Alfie Evans

I have forborne to comment on the tragic case of Alfie Evans, so far, for a few reasons.

One is the general principle that in such cases, the information widely available is rarely complete and almost always inaccurate to some extent, so it is foolhardy to rush to judgement.

Allied to that is my natural sympathy with Alfie's parents: I was intuitively on their side (and indeed have been praying for them and for Alfie over the last few weeks). The risk, of course, is that such sympathy over-rules one's reason.

Moreover, it was not clear to me what good it would have done to add to the furore, from a state of relative ignorance; and it did seem to me that much of the commentary on all sides added more heat than light to the debate.

Now that the dust has settled, I suggest that there are two issues at the heart of the case, from a Catholic point of view.

One is the rights of the parents as primarily responsible for their children's wellbeing.  That is a well-established principle in Catholic teaching; but it is clearly not an absolute. If a parent is deranged, or patently wishes to harm a child, it is both appropriate and proportionate for others - the state if necessary - to intervene to look after the child's best interests.  But I maintain that the bar for this must be set very high: it must be clear and unarguable, evident to the reasonable man, that such is the case - and that criterion was not met in the case of Alfie Evans. I believe the hospital and the state (in the judiciary) over-reached their authority.

The second is the principle of treating nutrition and hydration as 'medical care' which can then be withdrawn at the decision of medical experts. Again, we need to be careful about not making an absolute out of this: there are times, when somebody is actually dying, and when providing nutrition and hydration are causing suffering, when ceasing to provide them is the correct thing to do. However, as Joseph Shaw points out, the principles established in the Tony Bland case have taken that far too far; and that seems also to be what happened in the case of Alfie Evans, at least temporarily.

Please remember Alfie's parents in your prayers at this terrible time; Alfie himself, of course, is in no need of prayer: having been baptised and not yet reached the age of reason, he is clearly in heaven. May he pray for us all here below.

Euthanasia

Yet again, alas, it is à propos to post Elizabeth Jennings' poem.

Euthanasia:

The law's been passed and I am lying low 

Hoping to hide from those who think they are 

Kindly, compassionate. My step is slow. 

I hurry. Will the executioner 

Be watching how I go? 

Others about me clearly feel the same. 

The deafest one pretends that she can hear. 

The blindest hides her white stick while the lame 

Attempt to stride. Life has become so dear. 

Last time the doctor came, 

All who could speak said they felt very well. 

Did we imagine he was watching with 

A new deep scrutiny? We could not tell. 

Each minute now we think the stranger Death 

Will take us from each cell 

For that is what our little rooms now seem 

To be. We are prepared to bear much pain, 

Terror attacks us wakeful, every dream 

Is now a nightmare. Doctor's due again.

We hold on to the gleam 

Of sight, a word to hear. We act, we act, 

And doing so we wear our weak selves out. 

We said, "We want to die" once when we lacked 

The chance of it. We wait in fear and doubt. 

O life, you are so packed 

With possibility. Old age seems good. 

The ache, the anguish - we could bear them we 

Declare. The ones who pray plead with their God 

To turn the murdering ministers away, 

But they come softly shod.

Elizabeth Jennings

Recommended reading

I don't think I have got around to recommending this before, but the Catholic Medical Quarterly is well worth reading.  The Nov 2012 edition on Humanae Vitae, for example, is full of good articles.

The site also has an index of recent articles by topic (such as Abortion and Start of Life issues, Faith at Work, Medical Ethics etc) as well as an archive index of older articles in similar groupings (though many more categories).

I have not spent as much time exploring it as I should like, but will invest more time now that I have remembered it: it is a very rich resource for us all.

SPUC Conference

As my regular readers may be aware, I am not a wholly uncritical fan of SPUC's.  However, they have asked me to publicise this Conference and I am happy to do so.  A number of the speakers will be well worth hearing, and I am sure that many valuable friendships will also result.

The SPUC International Youth Conference is the only pro-life conference of its kind in the UK. This conference has proven a huge success every year and without doubt made an important contribution to renewed pro-life efforts by young people around the country. This weekend conference has been a place where the seed for new pro-life groups has been sown and new friendships forged. SPUC has ensured an exciting line-up of expert speakers in their respective fields, along with fun evening entertainment. This is an event not to be missed!

What: SPUC 6th International Pro-Life Youth Conference 2013

Facebook link: https://www.facebook.com/events/498830733488745/?ref=ts&fref=ts

SPUC weblink: http://www.spuc.org.uk/youth/international_youth_conference


Where: Hayes Conference Centre, Swanwick, Derbyshire, DE55 1AU
When: Friday 22 - Sunday 24 March 2013Time: registration from 4pm on Friday. The conference ends at 2pm on Sunday
Who: students and young people aged 16 upwards

Cost: £100 (price includes accommodation, meals, conference pack, access to all talks and evening entertainments).
Booking: 1) Book and pay via the SPUC website. Please click on this link http://www.spuc.org.uk/shop/list_products?category=30

2) Once we receive your payment a registration form will be emailed to you. Please fill it in and email it to: conference@spuc.org.uk or post it back to: SPUC Youth Conference, 3 Whitacre Mews, Stannary Street, London, SE11 4AB.

Contact us: If you have a query about the conference please email: conference@spuc.org.uk


Speakers and topics
Professor Patrick Pullicino: Liverpool Care Pathway
Dr Lisa Nolland: Sex Education
John Smeaton: Prolife Campaigns
Ira Winter: Natural Family Planning

James Bogle: Euthanasia
Fiorella Nash: Maternal Mortality
Dr Helen Watt: Pregnancy
Anthony Ozimic: Political Campaigning
Katherine Hampton: SPUC pro-life School’s Talk

Entertainment: Friday night film, Saturday night ceilidh with guest band Jigabit, and of course drinks in the bar (over 18s only) on Friday and Saturday evening.

Reports and photos about last year’s conference
http://spuc-director.blogspot.co.uk/2012/03/sun-is-shining-for-young-pro-life.html
http://spuc-director.blogspot.co.uk/2012/03/fantastic-spuc-youth-conference-paused.html
http://spuc-director.blogspot.co.uk/2012/03/kent-youth-rave-about-spucs-youth.html
https://www.facebook.com/media/set/?set=a.249905165097938.60281.107582715996851&type=3

We have a bishop!

We have a bishop in England who is leading as a bishop should.

Just days after his excellent comments on the destruction of marriage, +Egan of Portsmouth has issued a  Pastoral Teaching Message on the Care of the Dying, and his concerns about the Liverpool Care Pathway.

It is excellent; and note also how careful he is to be precise about its level of authority.  This is very important.

Ad multos annos!

Pushing the Boundaries

The BBC has announced a witty new comedy series, finding the hilarity in euthanasia (or assisted suicide as they euphemistically call it).

Eccles and Blondpidge have said most of what has to be said on this topic.

I would just add that the Greeks knew a thing or two: they saw drama as sacred; not something for everyday, but something of profundity serving a noble purpose.

The need of the modern 24/7 entertainment media to titillate ever more (due to the law of diminishing returns) will inevitably mean that 'edgy' comedy has to 'push the boundaries' further and further back. To the extent that very soon what Eccles prophesies (and worse) will indeed come to pass.

And of course, the BBC has the additional duty of softening us up, as a society, for change in the desired direction.

Incentivising the LCP

I have just been reading that hospitals are given financial rewards if they meet their targets for the numbers (or more accurately per centage) of patients who are on the LCP when they die.

That of course raises some serious questions.

According to the Daily Mail, Professor Patrick Pullicino, said: 'Given the fact that the diagnosis of impending death is such a subjective one, putting a financial incentive into the mix is really not a good idea and it could sway the decision-making process.' 

Quite.

The Liverpool Care Pathway

I know there are strong feelings on both sides of the debate about the LCP (about which I have blogged previously, here).

It is a complex issue, and I know people of good will who are strongly supportive of the LCP.   However, I also know two of the signatories of this letter, and when they are worried, I am worried.  They raise serious concerns, which should be properly addressed. 

-- 

Commentary on the Statement supporting the Liverpool Care Pathway

21 October 2012

The Statement supporting the Liverpool Care Pathway from the National End of Life Programme was published under multiple signatories. We have a number of serious reservations and questions about the working of the Liverpool Care Pathway.

1 The statement says, “it is not always easy to tell whether someone is very close to death”.

The fact is that there is no scientific evidence to support the diagnosis of impending death and there are no published criteria that allow this diagnosis to be made in an evidence-based manner. This is even more true of non cancer conditions. This diagnosis is a prediction, which is at best an educated guess. Predictions have been shown to be often in serious error.

There is no evidence that the diagnosis of impending death can be improved by using “the most senior doctor available “, and an actual misdiagnosis of impending death could result in a wrongful death.

2 “The Liverpool Care Pathway …is not a treatment”.

This statement belies what actually happens once a patient is signed up onto the LCP. The fact that morphine, midozelam and glycopyrrolate are prescribed makes the LCP a treatment protocol.

3 “The Liverpool Care Pathway …is…a framework for good practice.”

In the twenty-first century all good clinical practice is evidence based. Good clinical practice has always traditionally involved a close doctor-patient relationship and the management of symptoms in the best interest of the patient, as and when they arise. The LCP is more than a framework. It is a pathway that takes the patient in the direction of the outcome presumed by the diagnosis of impending death. The pathway leads to a suspension of evidence based practice and the normal doctor-patient relationship.

4 “The Liverpool Care Pathway does not….hasten death.”

It is self evident that stopping fluids whilst giving narcotics and sedatives hastens death. According to the National Audit 2010-2011, fluids were continued in only 16% of patients and none had fluids started.

The median time to death on the Liverpool Care Pathway is now 29 hours. Statistics show that even patients with terminal cancer and a poor prognosis may survive months or more if not put on the Liverpool Care Pathway.

Your statement fails to mention the relief of symptoms at all. We think this is a serious omission. The question of consent is not mentioned either.

If as you say, the LCP does not replace “clinical judgement”, and is a “framework for good”, why is it not endorsed by 28% of senior healthcare professionals? (National Audit 2010-2011)

Patients should receive an individual treatment plan according to best evidence based medicine. They should not be deprived of consciousness, but receive such treatment that is aimed at relieving all their symptoms including thirst. Nothing should be done which intentionally hastens death. An individual care plan based on best evidence is preferable to a rigid pathway.

Signed 

Professor P Pullicino

Prof of Neurosciences

Mr J Bogle 

Chairman Catholic Union of Great Britain

Dr P Howard

Chairman Joint Medico Ethical Committee Catholic Union

Dr R Hardie

President Catholic Medical Association

Dr A Cole

Chairman Medical Ethics Alliance 

Dr M Knowles

Secretary First Do No Harm

Mrs N McCarthy

Catholic Nurses Association

Ms T Lynch

Chairman Nurses Opposed to Euthanasia

Mr R Balfour

President Doctors who Respect Human Life

h/t John Smeaton

Fighting Abortion with Truth and Charity

In a previous post, I suggested that the pro-life battle is first of all a spiritual battle, and only incidentally a political and social struggle.

For that reason, I maintain that the weapons we should turn to first, and rely on most fundamentally, are spiritual weapons, not political ones.

I suggested truth and charity as essential, and also prayer and fasting.

In this post I want to explore these ideas a bit further.

I have singled out truth and charity for a specific reason.  If we as Christians claim to be pro-Life, it can only be because we are pro-Christ.  For He said ‘I am the way, the truth and the life.’  (John 14:6).  He identifies himself with life -and also with truth. Moreover, He tells us that He is the Way.  So if we are to fight for him as Life, the Way to do that is also Himself, and He is Truth.

This intimate connection of Way, Truth and Life, all expressions of Christ’s own identity, must surely inform and inspire our pro-Life work;  this aspect of Christ’s self-revelation is surpassed only by the ultimate revelation that ‘The Father and I are one.’ (John 10:30).  That, combined with St John’s profound understanding of God that leads him to assert ‘God is Love’ (1 John, 4:8) gives us the foundations of the Christian pro-Life stance.  We are pro-Life because we are pro-Christ; the Way in which we are to be pro-Life is also Christ; and Christ is Truth and Love.

What does that mean in practice?

First of all, it must mean that we are completely truthful in our pro-Life work.  We do not accept abortion up to a certain age, or abortion or euthanasia in certain circumstances, or for certain groups (eg the handicapped) in order to win political advantage.  If our goal is the elimination of abortion and euthanasia, then we must be honest about that goal.

Likewise, we must tell the truth about pro-life issues in season and out of season, not worried that we may be mis-represented or lose political advantage.  Thus we should not give the impression that we share the secular view that finally an individual’s autonomous choice is the right criterion for deciding whether to abort or not.  I have blogged previously about my concerns around non-directive counselling, for that very reason.

However, underpinning that is the law of charity.  We must continually purify our motives and intentions.  Precisely because abortion and euthanasia are so hateful, we must be on our guard against hating people associated with them.  Our concern, if we are to follow Christ, must always be for their well-being and in particular their salvation.  

The worst victims of abortion, from a spiritual point of view, are not the innocents who are killed, but those who, with some degree of guilt, are responsible for that.  Their very souls are in jeopardy. We cannot judge the guilt of any individual, of course.  But we may observe that the likelihood is that at least some of those involved have some culpability (even if only at the level of willful ignorance) and some may have considerable culpability.  They need our prayers and our love, even as we campaign against their actions.

That principle applies even more to women who are seeking abortions. Whilst we know that what they are contemplating is a terrible thing, we must always remember that we owe them love and support.  Indeed, it is almost axiomatic that a lack of love and support is what has led them to the terrible position in which they find themselves.

At the immediate level, that should govern our behaviour towards them and our speech and thinking about them. But at the more profound level, we cannot really claim to be pro-life if we are not actively seeking them out and offering love and support before, during and after whatever crisis drives them towards the dreadful choice of aborting their child.


I mentioned prayer and fasting as the other requirements of the fight - and that is because it is a spiritual battle against the Devil himself, and some kinds can only be cast out with prayer and fasting.  That is not optional for pro-life Christians...

There is much more to say about all of this, but this post feels long enough for now.  I may come back to the topic - and as ever welcome your views in the comms box.

LCP - Pathway to Euthanasia

There has been a lot of controversy, not least in the Catholic blogosphere, about the Liverpool Care Pathway.

It was originally developed by Marie Curie hospice in Liverpool, to ease the pain of patients dying from cancer.  

I have immense respect for Marie Curie nurses, from my personal experience - but that does not mean that they necessarily get everything right, and still less that an approach they piloted is not open to abuse.

According to Professor Patrick Pullocino, the LCP is frequently used to dehydrate and starve to death people who are not already imminently about to die.

He told a Medical Ethics Alliance conference in London: “If we accept the LCP we accept that euthanasia is part of the standard way of dying as it is now associated with 29 per cent of NHS deaths.”

He also revealed that he had taken a patient off the LCP (which had been implemented by a stand-in doctor on a weekend shift), and the patient then lived on for more than a year.  Given that LCP is meant to be for the last hours of life, that is deeply disturbing.

Disturbing, too, is the official line, given by A Spokesman for the Department of Health: ' A patient’s condition is monitored at least ever four hours and if a patient improves, they are taken off the Liverpool Care Pathway and given whatever treatment best suits their new needs.'  If you are sedated, starved and de-hydrated, improvement in your condition is a remote contingency: but that doesn't mean that you would otherwise have died...

I do not know Professor Pullocino, who is the latest in a number of concerned medical professionals to raise questions about the way in which the LCP is used (or abused).  But I do know Dr Philip Howard, both by reputation, and as a friend of friends - and I have heard him speaking on pro-life issues.  So when he speaks, I take it very seriously. 

He says: “It (the LCP) is a decision with an end in view. The patient is dying. Why? Because we say they are dying. Why? Because we have decided.”

He scarcely needed to add: “That’s a worry when you have the problem of getting it wrong.”

Before I get the outraged response of all those who have seen their dying relations' last minutes eased by the LCP, I would simply point this out: I am not saying that the LCP cannot be used ethically; merely that it can (and apparently is) also being used unethically - and that should concern us all.

H/t Diocese of Shrewsbury 

BBC's Euthanasia Campaign

As I write the lead story on the BBC's www site is:

'Strong case' for assisted dyingThere is a "strong case" for allowing assisted suicide for people who are terminally ill in England and Wales, a group of experts says.

If one follows through to the article, they do mention that 'Critics say it is biased.'

As it was set up by people with a commitment to Euthanasia, funded by people with a commitment to Euthanasia, and even the BMA recognised it was bogus and refused to give evidence, perhaps the BBC could have recognised the validity of the criticism...

But as so often, despite 'balance' to give the impression of impartiality, the BBC's view comes through loud and clear, just as it did on the Today programme this morning.

Apart from anything else, giving this top story billing lends it an importance and credibility that few other PR stunts could command, as does the unbalanced front page headline quoted above, (for 'experts', they could have had 'pro-euthanasia campaigners' if they had really wanted to remain impartial - and accurate).

Euthanasia

John Smeaton's blog reminds me that Lord Falconer is due to publish his dodgy euthanasia report tomorrow.

Many years ago, I had the privilege of meeting a Catholic Poet, Elizabeth Jennings (1926 - 2001).  She was fascinating, not least because her conversation (full of non sequiturs, interrupting self with multiple sub-clauses) was so different from her poetry (formal, precise, concise).

Here is her poem, Euthanasia:

The law's been passed and I am lying low 

Hoping to hide from those who think they are 

Kindly, compassionate. My step is slow. 

I hurry. Will the executioner 

Be watching how I go? 

Others about me clearly feel the same. 

The deafest one pretends that she can hear. 

The blindest hides her white stick while the lame 

Attempt to stride. Life has become so dear. 

Last time the doctor came, 

All who could speak said they felt very well. 

Did we imagine he was watching with 

A new deep scrutiny? We could not tell. 

Each minute now we think the stranger Death 

Will take us from each cell 

For that is what our little rooms now seem 

To be. We are prepared to bear much pain, 

Terror attacks us wakeful, every dream 

Is now a nightmare. Doctor's due again.

We hold on to the gleam 

Of sight, a word to hear. We act, we act, 

And doing so we wear our weak selves out. 

We said, "We want to die" once when we lacked 

The chance of it. We wait in fear and doubt. 

O life, you are so packed 

With possibility. Old age seems good. 

The ache, the anguish - we could bear them we 

Declare. The ones who pray plead with their God 

To turn the murdering ministers away, 

But they come softly shod.

Elizabeth Jennings

Just in time

A young man in an 'irreversible coma' woke just in time.  That is, just before the doctors were about to remove his vital organs for transplant, thus killing him.  Lifesite News carries the story.

When the death penalty was abolished in this country, it was done because there was a political consensus that the risk of killing an innocent person, small though it was, was not a risk that a civilised country ought to take.  This young man was 'thought to be' 'brain dead.'

Of course he was not dead: his heart was beating, his body was functioning at some level.  But that is necessary for vital organ donation: truly dead donors are of no value, as the vital organs deterioriate too quickly once the circulation of blood has stopped. (See previous posts tagged Organ donation for a fuller discussion and links...)

It is that necessity for what are called 'heart-beating donors' which has led to the redefinition of death so that vital organs may be taken from patients who (until recently) any doctor would have certified as still alive.

This case, along with many others, proves how costly that utilitarian re-definition is in reality.

We have come a long way since then - but I would not call it progress.

H/t Blondpidge on Twitter

IMPORTANT UPDATE: here

Courage and hope

Alison Davies gave an excellent interview on the PM programme tonight about the need for compassion for those who want to die - compassion being helping them find a reason to want to live.

Curiously, today's pm is not on BBC iPlayer: yesterday's and the days before's are... Was it off message?

I think we should be told...

Kill the Useless

Baronness Warnock - who chaired the Human Fertilisation and Embryology committee that culminated in the Warnock report - has revealed quite how corrupted her thinking really is.

This aging ethicist proclaimed on a BBC interview that not only should those who are useless and costly (because of Alzheimers) be allowed to choose assisted suicide, but also that - being useless and costly - they should want to die.

To their credit the Alzheimers Association were quick to condemn her ignorant and hostile remarks.

Mary Warnock was made a Baronness after giving the required answer in the Warnock Report - that anything goes.

And so the enemies of humanity march on...