Tony Nicklinson loses his case to be allowed voluntary euthanasia

The High Court has released its judgement in the case of Tony Nicklinson. It denies him the opportunity to end his life (his locked-in syndrome makes him unable to kill himself without assistance). It condemns him to an existence which neither he nor his family desires (and which he describes as one of "increasing misery", being unable to speak and barely move), and which society should not desire for him.

The judgement will almost certainly be appealed.

In the meantime, the Secular Medical Forum has released the following press release:

Today’s sad verdict leaves Tony Nicklinson with a terrible choice. Because other people regard his tortured life as somehow sacred, or are fearful of societal consequences, he is forced to endure his suffering or take desperate measures to end it. With no hope now of a quick release, he must choose between this torment and the torment of allowing his family to stand by and watch him starve himself to death. The law is failing people both ends up. People who do not want to die are not protected from unscrupulous relatives whose motives for ending their life will only be questioned when the patient is already dead. Those people, like Tony, who tell us quite reasonably why they would like to end their unbearable misery are prevented from doing so. 

Abortion and mental health: Christian Medical Fellowship changes its argument

In the face of the now overwhelming evidence that abortion has no effect on a woman's mental health, the Christian Medical Fellowship has been forced to change their argument in order to maintain their faith-based, pro-life position that abortion is a very bad thing.

The recent report by the National Collaborating Centre for Mental Health for the Academy of Medical Royal Colleges makes clear that any previous findings of adverse mental health outcomes of women having abortion were in fact due to the initial poorer mental health of women with unwanted pregnancies, and that women who choose to have an abortion have the same level of mental health problems as those who choose to carry their pregnancies to term. Indeed, such is the knockout blow inflicted on the myth that abortion has a negative effect on mental health (perpetuated by unsound studies and religious politicians) that the researchers who authored the new report state it would now not be fruitful to perform any more research on the matter.

This has prompted a major change in tack in the argument of the Christian Medical Fellowship. Dr. Peter Saunders, head of the CMF went on Radio 4's Today programme to air what he clearly feels is a clever new argument. He reiterates it here on his blog: he believes that the findings of the report now make 98% of abortions illegal in the UK. This is because 98% of abortion in the UK are carried out on mental health grounds (for which provision is made in the 1967 Abortion Act), specifically that continuation of the pregnancy would risk injury to the mental health of the woman.

Now that the new study has shown that the risk to the mental health of women having abortions is the same as women continuing with the pregnancy, doctors authorising abortions cannot do so on the grounds of mental health, and therefore by signing papers authorising abortion are acting illegally. Dr. Saunders states "If they continue to authorise abortions on mental health grounds from now on they will then be knowingly making false statements on legal documents". Their penalty? Dr. Saunders becomes even more hyperbolic here. Under the Offences Against the Person Act 1961, doctors could face life imprisonment as "making false statements on an abortion authorisation certificate is a form of perjury".

I'm sure most high school or university students with any training in critical thinking could spot the basic flaw in Dr. Saunders' new argument, which suggests he's either being disingenuous or doesn't understand some basic principles of logic: specifically, which comparison groups would enable us to make an evidence-based statement. It's pleasing, however, to see that he now accepts there is no link between mental health and abortion. Anyway, back to the fatal flaw in this shiny new argument; it's simply that those continuing with unwanted pregnancies (the comparison group in the new report) are a self-selecting group, of which a woman asking for an abortion is not a member. Let's imagine one such woman requesting an abortion; let's call her Julie. Dr. Saunders says I shouldn't sign the papers as it's now shown that there would be no damage to Julie's mental health if I failed to do so. He infers this from the report as it shows that giving birth to an 'unwanted pregancy' has the same effect on mental health as having an abortion.

Really? Would denying Julie an abortion and forcing her to have a child that she doesn't want not be prejudicial to her mental health? If I wanted to cause someone severe mental health problems, then high up my list of methods would be to force someone to carry a pregnancy and give birth to a child that they don't want. No studies have been carried out which compare the prospective mental health outcomes of those forced to have unwanted pregnancies versus those having abortion (because such studies would be highly unethical as commonsense tells us that they would be highly damaging to the women forced to carry unwanted pregnancies). Dr. Saunders' argument (that I am not doing Julie any harm by not signing the papers) could only be supported if we had such evidence. By asking for an abortion, Julie has placed herself in a different group to those women choosing to carry their pregnancies to term; she wishes to terminate her pregnancy.

Therefore, the new report tells us that by signing the documents, thereby authorising an abortion, I am not prejudicing Julie's mental health. The report (or any evidence) can never say that by failing to sign the documents I would not prejudice Julie's mental health, as Julie is by definition not a women choosing to continue with unwanted pregnancy (i.e. she is not part of the comparison group in the new report which provides the comparison group in Dr. Saunders' argument). The new report therefore does not tell me how I should behave when faced with a patient asking for an abortion (no report ever could, as to get a comparison group to answer the question, we would have to do a randomised trial of denying some women an abortion whilst allowing others to have one). I don't think anyone, even those opposed to abortion, would suggest we try that.

As the new report has nothing to say about the mental health effects of not signing the papers, doctors can of course continue to sign papers "in good faith" (as Dr. Saunders puts it) and could never be convicted under the Offences Against the Person Act. To reiterate: there is no evidence in this report or any other to suggest that refusal to authorise an abortion results in the same mental health outcome for the woman as if the abortion was authorised. To suggest doctors could thus receive life imprisonment for signing abortion requests is either obscurantist bunkum or a result of failure to understand basic logic and set theory. But logical argument never was a strong point amongst those of faith.

The Lords Spiritual, Exorcism, and the NHS

The UK's selection of some of its legislators by their religious beliefs (the 26 Lords Spiritual - senior Bishops - in the House of Lords) puts it in the same club as Iran. Bringing this incredible practice into the spotlight are the frankly bizarre utterances of the Archbishop of York who, in supporting a motion by the crossbench peer Baroness Hollins, explained how the NHS should be bound to take care of the spiritual health of people, not just their mental and physical health.

The Archbishop of York, who thinks that exorcism has relevance to the debate on the Health Bill

He illustrated his point by a wonderful story (from "Archbishop calls for NHS Bill to cover spiritual health" at BBC News):

...when he first became a vicar in south London, he was invited to a home where there was "a presence ", a phrase he said he did not understand at the time. At the home, he said, he found a young girl who had been unable to move for nearly three weeks and would shout out in the middle of the night. He was told the family had been to a witches' coven where a goat had been sacrificed. The young girl was petrified she would be next. Visits from a GP, psychiatrist and psychologist did little to help, he said, but then he said a prayer, anointed the girl and lit a candle on his visit. Shortly after, he received a phone call saying the girl was no longer terrified and was talking again. "That was not mental or physical illness; there was something in her spirit that needed to be set free" he told his peers.

The Archbishop's utterances are not much more bizarre than the motion by Baroness Hollins, who is a psychiatrist. Psychiatrists seem to get themselves into all sorts of problems with matters spiritual. The new Recommendations for Psychiatrists on Spirituality and Religion (PDF Link) is authored by Professor Christopher Cook (Chair of the Royal College of Psychiatrists Spirituality and Psychiatry Special Interest Group) who believes that mental disorder can be caused by demonic possession (published and presumably endorsed by the Christian Medical Fellowship). Here's the astonished response to his beliefs by me and by the medical ethicist Iain Brassington at the BMJ Medical Ethics Blog. Baroness Hollins's motion is equally bizarre, but with supporters like the Archbishop, you don't need me to tell you that. Time for the UK to exorcise the Lords Spiritual from its legislature.

British Medical Journal's 'Lobbywatch' puts the UK Islamic Medical Association under the microscope.

Last month the BMJ ran a rather damning expose of the Christian Medical Fellowship (an organisation which appears to have been hijacked by conservative Christians and used as a vehicle for pushing their increasingly extreme points of view on medical matters). This month it targets the UK's Islamic Medical Association who have equally wacky ideas on issues like vaccination. Their spokesman states:

...that he wants to promote a debate on the practice of vaccination in general. He has also urged British Muslims not to give their children vaccines such as that for measles, mumps, and rubella (MMR), because they contain substances that make them un-Islamic. He alleged that almost all vaccines contain “haraam” (forbidden) derivatives of animal or human tissue and that Muslim parents were better off letting children’s immune systems develop on their own.

Other medical practices are apparently not to be encouraged by Muslim doctors, such as giving condoms to unmarried persons, and the organisation sees its mandates as "joining actively the Pro-life campaign in Britain" and "Joining the campaign against the adding of Fluoride to our drinking water" (see http://www.islamicmedicine.org/imaUK.doc). 

The article notes that the British Medical Association and GMC have learned of Muslim students who are refusing to learn about alcohol related illness or sexually transmitted disease as it offends their religious beliefs and that "A small number were also reported to be refusing to treat patients of the opposite sex."

I guess that would at least shorten ward rounds by about half. Makes the Christian Medical Fellowship look almost moderate in its views. (OK, not really).

Where next for the anti-abortion brigade?

With the defeat of Nadine Dorries' abortion amendment in the House of Commons by 368 votes to 118, where can the UK anti-abortion lobby go now? The amendment had attempted to get 'independent' (read: 'faith-based') groups into pre-abortion counselling, with the aim of increasing the wait to abortion and applying pressure on those with unwanted pregnancies.

Well, the anti-choice lobby can take some comfort in the comments by the Under-Secretary for public health, Anne Milton, who was said that the Government was:

...supportive of the spirit of these amendments and we intend to bring forward proposals for regulations accordingly, but after consultation. Primary legislation is not only unnecessary but would deprive parliament of the opportunity to consider the detail of how this service would develop and evolve.

Ann Milton, Parliamentary Under Secretary of State for Public Health, and a supporter of 'the spirit' of Nadine Dorries' amendments

Milton has fallen for Dorries' trap, that there is a problem here that somehow needs correcting; that counselling services for women considering abortion are somehow currently skewed or inadequate (a contention for which not one jot of evidence exists). Dorries' (or 'Mad Nad' as Private Eye magazine now dub her) amendment was described by Diane Abbot (the shadow public health minister) as "a shoddy, ill-conceived attempt to promote non-facts to make a non-case".

That, however, is precisely the kind of strategy the anti-abortion lobby must now pursue. With no case to make for a comprehensive review of abortion law, they must concentrate on building up straw men using anecdotes, irrelevant facts, and presuming causation where there exists only correlation. Oh, and getting funding from US anti-abortion campaigners, who are suspected of bankrolling the 'Right to Know' campaign spearheaded by Dorries and her parliamentary colleague Frank Field. The anti-abortion campaigners must concentrate on peripheral or nonsensical arguments, such as the supposed mental health consequences of abortion, or the tiny proportion of late term abortions, in order to chip away steadily at the notion that universal access to abortion in the UK represents a huge advance in healthcare and reproductive ethics. Or, a new favourite, is to play the victim card: that people are conspiring against you (or even blackmailing others) or that you are the victim of censorship. And whatever happens, rule number one is always to use smokescreen arguments and to NEVER mention that you really object to abortion because you believe there exists a text which is actually the transcribed thoughts of a deity who wasn't too keen on female reproductive choice. And you think that this deity's writings should be forced upon other people who don't hold that belief.

Find out how your MP voted on the amendment here.

"Independent" abortion counselling: a solution in search of a problem

Rules designed to restrict abortion choice look set to be introduced by the coalition Government in the UK. The rules, proposed as an amendment to the Health and Social Care Bill by Labour MP Frank Field and Conservative MP Nadine Dorries (both devout Christians), will remove the role of abortion providers such as BPAS and Marie Stopes in providing pre-abortion advice. Ms. Dorries and Mr. Field state that there is a financial conflict of interest of abortion providers in providing pre-abortion counselling. It is of course a ridiculous idea, effectively accusing medics and nurses working for such organisations of failing to obtain informed consent (the cornerstone of medical ethics) for abortion procedures. There is not one study or piece of evidence to support their claim. Imagine if you are thinking of having your gallbladder removed due to gallstones. The very idea that a surgeon could not tell you about the procedure or alternative options because he/she has a financial stake in carrying out the operation (is paid by the NHS to carry out such operations) is a ludicrous one. But that is the logic of Ms. Dorries.

The amendment is supported by the secretive 'Right to Know' campaign, which rebuts all questions about its funding. It is widely suspected that it is financed by US evangelical conservative Christian groups (see interview with Dr. Evan Harris here), and is part of the 'chipping away' strategy that Ms. Dorries is adopting at UK abortion law.

Whilst this is only tinkering (reducing the gestation limit at which abortion is available was roundly rejected by MPs in 2008), Ms. Dorries has admitted to being advised by Dr. Peter Saunders, who is CEO of the Christian Medical Fellowship (which appears to be an increasingly extreme organisation peddling increasingly wacky ideas). A look at the powerpoint slides of Dr. Saunders here lays bare the 'chipping away' strategy. Ms. Dorries has indeed concentrated on the potential reduction in numbers of abortions her amendment might produce (she states up to 60,000) a year). More pragmatic commentators have stated that numbers will probably not be reduced a great deal, but that referral to the 'independent' counsellors will cause delays in abortion meaning later term abortions, which will be a matter of regret not only to Christian and secular organisations, but particularly for patients.

Pre-abortion advice provided by non-mainstream organisations has been found severely wanting. As The Guardian reported this month:

A survey of 10 centres operated by Christian and anti-abortion organisations found evidence in most of them of poor practice and factually incorrect advice, while the quality of counselling differs widely. Advice ranged from scaremongering – linking abortion with breast cancer, for example – to actions apparently designed to steer women away from abortion, such as showing them baby clothes and talking about "the child"...At a Life centre in Covent Garden, London, the undercover researcher was given a leaflet entitled Abortions – How they're Done, which said incorrectly that 85% of abortions are carried out using vacuum aspiration. It stated that "the unborn child is sucked down the tube" and that "the woman should wear some protection. She has to dispose of the corpse [in the case of chemically induced abortion]."

Finally, Ms. Dorries cites support for her campaign from BACP, the British Association of Counselling and Psychotherapy. This rather conflicts with the reply from BACP to a question about its supposed support to which the answer came "BACP has never suggested or implied that organisations like BPAS and Marie Stopes International should stop providing abortion advice or any of their other ancillary services."

It's good to know that the Government is, in straightened times, thinking of introducing complex, unfeasible, unceccessary, and expensive legislation for which there is no need, merely at the whim of a couple of backbench MPs. The amendments will also use up valuable time for debating the major aspects of the Bill - most notably, that GPs will be given the majority of the NHS budget to commission services, and the stealth privatisation of the NHS. I urge you to lobby your MP about this issue before the 6th Sept (when the amendment is likely to be debated), which can be done easily at this link:

http://www.abortionrights.org.uk/component/option,com_frontpage/Itemid,1/

The British Medical Journal's Lobbywatch targets the Christian Medical Fellowship

The British Medical Journal has got the right take on the Christian Medical Fellowship (CMF) in its "Lobbywatch" column of 20th July 2011. It notes that the evangelical Christian GP Richard Scott, currently having problems with the GMC for proselytising during consultations, has stated in the CMF's magazine that, for him, “saving the soul was ultimately far more important than mending the body”, and that:

“Evangelism is a job for all Christians, at all times and in all places, and Christian GPs are in a unique position to reach the lost in their local area. Sharing the gospel with patients is not an abuse of trust because God himself gives us the authority and salvation is their greatest need.”

The  CMF continues its attempt to legitimise proselytising to vulnerable patients by importing the notorious US 'Saline Course' which aims to equip doctors with the skills needed for "drawing patients in a natural way one step closer to God".

From the website of the cryptically named International Health Services which runs the Saline Course. "International Health Services teaches Christian medical professionals how to share Christ's love at the time of need, patient by patient"

GPs who consider our spiritual needs a higher priority than our medical treatment may think their authority comes from God, but their medical licensing comes from a higher power: the General Medical Council. Let's hope it protects us from doctors who see their patients as vehicles for their wacky beliefs.