Wednesday, October 26, 2016

The Girl on the Train

Now, leaving aside that Emily Blunt's Rachel is not a girl, or that millions of books fans complain that the action has been moved from London to New York, this is a enjoyable B movie thriller. But it left me feeling uncomfortable.

Maybe it was that despite having three strong female leads, the film fails the Bechdel test - all the dialogue shared by the women ends up revolving around the male characters, even though they are very much in supporting roles.

It might also be that all the women are in some way dysfunctional because of motherhood and social expectations around having children.

It could be because of the many plot holes that stretch the willing suspension of disbelief to the limit. Maybe.

Actually, for me it was the first two points that really bugged me (I cope with plot holes in most films and TV series reasonably well - otherwise I would never be able to watch most dramas!). Spoilers ahead for those who have neither read nor seen the film!

Movies that are about women being badly treated by men should, in this day and age actually be addressing the causes of that abuse, not just accepting it as an inevitability and giving the women the let out of a bloody revenge at the end. In the film, the reason the women were reduced to mere appendages to the men was the issue that was not  adequately explored. The book, apparently (I have not read it yet) addresses the fact that the women are trophy wives for successful men, despite having their own careers and skills and that their whole identity and purpose is tied up around their ability to produce offspring.  However, early on in the film one of the main characters observes bitterly that the whole suburb where the action happen is 'one big baby farm'.

This is the issue that the films never quite gets to the heart of. How much our culture still only values women because of their ability to reproduce. Rachel's real pain because she not only cannot have children, but has been replaced by a new wife who has given her ex-husband the child he wanted, is compounded by the expectations of society around her. Megan's grief over a lost child and her husband's pressure to give him a family that can only remind her of her awful loss cause her increasingly dysfunctional behaviour. But why the culture around these women sees this as their only value and purpose is never challenged.

The Bible has several stories about women facing the pain of the childlessness, and the social disgrace that went with it - Sarah and Rachel in Genesis and Hannah in 1 Samuel are obvious examples. However, God eventually gives them all children, There are no stories about the women denied the chance to have children or who chose not to, so we have to address those issues from elsewhere in scripture.

So what of those who cannot have children. And why is it just the women denied children who suffer - what about their husbands? It seems to me that our culture, including our churches makes the ideal of marriage and parenthood, especially motherhood, a dangerous idol. It leaves those not able or not willing to have children on the edge, left out of social gatherings and conversations that revolve around parenting. For those of us who are parents, the struggles and challenges of parenting occupy our time and energy so much that we are often blind to those around us who are left out.

For women though, the sense that one is only validated by being a mother is a toxic pressure. There is already the ludicrous notion that a woman can only be validated by a romantic relationship with a man. Then, once that man is found and domesticated, the only role left is to become a mother.

The bible does place motherhood (and fatherhood) in a place of great esteem, but Paul points to a higher calling that may lead women and men to eschew such a role, and Jesus himself gave hope that those denied biological parenthood can become mothers (and fathers) to many by other means. Marriage and parenthood matter, but they are not all there is to our humanity and value, and the more we hold on to the truth that there is more to us than our reproductive roles, the saner (and happier) we will be!

Saturday, October 08, 2016


So, a cult seventies science fiction fable about the perils of entrusting our entertainment to robots has been turned into a new cable TV series by the brother of Christopher ‘Inception’ Nolan and JJ ‘Lost’ Abrams.  Great Anglo-American cast (and a new Hemsworth brother to boot!), great production and directing credits, and a first episode that lived up to the promise of the hype.

Many are seeing Westworld as the next big thing after Game of Thrones, the HBO series that has outsold every other TV series and garnered a record breaking number of awards. But thematically and tonally it is much closer to Battlestar Galactica, the equally lauded series of eleven years back. Both BSG and Westworld rest on the oldest science fiction staple of all – the creation of artificial life and our responsibility to our creations.
Brain Aldiss has argued that Mary Shelley’s ‘Frankenstein: A Modern Prometheus’ was the first true science fiction novel, and I am loathe to disagree. Its central theme of the derogation of responsibility by the creator for his creature is often overlooked by film makers (Kenneth Brannagh’s version being a notable exception). Most just dwell on the monster being monstrous, but in Shelley’s original he is intelligent, eloquent and tortured by the rejection he faced from Frankenstein and wider society. He became monstrous because he was treated as a monster.

This theme has been re-visited so many times in science fiction, from the awful, killer robot stories of pulp fiction, to the more sophisticated treatment of Asimov’s Robot novels, through to Blade Runner, the Matrix films and BSG , and most recently the rather wonderful Channel 4 series ‘Humans’.

At its core, Westworld is about the creation of sentient beings for the sport of humans. These beings, known as ‘Hosts’ are androids with limited self-determination, their memories wiped at the end of each cycle, and each has a script to which they adhere, allowing them a limited repertoire of actions. In some this way mimics human existence, where our memories are selective, and that we all work within the limitations of ‘scripts’ determined by culture, upbringing and social expectation. It is also perhaps an echoing of Calvinist theology of predestination – free will is an illusion, we all ultimately serve God’s purposes.  

But the abuse meted out to the ‘Hosts’in the name of entertaining the worst fantasies of humans (especially men) who see a Western setting as a great excuse to show off such ‘manly’ virtues such as murder and rape.  The invitation to come to Westworld touts the fact that actions there have no consequences. Except, obviously, they do, because the Hosts are developing glitches, memories of past roles and past abuses are beginning to surface, causing failures. In one case Abernathy, one such ‘glitching’ Host delivers a Shakespearian, almost Biblically prophetic rant as he confronts his maker (in the form of Anthony Hopkins’s Frost). Quoting Romeo and Juliet, he enigmatically tells his creator “these violent delights have violent ends”, before being switched off. These are the final words he gives his ‘daughter’, Delores, at the end of the first episode. It is a warning of what is to come.

The creation of artificial life and artificial intelligence is becoming close to a technological reality, and it is stories like Westworld that remind us of the dangers of taking on the role of Creator when we lack the moral core to live up to that role.

However, in reality we do not need to create artificial beings to abuse.The abuse of those deemed lesser beings or sub-humans is a common symptom of decadent or primitive societies. Whether it is slavery and human trafficking, blood sports, proxy wars, racism and class or caste systems, we are prone to work out our worst human instincts through abuse of the ‘other’ who we can make subhuman to maintain our illusion of being good and moral.

CS Lewis in his seminal work The Abolition of Man pointed out that “the power of Man to make himself what he pleases means... the power of some men to make other men what THEY please.” As we become more technologically advanced, this power to shape other parts of humanity to our will grows rather than lessens.

The story of the birth, life and death of Jesus reminds us, as the German theologian Dietrich Bonhoeffer put it that “Through Christ’s incarnation, all of humanity regains the dignity of bearing the image of God. Whoever from now on attacks the least of people attacks Christ, who took on human form and who in himself has restored the image of God for all who bear a human countenance.” In short, we have a moral duty to all our fellow humanity to see and treat them on an equal footing - even if we must forgo our comforts and luxuries bought at the expense of others.

Westworld is about our moral responsibility to our fellow man, about the myth that our actions have no impact or consequence for us regardless of their consequences for others, and that playing God is presuming a role for humanity for which we are singularly not equipped. It has a resonance in social justice and bioethics. I look forward to seeing how it explores these themes in the coming weeks.

Friday, April 04, 2014

Getting under your skin

You can just picture the meeting in a Hollywood studio.  The British director pitching his new, high concept movie to the moguls; Scarlett Johanssen drives round the streets of Glasgow in a Ford Transit picking up strange men. And it will be mostly improvised using a candid camera and real people. Yep, that would have been a short meeting.

So, why is 'Under the Skin' picking up such rave reviews from critics? It certainly seems to be ticking some boxes in film circles.  Some are comparing its director Jonathan Glazer to Stanley Kubrick, others see echoes of Nicholas Roeg's 'The Man Who Fell to Earth'.  And I can see why - it has long, slow, observational scenes, minimal dialogue, an eerie musique concrète soundtrack, and some startling visual effects scenes alongside the mundane imagery of Johanssen driving round drab Glaswegian streets.  One truly magical moment is when she finds herself caught in the whiteout of a highland haar - both an everyday experience for a Scot, but a moment of bewildered wonder for an alien. Experiencing the mundane as alien is perhaps the most Kubrick or Roeg like qualities of the film.

Thematically it also draws parallels to those two directors.  An alien in human guise, with uncertain (i.e. alien) motivations finds themselves drawn towards the human condition, but finds themselves still an outsider and not able to connect.  The hunter become the hunted, gender roles and power imbalances are exposed. And there is the bizarre, abstract opening scene of something like a human eye being assembled in darkness, back-lit by a single point of light as the eerie three note main theme is played on electronically re-touched strings (very reminscent of Ligeti's 'Lux Aeterna'  playing against the Star Gate sequence in Kubrick's 2001) while a woman's voice hesitatingly tests out out the phonemes of English, as if learning to speak the language for the first time.

And there is a vein of horror, as the men Johansson's nameless alien picks up are sucked into a black, oily liquid and eviscerated - for reasons unknown - leaving just the haunting image of their empty skins floating in a black void. Another scene on a beach is even more horrific, as an awful family tragedy unfolds and a futile but heroic attempt at rescue culminates in a dispassionate Johanssen clubbing to death the rescuer and leaving the family to their fate without a whisper of emotion or empathy.

Audiences may have been less enthralled than many of the critics - the ending eliciting a loud raspberry from the back of the cinema when I viewed it recently.  It has, nevertheless stuck in the top ten for several weeks at the UK box office, which is no mean feat for an arthouse science fiction film.  Many, no doubt went to see what promised to be an erotic thriller with Johansen 'getting her kit off for the lads'.  Well, there is plenty of quite explicit nudity (male and female), but I found it profoundly un-erotic.  Johansen inhabits her skin as an alien, not sure why her body affects men the way it does, but knowing that the effect is useful to her purpose and having an idea of the rules she must play by to lure in her victims.  The one sex scene is awkward and ultimately futile - her alien body is not designed the same way as ours, a reality already hinted at by apparently not needing (nor being able) to eat or sleep. She remains an outsider, unable to fully experience what it is to be human.

Other things stick out. Particularly Johanssen as the predator, picking up men with a mixture of faux innocence and sexual appeal.  It could only work that way round - Brad Pitt driving around picking up women the same way would just have been sickening and creepy in the wrong way.  This is much more unsettling - it is the promise of strings free sex with a beautiful and available woman that is the undoing of the men in the film, none of them stopping to question why she would be offering herself to them like this. And when the tables are reversed, it is male abuse of power and drive for sex that undoes Joahnssen's character. The film does not paint a pretty picture of male sexuality and attitudes to women.

Johanssen is the star of the film - none of the other characters being much more than ciphers.  She acts by face and body language (or its absence) more than voice (although her clipped, London vowels are convincing, she barely utters more than a few dozen lines of mostly improv dialogue) and is quite compelling, especially as she starts to unravel in the film's last act.  And it is as she changes, as she experiences human kindness, as she tries to show mercy to one of her victims, as she seeks human connection with another man who helps her, so it is that she becomes more vulnerable.  As she becomes more the woman she seems to be, so it is that she also succumbs to the power imbalances that disadvantage women in our society.  All this is conveyed in a flawless performance by an actress who was obviously unafraid to take real risks in taking on such a difficult role.

In some ways the film is an honourable failure - the lack of human interest or development in the other characters and the lack of backstory or motivation making it a hard watch for those used to more conventional cinema. There is also a distinct jarring between the science fictional and the (largely improvised and candid camera filmed) realistic scenes in Glasgow. 

But somehow, it does get under ones skin. Particularly compelling are the eerie and unsettling soundtrack that borders on sound effects rather than music in places, the stark but beautiful visuals, but above all the view of humanity, especially human (particularly, male) sexuality that it deconstructs so disturbingly. All in all an interesting film that will be talked about for years, and will be worth revisiting.

Monday, January 20, 2014

Ancillary Justice

Every now and again I get interested in a book just because of a random review I stumble upon. But now I have a Kindle, it is also easy to just download a few sample chapters to see if it really is worth reading.

What I found here was the debut novel of Anne Leckie, Ancillary Justice which was getting a lot of buzz last autumn when it first came out.  The story opens with its (probably female) protagonist, Breq, on a wintery and brutal world acting with impulsive kindness to a former officer that she had served with in the armed forces of the aggressively expansionist Radchaai empire. It soon becomes apparent that Breq has hair trigger killer instincts, some interesting enhancements, and a lot of anger.  Thus far she is similar to the tough female killers that have populated science fiction novels from William Gibson to Iain M Banks for decades.

But Breq is rather unique - she is not what she once was. Literally. She was Justice of Toren, a massive troop carrying starship, most of whose soldiers were ancillaries, mind wiped prisoners of war, now slaved to the ship's Artificial Intelligence.  As a result, Justice of Toren sees the world through multiple eyes in multiple locations, and can speak (and indeed, sing) with literally thousands of voices. Only all that is now left of her is one, lone ancillary, Justice of Toren One Esk Nineteen, out to avenge the death of all she once was and all she had once cared for. She is an AI in a human body trying fit into human society, with a quest for vengeance.

The multiple conversations and observations that her multiple self shared with her human officers and the citizens of a world recently 'annexed' by the Radchaai makes for fascinating reading, and when this is broken down in one particularly traumatic event about of a third of the way into the novel, we get a real sense of the loss, disorientation and fear that ensues for her/it.

All of this is interesting science fiction, set in a standard space operatic format and happily playing with all the usual tropes of the genre (vast empires, massive spaceships run by AIs, special weapons, exotic worlds, epic battles). But actually the novel is a lot more than this precis suggests. Exploring the nature of empire, imperial expansionism and the war crimes that are committed in the name of protecting that empire, it does what the best science fiction does and holds a mirror up to our own world. Lecke is American, but as a Brit I got at once the sense of an empire reaching the end of its expansion and the yearning for the glory days of old amongst the officer class (and their obsession with drinking tea!). One telling quote summarises the realisation that some of the Radchaai were coming to about the nature of their empire:
luxury always comes at someone else’s expense. One of the many advantages of civilization is that one doesn't generally have to see that, if one doesn't wish.
Some amongst the Radchaai (a word that means 'civilised') are questioning the empire, and this hinges around two, appalling war crimes to which the Justice of Toren is both witness and contributor.  The tension between the conservative and progressive streams amongst the Radchaai are at the centre of the story.

Another interesting quirk of the narrative, and one that most reviewers (especially male reviewers) hone in on first is the use of gender. Radchaai culture and language make no apparent distinction between genders, using a single pronoun for either sex and no apparent differences in dress or social roles between male and female.  As a result, the non-human Breq struggles conceptually with languages and cultures that do make such distinctions. All characters are referred to in the feminine, except rarely where she must speak in other languages and to other cultures that do not make such distinctions, where we learn she regularly gets genders the wrong way round, causing much confusion and occasionally, offence! What this achieves is initially a sharp sense of confusion and dislocation in the reader, although by the end of the novel I had ceased to notice and was going with the flow.  It does ask the reader where her/his presuppositions about how we assume behaviour and social role will fall along gender lines, and how culturally prescribed these presuppositions are.

All this is done in a narrative that avoids too many space opera cliches that pander to the inner thirteen year old male of so many of the genre's fans. There is little violence (and when it does happen it is mostly 'off screen' and all the more disturbing for it), no sex or sexual tension (although Breq's underlying lack of humanity means she misses the cues that may be there).  Like Iain M Banks and Ken McLeod, Leckie is subverting the genre to look at political themes that this most politically conservative and masculine of all science fiction sub-genres generally eschews.

The book does end on an apparent anti-climax, but as it is the first book of a trilogy this is forgivable, leaving you at least wanting to know where it goes next. A strong start to a trilogy and an impressive debut novel. I look forward to the second volume out later this year.

Friday, September 02, 2011

UK HIV Response "Woefully Inadequate"

A report published yesterday by the HIV and AIDS in the UK Select Committee of the House of Lords has described the priority given to preventing HIV and AIDS in Britain as “woefully inadequate”. While nearly three quarters of a billion pounds is spent each year on HIV treatment, only a third of that is spent on prevention. In the last decade, the UK has trebled the number of people on anti-retroviral therapy for HIV (ART), while we face the number of people living with HIV topping the 100,000 mark in the next year if current trends continue – 25% of whom do not even know their diagnosis. And people unaware of their HIV status risk infecting others and worsening their own health.
While the scale of this problem has made headlines today, the underlying issue should come as no real surprise. As far back as 2006, while attending a function for UK civil society delegates to the UN High Level Meeting on AIDS in New York I was told by a Department of Health Civil Servant that the UK did not need a separate HIV prevention strategy any more, as it was all adequately dealt with by the UK’s sexual health strategy. Ignoring the fact that the most successful work has been done amongst drug users using needle exchanges, the astounding level of complacency this statement reveals is born out by not only today’s figures, but that the UK continues to have some of the highest STD and teenage pregnancy rates in Western Europe. If we cannot even tackle sexual health adequately, no wonder we are not tackling HIV!
In fact, the most worrying finding is that, a generation on from the start of the AIDS pandemic, the British population is more ignorant than ever about HIV, its effects routes of transmission and prevention.
While the British government has been applauded for its funding of HIV treatment and prevention work in the developing world, we remain shockingly inadequate (and even complacent) on the domestic front. Likewise, the global church has responded constructively to HIV in many parts of the world, especially sub-Saharan Africa, but the British church remains largely ignorant and unengaged with HIV as in issue in the UK. It is time for a change in our attitudes.
Well done to Lord Fowler (the originator of the ‘Don’t Die of Ignorance’ campaign in the eighties that many now credit with playing a significant part in saving the UK from a major HIV epidemic in the nineties) and his committee for reminding us the AIDS has not gone away, and getting it back in the headlines.

this post originally appeared on the blog of the Christian Medical Fellowship at

Saturday, April 02, 2011

Missing Midwives Costs Mothers’ Lives

On 1 April UNICEF and the Royal College of Midwives launched a campaign to find the missing midwives.  UNICEF’s recent research suggests that globally we need 350,000 midwives, and that this shortage of skilled birth attendants means as few as 6% of women in some developing countries have access to skilled birth attendants. This means that there are as many 1,000 women and 2,000 children dying daily, many of whose lives could be saved if a trained midwife was in attendance.

350,000 seems a remarkably small number and an achievable target. However, when you consider that the UK is also short of midwives, perhaps it is not a surprise that this gap has not been as easy to bridge as it at first seems.  As birth rates rise in the UK, we seem to be training fewer midwives.  Most midwives I know work in understaffed, over stressed units, and yet still manage to deliver a generally high standard of care that ensures that not only are the vast majority of British babies delivered safely, they are also delivered in a way that makes for a meaningful and happy experience for the mother.  One wonders for how much longer however, as we fail to train new midwives and support effectively those already working in the profession. As DFID gets behind the UNICEF campaign, it is worrying that other parts of the national and devolved governments are at best playing catch up and at worst reducing the numbers of midwives in this country!

However, in many parts of the world, there is no such provision.  Partly this is an issue of poverty, and partly a mixture of cultural and political values that do not prioritise motherhood or the life and health of women and children. As we highlighted in the CMF submission to DFID’s maternal health strategy consultation, it is only by addressing these issues, as well as the provision of trained midwives, obstetricians, appropriate medical supply chains etc, that we can turn around the gross inequality in maternal health and survival around the globe.

It is ironic, on Mother’s Day, to consider a world that really does not value mothers and motherhood. We live in a culture that here in the UK has such a disordered sense of human value that it does not train enough midwives, but prioritises free prescription of abortefactive post coital conception. In the process we are failing to address the deeper issues of fractured relationship and disordered sexuality that leads us to have one of the highest teen pregnancy rates in the Western world.  And as MPs seek to increase the amount of information, counselling and professional support being provided to women seeking an abortion, they are attacked for trying to harm women.  In other parts of the world a man will let his wife die rather than incur the cost of getting her to a hospital – other wives are always available, while his government will not put any money into training midwive who could have helpe her deliver her child more safely at home.  It is a sobering thought, as we celebrate our mothers this Sunday.  We need to do more than give a few gifts to say thanks to our mothers; we need to take action  seek to see motherhood properly supported around the world, and here at home.

To sign the UNICEF petition to UK Development Secretary to support the global drive for more midwives click here

Tuesday, December 07, 2010

It was the best of times, it was the worst of times...Advent Synchro Blog

Well, fourteen inches of snow in our back garden by last Friday, three days snowed in and working from home, chaos on the road and trains. Welcome to the British winter! Again.

It is interesting how just a few inches of frozen rain reveal how vulnerable our society is – shops running out of perishable supplies, major transport infrastructure going wrong, leaving people trapped in trains and cars overnight. What would happen is something really serious happened, and all of it just fell apart?

It puts me a bit in mind of Jesus’ warning to the disciples not get anxious about future or current troubles – it’s the way it will be. Sounds a bit fatalistic, but actually, it is reminder that we so easily get distracted by the immediate perils that we miss the bigger picture. If Jesus really is retuning, then things will be kicking off out there in way we cannot mistake – but history is replete with natural and manmade disasters that must have seemed like the end of the world. The long, hard winters at the start of the twelfth century, followed in less than a generation by the Black Death must have felt pretty apocalyptic to the people of Northern Europe And you can point to countless other events of similar ilk. A reminder that our lives on this planet hang by a thread.

Which is why knowing that Jesus is coming back remains so important in Christian thinking – because we know our fragility and ephemerality, we also realise that we have no help or hope other than God, and if the whole world comes crashing down around our ears, God remains firm. There is always a hope, even in the midst of hopelessness.

One of the most striking novels and films of recent times is ‘The Road’ which takes us to a world where is has all collapsed – there is no future, no hope, only a lingering (or if fortunate, a swift and painless) death. But although God never appears, there is that spark of hope, of light, of humanity in the midst of this devastation that looks onwards to a future. It is a human instinct to believe and hope that there is a better world coming – I believe that it has been planted there by God, because it makes us willing to get up every day, persist through the hard things, toil in the face of adversity, believe in the face of doubt, hostility and even persecution.

Wednesday, July 28, 2010

Where is it all going wrong?

Is Obama getting it wrong? There has been a lot of buzz lately about his responses to global health issues - particularly HIV & AIDS. I have blogged elsewhere on the detrimental impact of his changed funding priorities is having on HIV treatment, and the concern that much of the good done by PEPFAR could be lost.

This post from the Huffington Post suggests, quite rightly, that while Obama is right to focus on a wider range of health issues, including maternal and child health (arguing that you cannot deal with one disease at a time, but with the whole constellation of health crises), this should not be at the expense of the work already done on HIV treatment. It's both/and, not either/or.

But, at a time when the economic downturn is putting pressure on aid budgets everywhere, it is harder to make a case for the big spend. While our own government claims to be ring fencing aid spending, the reality is that many in the Tory Party, the right wing press, and quite a few members of the public, are arguing that we need to concentrate on our domestic ills rather than the needs of the world's poorest. Actually, the decision to up the aid to Afghanistan (a significant proportion of which seems to be disappearing into the pockets of a corrupt elite) only serves to strengthen the naysayers.

Aid, where it works, needs to be maintained and expanded - at least until such time as it is no longer needed (which should always be its ultimate aim). We cannot back peddle now!

Thursday, May 20, 2010

Earth is Crammed with Heaven

“Earth’s crammed with heaven, and every common bush afire with God; but only he who sees, takes off his shoes, the rest sit round it and pluck blackberries.”

Elizabeth Barrett Browning

I stumbled upon this quote just this morning in one of my wife's books. Every morning on the train I pass by a small glimpse of heaven (or at least what I would hope heaven might be like). Just past Cuxton on the way towards Meopham is a small valley full of farms and fields that change almost daily with the seasons. Going from alternate rich green and yellow fields in the spring, to a uniform green mottled with red poppies in early summer, then white with wheat in August. Meanwhile the trees in the hedgerows and a small woodland in the midst of the valley go from winter's bare skeletons to a riot of spring blossom to lush summer greens and then autumn golds and reds.

But most of the train is too buried in their papers, iPods books and (indeed) Blackberries, or else are too fast asleep to notice. I miss it too, most mornings, but every now and again I see this valley on my way in to London and my heart leaps and gives praise. On my way back from London, especially in the lighter evenings of spring and summer I give thanks whenever this valley comes into view, as it reminds me that I am near home - both physically and spiritually.

This little valley, glimpsed twice a day for barely a minute is, for me at least, a reminder of God's incredible creativity and artistry, and of his tangible presence in a Creation that holds together through his very Word.

Earth is crammed with heaven indeed, even in an obscure part of Northwest Kent.

Wednesday, May 19, 2010

Dying patients denied pain relief because of legal fears

A survey in Nursing Times has been published this morning claiming that "dying patients denied pain relief because of legal fears" - specifically that one in ten 'nurses' surveyed said that they were scared to give full doses of pain relieving opiates (even where prescribed) because of fears of being prosecuted for assisting in the death of a patient.

There are some real question marks to raise about this. First and foremost the methodology of the survey itself. This was an open survey that anyone could post to. Pro euthanasia groups were generically emailing their supporters asking for nurses to fill in the survey, but any of their supporters could have. The same may have happened on the other side. But the key point is that you did not need to be a Nursing Times subscriber or show any proof of being a registered, practising nurse to fill this in, so the results cannot be said to have a high degree of validity. The 2,311 respondents may have all been practising nurses, but there is no way to verify that. Furthermore it was a self selecting sample, so there is no way you can say this is a representative cross section of the profession.

Secondly, the survey asked distinctly slanted questions, which seem to look for answers that pointed to neglecting patients' symptoms for fear of prosecution. It was hard to give an answer that did not point in that direction without ticking an 'other' or 'not applicable' box. In other words, there was no real triangulation of data by asking different questions with different possible answers to make sure that the respondents were actually saying what they appear to have said.

In short, the methodology of the survey is so poor as to leave one wondering how many useful conclusions one could make from the data.

However, leaving aside the questions about the methodology and validity of the study, if one is to draw conclusions from it, then it does suggest a scary level of apparent ignorance of good clinical care and the law. 33% said they did not know what the law was (it hasn't changed, despite what you would have thought seeing the coverage of the DPP's guidelines on prosecution in cases of assisted suicide), and if 12% of nurses think it is better to titrate down the dose of opiate analgesics so that a patient is in pain rather than risk prosecution, that show a) a starling level of callousness and lack of care, b) a devastating level of ignorance about good palliative care and how hard it is to actually overdose someone on appropriately prescribe opiate analgesia, and c) a scary level of ignorance of the law on assisted suicide.

Has any nurse ever been prosecuted for simply giving an extra (prescribed) dose of diamorphine to a patient in terminal pain? I have never heard of such a case. You would have to give a huge dose to kill someone (people in severe pain can take considerably higher doses of opiate analgesia than people in no pain), and be either deliberately malicious or unbelievably incompetent to do so. In short, either this survey is picking up something that is not there by nature of its methodological flaws, or we really need to look again at nurse education on medical law and end of life care!

What is even more concerning is that the Royal College of Nursing has still to produce any professional guidance on this issue. The Nursing and Midwifery Council have spoken strongly, pointing out that the law has not changed, but despite the RCN changing their stance on assisted suicide to one of neutrality (supposedly to enable greater discussion of the issue), the main professional body for nurses in this country seems to be dithering and uncertain what to do. This lack of leadership may explain, at least in part, why so many nurses apparently feel ignorant and unable to act appropriately in the face of a person facing the end of their life in pain.

Leadership and education are what are needed here, not a change in the law!

Thursday, May 06, 2010

A Christian Manifesto

I was heartened to read the Evangelical Alliances' Open Letter to Party Leaders today, as it reflected the views of British Evangelical Christians on Facebook and Twitter, and refreshingly not a single reactionary idea amongst them!

  • Encourage the importance of marriage as the best environment to bring up children
  • A change to the voting system so that it is more representative of the votes cast
  • For politicians to act with honesty and integrity
Other suggestions that make up the top ten ideas include:
  • Foster social entrepreneurship in inner city areas that have suffered from long term deprivation
  • Fully worked out plans for supplying water and sanitation to those currently without in developing countries
  • An immigration policy that ensures we provide proper sanctuary for those fleeing persecution in their own country
  • Cap the interest rate that can be charged on loans and credit cards
  • Reform the House of Lords
  • Work to set up an international tax on financial transactions
  • Take hard choices to tackle the national debt
This is just a sample of the many ideas that were submitted to the Facebook group and via Twitter, and show that Christians are passionately committed to all areas of society. Which ever party or parties form the next Government we call on them to listen to these suggestions and engage with the Church. Across the country churches are an integral part of local communities and work for the good of all society. We ask that you work with the church as a key partner as you begin to govern.

The thinking is refreshingly global, focussed on justice, fairness and community - values at the heart of a Christ Centred, Biblical world view. I doubt that the party leaders will have listened that much (judging from most of their manifestos), but whatever government we find tomorrow morning, we have here some of the issues that Christians at least would like it to address - issues that will have a wider benefit rather than simply fulfilling sectarian interests.

Thursday, April 22, 2010

Where Was the Foregin Policy?

Tonight's Leaders Debate on Sky is being picked over by pundits ad nauseum, so thought I would add my own twopenny worth.

It was meant to be in foreign policy (although less than half was - especially if you take a pointed question about the Papal visit as being less about foreign policy and more about relationships with faith communities, which the leaders seemed to do). So we got Europe (sort of), Afghanistan (a lot) and the Special Relationship with the US (again, sort of). But nothing on overseas aid.

Four or five years back, that would have been in the top three questions asked by the audience or the pundits. Not now - the world's poor have dropped off the agenda again. Depressing. Inevitable, but depressing, because this election will once again be fought about who is going to put more pounds in my pocket - and the swing voters in middle England will be the ones who's pockets that party will want to promise to line. Our own poor, and the poor of the developing world, once again, not getting a seat at the table.

Update 4 May 2010:
Well, it seems the lack of Development related policy or questions was no surprise to some, and that that other have been dissecting the limited differences between all the parties (who all adhere notionally to the target of 0.7% of GDP going in aid by 2013). All well and good. And the One Campaign has got all the party leaders to go on record with their fairly trite statements on aid policy. All seem to be saying the same things, and none of them are bad. But I fear that the world's poor have genuinely slipped off our radar as a nation.

In Sarah Bosley's Global Health Blog in the Guardian this morning there was a pointed piece about Avastin, a bowel cancer drug that can (in very small doses) cure wet age related macular degeneration. But the drug companies are peddling the low doses of Avastin at a hugely inflated price and under another brand name. And this goes on all the time with diseases in the developing world, where treatments are denied the poorest of the poor because of profiteering. But this gets hardly any media or political attention.

This morning I led a morning devotion on Ezekiel 16 (one of the stronger passages in a pretty hard hitting prophetic book). Verses 49-50 say something quite scary - the sin of dear old Sodom, destroyed by sulphurous fire in Genesis, was not as is widely assumed, homosexuality, but rather that they sat back comfortably engrossed in their own pleasures and problems while the poor and vulnerable around them starved.

I fear for our nation - that we have let our own concerns (however relevant and valid they may be) deflect us from the real needs of the poor and our obligations to them as the rich world. And what judgement awaits us for this? Hmmm, read the rest of chapter 16 in Ezekiel and beyond...