72 Labour, 14 SNP, 3 Lib Dem and 1 Green).

330 voted against it (210 Conservative, 91 Labour, 11 SNP, 3 Lib Dem, 1 UKIP, 8 DUP, 3 SDLP, 1 Independent).

Here are some preliminary quick reflections on how people voted.

1. This was a huge (almost unprecedented) turnout considering this was a private member’s bill debate on a Friday when most MPs would be expected to be in their local constituencies. It is a measure of how important they considered the issue to be. 

2. Over half of all MPs (330) voted against it meaning that it would have been defeated even if all 650 MPs had been present.

3. More Labour MPs (91) voted against the bill than supported it (72) and the SNP and Lib Dems were more or less evenly split. This is hugely significant as it signals that assisted suicide is not a simple left/right political issue. In fact suicide prevention and protection of vulnerable people from exploitation and abuse resonate strongly with left wing politicians.

4. Most party leaders did not vote. Prime Minister David Cameron (Conservative) was not present. Nor was Tim Farron (Lib Dem), Angus Robertson (SNP) or Jeremy Corbyn (Labour). However all four had previously signalled their opposition to the bill.

5. Former Labour leaders and Blairites generally supported the bill. These included former Labour leader Ed Miliband and Deputy Leader (and recently acting Leader) Harriet Harman.

6. Medically qualified MPs were generally strongly opposed, notably former cabinet minister Liam Fox (Conservative), Sarah Woollaston (Conservative) and SNP health spokesperson Philippa Whitford.

7. Many current cabinet ministers opposed the Bill including Theresa May (Home Secretary), Michael Fallon (Defence), Michael Gove (Lord Chancellor), Iain Duncan Smith (Work and Pensions), Jeremy Hunt (Health), Chris Grayling (Leader of the House of Commons), Justine Greening (International Development), Patrick McLoughlin (Transport), Theresa Villiers (Northern Ireland), Stephen Crabb (Wales), Oliver Letwin (Duchy of Lancaster), David Mundell (Scotland), Robert Halfon (without portfolio), Greg Hands (Treasury),  Mark Harper (Chief Whip) and Jeremy Wright (Attorney General).

8. Other prominent MPs who opposed the bill included former London Mayor Boris Johnson, former Lib Dem leader Nick Clegg, former Attorney General Dominic Grieve, former Conservative cabinet ministers Eric Pickles and Peter Bottomley and former Labour Cabinet ministers Alan Johnson and David Lammy.

9. Former Director of Public Prosecutions (DPP) Keir Starmer, now a Labour MP, voted in favour of the bill. Perhaps this explains his apparent reluctance to prosecute people whilst in office. It will certainly raise further discussion about whether or not his published prosecution criteria amounted to stealth legalisation.

How did you MP vote? Full list of the politicians who took part

Out of 650 MPs, a total of 448 took part in the free vote on assisted dying. It was a free vote, which meant they could support either side or none, without being told to toe a party line. This is how they voted.

VOTED IN FAVOUR OF ASSISTED DYING

Conservatives (27)

Lucy Allan (Telford), Gavin Barwell (Croydon Central), Andrew Bingham (High Peak), Crispin Blunt (Reigate), Greg Clark (Tunbridge Wells), Tracey Crouch (Chatham and Aylesford), Lucy Frazer (Cambridgeshire South East), Nick Gibb (Bognor Regis & Littlehampton), Zac Goldsmith (Richmond Park), Peter Heaton-Jones (Devon North), Kevin Hollinrake (Thirsk & Malton), Robert Jenrick (Newark), Joseph Johnson (Orpington), Kit Malthouse (Hampshire North West), Scott Mann (Cornwall North), Tania Mathias (Twickenham), Huw Merriman (Bexhill & Battle), Nigel Mills (Amber Valley), Andrew Mitchell (Sutton Coldfield), Guy Opperman (Hexham), Claire Perry (Devizes), Chris Philp (Croydon South), Paul Scully (Sutton & Cheam), Chloe Smith (Norwich North), Anna Soubry (Broxtowe), Mel Stride (Devon Central) and Matt Warman (Boston & Skegness).

Labour (72)

Graham Allen (Nottingham North), Adrian Bailey (West Bromwich West), Kevin Barron (Rother Valley), Hilary Benn (Leeds Central), Clive Betts (Sheffield South East), Paul Blomfield (Sheffield Central), Nick Brown (Newcastle upon Tyne East), Karen Buck (Westminster North), Richard Burden (Birmingham Northfield), Ruth Cadbury (Brentford & Isleworth), Sarah Champion (Rotherham), Ann Coffey (Stockport), Jo Cox (Batley & Spen), Stella Creasy (Walthamstow), Wayne David (Caerphilly), Geraint Davies (Swansea West), Angela Eagle (Wallasey), Maria Eagle (Garston & Halewood), Jim Fitzpatrick (Poplar & Limehouse), Caroline Flint (Don Valley), Paul Flynn (Newport West), Vicky Foxcroft (Lewisham Deptford), Roger Godsiff (Birmingham Hall Green), Helen Goodman (Bishop Auckland), Kate Green (Stretford & Urmston), Lilian Greenwood (Nottingham South), Louise Haigh (Sheffield Heeley), Harriet Harman (Camberwell & Peckham), Carolyn Harris (Swansea East), Margaret Hodge (Barking), Kelvin Hopkins (Luton North), George Howarth (Knowsley), Liz Kendall (Leicester West), Stephen Kinnock (Aberavon), Dr Peter Kyle (Hove), Clive Lewis (Norwich South), Holly Lynch (Halifax), Kerry McCarthy (Bristol East), Pat McFadden (Wolverhampton South East), John Mann (Bassetlaw), Rob Marris (Wolverhampton South West), Ed Miliband (Doncaster North), Madeleine Moon (Bridgend), Ian Murray (Edinburgh South), Melanie Onn (Great Grimsby), Matthew Pennycook (Greenwich & Woolwich), Jess Phillips (Birmingham Yardley), Lucy Powell (Manchester Central) Jamie Reed (Copeland), Christina Rees (Neath), Emma Reynolds (Wolverhampton North East), Geoffrey Robinson (Coventry North West), Paula Sherriff (Dewsbury), Tulip Siddiq (Hampstead & Kilburn), Andy Slaughter (Hammersmith), Cat Smith (Lancaster & Fleetwood), Jeff Smith (Manchester Withington), Owen Smith (Pontypridd), Karin Smyth (Bristol South), Keir Starmer (Holborn & St Pancras), Jo Stevens (Cardiff Central), Wes Streeting (Ilford North), Anna Turley (Redcar), Karl Turner (Hull East), Stephen Twigg (Liverpool West Derby), Chuka Umunna (Streatham), Catherine West (Hornsey & Wood Green), Phil Wilson (Sedgefield), David Winnick (Walsall North), Rosie Winterton (Doncaster Central), Iain Wright (Hartlepool) and Daniel Zeichner (Cambridge).

Scottish National Party (14)

Kirsty Blackman (Aberdeen North), Alan Brown (Kilmarnock & Loudoun), Ronnie Cowan (Inverclyde), Stuart Donaldson (Aberdeenshire West & Kincardine), George Kerevan (East Lothian), Calum Kerr (Berwickshire, Roxburgh & Selkirk), Chris Law (Dundee West), Callum McCaig (Aberdeen South), Stewart McDonald (Glasgow South), Dr Paul Monaghan (Caithness, Sutherland & Easter Ross), Roger Mullin (Kirkcaldy & Cowdenbeath), John Nicolson (Dunbartonshire East), Tommy Sheppard (Edinburgh East) and Corri Wilson (Ayr, Carrick & Cumnock).

Liberal Democrats 

Tom Brake (Carshalton & Wallington), Alistair Carmichael (Orkney & Shetland), Norman Lamb (Norfolk North)

Green 

Caroline Lucas (Brighton Pavilion)

VOTED AGAINST ASSISTED DYING 

Conservatives (210)

MPs were: Peter Aldous (Waveney), Sir David Amess (Southend West), Stuart Andrew (Pudsey), Caroline Ansell (Eastbourne), Edward Argar (Charnwood), Richard Bacon (Norfolk South), Steven Baker (Wycombe), Harriett Baldwin (Worcestershire West), Stephen Barclay (Cambridgeshire North East), Guto Bebb (Aberconwy), Henry Bellingham (Norfolk North West), Richard Benyon (Newbury), Jake Berry (Rossendale & Darwen), James Berry (Kingston & Surbiton), Bob Blackman (Harrow East), Nicola Blackwood (Oxford West & Abingdon), Peter Bone (Wellingborough), Victoria Borwick (Kensington), Peter Bottomley (Worthing West), Karen Bradley (Staffordshire Moorlands), Graham Brady (Altrincham & Sale West), Julian Brazier (Canterbury), Andrew Bridgen (Leicestershire North West), Steve Brine (Winchester), James Brokenshire (Old Bexley & Sidcup), Fiona Bruce (Congleton), Robert Buckland (Swindon South), Conor Burns (Bournemouth West), Simon Burns (Chelmsford), David Burrowes (Enfield Southgate), Alun Cairns (Vale of Glamorgan), Neil Carmichael (Stroud), James Cartlidge (Suffolk South), Bill Cash (Stone), Maria Caulfield (Lewes), Alex Chalk (Cheltenham), Rehman Chishti (Gillingham & Rainham), Christopher Chope (Christchurch), Jo Churchill (Bury St Edmunds), Kenneth Clarke (Rushcliffe), James Cleverly (Braintree), Geoffrey Clifton-Brown (Cotswolds, The), Therese Coffey (Suffolk Coastal), Oliver Colvile (Plymouth Sutton & Devonport), Alberto Costa (Leicestershire South), Geoffrey Cox (Devon West & Torridge), Stephen Crabb (Preseli Pembrokeshire), Byron Davies (Gower), Chris Davies (Brecon & Radnorshire), David Davies (Monmouth), Glyn Davies (Montgomeryshire), James Davies (Vale of Clwyd), Mims Davies (Eastleigh), Philip Davies (Shipley), Michelle Donelan (Chippenham), Nadine Dorries (Bedfordshire Mid), Stephen Double (St Austell & Newquay), Jackie Doyle-Price (Thurrock), Flick Drummond (Portsmouth South), Iain Duncan Smith (Chingford & Woodford Green), Michael Ellis (Northampton North), Jane Ellison (Battersea), Charlie Elphicke (Dover), George Eustice (Camborne & Redruth), Graham Evans (Weaver Vale), Nigel Evans (Ribble Valley), David Evennett (Bexleyheath & Crayford), Michael Fallon (Sevenoaks), Suella Fernandes (Fareham), Mark Field (Cities of London & Westminster), Kevin Foster (Torbay), Dr Liam Fox (Somerset North), Mark Francois (Rayleigh & Wickford), George Freeman (Norfolk Mid), Richard Fuller (Bedford), Marcus Fysh (Yeovil), Roger Gale (Thanet North), Edward Garnier (Harborough), Cheryl Gillan (Chesham & Amersham), John Glen (Salisbury), Robert Goodwill (Scarborough & Whitby), Michael Gove (Surrey Heath), James Gray (Wiltshire North), Chris Grayling (Epsom & Ewell), Chris Green (Bolton West), Damian Green (Ashford), Justine Greening (Putney), Dominic Grieve (Beaconsfield), Andrew Griffiths (Burton), Ben Gummer (Ipswich), Sam Gyimah (Surrey East), Robert Halfon (Harlow), Luke Hall (Thornbury & Yate), Stephen Hammond (Wimbledon), Greg Hands (Chelsea & Fulham), Mark Harper (Forest of Dean), Sir Alan Haselhurst (Saffron Walden), John Hayes (South Holland & The Deepings), Sir Oliver Heald (Hertfordshire North East), James Heappey (Wells), Nick Herbert (Arundel & South Downs), Damian Hinds (Hampshire East), Simon Hoare (Dorset North), Philip Hollobone (Kettering), Adam Holloway (Gravesham), Kris Hopkins (Keighley), Ben Howlett (Bath), Jeremy Hunt (Surrey South West), Stewart Jackson (Peterborough), Margot James (Stourbridge), Ranil Jayawardena (Hampshire North East), Bernard Jenkin (Harwich & Essex North), Andrea Jenkyns (Morley & Outwood), Boris Johnson (Uxbridge & Ruislip South), Gareth Johnson (Dartford), Andrew Jones (Harrogate & Knaresborough), David Jones (Clwyd West), Marcus Jones (Nuneaton), Seema Kennedy (South Ribble), Simon Kirby (Brighton Kemptown), Greg Knight (Yorkshire East), Julian Knight (Solihull), Mark Lancaster (Milton Keynes North), Andrea Leadsom (Northamptonshire South), Phillip Lee (Bracknell), Jeremy Lefroy (Stafford), Sir Edward Leigh (Gainsborough), Oliver Letwin (Dorset West), Julian Lewis (New Forest East), David Lidington (Aylesbury), Tim Loughton (Worthing East & Shoreham), Karl McCartney (Lincoln), David Mackintosh (Northampton South), Patrick McLoughlin (Derbyshire Dales), Stephen McPartland (Stevenage), Anne Main (St Albans), Alan Mak (Havant), Theresa May (Maidenhead), Paul Maynard (Blackpool North & Cleveleys), Mark Menzies (Fylde), Johnny Mercer (Plymouth Moor View), Stephen Metcalfe (Basildon South & Thurrock East), Maria Miller (Basingstoke), Amanda Milling (Cannock Chase), Anne Milton (Guildford), James Morris (Halesowen & Rowley Regis), Wendy Morton (Aldridge-Brownhills), David Mundell (Dumfriesshire, Clydesdale & Tweeddale), Sarah Newton (Truro & Falmouth), Caroline Nokes (Romsey & Southampton North), David Nuttall (Bury North), Matthew Offord (Hendon), Neil Parish (Tiverton & Honiton), Owen Paterson (Shropshire North), Mark Pawsey (Rugby), Mike Penning (Hemel Hempstead), Andrew Percy (Brigg & Goole), Stephen Phillips (Sleaford & North Hykeham), Eric Pickles (Brentwood & Ongar), Christopher Pincher (Tamworth), Rebecca Pow (Taunton Deane), Victoria Prentis (Banbury), Mark Prisk (Hertford & Stortford), Tom Pursglove (Corby), Jeremy Quin (Horsham), Will Quince (Colchester), John Redwood (Wokingham), Jacob Rees-Mogg (Somerset North East), Laurence Robertson (Tewkesbury), Mary Robinson (Cheadle), David Rutley (Macclesfield), Antoinette Sandbach (Eddisbury), Andrew Selous (Bedfordshire South West), Alok Sharma (Reading West), Alec Shelbrooke (Elmet & Rothwell), Keith Simpson (Broadland), Julian Smith (Skipton & Ripon), Royston Smith (Southampton Itchen), Nicholas Soames (Sussex Mid), Amanda Solloway (Derby North), Caroline Spelman (Meriden), Bob Stewart (Beckenham), Iain Stewart (Milton Keynes South), Gary Streeter (Devon South West), Desmond Swayne (New Forest West), Robert Syms (Poole), Derek Thomas (St Ives), Maggie Throup (Erewash), Kelly Tolhurst (Rochester & Strood), Michael Tomlinson (Dorset Mid & Poole North), Craig Tracey (Warwickshire North), Anne-Marie Trevelyan (Berwick-upon-Tweed), Thomas Tugendhat (Tonbridge & Malling), Andrew Turner (Isle of Wight), Ed Vaizey (Wantage), Shailesh Vara (Cambridgeshire North West), Martin Vickers (Cleethorpes), Theresa Villiers (Chipping Barnet), Robin Walker (Worcester), Ben Wallace (Wyre & Preston North), David Warburton (Somerton & Frome), James Wharton (Stockton South), Helen Whately (Faversham & Kent Mid), Craig Williams (Cardiff North), Gavin Williamson (Staffordshire South), Rob Wilson (Reading East), Dr Sarah Wollaston (Totnes), Mike Wood (Dudley South), William Wragg (Hazel Grove) and Jeremy Wright (Kenilworth & Southam)

Labour (91)

Debbie Abrahams (Oldham East & Saddleworth), Rushanara Ali (Bethnal Green & Bow), David Anderson (Blaydon), Jon Ashworth (Leicester South), Tom Blenkinsop (Middlesbrough South & Cleveland East), Lyn Brown (West Ham), Chris Bryant (Rhondda), Richard Burgon (Leeds East), Dawn Butler (Brent Central), Alan Campbell (Tynemouth), Ann Clwyd (Cynon Valley), Rosie Cooper (Lancashire West), Neil Coyle (Bermondsey & Old Southwark), David Crausby (Bolton North East), Mary Creagh (Wakefield), Jon Cruddas (Dagenham & Rainham), Judith Cummins (Bradford South), Jim Cunningham (Coventry South), Stephen Doughty (Cardiff South & Penarth), Jim Dowd (Lewisham West & Penge), Peter Dowd (Bootle), Clive Efford (Eltham), Julie Elliott (Sunderland Central), Bill Esterson (Sefton Central), Chris Evans (Islwyn), Frank Field (Birkenhead), Rob Flello (Stoke-on-Trent South), Colleen Fletcher (Coventry North East), Barry Gardiner (Brent North), Pat Glass (Durham North West), Mary Glindon (Tyneside North), Margaret Greenwood (Wirral West), Nia Griffith (Llanelli), David Hanson (Delyn), Helen Hayes (Dulwich & West Norwood), Sue Hayman (Workington), Stephen Hepburn (Jarrow), Meg Hillier (Hackney South & Shoreditch), Sharon Hodgson (Washington & Sunderland West), Kate Hoey (Vauxhall), Imran Hussain (Bradford East), Alan Johnson (Hull West & Hessle), Gerald Jones (Merthyr Tydfil & Rhymney), Helen Jones (Warrington North), Susan Elan Jones (Clwyd South), Mike Kane (Wythenshawe & Sale East), Sir Gerald Kaufman (Manchester Gorton), Barbara Keeley (Worsley & Eccles South), David Lammy (Tottenham), Emma Lewell-Buck (South Shields), Ivan Lewis (Bury South), Ian Lucas (Wrexham), Rebecca Long-Bailey (Salford), Steve McCabe (Birmingham Selly Oak), Siobhain McDonagh (Mitcham & Morden), Andy McDonald (Middlesbrough), Conor McGinn (St Helens North), Liz McInnes (Heywood & Middleton), Catherine McKinnell (Newcastle upon Tyne North), Justin Madders (Ellesmere Port & Neston), Shabana Mahmood (Birmingham Ladywood), Seema Malhotra (Feltham & Heston), Gordon Marsden (Blackpool South), Rachael Maskell (York Central), Chris Matheson (Chester, City of), Grahame Morris (Easington), Albert Owen (Ynys Mon), Teresa Pearce (Erith & Thamesmead), Toby Perkins (Chesterfield), Bridget Phillipson (Houghton & Sunderland South), Stephen Pound (Ealing North), Yasmin Qureshi (Bolton South East), Kate Osamor (Edmonton), Angela Rayner (Ashton Under Lyne), Jonathan Reynolds (Stalybridge & Hyde), Marie Rimmer (St Helens South & Whiston), Virendra Sharma (Ealing Southall), Barry Sheerman(Huddersfield), Dennis Skinner (Bolsover), Gavin Shuker (Luton South), Andrew Smith (Oxford East), John Spellar (Warley), Graham Stringer (Blackley & Broughton), Gisela Stuart (Birmingham Edgbaston), Mark Tami (Alyn & Deeside), Nick Thomas-Symonds (Torfaen), Stephen Timms (East Ham), Derek Twigg (Halton), Keith Vaz (Leicester East), Valerie Vaz (Walsall South) and John Woodcock (Barrow & Furness).

Scottish National Party (11)

Richard Arkless (Dumfries & Galloway),Ian Blackford (Ross, Skye & Lochaber), Dr Lisa Cameron (East Kilbride, Strathaven & Lesmahagow), Marion Fellows (Motherwell & Wishaw), Margaret Ferrier (Rutherglen & Hamilton West), Patrick Grady (Glasgow North), Carol Monaghan (Glasgow North West), Gavin Newlands (Paisley & Renfrewshire North), Brendan O'Hara (Argyll & Bute), Christopher Stephens (Glasgow South West) and Dr Philippa Whitford (Ayrshire Central).

Liberal Democrats (3)

Nick Clegg (Sheffield Hallam), John Pugh (Southport) and Mark Williams (Ceredigion).

Ukip

Ukip MP Douglas Carswell

Democratic Unionist Party (8)

Gregory Campbell (Londonderry East), Nigel Dodds (Belfast North), Jeffrey Donaldson (Lagan Valley), Ian Paisley (Antrim North), Gavin Robinson (Belfast East), Jim Shannon (Strangford), David Simpson (Upper Bann) and Sammy Wilson (Antrim East).

SDLP (3)

Mark Durkan (Foyle), Dr Alasdair McDonnell (Belfast South) and Margaret Ritchie (Down South), one from the UUP, Tom Elliott (Fermanagh & South Tyrone)

Independent 

Lady Syvia Hermon (Down North). 

Labour's Rupa Huq (Ealing Central and Acton) is excluded after voting in both lobbies.  

Four easy ways to oppose the Marris Bill on assisted suicide

On Friday 11 September, MPs will vote on the Assisted Dying (No.2) Bill which aims to allow doctors to prescribe lethal drugs to mentally competent adults with a terminal illness.

It's a Private Members' Bill tabled by Labour's Rob Marris MP, with the support of campaign group Dignity in Dying (formerly the Voluntary Euthanasia Society). 

Here are four easy things you can do to oppose the bill ahead of Friday's vote in Parliament.

Read, Act, Pray and Go!  

Read - CMF and the Care Not Killing Alliance have produced a number of excellent reading materials to inform your arguments against the bill. Read this CMF Blog on why the current law is not 'broken' and doesn't need 'fixing'. Also read this useful guide on the bill.  

Act - Social media is becoming increasingly powerful as a tool to influence public opinion. If you're on Facebook would you share this post on your networks? Also if you're on Twitter please Retweet this Tweet. Together, our voice is stronger.

Pray - Please pray ahead of and during the vote that God's will would be done and that vulnerable human lives would be protected.

Go - If you are free this Friday please join us for a rally in Old Palace Yard (adjacent to Parliament Square), whilst the bill is being debated, beginning at 8.30am. All details here.  

‘Speak up for those who cannot speak for themselves’ (Proverbs 31:8).

Doctors writing in the Guardian in support of assisted suicide are the ‘usual suspects’ and do not speak for the wider medical profession

The Guardian has today published a letter from 27 doctors and two nurses – along with a commentary - in favour of Rob Marris’ Assisted Dying (No 2) Bill, which receives its second reading in the House of Commons this coming Friday 11 September.

Marris wants to make it legal for mentally competent adults with less than six months left to live to commit suicide using lethal drugs prescribed by a doctor.

The Guardian acknowledges that the letter was put together by Jacky Davis, an NHS radiologist and chair of Healthcare Professionals for Assisted Dying (HPAD), part of the Campaign Group ‘Dignity in Dying’ (DID) (more on HPAD here). 

Closer scrutiny shows that this is indeed a letter from the ‘usual suspects’. Amongst the 29 signatories there are:

•         five present or past officers of HPAD (see here and here)
•          twelve publicly listed HPAD supporters (see here and here)
•         two more DiD-linked (see here)

The views of this tiny group of well-known assisted suicide advocates, affiliated to the former Voluntary Euthanasia Society (now DID), are well out of step with the profession at large and every disability rights organisation in the UK.

The vast majority of UK doctors are opposed to legalising all forms euthanasia along with the British Medical Association, the Royal College of Physicians, the Royal College of General Practitioners, the Association for Palliative Medicine and the British Geriatric Society.

Those closest to dying patients are most strongly opposed because they both understand patient vulnerability and know how to manage symptoms at the end of life (and so do not feel the pressure to resort to killing people they don’t know how to treat).

Last month a group of 80 doctors, mainly engaged with end of life care, wrote to MPs urging them to reject the Marris proposals and arguing that 'assisting suicide runs counter to our duty of care'.

This was further underlined by three letters (scroll down from here) from experts in palliative medicine, published alongside the DID letter today, but not otherwise highlighted by the Guardian.

Baroness Ilora Finlay, Professor of Palliative Medicine in Cardiff, and joint chair of Living and Dying Well, writes:

‘Having been involved in the care of thousands of dying patients, I know that open conversations and good palliative care can transform life for the terminally ill. Sadly, bad deaths… still occur, but it is often a case of “we know what to do but just aren’t doing it”. Legalising assisted suicide would do nothing to improve the care of the dying. It suggests hopelessness and that they should contemplate suicide. This is not a message for the medical profession to endorse.’

In a similar vein, Robert Twycross, Emeritus clinical reader in palliative medicine, Oxford University argues:

‘…90% of palliative care doctors are opposed to the Marris assisted dying bill. From everyday clinical experience, we know that more people will be harmed than helped by legalising assisted suicide for the terminally ill…One of the most supportive responses to the patient who asks for “an injection to finish me off” is for the doctor to reply along the lines of, “I can’t do that – for one thing, it’s against the law. But, tell me, what made you say that?” This gives the patient the opportunity to express his distress and his fears. The conversation would conclude along the lines of, “This is what I suggest we do… And we can come back to the question of an injection to finish you off in a couple of weeks.” When challenged after this time, the patient invariably says, “I don’t feel like that any more.”’

These sentiments are echoed by Dr Kathryn Mannix, another Consultant in palliative medicine:

‘My experience of in-depth discussion with around 14,000 dying people over 30 years is that most deaths are gentle; that although people ask about “help to die” early in their illness, requests for earlier death are vanishingly rare as dying approaches; and that becoming ill enough to die makes even the strongest-minded vulnerable to fear of becoming a burden on their loved ones. Sadly, we also see occasional loveless families where coercion to “die sooner” would certainly occur should the law allow it.

Similar experience explains why those disciplines of medicine most familiar with patients’ experience at the very end of life are those most opposed to a change in the law. This includes palliative medicine, geriatric specialists and GPs. Is this because we are all religious zealots? No. It is because we recognise that the need to accelerate death as a means to end suffering is almost never required, and that the number of people who would be vulnerable to requesting unwanted assisted suicide as an act of generosity to their loved ones is considerable.’

When MPs vote later this week they should take seriously the views of those doctors closest to the dying patient and not be swayed by a group of largely retired activists who do not represent the wider medical profession. 

Recent cuts in proven cancer drugs will steer people toward assisted suicide if Marris Bill passes

The news broke last week that more than 5,000 cancer patients will be denied life-extending drugs under plans which charities say are a ‘dreadful’ step backwards for the NHS.

If, in addition, assisted suicide is legalised in Britain - and Rob Marris’s Assisted Dying (No 2) Bill is to be debated this coming Friday – then it would also leave vulnerable cancer patients being steered toward suicide as a cheaper ‘treatment option’.

The Cancer Drugs Fund was launched in 2011, following a manifesto pledge by David Cameron, who said patients should no longer be denied drugs on cost grounds.

Since its launch four years ago it has benefitted more than 50,000 patients, who received treatment which NHS rationing bodies had refused to pay for.

But now the fund’s budget is massively overspent.

Health officials have just announced sweeping restrictions on treatment, which will mean patients with breast, bowel, skin and pancreatic cancer will no longer be able to receive drugs funded by the NHS.

In total, 17 cancer drugs for 25 different indications will no longer be paid for in future.

The decision means that in total, two thirds of all treatments which were paid for by the scheme will no longer be paid for by the NHS.

Drugs which will no longer be funded include Kadcyla for advanced breast cancer, Avastin for many bowel and breast cancer patients, Revlimid and Imnovid for multiple myeloma, and Abraxane, the first treatment for pancreatic cancer in 17 years.

Note that these are drugs with proven therapeutic effectiveness.

Mark Flannagan, Chief Executive of the charity Beating Bowel Cancer, said: ’Nothing has changed in terms of the clinical effectiveness of these treatments. They remain as clinically effective now as they were when they were added to the list of funded drugs.’

There is also a much darker side to this move as we learn from the experience of the US state of Oregon, where assisted suicide was legalised in 1997.

Barbara Wagner (pictured) had recurrent lung cancer and Randy Stroup had prostate cancer. Both were on Medicaid, the state’s health insurance plan for the poor that, like some NHS services, is rationed.

The state denied both treatment, but told them it would pay for their assisted suicide, although they had not even considered the latter and did not ask for it.

‘It dropped my chin to the floor,’ Stroup told the media. ‘[How could they] not pay for medication that would help my life, and yet offer to pay to end my life? ’(Wagner eventually received free medication from the drug manufacturer. She has since died. The denial of chemotherapy to Stroup was reversed on appeal after his story hit the media.)

Despite Wagner and Stroup’s cases, advocates continue to insist that Oregon proves assisted suicide can be legalised with no abuses. But the more one learns about the actual experience, the shakier such assurances become.

If AS were to be legalised in the UK end-of-life care would be likely to worsen under financial pressures because it costs on average £3,000 to £4,000 a week to provide in-patient hospice care, but just pounds to pay for the drugs which would help a person commit suicide.

Cancer treatments like chemotherapy, radiotherapy or surgery cost much more. Do we really wish to place that temptation before families, NHS managers and Health Secretaries in cash-strapped Britain?

Because if we pass this law this is exactly what will happen. Assisted suicide will be costed just like any other ‘treatment’ and will be assessed alongside other ‘options’ for ‘cost-effectiveness’. And vulnerable cancer patients will be steered toward suicide. 

Doctors will then be left in the terrible position of having to present assisted suicide as an affordable ‘treatment option’. 

‘I’m afraid you have breast cancer. There is a drug called Kadcyla, which we used to prescribe to around 800 women a year. It has been shown to extend life by an average of six months, with fewer side effectives than any alternatives. But this drug is sadly no longer funded. We can however pay for your assisted suicide as it is so much cheaper.’

This is just one of the consequences of legalising assisted suicide.

You will find much more information on why we should not change the law in a new paper published this week by Care Not Killing: ‘Don’t Make Oregon’s mistake: Ten reasons why England and Wales should not follow suit and legalise assisted suicide’.

Three new worrying conscience cases – Christians must be prepared to pay the price for obeying God in the face of legal threats

There were three interesting stories this week involving people getting into trouble for exercising freedom of conscience.

The striking thing was that each of these occurred in supposedly democratic countries which pride themselves in upholding human rights – Canada, France and the United States.

In the first the Canadian Medical Association (CMA) voted to reject a motion to protect the conscience rights of physicians who refuse to refer patients to die by euthanasia. This requirement is not yet law but the lack of support for conscience rights from the doctors’ own representative body does not bode well.

The second case involved a French Muslim registrar who was sent to court for refusing to perform a same-sex marriage. The Marseille penal tribunal will render its judgment on 29 September. The maximum penalty for a registrar who illegally refuses to give access to a legal right is a 75,000-euro fine and 5 years' imprisonment.

In the third case a Kentucky county clerk has already been jailed for refusing to give marriage licenses to same-sex couples.

I tweeted about all three of these cases yesterday. The two tweets involving same sex marriage generated the most response and three people came back to me suggesting that custodial sentences were justified for conscientious objectors.

I’ve pasted their tweets below. Interestingly all three were doctors. I found their open hostility quite revealing – a sign of things to come perhaps. I also wondered how they themselves might react if forced to do something they considered morally wrong.

The Bibles teaches that God institutes human authorities and expects us to obey them:

‘Let everyone be subject to the governing authorities, for there is no authority except that which God has established. The authorities that exist have been established by God.  Consequently, whoever rebels against the authority is rebelling against what God has instituted, and those who do so will bring judgment on themselves.’ (Romans 13:1,2)

But Scripture is equally clear that if laws which discriminate against Christians are passed, and obeying such laws involves disobeying God, then there is a place for civil disobedience. In fact when we are forced to do something wrong it is a Christian duty.

When the King of Egypt ordered the Hebrew midwives to kill all male Hebrew children they refused to do so and God commended and rewarded them. (Exodus 1:15-22)

Rahab the harlot similarly refused to co-operate with the king of Jericho in handing over the innocent Israelite spies and was later praised for her faith.( Joshua 2:1-14)

Even death threats did not stop Shadrach, Meshach and Abednego refusing to bow down to the image of the king or Daniel persisting with public prayer.( Daniel 4:6-8, 6:1-10)

When Peter and John were commanded by the Jewish authorities not to preach the Gospel they replied, 'We must obey God rather than men' and continued to do it.(Acts 5:29)

So whilst recognising that we have an obligation to obey the governing authorities God has instituted, nonetheless our obedience to God himself takes precedence if the law of the land requires us to disobey him.

Of course we should do our best to oppose the passing of laws which seek to criminalise normal Christian behaviour. And if their passing looks inevitable we should seek for reasonable accommodation to be made. The Abortion Act and Human Fertilisation and Embryology Act, for example, both contain conscience clauses protecting those with a moral objection to the activities they legalise from being forced to be involved.

But we may not be successful, so in such circumstances we also need to be willing to count the cost and to pay the price for being faithful to God in the face of threats.

The long list of heroes of faith in Hebrews 11 contains those who were delivered from the legal consequences of civil disobedience but also those who paid the price.

And paying the price through facing discipline, dismissal, a fine, imprisonment or even execution may be what God requires us to do in similar circumstances.

In all this we have the confidence that we follow in the footsteps of a Saviour, who in facing everything the greatest Empire on earth could throw at him, willingly carried the cross and emerged ultimately victorious.

'Blessed are those who are persecuted because of righteousness, for theirs is the kingdom of heaven. Blessed are you when people insult you, persecute you and falsely say all kinds of evil against you because of me. Rejoice and be glad, because great is your reward in heaven, for in the same way they persecuted the prophets who were before you.'(Matthew 5:10-12)