Thursday, 14 May 2015

Home Secretary surgically dissected on Today Programme over new extremism disruption orders

This week Prime Minister David Cameron unveiled plans for a new counter-terrorism bill he intends to include in the Queen’s speech on 27 May.

The bill will include provision for extremism disruption orders giving the police powers to apply to the high court to limit the ‘harmful activities’ of an ‘extremist’ individual.

The orders were proposed during the last parliament in March, but were largely vetoed by the Liberal Democrats on the grounds of free speech. They were subsequently revived in the Conservative manifesto.

The measures would include a ban on broadcasting and a requirement to submit to the police in advance any proposed publication on the web and social media or in print. The bill will also contain plans for banning orders for extremist organisations which seek to ‘undermine democracy’ or use hate speech in public places.

There would also be new powers to close premises where extremists seek to influence others.

Cameron told the National Security Council on Wednesday:

‘For too long, we have been a passively tolerant society, saying to our citizens: as long as you obey the law, we will leave you alone… This government will conclusively turn the page on this failed approach. As the party of one nation, we will govern as one nation and bring our country together. That means actively promoting certain values. “Freedom of speech. Freedom of worship. Democracy. The rule of law. Equal rights regardless of race, gender or sexuality.”’

But just how far would these new orders extend?

Home Secretary Theresa May (pictured) appeared on Radio Four’s ‘Today programme’ (listen here) to explain it to presenter John Humphrys.

What followed was a masterclass in broadcast interviewing with Humphrys surgically dissecting May and brutally exposing the lack of clarity behind the new proposals.

The Home Secretary started by explaining that the new bill would include ‘banning orders for groups and disruption orders for individuals’ who were  ‘trying to promote hatred and intolerance’ which  ‘undermines our British values’.

‘But isn’t freedom of speech, an essential prerequisite of a tolerant and decent society’, asked Humphrys.

May answered that the ‘extremism’ the government was trying to prevent was that which ‘promotes(s) hatred’, which seeks ‘to divide our society’ and ‘undermine the very values that make us…  a great pluralistic society’

But what if ‘a group of people put together a meeting at which they expressed views about homosexuality that you or I might, perhaps, find repugnant. Would they be dividing society?’, said Humphrys.

May evaded the question so Humphrys asked, ‘At what point does it qualify for being banned?’
May again refused to define what she meant by ‘extremism’ but said that the aim was ‘to ensure that we can promote British values, the values that unite us as a society’.

Humphrys replied that ‘promoting British values’ was a woolly phrase and asked if May was intending to send people who refused to do it to jail. He pressed her again and again to define ‘extremism ‘ and ‘British values’ until she eventually offered a definition.

Apparently British values are ‘values like democracy, a belief in democracy, a belief in the rule of law, a belief in tolerance for other people, equality, and acceptance of other peoples’ faiths and religions.’

Which of course begs a whole host of questions: What is democracy? What law are we talking about? What should be tolerated and what shouldn’t be? What does equality entail? What does accepting another person’ faith actually mean?

These questions are crucial as the bottom line is that people who don’t promote what May calls ‘British values’ could be banned from broadcasting, required to submit their publications to the police, and have their organisation shut down and their premises closed.

But as Ian Dunt has said in an astute analysis on politics.co.uk:

‘The details are still not clear and won't get much clearer until the Queen's Speech – or probably afterwards. But we do know three things: 1) that the definition of an extremist is being expanded 2) that the process for how someone is officially designated as an extremist is shrouded in mystery, and 3) that the list of restrictions which applies to them once they have been designated an extremist is now extremely broad and intrusive.’

This appears to be a case where the price of freedom will be eternal vigilance. Every group whose views are judged to run counter to these poorly defined ‘British values’ could be in danger and would be strongly advised to subject the proposals, when they eventually appear, to the utmost scrutiny.

Ironically the Home Secretary’s interview was followed immediately by an interview with author AN Wilson (listen from 2h 24m here) , author of ‘Dante in Love’, marking the 750th anniversary of the birth of Italian poet Dante Alighieri.

Dante’s most famous work, the Divine Comedy – often described as one of the greatest ever written – is more than just the story of his journey through Hell, Purgatory and Paradise. It is a portrait of medieval society and a profound study of human psychology.

‘Dante had firm views about what our values are’, said Wilson. ‘He said they were based on the Christian religion and Roman law which runs through the whole of European Society and that’s what defines Europe.’

He went on to relate how Primo Levi , after been taken to Auschwitz by the Nazis, would recite to himself daily Ulysses speech in Dante’s divine comedy:

‘Consider your roots, where are you coming from, we are not just brute beasts, we are striving after knowledge and virtue’.

‘And these things’, Wilson concluded ‘are from Roman Law and Christianity’.

Quite.

Sadly the Home Secretary seems to have forgotten, or perhaps never to have known, what the real historic roots of British values actually are.

Friday, 8 May 2015

BMA calls on new parliament to debate six priorities for NHS

The British Medical Association (BMA) has today called on the newly elected UK parliament for ‘an open and honest debate about the NHS, focused on six priorities’ as follows:  

1. Address the funding shortfall for health

UK investment in health has slipped proportionately behind France, Germany, Denmark and Austria, and should be restored to a comparative level of GDP.

Increases in NHS funding based on unrealistic assumptions will not meet patient need. For example, an extra £8bn a year by 2020-21 overlooks the fact that an annual £22bn of efficiency savings will need to have been made by that time in order to close the £30bn funding gap on current services predicted by NHS England. There is still no credible plan, or commitment to invest enough, to enable this unprecedented scale of efficiency savings to be made. A good start would be for the government to fund NHS capital projects directly and to renegotiate existing PFI contracts to ensure a better deal for the nation, bringing our hospitals back into public ownership.

2. Remove market competition in healthcare

The Health and Social Care Act 2012 was a wasteful distraction from the real challenges in delivering healthcare and should be repealed.

A truly national health service needs an accountable leader; the health secretary’s statutory responsibilities to secure and provide universal and comprehensive healthcare must be restored and explicitly stated. The bureaucracy of competitive markets in the NHS in England hinders integration and prevents providers working together around patients’ needs. The government should use the NHS as its default provider, and not allow it to be destabilised by rival commercial providers.

3. Increase, retain and value doctors

Doctors are voting with their feet in neglected areas and services; the government has to recognise the need to improve working conditions.

Increasing the numbers of doctors in understaffed specialties such as general practice, psychiatry and emergency medicine will be impossible without this. Fair pay awards require that the independence of the Doctors’ and Dentists’ Pay Review Body (DDRB) should be restored and respected. Efficiency savings targets in the NHS should no longer be met at the expense of staff pay.

4. Maintain safeguards for patients and doctors

We must not return to the age of exhausted doctors; safeguards for patients and doctors assured by the Working Time Regulations must remain in place.

Seven-day services across the NHS should only be developed in response to clear patient demand and need, most acutely in urgent hospital care. Any proposals that dramatically change ways of working must follow rigorous analysis, have clear funding plans, and have workforce arrangements that protect both patient safety and doctors’ welfare.

5. Restore investment in general practice

General practice is the bedrock of many NHS services and the gatekeeper to the rest; it plays a vital role in all communities.

Significant investment in the workforce and facilities is overdue in order to meet rising patient need, in particular, that from older patients and those living with multiple conditions. The government must work more effectively with the profession to attract motivated doctors to work in general practice, and must invest in upgrading practice premises, delivering the ambition of true community care.

6. Prioritise health and wellbeing and strengthen ill-health prevention

Unhealthy lifestyle behaviours, such as poor nutrition, smoking and alcohol consumption, have a significant impact on quality of life and life expectancy and also place a huge burden on health services.

The government must tackle these behaviours and the industries that drive them, taking effective action to reduce health inequalities across society, improve the medical and social care of children, and develop a generation-long commitment to improve the public’s health. Health and well-being must be prioritised in all policy areas across government.

Saturday, 2 May 2015

What would a hung parliament really mean for the UK’s constitutional future?

With only four days left to go, who is likely to be governing us after the UK general election on 7 May, and what are the implications for the UK’s constitutional future?

There are 650 seats in the British parliament but only 194 marginal seats (those that would require less that a 5% swing to change hands). 

The current standing is Conservative (302), Labour (256), Lib Dem (56), DUP (9), SNP (6), Sinn Fein (5), Independent (5), Plaid Cymru (3), SDLP (3), UKIP (2), Green (1) Alliance (1), Respect (1).

Given that one Conservative MP (currently John Bercow) must serve as speaker, and that Sinn Fein do not take up their seats in the House of Commons, any party or coalition needs 323 seats to govern.

Nate Silver, the pollster who correctly predicted the last two US presidential elections has forecast the following 2015 election result on the basis of the latest opinion polls, historical elections results and census data:

Conservative (278), Labour (271), SNP (50), Lib Dem (28), DUP (9), Sinn Fein (5), Plaid Cymru (4), SDLP (2), UKIP (1), Green (1), UUP (1).

What is most striking here is how different the make-up might be if the UK used a system of proportional representation. The latest opinion polls have Conservatives (34%), Labour (33%), UKIP (14%), Lib Dem (8%), Green (5%).

So whilst UKIP has 14% of popular support, almost twice that of the Lib Dems, they are predicted to win only one seat against the Lib Dem’s 28. 'Is that really fair?', some might ask.

But, that aside, the most notable changes between 2010 and now, apart from the rise of Labour and the fall of the Conservatives, are the dramatic rise of the SNP, the latter mainly at the expense of Labour (see interactive map of constituencies) and the equally dramatic fall of the Lib Dems.

Clearly, if this result is repeated on Election Day, no one party will be able to form a majority government. But also, if the SNP does not go into coalition, then no party will be able to form a majority coalition government either.

A right of centre coalition of Conservative, Lib Dem, DUP and UKIP would have only 316 seats, 7 short of that needed. 

But a left of centre coalition of Labour, Lib Dem, Plaid Cymru, SDLP and Green would have only 306, a shortfall of 17.

But Plaid Cymru, DUP and UKIP have already signalled they will not be entering coalition and the Lib Dems are suggesting that they will drive a much harder bargain than last time. This makes the possibility of a majority coalition even more remote. 

This would mean that it would only be possible for either the Conservatives or Labour to pass the Queen’s speech on 27 May with the support of the SNP.

But the SNP has already ruled out a coalition (or any other arrangement) with the Tories, and Labour has ruled out a coalition or a ‘confidence and supply’ arrangement (ie. support in vote of confidence and for budget) with the SNP.

So, the only possibility of Labour continuing in government would be by some kind of vote by vote agreement with the SNP. This would leave Labour at the mercy of the SNP over specific policies like defence (especially Trident which the SNP wants to scrap), the economy and the constitution.

The SNP is strongly opposed to austerity and would push Labour to tax, borrow and spend much more than it would otherwise. It would undoubtedly also push for an early second referendum on Scottish independence.

So it appears that we may have a serious constitutional crisis.

Charles Moore suggested two weeks ago that the Scottish National Party (SNP) is seeking to engineer a reverse take-over of the Labour Party. In reality, they are intent on staging the Scots’ first attempt to capture their bigger neighbour since Bonnie Prince Charlie led his Jacobite army as far as Derby in 1745. 

So what will Cameron do with this result?

He remains Prime Minister until he stands down, just as Gordon Brown did in 2010 when he stayed put for five days with far fewer seats than the Tories.

Mr Cameron could challenge the Commons to vote him down (in a vote of no confidence) when it next meets on 27 May or go to the Queen and tender his resignation (which would be curtains for him personally).

This would leave Ed Miliband trying to form a government which he will only be able to do with the support of the SNP. But a minority government does not need a formal pact to sustain it in office, just the votes, and Nicola Sturgeon has all but guaranteed them to Labour.

The Telegraph’s Phillip Johnston has argued that if neither Mr Cameron nor Mr Miliband were able to put together a viable government, a second election would normally follow; but the Fixed-Term Parliaments Act 2011 complicates matters.

‘It provides for a dissolution of Parliament only when there is a specific vote of no confidence in the government or if two thirds of all MPs vote for an election. This makes the prospect of another early general election less likely. In any case, the parties may have little appetite for one given the expense and the prospect of losing support in a fresh contest.

Without a dissolution we would have a legislature but no government, a bit like Belgium, where the prime minister resigned in April 2010 and no new parliamentary majority could be established for almost two years. The country was run by a former prime minister brought out of retirement and a caretaker administration.’

As Johnston concludes, ‘One thing is clear: a minority Labour government, with fewer seats than the Tories, running the country while in thrall to a nationalist party that has only 2 or 3 per cent of the total UK vote, would test our constitutional structures to breaking point, and maybe beyond. More than that, it could test our creaking, centuries-old Union to destruction.’

One thing is abundantly clear. The UK’s days as a two party state where one party has an absolute majority are over. In the 1950s 97% of people voted Tory or Labour. Now barely 67% do.

This is a new era of coalition and shared power. But coalitions in a multi-party democracy can only rule effectively when they have an overall majority. And that may not happen without a shift to some form of proportional representation – like that or Italy, Israel or Greece.

Perhaps that is the direction in which we are inexorably drifting; either that, or Scottish independence, or both.

Thursday, 30 April 2015

Deeply flawed assisted suicide bill must be rejected by Scottish Parliament at the earliest opportunity

A report by MSPs criticising the proposed assisted suicide Bill before Holyrood has been welcomed by campaigners opposing the legislation. 

The Assisted Suicide (Scotland) Bill, introduced by Green Party MSP Patrick Harvie, is due to have its first stage debate in the Scottish Parliament by the end of May.

On a raft of crucial matters the committee has revealed the Bill to be lacking and deeply flawed.

And while stopping short of recommending MSPs to throw out the Bill they have made their view clear that the majority of the Health and Sport Committee, which has been scrutinising the Bill, oppose it.

Dr Gordon Macdonald of Care Not Killing (pictured giving evidence to the committee), said, ‘This report confirms what we have said along. The Bill is poorly thought out, ill-conceived, badly-drafted and effectively not fit for purpose. We are delighted that the committee agrees with us that the Bill contains significant flaws which are likely to prevent it from being enacted. It is gratifying to note a majority of the committee is against the Bill although they have not made a formal recommendation to the Parliament to reject the Bill.’

Catherine Garrod, Edinburgh Disability Rights Campaigner speaking on behalf of Not Dead Yet, another campaign group opposing the Bill, said: ‘Disabled people oppose assisted suicide because it gives the message that our lives are not worth living. Disabled people want assistance to live, investment in health and social care, good palliative care, support for independent living and the right to equality not assisted suicide.’

Care Not Killing is strongly opposed to legalising assisted suicide and firmly believes life should be protected and palliative care prioritised. It represents more than 40 professional groups, faith groups, human rights groups, medical professionals, palliative care specialists and legal experts who are convinced it would be dangerous and unnecessary to decriminalise the existing law on homicide.

Dr Macdonald said. ‘We do not want the state-sanctioned killing of old, ill and disabled people of all impairment.

‘We want support for people to live - not to die. In recent weeks as the Bill has been scrutinised we have witnessed repeated and sustained criticism  from a variety of sources and for a range of reasons because it is so badly drafted - leading experts in medicine and palliative care, senior lawyers and experienced ethicists who all express serious and genuine concerns. And more than 15,000 members of the public have signed our petition.

‘We have always maintained that assisted suicide is unnecessary, unethical and uncontrollable. This is compounded by the fact that this is a weakly thought-out and poorly-written Bill. The numbers of people who have criticised whole parts of it, quite aside from any moral or ethical objections, highlight the problems with the legislation.’

The Bill calls for the creation of  ‘licensed facilitators’ - aged as young as 16 - who would assist individuals end their life and would remain close by until such times and even film the scene as the individual dies or decides not to proceed with the assisted suicide.

In effect, the Scottish Government is being asked to fund and train licensed killers to preside over the suicide deaths of teenagers as young as 16.

Dr Macdonald added: ‘We believe the public needs to be fully aware of all the arguments and not just be influenced by the knee-jerk emotional arguments about so-called dignity in death from those who back the Bill.

‘People change their minds quickly on this issue when they are told about the possible impact on the vulnerable, those near the end of life, the sick, elderly, disabled and depressed who may consider themselves in some way a burden and through fear of becoming a financial, emotional or care burden find themselves pressured in some way to opt for assisted suicide.

‘The proposed safeguards contained in the Bill are simply not robust enough to prevent abuse from occurring. Many people, including leading doctors, spokespeople for disability groups and representatives of Scotland's churches, have criticised this Bill . And it must be rejected by MSPs and the Scottish Parliament at the soonest opportunity.

‘Countries which have enacted assisted suicide laws have seen the eligibility criteria expand and widen putting intolerable pressure on the ill, the elderly and the infirm. Recently a bill was introduced in Oregon seeking to widen the eligibility criteria for assisted suicide. This is a perfect example of the incremental and insidious widening which would inevitably follow here were the bill to be passed - Oregon is not an example we want to follow and that is the model upon which the Bill before Holyrood is based.’

Dr Macdonald added, ‘I am delighted the First Minister and other party leaders including Jim Murphy (Labour) and Willie Rennie (Liberal Democrats) have expressed their opposition to the legalisation of assisted suicide. They clearly understand it would bring pressure on vulnerable people to end their lives and put the elderly and disabled at risk of abuse as well as very ill young children.

‘The First Minister summed it up well when she said:  ‘I believe we should support people to live and I am therefore  in favour of good quality palliative care. There also remains a major stumbling block to assisted suicide: How could you have sufficient safeguards?’

‘The new Bill follows very closely the 2010 End of Life Assistance Bill proposals which MSPs comprehensively rejected in Holyrood by 85-16. MSPs are likely to again have a free vote on this Bill. The First Minister and other leaders have one vote each and we hope the vast majority of MSPs will  follow their example after examining all the evidence.’

Dr Macdonald highlighted a number of key conclusions of the committee criticising the Bill including:

*The Committee is not persuaded by the argument that the lack of certainty in the existing law on assisted suicide makes it desirable to legislate to permit assisted suicide;

*Members have also acknowledged that there are ways of responding to suffering (such as increased focus on palliative care and on supporting those with disabilities), which do not raise the kind of concerns about crossing a legal and ethical ‘Rubicon’ that are raised by assisted suicide.

*The Committee considers that a requirement for mandatory psychiatric assessment would be desirable in relation to any request for assisted suicide by a person who was terminally ill, under the age of 25, and/or with a history of mental disorder. The Committee also acknowledges the argument that given the magnitude of the decision to commit suicide, assessment by a psychiatrist ought to be routine in all cases.

*The Committee considers that legislation to permit assisted suicide seems discordant with a wider policy of suicide prevention by ‘normalising’ suicide and seeming to endorse it.

What you can do

Wednesday, 29 April 2015

New DNA editing technique for mitochondrial disease may render three parent embryos redundant

A new technique for removing harmful genes from strands of DNA could potentially obviate the need for three parent embryos for preventing mitochondrial disease.

Researchers from the Salk Institute for Biological Studies in La Jolla, California, have reported success for the first time in using gene-editing technology to prevent mitochondrial diseases being passed from female mice to their offspring.

Mitochondrial diseases are inherited maternally and cause a variety of severe conditions that currently have no cure. The UK government has recently legalised the controversial use of embryos carrying DNA from three genetic parents to prevent their transmission, but the proposed techniques have been criticised on both ethical and safety grounds (see my previous review).

This new research, published in the 23 April edition of Cell magazine, involves injecting affected embryos with RNA which leads to the production of enzymes which specifically target and remove faulty genes.

It is reported on this week in Nature, Popular Science, Medical News Today, Tech Times, and (amazingly) has even come to the attention of the BBC. Ted Morrow's blog gives a useful overview.

Authors Alejandro Ocampo and Juan Carlos Izpisua Belmonte realised that reducing the amount of mutant mitochondrial DNA in an egg or fertilised embryo could reduce the chance of mitochondrial disease developing.

They achieved this by injecting mouse embryos with a segment of RNA designed to produce DNA-cutting enzymes called restriction endonucleases and transcription activator-like effector nucleases (TALENs).

These enzymes then sought out mitochondria with mutated DNA and removed it while leaving the normal mitochondrial DNA intact.

The treated embryos were then transferred to female mice where they developed normally and resulted in healthy pups with low levels of the targeted mitochondrial DNA.

These pups later went on to give birth to healthy offspring themselves, demonstrating that this is a viable approach for preventing transgenerational transmission of mitochondrial diseases.

The researchers then trialled the TALENs using mouse eggs that contained genetic material from human patients mitochondrial DNA mutations known to cause two disorders - Leber's hereditary optic neuropathy and dystonia (LHOND) and neurogenic muscle weakness, ataxia, and retinitis pigmentosa (NARP).

Again, the technique resulted in a significant reduction of the mutated DNA.

It is early days with this new technique which will need thorough testing in mice and non-human primates before being ready for testing in humans.

However it has several obvious advantages over controversial three parent embryo techniques.

First, it does not require DNA donation and so avoids the health risks to donors (such as OHSS) associated with egg harvesting.

Second, it does not involve cell nuclear replacement (cloning) technology with all its safety concerns.

Third, it can be tested on eggs as well as embryos and does not involve the destruction of existing embryos.

Fourth, it is technically much easier to perform than the mitochondrial (or more accurately cytoplasmic) replacement used in three parent techniques. RNA injection is a technique that can be carried out relatively easily in IVF clinics.

Fifth, it appears to be a far more finely targeted technique, eliminating faulty genes rather than replacing the whole cytoplasm with all of it mitochondrial and other organelles. More like a sniper than a blunderbuss or carpet bomber.

Finally it does not produce offspring with three genetic parents.

However, we are still left with three concerns.

First, this new technique does still involve genetic medication of the germline, and the possibility that any ‘mistakes’ in editing would be passed on down the generations. This has already led David King of Human Genetics Alert to reject it outright.

Second, we cannot be sure, without a lot of further research, just how finely tuned it is as an editing tool. How much damage might be done to other genes in the vicinity and what effect might this have? 

Third, once this tool is more widely available, might it then be used by unscrupulous researchers or scientists to edit DNA in more dangerous contexts?

However, were it to work as well as some are hoping, it could potentially reduce the three parent technique, over which so much time, money and sweat has been expended, to a tiny historical footnote.

It will be intriguing to see how this research progresses and how long it takes for those British science journalists and parliamentarians who have been pushing three parent embryos so aggressively to take notice. 

Monday, 27 April 2015

DPP faces new legal challenge for ‘clarifying’ guidelines on prosecutions for assisted suicide

Perhaps surprisingly, the Sunday Times has been the only broadsheet newspaper to cover a landmark case (£) which challenges the powers of the crown prosecution service.

The CPS head Alison Saunders (pictured), Director of public prosecutions (DPP), is already in considerable hot water over her failure to prosecute Lord Janner for alleged sex abuse, an action she justified on grounds of him not being capable of standing trial because of dementia. This new development may add considerably to those difficulties. 

Sadly this latest case lies behind the Sunday Times paywall which has somewhat restricted it coming to the wider public attention that it deserves, so I will quote some of the article in this post. 

‘A woman who was once so paralysed she could only wink her right eye will this week launch a High Court challenge against “liberal” guidelines on assisted suicide brought in by Alison Saunders, the embattled director of public prosecutions (DPP).

Nikki Kenward, 62, will on Tuesday seek a judicial review after doctors and nurses who help severely disabled or terminally ill people to take their own lives were told that they are now less likely to face criminal charges.’

Kenward, a former theatre manager, was struck down by Guillian-Barre syndrome in 1990, aged 37.

She was initially fully paralysed for more than five months, and has been in a wheelchair since. She cannot tie her laces or hold a needle, but had a play staged last year and campaigns against euthanasia and assisted suicide through the Distant Voices pressure group. Her case is backed by the Christian Legal Centre.

Lawyers for Kenward will argue that Saunders exceeded her powers with a what she called a ‘clarification’ to the guidelines on prosecution for assisted suicide which she made last October (see my previous article here).

They will argue that she has entered a policy realm that should properly be a matter not for her but for parliament. They will also say that the attorney-general has failed in his duty to ‘superintend’ the DPP. In other words they will claim that she has gone beyond her remit which is to uphold the law and not to make the law.

To quote the Sunday Times again:

‘They are expected to argue Saunders’s guidance will “enable healthcare professionals operating on an ideological or other premise to offer their services to a person wishing to commit suicide . . . this is crossing the Rubicon”. They will add: it will “make any prohibition on a Dignitas-style of assisted suicide difficult to resist”.

“[It] weakens the protection given by parliament to people . . . coming under pressure to commit assisted suicide.”’

The fuller background to this case deserves unpacking.

Back in 2009, as a result of the Supreme Court judgement in the Debbie Purdy case, the DPP was required to make public the criteria by which he (then Keir Starmer) decided whether a prosecution in a given case of assisted suicide was in the public interest.

He published an interim policy and put it out to public consultation. After the consultation was completed he modified this interim policy and published his definitive policy in February 2010.

The summary of responses received and the responses themselves are still in the public domain.

The interim policy did not contain a paragraph about the role of medical professionals but as a result of the consultation one was included in the definitive policy.

It now says that a prosecution is more likely to be required if…

14. ‘the suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer [whether for payment or not], or as a person in authority, such as a prison officer, and the victim was in his or her care;’

Keir Starmer gave his reasons for including the new clause here.

Saunders, Starmer’s successor, subsequently ‘clarified’ the words in bold last October as follows:

‘For the avoidance of doubt the words "and the victim was in his or her care" qualify all of the preceding parts of this paragraph [43.14]. This factor does not apply merely because someone was acting in a capacity described within it: it applies only where there was, in addition, a relationship of care between the suspect and the victims such that it will be necessary to consider whether the suspect may have exerted some influence on the victim.’

The key questions raised by Kenward’s case are whether this amounts to a change in the policy or merely a clarification and whether the DPP should have made the change without consulting anybody.  

My own view is that DPP has actually crossed the line in both instances.

The relevant factors as I see it are as follows:

1. The ‘clarification’ makes it clear that doctors who do not have ‘a relationship of care between the suspect and the victims such that it will be necessary to consider whether the suspect may have exerted some influence on the victim’ are now not within the scope of this clause. This surely means that people like Philip Nitschke and Michael Irwin, who have made a name for themselves by assisting suicides in various ways whilst not being the patient’s primary care giver, are less likely to be prosecuted. This is real change in my view.  Irwin, who welcomed it as ‘a wonderful softening’ agrees with me. I think it is also clear from the current General Medical Council (GMC) guidance and Medical Defence Union (MDU) guidance (see also here) that these bodies did not understand the guidance in the way that Alison Saunders has now re-interpreted it. See below

2. Assisted suicide is contrary to all historical codes of medical ethics including the Hippocratic Oath, the Declaration of Geneva, the International code of medical ethics and the Statement of Marbella – which was reaffirmed by the World Medical association (WMA) as recently as 2013. The latter reads, ‘Physician-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically.’ So a strong argument could be made that this new ‘clarification’ is morally corrupting for the medical profession  as it makes possible their direct involvement in an unethical practice with far less possibility of prosecution.

3. Assisted Suicide is opposed by the British Medical Association, the World Medical Association, the Association for Palliative Medicine, the British Geriatric Society and virtually every Royal Medical College including the RCGP and the RCP.

4. The GMC makes it clear in its guidance on assisted suicide that ‘encouraging or assisted suicide’ is against the law. It makes no mention of any mitigating factors and warns doctors strongly against any involvement. It certainly does not convey the impression that doctors like Irwin, Nitschke etc are exempt. It is precisely this understanding of the law which led to Tony Nicklinson  and  Paul Lamb trying unsuccessfully to change it through the courts. Saunders seems now effectively to have done that at the mere stroke of a pen.

5. It is precisely people like Nitschke and Irwin who will push the envelope rather than ordinary GPs in a relationship of care with patients, although the ‘clarification’ does also give scope to GPs to do a little assisted suicide on the side with patients who are not ‘in their immediate care’. This clarification appears to give them free rein. 

6. The phrase ‘In their care’ can be interpreted in several different ways. One might argue that any doctor using his skill and expertise to help a patient kill themselves is actually involved in ‘care’ even if he is not their primary doctor.

7. The reason people responding to the original consultation pushed for the inclusion of the doctor clause in the first place was because of concerns about the unique position of doctors. Doctors possess the sort of knowledge and power that could easily be abused.  We have seen already how they push legal boundaries with abortion and how prosecutors are very unwilling to hold them accountable. This is why doctors need strong guidance and laws in place to ensure that some of them do not end up becoming the most dangerous people in the state. It is also why they should not be involved in assisted suicide.

8. As the doctor phrase (clause 14 quoted above) was introduced into the DPP guidance after, and as a direct result of, a lengthy public consultation (34% of respondents supported its inclusion) surely it should not be changed, or redefined, at a whim by the DPP without a similar public consultation. Simply asking medical bodies for their opinion would be inappropriate and inadequate – rather like asking the police about guidance on prosecuting policemen. This is why the GMC now has a strong lay membership because as a result of the Shipman case and others it was decided that doctors were not  capable of regulating themselves.

It seems to me that the DPP has not merely ‘clarified’, but actually changed the meaning and scope of the guidance. Furthermore she has made the change without apparently consulting anybody at all. 

I await the result of Kenward’s legal challenge with great interest.





 


Thursday, 23 April 2015

Lessons from Daniel – God is sovereign over the rise and fall of nations

When Jerusalem fell to the Babylonians in 587 BC, the nation of Judah was taken to Babylon in an exile that would last 70 years. As God's people in a foreign land that was hostile to their faith and values, they faced the challenge of living and serving as ‘aliens and strangers’.

There was great pressure to close ranks or to forget who they were. There was also great hand-wringing and lament.

Their emotions are beautifully described in Psalm 137, in words given popular currency by the pop band Boney M – a German based but ethnically Jamaican foursome – who achieved popularity during the disco era of the late 1970s.

In King James English: ‘By the rivers of Babylon, there we sat down, yea, we wept, when we remembered Zion.’(Psalm 137:1)

The psalm goes on to describe in graphic detail how they were tormented by their captors, unable to sing the songs of their homeland, pining for Jerusalem and longing for vengeance against those who had mistreated them.

They were forcibly displaced people - not even asylum seekers or refugees let alone economic migrants - but rather captives – prisoners of war in a country utterly different from their own in language, culture, values, religion and worldview.

God’s people – but made to serve in an evil empire, Babylon.

In the New Testament the symbolism of ‘Babylon’ is used by the apostles to describe Christian’s position in the world.

The apostle Peter talks of ‘living in Babylon’ and describes God's elect (Christians) as 'strangers in the world' (1 Peter 1:1), and 'aliens' (1 Peter 2:11).

We are called to 'be holy' – to be set apart – because we are 'a chosen people, a royal priesthood' and 'a holy nation' (1 Peter 2:9).

One of the key themes of the book of Daniel is that God is sovereign over all physical, spiritual, social and political processes (Daniel 2:21, 4:17, 5:21).

In other words, fire can’t burn, lions can’t bite and kings can’t rule unless God allows them to.

God’s rescue of Daniel from the lion’s den in Daniel 6 along with that of his friends Shadrach, Meshach and Abednego from the fiery furnace in Daniel 3, are well familiar to anyone who has attended Sunday school. 

But less appreciated and believed in – even in the church - is God’s control over political events and his sovereign rule over the rise and fall of nations.

‘He changes times and seasons; he deposes kings and raises up others.’ (Daniel 2:21)

‘The Most High is sovereign over all kingdoms on earth and gives them to anyone he wishes’ (Daniel 4:32). This same verse is repeated in Daniel 4:17, 25 and  5:21, 35.

Daniel’s two great dreams – in chapters 2 and 7 of this book – illustrate this.

First there is the great statue in chapter 2 with its head of gold, chest of silver, loins of bronze and legs of iron – representing the empire of Babylon and three more empires – usually identified by commentators as Medo-Persia, Greece and Rome - which will follow it.

Then there are the four great beasts of chapter 7 – representing probably the same four kingdoms – each falling to be replaced by the next.

Each dream ends in a similar way with these temporary earthly Kingdoms being destroyed to be replaced by a heavenly kingdom that will never end.

The statue made from four metals is smashed by a rock which grows to fill the whole world – a direct reference to Christ’s Kingdom.

The four beasts are superseded by one, we are told, like a ‘Son of Man’ (Daniel 7:13) coming with the clouds of heaven. He approaches the Ancient of Days (God the father) and is led into his presence. 

Then this Son of man ‘is given authority, glory and sovereign power; all nations and peoples of every language worship(ed) him. His dominion is an everlasting dominion that will not pass away, and his kingdom is one that will never be destroyed.’

‘Son of Man’ was of course Jesus’ favourite term for himself. It is Jesus who through his death and resurrection rules over all the kingdoms of men.

I live in St Albans – named after Britain’s first Christian martyr, a Roman nobleman called Alban - who was converted through the ministry of a priest fleeing persecution in the early 3rd century. When he refused to recant the Roman officials chopped his head off.

But centuries later when the Roman town of Verulamium where he lived lay in ruins they took the bricks and used them to build a cathedral on the very spot where he had given his life.

It’s a beautiful picture of what has, and is, happening in history – through the shedding of Jesus own blood at the hands of Roman Empire – God is building a living temple of his own people – the church.
 ‘The sovereignty, power and greatness of all the kingdoms under heaven will be handed over to the holy people of the Most High. His kingdom will be an everlasting kingdom, and all rulers will worship and obey him.’ (Daniel 7:27)

Of course what is true of the ancient world empires is equally true of the empires of today – the American, British and Soviet Empires – and equally the Empires of post-war western capitalism and Islam.

God has raised them all up and God will bring them all down.