Hazel McHaffie

assisted conception

Justice, rights, entitlement

The latest casualty of the coronavirus lockdown in this country is fertility care. As of Wednesday of this week, no new patients will be accepted, and even those in mid-treatment, those for whom this is their last hope, those who will be too old to qualify or stand a chance of success by the end of lockdown, will not now receive the necessary procedures towards which they’ve been working for so long. Yet another tragedy. More heartbreak. More hopelessness.

Which brings my thoughts to the ethical issues around assisted conception …

It’s now fifteen years since I wrote Double Trouble, a book about surrogate pregnancy. Fifteen years! Yoiks. But as with so many ethical dilemmas in medicine, the issues are still relevant today.

I was fascinated then, to watch the serialised BBC1 drama, The Nest, which finished this week, about a very wealthy but childless couple, Glasgow property tycoon Dan and his beautiful pampered wife Emily, who decide to go down this route. Click on the picture for the official trailer.

All attempts at IVF have proved unsuccessful. Dan’s sister has already tried to carry a baby for them but miscarried. They have one precious embryo left. One. Only one more chance. Emily meets the troubled teenage Kaya when she accidentally knocks into her in her car. Kaya sees an opportunity to get out of her impoverished life, and offers to be a surrogate for them in return for £50K. But as the story unravels we find that Kaya has secrets in her past and a very dubious pedigree indeed …; the would-be father Dan is something of a rough diamond too, dealing with a lot of shady characters and skullduggery …; Emily is single-minded about motherhood and what she wants, but privately troubled by the morality of what they are doing – always setting herself up as ‘the principled one‘ according to her sister-in-law. No-one in the UK will implant the last embryo. However, the Dochertys can well afford to go abroad for the simple procedure, and they do so.

On the face of it everyone stands to win. Kaya will be set on her dreamed-of pathway to becoming a successful business woman, able to ‘go on a plane, have one of these pull-along cases‘. The wealthy couple get their hearts’ desire. Better yet, surrogate and intended parents establish a relationship, even friendship. Kaya moves in with the Dochertys and gets a taste of a life of privilege. The baby will not only be much wanted, but will have every advantage money can buy.

Naturally – this is, after all, fiction, drama, a series requiring cliff hangers – things go pear-shaped. Relationships get confused. Loyalties are divided. Dubious and unsavoury motives emerge. But the underlying questions and challenges remain pertinent.

Is parenthood a right?
Is ‘want’ the same as ‘need’ in childbirth terms?
Payment for this service in the UK is forbidden. Should it be?
How binding should a contract between intending parents and surrogate be?
Should private arrangements for surrogacy be permitted?
Does a woman have the right to do whatever she likes with her own body?
What constitutes ‘reasonable expenses’?
Should those with the wherewithal be allowed to circumvent ethical and medical guidelines?
Does using someone far less powerful in this way constitute exploitation?
In the event of a dispute about whose baby it is, whose rights should take precedence, and who should decide?
What if the child is damaged/imperfect/not what was expected? Should the contract still stand? Who should accept responsibility for him/her?
What of the baby’s rights?
How much of its origins should a child be told?

Back to the drama … enter Kaya’s long-estranged mother, who encourages her to renege on the contract, hang on to the baby, become a mother herself, a better mother than she has been. But Dan already loves this child. Even when he finds out she is not his genetically, she’s still his daughter in his heart. The Dochertys call in their lawyer; the case goes to court. It’s left to the judge in the Family Court to put things into perspective – severely castigating their self-serving recklessness, the complete imbalance of power, the undesirable qualities on both sides. But, she says, at the end of the day it’s not a question of how she would judge them; it’s about what is in the baby’s best interests.

Contrary to expectation, there is a happy ending to this story, and both sides demonstrate they’ve learned important lessons about what matters in life. But the drama perfectly illustrates the power of fiction to challenge us to think about what society today should endorse, and how far the law can go in dealing with the fine nuances of moral questions in assisted reproduction. Well done, screenwriter Nicole Taylor.

 

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Father to thirty?!

Wow! The garden has gone from nought to sixty in one fell swoop. Everything is burgeoning and sprouting and bursting into colour, the birdsong has racheted up to symphony standard, the sunshine exceeding the benefits of any pharmacological tonic.

I’ve been alternating writing indoors with reading outside (when I’ve not been weeding and pruning and artistically directing, or course!) and loving the exhilaration of both. So it’s probably not surprising that, surrounded by all this new life and activity, my mind instantly latched onto a report about a different form of creation: babies.

This week it’s been revealed that a diminishing number of sperm donors are fathering eye-watering numbers of children. Now, as long ago as sixteen years (can it really be?!) I wrote a novel about the risks of this phenomenon: Paternity, so it’s a subject I’ve thought about long and hard. But even for me the statistics were like a cold water douche.

Figures from the Human Fertilisation and Embryology Authority (HFEA) show that, in a period of 24 years (1991-2015):
17 British men have fathered at least 30 babies each,
a further 104 have fathered between 20 and 29,
1,557 between 10 and 19,
and more than 6,000 have created up to 9 babies.

Though these men are offering hope to many many childless women/couples, huge risks are inherent in such practices. Obvious ones are passing on undetected hereditary diseases and risks, and half-brothers and -sisters forming sexual relationships and procreating together. Donated sperm are currently tested for diseases such as HIV, hepatitis B and C, CJD, Huntington’s and cystic fibrosis, but not for genes indicating increased risk of cancers or Altzheimer’s. In the face of the latest statistics, campaigners are calling for more stringent enhanced screening to try to reduce the incidence of faulty genes being passed on, but representatives from the world of assisted conception caution that further screening could reduce the number of donors coming forward or being deemed eligible to donate, already worryingly low.

Research in this area is complicated, not only by the powerful emotions and opinions and ethics around infertility, but also by the fact that sometimes the full consequences of what is permitted in this area are not fully apparent until a generation or more has gone by – which is why I felt compelled to write a sequel to Paternity: Double Trouble. And once you start tinkering with genes it can be impossible to repair any damage done.

So, what d’you think? Just how much control or interference should there be? What are the rights and interests of the babies as well as the parents, donors and recipients? What makes a man a father? Which diseases are worse than non-existence? Who decides?

Now there’s a little package of ethical conundrums to conjure with while you watch birds and animals multiplying prolifically all around you! Welcome to my world!

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Peeling back the gilt of Christmas

Nativity carouselAt this time of year it somehow seems extra tragic when bad things happen to good people. Aside from the global crises afflicting our world and unravelling before our eyes in our living rooms, I personally have a number of friends currently facing serious illness, impending death, sudden bereavement, and yet it must seem like everyone around them is caught up in trivia and pleasure, festivities and excess – in reality of course, who knows how many others are only hiding stresses and problems from public consumption?

Mrs Santa straw figureIt’s in this spirit that my mind has been wandering over the huge dilemmas facing different families; what would I choose in their circumstances? how would I cope?

Metropolitan police officer Heidi Loughlin, 33, discovered she had an aggressive form of breast cancer the day after finding out she was pregnant with her third child. She decided not to have a termination of the pregnancy but to delay treatment until after the birth. Her condition became so serious however that her baby girl was delivered by Caesarean Section on Friday, 12 weeks early, and Heidi has been given a short time to recover from the operation before starting powerful chemotherapy next week. She faces a pretty gruelling Christmas, but is determinedly looking forward to March when she will get her baby girl home to her two brothers. She has risked her life to give her daughter a chance and says she has no regrets; it was all worth it. What would I have chosen in this situation, I wonder? What would you?

Then there’s fireman Patrick Hardison. He entered a burning house in Mississippi; the roof collapsed on him leaving him with severely disfiguring burns across his face, head, neck and upper torso. Think for a moment of the pain of a small burn from an oven shelf, a hot iron … Multiply that by ten trillion. Even after 70 operations he was still so terribly mutilated (see pictures here if you can cope with them) that he would only go out heavily disguised. What kind of Christmases has he endured, I wonder? He recently underwent the most extensive face transplant ever performed. Factor in not only the excruciating pain at every stage but the risks … would I have been courageous enough to want to go on living? Would you?Antique Santa candle holder

Within the last two months, two transgender women have been found dead in their cells in all-male prisons: 21 year old Vikki Thompson in November, and 38 year old Joanne Latham in December. No more Christmases for them. Many difficult questions present themselves where transgender people are concerned and there is generally much greater sensitivity to their issues, but what about when they commit crimes, serious offences that land them in prison? Not only their own welfare is at stake but that of their fellow prisoners. Where would you have housed these two? Nearly 150,000 people signed a petition to house a third person, 26 year old Tara Hudson, in a female institution even though she had been convicted of assault. Would you have signed it?

A 50 year old woman, mother of three, is so determined not to grow old and ‘lose her sparkle’ that she has refused to undergo kidney dialysis. Her kidneys were seriously damaged when she took an overdose following a diagnosis of breast cancer. For years her life style has been chaotic to say the least, and one wonders, what is Christmas like in that household? Whatever, the Hospital Trust responsible for her care appealed to the courts to have treatment imposed against her wishes. But a senior judge has upheld her right to an autonomous choice to die. Was he right to do so, do you think?

I’m merely scratching the surface by way of illustration. Remember all the cases we’ve heard about recently – various scandals around abortions carried out on the grounds of gender alone; teenagers killing themselves because they’re obsessed with losing weight; all the dire warnings about how to deal with declining fertility; the consequences of a simple blood test at 18 weeks pregnancy that allows screening for thousands of genetic conditions  … the list goes on and on. My files are bulging with clippings and articles.

Scandinavian figuresSo at this time of celebration and joy, let’s spare a thought for families caught up in tragic circumstances, and the courageous souls who try to support and guide them. May they find wisdom, courage and strength. And I wish all visitors to this blog peace as you prepare for the festive season whatever it means to you.

 

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Ethics in the news

Every now and then I like to give you a glimpse into the world of medical ethics that continually fires my imagination. Just since I wrote my blog last week we’ve had the following stories in the media – apologies in advance, the list grew and grew as the week went on! See what you think about them? Do you have any simple answers? What would your solution be? Where does your mind travel? I’ll give you links so you can find out more about any of the cases you’re interested in.

Thinking about a solutionA grandmother has given birth to a surrogate child for her single son in his mid-twenties using his sperm with a donor egg. A judge has ruled that, though unusual, the arrangement is entirely lawful. But … is it ethically acceptable? Who is brother … father … mother …? What about sixteen years down the line? My mind goes into overdrive. How about yours?

Zach Parnaby is 20 months old and his family are already working down a bucket list of his favourite things before he dies. He has Krabbe Leukodystrophy. A pinprick screening test could have detected the disease soon after birth, giving them the option of a bone marrow transplant, but his parents were told it isn’t done for cost reasons. Is this reasonable and just? What price would you put on a child’s life? How would you juggle competing demands for limited resources?

Sarah Marquis is a 41 year old lawyer specialising in white collar crime. In 2008 doctors failed to spot that her appendix had burst and she was rendered infertile. The hospital have admitted liability but their lawyers are insisting that she deserves less compensation because she has been free to pursue her career without the breaks necessary for child bearing. Is this appropriate and fair? What if she went on to have a child through IVF … ?

17 years ago Zephany Nurse was stolen from her sleeping mother’s arms. But now, by a coincidence, she has met up with her biological sister and been reunited with her birth mother. Her abductor, whose own child was stillborn, apparently cared for her well, and this week we heard that Zephany refuses to testify against her. Should the woman be allowed to go free? Who do you think should best occupy the parenting role?

QuestioningFrom this week Canadian patients will be allowed to ask their physicians to help them end lives that have become burdensome to them. Their Supreme Court ruling was unanimous. Do you agree with them? Should the UK follow suit, d’you think?

Seven years ago an NHS consultant had a malignant growth removed from her thyroid gland and was discharged home the following morning, even though she was already showing signs of a dangerously low calcium level in her blood. However her medical knowledge told her she was in big trouble and she dialled 999, saving her own life. She has just been awarded a six figure sum by the hospital trust who admitted liability. How would this have all panned out if she’d been your average ordinary Joe Bloggs?

A US study has found that hard physical work damages a man’s sperm. So …? Does this give men the right to refuse to work on the grounds of their human rights? This could get interesting!

A proposal has been made that seriously ill patients could be offered organs from high risk donors (eg. cancer patients, smokers, the elderly or drug users) to help address the chronic shortage of available organs for transplant. Let your mind ramble over the possible scenarios of this in terms of the possible donors … Would you accept second best … for yourself? … for the person you love most in the world?

ImaginingThe NHS has just launched a controversial online calculator. It’s said to predict when someone will have a heart attack or stroke. Hello? Would you wish to be told that? Would you alter your lifestyle to prevent it? Would that negate the prediction? A couple of days later we’re told that ‘two families will be the first to receive personalised care based on their DNA as part of a national plan to sequence 1000,000 genomes.’ Is this science fiction coming true? Or a utopian dream? Where will it lead?

Back to the humdrum everyday … A survey of more than 1000 cancer patients has found that 1 in 10 is left unwashed, undressed or untoileted because of a lack of careworkers. And we all thought cancer was high priority; it was the elderly who were neglected. But then we hear that 26% of councils in England failed to properly consider the needs of people with arthritis, and 66% failed to consider back pain – conditions which affect 7 million people in England and account for £5 billion of NHS spending. What do these studies say about the allocation of resources and priorities? Oh, but hey ho, on the same page … scientists have found a class of drugs that dramatically slow ageing … in mice at least. So is this where the money will go? An elixir of youth? Ahhh, wait a wee minute … plans are in hand to build the UK’s first proton beam therapy cancer treatment centres in London and Manchester. Just who is deciding how and where the money is being allocated here? And if you were in charge …?

Still with resources … As from this week 16 very expensive drugs which have been clinically proven to increase the lifespan of terminally ill patients, are to be removed from the approved list of the Cancer Drugs Fund, as announced in January. Imagine your beloved was dying prematurely … Is it possible to reduce the well-being and hope of any family to pounds and pence? Should drug companies be allowed to raise obscene amounts of money from the tragedies of others?

Ex-serviceman Chris Graham is 39. He has a 6 week old baby. He also has early onset dementia. It’s in his genes. His brother has it; he’s 43 and totally incapacitated and dependent on others. Their father, grandfather, aunt and cousin all died of it in their forties too. Chris might have passed it on to his baby son. At what point should a halt be called to this perpetuation of tragedy? Should it ever? What if scientists modified the family germline …?

These news items were all reported in just one week of the year – a mere 7 days. They’re the kind of clippings that find their way into my ideas folders because they set my brain asking, ‘What if …?’. ‘Supposing ….’ ‘Would this be believable?’ Trouble is, my brain has a finite capacity … and shrinking! And there simply isn’t time to turn all these possibilities into stories.

(NB. For the purposes of this blog I’ve made no effort to pursue the facts behind these stories; I’m just sharing what anyone might know from the papers.)

 

 

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What the papers say

This post should carry a government health warning: If you are quickly bored with facts or allergic to conundrums do not continue with this week’s blog.

I’ve always maintained that the subjects I write about are issues which challenge us as a society; they repeatedly hit the headlines. And this remains the case. To illustrate the point, I decided to monitor the medical ethical challenges that were reported in one newspaper (The Telegraph) for just one week (4-10 August 2014) and share with you what I found. Wow! Even I was bowled over with the sheer volume of material in this category in just seven days.

Please bear in mind as you read, that papers have their own agendas and the facts might not all be correct. However, on this occasion I’m not going to research every issue or attach links or hedge the topics around with qualifiers and alternatives; all these ‘extras’ would detract from my focal point. I’ll simply itemise the issue, and leave you to ask yourself: How would I feel in this situation? What would I do in these circumstances? What should society do? What is fair and just? What are the implications for educating the public, or our limited resources, or competing demands? … Or you can just accept the point if you prefer an easier life!

So … are you sitting comfortably? …

Perusing the newspapers

ASSISTED CONCEPTION

There’s been an outcry against the first national sperm bank (in Birmingham) which openly caters for lesbians and single women who want to start a family without having a relationship with a man.

The ongoing story of Gammy, the baby with Downs Syndrome (discussed in my last post) who was allegedly rejected by his commissioning parents following a surrogate twin  pregnancy, rolled on with almost daily updates unravelling more and more bizarre aspects, bringing the whole question of surrogacy under the spotlight.

A Japanese businessman is said to have fathered nine babies during the past two years using Thai surrogate mothers. Seven nannies have been hired to care for them. Reports vary as to his motives: from ‘he wanted a big family for himself’, to ‘he’s part of a child trafficking ring’.

ASSISTED DYING

Former teacher, Dawn Faizey Webster, has been in a locked-in state following a stroke at the age of 30, two weeks after giving birth to her son. She was featured this week completing a university degree 12 years later, by blinking using a laptop that translates her eye movements into text. And yet other people in a similar state are pleading for assisted dying because life is intolerable.

MATERNAL v FETAL RIGHTS

Women who drink alcohol during pregnancy slow the development of their children’s brains, reported researchers in Los Angeles. They compared the brains of children with fetal alcohol spectrum disorders and unaffected children over a period of two years.

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DEMENTIA

Saga conducted a survey of the over 50s and found that far more are afraid of developing dementia than cancer.

A study of 1658 Americans aged 65 and over has found that a severe lack of vitamin D appears to more than double the risk of dementia. But hey, the winter sun in the UK is too weak to generate adequate vitamin levels and older skin is less efficient at doing so. Cue salmon, tuna, mackerel and fortified foods etc etc etc.

A report from the Centre for Economics and Business Research has estimated that the number of people who are forced to retire early because they have (or a loved one has) dementia will double within 15 years.

PERSONAL LIBERTY v PUBLIC SAFETY

Several Britons have been quarantined over fears of the Ebola virus entering this country. It’s alleged that certain ‘special’ patients have been given specific experimental untested drugs to good effect which are not available to others.

MENTAL HEALTH

A nationwide survey of people with bipolar disorder, their carers and the professionals who treat them, is about to begin in this country. The researchers say it’s too often the case that other people remote from the sharp end are the ones who influence research expenditure; they want to remedy this. Critics question the morality of including people with mental illnesses.

A teenage girl in Merseyside took her own life after visiting pro-anorexia websites and self-harming.

ORGAN DONATION

A 24 year old, Stephanie Reynolds, has launched an appeal for a kidney for her mother via Facebook. Thousands of strangers from around the world have offered to be tested to see if they are compatible as potential donors. Her mother, Elaine, has an autoimmune element which means she cannot have an organ from a blood relation. The odds of finding a match are less than one in 10,000. Hence Stephanie’s Facebook appeal. Apparently such appeals have been successful in the USA.

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PUBLIC HEALTH and LIFE STYLE CHOICES

Grizzly bears gorge themselves and become obese prior to hibernation but they don’t get diabetes. Scientists are asking: Could this offer a clue for treating humans?

A report in Annals of Oncology has stated that if everyone between 50 and 64 took a low dose aspirin daily for 10 years it would prevent 6518 cancer deaths each year and 474 fatal heart attacks. But the price would include an extra 896 deaths per annum from strokes and stomach bleeds. (Hmmmm. This one affects me personally. Some years ago, taking that small prophylactic dose for only six months triggered lymphocytic colitis which has plagued me ever since. So I wouldn’t myself describe it as poetically as Christopher Howse: ‘Aspirins are the vanilla cynosure of the rattling world of pills; unsparkling but attractive, like pearls’. Not in my book, matey! Sorry, I digress.)

It seems that prostate cancer screening could save more lives than programmes to detect breast cancer – so says a European study of 162,000 men from 8 countries. That would mean saving around 2300 lives per annum in the UK. And yet … the research has concluded that such screening should not be introduced. Why?  Because a high level of over-diagnosis (resulting from the unreliable PSA test) would mean thousands of men going through needless treatment and ending up with incontinence or impotence.

RESOURCE ISSUES

A staffing agency, Prestige Nursing + Care, has issued new figures which indicate that pensioners’ incomes have fallen further behind the cost of care homes. This is adding to the pressure on NHS hospitals and putting vulnerable elderly people in danger. Also the number of people receiving home adaptations has fallen by 12% since 2010, heightening the risk and incidence of falls and injuries.

A report, The Future of Loneliness, has predicted that hundreds of thousands of pensioners will be all but cut off from services, shops and their local communities within 15 years because of the rise in the use of the internet. The result will be a hugely inflated risk of loneliness, already a worrying aspect of old age.

A ‘wonder drug’, metformin, normally used to treat diabetes, has been found to increase the life expectancy of patients with other conditions such as cancer and cardiovascular disease. This could mean an extra two and a half – three years for today’s 65 year olds. What’s more it only costs 10p a day. But hey, we’re already struggling with the problems of an aging society …

The National Institute for Health and Care Excellence has decided that a revolutionary drug, Kadcyla, that is said to give women with advanced breast cancer an extra six months of life, will not be available on the NHS because it is too expensive, even after the manufacturers have offered a discount. Countries elsewhere in Europe fund it. Ahhh, the old chestnut: if you look at the individual cases, doesn’t every family want to hang on to their loved ones for as long as possible? – well, most families anyway. But add up all those astronomical bills and balance them against only a few more weeks of life and set that against all the other treatments competing for the limited pot of money, and the perspective looks different.

Researchers at Imperial College have found that injecting a patient’s CD34+ stem cells into their brain following a stroke encourages tissue repair and may save them from death or severe disability. However, an expert has said these improvements could just be due to chance or the special care this small safety trial has provided for a tiny number of patients.

FAILURES IN CARE

The Care Quality Commission has admitted that at least 750 homes providing care for the elderly and disabled have been failing to attain at least one basic standard for more than a year. Why? Because the CGC feared legal threats from the owners of the homes. As a result vulnerable people have been knowingly put at risk. The CQC say that a new regime is being introduced to make protection much more robust.

Official statistics on NHS waiting times have revealed that the number of patients forced to queue in ambulances outside A&E departments has almost doubled in three years. In addition, over 3 million people are now on waiting lists for operations – a rise of 700,000 compared with 2010 figures.

Phew! As you can see, I shall never run out of triggers for new novels! I’m constantly thinking, What if ……?

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Do I want … or do I need?

Little did I think back in 2005, when I wrote Double Trouble, that surrogate pregnancy would hit the headlines in quite the way it has.

Don’t get me wrong, I have huge sympathy for people who are genuinely unable to have children. Goodness, I’ve written two novels on the subject already. And I do believe surrogacy may well be a viable option for some couples. But what’s exercising my mind right now is the dividing line between a desperate ‘we need’ as against a petulant ‘I want’ – with real live children pawns in the game. And I guess it’s the juxtaposition with celebrity and wealth and selfish attitudes that’s disturbed me most.

First gay 64-year old Elton John. And now, married 43-year old Nicole Kidman. Positively flaunting the production (and I use the term advisedly) of children by this means.

Of course, I don’t have the ear of Kidman and her husband Keith Urban; there may be intimate factors about which I know nothing. But their story does prompt all sorts of questions. Off the top of my head:
a. What will baby Faith Margaret feel in years to come when she sees the news clippings of her parents thanking their ‘gestational carrier’ for her?
b. Is it right for anyone at any age to be encouraged to have children?
c. Should limits be imposed on assisting conception or pregnancy?
d. What sorts of circumstances justify ‘renting a womb’?
e. Does money buy happiness for children?
f. Should babies ever be saleable commodities?
g. Or the latest must-have accessory?
h. Are there doors which fame and fortune shouldn’t be able to open?
And I’m sure you’ll be able to think of plenty more.

I’m feeling the impact of these cases powerfully this week because I’m back to editing my forthcoming novel, Saving Sebastian. Sebastian Zair, is just four years old, a beautiful child, bright and lovable. But he suffers from a serious blood disorder. He requires frequent unpleasant treatments; his prognosis is grim. His parents, Yasmeen and Karim, are desperate to save his life. In order to give him a chance they’re seeking to create a matched child by IVF, using their own eggs and sperm. But the embryo will need to be carefully selected, other potential lives will be destroyed in the process, there are no guarantees. And consultant fertility expert, Justin Blaydon-Green, is juggling all sorts of competing interests; there’s already a shadow hanging over his unit, awkward questions are being asked. Campaigners are on the warpath. The press smell a story. But for the Zair family, time is running out …

Well, stack that against a convenient gift-wrapped bundle bought by celebrity parents … I rest my case.

Not good for my peace of mind, or my creative flow!

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Am I really me?

I’ve just had a complete stranger contact me to check: Do I exist? Am I really me? Did I actually win a prize in a writing competition as an advert claimed?

Now, I’ve lost count of the number of people who’ve told me they’ve seen this photo in the said advert – for a creative writing course with the Writers Bureau. It’s very small fry as prizes go and I was only runner-up, but the advert’s appeared in a range of different publications: Big Issue, The Daily Telegraph and Private Eye amongst others. And it’s been running for seven months now. Wahey! All free – and unsolicited – publicity for me!

But this is the first time I’ve had my credentials – nay, my very existence – challenged. It transpired this gentleman was wondering about taking a similar course but was suspicious it might all be a money-making scam. He checked me out on Google and there I was: a real live person. And a person who writes to boot.

So, now he wanted to check the authenticity of the prize. And that’s when he contacted me. I could easily reassure him that yes indeed, I’d won a couple of awards with the Bureau.

Back he came. Would I recommend the course? I would. Wholeheartedly. Now, a bona fide sceptic might be thinking, Well, she would say that, wouldn’t she? It’s quid pro quo. They promote her work; she endorses their course. But my recommendation was most sincere. Why? After all, lots of people say creative writing can’t be taught. You’ve either got ‘it’ or you haven’t. The course showed me that

Techniques can be taught
Two of my brothers, who are more practically inclined, think I definitely have a seriously abnormal quirk in my brain because I love words so much. I mean, who on earth would scribble a weekly blog from choice?! Well, the inclination may be innate, but the technique of writing publishable work, turning ideas and drafts into polished and focused articles or books which publishers will accept, even pay you for, is an art that can be honed and refined.

We are not our own best critics
As writers we have no end of baggage cluttering up our discriminatory antennae. There’s all the passion we feel about the subject, the pain of giving birth to that text, the protective instinct of a mother. We need other detached eyes (whoops! well you know what I mean) to see it for what it really is, and help us to identify our faults and relinquish the bits we cherish. And you need to really respect your critic’s skill and judgement to make that kind of sacrifice.

We benefit from knowledgeable and objective criticism
It’s delightful to have friends and your Mum telling you how much they love what you write, but what you really need, if you’re serious about writing, is people who truly understand what good writing looks like. Most if not all the tutors on the course I took are themselves established writers. They know the reality as well as the ideal. They speak with authority. They give advice that’s worth listening to. But they temper their criticism with kindness because they also know the sensitivities and vulnerability of the novice author.

Reading purely for pleasure isn’t the same as reading analytically
Tutors can help to direct the would-be writer to good prose, to analyse what makes it sing, and to apply the principles to their own writing.

Broadening experience of writing is beneficial
I must confess I was slightly begrudging about doing the non-fiction half of the course first. I’d already published nigh-on a hundred articles in prestigious peer-reviewed journals. Surely I didn’t need … What a waste … OK; I resolved to complete the early assignments as quickly as I could to get them out of the way, and then concentrate on the fiction component. Which showed me how wrong I’d been in my initial resistance. Writing to order – about things I’m no expert in – was a salutary experience and an excellent discipline. It opened my eyes to new experiences, made me observe in a different way. I wrote about events as diverse as attending a craft fair, visiting an exhibition of photography through the ages, going for a meal as if a food critic. And always there was the challenge: could I make words work for me without the underlying drive that had propelled my writing before? Words moreover that someone else would enjoy. And there was no room for half-hearted effort just because this wasn’t of any interest to me. A real live, eagle-eyed someone was poised ready to rip my mediocrity to pieces; how humiliating would that be? No, it was nowhere near the doddle I’d anticipated.

It helps to know one’s own strengths and weaknesses
Over the full course I covered everything from writing a letter to a newspaper through to a play for radio. Getting tasters of so many different kinds of writing not only opened up new avenues of experience, but also helped me see where I definitely didn’t want to go. Or probably shouldn’t attempt to go! I confess I was rather pleased with my play, a murder mystery with haunting subtleties and a nice twist in the tale … maybe … perhaps … I began to see the credits rolling … My tutor soon disillusioned me!

Creative writing courses aren’t like sausage machines
Some cynics dismiss these courses: they churn out clones producing formulaic writing. Not the distance-learning course I took! Far from it. It was always student-focused, individually tailored. The assignments were set, certainly, but I was free to interpret and respond as I saw fit. And my tutor always commented specifically about the work I produced; never forced me into a mould of her making. And her assessments were always fair and focused – on me, my style, my end game.

It helps to have aims and goals
Right from the start she’d wanted to know, what was I looking for from the course? What were my personal aims and ambitions? I did actually have a clear agenda from the outset: I wanted to write a set of novels about medical ethical dilemmas. To make ethics come alive through fiction. This was to be my unique selling point. My tutor understood and respected my need to be different. And she gave me good honest criticism to that end.

Knowing the market is vital
Every assignment had to be written for a particular publication or potential buyer. It took hours: analysing the market, trying to understand what editors and publishers were looking for. At times I found it tedious; I was reluctant to put in the effort. After all I had no intention of writing for food journals of women’s magazines or local papers. No way! I wanted to be a novelist. Again, how wrong I was. That discipline taught me much, and since I’ve published my novels, dealing with important life issues, I have indeed written for several newspapers and a range of magazines, bringing my books (and the issues) to a much wider audience than would otherwise be possible. But now I understand how important it is to do your homework.

Persistence and determination are essential for success
I am constantly amazed that I’ve won any prizes for my writing. I still feel like a raw amateur playing out of my league, in many ways. But the fact that I have serves to underline a sad fact. In today’s climate it’s hard to get published. You need an over-developed persistence gene and a hide like a rhinoceros. I happen to have inherited a stubbornly determined streak that refuses to give up on my ambition.

Having a niche market helps
I also have one unusual advantage. I inhabit a rarefied world; the world of medical ethics – the dilemmas thrown up by modern medicine.
In real life all of us are touched by these issues. Someone we know, or we ourselves, face these challenges. Maybe we develop a life-limiting illness; should we end our life before the agony becomes unbearable? Maybe we find ourselves unable to have children; do we go for sperm donation or surrogate pregnancy? Maybe we’re fertile all right, but we don’t want this unwelcome pregnancy; should we have an abortion? Maybe a loved one develops Alzheimer’s; how far should we go in caring for them?
But the subject of medical ethics is shrouded in esoteric language and obscure arguments. We need a user-friendly means by which ordinary people can be helped to understand the pros and cons of different sides of the arguments by getting inside the skins of people living through these scenarios. There’s a niche for novels that make the issues accessible.

There is a space for me.

Next week I promise a short post to compensate for today’s essay!

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One click ethics

Thanks to my daughter’s vigilance, I’ve just found an amazing website, tailor made for people like me who don’t get round to noting programmes about ethical issues until it’s too late, or who forget the ones they’ve seen. If you share my obsession about ethics you’ll probably know about it already. But just in case I’m not the very last ostrich out of the sand, I’m going to share this discovery with you. And no, the BBC aren’t paying me a penny!

It’s http://www.bbc.co.uk/ethics/ and it gives information about religion and ethics programmes broadcast by the BBC on TV and radio – past, present and future, so pretty comprehensive. And of course, giving appropriate links. Loads of cross referencing and fascinating diversions. The usual suspects are there – abortion, euthanasia, assisted conception, sexual exploitation … arguments for and against, recent controversial cases, documentaries, drama, comment. It’s great to have one site that gives easy access to the more obscure references as well as prime-time coverage.

I’m off on my travels again this week, so it’s good to know in advance what’s coming up and to know exactly where I can go with one click to catch up the following week if trains don’t run to time, or the hotel stages a fire alarm at the wrong moment, or I get so lost in my latest Robert Goddard novel that I lose all track of the hour.

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