Victory for gay rights in New York

The state becomes the sixth in the US to legalise same-sex marriage.

Cheers and celebrations echoed around New York's West Village well into the early hours - outside the Stonewall Inn where the modern gay rights movement was born more than forty years ago. For last night another milestone in equality for lesbians and gay men was passed - as the bill legalising same-sex marriage was signed into state law.

For New York's governor, Andrew Cuomo, this was a defining victory on an issue he'd made one of his top priorities - a victory too, for social justice. "New York has finally torn down the barrier that has prevented same-sex couples from exercising the freedom to marry and from receiving the fundamental protections that so many couples and families take for granted," he said. "With the world watching, the Legislature, by a bipartisan vote, has said that all New Yorkers are equal under the law. With this vote, marriage equality will become a reality in our state, delivering long overdue fairness and legal security to thousands of New Yorkers."

New York is now America's sixth, and largest state, to allow same-sex marriage, after the bill passed by 33 votes to 29. Just one Democrat voted against - but four Republicans crossed the floor to ensure the measure went through. One of them, Stephen Sarland, who voted against the issue two years ago, said he'd changed his mind. "I have to define doing the right thing as treating all persons with equality", he said, adding that he was at peace with his conscience. The city's republican mayor Michael Bloomberg, who'd helped to lobby for the law, called it an "historic triumph", declaring "together we have taken the next big step on our national journey toward a more perfect union".

The lobbying effort had been backed by a huge number of political figures and celebrities - from Bill Clinton to Lady Gaga - indeed the singer urged her fans to contact one Republican lawmaker, Mark Grissini, to persuade him to back the measure - and last night, he did just that.
But the vote was a huge political victory for Governor Cuomo, who spent two years planning and campaigning for this moment. As New York Magazine revealed, he worked relentlessly to make it happen. A close confidante paid tribute to his sheer persistance: "It's an orchestra, it's a symphony, it's political skills. It's 500 phone calls to individual senators. It's birthday calls, it's anniversary calls, it's going to their district, it's all last year campaigning with them."

The final piece in the jigsaw was a deal over a special exemption for religious groups, who want the right to refuse to perform services or provide the space for same-sex weddings. That agreement won over the final Republican votes, and the bill was passed into law.

There have been protests, of course - the state's Catholic bishops said they were "deeply disappointed and troubled", while the National Organisation for Marriage, which had lobbied hard against the new legisaltion accused New York's republican party of tearing up its contract with the voters'.

As for President Obama, his public position on gay marriage is said to be "evolving". From an early commitment to the policy, when he first ran for the Senate fifteen years ago, he changed his views during the 2008 election, declaring himself in favour of civil unions, but no more - citing his religious faith. This week at a fundraiser in New York, he tod a group of activists that "gay and lesbian couples deserve the same legal rights as every other couple in this country", although he wouldn't give any specific commitment on the same-sex marriage issue.

But last night there were plenty of New Yorkers who were unequivocally overjoyed - same-sex couples will just have to wait 30 days before the first marriages can take place.

Not so much of the country, though: it's still banned in 39 states - while California remains in something of a hiatus, after a judge overturned a ban - yet no gay marriages are able to take place while his ruling is being appealed - a decision which could go all the way to the Supreme Court.
Governor Andrew Cuomo is certainly hoping New York will lead the way: "This vote today will send a message across the country.", he said. "This is the way to go, the time to do it is now, and it is achievable; it's no longer a dream or an aspiration."

Or as Lady Gaga put it, on Twitter: 'the revolution is ours to fight for love, justice+equality. Rejoyce, NY and propose. We did it!!'.

Felicity Spector is a senior producer at Channel 4 News

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All doctors kill people – and the threat of prosecution is bad for everyone

We must recognise the reality of medical practice: just because a doctor makes a mistake, that doesn’t mean they’ve all broken the law. 

On 15 November the Court of Appeal quashed the 2013 conviction for gross negligence manslaughter (GNM) of a senior consultant surgeon in London, David Sellu. Sellu, who had completed his prison term by the time the appeal was heard, will never get back the 15 months of his life that he spent in jail. Nor will the personal and family trauma, or the damage to his reputation and livelihood, ever properly heal. After decades of exemplary practice – in the course of the investigation numerous colleagues testified to his unflappable expertise – Sellu has said that he has lost the heart ever to operate again.

All doctors kill people. Say we make 40 important decisions about patients in a working day: that’s roughly 10,000 per annum. No one is perfect, and medical dilemmas are frequently complex, but even if we are proved right 99 per cent of the time, that still leaves 100 choices every year where, with the benefit of hindsight, we were wrong.

Suppose 99 per cent of those have no negative consequences. That’s still one disaster every 12 months. And even if most of those don’t result in a fatal outcome, over the course of a career a few patients are – very regrettably – going to die as a result of our practice. Almost invariably, these fatalities occur under the care of highly skilled and experienced professionals, working in good faith to the very best of their abilities.

If one of these cases should come before a crown court, the jury needs meticulous direction from the trial judge on the legal threshold for a criminal act: in essence, if a doctor was clearly aware of, and recklessly indifferent to, the risk of death. Sellu’s conviction was quashed because the appeal court found that the judge in his trial had singularly failed to give the jury these directions. The judiciary make mistakes, too.

Prosecutions of health-care professionals for alleged GNM are increasing markedly. The Royal College of Surgeons of England identified ten cases in 2015 alone. This must reflect social trends – the so-called “blame culture”, in which we have come to believe that when a tragedy occurs, someone must be held responsible. In every one of these cases, of course, an individual’s life has been lost and a family left distraught; but there is a deepening sense in which society at large, and the police and Crown Prosecution Service (CPS), in particular, appear to be disconnected from the realities of medical practice.

Malpractice investigation and prosecution are horrendous ordeals for any individual. The cumulative impact on the wider health-care environment is equally serious. In a recent survey of doctors, 85 per cent of respondents admitted that they were less likely to be candid about mistakes, given the increasing involvement of the criminal law.

This is worrying, because the best way to avoid errors in future is by open discussion with the aim of learning from what has gone wrong. And all too often, severely adverse events point less to deficiencies on the part of individuals, and more to problems with systems. At Sellu’s hospital, emergency anaesthetic cover had to be arranged ad hoc, and this contributed to delays in potentially life-saving surgery. The tragic death of his patient highlighted this; management reacted by putting a formal rota system in place.

Doctors have long accepted the burden of civil litigation, and so insure themselves to cover claims for compensation. We are regulated by the General Medical Council, which has powers to protect patients from substandard practice, including striking off poorly performing doctors. The criminal law should remain an exceptional recourse.

We urgently need a thorough review of the legal grounds for a charge of GNM, with unambiguous directions to the police, CPS and judges, before the spectre of imprisonment becomes entrenched for those whose only concern is to provide good care for their patients. As Ken Woodburn, a consultant vascular surgeon in Cornwall who was accused and acquitted of GNM in 2001, has said: “You’re only ever one error away from a manslaughter prosecution.”

This article first appeared in the 01 December 2016 issue of the New Statesman, Age of outrage