Life Issues Update – February 2011
Abortion Statistics in the USA
So says the Guttmacher Institute in its recently-published Report entitled, Abortion incidence and access to services in the United States, 2008. It records that for the year 2008 (compared with 2005), abortion numbers actually increased, but only by 0.5% (1,212,350 versus 1,206,200) and the abortion rate increased by 1% (19·6 versus 19·4 per 1000 women aged 15-44 years). While the number of abortion providers plummeted from a peak of 2,900 in 1982, this figure too remained static at 1,793 in 2008 compared with 1,787 in 2005. Similarly, access to abortion has continued largely unchanged with a third of US women still living in counties with no abortion provider.
Some other small changes were noted. For example, there has been an increase in non-hospital clinics using medical, rather than surgical, abortions – 17% of the total in 2008 versus 14% in 2005. And the Report also mentioned that the ‘frequency of harassments’ at abortion clinics (mainly in the form of picketing and physical contact with, or blocking of, patients) rose from 82% in 2000 to 89% in 2008.
Let nobody think that the Guttmacher Institute is an independent think-tank – it promotes itself as, ‘anon-profit organization which works to advance sexual and reproductive health’, which is code for strictly pro-abortion. To prove it, its Report closes with this observation, ‘Harassment of abortion providers continues to be a problem, particularly in the Midwest and the South. More states need to enact and enforce laws that prohibit the most overt and damaging forms of harassment and allow access to this legal, needed and basic health care service.’ Yes, these abortionists want their autonomy, and our sympathy.
Pro-life Action in the USA
Currently the pro-life focus is on three major pieces of prospective legislation.The first is to implement a ban on late-term abortions on the basis that the fetus can experience pain after 20 weeks’ gestation. Nebraska passed the first such fetal pain abortion ban last April. Second, they want a legal requirement for an ultrasound scan of her unborn child to be shown to every pregnant woman prior to her abortion. Oklahoma enacted such a law last November. Third, the push is for a bar on the costs of abortions being paid for by health insurance coverage – lots of Americans object to their tax dollars being used to fund abortions.
Already in January 2011, two bills have been introduced into Congress that would restrictthe federal funding of abortion – they are the Protect Life Act and the No Taxpayer Funding for Abortion Act. One of the sponsors of the Protect Life Act is Joseph Pitts, Republican Representative of Pennsylvania. He considers that, ‘The momentum is on the pro-life side.’ Pitts has good pro-life credentials and he may be a man to watch, and a name to recall.
Abortion Practice in the USA
This is just about as grisly as it gets.
State authorities have suspended Dr Gosnell’slicence and closed the clinic. The court case continues. But how could this mess have continued year after year? Where were the inspectors? Pennsylvania is not a primitive society – I worked there for two years. It seems that while every other medical establishment groans under paperwork, regulations and inspections, abortion clinics are freed from all such red tape. Is the lower professional standard demanded of abortionists because their trade has only one predictable outcome, and so nobody really cares how it is achieved? Is there an underlying realisation that abortion is not proper medicine, therefore its practitioners can be released from any robust oversight? This is a story of barbaric and unlawful procedures, but would it have been more acceptable if the facilities at the Women’s Medical Society clinic were spick and span and its practices were just within the law?
Medical Abortion and Misoprostol
On 13 January, the UK’s largest independent provider of abortion, bpas, formerly known as the British Pregnancy Advisory Service, launched a High Court challenge to reinterpret the 1967 Abortion Act.
The challenge centres on the so-called abortion pill, which is used to terminate a pregnancy of up to 9 weeks. This is commonly known as an ‘early medical abortion’, or an EMA, of which69,000 were performed in the UK during 2009. It is a two-stage procedure. The active ingredient of the first pill is mifepristone, or RU-486, which was licensed in Britain in 1991. Mifepristone is an antiprogestin, which blocks the hormone progesterone, breaks down the lining of the womb, and makes any pregnancy unsustainable.
Mifepristone is the abortifacient, but another drug, misoprostol, a prostaglandin, is needed to cause the uterus to contract and expel the embryo or fetus. So an ‘early medical abortion’ requires two different drugs – 200 mg mifepristone orally, followed, 24 to 48 hours later, by 800 µg misoprostol vaginally or orally. In most cases, it is not until the misoprostol is administered that a woman will begin to experience abdominal cramping and bleeding, often with nausea and diarrhoea.
The legal issue at stake is thatsection 1(3) of the 1967 Abortion Act specifies that, ‘any treatment for the termination of pregnancy must be carried out in a hospital … or in a place approved for the purposes … by the Secretary of State.’ The Department of Health interprets this to mean that all EMA drugs must be both prescribed and administered on licensed abortion premises. This means women must make separate trips to a clinic to obtain each drug, which must then be taken at that premise, before travelling home. The bpas wishes to change the law to permit the administration of the second drug, the misoprostol, at home.
On 22 January 2011, the Royal College of Obstetricians and Gynaecologists just happened to publish its latest draft guidelines, The Care of Women Requesting Induced Abortion. It concludes, ‘Neither early medical abortion nor home administration of misoprostol suits all women. However, published data do not suggest any clinical reason why women should remain in hospital during their abortion, and demonstrate that it is safe for women to administer misoprostol at home.’ And, ‘While taking misoprostol at home is not legal in Great Britain the evidence would support its use were that to be possible at some time in the future.’ This is what is known as timely lobbying.
If the bpas challenge is successful, womenwill not get the physical and emotional support and information they deserve. There will be no way of monitoring their safety. Incomplete or failed early medical abortions (which account for 2 to 3%) require surgery, and other problems associated with heavy bleeding are not uncommon. Women will not always be prepared for how they might feel, especially if abortion has been portrayed as an easy, two-step process. It can be a frightening time, particularly for younger women. They will often have to go through the procedure completely alone, at home. Home should be a place of warmth and safety, not the place for being directly involved in abortion with potentially nasty complications, or the place for memories of a lonely medical ordeal. In addition, women will have to deal with the disposal of the dead embryo or fetus, which for many will be a highly traumatic experience with possible psychiatric sequelae.
The main purpose of the 1967 Act was to ensure that legal abortion was as safe as possible – no more unhygienic backstreet abortions, botched jobs by old crones, and so on.The long-term aim of bpas is to make abortion more and more accessible. It is a commercial business, which makes money out of abortion. It is difficult not to view its wish to spare women the inconvenience of a second bus ride with anything other than cynicism. Moreover, the bpas is trying to shift what is the major issue, namely, whether a women should, or should not, have an abortion, to a minor argument of where and how should she have it. We already know that the folks at bpas do not care about unborn children. Do they really care about women?
Added, 14 February 2011. Mr Justice Supperstone today dismissed the bpas challenge. Read the judgement at: http://www.judiciary.gov.uk/NR/rdonlyres/EA84E844-C189-42BE-B848-52830A718886/0/bpasvsecretaryofstateforhealth.pdf
Abortion and Adverse Mental Health
There is a growing corpus of studies that demonstrate that women are more likely to suffer a variety of mental health problems subsequent to abortion
In 2009, one more such study entitled, Induced abortion and anxiety, mood, and substance abuse disorders: Isolating the effects of abortion in the national comorbidity survey, was published in the Journal of Psychiatric Research by Priscilla Coleman of Bowling Green State University and her colleagues. It showed that women having abortions were at greater risk from anxiety (such as, panic disorder, panic attacks and agoraphobia) as well as mood (bipolar disorder, mania and major depression) and substance abuse (alcohol and drug abuse and dependence). Abortion was implicated in between 4.3% and 16.6% of the incidence of these disorders.
Such evidence for the existence of any contraindications to abortion, or so-called post-abortion syndrome, is anathema to supporters of abortion and two of them, Julia Steinberg of the University of California and Lawrence Finer of the Guttmacher Institute, have recently set out to disprove Coleman’s findings. The January 2011 issue of Social Science and Medicine includes their article, Examining the association of abortion history and current mental health: A reanalysis of the National Comorbidity Survey using a common-risk-factors Model.
Steinberg and Finer have apparently re-analysed Coleman’s data and, surprise, surprise, they could find no conclusive evidence for a link between abortion and adverse mental health. But according to Coleman, the pro-abortion researchers used a different set of criteria. She explained, ‘The critical distinction is in how the psychological disorders were defined. Our analyses reflected 12-month prevalence and their analyses reflected only the 30-day prevalence.’
Over the last 5 years there have been at least 30 studies published by researchers and scientists from the UK, USA, Norway, New Zealand, Australia and South Africa, which support the existence of an abortion-mental health link. Would Steinberg and Finer maintain that all these reports are also flawed? Is it true that the abortion industry (which Steinberg and Finer ardently support) wishes to hide the realities of abortion from women? Moreover, do not ignore the mass of anecdotal evidence – sit down and have a chat with any pro-life counsellor and hear what they have to say about the devastation, mental and otherwise, that abortion can wreak. Abortion does hurt women (and children).
Assisted Reproductive Technologies
Human Embryos and the HFEA
Ever since 2010, when the Human Fertilisation and Embryology Authority was threatened with the chop, its supporters have rallied round, wrung their hands and made up scare stories. For example, its current chairwoman, Lisa Jardine, has opined that if the HFEA's power to grant licences for embryo research is transferred to a centralised body, ‘the safeguarding of the special status of the embryo will be lost.’ And former HFEA member, Lord Harries of Pentregarth, has similarly maintained that the risk of unfortunate incidents may increase given the ‘special ethical status of the early embryo.’
So what exactly is this ‘special status of the embryo’? The phrase comes from the 1984 Warnock Report which asserted (section 11.17) that, ‘… the embryo of the human species ought to have a special status and that no one should undertake research on human embryos the purposes of which could be achieved by the use of other animals or in some other way.’ Nice, bold words. However, just two lines later, the Report enfeebles that very statement by concluding, ‘We recommend that the embryos of the human species should be afforded some protection in law.’ ‘Some’ – what a weasel word.
Despite the high-flown words, the LordHarries, an outspoken supporter of hybrid animal-human embryo research, has been happy to endorse the deliberate destruction of human embryos for many years. And Professor Jardine now presides over a quango that permits at least 100,000 human embryos to be destroyed each year. It is hard to take their belated bioethical bleatings seriously.
It has long been recognised that the biggest health hazard of IVF, for both mothers and their children, is the incidence of multiple pregnancies. Multiple pregnancies are associated with low birth weights, stillbirths, disabilities and neonatal deaths. In addition, their mothers are more likely to miscarry, have high blood pressure and haemorrhage. Such events inevitably increase costs to the health service. Currently, 22.8% of all IVF babies are either twins or triplets. The offending practice seemed so logical – to increase the chances of a pregnancy, doctors would transfer several embryos to the woman, however any resulting multiple pregnancies were always problematic, unless doctors resorted to the unspeakable procedure of ‘selective reduction’.
Yet the answer was always within the ambit of the IVF practitioners. Perhaps they were too enamoured with pregnancy success rates rather than their patients’ health. But in recent years the clinical evidence has been accumulating – less means more. The facts are these: while women who chose to receive a double-embryo transfer are more likely to become pregnant, those who elect for a single-embryo transfer (known as an eSET) improve their chances of delivering a healthy baby. The most recent international study, reported in the 21 December 2010 edition of the British Medical Journal, has shown that the chances of a full-term, single birth following single-embryo transfer is almost five times higher than those following the transfer of two embryos. The researchers concluded that the transfer of single embryos should become the 'default position' in IVF.
Since January 2009, the HFEA has adopted a policy to reduce the UK’s IVF multiple birth rate to just 10%, in stages, over several years. Each IVF clinic has been told to devise its own ‘multiple birth minimisation strategy’. In January 2009, the limit was set at 24%. The January 2010 level was 20%. In December 2010, the next year’s limit, to be achieved by March 2012, was set at 15%. IVF clinics, ‘that are statistically above this target will, as a first step, be asked to attend a management review meeting with HFEA staff to discuss recommended actions.’ Yes, and then what?
Does not this smell of an authoritarian control of human breeding? Of course we sympathise with infertile couples. But IVF looks more and more ugly. Because the entire process is unnatural, it unavoidably becomes subject to more and more management strictures. And let no one be lulled into thinking that single embryo transfer (eSET) means the end of the bioethical nightmare of all those ‘spare’ embryos. It does not. It is still standard procedure for every IVF clinic to superovulate women, harvest many ova, fertilise them, create numerous human embryos, and then select just a few to transfer to a woman – the leftovers will as a rule be deliberately destroyed. Nothing much about the bioethics of IVF changes.
Surrogacy and Celebrity and Money
Those with a long(ish) memory may remember that just about the only issue to which the Warnock Committee strongly objected was surrogacy. The Warnock Report (section 8.7) stated, ‘We are all agreed that surrogacy for convenience alone … is totally ethically unacceptable.’ Moreover, the Committee thought that if money changed hands, as in commercial surrogacy, then it must be wrong.
How times have changed. Commercial surrogacy is now becoming de rigueur, especially among those much-admired celebrities. First there was Sarah Jessica Parker, then Elton John, then Nicole Kidman. In all three cases the surrogates were American and significant amounts of money changed hands. It has all been so admired by the media. Are we on the cusp of seeing culture follow art? Are entertainers now setting the surrogacy agenda?
Surrogacy in the UK is not illegal as long as there is no commercial gain. The 1985 Surrogacy Arrangements Act allows only ‘reasonable expenses’ to be paid, including, for example, clothes, travel expenses and loss of earnings, though these apparently now average £15k. Moreover, the child does not automatically belong to the commissioning parents. But all this may change as a result of a recent High Court ruling. In December 2010, Mr Justice Hedley allowed a British couple to keep a child even though they paid in excess of ‘reasonable expenses’ to the American surrogate. The door opens just a little wider.
In other parts of the world, such as India and the Ukraine, surrogacy is legal, and big business, with legally-binding contracts to be made before the birth. Is surrogacy exploiting vulnerable women? Is it any more than womb renting? Does it not dehumanise women? Certainly Nicole Kidman thinks so when she denigrated her surrogate mother as a ‘gestational carrier’. Does not surrogacy commodify children as trade items, objects to buy and sell? Yes, yes, yes and yes.
Donating Sperm and Eggs: Have Your Say
Currently, the compensation limit for women undergoing the complex (andoften dangerous, because of the superovulation drug regime) process of egg donation is £250. Should gamete donors be paid more substantial sums, maybe even thousands of pounds? The HFEA wishes to test public opinion on this and some other related matters. On 17 January 2011, it launched a public consultation. See the details and the online questionnaire at http://www.hfea.gov.uk/5605.html Go on, give it a go, complete it! It will certainly make you think about the issues. The closing date is 8 April 2011.
The Good News About Euthanasia
Attempts to legalise euthanasia in any of its euphemistic forms, be they assisted suicide, or assisted dying, or physician-assisted suicide, are cropping up all around the world. The good news is that they are continually being defeated, often heavily. Here is a selection from the last 12 months.
In January 2010, an assisted suicide bill was defeated in the US state of New Hampshire's House of Representatives by a vote of 242 to 113. In April 2010, the Canadian parliament rejected a bill that would have legalised euthanasia by 228 votes to 59. In November 2010, a similar bill before the South Australia legislature was defeated by 12 votes to 9. In December 2010, the Scottish Parliament rejected Margo MacDonald’s End of Life Assistance (Scotland) Bill by 85 votes to 16, with 2 abstentions.
In January 2011, the Israeli Knesset rejected a proposal to allow terminally-ill patients to self-administer lethal drugs by 48 to 16 votes. In late January 2011, the French Senate rejected proposals to legalise euthanasia. The margin was 170 votes to 142. Francois Fillon, the French prime minister, spoke out strongly against the proposals, saying that, ‘They do not fit in with my views on respect for human life or the basic values of our society.’
The Bad News About Euthanasia
Dignitas is in trouble (again). Foreigners have been coming to Switzerland in larger numbers to die. It is the only country that allows doctors to help foreigners die and more than 25% of the 380 assisted suicides during 2009 were non-Swiss nationals. Besides continuing to upset its neighbours in Zurich, Dignitas is, according to some people, giving Switzerland a bad name as a paradise for suicide tourists. The voters of Zurich are due to decide in May whether to tighten the law, or to ban assisted suicide outright.
And, just a hop and a skip across France, in Belgium, a dire collision has occurred between two contentious bioethical practices. Belgian doctors have produced protocols to harvest transplantable organs from patients who have chosen to die by euthanasia. Apparently, many of those who opt for euthanasia suffer from diseases that do not directly affect the health of their organs, making them prime candidates for organ donations. To harvest suitable organs, the patient must be hospitalised before death rather than at home, because the organs must be removed from the donor moments after death. It prompts that old philosophical question: may we not do evil so good may come? See Romans 3:8.
The Ugly News About Euthanasia
A Commission on Assisted Dying was launched in London on 30 November 2010. It is NOT a government body, but rather the pet project of Lords Charlie Falconer and Joel Joffe, two politicians who have previously sponsored their own euthanasia bills at Westminster. It is funded by, among others, Sir Terry Pratchett, that well-known writer and proponent of euthanasia, and by Dignity in Dying, that dangerous organisation, formerly known as the Voluntary Euthanasia Society. The 'Commission' is a dodgy gathering, stuffed with pro-euthanasia people, pretending to be a rigorous and truth-seeking committee, but with the decided intent of making assisted suicide appear decent and honourable. Many good doctors and bioethicists have already refused to appear before it, or make a submission to it, for fear of giving it any credibility. The ‘Commission’ is expected to publish its report in October 2011.
The Morning-After Pill
The MAP is back in the news.You remember it, that so-called, but deceitfully misnamed, emergency ‘contraception’ pill, introduced into the UK in 2001, to be used only under medical supervision (to protect vulnerable people and to prevent abuse) and only in emergencies (because the health risks of multiple and long-term usage had never been assessed). Well, 10 years is a long time in sexual and reproductive health practice! The MAP’s consumption is now widespread, frequent, typically ‘on the house’, regularly unsupervised, and virtually unregulated.
The Cooperative Pharmacy Poll
Recently, the Cooperative Pharmacy polled 1,800 UK women and found that 20% of them, aged between 18 and 35, had taken the MAP in the last year.
The MAP’s Distribution
Health professionals should be getting worried.
The MAP’s Purpose
The MAP’s Failure
Professor Paton summarised the findings thus, ‘We find that offering the morning-after pill free of charge didn’t have the intended effect of cutting teenage pregnancies but did have the unfortunate side effect of increasing sexually transmitted infections. By focusing on sexually transmitted infections, it allows us to test whether there is an impact on sexual risk-taking, and that seems to be the implication.’
It is the law of unintended consequences – supplying the MAP produces an effect opposite to that intended or expected.Now what? The last government’s 10-year teenage pregnancy reduction plan has almost ended, and signally failed. What will the new coalition government propose? It has already scrapped the amoral Teenage Pregnancy Independent Advisory Group (TPIAG). Will abstinence now get a look in?
Stem Cell Technology
Can you believe this? We all thought that induced pluripotent stem (iPS) cells were amazing – now they are beginning to look decidedly like old-school technology. The original Yamanaka method, first published in 2006, took 2 to 4 weeks to create iPS cells, only a few of the adult cells were transformed, and it took another 2 to 4 weeks to induce them to become the desired cell type. In addition, because the method required the addition of several genes, the fear of generating cancerous cells was never far away. Such techniques have moved on – now the latest hot topic is direct reprogramming.
Stem cell researchers around the world are eagerly seeking better, faster, cheaper, more efficient protocols. For example, in November 2010, Canadian scientists, led by Mick Bhatia at McMaster University, reported a technique for the direct reprogramming of human skin cells into blood cells. The transformation dispenses with the need first to produce iPS cells, so the risk of tumour production is circumvented. The team created blood progenitor cells from which the other types of blood cells are derived. Human blood obtained from a patient’s own skin cells is a fascinating prospect. The hope is to begin clinical trials in 2012.
Or consider another example of direct reprogramming. At the end of January 2011, Professor Sheng Ding and his colleagues at the Scripps Research Institute at La Jolla, California, reported the conversion of adult skin cells directly into beating heart cells also by bypassing the iPS cell stage. They began with the conventional iPS cell production method, but replaced all but one of the usually-added four genes with a cocktail of chemicals. They switched off the process early and quickly signalled the transformation stage to begin. They went from skin cells to heart cells in just 11 days. OK, it was only with mouse cells – human cells may react differently.
Of course, direct reprogramming faces serious safety and technical hurdles, but it does seem like solid progress on the road to bioethically unobjectionable stem cell therapies. Listen – is that distant sound, the death knell of embryonic stem cell technology?
Mending Broken Hearts
The British Heart Foundation (BHF) has just launched its ‘Mending Broken Hearts’ appeal to raise £50m. It wants to invest this money, over the next five years, in, ‘stem cell research and developmental biology to see whether we can repair or replace damaged or dead heart tissue with new, healthy, functioning heart tissue.’ This is another example of regenerative medicineusing stem cells. It sounds an exciting and laudable project. Could you donate to this cause? Yes, of course you could, but first read the BHF’s policy statement, ‘We fund research that uses stem cells from human or animal embryos, and adult tissues, because we believe that both approaches are important.’ Oh dear!
The Evangelical Alliance (EA) in conjunction with Christian Research has recently produced a Report entitled, 21st Century Evangelicals - A Snapshot of the Beliefs and Habits of Evangelical Christians in the UK. Read all about it at http://www.eauk.org/snapshot/
Promoted as, ‘The first in a series of groundbreaking reports which will paint a comprehensive and detailed picture of evangelicals in the UK at the beginning of 21st century’, it is based on a survey of over 17,000 people who completed questionnaires at seven Christian festivals, plus 35 randomly-selected Evangelical Alliance member churches during 2010. Minimal differences existed in the views expressed between these two sample groups, which is perhaps another way of saying that members of EA-associated churches tend to go to Christian festivals.
Herein lies the Report’s principal weakness. It represents the views of only a certain sector of British evangelicalism, contrary to its intent to be, ‘as representative as possible of evangelical Christians in the UK.’ It would certainly seem that the more conservative, Reformed evangelical constituency is largely ignored. The Report’s authors’ assertion that, ‘we are confident that evangelical festival goers are broadly representative of UK evangelicals’ needs challenging.
That notwithstanding, this Report’s preliminary results are disturbing. While, for example, it may be of some comfort to know that 91% of respondents strongly agreed that, ‘Jesus is the only way to God’ (the other 9% were presumably evangelical agnostics), only 77% prayed daily. When it comes to bioethical issues, the results are even worse.
To the statement, ‘I believe that abortion can never be justified’, only 25% agreed a lot and 18% agreed a little. In other words, 57% were either unsure or disagreed with the statement. Thus, the majority of these polled ‘evangelicals’ are in favour of abortion under various, undefined circumstances.
To the statement, ‘I believe that assisted suicide is always wrong’, 61% agreed to some extent, though less than half (46%) strongly held this opinion. Hardly overwhelming agreement is it?
Just one more figure. As many as 85% of these ‘evangelical’ Christians said that their churches are engaged with the local community. Good, but also bad. If these abortion-agreeing, euthanasia-supporting people have a strong bioethical influence in their communities – help!
Polls, and their interpretation, can be easily flawed, but here there is only one obvious conclusion– these ‘21st-century evangelicals’ hold a frighteningly unbiblical, utilitarian, secular position on bioethical issues, and moreover, they are promoting those views within their families, churches and neighbourhoods.