Tag Archives: human rights

Consent, Divorce and Brexit

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images-1Sometimes people change their mind, especially when new evidence comes to light! For example, in the medical profession, the process of consent stays open right until the operation is about to take place. It would be ludicrous to tell someone they have to go through with a leg amputation, even after it’s been discovered that their leg is in fact healthy and savable, simply because the consent form is signed! I think Brexit feels like that, except in our case, we are the leg and we’re about to cut off the body to which we are joined! Or we could compare it to a couple being forced to go through with a divorce, with all the pain involved, even after they rediscover that they are really great together, have believed lies about each other, and will both be worse off without each other. Yes – they may have some things to work through and they may need to totally reimagine their relationship, but to force the divorce through just because they were going through a rough patch, might be hugely regretful. I think Brexit feels like that – a very sad outcome to what could have been a totally different kind of conversation.

 

Yes, I accept that there are things about the EU which have made many across the UK find it difficult to want to stay in a relationship with her. But we’ve been led to believe some things about Europe which are wholly untrue and our vision got really clouded. When we step back and recognise all the good things about the relationship, knowing that it isn’t perfect and would still need a lot of work; mediating a reimagined future is so much more preferable than what a divorce is going to mean. And sometimes, it’s only after you call something off that you begin to realise that it isn’t a break-up that you want, it’s just a different kind of relationship. We are literally about to make an unbelievably terrible mistake, but it’s not too late to change our minds. 

 

Unknown-1Let’s be honest, through the unraveling scandal of Cambridge Analytica et al. we now know that Brexit was NOT the result of a “democratic process”, and the idea that we now can’t change our minds, (even though the evidence is clear of how bad it will be), is beyond ludicrous. Yes, it’s true, we were told it would be a once in a lifetime vote, and that not leaving the EU will break people’s trust in our political system – but last time I looked, there wasn’t loads of faith in it anyway! The leave campaign broke the law in terms of what they spent, told many lies, and hard though it is for us to face up to, used immorally targeted psychological manipulation to get the vote they wanted, driven by hyper-nationalist media moguls. And so NO, we don’t actually have to take the result and live with the dire  consequences. It is time to stop this madness, say sorry to our European friends and renegotiate a New European Union that works for everybody. Clearly there are some huge problems, which is why we are seeing the rise of the far right across the continent. Many people feel un-listened to. Europe has forgotten how to create a positive story of the future and so we are retreating into narratives of fear and separation. But, rather than leave, what we need to do is come together with a bolder and more positive dream of what it means to be in Union together and then we can begin to face up to some of the really complex issues we face at a global level.  

 

images-2We’ve been worried that being part of the Union means that we are losing our own national identity. It doesn’t mean that at all! Have you seen the Dutch fans at a football match?! When I married my wife, I was still me, she was still her, but we also became something new together! The EU really doesn’t limit our sense of individual nationhood, rather it expands our sense of partnership! We’ve believed that that the union prevents our ability to make good and sensible laws, but this simply isn’t true! Rather, the EU upholds human rights and helps us to embrace ‘otherness’. Europe and the European Union is extraordinarily amazing, but it absolutely needs to modernise, change and embrace the positive new power movements which are emerging. In the bloodiest continent on the planet, we have managed to live at peace with each other for over 70 years, and more than that to have become friends with each other. 

 

Compared to many nations in Europe, we are not as amazing as we might like to believe. We have one of the highest levels of poverty, some of the least happy people, the widest inequality gaps by an absolute mile and some of the lowest spending on public services. We have the highest property prices and rents in Europe and significantly declining productivity. To top it all, we have the worst pension deal. This is not the fault of the EU, but of the economic systems we have championed but which the rest of Europe have been more careful about monitoring.

 

imagesSo, leaving the European Union will help us how? £350 million extra a week for the NHS
or social care, or education, or policing? Nope. A better deal in life for those living in our most economically deprived areas? No again. Will we be safer? The police chiefs tell us not. Will our borders be more secure so that we can control all the immigration that we are told is the root of all our problems? Well no, and although immigration is a complex issue, Brexit is not the answer to it and we need to resist a rhetoric of fear, division and hate. . Might we create division across a well-healed Irish border? Yes. Will we potentially lose loads of manufacturing jobs across the North? Yes (just look at the new manufacturing deal Japan have struck with the EU). Will many of our businesses suffer heavy losses? Yes. Will the NHS struggle to recruit workers when our workforce is already hugely overstretched? Yes. Are there likely to be food shortages and will food become more expensive? Yes. Are we more likely to see the break up of the UK? Yes – and what of our great sovereignty then?! England is a very small place on its own! We need to wake up!Unknown

 

 

I know, we had a referendum and the ‘remoaners’ lost. But we are all about to lose so much more if we actually go through with this madness. We don’t just need a people’s vote, we need some humility and some hope that we can restore the damage we have done to our friends across the continent and together face the huge complexities in front of us over this next century – climate change, the refugee crisis, the plastic in our seas, water shortages and so much more. We cannot face these things alone as isolated nation states, but together, in union, we can! So, enough with Brexit! Let’s stop this now and find a new way forward together. #togetherwecan

 

 

 

 

 

 

 

 

 

Rights, Choices and “Free” Healthcare

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Today I took part in a really fascinating hypothetical discussion forum with women from across North Lancashire. We looked together at the “right” of choosing to have a Cesarean Section instead of a vaginal birth when there is no clinical indication at all to have one. We also discussed the “right” of having a home birth against the advice of clinicians and current, sound clinical guidance. Unsurprisingly it sparked some good debate but it is this kind of conversation and indeed much wider ones that are vital if we’re going to continue having a National Health Service in the UK that is accessible to all, safe in its provision of care and sustainable for the future.

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The human rights agenda, if we are not careful, becomes a platform for each of us to act in a way that leaves no regard for the impact of our decisions on the ‘other’ (be that professionals involved in our care, or other people who will now have less choice available to them due to decisions we have made). But we must differentiate between choice and rights as they are not the same thing. In maternity services, a woman has the right to excellent maternity care in which she makes shared decisions with her midwife and obstetrician. However, does a woman have the “right” to demand care which is way outside of what is clinically safe, or to demand a much more expensive treatment option when there is a lack of evidence that she truly needs it, especially when resources are limited? Tough questions! The truth is, she does , of course, have that right. But a more difficult question is whether or not it is then within the gift of the NHS to then provide that kind of care.

So, for example within maternity, let’s take home birth. Two of my 3 children were born at home and it was a beautiful experience (says the man). It is really important that this choice is offered as widely as possible on the NHS. However, there are certain situations in which a home birth becomes extremely risky to the mother and unborn child and the clinical evidence really backs this up (see NICE guidance). So, as an example, a woman who hasimgres previously given birth and had a massive haemorrhage afterwards and in a subsequent pregnancy has gestational diabetes, obesity and a twin pregnancy would not be advised to give birth at home. For the best outcome of a healthy mum and baby the evidence would suggest that this birth would be better under closer supervision than can happen at home. However, what if she takes all this information in and still demands a home birth as her “right”? Well, currently, she would come to a shared care agreement with her midwife and obstetrician, come to an understanding of all the risks involved and have a home birth. And there is a huge part of me, as a feminist, that loves this. It is her own body and her own baby and she can make informed choices. But the cost implication of the time and resource taken from what is an understaffed and overworked midwifery service might then mean that very few other home births can happen in the week or two surrounding her due date and puts the clinicians under significant stress. So, the woman makes the choice to hold onto her “right”, but the impact on others is that their choices are now more limited.

So too with Cesarean Sections on demand. I understand the fear of some women about going through labour and various other reasons for choosing a section. The conversation is not about removing the choice for those who really need it, but the current rates of 25-27% of all births through C. Section is not sustainable in the long-term (nor is it supported by the Midwifery 2020 document). The NICE guidance has been interpreted very liberally by some obstetricians who do not want the hassle of saying ‘no’ and commissioners have in some places not been clear enough about what their own guidance is. But, vaginal birth is natural and safe and perhaps we need to see it as the norm for every woman unless there is a clear clinical reason (be that physical or psychological) as to why that can’t occur.

The tough question facing those who commission services for the NHS is whether or not choices should become more limited in certain situations so that the gift of the NHS can continue to be sustainable in the future for all. If choices were limited in order to protect everyone’s rights to free and excellent maternal care, it is not that women could not then go against guidance, but they may either have to go through an appeal panel or pay for the kind of care they want themselves……ouch (especially as this won’t be equitable for all).

Much of this comes down to good communication skills. I have been really heartened to imgresspend some time with AQuA (Advancing Quality Alliance), who are helping clinicians learn how to use better consultation skills to really share decision making with patients. It is based on a model of care which we use a lot in General Practice called “Calgary-Cambridge” (more on this another time). But it is vital that clinicians communicate choices better and come to shared decisions with their patients, so that they understand the impact of their choices both on themselves and their loved ones, but also on the system itself and therefore other people. We cannot have a situation where people can simply demand whatever they want without any thought of the implications and so good information sharing is vital. Equally, we cannot continue with patients being forced down one path of treatment or not understanding the choices available to them due to poor communication or a lack of humility on the part of the clinician. The clinical-patient relationship is a partnership.

If we are going to develop a new love-based politics, our own “rights” must also take into account the needs and rights of others.

Sacred Economics – The Trouble With Property

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Sorry it’s been a while! I was trying to do a chapter a week of this awesome IMG_1638book and then a few things converged at the same time and conspired to make blogging more tricky than I would have liked. And then, I went on holiday with my awesome wife and children and we had some QT in La Belle France. But, now I’m back and ready to plod on….

We were hoping that Charles might be coming to Lancaster, to speak at the Richardson Institute (a centre for peace studies at the university) in the late autumn, but alas, we cant make it work – but he is in York, giving the Schumacher Lecture, Friday 22nd November and then in Leeds on 23rd. (I’ll be in Toronto…..wooot, but sad to miss him!). Go if you can!

Onwards! This chapter is challenging to the core. The age of separation has reached a fullness of times. We find ourselves in cyclical crises, (so if you were thinking that the mini property boom in London is an indication that it’s back to business as usual, then think again!) and the trauma of this separation from one another, our community, nature itself and the divine have remedied themselves in self protectionism. The tragedy of this logic of me and mine, as CE rightly points out is that we seek to recover our loss by expanding and protecting the separate self and its extension: money and property.

So, the modern concept of property, or the ownership thereof is a symptom of imgresthe sovereignty of the individual. If we claim ownership of that for which we did not labour, the land, the rivers, the trees, the resources of the earth, which are a gift to us, then this is tantamount to theft. It was Marx, and others like him that proclaimed “property is robbery”, as the origin of most property was taken by force – witness most of the United States of America as just one example! It was the rich and powerful who seized the land and made the laws. So if property is robbery, then the laws which protect private property, so CE argues, are those which perpetuate a crime.

But he is not advocating the abolition of private property for three reasons. Firstly because abolition is a forceful imposition on the unwilling. Secondly, private property is only a symptom of the deeper sickness of separation. Thirdly, the problem is not necessarily ownership, per se, but the unfair advantages of having it.

So, what do we do? Sell everything we have and give to the poor? A beautifully radical way to live. Jesus challenged a rich young man to do just that. He couldn’t do it, because he loved his wealth and it gave him a status and position that he held too tightly. I often wrestle with wondering if I am like that man…..But then Jesus also says – to whom much is given, much is required…..

Perhaps if we embrace gift, we understand that nothing we possess is really ours. And so we must ask ourselves how we steward that which we have been given, so that it can be given again to the community in which we are embedded. Can our properties become gifts?