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Washing feet

Fri, 2020-03-27 13:54

John 13: 1-20

Jesus is approaching the climax of his life. All his acts of service were about to be culminated and summated in his willing sacrifice on the cross. And it is all motivated by agape love – the love that gives.

‘Having loved his own who were in the world, he loved them to the end (telos)’. The ultimate example of self-sacrificial love is about to be demonstrated in the act of foot-washing now, and in the cross to come. This is a sacred moment. Jesus is spending his last hours with his chosen few, and yet the evil one is in the room too – in the heart of Judas Iscariot.

John’s emphasis is on Jesus’ total and unshakeable knowledge – both of himself and his being, his status, his calling, and of this moment – ‘the hour had come’.

There are four things that Jesus knows utterly and unshakeably in the core of his being.

  1. The hour had come
  2. The Father had given all things into his hand
  3. He had come from God
  4. He was going back to God.

They encompass where he has come from. In the bliss of the Holy Trinity; his supreme position in the cosmos as Lord of Lords; the significance of this hour – the crux point – the pivot for the whole of salvation history; and his ultimate destiny at the Father’s right hand.

This is what Jesus knows, and this is what gives him total security in who he is. With such power and status, we might expect him to defeat the devil who is in the room with him in an overwhelming burst of spiritual power and light. ‘I saw the evil one fall from heaven like a flash of lightning’. He might have blown Judas away in a moment with a blast of divine wrath.

Instead, he gets up from the table and stoops to t floor. And he washes his disciples’ feet.

Washing feet was the most menial, lowly and despised occupation reserved for the lowest of the low. The streets of Jerusalem were dirty and disgusting – there was filth, disease, urine and excrement in the highways. It doesn’t take much imagination to see why washing feet was a filthy and demeaning task. It was particularly unacceptable to a religious person because it led to ritual impurity, and the foot washer would have been barred from all religious activities.

Some high-minded Jews insisted that Jewish slaves should not be required to wash the feet of others. In essence, this job should be reserved for Gentile slaves – or alternatively for women and children who didn’t count. And of course, we can see that to be forced by others to take on this role – to be compelled by force to wash the stinking feet of others – is profoundly abusive, damaging, humiliating.

The Jewish literature records that when Rabbi Ishmael returned home from synagogue one day his mother wished to wash his feet. He refused on the ground that the task was too demeaning. Apparently, there is no recorded instance in either Jewish, Greek or Roman literature of a superior washing the feet of an inferior.

So, the shock of the disciples at Jesus’ action is understandable. How can their Lord and Master do such a thing? Has he lost his mind? Or does this mean that perhaps Jesus is not who he claims to be?

The critical point is that John juxtaposes Jesus’s total and unshakable security in his self-knowledge with his action in humble and humiliating service. John’s deep psychological insight (and the inspiration of his words by the Spirit) is that it is precisely because of Jesus’s total security in his status that he is able to lower himself in this striking way.

It is an example of the profound Christian doctrine of kenosis. The one who though he was in the very nature of God, did not count equality with God a thing to be grasped, but emptied himself (kenosis) – made himself nothing – and took the form of a servant. He humbled himself by becoming obedient to the point of death, even death on a cross (Philippians 2).

Jesus takes off his outer clothing (perhaps symbolic of stripping himself of outward security), takes up the servant towel and puts it around his waist. He willingly adopts the garment and appearance of the most menial house slave. He pours water into a basin, stoops down to the floor and starts the filthy task.

The doctrine of kenosis does not mean that Jesus exchanges the form of God for the form of a servant. It means that Jesus willingly and self-consciously lowers himself in order that the true nature of his deity is revealed unmistakably through human frailty and humble sacrifice. His status is not lost through the act of foot washing – it is powerfully revealed, unveiled, and made-known.

Here’s a thought experiment. Imagine yourself incontinent, lying in faeces, urine and vomit, being gently and tenderly washed and cleaned by Christ himself. This is the true nature of God revealed in the face of Jesus Christ.

I think it is profoundly significant that Jesus washes the feet of Judas Iscariot too, the one indwelt by the evil one. He doesn’t just confine himself to nice people, to grateful people, to the chosen ones. He washes the feet of the unlovely, the hostile, the wicked, the abusive, the malevolent, the one dedicated to destroying him. He washes the feet of the evil one himself! What majestic and mysterious power. How can he do this? It comes from his total unshakeable security in who he is.

Having performed this dramatic and shocking action, Jesus then explains it. First, there is divine action, and then there is explanation.

V 12 Do you understand what I have done for you. You call me Teacher and Lord and you are right for so I am – If I then your Lord and Teacher have washed your feet, you also ought to wash one another’s feet. For I have given you an example that you also should do just as I have done to you. Truly, truly I say to you a servant is not greater than his master nor is a messenger greater than the one who sent him.

Jesus claims the title of Lord, the one who has total authority over his disciples, and Teacher, the one who instructs, guides and models.

‘You should do exactly what I have done to you’. But just as Christ’s loving and voluntary self-abasement is rooted in his security in his supreme status, so in the same way, we cannot take the lowest place unless we are rooted and founded in the knowledge and security of our own status.

To be forced by an external power to take on the role of the lowest of the low, the house slave, is damaging, abusive, destructive. But to voluntarily choose the lowest role, motivated by love and out of the security of knowing our real status, as dearly loved daughters and sons of the King, that is totally different. This is the profound dignity of Christ-like service.

So, Christ’s action is motivated by free agape love, ‘there is no compulsion in love’. It is not coerced, manipulated, even driven by a sense of duty, of ‘ought’. It is totally free and un-coerced.

And although it is not recorded in the passage, we know from elsewhere in the New Testament that Christ’s action was motivated by joy. ‘For the joy that was set before him, he endured the cross, and despised the shame.’ It was joy, bubbling, inexpressible, eternal joy that motivated Jesus to take on the role of the slave.

From the outside, the actions of Christ and the actions of the abused house slave may look indistinguishable. They are wearing the same clothes, grovelling on the floor, covered with filth, absorbed in back-breaking toil. But the house slave is driven by external force and necessity, she is conscious of her status as lowest of the low, bottom of the pile, human trash, and she is damaged, demeaned and further humiliated by the process.

The Christian servant is driven by agape love, compassion and joy is conscious of her or his supreme status as a loved and honoured princess or prince of the royal family, and is ennobled, upbuilt and fulfilled by the action, thrilled to be living out the life and love and presence of Jesus. From the outside, they are indistinguishable, but on the inside, the experience is totally different.

Jesus’s example and John’s description of it in his Gospel was a fuse which ignited an explosion of caring in the ancient world. It was profoundly formative as a model of Christian service and care for the sick, the infected and the dying. And if we have ears to hear it can ignite further explosions today.

John juxtaposes the story of Jesus washing the disciples’ feet with another foot washing – but this time it is Jesus whose feet are washed.

In John 12, John emphasises that this incident happens only a matter of days before Jesus is to be crucified at the time of the Passover – the time the sacrificial lamb was put to death.

Mary the one who has previously sat at Jesus’ feet now takes a litre of expensive perfume– a huge quantity equivalent to over 300 grams – stoops down to the feet of Jesus and anoints his feet (and probably other parts of his body) with the precious ointment. Such is the quantity of the perfume that the whole house is filled with the fragrance. And then in a shocking and intimate act, she releases her hair, stoops down to his feet and tenderly wipes them with her hair.

It is a strange and wonderful scene of extravagant sacrifice and intimate tenderness; it is a sensual and scandalous act. Respectable Jewish women did not let down their hair in male company – this was something for the intimacy and privacy of the bedroom.

Mary is demonstrating her love and concern for Christ by this act which encompasses humility and self-abasement, tenderness, and extravagant willing sacrifice for the person of Christ. Interestingly, this episode comes before the example of foot-washing in John 13. Mary does not need to be taught about foot-washing – she does it instinctively and generously.

The reaction of Judas is that of the sensible, pragmatic, evidence-based moralist. The ointment was worth nearly a year’s wages for a peasant worker. Thousands of pounds. But Jesus understands her heart and defends her. The meaning of his words is uncertain, but I suspect that Jesus saw that she was, in reality, anointing his body for burial. Commentators have pointed out that because of the intense fragrance and quantity of the perfume, the smell would still have been present when Jesus was crucified six days later. In other words, as Jesus hung on the cross, he was smelling the fragrance of Mary’s sacrificial act, the fragrance of sacrificial and costly love.

The whole house was filled with the fragrance of sacrificial and costly love.

Christian carers have frequently been called to self-sacrificial love, at the cost of abandoning family, comforts, marriage, sleep, health, sacrificial giving, even sacrificing their own lives to care for others. So, both Christian medicine and Christian nursing may call us to pay a very high price.

Notice that Mary’s sacrifice was entirely voluntary and uncompelled. It was a spontaneous act of astonishing generosity. It was motivated by love for Christ.

So, what is the most precious, the most costly closed container in our lives, in our heart? Are we prepared to sacrifice it out of generous and costly love for Christ? Our natural tendency is to grasp, to hold on to the things which are most precious. But the way of fruitfulness is to voluntarily open our hand and release those precious things we hold so tightly.

‘Unless a grain of wheat falls into the ground, it remains alone – but if it dies, it brings forth much fruit.’

As the twentieth-century martyr, Jim Elliott said ‘He is no fool who gives what he cannot keep to gain what he cannot lose.

I am very conscious that much of this is theory, and that I continue to struggle to live in the reality of this example. But I know in the core of my being that it is the way of fruitfulness and the way of joy. I am sure that Mary did not begrudge the sacrifice of that perfume. I am sure her eyes were filled with tears of love and joy. This is what the perfume was for, to anoint the body of her Lord for death, and to fill the house with the fragrance of love.

John Wyatt is Emeritus Professor of Neonatal Paediatrics at UCL and Senior Researcher at the Faraday Institute for Science and Religion, University of Cambridge.


Listen to John talking further on this topic on a recent 1st incision podcast from CMF.

Catch up with stories of Christian doctors and nurses responding to COVID-19 in our voices from the frontline podcast miniseries

Join with us at 19:00 (7 pm UTC) each day to pray for frontline workers, our nation and the world as we deal with the COVID-19 pandemic at #COVID1900Prayer

Categories: Discussion

Leadership in pandemics – six principles to guide us

Thu, 2020-03-26 10:26

The COVID19 epidemic has thrown nations into complete chaos.  Fear and panic have gripped the world. Many nations are struggling with the impact of large numbers of people falling ill and increasing numbers of new infections. Many nations are preparing for this eventuality, but struggling, not knowing what they should be doing since the current generation of leaders in the world has not faced such a pandemic before.

Health care Institutions and organizations are struggling with questions of their own responses and their staff safety. Christian institutions in the developing world, challenged with their resource constraints but with a desire to make a difference in such a context, are considering what they should do at this unprecedented time in the history of the world.

How should leaders respond at such a time as this? If we listen to the media reports, we hear stories of leaders denying the problem, other leaders giving into panic, yet others using the unfolding events for their personal and political positioning. Some others have been taking decisions that have no scientific validity.

As leaders of ICMDA and member organizations and institutions, how will we respond? What will guide our responses? Below are a few thoughts to guide us as each of us are challenged to respond in such a time as this.

1. Do not give in to panic

There is an overload of information going around in the news and social media, and there is an epidemic of fear. Institutions, organizations and states are in fear and panic and taking reactive decisions driven by fear for their own health and life or the impacts on their institutions and economy.

We have been given a spirit of courage and wisdom. We must not panic and take reflex decisions that will impact our people and community adversely.

‘For God gave us a spirit not of fear but of power and love and self-control.’
2 Timothy 1:7

‘For you did not receive the spirit of slavery to fall back into fear, but you have received the Spirit of adoption as sons, by whom we cry, “Abba! Father!”’ Romans 8:15

2. Be logical, rational and evidence-based

Panic must be replaced by a sound mind that considers the emerging and available evidence logically. Rationally looking at the numbers, the trends, the emerging evidence of how and what institutions and health care professionals should do, in order to respond effectively. The challenge that we face now is that the evidence we have is too early in the day and evidence that is emerging may not be relevant to our local context.

3. Innovate if we don’t have resources

It is in such situations we need to be creative and innovative. God has given us his nature of creativity. There are many innovative solutions that we can come up with for setting up workable systems. Many which were used during the Ebola and SARS epidemics are already being adapted.

Think globally but act locally – understand what is happening across the world but find ways of implementing locally relevant solutions.

At the same time, we need to be constantly looking at the emerging context and evidence and be aware of the trends and patterns. This will help us to root our responses wisely in the reality of the global scenario, but the responses will need to be adapted for the local context.

4. Be compassionate and protect the most vulnerable

We will need to protect ourselves and our colleagues, but our mandate is also to protect the vulnerable in our midst. It is important for us to reflect who are the most vulnerable and explore ways of preventing, mitigating the spread and caring for them if they need to be cared for.

Understand and help each other to understand that we are called to channels of hope in ‘such a time as this.’

None of us in this generation has faced such a pandemic. But as we look back at the history of pandemics and responses, we would understand that Christians in healthcare pioneered and responded with courage and compassion. We are part of such a legacy. We are kept in this generation to be channels of hope like our forefathers who left such a legacy for us.

‘For if you keep silent at this time, relief and deliverance will rise for the Jews from another place, but you and your father’s house will perish. And who knows whether you have not come to the kingdom for such a time as this?’ Esther 4:14

5. Have faith in God and reflect and learn what he is teaching us

Amid this, hold on to the sovereignty of God. Bonhoeffer wrote from prison, ‘Of course, not everything that happens is simply God’s will; yet in the last resort nothing happens ‘without God’s will.’’ (Matthew 10.29 – through every event, however untoward, there is access to God.)

This is the God in whom we trust, one who uses every context for his greater purposes. Let us reflect: what is God doing through this and what is he teaching us through this unprecedented time in history?

6. Review and change things as new evidence emerges

At the same time, cultivate an ongoing learning habit. Be willing to review, adapt and change as evidence and context emerge around us.

May God make us such leaders, who understand the times and know what to do like the men of Issachar.

‘Of Issachar, men who had understanding of the times, to know what Israel ought to do, 200 chiefs, and all their kinsmen under their command.’
1 Chronicles 12:32

Santhosh Mathew is the ICMDA Regional Secretary, South Asia


This blog post originally appeared on the blog of the International Christian Medical & Dental Association (ICMDA) on 24 March 2020 and is re-posted here with kind permission

Categories: Discussion

Coronavirus and the call to risk

Mon, 2020-03-23 11:52

It’s the early hours of the morning, and I’m standing in a cholera camp looking at the scene around me. There are people everywhere – on beds, on benches, on the floor, even lying in wheelbarrows. Sunken eyes look up at me as I look at the line of IV drips and giving sets attached to patients, the stench of chlorine lingering in my nose. The number of people is overwhelming – there are around 700 patients in a camp with a capacity for 200.

 Walking amongst them in the hastily erected tents is a team of nurses, doctors and medical students who are tending to the sick, cleaning up the vomit and diarrhoea, setting up IV drips for some and giving oral rehydration to others. One student is praying for a particularly sick elderly man. As I turn around, a 7-year-old is carried in – he looks about four, malnourished, barely breathing. A cannula is sited, and we pray he might live.

I wrote the above just over ten years ago during the cholera crisis in Zimbabwe. There were 98,585 reported cases and more than 4,000 deaths. The health service was overwhelmed. And yet in the middle of it all, something beautiful was happening. Christians were staying and caring for others in the harshest of circumstances. I found myself wondering, ‘what drives people to be the hands and feet of Jesus, even though it might cost them?’

So, to our current situation with COVID-19. What might it mean for healthcare professionals in the coming days and weeks? Perhaps risking our mental and physical health; being isolated from our families; being placed in intolerable situations, and seeing people die horrible deaths. Whilst we are not called to burn out or be unwise, we may be called to risk ourselves and put others’ needs before our own.

My favourite parable is Matthew 13:44, where Jesus says, The kingdom of heaven is like treasure hidden in a field. When a man found it, he hid it again, and then in his joy went and sold all he had and bought that field.”

Imagine walking in a field and coming across a treasure that is worth far more than anything you can ever gain in this life. More than a home, a family, a good job, even the joy of helping people. And you go home, and you sell everything to buy that field. People ask you, ‘What are you doing? What a foolish thing to do!’ But you go away with joy because you have found something worth losing everything for.

Billy Graham knew the treasure he found, and he gave his life to it. Before he died, he said, “Some day you will read or hear that Billy Graham is dead. Don’t you believe a word of it. I shall be more alive than I am now. I will just have changed my address. I will have gone into the presence of God.”

Like many who have gone before him, he had faith in the all-providing, all-satisfying son of God, Jesus. He knew he was safe; he knew that God is on the throne and is sovereign over life and death, sickness and health. The reality is that we are safe. Whether in life or in death, we are eternally safe in him (John 10:28-30).

Every crisis brings both threat and opportunity. You can’t untangle the two. Whilst threats surround us, so do opportunities for people to learn about Christian caring. Not only from Christians, perhaps but also from non-Christians who nevertheless bear the image of God and serve alongside us, perhaps not acknowledging the source of their empathy for fellow image-bearers.

So, let’s be the hands and feet of Christ and show him to the world. ‘Nothing makes the worth of Jesus shine more brightly than sacrificial love for other people in the name of Jesus. Laying down our lives for the good of others magnifies Jesus more than anything else’ (John Piper, Risk Is Right p15). ‘Greater love has no one than this: to lay down one’s life for one’s friends.’ (John 15:13). Many great men and women have gone before us. Many of them medics and nurses. Many of the 245 million Christians who suffered high levels of persecution last year we won’t have heard of. But we will meet them in heaven. Instead of asking, ‘Why should I take risks for Jesus’, many of them have said, ‘How can I NOT risk myself for Jesus?’

Back to the cholera camp. I walked over to one of the final year medical students who had been co-opted to help and asked him why he was there. He replied,

‘God is not a God who stands back and watches…Jesus is in this cholera camp, amongst the vomit and the diarrhoea, full of compassion for these people. I asked myself where Jesus would be at Christmas, and I knew he would be here, so I wanted to be here too.’

‘For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord’ (Romans 8:38).


Categories: Discussion

Christianity in a time of plague

Fri, 2020-03-20 08:36

Epidemic infections were a source of terror in the ancient world. They would sweep into the cities of the Roman Empire, causing devastation. The Plague of Cyprian was a pandemic that afflicted the Roman Empire from about AD 249 to 262. From 250 to 262, at the height of the outbreak, 5,000 people a day were said to be dying in the city of Rome itself.

Pontius of Carthage wrote a first-hand description:

Afterwards, there broke out a dreadful plague, and excessive destruction of a hateful disease invaded every house in succession of the trembling populace, carrying off day by day with abrupt attack numberless people, every one from his own house. All were shuddering, fleeing, shunning the contagion, impiously exposing their own friends, as if with the exclusion of the person who was sure to die of the plague, one could exclude death itself also. There lay about the meanwhile, over the whole city, no longer bodies, but the carcasses of many, and, by the contemplation of a lot which in their turn would be theirs, demanded the pity of the passers-by for themselves. No one regarded anything besides his cruel gains. No one trembled at the remembrance of a similar event. No one did to another what he himself wished to experience….’

Strikingly no first-hand accounts of the clinical symptoms and signs of plague have been recorded from the Hippocratic physicians at the time. Although the clinical descriptions of many other diseases were recorded with great detail, it has been remarked that the contemporary medical descriptions of plague seem vague and impressionistic.

Why was this? Almost certainly because at the first sign of plague, the Hippocratic physicians would have deserted the towns and fled to the safety of the countryside! When plague threatened Rome, the great physician Galen moved swiftly to a country estate in Asia Minor where he stayed until the danger had receded.

In the Hippocratic work ‘The Art’ the goal of the physician was defined as ‘to do away with the sufferings of the sick, to lessen the violence of their diseases, and to refuse to treat those who are overmastered by their diseases, realizing that in such cases medicine is powerless.’ To treat those who were dying was likely to bring the reputation of the profession into disrepute and damage faith in the healing skill of the physician.

So it is remarkable that it was a Christian bishop Cyprian, who provided the most accurate and detailed clinical description of ancient plague: ‘These are adduced as proof of faith: that, as the strength of the body is dissolved, the bowels dissipate in a flow; that a fire that begins in the inmost depths burns up into wounds in the throat; that the intestines are shaken with continuous vomiting; that the eyes are set on fire from the force of the blood; that the infection of the deadly putrefaction cuts off the feet or other extremities of some; and that as weakness prevails through the failures and losses of the bodies, the gait is crippled or the hearing is blocked, or the vision is blinded…

Cyprian’s account suggests that the third-century plague he witnessed may have been a highly infectious and lethal haemorrhagic viral infection similar to Ebola virus, although there is continuing controversy about the nature of these ancient epidemics.

What is clear is that there were scenes of horror – the streets filled with the bleeding bodies of the dying, and there were desperate attempts from the population to save themselves whatever the consequences for others. Here is another witness account from Dionysius in Alexandria ‘At the first onset of the disease, the pagans pushed the sufferers away and fled from their dearest, throwing them into the roads before they were dead and treated unburied corpses as dirt, hoping thereby to avert the spread and contagion of the fatal disease; but do what they might, they found it difficult to escape…’

Yet in many of those cities of the Roman Empire there was a small body of believers, often shunned and despised as ‘atheists’ (because there were no idols in their homes and assembly places) or ‘Galileans’. How will they respond in this time of horror and distress? Will they too head for the countryside in order to save their own lives?

Dionysius’s account continues, ‘…Most of our Christian brothers and sisters showed unbounded love and loyalty, never sparing themselves and thinking only of one another. Heedless of danger, they took charge of the sick, attending to their every need and ministering to them in Christ, and with them departed this life serenely happy; for they were infected by others with the disease, drawing on themselves the sickness of their neighbours and cheerfully accepting their pains. Many, in nursing and curing others, transferred their death to themselves and died in their stead…

Following the example of Christ, the Christian believers provided compassionate nursing care for their pagan neighbours – bringing them into their houses, washing wounds, cleaning up the blood and diarrhoea, providing water, food and basic medicines, ‘ministering to them in Christ’, even though they knew that they were exposing themselves to extreme risk.

The ancient world had never seen anything like this. Rodney Stark, a social historian, has undertaken a detailed analysis concluding that the actions of the Christians at time of plague were one of the most important factors in the explosive growth of the Christian church in this period.

When I read these accounts, I feel unworthy to be called by the same title as a Christian carer. How little I have experienced the cost of Christ-like caring compared with my sisters and brothers of the third century.

But over the succeeding centuries, Christian carers have behaved in the same way during the tragic history of epidemics from the Cyprian plague in 250 right up to the Ebola epidemic in 2014 and into the present. Many of the nurses and doctors in Sierra Leone who sacrificed their lives to care for Ebola victims were Christian believers. They knew that the protective equipment was substandard and that despite their best efforts, they could not completely protect themselves. And yet they kept on caring, just like their ancient sisters and brothers who ministered to the sick in Christ.

And I have no doubt that over the next weeks and months, stories of heroic self-sacrifice will emerge. Of course, it is not only Christian believers in our modern world who practice sacrificial care for strangers. We must celebrate the caring actions of everybody, whatever their creed or motivation. And of course, as professional carers, we must be wise about taking protective measures, so that we can continue to care whenever possible, rather than becoming a victim. But we should not forget the noble history of Christianity in a time of plague, remembering the words of Jesus just as those early Christians did, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me’ Matthew 25:40.

John Wyatt is Emeritus Professor of Neonatal Paediatrics at UCL and Senior Researcher at the Faraday Institute for Science and Religion, University of Cambridge.

Further reading

Rodney Stark, The rise of Christianity, HarperCollins

Categories: Discussion

Coronavirus – responding like Jesus

Fri, 2020-03-13 11:08

It is hard to have missed the news that coronavirus is a big thing. Government guidance and press conferences every few days; headlines screaming about the risks; editorials debating about the effectiveness of the Government’s measures; all bombard us daily.

We see the news from China, Italy and South Korea, with whole cities on lockdown, and wonder if this is what will be happening in our hometowns in the coming weeks.

We see the empty supermarket shelves as panic buying frenzy sweeps the nations. Seriously, who needs that much toilet paper, even in an emergency?

We hear about governments in other nations acting decisively and drastically or dithering and operating in an advanced state of confusion. The strengths and weaknesses of various public health systems are being exposed for all to see.

It leads us to ask, ‘Will I be OK? What about my children, my parents or grandparents? Will I still be able to work or to go on holiday? Will my kids’ schools be closed, and how will I look after them? Will my employer or my own business survive the economic pressures?

We can debate in detail whether the current UK measures are sufficient or too draconian until the cows come home. Others are writing on this. Suffice to say that if you want to know what the latest advice is from the Government, check out the official UK Government COVID-19 Advice site and the NHS 111 COVID-19 advice page. Get informed, keep abreast of what is actually going on, and stay away from the websites promoting conspiracy theories and peddling fear and misinformation!

But how should we respond as Christians?

Our focus should always be foremost on Christ’s greatest commandments, to love God with all our heart, soul, mind and strength and to love our neighbours as ourselves. (Mark 12:29-30)

Loving God means laying aside fear and anxiety – he is in control. Jesus warned us that things like this would happen and not to be anxious, but to recognise them as signs of creation’s groaning as it awaits his coming.

We love our neighbours by being more concerned about their welfare than our own. How can we protect others by our own actions? How can we support neighbours forced to self-isolate? Do they need shopping brought to them? Would they value a phone call just to let them know that they are not on their own? Be the voice of encouragement and comfort to those who are lonely, anxious and afraid.

How do we support those in the health and social care frontline? Those who are likely to be the most exposed to the virus are also those caring for and protecting the most vulnerable. They will also need support, as they juggle the huge pressures and difficult, day-to-day decisions in an already overstretched health system. Again, just a phone call or a text to say you are thinking of them and praying for them and to let them know you stand ready to help in whatever way you can.

Panic buying loo-roll and hand sanitizer is not loving God or our neighbour. It is giving in to fear. Checking on our elderly neighbours, washing hands, self-isolating if we think we may be unwell, supporting NHS and social care workers, is.

We need above all to be kind, not fearful.

Finally, we love God and neighbour by praying:

  • For the vulnerable; our elderly neighbours, those with serious health problems. But also remember those living in extreme poverty around the world, in slums and barrios, where self-isolation is not really possible, and access to healthcare is limited.
  • For those who are anxious and afraid, some without good cause, others with very good reason. Pray for reassurance and be prepared to be the one who gives that reassurance.
  • For health workers – those on the frontline in A&E departments, medical wards, ITUs, GP surgeries and community health services. For protection for their own health, and as they seek to manage care and services that will become even more overstretched in the coming months.
  • For NHS and Social Care managers, who will have to make hard decisions to ensure essential services are still running and that the most vulnerable receive the care that they need.
  • For care workers in nursing homes and in the community. Many are on zero-hours contracts, so balancing the need to earn money with the protection of the vulnerable for whom they are caring.
  • For those in Government and the public health services, as they make choices about when and how to escalate measures to slow the spread of the virus.

In the third century AD, as plague swept the cities of the Roman Empire, it was the Christians that stayed and cared for the sick, even for those who had been persecuting them. Sometimes at the cost of their own lives. It changed the world because no-one had ever acted like this before. Are we prepared to be as Christlike in our own response today?

Categories: Discussion

Transgender on trial

Mon, 2020-03-09 08:39

In March this year judges gave permission for Keira Bell, Susan Evans and a woman known as ‘Mrs A’ to bring a case against the Gender identity development services (GIDS) clinic at the Tavistock and Portman NHS Trust.

Bell is a former patient of the clinic. Born female, she felt a growing urge through childhood to change her gender, and as she learned more online about transitioning, her determination grew. She was referred to the Tavistock Centre at the age of 16 and was prescribed puberty blockers. A year later she was prescribed the male hormone testosterone. In 2017 she had what is known as ‘top surgery’ – a double mastectomy. However, Keira, now 23, regrets her decision and feels she should have been challenged more by clinicians rather than being allowed to pursue such ‘powerful and experimental’ treatment.

‘Mrs A’ is the mother of a fifteen-year-old girl who is currently on the waiting list for treatment at the Tavistock centre. Her daughter is autistic, and Mrs A has ‘deep concerns’ that her daughter will be placed on ‘an experimental treatment path that is not adequately regulated, where there are insufficient safeguards, where her autism will not be properly accounted for and where no-one (let alone my daughter) understands the risks and therefore [the clinic] cannot ensure informed consent is obtained.

Susan Evans was initially the lead claimant on the case, though that role has now been taken by Ms Bell. Mrs Evans is a former psychiatric nurse at the Tavistock Clinic, and raised concerns about their practices – in particular, to do with the speed at which young people were put on hormone treatment – as long ago as 2004.

The case will test the concept of informed consent of children. Since the 1980s children under the age of sixteen have been able to make certain decisions about their treatment – notably around contraception – under what is known as the ‘Gillick competency test’. The test is named after Victoria Gillick, a mother who tried – and failed – to obtain assurance that ‘it would be unlawful for a doctor to prescribe contraceptives to girls under 16 without the knowledge or consent of the parent’. The NHS guidelines around children’s consent state that, ‘Children under the age of 16 can consent to their own treatment if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment.’ [Gillick v West Norfolk & Wisbeck Area Health Authority [1986] AC 112 House of Lords].

Paul Conrathe, a solicitor with Sinclairslaw who are representing Bell et al., argues that ‘it is a leap too far to think that Gillick as a judgment could apply to this type of scenario, where a young person is being offered a treatment with lifelong consequences when they are at a stage of emotional and mental vulnerability.

Bell agrees. She notes that she was very sure and settled in her desire to transition’ and had ‘no doubt’ she wanted to become a boy: ‘I wanted to go onto the medical pathway as soon as possible, I was very eager and I was very reluctant about speaking to anyone who would possibly get in the way of that.’ But she now regrets her decision and thinks ‘ it’s up to these institutions, like the Tavistock, to step in and make children reconsider what they are saying, because it is a life-altering path.’

The case comes at a time when the Scottish government is considering the responses to its consultation on a proposed Bill to ‘[reform] the process by which trans people gain legal recognition of their lived gender through a gender recognition certificate.’ This would make it significantly easier and quicker for Scottish residents aged 16 and over to gain legal recognition of a change of gender.

Meanwhile, in Oxford, ‘a teenage girl has applied for judicial review over official school guidance that says she should share changing rooms, lavatories and residential dormitories with trans girls.’ The Safe Schools Alliance, supporting the legal action, says the guidance is ‘in direct opposition to all safeguarding protocols.’

The transgender agenda is being pushed very hard in some quarters, but cases such as these against the Tavistock centre and Oxfordshire County Council are shining a bright light on some of the flawed thinking that is driving change. While much of the pressure is coming from people with a genuine concern for the wellbeing of young people who are experiencing distress around questions of their identity and society’s expectations, their safety must come first. Placing the burden of consent on people too young and distressed to be able to fully understand the life-long implications of treatment – many of which are simply not known at this point – is unfair and unsafe. We applaud the courage of the women bringing these cases and hope and pray that reason will prevail.


Categories: Discussion

Scottish Government muddles sex and gender – and plans to legalise the confusion

Mon, 2020-03-02 11:03

The Scottish Government is consulting on a plan to make the existing process to obtain legal recognition under the Gender Recognition Act 2004 a better service for those trans and non-binary people in Scotland who wish to use it.

Under the law, as it stands, to legally change gender a person needs to be over 18, have been diagnosed with gender dysphoria by a medical practitioner, and have lived in their new gender identity for two years before applying to a gender recognition panel for a Gender Recognition Certificate (GRC). The recognition process is lengthy, interviews may be experienced as intrusive, and the gathering of evidence in support of the application can be costly, complicated and inaccessible to some trans people. Some reform is therefore required.

One proposal for streamlining is to remove the current requirement for a medical diagnosis, replacing it with a simple self-declaration process. A person’s gender would be defined by their subjective, innate sense of identity, whether male, female or something else (non-binary) and may or may not correspond to the sex assigned to them at birth. Under the proposals, a person could apply to the Registrar General for Scotland after having lived in their acquired gender for a minimum of three months (rather than the current two years). After a further three-month period of reflection, the applicant would be required to confirm their intention to live permanently in their acquired gender and swear to that effect in front of a notary public or a justice of the peace. Registration would give legal status to their self-declared gender identity and the right to update their birth certificate and other documents accordingly.

CMF opposes the move to a self-declaration model, not because we wish to endorse the assessment model in its current form, but because we believe the proposed change would lead to a worse outcome. You can find our submission to the consultation here.

What this whole debate cries out for is a clear understanding of the difference between sex and gender. In the public mind, the two things are becoming synonymous. Gender ideology insists that identity is the important thing and that sex is only a social construct. Failure to rightly distinguish the two concepts will lead to problems, not least in the area of healthcare.

Biological sex is immutable – it cannot be changed. Leaving aside those (fortunately) rare intersex disorders of sexual development, sex is a biological binary – male or female – based on a person’s chromosomes, anatomy, physiology and reproductive system. For the vast majority of people, including those who may later identify as trans, biological sex is easily determined at birth and is not disputed. The trans person has at some stage come to the view, held sincerely, that their true inner identity is incongruent with their biological sex. They may choose to change their physical characteristics through sex hormone therapy and gender reassignment surgery, but their underlying sex will not be changed. The question for doctors is: can someone who is clearly male or female, reproductively, reject their biology at a certain point and thereafter be treated as though they are the same as someone of the opposite sex?

Gender is much harder to define. It is often used to describe the framework of roles and behaviours associated with men and women in a particular culture. Gender identity refers to a person’s inner, subjective sense of how their own personality, preferences and behaviours fit with the norms of their culture’s role expectations for members of their sex. Gender Dysphoria (GD) results from a perceived mismatch between a person’s biological sex and their gender identity. There is no objective test that can be used to diagnose GD. Nor is there any objective means of measurement for gender identity – it is akin to a belief, a conviction that cannot be confirmed or measured empirically.

There is a tension between gender and sex in clinical practice. A trans person’s sense of selfhood is declared in their chosen gender identity, but their sex is expressed in their given natal biology. The General Medical Council (GMC) provides advice to doctors who care for persons who do not identify as their biological sex. Under the heading ‘Confidentiality and equality’ they say:

Respect a patient’s request to change the sex indicated on their medical records; you don’t have to wait for a Gender Recognition Certificate or an updated birth certificate. Don’t disclose a patient’s gender history unless it is directly relevant to the condition or its likely treatment. It’s unlawful to disclose a patient’s gender history without their consent.

Here’s the problem with that advice: changing the sex written on their medical record does not change the sex written in their biology. Sex is not ‘assigned’ at birth but revealed by it, recognised and recorded. It is not a social construct but an empirically observable, biological truth. The GMC is asking doctors to collude in a deception – that an individual’s sex can be changed with the stroke of a pen. Of course, a trans patient’s right to be assigned the gender consistent with their chosen identity and addressed in a manner consistent with that acquired gender identity must be respected. But should that assignation be recorded under the category sex, or under a separate category of gender identity? Might it not be in the best interests of trans individuals that their medical records continue to show their natal sex, alongside a record of their preferred gender identity?

As Sarah Dahlen has pointed out, if a trans man presents to a doctor in A&E with lower abdominal pain, and his medical record does not reveal that he was born biologically female, the doctor will not consider certain possible causes of his pain. The patient may find himself being referred to a gastroenterologist when a gynaecologist is what he needs. The same man, now officially categorised as male, will no longer receive reminders to attend for regular cervical screening and must remember to book in himself. Should he forget, he might be at greater risk of cervical cancer going unrecognised. Likewise, a natal male, newly designated female as a trans woman, may be distressed to receive an inappropriate invitation to attend for a smear test, lacking the anatomy.

Biological differences between females and males have an impact on many aspects of medical interpretation. For example, reference ranges for common blood tests differ between the sexes. Retaining natal sex as a category on patient notes, alongside gender identity, would prevent doctors from being misled and avoid added stress for trans patients caused by repeatedly having to explain their situations.

Research results will be impacted by obscuring trans patients within medical records. The particular health needs of trans patients will be impossible to identify. Separation of sex from gender identity is necessary to generate accurate research data.

The Scottish Government wants to streamline the process of gender recognition for people who identify as trans. Reform of the current process is necessary, but self-declaration and the removal of biological sex from medical records is not the way to go.

Categories: Discussion