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.

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!

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.