Evangelical Christian GP appointed to Advisory Council on the Misuse of Drugs

Evan Harris has written in The Guardian on Dr. Hans-Christian Raabe, a member of the Maranatha community, a group peddling oddities such as "We see the threat to society of false gods, secular humanism, the abandonment of God's ways." More worrying than that are his views on homosexuals expressed in an article entitled ‘Gay marriage’ and homosexuality: Some medical comments. 

"While the majority of homosexuals are not involved in paedophilia, it is of grave concern that there is a disproportionately greater number of homosexuals among paedophiles and an overlap between the gay movement and the movement to make paedophilia acceptable."

Let's hope his command of evidence surrounding drug misuse is of greater standing than the arguments he derives concerning homosexuality. The drive of the religious to base policy on nonsensical and outmoded systems of thought means they deserve great scrutiny when appointed to public bodies (Dr. Raabe's group states that "We endeavour to let God write our agenda"). If he had a record of peer-reviewed research into drug policy, Dr. Raabe might qualify for our confidence. In the absence of any relevant expertise, he does not.

Religious doctors more likely to flout professional guidelines on end of life care

A study finds that doctors who are religious are less likely to discuss options about end-of-life care than non-religious doctors (specifically, options relating to deep sedation and withdrawal of treatment that may be expected or partly intended to end life). These findings, reported in all the major media yesterday, suggest that religious doctors break GMC guidance (the UK General Medical Council) which states that end-of-life care issues such as withdrawal of feeding, 'do not resusitate' orders, and treatment decisions that may hasten death should be discussed with patients who have a terminal illness at the earliest appropriate opportunity.

Darwin used to extol the virtues of writing down any and every thought that might refute one's favoured hypotheses, and consider them at length. The results of this study agree with how I think religious doctors are likely to think and act. So, in case I am blindly accepting empirical data with preconceived notions, let's try to consider if the papers conclusions could be wrong: that it's possible that religious physicians are NOT more likely to break GMC guidance on end of life care. Possible methodological flaws that make this more likely include:

1) The doctors to whom the questionnaires were sent are not representative of their profession, or faiths.
2) The doctors who returned questionnaires represent a biased sample.
3) The doctors who returned questionnaires incorrectly recalled (or deliberately mis-stated) how they handled the cases of their last patient who died.

The paper, by Prof. Clive Seale at London University and published in The Journal of Medical Ethics, considers each of these possibilities. With regards to 1), the sample of doctors was selected to include disproportionate numbers of palliative care specialists, geratologists, and neurologists, whom are involved in complex end-of-life cases (e.g. in the case of neurologists, multiple sclerosis, motor neurone disease). The sample is thus biased, but biased in order to better elicit a good answer to the question in hand. With regards to 2), 42.1% of the 373 doctors sent questionnaires replied, and the proportion was as high as 67.3% for the palliative care specialists. This seems a relatively decent response rate for a postal survey to busy professionals. Furthermore, the author presents data to show that responders were not significantly different in attitudes from non-responders (whose attitudes were elicited by follow-up in another study).

3) is likely to be a far more valid criticism of the study, but it is also a problem with any attitudinal/self-report study. Although the questionnaire was anonymous, if I were a devotee of a religion which held as a core tenet that life should be preserved at all cost (even if the patient's suffering is increased as a result of my belief), I would certainly want to report that I never consider treatment that might shorten patients' lives (in case my deity took note of my response). And if I were an atheist doctor, I might want to show my support for the doctrine of double effect by answering that I consider terminal sedation a great way to avoid unnecessary suffering, even (but no because) it hastens death (the study also found that non-religious doctors are approximately twice as likely to report having taken treatment decisions that might be expected or partly intended to hasten death).

The British Medical Association said in response to the study: "Decisions about end-of-life care need to be taken on the basis of an assessment of the individual patient's circumstances - incorporating discussions with the patient and close family members where possible and appropriate. The religious beliefs of doctors should not be allowed to influence objective, patient-centred decision-making. End-of-life decisions must always be made in the best interests of patients."

Likewise, Dr Ann McPherson, the Oxford academic, GP, and patron of the charity 'Dignity in Dying' added that "The fact that some doctors are not discussing possible options at the end of life with their patients on account of their religious beliefs is deeply troubling". And, in spite of being an argumentum ad verecundiam, as a recipient of a CBE for her lifetime campaigning for patient choice, as well as being a terminally ill patient herself, Dr. McPherson's views might be thought somewhat more weighty than the author of this blog.

Unfortunately for those such as Dr. McPherson who believe that patients have a right to be involved in decision-making about their treatment, where ethical guidelines clash with religious beliefs, doctors appear to prefer the codes of their ancestral belief systems instead of the latest GMC guidelines. Whilst quality of end-of-life care is ranked higher in Britain than any other country, the moral of the story is, as soon as you are diagnosed as terminally ill, ask whether your doctor is religious. Or get a tattoo.

Genital mutilation of boys in Oxford for religious reasons

A research paper in the Journal of Public Health finds that 13 of 32 genital mutilations ('circumcisions') carried out for religious reasons on teenage boys by the Oxford Islamic community led to complications, including infections, urethral scarring and severe bleeding.

For these reasons, the NHS is urged to conduct mutilation under controlled circumstances, by well trained doctors in sterile conditions (rather than in the library of a faith school as some of these coerced and botched operations were performed).

Perhaps other health endangering practices of religion would benefit from controlled medical supervision. Female genital cutting, by which 8000 clitoridectomies, labial excisions or vaginal inibulations conducted throughout the world everyDAY (WHO report) should perhaps be conducted by doctors rather than by untrained mutilators who generally do not use sterile technique or anaesthetic. Stonings would no doubt be more humane if conducted under general anesthetic or at least victim sedation; medical checks on the child bride victims of public floggings (caution: link contains graphic violence) for running away from their husbands would certainly help safety of such events. As it's in the news, would not the Srebrenica massacre (perpetrated by Christians against Muslims for the VERY REASON that they were Muslims) have been far more palatable if 7000 lethal injections had been used instead of the far less clinical method of tearing up bodies with machine guns?

Benefits to the person (an 8 year old boy not having to be held down whilst his penis is mutilated under local anaesthetic which is a method of anaesthesia suitable only for Jewish newborn circumcision) whilst admittedly persuasive, are far outweighed by upholding the principle and practice of a faith-blind socialised health service that does not conspire to give respectibility to inherently unrespectable practices and ideas. That health services should assist in genital mutilation, or indeed assist in or mitigate the perpetration of any religious atrocity, is a notion as obscene as the acts themselves.