Religiousness and teen pregnancy rate linked

This paper finds that US states with greater levels of conservative religious beliefs have a higher teen birth rate. The statistical significance of this relationship survives controlling for mean income (more religious states tend to have lower mean income), and, of course controlling for abortion rates (if states with higher religiosity have lower abortion rates then higher teen birth birth rates would not necessarily be a surprise). Here is the graph (Mississippi is on the top right!)
 

The authors state "One possible explanation for this relationship is that teens in more religious communities may be less likely to use contraception". For example:

Rosenbaum compared adolescents who reported taking a virginity pledge with a matched sample of nonpledgers [12]. Among the matching variables was pre-pledge religiosity and attitudes toward sex and birth control. Pledgers did not differ from nonpledgers in lifetime sexual partners and age of first sex, but pledgers were less likely to have used birth control and condoms in the past year and at last sex.

So much for sex education which promotes abstinence as a viable form of contraception. And how astonishing that international aid organisations like Catholic Relief Services still see abstinence education as a key weapon in their fight against HIV/AIDS.

Another case of illogical beliefs resulting in very logical (and tragic) outcomes.

The foetus cannot feel pain before 24 weeks

The peer-reviewed working party report by the Royal College of Obstetrics and Gynaecologists is here. The findings of the committee hinge on the following evidence:

1) That the foetus is not conscious by that time, being kept in a state of "a continuous sleep-like unconsciousness or sedation".

2) That the neural connections allowing the experience of pain (by relay of neural signals to the cortex) are not sufficiently developed.

Recently, UK parliamentarians (including the Prime Minister, David Cameron) have begun making noises about possible downwards review of the 24 week limit. This follows bills introduced by various US states to limit late term abortions on the basis of the putative ability of foetuses to feel pain, most notably that of Nebraska which has decreased the upper limit to 20 weeks. Another 29 states have bills scheduled for the 2010-2011 legislative seasons. Of course, none of those bills will now pass if the lawmakers are interested in scientific evidence (and, of course, the separation between church and state means that the lawmakers will most certainly not be considering any religious views!).

I had calling from God to be a doctor, says GP who admits to shortening patients' lives

Dr. Howard Martin, age 75, has admitted he shortened the lives of "scores" of patients by administering large doses of opiate drugs (morphine/diamorphine), to enable them to die at home. He did this out of "Christian compassion":

"I don't believe I've killed any patients. I believe I've made them comfortable in their hour of need. But I am deemed to be arrogant because I used my discretion. They want to extrapolate that to say I'm choosing to kill people. It's not like that. The patients are about to die and I want to make sure they are comfortable. How can a so-called caring society not understand that? How can I be reckless with someone who is about to die?"

Dr. Martin is no doubt correct that there are serious problems with end of life care in the UK and that there is frequently a dissonance between public opinion and criminal law regarding voluntary euthanasia. However, he has also admitted that in two cases he hastened patients deaths without their permission. Professor Steve Field, chairman of the Royal College of General Practitioners, said:

"I'm horrified that the doctor seemed to indicate in the interview that he actually hastened the death of two patients without their consent - I'm speechless."

It is perhaps unsurprising that the GMC panel found that he had an "autocratic attitude" and believed he was always right.

“On Judgment Day I will have to answer to God, and my answer will be this: that I did my best for my patients.”

Dr. Martin's frequent religious references seem to indicate that there is a link between his faith and his medical care (or lack thereof, depending on viewpoint). As considered in a previous post, to make decisions using texts that exalt the stories of a group of iron-age shepherds (instead of using a process of rational and exhaustive ethical decision-making) is a recipe for poor decisions in which the patient comes second to the decision-maker's desire for supernatural approval.

For these reasons, and in spite of the importance of the topic and need for its careful reform, I find it difficult to imagine a worse medically-trained ambassador for end of life care issues than Dr. Martin.

OK, maybe one.

Justice John Paul Stevens — The Practice of Medicine and the Rule of Law

New England Journal of Medicine (free full text article) marks the retirement of Supreme Court Justice John Paul Stephens and his record of defending medicine against interference by government and other groups, including matters of abortion and assisted suicide:

Although it’s not a thought that has leapt to the minds of commentators, U.S. Supreme Court Justice John Paul Stevens will be missed by physicians and patients. Stevens believes that the Constitution prohibits government from interfering in personal decision making, including medical decisions that belong in the hands of physicians and their patients, not politicians and regulators; it was for this reason that he was Justice Harry Blackmun’s staunchest ally in upholding the Roe v. Wade abortion-rights decision.

What can be expected of his successor, Elena Kagan, here: Kagan Memos On Abortion Limits, Religious Rights

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.

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.

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). 

or:

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.