Friday, 28 May 2010

Christian Medical Fellowship and demonic possession of the mentally disordered

In these supposedly enlightened times, the Christian Medical Fellowship is publishing on its website material that would prove perfectly acceptable to the persecutors who wrote the malleus maleficarum five hundred years ago. The CMF presumably endorses the content of the essay, which considers that much psychiatric disorder might be a consequence of demonic possession (you read that right).

The following are quotes from this (not even pseudo-academic) bunk:

Demon Possession and Mental Illness (by Chris Cook)

For example, if people can become depressed because they are bereaved, or because of physical illness, why should they not also become depressed because of demonic interference in their lives?

...a psychiatric assessment may sometimes assist the non-medical minister to avoid attributing a primary psychological disturbance to demonic activity.

It would seem reasonable to argue that demon possession may be an aetiological factor in some cases of mental illness, but it may also be an aetiological factor in some non-psychiatric conditions, and in other cases it may be encountered in the absence of psychiatric or medical disorder.

As Christians in psychiatry, then, we have an important responsibility...The New Testament tells us that Jesus has commissioned us to ' drive out demons' (Mk 16:17), and we must be ready to respond to this commission if and when we are called to do so.

The astonishing thing is that at least one Christian psychiatrist, in an article buried amongst the Catholic rantings of the New Oxford Review, gives credence to such nonsense. In the article he gives undue prominence to his impressive list of qualifications. I want to write at greater length about doctors who hold religious beliefs, but lets concentrate on one matter at hand: how do such apparently intelligent believe such astonishing guff?

In  in Michael Shermer's excellent Why People Believe Weird Things (TED lecture here) he devotes a chapter to "Why SMART people believe weird things". Shermer examines beliefs in UFOs, intelligent design, resurrection and psychic phenomena by a roll-call of biochemistry professors, famous cosmologists, and those with multiple PhDs from leading universities. His conclusion? That smart people are good at proposing and defending ideas; when their thought processes go awry, they are even better than the rest of us at engaging in the cognitive biases and perturbations of reasoning that are necessary to accommodate weird beliefs. Their odd beliefs take root and endure for the same reasons as their host was thought to be smart in the first place.

That doesn't, of course, excuse the Christian Medical Fellowship from publishing material likely to stigmatise mentally disordered individuals who already face an uphill battle to dispel the multitude of public misconceptions about their condition.

Monday, 24 May 2010

Nun excommunicated for allowing abortion

Various sources are reporting the excommunication of Sister Margaret McBride for allowing a fetus to be aborted which, if the termination had not taken place, would almost certainly have resulted in the deaths of both the mother and the fetus. Bishop Thomas J. Olmstead, after finding out about the abortion, ordered the excommuncation of Sister McBride, every Catholic involved with the decision and the procedure, and indeed the patient herself.

In decrying the doctrine of double effect (for which, ironically, we owe a debt to Catholic theology), Rev. John Ehrich, the medical ethics director for the Diocese of Phoenix stated: "She consented in the murder of an unborn child...There are some situations where the mother may in fact die along with her child. But — and this is the Catholic perspective — you can't do evil to bring about good. The end does not justify the means."

The notion of a medical ethics director abiding not by principles of medical ethics, but by substituting (or overlaying) his or her system informed by faith, is against all tradition of medicine as an activity designed to better the lot of the ill, rather than to better the lot of the decision-maker or his church. Decision-making in medical ethics should shun 'absolute' (deontological) approaches and instead adopt frameworks that help guide the clinician or other agent to the best possible outcome for the particular case being considered by incorporating a wide range of moral considerations. Such a system is exemplified by the decision-making approach from the University of British Colombia detailed here (PDF), or the 'Ethox structured approach' from the Ethox Centre at the University of Oxford, which I reproduce below:

Compare the principalist and reflective decision-making process depicted here which includes elements such as 'Does this option respect the persons involved', with the deontological approach used by Rev. John Ehrich in the case of Sister McBride. His ethics come from the Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition, which states, for example:
Directive 36: Compassionate and understanding care should be given to a person who is the victim of sexual assault...It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.
The difference between the two methods of decision-making, the Ethox approach designed to produce the best outcome for the patient, and the Catholic approach which will frequently have the opposite effect, is so stark as to negate the latter as a system of medical ethics; it is instead dogma, which should not be tolerated by medicine.

But let us submit ourselves to dogma for a moment. We glance at Directive 47 of the above document:
Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.
In light of such provision, the justice administered to Sister McBride appears rather summary and in stark contrast to the leniency shown to the paedophilic actions of thousands of priests.

Friday, 21 May 2010

Society for the Protection of Unborn Children: Incompetent or deceitful?

The cryptically named Society for the Protection of Unborn Children (can children be unborn?) has put out a press release in response to the announcement by Marie Stopes International that they will be running a TV campaign to raise awareness of abortion services.

The SPUC release states "Abortion is in English law a criminal offence. Advertising of a criminal offence is not permitted". According to SPUC, the NHS and several hundred thousand health professionals (including myself) were mistaken in our belief that abortion was legal under the 1967 Abortion Act.

So SPUC's statement is either: 

1) A genuine mistake on the part of SPUC. Are they thinking about the The Offenses Against the Person Act, 1861, s.58 under which procuring or supplying abortion was an offence? Is it possible that a group (one of whose expressed aims is "To examine existing or proposed laws, legislation or regulations relating to abortion") are so incompetent as to be one hundred and fifty years out of date in their research? (the act they seem to think is still operating also mandates life imprisonment for homosexuality). 


2) A deliberate and grotesque attempt to mislead women at a vulnerable point in their lives.

I direct SPUC to the wording of the 1967 abortion act and presume that a further press release will follow shortly, admitting either 1) their incompetence; or 2) their willful deceit.

Thursday, 13 May 2010

Faith healing and medical obligation

Because of their religious beliefs, Jeffrey and Marci Beagley of Oregon allowed their 16 year old son die rather than take him to a doctor. His urinary tract obstruction could have been treated easily, but instead he died an unfathomably painful death from heart failure secondary to kidney failure. In March 2010 his parents received 16 months in prison for negligent homicide.

According to The Oregonian, Neil Beagley was taken to the home of his grandmother, Norma Louise Beagley, where more than 60 Followers of Christ Church members held a faith-healing session that included anointing the boy with oil, 'laying on of hands' and praying for a cure (not best evidence treatments subjected to Cochrane review).

The Christian Science Church, who shun medical treatment due to their belief that disease is an illusion caused by sin, had successfully lobbied Oregon legislators to introduce a 'spiritual defense law' which protected parents who 'treated' their children with prayer rather than medicine from charges of first or second degree homicide. However, following a series of deaths, laws were passed in 1999 which required faith healing parents of ill children to seek medical help or risk prosecution.

A US-wide study estimated that 172 children died between 1975 and 1995 due to parental rejection of medical care on religious grounds, not including 78 deaths reported in Oregon from 1955-98 or 12 reported in Idaho from 1980-98 that were probably due to the faith healing practices of the Church of which the Beagleys were members (Seth Asser & Rita Swan, Child Fatalities From Religion-motivated Medical Neglect, 101 Pediatrics 625, 626-629, Apr. 1998).

One of the authors of this study, Rita Swan, writes in a courageous article in The Humanist:
My husband Douglas and I were devout, lifelong Christian Scientists until 1977 when we lost our only son Matthew as a result of our religious beliefs regarding medical care. It's hard for most people to understand this. It's hard for many to grasp how parents could watch a beloved child suffer, yet not call a doctor.
Now, faith-healing is clearly a belief which endangers a child (or adult, for that matter) when it comes to preventing and treating disease, and parents are thus rightly prosecuted for the deaths of their children (though, in many states, they cannot be prosecuted for neglect causing serious injury - there is a faith-based get-out clause due to successful lobbying by the Christian Science church).

Attempting to put aside the moral outrage engendered by parents letting their child's eye tumour become as large as his head, so that he could only get around by supporting his head on the walls (leaving bloody stains from tumour haemorrhage), let us consider a further matter: if people are culpable for injurious effects of their beliefs, then should they be held culpable for death or injury due to other, non-faith-based, beliefs?

The most interesting of these would be anti-vaccination beliefs (particularly anti-MMR, as espoused, for example, by the actor Jim Carrey) leading to measles outbreaks and child deaths. It is difficult to see how rejection of child vaccination differs from faith-healing in terms of parental culpability for injury or death of a child. A parent has a legal responsibility to look after their child's welfare. If they fail to do so, and a child dies or is injured because of it, it matters not whether the neglect resulted from beliefs that are based on 'religous faith'. Should similarly preposterous beliefs rejecting all available evidence for vaccine safety should also qualify?

Thursday, 6 May 2010

Oklahoma abortion laws: physicians doing harm

The recently enacted Oklahoma abortion laws have been delayed for 45 days whilst the state prepares its defence to a legal challenge. A quick recap on the substance of these laws:

Law 1) Before an abortion, the woman must have an ultrasound in which the monitor must be turned towards her so she can see the fetus, and the physician must describe the condition of the heart, limbs, and fetal organs. No exceptions for rape/incest victims.

Law 2) Any woman who has a disabled baby may not sue her physician who withheld information as to fetal deformity, even if that physician withheld the information to prevent the woman from having an abortion.

There are myriad arguments against these positions, which cannot be dealt with here. I simply wish to address the ethical implications for physicians complying with these laws, in relation of the four principles of medical ethics outlined by Beauchamp & Childress in 'Principles of Medical Ethics' (1979). These are 'non-maleficence', 'beneficence', 'respect for autonomy', and 'justice'.

Law 1) violates the principles of 'first do no harm' (non-maleficence) and 'do good' ('beneficence') if the description or visual image causes distress to the woman, as these are not required for discharging the physician's clinical duty. This indeed seems to be the case; Jennifer Mondino, a staff attorney for the Center for Reproductive Rights (who filed the suit against the enactment of the laws), stated “We have been in touch with our clients and they are telling us stories of having women break down into tears hearing the description of the ultrasound”. The law also violates the principle of 'respect for patient autonomy' if the woman does not wish for such information to be revealed.

Law 2) violates principle of 'respect for patient autonomy' as witholding information (or, indeed lying) limits options available to the patient (e.g. choosing to abort a deformed fetus), preparing her life to look after a disabled child etc. Also violates the principle of 'justice' as the physician's actions may bring a potentially unwanted child into the world who will likely be a heavy consumer of scare medical and social resources.

Counterarguments to these violations of standard ethical frameworks will likely appeal to ethical duties to 'potential persons' i.e. the fetus overriding those of the woman. These are dealt with well by Francesca Minerva at the Oxford Practical Ethics blog.

Physicians clearly have an obligation to obey the law, but they also have a duty to uphold the ethical principles of their profession. When a law clashes with those principles, it's a fairly good barometer that the law itself is ethically flawed, or designed to serve the concerns of a particular group of people or lobby whom are unlikely to find themselves falling under that law's ambit.

Update: Satire can pinpoint ethical unease with great precision. The Onion news network: New Law Requires Women To Name Baby, Paint Nursery Before Getting Abortion.