Update on Life Issues - February 2009

Goodbye Bush, Hello Obama

Eight years as the most powerful politician in the world is enough for anyone – and so declared the American people last November.  The Bush years have certainly provided us with comedic value plus, it must be said, a decent bioethical stance.  We had hoped for more – a pro-life majority in the Supreme Court and a legal challenge to Roe v. Wade would have been welcome legacies.  But ‘Dubya’ held the line on other life issues.  For example, he extolled the benefits of adult stem cell technology and his stand against abortion was unequivocal.

What can we expect bioethically in the next four years from President Obama?  Sad to say, nothing much good.  The shift from a Republican to a Democrat leader will be all too clear.  Already senior appointments in the new administration reveal the direction the US is now taking – the liberals are back in power.

Obama’s promise in his inaugural address, ‘to restore science to its rightful place’ is regarded as code for a reversal of some of Bush’s interventionist agenda.  And as if to prove the point on 23 January, just three days into the new Presidential regime, the privately-funded biotech company, Geron, announced that it had been granted approval to conduct the world's first clinical trial of a therapy for spinal cord injury using human embryonic stem cells.  And if that seemed like ‘old science’ outshining ‘new politics’, Obama promptly, that is, on the same day, refuted any such notion by overturning the Bush ban on funding overseas agencies that promote abortion as part of a ‘woman’s reproductive health’.  This opening move by Obama was certainly not calculated to bring about harmony among the abortion-sensitive US electorate – it should be remembered that at least 58m people did not vote for him.

The new President and the Democratic leaders in Congress are also set to repeal the Bush administration’s ban on federal government funding for embryonic stem cell research, announced in August 2001.  But, though such a revocation seems inevitable, it could prove to be an acrimonious and stumbling start for the new White House team.  Besides, lately there has been an unprecedented rush of news reporting successful treatments using adult stem cells, which has proved to be something of an embarrassment for the ‘embryonic’ supporters.  Such radical legislation, but not the political ideology, may be put ‘on hold’ for a while.

During the Bush years, the US government has been spending more than $200m a year on abstinence-only sex education. This will doubtless stop.  Its replacement will be a comprehensive, value-free, pill and condom scheme, just like ours.  And we all know where that will lead.

During his last days in office, President Bush signed a Provider Conscience Rule.  This allows men and women to opt out of medical procedures that conflict with their consciences.  For instance, it protects doctors who object to performing abortions and pharmacists who refuse to supply the morning-after pill.  This is likely to be challenged and probably repealed in the days ahead.

The abortion front looks the bleakest. Obama has been labelled as the most pro-abortion President ever.  His new transition Cabinet is going to be stuffed with pro-choice fellow travellers.  For a start, there is Hillary Clinton, the new secretary of state and an outspoken supporter of abortion.  Obama's chief of staff, Rahm Emmanuel, is no better.  The names of Melody Barnes, Dawn Johnsen and Ellen Moran may not be readily recognisable, but they have previously either worked directly for the US abortion industry or strongly support it and they will be hugely influential in the running of the White House.  Among many others is Alta Charo, Obama's new ethics adviser, a powerful advocate of abortion and human embryo experimentation.

Well, with friends like these, the Obama years are heading in only one direction.  The inevitable bioethical damage, which is destined to become ‘the new normal’, will also become (almost) irreparable.  Even so, we must continue to pray for Barak Obama and his team – may God grant that they come to reverence all human life.  Perhaps the President should remember that he came from a broken home, abandoned by his father, while his single mother struggled to raise him – what a candidate for abortion he must have been.

[On 9 March 2009, as expected, President Obama lifted restrictions on federal funding for research on embryonic stem cells, ushering in a new phase of the destruction of early human life.  Moreover, Obama also signalled federal funding for the creation of embryos specifically for research purposes - at present embryos are obtained as 'leftovers' from IVF procedures.  This move would entail the repeal of the so-called Dickey-Wicker amendment by Congress.]

Euthanasia – OK, I was Wrong
Back in 2002, I was finishing my book, The Edge of Life – Dying, Death and Euthanasia.  Trying to predict the future pattern of the legalisation of euthanasia, I wrote:

‘There will be no radical law reform that permits the widespread administration of lethal injections, at least not yet.  Instead, euthanasia will creep up on us, in dribs and drabs.  First, there will be non-voluntary euthanasia for the incompetent, particularly those in a permanent vegetative state.  This, of course, has already begun.  Second, there will probably be the legal recognition of living wills, or advance directives.  This is already being officially discussed.  Third, legalized voluntary euthanasia, or medically-assisted suicide, will be brought in, for just a few, with alleged safeguards to prevent abuse of the many.  When these three steps have been taken, and found to be increasingly acceptable to the public, then the fourth stage, a comprehensive, permissive Act will be introduced.’

‘It will be euthanasia by knee-jerk decree.  It will be euthanasia by the backdoor.  It will come about without extensive discussion and without the establishment of any all-embracing ethical principles, until it is too late, and then the 2008 Euthanasia Act (the date is a sheer guess on my part, but interestingly, while writing this book I have already revised it downwards, twice) will be passed, granted Royal assent, and then enacted.’

OK, I was wrong – there was no 2008 Euthanasia Act.  I am certainly not disappointed about that.  On the other hand, three of the four steps noted in the first paragraph above have now been taken.  There is mounting pressure to take the fourth.

Here is some recent supporting evidence.  Lord Joffe is reported to be preparing for yet another crack, his third, at passing his Assisted Dying for the Terminally Ill Bill in the House of Lords.  Margo MacDonald MSP is doing something similar in the Scottish Parliament.  The high-profile case of Debbie Purdy, reminiscent of that of Mrs Diane Pretty and others, has recently challenged the provisions of the Suicide Act 1961.  Her request, and her Appeal, failed and the two High Court judges maintained that any change in the law was a task for Parliament.  The assisted suicide of the young rugby player, Daniel James, bought no prosecution of his ‘assisting’ parents.  Of the 100 or so Britons who have travelled to die at the Dignitas clinic in Switzerland, none of their ‘assistants’ has been prosecuted.  Now the new Director of Public Prosecutions, Keir Starmer, has hinted that a blind eye will be turned to this practice.  Dignity in Dying (formerly the Voluntary Euthanasia Society) is known to be gearing up for an imminent battle.  Those two grandes dames of social comment, Baroness Warnock and Dame Joan Bakewell, have stated their preference for putting down weak and vulnerable oldies.  MPs and peers will debate the issue as the Coroners and Justice Bill passes through both Houses of Parliament this year.  Polls show the majority of the public favours a change in the law.  Sky TV broadcast the assisted suicide of Craig Ewert from that awful clinic in Switzerland.

OK, so I was wrong about 2008.  What about the Euthanasia Act 2010?  Who would dare lay a wager against that?

Embryonic Stem Cells – OK, I Was Right
For many years in these columns, I have argued that the production of stem cells from human embryos is both unethical and unnecessary.  Unethical, because it destroys human embryos.  Unnecessary, because stem cells have always been available from diverse, alternative and uncontroversial sources such as, adult bone marrow, milk teeth and umbilical cords.  Moreover, the simplicity and elegance (not to mention, the cheapness) of another recently-discovered means of producing stem cells, known as cellular reprogramming, which creates induced pluripotent stem (iPS) cells, should have ended all talk and practice of human embryo destruction.  This iPS method was named as ‘the scientific breakthrough of the year’ by the US journal Science.  But no, experimenters say they still need to trash human embryos.

Last year’s ghastly Human Fertilisation and Embryology Act went a mad step further and controversially legalised the production of hybrid human-animal embryos, the so-called human admixed embryos.  When asked why, we were told that the work was essential to understand diseases like Alzheimer’s, Parkinson’s and diabetes.  We doubted it then, we doubt it even more now.

Now it seems that maybe a measure of sense has come to science.  Could it be that scientists are, at last, beginning to admit that there is no need to destroy early human life, and that better ways of understanding human biology and disease already exist?  In other words, that I (and many, many others too) was right, and that the scientific establishment was wrong.

The fascinating storyline is this.  Last year, three research groups (in London, Newcastle and Warwick) applied for grants to fund research that involved creating these human admixed embryos.  Now the funding agencies have refused to support the first two groups.  They, such as the Medical Research Council (MRC), appear to be favouring putting cash into iPS cell research.  Already the technique has been used for treating patients with diabetes, muscular dystrophy and Down's syndrome.

Furthermore, figures from the MRC confirm this unexpected switch towards iPS cell research.  Last year, funding for adult stem cell research, which includes that for iPS cells, rose from 46% to 61% of its stem cell budget.

And there is more bad news for the human admixed embryo researchers.  A study, published in the February 2009 edition of the journal Cloning and Stem Cells, suggests that these animal-human hybrids are going to be of no use to either basic science or medicine.  Dr Robert Lanza and his team from Advanced Cell Technology in Massachusetts inserted human DNA into cow and rabbit ova in the hope of producing unlimited supplies of embryonic stem cells, but the genes necessary for stem cell production were not activated.  All the hybrids prematurely stopped dividing and none reached the 100-cell blastocyst stage that is crucial for stem cell harvesting.  Why?  Probably because humans are not cows or rabbits and their genomes simply do not mix – now there’s a surprise!  Lanza and his colleagues concluded, ‘Our results suggest that bovine and rabbit ooyctes do not support appropriate embryonic genome reprogramming of human somatic cell nuclei, and call into question the ability of animal ooplasm to generate patient-specific human stem cells.’   In other words, human admixed embryos look like a blind alley.

It seems that all the bitter arguments over the need to create human admixed embryos during the passage of last year's Human Fertilisation and Embryology Bill may have been a waste of time.  The message is still, stick with adult stem cells.  Do I see the green shoots of common sense in this field of medical research?  I think I can, just.

[The 5 March edition of Nature contained yet another landmark advance in the reprogramming of induced pluripotent stem (iPS) cells.  The method originally reported by Shinya Yamanaka and his colleagues from Kyoto University used a virus to transport the required genetic factors into cells.  Such viruses were known to increase the likelihood of tumours.  Now, Andreas Nagy from the Mount Sinai Hospital in Toronto and Keisuke Kaji from the University of Edinburgh have reported the use of a virus-free 'cassette', first to transform mouse and human cells, and then an enzyme, transposase, to remove the cassette from reprogrammed mouse cells.  They are now working on the removal of the 'cassette' from human cells.  This new procedure brings to the use of iPS cells in human therapies another step closer.]

Designer Babies – Onward with PGD
In 1984, the Warnock Report (pp. 61-61) warned that, ‘… many people feel an instinctive opposition to research which they see as tampering with the creation of human life.  There is a widely felt concern at the possibility of unscrupulous scientists meddling with the process of reproduction in order to create hybrids, or to indulge theories of selective breeding and eugenic selection.’

For the last few years we have plotted the progressive use of pre-implantation genetic diagnosis (PGD), which, when used in conjunction with IVF, offers the most direct route to the truly designer baby.  Of course, it is nothing other than plain old eugenics.

The progenitors of PGD, namely amniocentesis and chorion villus sampling (CVS), could often detect disabilities such as Down’s syndrome and spina bifida in the unborn child and point the anxious mother towards an abortion clinic.  PGD is more subtle.

PGD arose from humble beginnings in mouse experiments during the early 1980s.  The Human Fertilisation and Embryology Act 1990 permitted human embryo research and PGD moved into the human realm.  The Human Fertilisation and Embryology Authority first approved the use of PGD in the case of a life-threatening sex-linked disorders.  The HFEA then licensed the use of PGD to screen human embryos for certain severe disorders.  This gave rise to the controversial production of ‘saviour siblings’ – embryos, and subsequently born children, with the right genetic makeup to provide treatment material, such as umbilical cord stem cells or bone marrow, for a sick sibling.  It was children as medical products.

But PGD did not stop there – every bioethical slope is endlessly slippery.  In 2006, the HFEA permitted the use of PGD to screen for so-called ‘susceptibility genes’.  These cause disorders, not prenatally or even postnatally, but much later in life, such as Huntington’s chorea and in particular, some cancers of the breast due to the presence of faulty genes known as BRCA-1 and BRCA-2.  These so-called ‘late onset disease genes’ detected in embryos by PGD raise a different set of bioethical concerns.  For example, carriers do not always develop the disease – perhaps 50 or 85 per cent do.  Detected carriers can live normal, healthy lives and some can even adopt lifestyles to avoid the disease.  For example, some women carrying the BRCA-1 gene have had their breasts removed to prevent the risk of cancer.

In January 2009, came news that the first baby in the UK, screened by PFD to ensure that she was free from the faulty BRCA-1 gene, had been born at University College London.  Women in three generations of her husband's family have been diagnosed with the disease in their 20s.

This represents a new step down the slippery slope because, for the first time, PGD has been used to reduce, not eliminate, the susceptibility of (perhaps by up to 80%) the girl's chances of getting breast cancer when she grows up.  Furthermore, those female embryos - her sisters - discarded in the process might have grown into cancer-free women.  And some of those who might have contracted cancer might have been cured.

The big bioethical questions are these: how much further down the PGD slippery slope do we want to go?  Is it right to continue selecting embryos free of specific genes that may, but also may not, cause particular diseases.  Is it right to continue destroying human embryos with faulty genes which may never exhibit such diseases?  Do we want to persist with eugenic medicine because PGD was never intended to be curative medicine – it has always been ‘find and squash’, a sophisticated form of the old-fashioned ‘search and destroy’ medicine, just like amniocentesis and chorion villus sampling.  Crumbs, was the Warnock Report’s warning in 1984, both candid and correct?

Teenage Pregnancies – Missing the Mark
Back in 1999, the Government’s Teenage Pregnancy Unit published its strategy to, ‘Halve the rate of conceptions among under 18 year olds in England by 2010; and to set a firmly established downward trend in the conception rates for under 16s by 2010.’  Remember that?  Some people wish you would forget.

We have always maintained that this was a laudable aim – teenage pregnancies are rarely a good idea – but we have always regarded that aim as unachievable.  At least, unachievable by the methods proposed.  And time is almost up for this grand social experiment with our children.  What do the latest results look like?  Answer – abysmal.

The grand plan was to improve the quality of sex education and teenagers’ access to contraception (including a ready supply of condoms, the pill and the morning-after pill, plus, when all else failed, abortion).  Once that was achieved, it was believed, the numbers of conceptions would inevitably decrease But they did not – in fact, in many towns and cities they actually increased.

So the Government stepped up its campaign, under the great delusion that more and more of a failing policy must eventually work.  Free contraceptives were dished out on school premises.  Teenage girls were censured for copying ‘celebrity’ mums.  VAT was removed from contraceptives.  Girls were condemned for getting pregnant just to jump up the housing list queue.  Parents were blamed for not talking to their children.  Parents were then blamed for telling their children what was right and wrong.  Girls were accused of using the MAP as a long-term contraceptive.  Pregnancy ‘hot spots’ in cities were targeted.  Binge drinking was held responsible.  Sex education in primary schools was proposed. Long-acting reversible contraceptives (LARC) were recommended for recalcitrant teenage girls.  And so on.  Never, ever a word about ‘abstinence’, except to dismiss it as ‘naïve’ and ‘unworkable’.

The latest official figures, relating to 2007, have just been released [see them here].  They have all increased.  A total of 42,918 girls, aged under 18, became pregnant throughout England and Wales.  This in up by 1,150 on the previous year.  Among the under 16s, a total of 8,196 girls became pregnant.  This is up by 370.  The Government’s all-important indicator, conception rates are also up from 40.9 conceptions per 1,000 girls in 2006 to 41.9 in 2007 for the under 18 year olds, and from 7.8 to 8.3 for the under 16 year olds.  The other facet of teenage conception, namely teenage abortion, shows that 50.0 % of these 2007 pregnancies ended in abortion, up by 2% on the 2006 figure.

The Government’s target to halve teenage conceptions by 2010 is now utterly unattainable.  As we come towards the end of this 10-year strategy, you might expect the decline to be approaching the 50% target, say 35 or 40%.  Do you know what the real percentage decline from the baseline of 1998 to 2007 has been?  Just a miserable 11%.

And the Government’s response to these cheerless figures?  On the very day they were announced the Government pledged an extra £20.5 million to, ‘… help young people get better access to contraception and support for teenagers and raise the awareness of the risks of unprotected sex.’  Simply more, more and more of the same.

When will the Government listen?  The problem and its solution are not that convoluted.  Last month I took my car to be serviced.  The garage owner kindly lent me his sports car for the day – it is capable of rushing up to 134 mph.  Driving home, I came to a long stretch of open road.  What did I do?  Yes, speed is fun, and I certainly had the means.  Sex is fun and now we have given every teenager the means.  But, I am an experienced driver (as well as a magistrate!) so I controlled myself and broke no laws.  By contrast, teenagers are generally inexperienced, lack self-control and typically enjoy a bit of risk taking.  And they are curious, but also inordinately vulnerable.  So what do we do?  We offer them, in fact, we insist on giving them, the means to get into trouble and become moral lawbreakers.  We are grooming our children.  Yes, of course, we should hold teenagers responsible for their actions, but we, as adults, are certainly not devoid of blame.  We have fed them an answer that is practical rather than moral.  We seem to be afraid to tell our children to say, ‘No’.

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