The very easy road to heaven. Oh, wait...

So...there's this massive humanitarian crisis in Syria and this is leading to a refugee crisis that no-one wants to deal with. Let's build fences. Let's share them out. Let's take people who really deserve help but not those who don't (laying aside the fact that anyone who views crossing the sea in a tiny boat as better than what they're going through right now is presumably in the middle of a pretty awful state of right now). Then we have the added complications of politics and political ramifications which mean that the response to such suffering isn't based just on the person in front of us and their need. This doesn't just happen at government level, but also on a personal one.

But I was thinking that welcoming the stranger is a corporal work of mercy, up there with feeding the hungry etc, so it's pretty clear that that's what we ought to be doing. Jesus was pretty unequivocal ergo let's get on with it. But perhaps the reason that we aren't getting on with it is the same reason Jesus had to be so specific is: these things are really, really hard work. I happen to know a bit more about one of these than the others: caring for the sick. This is my job. I get paid for it, and I really like it, but when I'm on call and I'm at home tucked up in bed and I get a call at midnight with a question from a doctor or a need for medication in an emergency, caring for the sick is not fun. I think it's hard and in these circumstances I might not even need to leave my home to do it. Having said that, it is a strangely priviledged experience to go to work at midnight because someone needs my help, even while I complain. But if the additional reimbursement I receive for on call work still leaves it challenging, how much more so doing these things without obvious compensation.

I am not sharing my house with a refugee right now. And while I don't claim to know what the answer is, I think we also need to recognise that it's not just the fact of refugees and migrants and human suffering which is hard, but also responding to that. Obvious, but hard.

Taking a break

I have decided to take a break from blogging.

 

I have been thinking about the direction of this blog for a while: why I am blogging, should I write about everything I think about writing about, should I focus only on healthcare (and bad hymns) (and mental illness) (and books), etc. However, since Advent began (and with the incessant bombardment that is seasonal advertising) I have realised that whilst I am not annoyed that I am a Christian, I am annoyed that everyone else isn't. I am angry that other people don't love and respect God: they forget his birthday, they cut him out of everything, they sleep around, they lie and cheat and start wars and kill babies, they ignore him at mass, they don't make a place for him in their hearts...and neither do I. There is nothing righteous or motivating about this anger. It is just anger. And impatience. And, let's face it, pride. Blogging involves looking at what's going on and passing comment. There is much more to say when what's going on is wrong or bad or silly. Right now, this means that I get more angry and impatient.

 

This is all bound up with recovering from depression. With depression, the world is the inside of your head in any given moment. As you get better, it expands to the size of the room you're in, the people who are in it, maybe the building, perhaps the street, perhaps for this hour, this morning, today, this week. I feel like I am waking up after spending 2 years as a zombie and I have all these new criteria for seeing, for understanding, for loving, but mostly I am just really angry. It is possible, I know, to be angry about something in a more detached way. It is possible for anger to be channelled against what is wrong in a useful way. I am not up to it. I need to calm down a bit first.

 

I enjoy blogging, and I like to think that I have got something to offer in the blogosphere, but right now it's not helping me grow in holiness. But I will be back because, apart from anything else, there is nothing edifying about this nativity set whatsoever  -

- and I am sufficiently opinionated to tell the world. Possibly the fact that I have always disliked Jenga isn't helping.

 

In the mean time, I wish you all a blessed Advent.

Social healthcare and the A & E thing

I should make it clear from the start that while I don't think the NHS is perfect (not to mention the  recent shambolic develpments across the Pond) I am absolutely in favour of social healthcare. I have seen children in shanty towns in Peru with no teeth, where those living in poverty will walk out of a hospital and die two days later from appendicitis because they can't afford to pay for the surgery. But I also know a man in the USA who had a kidney transplant but is no longer in work and can't afford health insurance which means he can't afford the medication he needs to prevent his transplant being rejected. Fortunately, the local transplant patients basically pool their meds so that if one month someone can't afford their tablets, then they will be supplied by someone else; a situation which strikes me as no less tragic (although on the other side, also restores one's faith in humanity). However, one of the biggest problems with free medicine (and the Welfare State in general) is what happens on the receiving end.

 

Research shows that people who get free prescriptions visit their GP when they are suffering from a minor ailment in order to obtain over the counter remedies on prescription rather than paying. This has led to the establishment of minor ailment schemes, whereby those people who are exempt from prescription charges can obtain such remedies free of charge. This frees up GP time and resources for people who have more serious problems.

 

Recently there has been a lot in the news about the pressure which A&E departments are facing this winter, with 40% of those patients seen in A&E not needing to be there: they could have been treated earlier and/or in the community. At the weekends, A&E is often full of alcohol-related (alcohol-fueled) injuries, and sometimes people will end up there because they are seriously ill and it is one of the paths to hospital admission. A while ago I saw an ambulance which bore an explanation of what was meant by a life-threatening emergency. (I was tempted to give my brother a similar list after he woke me up extremely early to ask where Mum was.) Tales of bizarre 999 calls, which often include people who want a lift to a hospital appointment, are frequent and mind-boggling.

 

Often it is the elderly who suffer, whether because they didn't go to their GP in time (couldn't get an appointment or didn't want to bother them), or because nobody took them or even noticed that they were a bit off colour. The point at which someone realises you have a mild case of cystitis shouldn't be when you're admitted to hospital with a broken hip (more common than you might suspect), because if someone is suddenly acting confused (often the first symptom of cystitis in older people) then your neighbour or your friend or your carer or someone should notice. And if someone is calling the ambulance service because they need help bringing the washing in and the path is icy, or they need a lift to the supermarket, then we should be asking ourselves why. Why is it that this person had to call 999 for help with a simple task? And I fear the answer has a lot more to do with individualism, loss of community and the selfish desire not to be burdened with other people and their problems (which some might call freedom) than the fact that our healthcare is free.

Whose conscience is it anyway?

I was browsing my September issue of Regula+e, published by the General Pharmaceutical Council, which is the regulatory body for pharmacies, pharmacists and pharmacy technicians, when I came across this article about a pharmacist who had had conditions placed on his practice, by the Fitness to Practise (FtP) committee, for 'imposing his beliefs on patients' (pp24-25).

The pharmacist, during the course of supplying the morning after pill (EHC), told a patient that it was "a chemical abortion, was ending a life, and that this would be on her conscience". The patient was shocked and felt "rotten and horrible". He did not give her the option to go to another pharmacy.

Recently I blogged, among other things, about the weirdness of the fact that while pharmacists do not have to supply EHC, they do have to tell the patient where they can obtain it. This pharmacist didn't tell his patient where they could get EHC, because he did not decline the supply. Yes, apparently he was in the habit of giving what the FtP committee deem 'an embarrassing and distressing lecture' and then giving the patient the morning after pill anyway.

 

There seems to be a whole lot of weird stuff going on here. The FtP committee, for their part, merely have to judge whether a pharmacist has breached the code of ethics and, if so, whether conditions should be imposed or the individual removed from the register, so I'm going to ignore them. It's the behaviour of the pharmacist in question which puzzles me. If it was for moral or religious reasons that the pharmacist gave these speeches to his patients, why did he then supply EHC? What was he hoping to achieve? Was he trying to absolutely prevent evil (ie the patient does not terminate her pregnancy) or just avoid co-operating (the patient gets upset and goes to another pharmacy instead). But if the latter, why did he then supply? It is a mystery to me (although I recogise that I don't have all of the information about the case). And then there is the patient, who reported the pharmacist because he made her feel "rotten and horrible". I'm not saying the pharmacist shouldn't have been investigated, as his actions come across as a bit odd, to say the least: was this his usual manner of advising patients? But as taking the morning after pill causes side effects of headache, nausea, abdominal pain, bleeding and fatigue (very commonly), and dizziness, diarrhoea and vomiting (commonly), the 'rotten and horrible' feeling was somewhat inevitable, if only on a physical level.

 

Whether you, healthcare professional, go with a straight refusal to supply or a slightly more in depth explanation as to why not, or an attempt to engage the patient in discussion as to the rights or wrongs of EHC (or whatever other substance), do so with charity and professionalism! Haranguing the inidividual is unlikely to achieve anything, and following the harangue with supply even less.

 

Interestingly, one of the conditions imposed is that the pharmacist is not to supply EHC in the future. Sounds like good news all round.

 

PS My viewing stats passed the 10,000 mark this week. The list of referring sites may suggest to me that a lot of these views are not real people, but to those actual people who are reading: thank you :-)

Is grief a mental illness (and has anyone even said so)?

The American Psychiatric Association have published their new diagnostic guide (DSM 5) and according to quite a lot of people (just google it) they have classed grief as a type of depression. As far as I can tell (without actually buying a copy) this isn't actually true. What has happened is that they have removed the so-called 'bereavement exclusion' which said that major depressive disorder (aka depression) should not be diagnosed following a significant bereavement. They have also listed something called 'Persistent Complex Bereavement Disorder' as requiring further study.

 

Why does it make sense to remove this bereavement exclusion clause? Well, suppose you had got depression already and then a loved one died and you then sought medical help for your depression. You might not be able to get the treatment you needed because DSM-IV said you shouldn't be diagnosed with it and therefore your insurance company would not pay for your treatment. Maybe you didn't have depression before this event. Maybe you just had a tendency, or a past episode, or were just starting mild depression. Given that the causes of depression are not well understood, maybe you didn't have depression at all. The result would be the same. No DSM number, no drugs. As there don't seem to have been any other exclusions (such as job loss, divorce, or other severe stress) it makes sense (to me, at least) to remove this exclusion which might be preventing people who really need help from getting that help.

 

On the other hand, as there does seem to be a trend for doctors to overprescribe anti-depressants anyway, it does mean that there is now further potential to misdiagnose depressive disorders. Furthermore, evidence shows that many doctors end up prescribing as a way of ending consultations. Also, as all of this is taking place in the USA where prescription medicines can be advertised to the public (not allowed in the UK), there is a possibility that drug companies could target the recently bereaved, who will then go to their doctors demanding anti-depressants which they will be prescribed and which will not help them because they do not have depression, they are grieving. Due to the stigma attached to mental illness it might also mean that some people don't seek the support (by which I don't mean treatment) they need in their grief because they're afraid of the potential diagnosis. All of which begs the question: when did it stop being OK to be sad?

 

Or perhaps we are sadder than we used to be. With the loss of God from our culture, we have also lost the resurrection and life after death. Funerals are now termed 'celebrations of life' and even mentioning the deceased can be something of a taboo. Deciding whether to tell a friend or acquaintance that you are praying for them and their loved one presents itself as a dilemma (even if praying for them is the first thing you would do).  A friend of mine told me recently that after agonising for some time, she decided to offer her condolences (and prayers) to a colleague whose father had died, with the awkwardness of trying to broach the subject with someone she didn't know that well compounded by the fact that everyone else in the department would fall silent as soon as he came into the room. Some time afterwards, he told her that she was the only person at work who had said anything at all to him.

 

We no longer seem to know that it's OK to be sad. It is wrong, and therefore pathological, an illness. And in a way, there is something 'wrong' in that sadness wasn't part of the original plan: sadness and grief, like death, are a consequence of moral and physical evil. We have no idea how to talk about death. We worry about exacerbating grief, making someone sadder, or causing offence or embarrassment (as if brief embarrassment on either side could really be worse than the death of a loved one?!). So here it is (for what it's worth), my opinion about being sad: it's OK to be sad. And this may be the key to telling the difference between grief and depression. Grief is not an illness, it is part of life, just as death is.

Wombs to let: £28,000

I suppose a baby factory is the obvious successor to the egg bank, but it wasn't something I was expecting to come across in last week's Metro.

 

The most ridiculous aspect (and now I've said that I am torn as to which bit is actually the most ridiculous) of this article is Dr Patel's claim that she is carrying out a feminist mission. As the Anscombe Bioethics Centre wrote in their review of the Human Fertilisation and Embryology Act:

 

Surrogate motherhood involves a further fragmentation and trivialisation of parenthood, in that a woman deliberately becomes a gestational mother with no intention of committing herself to caring for the child she gestates. This practice is exploitative of both the woman and the child, and damages the way conception and gestation are regarded in society as a whole. If surrogacy cannot be prohibited altogether (the option we would prefer), commercial surrogacy, at very least, should continue to be prohibited. We do not believe that agencies should be registered with the Department of Health, as the Brazier Committee recommends, as this would constitute official endorsement of such agencies. (An analogy might be with the case of prostitution: those opposed to prostitution are rightly unwilling to accept the official registering of brothels, as this effectively legitimises their existence.)

 

Dr Patel is clearly exploiting women; of the £28,000 a couple pay for a surrogate mother, the surrogate receives less than £5,000. For 9 months manual labour (a 'physical job') the mother earns approximately 73p an hour (based on a 40 week pregnancy). And paying a woman for the use of her body is definitely analagous to prostitution. But hey, at least facilities are sterile!

 

And then we have the desperate couples who choose this option and are willing and able to pay. Are they not also being exploited to a certain extent (albeit in a design of their own making)? This is not a good way to have a family: I know of one woman who regularly tells people how much her IVF twins cost her, apparently believing that their grades should be better than those of other children because they cost more. As they get older, will she dictate to them on the basis that she paid for them? Isn't that a form of slavery? As always it is the child who loses: exploited by both genetic and surrogate parents.

 

We are now way beyond the start of the slippery slope: there are those who are 'too posh to push', those who choose the gender or disability status of their children. It would not surprise me if there were also designer pregnancies, where the pregnancy happens to another person, whether a woman is fertile or not. Is this the new feminist ideal: the exploitation of one woman to spare another some nine months of inconvenience? Even organs are not commodities to be traded, selected, bought, sold or even rented, so why do we seem to think that children are?

A trip to the egg bank

On Tuesday the Mirror reported that an egg donor bank had opened in London; it has been operating on a trial basis since the beginning of the year. In my health news email digest, it stated that women would be able to choose characteristics of the baby, such as eye colour. (It has got a little more difficult to review these stories since the newspapers realised that people were accessing their articles free online and that they were clearly missing out and should start charging.)

 

Choosing eye colour might seem harmless enough, and I understand that a woman might well want a baby to bear some slight resemblence to her, but we have already seen the tragic consequences of sex-selection of babies, and allowing and encouraging any sort of picking and choosing definitely sets us on the path to designer babies. Having children is not a right, it is a privilege. Babies are not convenient: they do not sleep or smile or eat when we want them to, they are hungry and tired when we don't want them to be. They are people, and like all people they are creatures. We are created. We are fragile. We are dependent. There are some things that we don't get to choose because we are not in charge.

 

This was as far as I got when I actually went and read the Mirror's article. I was struck by the fact that the director talked about the 'needs' of people 'needing' donor eggs. Need is not the right word - children are a privilege, not a necessity. It would be more accurate to talk about desire and want. I also took note of the 53 year-old woman who said that she'd always wanted to have children but had never met the right person. There is in that statement a clear understanding that the 'right person' is a necessary part of the process of having children. There is no mention that she has now met that person, but she's decided to have a child anyway. In the same way that we have separated sexuality and procreation (see Humanae vitae and if you haven't read it, then read it) we have also separated the concepts of children and family. Sometimes there are ways of doing things which are just different. Other times there are right ways and wrong ways, and being created and finite we also don't get to choose what is right and what is wrong. We can choose whether to do right or wrong, between good and bad and frankly that is a complete misuse of the precious gift of our freedom. Right use of our freedom is using it to choose between good and better, not between good and bad.

 

It was at this point that I discovered the Telegraph's article on the same subject and realised how incredibly naive I am. It may be couched in terms of altruism, but this is not some benvolent institution, set up because of tragic needs which we cannot ignore (like, say, a food bank). The donors (something of a misnomer) will receive £750 for providing eggs. How long before we see young women funding their way thorough university by selling their eggs? And the profit margin is presumably quite high, as treatment (purchase of eggs) costs £10,000.

 

Whilst I have thrown words like right and wrong around, and asserted that children are a privilege and not a right, I do empathise with older women. And I do not wish to generalise or assume that it is only single women who seek IVF in later life, I know women who did not meet and marry their husbands until they were in their 50s and 60s and therefore never had children. My great uncle's second wife told me cheerfully that she had no regrets over not having met her husband sooner as he, a widower, had been married to someone else. There are also couples who are sadly, persistently infertile. Women are called to be mothers, whether biologically or spiritually, and the inability to answer that call for whatever reason must bring heartache. But we also need to remember that our actions always have consequences. The consequences of delaying children by prolonged, repeated use of contraceptives in order to advance a career, go on holiday more often and generally 'enjoy life' might be infertility. We are not in charge and we cannot have it all.

The LCP again

I blogged about the Liverpool Care Pathway for the Dying a while ago (Parts 1, 2 and 3 can be found here) and basically concluded that in itself it wasn't necessarily bad, but that it's application was likely to be problematic at best.

 

It seems that the recent inquiry (as reported by the BBC) highlights some of these problems more specifically. The fact that there is a financial incentive to use the LCP is an obviously disastrous initiative likely to lead to patients being innapproriately placed on the pathway and, in some cases, deliberately euthanised.

 

The comments of the medical student is also merits consideration. She says that "in medical school we focus so much on saving lives that dying is put to one side". I constantly read headlines about prevent deaths from cancer, heart disease, diabetes, you name it, we want to prevent deaths from it. But as finite creatures, death is an inescapable part of reality. As Christians, we know that it is our ordinary route of entry to eternal life. It is bizarre (or perhaps not) that the heady combination of atheistic humanism and aggressive secularism we now see is not sure whether to eliminate suffering by preventing death or to eliminate suffering by eliminating all those who suffer. While we live in a world which labours under the consequences of original sin and is in a state of journeying towards perfection, we experience both moral and physical evil and therefore neither of these contradicting so-called solutions can achieve its aim. The desire to do so shows that the problem is still the same: the desire to ignore our limited nature and be gods without God.

Credit where it's due

I often complain about the questionable practices in my parish. I often feel that the parish is a little island, cut off from the Universal Church. As a geographically large, rural parish at the farthest edge of a diocese without a bishop, which is in the care of a Religious Congregation rather than a diocesan priest we sometimes seem to "belong" only to ourselves. Never was this more evident than the week Pope Emeritus Benedict abdicated and didn't even get a mention.

 

I was, therefore, delighted that yesterday we participated in the Holy Hour called for by Pope Francis. It was fairly well attended (I was the youngest person there, but it was a busy Sunday in the parish, with an extra mass laid on for First Communion, and the village, with Open Gardens in aid of the Anglican parish), certainly there were more people there than just the usual suspects.

 

It was very reverent, there was incense (not seen in this Church since circa. 1995 when we ran out of altar servers) and we sang Tantum ergo (in Latin, a thing unheard of). If there was slightly too much 'Holy Hour input' for my taste, at least none of it was inappropriate, and I recognise that many people are not used to 60 minutes of silent prayer. There was Exposition of the Blessed Sacrament at a time when the vast majority of people were not at work and therefore able to attend.

 

The seemingly-Trappist Confirmation group, to my delight, broke their silence yesterday evening to say that they would prefer to have the organ than a guitar to accompany the hymns at the Confirmation mass next month and no-one requested Shine, Jesus, Shine. All in all, things are looking up a little.

Cherry-picking sin

Recently my facebook news feed seems to have been filling up with little red equals signs, mostly among my those of my cousins who fall into one of the following two groups: in their 40s or American. (I could do a nice little Venn diagram.) This morning one of them, who descibes herself as 'Catholic....sort of?', shared the Atheist Quote of the Day:

Homosexuality is not a sin. Atheism is not a sin. Belonging to the wrong religion is not a sin. You know why? Because sin is an imaginary disease invented to sell you an imaginary cure.

                                                                                                                  John Allen

A quick google tells me there are rather a lot of people called John Allen. I don't know which one of these he is or how exactly he arrived at his conclusions. Leaving aside the fact that a self-proclaimed Catholic (even if only self-proclaiming as 'sort of') is displaying support for same-sex marriage and showing appreciation for the Atheist Quote of the Day page, leaving aside the rejection of God and the downright relativism in the first half of said quote, the part which interests me particularly is the bit about sin being an imaginary disease and its complementary imaginary cure.

I recently blogged about the loss of the sense of sin, which Pius XII identified as the sin of the century, speaking in the USA in 1946. I and my fellow catechist also recently had a complaint from the parent of one of the members of our confirmation group. The underlying issue was that we had spoken regularly about sin and apparently we were supposed to be 'affirming' the young people and not 'making them feel bad about themselves'. Yes, we have talked about sin. Yes, we have talked about the devil. Yes, we have strongly encouraged them to go to confession. (No, we have not greatly succeeded in this and if anyone has any suggestions they would be greatly appreciated.) But I think I can put my hand on my heart and say that when we have talked about sin, we have always, invariably, talked about the love and mercy of God who is always waiting for us to come back to him.

John Allen is right about one thing: without the disease there is no need for a cure. Take away sin and God is worse than imaginary: he is irrelevant and unecesssary. Take away sin and the immeasurable gift of reconciliation is tossed aside as meaningless. (Of course it works both ways: take away God, take away the absolute and we immediately begin to drown in a mire of relativism without the compass of right and wrong.) If I do not recognise my own sinfulness and brokenness, I have no need of God, no need of reconciliation. Without recognising this I cannot recognise the immense love which God lavishes on me, God who made me for love and out of an overabundance of love, and who holds me in being at every moment. As the Exsultet proclaims:

Our birth would have been no gain, had we not been redeemed.
O wonder of your humble care for us! O love, O charity beyond all telling, to ransom a slave you gave away your Son!
O truly necessary sin of Adam, destroyed completely by the Death of Christ! O happy fault that earned so great, so glorious a Redeemer!
O truly blessed night, worthy alone to know the time and hour when Christ rose from the underworld!

Sin is not an imaginary disease, it is a reality which each one of us allows into the world because while we may like to count ourselves as 'OK' or 'better' on the basis that we are not murderers, there are no good sins. It is the root of injustice, poverty, famine, persecution, war, suffering... There are many ways of coming to know God, and I do not think that recognising evil can teach us the existence of abosulte good, but the knowledge of sin and our own sinfulness can help us to know how very much God loves us. 

No-blame culture and the loss of the sense of sin

When I was last working in a hospital (probably this would be a good point at which to say that I am a pharmacist) I was informed that we operated under a 'no-blame culture'. The idea was that if mistakes were made then it was important to be honest about them so that steps could be taken to reduce the causes of error. The rationale is obvious: a dispensing error can have serious consequences, but if you are afraid that you (or one of your colleagues) might lose your job (or be sued) over it you are unlikely to report near-misses.

 

To a certain extent, this makes sense. By encouraging reporting of near-misses you can look at the systems involved and take steps to reduce errors. The pharmacy I worked in was, like most hospital pharmacies, badly laid-out (usually because clinical pharmacy services have expanded rapidly in the last 20 to 25 years and most hospitals are older than that) and extremely busy. We provided pharmacy services to the equivalent of 3 hospitals and effectively needed to employ one person full time just to answer the phone for non-clinical enquiries (not helped when the town council once made a typo in some communication and we started getting all their phone enquiries as well!). Errors are bound to creep in with a turnover of this size, and it is important that systems do not faciliate them. By reporting near-misses you can take steps such as keeping all your high-risk (to the patient) medicines such as methotrexate and warfarin on a separate shelf; separate out the 6 types of Sinemet tablets and the 5 variations on Epilim instead of sticking to strict alphabetical order; check, double-check and triple check everything, and stick massive posters in your fridge so that everyone is careful to quadruple check the insulin. Manufacturers usually help by making the packs different colours (although it must be confessed that some of them appear to be more concerned with brand identity than patient safety). So far, so good.

 

But a no-blame culture can only go so far. Sometimes an individual is at fault. It is easy to mix up your Sinemet, true, but it is easier still if you are talking whilst checking, thinking about something else, have already been shouted at by a consultant that morning, rely on your memory when you aren't really sure, or were out the night before. A chief pharmacist I know once went a delivered an official reprimand to a cupboard (in another department) because whoever had filled in the incident form had stated that the error was 'the fault of the cupboard for being untidy'.

 

Pope Pius XII said that the 'sin of the century is the loss of the sense of sin'. We are all too ready to blame systems, or cupboards, or the fact that we weren't concentrating on the consultant who shouted at us, or the workload. No-blame culture may help improve patient safety, but it doesn't address the need to take responsibility for our actions. Often, when a patient is waiting to go home, it is 'pharmacy' who is blamed for the fact that they can't leave yet. Leaving aside the many occasions when actually the doctor hasn't written the discharge prescription yet, and the times when the medicines have been dispensed and delivered to the ward and carefully locked in a the medicines cupboard, if 'pharmacy' as a whole is to blame, then whose fault is it? The chief pharmacist? The ward pharmacist? The ward technician? The dispensary manager? The pharmacy rececptionist? The administrator who approved too much annual leave at once?

 

Following the Francis report there have been complaints that no-one at Stafford hospital lost their job. This situation is not quite the same as a dispensing error which is a genuine mistake, because a long-term, widespread cover-up of abuse is not a mistake. But in both cases, somebody must be responsible; there is a perpetrator (or more than one). Whether or not that person should be sued, or sacked, or strung up is another issue. The point is that we all need to recognise that we aren't perfect, we make mistakes, we choose badly, sometimes deliberately; we need to look at ourselves and admit that some circumstances are not beyond our control. And we need to start doing this on the small scale because some of us have jobs where errors are a matter of life and death. Some of us don't, but stop and think about the last time you broke a plate and whether or not you said 'the plate broke' or the 'the plate got broken' rather than 'I dropped it'. The truth will set you free: trust me, I'm a pharmacist.

If we're going to do it anyway, should it be allowed?

Today I read health-related story with a much wider implication than health. Apparently, a cross-party inquiry concludes that we should decriminalise illegal drugs. 

 

Having skimmed through the 150-pages I have to say that the BBC report is rather misleading. Whilst the inquiry talks about decriminalisation, it also calls this depenalisation. It is no so much about letting everyone have all the drugs they want, but recognising that addiction is a disease (albeit one which starts with a choice) and that treatment is a better solution than prison (especially given that there are a lot of drugs circulating in the prison system). I have no problem with this. In fact it seems like a good idea. Where cannabis is concerned, the inquiry recommends that the government monitor Colorado, Washington and Uruguay where it has recently been legalised.

 

The BBC article implies an attitude of "people are going to take drugs anyway, so let's make it safer for them to do so". I don't think this is really what the inquiry's recommendations are getting at, but I will say that the committee's document does contain phrases such as, 'We accept that it is impossible to...' with unsuprising regularity.

 

There seems to be a lot of this around at the moment. From those who talk about 'reality-based theology' to strategies for dealing with drug misuse and abuse which assume that the user will never be able to stop, it would appear that whichever way we turn there are people saying that we should accept something because it's like that.

 

I saw a postcard the other day which proclaimed "I set myself incredibly low standards and aim to fall just short of them" or words to that effect. This is mediocrity in the extreme and I for one am not buying into it. Yes, I have a tendency to sin; no, I cannot conquer it by my own efforts. But we were created good and nothing is impossible for God. A little co-operation with grace goes a long way. I don't think that we should ignore the fact that we are going to fail, to sin, to take drugs, to commit crimes, and we should be prepared, and we should devise and implement means which help us not to, and which help us to pick ourselves up and start again afterwards, but that does not mean we should re-define objective wrongs as acceptable.

 

God sees that we sin, he sent his only Son who suffered and died for our reconciliation, and he continues to love us and is always there when we turn back to him. And we must show this same face of compassionate welcome to others. But he doesn't say, "OK, everyone, 2000 years on you're still sinning, so we're having a new strategy: it no longer matters what you do." If we have this pessimistic attitude of 'it's going to happen anyway' we will never be able to accept the grace to get up again when we fall, never draw any closer to God, never grow in holiness. If we consider the inevitable as acceptable we will end up seeing it as good. Up will be down and black will be white. It will become even harder to choose between right and wrong, good and evil, life and death, if we start calling them by the same name: "legal".

Keeping up with life

The Daily Mail (not my favourite source of healthcare/science, or indeed any other kind of news, but anyway) reports a worrying trend in the number of women taking stimulants in order to cope with life.

Aside from the fact that Ritalin and friends are not licensed for the treatment of ADHD in adults (ie their safety and efficacy in this group of patients is not proven) and that buying medicines on the internet is a stupidly dangerous thing to do there are some other concerning aspects.

The women taking these drugs are obviously experiencing extreme pressure to perform and conform, but more seriously still we can see a tendency to measure people by what they do. We are not ourselves, or what we eat, but what we do. This is massive problem because if you cease to "do" then you also cease to "be". In the case of the students using these drugs, their measure of themselves is how well they perform in exams: I am only as good as my exam results. Others struggle with the demands of juggling work and family life, or long hours and pressure to meet targets. But where is the weakness in admitting that something is hard? There is also, as so often with mental health, a reduction of the human person to the merely biological.

According to the article, women aged 25 to 34 are the most stressed demographic group in the country. No surprises there: we are the group who first experienced student loans, SATs at 7, 11 and 14 years, league tables, contraceptives for all, abortion virtually on demand... We have grown up being encouraged to turn down children in favour of career success, with the advice that giving up work for motherhood makes you a failure, that instant gratification is our right and we are also the generation whose parents lapsed in their religious pratices meaning that many of us have never stepped foot inside a church. We started life with the understanding that, as women, we would have to fight tooth and nail to be recognised as good enough and we have arrived at adulthood finding that most of the work has been done.We have moved on from the time where everything was blamed on our parents not giving us enough attention. Now we are our bodies. We have been formed by secularism and individualism and taught that an expensive pair of shoes can solve all our probelms.

We were promised the world, and the world turned out to not be worth the paper it was written on. Only God's promises are worth trusting, and the majority of this group have no idea what they are.

Loneliness is bad for you

Since I started writing this blog, I have been struck by how the Church really is the expert par exellence in humanity. The Church knows that we are made for communion, for relation, and that this is essential for our happiness. Everyone else is only just catching up: the Daily Express reports that there is a link between loneliness and dementia.

I don't agree with their headline, that an active social life is the key, and later in the article they identify that it is feeling alone rather than being or living alone which is the important factor. In university we were taught that "people with fewer social contacts are more likely to commit suicide". That seems to suggest that it is being alone rather than experiencing loneliness which leads to ideation of suicide. But I would imagine that it is experiencing loneliness rather than being alone which contributes to depression. The correlation between depression and suicide is not well defined, but now appears to be less than 10% among all depressed people (although only 2% for the majority of people with depression) compared with 1% in the general population. Given that ideation of suicide is a symptom of depression, as well as the fact that depression interferes with normal rational thought processes, 2% seems fairly low.

There is also a strong link between depression and other illnesses. People with chronic illness are more likely to become depressed, and people with depression are at greater risk from other illnesses. Demonstrating direct causality here is probably nigh on impossible, given the number of interconnected factors involved...diet, medication, employment, relationship... Obviously there is going to be some overlap between being alone and feeling lonely and single households are now the most common type in the UK.

If this is a step up from last week's reduction to the biological it is still a reduction of the human person, only this time to the bio-psychological. Two out of three ain't bad, but there is a hierarchy and the spiritual always gets top billing. The first communion to which we are invited is communion with God. Faith and communion with God can transform and elevate all the other experiences of our lives, even illness and suffering. With God's presence, even loneliness is transformed and dispelled. But people are not going to realise this when five million only have their television for company (especially if they watch Eastenders). It's Advent, God is coming, so go and see one of the five million and tell them about it!

Something this simple shouldn't take two decades

For H: Keep up the good work!

Recently (with my Catholic Link hat on) I have been trying to find short videos or animations which explain the Church’s teaching on contraception. There is a huge want of apostolic resources on this topic and it has been something of a struggle. I was telling my brother (or unsuspecting apostolic guinea pig, as I like to call him) about this lack of videos on the topic and his response was, “Of course not, no-one wants to think about that stuff!” Eventually, I found something and then I sat down and tried to write a post. I ended up with a reflection on my own experience which was completely wrong for that site, but I decided to post it here instead.

In every parish I attended as a child there was always one family with more than four children who were regarded by the rest of the parish as more Catholic than everyone else at mass. Nobody ever explained why this was, but they were generally viewed with a mixture of superiority and guilt-fuelled admiration. Apparently being more Catholic meant that you were usually late for mass and were unable to get your children to sit still for 45 minutes.

At (my non-Catholic) secondary school that I learned that “Catholics believe that contraception is wrong”. There I also learned that contraception was the answer to pretty much all the world’s problems (and this was before the AIDS epidemic!). I had one conversation at home on the subject in which I was informed that “NFP probably works for clever people” and the clever couple cited had about five university degrees between them (and three children). I had a friend at school who was one of nine children. I used to hear people saying that they must be Catholic, which always mystified me as I knew they weren't.

In short, by the time I was 15, what I had learned about family planning was this:

• The Church is against contraception (apparently for no reason).
• Catholics themselves know better (and mostly ignore the Church).
• NFP is very complicated and difficult (and ineffective).
• Having children turns your life into chaos.
• Contraception will allow me, an intelligent woman, to have the life and career I deserve (and should want). Without contraception, this will not be possible. I am capable of making the world a better place and if I have children this will be impossible.

What a devastating combination! The world tells me all the disadvantages of children. The Catholics I know tell me nothing, in word or deed. (This sounds like poor me, I am a sad victim of the big, black formation hole, and that is not the point I am trying to make.) The world has got louder since then. It now assumes I want to have casual sex and assures me that there is no problem with that, in fact I should probably be encouraged in that line.

Now we have to fast forward almost ten years to the time of my personal conversion. Through prayer, formation and endless patience on the part of those who did apostolate to me I discovered that I believed in the Faith and that I wanted to live by the teachings of the Church. But I was still really stuck on the subject of contraception. I ended up feeling that I would have to go along with the Church even though there was no reason for what she said. I would have to suspend my own intelligence out of some sort of blind obedience to the Church and for this I would suffer: I would be unlikely to be able to find a sane man who would marry me under these conditions, and if I did I was going to have fifteen children (and probably die young, worn out from childbirth and never being able to afford a holiday). It took a lot more years of prayer and formation for me to understand and love the wisdom of the Church, a loving Mother who cares for her children and knows what is best for them.

It has taken nearly 20 years to undo the brainwashing I underwent at school. And it still isn’t completely done. (Interestingly, the undoing hasn’t come from having endless conversations about the merits of NFP over contraception but from understanding Catholic anthropology and the dignity of the human person.) I have a fairly constant mental battle with myself every time I read about sexually transmitted diseases, teenage pregnancy etc. I know that trying to address these problems with contraceptives is like sticking a plaster on a gaping, infected wound and expecting it to heal all by itself. But the world's roots go deep.

I am not surprised that “no-one wants to talk about that stuff”. There is a wall of silence surrounding the subject that probably stems from a fatal combination of “no sex please: we’re British” and abject ignorance on the part of the majority. I finally begin to understand the weirdos people (see what I mean about brainwashing) I knew at university who wouldn’t shut up about NFP: if people, and especially young people, don’t hear about the Church’s teaching from those faithful to the Church they are going to hear about it from somewhere else. And those other people who tell them about it are not going to have the integral wellbeing of the human person as their motivation and the inate dignity of that same human person has the foundation for all their reasoning. Because of this they will, however well-intentioned they may be, get it completely wrong.

Update: Contraception Can't: We need to talk!

It's not my fault!

I was somewhat bemused to read yesterday morning that there is a gene for binge drinking. Further inspection suggests that this gene predisposes some people to experience a stronger physiological response than others when drinking alcohol.

Personally, I would say that binge drinking has more to do with sin, freedom and the perennial search for happiness than genetics. Obviously binge drinking can't make us happy, any more than sleeping around can (and there does seem to be a strong correlation between the two). But whether they know God or not, everyone has a hunger for him, a longing for the infinite, and without knowledge of God this leads us to look for happiness in many places where it isn't to be found. Furthermore, I would say that not finding this happiness, not being able to satiate this desire we have (because for so many people they haven't chosen to reject God, it's just that faith has never been suggested to them as an option) we end up trying to fill up our lives with <i>anything</i> that might make us feel something, be it sex, drugs or rock n roll. Of course this self-destructive behaviour leads us into a downward spiral of increasing unhappiness: only in God and his loving Plan can we find happiness. He has made us for Himself and our hearts are restless until they rest in Him, to paraphrase St Augustine.

I am not some sort of neo-luddite who wishes to exclude science and technology from every facet of life. If people have genetic tendencies towards certain behaviours or illnesses then of course identifying that and seeking solutions can be a good thing. But the increasing tendency to identify genes is part of both the "loss of the sense of sin" bemoaned by Pope Pius XII (once we blamed "the system", now we blame our genes) and also constant reduction of the human person to the merely biological. Yes, I have a body, but I am not my body. Neither am I my DNA. And while we continue to place all our hopes on genetics we will never find the answer to those situations which many would agree are a problem.

The majority does not rule

A Bangor University study on assisted suicide reveals that two-thirds of people accept it. Apparently  62,000 people were included, which I first thought was quite a lot. However, it turns out that this was an international survey, and so actually this isn't a very large proportion. "Accept" is also a rather ambiguous word, which makes me wonder what people were actually asked. Careful reading shows that this study was in fact a literature review which brought together the results of studies already carried out. Hmmmmm.

Something which strikes me as interesting is the fact that this report states that a recent review shows that doctors consistently resist assisted suicide. Let's leave off the pity plea and be realistic: "assisted suicide" is an attempt at making "euthanasia" sound better. And the reason doctors are resisting it is hardly surprising, since they are the ones who would be assisting. A person might want to die, their relative might think that they should be allowed to, but if you are the one writing the prescription or supplying the drugs then you are not assisting, you are enabling.

Researchers apparently also said that 'headlines tended to feature professional arguments against celebrity campaigners, with ordinary people "less clearly represented".' When they speak of professional arguments, do they mean that they come from professional arguers (eg. Chris Moyles...I don't know his views on euthanasia but I'm prepared to bet he'd have an arguement about it, Richard Dawkins, possibly one of the most argumentative men on the planet, or anyone's youngest brother providing the person they are arguing with is an older sibling), or medical professionals. Because if it is the latter than surely this puts 'celebrity campaigners' on a level with 'ordinary people'. As Blessed John Henry Newman said:

All bow down before wealth. Wealth is that to which the multitude of men pay an instinctive homage. They measure happiness by wealth; and by wealth they measure respectability... It is a homage resulting from a profound faith... that with wealth he may do all things. Wealth is one idol of the day and notoriety is a second... Notoriety, or the making of a noise in the world -- it may be called 'newspaper fame' -- has come to be considered a great good in itself, and a ground of veneration.

One commentator said, 'The medical profession needs to recognise and have respect for this majority view even if we don't agree with it.' And a palliative care expert (who I suspect may have been quoted somewhat out of context, on the basis that palliative care is all about not walking away) said that doctors must 'never walk away from patients'. All this makes me want to label the article with a big flashing sign saying !RELATIVISM ALERT! Combining these two comments makes it sound as if doctors are neglecting their duties by not allowing the majority (otherwise known as 0.0006% of the world's population) to dictate how they do their jobs. Even if 99% of the world's population were in favour of euthanasia, it wouldn't change the fact that helping your patient to die with dignity has a lot to do with helping your patient to live with dignity and nothing to do with ending their life prematurely. It also would not affect the intrinsic wrong of killing. So-called "assisted suicide" is the final step in the wrong understanding and use of freedom. Funnily enough it's the same as the first step (when Eve took the apple): I am free and therefore I have the right to choose...so I choose death. I refuse to accept my limitations that I am a creature and am finite. I reject God. I want to be God without God.

The poor will always be with us: seriously?

The health inequalities between rich and poor are widening, reports BBC Health.

We've known this since the Black Report was published in 1980, and as not much notice was taken at the time, it's hardly surprising that 30 years on we're faced with the same problem, only bigger.

When I lived in Peru people often asked me if I was shocked by the poverty there. And yes, it is shocking to see shanty towns built up by the sides of motorways, to see shops which sell pre-fab sheds and then see the same sheds in the desert with entire families living in them, to hear children exclaim with excitement over such simple things as grass and trees and then ask with disinterest if they will be eating today, as so far they haven't. I saw children whose teeth were no more than shells and a toddler with a paraistic infection who rarely mentioned that his tummy hurt although it was the size of a football. I met a terrified young girl whose father had beaten her because she had her first period (in her innocence she had no idea why, but apparently her teenage sister had had a baby which possibly explains her father's concern although in now way justifies his action). I heard, from a volunteer doctor, of a patient with appendicitis who went home and died because he didn't have the money to pay for the operation, and read in the paper of a man whose body was thrown off the bus and left in the street when he died on his way to the hospital.

Yes, poverty in the developing world is indeed shocking. But what is more shocking is the divide between rich and poor. I saw a school with no toilets (the children go in the playground) and half an hour away another which had facilities that would put a state primary in this country to shame. The wealthy who live alongside poverty often completely ignore it, and one can grow up in Lima and never realise that there are such things as shanty towns (I'm not sure exactly how, but I'm assured by those who did that it is entirely possible).

In Lima, if you meet a child in a shanty town whose hands and face and clothes are dirty you know that it's because when you live in a desert, everything gets dirty very quickly; there is no running water at home, certainly not hot water or washing machines; there probably isn't any soap, because food is the prioity, and very possibly these are the only clothes she has, especially in winter when the humidity seems to make the cold penetrate one's bones and wearing everything you own is a better alternative than freezing. If a boy doesn't (can't or won't) use a knife and fork, it might be because his family don't own any, but it's equally likely that having not eaten all day he just wants to get it down as fast as he can. When you have nothing, staying alive is the priority, cutlery and soap are luxuries. The only answer to this reality is love. Love until it hurts and then love more, because without love the only answer is frustration and anger that there is injustice in the world, and despair at one's helplessness in the face of it.

If you go into a school in an inner city in the UK and see pupils with dirty clothes and hair, it's not because they don't have hot water or washing machines or soap. It's because they are neglected, whether that is because they have a single parent who works all hours to make ends meet or nobody bothers to wash them or their clothes. Some people have hard choices to make, other just choose to make bad ones. If they don't use a knife and fork it's because their family doesn't sit down together and eat meals at the table, or because they always eat processed food which comes in a handy pick-me-up-and-eat-me format. You do not expect "beans on toast" to be the answer to the question, "What did you have for Christmas dinner?" (and he didn't know it was Christmas anyway because his parents hadn't bothered to mention it). There are children with mobile phones but no crayons. What a difference from a child with nothing who on being given a packet of cocoa <i>in July</i> assures you that his family are going to save it for Christmas day.

The divide between rich and poor in this country is not manifested solely in deaths from heart disease. There is a spiritual and cultural "poor gap" which has nothing to do with economics. Poverty is shocking wherever you see it, but somehow it is more shocking here where everyone has access to  education, healthcare and doesn't need to make a choice between soap and food, between clothes and beds. The lack of God, the lack of Love, in this green and pleasant land makes us poorer by far. This is the poverty that should not be with us. Everyone has the right to know God, and the riches that come from abundant life, and this is why we need the New Evangelisation.

Sterilizing our children

This week there have been two articles worth mentioning in the news about contraception and teenagers.

The first is from the Telegraph and gives the details of girls as young as 13 being given contraceptive implants (effective for 3 years) and injections (3 months) at school, or in clinics, without parental knowledge or consent. First of all, I believe that patient confidentiality is essential, regardless of the age of the patient. However, confidentiality is intrinsically tied to consent: the person consenting is entitled to confidentiality. All medical treatment (legally this includes contraception - Medicines Act 1968) requires informed consent, and those under 16 can only give informed consent if they are deemed to be Gillick competent. Competence varies with every individual and intervention and I do not believe that any teenager, however smart can be deemed to be competent where a long-acting contraceptive is concerned. We see enough adults who struggle to conceive after years on the Pill; I cannot see that a teenager, who is unlikely to be considering the probability that they will one day want to have a family, would be able to give informed consent. Actually, come to think of it, there probably aren't many adults capable of giving fully informed consent to such an intervention, but unfortunately we aren't subject to the same criteria. If you are consenting to contraception, that assumes that you are consenting to sex, and that requires a level of psychological and spiritual maturity, not just intelligence. As such, not being competent, they cannot consent and therefore they are not entitled to confidentiality.

Secondly, we have an age of consent in this country which is 16. Why do we bother if promiscuity is going to be encouraged in this manner? Who are these 13 year olds sleeping with? Granted, there may be a small proportion who seek contraception as a badge of honour (a GP I knew who also worked in a Family Planning Clinic told me that she was somewhat plagued by teenagers who wanted contraceptives for the purpose of having them rather than using them), a rite of passage if you will. But given all the concerns over internet grooming and child abuse should we not be asking more questions? Teenage girls are not usually interested in boys their own age; even if a girl is 15 and her boyfriend is 16 that is still illegal.

This strategy is derived from the desire to decrease the incidence of teenage pregancy (I get it) at all costs (I don't). Given the current rates of STDs, especially the chlamydia epidemic, why aren't we thinking outside the box? What we need is a culture of openess: parents should not be their childrens' best friends or their worst enemies, but children should be able to talk to their parents. And the only guarenteed way to prevent pregnancy and STDs is through abstinece and I do not think we can promote abstinence without teaching young people about their own intrinsic dignity. Of course we have a problem in that we are now in the 2nd generation of permissive behaviour, the belief that freedom is all about doing what you want when you want, and the total absence of God which leads to seeking value in pleasure.

The other article states that girls are choosing the pill over condoms. Around 2006, the student newspaper in Manchester published the results of a survey which found that female students didn't want to go on the pill because they didn't want to be considered "easy". (It also discovered that a significant proportion of students believed that it was not possible to conceive whilst standing up, which says something about the level of education they had received, but I digress.) This suggests that they were not considering the pill because they were already in a sexual relationship but because they were expecting to have what I think could be termed 'random' sexual encounters. Someone who knows you is not likely to be judging you on being easy.

What am I bothered about? Well, firstly, these articles are about girls. No-one is talking about boys. Granted there are not so many contraceptive options available to them, but it appears that the current strategy is completely targeted at young women, and comes from an anti-life basis rather than the promotion of health and well-being. There was recent outcry when it was proposed that girls be taught abstinence. I agree that it is rather ridiculous, because boys also need to know about their dignity and worth (and sadly, teaching only one half of the population about abstinence would likely lead to an increase in the use of prostitutes). It could be argued that girls choosing these longer-acting forms of contraception are sleeping with their long-term boyfriends. But I think it could equally be argued that actually what is happening, extrapolating from the prevailing attitude of Manchester undergraduates, is that at least some girls are effectively sterilizing themselves in the expectation of casual sex. It is time that sex education was based on something real (anything! but preferably good anthropology) rather being completely out of context and taking sex out of context. Bring on existential sex education.

Who takes responsibility for this guesswork?

Over at the Hermeneutic of Continuity, Fr Tim Finigan mentioned (and I believe I am supposed to touch my forelock to him, but am new at this whole blogging thing so I am prepared to stand corrected) the case of Adrian Smith who was demoted from a managerial position for posting comments on facebook about same-sex marriage taken place in churches. I went and found the article in the Manchester Evening News because surely for such measures to be taken against him, citing gross misconduct, he must have written something actually bigoted (rather than just expressing an opinion, which is what is taken for bigotry these days) or incited people to burn down churches where same-sex marriages are performed or something equally extreme.

In fact, no.

Then I thought that maybe this is part of the recent spate of facebook/twitter crimes, by which an individual writes something more or less offensive (often whilst drunk) and gets sent to jail for it. I heard of a newly qualified teacher who didn't get the job he applied for because the governors saw pictures on facebook of him acting stupidly whilst drunk and decided that he didn't have the necessary character for forming young hearts and minds. People need to realise that twitter is public (and should be avoided when drunk) and that there is nothing private on the internet, including facebook. And, I think, the law needs to take account of modern means of communication which are changing much faster than the law ever can. Did Mr Smith, then, say something which he thought he was just saying to his nearest and dearest but turned out to be public?

In fact, no.

Mr Smith's 'crime' (bearing in mind that he is not being prosecuted, just sanctioned) turns out to be breach of his employer's code of conduct which, according to the MEN, states that employees must not "expressing religious or political views which may upset co-workers".

I think that warrants closer inspection...

Firstly, if you express views which may upset co-workers as long as they're not religious or political then that's fine. So if you were to express "Darcey's earrings are way too big but at least she's a better judge than Arlene was", or "I hope that Saddam rots in hell", "I am saddened and disappointed by the content of JK Rowling's new book. She may not agree but I think as a well known children's author she has a certain responsibilitiy" or even "I can't believe anyone thinks (insert name of celebrity) is good looking. He/she looks like they've been hit by a bus, and is also completely devoid of talent" all those are also fine. However, if you say "I don't see how Nick Clegg in conscience can remain head of the Lib Dems seeing as how he did a U-turn on tuition fees which has always been one of their manifesto promises," or "The government don't have a mandate for same-sex marriage and I can't help thinking that the furore is a cover-up to distract us from the failing economy, much like the issue of the Falklands in Argentina" that is not OK. And secondly, I feel there is a problem with the wording "may upset co-workers". It doesn't matter if no-one is actually upset by your religious or political views, just as long as they might be. But in this case, who decides? We're back to people being told that they can't wear a cross because someone "might" be offended. If no-one is offended, what is the basis for thinking they might be. And is there a difference if I say "I think abortion is wrong" and am a Catholic or if I say it and am an atheist. The statement equally "might" offend someone who has had an abortion but only in one case could it be argued to be a religious view.

It would seem that Adrian Smith has made two mistakes. Firstly, signing up to work for a company with such a ridiculous code of conduct and secondly using facebook whilst Christian.