BMJ gives platform to Secular Medical Forum to attack Christianity and promote abortion, physician assisted suicide and embryonic stem cell research

On 30 November the British Medical Journal published an article by Colin Brewer, ‘a director of the Secular Medical Forum’ , titled ‘Secularism needs a distinctive medical voice’.

The 900 word one page article, which appeared in the BMJ’s ‘personal view’ column, and claimed to be ‘not commissioned; not externally peer reviewed’, is essentially an advertorial for Brewer's organisation.

It depicts atheist doctors as a historically persecuted minority and claims that they are ‘still vilified by religious leaders’ who ‘typically suppress dissent’ and ‘forbid fundamental criticism of their sacred texts’.

He adds that ‘most Europeans now have relaxed views on both faith and their texts’ and ‘are often indistinguishable in their daily behaviour from frank unbelievers’. This, according to Brewer, ‘displeases the minority of enthusiasts who take their ideologies seriously and want us to live and die as they believe their texts dictate’.

He claims that ‘few matters of current medicoethical concern are mentioned in sacred texts, and then often obscurely or contradictorily’.

The Bible apparently ‘does not condemn suicide’ but nevertheless, ‘there are well organised religious campaigns against legalising assisted dying’. Objection to abortion is similarly misguided as the view that life begins at fertilisation dates to 1869 when the Vatican ‘moved the goalposts’. Other ‘religious practices’ involving ‘childhood transfusions and genital mutilation’ are now categorised as ‘child abuse’.

We are told that ‘text worshippers are inherently unwilling to re-examine old dogmas’ and that the ‘separation of church and state is more important than ever’.

All this is preparation for an appeal to doctors to join the ‘Secular Medical Forum’ (SMF) which represents people who ‘unlike text worshippers… are poorly organised, do not gather weekly, and have no priests to encourage us personally to badger our MPs and BMA representatives about proposed legislation’.

Instead the SMF ‘exists to give a voice to the many secular health professionals’ and its members ‘have varying views on the great ethical issues’.

I was interested therefore to examine the SMF website see if these claims about ‘varying views on the great ethical issues’ actually rang true.

The following ‘views’ of the forum are pasted verbatim from its website:

1. ‘The Secular Medical Forum strongly supports the right of women to have legal and safe abortions’;

2. ‘The Secular Medical Forum (SMF) believes that legislation for Physician assisted suicide, with adequate safeguards, for terminally ill, competent adults should be introduced in the UK as soon as possible’;

3. ‘The Secular Medical Forum fully supports embryonic stem cell research - and also the creation of hybrid embryos’;

4. ‘The SMF considers that people with strong objections to offering normal medical care and activities should responsibly choose to work in a speciality which does not bring their personal views into conflict with patient care’;

5. ‘The SMF thinks it imperative that patients are made aware of relevant personal views (of doctors) at the earliest opportunity … and would like for there to be a register of these people, centrally kept by the appropriate professional bodies to which they belong, which can be open to the public.’

On its ‘resources’ page it lists some submissions it has made to various official bodies and gives links to the British Humanist Association, National Secular Society and Lawyers' Secular Society along with others to ‘pro-choice’ and pro-euthanasia organisations including Abortion Rights, Brook Advisory Centres, Marie Stopes International, Education for Choice, Dignity in Dying and Friends At The End (FATE).

The website gives very little information about SMF’s membership or office holders, and no address or contact details apart from a contact email for a Dr Anthony Lempert, an anti-circumcision campaigner who received the 2010 ‘academic’ prize at the Erotic Awards, an annual British event that ‘honours achievement in erotica worldwide’.

We are told that the SMF was established in December 2006 ‘following informal discussions at the AGM of the National Secular Society’ and that it ‘drafted statements on a variety of subjects (ranging from physician-assisted suicide to HIV/AIDS, and from abortion to stem-cell research) during January and February 2007’.

The SMF website does not tell us that its first coordinator, ‘Michael Irwin, a retired GP and a former Medical Director of the United Nations’, was also previously head of the Voluntary Euthanasia Society (now 'Dignity in Dying') and is currently leader of the controversial pro-euthanasia group ‘Society for Old Age Rational Suicide’, nor that he was struck off the medical register by the General Medical Council in 2005 for trying to help a friend kill himself. Irwin admitted obtaining sleeping pills to help his friend die and a GMC panel found him guilty of serious professional misconduct.

And neither the website nor the BMJ article tell us that Colin Brewer himself was also struck off the medical register in 2006 after being found guilty of serious professional misconduct by the GMC following allegations of inappropriate drug prescribing for patients with addictions.

From all appearances the SMF is a small pressure group led by doctors with extreme views who are considered no longer fit to practice, which has been set up to promote abortion, assisted suicide and embryonic stem cell research. I would think that most atheist doctors would not choose to be associated with it.

How interesting that the BMJ editors have taken it upon themselves to give it an international platform.

Why legalizing same-sex marriage will weaken marriage as a social institution

With the launch of the ‘Scotland for marriage’ campaign this last week and the news that the Church of England will not be allowing civil partnerships to take place in Anglican churches without General Synod approval the temperature is beginning to rise on the same-sex marriage debate in the UK.

Later this week on 9 December the Scottish consultation on the matter closes and a Westminster consultation is apparently beginning in February. Prime Minister David Cameron has already voiced his support for legalistion.

Last weekend the Guardian newspaper, which has perhaps predictably positioned itself as a same-sex marriage advocate, has tried to anticipate what some of the arguments in the debate will be.

Much of the discussion will no doubt centre around the evidence about the link between legalizing same-sex marriage and the decline of marriage as traditionally understood.

A friend has just drawn my attention to an article by David Blankenhorn titled ‘Defining Marriage Down is no way to save it’.

Blankenhorn is president of the New York-based Institute for American Values and the author of ‘The Future of Marriage’.

He asks the question, ‘Does permitting same-sex marriage weaken marriage as a social institution or does it have little or no effect on marriage overall?

He points out that scholars and commentators have different views and that a straight causal relationship is difficult to prove.

However he goes on to argue that there is much to be gained from ‘giving up the search for causation and studying some recurring patterns in the data’ and demonstrates that ‘certain clusters of beliefs about and attitudes toward marriage consistently correlate with certain institutional arrangements’.

These correlations crop up in a large number of countries and recur in data drawn from different surveys of opinion.

‘Take the International Social Survey Programme (ISSP), a collaborative effort of universities in over 40 countries. It interviewed about 50,000 adults in 35 countries in 2002. What is useful for our purposes is that respondents were asked whether they agreed or disagreed with six statements that directly relate to marriage as an institution’:

1. Married people are generally happier than unmarried people.
2. People who want children ought to get married.
3. One parent can bring up a child as well as two parents together.
4. It is all right for a couple to live together without intending to get married.
5. Divorce is usually the best solution when a couple can't seem to work out their marriage problems.
6. The main purpose of marriage these days is to have children.

Let's stipulate that for statements one, two, and six, an "agree" answer indicates support for traditional marriage as an authoritative institution. Similarly, for statements three, four, and five, let's stipulate that agreement indicates a lack of support, or less support, for traditional marriage.

Then divide the countries surveyed into four categories: those that permit same-sex marriage; those that permit same-sex civil unions (but not same-sex marriage); those in which some regions permit same-sex marriage; and those that do not legally recognize same-sex unions.

The correlations are strong. Support for marriage is by far the weakest in countries with same-sex marriage. The countries with marriage-like civil unions show significantly more support for marriage. The two countries with only regional recognition of gay marriage (Australia and the United States) do better still on these support-for-marriage measurements, and those without either gay marriage or marriage-like civil unions do best of all.

In some instances, the differences are quite large. For example, people in nations with gay marriage are less than half as likely as people in nations without gay unions to say that married people are happier. Perhaps most important, they are significantly less likely to say that people who want children ought to get married (38 percent vs. 60 percent). They are also significantly more likely to say that cohabiting without intending to marry is all right (83 percent vs. 50 percent), and are somewhat more likely to say that divorce is usually the best solution to marital problems. Respondents in the countries with gay marriage are significantly more likely than those in Australia and the United States to say that divorce is usually the best solution…

So what of it? Granted that these correlations may or may not reflect causation, what exactly can be said about the fact that certain values and attitudes and legal arrangements tend to cluster?

Here's an analogy. Find some teenagers who smoke, and you can confidently predict that they are more likely to drink than their nonsmoking peers. Why? Because teen smoking and drinking tend to hang together. What's more, teens who engage in either of these activities are also more likely than nonsmokers or nondrinkers to engage in other risky behaviors, such as skipping school, getting insufficient sleep, and forming friendships with peers who get into trouble.

Because these behaviors correlate and tend to reinforce one another, it is virtually impossible for the researcher to pull out any one from the cluster and determine that it alone is causing or is likely to cause some personal or (even harder to measure) social result. All that can be said for sure is that these things go together…

It's the same with marriage. Certain trends in values and attitudes tend to cluster with each other and with certain trends in behavior. A rise in unwed childbearing goes hand in hand with a weakening of the belief that people who want to have children should get married. High divorce rates are encountered where the belief in marital permanence is low. More one-parent homes are found where the belief that children need both a father and a mother is weaker. A rise in nonmarital cohabitation is linked at least partly to the belief that marriage as an institution is outmoded. The legal endorsement of gay marriage occurs where the belief prevails that marriage itself should be redefined as a private personal relationship. And all of these marriage-weakening attitudes and behaviors are linked. Around the world, the surveys show, these things go together…

Inevitably, the pattern discernible in the statistics is borne out in the statements of the activists. Many of those who most vigorously champion same-sex marriage say that they do so precisely in the hope of dethroning once and for all the traditional "conjugal institution."’

He quotes similar evidence from related studies and then goes on to quote a number of same-sex marriage advocates to support his argument.

It’s well worth a read.

My favourite poem from my favourite poet

The Windhover - To Christ our Lord
(Gerard Manley Hopkins)

I caught this morning morning’s minion, king-
dom of daylight’s dauphin, dapple-dawn-drawn Falcon, in his riding
Of the rolling level underneath him steady air, and striding
High there, how he rung upon the rein of a wimpling wing
In his ecstasy! then off, off forth on swing,
As a skate’s heel sweeps smooth on a bow-bend: the hurl and gliding
Rebuffed the big wind. My heart in hiding
Stirred for a bird,—the achieve of; the mastery of the thing!

Brute beauty and valour and act, oh, air, pride, plume, here
Buckle! AND the fire that breaks from thee then, a billion
Times told lovelier, more dangerous, O my chevalier!

No wonder of it: shéer plód makes plough down sillion
Shine, and blue-bleak embers, ah my dear,
Fall, gall themselves, and gash gold-vermillion.

Beware of the 'Living Will Bill' - the shape of things to come?

Beware of the living will bill

The relatives (after reflection)
Requested a lethal injection
'Her mind's like a sieve, she's no reason to live...
(And the will is awaiting inspection)'

They claimed that once while of sound mind
She'd quite voluntarily signed
A medics' committee, if prompted by pity
Could authorise acts of this kind

You think that this never could be?
Well wake up and listen to me
It's happ'ning already, with pace that is steady
A short way across the North Sea

And here, I am told, that of late
They're having some earnest debate
With raising of thumbs, the physician becomes
The most dangerous man in the state

Beware of the 'Living Will Bill'
(Euphemisms get subtler still)
'Allowing to die' is a mischievous lie
It's a licence for doctors to kill

Tony Nicklinson deserves sympathy but hard cases make bad law

A severely disabled man from Wiltshire is to ask the High Court to allow a doctor to end his life.

Tony Nicklinson, 57, is paralysed from the neck down after suffering a stroke in 2005.

He cannot speak or move anything except his head and eyes and communicates through nodding his head at letters on a perspex board or by using a computer which responds to eye movements.

The Melksham man, who has been married for 25 years and has two daughters, sums up his life as 'dull, miserable, demeaning, undignified and intolerable'.

His lawyers want a doctor actively ending his life to have a ‘common law defence of necessity’ against any possible murder charge.

A spokesman for law firm Bindmans, which represents him, confirmed he had issued proceedings in the High Court asking for declarations that it is lawful for a doctor to terminate his life, with his consent and with him making the decision with full mental capacity.

Earlier this year Nicklinson’s legal team asked the Director of Public Prosecutions to clarify the law on so-called mercy killing but the DPP made it clear there was no flexibility on the law and anyone who deliberately took someone's life would be charged with murder.

They are therefore trying this new route.

In English law, the defence of necessity recognises that there may be situations of such overwhelming urgency that a person must be allowed to respond by breaking the law. There have been very few cases in which this defence has succeeded. However, the Crown Prosecution Service tends to choose not to prosecute those cases where it believes potential defendants have acted reasonably in all the circumstances.

This defence was used in the early trial of Regina v. Dudley & Stephens (1884) 14 QBD 273 DC, where four shipwrecked sailors were cast adrift in a small boat without provisions. To save themselves, the three strongest decided to eat the fourth, the 17 year-old cabin boy. The court ruled that cannibalising the boy was not urgently necessary. Even though the cabin boy would almost certainly have died of natural causes, the sailors killed the boy intentionally and were guilty of murder. There was some degree of necessity arising from the threat of starvation but, at any moment, a ship could have sailed over the horizon to save them as, indeed, the three were rescued. Since they could never be sure that the killing was actually necessary from one minute to the next, the defence was denied. Cannibalism itself is not an offence so long as the death occurs naturally.

Dudley and Stephens were convicted of murder and sentenced to be hanged, however their sentence was later reduced to just six months in prison. The fourth man, Brooks, was not tried, as he had not participated in the murder. The principles from this case form the basis of the defence of necessity not being available for murder.

In order for the defence of necessity to hold sway there must be an urgent and immediate threat to life which creates a situation in which the defendant reasonably believes that a proportionate response to that threat is to break the law.

It is difficult to see how this defence might help Nicklinson who is severely disabled, has a reasonable life expectancy and is not facing any imminent emergency.

However, it is thought that Nicklinson’s lawyers are likely to base their arguments on comments about necessity in the 2001 conjoined twins case where the court ruled that the life of a seriously disabled baby (Mary) could be sacrificed in order that her sister (Jodie) could survive. (A (Children) (Conjoined Twins: Medical Treatment) (No. 1) [2001] Fam 147).

In that case the Court of Appeal said that the doctrine of necessity was more elastic than it had been represented as being in the cabin boy case above.

The Human Rights Act also adds a new dimension.

Nicklinson has Article 8 rights under the European Convention on Human Rights (respect for his private life and family) which must be respected. His lawyers will no doubt argue that these rights cannot be respected unless he dies, and accordingly that the law of necessity needs to give a defence to a doctor who, in the act of respecting his rights, kills him.

However Article 8 also states that the right to respect for private life and family must in a democratic society be balanced with considerations of public safety, the prevention of crime, the protection of health and morals, and the protection of the rights and freedoms of others.

The Murder Act is there in part to protect vulnerable people from exploitation and abuse by those who might have an interest, financial or otherwise, in their deaths. Any further removal of legal protection by creating exceptions for bringing prosecutions would encourage unscrupulous people to take liberties and would place more vulnerable people – those who are elderly, disabled, sick or depressed – under pressure to end their lives so as not impose a burden on family, carers or society.

We also need to realise that cases like Nicklinson’s are extremely rare and that hard cases make bad law. The overwhelming majority of people with severe disability – even with ‘locked-in syndrome’ – do not wish to die but rather want support to live. I have previously highlighted inspiring stories on this blog of people who with good support have been able to get to a position where they can see meaning and purpose in lives even in the face of substantial suffering. It is assisted living most want, not assisted dying.

We all accept that there are limits to choice. Even in a free democratic society there are boundaries to our autonomy. We are not entitled to exercise ‘freedoms’ that will endanger the reasonable freedoms of others. That is why we have laws. Every law limits choice and stops some people doing what they might desperately wish to do. This is in order to maintain protection for others.

The current law is clear and right and does not need fixing or further weakening. On the one hand the penalties it holds in reserve act as a powerful deterrent to exploitation and abuse. On the other hand it gives judges some discretion to temper justice with mercy when sentencing in hard cases. We should not be meddling with it.

It was therefore refreshing to see a spokesperson for the British Medical Association saying yesterday: ‘The BMA is opposed to assisted suicide and to doctors taking a role in any form of assisted dying. We support the current law and are not seeking any change in UK legislation on this issue.’

Oregon Governor orders that some state-sanctioned killing must stop

Earlier this week, in an emotional declaration (£), the Governor of the US state of Oregon, John Kitzhaber, said he would refuse to sanction any further executions.

Today he was strongly criticised (£) by a condemned man who called him a ‘coward’.

Gary Haugen (pictured), a double murderer, wants to be executed to protest at weaknesses in the justice system. He told The Statesman Journal that Kitzhaber had acted on his personal beliefs instead of carrying out the will of Oregon voters who reinstated the death penalty in 1984.

‘I feel he’s a paper cowboy,’ Haugen said. ‘He couldn’t pull the trigger.’

Haugen, 49, was sentenced to death for stabbing a fellow prisoner in 2007 while serving a life sentence for killing a former girlfriend’s mother 30 years ago. He was to have been executed on 6 December until Mr Kitzhaber intervened.

Haugen says he is considering legal action to fight the reprieve which lasts until the governor leaves office.

Interestingly, Oregon is one of only two states in the US which have legalised assisted suicide, also in response to a referendum.

But the Governor isn’t showing any signs of repealing that law.

John Smeaton today draws attention to a letter from Charles J. Bentz, a physician practising medicine in Oregon, published by Times Colonist, an on-line Canadian journal.

In brief, Dr Bentz’s patient, being treated for cancer, became depressed. Dr Bentz’s letter concludes: ‘In most jurisdictions, suicidal ideation is interpreted as a cry for help. In Oregon, the only help my patient got was a lethal prescription intended to kill him. Don't make Oregon’s mistake.’

So Oregon is left in the curious position of endorsing ‘state-sanctioned killing on request’ in some circumstances (ie. for vulnerable sick people) but opposing it for others (ie. for those guilty of murder)

Wouldn’t it be better just to stop all state-sanctioned killing?

MDU warns that doctors who provide medical reports for patients seeking assisted suicide abroad could be prosecuted

The Medical Defence Union (MDU) in its latest advice to doctors (MDU Journal, Volume 27 issue 2 November 2011, Page 24) has published a case study to emphasise the point that doctors who supply medical records to patients who are intending to commit suicide could well be prosecuted.

In February 2010 the Director of Public Prosecutions (DPP) published his ‘Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide’

This lists 16 criteria which make prosecution more likely in any case of assisted suicide. One of these (14) is that ‘the suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer [whether for payment or not], or as a person in authority, such as a prison officer, and the victim was in his or her care’

Encouraging or assisting a suicide is a crime carrying a discretionary custodial sentence of up to 14 years. The MDU’s case study reproduced below is largely accurate in its conclusions except that it misquotes the Suicide Act 1961, which was actually amended in 2010 by section 59 the Coroners and Justice Act 2009.

The error is understandable given that the government hasn’t yet got around to amending the legislation on its own website even though the law was passed over two years ago!

In short, the words ‘aid, abet, procure or counsel’ have been updated to ‘encourage or assist’. The change was aimed at preventing the internet promotion of suicide.

Under the current law a person commits an offence ‘if (he/she) does an act capable of encouraging or assisting the suicide or attempted suicide of another person, and the act was intended to encourage or assist suicide or an attempt at suicide’.

Regardless of the unintentional error the MDU’s advice is very clear and should leave doctors in no doubt about any attempt to assist suicide even by simply providing documentation to a patient.

Here is the case study (which is not as far as I can see available on the internet)

The Scene

A consultant in palliative care received a request for medical records from a patient with multiple sclerosis. The patient had previously expressed her wish to arrange an assisted suicide and had approached her GP for a medical report and insertion of a cannula. The GP had refused to comply with her request. This consultant was in no doubt as to the patient’s motivation for requesting her records and rang the MDU advice line to find out what the repercussions might be if he complied and the patient later committed suicide.

The advice

The MDU adviser confirmed the consultant’s belief that if he knowingly assists a patient in committing suicide, he would be committing a criminal offence.

A doctor could face a criminal investigation if alleged to have assisted a patient with the act, even if the assistance is in the form of advice to the patient. Even if criminal proceedings do not follow, the GMC may still decide to investigate the doctor’s fitness to practise. The member was therefore advised not to engage in discussion about this matter with the patient.

Section 2(1) of the Suicide Act 1961 states: ‘A person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be liable on conviction on indictment to imprisonment for a term on exceeding 14 years.’

Although the Director of Public Prosecutions has decided in the past that it would not be in the public interest to prosecute those who have assisted, for example, patients travelling to Switzerland to commit suicide, the decisions have been case-specific and do not change the legal position for doctors caring for a patient.

It should also be noted that while healthcare professionals must follow an advance decision if it is valid and applies to the particular circumstances when a competent patient wishes to refuse treatment, this is not the same thing as taking active steps to kill a patient. Although the Mental Capacity Act 2005 provides for patients to make a written statement requesting certain treatment of expressing a preference, such statements will certainly not legally require doctors to take active steps to bring about a patient’s death and indeed Section 62 of the Act specifically states that nothing in the Act is to be taken to affect the law relating to murder, manslaughter or assisted suicide.