tag:blogger.com,1999:blog-26544556635198068992024-02-20T14:54:50.201-08:00Christian Medical CommentPeter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.comBlogger976125tag:blogger.com,1999:blog-2654455663519806899.post-30226324578029229082021-04-16T12:43:00.005-07:002021-04-16T13:08:11.919-07:00Keep me safe my God – Reflections on Psalm 16<p><span style="font-size: 12pt;"></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNyycwtmEJnXjQ_DiEmwQdWKnwLpqpsYsFVen56i93gNCPj8Z8v6Y6p41CLApcH9U5bf5gu7df18khjqRjNFI6b1SaIfZEonRQuw-g48GKzmR9RYCVnMDuoTVL_59cSWMKlb-5ErHEKRZH/s1376/psalms-16-1-2.jpg" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="1376" height="219" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNyycwtmEJnXjQ_DiEmwQdWKnwLpqpsYsFVen56i93gNCPj8Z8v6Y6p41CLApcH9U5bf5gu7df18khjqRjNFI6b1SaIfZEonRQuw-g48GKzmR9RYCVnMDuoTVL_59cSWMKlb-5ErHEKRZH/w421-h219/psalms-16-1-2.jpg" width="421" /></a></div><a href="https://www.biblegateway.com/passage/?search=Psalm%2016&version=NIV" style="font-size: 12pt;">Psalm
16</a><span style="font-size: 12pt;">, written in Hebrew about 3,000 years ago, is
called ‘a miktam of David’.</span><p></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">What is a miktam? Commentators differ.
It’s been suggested that means a golden psalm, a secret psalm or an inscribed psalm.
I’m afraid I can't enlighten you further. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">But what we do know is that this is
only one of six miktams in the psalter. The other five are psalms 56 to 60. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">All of these six psalms were written
at difficult times in David’s life when he was feeling harassed or being pursued:
when the Philistines had seized him at Gath, when he had fled from Saul into a
cave in fear of his life, when Saul had sent men to watch his house in order to
kill him. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">We do not know the exact circumstances
that occasioned the writing of Psalm 16, but we do know that David was under
great pressure and asking God to keep him safe: ‘Keep me safe, my God, for in
you I take refuge.’ <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">There were many points in David’s life
when he must have felt like this for different reasons: when facing the threat
of Goliath, the persecution of Saul, the betrayal of Absalom, or dealing with
his own personal sin over Bathsheba. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">It’s not necessary for us to know the precise
details, but we can imagine that David must have felt rather like he describes
in Psalm 55:<o:p></o:p></span></p>
<p class="MsoNormal"><i><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">‘Oh that I had
the wings of a dove! I would fly away and be at rest - I would flee far away
and stay in the desert; I would hurry to my place of shelter, far from the tempest
and storm.’<o:p></o:p></span></i></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">I wonder if you have ever felt like that
that; just wanting to run away and hide from whatever challenge you were
facing. Perhaps you feel like that right now. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">A close friend betraying you, people falsely
accusing you, a moral failure of which you're deeply ashamed, an issue in your
family which you feel unable to speak to anyone about, struggles at work - or
perhaps in this season struggles to find work. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Perhaps a physical illness, a bereavement
or disappointment. Whatever it is that is makes us feel this way, or which may
do in the future, the message to us in this psalm is to take refuge in God.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">One of the most striking things about Psalm
16 is that although the main petition in it is ‘keep me safe’ - the general mood
is actually one, not of despair and desperation, but of joy and contentment. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">What was David’s secret? Why does he
appear so together in such difficult circumstances and what can we learn from
this? <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Some years ago, I visited Auschwitz
death camp in southern Poland where one and a half million Jews were murdered by
the Nazis during the second world war. At the exit I picked up Victor Frankl’s classic
work ‘Man's search for meaning’ to read on the bus on the way back.<o:p></o:p></span></p>
<p class="MsoNormal"></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjkatFqIb9QfyLVlmn7pCZ3hVAbXpqZsnkC5mVZpm293IsQl9wDQDHpsMCRNc2nwJ3o5Yhyu8ofTUKqrb2wavI9HWa8AhX6K6lgcZ6SKlC1P7CYiMcOlXDQUuS9Vyl8Q7qoCg-EZPhEdJ1/s500/Frankl.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="500" data-original-width="322" height="459" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjkatFqIb9QfyLVlmn7pCZ3hVAbXpqZsnkC5mVZpm293IsQl9wDQDHpsMCRNc2nwJ3o5Yhyu8ofTUKqrb2wavI9HWa8AhX6K6lgcZ6SKlC1P7CYiMcOlXDQUuS9Vyl8Q7qoCg-EZPhEdJ1/w296-h459/Frankl.jpg" width="296" /></a></div><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Frankl was a Jewish psychiatrist who
amazingly survived Auschwitz and had a very successful practice treating people
with severe anxiety or depression in the post war years. <o:p></o:p></span><p></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">The book describes how he survived
emotionally and spiritually through such a harrowing experience. The recurring
quote throughout the book is:<o:p></o:p></span></p>
<p class="MsoNormal"><i><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">‘He who has a why
to live, can bear almost any how.’<o:p></o:p></span></i></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">This quote doesn't originally come
from Frankl, but from Nietzsche, but what Frankl was saying is that a person
who has found real purpose in life can overcome any obstacle in their path and can
suffer through almost any defeat without giving up. <i><o:p></o:p></i></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">So, what was David’s secret; what was David’s
‘why’ which enabled him to bear almost any ‘how’?<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">When we examine what it is that
enables him to maintain his composure, we see him actually counting his
blessings.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">First of all, in verse 2, he says to
the Lord, ‘You are my Lord, apart from you I have no good thing’.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">The words are reminiscent of the
Apostle Paul saying that he counted everything as loss for the surpassing
knowledge of knowing Christ (Philippians 3:8). <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">David is saying, in effect, ‘without
you God, even though I have everything else in the world, I have nothing. But
with you, I don't need anything else because everything good comes from you anyway.
I have all I need.’ <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Next, in verse 3, he reminds himself
that he is not alone. We know that David at times felt wretchedly alone but in
many situations, he was actually surrounded by people who loved him. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">At times it may have been just one or
two, who loved and valued him and in whose company, he gained strength. Here he
calls them ‘the saints who are in the land’ who are ‘the glorious ones and whom
is all my delight’. Fellow believers who were there for him.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">In verse 4 he reminds himself of the
folly of idolatry, putting anything in the place of God. For David, these were
the Pagan gods of the nations around Israel, but of course we know that an idol
can be anything that we put in the place of God to give us pleasure or numb our
pain.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">It might be some deeply damaging
addictive thing like drugs, alcohol or pornography, or it could be something
relatively innocent like a relationship, hobby, interest or a job which has
simply become the most important thing in our lives, but which will bring
ultimately only sorrow because it can never satisfy our deepest needs. David
didn’t look for comfort in the wrong places and neither should we.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">In verses five and six he reminds
himself of his ‘delightful inheritance’. The Israelites were all apportioned
land in Canaan. As the eighth son in the family David’s allotment would have
been small and there were times in his life when he had to flee even from his
own home to save his life. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">But he says, ‘Lord, you've assigned me
my portion and my cup you've made my lot secure. The boundary lines have fallen
for me in pleasant places.’ <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">The priests in Israel had no land (Numbers
18:20). Aaron was told that his share and inheritance was the Lord himself, and
this is probably what David is thinking of here.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">An inheritance is something we receive
in the future by virtue of being the sons or daughters of our parents. Probably,
what’s being alluded to here is the inheritance of hope in being a son or
daughter of God.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">In verse seven he talks about God’s
counsel and the instruction of his heart. Here is a man who has laid up God’s
commandments and wisdom in his heart so that they teach him through the day and
the night. The truth of God’s word gives him confidence and security. He
doesn’t wallow in self-destructive thoughts.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Next in verse eight, and again in verse
eleven, he reminds himself of the glorious truth that God is always with him at
his right hand and that therefore he can never be shaken by any circumstance he
faces. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">And then in verses nine and ten he
reminds himself of God’s protection. In saying ‘you will not abandon me to the
grave’, David is probably thinking of the fact that God had rescued him from
all his enemies and that he had always escaped with his life. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">But there are hints of something more
in verse 11 when he speaks of the joy of being in God's presence with ‘eternal
pleasures’. There’s more than a hint here that he’s looking to a relationship
with God himself that will endure beyond the grave. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">And so, David demonstrates to us
beautifully in this psalm the way of thinking, of counting one’s blessings, of
thinking liberating thoughts in the presence of difficulty, of reminding us of all
the things that nothing can ever take will strip away from us.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">We see these same thoughts echoed in
the New Testament in scriptures like, ‘I will never leave you nor for sake you’(Hebrews
13:5), ‘nothing will ever snatch you out of my hand’ (John 10:28), and ‘nothing
can ever separate us from the love of God’ (Romans 8:39). <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">It’s so important that as Christians
we cultivate these habits - thinking in this liberating way in spite of the
difficulties that we may face and not allowing ourselves to be drawn down into
the abyss of unbelief and despondency. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">So, this psalm is extraordinarily
therapeutic in the blessings that it brings to us in living the life of faith –
holding onto God’s promises, his people, his word, his presence and his
protection – taking refuge in him.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">But we're looking at it as part of our
Easter series because of the deeper truths that are buried in it. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">It was Augustine who said of the Old
and New Testaments, that ‘the new is in the old concealed and the old is in the
new revealed’.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">David’s readers at the time would not
have grasped the deeper mystery in verses eight to eleven which had not been
revealed to them. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">But as the Apostle Peter reminds us, ‘the
prophets who spoke of the grace that was to come to you searched intently and
with the greatest care, trying to find out the time and circumstances to which
the spirit of Christ in them was pointing when he predicted the sufferings of
Christ in the glories that would follow.’ (1 Peter 1:10,11)<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">It is in fact the Apostle Peter and
the Apostle Paul who in two sermons in the book of Acts demonstrate the deeper
meaning of Psalm 16. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">The question we might first ask is who
is this ‘Holy one’ (v10) who not ‘see decay’ and will not be abandoned ‘to the
grave’? <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">It surely cannot be David who, like
all of us, was a sinner and who did eventually die. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">The term ‘Holy One’ comes up several
times in the New Testament. It is the exact term that the demons used to
identify Christ in both Mark’s and Luke’s gospels (Mark 1:25; Luke 1:35). But
it is also the term that Peter uses in John 6:69 to describe Jesus: ‘We believe
and know that you are the Holy One of God’. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">The ‘Holy One’ is Jesus Christ. And
this is clearly spelt out for us in Peter’s sermon on the day of Pentecost, recorded
for us in Acts 2. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Peter, in talking to a Jewish audience
about Jesus, in Acts 2:25-28, says that God spoke these words about Jesus
himself, and then quotes Psalm 16:8-11. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">He then goes on to say in Acts
2:29-32:<o:p></o:p></span></p>
<p class="MsoNormal"><i><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">‘I can tell you
confidently that the patriarch David died and was buried and his tomb here to
this day. But he was a prophet and knew that God promised him on oath that he
would place one of his descendants on the throne. Seeing what was ahead, he
spoke of the resurrection of the Christ, that he was not abandoned to the grave
nor did his body see decay. God has raised this Jesus to life, and we are all
witnesses of the fact.’<o:p></o:p></span></i></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Likewise, Paul, in his sermon in the
synagogue at Pisidian Antioch in Acts 13 quotes the same verse from Psalm 16, ‘you
will not let your Holy One see decay’, and then goes to on to explain that this
is a reference to Jesus’ resurrection. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">But what does this mean for us
practically today?<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">It means that along with all the blessings
we can count with David about God’s sovereignty, protection and provision for
us in this life, is the overriding wonderful promise that for Christian
believers, death is not the end but that we too will one day be resurrected
like Jesus, with a body like his (Philippians 3:21), to live forever enjoying
the eternal pleasures in God’s presence with each other in a new heaven and a
new earth.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">But both Peter and Paul also draw out
the implications for unbelievers. They must turn from their sins and put their
faith in Christ. But the wonderful promise is that, if they do so, they will
have all their sins forgiven and also receive the gift of the Holy Spirit
giving them the power to live a new life pleasing to God. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">When I worked with the Christian Medical
Fellowship in student ministry back in the 1990s I once met a couple of keen
Christian medical students at Bristol University during a day of evangelism
training. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">A short time afterwards, Lucy and
Debbie, were both tragically killed in a road accident in South Africa while on
their medical elective together. There were only in their early 20s. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">I will never forget attending the
funeral and learning that Debbie had written a letter just before her death,
not knowing what was about to happen to her, saying that Psalm 16 was her
favourite because of the wonderful promise of the resurrection. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">She did not, and could not, have known
that her life would be cut short in the way that it was. But it’s a reminder to
us that we can never presume that we will live to a ripe old age. We do not
know what God has planned for us in the future, or when Christ will return. So,
we must always be ready and make the most of the tine that God has given us.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Perhaps one of the good things about COVID
is that it has reminded us all of our fragility and mortality. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">The Bible talks about people being
held in slavery by their fear of death (Hebrews 2:15). And so many people have
been so frightened by this pandemic.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">But that fear of death is not a
problem for Christians if we really understand that we are immortal until God decides
to call us home – that he is absolutely in control. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">The fear of death is not a problem if
we really understand what Jesus’ death and resurrection have achieved for us,
and that we look forward to a glorious future where ‘no eye has seen, no ear has
heard and no mind has conceived what God has prepared for those who love him’ (1
Corinthians 2:9), where the very worst sufferings of this life will seem but ‘light
and momentary’ in the light of the coming ‘eternal glory that far outweighs
them all’. (2 Corinthians 4:18)<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">As <a href="https://www.desiringgod.org/messages/the-path-to-full-and-lasting-pleasure">John
Piper</a> has put it, the message of this psalm is that ‘God will bring you -
body and soul - through life and death to full and everlasting pleasure, because
he is your safest refuge, and your supreme treasure, and your sovereign Lord,
and your trusted counsellor.’<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Let’s treasure and hold onto this
glorious truth.<o:p></o:p></span></p>
<p class="MsoNormal"><i><span style="font-size: 12pt; line-height: 107%; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">This blog is based
on sermon preached at Spicer Street Church on Sunday 11 April 2021<o:p></o:p></span></i></p>Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-63184743239386020582020-08-29T08:38:00.001-07:002020-08-29T08:38:31.219-07:00Jany Haddad - surgeon, pastor, leader, mentor and family man<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMSQJuLX_Pd8Ofhq5QUylTndF_wT6V-x38YPEAERDdHfXHhWzBwe3abXgEb5c5jbt7cLvksTaMrdMua_ZqbHtP8ec_qpLcjNH_D0gg4PNSHh2R-4ZY1Vxh3-hzcbaqzJSLO4Cz_XGhXjpZ/s1600/JanyHaddad.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="482" data-original-width="340" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMSQJuLX_Pd8Ofhq5QUylTndF_wT6V-x38YPEAERDdHfXHhWzBwe3abXgEb5c5jbt7cLvksTaMrdMua_ZqbHtP8ec_qpLcjNH_D0gg4PNSHh2R-4ZY1Vxh3-hzcbaqzJSLO4Cz_XGhXjpZ/s400/JanyHaddad.png" width="281" /></a></div>
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<i>Jany Haddad (born Teheran, Iran, 13<sup> </sup>March 1954,
died Aleppo, Syria, 14 August 2020)</i></div>
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<i><br /></i></div>
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‘Doctor, we plead with you, please do not leave Aleppo, you
are the salt of this land. You are the light of this city.’ <o:p></o:p></div>
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So spoke Dr Jany Haddad’s Muslim patients during the dark
days in Syria when hundreds of thousands were escaping the country to seek refuge
in Europe and beyond.<o:p></o:p></div>
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Dr Jany stayed, while the bombs fell and the bullets flew,
through ten years of the Syrian civil war operating on the wounded, caring for the
sick and ministering to the broken. <o:p></o:p></div>
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<br /></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Jany was a monumental figure and a leader among leaders, deeply
loved by many. His achievements were breath-taking, and he will be very greatly
missed. <o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br /></span></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">As the founder and president of both the Armenian Christian
Medical Association (ACMA) and ‘Living Hope for Family Ministries’ he touched
the lives of thousands and he inspired many others to join him and share in the
work to which God had called him.<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br /></span></div>
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Jany Haddad was born in Tehran, Iran, in 1954. He graduated
from Damascus medical university in Syria then specialised in general surgery. He
trained and worked in Kuwait, later gaining FRCS in Glasgow, Scotland. He later
gained training in 13 surgical subspecialties including oncology, endocrine,
microsurgery and laparoscopy. <o:p></o:p></div>
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<br /></div>
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He married Sonig Arabian in 1982 and God blessed them with
three children: Fouad (engineer), Manana (dietician) and Pethia (plastic
surgeon).<o:p></o:p></div>
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In 1985, he and Sonig started family ministry together in
Kuwait, interrupted by the Iraqi invasion.<o:p></o:p></div>
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When the Armenian earthquake struck in 1988, killing 50,000
and injuring 130,000, he felt God calling him to help this nation and chartered
two shipments of medical supplies. <o:p></o:p></div>
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In 1990, Jany moved to Syria, where he started the family
ministry once again in 1992, in Aleppo, with annual family conferences.<o:p></o:p></div>
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<span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">In 1996, God guided
him to found ‘Living Hope for Family Ministries’, registered initially in
Lebanon. The ministry expanded quickly and Jany wrote, translated, and
published many books on Christian family principles and discipleship.<o:p></o:p></span></div>
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<span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br /></span></div>
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In 2002, he had a vision of starting a Baptist church in
Aleppo, and in 2003, when others joined him, the Baptist Evangelical Church of
Aleppo was born. This was to become a seed which led to the planting of other
new Syrian churches. <o:p></o:p></div>
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In 2003, during the Iraqi war, Jany began ministering among
the Iraqi refugees, with medical care, food and supplies. <o:p></o:p></div>
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During this time, he visited Armenia twice a year from 2000,
running charitable surgical clinics for the poor in rural villages and towns.
This led to him founding the Armenian Christian Medical Association (ACMA) in
2006, which ran annual leadership conferences and weekly mobile medical and
dental clinics. <o:p></o:p></div>
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When the pastor of the<b> </b>Evangelical Baptist Church in
Aleppo migrated with his family in 2013, Jany took over as pastor, and expanded
<span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">‘Living Hope’ between 2013 and 2020 to embrace a huge
range of charitable and relief work during the Syrian war which had started in
2011.</span><b><o:p></o:p></b></div>
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<span lang="EN-US" style="mso-ansi-language: EN-US; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br /></span></div>
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This included support for internally displaced Syrians, digging
41 wells for drinking water (Isaac Project), spiritual and practical care for war
widows and orphans (Ladies of Living Hope), University student ministry and the
St Luke and Healing Grace medical charity centres.<o:p></o:p></div>
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The ‘Building Restoration Department’ helped families restore
and renovate their homes which had been damaged or destroyed during the war. An
elderly people’s ministry cared for the medical, social and spiritual needs of those
who had been left behind after their families left the country.<o:p></o:p></div>
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<br /></div>
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Other initiatives included a mini-enterprises ministry
providing food, a post-war trauma care centre, a psychological support centre,
and training in sewing and other skills. <o:p></o:p></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Jany died from complications of COVID on 14 August. It may be hard
to understand why God should preserve Jany through the war only to take him in this
way at a time when he seemingly had so much more to give and was still, even at
66, effectively in his prime. <o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br /></span></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">The mystery remains, but the Lord is sovereign. His ways are
always perfect and he always in all things works for the good of those who love
him. <o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br /></span></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">Jany is now in the presence of the Saviour he loved and served and
has finished the race. He joins that great cloud of witnesses cheering the rest
of us on. <o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br /></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvRS_zsM-L0rCDQlOdwWzEdB6UOUNLbqMsh8-pITBd0BJpxvBmPuplY-3riR6198uhiCFWJdMjeqHhu5i46JNrKESIjgyQLPtks1w8i02TGLZPzM0i3lRC2_0jhNRbzyDl6PaxliFI6ztk/s1600/JH+Family.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="500" data-original-width="750" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvRS_zsM-L0rCDQlOdwWzEdB6UOUNLbqMsh8-pITBd0BJpxvBmPuplY-3riR6198uhiCFWJdMjeqHhu5i46JNrKESIjgyQLPtks1w8i02TGLZPzM0i3lRC2_0jhNRbzyDl6PaxliFI6ztk/s320/JH+Family.jpg" width="320" /></a><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-hansi-font-family: Calibri;">He leaves behind friends and colleagues
from all over the world who he encouraged and inspired and who are thanking </span><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">God for his
faithfulness to Christ and his wonderful service to God’s church and the Syrian
and Armenian people as a surgeon, pastor, leader, teacher and mentor.<o:p></o:p></span></div>
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<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br /></span></div>
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<span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-hansi-font-family: Calibri;">The words posted by his daughter Pethia
this week, on behalf of his children and their families, are a lovely tribute: <o:p></o:p></span></div>
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<span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-hansi-font-family: Calibri;"><br /></span></div>
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<i><span style="mso-ascii-font-family: Calibri; mso-bidi-font-family: Calibri; mso-hansi-font-family: Calibri;">‘Our beloved father, you are now with
your Saviour… You planted in us the love of God and the spirit of service since
our childhood, have nurtured in us our abilities and talents and were the
motivation to reach successes we didn't dream about. You were the perfect
husband, the caring father, the honest shepherd and the healing doctor who
healed thousands of souls and bodies with his smile, words and blessed touch….
We trust God's appointments and know with all certainty that your mission has
not yet come to an end. We will continue it.’</span><o:p></o:p></i></div>
<br />Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-87563514561605362052020-08-23T12:55:00.002-07:002020-08-23T12:57:53.855-07:00Prophet, Priest and Prince - Haggai 2:1-23 <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1fObaO7tkWLdk53bNkbwOvGPerx-6ojVp4TGvuGmha3flYoa7bAsr49P4PO6a1VKj82e8esZLTCXnYnPDvgMgL6R-TAAhTAn04fNsh8ad0iko3nHkWRVFTHSpPrx_qbWSHNDaSPx0Vxf5/s1600/Haggai2_19.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="800" data-original-width="800" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1fObaO7tkWLdk53bNkbwOvGPerx-6ojVp4TGvuGmha3flYoa7bAsr49P4PO6a1VKj82e8esZLTCXnYnPDvgMgL6R-TAAhTAn04fNsh8ad0iko3nHkWRVFTHSpPrx_qbWSHNDaSPx0Vxf5/s320/Haggai2_19.jpg" width="320" /></a></div>
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<i>I preached this sermon on Sunday 23 August 2020, the second in a series of two on the book of Haggai.</i></div>
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If you were with us last Sunday, you will be familiar with
the historical backdrop to the book of Haggai. <o:p></o:p></div>
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Jerusalem – the capital of the Jewish Kingdom - was
destroyed by the Babylonians in 587 BC and those Jews who had not been killed
were taken into exile in the city of Babylon, in modern day Iraq. <o:p></o:p></div>
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It was about 50 years later in 538 BC that the conqueror of
Babylon, Cyrus King of Persia, issued a decree allowing them to return to Jerusalem
and rebuild the temple. <o:p></o:p></div>
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Led by the Royal Prince Zerubbabel, about 50,000 Jews
journeyed home and within two years completed the foundation of the temple amid
great rejoicing. <o:p></o:p></div>
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However, their success aroused the Samaritans and other
neighbours who feared the political and religious implications of a rebuilt
temple in a thriving Jewish state.<o:p></o:p></div>
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So, they opposed the project vigorously and managed to halt
work until Darius the Great became King of Persia 16 years later in 522 BC. <o:p></o:p></div>
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Darius was keen to promote all the religions in his empire, to
ensure peace between culturally diverse people, and it was in his second year,
520 BC that this book is set.<o:p></o:p></div>
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The Prophet Haggai, after whom the book is named, gives a
series of four messages during a few months encouraging Zerubbabel and the High
Priest Joshua to rebuild the temple. <o:p></o:p></div>
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Last week we looked at the first of these messages which was
an exhortation to get on with the work of rebuilding the temple. <o:p></o:p></div>
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We also looked at how that might apply to us as God’s living
temple today – encouraging us to use our gifts of speaking and service to build
each other up as members of the body of Christ. <o:p></o:p></div>
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In this second chapter, Haggai gives three more messages
over the space of just a few months – in our time from October to December 520
BC.<o:p></o:p></div>
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<br /></div>
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The NIV Bible translation helpfully breaks this chapter into
three sections, and we will look at each of those in turn. Each one has a clear
message to us. <o:p></o:p></div>
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<b>1 Trust God’s promises – 2:1-9<o:p></o:p></b></div>
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<b><br /></b></div>
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We are told in chapter 2 verse 1 that the word of God came
through Haggai to Zerubbabel and Joshua on the 21<sup>st</sup> day of the
seventh month in the Jewish calendar – that is the 17th October 520BC.<o:p></o:p></div>
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He asks them to compare the temple they were building with
Solomon’s temple beforehand. <o:p></o:p></div>
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Now, by comparison, Solomon's temple was extraordinarily
beautiful, opulent and lavish. This new one was much smaller and less
impressive. <o:p></o:p></div>
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In fact, in the eyes of some of the older members who
remembered the previous temple before its destruction by the Babylonians, this
one seemed a pale shadow.<o:p></o:p></div>
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However, Haggai reminds them that God is true to his
promises to bless his people and exhorts them to be strong, to continue the
work and not to be afraid. <o:p></o:p></div>
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Their work of temple restoration is something he planned
long ago, and he will make sure that they succeed. <o:p></o:p></div>
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Although they must have felt daunted by the strength of the
opposition and the power of the nations around them, not least the Persian
Empire itself, God reminds them that he is going to shake all nations. <o:p></o:p></div>
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God is much bigger and more powerful than the Assyrians, the
Babylonians, the Persians and of course the Greeks and the Romans still to
come. <o:p></o:p></div>
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He is in control and his purposes will be fulfilled no
matter what. <o:p></o:p></div>
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The phrase, “the desired of all nations will come, and I
will fill this house with glory”, in verse 7 has provoked great debate among
theologians and Bible commentators.<o:p></o:p></div>
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Does it refer to the silver and gold that we know, from Ezra
6:8, King Darius gave the Jews to furnish the temple with, or is it a reference
to the coming of the Messiah in the future? <o:p></o:p></div>
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Well, I'm going to suggest that it could well be both. The
immediate context in verse 8 is silver and gold. But there are also verses in
the New Testament that appear to make reference to this phrase in referring to
the Messiah.<o:p></o:p></div>
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Regardless, the crucial point is that God enables his people
to fulfil the work he prepares for them. He makes sure they succeed.<o:p></o:p></div>
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Does that encourage you? One of my favourite verses in Scripture
is Ephesians 2:10 where the Apostle Paul talks about the “good works, which God
prepared in advance” for us to do. <o:p></o:p></div>
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Each day God has prepared fruitful labour for each of us to
engage in. <o:p></o:p></div>
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How often do we look with disappointment at the small amount
of fruit we see in our lives, or in our Christian community, rather than
looking forward with confidence and expectation to what God can build from
small beginnings when we are faithful in the present? God describes the same
scene in Zechariah 4:10:<o:p></o:p></div>
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“Who despises the day of small things? Men will rejoice when
they see the plumb-line in the hand of Zerubbabel”, he says. <o:p></o:p></div>
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They are rejoicing not at the finished building – but just at
someone holding a plumb-line to measure it up. Because in the hands of God, a
small beginning is the guarantee of the completed task. <o:p></o:p></div>
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The whole of Christian history is full of stories of people
who were faithful in small things which led later, perhaps not even in their own
lifetime, to great fruit that was beyond their wildest imaginings. <o:p></o:p></div>
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What small but significant task are you currently involved
in in God’s service – in your family, workplace, community or in the church
itself? <o:p></o:p></div>
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Be encouraged to press on. God is faithful to his promises
and his purposes, worked out in small steps of obedience by his people, will be
fulfilled.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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<span style="mso-spacerun: yes;"><br /></span></div>
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Trust God’s promises.<o:p></o:p></div>
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<br /></div>
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<b>2 Prepare for God’s blessing – 2:10-19<o:p></o:p></b></div>
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<b><br /></b></div>
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Haggai’s second message, we read in 2:10, came on the 24<sup>th</sup>
day of the 9<sup>th</sup> month the same year - that’s the 18<sup>th</sup> of
December.<o:p></o:p></div>
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Haggai asks the priests two questions. <o:p></o:p></div>
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First, he says “if a person carries consecrated meat in the
fold of his garment, and that fold touches some bread or stew, some wine, oil
or other food, does it become consecrated?” The priests answer “no”. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
He then asks them a second question: “if a person defiled by
contact with a dead body touches one of these things does it become defiled?” The
priests reply “yes”. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Haggai is referring to regulations in the Old Covenant law of
Leviticus. The point is that clean things cannot make dirty things clean, but
dirty things can make clean things dirty. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Imagine, for example throwing some clean clothes into a pile
of muddy rugby gear. Would the dirty clothes become instantly clean? Of course
not. Similarly, dirty rugby gear jammed into a drawer of clean linen will
certainly make it dirty. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So, Haggai is saying that the Jewish people are unclean because
of their sin and so end up defiling everything they touch, even the temple
itself. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
if we try to do God’s work of building up God’s people, our
efforts will not be blessed if our own lives are not right.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Haggai urges them to “give careful thought” to what is
happening. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
He points out in verses 15 to 19 the poor harvest of grain
and wine and the fact that their crops were destroyed by blight, mildew and
hail; that there was little seed left in the barn or fruit on the trees. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This, he says is a direct consequence of their sin. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Note, in verse 17, that it is God himself who “struck all
the work of (their) hands”. He did this to catch the people’s attention and
draw them back to himself. However, he says “you did not turn to me”. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
These words are reminiscent of the words of another Prophet.
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Amos chapter 4 follows the same pattern. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
God declares through Amos that he struck his people with
famine, drought, and their gardens and vineyards with blight and mildew; sent
plagues among them and allowed them to be slaughtered by their enemies. These
things did not just happen. God made them happen. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Amos ends each declaration with the same words we see here, “yet
you have not returned to me”.<o:p></o:p><br />
<br /></div>
<div class="MsoNormal">
So, we see God withdrawing privileges and causing his people
pain to save them from the far greater peril of being completely abandoned by him
and facing his judgement.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The writer of Hebrews reminds us that “God disciplines those
whom he loves” (Hebrews 12:5), and that this discipline is “for our good that
we might share in his holiness” (Hebrews 12:10). He goes on to say that we
should “endure hardship as discipline” because “God is treating us as sons”
(Hebrews 12:7). <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Now we should not draw from this that all hardship we face
is a consequence of our own personal sin. We live in a fallen groaning world
and all of us bear its consequences. Jesus did too.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
However, the biblical pattern is that often the fate of a
community, society, country, or empire is a direct consequence of its corporate
sin. God removes his blessing and brings pain to cause us to turn back to him. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Haggai does not identify specific sins in this passage,
unlike many of the former prophets. He has of course pointed out the people’s
sins of omission in chapter one. They were so consumed with their own affairs
and their own private property that they neglected to serve the people of God. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But the call here is one of turning from sin generally and
it should perhaps lead each of us to allow God to examine us to help us see
what in our lives is not pleasing to him. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Let's leave that as an open question for each one of us.
What is it that we personally are doing, or failing to do, that is stopping us
serving God with all our heart, soul, mind and strength? It is not generally a
difficult question to answer. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
What is it that we are looking at, thinking about, longing
for, engaging in that is robbing our hearts of blessing and instead cursing our
steps?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The message of this section is very clear. If we want to be
effective in serving the Lord then we need, again in the words of Hebrews, to “throw
off everything that hinders and the sin that so easily entangles” in order to
“run with perseverance the race marked out for us ” (Hebrews 12:1). <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
You cannot run when you are weighed down with lead weights.
What sin is sapping your strength? <span style="mso-spacerun: yes;"> </span>Identify it and cast it off. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If we wish to be used by God - because that is what real
blessing is – then we need to get serious about sin in our lives. And then the
words that conclude this section, “from this day on I will bless you” will be
true of our lives, families and churches. God will use us more effectively. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Prepare for God’s blessing.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>3 Know that God will fulfil his purposes – 2:20-23<o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
Haggai’s third word, we are told, comes on the same day as
the second, the 24th day of the ninth month or the 18th of December. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Haggai tells Zerubbabel that God is going “to shake the
heavens and the earth”, “overturn royal thrones” and “shatter the power of foreign
kingdoms”. He will “overthrow chariots and their drivers; horses and their
riders will fall each by the sword of his brother”. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
You can see references here to the defeat of the Egyptian
Army in the Red Sea but also periods in Israel's history when their enemies
turned on each other rather than Israel itself.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
God was the architect of all these victories because he is
completely sovereign. In the same way he will act in the future.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
190 years later in 330 BC Alexander the Great would sweep
across the whole of the Middle East with his armies and destroy the great Persian
Empire. Then the Romans would crush the Greeks. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Throughout biblical history we see the rise and fall of
great kingdoms which ruled over most of the known world: Egypt, Assyria,
Babylon, Persia, Greece and Rome.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This progression is beautifully described ahead of time by
the Old Testament prophets like Daniel, who reminds us repeatedly that “the Most
High is sovereign over the kingdoms of the world and gives him to anyone he wishes”
(Daniel 4:18, 25, 32).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
God is sovereign over the rise and fall of nations and
empires. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Ever since, many other great empires ruling vast tracts of
the world’s surface have followed Rome and many great rulers have come and
gone. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The Goths, the Mongols, the Ottomans, the Spanish and
Portuguese, the French and British, the Communists, the Nazi and now we see the
United States and China battling it out in trade wars for world domination. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
God has always “shaken the nations”. He always will.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
With the benefit of hindsight, we can look back from 2020 over
the 2,500 years between the time this book was written and our own day. We see
the life death and resurrection of Christ, the extraordinary growth of the
church and the spread of the gospel almost now to every nation on earth. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Haggai wasn’t privy to this much detail about the future but,
under the inspiration of the Holy Spirit, he finishes this short book in a most
interesting way.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“On that day”, says the Lord, “I will take you my servant Zerubbabel,
son of Shealtiel and make you like my signet ring for I have chosen you
declares the Lord Almighty”. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The signet ring was used by a king to stamp documents with
his authority. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When Zerubbabel’s grandfather King Jehoiachin was captured
by the Babylonians his signet ring was removed, thereby stripping his authority.
There were no kings in the royal line after Jehoiachin. <o:p></o:p></div>
<div class="MsoNormal">
But Zerubbabel is to be God’s signet ring, carrying God’s
stamp or authority. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The expression “Zerubbabel, son of Shealtiel” crops up twice
in the New Testament, in the genealogies of Jesus in Matthew 1 and Luke 3.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Both genealogies trace Jesus’ family line from Abraham through
King David, but the list of names which follows David is different in each.
Matthew traces Jesus through David’s royal son Solomon, and Luke through David’s
son Nathan. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It is thought that Matthew’s line is that of Joseph, Jesus
earthly father, and Luke’s line that of Mary Jesus’ earthly mother. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But interestingly, Zerubbabel, and his father Shealtiel, are
the only people to appear in both genealogies.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Is this a strong hint that the Messiah will be a descendant
not just of Abraham, Isaac, Jacob, Judah and David but also of Zerubbabel? <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
That the life of this faithful prince is a pointer to the
Faithful Prince who is still to come – the Prince of Peace, Jesus Christ. Well
I’ll leave you to ponder on that. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There are three great characters in this small book, and it
is I am sure no mistake that they are a prophet (Haggai), a priest (Joshua) and
a Prince (Zerubbabel).<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"><br /></span></div>
<div class="MsoNormal">
Together they did a great work, but someone would come just
over 500 years later who Moses called the Prophet (Deuteronomy 18:15), who the
writer of Hebrews called our great High Priest, and who the angels called the
King of Kings. Someone for whom Haggai, Joshua and Zerubbabel are but pointers.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Someone who would speak God’s word like never before, who
would usher us into the very presence of God the Father, and who would rule
over all of the universe for ever and ever. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Trust God’s promises. Prepare for God’s
blessing. Know that God will fulfil his purposes. <o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
Let us celebrate these wonderful truths as we exalt Jesus
Christ our Lord and Saviour, our glorious prophet, priest and king in our final
hymn, Rock of Ages.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="line-height: normal;">
<i>All for sin could not atone; Thou
must save, and Thou alone.<o:p></o:p></i></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0cm;">
<i>When I soar
to worlds unknown, See Thee on Thy judgement throne,</i></div>
<div class="MsoNormal" style="line-height: normal;">
<i>
Rock of Ages, cleft for me, Let me hide myself in Thee.<o:p></o:p></i></div>
<br />Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-20029830117493483842020-08-20T12:56:00.003-07:002020-08-20T12:59:03.958-07:00A message for our time - Haggai 1:1-15<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYT4Rav8t7fmRTHMKrK6s0w8WGnoxH_XC7f-kBTtbuL-iRJTBsQkl0Rga9_b60UrBz7dySjYrVgiBATKfN1T43PMOFDVKjshL7OWQAPENMvxCruYqF2BLxiPYwGUWpXZaian1gNd6q0zoX/s1600/CyrusCylinder.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="240" data-original-width="512" height="187" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYT4Rav8t7fmRTHMKrK6s0w8WGnoxH_XC7f-kBTtbuL-iRJTBsQkl0Rga9_b60UrBz7dySjYrVgiBATKfN1T43PMOFDVKjshL7OWQAPENMvxCruYqF2BLxiPYwGUWpXZaian1gNd6q0zoX/s400/CyrusCylinder.jpg" width="400" /></a></div>
<i>I preached the following message at our church’s evening service on Sunday, 16 August.</i><br />
<br />
The British Museum reopens following its closure for COVID on 27 August - and you can book a timed ticket in advance. <br />
<br />
If you are planning a trip then one of its most famous exhibits is a clay artefact called the Cyrus cylinder (above). <br />
<br />
It was found by British archaeologists in the ruins of Babylon in 1879 and measures about 20 centimetres in length and 10 centimetres in diameter. <br />
<br />
The writing on it is in Akkadian cuneiform and it records the entry of the Persian King Cyrus into the capital city of Babylon in 539 BC. <br />
<br />
Cyrus was regarded as a peaceful and competent successor to the tyrant Babylonian King Nabonidus whom he replaced. <br />
<br />
He dreamed up an ingenious way to gain the loyalty of an extremely diverse multicultural society by giving each national and cultural group the freedom to carry out their own religious practices without interference. <br />
<br />
And so, one of his first actions, as recorded on the cylinder, was to equip peoples who had been enslaved during the Babylonian exile to go back to their homelands and re-establish their nations with his own protection and support. <br />
<br />
And so it was that the Jewish exiles in 538 BC returned to Jerusalem to rebuild the city. <br />
Among this group of exiles were two young men called Zerubbabel and Joshua. <br />
<br />
Zerubbabel was a royal prince and a direct descendant of King David and the Kings of Judah. <br />
Joshua was a high priest. <br />
<br />
Both wanted to resurrect their country after a time of great difficulty. <br />
<br />
We first learn about Zerubbabel and Joshua in the book of Ezra where they are mentioned in chapters 3 and 5. <br />
<br />
They also feature in the book of Zechariah which immediately follows Haggai chronologically. <br />
<br />
The original temple built by Solomon 400 years earlier had been demolished by the Babylonians in 587BC when the Jews were exiled. <br />
<br />
They began the task with great enthusiasm and built an altar along with the foundation of the temple but then, because of the opposition they faced from the locals, and because the task was difficult, they stopped. <br />
<br />
It was 16 years after this that the events which we are considering tonight took place. <br />
<br />
Haggai was a Jewish prophet who was sent by God to encourage Joshua, Zerubbabel and others to start rebuilding the temple. <br />
<br />
Chapter 1 of Haggai begins on the first day of the sixth month of the second year of King Darius, King of Persia, the grandson of Cyrus. <br />
<br />
That's the 29th of August 520 BC. Seldom are biblical dates identified so specifically. <br />
<br />
The chapter ends - just 23 days later - on the 24th day of the same month or the 21st of September 520 BC. <br />
<br />
So, these events took place almost exactly 2,540 years ago in Jerusalem. <br />
<br />
Now the people had rationalised their inactivity over the temple – look at verse 2: “the time is not yet come for the Lords house to be built”, they said. <br />
<br />
And yet, they seemed to be able to find plenty of time – verse 4 – for building their own houses while, we're told, the Lord’s house – the temple - remained a ruin. <br />
<br />
Not only this, but the restoration of their own houses had been done in a rather lavish fashion. <br />
<br />
The expression used here - “panelled houses” - is usually connected with royal dwellings which had cedar panelling. <br />
<br />
So, they hadn't spared any extravagance. <br />
<br />
And so, Haggai urges them to “give careful thought to their ways” and directly links the difficulties that they are facing with the fact that they have been unfaithful to God. <br />
<br />
They were concerned about their own homes, but not his. <br />
<br />
They were consumed with their own affairs and neglecting his. <br />
<br />
The way they had spent their time and money laid bare their true priorities.<br />
<br />
Haggai tells them that their poor harvests and the fact that they don't have enough to eat and drink or adequate clothes to wear are the result of God removing his blessing as indeed he had promised he would do in the Jewish law - see Deuteronomy 28:38-39. <br />
<br />
“You earn wages, only to put them in a purse with holes in it”. <br />
<br />
In other words, their money wasn't stretching far enough. <br />
<br />
Of course, when too much money is chasing not enough goods and services we know that that leads to inflation. The money has less and less buying power. <br />
<br />
So the nation of Judah was experiencing economic recession and inflation. <br />
<br />
God tells them explicitly - verse 11 - that the lack of rain on their fields is because of a drought which he has personally ordered to curse those three vital products - grain, new wine and oil – which were the backbone of the economy. <br />
<br />
This affected not just the people but their cattle as well. Why was this? <br />
<br />
“Because of my house, which remains a ruin, while each of you is busy with his own house” – verse 9. <br />
<br />
You see, it wasn't so much what they did, but rather what they neglected to do. These were sins of omission. <br />
<br />
Now throughout biblical history people have reacted in different ways to prophetic words. <br />
<br />
Many of the prophets were ignored, persecuted or even killed because people didn't appreciate the messages they brought. <br />
<br />
However, this is one of those rare occasions when the prophetic words are taken to heart. <br />
<br />
We are told that Zerubbabel, Joshua and indeed the whole remnant of the people – verse 14 - “obeyed the voice of the Lord their God and the message of the Prophet Haggai”. <br />
<br />
They recognised that God had sent him and they feared the Lord.<br />
<br />
Haggai, after his word of exhortation, brings a strong word of encouragement to tell them that the Lord is with them - verse 13. <br />
<br />
And we are told that the Lord “stirred up the spirit” of Zerubbabel and Joshua and so they began the work of rebuilding the temple. <br />
<br />
So, what can we learn from this seldom read obscure passage in the Old Testament that is relevant to us in 21st century coronavirus Britain? <br />
<br />
As it turns out, quite a lot. <br />
<br />
First, it reminds us that God is absolutely sovereign over the course of history. <br />
<br />
He rules over political, economic and environmental events. <br />
<br />
In fact, he does everything according to his own timetable. <br />
<br />
The rise and fall of nations, the seasons, droughts and floods, crop failures and indeed even the price of food, drink and clothing are under his direct control. <br />
<br />
Yes, even coronavirus with all its dramatic effects on politics, employment, economics and health. <br />
<br />
These men were simply pawns working out a divine plan. <br />
<br />
The Prophet Jeremiah, as remembered by the Prophet Daniel, had prophesied that the exile would last 70 years. <br />
<br />
The Babylonians had destroyed Jerusalem along with the original temple in 587BC. <br />
<br />
And according to the divine timetable, the temple was eventually completed 70 years later in 516BC. <br />
<br />
It was indeed the right time.<br />
<br />
God is sovereign and his purposes can never be thwarted. <br />
<br />
He is always in control. Isn’t that a comforting thought! <br />
<br />
Second, this account reminds us of the importance of prophecy. <br />
<br />
Had it not been for Haggai’s timely intervention the Jews may never have questioned their behaviour. <br />
<br />
It had to be pointed out to them. <br />
<br />
They were blind to it. <br />
<br />
The Prophet points out the sin, explains its results, tells them what they need to do to change and then encourages them to do it. <br />
<br />
Now, of course, there are differences between Old and New Testament prophets. <br />
<br />
But we know, from references in the book of Acts and the letters of the New Testament, that prophetic ministry was an important part of the early church, and there's no indication that this kind of ministry is no longer relevant.<br />
<br />
It is noteworthy, that in our present time of national crisis, there have been very few prophetic Christian voices calling the church or the nation to repentance. <br />
<br />
Third, we need to think about how the lessons of this chapter might apply to us in 21st century Britain. <br />
<br />
As Christians we do not have a temple, and our church buildings, which function largely as a place of meeting, teaching and worship, have a very different purpose than that of the temple.<br />
<br />
So, key question, what is the equivalent of the temple today, and what does “building the temple” mean for us. <br />
<br />
Thankfully the New Testament is very clear about this. <br />
<br />
The Apostle Peter tells us that the equivalent of the temple today is the people of God. <br />
<br />
1 Peter 2: 4 : “as you come to him, the living stone - rejected by men but chosen by God and precious to him - you also, like living stones, are being built into a spiritual house to be a holy priesthood, offering spiritual sacrifices acceptable to God through Jesus Christ.” <br />
<br />
So, the temple is now God's people. Jesus Christ is the cornerstone and all of us are “living stones”. <br />
<br />
What then does it mean then to build the temple? <br />
<br />
Ephesians 4:11-16 tells us that God gave “some to be apostles, some to be prophets, some to be evangelists and some to be pastors and teachers…”<br />
<br />
Why?<br />
<br />
“To prepare Gods people for works of service so that the body of Christ may be built up until we all reach unity in the in the faith and in the knowledge of the Son of God and become mature attaining to the whole measure of the fullness of Christ.” <br />
<br />
Just two verses later “speaking the truth and love, we will in all things grow up into him who is the head, that is, Christ. From him the whole body, joined and held together by every supporting ligament, grows and builds itself up in love, as each part does its work.”<br />
<br />
The two metaphors used for the church in the New Testament are the temple and the human body.<br />
<br />
In each illustration we see that the church is made up of component parts which, when each plays its role well, build up all the others. <br />
<br />
Now as Christians in the free church non-conformist tradition, we understand very well the concept of the priesthood of all believers. <br />
<br />
We do not believe that only some members of the body of Christ are there to minister. Each one of us has a gift that we are called to use for the common good.<br />
<br />
Some of these gifts are gifts of a service, and some of these gifts are gifts of speaking, as the Apostle Peter makes very clear in his first epistle - 1 Peter 4:9-11. <br />
<br />
“Each one should use whatever gift he has received to serve others, faithfully administering God's grace in its various forms. If anyone speaks, he should do it as one speaking the very words of God. If anyone serves, he should do it with the strength God provides, so that in all things God may be praised through Jesus Christ.” <br />
<br />
This is, argues Peter, what “loving each other deeply” looks like in practice. <br />
<br />
And so, this passage is a challenge to each one of us to ask if we are using our God-given gifts to help others.<br />
<br />
Or are we rather so consumed with our own affairs, perhaps literally even our own homes, that we have become distracted from our duty to serve one another? <br />
<br />
I heard it said recently that one of the purposes God had in sending this virus was to help the church grow up in using our gifts of speaking and service. <br />
<br />
This is perhaps no more clearly evident than in the family. <br />
<br />
Are we taking seriously our responsibility to build up our husbands and wives, our children, our parents, or those in our extended family. <br />
<br />
Or are these things that we delegate to the pastor, the elders, youth leaders and Sunday school teachers. <br />
<br />
And how seriously do we take our responsibility to build up our brothers and sisters in the wider body of Christ?<br />
<br />
Maybe it is the gift of teaching, preaching, prophecy or pastoral care. <br />
<br />
But maybe it is gifts of the kind that Paul lists in passages like Romans 12 and 1 Corinthians 12:<br />
Gifts of service, encouragement, contributing to the needs of others, leadership, governance, showing mercy, giving generously, administration or offering hospitality. <br />
<br />
What is it that each one of us has that we could be using more effectively to build up our fellow believers in Christ, which we are maybe neglecting to use because we've become self-absorbed? <br />
<br />
It's interesting to see which companies have done best throughout this present time of quarantine and isolation. <br />
<br />
Apart from goldmining companies and those IT companies who market technology like zoom, it is DIY companies, gardening centres, companies which make Warhammer figures or computer games, cycling equipment, sportswear, those marketing home movies. <br />
<br />
Because for many people in Britain these things have expanded to fill the void created by the virus. <br />
<br />
Perhaps, as Christians, we pride ourselves that we haven’t been tempted into drugs, alcohol or pornography – if in fact we haven’t – but have these softer more subtle things had the same effect of robbing us of our passion for God himself and for his people?<br />
<br />
Perhaps this chapter is a challenge to us to examine our lives to look at what, during this time of COVID, has distracted us and consumed our time and money such that we have neglected our responsibilities to one another. <br />
<br />
Now of course it is not wrong to be a good steward of one’s own property. <br />
<br />
There's nothing inherently sinful about a panelled house, just as there is nothing inherently wrong with DIY, hobbies, gardening, watching films, playing games or whatever. <br />
<br />
These things are all God given and part of a healthy balanced lifestyle.<br />
<br />
However, when they so focus our time and energy, that we cease to notice the needs around us within the church - and I'm talking not just about the local church but also the global Church of God - much of which is facing extraordinary difficulty at this time in history, then these simple and innocent pastimes can become the very thing that robs us of the fullness of life in Christ, and stops us demonstrating the love and unity with one another in the body of Christ, which is such a powerful magnet to draw unbelievers.<br />
<br />
Have we allowed ourselves to become too comfortable, so that we're simply not seeing and hearing, and therefore not responding to the need around us.<br />
<br />
That is the challenge of this extraordinary short passage. <br />
<br />
Fourth, and finally, we see in this passage, God's extraordinary generosity, mercy and patience with his people. <br />
<br />
He doesn't castigate them. He simply points out the fact that they have become distracted and invites them to re-evaluate their priorities. <br />
<br />
We often long and pray for God to act, but this passage beautifully illustrates the fact that God often acts in response to prayer through calling us his people to use the gifts that he has already given us to do good in the church and in the world. <br />
<br />
The answer to Haggai’s exhortation was not a miraculous intervention from the heavens. <br />
<br />
It was simply God’s people taking their responsibilities seriously and getting to work doing his work. <br />
<br />
What are the gifts God has given you and me that we are not using to the full? <br />
<br />
What responsibilities to God’s people are we neglecting? <br />
<br />
What has distracted us and is consuming our time, energy and money at this time of national crisis? <br />
<br />
And what is it that we need to do to be like the people of Israel, under Haggai, Zerubbabel and Joshua, who took their responsibilities seriously to do God’s work? <br />
<br />
Our final hymn, “Lord of the Church”, echoes these thoughts – why don’t we make it our prayer of rededication?<br />
<br />
<i>Lord of the church we pray for our renewing</i><br />
<i>To bring us nearer what a church should be</i><br />
<i><br /></i>
<i>Lord of the church we seek a Father's blessing</i><br />
<i>In Christ to live and love and serve and care</i><br />
<i><br /></i>
<i>Lord of the church we long for our uniting</i><br />
<i>True to one calling by one vision stirred</i><br />
<br />Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-85787451345345550752020-05-31T11:25:00.000-07:002020-05-31T12:44:14.806-07:00Coronavirus death rates – why some countries are doing so well and others so badly<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjip3w-Yh7gQU4_Ak2DSCfQtDmySEszeigqre74pHkZgL1ibEdcW2_nImkxMsHyACTtnutAwqNohawQM_FhpiaN8PK_BESx3i6HFiqUeCatqrsTOHc91CoRBhPDt6CY0PPYisUxExwPcg8M/s1600/Cases+and+deaths+per+day.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="436" data-original-width="654" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjip3w-Yh7gQU4_Ak2DSCfQtDmySEszeigqre74pHkZgL1ibEdcW2_nImkxMsHyACTtnutAwqNohawQM_FhpiaN8PK_BESx3i6HFiqUeCatqrsTOHc91CoRBhPDt6CY0PPYisUxExwPcg8M/s400/Cases+and+deaths+per+day.jpg" width="400" /></a></div>
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Last week I was on a conference call with 35 Christian doctors
and dentists in our East Asia network. We reviewed the status of the COVID-19
pandemic in each country. The figures are really illuminating.</div>
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<br /></div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
Taiwan has had <i>a total </i>of 7 deaths, Hong Kong 4 and
Mongolia 0. In China, Japan and South Korea the total deaths are much higher at
4,634, 874 and 269 respectively. <o:p></o:p></div>
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<br /></div>
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But even these latter numbers are tiny when considered on a
population basis. China has had 3 deaths per million people, Japan 7 and South
Korea 5. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
By contrast the UK has had over 38,000 deaths – equivalent
to 566 for every million people. This is a hundred times the number of deaths
per million in South Korea and over 1,000 times that in Hong Kong. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
For the US the equivalent
figures are 103,000 and 319. Again astronomical.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Overall, the US and Europe have been the worst in handling
this pandemic thus far. If we disregard those countries with tiny populations less
than 200,000 people (St Maartens, Andorra, San Marino, Isle of Man and Channel
Islands) the ten countries with the highest covid deaths per million population
are all European or North American. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Leading the list is Belgium with 816 death per million
followed by Spain (580), UK (566), Italy (551), France (441) and Sweden (435).
The next five are Netherlands (347), Ireland (335), USA (319) and Switzerland (222).<o:p></o:p></div>
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<br /></div>
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Following closely behind them are the rest of the Americas –
Ecuador (189), Canada (188), Peru (133) and Brazil (132).<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
It is now simply impossible to ignore the conclusion that
the Far East along with New Zealand and Australia - which have both had only 4
deaths per million population – have handled this crisis far, far better than
the Old World. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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Furthermore, it has all to do with decisions that leaders in
these successful countries have made which those of unsuccessful countries have
not made. <o:p></o:p></div>
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<br /></div>
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What did the successful countries do?<o:p></o:p></div>
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<br /></div>
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First,<b> they acted quickly</b>, immediately closing their
borders, quarantining every suspected case and tracing and testing every
contact. They knew exactly how many cases they had in the country and where
they were. They identified case clusters and wrestled them to the ground.<o:p></o:p></div>
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<br /></div>
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Lockdown, along with handwashing and social distancing,
helped to limit the spread, but it was the early closing of borders, quarantine and
test and trace that contained the virus. <o:p></o:p></div>
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<br /></div>
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Hong Kong and Taiwan immediately closed their borders because
of their past experience with SARS. New Zealand and Australia rapidly followed
suit. By contrast official Home Office figures <a href="https://www.msn.com/en-gb/news/coronavirus/at-least-20000-people-infected-with-coronavirus-arrived-in-the-uk-before-lockdown-amid-lack-of-restrictions/ar-BB13Dz66">reveal</a>
that at least 20,000 people infected with coronavirus entered the UK before
lockdown, but fewer than 300 were quarantined. These arrivals would have
infected some 50,000 more people given the World Health Organisation’s
assessment of an average transmission rate at the start of March of between 2
and 2.5.</div>
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<br /></div>
<div class="MsoNormal">
<o:p></o:p></div>
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Between 1 January and the end of March 18.1 million people
entered the UK without any health checks including from coronavirus hotspot
countries. Of these, just 273 were quarantined.<o:p></o:p></div>
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<br /></div>
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Subsequently 15,000 to 20,000 people a day returned to the UK
up to the end of April without being subject to the enforced quarantine that
had operated in successful countries virtually from day one.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
China got quickly on top of their outbreak through a <a href="https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf">vigorous
programme</a> of widespread testing followed by isolation of those affected,
backed up by travel restrictions. In Wuhan, where the pandemic started, more
than 1,800 teams of epidemiologists, with a minimum of 5 people/team, traced
tens of thousands of contacts a day. New Zealand similarly tracked down
every single case such that by 30 May there was only one active case left in the
country.<o:p></o:p></div>
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<br /></div>
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Compare this with the UK where testing was abandoned in early
March because the number of cases had overwhelmed our meagre testing facilities.
With a doubling time of three days the number of cases in the country is <a href="https://www.dailymail.co.uk/news/article-8351225/Coronavirus-cases-doubled-three-days-1-5m-UK.html">estimated</a>
to have increased from 11,000 to 1.5 million in the 20 days between 3 and 23
March while the government dithered and talked about ‘herd immunity’ and handwashing.<o:p></o:p></div>
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<br /></div>
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Second, <b>successful countries protected their vulnerable
populations</b>. New Zealand’s total of 22 deaths occurred mainly in two care homes;
yes remarkably the disease got into <i>only two</i> care homes. By contrast on 12 May it
was <a href="https://www.msn.com/en-gb/news/coronavirus/uk-coronavirus-death-toll-passes-40000-with-more-than-8000-in-care-homes/ar-BB13XDBv#image=BB11oRdJ|2">reported</a>
that more than 8,300 deaths in UK care homes had been linked to the virus since
the epidemic started.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We now know that this was because suspected cases in many UK
care homes were not even tested, staff were not supplied with PPE and hundreds
of people were discharged from hospitals into care homes taking the virus with
them. And so British care homes became incubators for COVID-19. <o:p></o:p></div>
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<br /></div>
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Third, <b>successful countries employed sensible exit strategies</b>.
Lockdown measures were not relaxed until the disease had been virtually eliminated
and test and trace techniques were sufficient to locate and isolate those few
cases which remained.<o:p></o:p></div>
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<br /></div>
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Again, by contrast, lockdown measures have been lifted when there
are still ten of thousands of active cases in European countries including the UK.
According to John Edmunds, a professor of infectious disease modelling at the
London School of Hygiene and Tropical Medicine, there are still <a href="https://www.theguardian.com/world/2020/may/29/covid-19-spreading-too-fast-to-lift-uk-lockdown-sage-adviser">8,000
new infections every day</a> in England without counting those in hospitals and
care homes.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Given that in many people the infection lasts for three
weeks (say 20 days) that would mean over 160,000 active cases in the UK at any
one time. In China the epidemic peaked at 3,000 cases a day (see p29 <a href="https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf">here</a>)
so we are still over double the number of new cases per day at China’s peak in
a country with less than 5% of China’s population.<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Worldwide the last three days (28, 29 and 30 May) have seen the
largest number of new cases since the pandemic began (116,000, 125,000 and 124,000
– see chart at top of this article).<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Test and trace strategies worked in China and New Zealand with
hundreds of active cases – but the manpower and organisation required to make
them work with over 100,000 active cases in the UK are much higher and our test
and trace workforce is not even yet up and running. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
Remember that the UK’s coronavirus cases went from 11,000 to
1.5 million in 20 days between 3 and 23 March this year. We are still at the
equivalent of 15 March even now. Understandably several advisors of the Sage
committee have <a href="https://www.theguardian.com/world/2020/may/29/covid-19-spreading-too-fast-to-lift-uk-lockdown-sage-adviser">expressed
concern</a> that we are taking our foot off the brake too early and risking a
second spike in cases. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal">
These concerns are amplified when we consider that recent
studies have shown that, although all those who have had the virus <a href="https://directorsblog.nih.gov/2020/05/07/study-finds-nearly-everyone-who-recovers-from-covid-19-makes-coronavirus-antibodies/">will
have antibodies</a> to it, only <a href="https://www.the-scientist.com/news-opinion/researchers-applaud-spanish-covid-19-serological-survey-67590">5%
of Spanish people</a> and <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/28may2020">7%
of UK people</a> on recent studies have antibodies now. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In other words, 95% of the Spanish population and 93% of the
British population are still susceptible to coronavirus infection, at a time
when we still have no treatment and no vaccine. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
And yet according to <a href="https://www.worldometers.info/coronavirus/">official figures</a> there
have already been 38,000 deaths in the UK and 27,000 in Spain. If the whole population
of both countries were to be infected these figures could rise as much as 15 to
20 times. And as these figures only include those cases proven by test to have
the virus the real numbers could be <a href="https://www.bbc.co.uk/news/health-52623141">considerably higher</a>. <span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"><br /></span></div>
<div class="MsoNormal">
This has led Mark Woolhouse, a professor of infectious
disease epidemiology at the University of Edinburgh, to <a href="https://www.theguardian.com/world/2020/may/29/covid-19-spreading-too-fast-to-lift-uk-lockdown-sage-adviser">suggest</a>
that intensive surveillance, large-scale screening, effective contact tracing,
isolation of cases, quarantine for international arrivals and some residual
physical distancing ‘is a possible new normal’.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It is perhaps easy to be wise in retrospect, but for many
countries in the developed world this crisis is far from over. Lockdown has flattened
the curve but prolonged the agony and we may only have witnessed the first act
of a very long play. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But the lessons are clear – the trajectory of COVID-19 in
any given country is largely a product of how that country handles it. Some
countries have done incredibly well – and others incredibly badly. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The important thing is that we learn the lessons for next time.
We can be thankful that COVID-19 is only moderately infectious and carries an
overall mortality rate of only about 1%. Imagine if it was as lethal as Ebola and
as easy to catch as chicken pox. Or perhaps try not to imagine. <o:p></o:p></div>
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<br /></div>
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<br /></div>
<br />Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com5tag:blogger.com,1999:blog-2654455663519806899.post-49003310326811325612020-04-13T04:57:00.000-07:002020-04-14T07:45:06.026-07:00Trusting God through difficulties – five keys to resilience and perseverance<br />
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<div class="MsoNormal" style="margin-left: 18.0pt;">
We all face difficulties in life.
What is unique about the coronavirus pandemic is that we are all facing the
same difficulty at the same time – although its effect on each one of us is
different. <o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
But each family has its own story
of illness – mental and physical, chronic or terminal. Each family at some time
will face loss – of money, possessions, hopes and dreams. Bereavement, failure
and disappointment is part of life for all of us at some point. And we all eventually
know the pain of broken relationships or loneliness and isolation – be it temporary
or permanent. In addition, for Christians there is the promise that in some way
or another we will face persecution (2 Timothy 3:12).<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
People of various worldviews and
faiths all have their explanations for suffering. For Muslims it’s about the will
of Allah – it’s all fate. For Buddhists, it has to do with unsatisfied desire –
it’s in the mind. For Hindus it is payback for past lives - it’s all karma. And
for atheists it’s the product of time and chance – it’s just random molecules.<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
But for Christians who believe in
a God who is at once all-powerful, all-knowing and all-loving – the question is
often raised – why doesn’t he do something about it? Surely, he must know and
care and be able to deal with it?<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Philosophers and theologians
throughout the ages have grappled with this question by devising ‘theodicies’ - explanations for why God might allow suffering. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
At one level these usually fall
in the category of one of four F’s.<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
First, we live in a <b>fallen
world</b> which is damaged by sin. The breaking of God’s relationship with
human beings (through our rebellion and indifference) has led also to a
breaking of our relationships with each other and with the planet. War, disease
and natural disasters are to be expected in such a world. The whole world is
‘groaning’ (Romans 8:22).<o:p></o:p></div>
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<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Next is the effect of <b>free
will</b>. God has granted human beings, and indeed the devil himself, the
ability to make choices. How much of the difficulty in our world results from
people (or demons) making bad choices or failing to make good ones?<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Third, we need to see
difficulties through the eyes of <b>faith</b>. God has higher purposes in
suffering which we, from our limited human perspective, may be unable to
discern. Suffering produces perseverance and perseverance produces character,
as the Apostle Paul reminds us. (Romans 5:3, 4).<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Finally, we need to see suffering
in the light of the <b>future</b>. God has unfinished business with this planet
and its inhabitants and his intention is to create a new heaven and new earth
where there is no suffering (Revelation 21:1-4). Everything will eventually be
put right. But he is in no hurry as he wants to give people a chance to turn to
him before it is too late. (2 Peter 3:9) And pain and difficulties, as CS Lewis
reminds us, are his megaphone to a deaf world. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
But the Bible is also a book for
life travellers more than armchair philosophers; and travellers ask different
questions: How do I get over this next hill or obstacle? Which route do I take
at this fork? Don’t expect to know the answers to all life’s mysteries and
especially what God’s purposes might be for you personally through them.<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
And so, we would expect Scripture
to be replete of practical advice for travellers – and it is. </div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Psalm 13 is a
great example, worthy of thousands of words. Facing problems? Keep praying
(Psalm 13:1-4), trust in his unfailing love (5), rejoice in his salvation (5)
and sing the Lord’s praise (5). All of these are life-transforming exhortations.
<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
But in this post, I want to draw to your attention five keys to resilience and perseverance from one of my favourite chapters in
the Bible – Hebrews 12. I hope they will be as much help to you as they have
been for me when I need something a little more. Hebrews 12 is a feast of
practical instruction – and its appeal is to use our minds to think our way out of
bitterness, despair and self-pity.<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b>1.Consider those who have gone
before (Hebrews 12:1-4)</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
The chapter starts with the word
‘therefore’ calling us to look back at what has just been said:<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<i>‘Therefore, since we are
surrounded by such a great cloud of witnesses, let us throw off everything that
hinders and the sin that so easily entangles. And let us run with
perseverance the race marked out for us’ (Hebrews 12:1,2)<o:p></o:p></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<i><br /></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Who is this great cloud of witnesses?
They are the heroes of faith whose names are listed in Hebrews 11 – Abel, Noah,
Abraham, Isaac, Jacob, Moses, Gideon, David, Samuel and the prophets. Many of
them won great victories – but none had a life devoid of suffering and
struggle.</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Some of them, we are told, were ‘tortured…
faced jeers and flogging, chains and imprisonment. They were put to death
by stoning… sawn in two, killed by the sword… persecuted and mistreated.’
(Hebrews 11:35-37). <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
In comparison many of own burdens
pale into insignificance. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
But most of all the author bids
us to consider Jesus Christ himself, who ‘endured the cross, scorning its
shame’ in order to win our salvation. In fact, he put himself through this
ordeal for ‘the joy that was set before him’ – the joy of saving us, and of
winning us for himself.<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Jesus, in his struggles on our behalf,
always had the end in view and this is what encouraged him to press on. In the
same we need to remember that nothing done in the Lord’s service is ever in
vain (1 Corinthians 15:58) and that our labours for him are fruitful
(Philippians 1:22) even if there are times when we cannot imagine the fruit, let
alone see it with our own eyes. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<i>‘Let us not become weary in
doing good, for at the proper time we will reap a harvest if we do not give up.’
(Galatians 6:9)<o:p></o:p></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<i><br /></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Have we ‘resisted to the point of
shedding our blood’? (12:4) Not many of us. So, let us consider those who have
gone before – especially Jesus Christ – and think about what they went through
before feeling too sorry for ourselves. Let’s instead ‘throw off everything
that hinders and the sin that so easily entangles’. (12:2)<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b>2.Endure hardship as
discipline (12:5-12)<o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<i>‘Endure hardship as
discipline; God is treating you as his children. For what children are not
disciplined by their father?’ (Hebrews 12:7)<o:p></o:p></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<i><br /></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
God uses the hardships we face to
build into us the qualities we need to be his effective disciples. ‘Perseverance
produces character’ says Paul (Romans 5:4). ‘Consider it pure joy when you face
trials of many kinds, because you know that the testing of your faith produces perseverance’,
says James. (James 1:2,3)<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Just as training hones the athlete
and grit produces a pearl in an oyster, so God uses trouble and difficulty to
shape and improve us, so that we are more useful to him. This is a mark of his
love for us. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
So, ‘do not lose heart when
he rebukes you, because the Lord disciplines the one he loves’. (12:5). Just as
our parents’ discipline is a mark of their love for us, so when God brings
hardship into our lives it is with a higher purpose of moulding us into his
image. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<i>‘No discipline seems pleasant
at the time, but painful. Later on, however, it produces a harvest of
righteousness and peace for those who have been trained by it.’ (Hebrews 12:11)<o:p></o:p></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<i><br /></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Often if we are honest, we find
ourselves taking exactly the opposite view and assuming that God cannot love us
because of what he has allowed us to go through – but in fact he never promised
us that life would be easy. Rather Jesus said to his disciples, ‘In this world
you will have trouble’. (John 16:33)<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
How we love to hear the tender
words of Jesus, ‘Come to me, all you who are weary and burdened, and I
will give you rest’ (Matthew 11:28). But sometimes we actually need him to be
tougher with us. Jesus said some unbelievably tough things to his disciples,
which they badly needed to hear for their own good. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
When Jeremiah was complaining to the
Lord about how difficult things were for him as the Lord’s prophet he received a
salutary telling off: <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<i>‘If you have raced with men on
foot and they have worn you out, how can you compete with horses? If you
stumble in safe country, how will you manage in the thickets by the Jordan?’
(Jeremiah 12:5) <o:p></o:p></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<i><br /></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Effectively God is saying, ‘toughen
up. If you think this is bad how are you going to cope with <span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">what is coming?’
<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">God disciplines us through the hardships
we face in order that he can use us more effectively in the future. <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b><sup><span style="background: white; color: #001320;">‘</span></sup></b><i><span style="background: white; color: #001320;">No discipline seems pleasant at the time, but painful. Later
on, however, it produces a harvest of righteousness and peace for those
who have been trained by it.’ (12:11)<o:p></o:p></span></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<i><span style="background: white; color: #001320;"><br /></span></i></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;">So, when we face difficulty a good
question to ask is, ‘What is God teaching me through this? What qualities is he
building into me as I rise to this occasion?’<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><br /></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b>3.Make every effort to live in
peace and be holy (12:13-17) </b><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Sometimes we can be tempted to
grumble against God when we face difficulties. In the Book of Malachi God accuses
his people of saying ‘harsh things’ against him. (Malachi 3:13). ‘What are
these harsh things?’ they ask. God replies that it is when they say, ‘it is futile
to serve God. What did we gain from carrying out his requirements’?<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
How often we fall prey to this – pouring
scorn upon our Lord and Saviour because we don’t like our personal circumstances.
<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
This part of Hebrews 12 warns us
of the danger of using hardship as an excuse to stop being serious about our discipleship.
Esau is cited as a sobering example in throwing away his inheritance just because
he was tired and hungry after a hard day’s work. (12:16)<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
We need to ensure that we do not
fall into bitterness, sexual immorality of fighting with others out of spite for
God or because we think that what we are going through gives an excuse for such
behaviour.<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Living holy lives and living in
peace with others are no less our duty when times are tough. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
As Peter reminds us, we ‘ought to
live holy and godly lives’ as we ‘look forward to the day of God and speed its
coming’. (2 Peter 3:13)<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
This is crucial if we are to commend
the Gospel to others. Let’s not use tough times as an excuse for sin.<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b>4.Remember what you have been
saved to (12:18-24)</b><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
The writer here draws a contrast between
the Old Covenant made by the Israelites on Mt Sinai and the New Covenant sealed
with the blood of Christ on the mount of crucifixion. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
The promised rewards of the former
were dependent on obedience to God’s commands (Exodus 19:5, 6) and there were accordingly
warnings, commands and punishments for disobedience (Deuteronomy 28:15-68). But there is no condemnation for those who are in
Christ Jesus (Romans 8:1).<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
By contrast, the New Covenant is
based on God’s grace – his unmerited favour to us through Jesus paying the price
for our sins on the cross. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
We look forward to the ‘heavenly Jerusalem’
(12:22) and a glorious eternity with God. Christians often forget that the rewards
in the Christian life are almost entirely in the future. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
And it is the glories and delights
of heaven that put the sufferings of this life into perspective. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
No eye has seen, no ear has
heard, and no human mind has conceived what God has prepared for those who love
him. (1 Corinthians 2:9) In the light of the eternal glory that is coming, our
troubles on earth, however bad, are but ‘light and momentary’ when seen from
this perspective. (2 Corinthians 4:17)</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b>5. Remember what you have been
saved from (12:25-29) </b><o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Keeping our troubles in
perspective against the joys of heaven is sobering, but so also is seeing them against
the horrors of hell, eternal separation from God. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
If God was simply a God of justice,
then he would have eliminated humankind at the moment Adam and Eve first
sinned. But he is thankfully also a God of mercy, who delays the judgment we
all deserve to enable us to repent. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
We cannot stand safely in his presence
unless we are clothed with the ‘righteousness of Christ’ (2 Corinthians 5:21) because
‘God is a consuming fire’. (12:29)<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
The author of Hebrews here reminds
us about the fate of people at the time of the Exodus who turned their backs on God.
<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
How much worse will it be if we
reject him now, after the coming of Christ. <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
The threat of coronavirus is
nothing compared to facing Jesus Christ unforgiven on the day of judgement so
we need to be thankful, reverent and humble before him. (12:28, 29) <o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b>Conclusion <o:p></o:p></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<b><br /></b></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Are you tempted to fear, despair
or give up? Consider those who have gone before. Endure hardship as discipline.
Make every effort to live in peace and be holy. And see things in an eternal perspective
– always remember what you have been saved to and what you have been saved from.</div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
<o:p></o:p></div>
<div class="MsoNormal" style="margin-left: 18.0pt;">
Let’s take these five keys to resilience
and perseverance to heart as we negotiate these current difficulties. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<br />Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-7635498371446546522020-04-01T15:11:00.001-07:002020-04-03T05:43:26.087-07:00‘Green zones’ for the vulnerable may be a cheap and effective option for preventing coronavirus spread in low-resource settings<br />
<div class="separator" style="clear: both; text-align: center;">
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<div class="MsoNormal">
US and Western Europe have so far been the hardest hit by the
coronavirus with over 80% of cases worldwide - but there’s good reason to think
that the Developing World will ultimately suffer most. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
According to a <a href="https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/">recent
report</a>, 40 million lives may be at risk this year (see my previous post <a href="http://pjsaunders.blogspot.com/2020/03/the-developing-world-and-not-west-will.html">here</a>).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Controlling spread of the virus there will be a very different prospect
in low-resource settings. What techniques are likely to work best?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A <a href="https://www.lshtm.ac.uk/newsevents/news/2020/covid-19-control-low-income-settings-and-displaced-populations-what-can">new
paper</a> from the London School of Hygiene and Tropical Medicine (LSHTM) is
advocating so-called green zoning – rather than quarantining those already
infected by the virus (red zoning), those individuals who are both unaffected and
vulnerable are protected by being separated off from the rest of the population.
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This may appear counterintuitive – after all developing countries
have a much lower proportion of older people – in Wales, for example 21% are
over 65 whereas in Ethiopia only 3% are.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But the authors identify three reasons why populations in
the developing world are likely to be more vulnerable to COVID-19.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
First is <b>reduced social distance</b>. Larger intergenerational
households, intense social mixing between the young and elderly,
overcrowding in urban slums and displaced people’s camps, and specific cultural
and faith practices such as mass prayer gatherings, large weddings and funerals
– all lead to higher transmissibility of the virus.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Second is <b>high numbers of vulnerable patients</b>. Non-communicable
diseases (NCDs), like diabetes, hypertension and chronic respiratory disease,
undernutrition, tuberculosis and HIV all make it more likely that coronavirus
infection will push people over the edge.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Third is <b>weaker health services</b>. Fewer hospital beds,
fewer health professionals, less intensive care facilities and poorer infrastructure
and healthcare delivery systems. Inadequate water and sanitation make it worse.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The strategies that have worked so effectively in containing
the virus in East Asian countries like Singapore, Hong Kong and South Korea – widespread
testing and meticulous contact tracing – are very resource-intensive and less
easily replicable in low-income and crisis settings.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Lockdowns are also likely to be very harmful for societies
in which most live from hand to mouth and have little if any savings. And when people
are stretched beyond their ability to cope they are less likely to comply with control
measures. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There is also little prospect of scaling up intensive care
to the levels required and isolation of cases in dedicated high-intensity wards
might offer little benefit as most transmission would still be due to mildly
unwell people spreading the virus to close contacts and family members.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
For all these reasons, it may be therefore a better use of
resources to focus on protecting the vulnerable.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In Ebola epidemics, the aim of isolating the ill into a
contaminated ‘red zone’ is primarily to protect the healthy. But with COVID-19,
the red zone is everywhere, so it makes more sense to protect those more likely
to suffer fatal illness from the rest of the population who are much more
likely to survive the infection. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The risk of coronavirus infection increases with age with a
particularly high risk among those aged over 70 (or even 60 in low-resource
settings) and/or living with NCDs and other immuno-suppressing conditions.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The authors suggest three options for shielding high-risk
community members – house-hold level, street-level and neighbourhood or sector
level. In the first two arrangements healthier members of the high-risk group could
care for those with disabilities. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Stringent infection control measures should operate with all
options. The green zone’s boundaries should probably remain virtual, but a
single physical entry point, with handwashing facilities, should be established
and food and other provisions should only be exchanged through this point.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Given that it may be difficult to isolate at-risk people for
long periods the strategy should be discontinued as soon as safe to do so. This
could be ascertained by serological testing, which is likely to be very cheap
once widely available.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Detailed guidelines need to be developed and other feasible,
high-yield interventions should be undertaken simultaneously (eg. staying home
if sick, limiting public transport use, reducing super-spreading events at
funerals or other mass gatherings, promoting hand-washing, soap distribution). <o:p></o:p><br />
<br />
In the meantime, those who develop symptoms of COVID-19 (fever, continuous cough) would be tested (if possible), isolated and quarantined for 14 days in the usual way (red-zoned), along with their close contacts (family members).<br />
<br />
This approach would enable the rest of the community to carry on with normal life with frequent handwashing etc (maybe we could call this the blue zone!), knowing that if they did catch the virus they would be very unlikely to suffer serious symptoms or die. Meanwhile, immunity would build up gradually in the general population.<br />
<br />
This simultaneous green zone/red zone approach also has the advantage of avoiding the negative effects of lockdown on the economy and normal life, whilst protecting those most vulnerable, until a time when a vaccine is available to confer longer-lasting protection.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Longer-term, as with other viral illnesses like influenza or
HIV, it will be vaccines or antiviral therapies that will best protect people in
low-resource settings – but in the meantime, in the absence of these, protection
in green zones seems a sensible, practical and low-cost option for reducing
mortality.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The protection of the vulnerable resonates well with Christian
ethics – and green zones operate on the ‘Passover principle’ where those located
in safe places (marked by blood on the lintel) were kept from harm. With Easter
coming up soon – this may be a good way to motivate faith leaders, who are often
the most trusted voices in developing world communities, to protect their flocks.
<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<br />Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com2tag:blogger.com,1999:blog-2654455663519806899.post-48448748521619042132020-03-28T16:15:00.002-07:002020-03-28T16:15:59.011-07:00The Developing World and not the West will bear the brunt of coronavirus – but acting quickly could save over 30 million lives this year<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuVwvJufljXvpSxRC82qjvvaQ9YpZBgy8qS2cMKy2VM4030CgUZE_xwE3MdYsGHDgPV9XFhP198Vf2DThe1okfwGGHJS8LuBk2qdOyo6Pi8YfqvMH8fL5k0WnoYcZ7JtrulvY2ByFQChgm/s1600/Africa.jpeg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="532" data-original-width="800" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuVwvJufljXvpSxRC82qjvvaQ9YpZBgy8qS2cMKy2VM4030CgUZE_xwE3MdYsGHDgPV9XFhP198Vf2DThe1okfwGGHJS8LuBk2qdOyo6Pi8YfqvMH8fL5k0WnoYcZ7JtrulvY2ByFQChgm/s400/Africa.jpeg" width="400" /></a></div>
<div class="MsoNormal">
With 80% of coronavirus deaths in Western Europe the focus of
the world’s media has understandably been there. The UK had 260 deaths today and
has had over 1,000 deaths overall.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
But COVID-19 is affecting <a href="https://www.worldometers.info/coronavirus/">199 countries and territories </a>around
the world.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Among these are 27 countries with between 3 and 40 deaths
today (where the UK was on 14-19 March) and 28 countries with 1 to 2 deaths today
(where the UK was on 5-13 March) – so that’s another 55 countries that on deaths
per day are only 9-23 days behind us.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Of those 55 countries over 20 are in the developing world. At
the current rate of spread – a 12% increase in global deaths per day - we <a href="https://pjsaunders.blogspot.com/2020/03/most-european-countries-are-on-similar.html">would
expect</a> to hit 100,000 total global deaths by 7 April, 500,000 by 21 April
and 1 million by 28 April.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But if we were to run this forward to the end of the year what
would we find?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A <a href="https://www.bbc.co.uk/news/health-52055546">new report</a>
this week claimed that doing nothing to combat the virus would leave the world
facing around 40 million deaths this year. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But they also claimed that up to 95% of these could be saved
if countries act quickly. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news--wuhan-coronavirus/">Researchers
from Imperial College in London</a> have looked at the impact of the
pandemic in 202 countries using different scenarios based on data from China
and Western countries.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Their conclusions? <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If countries adopt strict measures early (at a stage where
there are only 2 deaths per 1,000,000 population per week) - such as <a href="https://pjsaunders.blogspot.com/2020/03/diagnostic-capacity-at-scale-is-key-to.html">testing</a>,
isolating cases and wider social distancing to prevent transmission to more
people - 38.7 million lives could be saved.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But if these measures are introduced later (at 16 deaths per
1,000,000 population per week) the figure could drop to 30.7 million. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
On the other hand, social distancing alone would save only
20 million lives. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The effects of the pandemic are likely to be most severe in
developing countries – communication is worse, health facilities are poorer,
there are fewer health professionals and a high incidence of chronic infections
(like TB) and noncommunicable diseases (heart disease, lung disease and diabetes).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Different demographics mean that older people make up a smaller
proportion of the population (21% of people in Wales are in the vulnerable over
65 age-group but only 3% in Ethiopia) but this is more than compensated for by the
larger populations and the increased risk posed by larger multi-generation households.
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The ten most populous countries in the world include India (with
1,380 million people), Indonesia (273m), Pakistan (220m), Nigeria (206m),
Bangladesh (164m) and Mexico (128m). That’s 2,371 million people – about a
third of the world’s total population – in just six countries.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The ten next most populous countries include Philippines,
Egypt, Vietnam and Democratic Republic of Congo (DRC) with a combined population
of over 400 million.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This Is over twice the population of Western Europe (<a href="https://www.worldometers.info/world-population/western-europe-population/">currently
195m</a>).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There will be 25 times more patients needing critical care
than beds available, compared to seven times more in high-income countries, the
report says.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Seeking people’s compliance with infection reducing measures
like social distancing in a wealthy and technologically advanced country like the
UK where education levels are high and communication easy - everybody can be
reached easily by text and social media - is one thing. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Achieving this in many developing countries where infrastructure,
transport and communication systems are poor by comparison, literacy levels relatively
low and where governments and police are more likely to be corrupt,
unaccountable, under-resourced and unmotivated is another prospect altogether.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
According to the BBC, after the lockdown was <a href="https://www.bbc.co.uk/news/world-asia-india-52077395">announced in India</a>
this week, people in Delhi and the financial capital, Mumbai, quickly thronged
shops and pharmacies amid fears of shortages. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Meanwhile, millions have been
left jobless and without money as a result of the shutdown.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It has also sparked an exodus from major cities, where
thousands of migrant workers are setting out on long journeys back to their
home villages after transport was stopped.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
India ranked only 80<sup>th</sup> in Transparency International’s
<a href="https://www.transparency.org/cpi2019">world corruption perception index</a>
in 2019. Indonesia, Pakistan, Mexico, Nigeria and Bangladesh ranked even lower at
85<sup>th</sup>, 120<sup>th</sup>, 130<sup>th</sup> and 146<sup>th</sup> equal
respectively among the 180 countries included. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Corruption means that nothing can be achieved quickly and efficiently.
But as the virus spreads, only the most draconian measures will lessen the
impact and the countries least able to protect themselves will be among the
hardest hit.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Prof Neil Ferguson, from Imperial College London and author
of the report, said: ‘Our research adds to the growing evidence that the
COVID-19 pandemic poses a grave global public health threat.’<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
He adds that ’sharing both resources and best practice is
critically important if the potentially catastrophic impacts of the pandemic
are to be prevented at a global level.’<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Strategies to suppress the virus will need to be maintained
in some way until vaccines or effective treatments become available to avoid
the risk of another epidemic.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The West has huge expertise and now experience in battling COVID-19.
But what will we do to help the less-advantaged global south as they face an
even bigger challenge?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
One thing is clear – if interventions are to have an impact
and go any way to saving 95% of the 40 million who could die this year then we must
act quickly. In a matter of weeks, it could be too late. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We cannot wait as long as we did in the West before acting –
as developing countries do not have enough hospital beds and oxygen, let alone
ventilators to provide back up if prevention of spread of the virus is
unsuccessful. <o:p></o:p></div>
<br />Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com1tag:blogger.com,1999:blog-2654455663519806899.post-83826567708422406202020-03-26T16:52:00.000-07:002020-03-27T01:45:17.428-07:00Our prayers against coronavirus are being answered in amazing ways but one essential element is still missing<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRJGS-Ns9bTpoGMUNZJVfirGvgbMeaYXZ4xsIIXI9gm7L7TFkpfMyAnjeS4vUneaOW2Hl2OK4q0DwGNlKV6_r7E-PSyso5iQKGpsoiopoDoqc4_YtZVXlaMw4WjHAHoJeC73jbsgqm6v4G/s1600/Prayers.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1068" data-original-width="1600" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRJGS-Ns9bTpoGMUNZJVfirGvgbMeaYXZ4xsIIXI9gm7L7TFkpfMyAnjeS4vUneaOW2Hl2OK4q0DwGNlKV6_r7E-PSyso5iQKGpsoiopoDoqc4_YtZVXlaMw4WjHAHoJeC73jbsgqm6v4G/s400/Prayers.jpg" width="400" /></a></div>
<div class="MsoNormal">
Last Sunday night we lit a candle in our front window and
joined hundreds of thousands of other Christians up and down the country and throughout
the world to pray about the Coronavirus pandemic.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
We followed the <a href="https://www.sim.org/documents/25302/4450161/%23PraytoEndCOVID19+-+Prayer+Points.pdf/">#Praytoendcovid19
prayer points</a> as follows.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i style="text-indent: -18pt;"><br /></i></div>
<div class="MsoNormal">
<i style="text-indent: -18pt;">For <b>God to intervene</b> to stop the spread of the
coronavirus from this day forward</i></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<i><span style="text-indent: -18pt;"><span style="font-family: "symbol";"> </span>For <b>those who are sick</b>, that they will have
access to the care and treatment they need</span><br /><span style="text-indent: -18pt;">For protection and stamina for the <b>health
workers</b> who are caring for those with the virus</span><br /><span style="text-indent: -18pt;">For <b>grieving families</b> who have lost loved ones to
know God’s nearness and comfort</span><br /><span style="text-indent: -18pt;">For <b>pastors </b>serving their communities and nations
to have the right words and actions</span><br /><span style="text-indent: -18pt;">For <b>Christ’s body worldwide</b> to support those suffering
in prayer and in sacrifice</span><br /><span style="text-indent: -18pt;">For <b>government officials</b> and decision-makers to
mobilise resources quickly and effectively</span><br /><span style="text-indent: -18pt;">For <b>those waking up</b> to societal and economic fallout
from COVID-19 to reach out to God</span><br /><span style="text-indent: -18pt;">For <b>mission workers</b> worldwide especially those impacted
by COVID-19 to continue their work</span><br /><span style="text-indent: -18pt;">For <b>those who live and die</b> without the knowledge
of Jesus to hear about him and respond</span><o:p></o:p></i></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<i><o:p></o:p></i></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<i><o:p></o:p></i></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<i><o:p></o:p></i></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<i><o:p></o:p></i></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<i><o:p></o:p></i></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<i><o:p></o:p></i></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<i><o:p></o:p></i></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<i><o:p></o:p></i></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<i><o:p></o:p></i></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal">
Over the last week, we have seen these prayers answered in wonderful
ways but most of all in the <a href="https://www.bbc.co.uk/news/health-51714498">extraordinary
mobilisation</a> of people and resources. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
About 12,000 former staff in the UK have come forward,
including 2,600 doctors and more than 6,000 nurses.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
More than 18,700 student nurses and 5,500 final year medics
will also join the NHS workforce.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A call for 250,000 NHS volunteers to deliver food and medicines
to 1.5 million vulnerable people was answered within 24 hours by more than
500,000 people coming forward to offer their services.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Work is also well underway to set up the 4,000 bed 'Nightingale
Hospital' in London’s Excel Centre and the number of ventilators in the country
has been doubled from 4,000 to 8,000.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A nation is willingly complying with measures on social distancing
and quarantine and applauding health workers. And those of all political
parties are standing united to counter the threat. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This has all been accompanied by the most extraordinary
financial package in peacetime to help businesses survive the lockdown and workers
to make it through the crisis.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Britain is preparing for a literal <a href="https://www.bbc.co.uk/news/health-51714498">tsunami of need</a> on the near
horizon and through it all the government has opened itself up to media and public
scrutiny to keep people informed and to build confidence and unity. Our country
is rising to the challenge.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Tonight a <a href="https://www.bbc.co.uk/news/health-52055546">new report</a> from Imperial
College urges countries around the world to act quickly to save 30 million
lives, stressing that those most vulnerable are the elderly in developing countries
which do not have the resources we do. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Everyone has a different story to tell – for me as CEO of
ICMDA, with my next ten trips in March, April and May cancelled, I am asking how best to use these weeks
(and maybe months) to serve our 80 national associations of Christian doctors and
dentists around the world as they respond to this crisis.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
My son and daughter in law, both doctors, are back at work
now that their one year old has tested negative for the virus (saving them 14
days of quarantine and underlining <a href="http://pjsaunders.blogspot.com/2020/03/diagnostic-capacity-at-scale-is-key-to.html">how
important testing is</a>) and my wife is doing virtual paediatric clinics from
home. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
At ICMDA, we are laying other plans aside to support the thousands
of Christian doctors on the frontline. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I have been amazed at how quickly resources have been produced
(see some linked <a href="https://icmda.net/covid19/#resources">here</a>) to establish
treatment protocols for diagnosis and treatment, not just in the West but in resource
poor settings all over the world - ensuring that everyone is working in a way
that is led by the very best scientific evidence.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Our social media groups – especially WhatsApp and Facebook –
are buzzing with suggestions and advice as doctors and dentists from all over the
world share their expertise. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
E-books, on-line courses, protocols, manuals – even a <a href="https://www.medicalmissions.com/coronavirus">handbook for Christian healthcare
workers</a> – are being rushed out at breakneck speed. <a href="https://www.dropbox.com/s/klwenbpm0zgr49e/Clinical%20Management%20of%20Patients%20with%20suspected%20COVID_FINAL.pdf?dl=0">A
manual for emergency care of COVID-19 patients in low-resource settings</a> from
Africa, a <a href="https://video-intl.alicdn.com/Handbook%20of%20COVID-19%20Prevention%20and%20Treatment%20%28Standard%29.pdf?spm=a3c0i.14138300.8102420620.download.6df3647fAbDVPF&file=Handbook%20of%20COVID-19%20Prevention%20and%20Treatment%20%28Standard%29.pdf">68-page
handbook of COVID-19 prevention and treatment</a> from China, <a href="https://aphn.org/covid19-resources/">resources on palliative care for
COVID-19 patients</a> from Asia-Pacific.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
All this activity from governments, NGOs and ordinary people
is a massive answer to prayer and great cause for rejoicing. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It is right both to come to God on our knees and then to act
as best we can to do what each of us can with the gifts, skills and influence
that God has given us. All this is essential.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But one little thing still nags me – something still seems
lacking.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
My wife and I have been reading through some of the great
prayers of Scripture over the past week – and were struck particularly by those
of Nehemiah and Daniel – two of the most skilled and gifted leaders and administrators
in Jewish history. These men were great activists who got things done – but they
were also great men of prayer.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Can I encourage you to read (or reread) their prayers in
Nehemiah 1:5-11 and Daniel 9:4-19?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When Nehemiah heard of the plight of Jerusalem we are told that
he ‘sat down and wept’ then ‘mourned and fasted and prayed’ (Nehemiah 1:4). His
prayer was one of confession and repentance:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>‘I confess the sins we Israelites, including myself and my
father’s house. have committed against you. We have acted very wickedly towards
you. We have not obeyed the commands, decreases and laws you gave your servant
Moses.’ (Nehemiah 1:6,7)<o:p></o:p></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
When Daniel learned from the Scriptures that Judah’s 70-year
captivity in Babylon was coming to an end he ‘turned to the Lord and pleaded
with him in prayer and petition, in fasting and in sackcloth and ashes’.
(Daniel 9:3) Again his prayer was one of prayer and repentance:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>‘Lord you are righteous but this day we are covered with
shame… because of our unfaithfulness to you… we have not obeyed the Lord or
kept the laws he gave us through his servants the prophets…’ (Daniel 9:7-10).<o:p></o:p></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
The one prayer in the list above that God has not yet shown
signs of answering is to stop the spread of the coronavirus ‘from this day forward’.
The numbers of those affected and dying grow daily before our eyes and all the data
indicates that <a href="http://pjsaunders.blogspot.com/2020/03/most-european-countries-are-on-similar.html">the
worst is yet to come</a>. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The apostle Peter tells us that repentance starts with us
Christians. It is up to us to lead the way.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>‘For it is time for judgment to begin with God's
household; and if it begins with us, what will the outcome be for those who do
not obey the gospel of God?’ (1 Peter 4:17) <o:p></o:p></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
I have in a previous post looked at <a href="http://pjsaunders.blogspot.com/2020/03/covid-19-what-does-bible-say-about.html">what
the Bible says about plagues</a>. There is not the space to recount those lessons
here but the bottom line is that plagues happen under the sovereign will of God
and they are a warning to us, a sign of judgment, a call to repentance. (1
Kings 8:37-40)<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When Joshua fell before God to plead for his help after the Israelites
had been routed by the men of Ai God asked him what he was doing and ordered
him to ‘stand up’. (Joshua 7:10-12)<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Israel had sinned. It was no good asking for God’s help. They
needed first to repent.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I wonder if that is the fundamental problem here – we live
in a world that has turned its back upon God the Father and its Lord and Saviour
Jesus Christ. But we also, as God’s people, are seriously compromised. To a
large extent, the nation’s sins are also our own. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We are asking for his help in this crisis and he is answering
our prayers in many ways as outlined above. But he has not stopped the plague. In
fact, if anything it is accelerating. Perhaps it is because as a nation, and first
as God’s people in this nation – alongside all our other prayers and actions -
we need to repent.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>‘If I close the sky so there is no rain, or if I command
the locust to devour the land, or if I send a plague among My people, <a href="https://www.blogger.com/null" name="15"></a> and My people who are called by My name humble themselves and pray
and seek My face and turn from their wicked ways, then I will hear from heaven,
forgive their sin, and heal their land.’ (2 Chronicles 7:13,14)<o:p></o:p></i></div>
<div class="MsoNormal" style="background-color: white; color: #222222; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13.2px;">
<br /></div>
<br />Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com7tag:blogger.com,1999:blog-2654455663519806899.post-48630170107322200022020-03-22T15:40:00.000-07:002020-04-01T01:18:04.351-07:00Most European countries are on a similar coronavirus trajectory to Italy and the projected numbers of deaths world-wide are deeply sobering<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEic242xeUS3NJuAsWSMhi3dQyi6mMuDPhQ84XbAyNCdDx-21fH_pcTG0vlC9e-dSCJKN6O-zBvtqor5YmEenQlbbfJqI0uVYP29je4ytwKtaB8ri_sTTbCT1OQnY3d7YbjCMZ-zbrYRSdxq/s1600/ItalyChina.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="433" data-original-width="628" height="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEic242xeUS3NJuAsWSMhi3dQyi6mMuDPhQ84XbAyNCdDx-21fH_pcTG0vlC9e-dSCJKN6O-zBvtqor5YmEenQlbbfJqI0uVYP29je4ytwKtaB8ri_sTTbCT1OQnY3d7YbjCMZ-zbrYRSdxq/s400/ItalyChina.jpg" width="400" /></a></div>
<div class="MsoNormal">
<i>If you are in any doubt that coronavirus is a very
serious problem then please read this. </i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
One of the striking features of the COVID-19 pandemic has been
the different trajectories of spread in different countries. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The epidemic started in China but after 81,000 cases and just
over 3,200 deaths there have been no domestically acquired cases there in the last
three days. The danger now for China is for the virus to come back to the
country from overseas but it seems to have the virus well under
control.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhANWncd7DfGXK1rE756q_l86JlZB4nfiPeV5Kph9dj5RLEkiE6gYIrFFT4b2Ohy2S8FFNpEzI9IEmhl3JK7-59Jsb3dSVCyMOhOpHNVlRfYN9fKphOaZsrwX3Q6hs8pqmCyA0oYBlK2Viz/s1600/TotalDeaths2.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="429" data-original-width="288" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhANWncd7DfGXK1rE756q_l86JlZB4nfiPeV5Kph9dj5RLEkiE6gYIrFFT4b2Ohy2S8FFNpEzI9IEmhl3JK7-59Jsb3dSVCyMOhOpHNVlRfYN9fKphOaZsrwX3Q6hs8pqmCyA0oYBlK2Viz/s320/TotalDeaths2.jpg" width="214" /></a>China’s remarkable success in controlling the virus is
documented in the Report of the WHO-China Joint Mission on Coronavirus Disease
2019 (COVID-19) dated 16-24 February. You can read the whole report <a href="https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf">here</a> but
there is an excellent summary <a href="https://www.reddit.com/r/China_Flu/comments/fbt49e/the_who_sent_25_international_experts_to_china/">here</a>
(much more detail in my previous post <a href="https://pjsaunders.blogspot.com/2020/03/diagnostic-capacity-at-scale-is-key-to.html">here</a>).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
By contrast, in Italy the number of new cases is increasing exponentially.
Italy has 7,500 deaths to China’s 3,200 but on a population basis Italy has 1,230 cases per million population to China’s 56.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In fact, of the 198 countries and territories now with coronavirus, 72 of them have more cases than China when measured in cases per million population.
This 72 includes most of the countries in Europe.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Eastern countries like Singapore, Taiwan, South Korea, Hong
Kong and Japan are on a similar trajectory to China (see blue lines in graph below) – but most Western
countries are following the pattern of Italy (see also <a href="https://www.theguardian.com/world/2020/mar/21/coronavirus-asia-acted-west-dithered-hong-kong-taiwan-europe">here</a>).
The <a href="https://www.ft.com/coronavirus-latest">Financial Times</a> has an
illuminating series of graphs demonstrating this. </div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ6f_F1ZtkrkgFR6czvZfgaoG2N1YGc-euFSRBEW3rwDt0RUnk77iKwGtHcoPYoEf_uIThnPPpQKc4qXGgA8Ii-El722w3QIHu60y3qaZKJRfqSePvm_cl4Dga8XHXsckuCxXGE670yEU9/s1600/Trajectories.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="537" data-original-width="969" height="221" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQ6f_F1ZtkrkgFR6czvZfgaoG2N1YGc-euFSRBEW3rwDt0RUnk77iKwGtHcoPYoEf_uIThnPPpQKc4qXGgA8Ii-El722w3QIHu60y3qaZKJRfqSePvm_cl4Dga8XHXsckuCxXGE670yEU9/s400/Trajectories.jpg" width="400" /></a></div>
<o:p></o:p><br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The World Health Organisation’s top emergency expert, Mike
Ryan, <a href="https://www.irishpost.com/news/world-health-organisations-top-emergency-expert-says-lockdowns-not-enough-defeat-coronavirus-181973">speaking</a>
on 22 March on the BBC’s <i>Andrew Marr Show</i>, said that movement
restrictions and lockdowns are not enough to control spread of the virus (video
<a href="https://twitter.com/BBCPolitics/status/1241663266549641216?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1241663266549641216&ref_url=https%3A%2F%2Fwww.irishpost.com%2Fnews%2Fworld-health-organisations-top-emergency-expert-says-lockdowns-not-enough-defeat-coronavirus-181973">here</a>).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
‘What we really need to focus on is finding those who are
sick, those who have the virus, and isolate them, find their contacts and
isolate them,’ Ryan told Marr (see my previous post on the importance of testing
<a href="https://pjsaunders.blogspot.com/2020/03/diagnostic-capacity-at-scale-is-key-to.html">here</a>).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Much of Europe and the US, have introduced drastic
restrictions on travel for non-essential workers, many of whom are now working
from home, while schools, bars, pubs and restaurants have also been closed.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimjIH8X2GpLqc_H3vI9KfsUYvxWVCmIRTobHm2H5muh1MllVkxS6BGp3FxSLP18AGWqDKDBRqDj4_bJ3qcaUwP2Mg27_Mepj7l4BMjymvA-7qyjqkRClpaCYwcqXqt1LSCskUO7R1xxCrg/s1600/ItalyDeaths.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="524" data-original-width="636" height="263" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEimjIH8X2GpLqc_H3vI9KfsUYvxWVCmIRTobHm2H5muh1MllVkxS6BGp3FxSLP18AGWqDKDBRqDj4_bJ3qcaUwP2Mg27_Mepj7l4BMjymvA-7qyjqkRClpaCYwcqXqt1LSCskUO7R1xxCrg/s320/ItalyDeaths.jpg" width="320" /></a></div>
<div class="MsoNormal">
However, Mr Ryan said he believed these countries need to
follow the example of countries like China, Singapore and South Korea, where
these restrictions had been coupled with rigorous measures to test people
suspected of having the virus.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
‘Once we've suppressed the transmission, we have to go after
the virus. We have to take the fight to the virus,’ Mr Ryan added. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As I <a href="https://pjsaunders.blogspot.com/2020/03/diagnostic-capacity-at-scale-is-key-to.html">argued</a>
last week, the failure of countries like the US and UK, has been not having
enough testing kits to identify those infected. The UK is testing about 10,000 people
a day while China was producing 1.6 million testing kits per week at the height
of their crisis. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://www.bbc.co.uk/news/world-asia-51866102">Singapore</a>,
like China, has a sophisticated and extensive contact tracing programme, which
follows the chain of the virus from one person to the next, identifying and
isolating those people - and all their close contacts - before they can spread
the virus further.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As of 26 March, Singapore had confirmed 631 cases and no
deaths. For about 40% of those people, the first indication they had was the
health ministry telling them they needed to be tested and isolated.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In total, 6,000 people have been contact-traced to date,
using a combination of CCTV footage, police investigation and old fashioned,
labour-intensive detective work - which often starts with a simple telephone
call.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
By contrast, in the UK, we failed to do this in the early
stages allowing the virus to steal a march on us. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnO-9ENq4Ahsw3ofIx-a7e3dV5PazF_di8lVXB2IUwH2Bcj6WD2XyryYzLhyN5KO0ik3L4OWaSqvIvJCOG67ZXlyvgRaeDz0EP2z4P6j-uzFSZR3AwGw42tX6977odRwQZeurz-bmZkQZY/s1600/DailyDeaths.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="344" data-original-width="525" height="261" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhnO-9ENq4Ahsw3ofIx-a7e3dV5PazF_di8lVXB2IUwH2Bcj6WD2XyryYzLhyN5KO0ik3L4OWaSqvIvJCOG67ZXlyvgRaeDz0EP2z4P6j-uzFSZR3AwGw42tX6977odRwQZeurz-bmZkQZY/s400/DailyDeaths.jpg" width="400" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Now, because of the lack of resources to check anyone other
than hospitalised cases, we have junior doctors being quarantined at home for
two weeks simply because their child has a cold – when a simple test could clear
them to go back to work. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Similarly, potentially infected healthcare staff, who haven’t
been tested because we lack the resources to test them, are at risk of spreading the
virus around the wards.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We also have no way of knowing (because we are not testing)
just how many cases there are in the UK overall or who has it and who doesn’t.
Official figures show around 9,500 but government advisor Patrick Vallance admitted last week that the real number was closer to 55,000. Given the number of deaths
in the UK already it may be much higher. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The best indication we really have of the seriousness of coronavirus
in any given country currently is the <span style="mso-spacerun: yes;"> </span>number of deaths, but as death occurs on
average 14 days after first symptoms (in those who die) this leaves us a long
way behind the curve and means that any interventions we make may take some
time to have effect. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEarxw5uukJVUDOANmKTx99Q8FZhDnAj-6lnwMROV1dr3UJmjLmI1pwa_GHLJt-OdEpQ1_ubVSbURgnQskrmz4zSYIhPG8bVKXDpgvU4KB2forDL_1d6iMQyC5l5p1DuW-GAchVlHuT8rZ/s1600/Daily+Deaths.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="535" data-original-width="470" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEarxw5uukJVUDOANmKTx99Q8FZhDnAj-6lnwMROV1dr3UJmjLmI1pwa_GHLJt-OdEpQ1_ubVSbURgnQskrmz4zSYIhPG8bVKXDpgvU4KB2forDL_1d6iMQyC5l5p1DuW-GAchVlHuT8rZ/s320/Daily+Deaths.jpg" width="280" /></a>The number of deaths so far may seem quite small - only 21,000
in total globally by 26 March - but as can be seen from the numbers opposite (source
<a href="https://www.worldometers.info/coronavirus/coronavirus-death-toll/">here</a>)
the number of deaths <i>per day</i> increased from 100 to 1,600 in sixteen
days between 5 and 21 March. This amounts to a doubling of numbers every four days, or a 19% increase
daily. From 21 to 26 March the average daily increase was 10%.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If this trend were to continue, and I realise this is a big if because of the large number of potentially confounding variables not least interventions by governments,
then a 10% daily increase globally would result in 41,000 deaths worldwide by
31 March, 100,000 by 9 April, one million by 3 May, two million by 10 May, five million by 20 May, ten million by 27 May and 15 million by 31 May.<br />
<br />
So it is May when the increase will really kick in if we fail to stop it. The increases beyond this do not bear thinking about.
I have put the figures in a chart below. </div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
These numbers will of course be mitigated by preventive measures like rigorous
testing, tracing and isolation - or by social distancing and lockdown - but this
dramatic increase in numbers over time is the frightening effect of a 10% increase in daily death rates on the total number of deaths globally.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This is not scaremongering. This is simply what the maths
shows – and is what happens when a virus that is as contagious as Ebola and 30
times more deadly than the flu (with a mortality rate of 3.0-3.4% according to the
WHO – detail <a href="https://www.worldometers.info/coronavirus/coronavirus-death-rate/">here</a>)
is allowed to establish itself in a population. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Unless curbed this will simply overwhelm our health systems
with far more patients requiring oxygen and ventilators than we have capacity
for.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This is why it is so crucial that we all play our part – for
our leaders to get the policy right and resources right and for all of us to
help make it work. But we are also going to need some supernatural help to beat
this – more on that later.<o:p></o:p><br />
<br />
<i>The table below is based on a 10% daily increase in global deaths. The actual increase from 5 to 21 March was 19% daily and 10% daily from 21 to 26 March.</i><br />
<br />
<div class="MsoNormal" style="text-align: justify;">
<table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse; width: 291px;">
<colgroup><col span="3" style="width: 73pt;" width="97"></col>
</colgroup><tbody>
<tr height="23" style="height: 16.9pt; mso-height-source: userset;">
<td class="xl63" height="23" style="height: 16.9pt; width: 73pt;" width="97"><br /><table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse; width: 595px;">
<colgroup><col style="width: 73pt;" width="97"></col>
<col style="mso-width-alt: 3788; mso-width-source: userset; width: 83pt;" width="111"></col>
<col style="mso-width-alt: 3857; mso-width-source: userset; width: 85pt;" width="113"></col>
<col span="2" style="mso-width-alt: 4659; mso-width-source: userset; width: 102pt;" width="137"></col>
</colgroup><tbody>
<tr height="23" style="height: 16.9pt; mso-height-source: userset;">
<td class="xl65" height="23" style="height: 16.9pt; width: 73pt;" width="97">Date</td>
<td class="xl66" style="border-left: none; width: 83pt;" width="111">Daily deaths at
10% daily increase</td>
<td class="xl66" style="border-left: none; width: 85pt;" width="113">Total deaths at
10% daily increase </td>
<td class="xl65" style="border-left: none; width: 102pt;" width="137">Actual Daily
deaths</td>
<td class="xl66" style="border-left: none; width: 102pt;" width="137">Actual total
deaths </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">21/03/2020</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">1,600</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">13,000</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,634</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">13,013</td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">22/03/2020</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">1,760</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">14,760</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,626</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">14,647</td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">23/03/2020</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">1,936</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">16,696</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,873</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">16,154</td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">24/03/2020</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">2,130</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">18,826</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">2,381</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">18,894</td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">25/03/2020</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">2,343</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">21,168</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">2,390</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">21,284</td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">26/03/2020</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">2,577</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">23,745</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">2,791</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">24,073</td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">27/03/2020</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">2,834</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">26,579</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">3,217</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">27,344</td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">28/03/2020</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">3,118</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">29,697</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">3,518</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">30,862</td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">29/03/2020</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">3,430</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">33,127</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">3,105</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">33,966</td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">30/03/2020</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">3,773</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">36,900</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">3,723</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">37,788</td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">31/03/2020</td>
<td align="right" class="xl72" style="border-left: none; border-top: none;">4,150</td>
<td align="right" class="xl71" style="border-left: none; border-top: none;">41,050</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">4,535</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">42,309</td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">01/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">4,565</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">45,615</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">02/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">5,021</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">50,636</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">03/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">5,524</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">56,160</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">04/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">6,076</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">62,236</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">05/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">6,684</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">68,920</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">06/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">7,352</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">76,272</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">07/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">8,087</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">84,359</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">08/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">8,896</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">93,255</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">09/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">9,785</td>
<td align="right" class="xl71" style="border-left: none; border-top: none;">103,040</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">10/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">10,764</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">113,804</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">11/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">11,840</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">125,644</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">12/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">13,024</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">138,669</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">13/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">14,327</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">152,996</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">14/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">15,760</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">168,755</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">15/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">17,336</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">186,091</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">16/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">19,069</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">205,160</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">17/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">20,976</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">226,136</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">18/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">23,074</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">249,209</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">19/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">25,381</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">274,590</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">20/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">27,919</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">302,509</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">21/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">30,711</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">333,220</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">22/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">33,782</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">367,002</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">23/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">37,160</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">404,163</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">24/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">40,876</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">445,039</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">25/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">44,964</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">490,003</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">26/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">49,460</td>
<td align="right" class="xl71" style="border-left: none; border-top: none;">539,463</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">27/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">54,406</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">593,869</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">28/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">59,847</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">653,716</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">29/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">65,832</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">719,548</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">30/04/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">72,415</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">791,963</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">01/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">79,656</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">871,619</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">02/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">87,622</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">959,241</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">03/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">96,384</td>
<td align="right" class="xl71" style="border-left: none; border-top: none;">1,055,625</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">04/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">106,023</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,161,648</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">05/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">116,625</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,278,273</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">06/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">128,287</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,406,560</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">07/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">141,116</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,547,676</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">08/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">155,228</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,702,903</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">09/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">170,750</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,873,654</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">10/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">187,825</td>
<td align="right" class="xl71" style="border-left: none; border-top: none;">2,061,479</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">11/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">206,608</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">2,268,087</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">12/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">227,269</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">2,495,356</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">13/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">249,996</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">2,745,351</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">14/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">274,995</td>
<td align="right" class="xl71" style="border-left: none; border-top: none;">3,020,346</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">15/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">302,495</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">3,322,841</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">16/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">332,744</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">3,655,585</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">17/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">366,018</td>
<td align="right" class="xl71" style="border-left: none; border-top: none;">4,021,603</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">18/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">402,620</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">4,424,224</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">19/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">442,882</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">4,867,106</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">20/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">487,171</td>
<td align="right" class="xl71" style="border-left: none; border-top: none;">5,354,277</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">21/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">535,888</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">5,890,165</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">22/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">589,476</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">6,479,641</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">23/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">648,424</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">7,128,065</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">24/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">713,267</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">7,841,332</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">25/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">784,593</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">8,625,925</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">26/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">863,052</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">9,488,977</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">27/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">949,358</td>
<td align="right" class="xl71" style="border-left: none; border-top: none;">10,438,335</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">28/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,044,293</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">11,482,628</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">29/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,148,723</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">12,631,351</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">30/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,263,595</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">13,894,946</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
<tr height="18" style="height: 13.15pt;">
<td align="right" class="xl68" height="18" style="border-top: none; height: 13.15pt;">31/05/2020</td>
<td align="right" class="xl69" style="border-left: none; border-top: none;">1,389,955</td>
<td align="right" class="xl71" style="border-left: none; border-top: none;">15,284,901</td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
<td class="xl69" style="border-left: none; border-top: none;"> </td>
</tr>
</tbody></table>
</td><td class="xl64" style="border-left: none; width: 73pt;" width="97"></td><td class="xl64" style="border-left: none; width: 73pt;" width="97"></td></tr>
</tbody></table>
</div>
</div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com17tag:blogger.com,1999:blog-2654455663519806899.post-69148683461060753842020-03-19T09:55:00.000-07:002020-06-01T13:44:50.190-07:00COVID-19 – What does the Bible say about epidemics? Some uncomfortable truths<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCI6roono602VEZnLXcIfNuIIsy9O0ZrTpStE6uCcz8QpMGzMGT_5981nD6bhJd8XVYiAdavBPkMtBAJA8o7X3tZts1RRWFbfW4wFQQw0V6V3H8cPHKA7lxLl23TS0_Nzql7n5eRqkGDXf/s1600/Coronavirus_MGN_CDC.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="455" data-original-width="810" height="179" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCI6roono602VEZnLXcIfNuIIsy9O0ZrTpStE6uCcz8QpMGzMGT_5981nD6bhJd8XVYiAdavBPkMtBAJA8o7X3tZts1RRWFbfW4wFQQw0V6V3H8cPHKA7lxLl23TS0_Nzql7n5eRqkGDXf/s320/Coronavirus_MGN_CDC.jpg" width="320" /></a></div>
There have been many excellent prayers spoken and sermons
preached on the COVID-19 pandemic in the last few weeks.<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
They have emphasised such themes as the sovereignty of God,
the frailty of man and the call for Christians not to fear but rather to be
good citizens, voices of calm and agents of compassion in the crisis. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As the Bible tells us we need to keep things in an eternal
perspective through these ‘light and momentary troubles’ (2 Corinthians 4:17) and
remember that our true treasure is in heaven not on earth. (Matthew 6:19-21)<br />
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This is not easy to hear for those of us who are sitting in our
self-isolation bunkers watching 20 years of savings disappearing in two weeks
and wondering if the company which employs us will even exist in two months’ time.
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It’s not just the physical threat of the virus but the fact
that this is hitting a world which, even before this pandemic surfaced, was already
mired in debt (<a href="https://edition.cnn.com/2020/01/13/economy/global-debt-record/index.html">global
debt is now a record 322% of GDP</a>) and had already used all its fiscal
ammunition. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Most of us have never encountered an event causing such widespread
social and financial devastation before.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This is why it is essential that as Christians we keep our
cool and act as the agents of Christ in what we say and do.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
After all, we know that God will never leave us or forsake
us (Hebrews 13:5) and that nothing can separate us from the love of God that is
in Christ Jesus our Lord (Romans 8:38, 39). To live is Christ and to die is
gain, as the Apostle said. (Philippians 1:21)<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But we also need to do some hard thinking about our global
predicament – perhaps starting with asking what the Bible teaches about epidemics.
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We know from science that epidemics are caused by infective
agents (bacteria and viruses) that are passed from one person to another and from
history that they are not uncommon occurrences.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://en.wikipedia.org/wiki/List_of_epidemics">Wikipedia</a>
documents hundreds that have occurred throughout history – resulting in
hundreds to millions of death. This <a href="https://www.visualcapitalist.com/history-of-pandemics-deadliest/">history
of epidemics page</a> illustrates this graphically. Epidemics are nothing new.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8am1L-qrGNpcVkjQjtL9qmAeWvWkzVkzccSNyW5Ynkt9NtU_zVmkq3czNLmmsgYX9jskJz0m5DPCWRAf8fTa-lLS9dkyUtxXN_YHlK1kjah7Z4IIGsHIFPP2H29yA8iqh5NK05LzvimNI/s1600/Contagious.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="436" data-original-width="436" height="318" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8am1L-qrGNpcVkjQjtL9qmAeWvWkzVkzccSNyW5Ynkt9NtU_zVmkq3czNLmmsgYX9jskJz0m5DPCWRAf8fTa-lLS9dkyUtxXN_YHlK1kjah7Z4IIGsHIFPP2H29yA8iqh5NK05LzvimNI/s320/Contagious.jpg" width="320" /></a>Just how deadly they are will depend on a variety of factors
– the severity of the illness they cause, the infectiousness of the agent, the
level of immunity in the population and the existence of vaccines and
treatments. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Coronavirus is neither the worst nor the least we have
encountered. But it is nonetheless very serious.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It causes an illness that requires hospitalisation in about
20% of people, of whom about a quarter will require ventilation. Its mortality
cannot be known with certainly yet but is probably somewhere between 1 and 4%. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It is moderately infectious (as easy as Ebola to catch) and there is no pre-existing
immunity in the human population and as yet no vaccine. Nor is there any
specific curative treatment – just symptomatic treatments like pain relief (if
you can find any paracetamol in the shops) and supportive treatments like
oxygen and ventilation/ECMO. It has a particular predilection for the old and infirm.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Thus far it has killed <a href="https://www.worldometers.info/coronavirus/">over 10,000 people</a>
worldwide, but the numbers are rising rapidly as we all know. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
However, it still ranks
far below the worst epidemics in history listed below, all of which killed over
one million people.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidaYyT-by9YHNNOjWS6gFTJb8C3kCDj5Yzl6psZ6CfS34nlCXw5OJqzFrmmEsOBFC2k9zd_NPb7JB2NNKPp9CG-0PBEzgOeLWsX5p4VSYi4siSZb0ltoDTXWibRrdeulNb4eGwMuzTp46q/s1600/Historic+Epidemics.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="312" data-original-width="892" height="139" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidaYyT-by9YHNNOjWS6gFTJb8C3kCDj5Yzl6psZ6CfS34nlCXw5OJqzFrmmEsOBFC2k9zd_NPb7JB2NNKPp9CG-0PBEzgOeLWsX5p4VSYi4siSZb0ltoDTXWibRrdeulNb4eGwMuzTp46q/s400/Historic+Epidemics.jpg" width="400" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As you can see, the four worst epidemics in history in terms
of lives lost were the Plague of Justinian, the Black Death, the Spanish Flu and
the AIDS Epidemic, all of which claimed over 20 million lives. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So we have quite
some way to go yet.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So what does the Bible teach us about epidemics? And how
should this shape our response as believers?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
To understand this we need to look past viruses and bacteria
to the spiritual realities that lie beyond. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We know that God is utterly sovereign over everything that
happens in the universe. As the book of Daniel reminds us, Kings cannot rule,
lions cannot bite and fire cannot burn without his permission.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
God is sovereign over all things human, biological and physical
and especially the rise and fall of nations (Daniel 2:21, 4:25, 5:21). <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
God was the author of the plagues of Egypt in Exodus 7-12
and is equally the author of the plagues described in the book of
Revelation. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
God is our Saviour but he is also our judge and his judgement
is played out not just at the end of time but during the course of history. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Through the prophet Ezekiel God speaks of his ‘four dreadful
judgements’ (14:21) – sword, famine, wild beasts <i>and plague</i> – which he
sends both against Jerusalem (14:21) and ‘any country’ which sins against him
(14:13).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Deuteronomy 28 lists the curses of disobedience which the Lord
warns will strike Israel if she falls into apostasy and these include <i>infectious
diseases</i> (28:21-22, 58-63).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The books of the Prophets in the Old Testament outline in
great detail what will happen to each nation and empire in the course of history
as a result of societal sin (yes nations, as well as individuals, will be judged)
and in passages like Amos 4 God makes it very clear that he himself was the source
of the famine, drought, blight, locusts and plague (4:10) which Israel had
suffered. God is sovereign.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i>‘When disaster
comes to a city has not the Lord caused it?’ (Amos 3:6)<o:p></o:p></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i><br /></i></div>
<div class="MsoNormal">
When Solomon prays to the Lord in 2 Chronicles 6:12-42
asking him to deliver Israel from war, drought, famine and plague (28-31) God
in his reply (7:13) makes it very clear that he himself is the author of these
afflictions:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i>‘When <b>I shut up
</b>the sky so that there is no rain, or <b>command</b> <a href="https://www.bbc.co.uk/news/in-pictures-51618188">locusts</a> to devour
the land or <b>send</b> a plague among my people…’ (2 Chronicles 7:13)<o:p></o:p></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i><br /></i></div>
<div class="MsoNormal">
Jesus makes it very clear that the time between his first and
second comings will be characterised by war, earthquakes, famines and also ‘pestilences’
(Luke 21;10-11). <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The fourth horse of the apocalypse and its rider, named
Death and Hades, were given power ‘to kill by sword, famine <i>and plague</i> and
by wild beasts of the earth’. (Revelation 6:8)<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
All four horses of the apocalypse and indeed all the plagues
described in the book of Revelation are released by Jesus Christ himself. It is
the Lamb of God himself, who opens the seven seals (Revelation 6:1),
orders the blowing of the seven trumpets (8:1,2) and orders the pouring out of
the seven bowls of God’s wrath (16:1). <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Many Christians today prefer to blame human beings or Satan
for these kinds of cosmic events – but whilst they are most definitely involved
– it is God himself who is both author and judge. Satan has to ask God’s
permission to afflict Job (Job 2:4-8) or to sift Peter (Luke 22:31) – he is
like a dog on a leash.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So it should not surprise us when we look at the epidemics
described in the Bible - those events which seem most likely to be caused by
infective agents like viruses and bacteria – that it is God, or one of his
angels, who invariably is named as the active agent. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I have listed below seven major plagues described in the Old
Testament. You will observe that in each case God or the Angel of the Lord is described
as the active agent. Furthermore, in five of the seven it is Israel which is the
object of judgement. The Assyrians and Philistines fill the other two slots. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_7OOC2mgiZKB95U-Y6LQ1Cjyfd6aAlRCTyo1Uu0Tl3lyPVysBRNUCYzuENFn25ce30c26ANzvGht7H7BkSOXCCrvNTZb-a1ccSBI1YSVuUIpJaUx1EoI1Am8KdmRgzWUmoxD_kNRXhoa8/s1600/Biblical+Plagues.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="226" data-original-width="902" height="98" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_7OOC2mgiZKB95U-Y6LQ1Cjyfd6aAlRCTyo1Uu0Tl3lyPVysBRNUCYzuENFn25ce30c26ANzvGht7H7BkSOXCCrvNTZb-a1ccSBI1YSVuUIpJaUx1EoI1Am8KdmRgzWUmoxD_kNRXhoa8/s400/Biblical+Plagues.jpg" width="400" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Furthermore, each plague constitutes retribution for some specific
national sin – be it insubordination, sexual immorality, idolatry or something else.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So, how should we respond as Christians to the coronavirus? <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We must pray of course for the Lord's wisdom: for faith to
see God's plan through it all, for hope in our security in Christ Jesus, and
for strength to be the body of Christ in ministering to those in need. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There are great opportunities to show compassion to those
who are suffering and many churches are already leading the way in this. <span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"><br /></span></div>
<div class="MsoNormal">
But if we fail to see that God is also sovereign over this
event – that he has not only allowed it but also caused it and that this ‘plague’
is an act of judgement and a mark of our sin as nations – we will have badly
misunderstood. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i>‘I am the Lord,
and there is no other. I form light and create darkness, I make weal and
create woe; I the Lord do all these things.’ (Isaiah 45:6,7)<o:p></o:p></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i><br /></i></div>
<div class="MsoNormal">
Yes, God is our healer. He will bind us up. He is loving and
compassionate. But he is also the ultimate author of human suffering because he is also
our judge and uses it to wake us up from our spiritual slumber. As CS Lewis said:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i>‘We can ignore
even pleasure. But pain insists upon being attended to. God whispers to us in
our pleasures, speaks in our conscience, but shouts in our pains: it is
his megaphone to rouse a deaf world.’<o:p></o:p></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i><br /></i></div>
<div class="MsoNormal">
How are we deaf? It is interesting that this epidemic seems
to be hurting rich Western countries the most. That, in general terms the oldest
and most wealthy of us on the planet are currently being hit the hardest. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This virus threatens to outsmart us and overwhelm even our
incomparably vast medical, financial and social resources. We are fighting it
with all our wealth, ingenuity and scientific knowledge – and it is right to do
so – but we are ultimately in God’s hands. It is he who by a subtle turn of the
screw can choose to contain it or let it loose. We are putty, or dust, in his
hands.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbB-KhZY8nbonLZevIfzWGLcvCEZPjT_ugWM06DsT9i-e54ITuGt9Q-6Vwwl0inhqVJT6fpCvXB_QxcJU1sOzlXmjc0-0Emb7uje15XhkvZKJlB_Gw51sgCAvqQigkbYuDE4JPWx84sixZ/s1600/Mortality.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="227" data-original-width="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbB-KhZY8nbonLZevIfzWGLcvCEZPjT_ugWM06DsT9i-e54ITuGt9Q-6Vwwl0inhqVJT6fpCvXB_QxcJU1sOzlXmjc0-0Emb7uje15XhkvZKJlB_Gw51sgCAvqQigkbYuDE4JPWx84sixZ/s1600/Mortality.jpg" /></a></div>
<div class="MsoNormal">
And so alongside all the good things we are doing and must
do to contain, mitigate and turn back this virus, we need to ask what God might
be saying to us as the wealthy and profligate post-Christian West – an end-stage
culture which has turned its back on God and gone its own way.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It was Ezekiel who said of his own people many centuries ago:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i>‘Now this was the
sin of your sister Sodom: She and her daughters were
arrogant, overfed and unconcerned; they did not help the poor and
needy. They were haughty and did detestable things before me.
Therefore, I did away with them as you have seen.’ (Ezekiel 16:49,50)<o:p></o:p></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i><br /></i></div>
<div class="MsoNormal">
These words could equally well describe the Western world
today.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
One of the most interesting of the plague accounts listed
above is that surrounding the census, described in 2 Samuel 24 and 1 Chronicles
21.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
King David takes a census of the fighting men of Israel contrary
to God’s command. As a result, God sends an angel to bring a plague upon Israel.
70,000 people die throughout the length and breadth of the country – from Dan
to Beersheba (2 Samuel 24:15). <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But when the angel is about to destroy Jerusalem itself God calls
a halt, and says ‘Enough! Withdraw your hand’. (24:16) <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
David sees the angel who is at that time at the threshing
floor of Araunah the Jebusite and asks that God punishes him instead of the people
(given that the census was his fault). <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
God’s response is to ask David to build an altar on the site,
which he then purchases for 50 shekels, and sacrifices burnt offerings, fellowship
offerings and prayers which leads God to call off the plague.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The place where these events happen is deeply significant. <span style="mso-spacerun: yes;"> </span>We are told in 2 Chronicles 3:1-2 that the
threshing floor of Araunah was on Mount Moriah – the place where God provided a
ram substitute to Abraham for his son Isaac and where David’s son Solomon would
later build the Temple. We know it as the Temple Mount today. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
On Mount Moriah a ram dies in place of Isaac. On the threshing
floor of Araunah animals are sacrificed in place of the people of Jerusalem. On
the Temple Mount sheep and goats are later sacrificed in place of the people of
Israel. Each substitutionary death averts the wrath of God.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
All of these three events point forward prophetically to
Jesus’ death on the cross for our sins, taking the punishment that we deserved.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The Lamb of God – Jesus Christ - becomes our Saviour dying
in our place. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
What will happen with the coronavirus epidemic is in God’s
hands. We do not know at this point how many lives it will claim and if we will
personally be included in that number.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But we need to remember that the Lamb who gave his life in order
that we might stand before God with confidence on the day of judgement, is the same
Lamb who pulls off the seals of judgement in the book of Revelation to unleash the
four horsemen of the apocalypse. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We know that, regardless of how serious it is and how many people
die, the coronavirus plague will eventually pass and become just another event in
history. But are we reading the signs?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Sadly, in the context of Revelation most people on earth
missed the signs. We are told that in the face of these warnings they failed to
repent: <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><i><sup>‘</sup></i></b><i>The
rest of mankind who were not killed by these plagues still did not
repent of the work of their hands; they did not stop worshiping
demons, and idols of gold, silver, bronze, stone and wood—idols that
cannot see or hear or walk. Nor did they repent of their murders,
their magic arts, their sexual immorality or their thefts.’ (Revelation
9:20,21)<o:p></o:p></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i><br /></i></div>
<div class="MsoNormal">
Murders, magic arts, sexual immorality and thefts. It is not
difficult to see how these descriptions might apply today in our post-Christian
West in the shadow of the sexual revolution and all its societal consequences. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Not only did they fail to repent but later, when things got
worse, they like the Egyptians before them, ‘cursed the name of God, who
had control over these plagues’. (Revelation 16:9)<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Yes, we must do all we can humanly do to constrain and mitigate
this epidemic (see my <a href="http://pjsaunders.blogspot.com/2020/03/diagnostic-capacity-at-scale-is-key-to.html">recent
blog post</a> on how fundamental proper virus testing is to this) but if we do
this without reading this event as a warning from God we will have missed the point.
We need to see it through the eyes of Scripture as well as through the eyes of science.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
God’s words to Solomon were very clear: <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i>‘When I shut up
the heavens so that there is no rain, or command locusts to devour the
land or send a plague among my people, if my people, who are called by my
name, will humble themselves and pray and seek my face and
turn from their wicked ways, then I will hear from heaven, and I will
forgive their sin and will heal their land.’ (2 Chronicles 7:13,14)<o:p></o:p></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i><br /></i></div>
<div class="MsoNormal">
That is what we need to do as a church and as a nation –
humble ourselves, pray, seek the face of God and turn from our sins. We are
living in an end-stage culture and this is only the beginning of what will
befall us if we close our ears and eyes to the signs. It is not too late but we
need to act now before it is.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In Matthew’s Gospel we are told, that Jesus began to preach
with the words, ‘Repent for the Kingdom of heaven is near.’ It has never been
nearer than now. It is time to repent.<o:p></o:p></div>
<br />Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com16tag:blogger.com,1999:blog-2654455663519806899.post-74825294698310243792020-03-18T06:08:00.003-07:002020-03-21T04:59:10.531-07:00'Test, test, test' is the key to coronavirus epidemic control - the clear lesson from East Asia <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgudYjX535NSmoJXgTGUeCaTHHIZKE_29uehJTYmqhjVQ8sax3TebCiNnLskSaHPGwzCfBF5WaicBZocCeGY9Ei527bDuQ30lazFuBTK7Er6wCWvf67GszG4Wuj98GHgKPcCv9vVCTL-KZM/s1600/Testing.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="675" data-original-width="1200" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgudYjX535NSmoJXgTGUeCaTHHIZKE_29uehJTYmqhjVQ8sax3TebCiNnLskSaHPGwzCfBF5WaicBZocCeGY9Ei527bDuQ30lazFuBTK7Er6wCWvf67GszG4Wuj98GHgKPcCv9vVCTL-KZM/s400/Testing.jpg" width="400" /></a></div>
How many people will die in the UK as a result of the COVID-19
pandemic? According to the scientists it will be between 20,000 and 500,000 depending
very much on how we respond.<br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
A team at Imperial College has produced <a href="https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf">a
paper</a> which this week has prompted the government to embark upon a range of
new measures to stop the spread of the disease.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If we <a href="https://www.bbc.co.uk/news/health-51915302">do
nothing</a> and just let the virus pass through the population unhindered – in the
hope of producing so-called ‘herd immunity’ - then 81% of people would be
infected and 510,000 would die from coronavirus by August.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If we adopt a <a href="https://www.bbc.co.uk/news/health-51915302">mitigation strategy</a> - trying
to slow its spread to prevent a massive peak in cases that would overwhelm the
NHS many time overs – we can expect 250,000 deaths.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But a <a href="https://www.bbc.co.uk/news/health-51915302">suppression
approach</a> – breaking the chains of transmission in order to stop the
epidemic in its tracks – would reduce total deaths to thousands or tens of thousands.
<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<span style="mso-spacerun: yes;"><br /></span></div>
<div class="MsoNormal">
The government has now concluded that suppression is the
only viable line of approach. Their chief scientific adviser Patrick Vallance told
a committee of lawmakers this week that <a href="https://www.reuters.com/article/us-health-coronavirus-britain-vallance/uk-aiming-for-under-20000-deaths-from-virus-government-chief-scientist-idUSKBN2142M5">20,000
deaths</a> would then be ‘a good outcome in terms of where we would hope to get
to with this outbreak’.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Why has China done so much better than us?<o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
But this raises a huge question. If 20,000 deaths is a ‘good
outcome’, and the best we can hope to achieve, then why have there been only
3,000 deaths in China where the outbreak actually started? <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
On a population basis (the UK has 67 million people and China
1,435 million) the UK equivalent deaths to that in China would be just 140 had
we handled it as successfully as them. 20,000 is over 140 times this figure. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So, what have the Chinese done differently? And what, by implication,
have we failed to do?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The control of the spread of coronavirus in China is remarkable
but real. <a href="https://www.worldometers.info/coronavirus/">Today’s figures</a>
show a total of 80,000 cases but only 10-20 new cases a day. There are still
also 10-20 deaths a day from the virus in China but these are almost all people
who were infected weeks ago. Things have tailed off massively. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But China has also achieved this fall-off much more quickly
than other countries. 80,000 cases in China amounts to 56 cases per million population
which is a better measure of how badly the virus has affected any given
country. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
By contrast Italy, with 31,000 cases to date, has 521 cases
per million, almost ten times the China figure.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In fact, today on 18 March (and these figures are obviously increasing
daily) there are <a href="https://www.worldometers.info/coronavirus/">32 countries
or territories</a> with a higher density of cases than China. Some of these are
small population states like Luxembourg, Andorra and San Marino, but others include
Spain, Germany, France, Switzerland, Netherlands, Norway, Austria, Belgium and
Denmark.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The two anomalies are the US and UK – today with 20 and 29
cases per million population respectively – but we know from the number of
deaths alone in these two countries that the true number of those infected is
much higher than this. Vallance <a href="https://www.reuters.com/article/us-health-coronavirus-britain-vallance/uk-aiming-for-under-20000-deaths-from-virus-government-chief-scientist-idUSKBN2142M5">said
yesterday</a> that a ‘reasonable ballpark’ current figure for the UK was 55,000
cases, not the 1,900 actually reported.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The reason the US and UK total case figures are so low is because
we are doing so few tests for the virus. I’ll come back to that.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
China’s remarkable success in controlling the virus is
documented in the Report of the WHO-China Joint Mission on Coronavirus Disease
2019 (COVID-19) dated 16-24 February. You can read the whole report <a href="https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf">here</a>
but there is an excellent summary <a href="https://www.reddit.com/r/China_Flu/comments/fbt49e/the_who_sent_25_international_experts_to_china/">here</a>.
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The diagram reproduced below from page 29 of the report (you
can view it more easily <a href="https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf">here</a>)
shows the number of cases against time in China along with the major interventions
made to try and slow the disease. <o:p></o:p><br />
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrqWwniDlGEcA03vM-etzRZ8TJMwgoHSkQQNrvrAqleoQphaa9s1NXSwU-ewkxd4qLsekB2TDa-72jliVk31p0WqBUUsCelYTgsC7RN_iZ2EUg2ju-12vjNanWW5D4AMsVKQs4UPvoSIlt/s1600/ChinaResults.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="946" data-original-width="1600" height="235" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrqWwniDlGEcA03vM-etzRZ8TJMwgoHSkQQNrvrAqleoQphaa9s1NXSwU-ewkxd4qLsekB2TDa-72jliVk31p0WqBUUsCelYTgsC7RN_iZ2EUg2ju-12vjNanWW5D4AMsVKQs4UPvoSIlt/s400/ChinaResults.jpg" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The outbreak was first announced on 30 December and the new
coronavirus was isolated on 7 January and its gene sequence publicly shared on
10 January. The number of new cases per day peaked at around 3,000 just over
two weeks later on 26 January but had fallen to fewer than 500 cases daily by 14
February. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A paper published on 16 March in <i><a href="https://science.sciencemag.org/content/early/2020/03/13/science.abb3221">Science</a></i>
shows that the virus first got away on the Chinese because they were unable to
identify and isolate the very early cases.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
They estimated that 86% of all infections were undocumented prior
to the 23 January 2020 travel restrictions. The transmission rate of
undocumented infections was only 55% of documented infections, presumably because
those affected had less severe symptoms, yet, due to their greater numbers,
undocumented infections were the infection source for 79% of documented cases.
These findings explain the initial rapid geographic spread of the virus.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
However, after the initial stage China got quickly on top of
the outbreak through a vigorous programme of widespread testing followed by isolation
of those affected, backed up by travel restrictions.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Testing for coronavirus in China and the UK<o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
China has a policy of meticulous case and contact
identification for COVID-19. For example, in Wuhan more than 1,800 teams of
epidemiologists, with a minimum of 5 people/team, traced tens of thousands of
contacts a day. Contact follow up was painstaking, with a high percentage of
identified close contacts completing medical observation. Between 1% and 5% of
contacts were subsequently laboratory confirmed cases of COVID-19, depending on
location.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But the effort outside of Wuhan <a href="https://www.reddit.com/r/China_Flu/comments/fbt49e/the_who_sent_25_international_experts_to_china/">was
also huge</a>. In Shenzhen, for example, the infected named 2,842 contact
persons, all of whom were found, when testing was completed for 2,240 it was found
that 2.8% of those had contracted the virus. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Within weeks following the identification of the virus, a
series of reliable and sensitive diagnostic tools were developed and deployed. By
23 February, there were ten kits for detection of COVID-19 approved in China by
the NMPA and several other tests had been entered in the emergency approval
procedure. Overall, producers have the capacity to produce and distribute as
many as 1,650,000 tests/week.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In stark contrast, based on figures available on 13 March,
the UK had carried out around 30,000 Covid-19 tests, at a median of 1,600 tests
per day so far in March. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The World Health Organization director-general, Tedros
Adhanom Ghebreyesus, <a href="https://www.theguardian.com/world/video/2020/mar/16/test-test-test-who-calls-for-more-coronavirus-testing-video">said
this week</a> that he had a simple message to countries on how to deal with the
coronavirus outbreak sweeping the globe: ‘Test, test, test.’ <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Speaking during a news conference on Monday he urged countries
to test more suspected cases, warning that they ‘cannot fight a fire
blindfolded’. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But fighting the fire blindfolded is essentially what the UK
and US have been doing – simply because there are not enough testing kits. This
was admitted by UK government adviser Professor Chris Whitty this week.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
On 6 February, the World Health Organization <a href="https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-2019-novel-coronavirus" target="_blank">said</a> it had already shipped 250,000 tests to more than
70 laboratories around the world.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But as WHO shipped hundreds of thousands of tests, broader
US testing struggled to begin. The US kits, developed by the CDC, <a href="https://edition.cnn.com/2020/03/18/health/who-coronavirus-tests-cdc/index.html">were
found</a> not to be working as expected, which eventually required test kits to
be re-manufactured. In fact, earlier this week it was reported that the US <a href="https://www.vox.com/science-and-health/2020/3/12/21175034/coronavirus-covid-19-testing-usa">lags
almost all developed countries</a> in testing for the virus.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Whilst the abundance of testing kits in China meant that
everyone with a fever or who had had contact with an infected person <a href="https://www.reddit.com/r/China_Flu/comments/fbt49e/the_who_sent_25_international_experts_to_china/">was
tested</a>, the shortage of testing kits in the UK has meant that tests are not
even available for doctors on the frontline or for high-risk patients at risk. In
fact, the only people being tested until very recently were those with severe symptoms
admitted to hospital. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
What this means is that those with less serious cases of
COVID-19 have been able to roam free to spread disease, and frontline people (doctors
and other health professionals), who are unwell but do not actually have the virus,
are being unnecessarily quarantined for 14 days along with their families when
they could be treating patients. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>A pandemic out of control <o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
It is now over two months since China initiated its control
programme and countries seem now to be in two groups – those where the virus
appears to be propagating largely out of control (mainly Western Europe) and those
in East Asia where there has been success in getting on top of its spread.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="MsoNormal">
The diagram (below) demonstrates this dramatically.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDetwq0189v9jomtAKWsoSdgOt2AWnVAlq9-mhYK8mFDLL_2f7P3RGTPmfkBzLpqUFSJiRTUh8vmg-R7q3sX_1IhvSbR70XucAnqVfUCnh-hhJyICcBOD-aVp89bMWi5UYXzZ7bftHx2kl/s1600/Traj2.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="747" data-original-width="1260" height="236" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDetwq0189v9jomtAKWsoSdgOt2AWnVAlq9-mhYK8mFDLL_2f7P3RGTPmfkBzLpqUFSJiRTUh8vmg-R7q3sX_1IhvSbR70XucAnqVfUCnh-hhJyICcBOD-aVp89bMWi5UYXzZ7bftHx2kl/s400/Traj2.png" width="400" /></a></div>
Cases (and deaths) in Europe and the US are spiraling
out of control but in Singapore, Japan and Hong Kong – using more of a Chinese approach
- the curve is considerably flattening over time.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Just today an <a href="https://www.sciencemag.org/news/2020/03/coronavirus-cases-have-dropped-sharply-south-korea-whats-secret-its-success">article</a>
in <i>Science</i> attributed South Korea’s astounding success so far to the
most expansive and well-organized testing program in the world, combined with
extensive efforts to isolate infected people and trace and quarantine their
contacts.<br />
<br />
South Korea has tested more than 270,000 people, which amounts to
more than 5,200 tests per million inhabitants. By contrast, the US has so far
carried out 74 tests per 1 million inhabitants, data from the US Centers for
Disease Control and Prevention show.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
</div>
<div class="MsoNormal">
South Korea’s experience shows that ‘diagnostic capacity at
scale is key to epidemic control,’ says Raina MacIntyre, an emerging infectious
disease scholar at the University of New South Wales, Sydney.</div>
<br />
<div class="MsoNormal">
Reports last week from Italy described doctors opting not
even to assess high-risk patients, let alone tube and ventilate them, because they
were simply overwhelmed by the numbers (see frightening twitter thread <a href="https://twitter.com/jasonvanschoor/status/1237142891077697538">here</a> and
also Lancet paper from 13 March <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30627-9/fulltext">here</a>).
Spain is following closely but other countries including Germany, UK,
Netherlands and Switzerland, are only a week or two behind.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It is a fundamental principle of medicine that there is no treatment
without diagnosis. We need more testing kits rapidly deployed. It is incredible
that even at this late stage we don’t really know who has the disease and who
doesn’t. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There are already <a href="https://www.wired.co.uk/article/coronavirus-testing-uk">many types</a> of
testing kits available and capable of mass production (see also <a href="https://www.theengineer.co.uk/oxford-rapid-coronavirus-test/">here</a>). Can the UK government expedite
the approval process as China so successfully did to bring them on stream?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Of course, all the other measures to prevent spread, which the
UK has already implemented and with which we are well familiar, are absolutely
necessary and right. And we need many more doctors, oxygen and ventilators to
provide support for the rising tide of severe cases. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The <a href="https://www.reddit.com/r/China_Flu/comments/fbt49e/the_who_sent_25_international_experts_to_china/">figures
for China</a> are that 20% of all cases needed hospitalisation and oxygen often
for weeks and 25% of these (5% overall) needed ventilation or ECMO. When we
consider that the UK until recently only had 4,000 ventilators, 80% of which
were already occupied, we can start to appreciate how serious this is. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But it is also clear that had we deployed more rigorous testing, contact tracing and isolation in the early stages of this pandemic we would not be in the
position we are now. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We pride ourselves in the UK on both our standard of
medicine and on the NHS. But we are lagging far behind those in China and other
East Asian countries in our management of this crisis. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Whether it is too late to rectify this only time will tell.
Will we end up in the UK with 20,000 deaths, 250,000 or 500,000? <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
What is clear is that many times more than 140 will die (the
number of deaths the UK should have if equivalent to China on a population basis).
That total will be passed in the next few days and advisors are predicting that
new cases per day will not peak for another 10 to 14 weeks. The peak of the death
rate will be two to three weeks after that. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It is clear that, as of this week, the UK government is now much
better informed and pulling out all the stops to beat this challenge (helpful
summary <a href="https://www.bbc.co.uk/news/explainers-51632801">here</a>). As
we all work together we pray that these efforts will be successful and that the
UK death toll is much closer to 20,000 than 500,000. <o:p></o:p></div>
<br />Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-84068413970347934732018-08-12T11:32:00.000-07:002018-08-13T03:15:55.799-07:00Severely brain-damaged patients are commonly misdiagnosed, often aware and may well recover, says authoritative new report<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpQGKq8yZvScSrSgH4gwK5wZo5D56S8s3ASPWq3Nr0Sb5bz1vV_hsoEIux2hlT2bYPALoxWwLKE7YnmOeRwCVQnSLi9QTw-jgmOeXYom2oxboIBemIzhEiCPUCYLKSgzhKtbjsNdHEjdhP/s1600/_38520865_tonybland238.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="178" data-original-width="238" height="238" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpQGKq8yZvScSrSgH4gwK5wZo5D56S8s3ASPWq3Nr0Sb5bz1vV_hsoEIux2hlT2bYPALoxWwLKE7YnmOeRwCVQnSLi9QTw-jgmOeXYom2oxboIBemIzhEiCPUCYLKSgzhKtbjsNdHEjdhP/s320/_38520865_tonybland238.jpg" width="320" /></a></div>
<div class="MsoNormal">
People with severe brain damage are difficult to diagnose reliably, not uncommonly recover and are often much more aware than we think. Specifically:</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b>Four in ten people who are thought to be unconscious are actually aware<o:p></o:p></b></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b><br /></b></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b> One in five people with severe brain injury from trauma will recover to the point that they can live at home and care for themselves without help<o:p></o:p></b></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b><br /></b></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<b><span style="font-family: "symbol";"> T</span>he term PVS should be dropped and that pain relief should be given to patients affected</b><o:p></o:p></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<br /></div>
<div class="MsoNormal">
These are the <a href="https://www.medscape.com/viewarticle/900462?">startling conclusions</a> of a new US practice <a href="https://www.aan.com/Guidelines/home/GuidelineDetail/926">guideline</a> for managing prolonged disorders of consciousness (PDOC) issued earlier this week.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The guideline is acutely relevant to the UK, where on 30 July 2018, the British Supreme Court made a landmark decision, that food and fluids can be withdrawn from patients with PDOC provided that both doctors and relatives agree it is in a given patient’s ‘best interests’.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
According to Prof Derick Wade, a consultant in neurological rehabilitation based in Oxford, there could be <a href="https://www.bbc.co.uk/news/magazine-37444379">as many as 24,000 patients</a> in the NHS in England alone either in permanent vegetative state (PVS) or minimally conscious state (MCS), most of them in nursing homes.<o:p></o:p><br />
<br />
People with PVS are awake, with eyes open, but do not exhibit behaviour suggesting they are aware either of themselves or their surroundings. Those with MCS show definite signs of awareness of self or surroundings, but often, these behaviours may not be obvious or may not happen regularly. These signs include tracking people with their eyes or following an instruction to open their mouths, but the behaviours are often subtle and inconsistent.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A <a href="http://n.neurology.org/content/early/2018/08/08/WNL.0000000000005926">summary of the guideline</a>, together with an accompanying <a href="http://n.neurology.org/content/early/2018/08/08/WNL.0000000000005928">literature review</a> on which it was based, was published online on 8 August 2018 in the medical journal <i>Neurology</i>. An accompanying <a href="https://www.aan.com/PressRoom/Home/PressRelease/1665">press release</a> summarises the main points.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The new guideline updates the earlier <a href="https://www.nejm.org/doi/full/10.1056/NEJM199405263302107">1994 AAN practice parameter</a> on persistent vegetative state and the <a href="http://n.neurology.org/content/neurology/58/3/349.full.pdf">2002 case definition</a> for the minimally conscious state (MCS), some of the recommendations of which ‘probably no longer hold true’ <a href="https://www.medscape.com/viewarticle/900462?">according to</a> lead author Joseph Giacino.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The guideline carries weighty authority because it has been issued by the American Academy of Neurology (AAN), the world’s largest association of neurologists and neuroscience professionals, with over 34,000 members. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Experts carefully reviewed all of the available scientific studies on diagnosing, predicting health outcomes and caring for people with disorders of consciousness, focusing on evidence for people with prolonged disorders of consciousness—those cases lasting 28 days or longer.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The majority of those with PDOC are young people who have suffered head injuries or older people with hypoxic brain damage (lack of oxygen to the brain, for example during a cardiac arrest).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Errors in assessing awareness</b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As neuroscientist Adrian Owen's research demonstrates through the extraordinary testimonies in his book 'Into the Grey Zone', reviewed <a href="https://lefthandedbiochemist.wordpress.com/2018/08/07/questions-at-the-edge-of-consciousness-a-review-of-into-the-grey-zone/">here</a> by Chris Willmott, some patients with PVS and MCS have far more awareness than we might possibly imagine.<br />
<br />
The guideline, based on the latest research, states that about four in ten people who are thought to be unconscious are actually aware. This 40% rate of misdiagnosis is because underlying impairments can mask awareness, argues Giacino, and can lead to inappropriate care decisions as well as poor health outcomes. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
‘An inaccurate diagnosis can lead to inappropriate care decisions and poor health outcomes. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Misdiagnosis may result in premature or inappropriate treatment withdrawal, failure to recommend beneficial rehabilitative treatments and worse outcome. That is why an early and accurate diagnosis is so important’, he argues.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It is therefore essential that assessments of these patients are carried out only by real experts. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The guideline states, ‘People with prolonged disorders of consciousness after a brain injury need ongoing specialized health care provided by experts in diagnosing and treating these disorders.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Problems with diagnosis <o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
To get the right diagnosis, a clinician with specialized training in management of disorders of consciousness, such as a neurologist or brain injury rehabilitation specialist, should do a careful evaluation. This should be repeated several times early in recovery—especially during the first three months after a brain injury.’<br />
<br />
The guideline enlarges on this as follows (see <a href="https://www.aan.com/Guidelines/home/GetGuidelineContent/929">here</a> for the accompanying academic references): <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>‘The range of physical and cognitive impairments experienced by individuals with PDOC complicate diagnostic accuracy and make it difficult to distinguish behaviours that are indicative of conscious awareness from those that are random and nonpurposeful. <o:p></o:p></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
<i>Interpretation of inconsistent behaviours or simple motor responses is particularly challenging. Fluctuations in arousal and response to command further confound the reliability of clinical assessment.<o:p></o:p></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
<i>Underlying central and peripheral impairments such as aphasia, neuromuscular abnormalities, and sensory deficits may also mask conscious awareness.<o:p></o:p></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
<i>Clinician reliance on nonstandardised procedures, even when the examination is performed by experienced clinicians, contributes to diagnostic error, which consistently hovers around 40 percent. <o:p></o:p></i></div>
<div class="MsoNormal">
<i><br /></i></div>
<div class="MsoNormal">
<i>Diagnostic error also includes misdiagnosing the locked-in syndrome (a condition in which full consciousness is retained) for vegetative state and minimally conscious state (MCS).’</i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But it is not only diagnosis that is problematic. Prognoses too can be widely mistaken. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Difficulties in predicting outcomes<o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
‘The outcomes for people with prolonged disorders of consciousness differ greatly. Some people may remain permanently unconscious. Many will have severe disability and need help with daily activities. Others will eventually be able to function on their own and some will be able to go back to work.’<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
According to the guideline, approximately one in five people with severe brain injury from trauma will recover to the point that they can live at home and care for themselves without help. Those with a brain injury from trauma have a better chance of recovery than those with a brain injury from other causes. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
What about treatment? <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Treatments do exist <o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
‘Few treatments for disorders of consciousness have been carefully studied. However, moderate evidence shows that the drug amantadine can hasten recovery for persons with disorders of consciousness after traumatic brain injury when used within one to four months after injury.’<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
There are also advances being made in the treatment of some acute brain injury because of brain cooling techniques, intracranial pressure monitoring and neurosurgery.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Commenting on the new guideline, an <a href="http://n.neurology.org/content/early/2018/08/08/WNL.0000000000005927">editorial</a> in <i>Neurology</i>, agrees that the term PVS should be dropped and that pain relief should be given to patients affected.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Authors Joseph Fins and James Bernat, argue in their review titled ‘Ethical, palliative, and policy considerations in disorders of consciousness’ that PVS should be renamed as <span style="background: white; color: #333333;">‘chronic vegetative state given the increased frequency of reports of late improvements’. </span><o:p></o:p></div>
<div class="MsoNormal">
<span style="background: white; color: #333333;"><br /></span></div>
<div class="MsoNormal">
They also advocate ‘routine universal pain precautions as an important element of neuropalliative care for these patients given the risk of covert consciousness’ and ‘applaud the Guideline authors for this outstanding exemplar of engaged scholarship in the service of a frequently neglected group of brain-injured patients’.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>Conclusions <o:p></o:p></b></div>
<div class="MsoNormal">
<b><br /></b></div>
<div class="MsoNormal">
The publication of the new guideline, casts further doubt on last week’s UK Supreme Court decision and will no doubt lead to further criticism. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I have argued previously that doctors should not be starving and dehydrating non-dying brain damaged patients to death in any circumstances at all. The fact that a substantial number of these patients are misdiagnosed, feel pain and will later recover only makes the case more strongly.<o:p></o:p></div>
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This state of affairs was predicted in 1993 by Andrew Fergusson, former CMF General Secretary, when he argued that the Law Lords in the case of Hillsborough victim Tony Bland (pictured above) had made <b>three key false assumption</b>s: that food and fluids is treatment and not basic care; that death is in some people’s ‘best interests’; and that it is not euthanasia when food and fluids are withdrawn with the explicit intention of casing death by starvation and dehydration. Andrew’s <a href="http://www.cmf.org.uk/resources/publications/content/?context=article&id=1368">whole article</a>, ‘Should tube feeding be withdrawn in PVS?’ is well worthy of further study by all with an interest in this area.<o:p></o:p></div>
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The new guideline, issued by the American Academy of Neurology, has been jointly published by the American Congress of Rehabilitation Medicine and the National Institute on Disability, Independent Living, and Rehabilitation Research and has been endorsed by the American Academy of Physical Medicine and Rehabilitation, American College of Surgeons Committee on Trauma and Child Neurology Society.<o:p></o:p></div>
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I wonder how our own British medical organisations (and in particular the BMA and Royal College of Physicians) will respond. Given that they backed the Supreme Court decision, they most certainly ought to be asked for comment.<o:p></o:p></div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-88866866031649154642018-08-10T06:03:00.003-07:002018-09-04T02:43:07.707-07:00New draft guidance from the BMA will enable doctors to dehydrate and sedate to death large numbers of non-dying patients with dementia, stroke or brain damage<div class="separator" style="clear: both; text-align: center;">
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<i>This story was broken on 13 August 2018 by the <a href="http://www.dailymail.co.uk/news/article-6056715/Doctors-allowed-end-lives-patients-dementia-degenerative-diseases.html">Daily Mail</a>. </i><br />
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Is it justifiable to withdraw food and fluids from patients with dementia, stroke and brain injury who are not imminently dying?</div>
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New ‘confidential’ draft guidance from the British Medical Association (BMA) - the doctors’ trade union - says ‘yes’ provided that a doctor believes it is in the patient’s ‘best interests’.<o:p></o:p></div>
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The 77-page ‘confidential’ document, which is currently out for ‘consultation’ (although only to a few selected individuals), has been prepared by the BMA in conjunction with the Royal College of Physicians (RCP) and the doctors’ regulatory authority, the General Medical Council (GMC).<br />
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I understand from the BMA that it will not be open for public consultation at any point before publication in the autumn.<o:p></o:p></div>
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The draft guidance builds on case and statute law and on previous practice guidelines and has huge implications for the care of some of the most vulnerable people in England and Wales. <o:p></o:p></div>
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It comes complete with a six-page executive summary, flow charts and tick box forms to smooth the decision-making process. <o:p></o:p></div>
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The guidance says it is based on the current legal position which it defines as follows:<o:p></o:p></div>
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<!--[if !supportLists]--><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> <i> </i></span></span><!--[endif]--><i>Clinically assisted nutrition and hydration (CANH) - essentially food and fluids by a fine tube through the nose or through the skin into the stomach - is a form of medical treatment <o:p></o:p></i></div>
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<!--[if !supportLists]--><i><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Treatment should only be provided when it is in a patient’s 'best interests'<o:p></o:p></i></div>
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<!--[if !supportLists]--><i><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->Decision makers should start from the presumption that it is in a patient’s best interests to receive life-sustaining treatment but that presumption may be overturned in individual cases <o:p></o:p></i></div>
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<!--[if !supportLists]--><i><span style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]-->All decisions should be made in accordance with the Mental Capacity Act 2005 (see also my <a href="http://pjsaunders.blogspot.com/2018/07/supreme-court-rules-that-doctors-can.html">blog post</a> on the recent Supreme Court judgment)</i><o:p></o:p></div>
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It focuses on three categories of patients where CANH is the ‘primary life-sustaining treatment being provided’ and who ‘lack the capacity to make the decision for themselves’: those with ‘degenerative conditions’ (eg. Dementia, Parkinson’s etc); those who have suffered a sudden-onset, or rapidly progressing brain injury and have multiple comorbidities or frailty’ (eg. stroke); previously healthy patients who are in a vegetative state (VS) or minimally conscious state (MCS) following a sudden onset brain injury. <o:p></o:p></div>
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It makes it crystal clear that it does not cover patients who imminently dying and ‘expected to die within hours or days’ but rather those who ‘could go on living for some time if CANH is provided’. <o:p></o:p></div>
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<b>So in summary, the guidance decrees that dementia, stroke and brain injured patients who lack mental capacity but are not imminently dying can be starved and dehydrated to death in their supposed ‘best interests’.</b><o:p></o:p></div>
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Who makes these decisions? If there is an advance directive for refusal of treatment (ADRT) then the patient does (or at least has). If there is an appointed health and welfare attorney then they do, and if it’s not the case that ‘all parties agree’ then it falls to the Court of Protection. But in the remainder of cases – which must by any reckoning be the vast majority – it is ‘usually a consultant or general practitioner’.<o:p></o:p></div>
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No second opinion need be obtained unless there is ‘reasonable doubt about the diagnosis or prognosis, or where the healthcare team has limited experience of the condition in question’ and even if the patient is suffering from PVS or MCS ‘it is not necessary to wait until (investigations) have been completed’ if there is not ‘sufficient evidence’ that they will ‘affect the outcome of the best interests assessment’ (Executive Summary para 14).<o:p></o:p></div>
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<b>In other words, the diagnosis and prognosis are irrelevant if the decision is made that death is in the patient’s ‘best interests’. This </b><b>is especially disturbing g</b><b>iven that PVS and MCS are extremely difficult to diagnose, many patients have some degree of awareness and some later wake up.</b><br />
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And how are best interests to be determined? Decision makers must take into account ‘the individual’s past and present views, wishes, values and beliefs’ and in order to do this should consult ‘those engaged in caring for the patient or interested in his or her welfare’. This would ‘usually include family members and could also include friends and colleagues’. <o:p></o:p></div>
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So, what determines ‘best interests in a given case’?<o:p></o:p></div>
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It boils down to whether CANH is able to ‘provide a quality of life the patient would find acceptable’ (ES p23). Otherwise continuing to provide CANH is ‘forcing them to continue a life they would not have wanted’ (ES p16).</div>
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So, by a subtle twist, providing basic sustenance (food and fluids by tube) to someone who ‘would not have wanted’ to be in this ‘condition’ is a form of abuse. How very convenient. <o:p></o:p></div>
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The issue here, of course, is that most normal people do not think that they will find life with dementia, stroke or brain injury ‘acceptable’ and CANH – food and fluids - does not reverse these conditions just as it does not reverse cancer, diabetes, disabliity or mental illness.<br />
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This is precisely because CANH is not actually ‘treatment’ but rather part of basic care. But it does not follow that they should therefore have their lives ended. In fact, research shows that people who are sick value the quality of life they have left much more than they would expect to when well. <o:p></o:p></div>
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British parliaments have consistently refused to legalise euthanasia or assisted suicide for people with a quality of life they would not find ‘acceptable’ or would not ‘have wanted’. But the BMA is saying that to end these lives by starvation and dehydration, rather than with a lethal injection or drinking poison, is perfectly acceptable. <o:p></o:p></div>
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<b>This is actually nothing other than euthanasia by stealth – euthanasia by the back door. </b><br />
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It might, and has, been argued that starving and dehydrating people to death over two to three weeks is actually less compassionate than killing them quickly with lethal drugs.<o:p></o:p></div>
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What safeguards are there against abuse of this new guidance? Very few it appears. <o:p></o:p></div>
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There is a section reminding doctors that the GMC requires ‘a second medical opinion’ from a suitably qualified ‘senior clinician’ where it is proposed ‘not to start, or to stop CANH and the patient is not within hours or days of death’. This clinician should (note not must) ‘examine the patient and review the medical records’.<o:p></o:p></div>
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A ‘detailed record’ of the decision-making process should be kept and a ‘model proforma’ (see below) is ‘recommended’. Decisions should be subject to ‘internal audit and review’ and ‘external review’ by the Care Quality Commission and Healthcare Inspectorate Wales but health professionals need to ‘contribute to’ ‘relevant national data collection’ only if it ‘exists’. <o:p></o:p></div>
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So, no legal, or even ethical, obligations – just suggested ‘best practice’.<o:p></o:p></div>
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Quite how oversight or accountability will be possible is unclear as the death certificates need not make any reference to the fact that the patient died from starvation and dehydration after a feeding tube was removed. Instead ‘the original brain injury or medical condition should be given as the primary cause of death’ (2.11). And so, the doctor’s tracks are perfectly covered. <o:p></o:p></div>
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The body of the draft guidance contains a flow chart (page 19) outlining the decision-making procedure. <o:p></o:p></div>
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The simple ‘recommended’ ‘checklist’ (appendix 4), which could be filled out in a few minutes, could be the only record that remains in the patient’s notes (see inserts).<o:p></o:p></div>
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What is largely disguised here in a lengthy and turgid 77-page document that few doctors or carers will ever read is a simple mechanism for ending the lives of dementia, stroke and PVS patients who are not imminently dying and who otherwise could live for months, years or even decades.<o:p></o:p></div>
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A decision is made by a GP or hospital consultant, on the basis of information about the patient gathered from relatives or carers, that they would not ‘have wanted’ to live this way.<br />
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A simple tick-box form is completed, the tube is removed and the patient in question is dehydrated, starved and sedated to death. The true cause of death is not recorded in the death certificate.<o:p></o:p></div>
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I’m not suggesting that large numbers of doctors will not undertake these assessments and decisions with integrity and diligence. But the problem is with the protocol itself. Also, it will only require a few to cut corners out of laziness or driven by malice, ideology or vested interest. This mechanism of ending vulnerable people’s lives – essentially a conveyor belt from nursing home and hospital bed to the morgue – is open to the most extraordinary abuse at every level by health professionals, family members and health institutions who might have an interest, financial or emotional, in a given patient’s death. <o:p></o:p></div>
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Imagine the busy nursing home filled with dependent but non-dying stroke, dementia and brain injured patients whose relatives seldom visit. Feeding tubes have been placed by staff because they are far more convenient than standing over patients and feeding them with a spoon. Wards are understaffed and the patients are difficult to care for. <o:p></o:p></div>
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A visiting GP makes a decision that it is not in a certain patient’s ‘best interests’ to live. Relatives are consulted and agree that their ‘loved ones’ would not ‘have wanted’ to live like this. A ‘second opinion’ is obtained. Forms are filled out. The tube is removed and the patient moved to a side room to receive ‘palliative care’ consisting of deep sedation until they have died two to three weeks later from dehydration. <o:p></o:p></div>
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The death certificate is falsified with only the underlying condition being recorded. No data are collected and there is no proper internal audit. Everyone is too busy and distracted. No questions are asked or answers given. They are not required as this is all ‘good practice’ approved by the BMA. The police do not investigate. The CPS does not prosecute. The courts are not involved. Parliament turns a blind eye as it lacks the stomach to review the relevant legislation. It is easier to leave it to the doctors and their professional ‘guidance’. <o:p></o:p></div>
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This is a recipe for euthanasia by stealth, but all in the name of autonomy and ‘best interests’ – the very worst kind of doctor paternalism justified on the grounds that the patient would ‘have wanted’ it. <o:p></o:p></div>
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There are conceivably tens of thousands of patients in England and Wales who are vulnerable to the use and abuse of this ‘guidance’. It will be almost impossible to work out what has happened in a given case and there are no legal mechanisms in place for bringing abusers to justice.<o:p></o:p></div>
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How did we get here? This whole process has transpired by a small series of steps – each following logically from the one before and endorsed in case law, statute law, regulations and guidelines going back to the Law Lord’s decision on Hillsborough victim Tony Bland who was the first to die in this way. But the trickle is about to become a flood.</div>
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Once we accept that food and fluids by tube is ‘medical treatment’ rather than basic care and that providing this basic sustenance to someone with a medical condition they would not find ‘acceptable’ is not in their ‘best interests’, then we are inviting professionals to devise a simple scheme whereby the starvation of large numbers of non-dying but expensive and ‘burdensome’ patients can be achieved simply and efficiently, and largely undetected, without involving the courts. <o:p></o:p></div>
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When it came to light a few years ago that some doctors were misusing a palliative care tool called the Liverpool Care Pathway to starve, dehydrate and sedate non-dying patients to death there was a national outcry. <o:p></o:p></div>
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One might have expected to see a similar reaction to this draft BMA guidance. But thus far there has been not a whimper. <o:p></o:p></div>
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I am astounded that no MP or prominent doctor has yet raised any concerns about it. I wonder how long it will be.<o:p></o:p></div>
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<i>You can read CMF’s official response to the BMA draft guidance <a href="https://admin.cmf.org.uk/pdf/publicpolicy/CMF_submission_to_BMA_CANH_Final.pdf">here</a>.<o:p></o:p></i></div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-7862642604643735202018-08-07T07:28:00.002-07:002018-08-08T04:29:30.805-07:00Organ donation opt out plans in England – not nearly as clear cut as it might seem<br />
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All adults in England <a href="https://www.bmj.com/content/359/bmj.j5764">will be presumed</a> to be organ donors unless they have explicitly opted out, the government <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/731913/govt-response-organ-donation-consent.pdf">has announced</a>.</div>
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The new plans follow <a href="https://www.bmj.com/content/359/bmj.j5764">a public consultation</a> launched last December. Wales has had a similar opt-out system since 2015 and Scotland also plans to introduce one.<o:p></o:p></div>
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New legislation which will be introduced in parliament this autumn is intended to come into effect in spring 2020 giving people a 12-month transition period to make decisions about organ donation preferences.<o:p></o:p></div>
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According to the <a href="https://www.bbc.co.uk/news/health-45056780">BBC</a>, ‘Max's Law’ is named after Max Johnson, from Cheshire, who was saved by a heart transplant.<o:p></o:p></div>
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His search for a suitable heart was followed in a series of front-page stories in the <span style="mso-bidi-font-weight: bold;"><a href="https://www.mirror.co.uk/all-about/change-the-law-for-life-campaign">Daily Mirror</a>, as the newspaper campaigned for the change in the law.</span><o:p></o:p></div>
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Last year, Prime Minister <span style="mso-bidi-font-weight: bold;">Theresa May wrote to the ten-year-old, saying she chose the name after she heard his ‘inspirational story</span>’.<o:p></o:p></div>
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Groups excluded from ‘presumed consent’ will include under 18s, people lacking the mental capacity to understand the changes, and people who have not lived in England for at least twelve months before their death. <o:p></o:p></div>
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People who do not wish to donate their organs will be able to record their decision on the NHS Organ Donor Register, by calling a helpline, visiting the <a href="https://www.nhsbt.nhs.uk/what-we-do/transplantation-services/organ-donation-and-transplantation/">NHS Blood and Transplant website</a> or on a new NHS app. <span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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If people do not opt out they will be considered to be a potential organ donor but donation will not proceed if the family ‘objects strongly’. <o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">A clear-cut case?<o:p></o:p></b></div>
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About 17,000 people responded to the government consultation. Of these, 72% said that the proposed change in the law would make no difference to their decision about organ donation. 13% said that the change would make them opt in, while 15% of respondents said that they would opt out. <o:p></o:p></div>
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Around 5,100 people in England were waiting for a transplant at the end of March 2018 but although 80% of people in England would consider donating only 37% have so far signed up.<o:p></o:p></div>
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The government claim that the new plans will result in an extra 700 organ transplants taking place every year in England. <o:p></o:p></div>
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The <a href="https://www.bmj.com/content/359/bmj.j5764">Royal College of Physicians</a>, Kidney Care UK and the British Heart Foundation <a href="https://www.bbc.co.uk/news/health-45056780">all back the proposals</a> along with the British Medical Association. <o:p></o:p></div>
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It is therefore understandable that media coverage of the plans has been overwhelmingly favourable – so why do I have reservations?<o:p></o:p></div>
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Simply because, as the CMF advocacy team have argued many times before (see <a href="http://www.cmfblog.org.uk/2017/08/01/ideology-or-evidence-the-battle-over-presumed-consent-to-organ-donation/">here</a>, <a href="http://www.cmfblog.org.uk/2017/09/14/presumed-consent-for-organ-transplantation-what-does-the-bible-say/">here</a>, <a href="http://www.cmfblog.org.uk/2013/07/02/patients-families-and-organ-donation-who-should-decide-re-post/">here</a>, <a href="http://www.cmfblog.org.uk/2013/08/16/welsh-plans-to-introduce-a-system-of-presumed-consent-for-organ-donation-are-both-unnecessary-and-unethical/">here</a> and <a href="http://www.cmfblog.org.uk/2017/09/28/why-should-families-have-a-say-in-organ-retrieval/">here</a>) <span style="mso-spacerun: yes;"> </span>the case for an opt-out system for organ donation is not nearly as clear cut as it might seem. <o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Marginalised voices<o:p></o:p></b></div>
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First, there is lots of opposition from authoritative voices who are now being marginalised in the rush to embrace it.<o:p></o:p></div>
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Professor John Fabre, former President of the British Transplantation Society, has led a chorus of critics warning that the evidence shows an opt-out approach is counter-productive.<o:p></o:p></div>
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Speaking to <a href="https://www.christian.org.uk/news/organ-donation-presumed-consent-counter-productive/?e151217">BBC Radio 4</a>, Prof Fabre said it could be predicted ‘with a high level of certainty that it is not going to increase donor numbers in the way that we all want’.<o:p></o:p></div>
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Former National Clinical Director for Transplantation Professor Chris Rudge <a href="https://www.christian.org.uk/news/organ-donation-presumed-consent-counter-productive/?e151217">has said</a>: ‘The only evidence I have seen is that it won’t make any difference and it is not the answer to the problem, but there is a risk that it may make things worse.’<o:p></o:p></div>
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Hugh Whittall, Director of the Nuffield Council on Bioethics, <a href="https://www.theguardian.com/society/2017/dec/12/jeremy-hunt-launches-opt-out-organ-donation-plans-in-england-and-wales">said</a> he was concerned that the Government was asking how the law should be changed, rather than if it should be.<o:p></o:p></div>
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Keith Rigg, consultant transplant surgeon at Nottingham University Hospitals NHS Trust, <a href="https://www.bbc.co.uk/news/health-43060382">felt</a> that full results from Wales should be studied before such a move was considered in England.<o:p></o:p></div>
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These authorities have reservations because there is no clear evidence that opt-out actually works in increasing organ donation rates.<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Lack of evidence<o:p></o:p></b></div>
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Before implementing an opt-out system, Fabre <a href="https://www.christian.org.uk/news/organ-donation-presumed-consent-counter-productive/?e151217">said</a>, it is important to ask: ‘Does it actually make a difference?’ He concluded: ‘It actually doesn’t’. <o:p></o:p></div>
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Rigg again: ‘There is no clear evidence that this has resulted in an increase in organ donations and transplants where it has been introduced.’ <o:p></o:p></div>
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<a href="https://www.theguardian.com/society/2017/dec/12/jeremy-hunt-launches-opt-out-organ-donation-plans-in-england-and-wales">Whittall</a>: ‘The government should not be making this change until there is evidence that it works, and until we are confident that it won’t undermine people’s trust in the system in the long-term.’ <o:p></o:p></div>
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In a September 2017 review, the BBC <a href="https://www.bbc.co.uk/news/health-41199918">reported</a>: ‘In Wales, where an opt-out system was introduced in December 2015, there has actually been a small dip in the number of deceased donors, from 64 in 2015-16 to 61 in 2016-17. This resulted in a drop in organ transplants from 214 to 187 respectively.<o:p></o:p></div>
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This is not to say the opt-out scheme is having a negative effect - some fluctuation is to be expected - but so far, despite the claims, we don't have any evidence that it is having a positive effect.’<o:p></o:p></div>
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Opt-out schemes don't consistently translate to increased organ donor rates. In Sweden, such a scheme has been in force since 1996 but it remains one of the lowest-ranked countries for organ donation in Europe. Luxembourg and Bulgaria also have opt-out systems and low rates of organ donation. <o:p></o:p></div>
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In France and Brazil, variations on a ‘presumed consent’ system actually led to a decline in the rate of organ donation.<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">A better way <o:p></o:p></b></div>
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Spain is often cited as an opt-out scheme success story.<o:p></o:p></div>
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‘Presumed consent’ legislation was passed in 1979 but donor rates only began to go up ten years later when a new national transplant organisation was founded which co-ordinates the whole donation and transplantation process.<o:p></o:p></div>
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In other words, it was not opt-out but rather other changes, like better infrastructure, more funding for transplant programmes and more staff working to identify and build relationships with potential donors before their death that really made the difference.<o:p></o:p></div>
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As Rafael Matesanz, an expert on the Spanish situation has <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ajt.14296">recently argued</a>: ‘Spaniards consider insignificant the impact of the type of consent on the donation activity. To the contrary, infrastructure, organization around the process of deceased donation, and continuous innovation are deemed the keys for success… it was not until ten years after the (opt-out) Law approval that donation took off.’<o:p></o:p></div>
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In September the Nuffield Council on Bioethics <a href="http://nuffieldbioethics.org/news/2017/ethics-tank-calls-discussion-wishes-organ-donation-death">confirmed</a> that the evidence for introducing presumed consent is absent and highlighted instead the alternative option of investing more in Special Organ Donation Nurses. Where specialist nurses are available to speak to the family of the deceased they either donate or authorise donation in 68% of cases. Where they are absent the figure is just 27%.</div>
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<b style="mso-bidi-font-weight: normal;">Counterproductive<o:p></o:p></b></div>
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The positive spins on the impact of presumed consent also ignore the implications of people signing the opt-out register.<span style="mso-spacerun: yes;"> </span>During 2016-17, 174,886 people in Wales, around 6% of the population, were <a href="https://nhsbtdbe.blob.core.windows.net/umbraco-assets/1518/wales.pdf">signed up</a> to the opt-out register.<sup> </sup>In the first two quarters of 2017-2018 this <a href="https://nhsbtdbe.blob.core.windows.net/umbraco-assets/1518/wales.pdf">increased</a> to 178,062.<o:p></o:p></div>
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This means that nearly 175,000 people have now effectively been removed from being possible donors when previously their families, as their living representatives, might have been happy to donate organs at their death, in the absence of express direction to do otherwise.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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The potential for presumed consent to alienate people, precipitating withdrawal from the donation system is real. In giving oral evidence to the National Assembly Health and Social Care Committee in Wales, organ transplant specialist Dr Peter Matthews, who was based in Morriston Hospital in Swansea, made the following <a href="https://www.blogger.com/null" name="_Hlk487480756">statement</a>:<o:p></o:p></div>
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<i style="mso-bidi-font-style: normal;">‘My own experience is that the British psyche has a particular view that what it should do is donate organs as an altruistic gift, and if it is felt that the state is going to take over the organs, then there is the potential that people who may have been willing to become a donor will not do so. We have seen two cases in Morriston where patients who were on the organ donation register, on hearing about this, said to their families that if the state was going to take their organs, they were no longer willing to give them. We lost two donations because of that. So, there is a potential backlash.’ <o:p></o:p></i></div>
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<b style="mso-bidi-font-weight: normal;">Organ donation should be a gift<o:p></o:p></b></div>
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This underlines the fact that organ donation should be an altruistic gift. Opt-out is not ‘presumed consent’ because no consent has been given. <o:p></o:p></div>
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Consent which is presumed is not actually consent at all. It amounts rather to the body after death becoming the property of the state and the state taking organs rather than the donors or their families giving them. <o:p></o:p></div>
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At a time when so much emphasis is placed on autonomy and free choice, this runs in the opposite direction. I’ve looked at this in more detail <a href="http://www.cmfblog.org.uk/2017/09/14/presumed-consent-for-organ-transplantation-what-does-the-bible-say/">here</a>. <o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Costly <o:p></o:p></b></div>
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In their 2008 <a href="https://www.ncbi.nlm.nih.gov/pubmed/20817820">report</a> ‘The potential impact of an opt out system for organ donation in the UK’ the Organ Donation Taskforce looked at the costs for introducing a UK wide system of presumed consent. <o:p></o:p></div>
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They estimated that the cost of doing so would be ‘approximately £45 million in set up costs for IT and communications. There would be £2 million per year in IT running costs and an additional £5 million every few years to refresh public messages.’<o:p></o:p></div>
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Ths money would be far better spent employing trained specialist nurses in organ donation and developing an infrastructure like that of Spain.<o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Too many unanswered questions <o:p></o:p></b></div>
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There are simply too many unanswered questions about the opt-out system to be going precipitously down this road. <o:p></o:p></div>
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There are strong voices against it because there is no evidence it will work, better ways forward exist, its coercive nature risks alienating potential donors, it undermines the idea of donation as a gift and it will be very costly to implement. <o:p></o:p></div>
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It seems that the government is ignoring the facts in its haste for a headline win based on ideology rather than facts. They should think again and refrain from whipping their uninformed MPs through the lobbies to force opt-out onto the statute books.</div>
<br />Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-90202898279856932732018-08-03T09:35:00.002-07:002018-08-09T14:22:10.017-07:00Dignity in Dying’s response to this week’s Supreme Court ruling reveals its real agenda<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMMcHSIONBzLWLpuT_FBJN8YGC5lDEFFsSRVBKYNZ1FyeHrv3MeMvOwcuoP0oJEU-Ieyv0TQnyjETJ-LHR9TRYMCyGNh6eQx_FCzEjRpLZTlYptyYmp7k9AObcvTiLOOirvJUgCgeBrIMy/s1600/DID.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="183" data-original-width="275" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMMcHSIONBzLWLpuT_FBJN8YGC5lDEFFsSRVBKYNZ1FyeHrv3MeMvOwcuoP0oJEU-Ieyv0TQnyjETJ-LHR9TRYMCyGNh6eQx_FCzEjRpLZTlYptyYmp7k9AObcvTiLOOirvJUgCgeBrIMy/s1600/DID.jpg" /></a></div>
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The former Voluntary Euthanasia Society, rebranded ‘Dignity in Dying’ (DID) in 2006, in order to disguise its real objectives, has always been quick to emphasise that it only supports a change in the law to allow so-called ‘assisted dying’.</div>
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By this it means allowing mentally competent adults with less than six months to live to end their lives by being assisted to drink a lethal draft of barbiturate. ‘Assisted dying’ is, more accurately, assisted suicide for the terminally ill.<o:p></o:p></div>
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Both the Marris bill, which was defeated in the House of Commons in 2015, and the Falconer Bill, which ran out of parliamentary time in the House of Lords several months earlier, applied this ‘assisted dying’ formula. So did the Conway case, recently rejected by the Court of Appeal. All were understandably backed by DID. <o:p></o:p></div>
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DID, therefore, have always maintained that they oppose assisted suicide or euthanasia for the chronically ill, disabled people and those who lack mental capacity. You have to be a mentally competent adult with under six month’s life expectancy to qualify.<o:p></o:p></div>
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It was therefore interesting to see them so actively involved in the recent <a href="https://www.theguardian.com/law/2018/jul/30/uk-judges-will-no-longer-have-to-rule-in-vegetative-state-decisions-supreme-court">Supreme Court case</a> involving a man (Mr Y) who was left in a minimally conscious state (MCS) following a heart attack.<o:p></o:p></div>
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The Supreme Court ruled on Monday 30 July, that it is no longer necessary for cases involving patients suffering from PVS (permanent vegetative state) or MCS to go to the Court of Protection before CANH (clinically assisted nutrition and hydration) can be stopped, provided that both doctors and relatives are in agreement that this is in the patient’s ‘best interests’.<o:p></o:p></div>
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The judgement built on legal precedent dating back to the case of Hillsborough victim Tony Bland in 1993 – namely that death is some people’s ‘best interests’ and that deliberate dehydration is a legitimate means of achieving it.<o:p></o:p></div>
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The effect of this week’s ruling is that patients with PVS and MCS can now be dehydrated to death over a period of 2 to 3 weeks without recourse to the courts providing doctors and relatives agree that they would not have wanted to go on living with this degree of disability.<o:p></o:p></div>
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But adults with PVS or MCS lack mental competence and are not dying. They can breathe without ventilators, respond to painful stimuli and often live for years, if not decades, provided their basic requirements for food and fluids are met.<o:p></o:p></div>
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They most certainly do not fall in the category of patients that DID have previously targeted and by no stretch of the imagination can their deaths from dehydration therefore be called ‘assisted dying’.<o:p></o:p></div>
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It is therefore most revealing that the barrister representing Mrs Y in the case, was none other than <a href="https://compassionindying.org.uk/trustees/">Victoria Butler-Cole</a>, the chair of trustees of DID’s sister charity ‘Compassion in Dying’ (CID).<o:p></o:p></div>
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On the day that the Supreme Court handed down its decision other <a href="https://www.dignityindying.org.uk/about-us/staff-members/">staff</a> and <a href="https://www.dignityindying.org.uk/about-us/board-members/">trustees</a> of DID were also very active on the media in support of the decision. These included chief executive Sarah Wootton, director of legal strategy and policy Davina Hehir and trustee Jonathan Romain.<o:p></o:p></div>
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In the <a href="https://www.nejm.org/doi/full/10.1056/nejmsa071143">Netherlands</a>, where voluntary euthanasia is legal, death by deliberate dehydration (by withdrawing or withholding food and fluids) is categorised as an end of life decision with the ‘explicit intention of ending life’. This is because that is what it actually is, and the Dutch are not known for beating about the bush. It is a method of killing.<o:p></o:p></div>
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Other decisions in this category include euthanasia (achieved with a lethal injection of barbiturate), assisted suicide (as above), deliberate morphine overdose (as used recently in <a href="http://www.spiked-online.com/newsite/article/gosport-the-scandal-of-undervaluing-human-life/#.W2R_kNVKiUl">Gosport</a> to kill over 450 people) and continuous deep sedation (whereby a patient is sedated until they eventually die from dehydration). <o:p></o:p></div>
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These practices, apart from euthanasia itself, all represent ‘euthanasia by stealth’. In other words they are methods of deliberately ending a person’s life that fall short of administering a lethal injection. But they have the same intention. The key issue morally and ethically is the <i>intention</i> to end life.<o:p></o:p></div>
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DID’s behaviour around this Supreme Court case is not new but has in fact been part of pro-euthanasia strategy for over 30 years.<o:p></o:p></div>
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Dr Helga Kuhse, a leading campaigner for euthanasia, said in 1984: ‘If we can get people to accept the removal of all treatment and care - especially the removal of food and fluids - they will see what a painful way this is to die and then, in the patient's best interest, they will accept the lethal injection.’ (Fifth Biennial Congress of Societies for the Right to Die, held in Nice, Sept. 1984).<o:p></o:p></div>
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So we should not be surprised by this week’s events. Rather, they demonstrate the full extent of DID’s (and CID’s) agenda and the lengths they are prepared to go in order to achieve it. Including dehydrating non-dying disabled people to death - which I suggest could be described neither as dignified nor compassionate. <o:p></o:p></div>
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The great tragedy is that although patients with PVS or MCS lack some or in severe cases all awareness, they <a href="https://www.newscientist.com/article/mg21729055-500-people-in-a-vegetative-state-may-feel-pain/">still respond to pain</a>. And as neuroscientist Adrian Owen's research demonstrates in his book '<a href="https://lefthandedbiochemist.wordpress.com/2018/08/07/questions-at-the-edge-of-consciousness-a-review-of-into-the-grey-zone/">Into the Grey Zone</a>' some of them have far more awareness than we might imagine.<o:p></o:p></div>
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Therefore, we can expect as this new ruling takes effect, for reports to surface about brain-damaged patients suffering pain and distress from thirst while they are being dehydrated to death.<o:p></o:p></div>
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You can be sure that this will then be used as an argument to bring in lethal injections in order to achieve the desired end more quickly and with the minimum of fuss. <o:p></o:p></div>
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After all, it will be argued, that is what these patients would have really wanted. <o:p></o:p></div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-77850701404803147412018-07-30T04:32:00.000-07:002018-07-30T05:55:15.526-07:00Supreme Court rules that doctors can remove food and fluids from brain-damaged patients without going to court<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyKeGpMvlPGY3zQYp49MGgOkV6Durv0zHtMzl12chzrN9CnvmVMKR26Q_oD0UmNpirfXaqbFLNF1tZ1h1TgDkhYGBAooyDp1K_se6OayStZia3XYILHRKKgeY6KY3_rqRxQueR-e75Sf6O/s1600/lady-black-171002.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="300" data-original-width="450" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyKeGpMvlPGY3zQYp49MGgOkV6Durv0zHtMzl12chzrN9CnvmVMKR26Q_oD0UmNpirfXaqbFLNF1tZ1h1TgDkhYGBAooyDp1K_se6OayStZia3XYILHRKKgeY6KY3_rqRxQueR-e75Sf6O/s320/lady-black-171002.jpg" width="320" /></a></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;"><i>My Radio Four Today programme interview on this case is <a href="https://soundcloud.com/carenotkilling/supreme-court-on-canh-bbc-radio-4-today-30-july-2018-dr-peter-saunders">here</a>. Five Live <a href="https://bit.ly/2v3jUAs">here</a>.</i></span><br />
<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;"><br /></span> <span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">Should doctors be able to withdraw food and fluids from severely brain-damaged people who are not imminently dying? And if so, in what circumstances?</span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">The answer to these questions has changed significantly today because of a decision by the Supreme Court.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Patients with permanent vegetative state (PVS) and minimally conscious state (MCS) can now be effectively starved and dehydrated to death if the medical staff and relatives agree that this is in their ‘best interests’. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">People with PVS (awake but not aware) and MCS (awake but only intermittently or partially aware) can breathe without ventilators but need to have food and fluids by tube (clinically assisted nutrition and hydration or CANH).<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">These patients are not imminently dying and with good care can live for many years. Some even regain awareness. But if CANH is withdrawn, then they will die from dehydration and starvation within two or three weeks.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Until last year all cases of PVS and MCS have had to go to the Court of Protection before CANH could be withdrawn.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Under the old rules, only about 100 applications to stop tube feeding have been made in more than 20 years, since the Tony Bland case created the precedent in 1993. But this could now hugely increase. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">In two cases last year (known as M and Y) the High Court ruled that if the relatives and medical staff agreed that withdrawal of CANH was in the patient’s ‘best interests’ then the court need not be involved.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Three medical bodies - the BMA, RCP and GMC - issued interim guidance in line with this decision last December and at the same time the Court of Protection similarly changed its rules. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">The Official Solicitor <a href="http://pjsaunders.blogspot.com/2017/12/supreme-court-to-rule-on-whether.html">appealed this decision</a> to the Supreme Court in a hearing in February. The Supreme Court has only just issued its judgement today effectively upholding the decision of the High Court.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">In giving her judgement, Lady Black (pictured above), with whom the other four Supreme Court judges fully agreed, made three critical rulings. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">First, she argued that ‘there may come a time when life has to be relinquished because that is in the best interests of the patient’.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Second, she said that that there is no difference in principle between turning off a ventilator and removing a feeding tube as both are ‘forms of medical treatment’.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Third, she said patients with PVS and MCS should be treated in the same way as people with ‘severe stroke’ a ‘degenerative neurological condition’ or ‘other condition with a recognised downward trajectory’ where ‘decisions to withhold or withdraw CANH are made on a regular basis without recourse to the courts’.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">In making these declarations Lady Black has dramatically moved the goalposts on end of life decision-making. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Once we accept that death by dehydration is in some brain-damaged people’s ‘best interests’ we are on a very slippery slope indeed. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">There is a clear difference between turning off a ventilator on a brain-dead patient and removing CANH from a brain-damaged patient. In the first case the patient dies from their underlying brain injury. In the second they die from dehydration and starvation. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Similarly, PVS and MCS differ from conditions with a ‘downward trajectory’ because they are not progressive and do not in themselves lead inevitably to death. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">The Supreme Court has set a dangerous precedent. Taking these decisions away from the Court of Protection removes an important layer of legislative scrutiny and accountability and effectively weakens the law.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">It will make it more likely that severely brain-damaged patients will be starved or dehydrated to death in their supposed ‘best interests’ and that these decisions will be more influenced by those who have ideological or financial vested interests in this course of action.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Prof Derick Wade, a consultant in neurological rehabilitation based in Oxford, <a href="http://www.bbc.co.uk/news/magazine-37444379"><span style="color: #888888;">estimates</span></a> there could be as many as 24,000 patients in the NHS in England either in PVS or MCS, with most of them in nursing homes. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Given that it costs about £100,000 per year to care for a person with PVS or MCS the potential ‘saving’ for the NHS could be as much as £2.4 billion annually if most seek to go down this route. This is not a temptation we want to put before medical staff and administrators given current financial pressures.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">But it is also bad medicine.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">There are still significant uncertainties about diagnosis and prognosis in both PVS and MCS. These have increased rather than decreased in the last 20 years and this is why continued court oversight is necessary. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Making judgements about diagnosis, prognosis and best interests in these cases is fraught with difficulty and should be carried out only by those with specialist experience. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">The Court of Protection has already overturned some doctors’ decisions in previous cases and some patients have recovered awareness months or even years after being diagnosed with PVS or MCS. This is more common after traumatic brain injury than after oxygen deprivation.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">There are also advances being made in the treatment of some acute brain injury because of brain cooling techniques, intracranial pressure monitoring and neurosurgery.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">But most seriously there is the real risk that those who have vested ideological, financial or emotional interests in a person’s death could exert undue influence.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Recent experiences around the Liverpool care pathway, and in the Gosport hospital, should make us wary of leaving doctors without proper regulatory and legal oversight. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">When difficult medical decisions are left to doctors who are inexperienced, inadequately trained or working under intense pressure bad decisions can be made. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">When they are left to those who believe that brain-damaged patients are better off dead then we are in a very dangerous place indeed.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">It is just possible that today’s Supreme Court decision will not change medical practice in this area. <o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">But I am not holding my breath. <o:p></o:p></span><br />
<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><br /></span> <span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><i>The full judgement is available <a href="https://www.supremecourt.uk/cases/docs/uksc-2017-0202-judgment.pdf">here</a> and the press summary of the judgement <a href="https://www.supremecourt.uk/cases/docs/uksc-2017-0202-press-summary.pdf">here</a>.</i></span></div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-30500439167814014642018-05-26T14:19:00.001-07:002018-05-29T03:32:06.325-07:00Ireland votes to legalise abortion – a desperately sad day<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSyTCfD_LFpmZ3HwGKJe3CGxtyrOWIsanRQ9NlHP5i37LZIgAgDiQR9eIy88urv0a0RtNs7akbKnOgjRpDcUgu6lvE-jFEKmrZg3xyu3mPJZRMMd1660m0Nf7f-ONPCUtnGI7i_uTKk_0Z/s1600/Fetus12weeks.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="662" data-original-width="658" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSyTCfD_LFpmZ3HwGKJe3CGxtyrOWIsanRQ9NlHP5i37LZIgAgDiQR9eIy88urv0a0RtNs7akbKnOgjRpDcUgu6lvE-jFEKmrZg3xyu3mPJZRMMd1660m0Nf7f-ONPCUtnGI7i_uTKk_0Z/s320/Fetus12weeks.jpg" width="318" /></a></div>
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On Friday 25 May 2018 Irish voters <a href="http://www.bbc.co.uk/news/world-europe-43962738">backed the legalisation of abortion</a> by a majority of two to one in a national referendum.</div>
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<o:p></o:p></div>
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The vote repeals the Eighth Amendment of the Constitution — a 1983 measure that conferred equal rights on the baby and the mother, making abortion legal only to save the life of the mother.<o:p></o:p><br />
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The national vote was 66.4% to 33.6% with only one of 40 constituencies, Donegal, voting against it and support was highest amongst urban women under 25, 90% of whom backed it.</div>
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Before the referendum, the government had pledged to pass legislation by the end of the year to allow unrestricted terminations up to 12 weeks (see picture), and between 12 and 24 weeks to protect the mother’s health, if the amendment was set aside. <o:p></o:p></div>
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The Eighth Amendment to Ireland’s constitution, or Article 40.3.3, ‘acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right’.</div>
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<o:p></o:p></div>
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In other words, it treats the life of the mother and baby as equal. From now on that will no longer be so and babies up until 12 weeks will be able to be 'terminated' with impunity.</div>
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Ireland’s abortion law will thereby become more liberal that than in Britain which allows abortion only on medical grounds specified under the Abortion Act 1967, even though this law is largely flouted. </div>
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Currently in Britain <a href="http://pjsaunders.blogspot.co.uk/2011/12/why-98-of-abortions-in-britain-are-now.html">98% of abortions</a> are carried out on mental health grounds, when there is in fact no evidence to suggest that continuing a pregnancy poses any greater risk to a mother’s mental health than abortion.<br />
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Abortion is not healthcare - it treats no illness and offers no healthcare benefit and remains against the Hippocratic Oath. It is, at the end of the day, just killing.</div>
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<o:p></o:p></div>
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What can we expect now in Ireland?<o:p></o:p></div>
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In 2016 <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/679028/Abortions_stats_England_Wales_2016.pdf">3,265 Irish women</a> travelled to England and Wales to have abortions. But once it is legal in Ireland the number of abortions in that country is expected to rise to 13,000 per year given abortion rates in Britain. <o:p></o:p></div>
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In 2016 in England and Wales, there were 696,271 live births and 185,596 abortions. That means over 1 in 5 pregnancies ends in abortion. <o:p></o:p></div>
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There have been over 9 million abortions in England and Wales since 1967 – an astonishing number equivalent to one and a half times the number of Jews who died in the Nazi holocaust. In fact, there are 43 million abortions every year around the world - almost one in two human deaths involving a doctor or other healthcare worker ending the life of an unborn baby.<o:p></o:p></div>
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Also 92% of all abortions in England and Wales are carried out under 13 weeks, so it is likely that a similar percentage will qualify in Ireland.<o:p></o:p></div>
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Today’s vote will leave Northern Ireland as the only place in the British Isles where abortion remains largely illegal.<o:p></o:p></div>
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Last year i<a href="https://adfinternational.org/news/stats-confirm-100000-lives-saved-in-northern-ireland/">t was confirmed</a> that there are 100,000 people alive in NI today because of the current law. <o:p></o:p></div>
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The right to life is the most fundamental of all rights and all other rights depend on it. Every individual human life begins at fertilisation and every abortion stops a beating heart.<o:p></o:p></div>
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But the Irish vote has confirmed that two thirds of voters there do not consider that life before birth has equal value to life after birth.<o:p></o:p></div>
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In other words, they believe that it is legitimate to treat babies before birth differently to those after birth – on the basis of their age, size, dependency and mental capacity. <o:p></o:p></div>
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This is profoundly discriminatory but is being advanced ironically on grounds of equality, diversity and tolerance.<o:p></o:p></div>
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That it has been welcomed by most Irish is a stunning judgement on just how far the country has slid in the last 40 years. <o:p></o:p><br />
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But the roots go back to the sexual revolution and the widespread acceptance of sex outside marriage - it is also stark witness to the ineffectiveness of free contraception in preventing conception and the legacy of believing that people who are not willing or ready to be parents should be having sex.<br />
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Ireland, having held out for some decades against the rest of the so-called developed world, has now joined the pack with a vengeance. A society will always be judged on how it treats its weakest members. Women are not the victims here.</div>
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It is a desperately sad day for Ireland. The fight for the unborn will go on, but it has just been made a whole lot harder. <o:p></o:p></div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-59653686940022704102018-04-26T15:49:00.000-07:002018-04-29T10:26:39.153-07:00Alfie Evans has a progressive incurable illness but his parents should not be stopped from doing what they believe is best for him<div class="separator" style="clear: both; text-align: center;">
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<i>Hear my Premier Radio interview on this case <a href="https://bit.ly/2HU6BtK">here</a> .Alfie died at 0230 on Saturday 28 April, just over 24 hours after this post was written.</i></div>
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<a href="http://www.bbc.co.uk/news/uk-england-merseyside-43754949">Alfie Evans</a> was admitted to Alder Hey Hospital, Liverpool in December 2016 suffering from seizures. He was found to have a (still undiagnosed) progressive neurodegenerative disease and has now been in a semi-vegetative state for more than a year. During that time, he has been on a ventilator in the critical care unit. <o:p></o:p></div>
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Alder Hey NHS Trust went to the High Court last year to seek a declaration that continued ventilator support was not in Alfie’s ‘best interests’. They claimed that scans showed ‘catastrophic degradation of his brain tissue’ and that further treatment was not only <a href="http://www.bbc.co.uk/news/uk-england-merseyside-42903246">‘futile’ </a>but also ‘unkind and inhumane’. <o:p></o:p></div>
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But his parents disagreed and wanted permission to fly him to the Bambino Gesu Hospital in Rome in the hope of prolonging his life. <o:p></o:p></div>
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On 20 February, High Court Judge Mr Justice Hayden said doctors could <a href="http://www.bbc.co.uk/news/uk-england-merseyside-43133434">stop providing life support for Alfie against his parents' wishes</a>, saying the toddler required ‘peace, quiet and privacy’. A lengthy legal battle ensued with the eventual result that Alfie was taken off the ventilator on Monday 23 April. <o:p></o:p></div>
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At the time of writing, over 60 hours later, he is still alive breathing spontaneously on oxygen. <o:p></o:p></div>
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The Italian Ministry of Foreign Affairs had previously granted 23-month-old Alfie Italian citizenship, hoping it would allow an ‘immediate transfer to Italy’ but Hayden, who stated that ‘Alfie is a British citizen’ and ‘falls therefore under the jurisdiction of the High Court’, ruled that he could not go. This judgement was upheld on 25 April by three judges at the Court of Appeal. <o:p></o:p></div>
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The case has understandably generated international media interest, intense emotion and accusations on both sides with the medical staff, judiciary, Alfie's parents and supporters and his legal team all coming in for criticism from various quarters.<br />
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Everyone has an opinion, which makes me all the more reluctant to offer mine. I do so now only because I have spent much of yesterday refusing requests to go on adversarial media debates but at the same time having to answer questions from church members, CMF members, leaders of other organisations all over Europe and concerned members of the public who are wanting to know what to think and are deeply concerned about the tone of public discussions. Some of this criticism on both sides, from both media and public, has been particularly vicious and is to my mind inexcusable in what is a deeply complex and difficult case.<br />
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In doing so my heart first goes out in particular to Alfie's parents and the medical staff who have cared for him for so long to the best of their ability under the glare of the media spotlight.<br />
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I think there are two key questions with this case – ‘What is the best way of managing Alfie?’ and ‘Who should ultimately decide what treatment he has?’<o:p></o:p></div>
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They need to be considered separately. <o:p></o:p></div>
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<b>‘What is the best way of managing Alfie?<o:p></o:p></b></div>
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Alfie has incurable progressive brain damage which will eventually kill him. So, any treatment is only going to be supportive or palliative at best. However, it is not immediately apparent how long he might live either on, or off, a ventilator. <o:p></o:p></div>
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There is an important ethical difference between the active ending of life and the withdrawal of treatment. The former, I believe, is always wrong, whereas the latter is sometimes wrong and sometimes right depending on the clinical circumstances.<o:p></o:p></div>
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It is not always wrong to withdraw or withhold treatment. Sometimes, when death is imminent and inevitable and the burden of the treatment outweighs any benefit it gives, it can be good medicine. </div>
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There is a point when we say enough is enough. Similarly, we are not obliged to give every treatment to every patient just because those treatments exist. Doctors are making decisions to withhold or withdraw treatments of various kinds every day.<o:p></o:p></div>
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But these decisions must be made on grounds that the treatment is not worth giving, not that the patient is not worth treating – that the treatment is futile, or that it does more harm than good, rather than that the life is futile. Doctors are obliged to make judgements about the qualities of treatments, but not about the quality of lives. It is therefore sometimes appropriate and ethically defensible to turn off a ventilator in some cases of severe brain damage, just as it is appropriate in other situations to withdraw or withhold drug treatments or surgery.<o:p></o:p></div>
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But, when invasive treatments like ventilators are withheld or withdrawn, basic care including food and fluids (clinically assisted nutrition and hydration), oxygen and symptom relief should continue as it has with Alfie. The fact that Alfie is still breathing after almost 72 hours does not mean that his brain is not severely damaged, only that there is enough function in his brain stem (the respiratory centre) for him to continue the unconscious process of breathing. It does not mean that he is beginning a miraculous recovery, only that his brain stem is currently less badly damaged than his doctors thought.<o:p></o:p></div>
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I am not here making a judgement about whether it was clinically appropriate to stop Alfie’s ventilator as I am not privy to the full clinical details, but Alfie’s doctors clearly felt that it was and made this decision in good faith believing that Alfie was suffering and that the ventilation was providing more burden than benefit.<o:p></o:p></div>
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Other doctors might, and indeed have, disagreed with this conclusion, which tells us at very least that it is not a straightforward assessment. Personally, I don't share the view of the court that to keep Alfie on a ventilator is inhumane. If he is deeply unconscious and effectively insensate, then he will not by definition be suffering. On the other hand, the ventilator appears to be simply extending his life rather than improving his underlying brain damage, which is getting steadily worse.<o:p></o:p></div>
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<b>Who should ultimately decide what treatment Alfie has? <o:p></o:p></b></div>
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One of the dilemmas Alfie's case has raised is whether doctors or judges are the right people to determine whether withdrawing life-support treatment is in the ‘best interests’ of a terminally ill child. Should they be able to overrule parents?<o:p></o:p></div>
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Under UK law the rights of parents are not absolute. The 1989 Children's Act makes it clear that where a child is at risk of harm the state can and should intervene and the court in this case chose to overrule the parents. <o:p></o:p></div>
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It is this that has fuelled the greatest resentment and criticism. <o:p></o:p></div>
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I am not saying that ventilating Alfie was helping him (in terms of improving his condition) but equally I find it hard to see how it was harming him. His doctors may not agree with me and are entitled to their professional opinions. They might equally have argued with some justification (but have chosen not to) that there were other patients more likely to benefit from continued ventilation than Alfie who might have had a greater call on the equipment. <o:p></o:p></div>
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Doctors, of course, like parents, are moral agents and should not be forced to do something they believe is clinically inappropriate or even morally wrong. But Alfie’s parents, in seeking a second opinion elsewhere for their child, are similarly doing what they believe is best for him, even if they are clinging to false hope. <o:p></o:p></div>
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No one is suggesting that they are deliberately doing what they know is not in Alfie’s best interests or that they are incapable of seeking help for him. <o:p></o:p></div>
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Overriding parental responsibility should only be contemplated when a parent is harming a child deliberately or out of ignorance, or failing to care for it adequately. But none of these things apply in this case. <o:p></o:p></div>
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So, I do not see why Alfie’s parents should not be allowed to do what they believe is in the best interests of their son, even if it makes no difference to the eventual outcome of his illness. They are his parents after all.<o:p></o:p></div>
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Based on the clinical details that are in the public domain, it seems most likely that Alfie will continue his downward trajectory and die, but if his parents wish to try other treatment options and there are others who are prepared both to take on his treatment and also to pay for it, then the hospital and the courts should not stand in their way. <o:p></o:p></div>
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In doing so they risk appearing paternalistic and controlling and thereby doing huge damage to their own, and our country’s, reputation. <o:p></o:p></div>
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When a doctor or judge in good faith opts not to treat a child because he believes it is not right or appropriate to do so he (or she) should be respected in that professional judgement.<br />
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But he should not be able to stand in the way of a second opinion being sought by the child's equally committed parents.<br />
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I am not suggesting by this that Alfie's decline is in any way reversible. This is a progressive, terminal condition. But different doctors (both in the UK and abroad) will have different views about whether or not to restart ventilation, how long if so to continue it, and what specific elements of supportive and palliative care to employ. </div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-48627779119615209802018-03-22T11:13:00.001-07:002018-03-23T02:52:32.731-07:00Bill to ensure conscience rights for medical practitioners to receive Committee Stage tomorrow<div class="separator" style="clear: both; text-align: center;">
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<i>The <a href="http://www.freeconscience.org.uk/">Free Conscience Campaign</a> has just put out the following<a href="http://www.freeconscience.org.uk/press-release-bill-to-ensure-conscience-rights-for-medical-practitioners-to-receive-committee-stage-tomorrow/"> press release</a>.<o:p></o:p></i></div>
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Baroness O’Loan’s <a href="https://services.parliament.uk/bills/2017-19/conscientiousobjectionmedicalactivities.html" target="_blank">Conscientious Objection (Medical Activites) Bill</a> will go to a Committee Stage in the House of Lords tomorrow (Friday 23 March).<o:p></o:p></div>
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The Bill will clarify the law to ensure conscience protections are in place for medical practitioners to protect them from discrimination, enabling them to fully participate in their chosen professions and care for patients to the best of their ability. The Bill will give the right to withdraw from end of life treatment, activities under the Human Fertilisation and Embryology Act and abortion.<o:p></o:p></div>
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Under the existing law, some medical professionals are not protected from unjust discrimination. GPs, as well as many nurses, midwives, pharmacists, and other medical professionals have limited statutory conscience protection. As a result, some areas of the healthcare profession are becoming increasingly difficult places to work for those with certain deeply-held moral, philosophical or religious views. Not only is this discriminatory, it could also mean healthcare professions will become increasingly less diverse, inclusive, and representative of the views of the general population.<br />
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An <a href="http://www.conscienceinquiry.uk/wp-content/uploads/2016/12/Pro-Life-APPG-Freedom-of-Conscience-in-Abortion-Provision.pdf" target="_blank">Inquiry in 2016 found</a> that some doctors and nurses face discrimination in the workplace due to their conscientious objection to practices that they believe end a human life. <o:p></o:p></div>
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The conscience rights of midwives were also undermined by a <a href="https://www.supremecourt.uk/decided-cases/docs/UKSC_2013_0124_Judgment.pdf" target="_blank">2014 Supreme Court judgment</a>, which held that the conscience provision in the Abortion Act 1967 did not allow them to refuse to engage in aspects of abortion such as telling someone else that have to carry out an abortion.<o:p></o:p></div>
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A <a href="http://www.comresglobal.com/polls/where-do-they-stand-abortion-survey/" target="_blank">recent ComRes poll</a> found that a majority of the public oppose forcing doctors to participate in abortion procedures against their will if they want to remain in their profession.<o:p></o:p></div>
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The Free Conscience campaign, which has been launched to support the Bill, is calling on the public to visit their website (<a href="http://www.freeconscience.org.uk/" target="_blank">www.freeconscience.org.uk</a>) where they can write to their MP, asking them to support the Bill.<o:p></o:p></div>
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<b>Baroness O’Loan said:</b><o:p></o:p></div>
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<i>“No one should be coerced by the risk to their careers into violating their conscience, and it is plainly inconsistent with the principles of equality legislation to exclude whole sections of society from areas of medical employment simply because of their moral beliefs. Reasonable accommodation of conscientious objection is a matter both of liberty and equality: of individual freedom and social inclusion. It is promising to see support from across the country for the Bill</i>”.<o:p></o:p></div>
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<b>Mary Doogan, one of the two midwives in the <i>Greater Glasgow Health Board v Doogan & Anor</i> case, and spokesperson for the </b><a href="http://www.freeconscience.org.uk/" target="_blank">www.freeconscience.org.uk</a><b> campaign said:</b><o:p></o:p></div>
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<i>“It’s reassuring to see this Bill is gaining momentum and continues to progress through Parliament. This Bill will restore the conscience rights of those who work tirelessly day in and day out to serve and care for others. As medical professionals, we owe patients not only our efforts but also our best moral judgement, and this Bill would allow us once again to practise with the greatest integrity. I fully support this important legislation and commend it to Parliament and the wider public”.</i><o:p></o:p></div>
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<b>Dr. Mary Neal, leading conscience expert, senior lecturer at Strathclyde University and spokesperson for the </b><a href="http://www.freeconscience.org.uk/" target="_blank">www.freeconscience.org.uk</a><b> campaign said:</b></div>
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<i>“I am heartened to see that this Bill is progressing through Parliament, as it is necessary and much needed. There is a pressing need for statutory conscience rights which actually protect those who need protection. The current law fails to do this, so this Bill is a necessary and timely step.”</i><o:p></o:p></div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-83404434197384341602018-01-26T11:32:00.002-08:002018-01-26T11:38:22.902-08:00Baroness O’Loan’s Conscientious Objection (Medical Activities) Bill deserves our full support <div class="separator" style="clear: both; text-align: center;">
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<span style="font-size: 10pt;">As Christians, </span><span style="font-size: 10pt;">we are called to respect the governing authorities as they are instituted by God himself (Romans 13:1,2). But are there limits? What should we do if they try to force us to do something we believe is wrong?</span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">The </span><a href="http://freeconscience.org.uk/"><span style="font-size: 10.0pt; line-height: 115%;">‘Free Conscience’ campaign</span></a><span style="font-size: 10.0pt; line-height: 115%;">, launched this week with the backing of many Christian groups, supports Baroness O’Loan’s <a href="https://services.parliament.uk/bills/2017-19/conscientiousobjectionmedicalactivities.html">Conscientious Objection (Medical Activities) Bill</a> which passed its second reading (debate stage) in the House of Lords on Friday 26 January. It is now set for a Committee of the Whole House where amendments can be submitted and debated. If it then passes a third reading it will pass to the House of Commons.<o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">The bill aims to strengthen the conscience rights of healthcare professionals who believe it would be wrong to be involved in three specific activities – abortion, activities under the Human Fertilisation and Embryology Act 1990 (like embryo research or egg donation) and withdrawal of life-preserving treatment. <o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">Currently, the law offers general conscience protection. The <a href="https://www.legislation.gov.uk/ukpga/2010/15/contents">Equality Act 2010</a> includes religion and belief as two of nine ‘protected characteristics’ and the <a href="https://www.legislation.gov.uk/ukpga/1998/42/contents">Human Rights Act 1998</a>, which brought the European Convention of Human Rights (ECHR) into UK law, states that ‘everyone has the right to freedom of thought, conscience and religion’ (article 9). But these rights are limited.<o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">When it comes to specific protections the situation is much less clear and statute law currently only applies to abortion and activities under HFE Act. For abortion its scope is very limited. <o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">In 2014 the Supreme Court <a href="https://www.supremecourt.uk/decided-cases/docs/UKSC_2013_0124_Judgment.pdf">ruled</a> that two Glasgow midwives, who were working as labour ward coordinators, could not opt out of supervising abortions. It said that the conscience clause in the <a href="https://www.legislation.gov.uk/ukpga/1967/87/contents">Abortion Act 1967</a> only applied to those who were directly involved in abortion and not to those involved in delegation, planning, supervision and support. This left many health professionals vulnerable to coercion.<o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">Overall 25 peers spoke in the debate – 13 for and 11 against with the government responding. Labour health spokesperson Baroness Thornton made it clear that the Labour party would oppose the bill and Liberal Democrat Baroness Barker said that most of her party colleagues shared her strong opposition also. The government itself will allow a conscience vote. <o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">The major arguments against the bill were that it expanded the scope of the conscience clause to cover health professionals only indirectly involved in the activity concerned and expanded the number of activities protected. This, they claimed, would hinder access to patient care. Several peers also suggested that there should be a duty for professionals claiming conscience protection to refer the patient to someone who would comply.<o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">Supporters of the bill will need to address these specific concerns convincingly at committee stage if the bill is to proceed.<o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">As Christian citizens we must respect those who rule over us but the Bible is equally clear that if discriminatory laws are passed, and obeying such laws involves disobeying God, then our higher duty is to obey God. If you love me you will obey me, says Jesus (John 14:15). <o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">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).<o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">A fiery furnace did not stop Shadrach, Meshach and Abednego refusing to bow down to the image of the king and a lions’ den did not deter Daniel from persisting with public prayer (Daniel 3:16-18, 6:1-10).<o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">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).<o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">Of course, we should also do our best to oppose the passing of laws which seek to criminalise normal Christian behaviour which is what Baroness O’Loan’s bill is all about. We can thank God that in Britain we still have the democratic right to participate in shaping public policy.<o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">Freedom of conscience is not a minor or peripheral issue and it is not only Christians who are affected. It goes to the heart of healthcare practice as a moral activity. Current UK law and professional guidelines respect the right of doctors to refuse to engage in certain procedures to which they have a conscientious objection.<o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">The right of conscience helps to preserve the moral integrity of the individual clinician, preserves the distinctive characteristics and reputation of medicine as a profession, acts as a safeguard against coercive state power, and provides protection from discrimination for those with minority ethical beliefs.<o:p></o:p></span></div>
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<span style="font-size: 10.0pt; line-height: 115%;">It is worth fighting for. Christians can get involved through the </span><a href="http://freeconscience.org.uk/"><span style="font-size: 10.0pt; line-height: 115%;">Free Conscience website</span></a><span style="font-size: 10.0pt; line-height: 115%;"> which will tell you how to contact your MP and encourage them to support the bill. But it will first need to clear the House of Lords.<o:p></o:p></span></div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-36590586442424392902018-01-21T14:01:00.004-08:002018-01-29T04:06:18.532-08:00My big 60th birthday challenge - running the London Marathon for Sightsavers<div class="separator" style="clear: both; text-align: center;">
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I'm running the London Marathon on 22 April this year for <a href="https://www.sightsavers.org/">Sightsavers</a> because they excel in preventing and treating blindness. </div>
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If you’d like to support me my donations page is <a href="https://www.justgiving.com/fundraising/petersaunderssightsavers">here</a>.<o:p></o:p></div>
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As a general surgeon who has served in a Kenyan mission hospital I've witnessed first-hand the devastating damage that blindness can do to individuals and communities but also realise how effective, and relatively cheap, preventive and curative measures are. <o:p></o:p></div>
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As CEO of Christian Medical Fellowship I'm deeply committed to healthcare in the developing world.<br />
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I turn 60 this February so would like to celebrate that by running to support this great charity. This will be my sixth London marathon since my wife and kids told me (with good justification) in my mid-40s that I was going to seed so I am indebted to them that I can still run.<o:p></o:p></div>
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In five previous marathons between 2004 and 2014 friends and colleagues have generously helped me to raise over £25,000 for Whizz Kidz, Alzheimer's Society, Down's Syndrome, Help the Hospices and Christian Blind Mission. <o:p></o:p></div>
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Would you partner with me in raising another £5,000 to help Sightsavers protect and restore sight in developing world communities? <o:p></o:p></div>
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Donating through <a href="https://www.justgiving.com/fundraising/petersaunderssightsavers">JustGiving</a> is simple, fast and totally secure. <o:p></o:p></div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-60669986512505925922018-01-17T14:48:00.000-08:002018-02-03T11:55:24.426-08:00Conway assisted suicide case – autonomy is not absolute and this latest appeal should be dismissed<div class="separator" style="clear: both; text-align: center;">
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<i><span style="font-family: "arial" , sans-serif; font-size: 10.0pt;"><span style="color: #222222;">Watch my previous Sky News interview on the Conway case </span><span style="color: #888888;"><a href="http://bit.ly/2gVXpc6">here</a> </span>and listen to my radio interviews on BBC <a href="https://www.cmf.org.uk/resources/media/?context=entity&id=d48776b611797193f1142eac70e32ce9eab5722a">Shropshire</a> and <a href="https://www.cmf.org.uk/resources/media/?context=entity&id=0f74a2ec7d33371d66827bb41eb82a0208a01621">Coventry</a>.</span></i></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"> <br />A 68-year-old Shropshire man with motor neurone disease (MND) who wants help from doctors to kill himself has been <a href="http://metro.co.uk/2018/01/18/terminally-man-wins-legal-challenge-peaceful-dignified-death-7239499/">granted permission</a> to appeal an earlier decision rejecting his case. </span><br />
<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><br /></span> <span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">The judgement (see <a href="https://www.judiciary.gov.uk/wp-content/uploads/2018/01/conway-judgment18.1.18.pdf">here</a>) was handed down today (18 January 2018) following an oral hearing at the Royal Courts of Justice. </span><br />
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><a href="http://www.carenotkilling.org.uk/press-releases/judicial-review-cnk-to-intervene/"><span style="color: #888888;">Noel Conway</span></a> is backed by the former Voluntary Euthanasia Society (now rebranded Dignity in Dying (DID)), whose lawyers have argued that the current blanket ban on assisted suicide under the Suicide Act is incompatible with his rights under section 8 of the Human Rights Act (respect for private and family life).<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">Following a four-day hearing in the high court last July three senior judges <a href="http://www.carenotkilling.org.uk/articles/high-court-rules-on-conway/">dismissed Conway’s case</a> on 5 October (judgement <a href="http://www.bailii.org/ew/cases/EWHC/Admin/2017/2447.html">here</a>). They summarised their conclusions as follows: <o:p></o:p></span></div>
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<i><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">'It is legitimate in this area for the legislature to seek to lay down clear and defensible standards in order to provide guidance for society, to avoid distressing and difficult disputes at the end of life and<b> to avoid creating a slippery slope leading to incremental expansion over time of the categories of people to whom similar assistance for suicide might have to [be] provided</b>... we find that section 2 (of the Suicide Act 1961) is compatible with the Article 8 rights (private and family life) of Mr Conway. <b>We dismiss his application for a declaration of incompatibility</b>.'<sup><o:p></o:p></sup></span></i></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;">The Divisional Court refused permission to appeal, so Mr Conway then filed an application in the Court of Appeal seeking permission directly. This has now been granted.<o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">Conway's </span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><a href="http://www.carenotkilling.org.uk/articles/new-case-to-cover-old-ground/"><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial; color: #222222;">case is substantially the same</span></a><span style="background-attachment: initial; background-clip: initial; background-image: initial; background-origin: initial; background-position: initial; background-repeat: initial; background-size: initial;"> as that of Tony Nicklinson and Paul Lamb in 2014, except that his condition is terminal.</span><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">There have been over ten attempts to legalise assisted suicide through British Parliaments since 2003, all of which have failed. The last of these was the <a href="http://pjsaunders.blogspot.co.uk/2015/09/defeat-of-marris-assisted-dying-bill.html"><span style="color: #888888;">Marris Bill</span></a> in 2015 which was defeated by an overwhelming majority of 330 to 118 in the House of Commons amidst concerns about public safety.</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">Frustration at their lack of success in parliament has led DID and other campaigners to pursue their agenda through the courts.</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">In the last hearing Humanists UK (formerly the British Humanists’ Association (BHA)) intervened on the side of Conway and <a href="http://notdeadyetuk.org/6898-2/"><span style="color: #888888;">Not Dead Yet UK</span></a> and <a href="http://www.carenotkilling.org.uk/"><span style="color: #888888;">Care Not Killing</span></a> (CNK) on the side of the defendant.</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">A change in the law is opposed by every major disability rights organisation and doctors' group, including the BMA, Royal College of GPs and the Association for Palliative Medicine, who have looked at this issue in detail and concluded that there is no safe system of assisted suicide and euthanasia anywhere in the world.</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">Laws in the Netherlands and Belgium that were only meant to apply to mentally competent terminally ill adults, have been extended to include the elderly, disabled, those with mental health problems and even non-mentally competent children.</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">While in <a href="http://www.carenotkilling.org.uk/public/pdf/cnk-oregon-a4-1(9)-web.pdf"><span style="color: #888888;">Oregon</span></a>, the model often cited by those wanting to change the law, there are examples of cancer patients being denied lifesaving and life-extending drugs, yet offered the lethal cocktail of barbiturates to end their own lives.</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">Article 8 of the Human Rights Act 1998 (Right to respect for private and family life) states (8(1)) that ‘Everyone has the right to respect for his private and family life, his home and his correspondence.’</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">However, this right is not unlimited but is qualified in 8(2). Following this principle CNK and others argued that a blanket prohibition on euthanasia and assisted suicide was ‘necessary in a democratic society in the interests of public safety for the prevention of disorder or crime, for the protection of health or morals, and for the protection of the rights and freedoms of others.’</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">They also argued that to pursue this case in court was institutionally inappropriate given that parliament has repeatedly, rigorously and comprehensively considered this issue and decided not to change the law.</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">Legalising assisted suicide and/or euthanasia is dangerous because any law allowing either or both will 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 evidence from other jurisdictions demonstrates that the so-called ‘right to die’ may subtly become the ‘duty to die’.</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">The legalisation of assisted suicide and/or euthanasia is uncontrollable in practice because any law allowing either or both will be subject to incremental extension. We have observed in jurisdictions like Belgium and the Netherlands that over time there is an expansion of categories to be included beyond those originally intended and without any further change in the law: a shift from terminal conditions to chronic conditions, from physical illnesses to mental illnesses and from adults to children.</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">The essential problem is that the two major arguments for euthanasia - autonomy and compassion - can be applied to a very wide range of people. This means that any law which attempts to limit them, for argument’s sake to mentally competent people who are terminally ill, will in time be interpreted more liberally by sympathetic or ideologically motivated ‘assisters’ and may also be open to legal challenge under equality legislation on grounds of discrimination.</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">The legalisation of assisted suicide and/or euthanasia is also unnecessary because requests for euthanasia or assisted suicide are extremely rare when people’s physical, social, psychological and spiritual needs are adequately met. The overwhelming majority of people with terminal illnesses, including those with MND, want ‘assisted living’ not ‘assisted suicide’.</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">The safest law is one like Britain’s current law, which gives blanket prohibition on all assisted suicide and euthanasia. This deters exploitation and abuse through the penalties that it holds in reserve, but at the same time gives some discretion to prosecutors and judges to temper justice with mercy in hard cases.</span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">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. And one of the primary roles of government and the courts is to protect the most vulnerable even sometimes at the expense of not granting liberties to the desperate.</span></div>
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<span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10pt;">This issue has been considered exhaustively by parliaments and courts in the UK and is settled. While having every sympathy with Mr Conway's personal plight the consequences for society are too dangerous and far-reaching. I hope that the Court of Appeal will stand by the previous high court judgement and dismiss his case. </span><span style="color: #222222; font-family: "arial" , sans-serif; font-size: 10.0pt;"><o:p></o:p></span></div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-32521517372400446352018-01-12T13:20:00.000-08:002018-01-15T03:56:19.549-08:00A Christian framework for medical ethical decision-making<div class="separator" style="clear: both; text-align: center;">
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How should Christians make ethical decisions? Should we use secular decision-making systems that are deontological (rule-based) or consequentialist (outcome based)? Or can we derive an ethical framework from the Bible?</div>
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Christians are called to imitate God (Ephesians 5:2), imitate Christ (1 Corinthians 11:1) and to walk as Christ walked (1 John 2:6). We are to be holy because God himself is holy (Leviticus 19:2; I Peter 1:16). <o:p></o:p></div>
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We might say that this is impossible but we forget three things – that through Jesus death and resurrection God has granted us repentance (Acts 5:31), given us a new nature (2 Corinthians 5:17) and placed the Holy Spirit within in us to empower us to live lives which are pleasing to him (Romans 8:9-11). This is why it is possible for us both to ‘put off’ ungodly thoughts and actions and to ‘put on’ godly attitudes and behaviours (Ephesians 4:22-24). <o:p></o:p></div>
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So how are we then to make Christ-like ethical decisions? I would suggest that doing so involves four elements: sharing the mind of Christ, holding the commands of Christ, showing the character of Christ and carrying the cross of Christ. <o:p></o:p></div>
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Let’s consider each of those in turn. <o:p></o:p></div>
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<b>Sharing the mind of Christ<o:p></o:p></b></div>
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To share the mind of Christ, we first need to have a Christian worldview. We need to think about the world in the way that Jesus does and in the way the Bible teaches; in terms of creation, fall, redemption and future hope. <o:p></o:p></div>
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We are created by God in his image for an eternal relationship with him. But we have also, individually and collectively, fallen from grace. We are sinful and this sin has every aspect of our beings; our bodies, our emotions, our relationships, and our moral decision making. We are masterpieces created by the grand master, but we are flawed masterpieces in need of redemption. <o:p></o:p></div>
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God has initiated his great plan of redemption through his dealings with Israel and ultimately through the sending of his Son Jesus Christ, through whose death and resurrection we can be reconciled to God through repentance and faith. <o:p></o:p></div>
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We now have a hope that is certain, guaranteed by God himself, that we can have confidence for the day of judgment because of what Jesus has done for us, and will live together with God and fellow believers forever in God’s presence in a new heaven and new earth.<o:p></o:p></div>
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Sharing the mind of Christ involves having that linear view of history and that confidence about the future. <o:p></o:p></div>
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<b>Holding the commands of Christ <o:p></o:p></b></div>
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Holding the commands of Christ means being guided by his word in the way we make ethical decisions. Jesus said that if we love him we will obey his comands (John 14:15, 15:14). But what are his commands?<o:p></o:p></div>
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What starts in the Old Testament as the Old Covenant, the Ten Commandments and the 613 laws of the Pentateuch is, of course, a shadow prophetically pointing to the person of Christ, who will be the only one who is able to fulfil them (Colossian 2:17; Hebrews 10:1). <o:p></o:p></div>
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In the New Testament, specifically in the Sermon on the Mount (Matthew 5-7), we see Christ going beyond the mere external legalities of Old Testament law to the very spirit of love that underlies it. </div>
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He says (Matthew 22:37-40) that the most important commands in the law are to love God with all one’s heart, soul, mind and strength (Deuteronomy 6:5) and to love one’s neighbour as oneself (Leviticus 19:18).<o:p></o:p></div>
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Jesus also gave his disciples a new commandment, to love one another as he had loved them (John 13:34,35). <o:p></o:p></div>
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But we are told that all Scripture is inspired (literally breathed) by God and profitable for teaching, correction, reproof and training in righteousness (2 Timothy 3:16,17). So, we need to work hard at deducing biblical ethical principles to apply to today’s ethical dilemmas. <o:p></o:p></div>
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Here are some key biblical principles:<o:p></o:p></div>
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<i>Stewardship: </i>we are given skills and abilities, not in order to exploit the earth, but to be its vanguards and its stewards, caring for the earth and for each other in the same way that God would care (Genesis 1:26). We are God’s delegated vice-rulers. This obviously applies to the scientific knowledge and technology that he has given to us. In fact, we see the beginnings of science, in Adam naming the animals (taxonomy) (Genesis 2:19,20) and technology with Jubal and Tubal-Cain developing musical instruments and metal tools (Genesis 4:21,22).<o:p></o:p></div>
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<i>The sanctity of life:</i> every human being is precious in God’s sight because every human being is made in the image of God (Genesis 1:27). It is because of this that human beings cannot be unjustly killed (Exodus 20:13; Deuteronomy 5:17). God will hold us accountable for the shedding of innocent blood (Genesis 9:5,6).<o:p></o:p></div>
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<i>Chastity:</i> sexual faithfulness. As we learn, ultimately, in the New Testament, the pattern of ‘one man, one woman, for life’ (Genesis 2:24) is a beautiful picture or metaphor of Christ’s marriage with the Church (Ephesians 5:31,32) and points, eschatologically, to the New Jerusalem, and the new Heaven and the new Earth (Revelation 22:17). <o:p></o:p></div>
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<i>Veracity:</i> the telling of truth (Exodus 20:16; Leviticus 19:11; Deuteronomy 5:20), because God is truthful and tells no lies (Numbers 23:19; Titus 1:2).<o:p></o:p></div>
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<i>Justice:</i> both at an individual and corporate level, so that vulnerable people are protected from exploitation. So much of the Old Testament law, of course, is about guarding the weak (Proverbs 31:8,9). <o:p></o:p></div>
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<i>Grace:</i> giving people what they don’t deserve (Matthew 5:43-48).<o:p></o:p></div>
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<i>Mercy:</i> not giving people what they do deserve, so that we are called to share the mind of Christ, both from a worldview and ethics (Micah 6:8).<o:p></o:p></div>
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Having the mind of Christ and keeping the commands of Christ are crucial, but we are also called to show the character of Christ because Christian ethics is not just about what we do, but also about how we do it. <o:p></o:p></div>
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<b>Showing the character of Christ <o:p></o:p></b></div>
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This brings us back to Plato’s idea that in order to act virtuously, one has to be a virtuous person. One can only act virtuously, in a Christian sense, by being born again, and then transformed by the Holy Spirit so that one develops the fruit of the Holy Spirit: love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control (Galatians 5:22,23). <o:p></o:p></div>
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It is one thing to know the right thing to do. It is something else altogether to have the character to do it.<o:p></o:p></div>
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Standing firm in making correct ethical decisions requires great wisdom, patience, perseverance and courage.<o:p></o:p></div>
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<b>Carrying the cross of Christ<o:p></o:p></b></div>
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Carrying Christ’s cross means two things in a world hostile to Christian faith and values. It means, first of all, that we are prepared to fulfil the ‘Law of Christ’. <o:p></o:p></div>
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The Law of Christ is an interesting concept. It is mentioned twice in the New Testament. The first mention comes in 1 Corinthians, where Paul says, ‘I am not under the law, but I am under Christ’s law’ (1 Corinthians 9:21). Then, in Galatians, we have the command: ‘Bear one another’s burdens and so fulfil the law of Christ’ (Galatians 6:2).<o:p></o:p></div>
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This lines up with Christ’s words to his disciples at the Last Supper: ‘A new commandment I give to you: love one another as I have loved you’ (John 13:34,35).<o:p></o:p></div>
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If you like, it is the very opposite of the Darwinist ethic of the weak being sacrificed for the strong. It is instead the strong making sacrifices for, or laying down their lives for, the weak. <o:p></o:p></div>
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This is the guiding ethic for everything we see in the New Testament. For example, with the ethics of giving: ‘Christ, who was rich, became poor so that you might be rich’ (2 Corinthians 8:9). Why? In order that we ourselves might then become poor so that we can make others rich. We are called to emulate Christ in making sacrifices, or laying down our lives, for the weak (Romans 5:8). <o:p></o:p></div>
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Additionally, part of carrying the cross in a society hostile to Christian faith and values is that we are prepared to speak and act in godly ways, even when it is tremendously costly to do so; in other words, even when it leads to great opposition. This is part of the cross. <o:p></o:p></div>
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Christ bore the burdens of others and carried out great acts of compassion of healing and love. But he wasn’t crucified for these acts of compassion. It was actually his words that led to his death (John 7:7). It was when he spoke unpalatable truth about his own identity (John 5:18) and when he spoke prophetically about the nation in which he was placed (Matthew 26:63-68). That was when persecution really came to bear. <o:p></o:p></div>
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As Christ’s people living in this age we are called to carry the cross of Christ (Matthew 16:24; Luke 9:23, 14:27). That involves both sacrificial service and also faithfully speaking the truth, regardless of the cost, whether it is preaching the Gospel or speaking moral truth in the public sphere. <o:p></o:p></div>
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So there we have it – we can be imitators of Christ by having his mind, holding his commands, showing his character and carrying his cross.<o:p></o:p></div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0tag:blogger.com,1999:blog-2654455663519806899.post-54740504543569978542018-01-06T11:56:00.002-08:002018-01-11T05:24:38.869-08:00Some Big Public Policy Challenges in Bioethics we can expect in 2018<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDpvl6tlOGJ4S8qvdtgJEM2KCS3QlWiSjKGSV4F5dPy1tYl9sQsVbc-yjmcTtJscLOPM38VwYHNIbdrsdsNsLOWX5LU_kvSKm6d3PBhaR76NmbL7Kx2I-f2JfipTLrZJCtcOK66a6GVrOf/s1600/Bioethics_MS_Image11.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="420" data-original-width="594" height="281" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDpvl6tlOGJ4S8qvdtgJEM2KCS3QlWiSjKGSV4F5dPy1tYl9sQsVbc-yjmcTtJscLOPM38VwYHNIbdrsdsNsLOWX5LU_kvSKm6d3PBhaR76NmbL7Kx2I-f2JfipTLrZJCtcOK66a6GVrOf/s400/Bioethics_MS_Image11.jpg" width="400" /></a></div>
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As we look forward to the challenges that 2018 will bring I am struggling to think of a time when we have faced more major public policy challenges in bioethics in so many areas all at once. </div>
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This is perhaps inevitable given the march of secular humanism through parliament, the courts and institutions.<br />
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Here is some background on the five major threats currently looming.</div>
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<o:p></o:p></div>
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<!--[if !supportLists]--><b><i>1.<span style="font-size: 7pt; font-stretch: normal; font-style: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: normal; line-height: normal;"> </span></i></b><!--[endif]--><b>Assisted Suicide <i><o:p></o:p></i></b></div>
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Given that 11 attempts in British Parliaments to change the law to allow assisted suicide or euthanasia have failed since 2003 our opponents, not surprisingly, have shifted their attention to the courts in an attempt to change the law through the back door.<o:p></o:p></div>
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<b>Conway</b>, who has motor neurone disease and is seeking assisted suicide, <a href="http://www.bbc.co.uk/news/health-41506155">lost his case</a> in which CNK Alliance intervened in the Divisional Court in October, and his appeal to the High Court was denied. He now plans to appeal directly to the Court of Appeal. See my previous comments on the case <a href="http://pjsaunders.blogspot.co.uk/2017/07/the-conway-case-change-in-law-to-allow.html">here</a>.<o:p></o:p></div>
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<b>Omid, </b>who has multiple system atrophy and is also seeking assisted suicide, had a preliminary hearing on 21 November and has appealed to the judges to allow a full enquiry in which all witnesses can be cross-examined along the lines of the Carter case in Canada. We <a href="https://www.belfasttelegraph.co.uk/news/uk/man-with-incurable-disease-desperate-for-assisted-suicide-legal-battle-to-be-heard-36339981.html">await</a> their decision.<o:p></o:p></div>
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There have been three worrying judgements by the <b>Court of Protection</b> in the last few months (see <a href="http://www.bbc.co.uk/news/uk-41341482">here</a> and <a href="http://www.bbc.co.uk/news/magazine-37444379">here</a>). Formerly all patients with Permanent Vegetative State (PVS) and Minimally Conscious State (MCS) had to go to court for appeals about the removal of artificial nutrition and hydration (ANH), but now there are moves to withdraw ANH from these and less severely brain-damaged patients who are not imminently dying without going to court provided that both doctors and relatives agree that it is in the patient’s ‘best interests’. The Official Solicitor will appeal these judgements in the Supreme Court on 29 January. My fuller review is <a href="http://www.cmfblog.org.uk/2018/01/09/supreme-court-to-rule-on-whether-doctors-can-remove-food-and-fluids-from-brain-damaged-patients-without-going-to-court/">here</a>.<o:p></o:p></div>
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A <a href="http://www.telegraph.co.uk/news/2017/11/17/high-court-judge-says-man-helped-father-die-wrongfully-accused/">recent case</a> involving a pharmacist (<b>Desai</b>) who helped his father end his life with a morphine and insulin overdose resulted only in a nine-month suspended sentence. The general trend is toward fewer prosecutions and convictions for assisted suicide and the <a href="https://www.cps.gov.uk/legal-guidance/policy-prosecutors-respect-cases-encouraging-or-assisting-suicide">DPP’s prosecution criteria</a> on assisted suicide are being interpreted very liberally. <o:p></o:p></div>
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<!--[if !supportLists]--><b>2.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: normal; line-height: normal;"> </span></b><!--[endif]--><b>Abortion <o:p></o:p></b></div>
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The <a href="https://www.wetrustwomen.org.uk/">‘We Trust Women’ campaign</a> (masterminded by Ann Furedi of BPAS) is gaining momentum and now has the support of the RCOG, BMA and RCM. Whilst there is no bill currently before Parliament (and none likely to appear before 2019) proabortion activists may seek to amend a government health bill to achieve their aim of completely decriminalising abortion (see my previous posts <a href="http://www.cmfblog.org.uk/2017/03/14/11371/">here</a>, <a href="http://pjsaunders.blogspot.co.uk/2017/09/rcog-president-backs-total.html">here</a>, <a href="http://www.cmfblog.org.uk/2017/07/05/reflections-on-the-bmas-vote-to-decriminalise-abortion-ten-key-observations/">here</a> and <a href="http://www.cmfblog.org.uk/2017/06/26/over-1000-doctors-reject-bma-abortion-decriminalisation-motion-this-is-why/">here</a>).</div>
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This will most likely involve repealing Sections 58 and 59 of the <a href="https://www.legislation.gov.uk/ukpga/Vict/24-25/100/contents">Offences Against the Person Act 1861</a> (OAPA) which make procuring an abortion for oneself or others a crime punishable by life imprisonment. The effect would be to make abortion legal for any reason up to 28 weeks and, if the <a href="http://www.legislation.gov.uk/ukpga/Geo5/19-20/34/section/1">Infant Life (Preservation Act) 1929</a> is repealed too, up to birth. <o:p></o:p></div>
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Were this to succeed the <a href="https://www.legislation.gov.uk/ukpga/1967/87/contents">Abortion Act 1967</a> with all its provisions (two doctors, licensed premises, reporting, conscience clause etc) would fall as it is contingent upon the OAPA. <o:p></o:p></div>
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<span style="color: #222222; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">There are also calls to relax the abortion laws in Northern Ireland, Ireland and the Isle of Man. </span><o:p></o:p></div>
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<!--[if !supportLists]--><b>3.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: normal; line-height: normal;"> </span></b><!--[endif]--><b>Organ transplantation<o:p></o:p></b></div>
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Geoffrey Robinson MP wants to bring in an opt-out system for organ donation in England. His <a href="https://services.parliament.uk/bills/2017-19/organdonationdeemedconsent.html">Organ Donation (Deemed Consent) Bill </a>is due its second reading (debate stage) on 23 February 2018.<o:p></o:p></div>
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In 'deemed' (presumed) consent, a person, unless he or she specifically 'opts out', is assumed to have given consent to the harvest of their organs after death, even if their wishes are not known. Although relatives may be consulted (a so called 'soft' opt out), to ascertain any wishes of the deceased expressed before death, their views can still be overruled by the state should they decide against transplantation. Wales already operates an opt-out system for organ donation and it is likely that Scotland will follow. <o:p></o:p></div>
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Robinson's private member's bill may be overtaken by a new government bill seeking to achieve the same thing. The government has just launched a <a href="https://engage.dh.gov.uk/organdonation/">consultation</a>, closing on 6 March 2018, which <a href="https://www.theguardian.com/society/2017/dec/12/jeremy-hunt-launches-opt-out-organ-donation-plans-in-england-and-wales">proposes</a> 'changing the current law on organ donation consent whilst also allowing people to opt out if they want to'. Both Theresa May, the prime minister and Jeremy Corbyn, the leader of the opposition have signalled support and a Daily Mirror Campaign has built support. <o:p></o:p></div>
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However, evidence for the claim that an opt-out system will increase transplants is still lacking. In Wales, where an opt-out system was introduced in December 2015, there has been a small dip in the number of deceased donors. The Nuffield Council advised in October that <a href="http://www.bbc.co.uk/news/health-41199918">robust evidence is needed</a> before any change to the law is considered. But it is also unethical.<br />
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Donation must be without coercion and the final decision must lie with the family based on what the person would have wanted, if this is known. Organs are not the property of the state and must not be 'taken' without permission, however needy any prospective recipient may be (see previous CMF articles and blog posts <a href="https://www.cmf.org.uk/resources/publications/content/?context=article&id=26704">here</a>, <a href="http://www.cmfblog.org.uk/2017/09/28/why-should-families-have-a-say-in-organ-retrieval/">here</a> and <a href="http://www.cmfblog.org.uk/2017/09/28/why-should-families-have-a-say-in-organ-retrieval/">here</a>)<o:p></o:p></div>
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Under the <a href="https://www.legislation.gov.uk/ukpga/2004/7/contents">Gender Recognition Act 2014</a>, to change gender legally, one must have lived in one’s chosen gender for two years, be 18 or over, have a medical diagnosis of gender dysphoria and appear before a gender recognition panel.<o:p></o:p></div>
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Justine Greening, the Secretary of State for Education, Women and Equalities, wants to allow people to change their gender purely based on self-declaration without having to see a doctor nor appear before a gender recognition panel. <o:p></o:p></div>
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A consultation toward this end has been announced and is to be launched shortly. A <a href="https://consult.gov.scot/family-law/review-of-the-gender-recognition-act-2004/">Scottish consultation</a> is already underway and closes on 1 March.<o:p></o:p></div>
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She has the support of both Theresa May and Jeremy Corbyn although there is now some resistance growing and <a href="http://mailchi.mp/c4m/good-news-as-the-government-reconsiders-transgender-plans">recent reports</a> suggest that Greening may be having second thoughts (see further comment <a href="http://www.cmfblog.org.uk/2017/07/27/justine-greenings-transgender-proposals-are-unscientific-dangerous-part-of-a-greater-social-strategy/">here</a> and <a href="https://www.conservativewoman.co.uk/simon-marcus-justine-greening-must-stopped-pushing-transgenderism-children/">here</a>).<o:p></o:p></div>
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<!--[if !supportLists]--><b>5.<span style="font-size: 7pt; font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: normal; line-height: normal;"> </span></b><!--[endif]--><b>Freedom of Conscience in healthcare <o:p></o:p></b></div>
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Currently there is statutory conscience protection for health professionals only for involvement in abortion and activities authorised under the Human fertilisation and Embryology Act. The scope of the former is restricted because of a Supreme Court judgement on the case of two Glasgow midwives. <o:p></o:p></div>
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Freedom of conscience for other activities (eg. Hormones for transgender, abortifacient contraceptives, PrEP, withdrawal of ANH etc) is covered only partially by equality legislation. <o:p></o:p></div>
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There were two significant victories on freedom of conscience last year. The General Pharmaceutical Council, which regulates Pharmacists and Pharmacies, <a href="http://www.cmfblog.org.uk/2017/06/26/good-news-for-freedom-of-conscience-in-the-uk/">modified new guidance</a> which would have replaced a ‘right to refer’ with a ‘duty to dispense’, in response to protests from interest groups (see my previous comment <a href="http://www.cmfblog.org.uk/2017/02/21/regulators-proposal-to-remove-pharmacists-conscience-rights-is-unethical-unnecessary-and-quite-possibly-illegal/">here</a>). <o:p></o:p></div>
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The Faculty of Sexual and Reproductive Health (FSRH), part of the RCOG, <a href="https://pjsaunders.blogspot.co.uk/2017/08/college-climbs-down-over-ban-on.html">reversed regulations</a> which denied those with conscience objections to some contraceptives, from obtaining its diplomas. This appeared to be <a href="https://www.christiantoday.com/article/cmf-praises-climb-down-allowing-uk-medics-religious-exemption-from-contraception-prescription/120938.htm">in response to criticism</a> by CMF.<o:p></o:p></div>
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These two wins underline the fact that conscience freedom depends on constant vigilance.<o:p></o:p></div>
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Baroness O’Loan’s <a href="https://services.parliament.uk/bills/2017-19/conscientiousobjectionmedicalactivities.html">Conscientious Objection (Medical Activities) Bill</a> is to have its <a href="http://www.lordswhips.org.uk/speakers-lists/22012018">second reading</a> in the House of Lords on 26 January 2018. Although this bill is much narrower in scope than we would have preferred (covering only abortion, IVF and related technologies and withdrawal of treatment) it has our support. <o:p></o:p></div>
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So, a busy year awaits. Watch this space for further developments. <o:p></o:p></div>
Peter Saundershttp://www.blogger.com/profile/17222354018504253042noreply@blogger.com0