Cliff Richard and euthanasia – what did he really say and does it matter?

I’ve just done an interview on BBC Radio Humberside off the back of Sir Cliff Richard’s alleged support for euthanasia in this morning’s papers.

The headlines do certainly seem to indicate that the 71 year old entertainer wants a change in the law. The Daily Telegraph leads with ‘Cliff Richard: Why I would consider euthanasia’; the Daily Mail and Daily Express use the headline ‘I have a death pact with my sister’ and the Sun shouts ‘Kill me if I get dementia’.

The comments have been lifted from a BBC interview that Cliff Richard has recently done on the occasion of his 71st birthday, on which he was asked about his mother’s death at 87 from dementia.

The Daily Mail, which seems to be the original source of the story, reports as follows:

(Cliff) also revealed he had made a pact with the same sister to look after each other if they developed dementia.

Speaking in a BBC radio interview, he revealed: ‘I said, look if this happens to me, I’ll do the same for you if you’ll do it for me, don’t let it go on too long. And just make sure I’m looked after because I don’t want to be a burden on anybody else.’

He went on: ‘If it happened when I was 90, 20 years from now, they might well have allowed euthanasia or something like that.’

‘Dementia does not take your life – but it removes it away from you. You don’t have a life. It just stops you living.’

No one can help but sympathise with Sir Cliff over his feelings seeing his mother die from dementia. Many of us have also been there in various ways. But what did he really say and what did he actually mean?

On the face of it he was saying three things:

1.He doesn’t want to be a burden on others and so has made a pact with one of his sisters that if either of them gets dementia the other will take on the burden of looking after the one who is affected.

Well that seems perfectly reasonable and natural to me.

2.He doesn’t want to go on suffering too long if he gets dementia and wants his sister not to prolong his life in this situation.

Well again that seems very reasonable. Having seen my own father die from dementia we often prayed that his suffering would not be prolonged. But choosing not to prolong the dying process with aggressive interventions is a far cry from starving, sedating and dehydrating someone to death or giving them a lethal injection.

3.Euthanasia might be legalised in the next 20 years.

Well there is a possibility that it might be. Belgium and the Netherlands have already done so.

It seems to me that these dramatic headlines about Cliff Richard supporting euthanasia are largely a case of media hype and spin – and I hope that Sir Cliff will clarify soon what he actually meant.

But for argument’s sake, what if Sir Cliff really does think that euthanasia should be legalised? What then?

Well, in spite of the fact that Cliff Richard is both a Christian and a great entertainer who has survived five decades in the charts, this does not make him an expert either in ethics or public policy.

Parliament has three times in the last six years rejected a change in the law to allow assisted suicide or euthanasia on grounds of public safety.

The House of Lords, in 2006 and 2009, and the Scottish Parliament in 2010, decided that to legalise assisted suicide, even with so-called safeguards, would place pressure on vulnerable people to end their lives and would make it easier for those with an emotional or financial interest in their deaths literally ‘to get away with murder’.

Parliament also decided that our really priority should be improving care for people who are elderly, terminally ill or disabled. In this connection it is refreshing to see in this morning’s Times newspaper a report (£) featuring the Silver Manifesto – ‘50 ways to improve old age’.

But we should also note why the Cliff Richard story has hit the headlines today.

It is because the media is gearing up for the release of the Falconer Commission report next month, which will recommend a change in the law to allow ‘assisted suicide with safeguards’.

Falconer’s campaign has been repeatedly discredited in the press, the broadcast media and undermined by the British Medical Association but he nonetheless presses on and on.

This is why we saw last weekend Lord Falconer trumpeting in the Guardian and Star Trek actor Patrick Stewart is campaigning in the Telegraph.

There will be a lot more of this in the next few weeks as Dignity in Dying (formerly the Voluntary Euthanasia Society) ratchets up its well-funded celebrity-driven campaign to foist euthanasia in its various forms upon us. This is all part of a softening up process. Be warned.

Managing time - lessons from the grand master

Do you wake up in the morning and ask the Lord: 'What is it that you have prepared in advance for me to do today?'Or, like me, do you often wonder how you will complete all the tasks that lie before you?

Competing time demands are an inevitable part of life, and to some extent, the more seriously we take our Christian responsibilities, the more we will face them. Jesus grappled with competing time demands but was the master in time management. He uniquely maintained a balance between worship, prayer, family, friends, work and rest. To do this he maintained an intimate relationship with God and had a clear view of his life task. Here are just four key pointers from the Great Physician.

Jesus guarded his devotional life

Jesus spent time in prayer, especially during periods of intense activity. He prayed regularly and especially before each important decision. And he withdrew from his ministry to pray after periods of exhausting ministry. In Luke 5:15-16, a good prescription for busy doctors, we read that '...crowds of people came to hear him and to be healed of their sicknesses. But Jesus often withdrew to lonely places and prayed'. The more he worked the more he prayed. He was 'too busy not to pray'. I wonder if God often creates the delays and stoppages in our busy lives; the red lights, and traffic jams, the queues and holdups so that we might have the opportunity to pray more.

Similarly he was immersed in the Word of God - so much so that when the devil challenged him in the wilderness he could answer with three quotes from the book of Deuteronomy; a book that many of us could not easily find, let alone are familiar with. Do we regularly feed on God's Word? Do we make it one of our first priorities? Jesus did.

Jesus made time for people

In the midst of Jesus'busy ministry he did not let the urgent crowd out the important. As a surgeon I find the story of the woman with the haemorrhage very challenging. Jesus is on the way to see someone who is critically ill with an acute infection, and is stopped by a woman with chronic long-standing menorrhagia (Luke 8:40-56). She gets his full attention, and then as if to vindicate his decision God enables him to raise Jairus' daughter from the dead! In our lives as doctors we need to be ready to pause with certain individuals that God brings across our path. The gospel encounters are made up of a string of accounts of individuals who Jesus paused with. He did not pause with everyone; he healed only one man at the pool of Siloam, he spoke only to one Samaritan at the well, only one rich young ruler, only one tax collector - but he did make time for individuals.

Jesus equipped others

Jesus did not feel that he had to meet all the need himself. His strategy was rather to devote time to equipping others. This way the work carried on after he had returned to the Father. The effectiveness of a ministry is not measured by what is achieved but by what carries on after the key person leaves. Jesus spent a hugely disproportionate amount of time with those who would carry on his work.We too should always be asking how we can multiply the work God has given us by involving others. If we are given a choice between doing something ourselves or teaching someone else to do it, we should go for the latter. Jesus' response to seeing the harvest fields ripe for harvest was not to encourage the disciples to work all the more hard to bring it in. Rather he encouraged them to pray that God would raise up more workers (Matthew 9:37-38).

Jesus recognised the need for rest

Jesus was not legalistic about the Sabbath but rather recognised its true purpose. He realised that it was important to withdraw and rest, even in the face of pressing need. Burnout is a major problem for Christian doctors because we are motivated by a strong sense of responsibility and are aware of the vast amount of unmet need. But we need to timetable time for relaxation and recuperation. How we spend it will depend on our own personality and makeup.We may be alone or with others, doing a vigorous activity or a sedentary one - the important thing is that we take time out altogether from work and ministry at regular intervals.

The story is told of two men who chopped wood. One stopped for regular rests every hour while the other just kept chopping all day long. At the end of the day the one who rested had a far larger pile of chopped wood. The other was surprised until he learned that while resting, the other had been also sharpening his axe. Recognizing the need for rest is like sharpening the axe.

Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light. (Matthew 11:29-30)

David Fergusson wades in to defend Coleman over abortion mental health link

Priscilla Coleman’s recent meta-analysis showing a link between abortion and mental health problems not surprisingly has created a storm, coming as it did in the middle of the recent parliamentary debate over independent abortion counseling.

Whilst the left wing press and the BBC chose to ignore it, other academics in the field have attempted to undermine it in a flurry of letters to the British Journal of Psychiatry.

But David Fergusson, veteran researcher in the field, has just waded in to Coleman’s defence.

His letter is available on the BJ Psych website but here are some key excerpts. Fergusson writes:

The letter by Louise Howard and colleagues follows a well-trodden strategy which has been used in a number of reviews to dismiss any evidence suggesting that abortion may have adverse effects on mental health. In this strategy:

a) Methodological criteria are constructed to classify studies
b) No numerical analysis combining study findings is provided
c) Strong conclusions are drawn on the basis of a small number of ‘high quality’ studies

The use of this strategy led the APA review to claim that there was no evidence of adverse effects of single first trimester abortion on the basis of a single study, the conclusions drawn by Charles et al were based on four studies. Howard et al use a similar strategy in which they question the methodological quality of studies reviewed in the Coleman analysis and draw conclusions about the absence of association between abortion and mental health on the basis of a small number of studies. If the evidence is indeed as weak and as limited as these reviewers have claimed the appropriate conclusion to be drawn is that no firm conclusions can be made about the mental health consequences of abortion until further and better research is completed.

In the meantime, Coleman has done the field a service by bringing together a quantitative review of a large number of studies that have addressed the issue of abortion and mental health. What will be clear to any alert analyst is that there is a clear statistical footprint suggesting elevated risks of mental health problems amongst women having abortions, irrespective of the comparison group used or the outcome studied. This evidence clearly challenges the conclusions drawn from the reviews cited above.

Following the Coleman meta-analysis we have conducted a more refined analysis which addresses some of the concerns raised by Howard and colleagues. In this we confined the analysis to only those studies using an unwanted/unintended comparison and data was extracted from the original sources by two reviewers. This search yielded a total of eight studies reporting 14 results. These findings were used to conduct a series of meta-analyses for five separate outcomes: anxiety disorder; mood disorder; alcohol misuse; illicit drug use/misuse and suicidal behaviours. The results tell a clear story in which, with the exception of depression, there are significant small to moderate associations between abortion and increased risks of mental health problems.

The implications of this analysis are inescapable: despite the claims made in previous reviews about the absence of association between abortion and mental health, when data are pooled across studies there is consistent evidence suggesting that women having abortions are at modestly increased risks of mental health problems when compared with women coming to term with unplanned/unwanted pregnancies.

Fergusson is modest in his conclusions but his intervention is significant.

He promises a further review to be published soon.

Cometh the hour, cometh the man – Aaron Cruden is no stranger to challenge and adversity

Aaron Cruden may be New Zealand’s fourth choice fly half after Carter, Slade and Evans but he is no stranger to challenge and adversity and should not be underestimated going into the World Cup semifinal tomorrow against Australia.

The 22 year old made his provincial debut for Manawatu Turbos in 2008 and captained New Zealand to the 2009 IRB Junior World Championship title in 2009 in Japan, as well as being named IRB Junior Player of the Year 2009.

He made his Super 15 Hurricanes debut on 29 January 2010 against the Brumbies in Porirua and on 30 May last year was named as one of four new caps in the All Blacks squad to play test matches against Ireland and Wales.

On 12 June he made his All Blacks debut in the 66–28 victory over Ireland in New Plymouth, subbing for Dan Carter, and later took part off the replacement bench in two victories over Wales, then made his Tri Nations debut against the Springboks in Wellington on 17 July.

He missed out on the All Blacks Tri Nations and World Cup squad this year but played superbly during the Air New Zealand Cup and with the adductor injuries to Carter and Slade now finds himself starting at number 10 in the biggest test of his sporting life.

Cruden kept a cool head when coming on as a replacement in the All Blacks' 33-10 World Cup Quarter Final victory over Argentina, at Eden Park, and contributed a conversion to the score.

Now the nation’s hopes rest upon his young shoulders.

Without Carter there will always be question marks ahead of an All Blacks Aussie clash but Cruden has the potential to make it on the big stage. He has the talent, the confidence and the support to step up to the big occasion and has his Super 15 team mates around him. The injury to Carter now leaves the All Blacks with a Hurricanes backline from halfback to wing with Weepu, Cruden, Nonu, Smith and Jane at 9, 10, 12, 13 and 14 respectively.

And Cruden has shown that he also has the character to meet tough challenges.

He will be unfazed at being thrust into the World Cup pressure cooker after surviving a cancer scare three years ago, according to his father.

His father, Stu, said his son matured after being diagnosed with testicular cancer in 2008 and was ready for any challenge. He had to take time out from rugby to undergo surgery and an intensive nine-week chemotherapy course before receiving the all-clear by medics at the end of 2009.

‘He was a pretty well-balanced lad before that, pretty focussed on things he wanted to do and we can't really explain what came to him, or from him, from that cancer,’ Cruden senior said. ‘But we've certainly seen a changed person, he's more mature, he's more balanced and he just takes every opportunity he gets now. He doesn't get down when anything goes wrong, he just believes that every day's another day to be alive.’ He'll be the first to tell you that he's now past that part of his journey – his cancer's in remission and that's where he wants it to stay, he's just getting on with life,’ his father added. ‘Whatever life throws at his now, he's prepared to take the challenge.’

Cruden, who on the All Blacks' website lists cyclist and six times Tour de France winner Lance Armstrong, a fellow cancer survivor, as the person he would most like to meet, is now preparing to play the biggest game of his life.

Cometh the hour, cometh the man.

A converted abortionist speaks from beyond the grave about guilt, faith and tactics

Bernard Nathanson, who died last February, was an American medical doctor from New York who helped to found the National Association for the Repeal of Abortion Laws, but later became a pro-life activist.

His book ‘the Hand of God’ is the subject of a review in this week’s British Medical Journal, by Trevor Stammers, programme director in bioethics and medical law at St Mary’s University College, London

Stammers introduces Nathanson as ‘the only US abortionist to have changed his mind and faced national vilification twice over—initially for advocating abortion in the ‘60s and subsequently for campaigning against it, culminating in his widely available 1984 documentary The Silent Scream.’

He describes how Nathanson ‘found the tensions of the “moral whipsaw” of both aborting and delivering babies were becoming intolerable’ and later ‘became seized by “an unremitting black despair”’ which led eventually to his Christian conversion'.

I will leave you to read the review for yourself but I was interested also to find Nathanson’s ‘confession’ on line which gives insights into how he and others worked to legalise and popularise abortion in the United States:

‘I am personally responsible for 75,000 abortions. This legitimises my credentials to speak to you with some authority on the issue. I was one of the founders of the National Association for the Repeal of the Abortion Laws (NARAL) in the U.S. in 1968. A truthful poll of opinion then would have found that most Americans were against permissive abortion. Yet within five years we had convinced the U.S. Supreme Court to issue the decision which legalised abortion throughout America in 1973 and produced virtual abortion on demand up to birth. How did we do this? It is important to understand the tactics involved because these tactics have been used throughout the western world with one permutation or another, in order to change abortion law.’

What were these tactics? Essentially three:

1.Lie to the media about the true number of illegal abortions
2.Pretend that all opposition was Catholic
3.Denigrate and suppress all scientific evidence that life begins at conception

For more detail see Nathanson’s confession.

General Medical Council considers changes to its guidance that could further restrict faith discussions

Pulse magazine reported last week that the General Medical Council is planning to ‘harden’ its guidance on religion in practice.

The document Good Medical Practice (2006) is the core guidance to doctors and describes what is expected of all doctors registered with the GMC. Although the guidance is addressed to doctors, it is also intended to let the public know what they can expect from their doctors.

The GMC says that it is reviewing Good Medical Practice ‘to make sure it is up to date and fit for its many purposes’.

A formal consultation will be launched later this month and will lead to publication of a new edition of the guidance in 2012.

The new draft guidance has added a duty for GPs to consider ‘patients' religious, spiritual and cultural history' when assessing patients.

The regulator also plans to tighten up anti-discrimination guidance on doctors expressing personal views, including religious beliefs, in consultations.

Its previous guidance had stated: ‘You must not unfairly discriminate by allowing your personal views to affect adversely your professional relationship with patients.' Its new version removes the word ‘adversely', requiring GPs to challenge their colleagues' behaviour if there is any effect to the professional relationship.

Once ‘Good Medical Practice’ has been modified it is expected that the GMC will then move to modify its supplementary guidance ‘Personal Belief and Medical Practice’ which goes into these matters in far greater detail.

The revision of ‘Good Medical Practice’ comes during the course of an ongoing investigation into the case of Dr Richard Scott, a GP in Margate, Kent, who was the subject of a complaint for suggesting to a patient that he might find an examination of the Christian faith helpful.

The GMC had proposed giving Dr Scott a warning for discussing his Christian faith during a consultation, but he refused to accept it and opted instead for an oral hearing before its investigations committee.

Dr Scott told the BMJ in May that he had raised the possibility that Christianity might help his patient only in the last five minutes of a 20 minute consultation, after first asking his permission and being told to ‘go for it.’

His mother then brought a complaint to the GMC, saying that Dr Scott had ‘pushed religion’ on her son.

On 23 September, the second day of the two day hearing in Manchester, the committee adjourned ‘to make a further attempt to secure the attendance of Patient A,’ who has so far refused to appear before the committee. His absence prevented Dr Scott’s lawyer cross examining him to challenge his account of what happened at the consultation in August 2010.

The committee heard that Dr Scott had seen the 24 year old man at his surgery in Margate, Kent, after his mother had said that he was ‘suicidal’.

Paul Ozin, for the GMC, said, ‘A line was crossed because Dr Scott expressed his personal religious belief to a person he knew was a vulnerable patient in a way that was plainly liable to cause the patient distress.' However this is disputed by Dr Scott's lawyer, Paul Diamond of the Christian Legal Centre.

Ozin claimed that Dr Scott 'suggested that Jesus or Christianity - his own religion - offered something exclusive and superior to that offered by the patient’s own religion. It is a matter of record that Patient A subsequently complained about Dr Scott and said he was very upset about the consultation and he was offended by what he saw as the belittling of his own religion.’

The revision of the GMC’s guidance appears to have been influenced by this case. The suggested amendments indicate that the regulator is considering more formally acknowledging that doctors have a duty to consider a patient’s spiritual history whilst at the same time taking a sterner view of any attempt to share their own faith.

Interestingly the GMC guidance ‘Personal Beliefs and Medical Practice’ actually acknowledges that 'all doctors have personal beliefs which affect their day-to-day practice' and that these principles apply to all doctors whatever their political, religious or moral beliefs.

It also emphasises that 'personal beliefs and values, and cultural and religious practices are central to the lives of doctors and patients' (p4); that 'patients' personal beliefs may be fundamental to their sense of well-being and could help them to cope with pain or other negative aspects of illness or treatment.' (p5) and that 'discussing personal beliefs may, when approached sensitively, help you to work in partnership with patients to address their particular treatment needs.' (p9)

The GMC’s suggested new approach will not just make things more challenging for Christian doctors but will have implications for any doctor of any faith (or none) who expresses a personal belief that he or she feels might help (about anything) to a patient. This has the potential to lead to many more complaints against doctors and many more cases for the GMC to examine. The regulator could be walking a very delicate path indeed.

I suspect it will not just be Christian doctors who will be awaiting the draft guidance with much interest and examining its wording very carefully.

New suicide prevention strategy for England needs to address more effectively the phenomenon of media-induced suicide contagion

The Department of Health’s Consultation on its draft suicide prevention strategy for England closes on 11 October.

Over the past 10 years, there has been progress in reducing the already relatively low suicide rate in England. However, there were still nearly 4,400 suicides in England in 2009, the latest year for which national data is available.

One of the questions posed by the consultation reads as follows:

‘In your view, are there any additional measures or approaches that could promote the responsible reporting and portrayal of suicide and suicidal behaviour in the media?’

The Care Not Killing Alliance has responded as follows:

The WHO international guidelines on suicide portrayal refer to over 50 published studies, systematic reviews of which have consistently drawn the same conclusion, that media reporting of suicide can lead to imitative suicidal behaviours. This phenomenon is variably termed suicide contagion, copycat suicide, suicide cluster or the Werther effect.

Its recommendations to media professionals include the following:

• Avoid language which sensationalizes or normalizes suicide, or presents it as a solution to problems
• Avoid prominent placement and undue repetition of stories about suicide
• Avoid explicit description of the method used in a completed or attempted suicide
• Avoid providing detailed information about the site of a completed or attempted suicide
• Exercise caution in using photographs or video footage
• Take particular care in reporting celebrity suicides'

A recent paper by Austrian authors published in the British Medical Journal and a much longer one by the same group in the British Journal of Psychiatry published only late last year review media coverage of suicide.

The authors note in the first (BMJ) paper, ‘Papageno vs Werther Effect’, that some media coverage of suicide actually leads to a decrease rather than an increase in suicide rates.

‘Newspaper items accounting for (a decrease) form a distinct non-sensationalist class of suicide reporting. They follow the recommendations of the World Health Organization in reporting suicide—for example, avoiding terms such as suicide epidemic. Our findings suggest that media reports on individual mastery of suicidal crises are highly relevant in preventing suicide.’

In other words, media stories about how people coped positively with suicidal feelings actually lead to a decrease in levels of suicide in the general population.

They name this protective effect ‘the Papageno effect’ in honour of the character in Mozart’s opera the Magic Flute.

‘When Papageno fears that he has lost his love, Papagena, he prepares to kill himself. But three boys save him at the last minute by reminding him of other alternatives to dying.’

The second (BJPsych) paper had the aim ‘to test the hypotheses that certain media content is associated with an increase in suicide, suggesting a so-called Werther effect, and that other content is associated with a decrease in suicide, conceptualised as a Papageno effect.’

It concludes that ‘The impact of suicide reporting may not be restricted to harmful effects; rather, coverage of positive coping in adverse circumstances, as covered in media items about suicidal ideation, may have protective effects.’

Since 2008 the BBC has screened no less than five docudramas and documentaries portraying assisted suicide in a positive light and none giving the opposite perspective. The WHO recommendations have been repeatedly and consistently breached. The latest featured Terry Pratchett and Peter Smedley and showed the latter taking his life at the Dignitas Suicide facility in Zurich.

Figures from the Office for National Statistics show that suicides in England rose from 3,993 in 2007 to 4,390 in 2009 – an overall increase of 10% and the greatest two year rise in over a decade. Amongst males aged 45-74, the age group of Terry Pratchett and Peter Smedley, the rise has been 16% from 1,174 to 1370. The latter figure is the highest in over 20 years.

It is noteworthy that the national suicide prevention strategy for England, launched in 2002, is failing dismally to reach its targets and, perhaps tellingly, no annual reports are available since 2008.

Two recent media stories featured people who pointed to the Terry Pratchett programme as contributing to a real suicide or leading to the contemplation of suicide as a solution.

The full CNK submission is available on the CNK website.