Friday, 26 January 2018

Baroness O’Loan’s Conscientious Objection (Medical Activities) Bill deserves our full support

As Christians, we are called to respect the governing authorities as they are instituted by God himself (Romans 13:1,2). But are there limits? What should we do if they try to force us to do something we believe is wrong?

The ‘Free Conscience’ campaign, launched this week with the backing of many Christian groups, supports Baroness O’Loan’s Conscientious Objection (Medical Activities) Bill which passed its second reading (debate stage) in the House of Lords on Friday 26 January. It is now set for a Committee of the Whole House where amendments can be submitted and debated. If it then passes a third reading it will pass to the House of Commons.

The bill aims to strengthen the conscience rights of healthcare professionals who believe it would be wrong to be involved in three specific activities – abortion, activities under the Human Fertilisation and Embryology Act 1990 (like embryo research or egg donation) and withdrawal of life-preserving treatment.

Currently, the law offers general conscience protection. The Equality Act 2010 includes religion and belief as two of nine ‘protected characteristics’ and the Human Rights Act 1998, which brought the European Convention of Human Rights (ECHR) into UK law, states that ‘everyone has the right to freedom of thought, conscience and religion’ (article 9). But these rights are limited.

When it comes to specific protections the situation is much less clear and statute law currently only applies to abortion and activities under HFE Act. For abortion its scope is very limited.

In 2014 the Supreme Court ruled that two Glasgow midwives, who were working as labour ward coordinators, could not opt out of supervising abortions. It said that the conscience clause in the Abortion Act 1967 only applied to those who were directly involved in abortion and not to those involved in delegation, planning, supervision and support. This left many health professionals vulnerable to coercion.

Overall 25 peers spoke in the debate – 13 for and 11 against with the government responding. Labour health spokesperson Baroness Thornton made it clear that the Labour party would oppose the bill and Liberal Democrat Baroness Barker said that most of her party colleagues shared her strong opposition also. The government itself will allow a conscience vote.

The major arguments against the bill were that it expanded the scope of the conscience clause to cover health professionals only indirectly involved in the activity concerned and expanded the number of activities protected. This, they claimed, would hinder access to patient care. Several peers also suggested that there should be a duty for professionals claiming conscience protection to refer the patient to someone who would comply.

Supporters of the bill will need to address these specific concerns convincingly at committee stage if the bill is to proceed.

As Christian citizens we must respect those who rule over us but the Bible is equally clear that if discriminatory laws are passed, and obeying such laws involves disobeying God, then our higher duty is to obey God. If you love me you will obey me, says Jesus (John 14:15).

When the King of Egypt ordered the Hebrew midwives to kill all male Hebrew children they refused to do so and God commended and rewarded them (Exodus 1:15-22).

A fiery furnace did not stop Shadrach, Meshach and Abednego refusing to bow down to the image of the king and a lions’ den did not deter Daniel from persisting with public prayer (Daniel 3:16-18, 6:1-10).

When Peter and John were commanded by the Jewish authorities not to preach the Gospel they replied, 'We must obey God rather than men' and continued to do it (Acts 5:29).

Of course, we should also do our best to oppose the passing of laws which seek to criminalise normal Christian behaviour which is what Baroness O’Loan’s bill is all about. We can thank God that in Britain we still have the democratic right to participate in shaping public policy.

Freedom of conscience is not a minor or peripheral issue and it is not only Christians who are affected. It goes to the heart of healthcare practice as a moral activity. Current UK law and professional guidelines respect the right of doctors to refuse to engage in certain procedures to which they have a conscientious objection.

The right of conscience helps to preserve the moral integrity of the individual clinician, preserves the distinctive characteristics and reputation of medicine as a profession, acts as a safeguard against coercive state power, and provides protection from discrimination for those with minority ethical beliefs.

It is worth fighting for. Christians can get involved through the Free Conscience website which will tell you how to contact your MP and encourage them to support the bill. But it will first need to clear the House of Lords.

Sunday, 21 January 2018

My big 60th birthday challenge - running the London Marathon for Sightsavers

I'm running the London Marathon on 22 April this year for Sightsavers because they excel in preventing and treating blindness. 

If you’d like to support me my donations page is here.

As a general surgeon who has served in a Kenyan mission hospital I've witnessed first-hand the devastating damage that blindness can do to individuals and communities but also realise how effective, and relatively cheap, preventive and curative measures are. 

As CEO of Christian Medical Fellowship I'm deeply committed to healthcare in the developing world.

I turn 60 this February so would like to celebrate that by running to support this great charity. This will be my sixth London marathon since my wife and kids told me (with good justification) in my mid-40s that I was going to seed so I am indebted to them that I can still run.

In five previous marathons between 2004 and 2014  friends and colleagues have generously helped me to raise over £25,000 for Whizz Kidz, Alzheimer's Society, Down's Syndrome, Help the Hospices and Christian Blind Mission.  

Would you partner with me in raising another £5,000 to help Sightsavers protect and restore sight in developing world communities? 

Donating through JustGiving is simple, fast and totally secure. 

Wednesday, 17 January 2018

Conway assisted suicide case – autonomy is not absolute and this latest appeal should be dismissed

Watch my previous Sky News interview on the Conway case here and listen to my radio interviews on BBC Shropshire and Coventry.

A 68-year-old Shropshire man with motor neurone disease (MND) who wants help from doctors to kill himself has been granted permission to appeal an earlier decision rejecting his case. 


The judgement (see here) was handed down today (18 January 2018) following an oral hearing at the Royal Courts of Justice. 

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

Following a four-day hearing in the high court last July three senior judges dismissed Conway’s case on 5 October (judgement here). They summarised their conclusions as follows:  

'It is legitimate in this area for the legislature to seek to lay down clear and defensible standards in order to provide guidance for society, to avoid distressing and difficult disputes at the end of life and to avoid creating a slippery slope leading to incremental expansion over time of the categories of people to whom similar assistance for suicide might have to [be] provided... we find that section 2 (of the Suicide Act 1961) is compatible with the Article 8 rights (private and family life) of Mr Conway. We dismiss his application for a declaration of incompatibility.'

The Divisional Court refused permission to appeal, so Mr Conway then filed an application in the Court of Appeal seeking permission directly. This has now been granted.

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.

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

In the last hearing Humanists UK (formerly the British Humanists’ Association (BHA)) intervened 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). Following this principle CNK and others argued that a blanket prohibition on euthanasia and assisted suicide was ‘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.’

They also argued that to pursue this case in court was 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.

This issue has been considered exhaustively by parliaments and courts in the UK and is settled. While having every sympathy with Mr Conway's personal plight the consequences for society are too dangerous and far-reaching. I hope that the Court of Appeal will stand by the previous high court judgement and dismiss his case. 

Friday, 12 January 2018

A Christian framework for medical ethical decision-making

How should Christians make ethical decisions? Should we use secular decision-making systems that are deontological (rule-based) or consequentialist (outcome based)? Or can we derive an ethical framework from the Bible?

Christians are called to imitate God (Ephesians 5:2), imitate Christ (1 Corinthians 11:1) and to walk as Christ walked (1 John 2:6). We are to be holy because God himself is holy (Leviticus 19:2; I Peter 1:16).

We might say that this is impossible but we forget three things – that through Jesus death and resurrection God has granted us repentance (Acts 5:31), given us a new nature (2 Corinthians 5:17) and placed the Holy Spirit within in us to empower us to live lives which are pleasing to him (Romans 8:9-11). This is why it is possible for us both to ‘put off’ ungodly thoughts and actions and to ‘put on’ godly attitudes and behaviours (Ephesians 4:22-24).

So how are we then to make Christ-like ethical decisions? I would suggest that doing so involves four elements: sharing the mind of Christ, holding the commands of Christ, showing the character of Christ and carrying the cross of Christ.

Let’s consider each of those in turn.

Sharing the mind of Christ

To share the mind of Christ, we first need to have a Christian worldview. We need to think about the world in the way that Jesus does and in the way the Bible teaches; in terms of creation, fall, redemption and future hope.

We are created by God in his image for an eternal relationship with him. But we have also, individually and collectively, fallen from grace. We are sinful and this sin has every aspect of our beings; our bodies, our emotions, our relationships, and our moral decision making. We are masterpieces created by the grand master, but we are flawed masterpieces in need of redemption.

God has initiated his great plan of redemption through his dealings with Israel and ultimately through the sending of his Son Jesus Christ, through whose death and resurrection we can be reconciled to God through repentance and faith.

We now have a hope that is certain, guaranteed by God himself, that we can have confidence for the day of judgment because of what Jesus has done for us, and will live together with God and fellow believers forever in God’s presence in a new heaven and new earth.

Sharing the mind of Christ involves having that linear view of history and that confidence about the future. 

Holding the commands of Christ

Holding the commands of Christ means being guided by his word in the way we make ethical decisions. Jesus said that if we love him we will obey his comands (John 14:15, 15:14). But what are his commands?

What starts in the Old Testament as the Old Covenant, the Ten Commandments and the 613 laws of the Pentateuch is, of course, a shadow prophetically pointing to the person of Christ, who will be the only one who is able to fulfil them (Colossian 2:17; Hebrews 10:1).

In the New Testament, specifically in the Sermon on the Mount (Matthew 5-7), we see Christ going beyond the mere external legalities of Old Testament law to the very spirit of love that underlies it. 

He says (Matthew 22:37-40) that the most important commands in the law are to love God with all one’s heart, soul, mind and strength (Deuteronomy 6:5) and to love one’s neighbour as oneself (Leviticus 19:18).

Jesus also gave his disciples a new commandment, to love one another as he had loved them (John 13:34,35).

But we are told that all Scripture is inspired (literally breathed) by God and profitable for teaching, correction, reproof and training in righteousness (2 Timothy 3:16,17). So, we need to work hard at deducing biblical ethical principles to apply to today’s ethical dilemmas.

Here are some key biblical principles:

Stewardship: we are given skills and abilities, not in order to exploit the earth, but to be its vanguards and its stewards, caring for the earth and for each other in the same way that God would care (Genesis 1:26). We are God’s delegated vice-rulers. This obviously applies to the scientific knowledge and technology that he has given to us. In fact, we see the beginnings of science, in Adam naming the animals (taxonomy) (Genesis 2:19,20) and technology with Jubal and Tubal-Cain developing musical instruments and metal tools (Genesis 4:21,22).

The sanctity of life: every human being is precious in God’s sight because every human being is made in the image of God (Genesis 1:27). It is because of this that human beings cannot be unjustly killed (Exodus 20:13; Deuteronomy 5:17). God will hold us accountable for the shedding of innocent blood (Genesis 9:5,6).

Chastity: sexual faithfulness. As we learn, ultimately, in the New Testament, the pattern of ‘one man, one woman, for life’ (Genesis 2:24) is a beautiful picture or metaphor of Christ’s marriage with the Church (Ephesians 5:31,32) and points, eschatologically, to the New Jerusalem, and the new Heaven and the new Earth (Revelation 22:17).

Veracity: the telling of truth (Exodus 20:16; Leviticus 19:11; Deuteronomy 5:20), because God is truthful and tells no lies (Numbers 23:19; Titus 1:2).

Justice: both at an individual and corporate level, so that vulnerable people are protected from exploitation. So much of the Old Testament law, of course, is about guarding the weak (Proverbs 31:8,9).

Grace: giving people what they don’t deserve (Matthew 5:43-48).

Mercy: not giving people what they do deserve, so that we are called to share the mind of Christ, both from a worldview and ethics (Micah 6:8).

Having the mind of Christ and keeping the commands of Christ are crucial, but we are also called to show the character of Christ because Christian ethics is not just about what we do, but also about how we do it. 

Showing the character of Christ

This brings us back to Plato’s idea that in order to act virtuously, one has to be a virtuous person. One can only act virtuously, in a Christian sense, by being born again, and then transformed by the Holy Spirit so that one develops the fruit of the Holy Spirit: love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control (Galatians 5:22,23).

It is one thing to know the right thing to do. It is something else altogether to have the character to do it.

Standing firm in making correct ethical decisions requires great wisdom, patience, perseverance and courage.

Carrying the cross of Christ

Carrying Christ’s cross means two things in a world hostile to Christian faith and values. It means, first of all, that we are prepared to fulfil the ‘Law of Christ’.

The Law of Christ is an interesting concept. It is mentioned twice in the New Testament. The first mention comes in 1 Corinthians, where Paul says, ‘I am not under the law, but I am under Christ’s law’ (1 Corinthians 9:21). Then, in Galatians, we have the command: ‘Bear one another’s burdens and so fulfil the law of Christ’ (Galatians 6:2).

This lines up with Christ’s words to his disciples at the Last Supper: ‘A new commandment I give to you: love one another as I have loved you’ (John 13:34,35).

If you like, it is the very opposite of the Darwinist ethic of the weak being sacrificed for the strong. It is instead the strong making sacrifices for, or laying down their lives for, the weak.

This is the guiding ethic for everything we see in the New Testament. For example, with the ethics of giving: ‘Christ, who was rich, became poor so that you might be rich’ (2 Corinthians 8:9). Why? In order that we ourselves might then become poor so that we can make others rich. We are called to emulate Christ in making sacrifices, or laying down our lives, for the weak (Romans 5:8).

Additionally, part of carrying the cross in a society hostile to Christian faith and values is that we are prepared to speak and act in godly ways, even when it is tremendously costly to do so; in other words, even when it leads to great opposition. This is part of the cross.

Christ bore the burdens of others and carried out great acts of compassion of healing and love. But he wasn’t crucified for these acts of compassion. It was actually his words that led to his death (John 7:7). It was when he spoke unpalatable truth about his own identity (John 5:18) and when he spoke prophetically about the nation in which he was placed (Matthew 26:63-68). That was when persecution really came to bear.

As Christ’s people living in this age we are called to carry the cross of Christ (Matthew 16:24; Luke 9:23, 14:27). That involves both sacrificial service and also faithfully speaking the truth, regardless of the cost, whether it is preaching the Gospel or speaking moral truth in the public sphere.

So there we have it – we can be imitators of Christ by having his mind, holding his commands, showing his character and carrying his cross.

Saturday, 6 January 2018

Some Big Public Policy Challenges in Bioethics we can expect in 2018

As we look forward to the challenges that 2018 will bring I am struggling to think of a time when we have faced more major public policy challenges in bioethics in so many areas all at once. 

This is perhaps inevitable given the march of secular humanism through parliament, the courts and institutions.

Here is some background on the five major threats currently looming.

1.       Assisted Suicide

Given that 11 attempts in British Parliaments to change the law to allow assisted suicide or euthanasia have failed since 2003 our opponents, not surprisingly, have shifted their attention to the courts in an attempt to change the law through the back door.

Conway, who has motor neurone disease and is seeking assisted suicide, lost his case in which CNK Alliance intervened in the Divisional Court in October, and his appeal to the High Court was denied. He now plans to appeal directly to the Court of Appeal. See my previous comments on the case here.

Omid, who has multiple system atrophy and is also seeking assisted suicide, had a preliminary hearing on 21 November and has appealed to the judges to allow a full enquiry in which all witnesses can be cross-examined along the lines of the Carter case in Canada. We await their decision.

There have been three worrying judgements by the Court of Protection in the last few months (see here and here). Formerly all patients with Permanent Vegetative State (PVS) and Minimally Conscious State (MCS) had to go to court for appeals about the removal of artificial nutrition and hydration (ANH), but now there are moves to withdraw ANH from these and less severely brain-damaged patients who are not imminently dying without going to court provided that both doctors and relatives agree that it is in the patient’s ‘best interests’. The Official Solicitor will appeal these judgements in the Supreme Court on 29 January. My fuller review is here.

A recent case involving a pharmacist (Desai) who helped his father end his life with a morphine and insulin overdose resulted only in a nine-month suspended sentence. The general trend is toward fewer prosecutions and convictions for assisted suicide and the DPP’s prosecution criteria on assisted suicide are being interpreted very liberally.

2.       Abortion

The ‘We Trust Women’ campaign (masterminded by Ann Furedi of BPAS) is gaining momentum and now has the support of the RCOG, BMA and RCM. Whilst there is no bill currently before Parliament (and none likely to appear before 2019) proabortion activists may seek to amend a government health bill to achieve their aim of completely decriminalising abortion (see my previous posts here, here, here and here).

This will most likely involve repealing Sections 58 and 59 of the Offences Against the Person Act 1861 (OAPA) which make procuring an abortion for oneself or others a crime punishable by life imprisonment. The effect would be to make abortion legal for any reason up to 28 weeks and, if the Infant Life (Preservation Act) 1929 is repealed too, up to birth.

Were this to succeed the Abortion Act 1967 with all its provisions (two doctors, licensed premises, reporting, conscience clause etc) would fall as it is contingent upon the OAPA.

There are also calls to relax the abortion laws in Northern Ireland, Ireland and the Isle of Man.

3.       Organ transplantation

Geoffrey Robinson MP wants to bring in an opt-out system for organ donation in England. His Organ Donation (Deemed Consent) Bill is due its second reading (debate stage) on 23 February 2018.

In 'deemed' (presumed) consent, a person, unless he or she specifically 'opts out', is assumed to have given consent to the harvest of their organs after death, even if their wishes are not known. Although relatives may be consulted (a so called 'soft' opt out), to ascertain any wishes of the deceased expressed before death, their views can still be overruled by the state should they decide against transplantation. Wales already operates an opt-out system for organ donation and it is likely that Scotland will follow.

Robinson's private member's bill may be overtaken by a new government bill seeking to achieve the same thing. The government has just launched a consultation, closing on 6 March 2018, which proposes 'changing the current law on organ donation consent whilst also allowing people to opt out if they want to'. Both Theresa May, the prime minister and Jeremy Corbyn, the leader of the opposition have signalled support and a Daily Mirror Campaign has built support.

However, evidence for the claim that an opt-out system will increase transplants is still lacking. In Wales, where an opt-out system was introduced in December 2015, there has been a small dip in the number of deceased donors. The Nuffield Council advised in October that robust evidence is needed before any change to the law is considered. But it is also unethical.

Donation must be without coercion and the final decision must lie with the family based on what the person would have wanted, if this is known. Organs are not the property of the state and must not be 'taken' without permission, however needy any prospective recipient may be (see previous CMF articles and blog posts here, here and here)

4.       Transgender

Under the Gender Recognition Act 2014, to change gender legally, one must have lived in one’s chosen gender for two years, be 18 or over, have a medical diagnosis of gender dysphoria and appear before a gender recognition panel.

Justine Greening, the Secretary of State for Education, Women and Equalities, wants to allow people to change their gender purely based on self-declaration without having to see a doctor nor appear before a gender recognition panel.

A consultation toward this end has been announced and is to be launched shortly. A Scottish consultation is already underway and closes on 1 March.

She has the support of both Theresa May and Jeremy Corbyn although there is now some resistance growing and recent reports suggest that Greening may be having second thoughts (see further comment here and here).

5.       Freedom of Conscience in healthcare

Currently there is statutory conscience protection for health professionals only for involvement in abortion and activities authorised under the Human fertilisation and Embryology Act. The scope of the former is restricted because of a Supreme Court judgement on the case of two Glasgow midwives.

Freedom of conscience for other activities (eg. Hormones for transgender, abortifacient contraceptives, PrEP, withdrawal of ANH etc) is covered only partially by equality legislation.

There were two significant victories on freedom of conscience last year. The General Pharmaceutical Council, which regulates Pharmacists and Pharmacies, modified new guidance which would have replaced a ‘right to refer’ with a ‘duty to dispense’, in response to protests from interest groups (see my previous comment here).

The Faculty of Sexual and Reproductive Health (FSRH), part of the RCOG, reversed regulations which denied those with conscience objections to some contraceptives, from obtaining its diplomas. This appeared to be in response to criticism by CMF.

These two wins underline the fact that conscience freedom depends on constant vigilance.

Baroness O’Loan’s Conscientious Objection (Medical Activities) Bill is to have its second reading in the House of Lords on 26 January 2018. Although this bill is much narrower in scope than we would have preferred (covering only abortion, IVF and related technologies and withdrawal of treatment) it has our support.

So, a busy year awaits. Watch this space for further developments. 

Thursday, 28 December 2017

Supreme Court to rule on whether doctors can remove food and fluids from brain-damaged patients without going to court

Should doctors be able to withdraw food and fluids from severely brain-damaged patients who are not imminently dying? And if so, in what circumstances?

The answer to these questions has changed dramatically as a result of recent decisions by the Court of Protection which are due to be appealed in the Supreme Court on 29 January 2018.

The case of Tony Bland in 1993 (who was in a permanent vegetative state (PVS) after being injured at the Hillsborough Stadium Disaster) established that clinically assisted nutrition and hydration (CANH) is a form of medical treatment that can be withdrawn in some circumstances.

In that case it was also held that, in England and Wales, prior court approval should be sought for the withdrawal of CANH in all such cases. This now also applies for patients in minimally conscious state (MCS).

A vegetative state is when a person is awake but is showing no signs of awareness; they may open their eyes, wake up and fall asleep at regular intervals and have basic reflexes; they're also able to regulate their heartbeat and breathing without assistance.

A person in a vegetative state doesn't show any meaningful responses, such as following an object with their eyes or responding to voices; they also show no signs of experiencing emotions.

Permanent vegetative state (PVS) is diagnosed if these features persist for more than six months if caused by a non-traumatic brain injury, or more than 12 months if caused by a traumatic brain injury. If a person is diagnosed as being in PVS, recovery is extremely unlikely but not impossible.

By contrast, somebody in a minimally conscious state (MCS) shows clear but minimal or inconsistent awareness and may have periods where they can communicate or respond to commands, such as moving a finger when asked.

Prof Derick Wade is one of the country's leading experts in this area, a consultant in neurological rehabilitation based in Oxford. He estimates there could be as many as 24,000 patients in the NHS in England either in a permanent vegetative state, or minimally conscious.

Patients with PVS and MCS are severely brain-damaged but they are not imminently dying and with good care can live for many years. But if CANH is withdrawn, then they will die from dehydration and starvation within two or three weeks.

In such cases, doctors can withhold food and liquid - if they consider there's no likelihood of improvement, and if the family agree. But to do that, they need to wait - six months for cases with brain injury caused by disease or a year in cases of traumatic injury (see diagnostic guidelines here).

Then the patient has to be assessed by a specialist unit, before being diagnosed as being in PVS or MCS. Then, the procedure is to seek permission from the Court of Protection to take out their feeding tube.

The applications are made by the local Clinical Commissioning Group (CCG) and usually cost around £50,000. Only about 100 such applications have been made in more than 20 years.

Two recent legal judgments have held that there is no requirement for treating clinicians to seek the court’s prior approval to withdrawing CANH for a patient in PVS or MCS where existing professional clinical guidance has been followed and where the treating team and those close to the patient are all in agreement that it is not in the patient’s ‘best interests’ to continue such treatment.

The Official Solicitor is contesting the second of these two judgements in the Supreme Court.

The first case concerned M, a woman who had suffered from Huntington's disease for 20 years and was now in MCS.  It was argued that it was in M's best interests not to continue to receive clinically assisted nutrition and hydration (CANH), with the consequence that she would die. 

The application was supported by M’s family, her clinicians, and an external specialist second opinion. At a public hearing on 22 June, Justice Peter Jackson made the orders requested, giving short reasons and reserving fuller judgment. On 24 July, CANH was withdrawn from M, who then received palliative care, and on 4 August she died. She was 50 years old at the time of her death. 

In his fuller judgement on the case on 20 September, which was widely reported in the press (see Guardian and Telegraph), Mr Justice Jackson said in future judges should not be required to make rulings in similar cases - where relatives and doctors were in agreement and medical guidelines had been followed.

The second case involved a 52-year-old man (Y), married with two adult children who in June 2017, suffered a cardiac arrest after a myocardial infarction (heart attack) as a result of coronary heart disease. It had not been possible to resuscitate him for well over ten minutes, resulting in severe cerebral hypoxia and causing extensive brain damage (See Guardian, Times (£) and full judgement (£)).

Mr Y had been in a prolonged disorder of consciousness since his cardiac arrest and, in July, was admitted to a regional hyper-acute rehabilitation unit under the control of the claimant NHS Trust. 

Two medical experts with extensive qualifications and experience in the field of neurological rehabilitation agreed that Mr Y was in a very low level of responsiveness, he had no awareness of self or his environment, and it was highly improbable that he would re-emerge into consciousness.

The clinical team and Mr Y's family, including his wife, Mrs Y, agreed that it would be in his best interests for clinically assisted nutrition and hydration (CANH) to be withdrawn, with the consequence that he would die within a period of two to three weeks.

The NHS Trust sought a declaration that there was no mandatory requirement to seek consent from the court to the withdrawal of CANH, which the court had upheld. However, the Official Solicitor has appealed this decision and, as noted above, the Supreme Court hearing is expected to take place on 29 January.

I was asked to comment at the time of the first hearing on 20 September and my words were later picked up by Life Site News.

I said that the court decision had set a dangerous precedent and should be appealed. Taking these decisions away from the Court of Protection removes an important layer of legislative scrutiny and accountability and effectively weakens the law.

This will make it more likely that severely brain-damaged patients will be starved or dehydrated to death in their supposed best interests and that these decisions will be more influenced by those who have ideological or financial vested interests in this course of action.

I think that the key issues legally and ethically separating right and wrong in end of life decisions are:

1.   What is the intention of this particular action or omission?

2.   We can say a treatment is futile (ie burden outweighs benefit measured in terms of cure/relief) but not that a life is futile

It seems to me that these recent decisions have been made with the intention of ending the life of a person who is not imminently dying because their life has been judged futile. This is a very dangerous precedent indeed.

Furthermore, there are still significant uncertainties about diagnosis and prognosis in both PVS and MCS. These have increased rather than decreased since the Bland case and this is why continued court endorsement of the withdrawal of life-sustaining nutrition and hydration in such cases is necessary. Well-intentioned people - relatives, carers and clinicians - often make mistakes about diagnosis/prognosis and accordingly, agreement between all of them about withdrawal of CANH is not adequate protection.

Life Site News noted that whilst starvation and dehydration certainly hasten death, this is not a painless procedure. In 2006, a British euthanasia activist gave up her own freely chosen attempt to starve to death after 19 days, saying it was too painful. ‘I would not wish what I have been going through on my worst enemy,’ Kelly Taylor said.

At the moment, because of the current policy of involving the court in all such cases, the number of cases we see are very few (fewer than 100 in over 20 years as noted above). But if the court were to be removed from the equation, this could very well lead to a huge escalation of cases, given how many people in Britain have either PVS or MCS.

Doctors are already moving in this direction as a recent article in the Journal of Medical Ethics argues. Furthermore, in the light of these recent court decisions, new interim guidance for health professionals in England and Wales has been issued by the BMA, Royal College of Physicians (RCP) and General Medical Council (GMC). They plan to publish new definitive guidance in May 2018 which will make this new direction official.

In their interim guidance they note however that it 'may need revision if a case concerning these issues is considered by the Supreme Court'.

This is now happening and we await the hearing with great interest. 

Wednesday, 1 November 2017

The Reformation and Medicine - My lecture to commemorate the 500th anniversary

This is the text of the talk I gave at the Guildhall, Guildford on Wednesday 1 November 2017 as part of an eight-lecture series to mark the 500th anniversary of the Reformation. The main sources are listed at the end.

Christian doctors motivated by Christ’s teaching and example have been profoundly influential in shaping healthcare’s history. 

 You may be surprised to know just how many of medicine's pioneers were men and women of faith: Ambroise Pare, Louis Pasteur, Joseph Lister, James Paget, Thomas Barnardo, Edward Jenner, James Simpson, Thomas Sydenham, William Osler, Ida Scudder, David Livingstone and many more.

Christians remain active in all fields of medicine today but particularly in AIDS care and education, drug rehabilitation, child health, palliative care, relief of poverty and in service to the developing world.

This should not surprise us. Jesus Christ is known as the Great Physician for good reason.

According to eyewitnesses, his dynamic entry into first century Palestine was marked by miraculous healing of many illnesses for which even today there are no known treatments.

But along with his compassion to restore health he also brought a message of healing of broken relationships - between human beings, between human beings and the planet and most crucially between human beings and God.

In his historical account of those events, Luke, probably the first ever Christian physician, tells us that Jesus described his own ministry in terms of preaching, healing, deliverance and justice (Luke 4:18-19) and sent his followers out 'to preach the kingdom of God and to heal the sick’ (Luke 9:2).

When I told colleagues that I had been asked to speak about Medicine and the Reformation, some questioned whether there was any connection at all. There is a perception that the Reformation in England actually took medicine back to the dark ages as a result of King Henry VIII suppressing the monasteries. And there is some truth in this. Henry’s actions indirectly deprived many suffering and disabled people of their only means of support. Patients of hospitals like St Thomas’ and St Bartholomew’s, founded and run by monastic orders, were thrown onto the streets and the onus for health care was shifted to the City Fathers and municipalities.

But in considering how the Reformation influenced medicine we are not saying that every political consequence of the Reformation was good for medicine and society, nor that Christianity’s involvement with medicine began with the reformation.

Rather we are claiming that the biblical doctrines which the Reformers rediscovered and emphasised provided the framework out of which modern medicine was available eventually to develop.  It did not happen immediately but rather the Reformation laid the seedbed which gave rise in Britain to the Puritan century of 1560 to 1660, the evangelical revival of the 1700s and the ensuing social reforms of the 1800s which in turn led to the explosive advances in medicine and surgery which characterised the 1900s and which continue unabated today.

When Martin Luther (1483–1546) nailed his ‘Ninety-Five Theses’ to the door of the castle church at Wittenberg on 31 October 1517, he initiated not simply a schism in the church, but a subtly different way of thinking about the relationship between God and human beings. The doctrines summed up in the five solas provided the foundation.

Sola Gratia (Grace alone) – God’s love offered to those who cannot pay or help themselves
Sola Fide (Faith alone) – God’s forgiveness granted to those who truly believe and trust him
Solus Christus (Christ alone) – God revealing himself fully in the person and work of Christ
Sola Scriptura (Scripture alone) – God speaking clearly through the Old and New Testaments
Sola Deo Christus (To the glory of God alone) – Man’s chief end being to honour and glorify God

In considering how these foundational beliefs – the five solas – shaped medicine I can think of no better example than Thomas Sydenham, an outstanding medical pioneer who has been called 'The Father of English Medicine'.

Thomas Sydenham was born in Dorset in 1624 into a Puritan family and was himself a man of deep Christian faith in the Puritan tradition.

He studied medicine at Oxford, befriending scientist, Robert Boyle and philosopher, John Locke. He graduated in 1648 and, after fighting alongside his father and four brothers in the Civil war on the Parliamentary (Cromwell's) side, resumed medical practice in Westminster. When the bubonic plague struck in 1665 he risked his life by returning to London to care for those affected.

Sydenham’s Christian ideals are apparent in his advice to medical students as published in 'Medical Observations concerning the History and Cure of Acute Diseases' in 1668:

'Whoever applies himself to medicine should seriously weigh the following considerations:

First, that he will one day have to render an account to the Supreme Judge of the lives of sick persons committed to his care.

Next, whatever skill or knowledge he may, by the divine favour, become possessed of, should be devoted above all things to the glory of God and the welfare of the human race.

Thirdly, he must remember that it is no mean or ignoble creature that he deals with. We may ascertain the worth of the human race since for its sake God’s only begotten Son became man and thereby ennobled the nature that he took upon him.

Finally, the physician should bear in mind that he himself is not exempt from the common lot but is subject to the same laws of mortality and disease as his fellows and he will care for the sick with more diligence and tenderness if he remembers that he himself is their fellow sufferer.'

We see here several powerful biblical doctrines which underpinned his medical practice

A belief in the value of human beings as creatures made in the image of God
A conviction that scientific knowledge and technology should be used to serve human beings
An understanding of disease as a consequence of living in e fallen world
A sense of vocation, giving one’s life to serve the needy and to glorify God
The reality of the judgement and the need to give account to God for how he had lived 

These doctrines, of course, were not new but they were freshly rediscovered and applied by the reformers.

They might perhaps be summed up in the words of the Apostle Paul to the Galatians, ‘Bear one another’s burdens and so fulfil the law of Christ’.

But first let’s go back to the early centuries of Christendom to trace Christianity’s relationship with medicine.

While so-called healers have always existed (and there is no shortage today), modern, scientific medicine has its roots in ancient Greece. The study of illness and the treatment of disease are traced back to the school of Hippocrates. However, for all the intellectual interest they had in medicine, the ancient Greeks had little interest in hospitals. There has not been much prospect of real cure for most illnesses until the last century. The real challenge down the ages has been to care.

As the aphorism goes, ‘Cure sometimes, relieve often, comfort always’.

Leading Christian writers of the earliest centuries of Christianity for the most part exhibit positive views of medicine. Thus Origen (c. 185–c. 254) considered medicine ‘beneficial and essential to mankind’ (Contra Celsum 3.12), and Tertullian (c. 200 ce), who was fond of employing medical analogies in his writings, believed that medicine was appropriate for Christians to use.

The theme of Jesus as the Great Physician (Christus medicus) was popular in the writings of the Church Fathers.

Christian concepts of philanthropy were motivated by agape, a self-sacrificing love of others that bore witness to the love of Christ as reflected in his incarnation and redemptive work on the cross (e.g., Mt. 25:35–40, Jas. 1:27). Christians were encouraged to visit the sick privately, and deacons (whose duties largely consisted of the relief of physical want and suffering) were expected to visit the ill.

Beginning in 250, the cities of the Roman Empire experienced a major plague that lasted for fifteen to twenty years and reached epidemic proportions. Because the civic authorities did little to deal with the plague, the Christian churches undertook the systematic care of both pagan and Christian plague victims and the burial of the dead, despite the fact that Christians were at the time a persecuted minority.

It wasn't until Constantine granted the first Edict of Toleration in AD 311, that Christians were able to give public expression to their ethical convictions and undertake social reform. From the fourth-century to present times, Christians have been especially prominent in the planning, siting and building of hospitals, as well as fundraising for them.

The embracing of Christianity by the Roman Empire from 313AD allowed the rise of institutions devoted to nursing care. Important hospitals were founded in Caesarea (369), Edessa (375), Monte Cassino (529), Iona (563), Ephesus (610) and St Albans (794).

A few decades after Constantine, Julian, who came to power in AD 355, was the last Roman Emperor to try to re-institute paganism. In his Apology, Julian said that if the old religion wanted to succeed, it would need to care for people even better than the way Christians cared.

In AD 369, St Basil of Caesarea founded a 300-bed hospital. This was the first large-scale hospital for the seriously ill and disabled. It cared for victims of the plague. There were hospices for the poor and aged isolation units, wards for travellers who were sick and a leprosy house. It was the first of many built by the Christian Church.

In the so-called Dark Ages (476-1000) rulers influenced by Christian principles encouraged building of hospitals. Charlemagne decreed that every cathedral should have a school, monastery and hospital attached.

As Europe began to change from a largely rural and manor-based society to an urbanized one in the eleventh century, medicine developed into a profession and the clergy's role was diminished over time.

By the Middle Ages, across Europe, churches and religious orders cared for the elderly, the weak, the insane, the sick, and the dying, as well as passing travellers in need of shelter. The foundation charter of the Pantokrator hospital in Constantinople (1136) says that medical teaching also took place there.

In the later Middle Ages, in cities with large Christian populations, monks began to 'profess' medicine and care for the sick. Monastic infirmaries were expanded to accommodate more of the local population and even the surrounding areas.

In England, there are said to have been nearly 500 hospitals by the close of the fourteenth century.The main institutions were in cities. In London, St Bartholomew's had been founded in 1137; St Thomas's in 1215.

But the Reformation, through the doctrines it emphasised, took medicine several giant steps forward over the next few centuries – establishing it as a professional calling or vocation in its own right, putting it on a scientific footing, enhancing medical training, building specialities, making it truly holistic, bolstering its ethical framework, extending its role into public health and taking it to the developing world.

Protestants differed from Catholics in their approach to the Christian life. The Catholic tradition saw in the ascetic or reclusive life the Christian ideal, whereas Protestants encouraged a life of active participation in the world. In Catholic thought the world was divided into temporal and spiritual estates. Catholics who desired wholeheartedly to serve God entered holy orders, and they considered secular professions to be of secondary importance.

Martin Luther and John Calvin (1509–1564) abolished the distinction between secular and sacred

callings. They broadened the idea of vocation (in medieval terms, a call to a contemplative life) by incorporating into it the secular professions. A physician or a nurse might glorify God in treating others medically as much as a priest might do so in caring for souls. The reformers' desire was to extend God's redeeming grace into every activity of life.

Luther became influential in changing how the public viewed physicians by emphasizing that most diseases could be traced to natural explanations and were not always caused by black magic and Satan. He promoted medicine by advocating that physicians should be used whenever possible to treat a disease and that God would reveal medical information the physicians who sought for answers. Physicians were, in this way, similar to ministers who could heal the heart and soul and act as extensions of God’s will. Specifically, Luther recommended the use of apothecaries, barbers, physicians, and nurses to cure physical ailments when he ministered to the sick.

He also recommended fumigation for homes contaminated with the plague and avoidance of unnecessary travel and exposure to different places. During the plague, Luther also suggested that neighbours help each other and provide sympathetic support to the sick and to the mourning.

Luther’s friend Bugenhagen implemented health reforms centering on baptism, midwifery, nursing, and hospitals. He argued that midwives should be regulated, qualified, and honest. By his promotion of public health concerns, the medical community gained the necessary funding, support, and personnel to treat the diseases of the day.

Luther argued that God gave man the ability to think so that man could use tools such as medicine in order to have healthy, productive lives. In the same way that God gave man the ability to make clothes, to be used as protection against the elements, God gave man the ability to make medicine to be used for healing. An acquaintance of Luther, Philip Melanchthon, based his medical school curriculum at Wittenberg University on the exploration of dissected bodies - a practice that was not usually socially acceptable.

Clergy-physicians played an important role among Protestant ministers from the sixteenth through the eighteenth centuries. In an age in which trained physicians were especially uncommon in villages and rural areas, the Protestant belief in an educated clergy ensured a supply of persons who had both the leisure and the learning to read medical books. John Wesley (1703–1791) took a course in medicine so that as a minister he could be of help to those who had no regular physician. In 1746 he opened a dispensary and in the next year published a lay medical guide, Primitive Physick. 

Clerical physicians were also common in colonial New England, where Cotton Mather (1663–1728), a Bostonian minister who himself practised medicine, called the combination of the care of soul and body the "angelical conjunction." During an epidemic of smallpox in 1721, many physicians (together with members of the local press) opposed inoculation as a hazard to health and a rejection of divine providence. Mather defended the practice, maintaining that any medical procedure might invite the same kind of objections. He was supported by five other prominent clergymen.

In eighteenth-century Edinburgh, the center of a strong Presbyterian (Calvinist) tradition, the Scots established what became one of the most celebrated medical faculties in Europe. It was not until the eighteenth century that the Christian hospital movement re-emerged. The religious revival sparked in England by the preaching of John Wesley and George Whitefield was part of an enormous unleashing of Christian energy throughout 'Enlightenment' Western Europe. It reminded Christians to remember the poor and needy in their midst. They came to understand afresh that bodies needed tending as much as souls.

A new 'Age of Hospitals' began, with new institutions built by devout Christians for the 'sick poor', supported mainly by voluntary contributions. The influence of this new age was felt overseas as well as in England. Healthcare by Christians in continental Europe received a new impetus. The first hospitals in the New World were founded by Christian pioneers. Christians were at the forefront of the dispensary movement (the prototype of general practice), providing medical care for the urban poor in the congested areas of large cities.

When the National Health Service took over most voluntary hospitals, it became clear just how indebted the community was to these hospitals and the Christian zeal and money that supported them over centuries. In fact, the NHS was essentially created through the nationalisation of Christian hospitals like St Bartholomew’s, St Thomas’s, St Mary’s and St George’s. 

Many very important discoveries in many medical fields were made by people who held a Christian commitment and there is not time to mention them all here: William Harvey (circulation), Jan Swammerdam (lymph vessels and red cells) and Niels Stensen (fibrils in muscle contraction) were all people of faith, while Albrecht von Haller, widely regarded as the founder of modern physiology and author of the first physiology textbook, was a devout believer; Abbe Spallanzani (digestion, reproductive physiology), Stephen Hales (haemostatics, urinary calculi and artificial ventilation), Marshall Hall (reflex nerve action) and Michael Foster (heart muscle contraction and founder of Journal of Physiology) were just some among many others.

The same can be said of the advance of surgical techniques and practice. Ambroise Pare abandoned the horrific use of the cautery to treat wounds and made many significant surgical discoveries and improvements. The Catholic Louis Pasteur's discovery of germs was a turning point in the understanding of infection. Lister (a Quaker) was the first to apply his discoveries to surgery, changing surgical practice forever. Davy and Faraday, who discovered and pioneered the use of anaesthesia in surgery, were well known for their Christian faith, and the obstetrician James Simpson, a very humble believer, was the first to use ether and chloroform in midwifery. James Syme, an excellent pioneer Episcopalian surgeon, was among the first to use anaesthesia and aseptic techniques together. William Halsted of Johns Hopkins pioneered many new operations and introduced many more aseptic practices (eg rubber gloves), while William Keen, a Baptist, was the first to successfully operate on a brain tumour.

It is not surprising to find that, again, due to their commitment to love and serve those weaker than themselves as Christ did, Christians were at the forefront of advancing standards of clinical medicine and patient care throughout the ages. Thomas Sydenham, who we considered earlier, stressed the importance of personal, scientific observation and holistic care for patients.

Herman Boerhaave followed in Sydenham's footsteps, and was very influential in pioneering modern clinical medicine, while William Osler taught all medical students to base their attitudes and care for their patients on the standards laid down in the Bible. He was also a leading pioneer in whole person or holistic medicine.

Herman Boerhaave (1668- 1738) was the son of a Reformed minister in Leyden who switched from theology studies to medicine. By 1718 he was the Professor of Medicine, Botany and also Chemistry.

He was much influenced by the writings of Thomas Sydenham, especially his empirical attitude to disease. Boerhaave re-introduced bedside teaching and laid down clinical attitudes to patient care that came to be widely followed by his disciples throughout Europe. Several of them became highly influential, including: von Haller and Linnaeus (founders of modern physiology and natural history), as well as van Swieten and de Haen (whose open-minded scientific empiricism, based on Boerhaave’s teaching, transformed the outlook and approach of the Viennese School of Medicine, which in turn became the pattern of the new Western Medicine).

The Hippocratic ideal was expanded by doctors such as Thomas Browne (seventeenth-century), a Christian physician who was one of the first to write on medical ethics and whole-person care. 

Thomas Percival, a zealous social reformer as well as a physician of integrity, drew up the first professional code of ethics in the eighteenth-century. From that time Christian thought has shaped much of the modern profession’s ethical conduct, promoting personal integrity, truthfulness and honesty.

The Christian contribution to the many specialist branches of medicine is huge.

Specialties

The emerging practice of orthopaedics was much enhanced by the Lutheran Rosenstein's textbook on the subject, while the devout Underwood's Treatise on the Diseases of Children became a classic. Still's disease was named after George Still of King's College Hospital and Great Ormond Street Hospital, who was a Lutheran and a vigorous supporter of Barnardo's homes. In the field of dermatology, Willan (who wrote a history of Christ) was the first to classify skin diseases, while many Christian clergymen-physicians such as Blackmore, Willis and Fox were pioneers in the advance of psychiatry. In the USA Daniel Drake, an Episcopalian, was among the first to study geographical pathology, and WH Welch of the Johns Hopkins, was an outstanding Christian pathologist who discovered the bacillus of gas gangrene. James Simpson, Howard Kelly and Ephraim McDowell, all devout believers, were towering figures in obstetrics and gynaecology. When asked by a journalist about his greatest discovery, Simpson said that his greatest discovery was not chloroform in anaesthesia, but that he was a sinner and Jesus Christ his saviour. Whilst most medical advances and discoveries have taken place in hospitals, numerous general practitioners such as Sydenham, James Mackenzie and Clement Gunn worked tirelessly in day-to-day practice, striving to embody the ideals of Christianity in their ethics and care of their patients.

Public health, preventative medicine and epidemiology

Early on Christians realised the connection between health and hygiene. Girolamo Fracastoro, a very versatile student in the sixteenth-century, began to investigate the spread of contagious diseases. In the next century his work was continued by Thomas Sydenham. Ministers advocated personal hygiene. It was John Wesley who said 'Cleanliness is, indeed, next to Godliness.' The social activism of the Quakers is well-known, among them John Fothergill who campaigned to eliminate social wrongs on grounds that they undermined the health of the people. Another Quaker, John Howard, had a great concern for prisons, where overcrowding and typhus were rife, and successfully promoted two prison reform Acts of Parliament. Edward Jenner, was responsible for the beginnings of immunology and in ridding the world of the scourge of smallpox.

Social need

In the nineteenth-century, the Industrial Revolution had led a drift to the inner cities and intense social needs among the poor. It was the Quakers, Evangelicals and Methodists who in particular applied themselves vigorously to meeting these needs. A nationwide movement of Christian missions to help the poor was founded. Huge sums of money were raised by voluntary subscriptions. And armies of volunteers went to slum areas to offer practical help. Attention was paid to the misfits of society, such as drunkards, criminals and prostitutes, as well as homeless teenagers.

The Salvation Army, founded in 1865 by William Booth, provided much-needed medical care in impoverished inner city areas and homes for women who had been induced into prostitution. Unmarried mothers were cared for, and these projects have spread all over the world. Great Ormond Street Hospital was founded by Charles West, a Baptist, to meet the needs of sick children who were inadequately cared for by 'habitually drunk (nurses) with easy-going, selfish indifference to their patients, and no knowledge or skill of nursing.'

Dr Thomas Barnardo set up his children's homes after seeing the terrible plight of thousands of hungry and homeless children in the East End. Inner city missions bringing a combination of medical care and the gospel were set up. Christians were at the forefront of temperance movements. Care for the blind and deaf were areas drawing direct inspiration from Jesus. Use of Braille worldwide and schools for the deaf were pioneered by evangelical Christians.

St Joseph's Hospice in Hackney, founded by the Sisters of Charity in 1905, was the prototype of the modern hospice movement. Dame Cicely Saunders founded St Christopher's Hospice in 1967, with the aim of providing as peaceful an atmosphere as possible for those in their terminal illness, while offering an environment of Christian love and support.

Developing world missions

Jesus commanded his followers to go and make disciples of all nations (Matthew 28:19), as well as exhorting them to love their neighbours as themselves. There have been several waves of missionary work during two millennia, and in each case medical work has played a key part.

Dr John Scudder was among the first Western missionaries of the modern era and in 1819 went to Ceylon, now Sri Lanka. Among the best-known pioneer medical missionaries were David Livingstone (Central Africa), Albert Schweitzer, a talented doctor, theologian and musician, who devoted his life to people living in the remote forests of Gabon, and Albert Cook, who founded Mengo Hospital in Uganda. William Wanless founded the Christian Miraj Hospital in India, and Ida Scudder, daughter of John, founded the world-famous Vellore Medical College in the same country. Hudson Taylor spread the gospel and western medicine to China and founded the China Inland Mission. Paul Brand pioneered missions to lepers. Henry Holland and his team, working in the north-west frontier of the Indian sub-continent, operated on hundreds of cataracts every day. Others have been influential in the prevention of such diseases as malaria and tuberculosis.

Women doctors

There was a strong Christian element in the motivation of the pioneers of medical education for women. Elizabeth Blackwell, the first woman doctor, was a Quaker, while Elizabeth Garrett came from a very devout family. Ann Clark, another Quaker, was the first woman surgeon and worked at the Women's Hospital and the Children's Hospital in Birmingham. Sophia Jex-Blake, another devout Christian, founded the London School of Medicine for Women, while Clara Swain was the first woman doctor to go overseas (to Asia) as a medical missionary.

Christianity gives men and women a new perspective and allegiance; their lives are spent in joyful grateful service of the God who has redeemed them and given them new life. In many ways, Christianity and medicine are natural allies; medicine gives men and women unique opportunities to express their faith in daily practical caring for others, embodying the commands of Christ; 'whatever you did for one of the least of these brothers of mine, you did for me.' (Matthew 25:40)

Conclusion

The example and principles we see in the teaching of Jesus and his apostles led to the natural marriage of Christianity and medicine throughout the centuries. But they gained fresh impetus, voice and expression after the Reformation and through the Puritan century, the evangelical revival and the social reforms and world missionary movement that it spawned in the 19th century – medicine as a vocation, scientific evidence, medical training, whole person medicine, specialities, ethics, public health and medicine in the developing world. We still bask in its legacy today.

The following were the main sources used in compiling this lecture

Medicine and the Reformation – Elizabeth Ping (2011)
Healing and Medicine in Christianity – Encyclopaedia of Religion (2005)
The Christian Contribution to Medicine – Rosie Beal-Preston (2000) Triple Helix
Jesus - the Pivot of History and Medical Care – Peter May (2000) Triple Helix
Faith in Medicine – Peter Saunders (2000) Triple Helix