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Family planning – ‘summit of a mess’

Tue, 2017-07-18 10:25

Last week’s London Family Planning Summit was, on the surface, a ‘successful’ follow up to the 2012 Family Planning Summit, which aimed to increase access to contraception for 120 million women. US$2.5 billion was pledged by governments and other donors to ‘improve and expand the reach of reproductive health services to women and girls in developing countries’. The UK’s own Department for International Development (DFID) pledged £45 million to this fund.

In part, the need to commit extra funding has been driven by the US administration’s resumption of the so-called Mexico City Protocol that denies funding to any family planning organisation that offers or promotes abortion as a family planning strategy. This means that UNFPA and other could lose up to 47% of their funding. The Swedish Government has swung the other way and is refusing to fund any agency that doesn’t promote abortion!

The Gates Foundation has been at the heart of both summits. In an attempt to steer a low controversy, middle ground, Melinda Gates has maintained throughout that family planning does not include abortion, and that indeed, increasing access to contraception decreases the need for, and thus the incidence of, abortion.

Anne Furedi, coming from a strongly pro-abortion position, argues that this is nonsense – just look at the UK’s 200,000 abortions a year, despite high access to free contraception she argues. Contraceptives fail, women make other choices, and so abortion will always be part of the mix.

The Summit promoted the idea that family planning is vital to economic development. Reduction of family size is linked with increased prosperity, they argue. However, the evidence seems to show that it is the increased prosperity that leads to reduced family size – not the other way around.

It’s all a bit messy really, especially as the Gates Foundation’s partners in the summit include UNFPA and Marie Stope International, who are very much for abortion as part of their reproductive health strategy. And there is quite a troubling legacy in the history of many of these organisations with which many developing countries live to this day.

But abortion is not the only issue that will give Christian organisations pause for thought. While there are a spectrum of beliefs and approaches to helping families in developing countries plan and space the births of their children, all Christian groups unite around some core values. Firstly, that human life is sacred, from womb to tomb. That human sexuality is gift from God and is best expressed in marriage (one woman, one man, for life). That marriage is a core unit of family (with both biological and adopted children), and family is a core unit of society.

Around these beliefs we can work together and with other bodies. We certainly should be working with churches and church leaders to get sexual and reproductive health messages out to their congregations and communities that bring together Christian teaching and science.

Unfortunately, the community and family based focus that Christians have is at odds with the individualistic, human rights based approach of most of the family planning community. As one African commentator put it recently, this current push for family planning is another form of Western, ‘ideological colonisation’. For that reason alone, it is unlikely that much of this extra pledged funding will make its way to Christian organisations, which may be a blessing in disguise.

As we have blogged before, the population control lobby have seen reducing the size of the world’s poor populations as vital to the future development of humanity. We are seeing the legacy of this thinking now in the developed world (especially Korea and Japan), where a shrinking birth rate (and indeed, marriage and sex rate!) sees an ageing population with a rapidly dwindling working age population. Migration is mitigating that problem for Europe and America to some extent, but that also drives other social problems.

The disproportionate number of boys and young men to women, especially in China and India, also driven by the policies of the family planning community, are creating huge social problems.

Christian organisations and churches should be involved with family planning and sex education, because we have a better story to tell. That we have not told it for far too long is our failing.

Categories: Discussion

The Conway Case – a change in the law to allow assisted suicide is dangerous and unnecessary

Mon, 2017-07-17 10:14

A 67-year-old Shropshire man with motor neurone disease (MND) is seeking to overturn the law banning assisted suicide.

Noel Conway is backed by the former Voluntary Euthanasia Society (now rebranded Dignity in Dying (DID)), whose lawyers will argue that the current blanket ban on assisted suicide under the Suicide Act is incompatible with his rights under sections 8 and 14 the Human Rights Act (respect for private and family life and protection from discrimination).

The four day hearing in the high court, involving three senior judges, begins on Monday 17 July.

Mr Conway’s case is substantially the same as that of Tony Nicklinson and Paul Lamb in 2014, except that his condition is terminal.

There have been over ten attempts to legalise assisted suicide through British Parliaments since 2003, all of which have failed. The last of these was the Marris Bill in 2015 which was defeated by an overwhelming majority of 330 to 118 in the House of Commons amidst concerns about public safety.

Frustrated at their lack of success in parliament has led DID and other campaigners to pursue their agenda through the courts.

Conway is bringing his case against the Secretary State for Justice. Three other organisations have been granted permission to intervene in the case – Humanists UK (formerly the British Humanists’ Association (BHA)) on the side of Conway and Not Dead Yet UK and Care Not Killing (CNK) on the side of the defendant.

A change in the law is opposed by every major disability rights organisation and doctors’ group, including the BMA, Royal College of GPs and the Association for Palliative Medicine, who have looked at this issue in detail and concluded that there is no safe system of assisted suicide and euthanasia anywhere in the world.

Laws in the Netherlands and Belgium that were only meant to apply to mentally competent terminally ill adults, have been extended to include the elderly, disabled, those with mental health problems and even non-mentally competent children.

While in Oregon, the model often cited by those wanting to change the law, there are examples of cancer patients being denied lifesaving and life extending drugs, yet offered the lethal cocktail of barbiturates to end their own lives.

Article 8 of the Human Rights Act 1998 (Right to respect for private and family life) states (8(1)) that ‘Everyone has the right to respect for his private and family life, his home and his correspondence.’

However, this right is not unlimited but is qualified in 8(2). CNK will argue that a blanket prohibition on euthanasia and assisted suicide is ‘necessary in a democratic society in the interests of public safety for the prevention of disorder or crime, for the protection of health or morals, and for the protection of the rights and freedoms of others.’

CNK will also argue that to pursue this case in court in institutionally inappropriate given that parliament has repeatedly, rigorously and comprehensively considered this issue and decided not to change the law.

Legalising assisted suicide and/or euthanasia is dangerous because any law allowing either or both will place pressure on vulnerable people to end their lives in fear of being a burden upon relatives, carers or a state that is short of resources. Especially vulnerable are those who are elderly, disabled, sick or mentally ill. The evidence from other jurisdictions demonstrates that the so called ‘right to die’ may subtly become the ‘duty to die’.

The legalisation of assisted suicide and/or euthanasia is uncontrollable in practice because any law allowing either or both will be subject to incremental extension. We have observed in jurisdictions like Belgium and the Netherlands that over time we observe an expansion of categories to be included beyond those originally intended and without any further change in the law: a shift from terminal conditions to chronic conditions, from physical illnesses to mental illnesses and from adults to children.

The essential problem is that the two major arguments for euthanasia – autonomy and compassion – can be applied to a very wide range of people. This means that any law which attempts to limit them, for argument’s sake to mentally competent people who are terminally ill, will in time be interpreted more liberally by sympathetic or ideologically motivated ‘assisters’ and may also be open to legal challenge under equality legislation on grounds of discrimination.

The legalisation of assisted suicide and/or euthanasia is also unnecessary because requests for euthanasia or assisted suicide are extremely rare when people’s physical, social, psychological and spiritual needs are adequately met. The overwhelming majority of people with terminal illnesses, including those with MND, want ‘assisted living’ not ‘assisted suicide’.

The safest law is one like Britain’s current law, which gives blanket prohibition on all assisted suicide and euthanasia. This deters exploitation and abuse through the penalties that it holds in reserve, but at the same time gives some discretion to prosecutors and judges to temper justice with mercy in hard cases.

Leaving the law as it is will mean that some people who desperately wish help to end their lives will not have access to such a service. But part of living in a free democratic society is that we recognise that personal autonomy is not absolute. And one of the primary roles of government and the courts is to protect the most vulnerable even sometimes at the expense of not granting liberties to those who are desperate to die.

Categories: Discussion

Troubled times: Is God giving Britain over?

Thu, 2017-07-13 19:48

The rollercoaster journey of the last twelve months has left many UK citizens feeling dislocated and anxious about the future of our country.

Political events – Brexit, Trump, a snap general election, a hung parliament, confidence and supply arrangements and the Queen’s speech – have laid bare deep divisions between old and young, right and left, urban and rural. These tensions have been exacerbated by terrorist incidents in London and Manchester, plus the Grenfell Tower fire, in turn politicised and re-channelled into blame and recrimination.

There is no clear consensus emerging about how to resolve debates about ‘austerity’, security, cuts in public services, the burgeoning national and personal debt and the mode of our exit from the European Union. Our leaders also seem to lack the confidence and skills necessary to show us the way forward. Furthermore, this cultural and political deadlock has divided friends and families and toxified social media. Britain is imploding.

Alongside all this is a rising hostility to Christian faith and values. The British General Election may have turned the world of Westminster upside down, but in its aftermath evangelicalism has emerged as a key theme: the resignation of Liberal Democrat leader Tim Farron over his views on homosexuality1 and the extraordinary level of public criticism of the Democratic Unionists (DUP) for their Christian beliefs and opposition to same-sex marriage and abortion. With this resentment toward the DUP and its partnership with the Tory government has come a political resolve to extend the Abortion Act and same-sex marriage to Northern Ireland. This intensifying backlash against conservative moral values on life and sexuality betrays a conviction amongst many mainstream politicians that Bible-believing Christians ought not to hold public office.

With social policy following such a liberalised trajectory in the media and corridors of power, one wonders if there would any longer be a place for evangelical luminaries like William Wilberforce or the Earl of Shaftesbury in contemporary British politics.

It is not all one way – the recent decision of the General Pharmaceutical Council to allow scope for freedom of conscience in its latest guidelines was a welcome surprise as was the Belfast Court of Appeal decision to declare Northern Ireland’s restrictive abortion law compatible with the Human Rights Act.  But the recent decision of the British Medical Association to back the complete decriminalisation of abortion and the government’s reflex decision to fund abortions for Northern Irish women traveling elsewhere in the UK, were truly astonishing.

There are serious challenges ahead. The Queen’s Speech foreshadowed plans to combat ‘non-violent extremism’ and establish a Commission for Countering Extremism, which will ‘support the government in stamping out extremist ideology in all its forms’. Already voices such as the Evangelical Alliance have pointed out that ‘extremism’ is a slippery concept and there is no consensus about what it means. Might Christians holding biblical views on life issues and sexuality lie in its cross hairs? ‘Hate speech’ accusations and reports of ‘thought-policing’ in the public service do not bode well. The government already ‘has tried and failed in recent years to define extremism in a way that tackles terrorism and its causes without restricting freedom of ideas’.

We are living in a post-Christian society where an atheistic mindset and the ethics of secular humanism have growing influence. The myth of secular neutrality holds that this is some kind of neutral default position, unlike the ‘faiths’ of Christianity and Islam. And yet secular humanists have their own strong philosophical and ethical convictions that are based as much on ideology as evidence, and which exponents are forcing on others using political and legal mechanisms. ‘Tolerance’ once meant ‘respectful disagreement’. Now it seems to mean ‘affirm my beliefs and celebrate my behaviour or else’.

The apostle Paul, speaking of a society that had similarly turned its back on God highlighted the link between unbelief and moral decay in talking of men who ‘suppress the truth by their wickedness’, neither glorifying God nor thanking him and futile and foolish in their thinking. That generation was guilty of three ungodly ‘exchanges’. They exchanged ‘the glory of the immortal God for images’, ‘the truth of God for a lie’ and ‘natural relations for unnatural ones’. Homosexual acts were a key marker of such cultural decline – along with greed, depravity, envy, murder, strife, deceit, malice, slander, arrogance and hatred of God.

As a result, God ‘gave them over to a depraved mind, to do what ought not to be done’. Is God similarly giving Britain over? If so, we can expect these challenges to increase in coming years – and as Christian doctors and nurses the need to preach Christ and walk in his footsteps will be as great as ever.

God is our refuge and strength, an ever-present help in trouble. Therefore, we will not fear…

Categories: Discussion

A personal response to the BMA vote on abortion

Thu, 2017-07-06 09:49

I was saddened to hear that the BMA have voted to recommend the decriminalisation of abortion. Having lost a baby at 29 weeks, I know only too well the effect that these laws have on those, who like me, refuse a termination and who lose a child.

In the summer of 2015, at 23 weeks pregnant, I was admitted to hospital with a diagnosis of severe pre-eclampsia and a baby suffering from Intrauterine Growth Restriction. After many scans and tests, we were told in stark terms that the baby had a 1% chance of survival and that, in the doctor’s experience, within two weeks I would be so ill that they would have no choice but to intervene to save my life. Knowing that my husband and I were Christians, the doctor said, ‘for those with no faith the answer is easy, you terminate.’  It being a Friday afternoon he gave us the weekend to decide.

That weekend was the most distressing of my life.  It seemed an impossible decision to make: risk my life for a baby who might not survive, or terminate our already deeply loved baby.  The fact that I was being looked after in a maternity ward, surrounded by other pregnant women and new born babies, did little to help my mental or emotional wellbeing. I made a list of questions to talk to the doctor about, but the one that wouldn’t even leave my pen was, ‘and how do I live with myself?’

My husband and I decided that we would continue with the pregnancy, taking medical advice if I became dangerously ill, but also allowing the baby time to grow.  We understood that I would need to remain in hospital indefinitely.  A card with the words from Psalm 139 v16, ‘all the days ordained for me were written in your book before one of them came to be’, played a part in us understanding God’s view of our baby.

A midwife was able to reassure me that I was not in immediate danger and that my blood results were not overly concerning. She encouraged me to enjoy the time that I was spending with the baby now, to enjoy her kicks and her heart beat. These words helped us to appreciate the value of the life that the baby was already living.

The midwives were supportive of our decision not to terminate our baby, but some of the doctors regularly challenged us. Over the next four weeks, I would be subjected to many conversations advising me to terminate the pregnancy. It was clear that some were unhappy with the decision that we had made and were keen to change our minds. We were very aware of the risks that we were taking, but whilst I remained stable we did not want to intervene in the pregnancy. One of the doctors seemed so frustrated by it that she stated angrily one day, ‘Is it birth at any costs then?’

It became very distressing to constantly have to stand up to the doctors and to speak again about our reasons for not wanting a termination, especially as the predicted crisis just wasn’t happening. The baby grew slowly and we were beginning to have more hope.

Very sadly, at 29 weeks of my pregnancy, the midwife came to listen into the baby’s heart beat and there was none; our baby had died in the womb. I had to go through a natural delivery with our baby daughter, who we named Rachel Marie. The time that I spent carrying and nurturing her was very precious to us, and we are grateful that we do not have to live with the questions of ‘what if?’

Looking back over my time in hospital, I am concerned as to the amount of challenge there was of our refusal to terminate. As a society, there is much talk about a woman’s right to choose. However, when that choice is different from what the doctor has recommended, I have experienced the pressure that is exerted. I know that my mental health would have been severely affected had we chosen to terminate the pregnancy. It was most definitely the right choice for us and should have been respected.

Losing a child through miscarriage or stillbirth is a traumatic and devastating experience. However, society as a whole does not seem to understand just what has been lost. With conversations over when life begins, viability, and the legal cut off age for an abortion comes the view that this wasn’t quite a baby yet and therefore nothing to grieve over. Many parents are suffering in silence, feeling unable to speak about their loss and feeling that they must justify their sadness.

With the abortion laws has come a growing use of terminology in hospitals to distance ourselves from the growing child. I heard of a woman who had had a miscarriage who was taken into hospital for a procedure to deal with the ‘products of conception.’ However, for this mother, this was not just a collection of cells to be dealt with. From the minute the pregnancy test revealed the result she would have announced, ‘I am expecting a baby’, and indeed that was what her whole mind, body and spirit was reaching towards. It is so important that we acknowledge the extent of the loss, and this will only happen with a change in the way that the unborn child is referred to and protected.

I believe that Rachel’s life, short though it was, mattered. It mattered to us, her family and it mattered to God. He gives her worth and value. He saw her as she was growing. ‘My frame was not hidden from you when I was made in the secret place’ (Psalm 139 v15). I believe that it is only through acknowledging just how precious each of these growing lives are that we will be able to give value and dignity back to both the baby and to their parents


Categories: Discussion

Reflections on the BMA’s vote to ‘decriminalise’ abortion – ten key observations

Wed, 2017-07-05 09:00

Last week delegates at the BMA annual representative meeting (ARM) voted to support the decriminalisation of abortion. You can listen to the whole debate here and five brilliant two-minute speeches against the motion here. Two previous blog posts give the background in more detail here and here.

The opposition speakers spoke with grace, eloquence and courage but were unable to sway the meeting.

Many people may be surprised to know that abortion is still illegal in Britain. After all, there have been over 8 million abortions Britain since the Abortion Act came into being 50 years ago in 1967.

Department of Health figures for England and Wales released last month show that there were 190,406 abortions in 2016 and that 98% of these were carried out on mental health grounds. The Abortion Act was intended to be restrictive, allowing abortion only in limited circumstances, but its provisions have been very liberally interpreted by doctors so that now one in every five pregnancies ends in abortion.

So in practice, although abortion is still technically illegal, the law is widely flouted. But, nonetheless, abortion remains illegal under the Offences Against the Person Act (OAPA). The clue as to why this law exists is the name – it’s based on the idea that the baby in the womb is a person who deserves legal protection along with the mother; in other words, that both lives matter. Every abortion stops a human heart beating and that is why abortion has been treated as legally different from any other medical procedure. It takes a human life.

Anyway, here are ten observations on the vote to legalise all abortion.

  1. This change was brought about by a very small number of doctors. The BMA, Britain’s medical trade union, currently has 156,000 doctors and 19,000 medical students as members. That’s a total of 175,000.  Only 500 members, however, attended the annual representative meeting and the five parts of the six-part motion supporting decriminalisation (ii-vi below as i was uncontroversial) were backed by fewer than half of these. There were also a significant number of abstentions which were not recorded as the electronic voting devices only gave ‘yes’ and ‘no’ options leaving delegates to wave cards to abstain. I’ve appended the full voting details at the end of this article, but between 155 and 180 people voted in favour of each decriminalisation clause. This is about 0.1% or one thousandth of the total membership of BMA. Given that those who attend trade union meetings tend to be more socially liberal and left-wing in their outlook the vote can hardly be taken as representative. It is striking that over 1,500 doctors and medical students signed an open letter in just six days leading up to the vote calling on the BMA to reject the motion. This vote is reminiscent of a small number of members moving the BMA neutral on assisted suicide back in 2005. That vote produced similar outrage and was actually overturned a year later.
  1. The BMA has betrayed its own ethics and turned its back on 2,500 years of history. The Hippocratic Oath (400 BC), which all doctors used to take on graduation, gives a blanket prohibition on all abortion: ‘I will give no deadly medicine to anyone if asked, nor suggest such counsel, nor in like manner will I give a woman a pessary to produce abortion’. It is somewhat ironic that just 70 years ago in 1947 the BMA called abortion ‘the greatest crime’. The Declaration of Geneva (1948) which the BMA once affirmed, declares ‘I will maintain the utmost respect for human life from the time of conception even against threat’. So by becoming abortion’s greatest promoter and facilitator the medical profession in this country has betrayed its own historic position.
  1. This vote was carefully stage-managed. Last year the same BMA meeting agreed to do some research into decriminalisation of abortion and a 52 page briefing document was produced. This was this purported to hold an objective centre ground but was heavily supportive of decriminalisation and selective in its presentation. The document was ‘discussed’ in an almost unprecedented one hour meeting immediately prior to the debate and one attendee remarked to me that after this they felt the vote was already a ‘done deal’. It was very clear that some members of the BMA ethics committee who had contributed substantially to the report were heavily committed to decriminalisation. One, Wendy Savage, claimed to have performed 10,000 abortions personally.
  1. The debate was poorly informed and in fact actively misled. On two occasions, during the debate itself, incorrect information was given to delegates which would have affected their assessment of the issues. Several opposition delegates mentioned a ComRes poll which showed that only 1% of women wanted the abortion upper limit of 24 weeks to increase and 70% wanted to see a decrease to 24 weeks or below. In order to undermine this poll one pro-abortion delegate, Emma Runswick, gave a ‘point of information’: ‘The ComRes poll has been mentioned a number of times. I googled it and it had 2,008 people in it. 904 were men, more than 1,000 of these people were over 50, 24-34 year olds 290 of them and no under 25s. Thank you.’ The obvious intention as to undermine the poll by implying that under 25s were not asked their views. The totals of 2,008 and 904 she quoted were actually correct but 186 of these were people aged 18-24. How Runswick missed this is hard to understand as these figures were all on the same page. Another speaker, Coral Jones, responded to the point made in a prominent Canadian medical journal that Canada has become  ‘a haven for parents who would terminate female foetuses in favour of having sons’ after decriminalising abortion (see also here). Jones announced that she also had googled male/female ratios in Canada  and found them to be the same. She conveniently ignored the fact that these variations in ratios occur only in certain ethnic subgroups. This disinformation had the effect of undermining the credibility of opposition speakers who were actually telling the truth.
  1. There was huge confusion among delegates about abortion gestational limits. The most obvious, and perhaps, the only way of decriminalising abortion would be to repeal section 58 and 59 of the OAPA, which makes carrying out abortions, or supplying drugs or equipment for that purpose, illegal. This would render the Abortion Act, with all its provisions including the 24 weeks gestation limit, null and void. The fall-back position would be then the Infant Life (Preservation) Act (1929), which makes it illegal to destroy a child ‘capable of being born alive’. The problem is that this Act defines this threshold as 28 weeks, although many babies born now as early as 23 to 24 weeks will survive with good neonatal care. So scrapping the relevant sections of the OAPA would leave us with a 28 week limit. If the ILPA were also to go it would make abortion legal for any and every reason right up to term. Delegates asked the chairman of the ethics committee, John Chisholm, to clarify this but the answer of 24 weeks was given with no legal justification or explanation. Later, after the vote had been taken there was an apology from the chair of the meeting about the confusion this created. As it is, the meeting referred the matter of ‘viability’ to the Royal College of obstetricians and gynaecologists to seek their advice. But it was not clear how long that would take.
  1. The decriminalisation move was backed by a campaign run by abortion provider BPAS (British pregnancy advisory service). BPAS have specifically acknowledged that they campaign for removal of all gestation of time limits to abortion. Their CEO Ann Furedi stated categorically at the London launch of the campaign, ‘I want to be very, very clear and blunt… There should be no legal upper limit.’ Abortion providers have a huge vested interest in decriminalisation because it would mean far less accountability and scrutiny for them. It’s fully understandable why they might seek this given the fact that the Care Quality Commission (CQC) had to step in to protect women from potential harm at Mary Stopes abortion clinics last year. Their report showed doctors had been block signing consent forms, babies had been left in open beds, women were left at risk of infection, staff were not trained in how to respond to deteriorating patients and post-surgery safety checks had been completed before the surgery started.
  1.      Regulation alone, which is what the BMA is seeking, pulls any legal teeth from abortion oversight. Regulation, as opposed to legislation, would effectively leave doctors regulating themselves, and given how current guidelines are already flouted, we could only expect more of the same. Doctors are not above the law and they should be held legally accountable. We know that abortion can be used to cover up sexual crimes like rape, paedophilia, sexual abuse and incest.
  1. The BPAS campaign is titled ‘We Trust Women’ but there is no evidence that women are actually seeking a change in the law. A ComRes poll in May 2017 (see above) found that only 1% of women wanted to see the time limit for abortion extended above 24 weeks and that 70% wanted to see the abortion limit reduced to 20 weeks or below. 91% of women favoured a total an explicit ban on sex selective abortion. So women want the law to be stricter on the legality and regulation of abortion, not more lax. This whole campaign has been based on the false premise that women who seek abortions are living under the constant shadow of arrest. This is simply not true. Prosecutions are exceptionally rare – in many years there have been none at all – and in the past two years there were just two convictions both in extreme and disturbing scenarios.
  1. Decriminalisation will move Britain in a direction that has not worked in other countries. China and Canada are currently the only countries which have gone down this route and after two states in Australia did so, concerns about an increase in late abortions, abortion tourism and babies being born alive after abortion, led other Australian states not to follow suit  (see herehereand here).
  1. The move at the BMA ARM has been cynically planned just ahead of a new private member’s bill in the House of Commons. Earlier this year a 10-minute rule bill, tabled by Diane Johnson, attempted to decriminalise abortion. It passed by a slim majority but later ran out of parliamentary time. It is expected that this bill will return, quite possibly in the current private members’ ballot. We’ll know in just a few weeks’ time.

It was noteworthy that the BMA made its decision to decriminalise abortion the very same week that the Minister of women and equalities, Justin Greening, agreed to fund abortions in England and Wales for women from Northern Ireland, where it is currently illegal. The move followed a threat to place the measure as an amendment to the Queen’s speech, which could well have put the government itself at risk of a vote of no confidence at a very critical time in British history.

It’s clear that there has been a huge cultural shift within Britain in attitudes towards abortion amongst the general population, but especially amongst doctors. Sociologically, this is the consequence of the sexual revolution of 1960s which led to a huge increase in sex outside marriage, and accordingly a large increase in unplanned pregnancies. But, undoubtedly, the decline of the Christian faith and with it the view that the baby in the womb is a person made in the image of God due respect, wonder, empathy and legal protection, has undoubtedly played a part.

Some doctors have already resigned from the BMA after the vote. I will not be doing so myself, because I believe it’s best to try and fight these battles from within. Furthermore, I object to the doctors’ trade union being hijacked by a small number of activists with extreme views to achieve their ideological and political goals.

This decision could be reversed, but unless we act quickly to prevent any ensuing bill going through parliament, it may be too late. Regardless, doctors who respect human life before birth, could easily overturn the decision by bringing opposing motions next year and ensuring that they turn up in sufficient numbers to win the vote. Whether this happens not, time only will tell. However, I can’t help thinking that the real blame lies with the bulk of the medical profession who have either capitulated to the new ethic or acquiesced in silence whilst allowing others steer the ship. The church has also been largely silent.

The aim of medicine is to prevent and treat illness. Abortion, the intentional taking of human life before birth, neither prevents nor treats any illness. Pregnancy is not a disease. Abortion runs contrary to the general strategy of medicine which is why it is against all historic codes of medical ethics.

When the OAPA was first passed in 1861 it was inconceivable that doctors would ever be involved in abortion. However, now they are leading the way in the destruction of innocent human life. It is not too late to stop this, but only if we have the collective will and courage to do so.

The abortion decriminalisation motion with votes

The six-part motion (motion 50), from the BMA agenda committee, was proposed by the BMA’s City and Hackney Division and was passed in full on 27 June. Votes and percentages are shown for each clause. Abstentions were not recorded which is why the total numbers fall so short of the 500 delegates present at the ARM.

That this meeting:
i) supports the principles set out in part three of the February 2017 BMA discussion paper on decriminalisation of abortion; (Passed by 247 votes to 29; 89% to 11%)
ii) believes that abortion should be decriminalised in respect of health professionals administering abortions within the context of their clinical practice;(173 to 74; 70/30)
iii) believes that abortion should be decriminalised in respect of women procuring and administering the means of their own abortion;(155 to 91; 63/37)
iv) believes that decriminalisation should apply only up to viability in respect of health professionals; (173 to 69; 71/29)
v) believes that decriminalisation should apply only up to viability in respect of women procuring and administering the means of their own abortion;(160 to 72; 69/31)
vi) believes that abortion should be regulated in the same way as other medical treatments.(180 to 75; 71/29)

Categories: Discussion

How should Christians respond to the transgender issue?

Tue, 2017-07-04 09:10

You might think that there are few things more self-evident than the fact that human beings are divided into two distinct types, male and female. Females have XX chromosomes, female hormones, breasts, ovaries, wombs and vaginas. Males have XY chromosomes, male hormones, testes and penises. Don’t they?

But now we’re being told that gender is simply a social construct, the product of a biased society. That gender has no biological basis at all. That gender roles are being forced upon people. That it’s all simply a result of the way that people are being brought up. That gender is fluid.

When even feminist and gay icons like Germaine Greer and Peter Tatchell get called ‘transphobic bigots’ and being barred from speaking in British universities simply for expressing the view that ‘trans women’ are not real women then the situation is getting pretty serious.

We are starting to see real pressure being put on people to adopt a new ideology, use new language, affirm the beliefs of transgender people and participate in surgical and hormonal gender reassignment. Some lobby groups want these things to be legally enforced.

The problem seems to be increasing. A family doctor in a British university town recently told me, ‘I’m seeing one gender conflicted teenager every day. They’re all asking to be referred to the gender reassignment clinic in London and they are all on antidepressants. What should I do?’

There’s been a huge increase in the number of children and teenagers being referred to this clinic with numbers doubling with each passing year. The same thing is happening all over the UK and elsewhere in the Western world. This new ideology seems to be quite contagious and now schools are being accused of ‘sowing confusion’ in children’s minds by over-promoting transgender issues.

So what actually is transgender? Is a ‘trans woman’ really a woman trapped in a man’s body? Or is ‘she’ really just a man who has an unshakeable false belief that he is a woman?

As recently as 2013 doctors called this condition ‘gender identity disorder’. Many doctors, like me, feel it should still be called that. We believe that giving sex hormones and gender reassignment surgery to transgender people is not only clinically inappropriate but an abuse of professional privilege.

But some doctors, driven more by cultural pressure than scientific evidence, have changed their minds. They think we should be offering these people hormones and surgery.

So what’s going on? Let’s start by being clear on two things.

First, there is such a thing as ‘intersex’ where there are abnormalities in a person’s chromosomes, hormones or external or internal genitalia. Doctors recognise dozens of these conditions and there are fairly clear guidelines about how to treat each one. But this is not transgender. In transgender people chromosomes, hormones and genitalia are either male or female.

Second, there is a real medical condition that used to be called ‘gender identity disorder’ and is now being called ‘gender dysphoria’ (It is incidentally still called ‘gender identity disorder’ in the ICD 10). It’s very rare affecting fewer than one in 10,000 people. The affected person feels deep distress over the sex that they had been born with and tries to resolve these feelings by identifying with the opposite sex.

So this is the key question. If there is a disconnection between the body and mind, then do you shape the body to fit the mind or do you shape the mind to fit the body? Do you try to help them to become reconciled with their body through counselling and psychotherapy? Or do you give them hormones and surgery so that their body conforms to their chosen gender identity?

Well, it depends on whether you think the real problem is in the body or the mind. And I, like many other doctors, am in the latter category. I think we’re being seduced and even coerced into thinking that the body, rather than the mind, is the real problem when there is actually no scientific evidence to back that up.

Everyone can see that a woman with anorexia nervosa is not fat, but she has an unshakeable belief that she is, so she is radically dieting and regularly purging herself. How do we help someone in this situation?

Well, we certainly don’t affirm her belief that she is fat or encourage her to diet or, least of all, offer her liposuction. And yet anorexia nervosa has a lot of similarities to gender dysphoria. You have a person who is deeply dissatisfied with the body that they’ve been given and may be obsessively preoccupied and distressed by it.

A high proportion of people who suffer from gender identity disorder also suffer from other mental health conditions like depression, anxiety, substance abuse, self-harm, suicidal thoughts, personality disorders and autism (see also here and here). In many of them these problems do not resolve with gender reassignment. In fact hormones and surgery deal only very superficially with what is often a very deep psychosocial problem that doesn’t lend itself to quick technological fixes.

So how should Christians respond to the phenomenon of transgender?

First, we need to see it through the lens of creation. The Bible is unashamedly binary. Genesis 1:27 tells us that God created man in his own image – male and female. This is perfectly consistent with what we see in nature – male and female are different – genetically, hormonally and physically. Researchers have identified 6,500 genes that are expressed differently in men and women.

Next, we must appreciate that we live in a fallen world where our collective rejection of God (Genesis 3) has affected the human race at all levels – physical, psychological, emotional and spiritual – so we should expect to find conditions like intersex and transgender. People affected by these conditions are often deeply hurting and we need to treat them with the love and respect we should show to any human being made in God’s image. We are all tainted by the consequences of the fall and we are all sinners in need of God’s forgiveness.

Third, we must not capitulate to transgender ideology. Loving people does not mean affirming their false beliefs, using their chosen names, admitting them to their chosen facilities, allowing them to compete as the opposite sex in sports events and offering them hormones and gender reassignment surgery. That is not love – it’s actually a form of abuse. You might get called a transphobic bigot or worse. But the Bible, science and common sense are on your side. God created us male and female. It’s really that simple.

Fourth, we must grasp the gospel opportunity transgender presents. Jesus welcomed everyone but in so doing he did not endorse all their beliefs and behaviour. Rather he called them to repentance and faith – to a life of obedience enabled by the Spirit, to be transformed by the renewal of their minds (Romans 12:1,2). And he called them to find their identity not in their chosen gender, or anything else, but in him.

Finally, we need to get informed better about the issue.

Here are four helpful resources that can get you started:

Gender Dysphoria – CMF File 59 – Rick Thomas and Peter Saunders

True to Form – FIEC Primer Issue 03 – Various authors

Transgender – Talking Points – Vaughan Roberts

Sexuality and Gender – The New Atlantis – Lawrence Mayer and Paul McHugh

Categories: Discussion

Where have all the nurses gone? NMC survey reveals an accelerating attrition of nurses and midwives

Mon, 2017-07-03 14:12

It seems sadly ironic that a week after Lord Crisp announced plans for a global campaign to promote the value of nursing in global health and development, the UK’s Nursing and Midwifery Council announced that in the last year 1,783 more nurses and midwives have left the professions than joined for the first time in over a decade.

Inevitably this has fed into the current calls for an end to the public sector pay cap, for more certainty about the future of EU nationals working in the UK after Brexit, and to reinstate bursaries for student nurses, etc.

Dig into the figures however, and a more complex picture emerges. Not least is that this is not a new story – the concerns about training, recruitment and retention of nurses and midwives goes back several years.

First, those that are leaving in largest numbers are nurses first registered in the UK. Of the 35,000 nurses and midwives leaving the register in 2016/2017, over 29,000 were British. We have known for some time that fewer EU nationals are applying for nurse jobs in the UK, and many are leaving. However, EU nationals make up barely 4% of the nursing workforce. Filipinos, Pakistanis and Indians are a bigger proportion of the workforce, and NHS trusts are increasingly going to those countries to recruit.

However, over 85% of nurses and midwives working in the UK are British nationals. This then is not primarily a Brexit crisis, although uncertainty around Britain’s departure looks to be a minor contributory factor.

Second, among those who have been surveyed about their reasons for leaving, pay was not the primary cause. About half are leaving because of retirement, and of those leaving for other reasons, only 18% rank pay and benefits as their main reason. Working conditions, including staffing levels, were the biggest reason for non-retirees leaving the profession.

But the main reason most give for leaving is stress and finding the workload, short staffing and pressures too much to manage (44% of those leaving for reasons other than retirement).  Secondarily, many cite that not being able to give the level of care they want to because of these pressures has made it impossible for them to carry on their work. New research suggests that the prevalence of twelve hour shift patterns is adding to this unmanageable stress load. When the very nature of the system stops health professionals from feeling able to do their job properly, then questions need to be asked.

The Government says that there are more than 13,000 more nurses working on our wards than in 2010, and that there are 52,000 students in training. However, with an estimated 40,000 nursing and 3,500 midwifery vacancies unfilled in England alone, those assertions are disputed. It is therefore not too hard to see why staffing is a contributory factor in workplace pressures.

More troubling still is the profile of those leaving. The average age is 51 – that’s four years younger than the average age of leavers in 2012-2013. We have long known that we are facing a retirement cliff edge, with one in three nurses due to retire in the next decade. Thus the majority of those leaving are experienced, skilled nurses and midwives. That experience is not quickly replaced, and the attrition of experienced, skilled staff will have a real impact. The even bigger worry though, is the number of younger nurses that are leaving. This has doubled in the last three years. This means fewer staff building up the skills and experience in the long-term to replace those reaching retirement.

The other concern is the reduction in people applying to train as nurses or midwives. Since the abolition of bursaries last year, there has been a 23% drop off in applications. Anecdotal evidence suggests that tuition fees and stacking up major debts to train for a relatively low paid job is putting off many prospective students. Whether the shortfall continues past this year we wait to see, although the government remains confident that student numbers will pick up over the next couple of years. Whether there will be the funding for clinical placements for those students is another issue vexing universities.

Finally, the survey reveals that about 4,000 nurses and midwives have left the UK to work overseas, especially in Australia, the USA and Ireland. While the UK has been a net recipient of migrant nurses over the years, are we now moving towards being more of an ‘exporter’? This also highlights how internationally mobile the nursing workforce is. If the UK does not provide the best work environment, many will up stakes and move to parts of the world that offer better working conditions and pay. The NHS has to compete globally for nurses and midwives.

This is a complex issue that has been brewing for many years. As I said, it is also ironic that a parliamentary committee produced a report not twelve months ago that showed the way to improve a nation’s health, economic and social development and improve the status of women, was to invest in nursing. Despite successive British governments promising that they will do / are doing this, the evidence is stacking up that they have not really succeeded.

Where do we go from here?

We can continue to recruit from non-EU countries. While this has benefits, it also adds to the brain drain from many developing nations. The nursing workforce is globally much smaller than needed. Our struggle to recruit can only be addressed in the long-term by tackling this problem.

We could invest in training nurses and reinstating bursaries, but we were already struggling to fill nursing places before bursaries were introduced. We could scrap the 1% public sector pay cap, but this would cost the government £9 billion according to the IFS, and for now the government is ruling that out as an option.

The question is, as always, from where will the money come to pay for any or all of this? So the first issue to address is, what kind of healthcare system do we need, and how are we willing to pay for it? The answers today will be quite different to those raised at the birth of the NHS in 1948.

 Second, the core values of the nursing profession are deeply Christian in their origins. However, the increasingly technical, acute and high throughput model of medicine under which the NHS operates makes this hard to live out in practice. This dissonance between the values of patient centred, whole person care on the one hand and a technological, protocol driven medicine on the other is increasingly difficult for nurses (and other health professionals) to live with. Until we can address this dissonance and answer what kind of model of health care we really want and can deliver, we will continue to struggle with a long-term solution.

In the meantime, the church can do a lot to support its own health workers – spiritually through flexible worship and home/prayer group arrangements that take into account shift patterns and anti-social hours, and creating groups specifically for health professionals to support one another.

Churches can be sources of encouragement and thanks to the wider community of NHS staff – making sure that health professionals and other NHS staff in their communities get thanks and encouragement regularly for the work they do.

Categories: Discussion

Over 1,000 doctors reject BMA abortion decriminalisation motion – this is why

Mon, 2017-06-26 11:41

Over 1,000 doctors and medical students have signed an open letter urging the British Medical Association (BMA) to reject a motion calling for the complete decriminalisation of abortion. Also, just under 21,000 members of the public have signed a similar petition on Citizen Go.

Motion 50, which I have already reviewed in some detail, will be debated at the BMA annual representative meeting in Bournemouth at 10am on Tuesday 27 June. The debate will be streamed online via the BMA website.

The letter, titled ‘Reject motion 50’, hits out at extreme pro-abortion campaigners who have been working behind the scenes to get the BMA’s support ahead of a private member’s bill in Parliament calling for all abortion to be decriminalised.

The bill is expected to be drafted along the same lines as Diana Johnson’s radical Reproductive Health (Access to Terminations) Billwhich received some support in parliament earlier this year. At that time Maria Caulfield MP argued strongly against the bill, in a speech well worthy of study.

The doctors’ letter argues that the overwhelming majority of women do not wish to see abortion decriminalised and that if the BMA passes the motion it will not only be completely out of touch with the mood of the nation but will but will also severely damage the reputation of the medical profession.

In the last few years, polls have consistently shown that a larger proportion of women want more, not fewer restrictions on abortion. A ComRes poll in May 2017 found that only 1% of women wanted to see the time limit for abortion extended above 24 weeks and only 1% of women wanted to see the time limit for abortion extended through to birth. The same poll found that 70% of women wanted to see the abortion time limit reduced to 20 weeks or below. The poll also found that 91% of women favour a total and explicit ban on sex-selective abortion. Clearly, women want the law to be stricter on the legality and regulation of abortion, not more lax.

Last year, the Royal College of Midwives saw a major media and public backlash following their announcement that they would be supporting a campaign to introduce abortion for any reason, up to birth. Many commentators on this controversy were pro-choice but recognised that taking this position was an extreme move, and the outrage caused reputational damage both to the Royal College of Midwives and to the wider midwifery profession. If the BMA follows suit, it will risk severely damaging its reputation as a professional body.

These alone are two good enough reasons to reject motion 50 but there are many more.

First, this whole campaign is based on the false premise that women who seek ordinary abortions are living under the constant shadow of arrest. That is clearly not the case. Prosecutions are already exceptionally rare under the existing criminal provisions [section 58/59 of the Offences Against Persons Act / Infant Life (Preservation) Act] and abortion is widely available under the terms of the Abortion Act. Prosecutions are exceptionally rare—in many years there have been none at all—and in the past two years there were just two convictions, both of them in extreme and disturbing scenarios. One involved a man who had attacked a pregnant woman and caused her to miscarry and the other a woman who aborted herself at 32 weeks.

Second, decriminalising abortion would remove abortion from the Offences Against Persons Act and render the Abortion Act null and void. This would mean that anyone at all could cause the death of an unborn baby in any way whatsoever, with or without the mother’s consent, and be liable only for any damage done to the woman. Furthermore, this could happen right up until 28 weeks, the statutory age of ‘viability’ under the Infant Life Preservation Act. Babies now survive in large numbers in neonatal units from 23-24 weeks so this would mean legalising abortion for babies aged 24-28 weeks who would normally be born alive – effectively legalising infanticide.

It would also dismantle the entire regulatory framework surrounding abortion – including the need for two doctors’ signatures, the 24 week upper limit, the need for approved premises, licensed drugs, conscientious objection, reporting and accountability.  Abortions could be done for any reason, by anyone, in any way and anywhere at any gestation up to 28 weeks. So that includes sex selection abortion, abortion to cover up rape, sexual abuse and incest, do-it-yourself abortion – it would mean abortion on demand.

Decriminalisation would also aggravate the problem of amateur or backstreet abortion and would surely lead to a huge increase in the availability, circulation and use of abortifacients. It would facilitate the procuring and supply of abortion pills, whether by women (including teenagers), who could lawfully take them and/or pass them round to their friends and acquaintances, or by men, not least those who have impregnated women and who would ‘encourage’ those women to take them.

Third, the tide is turning against decriminalisation in jurisdictions where it has been tried and found wanting. It appears that the abuses that have been seen in the two Australian states that decriminalised abortion previously (Victoria, 2008 and Tasmania, 2013) have made it clear to politicians and wider society that radical laws should not be more widely adopted.

Both New South Wales and Queensland have more recently rejected moves to decriminalise.  In fact, there are now moves underway to repeal the law in Victoria because of the problems there – an increase in the number of later abortions and abortion tourism (see here, here and here).

No decriminalised abortion model has yet shown to provide accurate abortion statistics. In jurisdictions like Canada and the states of Victoria and Tasmania, where abortion is decriminalised and largely deregulated, abortion data collection is unreliable or simply not recorded in any meaningful way. Canada, for example, recorded a 40% drop in the number of abortions between 2004 and 2010, due to a lack of data being reported by abortion practitioners. That said, all the current anecdotal evidence (see herehere and here) indicates a big increase in terminations post-24 weeks and a host of other problems such as a very sharp increase in babies born alive following termination.

Sex selection abortion is also fuelled by decriminalisation. In 2012 the Canadian Medical Journal reported that easy access to abortion and advances in prenatal sex determination have combined to make Canada a haven for parents who would terminate female fetuses in favour of having sons, despite overwhelming censure of the practice. A 2006 investigative report entitled ‘Canada’s lost daughters’ has highlighted how sex selection abortion has impacted on male female ratios in certain ethnic communities. In Brampton, Sikh areas had 109 boys to 100 girls and areas around Chinatown showed ratios of 108 boys to 100 girls.

Fourth, decriminalisation would remove scrutiny from private abortion providers at a time when they are increasingly under the spotlight. Perhaps this is why they are leading the charge for it. The majority of abortions in the UK take place at private abortion providers and recently, severe and repeated malpractice has been discovered.

In August 2016, the Care Quality Commission (CQC) had to step in to protect women from potential harm at Marie Stopes abortion clinics and their report in December showed doctors had been bulk-signing abortion consent forms, babies remains had been left in open bins, women were left at risk of infection, staff were not trained in how to respond to deteriorating patients and post-surgery safety checks were being completed before the surgery started.

An investigation by a national newspaper revealed in March 2017 that practices that concerned CQC inspectors are continuing at Marie Stopes clinics, with, for example, abortions being signed off by call centre workers with no medical training after discussions which were as short as 22 seconds.

Already within our current legal framework we have seen doctors pre-signing abortion forms, gender-selective abortions being offered, live babies being left to die following abortions that have gone wrong and children with minor disabilities, such as cleft palate, being aborted. In this context, where the current law is supposed to be preventing such appalling practices, the thought of allowing abortion, on demand, up to 28 weeks or even birth, is seriously worrying. If these kinds of breaches in patient safety protocols are occurring under the current law and close inspection of clinics, what would happen if all legal restrictions are lifted from abortion practice?

But fifth, and finally, the decriminalisation campaign ignores the key fact that abortion is not like other healthcare procedures because it involves the intentional taking of another human life. This is precisely why the law has always treated it differently from regular medical procedures, and continues to do so.

The Offences against the Person Act, like many of our country’s laws, was originally based on the Judeo-Christian ethic which forbids the taking of innocent human life on the basis that all human lives are made in the image of God.  It treats abortion in the same way as murder – that is, as a crime punishable by life imprisonment.

Not many people know that abortion is also against historic codes of ethics like the Hippocratic Oath, the Declaration of Geneva (1948) and the International Code of Medical Ethics (1949) or that in 1947 the British Medical Association itself called abortion ‘the greatest crime’. Ironic indeed!

There are many good reasons for the BMA to give this decriminalisation motion short shrift on Tuesday. Let’s hope that it does so.

Categories: Discussion

Good news for freedom of conscience in the UK

Mon, 2017-06-26 11:21

For some time we have been concerned at CMF about a possible weakening of conscience protection for pharmacists in the UK.  In December 2016 the pharmacy regulator, the General Pharmaceutical Council (GPhC), issued new draft standards and guidance that changed a previous ‘right to refer’ with a ‘duty to dispense’.  The GPhC admitted at the time that removing the right to refer represented ‘a significant change’.

During a consultation on this draft guidance, CMF and others had meetings with the GPhC, and many individuals and organisations wrote to the GPhC expressing concern about their failure to recognise conscience rights. Dr Peter Saunders warned in a blog post that the draft proposal to remove pharmacists’ conscience rights was ‘disproportionate, unethical, unnecessary and quite possibly illegal’.  We were also concerned that the changes could have prevented Christians from pursuing a career in pharmacy altogether. Other health professionals feared that if such changes were implemented by the GPhC it could have repercussions for freedom of conscience for doctors and nurses in the longer term.

So it has come as something of a relief to see the final guidance issued on 22 June 2017 by the GPhC: ‘In practice: Guidance on religion, personal values and beliefs.’

The new guidance should be read alongside the Standards for pharmacy professionals that all pharmacy professionals must meet.  Standard 1 says: ‘Pharmacy professionals must provide person-centred care.’ The new guidance for Standard 1 emphasises at the outset the need for: ‘ensuring that person-centred care is not compromised because of personal values and beliefs’ (p5), however the guidance also makes it clear that: Pharmacy professionals have the right to practise in line with their religion, personal values or beliefs’ (p7). The guidance clarifies that under Article 9 of the European Convention on Human Rights (ECHR) a pharmacist’s right to freedom of thought, conscience and religion is protected.

This is a marked shift in tone and emphasis from the draft guidance that had so concerned us.

The new guidance puts the legal framework at the beginning, unlike the draft where it consisted of one brief page towards the end, with the sole legal precedent cited in draft guidance being the British Equality Act 2010.  As well as Article 9 of the ECHR, the final guidance also cites the Equality Act, which protects individuals from direct and indirect discrimination and harassment because of nine ‘protected characteristics’, including religion or belief.

Crucially, there is now clear recognition that referral to another service provider is still an option: ‘We want to be clear that referral to another health professional may be an appropriate option, and this can include handover to another pharmacist at the same, or another, pharmacy or service provider.’ (p8).

So individual pharmacists should still be able to refer customers to other pharmacists if they request, for example, abortifacient drugs such as the morning after pill, or hormone blocking drugs which are used by transsexual patients.

The new guidance for pharmacists is now similar to the General Medical Council’s Good Medical Practice guidance for doctors. The GMC guidance permits doctors to: ‘opt out of providing a particular procedure because of [your] personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients’ (para 8). In such situations, a doctor must ensure the patient understands his/her right to see another practitioner and must: ‘Make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection as you.’ (para 12).

Many conscientious objectors find even referral unacceptable, and consider that a referral is effectively participating in, or complicity with, the procedure to which they are objecting.  For doctors there is no legal obligation to refer under the GMC guidance (see here for more detail) as long as enough information is given to the patient to arrange to see another doctor.  The GPhC guidance suggests it is probably similar for pharmacists. It states (my emphasis added):

Pharmacy professionals should use their professional judgement to decide whether a referral is appropriate in each individual situation, and take responsibility for the outcome of the person’s care. This includes considering the impact of their decision on the person asking for care, and meeting their legal responsibilities.

There are a number of factors for pharmacy professionals to consider when deciding whether a referral is appropriate in the circumstances. In particular, pharmacy professionals should make sure:

  • people receive the care they need as a priority
  • people are provided with all the relevant information to help them access the care they need, and
  • people are treated as individuals, fairly and with respect’ (p8).

Rightly, the guidance for pharmacists also emphasises the importance of openness and sensitive communication with colleagues and employers:

‘Pharmacy professionals should also:

  • Tell their employer, as soon as possible, if their religion, personal values or beliefs might prevent them from providing certain pharmacy services, and
  • work in partnership with their employer to make sure adequate and appropriate arrangements are put in place

I have written in more detail elsewhere about the importance of clarifying carefully with colleagues the extent of involvement in controversial procedures, to avoid potential future conflict and to negotiate reasonable accommodation for exercising freedom of conscience.

Encouragingly, in a statement accompanying the publication of the new guidance, the Chief Executive of the GPhC, Duncan Rudkin, highlighted the positive contribution pharmacists’ faith can make in their position of care:

We recognise and respect that a pharmacy professional’s religion, personal values and beliefs are often central to their lives and can make a positive contribution to their providing safe and effective care to a diverse population.

This new guidance represents a victory for freedom of conscience. It reflects a rebalancing from the draft which now takes on board the rights of pharmacists and the need to balance those with the rights and best interests of service users.

Nevertheless, I suspect that the change from the draft may well have primarily been due to the legal protection for freedom of conscience provided by the EA and ECHR, and without that welcome protection pharmacists who do not wish to dispense treatment for moral reasons would be in a very difficult and different situation now. Steve Fouch has written here that we are already seeing an erosion of the freedom of conscience for nurses and midwives in the UK, which is part of a bigger threat worldwide to undermine freedom of conscience. Toni Saad has recently warned that there is ample cause for concern; the momentum is not on the side of conscience. But for now, we can be grateful this guidance respects the right of pharmacists to refuse to engage in certain procedures which violate their most profound moral convictions.

Categories: Discussion