Home Secretary Theresa May wants to expand powers to remove UK citizenship. Photo: Getty
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Theresa May's citizenship-stripping proposal is worse than medieval banishment

The Home Secretary should remember the US Supreme Court's description of making someone stateless: "a form of punishment more primitive than torture".

In medieval England, those who had been forced to “abjure the realm” and go into exile would be required to walk barefoot, carrying a wooden cross, to the nearest port.  There, they were to take passage on the first available ship; until they were able to do so, they had to wade, daily, into the sea, as testimony to their willingness to leave the country.

This specific provision is absent from the Home Secretary’s proposed expansion of her powers to arbitrarily deprive Britons of their citizenship – expected to be considered again by MPs this week.  But the echo of the medieval punishment of banishment in the modern measure of ‘citizenship-stripping’ is impossible to ignore. It has perhaps been best summed up by the Supreme Court of the United States, which has described the practice of making someone stateless by removing their citizenship as “a form of punishment more primitive than torture.”

And in some ways, the modern procedure of which Theresa May is so fond is worse than its centuries-old equivalent.  By and large, those medieval unfortunates forced to abjure the realm were not at risk of further punishment from the state provided they stayed out of the country.  The same cannot be said of those who have been deprived of British citizenship under the current government's existing, limited powers, which they are currently seeking to expand.  According to the Bureau of Investigative Journalism, of the estimated 37 people who have had their passports torn up by the current British Home Secretary, two have so far been killed in covert US drone strikes, and one has been kidnapped and “rendered,” also by the US. 

Conveniently for both governments, the removal of British nationality from these people means that the obligations on the British authorities – in terms of the provision of consular services to those detained, or the carrying out of an inquest into the deaths of those killed overseas – are lifted.

As leading lawyer Baroness Kennedy QC put it during the Lords debate on these proposals, contained in the Immigration Bill:

“Is... the purpose of this change of law, that we might be able to do things that make people vulnerable and deny them their rights, creating yet more black holes where no law obtains but where we cannot be accused of complicity?”

Notably, this was not a question to which the government minister responded.  Despite a growing body of evidence demonstrating the UK's involvement in CIA activities ranging from rendition and torture to the covert drone programme, the British government – on the grounds that it must avoid at all costs embarrassing its US ally – has refused to come clean over its role in any of them. 

This way of thinking is not limited to parliament – it has also infected the British Courts.  Last year, a High Court judge told one of the victims of CIA torture that although he had a “well-founded claim,” he should not be allowed to pursue his case for fear of damaging UK-US relations.

Meanwhile, on the covert drone programme, despite a wave of reports demonstrating that the UK supports it by providing everything from intelligence to crucial infrastructure at US bases on British soil, UK ministers have stonewalled, refusing to go any further than the bland statement that “the use of unmanned aerial vehicles against terrorist targets is a matter for the states involved.”

The picture that emerges from all this is of a Britain which is prepared to take measures that even the US has long determined to be beyond the pale.  It is worth returning here to that US Supreme Court ruling mentioned above, which railed against “subject[ing someone] to banishment, a fate universally decried by civilized people,” and making them “stateless, a condition deplored in the international community of democracies.”

Home Secretary Theresa May's measures – which would lift the ban on depriving someone of citizenship, even where doing so would render them stateless – were defeated in the Lords last month.  But the government is expected to seek their return in the Commons this week.  Aside from putting Britain beyond the “civilized... community of democracies,” in the US Supreme Court's words, they will open up many millions of Britons to the threat of the arbitrary loss of their citizenship, and, potentially, leave them vulnerable to the lawless excesses of the ‘War on Terror’: kidnap or death by drone.

It seems safe to say that the sight of would-be exiles wading into the sea at the Channel ports is not set to return.  But the arbitrary nature of these powers, which allow the Home Secretary to act without any legal process and without any crime having been committed, would be all too familiar to the medieval despots of this country’s past.

Donald Campbell is Head of Communications at Reprieve

Flickr/Michael Coghlan
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Why does the medical establishment fail to take women in pain seriously?

Women with mesh implants have been suffering for years. And it's not the only time they have been ignored. 

Claire Cooper’s voice wavered as she told the BBC interviewer that she had thought of suicide, after her mesh implant left her in life-long debilitating pain. “I lost my womb for no reason”, she said, describing the hysterectomy to which she resorted in a desperate attempt to end her pain. She is not alone, but for years she was denied the knowledge that she was just one in a large group of patients whose mesh implants had terribly malfunctioned.

Trans-vaginal mesh is a kind of permanent “tape” inserted into the body to treat stress urinary incontinence and to prevent pelvic organ prolapse, both of which can occur following childbirth. But for some patients, this is a solution in name only. For years now, these patients – predominantly women – have been experiencing intense pain due to the implant shifting, and scraping their insides. But they struggled to be taken seriously.

The mesh implants has become this month's surgical scandal, after affected women decided to sue. But it should really have been the focus of so much attention three years ago, when former Scottish Health Secretary Alex Neil called for a suspension of mesh procedures by NHS Scotland and an inquiry into their risks and benefits. Or six years ago, in 2011, when the US Food and Drug Administration revealed that the mesh was unsafe. Or at any point when it became public knowledge that people were becoming disabled and dying as a result of their surgery.

When Cooper complained about the pain, a GP told her she was imagining it. Likewise, the interim report requested by the Scottish government found the medical establishment had not believed some of the recipients who experienced adverse effects. 

This is not a rare phenomenon when it comes to women's health. Their health problems are repeatedly deprioritised, until they are labelled “hysterical” for calling for them to be addressed. As Joe Fassler documented for The Atlantic, when his wife's medical problem was undiagnosed for hours, he began to detect a certain sexism in the way she was treated:

“Why”, I kept asking myself, when reading his piece, “are they assuming that she doesn’t know how much pain she’s feeling? Why is the expectation that she’s frenzied for no real reason? Does this happen to a lot of women?”

This is not just a journalist's account. The legal study The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain found that women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively. 

An extreme example is “Yentl Syndrome”. This is the fact that half of US women are likely to experience cardiovascular disease and exhibit different symptoms to men, because male symptoms are taught as ungendered, many women die following misdiagnosis. More often than should be acceptable, female pain is treated as irrelevant or counterfeit.

In another significant case, when the news broke that the most common hormonal birth control pill is heavily linked to a lower quality of life, many uterus-owning users were unsurprised. After all, they had been observing these symptoms for years. Social media movements, such as #MyPillStory, had long been born of the frustration that medical experts weren’t doing enough to examine or counter the negative side effects. Even after randomised trials were conducted and statements were released, nothing was officially changed.

Men could of course shoulder the burden of birth control pills - there has been research over the years into one. But too many men are unwilling to swallow the side effects. A Cosmopolitan survey found that 63 per cent of men would not consider using a form of birth control that could result in acne or weight gain. That’s 2 per cent more than the number who said that they would reject the option of having an annual testicular injection. So if we’re taking men who are afraid of much lesser symptoms than those experienced by women seriously, why is it that women are continually overlooked by health professionals? 

These double standards mean that while men are treated with kid gloves, women’s reactions to drugs are used to alter recommended dosages post-hoc. Medical trials are intended to unearth any potential issues prior to prescription, before the dangers arise. But the disproportionate lack of focus on women’s health issues has historically extended to medical testing.

In the US, from 1977 to 1993, there was a ban on “premenopausal female[s] capable of becoming pregnant” participating in medical trials. This was only overturned when Congress passed the National Institutes of Health (NIH) Revitalisation Act, which required all government funded gender-neutral clinical trials to feature female test subjects. However, it was not until 2014 that the National Institutes of Health decreed that both male and female animals must be used in preclinical studies.

Women’s exclusion from clinical studies has traditionally occurred for a number of reasons. A major problem has been the wrongful assumption that biologically women aren’t all that different from men, except for menstruation. Yet this does not take into account different hormone cycles, and recent studies have revealed that this is demonstrably untrue. In reality, sex is a factor in one’s biological response to both illness and treatment, but this is not as dependent on the menstrual cycle as previously imagined.

Even with evidence of their suffering, women are often ignored. The UK Medicines and Healthcare Regulatory Agency (MHRA) released data for 2012-2017 that shows that 1,049 incidents had occurred as a result of mesh surgery, but said that this did not necessarily provide evidence that any device should be discontinued.

Yes, this may be true. Utilitarian thinking dictates that we look at the overall picture to decide whether the implants do more harm than good. However, when so many people are negatively impacted by the mesh, it prompts the question: Why are alternatives not being looked into more urgently?

The inquiry into the mesh scandal is two years past its deadline, and its chairperson recently stepped down. If this isn’t evidence that the massive medical negligence case is being neglected then what is?

Once again, the biggest maker of the problematic implants is Johnson&Johnson, who have previously been in trouble for their faulty artificial hips and – along with the NHS – are currently being sued by over 800 mesh implant recipients. A leaked email from the company suggested that the company was already aware of the damage that the implants were causing (Johnson&Johnson said the email was taken out of context).

In the case of the mesh implants slicing through vaginas “like a cheese-wire”, whether or not the manufacturers were aware of the dangers posed by their product seems almost irrelevant. Individual doctors have been dealing with complaints of chronic or debilitating pain following mesh insertions for some time. Many of them just have not reported the issues that they have seen to the MHRA’s Yellow Card scheme for identifying flawed medical devices.

Shona Robison, the Scottish Cabinet Secretary for Health and Sport, asked why the mesh recipients had been forced to campaign for their distress to be acknowledged and investigated. I would like to second her question. The mesh problem seems to be symptomatic of a larger issue in medical care – the assumption that women should be able to handle unnecessary amounts of pain without kicking up a fuss. It's time that the medical establishment started listening instead. 

 

Anjuli R. K. Shere is a 2016/17 Wellcome Scholar and science intern at the New Statesman

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