Monday, 24 July 2017

Why the rush to change blood donation deferral policies for men who have sex with men?

Commercial sex workers and men who have sex with men (MSM) in Britain and Scotland are to be allowed to donate blood three months after they last had sex (see also here, here and here).

The rule changes will come into force at blood donation centres in Scotland in November and in England in early 2018.

The Government accepted the recommendations of the advisory committee on the safety of blood, tissues and organs (SaBTO) and are introducing the changes under ‘equalities reforms’.

The rule change will allow more people to donate blood without compromising blood supply safety, experts say.  

Gay rights advocacy groups have praised the move as a triumph for science over prejudice and stigmatisation. Education Secretary Justine Greening (who is herself ‘gay’) has said the changes ‘would build on the progress made in tackling prejudice in the 50 years since the partial decriminalisation of homosexuality’.

All blood that is donated in the UK undergoes a mandatory test for HIV, Hepatitis B and C, and some other viruses.

During the HIV/AIDS epidemic of the 1980s, most of the developed world instituted a permanent ban on blood donations from men who have sex with men (MSM). This is because of the high risk of transmission from sex practices, such as anal intercourse, which are used in high frequency by this group.

People do not easily forget the 'tainted blood scandal', where around 4,670 British haemophiliacs were infected with Hepatitis C - and a further 1,243 co-infected with HIV. More than 2,000 people have died because of their HIV and Hepatitis C infections, while many others are terminally ill.

They were infected through contaminated clotting factor products, which were supplied by the National Health Service in the 1970s and 80s.

International comparisons

In recent years, countries around the world have revised their blood donation policies regarding gay and bisexual men, and other men who have sex with men (MSM).

As of 2015, Austria, Germany and Belgium still had lifetime bans for MSM who wish to donate blood.

The lifetime ban on MSM donating blood was lifted in 2011 in England, Scotland, and Wales, and in 2016 in Northern Ireland and was replaced with a one-year deferral period for sexually active MSM.

The United States lifted the lifetime ban on MSM from donating blood in 2015, replacing it with a one year deferral policy allowing MSM to donate if they abstain from sex for 12 months.

Other countries followed suit, while Italy and Spain have implemented deferral policies based on individual risk assessments regardless of sexual orientation.

Canada reduced its lifetime deferral for MSM to five years in 2013 and to one year in 2016.
Japan, the Netherlands, Australia and New Zealand all have one-year deferrals for MSM blood donation.

In Italy and Spain, donors are screened for high-risk sexual behaviour regardless of the sex of their partners or their sexual orientation. Deferrals are made based on individual risk.

But thus far no one has adopted a three month policy.

The American Red Cross policy is especially sobering:

‘If you ever tested positive for hepatitis B or hepatitis C, at any age, you are not eligible to donate, even if you were never sick or jaundiced from the infection. You should not give blood if you have AIDS or have ever had a positive HIV test, or if you have done something that puts you at risk for becoming infected with HIV. You are at risk for getting infected if you… are a male who has had sexual contact with another male, in the last 12 months’

Scientific basis

Britain’s proposed new policy does have a scientific basis. The nucleic acid test (NAT) used to screen blood can detect HIV in just 9–11 days after infection. New technological advances greatly decrease the risk of HIV-infected blood escaping detection; however, they cannot completely eliminate the risk of HIV in the blood supply. Therefore, NAT technology should be used in conjunction with comprehensive individual risk assessments that can adequately screen potential donors for low- and high-risk sexual behaviours.

It is important to keep this in context. The risk of getting HIV from a blood transfusion is lower than the risk of getting killed by lightning. Only about 1 in 2 million donations might carry HIV and transmit HIV if given to a patient.

The risk of having a donation that carries hepatitis B is about 1 in 205,000. The risk for hepatitis C is 1 in 2 million although if you receive blood during a transfusion that contains hepatitis, you'll likely develop the virus.

But the cost of infection is great and just one infection would be a tragedy.

Are we applying the same risk management principles in all areas of population health or do we make a special case of leniency when it involves the LGBT lobby I wonder? I raised similar questions about the speed at which approval the HIV prevention drug PrEP was railroaded through late last year.

Reason for caution

I argued back in 2011 that allowing sexually active gay men to donate blood was simply not worth the risk and would recommend that readers revisit that article.

Whilst detection technology has moved on one has to question why going down to a three month deferral period after last sexual contact for both men who have sex with men and commercial sex workers is necessary now given that NHS Blood and Transplant have said there is not currently a shortage of blood in the UK.

Also given that MSM make up just a tiny proportion of the UK population and that far fewer of them will abstinent from sex for a three month period, what is the urgency with this measure?

It would seem sensible to err on the side of caution rather than rushing into this especially given that the majority of the international community are being much more cautious.

The push for this seems to be coming much more from gay rights advocacy groups like the National AIDS Trust and Terence Higgins Trust rather than from any pressing need. And it seems that the aim to avoid stigma for gay and bisexual men is the main driver rather than to address any real clinical priority.

People will be reluctant to question the policy in these circumstances for fear of being accused of discrimination but the powerful media support for this relatively insignificant story speaks volumes about just how powerful the gay rights advocacy media machinery is and the level of priority the mainstream media, and especially the BBC, gives to its stories. 

Boots chemist should not have capitulated to pressure from BPAS over emergency contraception

Last night I waded into the debate on whether Boots should reduce the price of the so-called ‘morning-after pill’ and criticised the high street chemist for ‘capitulating in the face of political pressure’. 

Let me explain why.

Boots had originally defied calls to slash the price of ‘emergency contraception’ – with its chief pharmacist saying it did not want to ‘incentivise inappropriate use’.

But late on Friday night Boots released a statement to say it was ‘truly sorry’ about its ‘poor choice of words’, and was looking at cheaper alternatives (see here, here, here, here and here).

The about-face was the result of a high-level campaign on social media by abortion provider BPAS and a group of 35 Labour women MPs.

It all began when BPAS (the British Pregnancy Advisory Service) wrote to Boots’ head pharmacist, Marc Donovan, pointing out that generic versions of the Levonelle brand of emergency hormonal contraception can be bought cheaply by pharmacies and can retail for as little as £5.50 in France. By comparison, Boots charges £26.75 for its own version.

Mr Donovan wrote back to say that if Boots did make the pill cheap it could be ‘accused of incentivising inappropriate use’.

This led to an explosion on social media from Labour women MPs calling for women to boycott the chemist and forcing Boots to back down.

I have three main concerns about this whole furore.

First, public policy decisions about women’s health should not be made on the hoof after twitter rants especially when these are strongly ideologically motivated. They should rather be made after proper and robust debate on the facts. The knee-jerk assumption of most people is that making emergency contraception readily available either free or cheap over the counter without prescription will reduce unplanned pregnancies and safeguard women’s health. In fact there is no evidence to suggest that this is actually true (see below).

This latest broadside needs to be seen for what it is – part of a high level campaign by  abortion industry leader BPAS – which receives £30miliion of taxpayers money annually – to advance its agenda of abortion on demand up to birth and free contraception for all. They are prepared to bully, blackmail and boycott to achieve their agenda and sadly few are willing to stand up to them. If MPs wish to influence pharmacy practice they should raise it in the House of Commons in a responsible way, not form a social media lynch mob.

Second, all the evidence suggests that ready availability of emergency contraception does nothing to reduce abortion rates and actually increases rates of sexually transmitted diseases.

For a start levonelle is not 100% effective in any given case.  Its success rate is relatively low (95% within 24 hours of sexual intercourse, 85% from 25-48 hours and 58% from 49-72 hours). 

A 2012 study in Washington State showed that free access to emergency contraception caused a statistically significant increase in STI rates (specifically gonorrhoea rates) and no change in birth and abortion rates.

The results were almost identical to those of a British study published in the Journal of Health Economics (full text) in December 2010 and reported in the Daily Telegraph in January 2011. (See my previous blogs on this here and here).  The researchers found that rates of pregnancy among girls under 16 remained the same, but that rates of sexually transmitted infections increased by 12%.

In fact, in a systematic review published in 2007, twenty-three studies published between 1998 and 2006 measured the effect of increased EC access on EC use, unintended pregnancy, and abortion. Not a single study among the 23 found a reduction in unintended pregnancies or abortions following increased access to emergency contraception (see also fact sheet here).

The phenomenon whereby applying a prevention measure results in an increase in the very thing it is trying to prevent is known as ‘risk compensation’. The term has been applied to the fact that the wearing of seatbelts does not decrease the frequency of some forms of road traffic injuries since drivers are thereby encouraged to drive more recklessly. In the same way ready access to emergency contraception encourages young people to take more risks and can also be used as a tool by abusers to negotiate for sex.

In 2015 the total number of new STI diagnoses in England was 434,456. This included more than 129,000 diagnoses of chlamydia (a major cause of infertility) in 15-24-year-olds.  Young females are more at risk of a diagnosis than young males. The male diagnosis rate among 15 to 19-year olds was 824.4 per 100,000 population and 1,693.8 among 20-24-year-olds compared to 2,436.8 among 15 to 19-year-old females and 2,557 among females aged 20-24. Gonorrhoea is also most common among the 20-24 age group, with a rate of 269.5 per 100,000 population.

So making the emergency contraceptive pill available over the counter free or cheap, without prescription, is sadly an ill-conceived knee-jerk response to Britain’s spiralling epidemic of unplanned pregnancy, abortion and sexually transmitted disease amongst teenagers. It is also not evidence-based.

Third, the emergency contraceptive levonelle is already available free from Brook centres, some pharmacies , most sexual health clinics, most NHS walk-in centres,  most GP surgeries and some hospital accident and emergency (A&E) departments. For pharmacies it is a free market. Boots’ own  price tag was based on the cost of the medicine and the regulated mandatory consultation with the pharmacist. It is surely only fair that as a retail pharmacy they don’t compromise or undervalue this professional service.

It is regrettable that Boots has capitulated in the face of political pressure and failed to support its chief UK pharmacist in his legitimate concerns over incentivising the inappropriate use of emergency contraception. It is settled science that making so-called emergency contraception more easily available does not reduce pregnancy rates in a population and actually raises rates of sexually transmitted diseases. 

By appeasing this cartel of radical feminist MPs Boots is encouraging more reckless sexual behaviour and thereby exposing young people to an increased risk of sexually transmitted infections. They are also encouraging MPs and sections of the media to force changes in medical practice through bullying, name calling and blackmail rather than sound evidenced-based argument. The same campaign is going to target Lloyd’s Pharmacy next. This is bad medicine, bad leadership and bad public policy.

But perhaps the most frightening aspect of this whole episode is the deafening silence of other sitting MPs at Westminster who by their failure to speak out have signalled complicity with both process and practice.

The best way to counter the epidemic of unplanned pregnancy and sexually transmitted disease is to promote real behaviour change. The government would be well advised to enter into dialogue with leaders of communities in Britain where rates of sexually transmitted diseases and unplanned pregnancy are low, especially Christian faith communities, to learn about what actually works.

Church-based programmes such as Love for Life (Northern Ireland), Love2last (Sheffield), Challenge Team, Romance Academy or Lovewise (Newcastle) are getting great results and have much wisdom to pass on.

Sunday, 16 July 2017

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

Watch my Sky News interview on the Conway case here.

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.E+W+S+N.I.

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 is 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 there is 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 the desperate.

Friday, 14 July 2017

Troubled times - Is God giving Britain over?

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 four terrorist incidents in London and Manchester, plus the Grenfell Tower fire, in turn politicised and rechanneled 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 political 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 homosexuality 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’ (see here and here). 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’.
The metropolitan liberal elite seem less tolerant of opposing views and more likely to believe that those with alternative convictions must be either evil or unenlightened or both. Former UKIP leader Nigel Farage has remarked, ‘We are bringing up a generation to believe there is only one acceptable view on every issue… Schools are terrified of saying or teaching anything that might be considered inflammatory. Kids think people don’t have the right to opposing opinions. It’s Orwellian!’
We are living in a post-Christian society where an atheistic mind-set 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 which 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 – along with greed, depravity, envy, murder, strife, deceit, malice, slander, arrogance and hatred of God – were a key marker of such cultural decline (Romans 1:18-32).
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 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…’ (Psalm 46:1,2)
Editorial from the Summer 2017 edition of Triple Helix, the magazine of Christian Medical Fellowship 

Monday, 3 July 2017

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

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 in 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.

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 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.

2.       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.

3.       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 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.

4.       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 20 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 in the report. 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 one to one. She conveniently ignored the fact that these variations in ratios noted in the journal occurred only in certain ethnic subgroups. This disinformation had the effect of undermining the credibility of opposition speakers who were actually telling the truth.

5.       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.

6.       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 Marie 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.

7.       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.

8.       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 laxer. 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.

9.       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 herehere and here).

10.   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 or 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)

Friday, 30 June 2017

How should Christians respond to the transgender issue?

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

Sunday, 25 June 2017

Over 1,000 doctors reject BMA abortion decriminalisation motion 50 – this is why

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.