Update on Life Issues - February 2014
Abortion Act 1967
Just before Christmas, the Department of Health furtively launched a consultation – it was neither announced on its website, nor via a press release. It is entitled, ‘Procedures for the Approval of Independent Sector Places for the Termination of Pregnancy’. Its intention is to weaken still further the provisions of the 1967 Act.
Is this a genuine consultation? Will the Department take notice of responses? Maybe not, because apparently new guidelines have already been drafted. They suggest, for instance, that nurses alone can administer abortions, at least, those of the medical variety. And that women using such abortion pills should be allowed to go home for the expulsion of the foetus.
Moreover, the guidelines propose that abortions can be authorised without patients having to see a doctor. However, the Act insists that two doctors must decide ‘in good faith’ whether a woman requesting an abortion satisfies the terms of the Act. This was originally included in the Act as a safeguard so that a doctor was sure his authorization was justified by obtaining the endorsement of a colleague. It was also a protective arrangement for the woman as a safeguard against a hasty decision. Now the proposal is that doctors can be bypassed entirely – they have merely to rubberstamp the official consent forms. Since the vast majority of abortions are performed for mental health reasons – ground C, the ‘social clause’ – how can a proper assessment of a patient's mental health be arrived at without a doctor actually seeing the patient? But, disturbingly, this is already happening. Jane Ellison, a health minister, has recently admitted that only 46% (83,930) of women who had abortions under ground C during 2012, were seen by a doctor – this means that approximately 96,250 women sidestepped the Act. The question needs asking again: Is a coach and horses being driven though the provisions of the 1967 Act? Are most of these abortions illegal?
The Department of Health needs to ensure that the stipulations of the 1967 Act are followed, not give licence for a free-for-all. When questioned about this debacle, a Department of Health spokesman feebly stated, ‘The law requires that two doctors certify in good faith that there are lawful grounds for any abortion. Doctors must comply with that approach.’ So, what is the Department doing to ensure legal compliance?
Back in February 2012, The Daily Telegraph published some convincing evidence that sex-selection abortions were occurring in the UK. In particular, three doctors were accused, but the Crown Prosecution Service decided not to proceed with prosecutions because the General Medical Council would conduct its own investigation and, if necessary, discipline these doctors. In the meantime, the Government mounted its own inquiry, which concluded that there was ‘no evidence at all of gender-related abortions in the UK.' Anyone who took an interest in the issue could see the whitewash – it was blinding.
Now, in January 2014, comes even more compelling evidence for the illegal practice from a detailed analysis of data based on the March 2011 National Census. The study involved scrutiny of children born to ethnic groupings, especially to mothers originally from Pakistan and Bangladesh, and depended on the premise that such families are more accepting of a daughter as a first-born child. Therefore the research examined the ratio of second-born children. It was here that the natural ratio of approximately 50:50 was abnormally skewed towards boys. There are two explanations for this imbalance. Either women are continuing to have children until a son is born, or women are choosing to abort female foetuses. According to the study’s statisticians from Imperial College, London, the latter is the more likely. The work was commissioned by the Independent newspaper and it concluded that gender-section abortion '… has led to the "disappearance" of between 1,400 and 4,700 females from the national census records of England and Wales.' Now will the Government do something?
On 20 December 2013, the government of Spain approved a radical bill that would repeal its current law, which allows abortion up to 14 weeks. Alberto Ruiz-Gallardón, the Spanish justice minister, confirmed that abortion in the future will only be allowed in the case of rape, or when there is a serious mental or physical health risk to the mother, or when serious foetal deformity is suspected. And under 18-year-olds will once again have to obtain permission from their parents before having an abortion. The bill has yet to be approved by the Spanish parliament, but it does look likely that Spain is about to become the first country in the EU to back-pedal its abortion law. Such a move demonstrates that abortion laws can be tightened when pro-life groups and individuals exert pressure on politicians.
Moreover, across America, more and more states are passing laws that are restricting abortion provision. The effects are easy to see – in 1991, there were 2,176 abortion clinics nationwide, by the end of 2013, there were 582. And there is a New Year frisson across the land concerning the Pain Capable Unborn Child Protection Act. This would ban most abortions after 20 weeks’ gestation on the grounds that unborn babies at that stage are capable of feeling pain. Further evidence that a US pro-life momentum is growing came when a recent Washington Post/ABC News poll showed that a majority – 56% – of Americans supported restricting abortions after 20 weeks. And such thinking is leading to action. For instance, in Arizona, a lower court confirmed the legality of a new state law banning post-20 week abortions. Of course it was challenged, but, in January 2014, the US Supreme Court refused to review this Arizonian law.
How do you react to this sort of news? There are only three answers. Are you pleased, or are you appalled by the state control of women’s rights, or are you just confused? If either of the latter two characterizes your response, then you have probably been subject to the great abortion conspiracy – abortion is safe, simple and a woman’s right. In other words, you have been overly affected by the zeitgeist of Western liberal democracy. And you are also out of kilter with history. Here in the UK, the 1861 Offences against the Person Act made abortion a serious offence with a maximum penalty of life imprisonment. Prior to the infamous 1967 Abortion Act, public condemnation of abortion was widespread, there was considerable protection for the unborn and their mothers, the law was restrictive, and the punishments for those involved were severe. How times have changed!
Is abortion a human
Good question – there is no doubt that many would like the answer to be, ‘Yes.’ But on 10 December 2013, the European Parliament plenary session voted, albeit narrowly by 334 vs. 327, to defeat a resolution that would have made access to abortion a fundamental human right. The Report on Sexual and Reproductive Health and Rights, was put forward by Portuguese Socialist MEP, Edite Estrela. The Report contained an aggressive pro-abortion stance. Rather than leaving abortion as an issue to be dealt with by individual EU member states, it went much further in declaring abortion to be a human right. Controversially, it also called for compulsory sex education at primary school level, and it challenged the right of healthcare professionals, doctors and nurses, to refuse to perform abortions because of conscientious objection.
Of course, most countries within the EU have laws which permit some abortion under specific and limited conditions. But millions of EU citizens uphold basic pro-life principles, including the protection of all human life from conception. In addition, many others consider that while abortion should be available as a last resort, it should not be regarded as a human right, on demand. However, considering the narrowness of the vote and the resolve of the pro-abortion lobby, it is expected that the Estrela Report, or something similar, will resurface before too long.
The ABC, the
abortion-breast cancer link
Pro-abortionists have long denied the existence of any association between abortion and breast cancer, the so-called ABC link. Pro-lifers have long insisted that such a link exists. New evidence from China demonstrates not only the reality of the link, but also that the cancer risk rises with each abortion a woman has. This report has been described as a ‘real game-changer’ for ABC link deniers.
The study, entitled ‘A meta-analysis of the association between induced abortion and breast cancer risk among Chinese females’ was published in the November 2013 edition of Cancer Causes and Control. The research was conducted by Yubei Huang and colleagues at the Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Hospital. Chinese women have typically had lower rates of breast cancer than their Western counterparts. However, over the last two decades, coinciding with the implementation of the Chinese one-child policy coupled with rampant abortion, rates have increased at ‘an alarming rate’.
The findings are the combined result of 36 studies, covering 16 provinces in China, and they record a ‘dose-response relationship’. In other words, the risk of developing breast cancer is increased by 44% among women having one abortion. This increased to 76% after two abortions and up to 89% after three. The Chinese researchers concluded that, ‘IA [induced abortion] is significantly associated with an increased risk of breast cancer among Chinese females, and the risk of breast cancer increases as the number of IA increases.’
Two other recent, much smaller and perhaps less rigorous, studies provide some additional evidence for an ABC link among Asian women. They show that in Bangladesh and India breast cancer risk has increased with unprecedented magnitude among women who have had induced abortions.
In Bangladesh, the paper entitled, Breast cancer and some epidemiological factors, a hospital based study, was reported by Suraiya Jabeen and co-workers in the Journal of Dhaka Medical College (2013, 22: 61-66). It found a 20-fold increased risk for breast cancer among women with abortion histories.
And also in 2013, there was a study entitled, ‘Reproductive factors and breast cancer: A case-control study in tertiary care hospital of North India’ by A S Bhadoria and colleagues, published in the Indian Journal of Cancer (2013, 50: 316-321). It stated, ‘History of abortion was also found to be positively associated with the risk of breast cancer with 6.26 times higher risk in women having a history of abortion.’
Now consider this. The Royal College of Obstetricians and Gynaecologists in its revised 2011 review, ‘The Care of Women requesting induced abortion’ declared that ‘Women should be informed that induced abortion is not associated with an increase in breast cancer risk.’ Or consider the Q&A page from the website of the Planned Parenthood Federation of America. ‘Q. Does having an abortion really lead to breast cancer? A. No. No. No. No. No. There is no truth to this at all. It is one of those nasty myths invented by anti-choice organizations to frighten women away from having an abortion.’ How much longer will this sort of advice, from both sides of the Atlantic, be given?
All change at the top
of the HFEA
In January 2014, Professor Lisa Jardine CBE completed her six-year undertaking as Chair (ugh!) of the Human Fertilisation and Embryology Authority (HFEA). Reflecting on her time at the HFEA she said, ‘The efforts we have made to reduce multiple births, provide fairer compensation for donors, reduce regulatory overlap and give better access to data for researchers are just a few of the projects I am delighted to have seen implemented during my time here. I am particularly honoured to have overseen the Medical Frontiers: debating mitochondria replacement public consultation. It clearly demonstrated the specialised ability the HFEA has to engage, educate and communicate complex science and public opinion.’
Some would beg to differ that these were anything like notable achievements. ‘The efforts we have made to reduce multiple births’ have been a disaster. In 2009, the HFEA began a national strategy to cut the number of multiple births. In 2011, it imposed sanctions on fertility clinics if they overstepped the prescribed 10% target. Mohamed Taranissi, the notorious IVF practitioner, thought the rule was barmy and took the HFEA to court. It lost. The HFEA then withdrew its ill-designed policy. The ‘compensation for donors’ was concerned partly with keeping up with inflation but also, more seriously, was a recognition that donation of human sperm, ova and embryos were items of everyday trading. ‘Regulatory overlap’ was reduced only because the HFEA was threatened by closure or amalgamation with the Human Tissue Authority (HTA). In the end, the Government relented and the HFEA lives on. ‘Better access to data’ is a laugh. HFEA statistics are often out of date and, when they are published, they are so complex and opaque that they serve little purpose. On the other hand, I must acknowledge that HFEA staff do willingly respond to my requests for data clarification under the Freedom of Information Act (2000) – though they often take a long time to answer. As for the public consultation over ‘three-parent’ IVF, this has generally been regarded as a farce. The HFEA insisted that there was ‘broad support’ for authorizing the technique. This was a flawed conclusion. The majority of submissions opposed legalisation, but the HFEA gave unwarranted credence to opinions expressed during a limited number of its own ‘public engagement’ sessions, where the attendees were addressed by pro-‘three-parent’ IVF experts. If Professor Jardine was ‘delighted’ and ‘honoured’ to have overseen these projects, we can be glad she did not disclose anything she was ‘forlorn’ or ‘shamed’ about during her reign.
Sally Cheshire, a long-standing member of the HFEA, has been appointed as the interim chair. The post has been advertised and, at £37,148 to £47,360 for 2 to 3 days per week plus travel and subsistence expenses, it looks attractive. Moral absolutists need not apply. It is a job suited only to bioethical utilitarians and pragmatists. You’ll see!
This may be just another brick in the ART sub-standard wall, but it is still serious. Scientists at the University Adelaide studied 300,000 births that occurred between 1986 and 2002 in South Australia, of which 4,300 were the result of IVF or ICSI. The report was entitled, 'Perinatal outcomes by mode of assisted conception and sub-fertility in an Australian data linkage cohort’ and was published in January 2014 online at the Public Library of Science ONE.
The lead scientist, Professor Michael Davies, stated, ‘Compared with spontaneous conceptions in couples with no record of infertility, singleton babies from assisted conception were almost twice as likely to be stillborn, more than twice as likely to be pre-term, almost three times as likely to have very low birth weight and twice as likely to die within the first 28 days of birth.’
These adverse outcomes were more common with IVF than with ICSI treatments. Using frozen, rather than fresh, embryos eliminated all significant outcomes with ICSI but not with IVF. Moreover, a group of infertile couples, who eventually conceived naturally, experienced even greater adverse effects with their babies. This suggests that the problems were precipitated not only by the ART treatments per se, but rather by the underlying medical conditions that caused the infertility in all the parents.
The legal status of
the human embryo
The European Court of Human Rights (ECtHR) has decided to hear the case of Parrillo v. Italy, which will have major implications for the legal status of the human embryo. At issue is this question: Are human embryos merely property, or do they have rights?
The case concerns Adelina Parrillo, who in 2002, at the age of 48, decided together with her husband to have children by means of IVF. Five embryos were created and frozen for future transfer. In 2003, the applicant lost her husband and gave up the idea of IVF. However in 2011, Mrs Parrillo realised that a 2004 Italian law forbade the destruction of her embryos. She applied directly to the ECHR, alleging that her ‘property rights’ over the five frozen embryos and her ‘right to private life’ were breached by this law which prohibits her from donating the embryos to scientific research, and ‘obliging her to keep them in a state of cryopreservation until they were no longer viable.’
It is most surprising that the ECHR has agreed to even consider this case, especially since the Court has previously failed to provide legal protection for human embryos. In the past, the Court has certainly handed down some bizarre decisions. For example, in the 2004 case of Vo v. France, the Court stated that there is ‘common ground between States that the embryo/foetus belongs to the human race.’ Yes, OK. It further asserted that, ‘the potentiality of that being and its capacity to become a person … require protection in the name of human dignity, without making it a "person" with the "right to life"’. Apparently the judges were not prepared to give legal protection until the embryo attained ‘personhood’, which the Court did not – of course – define. However, the Court did manage to duck the big question by maintaining that, ‘the Court is convinced that it is neither desirable, nor even possible as matters stand, to answer in the abstract the question whether the unborn child is a person for the purposes of Article 2 of the Convention.’ It is patently obvious that the Court was determined not to assign human rights to the unborn child – that would definitely have upset the European bioethical applecart. So the Court invented, or at least, applied the undefined criterion of ‘personhood’.
This is all contrary to the 2004 Act 40 of Italian law, which recognizes the human embryo in vitro as a ‘subject of law’ and which clearly regards the human embryo as more than mere biological material with property rights. No hearing date for Parrillo v. Italy has been announced, and it may even be referred to the Grand Chamber for judgement, but the outcome of this case will be fascinating as well as significant.
The case of Brüstle v.
This has been a most unusual legal case. Way back in September 1997, Professor Oliver Brüstle, of the University of Bonn Medical Centre, applied for a German patent on isolated and purified neural progenitor cells, which he derived from embryonic stem cells as a potential treatment for Parkinson's disease. Brüstle’s patent request was granted, but Greenpeace objected and took legal action. The German Federal Patent Court noted that the European Biotechnology Directive affected the patenting of stem cell developments in the EU. Article 6 of the Directive prohibits, ‘uses of human embryos for industrial or commercial purposes’, but it does not define what it meant by ‘human embryos’. This is where the European Court of Justice (ECJ) stepped in. In 2011, the ECJ held that because there was no agreed definition across Member States, ‘the concept of "human embryo" … must be understood in a wide sense.’ The ECJ therefore ruled inter alia, ‘that a human embryo is any human ovum after fertilisation.’ That is to say, it is, ‘capable of commencing the process of development of a human being.’
The ECJ further ruled that, ‘In the context of a case concerning the patentability of an invention involving the production of neural precursor cells, which presupposes the use of stem cells obtained from a human embryo at the blastocyst stage, entailing the destruction of that embryo, an invention must be regarded as unpatentable.’ In other words, a patent should not be granted to an invention if it requires the prior destruction of human embryos, such as the production of human embryonic stem-cell lines. Put more plainly, Greenpeace won, Brüstle lost.
The ‘One of Us’
European Citizens Initiative
As a consequence of the Brüstle v. Greenpeace decision, the ‘One of Us’ European Citizens’ Initiative was launched with the intention of broader, Europe-wide action to protect human embryos. The organisers published a petition which stated, ‘The EU should establish a ban and end the financing of activities which presuppose the destruction of human embryos.’ The petition, which closed on 2 November 2013, gathered more than 1.89 million signatures from 20 countries.
During 2014, possibly in February, the ‘One of Us’ Initiative will formally present its petition to the European Commission. The legislation it proposes, if adopted, would have the effect of retrospectively amending the Horizon 2020 Regulation, which hastily committed huge sums of funding to research projects, which will involve the destruction of human embryos. Several MEPs have asked the Commission to institute a temporary ban on funding projects, such as embryonic stem-cell research, until the Initiative has been considered by the Commission and any subsequent legislation has been voted on by the Parliament and Council of the EU. It is all very complex, innovative and uncertain. Yet the battle has been enjoined and has already proved that there is considerable pro-life sentiment across Europe.
Yet another stem cell
surprise - STAP cells
The story of stem-cell technologies has been one full of shock and awe. Here is another chapter. It has been heralded – probably with too much hype – as a ‘major scientific discovery’. This is how the BBC described it, ‘Scientists in Japan showed stem cells can now be made quickly just by dipping blood cells into acid.’ The actual report is called ‘Stimulus-triggered fate conversion of somatic cells into pluripotency’ by Haruko Obokata and her colleagues at the Riken Center for Developmental Biology, Kobe, Japan and it is published in Nature (30 January 2014), 505: 641–647.
Basically, the study showed that simply ‘shocking’ blood cells by lowering the pH of their environment, to between pH 5.4 and 5.8 for less than 30 minutes, can trigger their transformation into stem cells. These have been awkwardly named ‘stimulus-triggered acquisition of pluripotency' cells, or STAP cells. According to the authors, ‘In STAP, strong external stimuli such as a transient low-pH stressor reprogrammed mammalian somatic cells, resulting in the generation of pluripotent cells.’ And, ‘Thus, our findings indicate that epigenetic fate determination of mammalian cells can be markedly converted in a context-dependent manner by strong environmental cues.’ And they concluded that, ‘This study has revealed that somatic cells latently possess a surprising plasticity. This dynamic plasticity—the ability to become pluripotent cells—emerges when cells are transiently exposed to strong stimuli that they would not normally experience in their living environments.’ The research team was ‘really surprised’ by its discovery. Dr Obokata stated, ‘It's exciting to think about the new possibilities these findings offer … in regenerative medicine.’ Others said, 'It is a game changer' and ‘… it looks faster, cheaper and possibly safer than other cell reprogramming technologies.’
But here is the great caveat. The Japanese work used mouse blood. If – and so far, this is an entirely unknown ‘if’ – it could work with human blood, then the age of personalised reprogrammed-cell therapies may be upon us faster than we had previously thought. Could it be the end of potential therapies based on embryonic stem cells, or even iPS cells? Let’s wait and see – there may yet be more shock and awe around the corner.
Stem cells and organ
There has always been an aspirational connection between the two entities of stem cells and organ transplants. Now the Japanese have moved one step nearer realising the dream. Professor Hiroshi Nagashima of Meiji University plans to create special embryos and, by transferring them into the uterus of a surrogate mother, he hopes to produce fully-grown offspring. Here is the twist – so far, the surrogate is a pig and the special embryos are chimeric, that is, they contain genetic material from two different animals.
For example, Nagashima and his colleagues have already created a white pig that contains the pancreas of a black pig. Using a white pig embryo, the gene for developing the pancreas is turned off. Then stem cells from a black pig are introduced and these create a ‘black pig’ pancreas.
Professor Hiro Nakauchi of the Institute of Medical Science at the University of Tokyo (IMSUT) has gone one step further. He has taken skin cells from an adult brown rat and converted these into induced pluripotent stem (iPS) cells. Using these he has grown a brown rat pancreas inside a white mouse.
Where is all this leading? The goal is xenotransplantation, growing human organs inside other animals, especially pigs, to overcome the shortage of hearts, kidneys, and so on, for donation. Xenotransplantation has been in the air for the last 50 years but with hardly any success. Nakauchi’s ultimate goal is to be able to take human skin cells, change them into iPS cells, inject them into pig embryos and so produce organs genetically matched to the skin cell donor. The end of transplant rejection and the end of transplant waiting list – maybe. Numerous hurdles, biological and bioethical, are awaiting – pigs and humans are dissimilar in so many ways, and the creation of human-animal hybrids is generally illegal worldwide. This does not look like bioethically-attractive stem-cell technology.
Global opposition to the proposal of mitochondrial replacement (MR) is growing. The technique is basically as follows. The nucleus of a donor ovum is removed and replaced by the nucleus of a woman with mitochondrial disease. This genetically-engineered egg is then fertilized with sperm creating an embryo that has genetic material from three persons – mitochondrial DNA from the donor and nuclear DNA contributed by the parents. Thus the constructed embryo is expected to be free from diseased mitochondria which are inherited only via mothers.
Here are three of the major arguments against MR. First, this is germ-line (as opposed to somatic) genetic modification, which means it will be passed on to further generations. It would therefore cross a previously-robust, anti-eugenic Rubicon, upheld by most jurisdictions worldwide. Second, there has been a serious lack of animal experiments to test the efficacy of MR. Third, this process of MR is technically very similar to somatic cell nuclear replacement (SCNT), the cloning technique. That should in itself cause concern. Moreover, SCNT in animals has consistently caused serious malformations in both unborn and born offspring.
Marcy Darnovsky of the Center for Genetics and Society considers that allowing such genetic modification trials with humans, ‘… would be clinically, ethically and socially dangerous, and would be a breach of international norms.’ Indeed, if ‘three-parent’ IVF is permitted, it will change human biotechnology forever. It will usher in the age of the genetically-engineered children. It will lead to a eugenic 'designer baby' market. It will also challenge the concept of what it means to be human.
The proper bioethically-responsible way forward is to focus on cures and treatments for mitochondrial diseases for the people, not of future generations, but for those who are living with them right now. The Department of Health is currently devising guidelines to enable Britain to become the world’s first user of the technique. A final decision on allowing the new ‘treatments’ to be offered will be subject to a vote in Parliament. If approved, it is expected that the first patients could be treated within the next two years.
We are still waiting for positive news. Embryonic stem-cell research has failed to demonstrate the promised ‘miracle’ cures and instead it has created dangerous side effects. The excitement generated a decade ago by scientists, the media and Hollywood about the potential of embryonic stem cells has quietly dissipated, as has its funding. If you believe that ‘money chases opportunity’, then consider this. Two of the USA’s most liberal states, namely, California and Maryland, are switching their financial investments to support not embryonic, but rather adult stem-cell research.
In 2007, the California Institute for Regenerative Medicine (CIRM) funded 100 embryonic stem-cell research projects. In 2012, it was only six, but 15 to scientists who were conducting non-embryonic stem-cell research. Similarly, in Maryland, 11 embryonic projects and 4 adult stem-cell projects were funded in 2007. By 2012, 28 non-embryonic grants were made, but only 1 for embryonic stem-cell research. What does that tell us?
still going strong
It was in 2008 that the Lancet reported the first full transplant of a human organ grown from adult stem cells. It was carried out at the Hospital Clinic of Barcelona on Claudia Castillo, a 30-year-old mother of two. Her windpipe had been severely damaged as a result of tuberculosis. Researchers harvested a portion of trachea from a donor and stripped off the cells that could cause an adverse immune reaction, leaving a three-dimensional trunk of cartilage. This bio-scaffold was then ‘seeded’ with stem cells taken from the bone marrow of Ms Castillo's hip and this new section of trachea was grown in the laboratory over four days. It was then transplanted into the left main bronchus of the patient. Because the stem cells were harvested from the patient's own bone marrow it was not necessary to give her anti-rejection, immunosuppressive drugs. Before the surgery, Ms Castillo struggled to climb a flight of stairs. After the operation, she began to lead a normal life – apparently she has even been known to go out dancing! This adult stem-cell and surgical procedure was a medical milestone.
In October 2013, the Lancet published an important paper entitled, ‘The first tissue-engineered airway transplantation: 5-year follow-up results.’ Claudia Castillo’s medical team reported that, ‘Lung function and cough reflex were normal. No stem-cell-related teratoma formed and no anti-donor antibodies developed. Aside from intermittent bronchoscopic interventions, the patient had a normal social and working life.’ And they concluded that this tissue-engineering strategy ‘is safe and promising.’ Another triumph for adult stem-cell technologies!
Euthanasia and assisted suicide
The battle is
Euthanasia and assisted suicide are destined to become the dominant bioethical issues of 2014. Lord Falconer’s private member’s Assisted Dying Bill will come before the House of Lords for its second reading some time this summer, after the new parliamentary year begins in May. Could there be a separate Bill in the Commons, or even a parallel debate in both Houses? A YouGov poll, conducted in April 2013, showed that 76% of adults in England and Wales support the Bill’s proposals. And in Scotland, there will be Margo MacDonald’s Assisted Suicide (Scotland) Bill coming before the Scottish Parliament this year. Dignity in Dying, the foremost pro-euthanasia organisation in the UK, is gearing up for its biggest campaign ever. Expect sympathetic coverage in the mass media, personal horror stories, endorsements from celebrities, biased programmes on TV and radio, emotive letters to the press, and so on.
Indeed, the deluge has started. On 14 January, the Sun, Britain’s most popular newspaper, came out in favour of the Falconer Bill. The editorial stated, ‘The risks of legalisation seem tiny to us compared with the suffering it would ease.’ Under the headline, ‘Let sick Brits die like Hayley’, it announced that 73% of its readers believe that existing laws that ban assisted suicide should be changed so that terminally ill patients should get the right to end their suffering like Corrie’s Hayley Cropper. The reference is to pancreatic cancer-stricken Hayley Cropper, a character played by Julie Hesmondhalgh, in the ITV soap opera Coronation Street. Not incidentally, the actress is a supporter of the legalisation of assisted suicide. On Monday 20 January, she is shown with no real help from her husband, Roy, taking a lethal cocktail of drugs and thus committing suicide, not the assisted variety. Many are concerned that this will normalise assisted suicide. The Samaritans are fearful that copycat suicides may follow.
So now is the time to clarify the issues in your brain – the need is urgent. Are you ready? One of the best resources is www.carenotkilling.org.uk In addition, a report, published in November 2013, by three distinguished peers argues that the Falconer Bill is proposing, ‘no mere amendment of the law but a fundamental change to it’ and, ‘is asking Parliament to sign a blank cheque.’ Lord Brennan QC, the Rt Hon Baroness Butler-Sloss GBE and Lord Carlile QC CBE write that there is, ‘widespread misunderstanding and misinformation, on what the law, namely, the Suicide Act 1961, says and how it works. Their excellent report can be accessed at www.livinganddyingwell.org.uk I might also add that my book, The Edge of Life – Dying, Death and Euthanasia (Day One) deals with these very issues from a Christian perspective.
Nicklinson-Martin-Lamb case at the Supreme Court
The names of Tony Nicklinson, ‘Martin’ and Paul Lamb have become synonymous with the legal battle to establish a right to end their lives at a time and in a manner of their choosing. The case rumbles on. On 16 December 2013, this trio of 'right-to-life' test cases finally arrived at the UK's Supreme Court before a panel of nine judges – an unprecedented number, which indicates the hearing's legal significance. The case lasted four days and judgement is expected in early 2014.
We must have the utmost empathy and sympathy for all those who live and suffer on a daily basis. However, the gravity and consequences of changing the law on assisted suicide or murder, whether these men and women are terminally-ill or not, whether their diseases are debilitating or not, are too great. The outcome would be too far-reaching, too devastating for the disadvantaged, the disabled and the dying. The floodgates to euthanasia would be opened – medical practice, legal protection and our regard for human life would never be the same again, and never safe.
Euthanasia in Belgium
Nowhere in the world has taken to euthanasia like Belgium. Voluntary euthanasia was legalised in 2002 and ever since the Belgian situation has become worse and worse. There have been increasing numbers and also an alarmingly-widening scope. Officially reported cases of euthanasia have increased sixfold in ten years, from 235 in 2003 to 1,432 in 2012. Moreover, in some parts of the country, it is reckoned that half of the cases are not reported and a third are involuntary, yet nobody has ever been prosecuted.
A decade ago, Belgians believed that their new law would uphold proper safeguards and ensure strict compliance. Now there is euthanasia linked directly to organ harvesting (so-called organ-donation euthanasia, ODE), joint euthanasia for elderly couples, euthanasia after a botched sex-change operation, a double euthanasia for deaf twins because of their fear of failing eyesight, and euthanasia for a sexually-abused anorexic woman. Euthanasia for psychological suffering among the non-terminally ill has become de rigueur. And that is not all. At the end of 2013, the Belgian Senate voted, by a massive margin of 50 to 17, to approve euthanasia for children – a measure expected to be legalized in 2014. Also in the near future, those Belgians with dementia are likely to become eligible candidates. And who’s next? What about the unhappy?
On St Valentine's Day 2014, as expected, the Belgian Lower House passed the bill allowing child euthanasia by a vote of 86 to 44, with 12 abstentions. All that now remains is for King Philippe to give it the royal assent. Then Belgium will become the only country in the world which allows euthanasia without an age limit. Even the Netherlands permits euthanasia for children only from the age of 12. Proponents of the new law say that it will apply to only a few children who must been terminally ill, in great pain and with parental consent. The short history of Belgian adult euthanasia would suggest that such safeguards will soon be overridden - children can usually be easily persuaded to please adults, especially their parents. This new law is but the logical extension of eligibility categories - legalizing euthanasia creates an insatiable appetite for more and more. We already bar children from making many economic and emotional decisions - and with good protective reasoning, primarily because they are childish and vulnerable. Now, at least in Belgium, they can decide to be killed. Something is seriously wrong here. Tellingly, the majority of pro-euthanasia organizations around the world have fallen silent on the matter - is this Belgian move a step too far even for them?
News from the USA and Elsewhere
Hobby Lobby and
The case rolls on, slowly. Hobby Lobby is the arts and crafts outlet owned by David Green and his family, which aims at ‘honoring the Lord’ in all it does ‘by operating the company in a manner consistent with biblical principles’. It is arguing that Obamacare’s requirement that compulsory health insurance coverage for its employees, including access to the morning-after pill, other emergency ‘contraceptive’ methods and intrauterine devices, restricts its freedom of religion.
Hobby Lobby is not alone. There is a string of organizations, ranging from the Little Sisters of the Poor to Wheaton College, objecting to the provisions of Obamacare. And there is increasing opposition among the American public. A poll, conducted during November 2013, showed that 59% of those questioned, ‘oppose the mandate requiring the coverage of preventive care services for women which includes all FDA approved contraceptives, including drugs that can destroy a human embryo, and sterilization services without a direct cost to the patient.’
On 26 November 2013, the Supreme Court announced that it will agree to hear the Hobby Lobby case. Kyle Duncan, lead lawyer for Hobby Lobby said, ‘We are hopeful that the Supreme Court will clarify once and for all that religious freedom in our country should be protected for family business owners like the Greens.’
Another of Hobby Lobby’s legal team, Joshua Hawley stated, ‘Some might say that corporate conscience is all well and good, but Hobby Lobby is attempting to impose its convictions on its employees. But this is quite wrong. Hobby Lobby has no objection to its employees using whatever forms of contraception they may choose. Hobby Lobby is not asking that any contraceptive drugs be made unavailable. It is simply asking not to be forced to pay for a handful of contraceptives that can cause abortions.’
David Green, Hobby Lobby’s founder and CEO, has said, ‘My family and I are encouraged that the U.S. Supreme Court has agreed to decide our case. This legal challenge has always remained about one thing and one thing only: the right of our family businesses to live out our sincere and deeply held religious convictions as guaranteed by the law and the Constitution. Business owners should not have to choose between violating their faith and violating the law.’
It has been announced that the U.S. Supreme Court will hear oral arguments for the case of Sebelius v. Hobby Lobby Stores Inc. on Tuesday 25 March 2014, starting at 10.00 am.
23andMe – the failure
and triumph of a genetic testing kit
The road to personalized genomic medicine was always going to be long and winding, even bumpy. Simple home testing kits, for simple diseases, like diabetes or hypercholesterolaemia, have been the first spin-offs. Then came the bigger and wider approaches. One of these was developed and marketed by the ambitious, Californian biotech company, 23andMe. It produced a popular $99 testing service and about 500,000 people have bought them. Users provide their DNA by mailing a saliva sample – spit and send – to the company, which it analyses and then returns the results. 23andMe claims that this so-called Personal Genome Service (PGS) can discover the user’s predisposition to more than 250 different genetic diseases. The US Food and Drug Administration (FDA) is not convinced.
Genomic medicine has reached the stage where DNA sequencing and DNA testing are becoming relatively fast and cheap. The current problem has shifted from merely gathering raw genetic information to the interpretation of its medical meaning. Thus, in November 2013, the FDA stepped in and halted 23andMe sales because it was proceeding ‘without marketing clearance or approval.’ And, the FDA continued, ‘Serious concerns are raised if test results are not adequately understood by patients or if incorrect test results are reported.’ In other words, the FDA wants positive evidence that the biological-clinical interface is being rigorously determined and explained. The two adversaries are hoping to resolve this conflict soon.
Meanwhile, 23andMe made the news again in January 2014. This too comes with another word of warning – genetic testing can have an upside as well as a downside. Consider this true story, though the real names have not been used. In the 1992, Paula and Jeff used the facilities of Reproductive Medical Technologies in Midvale, Utah to conceive a daughter, Ashley. Thanks – if that is anything like the right word – to 23andMe testing, they now know that Ashley’s father is not Jeff, but rather the fertility clinic’s former receptionist, Thomas Lippert, now deceased. This jaw-dropping revelation has caused Paula to feel defiled, Jeff says it is like theft, and Ashley has to struggle that a complete stranger is part of her DNA. It gets worse. In 1975, Thomas Lippert was imprisoned for six years for kidnapping and assaulting a Purdue University student. It is also reported that Lipper was a drunkard, suffered from paranoid delusions and exhibited violent behaviour. So poor Ashley’s biological father was a criminal, a madman, a cheat and a liar. And one can only fear that he may have other unidentified children out there. Does 23andMe and other genetic testing companies provide a positive or a negative service? Should we go looking for trouble by digging up our past or should we accept our relatives as they are? Or are artificial reproductive technologies, like IVF and artificial insemination by donor, the real culprits here?
On 15 November 2013, China's highest legislature, the third plenary session of the 18th Communist Party of China Central Committee, acted to ease its infamous one-child policy. The changes come as no surprise. It is not only pressure from Western countries, but also China’s own looming demographic crisis with a shrinking labour force, a rapidly ageing population and a serious gender imbalance, that have brought about reform. The facts are indisputable. By 2050, it is estimated that a quarter of the Chinese population will be over 65. The elderly are commonly cared for by relatives, so the only child typically faces what is known as the 4-2-1 phenomenon, caring for two parents and four grandparents. And by 2020, because of gender-selection abortions and girl infanticide, there will be some 24 million ‘leftover men’, unable to find a wife.
The policy, introduced in 1979, has always been somewhat piecemeal and applied most strictly to those living in urban areas, while for some years, rural communities and ethnic minorities have been exempt, especially if a couple’s first child was a girl, or where both parents of a couple were only children. Now comes this further relaxation – all families will, in future, be allowed to have two children if either parent is an only child.
It is estimated that the original policy has prevented an estimated 400 million births. Those found guilty of breaking it have been subjected to forced abortions and female infanticides or massive fines. An extreme example of the latter came to light in January 2014, when news that the well-known film director and the man in charge of the 2008 Beijing Olympics opening ceremony, Zhang Yimou had been fined 7.5m yuan (£729,000) for violating the policy. Zhang, who admitted that he has three children, apologised for violating the policy. He was given 30 days to pay.
Abortion in Russia
It may be hard to believe, but even post-Soviet Russia has moved to curtail its massive abortion industry, with its estimated 1.2 million terminations each year and with, until recently, the average Russian woman having seven abortions during her lifetime. In 2011, Russia banned most abortions after 12 weeks and introduced a minimum 48-hour cooling-off period. And in December 2013, President Putin signed a law which bans abortion advertising. The reasons given for this volte-face are the country’s plunging population and a wish to recover traditional moral values.
Miscellaneous, but still important
Finally, here are two obituaries of people who were extraordinary for quite different reasons, yet they both have their place in bioethical history.
Sanger (1918 - 2013)
Frederick Sanger was the biochemist who was the only Briton ever to be awarded two Nobel Prizes and the only person in the world ever to win the Prize in Chemistry twice. He has been described variously as ‘the father of genomics’, ‘one of the greatest scientists of any generation’ and a ‘real hero of twentieth-century British science’. He was born in 1918 in Gloucester and died in Cambridge on 19 November 2013, aged 95.
He won a place at Cambridge to study medicine, following in the footsteps of his father, a general practitioner, who had worked as an Anglican medical missionary in China. But before Frederick arrived at university he had decided that science would suit his single-minded personality more than medicine, so he switched and studied biochemistry. He graduated from St John’s College in 1939, and went on to work for a PhD under the distinguished researcher, Albert Neuberger. In 1943, Sanger joined the group led by A C Chibnall, the man who ‘gave’ him the job of sequencing the insulin molecule. Sanger devised a novel method for identifying the sequence of the individual amino acids in the protein. It took him several years, but he succeeded, and in 1958 it earned him his first Nobel Prize in Chemistry. My research group regularly used the so-called Sanger method in my ‘other life’ as a biochemistry lecturer – and yes, it worked!
In 1962, Sanger moved to the Medical Research Council's new Laboratory of Molecular Biology in Cambridge. There he became fascinated by the molecular structure of DNA. The problem of sequencing DNA was even tougher than that for proteins, but by modifying his own Sanger method, he again succeeded. And again it brought him a Nobel Prize in Chemistry. Yet he still remained at the bench in his laboratory. He said, ‘Most people, when they get the Prize, they get big jobs. They become professors or directors of large groups. I didn't because I wasn't any good at that. But I was quite good at research.’ Some measure of his achievement is that it underpinned the methodology used in Human Genome Project. And when the Wellcome Trust decided to build a new laboratory in Cambridge for the study of genomics they named it the Sanger Institute.
Despite all his successes and accolades, Sanger was a disarmingly self-effacing, modest man, who once said of himself, 'I was just a chap who messed about in his lab.’ He believed that science was a search for truth and he attributed his own pursuit of it to his Quaker upbringing. As a schoolboy, he learned self-reliance and practical manual skills. Much later, he refused a knighthood because he said, ‘I didn't think it would suit me.’ Although Sanger excelled at his work, he was content to set it all aside when it was finished. On his retirement in 1983, he quit his laboratory more or less overnight, and spent much of the next 30 years tending his garden and building boats. Sanger married Margaret Howe in 1940, an economics graduate he met at Cambridge. They had three children and remained married until her death in 2012. He gladly declared that his wife had contributed more to his work than anyone else by providing a peaceful and happy home.
Sanger said that he found no evidence for a God, so he became an agnostic. He said in an interview with The Times in 2000, ‘My father was a committed Quaker and I was brought up as a Quaker, and for them truth is very important. I drifted away from those beliefs – one is obviously looking for truth, but one needs some evidence for it. Even if I wanted to believe in God I would find it very difficult. I would need to see proof.’ And so he missed out on the greatest accolade and adventure of his life – to be a Christian. Yet, what a man! I have great respect for someone of his unassuming character and his most remarkable legacy. Yet, what a lost man!
Alison Davis (1955 -
Alison Davis was a remarkable woman. She was born in 1955 with spina bifida and hydrocephalus and for much of her life she was wheelchair-bound and battled her other illnesses, including emphysema, arthritis, lordosis, kyphoscoliosis and osteoporosis. From 1982, she became the national coordinator of the disability rights group, No Less Human. She died on 3 December 2013, at the age of 58.
At university, Alison had strongly supported a woman’s right to choose abortion. Her attitude changed after reading about the case of a baby girl, Louise, born in 1979 and diagnosed with the same disabilities as hers. Louise had been deliberately starved and dehydrated to death by Dr Donald Garrow of the High Wycombe Hospital. The case, which received wide publicity at the time, shocked Alison to the core. She wrote to the doctor and, ‘explained that I was disabled to just the extent that Louise had been, and that I felt he had made a horribly wrong decision … and that it was in any case wrong to deliberately kill any child on grounds of his/her disability.’ After that incident, Alison became an ardent pro-life campaigner.
She knew all about pain and suffering. She wrote in 2009, ‘When the pain is at its worst I can't move or think or speak. About 20 years ago pain of various sorts compounded to make me feel I wanted to die. At that time, doctors believed that I did not have much longer to live. Over time, my desire to die became a settled wish and it lasted about ten years. During the first five of those years I attempted suicide several times. I became ingenious at finding ways of hurting myself to add to my already severe spinal pain. If euthanasia had been legal then, I would have requested it with no hesitation at all, and if living wills had been legally binding, I would certainly have written one, refusing all life-saving treatment. I would have satisfied all the supposedly ‘strict criteria’ which pro-euthanasia groups want.’
The efforts of her friends and a trip to India in 1995, during which she met with disabled children, who she later began to support financially, helped turn her life around. After that trip she said, ‘Do you know, I think I want to live.’ It was the first time she had thought that for over ten years. She added, ‘Had euthanasia or assisted suicide been legal I would have missed the best years of my life. And no one would ever have known that the future held such good times, and that the doctors were wrong in thinking I didn't have long to live.’
Alison was to become one of the world’s greatest advocates for the right to life of people with disabilities. Who could gainsay her? She understood pain, suffering and depression, yet she was a tremendously caring person who effectively communicated her support for life and her opposition to killing by euthanasia. She led No Less Human, a grouping within the Society for the Protection of Unborn Children (SPUC), which campaigns to promote a positive view of disability. John Smeaton, SPUC’s director, spoke warmly of Alison, saying, ‘Frail in body, she was full of strength in defence of the most defenceless human beings – disabled unborn children. Her keen insight and uncompromising solidarity have proved a powerful defence for the sick and disabled targeted with euthanasia.’ After her marriage had failed in 1985, she began to seek spiritual truth. She turned to the Bible, ‘I began to think it could just be true.’ In 1991, she was received into the Roman Catholic Church.
I was often aware of Alison – she wrote letters to the newspapers and articles for magazines, she appeared on TV discussions, and spoke at various conferences. I met her several times – usually at LIFE Conferences or lobbying at Westminster. She was invariably bright and cheerful, with lots to say. She was also a good correspondent and now and again, we phoned or e-mailed each other. Ecclesiastically, we were miles apart – in the pro-life cause we were side by side, co-belligerents. Her loss is our loss.