Carry On, Regardless

Dr Peter Saunders, the Chief Exec of the Christian Medical Fellowship** has written a pamphlet called Live and Let Live, opposing assisted dying.

Dr Saunders has chosen his moment because Lord Falconer’s Assisted Dying Bill will receive its Second Reading in the House of Lords on 18 July. Lord Falconer’s proposals would apply only to terminally ill, mentally competent patients with strict legal safeguards.

These are some of the arguments Dr Saunders uses against changing the law. He makes no distinction between euthanasia, assisted suicide and assisted dying - legally, medically or morally. There is no detail on what assisted dying would involve, just fear-mongering and moralising. This is a complex issue but for the CMF it’s just wrong, full stop, no debate.

Murder is against the ten commandments. Our lives belong to God not to ourselves so euthanasia, suicide and assisted suicide are wrong.

Patient autonomy, informed choice and doing what is in the patient’s best interest are tenets of medical ethics. The pamphlet should really be called Live and Force to Live. The sanctity of life argument is concerned only with quantity, not quality.

There are plenty of Biblical examples of killing that is not wrong. There are plenty of wars and massacres sanctioned by God, who even got hands-on and slaughtered the first born of the Egyptians himself. Many religious people support capital punishment, particularly in the US. But then, it’s easy to be selective with which bits of the Bible suit your argument.

Death is not the end. For non-believers, assisted suicide may be ‘propelling them towards a judgment for which they are unprepared. This may be the worst thing we could ever do for them’.

By ‘non-believers’ he means non-Christians, so not just atheists but people who sincerely believe in other religions. There’s always the chance of a deathbed conversion. We’re all lost little lambs who can’t be trusted to make our own decisions. This goes against ethical principles of patient autonomy and informed consent, which they’re happy to apply in other areas of medicine, as long as they have the CMF stamp of approval.

The CMF and Dr Saunders cannot claim to represent all believers. The 2010 British Social Attitude Survey found that 71% of religious people agreed that a doctor should probably or definitely be allowed to end the life of a patient with a painful incurable disease at the patient’s request.

Religious views, unlike the ten commandments, are not set in stone. They evolve constantly. In the past, the Church disapproved of inoculation, vaccination, quinine as an anti-malarial and the use of chloroform in childbirth. Just because a minority of believers currently oppose assisted dying does not mean that they always will. At some point, they will move on to some other area of medicine or scientific break-through and condemn that. They’re fickle like that.

The CMF is also well out of step with society as a whole (not that this has ever bothered them). The 2010 British Social Attitude Survey found that 82% of the general public believe that a doctor should probably or definitely be allowed to end the life of a patient with a painful incurable disease at the patient’s request.

A change in the law would put pressure on the vulnerable

This is the slippery slope argument; it is fear-based, not evidence-based. The way to stop something sliding down a slope is to build a wall across it. That’s what a new law would do. It would also make it easier to identify and prosecute suspicious deaths.

People may feel obliged to die to relieve their families of a burden, especially in tough financial times, they claim. The new law is very specific about who can apply for assisted death; it would not be a free-for-all for anyone who wants to die or feels they should and would involve only a very small number of people. A 2013 report from Oregon shows that only 0.2% of deaths in that state were by assisted dying and this figure has been stable for six years.

The evidence (as opposed to the fear-mongering) shows that an assisted dying law has worked in Oregon for over 16 years. There have been no cases of abuse and no calls to extend the law beyond terminally ill, mentally competent adults. In addition, in Holland in the 1990s, doctors rejected around two thirds of patients who requested death.

Members of the medical profession and disability advocates oppose it because it is dangerous

The CMF pamphlet doesn’t discuss the various and complex reasons why doctors and disability activists are opposed to assisted dying. They don’t want a debate, they want to lay down the law.

As with abortion, doctors would not be forced to do it, there would be conscience opt-outs. For those medical professionals who see assisted dying as the final part of patient care, a new law would give them clear guidance so that they could be compassionate and humane without risking prosecution.

The 2007 British Social Attitudes survey found that 75% of people with a disability believed that a person with a terminal and painful illness from which they will die should be allowed an assisted death. There are genuine concerns among disability activists that need to be addressed sensitively through debate and careful legislation but the CMF don’t say why it would be dangerous. They get out the pitchforks and flaming torches and whip the villagers into a frenzy of fear for their lives about a non-specific monster hiding in the barn. That’s their MO.

The principle of double effect

This is treatment that may shorten life, for example large doses of morphine for pain relief that are also fatal. This apparently is not considered assisted dying because the effect is foreseen but not intended. You may have trouble getting your head round the difference because it’s nonsense. But currently it’s nonsense that keeps doctors on the right side of the law. It’s not enough for patients and it’s not fair on doctors.

Hospice and palliative care are better alternatives
The 2013 Oregon report found that 90% of people who requested assisted dying were already in hospice care. It’s not an alternative to this care, it’s part of it. For some people, hospice care is enough but others should have the choice of the time and the way their lives end so that they can die with dignity – not just for themselves but for their families too so that they can make the most of the time that remains.

At the moment, there is the option of going to Switzerland but this is expensive and thus excludes many people. It also means that people may die sooner than they want to for fear of not being able to get there when they really need to.

The CMF’s position is not humane and it’s not compassionate. Nor is it well-informed. CMF members, like anyone else, are entitled to their beliefs but in trying to foist them onto the whole population, its members want their own moral purity enforced at the expense of the suffering of others. As usual.

For more information:
The Dignity in Dying web site.
Classic Cases in Medical Ethics by Gregory E Pence (I used the 4th edition, 2004)
Easeful Death by Mary Warnock & Elisabeth Macdonald (2008)
Medical Ethics by Tony Hope 2004
Lord Falconer’s Bill


**The CMF claims to represent over 4,000 UK doctors and around 800 UK medical students. I’ve written several pieces about them over the past few years. These are some of them:
CMF on gender reassignment surgery
CMF on mental illness
CMF on abortion
 

Always let your conscience be your guide? Part 4

The Christian Medical Fellowship is at it again. This time, it has gender reassignment surgery in its sights. And just like all the other times, its relationship with facts is non-monogamous.

Dr Peter Saunders of the CMF is claiming that doctors risk disciplinary action if they refuse to carry out gender reassignment surgery. He says this is yet another symptom of how Christian doctors are being marginalised and penalised for their beliefs.

However, the Royal College of Surgeons has confirmed that gender reassignment operations are not something a general surgeon would be expected to do. There are many different kinds of surgery involved and like other areas of specialist surgery they require training. A doctor who had objections wouldn’t elect to be trained in this area in the first place.

So where is the problem? Has Dr Saunders read the story of the boy who cried wolf?

Not surprisingly, the Mail has written Doctors 'forced to carry out sex-change ops' under rules meant to 'marginalise Christian medics'.

They got the story from Dr Saunders’ blog Christian Medical Comment where he claims that ‘Legislation and regulations are being used to marginalise Christian health professionals in Britain. British medicine in the 21st Century now involves practices which many doctors regard as unethical. A significant number of doctors do not wish to be involved in sex-change operations or prescribing contraceptives to unmarried couples.’

He gives no evidence for what this ‘significant number’ might be.

The CMF website says things like

God created each of us in his image, male and female, and he doesn't make mistakes… This issue has tremendous implications for society at large and the institution of marriage in particular… the doctor's duty in treating his/her patients is to restore people to what God originally intended … giving sex change treatment goes beyond this remit.

In his rant blog, Saunders refers to the General Medical Council’s current consultation on personal belief and medical practice, including conscientious objections. Draft guidance says

‘You may choose to opt out of providing a particular procedure because of your personal beliefs and values’ and adds ‘The exception to this is gender reassignment since this procedure is only sought by a particular group of patients (and cannot therefore be subject to a conscientious objection)’.

Gender reassignment surgery has been available on the NHS since 1999 and the Equality Act 2010 prohibits doctors from discriminating against people who are undergoing gender reassignment treatment. So this is not just something the GMC has come up with on a whim, it’s the law.

Although his blog mostly relates to surgery, Saunders also mentions GPs with religious objections who would not currently be allowed to opt out of referring a patient to a specialist or providing related treatments.

It appears that he has not read his own web site. For example, one doctor writes:

I would emphasise that I am no expert in this type of problem and would be happy to refer him to a psychologist to explore his request further.

This may be a fudge to avoid being accused of discrimination but it would ensure that the doctor’s beliefs would not affect the patient. It also means that Saunders does not even represent all CMF members or Christian doctors.

The GMC consultation closes on 13 June. The CMF’s response to the consultation is here.

We are Legion: religion and mental illness

One last look at the Christian Medical Fellowship (I hope). For first-time readers, the CMF is a group of British Christian doctors, around 4500 strong.

The CMF has a guidance section on its website called Demon Possession and Mental Illness which asks if doctors should 'see demonic influence as being a neglected aetiological factor within a multifactorial model for the aetiology of mental disorder?'

In other words, should doctors include possession by the devil in the list of causes for mental illness ?

The CMF's answer is yes.

This is in another category entirely to the usual CMF guidance as it is predicated on a world view that includes demons as real and active beings rather than a selective or fanciful use of data to support a religious moral stance. It is not a matter of claiming that condoms don't work, homosexuality can/should be cured or that abortion leads to insanity and social breakdown (as I have covered in earlier posts). This is a matter of practising medical doctors who believe that demons exist and possess people.

I suppose it shouldn't be a surprise that people who believe in the existence of a deity also believe in his opposite number but there are many doctors (and others) who have faith but do not go this far.

The guidance refers to an article called Demons and The Mind by Roy Clements, published in Cambridge Papers (Towards A Biblical Mind) vol 5 no 3 September 1996. Clements has a PhD in physical chemistry and a diploma in theology. At the time of writing, he was minister of Eden Baptist Church in Cambridge.

This article is not available online but I have a copy. In it, Clements argues for a more holistic model of the human personality in which 'mental illness might be caused by faulty body chemistry (physical influence), dysfunctional family experience (social influence), demonic assault (spiritual influence) and unresolved guilt (personal sin).' (my italics)

He recommends that 'drug treatment, psychotherapy and exorcism should not be regarded as mutually incompatible remedies but as complementary therapeutic interventions, each exploiting a different facet of human nature'. This holistic model, he believes 'can do justice to both modern science and the Bible'. In other words, he is placing science and the supernatural on an equal footing.

He is also seeking to exploit the current trend for so-called alternative and holistic treatments, stating that 'many people today are dissatisfied with the hubris of modern medical science and are sympathetic towards more holistic forms of therapy'. The CMF echoes this sentiment with 'not all human problems will be explicable by medical science'.

Three points come to mind:

1. These are scientifically trained doctors, paid for out of public money, many of them working in GP surgeries around the UK, not people who have bought bogus PhDs from imaginary American colleges seeking to fleece the gullible and the desperate or New Agers using vague terms like 'energy' and 'natural' and 'detox' to sell their products.

2. Medical science doesn't claim to treat all human problems. No branch of science claims to know or explain everything. It's not how much you know, it's how you know it - evidence-based, peer-reviewed, replicable testing would be a start.

3. Anyone talking about the hubris, arrogance, coldness etc etc of modern medicine usually has something to sell based on an unassailable certainty that they are right.

Clements is very clear that he wants exorcism and related 'treatments' to be firmly based in the English Protestant tradition, which would require an approach 'far more responsible than that which prevails in much of the deliverance ministry scene at the moment'. None of your foreign all-singing, all-dancing exorcism, then. (Much deliverance ministry is done in the UK by Afro-Caribbean churches).

Catholic exorcism has traditionally been far from the variety Clements is proposing. Just one example is Father Gabriele Amorth, a Catholic exorcist working in Rome. Amorth says that 'he always asks for someone's medical history and consults a psychiatrist if he thinks it useful. On the other hand, he argues that only performing an exorcism provides certainty, because it is in the reaction to the exorcism that one detects the presence of a demon. Besides, he said, "An exorcism never harmed anyone".' It would be interesting to know his definition of 'anyone'.

They really haven't thought this one through.

1. Would Clements' Protestant version be any safer?
   
2. What safeguards would there be?
   
3. Are the CMF proposing that deliverance should be recommended or even practised by NHS doctors?
   
4. Who would train these doctors to recognise the signs of possession?
   
5. Would there be a demon-spotting module in medical degrees?
   
6. What about non-Christian doctors (and nurses too), whether atheist or of other religions?
   
7. Would there be discrimination against patients who do not share this belief or who reject a diagnosis?
   
8. What about equality of service provision?
   
9. What do the BMA think about all this?
   
10. And many other questions.

The CMF guidance lists a series of examples from the New Testament where Jesus casts out evil spirits; the list includes an episode, repeated in all three synoptic gospels, where an epileptic boy is cured in this way. No doubt, as doctors, CMF members know the difference between epilepsy and mental illness, which makes it even more puzzling for them to include it. There are cases of epilepsy being confused with possession throughout history right up to the present day but lumping it in with mental illness does nothing to help the stigma of it.

Incidentally, demon possession 'may also be an aetiological factor in some non-psychiatric conditions' - although there is no mention of which ones. Kidney stones? Diabetes? Cancer? A broken leg?

The CMF guidance is reproduced on a website with the innocuous title of Ethics for Schools, which is entirely written by Christian doctors for students of philosophy, ethics and religious studies.

Just in case it looks like the CMF are the only villains or that I am unfairly targeting them, as a random sample, the website schizophrenia.com might be expected to deal with mental illness in a scientific or at least objective way. The home page seems entirely rational, helpful and informative. Except that the site also promotes schizophrenia as a marketing opportunity for God: 'the Bible has great relevance to the needs and questions among families of the mentally ill. (...) These families comprise a huge, overlooked target group for evangelism.' It's not the same thing, but it is another example of religion trying to stake its claim on mental illness.

On a personal note, the death knell of my (mercifully brief) teenage religious phase was sounded when the leader of a youth group I belonged to told me that he had visited a local mental hospital and was convinced that the illness of some of the patients was clearly caused by the devil possessing them. He was not a doctor but a dentist, someone who had also received science-based training.

I sincerely hope that I am now done with the CMF.

Lying for Jesus? :2 Condoms

Following on from my previous post, the second part of the Christian Medical Fellowship's submission to BCAP concerns condom advertising on TV.


They note that the Government's Independent Advisory Group on Sexual Health and HIV wrote to BCAP requesting a review of scheduling restrictions on condom advertising, noting that the UK had the highest teenage pregnancy rate in Europe and spiralling rates of sexually transmitted infections.


First off, it's western Europe. Secondly, as a PubMed article shows, such claims about pregnancy have been inflated by the media: International comparisons suggest that the rate is moderate and that the past six decades have seen a decline rather than a rise (...) We believe that the selective reporting of international and time comparisons by public policy makers results in a 'manufactured risk' and has more to do with moral panic than with public health.


This does not bode well for what follows. But back to the CMF with an open mind. Things can only get better.


Or not. They continue that: The presupposition in this proposal is that more condom advertising to an ever wider range of young people will reduce unintended pregnancy and offer some protection against sexually transmitted infections. Briefly, the evidence shows, instead, a correlation between the government's policy of increasing promotion of contraception and the very rises Baroness Gould [of the AIG] notes. (..) The negative effect of the 'message' trumps any possible positive medical benefits. (my bold)


Does the evidence show that promoting contraception correlates directly with an increase in STIs? It could well be that there are other confounding factors involved, for instance that contraception is not being promoted in the most effective way or that there are reasons for promotions being ignored. Did the rise occur before, during or after the promotion? Or it could be that the evidence doesn't show that at all. No trumps on the table just yet.


The CMF conclude that: Further promotion of condom advertising to children aged 10-16 is unnecessary and unethical.


Why is it unethical? Two papers are cited in defence of their assertion. One is Are condoms the answer to rising rates of non-HIV sexually transmitted infection? No by Stephen Genius. This is a response to a previous piece called Are condoms the answer to rising rates of non-HIV sexually transmitted infection? Yes by Steiner and Cates.


The Steiner/Cates article is a balanced one citing strong evidence that condom use is effective in reducing STIs and unwanted pregnancy but making it very clear that condoms are not the whole story; better sex education about risk avoidance and reduction is essential, with condoms as part of the package. It warns that We need to focus on ensuring consistent and correct condom use rather than denigrating condoms as being less than perfect.


However, Genius' response does just that. His basic position is that condoms cannot be the definitive answer to sexually transmitted infection because they provide insufficient protection against transmission of many common diseases [such as] "Skin to skin" and "skin to sore" infections.


But no one is saying that they are. As all students are taught right from the start - answer the question in front of you, not some other question that you've prepared better for.


Ironically, Genius states early on that A fundamental tenet of medicine is adherence to scientific fact and experiential evidence to develop treatments and programmes that maximise and sustain health and later that Political correctness and ideological interests need to be usurped by sound science. But then he proceeds to cherry-pick data that back up his anti-condom stance. He doesn't even address the main point of the piece he is responding to, which is that condoms can work as part of an educational package. His response is that any package must be a moral one only.


Genius' other objection is that many people do not bother with condoms or do not use them properly, particularly if they are drunk or have taken drugs: protection is usually compromised by compliance issues, incorrect use, or mechanical failure. One of the supportive responses to his article adds that When you talk to young people, it is still considered uncool to carry condoms with you.


So his two arguments against promoting condoms are that they don't protect and most people don't use them properly anyway (which is irrelevant if they don't work).


Instead of recognising that the rising rate of infection is a complex problem, Genius is against anything at all that may reduce risk except for abstinence because: The more that sexual behaviour is trivialized, the greater will be the numbers of those involved in casual behaviour. The correct strategy is to promote responsible sexual choices by young people and television can have great power for good here (...) Those for whom condom knowledge is relevant will find it anyway, and the ever increasing trivialization of sexual behaviour will damage more and more children and young people.


Rather than seeing condom adverts as a way to make condom use more acceptable and more widespread, he disingenuously and consistently tries to discredit condoms to give his moral position some scientific authority. His simple solution to a complex situation is: Just say No.


His other point about condom knowledge being easy to find is the same point that the CMF make about abortions, which I dealt with in the last post.


This promotion of abstinence and warnings about 'trivializing' sex is based on as little reality as the Catholic Church's attempt to prevent teenage girls having the HPV vaccine because it would encourage them to have sex. After protests they reluctantly allowed the vaccine as long as no sex ed accompanied it, thus leaving them vulnerable to every other kind of infection, along with pregnancy.


The second article the CMF cite in support of their submission is written by Stammers, a trustee of Family Education Trust and Challenge Teams UK; both charities provide abstinence centred sex education packages to secondary schools in the UK. He is also a (volunteer) web doctor for Love for Life, the largest provider of abstinence centred sex education to schools in Northern Ireland, and did paid consultation work for them in the past.


Right away, the card are on the table this time. But again, let us not jump to conclusions before looking at the evidence. Being a Christian does not preclude being a good scientist...


Stammers position is that abstinence taught by parents is the answer, the only answer. He thinks, rather quaintly, that 'saved sex' is a more useful term than abstinence and asserts that: The false assumption that "young teens will have sex anyway" is an insult to many young people who have the capacity to rise to a far more effective challenge than just "use a condom every time".


He also says that Of course, to be involved in this way, parents have to be with their children and claims that the lower rate of single parenthood in the Netherlands is an important factor in the lower rate of teenage pregnancy.


This all fits neatly with the CMF'S own stated position that they are advocating marriage as God's intention for human sexual relationships.


So, saved sex and happy families will save society. Not condoms or sex education. Don't do it until you're married, then stay married and teach your children not to do it either. Easy.


Responses to this article in the BMJ are mixed, some in support of the moral stance, some pointing out the flaws in Stammers' argument and his biased starting point. To pick just one of the responses that challenge him:


Stammers' editorial on sex education raises a number of interesting public health issues. However, in the light of our recent investigation into abstinence-based programmes for HIV prevention in high-income countries, several of his assertions appear flawed on key methodological principles.


Recent research also contests Stammers' suggestion that declines in adolescent pregnancy rates (specifially, US adolescent pregnancy rates) are primarily attributable to delayed first sex.


It is interesting to note the contradiction between Stammers' suggestion that sex education studies assessing condom use make "false claims of success", and his acceptance of attitudinal outcomes of an abstinence-only programme trial as indications of "greatly enhanced" effectiveness.

The most methodologically rigorous systematic reviews to date have documented no behavioural or biological evidence that abstinence-only programmes can reduce sexual risk with respect to HIV infection or pregnancy, as compared to a range of control groups. (my highlighting, references to support this extract in the link above)


Flawed methodology, out of date information, cherry picking and pot calling the kettle black, then.


Whereas the part of the CMF submission dealing with abortion made overtly (and unsubstantiated) medical claims against it, this section tries to prohibit or severely limit condom adverts on moral grounds, using a spurious efficacy argument. At best, this is a muddled message; the efficacy of condoms is entirely separate from the moral question but the submission mixes the two. Not only that, the submission itself does not use the A word even though it is the principle message of the two papers. Why not, if this is their real agenda? Perhaps because it would undermine their attempt to appear scientific.


The CMF's moral recipe also appears ignorant of teenage behaviour. Teenagers do not need encouragement to have sex. Some do resist, for whatever reason, but it cannot be assumed that they will. For those who don't, there must be a safer way.


The CMF's preaching is masked as concern for teenagers and for society - the ever increasing trivialization of sexual behaviour will damage more and more children and young people - in the same way that their abortion propaganda indulged in hand-wringing about the dangers to women.



The mission is to save teenagers from themselves. The idea that the teenage sexual urge is something base to be overcome through the Grace of God is a primitive idea, harking back to Calvin and nodding to Descartes with his mind/body dualism. It also has echoes of Freud's concept of the id, the dark and lusty part of our nature to be smacked into submission if we are to be socialized (and, in religious terms, saved - that word again). And then there is the fear/hatred of sex that has permeated religion ever since St Paul. If you must have sex, wait until you're married and then do it only for procreative purposes, never ever for recreational ones. It is easy to caricature the CMF position because they lay themselves open to it with their disingenuous submission and their questionable evidence. But this should not distract from the real dangers that their position entails.



Unbiased commentators recognise that condoms are not the whole answer and that this is a complex issue; they see condoms as an essential part of a package based on evidence and real life, not just religious wishful thinking.

Addendum: Dr Petra Boyton has written in her latest blog about intitatives to reduce teenage pregnancy, something the CMF think are a waste of time.

Lying for Jesus? The Christian Medical Fellowship on Abortion

I recently wrote a response for the National Secular Society to the BCAP Broadcast Advertising Standards Code consultation about advertising for family planning and abortion centres, and for condoms. Since then, the Christian Medical Forum has published its response. I was expecting moralising but not quite such an interesting relationship with evidence.

The CMF have, according to their website, more than 4,500 British doctors as members. All are Christians who desire their professional and personal lives to be governed by the Christian faith as revealed in the Bible. It exists to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.

There are many areas in their submission to deal with, particularly their stance on condom adverts, which I plan to come back to. For now I'm going to focus on abortion advertising.

The CMF say there is no need to advertise abortion centres on TV because: Any woman considering abortion will be sufficiently motivated and will easily be able (with the help of friends if necessary) to find information about abortion providers from the wide range of sources currently available.

This argument could be applied to any product. No need for any TV adverts at all. But young women and those living in communities, religious or otherwise, that do not approve of abortion - or who condemn and punish it - are not going to find it easy to get information and support, and may even be afraid to go to their GP in case their families find out.

Once the CMF has made its pro-life stance clear with: Abortion is always a procedure with a 50% mortality - the life of the fetus is intentionally ended, they mostly avoid the explicitly moralistic angle and turn to highlighting the medical 'risks' of abortion (they are doctors, after all).

They baldly state that: Breast cancer rates are rising in Europe and North America and are projected to rise further. Then they say: There is evidence suggesting that having an abortion may increase a woman's risk of breast cancer in later life. However, it is undisputed that a full term pregnancy protects against subsequent breast cancer. The link is therefore biologically plausible.

Is this a plausible link? Is it even logical? Being childless also increases the risk, as does living longer, having it in the family - and being a nun. Should convents be banned from recruiting and are all childless women (wilfully barren wombs) including nuns somehow complicit in their own cancer?

There are many sources that cast doubt on the CMF 'evidence'. For example, The New England Journal of Medicine published the largest-scale study ever on this subject - with 1.5 million participants - which concluded that there is no independent link between abortion and breast cancer. Clearly if abortion does increase the risk of breast cancer, it does so by an undetectably small margin. Another source says In March 2003 the National Cancer Institute (NCI) declared emphatically that 'newer studies consistently showed no association between induced and spontaneous abortions and breast cancer risk'. NCI convened a symposium of over 100 of the world's leading experts to review existing studies on the relationship between pregnancy, abortion, miscarriage and breast cancer risk and concluded that having an abortion does not increase a woman's subsequent risk of developing breast cancer.

The CMF have used weasel-words 'may cause' and 'plausible' but once the spectre of cancer is raised, it is hard to exorcise. Playing on women's fears is a low tactic, especially women who may already be vulnerable because of an unwanted pregnancy.

Then there are the mental-health consequences. The first of these is: increased psychiatric hospitalisation - admission rates were higher post-abortion than post-partum when those with a priori psychiatric history were excluded.

However, the paper they cite to back up this assertion says in its conclusion: The observed associations may be the result of less social support for women who have an abortion compared with women who deliver; reactions to abortion itself or common risk factors among mentally ill women and those who have abortions have not yet been identified. And Our data controls for socioeconomic status by using only women from the lowest socioeconomic group in the United States. This strength, however, also limits our ability to draw any conclusions from these findings regarding women of other socioeconomic groups. And This suggests that social support following an abortion may be a significant mediator of adjustment. And Differences in earlier mental health history, more than a year before the pregnancy, may also have influenced the results.

Did the CMF actually read the paper? Four separate statements in one study that contradict them.

Another claimed link is for increased death rates from injury, suicide and homicide. As evidence, they cite this study which says that: It is unlikely that induced abortion itself causes death due to injury; instead it is more likely that induced abortions and deaths due to injury share common risk factors. It also notes that: Beginning in the mid-1990s, some studies reported that the check-up recommended to occur a few weeks after an induced abortion was also omitted, which ties in with what was noted earlier about post-abortion support making a big difference.

What's more, the study looked at 1,141,267 women who were pregnant or who had been one year before their deaths, from 1987-2000, and found that 82 died after giving birth and 92 after an abortion. Ninety two. Out of 1.1 million. It's a call for more support, it is not against abortion.

Just to make it even clearer, the time of greatest distress is likely to be before the abortion. While some women may experience sensations of regret, sadness and guilt after an abortion, the overwhelming responses are relief and happiness. In another study of 5,295 women over eight years, researchers concluded that the most important predictor of emotional well-being in post-abortion women was their well-being before the abortion and also noted that the incidence of diagnosed psychiatric illness and hospitalization is considerably lower following abortion than following childbirth. 

There are two further CMF reasons for not advertising abortion clinics. One is that people will start to see abortion as a form of contraception (that old one). The other is that men will stop using condoms, which will put them at a greater risk of STIs. Not women, just men. This is highly ironic given that the submission rails against condom adverts.

Mixed messages, misogyny, cherry-picking, biased reporting of evidence, dodgy methodology - whatever happened to Exodus 20:16?