Another brother

I found that the guest post by two of my brothers recently was far more popular than my usual scribblings, so I thought I would introduce another of my brothers to my delightful and discerning readership.

This is my most highly professionally qualified brother, a senior psychiatrist.

Non Trovato writes:

I was delighted to help with the drafting of the Royal College of Psychiatrists' statement on sexual orientation.

I am proud that my early studying of the works of George Orwell has finally proved worthwhile, and would like to share some of the highlights of my contribution. 

The Royal College of Psychiatrists considers that sexual orientation is determined by a combination of biological and postnatal environmental factors. There is no evidence to go beyond this and impute any kind of choice into the origins of sexual orientation.

Note how we get over the most difficult bits early on. We could not get away with attributing sexual orientation solely to biological factors, as there is no evidence to support that hypothesis and significant evidence against it. But we undo the potential harm of that admission in the very next sentence, with a couple of techniques that I commend to your attention. 

The first is the 'there is no evidence' claim. Of course that is a lie, so is best placed early.  There is, at least, anecdotal evidence in some cases.  But we choose to discount that, and if challenged can say that by 'no evidence' we mean 'no peer-reviewed academic papers which we deem worthy of taking seriously'. That is quite a tenable position (though we use different standards later in this document, but nobody will notice that).  Moreover, 'there is no evidence' is clearly used here to deny the possibility of choice, rather than leave it hanging as an issue that is not yet sufficiently researched. Clever, eh? 

The second is the careful wording of 'choice into the origins of sexual orientation.' Of course, there are massive choices about how an individual responds to experiencing same sex attraction, but we really don't want to go there.  So without actually denying that, we knock that consideration into the long grass. 

So now  I'm sure you understand why I am particularly proud of that first paragraph! However, there are some other gems. 

The College wishes to clarify that homosexuality is not a psychiatric disorder. In 1973 the American Psychiatric Association (APA) concluded there was no scientific evidence that homosexuality was a disorder and removed it from its diagnostic glossary of mental disorders. The International Classification of Diseases of the World Health Organization followed suit in 1992.

A few clever points here; we replay the no evidence trick, of course, and neglect the philosophical question of what counts as evidence with regards to an issue such as this. The fact that we classify 'eating disorders' as 'disorders' precisely because they work against what eating is, biologically, intended to accomplish is one of the unhelpful facts that we gloss over by this elegant manoeuvre.  We also slide seamlessly between the specific ('psychiatric disorder' on which we are, at least theoretically, competent to judge) to the general 'disorder', touching on another category 'mental disorder' in passing.  It was also clever to boost our credibility by citing the APA and the WHO, regardless of the fact that their policies were driven by ideology, not evidence. 

The College holds the view that lesbian, gay and bisexual people are and should be regarded as valued members of society, who have exactly similar rights and responsibilities as all other citizens. This includes equal access to healthcare, the rights and responsibilities involved in a civil partnership/marriage, the rights and responsibilities involved in procreating and bringing up children, freedom to practise a religion as a lay person or religious leader, freedom from harassment or discrimination in any sphere and a right to protection from therapies that are potentially damaging, particularly those that purport to change sexual orientation.

Another clever paragraph here.  We debated long and hard about whether we could get away with 'exactly similar' and I am glad that my view, inspired by Orwell, prevailed. Some of the more academic types were concerned that it was a nonsense, intellectually, from a scientific body, but I helped them to understand that they were rather missing the point.  The paragraph was also cleverly constructed to start with the unarguable, slip the unjustifiable in along the way, and end on a topic about which, once again, we have some professional authority to comment. You see, the tricky point here is that there is no long term evidence to support the rather improbable assumption that same-sex parenting will be exactly as good as parenting by a heterosexual couple. What evidence we have rather suggests the opposite. 

Again we debated long and hard about 'procreating' but again, my view prevailed: it is the impact of the statement that counts, not the literal meaning.  That was also the outcome of the the debate around the words 'potentially damaging.' Of course, any therapy is potentially damaging; there is risk in all areas of life.  But we wanted to make clear our disapproval of this particular type of therapy, without having to cite any evidence to support that view (and we continue in the next...) 

Leading therapy organisations across the world have published statements warning of the ineffectiveness of treatments to change sexual orientation, their potential for harm and their influence in stigmatising lesbian, gay and bisexual people.  

Again, we faced a challenge.  Evidence is hard to come by, and doesn't always indicate what we want it to, so again we glossed that by the association with reputable others line of argument, and that invaluable (and indisputable) phrase potential for harm.

There is now a large body of research evidence that indicates that being gay, lesbian or bisexual is compatible with normal mental health and social adjustment. However, it is eminently reasonable that the experiences of discrimination in society and possible rejection by friends, families and others (such as employers), means that some lesbian, gay and bisexual people experience a greater than expected prevalence of mental health and substance misuse problems. Lifestyle issues may be important in some gay men and lesbians, particularly with respect to higher rates of substance misuse.

Another elegant paragraph, which manages to explain away the rather tricky data that indicate that the gay lifestyle is harmful. Note the compatibility argument: a lovely piece of casuistry! Having defined homosexuality a priori as not a disorder, we can then argue that it is compatible with normal mental health. Of course, we could do the same with Bulimia if that were politically expedient. Neat, huh?  Moreover, given that a priori assumption, we can then attribute all the data that might challenge that as being the result of other factors; confident that nobody will notice either the sleight of hand or the lack of research references at this point. 

It is not the case that sexual orientation is immutable or might not vary to some extent in a person’s life. Nevertheless, sexual orientation for most people seems to be set around a point that is largely heterosexual or homosexual. Bisexual people may have a degree of choice in terms of sexual expression in which they can focus on their heterosexual or homosexual side.  It is also the case that for people who are unhappy about their sexual orientation – whether heterosexual, homosexual or bisexual – there may be grounds for exploring therapeutic options to help them live more comfortably with it, reduce their distress and reach a greater degree of acceptance of their sexual orientation.  

This paragraph was one of my finest contributions, accepted without change by my colleagues.  It manages to pass over the really inconvenient truth that orientation is not immutable, and then proceed to say almost nothing (which means it is not open to critical challenge) whilst sounding very worthy, and promoting the approved attitudes. Why there is no 'potential for harm' in therapy in this direction, when there is in the opposite one, is a question that only the meanest reader would raise. There is of course no hard evidence in support of that proposition, which makes the opening line of the next paragraph a line of pure beauty and genius: 

The College believes strongly in evidence-based treatment. There is no sound scientific evidence that sexual orientation can be changed. Systematic reviews carried out by both the APA and Serovich et al suggest that studies which have shown conversion therapies to be successful are seriously methodologically flawed. 

The joy of nuance! 'Sound' 'suggest'

Furthermore, so-called treatments of homosexuality can create a setting in which prejudice and discrimination flourish, and there is evidence that they are potentially harmful. The College considers that the provision of any intervention purporting to ‘treat’ something which is not a disorder is wholly unethical. 

And again: 'can' 'potentially.' And the beautiful circularity of 'we have decided a priori it is not a disorder, therefore it is wrong to treat it as though it is one.'  I was really getting into my stride here! 

The College would not support a therapy for converting people from homosexuality any more than we would do so from heterosexuality. Psychiatrists should be committed to reducing inequalities, not supporting practices that are explicitly based on pathologising homosexuality. As such, the College remains in favour of legislative efforts to ban such conversion therapies. 

And onto the moral highground. The shift from science to propaganda is an elegant manoeuvre, which few, if any, will spot. 

Good Psychiatric Practice clearly states: ‘A psychiatrist must provide care that does not discriminate and is sensitive to issues of gender, ethnicity, colour, culture, lifestyle, beliefs, sexual orientation, age and disability’ (p. 12). The College expects all its members to follow Good Psychiatric Practice.

UPDATE

In my excitement at receiving my brother's fascinating commentary, I forgot to credit Peter Ould, whose post drew this to my attention, and @PartTimePilgrim who drew my attention to Peter Ould's post.

Keeping the Focus

As the liberal media and the pro-choice lobbyists start to comment on the Gosnell case, it is worth keeping a sharp focus on the most important issues and considering how to refute the claim that it exemplifies the need for easy, early abortion.

The first thing to stress, and to keep coming back to, is that whilst Gosnell did many horrendous things, the most serious repeat offence was deliberately snipping the spinal cords of newly-born living babies.  The killing of mothers was also, of course, a great evil, but it was never the intended outcome, whereas the murdering of the babies clearly was.

The testimonies of the workers at his abortion centre, and the distressing pictures, leave one in no doubt about both the fact of the practice, and the fact that these were human babies, not merely 'clumps of cells' or 'products of conception.'  They were these, too, of course, just as you and I are clumps of cells and the product of conception.

Don't allow those who are confused by the propaganda battle (waged by those seeking to use Gosnell to further a pro-choice agenda) to duck the question: was that wrong or not?  If not, then they are saying that infanticide is morally permissible.  That is a morally consistent position for abortionists, but fortunately it is still one that is abhorrent to most people.

If they agree that it was wrong to cut the spinal cords of these babies, the question is: why?  Merely to say that it was against the law will not do.  If that line is used, ask if they would condone it if legal: if so they are back to infanticide.  If not, press on why not?

That then leads to the question: if it is wrong once the baby is delivered, is it also wrong when the baby is partially delivered?

One can then progress backwards: if wrong when the baby is so completely formed, what about a week earlier?  And a week earlier?  And so on.

Keep the focus on these questions, as they are the key moral issues.  What we are seeking to make clear is that all abortion is precisely about the killing of innocent, unborn human beings.

What Gosnell's crimes have forced into the light of day is the humanity of his victims: not just the poor, desperate women who went to his clinics, but also their children, murdered for cash.

Our job is to help people, who will be resistant to this, to understand that what he was doing is what all abortions do.

There is a need for sensitivity here, of course: the odds are that anyone you talk to about this will have direct or proximate experience of abortion, as I noted in a previous post. It is both difficult and essential to balance clarity of intellectual argument with human sensitivity and compassion.  Veritas and Caritas...

Be ready, too, for the counter-attack: 'So you want to return to the days of back-street abortions!'

That is more a rhetorical and emotive argument than a rational one. Nobody argues that we should licence the killing by gangs of their rivals, to ensure no innocent people get caught in the cross-fire, on the basis that such killings are going to happen anyway, so we should minimise the damage.

The first question is, is it morally permissible to kill another innocent human being?  If it is not, then how can we minimise that, and also do so in a way that minimises other harms that may arise?

The evils of back-street abortions, or maternal suicides, are real and terrible risks, and should be engaged with as best we can as a society: but we cannot sacrifice thousands of innocents on the altars of these risks.  We must strive for solutions to all aspects of this evil, seeking the good of the mother and the child in equal measure; and also of the father, the medical profession, and civil society.

Draft Consultation Response

Draft of my response to the Mitochondrial Replacement Consultation.

I post it here for two reasons.

One is to encourage others to respond, and to give an example of how the Anscombe Centre's ecellent guidance notes have been turned into answers by one individual - but please don't copy my answers verbatim, as I think that would minimise the effectiveness of both our responses.

The other is to invite correction: if I have misunderstood anything, or got it wrong.

1. Permissibility of new techniques
Having read the information on this website about the two mitochondria replacement techniques, what are your views on offering (one or both of) these techniques to people at risk of passing on mitochondrial disease to their child? You may wish to address the two techniques separately. 

My views are that both of these techniques are seriously problematic, for a number of reasons, and should not be offered.

The benefits - having some genetic connection between parents and child - do not justify the procedures. There seem to be no other benefits that could not be realised in other ways.

MST is creating a child from three parents: this creates a series of ethical problems.  One is that it denies the child the natural inheritance of two parents which all other human beings heretofore have had.  That risks creating sever problems around identity.  It also creates problems around knowledge: would a child have the right to know all her or his genetic parents? 

PNT, as I understand it, is ethically even more problematic, as it included the deliberate creation and destruction of two human embryos, as a necessary part of the process.  Again, the resultant child may have severe problems around her or his identity and origins, including a sense of sibling loss (or even sibling sacrifice).

A further risk of both is cultivating an assumption in society that children are, in some sense, commodities that can be created to order. I have profound misgivings about the implications of such an assumption becoming widespread.

2. Changing the germ line
Do you think there are social and ethical implications to changing the germ line in the way the techniques do? If so, what are they? 

We are playing here with the very stuff of human life and human identity: of course there are social and ethical implications.  Because we are at the boundaries of existing knowledge and practice, it is not clear precisely what they are, and for that reason alone we should be very wary.  By the nature of it, any change in the germ lines will be passed on from generation to generation: we do not know what we are doing here, or what may result.  Further, once we allow such techniques in principle once, they will doubtless be employed in more and more situations.  There is a real risk of unleashing changes we do not understand, cannot reverse, and which will spread exponentially.

3. Implications for identity
Considering the possible impact of mitochondria replacement on a person's sense of identity, do you think there are social and ethical implications? If so, what are they? 

The attempts to erase the identity of the donor mother in MST strike me as very problematic in terms of the resultant child's identity.  I try to put myself in the shoes of a resultant child and ponder the questions I would have about my origins, parentage and identity, and it is very murky.  Why should we even consider doing this to a child?

Similar considerations arise with regard to PNT: I would see myself as a clone created from the spare parts of two siblings, created and destroyed in order that I might be brought to life. How can we predict what effect that might have on a child?  Why should we do this to someone?

4. The status of the mitochondria donor
a) In your view how does the donation of mitochondria compare to existing types of donation? Please specify what you think this means for the status of a mitochondria donor. 

This is a very murky area. In the case of MST, the donor is donating the spindle, that is nuclear genes, but not the egg itself.  So the spindle donor and the egg donor are both partial mothers - an entirely new category that would be brought into existence by this technology.

Likewise in PNT, the pro-nucleus is transferred into a scond egg - but this is then cloned  and the original embryo destroyed.  What does that make the status of the donor? It is very hard to say, but the most accurate description would be the partial mother of an embryo that was always destined to be destroyed.  I suspect donors are likely to struggle with this concept, if they are able to grasp it at all.

Given current concerns about the potential exploitation of donors already, it seems reckless to introduce these further complications and risks, whose impact on the donors is unpredictable.

b) Thinking about your response to 4a, what information about the mitochondria donor do you think a child should have? (Choose one response only)

•   The child should get no information
  
•   The child should be able to get medical and personal information about the mitochondria donor,
  but never know their identity
  
•   The child should be able to get medical and personal information about the mitochondria donor
  and be able to contact them once the child reaches the age of 18
  
•   Other
  
•   I do not think mitochondria replacement should be permitted in treatment at all Please explain your choice. 
  

I think that the name mitochondrial replacement is a misnomer: it does not accurately describe either MST or PNT. I also think that neither of them should be allowed, as the risks and ethical concerns they raise far outweigh the benefits, nearly all of which could be realised in other, wholly ethical ways.

However, if MST were to be allowed, I believe it important that any resultant children should have the same rights as any other child conceived using donor eggs and sperm, in terms of knowing all their genetic parentage.

If I have understood it correctly, in PNT there may be as many as four parents involved in the construction of the two IVF embryos, from which a third will be cloned whilst the original two are destroyed. Again, if this labyrinthine process were to be legalised, any resultant children should have the same rights as any other child conceived using donor eggs and sperm, in terms of knowing all their genetic parentage.

I am concerned that this consultation offers a single box to tick, when the issues are so complex: on the one hand, I think (as I have ticked) that neither process should be allowed. But, should they be allowed, I also have views on how some of the impacts should be mitigated: it would have been helpful to have a process that invited such rich responses.  It worries me that such complexity is being reduced to binary thinking.

5. Regulation of mitochondria replacement
If the law changed to allow mitochondria replacement to take place in a specialist clinic regulated by the HFEA, how should decisions be made on who can access this treatment? (Choose one response only)

•   Clinics and their patients should decide when mitochondria replacement is appropriate in individual cases
  
•   The regulator should decide which mitochondrial diseases are serious enough to require mitochondria replacement and, just for these diseases, permit clinics and patients to decide when it is appropriate in individual cases
  
•   The regulator should decide which mitochondrial diseases are serious enough to require mitochondria replacement and also decide, just for these diseases, when it is appropriate in individual cases
  

 I do not think mitochondria replacement should be permitted in treatment at all Please explain your choice. 

As noted above, I think that the name mitochondrial replacement is a misnomer: it does not accurately describe either MST or PNT. I also think that neither of them should be allowed, as the risks and ethical concerns they raise far outweigh the benefits, nearly all of which could be realised in other, wholly ethical ways.

I have no confidence in regulatory bodies, as their recent history has been lamentable.  Should such techniques be approved at all, I think their should be a clear set of laws limiting them, saying both what is allowed and what is not,  debated and passed in parliament, with no room for ambiguity, interpretation or other erosion.  The regulator's role should be to enforce the law, not interpret or soften it, or campaign for its creative reinterpretation etc...

As in 4c above, I am concerned that this consultation offers a single box to tick, when the issues are so complex: on the one hand, I think (as I have ticked) that neither process should be allowed. But, should they be allowed, I also have views on how some of the impacts should be mitigated: it woul have been helpful to have a process that invited such rich responses.  It worries me that such complexity is being reduced to binary thinking.

6. Should the law be changed?
In Question 1, we asked for your views on these techniques. Please could you now tell us if you think the law should be changed to allow (one or both of) these techniques to be made available to people who are at risk of passing on mitochondrial disease to their child? You may wish to address the two techniques separately. 

I believe that neither MST nor PNT should be allowed, for all the reasons stated above.

I also believe that of the two techniques, PNT is distinctly the worst, as it invovlves the deliberate creation, for foreseen destruction, of human embryos; therefore even if the government is determined to allow some such technology, it should certainly not allow PNT.

7. Further considerations
Are there any other considerations you think decision makers should take into account when deciding whether or not to permit mitochondria replacement? 

This is the wrong response to the problem.

There are far more humane solutions to the problems facing parents who are at risk of passing on disease to any children, one of which is adoption.  I believe that radical improvement of adoption services could serve offer a de-medicalised path to such parents, and also offer better alternatives to women facing crisis pregnancies, thus reducing the number of medical terminations of pregnancy.  Such humane approaches are where the efforts, energy and resources should be directed, rather than ever complex and ethically worrying technological solutions, exciting though these may be to the scientists and medics involved.

Not surprised...

Why am I not surprised at the story emerging from Denmark that a young woman, 19-year old Carina Melchior, deemed to be dying and whose family were asked to agree to having her organs transplanted, was not in fact dying.

In fact, she is lucky to be alive, as her respirator was turned off by the doctors, once they had the family's consent to use her vital organs. 'Those bandits in white coats gave up too quickly because they wanted an organ donor,' her enraged father protested - and one can sympathise with his outrage.

However she did survive; as has happened before, the doctors' diagnosis of imminent death, whilst convenient for their desire to harvest her organs, was in fact incorrect.

The problem lies in the fact that for transplants of vital organs (eg the heart) there is a desperate urgency, which drives calamitous decision-making.  In fact, as I have blogged before, doctors cannot afford to wait until somebody is dead to remove their heart.  Once the heart stops beating, it deteriorates too quickly to be available for transplant.

That is why the diagnosis  of 'brain-dead' has been invented: to legitimise the removal of organs from 'heart-beating donors'.  Of course, in order to do that, you frequently have to anaesthetise the 'dead' person too, or they wince when they are cut open, which is distressing for the medical staff...  One who was not anaesthetised  put his arm around a nurse, just before they were about to remove his heart.  That saved his life, but had he been anaesthetised, of course, the outcome would have been very different.

Curiously, after the documentary about the Danish girl, many Danish people tore up their donor cards.

But my bet is that most donor-card carriers in this country are completely unaware that they may be sedated and have their hearts removed while their hearts are still beating, their flesh is warm - but someone has decided (and not infallibly, as so many cases prove) that they are dead.


IMPORTANT UPDATE: here

Three parent embryos: the time to respond is now!

The government's consultation period about mitochondrial donation (by which three-parent embryos may be created) ends soon, so don't forget to let your views be known.  The home page for the consultation has some useful information about the techniques involved, and the consultation itself is here.

I don't suppose it will make much difference (cf the consultation on redefining marriage) but nonetheless I believe we have an obligation to speak out. 

The science is clever, of course, which is why the scientists and doctors are keen to do this, but the implications are worrying.

Essentially, there are two different techniques under consideration (Maternal Spindle Transfer [MST] and Pro-Nuclear Transfer [PNT]), but neither are acceptable ethically, and both risk causing severe problems of identity for any resulting children, who will have three genetic parents.

The excellent Anscombe Centre have published guidance on the issues at stake, including a question-by-question guide to the consultation and the things to bear in mind whilst answering it.

Their last line is particularly telling, it seems to me: 

The aim of MST and PNT is to satisfy the wish for a genetically related child, and this wish does not justify cloning, embryo destruction, genetically modifying the child or altering the germline.

This is the root of the problem: people believing that they may  - indeed should - do anything to gratify a wish for a genetically related child.  The child becomes an object of choice (a philosophy closely related to the abortion industry, of course) rather than intrinsically worthy of love, which might lead more to consider adoption (and reject abortion).

We live in a deeply damaged society, but if we do not at least strive to limit the damage, we are co-responsible for that.

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

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 

We're getting a reputation at the School...

Breakfast dialogue at the Trovato table today:


Self: Why are you wearing that?
Dominique: It's own clothes day: it's the last day tomorrow, but we have the end of term Service, so it's own clothes today.
Self: What's it in aid of this time?
Dom: Cancer research...
Self: Did you...?
Dom (interrupting): Yes, I went to reception, and they said as long as I gave a pound to some charity, I didn't have to give it to them.
Self: Were they curious why you didn't want to...?
Dom (interrupting): No, they're used to us.


If you don't know why we don't support Cancer Research, look at SPUC's Charities bulletin.  Cancer Research UK is, inter alia, a member of the Association of Medical Research Charities, which campaigned in favour of the Human Fertilisation and Embryology Act 2008, which Cancer Research UK also supports.

Why are abortion doctors so unethical?

According to the Telegraph,  the unannounced inspections of abortion clinics yesterday revealed that in several, piles of abortion forms were pre-signed.

Apart from noting that I am not surprised (and I shouldn’t think anyone else is, despite Andrew Lansley’s ‘shock horror' protestations) I think that this is worthy of comment.

For although I am not surprised, it is in fact a very grave issue.  Parliament has laid down stringent conditions; Doctors are bound by that and by the professional standards one expects or them; yet here they are flagrantly breaking both the spirit and the letter of the law.

Moreover, the lack of surprise itself is worth unpicking.  At a superficial level, it is simply because we all know that we have, de facto though not de jure, abortion on demand in this country.

But I think the more profound level is the intuitive understanding that a doctors who so compromise their profession, indeed their vocation, as to undertake abortions on the flimsy grounds allowed for by the Abortion Act, have already compromised their integrity.  They may genuinely believe  that what they are doing is good and  right, but to have reached that state of subjective certainty, they have had to abandon the ethics laid down in the Hippocratic oath.  So we are not surprised when they see other ethical considerations, such as breaking the law and denying women the protection and support which the law is designed to offer them, as simply bureaucratic details which can be conveniently brushed aside.

And astonishingly, they risk their professional lives in their arrogance: in theory (though I bet it won't come to this) they could be struck off by the GMC for this.  How could they do this?  Again, I think once people start playing God, they take on more and more characteristics of the role - to their ultimate undoing.

However, my fear is that this latest scandal will actually be used to promote the pro-abortion cause politically: the cry will be that the law is out of step with society, medical opinion and current practice, and so needs to be reformed.

We must pray for our doctors and our politicians, as well as for all other affected by the scourge of abortion.

Protesting too much

Readers will remember that article in the Journal of Medical Ethics which pointed out, (correctly), that the moral status of a new-born infant was the same as that of the same infant immediately prior to birth, and argued (incorrectly) that as we now accept abortion, we should likewise accept ‘post birth abortion.’

I blogged about it here.

Thanks to the indefatigable and always interesting Stuart at Echurch blog  I have been enjoying (?) the authors’ open letter.

Clearly, it is quite wrong of anyone personally to abuse the authors and threaten them.

It is true that it is hard to know precisely the correct response to someone advancing an ethical argument for infanticide; outrage and anger are both appropriate, I think, but they should be directed at the arguments and the culture which produces them (modern ethics) rather than the individuals.  Hate the sin, love the sinner, remember? 

However if the response was, in some quarters, intemperate (to put it mildly) I do think the authors  protest too much.

In the forthcoming Research Excellence Framework (REF) which is the national exercise run by HEFCE (Higher Education Funding Council for England and Wales) to judge the quality of research undertaken at Universities, in order to allocate core research funding to them, there is, for the first time, to be a lot of emphasis on ‘impact.’  While the meaning of impact is somewhat unclear, it does seem to me unthinkable that academics publishing at the moment will not be giving the concept some thought.

So when Giubilini and Minerva claim: ‘we had no idea that our paper would raise such a heated debate,’ I am left scratching my head.  Part of me, if I’m honest, wonders if heated debate was precisely the impact they wanted - it just got rather more heated than they liked.

They claim their article was about logic: ‘It was meant to be a pure exercise of logic: if X, then Y.’

As the paper has since been removed from the online publicly available version of the Journal, I can’t check the precise words they used, but I seem to remember their saying ‘we prefer the term after-birth abortion’ or words to that effect.

That strikes me as rhetoric: it is not logic, which is what they claim the paper was about.  Rhetoric serves a different purpose from logic: to influence or persuade.

So their claim that ‘we never meant to suggest that after-birth abortion should become legal’ raises the question: what where you trying to persuade people of?

Their further claim: ‘Moreover, we did not suggest that after birth abortion should be permissible for months or years as the media erroneously reported,’ does seem to concede that they were in fact suggesting that after-birth abortion should be permissible for some period of time; which was clearly how many who read the article interpreted it.

They continue: ‘What people understood was that we were in favour of killing people.  This, of course, is not what we suggested.’ Yes, it was.  They can only use this arguement because they are busy re-defining ‘people’ to mean ‘people whom we deem worthy of life.’

They further write: ‘We did not recommend or suggest anything in the paper about what people should do (or about what policies should allow).’  That is clearly rubish.  Their discipline is ethics.  That is what ethics is about.  The kind of stuff published and debated in ethical journals filters through into ethics committees in hospitals, universities and professional bodies.  They then lobby in parliament.  The doctors say ‘we’re not ethicists: that’s an important debate, but it is held elsewhere.’  Where? In journals such as this.

If some sections of the public protested too much at this outrageous article, (or more precisely, protested in the wrong way) I think it is also true that the authors protest their innocence rather more than the facts sustain.

Killing Babies

There has been a lot of noise on the blogosphere about the article in the Journal of Medical Ethics arguing that we should be allowed to kill new-born babies.  There has been more noise about the Journal editors' apologia justifying the publication of the article.

Personally, I am glad it has been published, for a few reasons.

One is that if Medical Ethicists are really thinking this, we should know about it.  The second is, it exposes both the paucity and the inhumanity of their arguments; let us hope that other and better academics get published exposing both. The third is that it may just provoke a moral awakening in people of good will: the one point on which the authors are clearly correct is that the unborn child and the newly born child are of the same moral worth.  My prayer is that people will draw the correct conclusion from that premiss: that abortion is therefore absolutely wrong.

The apologia was interesting, though.  Whilst claiming a position of academic moral neutrality, it also assumed a tone of indignant outrage that some criticism had been couched in terms it deemed 'racist.'  As so often, the neutrality disappears when something we really believe in (in this case the inherent evil of racism) is at issue.  From which I can only conclude that their 'neutrality' on infanticide is a neutrality that condones the notion - or they would be similarly outraged.

At what price?

It’s what every parent dreads: the arrival of the police at the door, with bad news about your child.

‘She was on a caving trip from University and there’s been accident.  A flash flood has caused a small rockfall, and one student is trapped in a narrow passage.  Your daughter is behind her, and there is no way to get her out.  The student in front of her is in a bad way, with a spinal injury, and can’t be moved without risk to her life.  But we can keep her alive at least for a while, with food and water.  But your daughter simply can’t be reached, so will not hold out for long.  I’m sorry.  The tragedy is that there’s no chance of the student who is blocking the passage living.  She’s on borrowed time and heavily sedated.  The only way we could save your daughter is actually to kill the student in front of her.  And even though we know she’s not going to survive, we obviously can’t do that.’

Obviously; and rightly.

None of this has happened, of course: so what is this about?

This morning I heard an exchange on the radio (the Sunday Programme, I think) about organ donation and presumed consent.  For balance, they had someone from each side of the debate; that is each side of the 'presumed consent' debate.  But both were clear their goals were the same: to increase the number of organ donors.

I am against presumed (= involuntary) consent - for the obvious reasons.

Further, for me, consent is meaningless if uninformed; but how may people know that when they donate a vital organ, it will be taken from them while their heart is still beating?

Finally, I am against the whole business of vital organ donation: that is the removal of organs, whose removal will cause the death of the donor.  Non-vital donation is fine and noble: the donor will live on healthily.  But vital organs can only be donated by living patients: once the heart stops beating, they deteriorate too quickly.  So medics have had to re-define 'death' to justify taking organs from living donors.  I have blogged about this before, at more length, here.

And also about the case of the ‘dead’ donor who woke up just in time here.

But Ben, Ben, if it was your child who needed a new heart...!

That’s why I started this post with the caving story.  If my daughter were trapped behind someone, even if they were dying, I would not sanction their being murdered to save my child.  Likewise, I would not accept the premature killing, even of an (apparently) dying patient so that my child could live longer.  Indeed, the medics should never put me in the position to make such a choice.  One of the tragic things about the retreat from proper Medical Ethics in favour of a utilitarian culture of abortion, cloning, embryo experimentation, euthanasia, transplanting organs from living patients etc, is the corruption of the medical profession.

Death is not as bad as sin…


IMPORTANT UPDATE: here

Breast Enlargement and Mind Contraction

All the fuss about faulty breast implants has prompted me to reflect on the similarities of this issue with the abortion debate.

Clearly the scale of seriousness is different, but there are parallels.

First, I should say that I am not talking here about reconstructive surgery, but cosmetic surgery.

When a doctor agrees to undertake cosmetic surgery for trivial reasons he or she is, in my view, doing something similar to an abortionist, in this way.  He is treating social and psychological problems as though a physical solution is the right answer.

Thus he is not only colluding with the superficial diagnosis of the patient ('If only I had bigger breasts, then I'd be happy/confident/loved...') but also contributing both to her not addressing the underlying issues, and also to others feeling under greater pressure to conform to undesirable social norms (that all women should aspire to look like pin-up girls).

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

Everyone was so upset the baby turned out to be healthy...

Where on earth would one expect to come across such a comment?

When the healthy child survived the attempted abortion, was delivered alive, but allowed to die, because it was thought to be unwanted (though in fact the mother had been scared into having the abortion by medics telling her the child was severely handicapped).

Here's how the Independent reported the NHS Medical Director's reaction:

Richard Blunt, medical director of the Dudley Group of Hospitals NHS Trust, said that no attempt to resuscitate the baby was made, despite it appearing healthy, because Ms James was undergoing a termination. "If you do a termination late in pregnancy then [the foetus] comes out in one piece ... and that therefore it may be alive and kicking. This is the dreadful thing. [The foetus] did not have any major physical abnormalities, but it would require a post-mortem to establish any internal problems. Everyone was so upset it turned out to be healthy."

This was back in 1994 (the report is from 1996), but I don't remember coming across it then.

Read the full article, weep and pray...

Physical means to therapeutic ends?...

A general rule of thumb in medicine is to ensure a correct diagnosis before proceeding to treatment.

I have also heard wise medics say: the presenting problem is often not the real problem.'  that is why many are concerned at (for example) the self-prescription of Ibuprofen and other drugs: without a proper diagnosis, patients may be covering up symptoms of something that needs different, and possibly more serious, treatment.

Let us turn then to the issue of abortion.  95 - 98% of abortions (let us not quarrel about the precise number, it is big enough in either case) are performed for therapeutic reasons - that is reasons related to the mental wellbeing of the mother or of other existing children.

Yet the treatment is a physical one: destruction of the unborn baby (or foetus/embryo/, if you will).

That is poor medicine - as is evidenced by the fact that the same procedure frequently has to be carried out again and again on the same women.  The underlying problems are not being addressed.

The real problems are things like:

Some women getting pregnant when they do not want to, or are in no position to, raise a child

A society which teaches that it is better to have an unwanted child aborted than adopted;

Some women viewing pregnancy as a disease or a disaster or something to be feared, rather than a blessing (as many do, of course);

Some men demanding that women be sexually available to them 'without consequences;'

Some men putting huge pressure on women to have an abortion the woman does not in fact want;

Lack of social and societal support for women facing unwanted pregnancies;

and on and on.... (speak to anyone who works in pregnancy counselling for a long list).

Abortion, of course, solves none of these: how could it?

Doctors do themselves and women, not to mention their unborn children, a huge injustice when they collude with the pretence that abortion is the solution.  They should undertake a proper diagnosis, and then help women form a positive plan, with the necessary support, to start to address the problems surrounding their pregnancy.

Are 98% of abortions in Britain illegal?

That is the case argued by Dr Peter Sanders

He made the claim on a Radio 4 Today programme interview/debate, and has substantiated on his blog.

It is a long post and well worth reading, but the summary is this:

Summary 
So where does this leave doctors? Let me sum it up:
1.There is no evidence that continuing with an unwanted pregnancy poses any greater risk to a pregnant woman’s mental health than an abortion does and yet 98% of abortions are authorised on these grounds
2.The doctors who are authorising these abortions are not therefore doing so ‘in good faith’
3.These abortions are therefore unlawful under the Abortion Act 1967 and Offences Against the Person Act 1861 and those doctors who are carrying them out are committing a criminal offence 
4.Those doctors who are authorising them are knowingly and wilfully making false statements on legal documents and are thereby committing an offence under the Perjury Act 1911
5.These offences under the Abortion Act and Perjury Act both carry custodial sentences

His blog is generally worth a look, too.  See, for example, his comments on the BBC and Gay issues...

H/t Blondpidge on Twitter.

Organ Donation: another assault on life

I have decided to re-post on the subject of Organ Donation, as it is some years since I last mentioned this important and misunderstood subject, and I have rather more readers now than I did have then...


Until I researched it a bit, I had not realised that for hearts (and certain other vital organs) to be transplanted successfully, they must be taken from a living body, as they deteriorate beyond usefulness on death. And that in order to facilitate that, the medical profession has introduced the notion of ‘brain death’ to legitimise the practice.


This has disturbed many nurses and others, as they cannot believe that the donor is dead when his or her heart is beating, flesh is warm, and (in one case) when he put his arm around the nurse just before they were about to remove his heart.


So what do our medical professionals do? Inject a drug that paralyses the donor - and then proceed.


The parallels with the murderous assaults on the unborn in the womb are extraordinary: the start of life re-defined contrary to the evidence, the injection of tranquilisers or anaesthetics prior to the killing...


A good source of information is the Anscombe Centre (formerly the Linacre Centre). In their article on criteria for death, they comment on the problems with the (relatively) recent notion of 'brain death' as the determining criterion: 


The Anscombe Centre's own view is that `brain death' protocols are insufficient for establishing the death of the body: we have become increasingly convinced by evidence suggesting that integrated bodily activity can continue after `brain death' has been diagnosed. There have been documented cases of `brain dead' patients maintaining bodily functions for months or even years: pregnant women have gone through pregnancy, children have grown up and passed through puberty, etc. 3 Moreover, it is well-known to transplant teams that heartbeating donors move when organs are taken, unless they are paralysed by drugs, and that their blood pressure goes up when the incision is made. It is worth noting that some anaesthetists recommend that the supposed `cadaver' be anaesthetised when his/her organs are retrieved. Most organ donors are unaware that their hearts may be beating when their organs are taken, and that they may be pink, warm, able to heal wounds, fight infections, respond to stimuli, etc.


(Link here, and see also their 'Definition of Death' comments)


In 2008 a government commissioned report, after studying a huge body of evidence, came to the 'wrong' conclusion that the consent of organ donors should be explicit not presumed: however, the political class did not want that answer, and are positioning themselves to ignore it.  The BBC, of course, will be involved in a campaign to soften up public opinion.  


We have another fight on our hands…

IMPORTANT UPDATE: here

Sex Ed: hazardous to your child's health

National Review Online carries a fascinating interview with Dr Miriam Grossman, about her new book: You’re Teaching My Child What?: A Physician Exposes the Lies of Sex Ed and How They Harm Your Child.

It includes, inter alia:

When teens are questioned about their last sexual encounter, more than half admit they did not use a condom. This will not come as a surprise to anyone who is aware of the insights this new century has brought us about adolescent brain development. Neither should we rush to increase the truckloads of free condoms delivered to our schools. Biology is saying the answer isn’t latex, the answer is time.

Towards the end, she comments on National (US) guidelines on sexuality for teenagers:

Later, readers are advised, “It is up to you to determine how much risk you are willing to take.” And: “Many teens choose to be sexually active and many choose not to. You have the right to decide exactly what behaviors, if any, you are comfortable participating in.”
Imagine if a nutritionist taught your child: “There are many types of diets. A diet low in saturated fats, carbohydrates, and sugars helps prevent obesity and cardiac disease. Some kids try to keep a healthy diet, others don’t. You have the right to decide what to eat.”
I don’t think this approach would be well-received. Yet this is what passes as sex education in our country.

All of it is worth reading, so go and have a look.

H/t Challenge Team UK on Facebook

Abortion better for you than eating apples, study (almost) concludes...

The ever-wonderful BBC has been trumpeting the news that a new study has shown that abortion has no worse effects on a woman than carrying a pregnancy to term.

Leave aside the effect on the child (death) and the effect on anyone else (siblings, father etc) for a moment.

Let's just examine that claim. Because even the BBC admit in their report: 'The scope of the review excluded reactions such as guilt, shame and regret - although these were considered important - and also assessments of mental state within 90 days of an abortion.'

Although these are important, we will exclude them. Why?

For a comprehensive list of studies reaching rather different conclusions, visit John Smeaton's blog.