I first wrote about my concerns over organ donation from those requesting euthanasia (ODfE) in 2017 when Belgium was at the time pioneering the practice.
Belgium has now, unsurprisingly, been overtaken by Canada which ensured, right from the introduction of their ‘medical assistance in dying’ (MAID) legislation, that the opportunity of organ donation was embedded in the process.
National reporting of the number of organs obtained and transplanted from the euthanized is patchy and is not a statutory requirement anywhere. It is no surprise, however, that in a recent worldwide scoping review of ODfE, 39.7 per cent of the papers found were from experiences in Canada. Canada leads the world in harvesting organs from those euthanized there. One study found that in Canada, Belgium, the Netherlands, and Spain, a total of 286 people who sought euthanasia donated organs that were transplanted into 837 people. Out of those 286 donors, nearly half (136) came from Canada.
Very recently, Canadian policy guidance was updated. There are several new recommendations that are of concern including:
‘…patients who are potentially eligible for organ donation should be approached for first-person consent for donation after MAiD once MAiD eligibility has been confirmed, regardless of when their eligibility for MAiD is confirmed within the 90-day assessment period…’
‘Further work is needed to assess the potential for donation after MAiD at home in Canada. In the interim, patient-initiated requests for donation after MAiD at home warrant consideration on a case-by-case basis, where feasible.’
‘Organ donation organizations and transplantation programs should develop a policy on directed deceased donation for patients pursuing MAiD, in alignment with the directed donation principles and practices that are in place for living donation in their jurisdiction.’
With regard to the last one listed above, if a person requesting euthanasia has a relative in need of an organ, the allowance of such directed donations after euthanasia could easily precipitate subconscious or even overt pressure for the donor to go ahead with their death.
Even before this new guidance was introduced, the percentage of all deceased donors who were given MAID increased from 4.9 per cent (8/164) in 2018, to 14 per cent (24/171) in 2022. Furthermore, whilst the total number of euthanasia donors had increased almost five-fold in this period, the number of other types of deceased donors has remained about the same (156 to 147).
All of this had taken place at a time when Canada has equivocated over permitting euthanasia for solely psychiatric disorders. It has only recently decided to delay its introduction to 2027, having already deferred it to March 2024 from the previous year.
Experience in other countries where ODfE has been in place for many years and is already offered for those with mental disorders shows why organs from such cases are especially desirable for transplantation. There is usually no physical disease present that could preclude or adversely affect the quality of organs. These patients are often very young with organs which may consequently last for decades. In the Netherlands, one study shows that over the decade 2012-2022, whilst psychiatric cases only constituted two per cent of all patients given euthanasia, they never the less accounted for 29 per cent of all organ donors following euthanasia.
Public trust is crucial to maintaining levels of both deceased and living donations. Those wanting to take things a step further than ODfE by promoting euthanasia by the removal of vital organs (ERVO) show themselves all too aware of this when they state:
‘Regardless of a possible change in the law, it is crucial to avoid that the general public is given the impression that there is a “hunt” for organs, to take vital organs from a living patient.’
ERVO is the obvious next logical step in the relentless progress of what a medical colleague of mine refers to as ‘organ greed’. Standard euthanasia protocols usually adversely affect the heart with cardioplegic drugs – stopping the heart is, after all, the aim of euthanasia. However, removing the heart from unconscious anaesthetized but living patients and euthanizing them by this means, would maximise the use of organs. ERVO has, however, recently been critiqued from a personalist ethics perspective, and it would certainly violate the dead-donor rule. But calls to scrap that rule have been around for well over a decade at least.
Though the utilitarian case for ODfE and even ERVO is overwhelming, from a biblical perspective we should not ‘do evil that good may result’. (Romans 3:8) Euthanasia and suicide are both evils that are not justified, even if others may afterwards live longer as a result of receiving the organs removed from those whose lives are ended.
Trevor Stammers is the author of Ethics of Global Organ Acquisition: Moral arguments about transplantation
]]>If I thought the news headlines were hard to read, the report’s content knocked me for six. Reading almost 150 pages of first-hand accounts of incivility and bullying of staff, some at the hands of the very people who were supposed to advocate for them, reduced me to tears. I found myself echoing David’s words to God in Psalm 13: ‘How long Lord?… How long will my enemy triumph over me?’. I have been very blessed that I have never experienced bullying in my career, but I grieve for my fellow midwives who are suffering. First, an erosion to the way the art of midwifery can be performed; next, chronic staff shortages and burnout; and now this.
It certainly seems like a dark and hopeless time for midwifery at the moment. I mourn for the student midwives who are trying to learn how to care for women in a system where ‘care is being squeezed out in the interest of efficiency‘ (Bunting M. Labours of Love: The Crisis of Care. London: Granta Books, 2020). I mourn for the newly qualified midwives, who are expected to take on too much too soon because there is no one else to do it. I mourn for the midwives who don’t feel like they can speak out against bullying for fear of their jobs being made harder than they already are. I mourn for the loss of my great love, my calling, this huge part of me…
…And yet, I cannot walk away. So what keeps me?
I believe in our workforce. The newspapers report toxic midwifery cultures, and they do exist, but here’s what I know about midwives. They love, they care, and they go above and beyond to be with women – the original meaning of midwife. I could tell you so many stories of the selfless, Christ-like care I have witnessed midwives giving at my trust, enough to fill an entire newspaper. But here are just a few.
During the pandemic, outside pressures meant the homebirth team had to disband. However, now when the call goes out to see if anyone can attend a homebirth, midwives of all grades and from all areas of maternity voluntarily give up their precious days off to facilitate the best possible birth experience. Furthermore, one of our community midwife teams has recently set up a hub in a particularly poverty-stricken area so that they can reach women at risk of poorer maternal and fetal morbidity and mortality outcomes. The midwives always stay late, trying to ensure that their ladies are safeguarded from mental and physical harm and that they receive the appropriate care they need. I know many midwives who have stayed on shift several hours after their twelve-and-a-half-hour day to help a birthing woman deliver her baby, come in on days off to support a bereaved family, missing family birthday celebrations, Christmas with their little ones, and school plays, all because they care. So, reading those headlines moved me to anger that these deeply caring souls are turning against each other because they are so overstretched on understaffed teams.
Midwives should not have to work in these conditions. And while understaffing and other systemic changes need to be addressed from the top down, we can do something about injustice and incivility. We can speak out against it, just as Jesus did. Jesus clearly identified that all people were made in his image. That we are all of equal value in God’s eyes, and we are duty-bound to alleviate oppression and discrimination wherever we see it. When Jesus saw that the Pharisees were more interested in observing the Law than they were interested in caring for the lost sheep of Israel, Jesus said:
Woe to you, teachers of the law and Pharisees, you hypocrites! You give a tenth of your spices – mint, dill and cumin. But you have neglected the more important matters of the law – justice, mercy and faithfulness. You should have practised the latter without neglecting the former. You blind guides! You strain out a gnat but swallow a camel. (Mathew 23:23-24)
As a profession, we need to be actively speaking out against bullying and speaking up against the poor working conditions that midwives face. We need to lobby our union reps, senior management teams, and the government in a call to action for meaningful change, for more funding to plug the numbers of midwives who haemorrhaged from the profession during and after the pandemic, and for better wellbeing strategies to be implemented to care for those who remain. Most importantly, we need to be actively praying, calling out to God, who hears our prayers (Mark 11:24), for peace, for us to be made more like Christ, and that he would bring his kingdom through us to transform our workplaces. I pray that our culture would be so radically changed from negative to positive that the newspaper headlines would only be able to tell of the amazing things that midwives do.
Gemma Griffiths is a Growth Assessment Protocol (GAP) Midwife in Northampton, and CMF Nurses and Midwives Staffworker
]]>In the end, although I did hear of struggles, I was encouraged to find nearly 200 doctors still rejoicing in and doing their best to follow Christ’s call to be his followers in healthcare.
Throughout the weekend, in between the usual slightly bonkers ‘medic chat’ one inevitable, unavoidable topic kept raising its head: doctors’ strikes.
We’re now a couple of months on. We have just had the longest strike in NHS history. I know many of those I met that weekend who were on strike this month. I also know some who weren’t.
I wonder if any made a different decision after the weekend’s discussions…?
I had the chance to share some thoughts on strike action during a Q+A at the conference. It now seems that we’re at another new juncture. The consultants have just rejected the latest government offer. What next for consultants and juniors as strike action looks likely to continue?
One conversation from that weekend away has been haunting me. I had suggested that an important step for someone considering strike decisions might be to chat with their pastor. But two or three juniors came to me afterwards saying, ‘I tried, but my pastor didn’t feel they knew enough.’
Fair enough. We pastors aren’t called to know everything about everything. But as a former medic and now pastor, my longing is to see that Christian doctors are equipped to make godly decisions. So, I offer you my effort to help.
First, an important caveat:
This isn’t a once-made decision.
I suspect it is quite easy to forget this.
The decision to strike or not is a repeated one. Each day brings a new decision. When strikes are called based on union ballots, we might think we have to stick with whatever we voted for, or whatever we did last time, and even (in the middle of a set of strike days) whatever we did yesterday.
That isn’t true.
Each round follows a fresh wave of public rhetoric and adjustments to the articulation and receipt of arguments. Each also comes with new circumstances. What seemed the right decision before the Lord yesterday might not be the same today – and in the context of something like strike action, that is OK!
In fact, discovering new things about yourself and your situation is part of being human. Responding rightly before the Lord to those discoveries is, then, part of growing as a Christian.
So, you may think your decision is made until others change their minds. But whether or not you change your mind tomorrow or next time, this isn’t a one-off decision.
This prompts the big question of how to decide?! For what they’re worth, here are six principles that I offer to work into your decision-making.
1: As Christians, our reasons for acting either way flow from our allegiance to our Lord
To put it as a question: can you articulate a thought-through Christian basis for your decision (whether to strike or not)? You may find yourself standing alongside colleagues who do not share your allegiance to your Lord, which means that even if you are acting in a similar manner, your reasons for doing what you do will look starkly different to theirs at the deepest level.
‘You were bought at a price. Therefore honour God with your bodies.’ (1 Corinthians 6:20) –including whether you use those bodies to work or withhold your work.
So, Q1: How does your allegiance to Christ inform your decision?
2. As Christians, we need to be able to display and declare that allegiance to our Lord
Next, can you articulate your reasons in a way that means they can be heard?
Christians standing alongside non-Christians on any issue (which happens very frequently, of course) need to take care. Hundreds of apparently good stances are taken for terrible reasons. If we’re willing to simply stand alongside those hollering their arguments to the rooftops because we think their conclusions are OK but fail to pay attention to their reasons, we could be in trouble. That’s especially true if we’re wearing the same uniform, standing beneath the same banners, and shouting the same slogans. We need to be careful not to compromise our ability (or the ability of our brothers and sisters in Christ) to declare and display our love for the One we say we serve.
It is clear that some doctors have thought very deeply and can articulate their arguments in terms which reflect their love for Christ.
My question is, can those reasons be heard, or are they swallowed in the herd?
So, here’s Q2: As you take this course of action (to strike, or not) are you able to make your reasons heard as you serve Christ?
3. Christian values have historically driven industrial action but are too easily forgotten
Many of the values driving early industrial action had Christian roots.
Which means Christian arguments for strike action can be made. Usually, they’re rooted in the fundamental worth of every human as God’s image-bearers. At its best, though, Christian theology drives people not to focus on self but on others. Truly Christian industrial action has always been about the rights and treatment of others – ‘myself’ coming only as a secondary part of that whole.
There is one place in the New Testament where we might recognise someone taking a stand on his rights. On a few occasions, Paul avoids a flogging by pointing out his Roman citizenship.
But if he were ‘standing up for his rights’ (at least in the sense we tend to hear that phrase used), he would do so every time. In fact, more often than not, he receives the beating without a word.
Rather, Paul asserts his ‘rights’ as a Roman only when it benefits others eg in Philippi (Acts 16), a Roman colony where the new church will inevitably contain numerous Roman Citizens. After all, this is the same Paul who wrote of his rejoicing ‘in what I am suffering for you’ (Colossians 1:24). By God’s grace, Paul’s focus on others was almost unerring.
Contrast this with so much modern rhetoric about injustice that begins and ends with self.
The justice God repeatedly calls us to is for the better-off to speak up for and act on behalf of the less-well-treated. There’s a huge difference between arguing ‘I should be treated like them’ and advocating that ‘they should be treated like me’. But both can be employed to seek something we then call ‘justice.’
The thing is, one is Christlike, the other is not.
Q3: In what way is my decision exhibiting a stance for others rather than myself?
4. As Christians, our value is rooted in an entirely different world to that of money and work
I am not right inside the medical world anymore, but I have heard some of the debate on various Social Media forums and the like. I know every doctor has varied reasons for taking action.
However, outside the medical echo chamber, one justification for strike action above all has become deafening: because we’re worth it.
What does that convey? That you’re worth the number on your payslip?
As a pastor, as a Christian brother, I urge you: don’t lower yourself to that. You are made in the image of God, created to represent and reflect the uncreated One who dwells in unimaginable glory. As you trust in Christ, you have been bought at the price of his death and are being restored according to his image.
I know you wouldn’t stand for the lives of your patients being reduced to a monetary value. Don’t allow it to happen to you!
Q4: As I make my decision, am I avoiding a sub-Christian way of understanding my value?
5. As Christians, we know that the only thing more deceitful than money is our hearts
I haven’t spoken to a single Christian doctor who agrees that the strikes are about money. I’m glad about that! But I suspect the most honest are those who’ve said, ‘well, it’s not only about money.’
It is uncomfortable but unmissable: Money seems to be Jesus’ favourite topic. And he is clear: the love of money blinds us. One way it can do that is by dressing up as a noble cause.
But as money goes to work on our hearts, it resets our expectations, alters our hopes, and distorts our sense of self and value.
So, we must be as honest with ourselves as our deceived hearts allow. We’re quick to recognise the twisted love of money masquerading as more noble ambitions in others (especially those we would call ‘rich’). Why believe ourselves to be any different?
Q5: Have I reflected deeply on the ways my heart (and bank account) may be deceiving me?
6. As Christians, the One who saves us also leaves us an example to follow
My final theological principle for these decisions actually lies behind all the others: look to Jesus!
‘The Son of Man must suffer many things and be rejected by the elders, the chief priests and the teachers of the law, and he must be killed and on the third day be raised to life…Whoever wants to be my disciple must deny themselves and take up their cross daily and follow me.’ (Luke 9:22-23)
Being a Christian means following after the one who died and rose for us. Daily. The way you live each moment – including the moment you choose to strike or not – adds up to the way you live the Christian life.
Doctors are urged to lay down so much at the feet of ‘medicine’ and ‘patient care’. A Christian doctor, though, doesn’t lay anything down there. Instead, they lay their whole selves down for their Lord, who trod that path before them.
Why does Jesus call us to follow him like that? Because the way followers live puts their Lord on display. That’s what we’re called to: put Jesus on display as we declare him as Lord.
Do we ever see Jesus standing up for his rights? Or do we see him – to whom infinite glory and wealth and honour and value belongs – making himself nothing for our sake?
Q6: In my decision to strike or not, how am I following the example of Christ who rescued me?
Matt Lillicrap is pastor of Hope Community Church, Cambridge and a tutor for Crosslands Seminary. He is a former medical registrar in the NHS and CMF Staffworker.
]]>Suppose you could jump in a time machine, and go forward ten years; what do you think the NHS, and healthcare in the UK in general, would look like?
Given the current morale and state of the NHS, I have to admit I don’t have much hope for what I might find.
But what if you could do something today, that could change that picture of healthcare in 10 years’ time? What if you could do something now that could shape and influence that future?
Consider this: what could British healthcare look like in ten years’ time if the gospel of Christ significantly impacted culture, patient care, relationships, systems, policies and services through Christian doctors for the glory of God?
Imagine a society in which Christian doctors were known for being trustworthy, compassionate, truthful, just, gracious and kind, seeking the greatest good and caring about the vulnerable – because of the God whom we worship – lights shining in the darkness.
What if the Christian’s response to ‘heartsink’ patients, stress, competition, gossip, grumbling, and cynicism was so distinctive that others would sit up and notice, asking us about the hope that we have?
Is it possible, that together, as a fellowship of Christians in healthcare, we can grasp that vision, and make that change?
Now, you may be feeling overwhelmed but also excited by such a prospect. We’ll be doing it in God’s strength and wisdom. His word tells us that he works best in our weakness (2 Corinthians 12:9) and that he uses our weakness and imperfection so that he gets all the glory, not us (2 Corinthians 4:6-7; 1 Corinthians 1:27-29).
Real, lasting transformation comes only by the power of the gospel through the Word of God and the power of the Holy Spirit.
But where shall we even begin?
I suggest we start by considering how to build up today’s generation of junior doctors in Christ – because today’s junior doctor is tomorrow’s NHS leader.
CMF is here to unite and equip Christian doctors and nurses to live and speak for Jesus Christ. Those of us who work in CMF could probably all recite this mission statement in our sleep, but I was recently reminded by a non-medic how incredible it is that CMF even exists and has such a vision; we are all immensely blessed to be working with those who, by virtue of our profession, are already in a position to make a difference in society.
Research by Barna, published in 2019 as Faith for Exiles – 5 ways for a new generation to follow Jesus in a digital platform, found that resilience in today’s generation of Christians is characterised by:
CMF can encourage, equip and empower doctors in all these areas, building their resilience and emboldening them to live and speak for Jesus wherever they are.
I am convinced that the focus has to be on the areas of how God’s Word is living, active and relevant in our lives today (Hebrews 4:12; 2 Timothy 3:16; Colossians 3:16), critical thinking – how to ask the right questions and engage through gospel lenses with the world around us (Romans 12:2), and the significance of work, because everything we do is for God’s glory (Colossians 3:17).
How will we at CMF together equip our future Christian leaders to shape and influence healthcare and wider society with gospel values? By walking alongside one another in mentoring and pastoral care, fostering a Christian medical community where you live and work through Catalyst Teams, building up leaders, or serving with the gifts God has given you in this Kingdom vision.
How amazing that we can have a hand in changing the future by getting together behind this vision – we each have a part to play, no matter how big or small, in the ‘good works’ that God has equipped us for (Ephesians 2:10)
If you’re a junior doctor, nurse, or student – this applies to you. We’re cheering you on to keep running the race, keeping the faith, and getting you ready for tomorrow’s NHS. So don’t miss out on all the fantastic things we have at CMF to unite and equip you in your profession – drop me a line if you want to get involved.
If you’re none of the above – this still applies to you. Where has God put you, and how will you serve in this kingdom vision? Praying, mentoring, teaching, organising, hosting, training, and meeting for coffee, the possibilities are endless within CMF. Drop me a line – I’d love us to work together.
So, let me ask you – what single thing will you do this year, that would matter most in ten years? In eternity?
Let’s go back to the future: If you could jump in a time machine, and go forward 10 years, what could the NHS, and healthcare in general across the British Isles, look like?
Together, today, we can change tomorrow’s NHS for Christ.
]]>‘For the grace of God has appeared that offers salvation to all people. It teaches us to say “No” to ungodliness and worldly passions, and to live self-controlled, upright and godly lives in this present age, while we wait for the blessed hope—the appearing of the glory of our great God and Savior, Jesus Christ, who gave himself for us to redeem us from all wickedness and to purify for himself a people that are his very own, eager to do what is good.’
(Titus 2:11-14)
Firstly, let me say that I cannot even begin to imagine the grief the families involved in this case must have gone through these last eight years and are still going through. The atrocities committed by Lucy Letby are chilling and deeply distressing. Honestly, it doesn’t seem enough to say that my ‘thoughts and prayers’ are with them, as that phrase often sounds trite coming from the mouths of politicians. And the truth is that I’m struggling to find the words to pray in the face of this, but find reassurance in Romans 8:26, ‘In the same way, the Spirit helps us in our weakness. We do not know what we ought to pray for, but the Spirit himself intercedes for us through wordless groans’. So, I trust that my tears are wordless prayers, joining our God’s low guttural groans.
I also need to say that, although I had a placement on a special care baby unit (SCBU) during my children’s nursing degree, I’m sure this case is having a profound impact on neonatal nurses countrywide, far greater than my own experience. In short, I am not writing this as one who has suffered much, if at all. But since this case has sent shockwaves around the country, I am merely reflecting honestly on how it has felt for those waves to crash down in my quiet corner of paediatric nursing. I definitely don’t have all the answers, but God is kindly helping me to process some of my feelings about the case. And rather than wait for a more polished ‘perfect’ response, here’s where God’s got me to so far in its raw form. I pray it encourages you, where you’re at too.
At the end of August, my CMF inbox was full of ‘subject: Lucy Letby case’ or variants of, as our team discussed what our response should be to the court’s verdict and how we can support our members. ‘Is anyone available to do a radio interview at 9 am tomorrow?’ ‘I’ve made the edits on the blog, so it’s ready to go live’. But I have a confession. Seeing her name so repeatedly on my computer screen brought out such a strong reaction in me. I was angry, livid even. Never has there been such an incentive for me to get through my emails. Reply and archive. Reply and delete. Archive. Delete. Delete. I don’t think I’ve ever been so productive and responsive to mail. Before long, she’s gone, and I start to feel my anger subside again for now.
I don’t consider myself to be a particularly angry person, so where did it come from? Maybe it started when every time I heard her being referred to as ‘nurse’, I could feel myself recoiling. ‘You mean FORMER paediatric nurse’ I would shout at the car radio during the news report, to my kids’ dismay. Because she’s not anymore. I know that’s obvious, but I realise I feel strongly that she shouldn’t be able to call herself a nurse anymore. And I suppose, I don’t want to, or more, I can’t think of her as one of us. My brain can’t get itself around the idea of a colleague, someone you trust and admire, someone you work so closely alongside for long twelve-hour shifts, multiple days a week doing the things she did. Repeatedly. I am proud to be a nurse. I was proud before the pandemic hit, and the rest of the country got to see what I already knew. I was proud that nurses work tirelessly and sacrificially to care for their patients and their families. They go above and beyond. We are the backbone of the NHS. No, Lucy Letby doesn’t belong to the body of men and women that I hold with such high esteem.
But then, slowly, I realised how much I struggled to use her name. Even when writing it above, I still feel a twinge of pain. I found myself using ‘the defendant’ where I could as if she didn’t deserve to be named. I hate that Lucy Letby’s crimes stemmed from a ‘persistent desire for drama and attention’ (as Baby C’s mother put it in her impact statement), and here she was getting more of my attention. But I felt myself on a slippery slope. First, take her profession. Secondly, her name. When would she become a ‘monster’, or an ‘it’ instead of a ‘her’? I felt God intervene. He is so kind and merciful, isn’t he? I know that I was starting to dehumanise her, and he was gently convicting me of that.
A flurry of messages comes through on our ward’s WhatsApp group.
‘Feeling very affected by the nurse Lucy Letby killing seven or more children.’
‘Can hardly bear to read it.’
‘It’s unimaginable. Those poor families. I wonder how her colleagues must feel too?’
Then on every shift, someone mentions the case.
‘I didn’t sleep last night thinking about it.’
‘Have you noticed parents asking you more questions about what you’re doing?’
‘I know I am overly explaining myself, but I can’t help it’.
I found myself thinking about Lucy Letby’s victims every time I give an intravenous medication. Every time I used an enteral feeding tube. Injecting in fluid, or syringing in feed. I became acutely aware of how vulnerable my patients are, and the power I have as a healthcare professional. It was terrifying. Why did I feel like I did when I first got my pin as a newly qualified nurse? When I think about it too much, the responsibility for my patient’s lives feels overwhelming. I found myself double and triple-checking everything I did, and I noticed my colleagues doing the same. We’d become anxious about making a mistake and causing harm by accident. But therein lies the difference. Most nurses are vigilant and thorough. It’s in our code of conduct to practice safely and to stay competent, with ongoing professional development and training. This case wasn’t about a nurse who made mistakes. She deliberately caused harm to her patients. So now I refuse to let her actions make me question my competence. I’ve been working as a paediatric nurse for 18 years now. Why should I let my confidence be knocked by the actions of one deeply disturbed individual? Can I encourage you to talk openly with your colleagues about how we’re feeling, they might be feeling it too. Remember, this is what we’re best at. We support and encourage one another, whilst doing a tremendously difficult job. I try and change the tide of conversation with, ‘Gosh, you’re good at what you do.’ ‘I loved the way you handled that’.
If you are in need of extra support from us, please do get in touch with our CMF Wellbeing Team. It’s what they’re here for, and they’d be only too happy to listen and pray with you. I for one will continue to pray for peace as I go onto my shifts for myself and as well as my colleagues. I’m asking God to help me practice peace as well, as I know that it comes from him, but there’s some responsibility on me to live wisely too. I realise that there’s a line for me between healthy and unhealthy interest in the details of the case. So, I’ve put boundaries on how much I will read, watch, and listen to about it, and I’m careful not to think about it late at night as I try and help my mind switch off before bed. May God lead you too in practising peace, and I pray that ‘…the peace of God, which transcends all understanding, will guard your hearts and minds in Christ Jesus’ (Philippians 4:7).
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One of my lawyer colleagues remarked how little comment there has been, if any, about the ethical aspects of this first UK womb transplant and so wrote a helpful article on the topic herself.
There are several issues not raised in that article, however, that appear to have gone entirely without comment. The first relates to informed consent and the importance of receiving accurate information rather than skewed statistics.
In the case of wombs, a successful transplant is not saving a life but ultimately about successfully gestating a healthy new life to the point of viability, despite the considerable risk to the recipient. In order to give valid consent, the chances of success of delivering a so-called ‘take home baby’ – of necessity via a Caesarean section followed by hysterectomy to avoid continuation of immunosuppressive medications – needs to be communicated accurately. Worldwide, with over 90 womb transplants carried out and 50 babies delivered, the success rate is in the order of 50 per cent. In 2019, one US medical centre said a womb transplant was not worth the risk. However, some other clinics are putting out statistics of almost 80 per cent success rates because they use the number of successful transplants, rather than the total number performed, as the denominator for calculating the rate. Thus, one clinic boasts a headline and opening paragraph as follows:
Uterus Transplant Team Has a Current Success Rate Close to 80%
As the publication shares, out of the 14 (out of 20) technically successful uterus transplants, there have been 12 successful live births, which gives us a success rate of 79%.
However, only 12 out of 20 transplants actually resulted in a baby. Sixty-two per cent, though not really close to 80 per cent at all, gives a far more accurate picture to those considering the procedure.
The second point not mentioned by the media concerns the fact that most of the world’s 100 or so uterine transplants have been from deceased donors. Consent for the deceased donation of organs considered routine for transplantation (such as heart, lungs, kidneys, liver, corneas, pancreas, and small bowel) is assumed in the UK unless the person concerned actively opts out. Although we are many years away from uterine transplants becoming routine, should they become so, they will be unique in that only biological females will be possible donors. Potential donors may regard a non-life (or non-sight) saving transplant in a different light from already well-established, routine transplants. Indeed, research will need to be carried out to ensure women are not deterred from donating other organs because of reservations they may have about uterine donation after death.
Usually, the recipient of a deceased donation cannot be specified by the donor. Still, if it does eventually become technically possible to transplant a uterus successfully into a biological male, many women may not wish to donate their wombs in such circumstances. This is a long way off, of course. In response to questions, co-lead surgeon of the first UK transplant, Professor Richard Smith, said he thought this was decades away because it was technically more difficult due to ‘anatomical differences’ and other issues such as differing microbiomes in men and women. Nevertheless, if not given a choice to express a view on such a divisive issue, some women who might otherwise have elected to donate after death might opt out.
Finally, there is the high financial cost of uterus transplants and the question of who pays for them. The UK’s first womb transplant cost £25,000, even with the surgeons working pro bono, and was paid for by a charity. Is the NHS going to be able to afford the costs of such transplants into biological women with uterine factor infertility, let alone into biological men in whom the likelihood of a successful transplant (let alone the delivery of a healthy infant) is far more remote? Is this a justifiable use of public funding?
Truthfulness (Psalm 51:6) and justice (Micah 6:8) are important biblical ethical principles, and both are often absent in debates about fertility treatment more generally. Sadly, discussions – or lack of them – about uterine transplantation don’t look set to herald much change in that tendency.
Trevor Stammers
CMF Associate in Public Policy and author of The Ethics of Global Organ Acquisition: Moral arguments about organ transplantation
Trevor has also discussed these and related issues around the ethics of organ transplantation on CMF’s 1st incision podcast.
]]>Undoubtedly, mistakes were made that look even worse with the power and accuracy of the ‘retrospectoscope’.
Patient safety was not put first, nor was the dogged pursuit of the truth of what happened in each case. It seems these were trumped by reputational concerns and a desire not to upset the feelings of the individual involved.
The precautionary principle was not applied.
However, I find the official NHS response disingenuous.
There are good whistle-blowing policies in place, we are all in a governance structure, and an accountability framework, and all staff do (or should) have appraisals. But these policies ‘sit on a shelf’. At the same time, day by day, there is enormous pressure from above that gives a very different message – ‘do not complain, do not cause a scandal, meet the targets, do everything – regardless of resource, regardless of staff shortages – and do this while also delivering this year’s cost savings’. Even though this is patently impossible.
This is an unequal fight between a good, well-written policy and the daily pressure, whose message is in many ways the opposite – ‘deliver, and do whatever is needed to deliver’. The government, NHS England, CEOs, and Trust Boards don’t always want to hear the truth.
The government’s primary concern is re-election, and the avoidance of, and limitation of, reputational damage. This culture is cascaded down through the system, not least through Trust CEOs, whose jobs are on the line if they are deemed responsible for reputational damage and the ensuing political fallout. With an average tenure of only three years for an NHS CEO, this is a very well-grounded fear!
There is often no honest conversation.
Indeed, a candid conversation is often discouraged in practice (despite what is said). The system doesn’t want to hear about the daily shortages and shortfalls. There is neither the political courage nor will for the honest conversation that recognises that, at this time, with these resources, and with these limitations, we can do ‘this’, but not ‘everything’. It feels like plausible deniability has become an NHS art form.
I would suggest this is responsible for a highly politicised and corrosive culture coming from the top, which is, at least in part, the culture that allowed the dreadful events of the Lucy Letby case to continue when they should have been stopped much earlier.
It is a culture in which reputation and massaging the truth for the best political spin are more important than the truth or patient care.
Which leads us to prayerfully reflect on our role as Christians. What is God calling us to do, or perhaps more importantly, calling us to be?
To pray certainly, but also to be champions of multiple, honest conversations in the corridors of power and locally in wards, surgeries, and departments throughout the country, day by day.
Honest conversations in support of our colleagues (often more junior) on an impossible night shift or an under-staffed ward, but also with our CEOs and Directors of Finance and Execs who make impossible decisions every day with the constant threat of the sack hanging over them.
And then, of course, to support each other as Christians working in healthcare and healthcare leadership roles throughout the NHS, as we seek daily to have those honest, supportive conversations. We support our juniors and nurses when they are put in impossible clinical situations, and we also support our CEOs and managers who have to make impossible decisions. To support each other as we seek to do this in a godly way. The Christian Medical Fellowship’s Christians in Healthcare Leadership Network (CHLN) has been started to do just this – a supportive network where those who live and breathe the challenges of getting stuff done in the NHS can thoughtfully and prayerfully consider how to apply our faith day to day and support each other in that.
In today’s NHS, true honesty is not always a welcome message. It is a hard message to give against the pressure to be quiet and not rock the boat. It has not ended well for most whistle-blowers in the NHS, in the same way as it did not end well for many of the prophets of the Old Testament. Yet, God did and still does call us to champion the truth and to speak up for the voiceless, as he called Jeremiah to speak to King Zedekiah, or Nathan to King David, or Moses to Pharaoh.
The GMC’s newly-updated Good Medical Practice is with us on this, giving:
formal recognition of the role we all hold in shaping workplace culture regardless of seniority or specialty. Clinical leaders are especially important in modelling and enabling the values and behaviours which support and encourage environments where concerns can be raised, questions asked and everyone feels valued.
God’s call on our lives is the same today as it was 2,500 years ago; God calls us to get involved in the messy, complex business of the secular world and to make a difference.
Chris Holcombe is a recently retired surgeon who has held multiple leadership roles in the NHS. He now heads up CMF’s Christians in Healthcare Leadership Network (CHLN)
]]>First, we’d like to start by extending our heartfelt sympathy and compassion to the families involved.
I myself (Pippa) have had personal experience of two of my own babies being born extremely prematurely and having months on neonatal units. I know first-hand how helpless and vulnerable you already feel as a parent, just having to trust your baby into the hands of doctors and nurses, especially when you have to go home and leave them in hospital. It’s unimaginable that one of those you trust, a nurse, can act in such an evil way and murder your baby. Neonatal nurses are charged with caring and often saving the lives of the smallest and most vulnerable people – newborn babies. As one parent of two of the baby victims disbelievingly said, ‘a nurse is someone supposed to protect them’.
It has caused unspeakable pain to these dear grieving families, who we are praying for. Let’s also be praying for the anxious parents of babies currently in neonatal units across our land that they would get quality care and have their trust restored in the doctors and nurses caring for their little ones.
The nurses we know are also reeling. The Chief Nursing Officer for England reports nursing staff across the NHS are ‘shocked and sickened’ to learn of Lucy Letby’s crimes. They have struck to the very heart of nurses’ responsibility to ‘do no harm’.
Nurses tend to enter this profession because they are caring and compassionate people. Remember how we saw during the pandemic the overwhelming majority of nurses coming to work, sometimes putting their own health at risk, because they cared deeply for the people in their care and their families.
Lucy Letby is, thankfully, a rare anomaly to what the core of nursing is; she is an extreme exception. Nevertheless, she was able to get away with the repeated murder of those under her care and understandably, it left nurses, and indeed all healthcare professionals, deeply shocked.
At the same time, there’s been great damage to the public trust in nurses who before had a privileged position of trust in society. The Guardian newspaper on 22 August stated that ‘the nursing profession faces a long task to reassure families and patients that crimes and apparent failings will not be repeated’.
Nursing is already a hard profession to be in; it’s made all the harder when working in an environment of suspicion and distrust. We are aware this is especially tough on neonatal nurses and doctors, on whom the spotlight is focused, and we want to particularly pray for and support our members working in this field.
Finally, it highlighted the hopelessness some NHS staff feel about speaking up about issues in their workplaces; that it is ‘futile’ and will result in no change. Ongoing staff shortages that aren’t addressed, and the resulting feelings of being unsafe in our clinical practice, adds to this sense of hopelessness.
In Lucy’s case, concerns were first raised in 2015; why wasn’t she found out earlier? Hospital management dismissed the concerns of seven hospital consultants; indeed, they were disciplined for raising these concerns.
There are big questions about the accountability of the hospital managers and executives who reportedly dismissed the concerns of the doctors, seemingly in the name of protecting the reputation of the hospital. There is now a call for the individual executives involved to face justice for their inaction, as well as wider calls for hospital managers to be independently regulated in the same way that doctors and nurses are. It’s terrifying to think that this culture of silencing and dismissing whistle-blowers may be currently allowing all sorts of scandals and malpractices to continue in the NHS. As healthcare professionals, we can – and must – speak up if something doesn’t feel right. Not least, we have a biblical mandate as Christians to speak up for justice. Let’s support each other as, together, we seek to change the parts of the NHS culture that need seriously redeeming. And let’s work on modelling good listening to our colleagues and respectful interdisciplinary relationships.
We can thank God that Lucy Letby has been brought to justice by the court this week and jailed for life. As Christians, we can take further comfort that God is justice, and that one day, Letby will also be held accountable, facing judgment by God himself, and the victims and their families will see true justice served.
We are with you at this hard time. We are also troubled and grieved. There are no easy answers, and it is at times like this that we especially need each other, a supportive Christian community, to talk things through, to listen, and to pray.
Our CMF Wellbeing service is ready and willing to extend care, time, and a listening ear to you. We would invite members to e-mail us via wellbeing@cmf.org.uk. Please head your enquiry ‘#Wellbeing‘ and do leave contact numbers for a call back for prayer or conversation.
The CMF Nurses & Midwives Team
]]>But will a strike work? And is this something Jesus asks me to do? I’m conflicted.
The Scriptures get me thinking.
‘Don’t be selfish; don’t try to impress others. Be humble, thinking of others as better than yourselves. Don’t look out only for your own interests, but take an interest in others, too. You must have the same attitude that Christ Jesus had.’ (Philippians 2:3 NLT)
If I walk away and make my point, are you OK with that Lord? Someone else will cover, won’t they? The clinic can be re-booked, can’t it?
Still, patients will be cancelled, and colleagues who cover will be taken away from ‘routine work’. And the queue of suffering will grow some more.
Nevertheless, when all is said and done, the NHS is not playing fair; they expect everything and erode my salary by stealth.
But God, don’t you say:
‘Why not rather suffer wrong? Why not rather be defrauded?’ (1 Corinthians 6:7 RSV)?
Yet they have treated me like a slave. The phrase ‘making bricks without straw’ comes to mind. They can’t even provide a kettle and some coffee when I work all night. Enough is enough.
‘Slaves, be obedient to those who are your earthly masters, with fear and trembling, in singleness of heart, as to Christ; not in the way of eye-service, as men-pleasers, but as servants of Christ, doing the will of God from the heart, rendering service with a good will as to the Lord and not to men.’ (Ephesians 6:5-7 RSV)
You mean I work for you, Lord?
Well, I am not going in today, the BMA said not to. I need to show the government we mean business.
‘Slaves, obey in everything those who are your earthly masters, not with eyeservice, as men-pleasers, but in singleness of heart, fearing the Lord. Whatever your task, work heartily, as serving the Lord and not men.’ (Colossians 3:22-23 RSV)
But God, I am not a slave. I am a twenty-first-century medic. I deserve respect and a decent salary. They are taking the mick.
However, you say I should think I work for you, not them, Lord? Do I really have to trust you to meet my needs? Or must I fight and campaign for my rights?
But then I think, ‘What about the patients?’ Over 400,000 appointments and operations cancelled so far. My friend at church sees her hip replacement OPA deferred for weeks or months. A And that is multiplied thousands of times.
Some proverbs come to mind:
‘Do not withhold good from those to whom it is due, when it is in your power to do it.’ (Proverbs 3:27 (ESV)
‘He who closes his ear to the cry of the poor will himself cry out and not be heard.’ (Proverbs 3:27 ESV)
I guess, just because we can’t hear the pain and distress doesn’t mean it isn’t there. Perhaps, this is something that isn’t all about me?
God, I know you hear and see and feel, particularly for the needy and oppressed.
But what about my oppression as someone abused by the system?
Another Proverb rings hollow:
‘As workers who tend a fig tree are allowed to eat the fruit, so workers who protect their employer’s interests will be rewarded. ‘(Proverbs 27:18 NLT)
I work hard, and they do not care. The rewards are not fair.
Maybe I should ask who does the rewarding? Is it you, Lord, or is it my employers? Surely it is in your hands, God?
Nevertheless, an overwhelming majority of doctors support this action. There is a massive mandate to do this. And yet your word says:
’You must not follow the crowd in doing wrong. When you are called to testify in a dispute, do not be swayed by the crowd to twist justice.’ (Exodus 23:2 NLT)
Whatever the BMA says, it all depends on whether or not we see depriving patients of treatment as wrong, I guess?
And are we missing a trick to shine as lights in the world, not as some creepy do-gooders, but because we genuinely care for people in need, like our ancestors did when they started the first hospitals?
‘Do all things without grumbling or disputing, that you may be blameless and innocent, children of God without blemish in the midst of a crooked and twisted generation, among whom you shine as lights in the world. (Philippians 2:14-16 ESV)
Yes, the Scriptures get me thinking. For me, as a Christian, this is more than just a technicality of employment. There are some visceral principles to think through. It’s different.
Where do we go?
As Christian doctors, shouldn’t we reflect on the impact of our choices with respect to the right to strike? The right to protest is very different and may even be the right thing to do. Withdrawing labour unilaterally, however, looks like it may be destructive and morally dubious. And does it reflect the life of Christ?
Shouldn’t we distance ourselves from the apparently self-seeking philosophy behind this industrial action and instead speak of the love and care we have in our hearts for patients, love that is inspired by the Christ who lived, died, and rose again for them and whose Spirit constrains us to love as he loved?
Steve Sturman is a neurology consultant and CMF’s Associate Head of Doctors Ministries
]]>For me, however, it was not a headline but a picture on Twitter of a baby born at 32 weeks that made me realise that the life of the unborn child in this case – which was totally disregarded in almost all media discussion – would have been at the story’s very heart had the mother ended the same child’s life by removing their life support on a premature baby unit. Children’s lives rightly matter, and they deserve the full protection of the law. This is the essence of Alison Pearson’s argument under the one dissenting headline. ‘A woman’s “reproductive rights” do not include stopping the heart of a baby that can live outside its mother’s body’. During the crisis of the pandemic, the law was changed under pressure from abortion providers and their allies, making it all too easy for women to obtain abortion pills without having any independent confirmation of gestational age. A policy that Lord Alton predicted at the time would inevitably lead to cases such as this.
Surely those who provide abortion pills without adequate safeguards also have responsibility in this tragic outcome? Furthermore, if legal proceedings did not ensue against the mother in this case, on what rational basis can one possibly hold legally to account a mother who removes her infant from the special care unit, thereby causing death? Does the value of a viable infant’s life depend only on whether it is born? This important question is not a new one but is arguably even more important in an age of online abortion pills on request. It should not be drowned out by calls for total decriminalisation of all abortions and cries of outrage against the case being brought at all.
Pearson unwaveringly continues, ‘...as it happens I too am outraged. Outraged on behalf of the baby in this case whose mother did a Google search for “I need to have an abortion and I’m past 24 weeks” and “Could I go to jail for aborting my baby at 30 weeks?” Thankfully the answer to the latter question is still yes.’
One might be forgiven, on reading most other accounts, for not realising that the mother, in this case, almost certainly knew what she was doing at the time she took the pills, which is why the judge felt he could not give a suspended sentence. Reading his sentencing remarks certainly puts the case in a very different light from most of the selective accounts in a media that never dares question any aspect of an industry that ends almost a quarter of a million unborn lives in the UK every year.
Jennie Pollock and Trevor Stammers
Readers may wish to use this tool, created by Right to Life, to write to their MP requesting that rather than decriminalising abortion, personal appointments are reinstated for all initial abortion consultations.
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