The Nicklinson-case continues
Jane, the widow of the right-to-die campaigner Tony Nicklinson, is taking his fight to the European Court of Human Rights.  She has submitted an application in her own right and on behalf of her late husband arguing that the UK violated their human rights because the Supreme Court has ducked the issue of assisted suicide.

Saimo Chahal, Mrs Nicklinson’s lawyer, maintains that the Supreme Court’s decision in June 2014 failed to declare that the Suicide Act 1961 was incompatible with human rights.  Moreover, Lord Neuberger, president of the Supreme Court, had on that occasion stated that if Parliament did not give serious consideration to legalising assisted suicide, there was a ‘real prospect’ that a future legal challenge would succeed.  Therefore, claims Chahal, the Supreme Court has breached the Nicklinsons’ human rights under Article 8 of the European Convention on Human Rights by refusing to decide on the compatibility of the existing law on assisted suicide.  Instead, the Court referred the matter to Parliament.

Euthanasia and organ donation
It is not a new concept, but it has emerged again.  Already the practice is fairly common in Belgium and the Netherlands.  A patient requests assisted suicide or euthanasia and instead of wasting decent, life-giving organs, they are harvested at a time and place convenient for both medical teams – the euthanasiasts and the transplant surgeons.  Now David Shaw, a bioethicist at the University of Basel, is suggesting the same procedure could be usefully employed in Switzerland.  What is more troubling, for us UK residents, is that Dr Shaw serves on the UK Donation Ethics Committee (UKDEC).

But surely this proposal must be regarded as a splendid idea – a double-whammy procedure.  And after all, it will help vulnerable, despairing suicidal people to believe that their premature deaths are serving as a departing gift to humanity, indeed, that their deaths have greater value than their lives.  Don’t you think so?

I almost died laughing
This is hard to believe.  Dr Philip Nitschke, Australia’s Dr Death, is the man who spends most of his time promoting euthanasia in Australia and around the world.  Last year, a Perth man, Nigel Brayley, contacted Nitschke for details about committing suicide – Nitschke obliged and the man later killed himself.  As a consequence, in July, the Medical Board of Australia suspended him and in January 2015 it rejected his appeal and deregistered Nitschke as a doctor.  Now Dr – or rather Mr – Nitschke plans a new career as a comic.  He is scheduled to appear as a stand-up comedian at the Edinburgh Fringe Festival in August.  That is definitely NOT funny.

Roe v Wade 42 years on
Thursday 22 January 2015 was the 42nd anniversary of the landmark US Supreme Court’s decision that established abortion as a constitutional right for women – forty-two years of legalized abortion has led to 57 million US abortions.  The sad event is marked each year in Washington DC (and other cities) by the March for Life, when some 300,000 pro-life Americans brave the usually cold weather and rally at the steps of the US Supreme Court.  They call it ‘The largest human rights march in the world’ or ‘The largest pro-life event in the world.’

As an extra tribute on that day, Republican leaders had planned to vote on a federal 20-week abortion ban, known as the Pain Capable Unborn Child Protection Act, in the House of Representatives.  The Act would establish a national, US-wide ban on all abortions after 20 weeks on the basis that such a measure would prevent foetal pain.

President Obama has threatened to veto the Act.  He has said it, ‘shows contempt for women's health and rights, the role doctors play in their patients' health care decisions, and the Constitution.’  But it might never get to his desk because of the unknown voting intentions of several Senators.  Even so, polls show that a 60% majority of Americans support the late-term ban, which includes exceptions for rape, incest and life of the mother.  And as many as eight possible Republican candidates for the 2016 presidential election also support the Act.  One pro-life leader has said, ‘It is time to move the United States off the list of only seven countries to allow abortion on demand beyond this point.’  If it were passed, the Act would save the lives of about 18,000 unborn children each year.

However, none of this expected political activity in the House of Representatives happened.  The day before the March for Life, the House Republican leadership decided to pull the Pain Capable Unborn Child Protection Act because of arguments over its rape exception and other related provisions.  Instead, the House considered the No Taxpayer Funding for Abortion Act and the Abortion Insurance Full Disclosure Act of 2015, which would prevent all federal funding of abortions, except in the case of rape, incest and to save the life of the mother.  This late volte-face did not please many pro-life supporters – they regarded it as moral cowardice or worse.  But the politicians defended their action and insisted that both Acts would eventually come before the House.  It is also fairly clear that the President will veto both Acts.  But that’s politics, US-style.

Yet all was not lost.  The No Taxpayer Funding for Abortion Act was passed, 242 Yeas and 179 Nays with 12 Abstentions.  However, its compass is not great.  It seeks to end the coverage of abortion services by private insurance companies – it would make it illegal for women to use federal tax credits and other government subsidies, namely taxpayer’s money, to purchase private insurance for abortion.  Obama will not like that.  Then on 28 January, the House agenda for February was released – where was the promised Pain Capable Unborn Child Protection Act?  Not listed.  Obama will like that.

Pro-life activity in the USA
Something significant occurred in the USA on 4 November 2014.  As a result of the mid-term elections, Republicans took control of the US Senate.  It gave the party control of both chambers of Congress for the first time in eight years.  As a rule of thumb, Republicans are more pro-life than their Democratic counterparts.  And all this while a Democrat president lives in the White House.

Apparently, pro-abortion leaders in the USA are becoming more and more anxious – 2014 has been a bad year for them.  According to a January 2015 report from the influential pro-abortion think-tank, the Guttmacher Institute, ‘During the 2014 state legislative session, lawmakers introduced 341 provisions aimed at restricting access to abortion.  By the end of the year, 15 states had enacted 26 new abortion restrictions.  Including these new provisions, states have adopted 231 new abortion restrictions since the 2010 midterm elections swept abortion opponents into power in state capitals across the country.’

Indeed, across the country, more abortion clinics are closing and more pro-life legislation is being enacted.  The pro-life movement is gaining ground.  According to the Guttmacher Institute, in 2000, 13 states had abortion restrictions making them, in the Institute’s words, ‘hostile to abortion rights’.  By 2010, 22 states were considered ‘hostile’ and by 2014, 27 states were so called.  Additional evidence of this growing pro-life trend comes from Rev Harry Knox, the leader of the Religious Coalition for Reproductive Choice, who, on 15 December, wrote, ‘If 2014 was a rough year for reproductive justice, 2015 is shaping up to be even worse.’

Let us keep a sense of proportion – abortion is declining, but it is not stopping in the USA.  During 2012, there were still an estimated 1.04 million abortions across the Land of the Free.  And according to the latest annual report of Planned Parenthood, ‘America’s most trusted provider of reproductive health care’, it alone performed 327,653 abortions and received more than $528 million in tax dollars during the year 2013-2014.  Abortion is still big business, numerically and financially.  Nevertheless, several trends are looking pretty hunky-dory.

Canada legalises assisted suicide
Canada is a most strange land.  This is not only because of its reputation as ‘the world's most boring country’.  It is also strange, bioethically.  For example, it has no criminal law restricting abortion.  And it was the first non-European country to legalise same-sex ‘marriage’.  Now it has decriminalised assisted suicide.

On Friday 6 February 2015, the nine judges of the Supreme Court of Canada unanimously ruled that prohibiting assisted suicide is unconstitutional and a violation of the country’s Charter of Rights and Freedoms.  The issue has been gathering force for years.  In 2011, a report from the Royal Society of Canada strongly recommended the legalisation of assisted suicide.  In June 2014, Quebec passed legislation allowing it.  In August 2014, the Canadian Medical Association voted to stop opposing it.

The legal story really starts in April 2011, when the British Columbia Civil Liberties Association (BCCLA) challenged laws that prohibited assisted suicide.  On 29 June 2011, Gloria Taylor filed an application to be a plaintiff in the BCCLA’s case.  Taylor was a Canadian advocate of assisted suicide and she suffered from amyotrophic lateral sclerosis (ALS).  The lawsuit, with several co-plaintiffs including the family of Kay Carter, a woman suffering from spinal degeneration, became known as Carter vs. Canada.  It sought permission for incurably-ill, mentally-competent adults to receive medical assistance to hasten their deaths.  In June 2012, the BC Supreme Court ruled that the right to die was protected by the Charter of Rights and Freedoms and it granted Taylor a personal exemption so that a doctor could assist her to die.  She died on 4 October 2012, not as a result of assisted suicide, but from an infected perforated colon.  Meanwhile, the Canadian federal government had appealed the BC Supreme Court decision, which was overturned by a two-to-one verdict in the British Columbia Court of Appeal in October 2013.  The BCCLA then filed an appeal to the Supreme Court of Canada.

On 15 October 2014, the BCCLA took its case to the Supreme Court.  And on 6 February 2015, the Court delivered its judgement and affirmed that Canadians have the constitutional right to dignity and self-determination at the end of life, otherwise known as doctor-assisted suicide.

Thus Canada has joined the select club of Holland, Belgium, Switzerland and a few other jurisdictions which permit assisted suicide.  However, the Canadian Court ruling is particularly vague and will inevitably be open to challenge and abuse.  The Court has given Parliament 12 months to draft an appropriate law.

Margaret Somerville, professor of law at McGill University and one of Canada’s leading bioethicists, assessed the new ruling, ‘Canada has fallen over the edge of the abyss in legalizing the intentional infliction of death on our most vulnerable citizens – those who are old, frail, disabled, depressed, mentally, physically, or terminally ill.’  She continued, ‘This is not an incremental change, but a seismic shift in one of our most important foundational values – respect for human life at both the individual and societal levels.’  And, ‘I believe that future generations will look back on this decision, in the light of its future consequences, as the most important, harmful and regrettable ethical, legal and public-policy decisions of the 21st century.’

‘Deep continuous sedation’ in France
France has long possessed an ambiguous euthanasia law.  At the end of 2014, the French president, François Hollande, approved a report recommending that terminally-ill patients should have a right to ‘deep continuous sedation’ – that document is expected to be submitted to the French Parliament in early 2015.

The report stops short of recommending euthanasia but instead advocates administering sufficient sedatives and painkillers to ensure that the patient loses consciousness up to the time of death.  This is often called ‘slow euthanasia’.  It is not even ‘heavy sedation’ that is medically legitimate in some cases of intractable pain or excessive restlessness.  This is the sort of ‘deep continuous sedation’ commonly practised in the Netherlands and Belgium, where it is used to fudge the figures in order to show a decrease in the number of cases of ‘real’ euthanasia.

Abortion in France
In December 2014, a resolution proclaiming abortion to be a ‘fundamental right’ was adopted by a large majority in the French National Assembly.  Only 151 members of the Assembly were present out of the total of 577 deputies.  Perhaps the absentees were too embarrassed to share their views on national TV.  Unsurprisingly the vote was overwhelmingly in favour – 143 for and just 7 against.

Such an Assembly resolution has no legal force, but it sends a strong signal to bureaucrats, judges, doctors and the people.  The original French abortion law, or ‘loi Veil’ as it is known after its promoter of 1974, Simone Veil, has, over the years, been amended so that abortions are now performed on request up to 12 weeks of gestation and, from Easter 2014, they have been fully funded by the government and there are tough penalties for anyone who hinders a woman, physically or psychologically, from accessing an abortion.  In other words, abortions, or as they are called in France ‘voluntary interruptions of pregnancy’, have effectively been a right for women for years.  And about 220,000 French women avail themselves of that right each year.

The MAP in Poland and elsewhere
In November, the European Medical Authority (EMA) recommended that all member states should allow women throughout the European Union (EU) to obtain the morning-after pill (MAP) over the counter, without a prescription.  Early in January 2015, the European Commission issued its so-called Implementing Decision.  These new guidelines will gently try to cajole five countries to conform.  Italy may resist, Germany is not keen and Hungary has already ignored the directive, ensuring that the MAP remains prescription only.  These countries are concerned not only about the MAP’s abortifacient action, but also the prospect of a lack of any medical consultation with potential users.

One of those other countries is Poland.  Poland is sometimes regarded as one of the last bastions of rugged pro-life legislation in Europe.  Abortion is illegal there and the Polish Constitution states that human life begins at conception.

Now, following this EU ruling, Poles may be able to buy the EllaOne version of the MAP over the counter, with no prescription.  The decision has polarised the country.  The Polish Federation for Women and Family Planning stated, ‘We do not want to be a bargaining chip on the political and ideological stage.  Access to contraception is our right.’  And Stanislaw Wawrzeszak, the chaplain of the national health care association, declared, ‘The availability of the so-called morning-after pill for sale without a prescription is an ideological action.  It takes away people’s responsibility for procreation.’

Which way will Poland go?  As Anna Zalewska MP noted, the European Commission directive was merely a ‘recommendation’ and it was up to the individual governments to decide.  She continued, ‘I'm surprised that the Polish government and the [Health] Ministry want to thoughtlessly submit to this decision.’

Nobody in the UK should be surprised by this European bioethical downgrade.  The MAP was introduced into the UK in 2000, as a prescription-only drug.  By 2001, it could be obtained over the counter by girls 16 years old and above.  By 2004, it could be brought from pharmacies for about £25, or obtained free from NHS clinics.  Now it is available via the Internet.  Poland has long wanted to be a member of the EU – apparently that membership comes with a bioethical price.

Tim Black, 1937 - 2014
In the mid-1960s, Dr Tim Black was a young doctor working in the jungles of Papua New Guinea.  After successfully operating on a three-month-old baby he excitedly realised that he had just saved the boy’s life.  He gave him back to his mother only to realise her anguish – here was another mouth to feed, with no father, no education and no future.  It was a pivotal moment.  Tim Black suddenly believed that it was as important to prevent a life as it was to save it.

He resolved to change his practice of medicine.  In 1975, with the help of his wife and £3,000, he rescued the Marie Stopes Foundation (MSF) from bankruptcy and bought the lease of the famous clinic at 108 Whitfield Street, London, where the birth-control pioneer Marie Stopes had opened her Mothers’ Clinic in 1925.  He transformed MSF into a money-making business selling contraception, pregnancy testing, vasectomies and abortion.  His medicine became marketable.  His patients became his customers.  The Foundation became Marie Stopes International (MSI).

Dr Black was MSI’s CEO from 1976 until 2006.  He moved the organisation away from the stuffy NHS and provided his services promptly and in a friendly, nurse-led environment.  He never had a business plan.  He hated group meetings.  His management mantra was that, ‘the best committee is made up of two people – with one away sick.’

Today the business is worldwide and flourishing with over 600 clinics and programmes in 41 countries.  In 2013, MSI reported an annual global income of £211.9m.  Part of this was spent on contraception, in its own words, ‘averting 5.3 million unintended pregnancies’ and part on abortion, again in its own words ‘preventing 2.1 million pregnancies’.  Around £14 million of its income came from UK NHS contracts.  Thirty-three employees of MSI earned between £60,000 and £100,000, with the highest at £300,000.  Above all, MSI has become a massive supplier of mass abortion.

Timothy Rueben Ladbroke Black was born in Sussex in 1937.  In 1962, he qualified as a doctor at St George’s Hospital Medical School, London, and also married his childhood sweetheart, Jean.  They set out combining global travel, adventure and a deep medical commitment to needy people, especially vulnerable women.

He was a forceful, irascible character who delighted in controversy, especially with his pro-life detractors.  In 1979, his clinics introduced the abortifacient intrauterine device (IUD) in contravention of the 1967 Abortion Act.  In 1997, he instituted the ‘lunchtime’ abortion for £285.  He relaxed by sitting in a treehouse at his home.  He worked from his garden shed rather than his central London HQ, except on Fridays when he visited there to perform vasectomies – it is reckoned that he completed the four-minute procedure 15,000 times and once live on TV.  In 2004, he and one of his daughters, Julia, made a landmark documentary for Channel 4 entitled, My Foetus.  It was the first time that an abortion had been shown on British TV.

He collapsed and died on 11 December just after completing one of his favourite walks through the woods near his house.  To the end he was driven by his belief that, ‘Women don’t lease their bodies from the State or Church.  They own them.’  Every businessman has a business slogan – Tim Black’s was ‘Children by choice, not chance.’  He thought that aborting millions of unborn children every year was a praiseworthy enterprise.  He was wrong – it is entirely blameworthy.

Debbie Purdy, 1963 - 2014
Deborah Purdy was born, on her parents’ bedroom floor, in south London, the youngest of five children.  She joined the Liberal Party as a teenager and left home to become a squatter with a stockbroker and a Buddhist.  She tried studying humanities at Birmingham University, working for Yellow Pages in Edinburgh, selling jewellery in Oslo and learning to ski.  Her nomadic lifestyle took her to Houston, Tokyo and Hong Kong before she returned to the UK in 1990 to nurse her dying mother.

In 1994, she was writing adventure travel brochures for a company in Singapore.  It was there that she met her husband-to-be, Omar Puente, a Cuban-born violinist, who was playing with his band in the same city.  They communicated badly in French, Spanish and English.  At about that time she felt something was wrong with her health.  While dancing it was as if she ‘was wearing trainers and they were sticking to chewing gum.’  She flew home briefly to the UK to see a neurologist who instantly diagnosed her, aged 31, with primary progressive multiple sclerosis.

For some time after her diagnosis she continued her wanderlust – she became the manager of Omar’s band, she bought a walking stick, she gave up tea and coffee, but her symptoms were gradually worsening and she had to buy a wheelchair.  On one occasion, she managed the 10-hour flight back to the UK but promptly burst into tears when she was stranded at a railway station with no wheelchair exit.

Debbie and Omar married in 1998 at a ceremony that cost £110 and they settled in Bradford.  They were poor – one Christmas her present was a song he had composed.  She had previously been sterilised but managed to become pregnant by IVF, only to miscarry their baby after 11 weeks.

It was in 2001 that Diane Pretty, who had motor neurone disease, lost her long legal battle to win the right to die with the help of her husband, Brian.  It caused Purdy to think about her own future.  Her voice was going, so was her dexterity and she was now permanently confined to her wheelchair.  In 2003, she heard about the Dignitas ‘clinic’ in Zurich and Lord Joffe’s Patient (Assisted Dying) Bill in the House of Lords.  In 2005, she contacted the Voluntary Euthanasia Society (now called, Dignity in Dying) to ask for help.  It supported her to initiate her own legal challenge.

The Suicide Act 1961 had made it a criminal offence for ‘A person who aids, abets, counsels or procures the suicide of another …’  If Omar helped her to go to Dignitas to commit suicide, would he be faced with prosecution and a possible 14-year prison sentence?  ‘But I love him and, however remote the chance, I won’t let that happen’, was her response.  So, in 2008, she challenged the government to clarify the circumstances under which an ‘assister’ would be prosecuted.  At the High Court hearing in June 2008, her case failed.  And in February 2009, it failed again in the Court of Appeal.  In July 2009, her case was adjudicated at the House of Lords.  The Law Lords agreed that the law was unclear and ordered Keir Starmer, the then Director of Public Prosecutions (DPP), to spell out the likely circumstances for prosecution.

The DPP duly published the mandated interim guidelines, a public consultation period ensued, and a final document, Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide, was released in February 2010.  This consisted of sixteen ‘public interest factors’ likely to favour a prosecution, and six factors against taking any legal action.  Keir Starmer stated, ‘The policy does not change the law on assisted suicide.  It does not open the door for euthanasia.  It does not override the will of Parliament.’  As a result, assisted suicide remained illegal.  Every suspected assisted suicide would still be investigated.  No one would be guaranteed immunity from prosecution.  However, the new policy did state that, for example, a prosecution where ‘the suspect was wholly motivated by compassion’ is less likely to proceed than, say, when a doctor or other healthcare professional is involved.  All this conveyed a subtle message – it tells people in advance that, if certain conditions are met, assisting in suicide can be legally acceptable, that is, you are not likely to be prosecuted.

That was a move in the wrong direction.  And so assisted suicide has continued to slide down the slippery slope by, for example, the 17 October 2014 decision of the new DPP, Alison Saunders, that doctors and nurses will henceforth be less likely to be prosecuted for assisting, and by the pressure being exerted by Lord Falconer’s Assisted Dying Bill in the House of Lords.  The fact is that Debbie Purdy did change the law on assisted suicide, just a little, but still too much.

From 2003, when she first heard about the Dignitas ‘clinic’, she began to become obsessed with assisted suicide.  Her resolute wish was that she wanted to die, but not quite yet.  Then in 2014, the news broke that she had become too poor and too disabled to make the trip to Switzerland.  Instead, she booked into the Marie Curie Hospice in Bradford and eventually began deliberately refusing to eat.  She died there on 23 December 2014, aged 51.

Debbie Purdy was an amazing woman in many ways – smiley, full of enthusiasm and wit.  Perhaps strangely, I found her quite inspirational. What a pity she took the wrong path.  I fear that, like many before and after her, she became a pawn of the euthanasia movement.  Even so, it was palliative care that won the final argument.  Her husband Omar could say after her death, ‘We would like to thank the Marie Curie Hospice in Bradford for the care the staff gave her, which allowed her last year to be as peaceful and dignified as she wished.’