Catholic Medical Quarterly Volume 73(1) February 2023

Correspondence

1. Conflicts surrounding end of life care in children

Tony Cole Archie Battersbee was the latest child at the centre of a conflict between parents and clinicians over the withdrawal of life support. Is there a better way of resolving such conflicts rather than to seek access to the courts? There, the parents will have no equality of arms against expert witnesses and fully funded lawyers.

Mediation is now widely available whereby parents and clinicians can seek a consensus on end of life care. It is confidential, voluntary and completely independent and may extend to obtaining second opinions. It is not part of the legal process and cannot be used in evidence.

The Health and Care Act 2023 has yet to be fully implemented, but under section 174 there is provision for a review of cases which would be put before Parliament within a year. Why has this not yet been implemented?

Meanwhile, clinicians should exercise patience and wait until parents can accept that the life of their child is coming to its end. Then, is there a private homely space where they can say their goodbyes? Kindness and understanding are essential and good medicine.

Dr A P Cole J P FRCPCH
Consultant paediatrician (Retired)

2. Letter from the World Federation of Catholoic Medical Associations

Readers will recall that the World Medical Associations proposed new code of ethics included provision that mandated referral of patients when a doctor had a conscientious objection to treatment. We are please to report that lobbying and good argument prevailed and that the code was further revised to preserve appropriate protections for both patients and doctors. The WMA Code of Ethics is available in full at

The key paragraph (29) now reads “This Code represents the physician’s ethical duties. However, on some issues there are profound moral dilemmas concerning which physicians and patients may hold deeply considered but conflicting conscientious beliefs.

The physician has an ethical obligation to minimise disruption to patient care. Physician conscientious objection to provision of any lawful medical interventions may only be exercised if the individual patient is not harmed or discriminated against and if the patient’s health is not endangered.

The physician must immediately and respectfully inform the patient of this objection and of the patient’s right to consult another qualified physician and provide sufficient information to enable the patient to initiate such a consultation in a timely manner.”

from the World Federation of Catholoic Medical Associations

To:   Dr Heidi Stensmyren, President of the World Medical Association (WMA)
        Dr. Osahon Enabulele, President Elect.
        Dr. David Barbe, Immediate Past-President
        Dr. Otmar Kloiber, Secretary-General.

Dear Dr Stensmyren, Enabulele, Barbe and Kloiber, the WMA Council and Executive,

As president of the World Federation of Catholic Medical Associations (FIAMC), in concert with the president of the European Federation of Catholic Medical Associations (FEAMC), Prof. Dr. Vincenzo Defilippis, I wish you an inspiring and successful Conference in Berlin in liaison with the German Medical Association.

We are a global Physician’s Organization with 80+ National Association members. We share your vision that the International Code of Medical Ethics (ICME) should provide a global framework to ensure compassionate and ethical medical care for patients worldwide and help banish torture and degrading treatment. The ICME should offer support and guidance to Medical Practices at personal, team, organizational and national levels. Moreover it should also inform and illuminate Government and Legal Processes at local and national levels.

The WMA was born of the tragedy of the Second World War and the complicity of fellow Physicians from the prosperous, well educated and deeply cultured centre of Europe. Some FIAMC colleagues lived through these times, most learnt from the media and a few from family’s friend’s or patient’s experience.

What if Conscientious Objection (CO) had practically been available to Physicians of that time? Could CO sow seeds of doubt in others “who were just following orders”, when the Nazis started killing those with learning and other disabilities? Pastor Niemoller recanted, for he wasn’t a Communist, Socialist, Trade Unionist or Jew but “then they came for me and there was nobody left to speak for me”.

Seventy-five years later there remain multiple conflicts leading to torture and ill treatment of humans especially by authoritarian regimes. The treatment of the Uyghur people and others in China demonstrates this. Complicit physicians must have some ethical notions but no conscience?

Conscientious Objection has a wider role than perceived. Conscientious Objection is paramount to the Medical Practice of Physicians with diverse beliefs, notably even in cohorts of Physicians approving of Assisted Dying/Euthanasia since few are prepared to actually do the killing.

We urge the WMA to ratify the compromise paragraph of the ICME agreed to at the International Expert Committee in Washington D.C., in August 2022. It maintains the right to Conscientious Objection without onward (or maybe a mandated) referral.

Prof. Dr. Bernard Ars, MD. PhD. Professor of Internal and Forensic Medicine, President FIAMC
Prof. Dr. Vincenzo Defilippis, MD. PhD. Professor of ENT Surgery, President FEAMC

3. Introduction to organisations teaching NFP / Natural Fertility

There is an increase in Environmental awareness nowadays, and with this a desire to simplify our lives. Maintaining optimum health is a priority for most people and along with this there is also a growth in understanding Natural Fertility.

NFP has been misunderstood and lacked respect for many years. Sometimes it is difficult to access teaching, so people become fearful of committing themselves when the method is thought to be unreliable.

Thanks to courageous researchers, we now have a reliable, safe and scientific based method of Natural Family Planning, known as Sympto‑thermal method.. safe to use, no harmful side effects, and it can strengthen relationships when used by motivated, mutually supportive and knowledgeable couples. From this base, there is also medical support for women / couples with subfertility problems. (IRRM).....and there are other organisations that will help children and adolescents learn more about relationships and puberty.

Human anatomy and physiology is basically the same the world over and we welcome interest from people of good will whatever their philosophy for life.

Below are links to organisations that teach Natural Family Planning / Natural Fertility. sometimes online and where possible face to face

LIST of NFP WEBSITES

Billings ovulation Method www.billings.life
This is the first NFP organisation. It was developed in Australia in the 1950’s by Dr Evelyn and Dr John Billings, a married couple, both medical doctors.The focus is on recognising the changes in the cervical mucus.
The Natural Family Planning Teachers Association www.nfpta.org.uk
This organisation started in 1984, by Dr John Kelly who worked with his colleague Dr Anna Flynn, in Birmingham. The Sympto- thermal method is taught which uses 4 indices of Fertility in the Female Cycle. The website give good information and on line tuition is available.
The Couple to Couple League in GB www.cclgb.org.uk
As the name indicates, couples teach couple couples. It originated in America and the Sympto thermal method is taught.
Fertility Care Centres Great Britain https://fccgb.org
Within the website information is a map to show locations for teaching support. Many teachers also give online tuition.
Natural Fertility Support in UK www.fiatfertilitycare.co.uk
Both these organisations teach natural fertility with a particular focus on cervical mucus. Couples with difficulty conceiving can be referred on for medical support.
Marquette Method https://www.mmnfp.com This is originally an American organisation. To find a UK based Marquette instructor, contact www.famc.eastanglia@rcdea.org.uk
Fertility UK. https://www.fertilityuk.org
This is an organisation that has been accepted within Healthcare in the UK.
Fertility Clinic Dublin www.neofertility.ie This is one of two clinics that are based in Ireland where NaPro Technology is offered as a part of the Restorative Reproductive Medicine.
International Institute for Restorative Reproductive Medicine https://iirrm.org
There are centres for RRM in many countries in Europe but at present it is not always easy to access this medical treatment in the UK. More information is on the website. This organisation is particularly helpful for couples wishing to achieve a pregnancy and would prefer a method in harmony with the natural female cycle rather than a more technological approach.
Saint Pope Paul VI Institute
www.fertilitycare.org/pope-paul-vi-institute This is a centre based in Nabraska USA and is a world leader on Natural Fertility Research . Under the directorship of Dr Thomas Hilgers
TeenSTAR www.teenstarcourses.org.uk This organisation runs a programme for teenagers helping them with relationships, moral values and understanding their fertility.
My Fertility Matter www.mfmprojectuk.org
An organisation for children at senior level in Primary school introducing them to the changes that will take place in their bodies as the go through puberty. Run in small groups, minimum of 5 children.
European organisation for Natural Fertility can give links to other European organisations.
www.eifle.org (English) www.ieef.eu (French) These are the same organisation. Globally there are 5 ‘umbrella’ organisations and this is the European branch. It was founded in 1992 in Grenoble, France and Dr Anna Flynn, from Birmingham, was a founder member.

Catholic Medical Quarterly