Update on Life Issues - November 2017


Abortion – 50 Years of Shame
Much more could be written about the 50th anniversary of the 1967 Abortion Act and its hideous aftermath, but there is no real need.  All I want to say appears in my little piece, Abortion – 50 Years of Shame.  Read it here.
The decriminalisation of abortion
Rather than hang their heads in shame at the 9 million or so lives that have been summarily snuffed out since 1967, some have used the 50th anniversary of the Abortion Act to press for more exploits and less restrictions – the decriminalisation of abortion.

Foremost among these efforts has been that of Diana Johnson, Labour MP for Kingston upon Hull North.  In March this year, her ten-minute rule Bill to decriminalise abortion alarmingly passed its First Reading by 172 votes to 142.  Then on 6 November, she secured a further late-night discussion on the issue.  During that debate she was asked by her pro-choice friend, Kate Green, the Labour MP for Stretford and Urmston, ‘Does she agree that parliamentary opinion on this matter is massively out of step with public opinion?  The vast majority of people in this country favour safe and legal abortion.’  Of course, she replied, Yes.

But that was a planted question and a rather dishonest answer.  It took Fiona Bruce, Conservative MP for Congleton several intervention to get to the heart of the matter.  For example, on the issue of jettisoning the two-doctor requirement of the 1967 Act, Bruce stated, ‘A ComRes poll of 2,000 adults last week showed that 72% of the public think that abortions should continue to be subject to that legal requirement because it ensures protection for women, particularly for those in an abusive relationship.  It might be the opportunity they have to talk to someone in a safe environment about the pressure that they might be being put under to have an abortion.’  Furthermore, that ComRes poll also showed that 62% want the upper time limit of 24 weeks to remain in place.

Not to be silenced a second time, Fiona Bruce again tackled other worrying and misleading statements on the following day during the Autumn Adjournment statements.  She expressed concern about the reports resulting from Care Quality Commission’s investigations into the appalling abortion practices of some Marie Stopes International clinics, including criticism after the discovery of dead unborn babies in open bins.  She asked, ‘Again, what steps are Ministers taking to address these concerns?’

She clarified the previous day’s criticism of the £250,000 grant from the ‘tampon tax’ fund given to the charity, Life.  She asserted that it was not the largest sum from that fund and that Life seeks to give women a genuine choice and that, ‘Life has helped to house more than 12,000 vulnerable mothers and babies and provided help and non-directive counselling to tens of thousands more.’  This relatively small sum she compared to that, ‘Over the past decade, hundreds of millions of pounds of taxpayers’ money have been paid to private sector abortionists.’

And she drew attention to a recent letter from BPAS which asked all parliamentarians to ‘… support decriminalisation of abortion in the UK.’  She further noted that the CEO of BPAS, Ann Furedi had previously stated that, ‘I want to be very, very clear and blunt ... there should be no legal upper limit.’  Mrs Bruce asked, ‘What steps are being taken, both by the Government and the Charity Commission, to address lobbying of this nature by a government-funded organisation?’

She also drew attention to the campaigning of Professor Lesley Regan from the Royal College of Obstetricians and Gynaecologists.  Fiona Bruce continued, ‘…who I understand supports decriminalisation and persuaded its council – but not the membership – to back decriminalisation in a ballot.  I understand Professor Regan has argued that the practice of abortion should be no more restricted by the law than the practice of having a bunion removed.’

She also cited, ‘The extensive BBC-commissioned polling by ICM that clearly showed respondents supporting two doctors continuing to approve an abortion.  It showed a clear rejection on the grounds of abortion due to disability and far lower support for abortion under other circumstances than may have been expected, and certainly would be expected if one listened only to the campaigning of those who are pushing for decriminalisation.  As these polls indicate, that is not what the British public want.  A ComRes poll from May shows that 70% of people want the 24-week time limit lowered - not surprisingly bearing in mind medical advancements in foetal viability over the last 50 years – and that 91% want a specific ban on the practice of abortion on the grounds of a child’s sex.’

As I have written before on this website, ‘There is clearly an alliance of radical pro-abortionists currently pushing their extreme agenda.  Decriminalised abortion for any, or no, reason, at any stage of pregnancy, performed anywhere would be a truly disturbing prospect.’

Abortion in Northern Ireland
The 1967 Abortion Act does not extend to Northern Ireland.  Some want it to.  In June this year, the British Government announced that all women in Northern Ireland are now entitled to undergo an abortion in England at no cost, regardless of their income.  In July, the Welsh Assembly also agreed to fund abortions in the Principality for women coming from Northern Ireland.

In October, Secretary of State for Education and Minister for Women and Equalities, Justine Greening, revealed that the Government will now be funding abortions, alongside travel and accommodation costs for girls under the age of 16 who travel to England.  Parental consent will not be required for these girls from Northern Ireland to access abortions.

Has the Government overstretched its remit?  It should not intervene in these Northern Ireland matters because abortion is a devolved issue and should be rightly decided by the Northern Ireland Assembly.  Ms Greening wriggled out by stating that, ‘Our proposals do not include the provision of any services in Northern Ireland.’

Abortion in Scotland
Abortions can be procured either surgically or medically.  The latter are becoming more commonplace though all abortions must, according to the 1967 Act, be undertaken in registered premises, such as hospitals, clinics or surgeries.  A medical abortion consists of two parts – the first tablet, Mifepristone, blocks the action of the hormone progesterone, which is needed to maintain the pregnancy.  The second is Misoprostol, and is usually taken a day or two later when it causes contractions to expel the dead foetus.

In practice, a medical abortion involves two visits to an abortion provider.  This, says the BPAS is inconvenient, outdated and unnecessary and has lobbied for many years for a change in the law.

In October, Scotland's Chief Medical Officer, Dr Catherine Calderwood, wrote to all health boards in that country saying that Misoprostol can be taken by women outside a clinical setting, that is, at home.  This is an irresponsible and retrograde step.  The Scottish Government made this significant policy change without any parliamentary scrutiny or public consultation.  Many vulnerable women having a medical abortion will now have no healthcare oversight.  Some will be shocked to deliver a fully-formed foetus up to 9 weeks old, alone, at home.  There is widespread concern for their physical and mental wellbeing.

Abortion in Ireland
For nearly half a century, Ireland has stood, almost alone in Western Europe, in defence of the right to life of every unborn human being – it’s written in its Constitution.  Yet Ireland is now on the brink of repealing her pro-life constitutional amendment and opening the way to aborting her unborn children.

Leo Varadkar, the Irish Taoiseach, has announced that the long expected referendum on the repeal or alteration of Ireland’s pro-life Constitutional Eighth Amendment will be held in May or June next year.  The Amendment, which was approved by 67% of Irish people in a referendum on 7 September 1983, reads, ‘The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.’  In other words, it upholds the right to life of both the mother and her child.

Back in November 2016, the Irish government established a ‘Citizens’ Assembly’ consisting of 99 members of the public, supposedly selected at random, to consider the future of the Eighth Amendment.  In April, the Citizens’ Assembly concluded its discussions by voting that the Eighth Amendment should be repealed.  The Assembly voted by 95% that abortion should be permitted on grounds of a mental or physical threat to the life of the mother, by 80% in cases of disability, and by 72% for socio-economic reasons.  The bioethical beauty of Ireland seems about to become ugly.

Abortion in the Isle of Man
At present, abortions on the Isle are subject to its 1995 Termination of Pregnancy (Medical Defences) Act.  In affect abortions can only be carried out if a pregnancy is the result of rape or because of mental health concerns.  Last year, 88 women travelled from the Isle of Man to England for abortions.

In January 2017, the Manx parliament, the Tynwald, gave leave for a redrafting of its abortion law.  And Dr Alex Allison, the elected MHK for Ramsey, published his private member’s bill, the Abortion Reform Bill 2017.  Its main provisions would see abortion on request up to 14 weeks and terminations available up to 24 weeks if there are serious health concerns, serious social grounds or severe foetal abnormalities.  Between 7 July and 18 September 2017, an online public consultation was undertaken – 3, 644 people responded.

The majority of respondents were in favour of reform.  For example, 87% agreed that a woman should have the choice to request an abortion up to 14 weeks.  84.7% agreed that a woman should have the choice to request an abortion without having to report the rape.  And 81.5% thought that a woman should have the choice to request an abortion if a fatal abnormality is identified, including after 24 weeks.

Dr Allison is anxious that Manx law is, ‘up-to-date and fit for the women of this Island.’  How wrong can a man be?  Apparently a lot of young doctors come to the Isle because there's very little abortion there.  His Bill is to be debated at a later, as yet undisclosed, date.

Abortion in England and Wales – the 2016 statistics

Last, but by no means least, are the latest abortion figures, published by the Department of Health and available to read here

The following is a brief summary:
There were 190,406 abortions carried out in England and Wales in 2016, slightly lower than in 2015 (191,014).  For women residents of England and Wales the number of abortions was 185,596, slightly lower than in 2015 (185,824) and 4.2% lower than a decade ago in 2006 (193,737).

The age-standardised abortion rate was 16.0 per 1,000 resident women aged 15-44.  This is the same as in 2015 and 9.1% lower than in 2006 (17.6).  The abortion rate was highest for women at the age of 22 (at 27.9 per 1,000) compared with the age of 21 (at 28.7 per 1,000) in 2015.  The under-16 abortion rate was 1.7 per 1,000 women and the under-18 rate was 8.9 per 1,000 women.  Both were lower than in 2015 (2.0 and 9.9 per 1,000 women respectively) and ten years previously in 2006 (3.9 and 18.2 per 1,000 women respectively).

The NHS funded 98% of these abortions.  Of these, over two thirds (68%) took place in the independent sector under NHS contract, as was the case in 2015 (68%).

92% of abortions were carried out at under 13 weeks gestation and 81% were carried out at under 10 weeks, which is slightly higher than in 2015 at 80%, and considerably higher than 2006 at 68%.

Medical abortions in 2016 accounted for 62% of the total.  This is considerably higher than in 2015 (55%), and more than double the proportion in 2006 (30%).

In 2016, 97% of all abortions (180,794) were undertaken under ground C – the so-called ‘social clause’.  Ground C abortions have consistently accounted for over 95% of abortions over the last 10 years.  The vast majority (99.8%) of abortions carried out under ground C alone were reported as being performed because of a risk to the woman’s mental, rather than her physical, health.

There were 3,208 abortions (2%) carried out under ground E (risk that the child would be born ‘seriously handicapped’).  This is similar to 2015 when there were 3,213 (2%) abortions carried under ground E.

38% of abortions in 2016 were for women who had had one or more previous abortions, the same proportion as in 2015.

In 2016, there were 4,810 abortions for non-residents carried out in hospitals and clinics in England and Wales compared to 5,190 in 2015.  The 2016 total is the lowest in any year since 1969.

The Scottish figures for 2016 can be found here.  The total number of abortions in Scotland during 2016 was 12,063, down from 12,134 in 2015.  Added together there were 202,469 abortions in Great Britain during 2016.

These numbers give some idea of the magnitude and intensity of our heinous abortion industry.  But they cannot convey the heartache and tears that killing our unborn children brings.  We need to ask again, ‘What are we doing?'

Assisted Reproductive Technologies

Yet another IVF dilemma
In October, a father and businessman, referred to as ARB, went to the High Court in London.  He was suing IVF Hammersmith Ltd for £1 million needed, he claimed, to pay for the upbringing of his daughter to include private school fees, holidays, refurbishing her bedroom and even her wedding.

The case commenced after his ex-partner, known only as R, forged his signature allowing doctors to transfer one of the couple’s embryos in October 2010, five months after the couple split up.  A baby girl was born in July 2011.

He failed in his action.  The Court ruled that, while the woman did falsify his signature, the fertility clinic had not been negligent.  The judge, Mr Justice Jay, announced that, ‘Although he has lost this case, my judgment must be seen as a complete personal and moral vindication for [the father].  The same, of course, cannot be said for [the woman].’  He granted the father permission to appeal.

The father, who has since remarried, told the Court that he loves his daughter despite the circumstances of her conception, but blames the clinic for transferring the embryo without his knowledge.  More of their ova and sperm are still being held in cold storage at the Harley Street clinic, run by IVF Hammersmith Ltd.

After the judgment, the father stated, ‘This claim has never been about money – it is about justice.  We felt compelled to bring to public attention the catastrophic failings of the Human Fertility and Embryology Authority (HFEA), and the unacceptable conduct of fertility clinics, which have grown into multi-million pound businesses on the back of sharp practices.  Today we have achieved that aim.  This case should never have come before the Court.  IVF Hammersmith Ltd failed in its duty by neglecting to put in place effective safeguards to prevent abuse.  This judgment affirms that the clinic was in breach of General Medical Council guidance, Department of Health guidance, the HFEA code of practice, its own standard operating procedure, the terms of its licence, the 1990 HFEA Act, and common law.’  The father confirmed that he would appeal the case, taking it to the Supreme Court if necessary.

You cannot make this up
In February 2016, Melissa Cook, a 48-year-old surrogate mother, gave birth to three babies in California.  She had been previously hired by Chester Moore Jr, whom she never met, but who arranged for anonymous donor ova to be fertilised with his sperm and transferred to Cook’s womb.  When he realised that she was carrying triplets he decided he could not afford all three and asked Cook to abort one by selective reduction.  She responded, ‘I am pro-life and I'm not having an abortion.’

When the babies were born on 22 February, after only 30 weeks of pregnancy, they were taken away from Cook because Moore did not want her to see them.  She expressed milk for them, but Moore barred them from receiving it.  Because of their prematurity, the babies spent the next three months in hospital.  When she asked about their health, she was simply told by staff, ‘We can’t give you that information.’   Moore apparently visited them on just three or four occasions.  Eventually, all three were taken by Moore even though Cook wanted the third and Moore did not.

The case mushroomed when Cook contested Moore’s suitability to be a father.  He was 51 years old, deaf and mute, living with his invalid parents in a cigarette smoke-filled house in Georgia, where the newborns were living in a decrepit basement.  Moore's sister, Melinda, provided further support, ‘I was horrified by the prospect that our brother, who has not been able to take care of himself, would attempt to take on raising triplets on his own while he lived in the chaos at my parents’ home.’  Even the local hospital advised the authorities to ‘… take the children … because [Moore] can’t care for them.’

Eventually, Cook challenged California's liberal surrogacy laws in court, saying they violated her and her babies' rights.  Kathleen Sloan, an amicus curiae, a friend of the court, argued that, ‘Surrogacy is creating a generation of children severed from biological and genetic identity and a breeder class of marginalized women.  Both are being transformed into commodities for sale.  This can only be accepted and condoned by a society untethered from any sense of ethics, human rights, dignity, or moral values.’

Melissa Cook lost her case in both federal and state courts.  Undaunted, she continued her fight for the best interests of the triplets by appealing to the US Supreme Court.  It refused to hear her case.  Now, not only do the triplets stay in Moore's basement, but, according to a recent change in Californian law, child ‘purchasers’ rights to their ‘property’ overrules what Cook believes is the best interest of the children.  In other words, Californian law has left surrogates and their children with 'zero rights', which Cook argued is unconstitutional.  She maintains that the surrogate is their mother.  She is the only mother the babies have.

Child’s rights advocates say there needs to be limits on surrogacy laws for the sake of the children created.  According to Sloan, ‘Surrogacy is out of control in the United States.’  She asks, ‘When the primal bond – as ancient as humankind itself – between mother and child is destroyed, what will be left?’  The bottom line, pro-lifers say, is that surrogacy creates a market for human beings.  It is a lot like human trafficking – in fact, it is human trafficking for profit.  Others have asked, 'How did America become so cruel that we are treating children as if they were products to be bought and sold?'

Sperm banks and criminals
Sperm banks have never been a good idea.  Procreation via anonymous donors, whether ova or sperm, are ethically dubious, financially shady and open to deceit.  The faintest whiff of money always attracts criminals.  So it has proven in every aspect of the ART industry.

Now, a leading sperm bank, California Cryobank, has become the first to include not only a formal clinical psychological assessment, but also a criminal background check in its standard donor-screening process.

Why the need to weed out criminals?  After all, felons can be handsome, blue-eyed and intelligent – exactly the sort of desirable donor characteristics that clients look for.  But perhaps California Cryobank’s move has been prompted by the Xytec Corp debacle of 2016.  This Atlanta-based sperm bank is currently being sued for misrepresentation of one of its donors whose sperm has led to the birth of at least 36 children in Canada, the USA and Britain.  He was described on Xytec’s website as a man with an IQ of 160, an internationally-acclaimed drummer and a PhD student in neuroscience engineering.  In reality, he was a convicted criminal with several mental illness diagnoses including schizophrenia, narcissistic personality disorder and grandiose delusions.  Procreation demands more than the transmission of genetic material – where is the love?

Sperm banks and chaos
The Dutch always seem calm, orderly people, but they certainly cannot run sperm banks.  Dutch law bans men from donating sperm at more than one clinic and restricts the number of children generated to 25.  But there is no central sperm donor registry in the Netherlands, so nobody knows if the rules are being obeyed.

And everyone knows that rules are there to be broken.  And in September 2017, two Dutch lawbreakers came to light.  One anonymous man has deceptively donated to 11 IVF clinics and is responsible for 102 children.  Another has donated to two clinics and fathered two children.

The Dutch gynaecologists association, the NVOG, has asked IVF clinics to stop using these men’s sperm immediately.  Moreover, the NVOG has been informed by a group of single mothers, who suspect that the two men may have fathered many other children using the more traditional method.

The Dutch seem to have a penchant for this sort of shenanigan.  The infamous 47-year-old teacher called Ed Houben reached his maximum number of donations long ago.  He now advertises his services as a freelance donor.  Helping desperate women to become pregnant is, he believes, an altruistic matter.  So far he believes that he has sired 114 children worldwide.

But of course the chaos extends beyond the Netherlands.  In a BBC Three documentary, screened in August and entitled Desperately Seeking Semen, one anonymous British donor confided that he had fathered more than 60 children without his wife knowing.  ‘Currently I have 59 donor babies, seven on the way – my wife doesn’t know anything about it,’ he said.  ‘To find out your husband has not got six children any more, he’s got way over 60, it would be disastrous really.  It’s just a secret I have to take to the grave.’

ARTs and transgenderism
Think about it – it is an inevitable development.  The UK Government is now paying for gender-confused boys, as young as 12, to freeze their sperm so that after they ‘transition’ to having no male genitals, they can still father children by IVF, or artificial insemination (AI), or surrogacy.

In line with equality, the Government is also paying for gender-confused girls, as young as 16, to freeze their ova so that if they decide to undergo a hysterectomy as part of ‘transition’ surgery, they can still have the option of having their own genetic children.

NHS clinics are freezing sperm and ova from these children at a cost to UK taxpayers of £400 and £4,000 respectively.  Storage costs are another £300 annually.  Once their gametes are frozen, these children can begin taking puberty-blocking hormones to abolish their fertility.

Professor Gary Butler, head clinician for gender dysphoric minors at London’s University College Hospital (UCH), suggested that freezing sperm and ova is worthy of public funding because it is not a ‘lifestyle choice’ that prompts the transpatients he serves to undergo a transition.  He considers that, ‘They are following their biological and psychological make-up about their identity.’

Watch with mother
Come on, keep up – an app has been created for couples undergoing IVF whereby they can watch their embryos growing using their mobile phones.  The Barcelona-based Institut Marquès, which has a clinic in Harley Street, London, is using Embryoscopes, high-tech IVF incubators with cameras attached to view the developing embryos.

Embryomobile is the new mobile app which allows patients to observe the growth of their embryos from the comfort of their own homes.  It is considered to be psychologically good for the parents – it encourages bonding.  So far, more than 3,000 patients have already bought the Embryomobile app, and on average they connect up to four times every day, for hours at a time.

Gene Editing

Another CRISPR first for the Chinese
Can editing genes in human embryos correct serious genetic diseases?  Maybe.  A team in China has recently reportedly fixed the genetic mutation linked to the potentially fatal blood disorder β-thalassaemia.  Their proof of concept experiments unethically destroyed human embryos, but the outcome could save those affected from numerous life-sustaining blood transfusions.

The team was led by Junjiu Huang at Sun Yat-sen University in Guangzhou and their report was published on 23 September in Protein & Cell, under the title, ‘Correction of β-thalassemia mutant by base editor in human embryos.’

The researchers first created cloned embryos with the deliberately added genetic mutation for β-thalassaemia. Then, using CRISPR-Cas9 technology, they precisely corrected the specific DNA fault.  The hope is that this and other genetic diseases might be prevented at the earliest stages of human development.

Huang’s team was the first the edit human embryos by the CRISPR–Cas9 enzyme complex in a study reported in April 2015.  Since then scientists around the world have published eight studies of gene editing in human embryos – five in the past two months.  These studies have tested gene-editing technologies, edited various disease-related genes, or explored the mechanisms behind early human embryonic development.  None has permitted the embryos to develop beyond 14 days.

CRISPR-Gold and muscular dystrophy
Can, for example, gene editing help sufferers with muscular dystrophy, including the particularly severe form, Duchenne’s?  Well, preliminary results from an animal model look promising.

A new delivery system of CRISPR-Cas9 comes from the University of California, Berkeley – it is called CRISPR-Gold because gold nanoparticles are a component.  These coat the donor DNA, which corrects the mutated gene, and bind the Cas9 protein.  The advantage of this technique is that viruses are not required to deliver the CRISPR-Cas9 complex.  The use of viral delivery systems has previously been shown to be unpredictable and hazardous.

The initial outcome, albeit in affected mice, was an 18-fold increase in the correction rate of the faulty gene compared with a control group.  This work was published in Nature Biomedical Engineering (2 October 2017), entitled ‘Nanoparticle delivery of Cas9 ribonucleoprotein and donor DNA in vivo induces homology-directed DNA repair.’

According to these researchers, ‘These experiments suggest that it will be possible to develop non-viral CRISPR therapeutics that can safely correct gene mutations, via the process of homology-directed repair, by simply developing nanoparticles that can simultaneously encapsulate all of the CRISPR components.’

The lead scientist, Niren Murthy stated, ‘Genetic diseases cause devastating levels of mortality and morbidity, and new strategies for treating them are greatly needed.  CRISPR-Gold was able to correct disease-causing gene mutations in vivo, via the non-viral delivery of Cas9 protein, guide RNA and donor DNA, and therefore has the potential to develop into a therapeutic for treating genetic diseases.’

From gene editing to embryo factories?
Not all is rosy in the gene-editing garden.  For the first time in the UK, human embryos have had their DNA modified.  A paper entitled ‘Genome editing reveals a role for OCT4 in human embryogenesis’ by Fogarty et al., appeared in Nature (5 October 2017, 550: 67–73).  The group, headed by Kathy Niakan, is based at the Francis Crick Institute in London.

These scientists studied whether CRISPR-Cas9 can be used to understand gene function in early human embryo development.  They chose to target POU5F1, a gene encoding the developmental regulator OCT4, which is regarded as a ‘superstar’ factor in early embryo development.  It first appears at the four- to eight-cell stage of the embryo, whereas OCT4 is not detectable until the eight-cell stage.

When POU5F1 was removed, no OCT4 was produced and the vast majority of the 41 human embryos used died before 7 days – in other words the blastocyst stage was never reached.  This study was ostensibly looking at causes of early miscarriage and specifically methods, ‘leading to improvements in the establishment and therapeutic use of stem cells and in IVF treatments.’  For example, during typical IVF treatments, of 100 fertilised ova, fewer than 50 reach the blastocyst stage, 25 implant into the womb and only 13 develop beyond three months.  Overall, the scientists stated that, ‘We conclude that CRISPR-Cas9-mediated genome editing is a powerful method for investigating gene function in the context of human development.’

However, not everyone in the field is so happy with this type of research.  Jennifer Doudna was the co-pioneer of the CRISPR-Cas9 technique.  In an interview with The Times (23 September 2017), she explains her fears that its use could lead to human embryo factories being set up in the UK.  She warns that because of the impetus to become world-leaders, the UK could end up crossing more moral and ethical lines.  She stated, ‘I have to admit that I feel personally uncomfortable with the idea that there could eventually be factories pumping out lots of human embryos for the purposes of experimentation.  I can’t put my finger on why but it feels like it cheapens something about human life.’  Too true, Jenny!

'Base editing' developments published in Nature and Scienc
Two widely-reported pieces of research using a variation on genome-editing techniques, known as base editing, were published in Science and Nature both on 25 October.

‘Base editing’ has been described as a version of genome editing which, unlike the more common CRISPR-Cas9 method, does not involve deliberately making a double-stranded break in the DNA of the target cells.  Instead, the technique directly targets DNA base pairs to deliver a form of ‘precision chemical surgery’.

The Nature study is ‘Programmable base editing of A•T to G•C in genomic DNA without DNA cleavage’ by Gaudelli et al., and was published online on 25 October.  It was conducted by David Liu’s team at the Broad Institute at Harvard.  It reports advances in team’s 2016 research, which developed a base editing technique able to convert a guanine-cytosine (G–C) base pair into an adenine-thymine (A–T) pair.  This new work demonstrates conversions in the other direction, converting T to C or A to G – achieved by an enzyme that converts the adenine to inosine, which has a base-pairing preference for cytosine.  This means that the technique can be used to undo the most common types of point mutations involving single bases.

The other study, ‘RNA editing with CRISPR-Cas13’ by Cox et al., was published in Science, also on 25 October, and conducted by a group, also at the Broad Institute, led by Feng Zhang, who was involved in the early development of the original CRISPR-Cas9 method.  This new work used similar approach to make modifications to RNA rather than DNA.  However, in this new work Cas9 was replaced by Cas13, which acts to modify RNA rather than DNA. Possible advantages of targeting changes at the RNA level are that disease-causing mutations might be altered without permanent modification of the genome, meaning that the effects of any therapies based on the technique would be modifiable and potentially safer.  As expected, all these researchers claim that their work has broad applicability for research, therapeutics and biotechnology.  Well, what else would we expect?

Stem-Cell Technologies

This is truly remarkable
Who could predict this sort of success?  A paper published online by Hirsch et al., in Nature (8 November 2017) and entitled ‘Regeneration of the entire human epidermis using transgenic stem cells’, tells the remarkable medical story of a nine-year-old Syrian refugee living in Germany.  He was suffering from junctional epidermolysis bullosa, or 
JEB.  That is, he carried a faulty gene that controls the integrity of the skin so that some 80% of his simply fell away.  Two years ago, he was confined to a hospital bed, dying from a devastating and life-threatening form of this rare disease.

In 2015, a team of scientists, led by Michele De Luca, at the University of Modena had produced Holoclar, a treatment for blindness that can replace the eye’s cornea and which became the world’s first commercial stem-cell therapy.  The team then became expert pioneers in human skin regeneration by growing small sheets of skin from cells, taken from burns patients, which they subsequently used for grafts.

The boy’s surgeons in Germany knew of De Luca’s work and asked for his help.  They sent a biopsy of remaining good skin from the boy to Modena.  De Luca and his colleagues used both novel stem-cell technologies and gene therapy to generate stem cells from his skin and to replace the disease-causing gene in them and to grow sheets of healthy skin on scaffolds in the laboratory.  Two major transplants of these skin sheets to cover almost his entire body followed.  Six months after the initial biopsy, the boy returned to school.  Since then, he has taken no medications and has not had even a blister on his ‘new skin’.

These breath-taking advances, combining gene therapy and stem-cell technologies using an individual’s own stem cells, can not only produce astonishing clinical treatments, but they can also expand our basic biological understanding.  In this case, it was discovered that the normal regeneration of the skin’s epidermis is directed by a limited number of long-lived stem cells that can self-renew.  In other words, once the skin transplants had successfully integrated, the specialised skin stem cells were able to renew and sustain an entire healthy skin. 
Yes, I’m impressed too.

Stem cells and ‘synthetic embryology’
Not all stem-cell technologies are good.  With advances come novel bioethical dilemmas.  One example is the rise of so-called ‘organoid’ research.  That is, stem cells are being used to create clumps of cells that resemble fragments of brain, lungs, intestines, or even embryos.  This latter instance of emerging technology has become known as ‘synthetic embryology’.

Human embryo research is, by and large, limited to using surplus embryos from IVF clinics and a time limit of 14 days.  ‘Synthetic embryology’ could allow the investigation of human embryo development and the testing of drugs without overstepping any legal limits.  The argument is that if ‘synthetic embryos’ are not real embryos, then the 14-day rule cannot apply.

Expanded-potential stem cells (EPSCs)
When embryonic stem cells were harvested from very young mouse embryos and given a biochemical cocktail to prevent them from any further maturing, the cells were trapped in a very young, primordial state.

This is the work of Pentao Liu and his colleagues at the Sanger Institute in Cambridge, with the aim of understanding the biological mechanisms behind many failed early pregnancies.  They named these trapped cells ‘expanded-potential stem cells’ (EPSCs) and the results appeared in Nature (550: 393–397) under the title, ‘Establishment of mouse expanded potential stem cells’ by Yang et al.

The search for new treatments to prevent recurrent human miscarriage is a worthy one.  However, it is also a bioethical minefield.  Any research that includes the use of human embryos and their subsequent, and inevitable destruction, is unworthy.  It is hard to see how the objective of this recent study cannot be achieved using bioethically-acceptable methods, such as the use of induced pluripotent stem (iPS) cells.

Stem-cell treatments for Parkinson’s disease I
For many years regenerative medicine scientists have had a long-term goal of restoring neuron function in Parkinson sufferers by implanting dopaminergic (DA) neuron-derived stem cells.  That goal has recently moved a step closer.

Jun Takahashi and colleagues at the Center for iPS Cell Research and Application, Kyoto University, have now shown that DA progenitors derived from human induced pluripotent stem (iPS) cells exhibited long-term survival and functioned as midbrain DA neurons when implanted in monkeys with induced Parkinson's disease.

This work was published in Nature (548: 592–596) under the title ‘Human iPS cell-derived dopaminergic neurons function in a primate Parkinson’s disease model.’  The implanted cells restored a range of movements and no tumours were observed after two years.  This is an encouraging, bioethical piece of work.

Stem-cell treatments for Parkinson’s disease II
Within the next few months, surgeons at the First Affiliated Hospital of Zhengzhou University in Henan province will drill through the skulls of ten patients with Parkinson’s disease and inject 4 million embryonic stem cell-derived neuronal-precursor cells, immature neurons, into each of their brains.  The patients will then be patched up and sent home to wait.

This will mark the start of the first clinical trial in China using human embryonic stem (ES) cells, and the first one worldwide aimed at treating Parkinson’s disease using ES cells from fertilized human embryos.  While some researchers regard this as a major leap forward, other worry that the trials might be misguided.

Qi Zhou, a stem-cell specialist, is leading the clinical trial.  In his team’s unpublished study with 15 monkeys, no improvements in movement were initially observed.  But by the end of the first year, it is claimed that half of the monkeys’ brains showed the stem cells had turned into dopamine-releasing cells.  And after several years, 50% improvements were noted in the remaining monkeys.  However, other stem-cell researchers are critical of the trial because it uses neural precursors and not ES cell-derived cells that have fully committed to becoming dopamine-producing cells.  Such precursor cells could turn into other kinds of neurons and they could also accumulate dangerous mutations during their cell divisions.  And there are those who object to all research that involves the destruction of human embryos to harvest those embryonic stem cells.

Stem cells and ageing
Could stem cells in the brain be central to slowing ageing and extending life?  We might all be interested in that proposition.  Certainly when adult mice were injected with stem cells from the hypothalamic region of newborn mice, they seemed to age more slowly.  Moreover, they re¬invigorated declining brain function and muscle strength in middle-aged mice.  Yes, we’re all definitely interested in that.

This study was conducted by Dongsheng Cai and his team at the Albert Einstein College of Medicine in New York City and reported in Nature (548: 52–57) with the title, ‘Hypothalamic stem cells control ageing speed partly through exosomal miRNAs.’

They found that stem cells in the hypothalamus disappeared as the mice aged.  When viruses destroyed these cells, the animals grew older faster and experienced declines in memory, muscle strength, endurance and coordination. They also died sooner than untreated mice of the same age.

When adult mice were injected with hypothalamic stem cells from newborn mice these middle-aged animals, just 4 months after the treatment, had better cognitive and muscular function than untreated mice of the same age.  They also lived on average about 10% longer.

How does all this work?  Certainly it is well known that the hypothalamus can act as the master regulator.  It may be that these non-embryonic stem cells have a role in regulating the neurons that release a hormone called GnRH, which is secreted by the hypothalamus and is associated with ageing.  In addition, Cai and his team found that these hypothalamic stem cells released molecules called microRNAs or miRNAs, which help to regulate gene expression in cerebro¬spinal fluid.  Hence, when miRNAs were injected into the brains of middle-aged mice, cognitive decline and muscle degeneration were slowed.  Currently these scientists are trying to identify which of the thousands of miRNAs are involved and whether similar mechanisms exist in non-human primates.

The authors write, ‘In conclusion, ageing speed is substantially controlled by hypothalamic stem cells, partially through the release of exosomal miRNAs.’  This sort of work may not lead to significantly extending human life, but it could lead to various ways of developing anti-ageing therapies for some ill people and slowing the adverse effects of ageing in others.

Euthanasia and Assisted Suicide

Noel Conway – the latest
Assisted suicide has again been in the High Court.  Noel Conway, the 67-year-old former lecturer who suffers from motor neurone disease, is attempting to overturn the law.  Hearings took place during July 2017.  The case, backed by Dignity in Dying, argues that the 1961 Suicide Act, specifically section 2, breaches Articles 8 and 14 of the 1998 Human Rights Act.  Article 8 concerns the right to a private and family life, while Article 14 deals with non-discrimination.  Mr Conway was too unwell to attend Court.

His case has many similarities with those of Paul Lamb and Tony Nicklinson, although they were not terminally ill as Mr Conway is.  In those former cases, the Court ruled against any change in the law, stating that that was a matter for Parliament.  In September 2015, Parliament pronounced and rejected the Assisted Dying (no. 2) Bill 2015-16 by 330 votes to 118.

On 5 October, the High Court pronounced.  The three justices rejected his claim.  They concluded in their written judgement, ‘For the reasons given above, we find that section 2 [of the 1961 Suicide Act] is compatible with the Article 8 rights of Mr Conway.  We dismiss his application for a declaration of incompatibility.’  It is understood that Noel Conway will now seek permission to take his case to the Appeal courts.

US doctors oppose assisted suicide
In September, the American College of Physicians (ACP) issued a policy statement against the legalisation of assisted suicide.  The ACP Position Paper stated, ‘Society’s goal should be to make dying less, not more, medical.  Physician-assisted suicide is neither a therapy nor a solution to difficult questions raised at the end of life.’

‘On the basis of substantive ethics, clinical practice, policy, and other concerns, the ACP does not support legalization of physician-assisted suicide.  This practice is problematic given the nature of the patient-physician relationship, affects trust in that relationship as well as in the profession, and fundamentally alters the medical profession’s role in society.’

‘Furthermore, the principles at stake in this debate also underlie medicine’s responsibilities on other issues and the physician’s duty to provide care based on clinical judgment, evidence, and ethics.’

‘Control over the manner and timing of a person’s death has not been and should not be a goal of medicine.  However, through high-quality care, effective communication, compassionate support, and the right resources, physicians can help patients control many aspects of how they live out life’s last chapter.’

This is a heart-warming and robust set of statements from decent doctors.  In short, they urge greater quality of care for dying patients – not assistance in their killing.

Assisted suicide in Oregon – 20 years on
In 1997, the Death with Dignity Act (DWDA) became law in Oregon.  It has since become the benchmark for assisted suicide legislation around the world.  What has happened over the last two decades?

In this time, 0.2% of deaths in Oregon have been attributable to physician-assisted suicide. The numbers may be small, but they are increasing steadily.  DWDA death rates have increased by 14% each year from 1998 to 2013 and 36% annually from 2013 to 2015 with a levelling off in 2016.

And who are these Oregonian patients committing suicide?  Nearly all (96%) of those requesting DWDA prescriptions were white, a majority (72%) had some college education and just over half (52%) were men.  Their median age was 72 years, compared with a median age of death at 76 years among Oregonians who died of the same underlying illnesses but without DWDA prescriptions.

And why?  The patients' primary reasons for seeking DWDA assistance were a loss of autonomy (91%) and a decreasing ability to participate in enjoyable activities (89%).  Only just over a quarter (26%) cited pain, and 4% cited finances.

Euthanasia in the Netherlands – 25 years on
The Dutch psychiatrist, Dr Boudewijn Chabot, has been called the Grand Old Man of Dutch Euthanasia.  In 1991, he gave Mrs B a lethal dose of medication.  In 1993, the Supreme Court declared him guilty of assisting a suicide, but did not punish him.  It was a landmark case in the steady advance towards Dutch legalisation of euthanasia in 2002.

That was 25 years ago.  Now Dr Chabot has recently looked back and is horrified by what he sees.  He notes that the legal safeguards for euthanasia are slowly being eroded and that the law no longer protects people with psychiatric conditions and dementia.  He considers that the Dutch are complacent about their famous law, but declares that there is no room for complacency.

Under current legislation, euthanasia in the Netherlands is only legal if a doctor believes that three conditions have been met.  1] the request is voluntary and deliberate.  2] there is unbearable suffering with no hope of improvement.  And 3] there is no reasonable alternative to euthanasia.  However, as euthanasia has become more commonplace, the 2] and 3] conditions have withered.  Patients now define what is unbearable and what is a reasonable alternative.  Unhappiness can be unbearable and a nursing home may not be a reasonable alternative.  In other words, patient autonomy has trumped medical assessment.  As a result, the number of Dutch euthanasia cases has roughly tripled between 2007 and 2016, from about 2,000 to 6,091, or 4% of all Dutch deaths.  This year the number is expected to be around 7,000.

Euthanasia in Canada
Canada has become a prime example of how regulating euthanasia cannot be controlled and why legal boundaries will inevitably be expanded.  Data from Health Canada's second Interim Report on assisted dying states that there were 1,982 reported assisted deaths (1,977 reported euthanasia deaths and five reported assisted-suicide deaths) in the first full year since legalisation.  In addition, there were 167 reported euthanasia deaths in Québec, so the grand Canadian total was 2,149.

Or maybe it was higher.  The Canadian euthanasia scheme is a self-reporting system, meaning that the doctor who carries out the death is the doctor who reports the death, therefore it is quite possible that under-reporting and other abuses of the law are occurring.  Based on the first Québec government euthanasia report, 14% of the assisted deaths in that province did not comply with the law.  In other words, more people are probably dying by euthanasia than reported.

Euthanasia in Australia
On Thursday 16 November, after a marathon all-day debate that ended at nearly midnight, a bill to legalise voluntary assisted suicide failed to pass the New South Wales' Upper House of Parliament, albeit by a close call.  The final voting was 19 in support but 20 against.  The bill, introduced by the MP Trevor Khan, would have allowed terminally-ill patients over the age of 25 to end their own lives with the help of doctors.  Mr Khan said he was ‘obviously disappointed’ with the vote, but pledged to keep pushing for the legislation.

Another bill, another state - in Victoria a similar bill has reached the Senate.  On Friday 20 October, the Lower House passed the Voluntary Assisted Dying Bill by 47 votes to 37.  The bill has since been subjected to significant amendments in the hope of ensuring its passage through the Upper House.  For example, though the original bill specified that terminally-ill adults in severe pain and with only a year to live could apply to access lethal drugs, that time-frame has been cut to 6 months.  However, it remains 12 months for sufferers of neurodegenerative conditions, such as motor neurone disease and multiple sclerosis.

Funding for palliative care in Victoria will also get a boost.  The Government has announced a $62 million funding package for better end-of-life choices, including $19 million for palliative care.  Other amendments include restricting the scheme to people who have lived in Victoria for 12 months and will require a death to be recorded as assisted dying, as well as the underlying disease.  It is believed that 20 MPs in the Upper House will support the bill, which is one short of the majority needed.  About five MPs remain publicly undecided on they how they will vote.  The Upper House began debating the 141 amendments on Thursday morning 16 November, but the session was suspended the following day after Daniel Mulino MP suffered a medical emergency and was taken away in an ambulance.

On Wednesday 22 November, after sitting for more than 28 hours straight, the Upper Chamber voted 22 to 18 for Victoria to become the first state in Australia to legalise physician-assisted suicide and some euthanasia.  The law will take effect in 2019. 
In the meantime, the President of the Australian Medical Association (AMA), Michael Gannon, has clearly stated that physicians who are involved in the killing of their patients are contravening the AMA code of ethics.
Legal permission and CAHN
In September, a High Court judge, Mr Justice Peter Jackson, made a landmark decision in a case before the UK Court of Protection.  He announced that legal permission will no longer be required before life-supporting treatment, namely clinically-assisted nutrition and hydration (CANH), is withdrawn from patients on life support with severely debilitating illnesses, such as minimally conscious or permanent vegetative states (PVS).

The judge declared that as long as doctors and relatives of the patient are in agreement and medical guidelines issued by the Royal College of Physicians have been observed, there is no need to bring such typically lengthy and costly cases to court to obtain judicial authorisation.  The official solicitor, who intervened in the case, is, however, likely to appeal against the decision.  He argued that every such case should come before the courts.

The case centred on a woman, identified only as ‘M’, who had suffered from Huntington’s disease for 25 years.  She was said to have been in a minimally conscious state in a Midlands hospital.  The request for life-sustaining treatment to be ended was heard in April.  The judge gave permission in June.  On 24 July, her CANH was stopped and she died, aged 50, on 4 August, that is, 11 days later.

Death and permanent vegetative state (PVS)
Since the 1993 assisted death of Anthony Bland, the young football fan and victim of the Hillsborough disaster, who suffered from what was considered to be the irrecoverable condition of permanent vegetative state (PVS), the illness has confounded many.  Are sufferers mostly dead and dying, or just incommunicable?  There is growing evidence that the latter can be true.

Additional proof comes from the case of ‘Jack’, a 35-year-old Frenchman, who has spent 15 unresponsive years after a severe car accident.  Doctors at the Institute of Cognitive Science in Lyon implanted a device to stimulate Jack’s vagus nerve, the longest of the involuntary nerves that runs from the base of the brain to the abdomen.  Besides helping regulate heart, lungs and digestive tract, this nerve is associated with wakefulness and attention.

Doctors artificially stimulated his vagus nerve every day for a month.  The results were unexpected.  Jack responded for the first time in 15 years.  OK, he did not gain full awareness nor can he talk, but he responded to simple requests and he followed objects with his eyes, he could turn his head when asked, he listened to a therapist read a book, and so on.  In medical terms, he went from a permanent vegetative state to a minimally conscious state.  He was awake and aware.

Such evidence should halt the routine removal of feeding and hydrating tubes, known as clinically-assisted nutrition and hydration (CANH), from patients in these sorts of conditions whereby they are dehydrated to death over a period of a week or two.  It is thus a warning to all those who believe that this state is hopeless and it also brings hope to patients in PVS and their families that it may yet be possible to re-establish some form of two-way communication.

USA and Elsewhere

US Health Department goes pro-life
Every four years, the US Department of Health and Human Services (HHS) publishes its strategic plan.  Its most recently-released one, if approved, will run from 2018 to 2022.

It is certainly bold and controversial – and decidedly pro-life.  For example, the HHS mission statement now reads, ‘HHS accomplishes its mission through programs and initiatives that cover a wide spectrum of activities, serving and protecting Americans at every stage of life, beginning at conception.’  It also uses phrases like respecting ‘the inherent dignity of persons from conception to natural death’ and ‘the value of healthy marriages.’

Wow!  Let’s see how that runs.  Though the strategic plan does not have the force of law, its purpose is to guide the policies of government agencies.

Trump exits UN agencies
In April 2017, President Trump withdrew US support from the United Nations Population Fund (UNFPA) over its participation in China's forced abortion regime.

In October 2017, President Trump announced that the US is pulling out of another UN agency that advocates and promotes abortion, homosexuality and radical sex education for young children.  The United Nations Educational, Scientific and Cultural Organization (UNESCO) has for years endorsed the teaching of pro-abortion and pro-LGBT topics to children.  The withdrawal by the US from this controversial agency will take effect on 31 December 2018.

Rolling back Obamacare
In 2012, the Obama administration decided that contraception must be part of the mandatory coverage under the 2010 Affordable Care Act, commonly called Obamacare.  This offended faith-based employers who were opposed to some types of contraceptives, such as those with a known abortifacient mode of action, like the morning-after pill (MAP).  Years of conflict followed as Roman Catholic nuns, evangelical colleges and many business owners who objected on religious or moral grounds sought exemption through long drawn-out court battles.

In October, the Trump administration cut through the red tape.  It announced that it was rolling back Obamacare’s contraceptive coverage mandate by creating an exemption for faith-based organisations who said that paying for employees’ contraceptives violated their faith.  Such organisations will now be exempt as long as they notify their employees of the change.

Abortion law in Brazil
Currently, abortion is illegal in Brazil, but it is decriminalised in cases of rape, danger to the life of the mother and anencephaly.

In November, the Special Commission of the Chamber of Deputies of Brazil’s lower legislative house approved a constitutional amendment that would protect the right to life from conception.  The amendment was passed by a 19-1 vote, making it unlikely that the legislation will be modified before passing to the full Chamber of Deputies for a vote.

However, the amendment must still pass two votes, first by the whole Chamber of Deputies, and then be approved by the Senate before being signed by the country’s president.  But it’s a good start.

Poland and the MAP
The Polish Government has been accused of launching a ‘sexual counter-revolution’ which is an affront to European values after passing legislation that reduces women’s access to the morning-after pill (MAP).  In late June, a law was signed off by the Polish president, Andrzej Duda, which turned the so-called emergency ‘contraception’ into a prescription-only drug.

Women and girls 15 and over will now need to make an appointment with a doctor to obtain a MAP prescription.  The move brought vitriolic criticism from feminist groups and politicians across Europe.

Poland’s Law and Justice Government is under additional fire from similar groups because of its perceived push for legislation and its attitude to other reproductive health issues.  For example, Poland currently has some of the most restrictive laws on abortion in Europe.  It bans all terminations unless a pregnancy is the result of incest or rape, it presents a health risk to the mother, or if the foetus is found to be severely deformed.  Future ideological clashes, both on the streets and within the Senate and the Sejm, over such matters are inevitable.

Polish bunnies
Although Poland is one of the most pro-life countries in Europe, it has a birth-rate of only 1.32 children per woman, entirely insufficient to maintain its population.

To encourage its young couples to attain and then maintain healthy lifestyles and thus improve their fertility, the Polish Ministry for Health is advising would-be parents to be ‘like rabbits’.  With a 30-second television commercial entitled ‘Króliczki’ (‘Little bunnies’) it is hoped to raise the fertility rate.  The voiceover states, ‘We rabbits know how to parent many offspring.  Do you want to know our secret?  First, we exercise a lot.  Second, we eat healthily.  Third, we don’t stress out when we don’t have to.  And fourth, we don’t burn the candle at both ends.  So when you want to become parents, take bunnies as a model.’

And, ‘I know what I’m talking about’, the rabbit continues.  ‘My father had 63 of us!’  Will the campaign work?  We must wait and see.


The Declaration of Geneva revised
For centuries medical ethics and practice were governed and guarded by the Hippocratic Oath, with its explicit prohibition of abortion and euthanasia.  Then in 1947, the Declaration of Geneva was introduced and in 1948 it was adopted by the World Medical Association.  Since then, in many countries it has been part of the medical profession’s code, and in some it is even legally binding.  However, over the years, the Declaration has been revised and bioethically downgraded.

Now comes the latest revision, the 2017 version that has similarly been approved by the World Medical Association.  Sadly, it is a poor thing compared with its robust predecessors.

First, this new Declaration of Geneva is to be regarded not as an oath, but as a pledge.  Its most striking change is the emphasis on patient autonomy.  An entirely new clause has been inserted into the 2017 edition which says, ‘I will respect the autonomy and dignity of my patient.’  And another new clause requires doctors, somewhat unusually, to look after their own health, ‘I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.’  And there is a new obligation for doctors to share their knowledge for the benefit of their patients and for the advancement of healthcare.

It is instructive, if disappointing, to compare the 2017 version with the original 1948 version.  For example,
    1948: ‘I will maintain the utmost respect for human life from the time of conception.
    2017: ‘I will maintain the utmost respect for human life.’

    1948: ‘Even under threat, I will not use my medical knowledge contrary to the laws of humanity.’
    2017: ‘I will not use my medical knowledge to violate human rights and civil liberties, even under threat.’

    1948: ‘I will maintain by all the means in my power, the honour and the noble traditions of the medical profession; my colleagues will be my brothers.’
    2017: ‘I will foster the honour and noble traditions of the medical profession.’

Of course the world and medical practice of today is significantly different from that of 1948.  But why is the ‘old’ so often regarded as ‘wrong’ or ‘out-dated’ and in need of revision?  After all, the Ten Commandments still stand – unaltered and majestic.

UK, the teenage motherhood capital of Europe
We are still No. 1 in Europe.  The table of women who had their first child before the age of 20 shows that UK teenagers remain at the top.  According to Eurostat data, a total of 16,662 UK girls gave birth in 2015, down from 17,500 in 2014 and 19,679 in 2013.  The second highest European nation was Romania (12,802) and the third, France (12,059).

As a share of all births, the rate, as opposed to numbers, of first births to teen mothers was higher in Britain than in any western European country, with only five former Communist states showing higher levels.  The most recent teen pregnancy figures for England and Wales showed that only 21 girls in every 1,000 aged between 15 and 17 became pregnant in 2015, half the 42 in 1,000 recorded in 2007.

Teen pregnancy rates in England and Wales have indeed halved since 2008.  These have been years in which teenage habits have been changed by social media, long-term contraception, the morning-after pill and pro-life education.

Lord Joel Joffe (1932 – 2017)
Joel Joffe first came to the public eye when, in 1963 and 64, he was the instructing solicitor for Nelson Mandela’s defence team in the Rivonia trial.  Eight of the nine defendants were sentenced to life imprisonment – Nelson Mandela would spend the next twenty-five years and eight months in prison.  Joffe went on to co-found Abbey Life Assurance that later became Allied Dunbar and for six years he chaired Oxfam, the international development charity.  But he will be best remembered as a dogged campaigner for assisted suicide.

Joel Goodman Joffe was born in Johannesburg, South Africa in May 1932 to a mother born in Palestine and a father born in Lithuania.  He grew up in this Jewish household before being sent to a Roman Catholic boarding school.  He studied law at the University of the Witwatersrand and, after graduating in 1955, he worked as a lawyer in that country until 1965 when he wished to emigrate to Australia.  But he was regarded there as an undesirable so instead he relocated to the UK and moved into the financial sector from which he made a fortune.  ‘I always felt a bit guilty about earning lots of money and not doing anything,’ he said.  His way of paying back his professed dues was to become deeply involved in charity and philanthropic work.

He became a member of the House of Lords in 2000.  It was there that he displayed his passion and dedication for his long-standing ambition to amend the 1961 Suicide Act.  First, in 2003, he sponsored his House of Lord’s Patient (Assisted Dying) Bill, followed in 2004 and 2005 by revised versions of it, modelled on the 1997 Oregon Death with Dignity Act, which he much admired.  Despite all these measures being lost, he persisted in 2006 with yet another attempt, his Assisted Dying for the Terminally-Ill (ADTI) Bill.  I sat through all the 7.5 hours of that debate.  In the end, his Bill was resoundingly defeated by 148 to 100.  In fact, all his attempts to change the law foundered.

In 2009, he supported Lord Charlie Falconer, the former Lord Chancellor, in trying to slip an amendment into the Coroners and Justice Bill to allow Britons to accompany those travelling to Dignitas without fear of prosecution.  That failed.  Then in 2011, he joined forces with Lord Falconer to head the Commission on Assisted Dying.  This may have sounded like a grandiose official inquiry, but it was a bogus assembly, stuffed with pro-euthanasia advocates.  Its 400-page Report, published in 2012, concluded, true to form, ‘That the Commission finds that the choice of assisted dying could safely be offered to people who are suffering at the end of life and likely to die within twelve months, provided that they satisfy the eligibility criteria.’  No surprises there.  The Report rapidly gathered dust on a thousand bookshelves.  His support continued behind the scenes to ensure that Lord Falconer’s Assisted Dying Bill received support, albeit insufficient, in the House of Lords in 2014 and 2015.  Lord Joffe retired from the House of Lords in March 2015.

He was a Jewish atheist and a humanist.  He was also a devoted member and patron of Humanists UK.  Apparently, he was a man of sharp wit, astute analysis and fierce intelligence.  These attributes convinced many of the finest minds in the Lords and gave encouragement to those supporters of assisted suicide.  He was convinced that, ‘As a caring society, we cannot sit back and complacently accept that terminally-ill patients, who are suffering unbearably, should simply continue to suffer for the good of society as a whole.’

In 1962, he married Vanetta Pretorius, an artist, and they had three daughters, Lisa, Abigail and Deborah, and four grandchildren.  He died on 18 June 2017, after a short illness, at his charming16th-century home, Liddington Manor in Wiltshire.

Simone Veil (1927 – 2017)
She was a French survivor of the Nazi death camps, lawyer, politician and militant feminist, who served as Minister of Health, President of the European Parliament and member of the Constitutional Council of France.  And she was the champion of legalising abortion throughout France.

Simone Annie Liline Jacob was born in 1927 in Nice, the fourth child of André Jacob and Yvonne Steinmetz, a non-practicing Jewish family.  In 1946, she married Antoine Veil, a lawyer – their marriage lasted for more than 60 years.  They had three sons, Nicolas, Pierre-François and Jean.  She died in her Paris home in June 2017 at the age of 89.

The Second World War broke out when she was 11.  Though her family obtained fake documents, they were arrested in 1944 and she was deported to Auschwitz-Birkenau and then Bergen-Belsen.  When the War ended, she and her two sisters were the only members of the family who returned to France – all the others were killed.

After marriage and motherhood, she studied law and became a magistrate.  Simone Veil’s political career began in earnest in 1974 when she entered Jacques Chirac’s government as Health minister.  Early on in that role, she made access to contraception easier for French women.

Then her first major political test came in 1974 with her support for a law to decriminalize abortion – once ratified, it became known as the ‘la loi Veil’.  The fact that she had suffered persecution as a Jew, helped her garner support – opposition was often interpreted as anti-Semitism.  Her astute strategy was to present abortion as a ‘failure’, as an ‘exceptional’ act that ‘no women will choose light-heartedly’, but that nevertheless needed to be ‘tolerated’.  The law was passed by the National Assembly in November 1974 by a vote of 284 to 189.  Its practical enactment in 1975 contained several restrictions, including two compulsory medical consultations, dissuasive counselling and an eight-day cooling-off period.  Any woman seeking an abortion also had to prove that she was in a position of distress, economic or otherwise.  Of course, all such limitations have vanished in 21st-century France.  Though she never claimed that abortion, or the ‘voluntary interruption of pregnancy’ as it is known in France, was a ‘woman’s right’, she never opposed the gradual liberalisation of her 1975 ‘loi Veil’.

From 1979 to 1982, Veil presided over the European Parliament.  Such was her standing in France that she received a State funeral in the Court of Honour of the Palace of the Invalides in Paris in the presence of President Macron.  Across Europe, flags were flown at half-mast, and French flags on official buildings bore black crepe streamers.  What extraordinary admiration for the woman who became most famous for legalising the killing of the French unborn, currently accounting for some 200,000 lives each year.

When does death occur?
Here’s an odd thing.  We all know that death is inevitable and that we will all experience it, most of us this century.  And yet we are still unsure when it occurs.  That is, how to diagnose it.  We tend to use either the old-fashioned, but mostly reliable, cessation of heartbeat and breathing, or the more sophisticated, but more problematic, measure of brain death.

A recent essay in the Journal of Medical Ethics entitled, ‘Do the ‘brain dead’ merely appear to be alive?’ by Michael Nair-Collins and Franklin G Miller challenges both conventions, especially the latter.

Collins and Miller maintain that patients who are judged to be brain dead may nevertheless be said to have retained the integrated functioning characteristic of human life.  This is the case even when the patient is supposedly ‘dependent’ on a ventilator.  They observe that mechanical interventions, such as a ventilator, do not, in and of themselves, allow for the functioning of the lungs and heart – other natural bodily operations play an equally important causal role.

For instance, they argue that, ‘The ventilator does not cause the heart to beat.  The ventilator does not cause gas exchange.  The ventilator does not trigger the actions of the other organs.  And the ventilator certainly does not cause the coordination of activity between the different organs.  It blows air in and out; the living organism does all the rest.’

And they assert that, ‘The science underlying the claim that the ‘brain dead’ are biologically dead organisms is weak and fundamentally flawed.  Since the accepted ethical rationale for vital organ procurement from ‘brain dead’ patients relies on the validity of the neurological standard for determining death, the accepted ethical rationale is undermined as well.’

The authors call for ‘a new consensus’ on the ethics of vital organ transplantation –‘one which is not premised on demonstrably false claims about the vital status of biologically living patients.’  In that, they echo the accusations made by others about the invalidity of current justifications of brain death.

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