Monday 13 March 2017

Diana Johnson’s radical abortion bill narrowly passes first hurdle but is unlikely to become law

You can listen to my Premier Radio interview on this bill here.

Today, Monday 13 March 2017, Diana Johnson’s radical Reproductive Health (Access to Terminations) Bill, which seeks to remove all legal restrictions on abortion, passed narrowly by 172 votes 142.

As this was a Ten Minute Rule Bill it is very unlikely that it will be given further time by the Government to be debated in Parliament. It is even less likely that it will become law.

In theory, Johnson’s bill would make the 1967 Abortion Act defunct by scrapping section 58 and 59 of the Offences Against the Person Act, which make carrying out abortions, or supplying drugs or equipment for that purpose, illegal.

Johnson implied that the 1929 Infant Life (Preservation) Act, which makes it illegal to destroy a child capable of being born alive, may also be scrapped under her plans. If so this would make abortion legal for any and every reason right up to term.

Johnson’s Bill is primarily backed by private abortion provider BPAS. The decriminalisation campaign specifically acknowledges that they are campaigning for a situation that would remove all gestational time limits for abortion. This position was affirmed by BPAS CEO, Ann Furedi, who said at the London launch of the campaign, ‘I want to be very, very clear and blunt... there should be no legal upper limit.’

If the motion were to become law, abortions could be carried out legally in any location, for any reason, potentially at any stage during pregnancy. Without legislation on abortion, practices such as sex-selective abortions, mail-order abortions and school nurses handing out abortions pills on school premises would all be perfectly legal. The conscience clause would also fall, meaning that health professionals might be forced to carry out abortions or lose their licenses to practise.

Last year the Royal College of Midwives support for the BPAS’ abortion up-to-birth campaign caused widespread condemnation from midwives, the media and the general public against this extreme proposal. Over 1,000 midwives have now signed the open letter asking for RCM position to be revoked.

The bill comes at a time where the private abortion industry is knee-deep in scandal and revelations of unethical, unsafe and unprofessional practices.

Last year, the Care Quality Commission had to step in to protect women from potential harm at Marie Stopes abortion clinics. Their subsequent report showed that women were left at risk of infection, doctors were going home with women under sedation, fetal tissue from a succession of terminations left in open waste bins, staff were not trained in how to respond to help deteriorating patients, 2,600 serious incidents were reported at the clinics and post-surgery safety checks were completed before the surgery had even started.

MP Maria Caulfield, who spoke in opposition to the bill, pointed out that its extreme position is in direct conflict with what the majority of British women want with regard to the UK abortion law.
One 2011 YouGov poll showed that 88% of women in the UK either want to keep the current law and time limit as it is, or restrict it further. This contrasts with the 2% of women who wanted to see an increase in the abortion time limit beyond 24 weeks.

Conservative MP for Lewes, Maria Caulfield, speaking in the debate said:

‘This Bill would not protect women. Instead it would embolden those men who pressurise women into abortions they do not wish to have; whether it is a controlling relationship, or the wider communal discrimination and pressure that tells a woman she must abort her child because it is a girl, or because it has Down’s Syndrome or disabilities. This Bill would make those women more vulnerable...

Indeed, by undermining all the safeguards and regulations around abortion... the Bill becomes a charter for extreme abortion practices, such as sex-selective abortion...

This Bill is a response to a non-existent threat; it would exacerbate the dangers posed by any increase in the availability of abortion pills; and it would remove some of the few protections and regulations in abortion law – fuelling unethical and unsafe practices in many UK abortion clinics, and leaving women less safe and less informed.’

Most people aren’t aware that abortion is still illegal in Britain. But what the 1967 Abortion Act did was to provide legal protection to doctors carrying it out only in certain limited circumstances.

However, the current law has been widely flouted and has resulted in 200,000 abortions per year in Britain and over 8 million since the act was passed.

Currently one in every five pregnancies ends in abortion and abortion is legal right up to birth for disabled babies.

Were Johnson’s bill, or another similar one, eventually to pass this already bad situation would worsen even further.

It is chilling that so many MPs supported a bill that removes all legal protection from these most vulnerable of all human beings. 

But this is Britain in the 21st century and we need to wake up to reality.

Today’s events have shown that the price of freedom and protection for unborn children in this country is eternal vigilance. 

Elijah’s mental meltdown and what it teaches us about God

I gave the following talk at the CMF Cambridge Day conference (an event for Christian doctors and lawyers) on Saturday 11 March 2017. The talk is based on the prophet Elijah’s mental meltdown as described in 1 Kings 19:1-18.

I wonder what some of your more stressful experiences have been -  for me a few stand out.

Being rescued by helicopter in the Scottish Highlands last summer attempting to scale a (relatively minor) Munro

Being rescued by police launch off the Coromandel coast in New Zealand after a capsize on a Scripture Union leaders canoe trip.

Rolling my mother’s car down a bank a few days later on the same trip with four people on board.

I’m not sure what was more stressful - anticipating major injury and/or death as the car turned or having to break the news about the state of the car to my mother afterwards.

Or maybe it was taking a young man with a ruptured spleen, following a renal biopsy that had gone wrong, over the Auckland Harbour Bridge in gridlocked rush-hour traffic as he slowly bled out in the back of an ambulance.

What made that one particularly stressful was that he was the son of one of my former bosses. Thankfully, he also was saved.

Well, I’m sure we can trade stories over coffee later.

But for me the common thread in all these experiences was that the stressful situation was completely beyond my control and power to rectify but also that I felt deeply responsible even if not all of these incidents were entirely my own fault.

We do have this expectation that Christians under great stress will sail through difficult circumstances without ruffling their feathers, and certainly without “losing it”.

We know that we are “not to be anxious about anything”, but rather experience “the peace of God that passes understanding” in all circumstances. And we can be very hard on ourselves when events push us beyond the limit.

I don’t know about you, but I derive huge comfort from the fact that some of the greatest heroes of faith were tested apparently way beyond their ability to endure and did actually “lose it”. And in those situations they said some quite extraordinary things about the Lord and even to the Lord.

Consider some of these:

‘We were under great pressure, far beyond our ability to endure, so that we despaired of life.’ (2 Corinthians 1:8) – the apostle Paul

‘The word of the Lord has brought me insult and reproach day-long... Why did I ever come out of the womb to see trouble and sorrow and to end my days in shame?’ (Jeremiah 20:8, 18) – the prophet Jeremiah

‘I cannot carry all these people by myself; the burden is too heavy for me. If this is how you are going to treat me, put me to death right now.’ (Numbers 11:14,15) – the prophet Moses

‘All was well with me, but he shattered me: he seized me by the neck and crushed me.’ (Job 16:12) – Job

‘Save me, O God, for the waters have come up to my neck. I sink in the miry depths, with there is no foothold.’ (Psalm 69:1,2) – King David

‘We were harassed at every turn - conflicts on the outside, fears within.’ (2 Corinthians 7:5) – the apostle Paul

‘I have laboured to no purpose; I’ve spent my strength and for nothing.’ (Isaiah 49:4) – the prophet Isaiah

The last of these is particularly striking as it comes from the first of Isaiah’s four ‘Servant Songs’ which look forward to the coming of Christ. So the very clear implication is that Jesus himself would feel this too.

So it shouldn’t surprise us to see that the Bible has quite a lot to say about stress.

We might attack this subject biblically in a variety of ways. But I want today to focus on one character who faced an unbelievable amount of stress and came through it with God’s help.

I’ve chosen Elijah for several reasons.

First, because he was a remarkable man of God who suffered extraordinary pressure. Alongside Moses, he was arguably the greatest prophet of the Old Testament. It’s telling that he appears with Moses at Christ’s transfiguration and that John the Baptist is described as “the Elijah who was to come”.

Second, because of the obvious similarities between the role of the Prophet and the role of a doctor or lawyer. Like a prophet, doctors and lawyers have privileged information, special powers and high accountability for the way that we use them.

Third, because the time Elijah lived was remarkably similar to ours. There was widespread unbelief, apostasy, immorality and very little tolerance of genuine believers.

Finally, James tells us that he was “a man just like us”.

The passage we have just heard read is set in one of the darkest times of Israel’s history. The northern kingdom is under the rule of King Ahab, the son of Omri, who had seized power in a military coup. 

Ahab’s wife, Jezebel, was a Sidonian Princess who had introduced Baal worship and attempted to kill off all the Lord’s prophets. Obadiah, who was in charge of Ahab’s palace, had managed to hide a hundred prophets in caves. But Elijah had sought refuge in the wilderness.

Under God’s instruction, he had returned to confront Ahab and had called 450 prophets of Baal to meet him on Mount Carmel where he arranged a contest to demonstrate whose God was more powerful.

The prophets of Baal had sacrificed a bull, and in response to Elijah’s challenge had called on their God to answer with fire, but to no avail.

When Elijah sacrificed a bull on a second altar and called upon Jehovah, he answered with fire which not only burned up the sacrifice, the wood the stones and the soil, but also licked up water from a trench which Elijah had dug around it to make the task that much harder.

It was a stupendous result and Elijah had then taken the 450 prophets of Baal down to the Kishon River and slaughtered them there. His prayers then brought a three-year drought to a rapid end.

Jezebel, not surprisingly, was none too pleased and when she breathed death threats against Elijah he was afraid and ran for his life, as we have just read in the passage from 1 Kings 19.

In considering this passage I want to look at the specific stressors that Elijah faced, the clinical features of his meltdown, the positive aspects of his response and God’s prescription for his recovery.

So first, the specific stressors that Elijah faced:

The first stressor was internal: Elijah’s own determination to be faithful to the Lord. Had he chosen to escape, migrate, remain silent or otherwise just keep his head down he could have saved himself a huge amount of trouble. But as he says in verse 10 and 14, “I have been zealous for the Lord Almighty”. And he most certainly had been.

It was true that he had confronted the king on more than one occasion, obeyed the Lord in praying for drought, tended to the widow of Zarephath at a time when he himself was under attack, and finally taken on 450 prophets in a fight to the death. How often do we avoid potentially difficult or embarrassing situations through small compromises and subtle denials of Christ, perhaps by telling ourselves that this is neither the time nor the place to speak out. Elijah was determined to be faithful no matter what.

The second stressor was the rejection of God’s laws. “The Israelites have rejected your covenant”, he said. He confronts Ahab in 18:18: “you have abandoned the Lord’s commands and have followed the Baals”. The false religion that Elijah confronted had three major features: sexual immorality, the shedding of innocent blood and the undermining of civil liberties. These were the three characteristics of all Canaanite religion, but they are also the features of almost every ideology which seeks to dethrone the God of the Bible: Nazism, Stalinism, Maoism, paganism but also interestingly secular humanism: sexual immorality, the shedding of innocent blood (abortion on an industrial scale) and the undermining of Christian civil liberties.

The third stressor was the divorce of public worship from public life. They have “broken down your altars” says Elijah to the Lord. Those Israelites who had compromised with Baal worship had mixed in its idolatrous elements with their worship of Yahweh. In 2 Kings 17:40,41 we read God’s final verdict on the northern kingdom after its destruction by the Assyrians. “Even while these people were worshipping the Lord, they were serving their idols.”  They had, in Paul’s words to Timothy, “a form of godliness but denying its power”. Or in the words of Isaiah, they spread out their hands in prayer, but their hands were full of blood.

The fourth stressor was the suppression of truth. The prophets were put to death. They were silenced. Similarly, in our own society we are seeing an increasing level of hostility to Christian faith and values with Christian believers being gagged in the name of this suffocating political correctness. The recent case of Mike Overd, who was convicted simply for reading the Bible in the course of street preaching, is a case in point. Astounding that the Archdeacon of Oxford could call in response for a ban on street preaching. In Britain! Among Overd’s alleged indiscretions were claiming that Jesus was the only way to God and that sexual acts outside lifelong heterosexual marriage were morally wrong.

Next was the scarcity of obvious believers, such that Elijah could say “I am the only one left”. This was no delusion but simply what he experienced. He confronted Ahab alone and he met the prophets of Baal alone. He did not know about the hundred prophets of Jehovah that Obadiah had hidden, nor of the 7000 who had not bowed the knee to Baal. Part of the cost of being faithful to God in a society such as ours, is that we will find ourselves not infrequently in a minority of one. And this pressure will be faced at all ages. A good friend was telling me the other day of his seven-year-old grandson coming home from school after a lesson on “transgender” and saying that he was the only Christian boy in his class of 30.

Finally, was the stressor of discrimination against practising believers: ostracism, misunderstanding, loss of reputation, job, career, freedom of speech, freedom of assembly, freedom of movement and ultimately loss of life.

So, these were some of the stressors that Elijah faced, all of which we face in some measure in post-Christian Britain today.

So what were the clinical features of Elijah’s meltdown?

Fear - He was afraid of what might happen to him and went into hiding.

Withdrawal - He sought to avoid any further confrontation.

Lack of energy - He was physically and emotionally exhausted.

Despite his great success, he entertained suicidal thoughts: “take my life; I’m no better than my ancestors”.

He was selective in his memory. We see him concentrating on all the things that have gone wrong: “they have rejected your covenant, broken down your altars, and put your profits to death with the sword. I am the only one left, and now they are trying to kill me too.”

No apparent recollection here of God’s extraordinary faithfulness to him in so many ways over the previous few years: fed by ravens, manufacturing oil from nothing for a widow who couldn’t pay her debts, raising her child from the dead, causing and then dramatically ending a three-year drought, and then that amazing victory over the prophets of Baal.

Fear, withdrawal, physical and mental exhaustion, selective memory and desire for it all to end.

Psychiatrists will argue about whether this was a case of burnout or just an acute stress reaction, and I’ll leave that to the experts to unpack later. But certainly Elijah had been subject to heavy prolonged stress and this was a major meltdown.

So what were the strengths of Elijah’s response?

It is striking that through all of this he kept communicating with God. It wasn’t “I’ve had enough, I’m ending my life, goodbye cruel world”. It was rather “I have had enough, Lord. Take my life; I’m no better than my ancestors.” He even recognised that he could not commit suicide, that his only hope of death was if God intervened to take his life. We see this open, honest communication with God throughout Scripture in great men and women of God: the Psalms of David, Jeremiah’s self-destruct passage we quoted from earlier, Moses’ total meltdown in the face of overwhelming responsibility. None of them hide their feelings from God or toward God. Rather they are in constant communication with him through it all.

Note also that even in the midst of it Elijah is remembering God’s promises. It is striking that the two places he visits during his flight - Beersheba and Horeb - are places of God’s revelation. He wants to hear God’s voice. He is seeking a message and a refilling with God’s power. Beersheba was where God appeared to Isaac and declared “I am the God of your father Abraham. Do not be afraid, for I am with you. I will bless you.” It was in exactly the same place, Beersheba, that God spoke to Jacob: “I am God, the God of your father. Do not be afraid to go down to Egypt. I will go down with you.”

Horeb was of course where Moses received the then Commandments. Do we, and at times of greatest need return to God’s promises, remember his past faithfulness to us, and seek his voice afresh?

Note also, that Elijah willingly submits to God’s scrutiny: “what are you doing here, Elijah?” The Lord specialises in questions that cut right to the heart. From the earliest pages of Genesis we see this: “Who told you that you were naked?” “Have you eaten from the tree from which I commanded you not to eat?” “Where is your brother?” He questions Job after his trials for three whole chapters? 

And of course Jesus did much of this teaching through asking searching questions. David submits to God’s Psalm 139: “Search me, O God, and know my heart; test me and know my anxious thoughts. See if there is any offensive way in me, and lead me in the way everlasting.”

It is one thing to desire God’s help. It can be quite another actually to let him search us in order to help us.

Finally, what was God’s prescription for Elijah?

We don’t find any trace of rebuke, condemnation or instructions to pull himself together. God’s response is gentle, measured and sequential.

It is at first, entirely practical and simple: food, rest and solitude. He ministers to Elijah’s physical needs. Lack of food and rest can distort one’s perception of reality and impair one’s ability to cope. One of the first lessons I learnt as a junior doctor on call was to make sure, even on a busy take, that I made time to eat. One of the first statements in the Lord’s prayer is “give us this day our daily bread”. One of my favourite verses for busy doctors is Luke 5:16: “the news about him spread all the more, so that crowds of people came to hear him and to be healed of their sicknesses. But Jesus often withdrew to lonely places and prayed.” Food, rest and solitude.

Next, God urged reflection: he twice asks in different locations, “what are you doing here, Elijah?” (v9 and 13) The question on each occasion elicits the same response: “I have been very zealous for the Lord God Almighty. The Israelites have rejected your covenant, broken down your altars, and put your prophets to death with the sword. I am the only one left, and now they are trying to kill me too.” In answering the questions, Elijah is prompted to remind himself that he’s in this situation precisely because he was trying to be faithful to God, and also to remind himself that he had, in fact, faced extraordinary trials. In so reminding himself he is beginning to understand the genuine reasons for his stress, good reasons. He comes to see that his stress is completely understandable and appropriate. God urged reflection.

Next, God reminds him of his power. Elijah had to some extent forgotten who he was working for and what he had already been used to do. These reminders are dramatic. We see a great and powerful wind tearing the mountains apart and shattering the rocks. Then an earthquake. Then the fire. Then a gentle whisper. Then more questions. Elijah is beginning to know again the peace that passes understanding. To be still and know that God is God.

But God is not finished with him yet. Next comes his recommissioning in verse 15: “go back the way you came, and go to the desert of Damascus. When you get there anoint Hazael king over Aram. Anoint Jehu son of Nimshi king over Israel, and anoint Elisha son of Shaphat from Abel Meholah to succeed you as prophet”. It is striking that these tasks all involve the equipping of others, because although Elijah was used mightily to start the fightback against Baal-inspired apostasy it was a task that could only be fully accomplished with the help of others.

It’s somewhat ironic that Elijah only anointed the last of these three - Elisha. Perhaps, he already had an inkling of the extraordinary destruction against his own people that both Hazael and Jehu would unleash. We are not told but we do learn in the subsequent chapters that some of Elijah’s greatest work is yet to come. God had not finished with him. Rather, he was learning like the Apostle Paul that “God’s strength is made perfect in weakness”, that God “comforts us in our distress so that we might in turn comfort others” and that “these things happen that we might rely not on ourselves but on God who raises the dead”.

Every man and woman of God who is used mightily needs preparation in the crucible of trial. Even the Lord Jesus, we are told, “learned obedience through what he suffered”. Not that he was ever disobedient, but rather that his trials prepared him ultimately for the cross that won our salvation, and that in the midst of them he was sustained by that “joy that was set before him”. In small measure, Elijah’s suffering was to aid the salvation of a chosen remnant.

Which brings us to the next element of God’s prescription: reinforcements. Although Elijah had faced Ahab, Jezebel and the prophets of Baal alone, he was not actually alone. There were 7000 others who had not bowed the knee to Baal, who had not compromised and who would ultimately stand alongside him and be that faithful remnant who God would use in coming days.

It’s a reminder for us that however alone and isolated we may feel in the battles we face, that a multitude of Christian brothers and sisters too great for anyone to count is being kept similarly faithful in their small corners of the vineyard all around the world. And that one day we will stand with all of them drawn from throughout the ages before the throne of Christ.

Finally, Elijah is reminded of God’s sovereignty. It is the Lord who is in control of this great drama working it all out to a glorious conclusion. Because Elijah, one of the greatest prophets who ever lived, points forward to that “Elijah who was to come”, John the Baptist. Just as Elijah was to point out and introduce to the world Elisha who would follow him and surpass him, so John the Baptist would point Jesus out to his disciples and declare “I must decrease and he must increase “.

Because, Elijah would stand with Moses on the Mount of Transfiguration witnessing to Peter, James and John just who Jesus was. And Elijah, like all of us, would ultimately join in Christ’s victory procession at the end of the age through the shedding of Christ’s blood and the power of his glorious resurrection.

So, I hope this short reflection on a life of faith once lived in the face of extraordinary pressure will serve as encouragement to us as we begin this day on “burnout or resilience”.

That we will bear in the mind, in the light of the stresses that we face as believers today, the need to keep communication open with God, to remember his promises and past faithfulness and to submit to his searching questions.

That we will seek wisely to ensure that our physical needs of food, sleep and solitude are met.

That we take time out regularly.

That we reflect on the reasons for our stress.

That we are reminded of God’s extraordinary power made perfect in weakness.

That we are ready to be recommissioned once filled afresh with his spirit.

That we seek to involve others and share our load.

And finally that we never forget that God is utterly sovereign, completely in control and working all things both for our good, and toward a glorious and certain conclusion.

Monday 6 March 2017

Increasing survival of extremely premature babies again raises questions about upper abortion limits

The increasing survival of extremely premature babies is again raising serious questions about the 24 week upper limit for social abortion.

Tonight, 6 March, Inside Out on BBC One in the East Midlands related how new treatments - including some trialled in Nottingham and Leicester - are helping to limit disabilities and boost life expectancy in premature babies weighing as little as one pound (450g).

Last week, under the headline “extremely premature baby saved by groundbreaking NHS surgical team”, the Guardian reported on the astounding case of Abiageal Peters who last year became the youngest baby ever to survive major abdominal surgery.

Abiageal was born three months premature in October 2016 at St Peter’s hospital, Chertsey after a gestation of only 23 weeks.

Her parents were warned at her birth that she had very little chance of surviving a severe gut condition known as perforated necrotising enterocolitis.

But thanks to the surgical team led by consultant Zahid Mukhta, Abiageal made an extraordinary recovery. ‘Any patient that comes into our system gets the best we can do for them’, Mukhta said.

Yesterday, the Sunday Times (£) reported that survival rates for babies born at 23 weeks’ gestation are now so high that up to 70% are being saved at some hospitals:

At University College London Hospitals, one of Britain’s leading trusts, the figures show that in the past five years, 22 out of 30 babies born after 23 weeks in the womb survived, according to new figures obtained under Freedom of Information laws.

At Leeds Teaching Hospitals NHS Trust, 16 out of 25 babies born at 23 weeks between 2011 and 2016 survived, and at East Kent Hospitals University NHS Foundation Trust, 9 of the 18 babies born at 23 weeks between 2012 and 2016 survived.

These figures are strongly at odds with those from the last national study, Epicure 2, which looked at babies born in 2006, and found survival of babies at 23 weeks of just 19%.

The best survival rates, not surprisingly, come from centres with expert levels of neonatal intensive care, but lower survivals elsewhere are nonetheless something of a self-fulfilling prophecy.

Although there has been no comparable national study since Epicure 2 to assess how survival rates are improving, many units are still being guided in their treatment decisions by these antiquated figures.

Lower survival of premature babies in some parts of the country is not surprising when, backed by the RCOG and BMA,  neonatal units apply blanket rulings on resuscitation based on a simplistic assessment of gestational age – which is often inaccurate – and fail to treat each baby as an individual in her or his own right.

This means effectively that that some babies that could be saved are dying from neglect.

There is an excellent article on this in the CMF journal Triple Helix by Professor John Wyatt which makes these points in greater detail.

These latest figures from centres of excellence demonstrate dramatically what can be achieved with a proactive approach and skilled staff and they highlight an unacceptable postcode lottery of care.

Every extremely pre-term baby deserves the chance to be considered for treatment and, even if curative treatment is not possible, to be given the best possible palliative care.

If there is a realistic chance that a particular baby can survive without overwhelming and catastrophic injury, then surely as a wealthy country we owe it to each child to give them a chance of life.

In this situation it is best to start ‘provisional intensive care’, giving the baby the initial benefit of the doubt, and taking each day as it comes.

But these latest figures will also fuel calls for the Abortion Act upper limit for able-bodied babies of 24 weeks to be revised (abortion is of course currently legal up until full term (40 weeks) for disabled babies, a situation which Lord Shinkwin is currently attempting to change with his abortion (disability equality) bill).

It is utterly incongruous that on the one hand we are aborting babies at a gestation when others are surviving with good neonatal care. Abortion at this gestation is tantamount to infanticide.

When this issue was last debated in Parliament, in 2008, MPs voted by a narrow margin not to lower the upper limit from 24 weeks to either 20 or 22 weeks. I argued back then (and again here) that it was time for change. 

But since this time survival rates have improved yet further and the composition of Parliament has also changed. At the last vote Labour government MPs were informally whipped to vote against any lowering of limits.

Were the issue to be revisited now there’s a good chance of a very different result.

A lowering of the upper abortion limit to 20 weeks would save more than 3,000 babies a year.

That may be a small start when we consider that there are around 200,000 abortions a year in Britain. However, for those 3,000 it would represent every difference in the world.

Ultimately each society will be judged on the basis of how it treats its weakest members. Neonatal centres of excellence in Britain are already demonstrating how worthwhile it is to make sacrifices for these most vulnerable of human beings.

Nearly two thirds of the public and more than three-quarters of women support a reduction in the 24-week upper age limit. 

76% of the public think that aborting a baby at six months is cruel. Furthermore, a 2007 poll by Marie Stopes International found that two thirds of GPs wanted a reduction from 24 weeks (more similar figures here). 

It’s time now for Parliament again to ask serious questions about late abortion.

Sunday 5 March 2017

My speech to the New Zealand Parliament Health Select Committee on Assisted Suicide

I have just given oral evidence on behalf of Care Not Killing to the New Zealand Parliament’s Health Select Committee on assisted suicide.

The committee has received a petition requesting, ‘That the House of Representatives investigate fully public attitudes towards the introduction of legislation which would permit medically-assisted dying in the event of a terminal illness or an irreversible condition which makes life unbearable.’

The petition asks for a change to existing law. Therefore the committee is undertaking an investigation into ending one’s life in New Zealand focusing on four main questions:

1. The factors that contribute to the desire to end one’s life.
2. The effectiveness of services and support available to those who desire to end their own lives.
3. The attitudes of New Zealanders towards the ending of one's life and the current legal situation.
4. International experiences. The committee will seek to hear from all interested groups and individuals.

Here is what I said:

Thank you for this opportunity to give evidence to the select committee.

I represent Care Not Killing which is a UK alliance of about 40 organisations spanning healthcare, law, disability rights, education and faith groups which in turn represent several hundred thousand people. We were established in 2005 and seek to promote better palliative care and ensure that existing laws against euthanasia and assisted suicide are not weakened or repealed.

I’m a New Zealand citizen but have lived in the UK for 28 years.

I trained in medicine in Auckland and specialised in general surgery and my day job here is as the chief executive of one of CNK’s 40 member groups, the Christian Medical Fellowship, which itself has over 5,000 medically qualified members.

I’ve been campaigning against the legalisation of assisted suicide and euthanasia for 12 years during which time we’ve had 10 attempts to change the law through British Parliaments all of which have failed.

I’ve also got skin in the game. My grandfather died from an aggressive cancer with spinal secondaries with pain that was very difficult to control and my father died from a very rapidly progressive dementia, both in Auckland. I’ve just been back to NZ with my wife over Christmas to place her elderly parents, both retired doctors aged 91 and 89, with dementia and Parkinson’s respectively, into an excellent private hospital in Auckland.

So my interest is professional and political but also personal.

The most recent attempt to change the law in Britain was in September 2015, when the Marris Bill, which attempted to legalise assisted suicide for the terminally ill, was defeated in the House of Commons by a 3 to 1 margin - 330 votes to 118.

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.

A majority of both Conservative and Labour MPs voted against the bill. This is hugely significant as it signals that assisted suicide is not a simple left/right political issue here. In fact suicide prevention and protection of vulnerable people from exploitation and abuse resonate strongly with left of centre politicians because of their concern for disabled people’s groups and for those less able to access good healthcare.

Our case against the legalisation of assisted suicide and euthanasia is that it is dangerous, uncontrollable and unnecessary.

It’s dangerous because any law allowing it will inevitably place pressure on vulnerable people to end their lives in fear of being a burden upon relatives, carers or a state that is short of resources. 

Especially vulnerable are those who are elderly, disabled, sick or mentally ill. The right to die can so easily become the duty to die.

It’s uncontrollable because any law allowing it will be subject to incremental extension. We’ve seen in jurisdictions like Belgium and the Netherlands that over time you see a shift from terminal conditions to chronic conditions, from physical illnesses to mental illnesses and from adults to children.

The essential problem is that the two major arguments for euthanasia - that is, autonomy and compassion - can be applied to a very wide range of people. This means that any law which attempts to limit it, for arguments sake to mentally competent people who are terminally ill, will in time be open to challenge under equality legislation.

It is unnecessary because requests for euthanasia or assisted suicide are extremely rare when people’s physical, social, psychological and spiritual needs are adequately met. In other words, you should kill the pain not the patient. Britain was recently ranked number one in palliative care in the Economist magazine. But we still have some way to go in making this high-quality palliative care fully accessible to all.

So, in summary the best law is one like New Zealand and Britain’s current law,  that gives blanket prohibition on all assisted suicide and euthanasia. This will deter exploitation and abuse through the penalties that it holds in reserve, but at the same time give some discretion to prosecutors and judges to temper justice with mercy in hard cases. The current law has both a stern face and a kind heart and does not need changing. We have an aphorism in surgery, if it ain’t broke, don’t fix it.

Leaving the law as it is will mean that some people who desperately wish help to end their lives will not have access to such a service. But part of living in a free democratic society is that we recognise that personal autonomy is not absolute. That’s precisely why we have laws. We must not allow so-called freedoms which will at the same time undermine or endanger the reasonable freedoms of others. And one of the primary roles of government is to protect the most vulnerable even sometimes at the expense of not giving liberties to the desperate.

I wanted, finally, to make some brief comments about the four questions raised by the consultation.
First, on factors that contribute to the desire to end one’s life, we know that 90% of those who commit suicide suffer from some form of mental illness including depression, bipolar disorder, 
borderline personality disorder and alcohol and drug misuse. We know that in Oregon, in 2013 despite 26% of assisted suicide cases meeting the clinical criteria for depression, less than 3% of them had a psychiatric assessment.

But even more striking was the fact that most people making use of Oregon’s death with dignity act in 2016 - the figures came out just three weeks ago - cited existential or spiritual symptoms as their reason. 89.5% cited loss of autonomy, an identical percentage cited being less able to engage in activities making life enjoyable and 65% loss of dignity. Pain, or even concern about it, did not feature in the top five.

More worryingly 48.9% cited being a burden on family, friends or caregivers. The equivalent figure in neighbouring Washington state the year before was 52%. I would submit that it is an abuse of medicine to treat fear of the future or loss of meaning and hope with lethal injections or draughts of barbiturates. The best response to existential suffering is to do all we can to restore hope and allay fear by caring for the needs of the whole person.

Second, in terms of the effectiveness of services and support available to those who might wish to end their own lives, people contemplating death from a progressive terminal illness will understandably experience fear and anxiety and may in rare cases consider suicide.

These fears can be heightened by high-profile media cases, especially those involving celebrities – we call it suicide contagion or the Werther effect. But we know that only a very tiny minority have persistent ongoing death requests once they have experienced what proper support and good palliative care can offer. Rob George, former president of the Association for palliative medicine in Britain said that after a lifetime of managing over 20,000 dying patients, he could count on the fingers of one hand those who still wanted assisted suicide or euthanasia after receiving good palliative care.

This is why every Royal Medical College in Britain along with the British Medical Association is opposed to any change in the law. And those who are closest to the dying patient, namely geriatricians and those in palliative medicine, are most opposed for two main reasons. They know how to treat the symptoms of dying people effectively, and they understand the vulnerability of dying patients better than anyone else.

Third, with respect to the attitude of New Zealanders to change the law, in most Western countries approximately three out of four will be in favour of legalisation in opinion polls depending on how the question is framed. However, these opinions tend to be reflex rather than considered and largely uninformed about the complexities involved. Our experience in Britain has been that when legislators have been able to consider the arguments carefully they have invariably opted not to legalise.

Strikingly, when ordinary people are given the arguments against they too will change their minds. In 2014, 73% of the general public was supportive of Lord Falconer’s assisted dying bill. However, this reduced to 43% once they heard the five major arguments against it. These were:
  1. people may feel pressurised to end their life so as not to burden loved ones
  2. there’s been a steady rise in assisted suicide in places where it has been legalised
  3. end-of-life care may worsen, given its cost, as against of lethal drugs
  4. major disability rights groups oppose a change in the law
  5. the majority of doctors oppose it including the BMA and Royal College of GPs
Finally, with respect to international experiences of legalisation the frightening consequences in Belgium and the Netherlands are well-publicised and well known and played a major role in convincing British legislators. Every year, with each new report from Belgium or Holland, our job gets easier. The recent story of a female Dutch doctor drugging the coffee of a patient with dementia and then asking her family to hold her down as she fought while being given a lethal injection, is a poignant case in point.

But I want to draw your attention to what’s happening in a jurisdiction with far more modest legislation. And to this end we will send you a copy of our brochure “don’t make Oregon’s mistake” as supplementary evidence.

·        In Oregon there’s been a steady increase in annual numbers of people undergoing assisted suicide -more than 500% over 19 years.
·        The Oregon health department is funding assisted suicide but not treatment for some cancer patients
·        Patients are living for in some cases many years after having been prescribed lethal drugs showing that the eligibility criteria for terminal illness are being stretched
·        the vast majority of those choosing to kill themselves are doing so for existential reasons large rather than on the basis of real medical symptoms
·        many give “fear of being a burden on others” as the reason for ending their lives
·        fewer than one in 20 patients are being referred for formal psychiatric or psychological evaluation
·        a substantial number of patients dying under the Oregon act do not have terminal illnesses
·        some doctors know the patient for less than a week before prescribing the lethal drugs.

We would urge the New Zealand Parliament if it comes to consider legislation on this issue, not to proceed with it but rather to focus on suicide prevention and on providing better care and support.

Thank you very much for your time.