70 children dead from religious opposition to vaccination

As if the children of that country have't got enough problems, Pharyngula notes that a measles outbreak in Zimbabwe has killed at least seventy children over the last two weeks. The outbreaks are mainly in apostolic religious sects which combine Christian Fundamentalism with traditional African religious practices, with children being treated with holy water and prayer. They are strictly opposed to vaccination. But I suppose at least they can claim poor education, a country ravaged by poverty and corruption, and colonial religious indoctrination. Unlike other supernaturalists such as the adult model Jenny McCarthy, the actor Jim Carrey, or sundry Christian Science sects who hold similar beliefs with similarly tragic consequences.

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.

Summer holidays: Peak time for female genital mutilation of UK schoolgirls

According to this Guardian report and video (warning: shocking images), up to 2000 British schoolgirls will be taken abroad to undergo female genital mutilation this summer. Summer holidays are the peak time as the girls have to have their legs bound together for several weeks afterwards.

Like any 12-year-old, Jamelia was excited at the prospect of a plane journey and a long summer holiday in the sun. An avid reader, she had filled her suitcases with books and was reading Harry Potter and the Prisoner of Azkaban when her mother came for her. "She said, 'You know it's going to be today?' I didn't know exactly what it would entail but I knew something was going to be cut. I was made to believe it was genuinely part of our religion."

Perhaps it's insensitive of me to criticise this practice, and it's about time I became a convert to ethical anti-universalism.

More religious healing (child abuse) in Oregon

Viewing pictures of victims of acts of questionable morality (and even use of the word 'victim') increases the likelihood of making emotive rather than rational judgements of the culpability of the actors/perpetrators. However, an Oregonian op-ed, about an 8 month girl whose parents preferred Christ's healing power to that of doctors, shows the astonishing effects of faith in the form of a huge haemangioma that may cause the girl to lose sight in the affected eye (image from Clackamas County Sheriff's Office and linked from oregonlive.com).

Perhaps the only way such treatment could not be labelled child abuse is a distinction between acts and omissions. As Jonathan Glover (whose tidy desk policy speaks to his philosophical credentials) states:

...in certain contexts, failure to perform an act, with certain foreseen bad consequences of that failure, is morally less bad than to perform a different act which has the identical foreseen bad consequences. It is worse to kill someone than to let them die. (Glover, J. Causing Death and Saving Lives. 1977. Penguin. p.93).

The doctrine of distinction between acts and omissions is often invoked, for example, to explain why we are less morally culpable for the death of a child in Africa through failure to give to charity than we are for deliberately running over a child in our country. In such cases the remoteness of cause/effect is frequently invoked to explain our moral hunch that the latter is grossly more culpable than the former. However, if my child has crawled into the path of my car as I reverse, and I am fully aware of that, then I am no less liable for resultant injury than ifI intentionally place the child there just before backing the car out. There is no remoteness of cause and effect to invoke the acts/omissions distinction of crawling versus being placed there, just as no distinction can be made in the Oregon cases of blinding a child versus letting the child go blind through failure to seek medical help.

However, the courts in Orgeon continue to protect parents who, for faith reasons, do not seek medical treatment for their children. According to the state medical office, more than 20 childen of parents who belong to the same church as the girl pictured above have died of treatable illnesses. My suspicion is that the courts think little of leniency to those of faith (not unlike Cherie Blair showing clemency to a man who broke another's jaw in a fight, simply because he was a man of faith; AC Grayling's take on the matter here). Whilst it is always reprehensible for religious persons to be treated more leniently by the criminal justice system than the non-religious, it's particularly ironic to adopt such a position when faith itself is the cause of the criminality! Maybe photos such as that above can help combat such misplaced tolerance towards the results of 'faith', no matter how emotive they may be.

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.

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!).