Update on Life Issues – February 2013


Abortion statistics – are they accurate?
There appears to be a serious discrepancy.  The National Down Syndrome Cytogenetic Register (NDSCR) collects data from all the clinical cytogenetic laboratories in England and Wales.  It reported that in 2010 there were 1,188 unborn children prenatally diagnosed with Down's syndrome and that 942 of them were aborted under Ground E of the Abortion Act 1967.  However, the official government figures, published by the Department of Health, record that in 2010 only 482 abortions were performed for Down's syndrome.

Why the 50% disparity?  Are the Department's figures wrong?  Are doctors neglecting to report the real reasons for abortions on the grounds of disability, or are they falsifying their paperwork, deliberately or negligently, and therefore illegally?  Does this apparent numerical inconsistency for Down’s extend to cleft palate, club foot and other disability abortions?  Is this discrepancy indicative of an even greater failure to report abortions performed for reasons other than Ground E?  Is the Department of Health's official annual total of some 196,000 abortions in England and Wales an underestimate?  We need to know.

Inquiry into Abortion on the Grounds of Disability
This is the title of a cross-party Parliamentary Inquiry chaired by Fiona Bruce, evangelical Christian and MP for Congleton.  She has long been concerned about the disabled, especially since one of her sons was born with a club foot.  The Inquiry opened on 31 January and will seek written and oral evidence from parents, medical practitioners, academics, support groups, disability groups and interested others.

Ground E of the Abortion Act 1967 states that an abortion is justified if ‘… there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.’  There is no time limit on this Ground, in other words, under it, an abortion can take place up to birth, that is, up to 40 weeks.

On the other hand, the Equality Act 2010 protects disabled people from discrimination.  That is, it prevents anyone treating another person less favourably because of a disability.  The Inquiry will examine this seemingly-anomalous clash between the two Acts.  As Mrs Bruce stated, ‘This commission will establish whether there is room for a review of this legislation bearing in mind both medical advances and advances in our attitudes to disability over recent years.’  The Inquiry’s Report is expected in May 2013.

Abortion in the Irish Republic
On 21 October 2012, Savita Halappanavar, a 31-year-old Indian-born dentist was admitted to the University Hospital Galway.  She was 17 weeks pregnant.  Seven days later, she died there from suspected septicaemia following a miscarriage.  Her family claims that Mrs Halappanavar had asked several times for an abortion, but because of the strict Irish Republic’s abortion laws, doctors refused her request as a foetal heartbeat was detected.  At this stage, it is fair to say that the facts are contested by both sides.

The case has re-ignited the abortion debate in Ireland.  The country’s Constitution has a strong pro-life ethos, perhaps the strongest in Europe.  For example, in 1983, the Eighth Amendment (Article 40.3.3) was passed, guaranteeing the unborn an equal right to life with that of the pregnant woman.  Furthermore, the people of the Irish Republic have rejected abortion in numerous referendums over the past 30 years.  There is also the famous X case of 1992, in which the Irish Supreme Court established the right to abortion where the mother's life is threatened, including by suicide.  But in the intervening years, six successive Irish governments have managed to avoid the issue.  2013 may mark the beginning of the end of Irish vacillation.

Mrs Halappanavar’s death has prompted an inquest and at least two separate inquiries.  Pro-abortion individuals and organisations from around the world have seen this case as a lever to bring legalised abortion into Ireland.  The Irish government is under pressure.  Its Taoiseach, Enda Kenny, is caught between the general public’s disapproval of abortion and his own Fine Gael party TDs and his coalition Labour partners who have abortion legalisation on their political agenda.

On 18 December, the Irish government announced proposals that would create a loophole in Irish law to allow abortions in cases where pregnant women threaten suicide.  Public hearings on this matter have already opened.  Several medical experts have testified that there is never a medical necessity to abort to save the life of the mother – where delivery before viability becomes necessary there is ‘no intention to kill the foetus’.  Such a procedure is regarded not as ‘regular’ abortion, but as ‘indirect’ abortion, and in the circumstances as ‘best practice’.  Indeed, this provision of life-saving medical treatment is already allowed by Ireland’s pro-life laws.  Moreover, the experts also affirmed that abortion is not a treatment for suicidal thoughts or threats.  Nevertheless, the government has promised to present a bill in February that will permit abortions ‘in limited circumstances’.  Such a move would be contrary to Fine Gael’s election promise ‘never’ to legalise abortion.  Yet Mr Kenny has declared that, ‘There will be no free vote on this’ and all the TDs in the ruling Gael party will be required to vote in favour.  And we all know what happens to a so-called little legal loophole.

So the Irish abortion battle is enjoined.  In January, some 25,000 people attended a pro-life rally in Dublin to oppose the government’s plan.  Meanwhile, BPAS, the UK’s largest provider of abortions, is offering Irish medical students one-week placements in London to ‘gain experience of abortion care’ and ‘witness how abortion procedures are carried out.’  And as if to cap it all, Kitty Holland, the Irish Times journalist who broke the story of Savita Halappanavar’s death, has admitted that the facts of the case are unclear and that there may have been ‘no request for a termination’.  Furthermore, it has emerged that the chairman of the government-appointed inquiry, Professor Sir Sabaratnam Arulkumaran, head of obstetrics and gynaecology at St George’s Hospital London, has recently been elected as the president of the abortion advocacy group, International Federation of Gynecology and Obstetrics (FIGO).  He has stated in 2009 that countries with ‘restrictive abortion laws’ should ‘look at the evidence available in favour of liberal abortions laws and debate the possibility of making the choice of termination of pregnancy a legal right for women.’  Is he some sort of political puppet?

In mid-January, the preliminary inquest into Mrs Halappanavar’s death opened when the coroner promised it would be transparent and open to public scrutiny.  It is set to resume on 8 April at the Galway Courthouse.

Extension and contraction
While Ireland struggles over its legislation and practice of maternal lifesaving abortion, the global news about non-lifesaving abortion is rather different.  Consider, for example, events in the USA and Russia.  For many years both have allowed abortion with no restrictions.  Now, these old Cold War adversaries have begun to restrict their former liberal policies.  Many of the changes have come about as a result of pro-life, Christian and otherwise, campaigning.  For example, the former president of Russia and now its current Russian prime minister, Dmitri Medvedev together with his pro-life wife, Svetlana, and his government have close ties with Russia’s Orthodox Church.  As a result, the Russian parliament has voted to change the upper limit for abortion to just 12 weeks, or 22 weeks in the case of rape.  An additional measure means that every woman must be informed of the associated physical and mental risks prior to
her having an abortion.

Meanwhile, in the USA legal restrictions to abortion continue.  During 2011, several of the US states approved a total of 92 new legal provisions to limit abortions.  Even in the UK we now have a Secretary of State for Health, Jeremy Hunt, who has expressed a wish to reduce the upper abortion limit from 24 to 12 weeks.  I ask again: Is the generation that has been brought up with legalised abortion beginning to reject it?’

Midwives challenge the 1967 Act
Mary Doogan and Concepta Wood were two midwifery sisters employed by the Southern General Hospital in Glasgow as labour ward coordinators.  Both had previously and formally given notice, under Section 4 the Abortion Act 1967, that they had a conscientious objection to abortion.  That Section states that, '
no person shall be under any duty to participate in any treatment authorised by this Act to which he has a conscientious objection.'  Even so, the Act insists that every healthcare staff member is obliged to participate in emergency abortion procedures when a woman's life may be in jeopardy – an extremely rare occurrence.

In 2007, all abortions at these midwives’ hospital were moved to their labour ward.  In January 2012, they took their employer to court claiming that previously they had not been required to delegate, supervise or support staff members who were involved in the care of patients undergoing abortions.  They also claimed that their rights under Article 9 of the European Convention on Human Rights, which guarantees the right to freedom of religion, had been breached.  At the judicial review in February 2012, at the Court of Session in Edinburgh, the judge, Lady Anne Smith, ruled against the women.  The Judge decided that their Article 9 rights were not being interfered with and that their right of conscientious objection was not unqualified.  She declared that, ‘… the nature of their duties …’ did not ‘… require them to provide treatment to terminate pregnancies directly’ and therefore the Act’s provision did not apply.

In April 2012, the two women launched an appeal, which began in January 2013 before three judges in Edinburgh.  A ruling is expected some time in the Spring.  It is important because it will define the real meaning of Act’s conscientious objection provision, particularly the meaning of the word ‘participate’.  The case could eventually go to the UK Supreme Court.


Assisted Reproductive Technologies

IVF on the cheap
Everyone knows that IVF is expensive (around £4,000 per treatment cycle) and subject to low success rates (about 25% at most clinics).  Now a doctor from Davis, California has come up with a money-back guarantee of success, and all for less than $10,000.  The downside is that patients will have someone else’s embryos transferred.

Dr. Ernest Zeringue creates a batch of embryos using ova and sperm from just one donor woman and one donor man.  Their resulting embryos are then transferred to several patients.  It thereby cuts the costs of paying multiple gamete donors and repeated laboratory procedure fees – in other settings, we call it mass production.  Of course, the parents are genetically unrelated to their child, but Zeringue says that his California Conceptions Donated Embryo Program is therefore similar to adoption, but more enjoyable, with fewer legal complications.  It sounds more like selling embryos created by strangers – little short of the commodification of human life and children.  And I thought I’d heard of everything IVF-wise!

IVF numbers
Lord David Alton, the indefatigable pro-life peer, has again asked the government that fundamental question – how many human embryos has IVF produced?  The written answer was given by the Health Minister, Lord Howe.  Between August 1991, when the HFEA was set up, and 2012, there have been 3,546,818 human embryos created in IVF clinics throughout the UK.

Of these, 1,388,443 embryos have been transferred to women as a part of their fertility treatments.  A total of 839,325 have been put into frozen storage for future use, though 23,480 were discarded after being taken out of storage.  Only 2,071 have been for donated to other women.  A further 5,876 were set aside for scientific research.  And of the rest, 1,691,090 were discarded unused – that is 47.5%, nearly half, of the total.  Only 7% of the total, or 1 in 15, lead to a pregnancy and a ‘take-home’ baby.

Lord Alton commented, 'This sheer destruction of human embryos – most people would not know that it took place on such a scale.  Most people wouldn't have any idea about the numbers of embryos being created in that process and would also feel very uneasy about them being experimented on as well.'  IVF produces, uses and abuses human embryos as if they were mere biological products rather than human lives.

Costa Rica is the last
In this tiny island of 4.7 million people, a legal battle has been raging for the last ten years.  IVF was legal in Costa Rica between 1995 and 2000, but in 2000, a ruling by Costa Rica’s Constitutional Chamber of the Supreme Court – the country’s highest judicial body – banned IVF, arguing that its inevitable practice of discarding ‘spare’ embryos violated the island’s constitutional protection of human life as well as various international human rights conventions.

Since then, nine infertile couples, unable to access IVF services in Costa Rica, have fought the government for that ‘right’.  In December 2012, the Inter-American Court of Human Rights (IACHR) ordered Costa Rica to legalise the procedure and make it available through the country’s public healthcare system within 12 months.  It ruled that Costa Rica's prohibition on IVF infringed the rights to privacy and family, and also the principle of non-discrimination.  The IACHR therefore elevated secondary rights, such as the right to privacy, the right to personal autonomy and the right to sexual and reproductive health, above the right to life.  This must be incorrect because the right to life must take precedence over these other rights – without it, the others cannot exist.  Moreover, the Court stated that, ‘The regulation trends in international law do not lead to the conclusion that the embryo must be treated equally as a person or that it has a right to life.’  In other words, they played the false ‘personhood’ card and also accepted the flawed argument that life begins at implantation.

Thus Costa Rica, the last country in the world to prohibit IVF completely, has been forced to lift its ban.  Its government has said it will comply with the IACHR’s decision. But that will not be easy.  The Costa Rican healthcare system is facing bankruptcy, the required legislation has not yet been drafted, the necessary IVF doctors and staff need two years of training, and the government of President Laura Chinchilla (yes, really!) has given the move little support.  Will the 12-month deadline be met?  We shall see.


Stem-cell Technologies

Are iPS cells like embryonic stem cells?
Embryonic stem cells have long been regarded as the ‘gold standard’ of stem-cell technologies.  From them, at least in theory, can be derived any of the 200 or so cell types that constitute the adult human body.  But embryonic stem cells are bioethically unacceptable because their harvesting destroys human embryos.  Adult stem cells have generally been regarded as less flexible despite their evident utility and efficacy in hundreds of human treatment trials.  The discovery in 2006 of induced pluripotent stem (iPS) cells caused biological excitement, but raised novel questions about their ability to mimic their embryonic ‘cousins’.  They may look the same, but are they functionally the same?  That is the key question.

Some have suggested that iPS cells may contain more genetic abnormalities than embryonic stem cells.  Could the former therefore cause adverse side effects if used therapeutically?  Experiments making direct comparisons were needed.  In a preliminary study with mice in 2011, Yang Xu and his research team at the University of California, San Diego reported that iPS cells were functionally inferior.  Their iPS cells provoked immune responses and were rejected, even when injected into the mice from which they had been derived.  It was serious blow to the hopes of future iPS-cell therapies.

But the doubts appear to have been short lived.  In the January 2013 online edition of Nature, Ryoko Araki and his colleagues in Chiba, Japan reported a more advanced comparative study.  They derived iPS cells from mice and injected them back into the animals and at the same time they injected other mice with embryonic stem cells.  They also transplanted skin and bone-marrow cells derived from iPS and embryonic cells into mice. The success rates were similar between the groups.  And the immune response of both sets of tissues was indistinguishable.  So, that is good news for the supporters of both iPS cells and rigorous bioethics.  Except that mice are not men – human stem cell comparisons are now needed.

How are iPS cells formed?
The reprogramming of somatic cells to iPS cells is fairly inefficient and the underlying mechanisms, remarkable as they are, are poorly understood.  Three recent papers published in Cell and Cell Reports reveal some of these processes.  Yamanaka showed in 2006 that reprogramming required the addition of four transcription factors, Oct-4, Sox2, c-Myc and Klf4, the so-called Yamanaka factors.  Their biochemical sequence in reprogramming has now been elucidated – c-Myc is the driving force during the early phase, whereas Oct-4 and Sox2 play a crucial part during the intermediate phases and Klf4 is especially active during the early and late phases.  Such results are crucial to understanding the reprogramming process and will help to optimise and increase the efficiency of reprogramming strategies.  And that will lead to the production of iPS cells for human clinical applications – the transition from lab to bedside.

Leprosy and stem cells
Is there no end to the biological role of stem cells?  Anura Rambukkana of the University of Edinburgh and his colleagues have now demonstrated a novel role for them in the onset and development of leprosy, also known as Hansen’s disease.

Leprosy is caused by the bacterium Mycobacterium leprae, which acts as a pathogen infecting the Schwann cells, the components that insulate the cells of the peripheral nervous system.  Schwann cells are essential for the conduction of nervous impulses along the axons.  Their damage is the primary cause of sensory loss and motor dysfunction in leprosy sufferers.  These bacteria spread through the body by reprogramming infected cells to become stem cells, or at least, stem cell-like cells that can then form other cell types.

The Edinburgh team infected Schwann cells of mice with the leprosy-causing bacteria.  These cells then expressed genes typical of early development – akin to reprogrammed iPS stem cells – and when injected into mouse muscle they turned into muscle cells and then spread to adjacent muscle tissues.  These stem-like cells also transferred the M. leprae bacteria to cells of the immune system and so the infection spread further.

Leprosy remains an age-old scourge of human civilisation and it still represents a serious global health problem as it affects an estimated 1.15 million people.  This new understanding of how the M. leprae bacteria can reprogram body cells could lead to more effective treatment strategies.


Euthanasia and Assisted Suicide

Euthanasia in Belgium
We tend to look to the Netherlands as the pioneer of rushed legalisation of euthanasia.  That is not really true.  Long before Dutch euthanasia was decriminalised in 2001, it had been officially tolerated and debated.  For example, in 1984, the Dutch Supreme Court and the Royal Dutch Medical Association (KNMG) issued guidelines concerning the ethic and practice of euthanasia.  In other words, it took about two decades of turning a blind bioethical eye and of failing to prosecute doctors before a euthanasia law was passed.  In Belgium that leap took about five years.  The Belgian parliament
legalised euthanasia in late September 2002.  It was a hasty decision.

Now, a decade later, Belgium is considering extending its euthanasia law to allow minors, those under the age of 18, and Alzheimer's sufferers to seek permission to die.  Although no date has been set for the debate, it is thought that approval is a foregone conclusion.  Euthanasia for Alzheimer's patients was permitted for the first time in the Netherlands last year.  It was on 1 April 2009 that Luxembourg legalised euthanasia.  There does seem to be a Benelux ‘follow my neighbour’ theme here.

Back to Belgium.  During 2011 there were 1,133 instances of euthanasia, mostly for terminal cancer, performed there.  These are equivalent to about 1% of all deaths in that country.  Whether these official figures are accurate is a moot point, as with the official Dutch data, they are widely recognised to be serious underestimates.  Doubts are expressed because it has previously been reported that almost half of Belgian euthanasia cases go unreported, almost half of Belgian euthanasia nurses have committed non-voluntary euthanasia, one third of euthanasia cases in the Flemish region of the country were non-voluntary, and nowadays Belgian euthanasia has become strongly linked to the harvesting of body parts to be used in organ donations.

In 2012, the European Institute of Bioethics (IEB) published a report on 10 years of euthanasia in Belgium.  That document is now available in English.  It is scathing.  According to the report the Belgian euthanasia watchdog, the Federal Control and Assessment Commission, is both ineffective and biased.  Ineffective, because, after 10 years and about 5,500 cases of euthanasia, the Commission, ‘… has never felt the need to refer a single medical file to the Crown Prosecution Service.’  As the IEB report asks, ‘Is it not illusory to expect a medical practitioner to denounce him/herself when he/she has failed to comply with one or several basic rules and regulations?’  And biased, because nearly half of the statutory Commission’s 16 appointees are members or associates of the leading right-to-die organisation in Belgium, the Association pour le Droit de Mourir dans la Dignité (ADMD).  The IEB comments, ‘In view of the Commission’s composition, one can understand the absence of any effective control and the ever-widening interpretation, which the Commission intends to give the law.  One may also be very worried by this.’

The IEB report describes the lack of enforcement of the law.  For example, the Commission often waives the legal requirement of a written request for euthanasia.  The legal criterion of a life-threatening and incurable illness had now become an illness that is only serious and debilitating.  Pain was supposed to be unbearable, unremitting and unrelievable, but now a patient is allowed to refuse medication to relieve that pain.  And the definition of ‘psychological suffering’ has become ever-wider.  Moreover, the 2002 law permits euthanasia, but not doctor-assisted suicide, yet the latter is regularly ignored by the Commission.  In other words, the slippery slope or ‘mission creep’ has undoubtedly crept into Belgian law and medicine.

The deaf Belgian twins
Legalised euthanasia turns medicine on its head and produces quite abnormal cases.  Here is one from Belgium.  At the beginning of 2013, Marc and Eddy Verbessem from the village of Putte, near the city of Mechelen, were euthanised.  They were deaf identical twins who chose to die because they 'had nothing to live for' after learning that they might soon become blind as a result of a genetic form of glaucoma.  The 45-year-olds had lived together their entire adult lives, working as cobblers, communicating by their own sign language and being not understood by the outside world.  Apparently they were terrified of never being able to see each other and they feared losing their independence if placed in an institution.

It took them two years to find a medical facility willing to perform the deed.  In the end, they died by lethal injection, dressed in new shoes and suits, with their parents and brother by their sides, at the Brussels University Hospital in Jette.  The case is poignantly sad.  But it is also bioethically disturbing because neither twin was suffering extreme physical pain or was terminally ill.

Consider a hypothetical case of twins who were also similarly inseparable companions.  One of them is shot, struck by lightning, or run over – whatever, he dies.  The surviving twin says that separation from his brother is intolerable and so he asks the state to kill him.  Is that a ground for euthanasia?  It would probably be so in Belgium.  And that is the point – once a country legalises euthanasia, or any other deadly procedure like abortion or human embryo abuse, the legal regulations are stretched and the safeguards are trampled.

Assisted suicide in France
A report, commissioned by the French government, has proposed the legalisation of medically-assisted suicide in France.
 The report, released on 18 December 2012, recommends that France allows doctors to ‘accelerate death’ for terminally-ill patients who want to end their lives.  In October, the French people were polled, and, as nearly everywhere that such surveys have been conducted, the French voted in overwhelming support (89%) of assisted suicide.

President François Hollande had pledged ahead of his election in May 2012 to follow the forthcoming report’s recommendations.  These have now been referred to a national council on medical ethics that will examine the precise circumstances under which doctors can assist in ending a patient’s life.  Draft legislation could be produced as early as June 2013.

The report has been heavily criticised by doctors and others.  However, its author, Didier Sicard, professor of medicine at the University Paris Descartes, retorted that French doctors have been too reluctant in applying an existing 2005 law, which allows them to ‘leave patients to die.’  According to President Hollande, ‘The existing legislation does not meet the legitimate concerns expressed by people who are gravely and incurably ill.’  Sicard has further accused doctors of creating a ‘cure at all costs’ culture that is ‘deaf to the psychological distress of patients and of their wishes.’  Somewhat confusingly, he also maintains that he will not support any legislation that would ‘suddenly and prematurely end life’ and that he ‘radically opposes inscribing euthanasia into law.’  Confused?  He is.  So am I.

Assisted suicide in Ireland
Marie Fleming is a 59-year-old mother of two.  In 1985 she was diagnosed with multiple sclerosis and is now in the terminal phase of that disease.  She wants an assisted suicide at home and so she mounted a legal challenge to the Irish Criminal Law (Suicide) Act 1993, which prevents her and, which she maintained is unconstitutional on the grounds that it breaches her human rights
.  She claimed that this Act discriminates against people who are unable to travel abroad to places like Dignitas in Switzerland.  In a move similar to that of Debbie Purdy’s in 2009, she also wanted the Irish Director of Public Prosecutions (DPP), Claire Loftus, to publish guidelines on the factors that would lead to likely prosecutions in cases of suicide assistance.  Ms Loftus refused stating that if she did so, her office could be exposed to a charge of ‘aiding and abetting’ in the commission of a crime.

On 10 January, after a six-day hearing, the specially-convened divisional Court of three judges unanimously ruled against Mrs Fleming.  In its 100-page judgement, the Court said that it was impossible to liberalise the law on assisted suicide and at the same time protect vulnerable persons, such as, the aged, the disabled, the poor, the unwanted and others including those who were financially compromised, who may be vulnerable to assisted suicide.  On 16 January, Mrs Fleming appealed the Court's decision.  Given the importance of the issues raised in the case, it is likely the appeal will be heard by a seven-judge Supreme Court.

Massachusetts rejects assisted suicide
To counter the above gloom, it should be noted that on 7 November the voters of Massachusetts narrowly (51% to 49%), but still sufficiently, rejected a referendum question that would have legalised doctor-assisted suicide.  This was an important victory.  It sent a message across the USA and around the world that even the liberal-minded citizens of New England are opposed to euthanasia, at least, one form of it.

Upcoming challenges in the UK
Tony Nicklinson was diagnosed with ‘locked-in-syndrome’ after suffering a stroke in 2005.  He died in August 2012, a week after losing his High Court legal bid for doctors to end his life without facing criminal charges, in effect, to allow doctors to kill him in contravention of the Murder Act 1965.

In September, his wife Jane and her two daughters promised to continue his campaign to change the law after seeking permission to appeal the Court’s 16 August ruling.  On 2 October, High Court judges refused Jane Nicklinson’s application for leave to appeal.  The judges said they were, ‘… deeply conscious of her suffering’ since her husband's stroke and of ‘… her frustration and distress over the state of the law’ but said they did ‘… not consider that the proposed appeal has any real prospect of success.’  The Nicklinson family then lodged papers seeking to overturn that decision.  Mrs Nicklinson has vowed to continue her campaign, ‘This is part of Tony's legacy, we're fighting for him, on his behalf’, she said.  However, the Court did grant permission for Mrs Nicklinson to appeal the High Court’s ruling which found that the current law did not breach human rights and that it was for Parliament, not the courts, to decide whether the law should be changed.

It was in 2010 that Margo MacDonald MSP championed her own Assisted Suicide (Scotland) Bill.  It was heavily defeated in the Scottish Parliament by 85 votes to 16.  Now, she is about to present a revised version, based on the model of the Oregon Death with Dignity Act.  Her preliminary public consultation resulted in 65% of the responses opposed to any change in the law.

And Lord Falconer, probably in cahoots with Lord Joffe, is preparing to table a Private Member's Bill on Assisted Dying in the House of Lords, probably during May.  Already the Choice at the End of Life All-Party Group (APPGCEL) at Westminster, supported by the Dignity in Dying organisation, has published such a Bill, which is essentially based on the recommendations of the bogus 2011 Falconer Commission on Assisted Dying.  No dates for the other challenges have so far been published.


News from the USA

Conscientious objection
Conscientious objection is a delicate, but essential, feature of an ethical lifestyle and it is under threat everywhere.  Way back in 2005, the Illinois state governor, Rod Blagojevich, issued a rule mandating all pharmacies and pharmacists to stock and provide drugs, such as the abortifacient morning-after pill, Plan B.  He told objectors that if they had a conscientious objection, they should ‘find another profession.’

Objectors protested and in 2011 two pharmacists took the state to court.  The trial court quashed the rule, because it violated several laws, including the Illinois Health Care Right of Conscience Act.  The state appealed, but in late September 2012, the Illinois Court of Appeals ruled that pharmacists and pharmacies cannot be forced to stock and dispense abortion-inducing drugs in violation of their religious beliefs.  Then on 14 December 2012, the state of Illinois gave in and declined to appeal that decision.

Maintaining the entitlement to conscientious objection can be a long, and often costly, process.  The Illinois decision marks the end of the state’s seven-year campaign against religious objectors.  The legal battle was worthwhile.  Now ordinary Illinois citizens can run their small businesses in accordance with their beliefs.

The Hobby Lobby Saga (continued)
The story so far.  On 23 March 2010, President Obama signed into law the Patient Protection and Affordable Care Act, commonly known as Obamacare.  Many US citizens, organisations and companies protested.  Their primary objection was because the Act required employers to pay for health insurance plans which included them to provide their employees with free contraceptives, sterilisations and abortion-inducing drugs, such as the morning-after pill.  Such provisions were against the religious beliefs and ethical stance of some employers.

One such objector was Hobby Lobby, a chain of over 520 arts-and-crafts stores with 13,600 employees in 41 states, and its sister book-selling company, Mardel Inc.  The chain is owned by David Green, an evangelical Christian and his family.  He has said, ‘It is by God's grace and provision that Hobby Lobby has endured.  Therefore we seek to honor God by operating the company in a manner consistent with biblical principles.’  Indeed, Hobby Lobby calls itself a ‘biblically-founded business’ and is, for example, closed on Sundays.

Faced with a potential legal showdown, in January 2012, the Department of Health and Human Services (HHS) issued a mandate under the Act forcing employers to pay for such health insurance plans.  On 12 September, Hobby Lobby’s owners filed a lawsuit in the US District Court for the Western District of Oklahoma, opposing the HHS mandate and seeking to block the offending part of the Act.  On 19 November, District Judge Joe Heaton ruled that while churches and other religious organisations have been granted constitutional protection from the birth-control provisions, ‘Hobby Lobby and Mardel are not religious organisations.’  The next day, 20 November, Hobby Lobby appealed to the federal Tenth Circuit Court of Appeals seeking emergency relief from the abortion pill mandate.

On 20 December, a federal court denied Hobby Lobby’s request for a temporary block on the enforcement of the mandate.  Hobby Lobby then appealed to the Supreme Court.  On 26 December, Supreme Justice Sonia Sotomayor denied the company's last-minute appeal for an injunction while its lawsuit is pending, but agreed that the company may continue to challenge the constitutionality of the mandate in lower courts.

At the end of 2012, Kyle Duncan, a lawyer for Hobby Lobby Stores, said in a statement that the arts-and-crafts chain plans to defy the federal mandate even though it risks fines of up to $1.3 million per day from 1 January 2013.  He also made clear that, ‘The company will continue to provide health insurance to all qualified employees.  To remain true to their faith, it is not their intention, as a company, to pay for abortion-inducing drugs.’

On 10 January 2013, Hobby Lobby announced that it had discovered a way to shift the start date of its employee health insurance, thus postponing the effective date of the HHS mandate for several months.  The company is still pursuing its appeal in the Tenth Circuit.

There have been at least 44 cases and over 130 individuals before the courts in this matter representing hospitals, universities, businesses and schools, such as, Wheaton College, Houston Baptist University, The Eternal Word Television Network and Ava Maria University.  Hobby Lobby is the largest and the first non-Catholic-owned corporation to sue over the HHS mandate.  On Tuesday 19 December, a federal appeals court handed Wheaton College and Belmont Abbey College a victory in their challenges.  As for Hobby Lobby, as they say, the case continues.

Abortion amendments
During 2012, a total of 19 US states passed 43 new legislative provisions that variously restricted their abortion services.  That number is only second to the record-breaking total of 92 passed in the previous year.  None of these changes affects the legality of abortion established by the 1973 Supreme Court decisions in Roe v. Wade and Doe v. Bolton.  Abortion remains legal in the US throughout all nine months of pregnancy.  Nevertheless these amendments do tighten up abortion provision, the workings of abortion clinics and the protection of women facing abortion.

Most of these changes affect the upper time limits for abortion and the limit of abortion funding by state health insurance schemes.  Such limitations are, of course, viewed with horror by US abortionists and organisations like the Guttmacher Institute, which incidentally published the above figures.

Consider the situation, for example, in Michigan.  At the eleventh hour on the last day of the legislative session in December, the Michigan House of Representatives voted 72 to 35 to accept changes made in the Michigan Senate to a measure known as House Bill 5711.  On 28 December, the Governor of Michigan, Rick Snyder, said he signed the Bill, ‘because of its important and reasonable emphasis on protecting the health and wellness of pregnant women in Michigan.’

HB 5711 is a combination of five previously-introduced bills rolled into a single, ‘super bill’.  Its intention is to reform Michigan’s substandard abortion industry.  It will, for instance, require all surgical abortion clinics to be licensed and inspected by the state.  Currently only four of the 32 abortion clinics in Michigan are licensed, meaning that the other 28 are rarely, if ever inspected by state officials for basic health and safety requirements.  It will also require abortion clinics to question women to ensure they are not being coerced into abortion.  It will also prohibit prescribing and dispensing RU-486 abortion pills via Internet webcam connections.  It will also require the humane disposal of the bodies of aborted babies.  And finally, it will make it a crime and establish penalties for those who coerce women into abortions.

Texas is another state where pro-life legislation is making progress.  A series of pro-life bills have the enthusiastic support of the state’s governor, Rick Perry.  Apparently, there is a strong coalition of Republicans and Democrats in Austin determined to defend and advance the cause of human life.

For example, coming before the legislature this year will be the Texas Preborn Pain Bill.  It will protect the lives of unborn children, who could feel pain, by banning abortion after the 20-week mark.  And there is the Abortion Industry Accountability Bill.  This would compel abortion clinics to follow state inspection laws, insist that abortionists pre-arrange admission privileges with local hospitals so that women and babies who survive botched abortions can undergo emergency, life-saving care immediately.

These are typical of the bills that several other states are proposing in order to clean up the US abortion industry, which for too long has ignored matters of health and hygiene, let alone the best interests of its clients.


Miscellaneous but not Unimportant

Marriage (Same Sex Couples) Bill 2012-13
This proposed piece of misguided legislation was published by the government on 25 January 2013 in its attempt to redefine marriage.  This is not the place to criticise those proposals.  But the Bill does have unexpected and far-reaching ramifications.  For example, it would amend the Human Fertilisation and Embryology Act 2008.  Part 2 of that Act deals with the issues of 'Parenthood in cases involving assisted reproduction.'  Section 35 deals with the role of women as parents and is headed 'Woman married at the time of treatment.'  The Marriage (Same Sex Couples) Bill would amend this to 'Woman married to a man at the time of treatment.'  See what I mean, weird or what?  And if the Bill becomes law, I shall probably be taken to court for making that statement.

Compassion in Practice
This is the name of a new three-year plan launched across England at the end of 2012.  All NHS nursing staff have been told ‘to embrace’ the values of patient care which the strategy sets out.  At its core are the ‘6 Cs’ which will help achieve the plan’s goals.  And they are: care, compassion, competence, communication, courage and commitment.

It is a sad comment on the state of the NHS, the quality of its in-house training, its recruits and its bioethical ethos that such a strategy is required to be instituted.  Vocation, pride in work and job satisfaction must be at an all-time low.  Where are the matrons of yesteryear who would insist that all nurses, at all times, were so trained that they practised the ‘6 Cs’ without a conscious thought about their need or correctness?

If practices such as abortion and euthanasia become more widespread and if healthcare staff lose their right to conscientious objection, then suitable candidates, Christian and otherwise, will not join the NHS.  Then good nurses will be at a premium.  On the other hand, let us recognise that twenty-first century nursing has changed, become more technical and less patient-oriented.  Therefore let us welcome the Compassion in Practice plan before it is too late.

Julie Bentley and the Girl Guides
Bioethical issues often come with surprises and sometimes with shocks.  Here is one of the latter.  It was announced in November 2012 that Julie Bentley had been appointed the chief executive of Girlguiding UK.  Ms Bentley was the former head of the Family Planning Association.  In that role she had spent the previous five years campaigning to introduce abortion into Northern Ireland, maintaining the 24-week abortion time limit, and pressing for mandatory and explicit sex education in schools.

She is certainly not the sort of person suitable to head a decent institution that has in the past protected young girls from such pressures.  One can only hope that she is either soon and deeply influenced by Bear Grylls, the Chief Scout and a professing Christian, or that she moves on to other pastures before she infects the Guides with her liberal, amoral thinking.

E Donnall Thomas
Not many men (or women) have the privilege of making a lasting effect upon the lives of thousands and thousands of others.  That is the legacy of Edward Donnall Thomas, the Nobel laureate, who died on 20 October 2012, aged 92.

His worldwide reputation came about because of his pioneering work in stem-cell research and bone-marrow transplantation.  He helped save the lives of tens of thousands of people with otherwise fatal diseases, such as, leukaemia, lymphoma, thalassaemia and aplastic anaemia.  His patients understandably loved him.  He was, by all accounts, a quiet, modest, kindly and wise doctor.

Thomas was born in Mart, Texas, the only child of a general practitioner and a teacher.  Don, as he was known to family and friends, grew up in rural Texas, where his chief interests were the great outdoors, hunting and fishing.  He went through the school system, studied organic chemistry at the University of Texas at Austin, graduated from Harvard Medical School in 1946, joined the US Army and eventually became physician-in-chief at a hospital in Cooperstown, New York.  It was there that he began to study the effects of lethal doses of radiation in rats and how they could survive by the infusion of donor bone-marrow cells, stem cells.  He progressed from rats to dogs and then to humans.

In 1957 Thomas first treated a human leukaemia patient using high doses of irradiation to wipe out the cancer and then giving an infusion of marrow cells from the patient’s identical twin.  The transplant was initially successful, though the patient later died from a recurrence of the leukaemia.

Then in 1963 he moved to the United States Public Health Service (USPHS) Hospital in Seattle.  It was here, some 50 years ago, that Thomas began labouring away in a temporary basement laboratory.  He was a bit of a medical visionary, determined to succeed in ways that others were convinced would never work – perhaps his forebears were Welsh and stubborn!  He was sure that leukaemias and other cancers of the blood could be cured by destroying a human patient's diseased bone marrow with near-lethal doses of radiation and chemotherapy and then transplanting healthy marrow from a donor.  At that time, a leukaemia diagnosis was a death sentence with the chances of survival little more than zero.  Eventually, after many setbacks, Don Thomas demonstrated that infusions of donor bone-marrow cells into patients could re-establish their blood cell production.

Thanks to his persistent and ground-breaking work, tens of thousands of leukaemia patients can now lead normal, productive lives.  As one of his many assistant investigators put it, ‘Virtually every major transplant centre in the world got its start by sending someone to train under Don Thomas.’  In 1990, Thomas received the Nobel Prize in Physiology or Medicine for this lifesaving work.  Nice story, good man.

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