Update on Life Issues - February 2015
Tuesday 4 November 2014 was an historic day in the House of Commons. It was the day that Fiona Bruce MP introduced her Ten Minute Rule Bill, entitled The Abortion (Sex-Selection) Bill. Its purpose was to underline that UK law prohibits abortion on the grounds of gender. It would also provide an opportunity to examine what sort of support can be offered to those under pressure to abort a baby on the basis of gender.
Back in March 2014, the Prime Minister, David Cameron, had told the House of Commons, ‘The Government have made clear that abortion on the grounds of gender alone is illegal. The Chief Medical Officer wrote to all doctors on 22 November last year  reminding them of their responsibilities.’
The historic outcome of 4 November 2014 was that voting on the Bill produced a thumping majority of 180 in favour with 1 against – the latter was Glenda Jackson MP. Read all about it here: http://www.publications.parliament.uk/pa/cm201415/cmhansrd/cm141104/debtext/141104-0001.htm#14110444000001 This was the first Parliamentary win for the pro-life movement since the Abortion Act 1967 was enacted.
But there was also an important corollary to that vote that was not so obvious. If Parliament opposes sex-selection abortion, then it also opposes abortion per se. If unborn baby girls deserve protection from the abortionist’s scalpel then so too do baby boys. Moreover, if this is a matter of sex equality, then all unborn children have a right to be protected from harm and death. In other words, the Abortion (Sex-Selection) Bill recognises the humanity and value of the unborn – all of them.
The Second Reading of the Bill was expected to have taken place on 23 January, but to make progress it needed to be granted government time. This was deemed unlikely. Therefore Fiona Bruce allowed her Bill to be incorporated into Part 5, section 65 of the Serious Crime Bill (2014-2015) currently going through Parliament. At least 104 MPs signed in support of her amendment. It states, ‘Nothing in section 1 of the Abortion Act 1967 is to be interpreted as allowing a pregnancy to be terminated on the grounds of the sex of the unborn child.’ The amendment has two aims. First, it will clarify that sex-selective abortion is impermissible in UK law. Second, Clause 74(2) of the Bill would oblige the Government to think creatively about ways to help women who are under pressure to have sex-selective abortions. It is expected that on Monday 23 February the amendment will be debated and voted on. We await the outcome and hope that no tricks delay or scupper its approval.
And this is the outcome. During the evening of Monday 23 February, Fiona Bruce tabled New Clause 1 to the Serious Crime Bill. Its wording was exactly the same as her previous Bill. Some prior procedural skulduggery almost got it shunted to the end of proceedings, and maybe even out of time. But, no, its debate began at about 20.00. Mrs Bruce, supported by colleagues such as David Burrowes, Sir Edward Leigh, Dominic Grieve and Jim Shannon – but notably no women of note – presented her case to clarify the law both bravely and clearly. But the opposition, led by Ann Coffey, Sarah Wollaston and Fiona Mactaggart, had a plan. They had a counter-amendment, New Clause 25, which would require the collection and review of evidence of sex-selective abortion in England, Wales and Scotland. Incredulously, many still believe that sex-selective abortion is merely a myth. And pressure had been brought to bear on Labour MPs not only by the TUC but also by a letter from Shadow Cabinet members Yvette Cooper and Liz Kendall, urging them to vote against New Clause 1. Moreover, it was obvious that the phrase 'the unborn child' was causing considerable unrest among the pro-abortionist MPs – they would hate to confer 'personhood' or any such human attribute on the human foetus.
The last word in the debate was from Sir Edward Leigh, with typical robustness, he stated, 'If the whole House is agreed that it is morally repugnant to destroy a foetus simply on the basis of its gender - it is usually a girl - let us make that explicit in law.' At 21.00, the proposal was that New Clause 1 be read a Second time. The House divided and the vote was sadly Ayes 201, Noes 292. The full Hansard account is here: http://www.publications.parliament.uk/pa/cm201415/cmhansrd/cm150223/debtext/150223-0003.htm (scroll down). Whenever there is the merest whiff of any change to the colossus of the 1967 Abortion Act it is enough to put fear into too many MPs. Much later that evening, when the House voted on New Clause 25, the result was Ayes 491, Noes 2. It was a better-than-nothing vote. Now the Secretary of State must be held to account to ensure that the evidence is collected and reported. And which doctors will confess and supply that evidence? And which women will admit to having such abortions? And how half-hearted will the Government investigations be? In the meantime, the law remains unclear and open to several interpretations. This cannot be good.
On 5 December 2014, Dr Prabha Sivaraman appeared at Manchester Magistrates' Court accused of offering an abortion based on an unborn child's gender. The case dates back to February 2012 when a sting, launched by the Daily Telegraph, uncovered several doctors operating outside the provisions of the Abortion Act 1967. Though the Prime Minister, David Cameron, announced the illegality of sex-selection abortions, the Crown Prosecution Service (CPS) decided not to prosecute. This Sivaraman case is now the result of a private prosecution launched by a pro-life campaigner, Aisling Hubert.
In December, the District Judge, Khalid Qureshi, chose to ‘send it up’. The case was therefore committed to Manchester Crown Court for a preliminary hearing on 6 February. On that date, lawyers for Aisling Hubert asked Judge Martin Steiger QC to issue a summons against the Daily Telegraph to provide the full video evidence so they can pursue the private prosecution before a jury. Lawyers for the newspaper opposed handing over the requested video. The Judge refused the summons application and said he will give his reasons in writing within 14 days. Moreover, there is now the fear that Dr Sivaraman's lawyers have asked the CPS to take over the case and then drop it.
In a similar case on 26 January, Dr Palaniappan Rajmohan, who worked at the infamous Calthorpe Clinic in Edgbaston, appeared at Birmingham Magistrates' Court and was instructed to appear at Birmingham Crown Court on 21 May.
The Glasgow midwives and
The story so far. Mary Doogan and Concepta Wood were two senior midwives employed by the Southern General Hospital in Glasgow as labour ward coordinators. Both had formally given notice, under Section 4 the Abortion Act 1967, that they had a conscientious objection to abortion.
This was no problem, because their ward dealt with births only. That is until 2007, when a reorganisation occurred and all abortions at the midwives' hospital were moved onto 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. In February 2012, at a judicial review at the Court of Session in Edinburgh, the judge, Lady Anne Smith, ruled against the women. She declared that, ‘… the nature of their duties …’ did not ‘… require them to provide treatment to terminate pregnancies directly’ and therefore the 1967 Act’s conscientious objection provision did not apply. In April 2012, the two women launched an appeal, which began in January 2013 before three judges in Edinburgh. In April 2013, the midwives won their seemingly landmark case. The judges stated that the midwives could refuse to delegate, supervise or support staff involved in abortions, that is, conscientious objection extends beyond direct involvement in abortion. The NHS Greater Glasgow and Clyde promptly declared that its health board would appeal the decision.
On 17 December 2014, came the bad news – the Supreme Court decided in favour of the hospital Trust. The Court ruled that, ‘the conscience clause does not cover’ the two midwives because it applies only to ‘direct participation in the treatment involved’ and not to ‘administrative and managerial tasks.’ In other words, the midwives were exempt from actually holding the curette, but they had to supervise the curette holdáer. This sounds too much like the specious arguments of innocence raised by the Nazi doctors at the Nuremburg trials – ‘I only devised the gas chambers, I didn’t release the gas.’ Where does participation and culpability begin and end?
But the Supreme Court went further. Justice Hale directed that all healthcare professionals with objections to abortion should now refer their patients, not just to another doctor, but to one whom they know is willing to authorise the procedure. Moreover, conscientious objection does henceforth not apply even to doctors asked to sign the forms authorising abortions.
The Glasgow midwives had always contended that their work on the labour ward involved very little contact with the abortions taking place there, and that their conscientious objection could have been accommodated with minimal effort. In effect the courts said, ‘No. No such accommodation will be tolerated. Freedom of conscience is not allowed. If you don’t like it, find another job.’ This is the pathway that leads to the ousting of doctors and nurses from the NHS who have a conscientious objection to abortion. Once that happens, the loss of such morally-sensitive healthcare workers will be immense and tragic.
The Doogan and Wood case had taken 7 years and, not surprisingly, the midwives commented, ‘We are both saddened and extremely disappointed with today’s verdict from the Supreme Court and can only imagine the subsequent detrimental consequences that will result from today’s decision on staff of conscience throughout the UK.’
Abortion in Ireland and
The issue of abortion for cases of foetal abnormality has been a recent hot topic in both jurisdictions. Clare Daly, an Independent Socialist member of the Dáil (TD), introduced a Private Members' Bill in early February. It was roundly defeated by 104 votes to 20. Before the vote the Irish Prime Minister, the Taoiseach, Enda Kenny informed the Dáil that the attorney general had advised that the Bill was unconstitutional.
Meanwhile, in Northern Ireland, the Justice Minister, David Ford has similarly proposed legalising abortion for cases of serious foetal abnormality. The Abortion Act 1967 does not apply to the Province and abortion is allowed there only if there is a direct threat to the life of the mother or a risk of permanent or serious damage to her mental or physical health.
Debate about widening the law to include rape, incest and fatal abnormality has been ongoing and in October 2014 the Department of Justice launched a public consultation, which closed in January. It focused on the issue of foetal abnormality. The Northern Ireland Human Rights Commission (NIHRC) considered this was too narrow. In early February, a judge at the High Court in Belfast, Mr Justice Treacy, granted the NIHRC a three-day judicial review in mid-June to examine if the current and proposed law breaches the European Convention on Human Rights.
Abortion in Italy, Spain
Italian abortionists have recently warned that the procedure may become all but impossible within the next five to ten years, as the current generation of pro-choice practitioners retires and the proportion of pro-life supporters rises. According to the campaign group Laiga, in some regions of Italy the proportion of doctors who refuse to perform abortions in the first 90 days of pregnancy has reached ‘shocking levels’.
On a Saturday in late November, Madrid witnessed a demonstration demanding that the Spanish government live up to its election promise to enact legislation to protect the unborn. According to the organizers, there were 1,400,000 people on the streets – according to the police there were 60,000. Whatever the crowd numbers, there was no denying that they wanted a reversal of the previous Zapatero government’s law which allows abortion-on-demand up to 14 weeks.
In October, a judge in Poland banned two pro-life demonstrators from saying that abortions performed at the Pro-Familia hospital in Rzeszwa are ‘killing’ babies. According to the Hospital, ‘pregnancy terminations cannot be called killing unborn children.’ The court verdict has stunned many Poles. The Polish Constitution clearly states that human life begins at conception. So, you may ask, ‘What exactly does an abortion do if it does not end the life of, that is, kill, an unborn child?’
Assisted Reproductive Technologies
What’s trending in IVF?
In December 2014, the Human Fertilisation and Embryology Authority (HFEA) published its latest report, Fertility treatment in 2013: trends and figures. It covers treatment cycles and their outcomes started in 2012 and 2013 and can be read at http://www.hfea.gov.uk/docs/FertilityTreatment2012TrendsFigures.PDF Warning – these data may cause mild, or even severe, discombobulation!
Overall, 49,636 women had a total of 64,600 cycles of IVF in the UK’s 78 clinics during 2013. Success rates remained constant, as they have for several years, at around 25%. A total of 14,062 pregnancies were reported as a result of IVF treatments started in 2013 and 13,839 babies were actually born. In 2012, 2.2% of all babies born in the UK were conceived as a result of IVF treatment – in 1992 and 2002, that figure was 0.3% and 1.4% respectively. In the UK between 1991 and 2012, a total of 221,555 babies have been born following IVF treatment.
Multiple pregnancies are still troublesome, accounting for 16.5% of IVF cycles, as opposed to the natural rate of twinning of about 1%. The average age of women using IVF remains static at 35 and the average length of time patients reported trying to conceive before seeking IVF was 4.5 years.
A 41.3% minority of IVF treatment cycles were funded by the NHS – the 58.7% majority were privately funded. About half (52.6%) of IVF treatments in 2013 involved ICSI (intracytoplasmic sperm injection). Around 5% of all IVF cycles used donated ova, though for women over 45, around 60% of their treatment cycles used donor ova. About 5.5% of all cycles used donated sperm. Only 807 cycles were so-called ‘natural IVF’, where no superovulatory drugs were used.
A total of 85,767 embryos were transferred during the course of fertility treatments in 2013. Of these, 65,810 were fresh embryos and 18,780 were thawed embryos which had previously been stored frozen – presumably the 1,177 shortfall can be accounted for by donated embryos. PGD (preimplantation genetic diagnosis) was performed during 533 cycles with 422 patients – they resulted in 137 live births.
Two significant trends are emerging. First, the medically-dangerous multiple births have continued to decrease, from 18.8% of treatment cycles in 2012 to 16.5% in 2013. Second, the number of IVF treatment cycles involving same-sex female couples has increased by nearly 20% year-on-year, rising from 766 treatments in 2011 to 902 in 2012, which resulted in 268 live births.
This issue is of great bioethical moment, and the world was waiting to see which way the UK government would jump. Would it ignore the warnings that the methodology is largely untested in animals and humans and therefore of unknown safety? Would it instinctively approve the techniques because it wants to be at the forefront of global medical research? Would it hesitate and agree not to cross the bioethical Rubicon by refusing to permit such germline gene therapy? Would it intensify efforts to develop proper methods of treating patients with mitochondrial diseases rather than the proposed ‘search and destroy’ tactics? Would it re-examine the results of several consultations and heed the public’s clear disapproval of mitochondrial donation?
The experts disagreed. Professor Lovell-Badge, an authority on embryology and stem cells at the Medical Research Council’s National Institute for Medical Research, London and Professor Braude, an expert on genetic testing and IVF at King’s College London, say, ‘The risk of treatment must be balanced against the certainty of adverse outcome without.’ On the other hand, Evan Snyder, who chairs a scientific panel advising the US Food and Drug Administration on mitochondrial transfer, warns that further research on safety needs to be done before clinical trials could begin in America – which could take between two and five more years.
Following the government’s announcement that it intended to place Regulations before Parliament to allow ‘three-parent’ IVF, there was, on 22 October, a final one-off evidence session to examine the science and proposed control of mitochondrial donation. The outcome of that meeting of the House of Commons’ Science and Technology Committee was that it urged the government to proceed. On 17 December, The Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015 were laid. This Statutory Instrument was discussed at the Secondary Legislation Scrutiny Committee’s meeting on 20 January. In the meantime, the Department of Health confirmed that the Parliamentary debate was likely to take place within the next few weeks and almost certainly ahead of the general election in May.
And that is how it transpired. The fear was that the necessary approval would be granted by a small committee of ‘experts’. But on 29 January, the government agreed that such a landmark decision should be debated in Parliament. And that debate in the House of Commons began at 14.00 on Tuesday 3 February. And it was timetabled for just 90 minutes! Someone pointed out that Parliament had previously spent 90 hours debating fox hunting. Allowing just an hour and a half to discuss such a significant piece of legislation, which would permit germline genetic modification, was a scandal. The debate was terribly rushed as can be sensed from the record in Hansard at: http://www.publications.parliament.uk/pa/cm201415/cmhansrd/cm150203/debtext/150203-0002.htm#15020348000001 Moreover, the debate was misguided. It concentrated too much on safety aspects, which are inevitably uncertain with all new medical procedures, and too little on the crucial germline nature of the proposals. At 15.34 the division was called and at 15.45 the voting was announced – 382 Ayes vs. 128 Noes. And that was that. The House of Lords now has its say on 24 February and then the HFEA must decide whether or not to issue licences to allow mitochondrial donation. I will eat my hat if it refuses any such applications.
On Tuesday 24 February, from 14.23 onwards, the House of Lords debated a Motion to approve the Bill. But first there was an amendment to the Motion from Lord Deben, the former MP John Gummer. He proposed that a joint committee of both Houses be set up to examine the Regulations. He opened his speech, 'My Lords, first, I have to say that I am in favour of mitochondrial donation. I am not opposed to it in principle.' In other words, his amendment he wanted more time to look at the safety, legality and definitions of the Regulations. It was a decent try, and it was ably supported by Lord David Alton, Baroness Scotland and a few others, but the House was in no mood to delay getting mitochondrial donation onto the Statute book. And so it was - at 20.16 the House divided and and the amendment was disagreed, Contents 48, Not-Contents 280. The full record can be read at: http://www.publications.parliament.uk/pa/ld201415/ldhansrd/text/150224-0001.htm (scroll down)
The UK thus became the first country in the world to approve such germline genetic modification. We are now set to become the world's leading manufacturer of babies. The Lords' vote has been hailed as, 'wonderful news for patients and families' and 'a great day for UK science.' Yet no one with a mitochondrial disease will be cured and this great scientific experiment may proved to be a genetic disaster. The next move is that from March to August, the HFEA will develop and publish its licensing rules for 'three-parent' IVF. Then during the early summer, the research team at Newcastle will publish its final safety experiments as demanded by the HFEA. On 29 October, the Regulations come into force. From 24 November, clinics can apply to the HFEA for a licence. And by the end of 2015, the first attempt could take place, with the first baby possibly born in mid-2016. My hat is still available!
The UK’s first sperm bank
We are familiar with river banks, high street banks and blood banks, but a sperm bank? Yes, the first sperm bank in the UK opened in October 2014 at the Women’s Hospital, Birmingham.
Why? To reverse the shortage of donor sperm. Why? Because fertility clinics are increasingly having to rely on imported sperm, especially from the USA and Denmark – use of the latter has given rise to the growing phenomenon of ‘Viking babies’. Why? Because the number of newly registered UK sperm donors fell from 631 in 2012 to 586 in 2013. Why? Because from March 2005 sperm donors lost their anonymity. And because nowadays 10% of IVF cycles use donated ova or sperm. Why? Because 30% of IVF cycles that use donated gametes are for same-sex couples or single women – they have ova, but need donated sperm.
Commending the opening in Birmingham, Laura Witjens, the chief executive of the National Gamete Donor Trust said, ‘Sperm donors are very special men who are doing something they and their families can be exceptionally proud of. These are men who are doing something life-changing for themselves and for others. It's time to shout about how fantastic these guys are.’ Dr Allan Pacey, chairman of the British Fertility Society, also said, ‘We are importing as a nation more and more sperm from overseas, without being xenophobic it kind of just doesn't feel right, it's a problem that's not going away.’ Oh, the very joys of pragmatism – you can say anything, however outlandish, and still sound so bioethically honourable!
Stem-cell scientist resigns
Stem-cell technologies have two opposing features – they bring medical advances and they bring medical scandals. An example of the latter has now been concluded. Dr Haruko Obokata has, at last, resigned. In January 2014, she published two articles purporting to show that so-called stimulus-triggered acquisition of pluripotency (STAP) cells could be produced by simply dipping normal adult cells in acid for 30 minutes. It was initially hailed as a game-changer. It was finally condemned as a sham.
In April 2014, her employer, the RIKEN Center for Developmental Biology (CDB) in Kobe, Japan, found her guilty of misconduct. In July, the papers were retracted by Nature. She was then given time to repeat her results. She failed. In December, in her resignation announcement, Dr Obokata said, ‘I worked hard for three months to show significant results, but I'm so exhausted now and extremely puzzled. I even can't find the words for an apology.’ All science depends upon rugged truthfulness, not wishful dreaming. The Obokata affair is over, but the additional stain on stem-cell technologies remains.
Holoclar – the first
For the first time ever a stem-cell therapy has been conditionally approved for widespread medical use throughout the EU. The treatment is marketed as Holoclar, which is described as an ‘ex-vivo expanded autologous human corneal epithelial cells containing stem cells.’ It is intended to treat some eye conditions that can lead to blindness. The European Medicines Agency (EMA) said the approval represented, ‘a major step forward in delivering new and innovative medicines to patients.’
The medicine is based on the groundbreaking work of Graziella Pellegrini and colleagues at the University of Modena, which was published in the New England Journal of Medicine (2012, 363:147-155). They showed remarkable, almost 80%, improvements in the eyesight of patients with eye burns or infections by simply transferring limbal stem cells from their good eyes to their bad eyes. The work represents one of the longest – up to 10 years – monitored clinical trials which uses adult stem cells. I am especially pleased at this news because I have favourably referenced Pellegrini’s work in many talks and on p.127 of my Bioethical Issues book.
Holoclar has been developed by the Italian pharmaceutical company Chiesi Farmaceutici S.p.A. T here are now some additional regulatory hurdles to jump before NICE can decide whether to approve this therapy for use by the NHS. But already the Moorfields Eye Hospital in London has successfully treated around 20 people with Holoclar.
Patents for human embryos
Way back in October 2011, the European Court of Justice (ECJ), in the case of Oliver Brüstle v Greenpeace eV, defined human embryos as anything capable of commencing the process of development of a human being. This, it said, covered ‘any non-fertilised human ovum whose division and further development have been stimulated by parthenogenesis.’ Thus, the ECJ declared that any stem-cell production methods, which require the destruction of human embryos, or are based upon the use of human embryos, are not patentable. The ruling was specifically aimed at those, including Oliver Brüstle from the University of Büonn, who destroy human embryos in the course of producing embryonic stem cells.
On 18 December 2015, the ECJ backtracked on, or perhaps refined, or even nuanced, its 2011 ruling. Now the ECJ has cleared the way for patents of products derived from human parthenotes for industrial and commercial purposes. For example, a new class of human embryonic stem cells, called human parthenogenetic stem cells (hpSCs) can be made from unfertilized ova and can now be patented. Why? Because, according to the ECJ, parthenotes lack the inherent capacity to develop into human beings. The hpSCs are created by chemically stimulating human ova to begin cell division. The ova are technically not fertilized and therefore no viable human embryos are created or destroyed. Parthenotes – from the Greek for virgin and birth – are cells that are created by this process of asexual reproduction, known as parthenogenesis, to divide and grow like fertilised ova, although they cannot develop properly.
This U-turn by the ECJ occurred after International Stem Cell Corporation (ISCO), a biotechnology company based in Carlsbad, California, challenged the 2011 ruling when its UK application for two patents was rejected by the UK Intellectual Property Office (UK IPO) on the basis that they involved human embryos. The UK High Court referred the case to the ECJ. The intended patents covered methods for generating corneal tissue from embryonic stem cells made from human ova by parthenogenesis. The ISCO’s legal challenge was based on the fact that since human parthenotes contain only a single set of DNA, they are technically unable to develop into human beings and should therefore not be considered to be 'human embryos'. In December, the ECJ agreed. It stated that ‘the mere fact that that organism [a parthenogenetically-activated human ovum] commences a process of development is not sufficient for it to be regarded as a ‘human embryo’, within the meaning and for the purposes of [Article 6(2) of] the [Biotech] Directive.’
Now the UK courts must decide whether the cells generated by ISCO qualify for patent protection. In other words, it is now for national courts to decide how to interpret the ECJ’s new ruling. Switzerland, for example, has already decided to exclude parthenotes from patentability.
But the EJC’s verdict may have far wider, far worse, implications. It could pave the way for other methods for creating embryonic stem cells, including somatic cell nuclear transfer (SCNT), aka human cloning, to become patentable. What next, embryonic stem cells from patented human embryos? Surely not!
The world’s first induced
pluripotent stem-cell trial
On 12 September 2014, Masayo Takahashi, an ophthalmologist at the RIKEN Center for Developmental Biology (CDB) in Kobe, Japan, watched as a surgeon transplanted a sheet of epithelial cells, that she had grown, into the back of a woman's damaged retina. Takahashi had made the retinal cells by transforming induced pluripotent stem (iPS) cells derived from the patient’s skin cells. This was the world’s first human clinical trial using such iPS cells.
For the past decade, Takahashi had been devising possible stem-cell therapies to repair retinal damage. In 2006, her work had been given a renewed impetus by the discovery of iPS cells by Shinya Yamanaka at Kyoto University. Their joint collaboration meant that she discovered how to convert iPS cells into sheets of retinal epithelial cells. She then tested these in mice and monkeys – they appeared to be safe. Now she was ready for the ultimate test, transplanting the cells into a human subject suffering from the common eye condition known as age-related macular degeneration (AMD).
The immediate operation was a success, but it will take another 12 months to determine if the overall therapy has been beneficial. The patient, a woman in her 70s, was already largely blind, so the trial will probably not restore her sight, but it should slow down further deterioration. Takahashi has a further six AMD patients waiting. These are exciting days for such pioneering regenerative medicine. If this little trial in Japan is successful, worldwide medicine will be changed.
Human gametes from iPS
As remarkable as iPS cells are in their properties and as alternatives to the bioethically-unacceptable use of embryonic stem cells, it was always the fear that someone, somewhere, would abuse them. It seems as though Israeli and UK researchers have recently set foot down that dreadful road.
In 2012, stem-cell biologist Mitinori Saitou of Kyoto University, Japan and her coworkers created the first artificial primordial germ cells (PGCs) using skin cells from adult mice and reprogramming them via iPS-cell technology. In the early weeks of normal embryo development, some embryonic stem cells differentiate into PGCs, which eventually become mature sperm or ova.
In a recent paper in Cell (online, 24 December 2014) entitled, ‘SOX17 Is a Critical Specifier of Human Primordial Germ Cell Fate’, Naoko Irie and colleagues at the University of Cambridge and the Weizmann Institute of Science demonstrated the creation of human PGCs in vitro. Starting with a person's skin cells, these were converted to iPS cells and then to PGCs. This work showed that a gene known as SOX17 was critical for directing human stem cells to become PGCs, by a process known as 'specification'. SOX17 was not required in Saitou’s earlier mouse model.
The next logical step would be to introduce the engineered PGCs into human testes or ovaries, to prove that they are capable of developing into fully-functional sperm or ova. That step has not yet been undertaken in mice. And so far, these researchers say they are ‘not ready to take that plunge’ in humans. Not only would there be too many scientific unknowns but it would be hugely controversial and, if not entirely banned, hopefully, it would be subject to stringent regulatory considerations.
Yet this current work is seen by some as a valuable step towards infertility treatment enabling sterile men and women, maybe as a result of chemotherapy or premature menopause, to conceive. In principle, the process could also allow the production of ova from a man’s skin cells. Using IVF, these could be fertilized by another man's sperm and the resulting embryo could be transferred to a surrogate mother – thus two man could have a child genetically their own. It would be trickier for two women to have a biological child together because only men have the Y chromosome, which is essential for the production of sperm cells. I do not wish to crow about such matters, but I have already foreseen this sort of dystopia on p. 98 of my Bioethical Issues book.
Euthanasia and Assisted Suicide
Assisted Dying Bill
Here is the Bill’s progress so far in the House of Lords. First reading, 5 June 2014. Second reading, 18 July. Committee stage, first sitting, 7 November 2014. Committee stage, second sitting, 17 January 2015. As a reminder, the Bill seeks to legalise assisted suicide for mentally-competent, terminally-ill adults with less than six months to live, subject to approval by two doctors.
The First reading of any Bill is, by tradition, a simple recitation with no debate. At the Second reading on 18 July, the Bill was debated with 126 speakers taking part for 9 hours and 37 minutes. In the end no vote was taken and the Bill was given an unopposed passage to the Committee stage. At that time the House was under considerable pressure from the Supreme Court. On 25 June 2014, campaigners for the right to die had lost their appeal in the Nicklinson-Lamb case. However, a majority of the nine Supreme Court justices had stated that the questions they were being asked involved moral judgements rather than points of law and the matter should therefore be addressed by a democratically-elected Parliament, not the courts. Members of the House of Lords were cognisant of that edict, even though neither Nicklinson nor Lamb was terminally ill. The strategy of the Bill’s opponents was that no votes should be taken at this stage and that its flaws could be readily exposed in Committee. Nevertheless, the Bill was given an unopposed Second reading, meaning that it was not rejected in principle, but as spin-doctors would say, the Bill was ‘accepted in principle' – that was a most dangerous presumption.
On Friday 7 November, the Bill began its Committee stage in the House of Lords. This is the line-by-line consideration of amendments and there were 174 of them, tabled and organised into some 40 groupings. The primary issue before the House was one of safeguards, even though so-called ‘strict guidelines’ are bioethical and practical nonsense. Was it sufficient that two doctors should oversee the eligibility of the suicidal patient? In the end, a compromise was struck so that a judge from the Family Division of the High Court, rather than a doctor, must ensure that each person’s declaration to end his or her life was ‘clear and settled’, not coerced, and that all other criteria were met before permitting the assisted suicide to proceed.
There is a convention in the House of Lords that no votes are taken on amendments until the Report stage. However, Lord Pannick, rather impudently, pressed for a vote. Opponents of the Bill simply abstained, and although no vote was officially recorded, much of the media reported it as an ‘accepted amendment’. This might appear to be only a minor victory for the Bill’s supporters. I think it represents a dangerous landmark point-of-no-return. Whatever the outcome of this particular Bill, any future proposed legislation could return to this point in the debate and use it as an accepted launch pad. As Sarah Wootton, the chief executive of Dignity in Dying, the pro-euthanasia campaign group, expressed it, ‘We are fast approaching tipping point on the issue of assisted dying. It is now a question of how, not if, we change the law.’
The Committee stage, second sitting took place on 17 January. Several issues were debated. Amendment 12B concerned the title of the Bill – was it to be Assisted Dying or Assisted Suicide? Which was more truthful? Despite sound arguments that the Bill would alter the Suicide Act 1961 and the definition of suicide from the Oxford English Dictionary is ‘the intentional killing of oneself’, the amendment was lost. Lexical engineering won the day and the amorphous euphemism ‘Assisted Dying’ was retained by 179 votes to 106. [One peer voted in both lobbies!]. Next time it might even be called The Dignicide Bill.
The other major issue discussed was the type of overseeing doctors. Should they be registered or licensed? The substantive amendment 13 was that ‘at least two registered medical practitioners, with one of whom the person has been registered for medical care for at least six months immediately prior to making the declaration’. This amendment was lost 61 votes to 119. So any old pro-euthanasia doctor will do, as long as he, or she, is enrolled as a member of a registered death squad. The Bill is beginning to look seriously half-baked, but also doubly dangerous. And there is a huge twofold irony here – first, the UK long ago repealed the death penalty, and second, doctors have recently been instructed to redouble their efforts to stop patients committing suicide.
A further day of Committee debate is yet to be scheduled. There is now very little time for the Bill to complete the Committee stages in the House of Lords. And it seems most unlikely that it will even enter the House of Commons. Moreover, Parliament is to be dissolved on 30 March. The upshot is that this Bill will fall. But make no mistake – a similar Bill will be back at Westminster later this year. And that Bill will include the ‘agreed amendments’ of Falconer’s. It will therefore be even harder to defeat.
Assisted suicide in
the Welsh Assembly
On 10 December, the National Assembly of Wales debated the principles of Lord Falconer’s Assisted Dying Bill. It was a decent and informed discussion. Thankfully, the motion was defeated by 21 votes against, 12 for, with 20 abstentions. That certainly sent the right and robust message to Westminster, namely, that Wales does not want assisted suicide to be legalised.
Suicide (Scotland) Bill
This Bill was introduced into the Scottish Parliament in November 2013 by the late Margo MacDonald MSP. It is now being steered by Patrick Harvie MSP, as the ‘member in charge’. The Bill sets out, inter alia, the credentials and duties of what it calls ‘licensed facilitators’, non-medically qualified members of a death team. The Bill is currently being scrutinised by the nine MSPs on the Health and Sport Committee at Holyrood. The first Committee hearings of oral evidence from various individuals and organisations began on 13 January. Evidence from Care Not Killing and CARE for Scotland was heard on 3 February.
Suicide in the Isle of Man
On 3 February, members of the House of Keys, the Lower House of the Tynwald – the Manx Parliament – firmly rejected a Bill calling for the legalisation of assisted suicide by 17 votes to 5. The issue has been raised several times before on the Island. This current defeat is doubly reassuring for me because in 2011, I spent several days there speaking in the Tynwald, churches, schools and other meeting places. The Manx people have spoken!
Surveys of doctors on
In November 2014, the Royal College of Physicians (RCP) published the results of a recent survey of its fellows and members. It asked four questions, somewhat abbreviated here, with the results from approximately 6,700 doctors.
First, do you support a change in the law on assisted suicide? Yes, 32.3%. Yes, but not by doctors, 10.2%. No, 57.5%.
Second, a change in legislation is not needed. Do you agree? Yes, 62.5%. No, 37.5%.
Third, what should the College’s position be on assisted dying? I n favour, 24.6%. Opposed, 44.4%. Neutral/no stance, 31.0%.
Fourth, would you personally be prepared to participate actively in assisted dying? In favour 21.4%. Opposed, 58.4%. Neutral 20.1%.
As a consequence, only a third of doctors support the provisions of Lord Falconer’s Bill. While there is still a 62.5% majority opposing a change in the law on assisted dying, there has been a 10.7% decrease in that percentage since the survey was last conducted by the RCP in 2006. Only 24.6% want the College to change its stance to favour assisted dying. And not many, 21.4% of respondents, would be prepared to participate in the dirty deed. The RCP has used these 2014 survey results to reaffirm its stance of opposition to assisted dying.
A smaller survey by the Association for Palliative Medicine (APM) of its members was published in January 2015. The results showed that a majority of respondents (82%) do not support a change in the law on assisted suicide. A total of 85% of palliative physicians who are members of the RCP opposed any change in the law and 92% opposed physician-assisted suicide. Only 4% of APM doctors would be willing to participate actively if physician-assisted suicide were to be made legal under the current provisions of the Falconer Bill. APM President, Dr David Brooks, Macmillan consultant in palliative medicine, stated, ‘These results give a clear message to legislators. Those who care for terminally ill people day-in day-out believe society should be supporting people at this time in their lives, not putting them at risk. They also make clear that if society does want to legalise assisting suicide, this should not be part of medical practice. People need to be confident that the doctor is there to care for them whatever happens, not to kill them.’
It should also be noted that the current position of the British Medical Association (BMA) is that of ‘opposing all forms of assisted suicide and euthanasia’. The BMA 'supports the provision of high quality person-centred palliative care for those individuals facing the effects of terminal illnesses and conditions.' A spokesman has recently declared that the BMA, ‘is concerned that giving them [patients] a legal right to end their lives with physician assistance, even where that assistance is limited to assessment, verification and prescribing, could alter the ethos within which medical care is provided.’
Jane, the widow of the right-to-die campaigner Tony Nicklinson, is taking his fight to the European Court of Human Rights. She has submitted an application in her own right and on behalf of her late husband arguing that the UK violated their human rights because the Supreme Court has ducked the issue of assisted suicide.
Saimo Chahal, Mrs Nicklinson’s lawyer, maintains that the Supreme Court’s decision in June 2014 failed to declare that the Suicide Act 1961 was incompatible with human rights. Moreover, Lord Neuberger, president of the Supreme Court, had on that occasion stated that if Parliament did not give serious consideration to legalising assisted suicide, there was a ‘real prospect’ that a future legal challenge would succeed. Therefore, claims Chahal, the Supreme Court has breached the Nicklinsons’ human rights under Article 8 of the European Convention on Human Rights by refusing to decide on the compatibility of the existing law on assisted suicide. Instead, the Court referred the matter to Parliament.
Euthanasia and organ
It is not a new concept, but it has emerged again. Already the practice is fairly common in Belgium and the Netherlands. A patient requests assisted suicide or euthanasia and instead of wasting decent, life-giving organs, they are harvested at a time and place convenient for both medical teams – the euthanasiasts and the transplant surgeons. Now David Shaw, a bioethicist at the University of Basel, is suggesting the same procedure could be usefully employed in Switzerland. What is more troubling, for us UK residents, is that Dr Shaw serves on the UK Donation Ethics Committee (UKDEC).
But surely this proposal must be regarded as a splendid idea – a double-whammy procedure. And after all, it will help vulnerable, despairing suicidal people to believe that their premature deaths are serving as a departing gift to humanity, indeed, that their deaths have greater value than their lives. Don’t you think so?
I almost died laughing
This is hard to believe. Dr Philip Nitschke, Australia’s Dr Death, is the man who spends most of his time promoting euthanasia in Australia and around the world. Last year, a Perth man, Nigel Brayley, contacted Nitschke for details about committing suicide – Nitschke obliged and the man later killed himself. As a consequence, in July, the Medical Board of Australia suspended him and in January 2015 it rejected his appeal and deregistered Nitschke as a doctor. Now Dr – or rather Mr – Nitschke plans a new career as a comic. He is scheduled to appear as a stand-up comedian at the Edinburgh Fringe Festival in August. That is definitely NOT funny.
USA and Elsewhere
Roe v Wade 42 years on
Thursday 22 January 2015 was the 42nd anniversary of the landmark US Supreme Court’s decision that established abortion as a constitutional right for women – forty-two years of legalized abortion has led to 57 million US abortions. The sad event is marked each year in Washington DC (and other cities) by the March for Life, when some 300,000 pro-life Americans brave the usually cold weather and rally at the steps of the US Supreme Court. They call it ‘The largest human rights march in the world’ or ‘The largest pro-life event in the world.’
As an extra tribute on that day, Republican leaders had planned to vote on a federal 20-week abortion ban, known as the Pain Capable Unborn Child Protection Act, in the House of Representatives. The Act would establish a national, US-wide ban on all abortions after 20 weeks on the basis that such a measure would prevent foetal pain.
President Obama has threatened to veto the Act. He has said it, ‘shows contempt for women's health and rights, the role doctors play in their patients' health care decisions, and the Constitution.’ But it might never get to his desk because of the unknown voting intentions of several Senators. Even so, polls show that a 60% majority of Americans support the late-term ban, which includes exceptions for rape, incest and life of the mother. And as many as eight possible Republican candidates for the 2016 presidential election also support the Act. One pro-life leader has said, ‘It is time to move the United States off the list of only seven countries to allow abortion on demand beyond this point.’ If it were passed, the Act would save the lives of about 18,000 unborn children each year.
However, none of this expected political activity in the House of Representatives happened. The day before the March for Life, the House Republican leadership decided to pull the Pain Capable Unborn Child Protection Act because of arguments over its rape exception and other related provisions. Instead, the House considered the No Taxpayer Funding for Abortion Act and the Abortion Insurance Full Disclosure Act of 2015, which would prevent all federal funding of abortions, except in the case of rape, incest and to save the life of the mother. This late volte-face did not please many pro-life supporters – they regarded it as moral cowardice or worse. But the politicians defended their action and insisted that both Acts would eventually come before the House. It is also fairly clear that the President will veto both Acts. But that’s politics, US-style.
Yet all was not lost. The No Taxpayer Funding for Abortion Act was passed, 242 Yeas and 179 Nays with 12 Abstentions. However, its compass is not great. It seeks to end the coverage of abortion services by private insurance companies – it would make it illegal for women to use federal tax credits and other government subsidies, namely taxpayer’s money, to purchase private insurance for abortion. Obama will not like that. Then on 28 January, the House agenda for February was released – where was the promised Pain Capable Unborn Child Protection Act? Not listed. Obama will like that.
Pro-life activity in the
Something significant occurred in the USA on 4 November 2014. As a result of the mid-term elections, Republicans took control of the US Senate. It gave the party control of both chambers of Congress for the first time in eight years. As a rule of thumb, Republicans are more pro-life than their Democratic counterparts. And all this while a Democrat president lives in the White House.
Apparently, pro-abortion leaders in the USA are becoming more and more anxious – 2014 has been a bad year for them. According to a January 2015 report from the influential pro-abortion think-tank, the Guttmacher Institute, ‘During the 2014 state legislative session, lawmakers introduced 341 provisions aimed at restricting access to abortion. By the end of the year, 15 states had enacted 26 new abortion restrictions. Including these new provisions, states have adopted 231 new abortion restrictions since the 2010 midterm elections swept abortion opponents into power in state capitals across the country.’
Indeed, across the country, more abortion clinics are closing and more pro-life legislation is being enacted. The pro-life movement is gaining ground. According to the Guttmacher Institute, in 2000, 13 states had abortion restrictions making them, in the Institute’s words, ‘hostile to abortion rights’. By 2010, 22 states were considered ‘hostile’ and by 2014, 27 states were so called. Additional evidence of this growing pro-life trend comes from Rev Harry Knox, the leader of the Religious Coalition for Reproductive Choice, who, on 15 December, wrote, ‘If 2014 was a rough year for reproductive justice, 2015 is shaping up to be even worse.’
Let us keep a sense of proportion – abortion is declining, but it is not stopping in the USA. During 2012, there were still an estimated 1.04 million abortions across the Land of the Free. And according to the latest annual report of Planned Parenthood, ‘America’s most trusted provider of reproductive health care’, it alone performed 327,653 abortions and received more than $528 million in tax dollars during the year 2013-2014. Abortion is still big business, numerically and financially. Nevertheless, several trends are looking pretty hunky-dory.
Canada legalises assisted
Canada is a most strange land. This is not only because of its reputation as ‘the world's most boring country’. It is also strange, bioethically. For example, it has no criminal law restricting abortion. And it was the first non-European country to legalise same-sex ‘marriage’. Now it has decriminalised assisted suicide.
On Friday 6 February 2015, the nine judges of the Supreme Court of Canada unanimously ruled that prohibiting assisted suicide is unconstitutional and a violation of the country’s Charter of Rights and Freedoms. The issue has been gathering force for years. In 2011, a report from the Royal Society of Canada strongly recommended the legalisation of assisted suicide. In June 2014, Quebec passed legislation allowing it. In August 2014, the Canadian Medical Association voted to stop opposing it.
The legal story really starts in April 2011, when the British Columbia Civil Liberties Association (BCCLA) challenged laws that prohibited assisted suicide. On 29 June 2011, Gloria Taylor filed an application to be a plaintiff in the BCCLA’s case. Taylor was a Canadian advocate of assisted suicide and she suffered from amyotrophic lateral sclerosis (ALS). The lawsuit, with several co-plaintiffs including the family of Kay Carter, a woman suffering from spinal degeneration, became known as Carter vs. Canada. It sought permission for incurably-ill, mentally-competent adults to receive medical assistance to hasten their deaths. In June 2012, the BC Supreme Court ruled that the right to die was protected by the Charter of Rights and Freedoms and it granted Taylor a personal exemption so that a doctor could assist her to die. She died on 4 October 2012, not as a result of assisted suicide, but from an infected perforated colon. Meanwhile, the Canadian federal government had appealed the BC Supreme Court decision, which was overturned by a two-to-one verdict in the British Columbia Court of Appeal in October 2013. The BCCLA then filed an appeal to the Supreme Court of Canada.
On 15 October 2014, the BCCLA took its case to the Supreme Court. And on 6 February 2015, the Court delivered its judgement and affirmed that Canadians have the constitutional right to dignity and self-determination at the end of life, otherwise known as doctor-assisted suicide.
Thus Canada has joined the select club of Holland, Belgium, Switzerland and a few other jurisdictions which permit assisted suicide. However, the Canadian Court ruling is particularly vague and will inevitably be open to challenge and abuse. The Court has given Parliament 12 months to draft an appropriate law.
Margaret Somerville, professor of law at McGill University and one of Canada’s leading bioethicists, assessed the new ruling, ‘Canada has fallen over the edge of the abyss in legalizing the intentional infliction of death on our most vulnerable citizens – those who are old, frail, disabled, depressed, mentally, physically, or terminally ill.’ She continued, ‘This is not an incremental change, but a seismic shift in one of our most important foundational values – respect for human life at both the individual and societal levels.’ And, ‘I believe that future generations will look back on this decision, in the light of its future consequences, as the most important, harmful and regrettable ethical, legal and public-policy decisions of the 21st century.’
sedation’ in France
France has long possessed an ambiguous euthanasia law. At the end of 2014, the French president, FranÃ§ois Hollande, approved a report recommending that terminally-ill patients should have a right to ‘deep continuous sedation’ – that document is expected to be submitted to the French Parliament in early 2015.
The report stops short of recommending euthanasia but instead advocates administering sufficient sedatives and painkillers to ensure that the patient loses consciousness up to the time of death. This is often called ‘slow euthanasia’. It is not even ‘heavy sedation’ that is medically legitimate in some cases of intractable pain or excessive restlessness. This is the sort of ‘deep continuous sedation’ commonly practised in the Netherlands and Belgium, where it is used to fudge the figures in order to show a decrease in the number of cases of ‘real’ euthanasia.
Abortion in France
In December 2014, a resolution proclaiming abortion to be a ‘fundamental right’ was adopted by a large majority in the French National Assembly. Only 151 members of the Assembly were present out of the total of 577 deputies. Perhaps the absentees were too embarrassed to share their views on national TV. Unsurprisingly the vote was overwhelmingly in favour – 143 for and just 7 against.
Such an Assembly resolution has no legal force, but it sends a strong signal to bureaucrats, judges, doctors and the people. The original French abortion law, or ‘loi Veil’ as it is known after its promoter of 1974, Simone Veil, has, over the years, been amended so that abortions are now performed on request up to 12 weeks of gestation and, from Easter 2014, they have been fully funded by the government and there are tough penalties for anyone who hinders a woman, physically or psychologically, from accessing an abortion. In other words, abortions, or as they are called in France ‘voluntary interruptions of pregnancy’, have effectively been a right for women for years. And about 220,000 French women avail themselves of that right each year.
The MAP in Poland and
In November, the European Medical Authority (EMA) recommended that all member states should allow women throughout the European Union (EU) to obtain the morning-after pill (MAP) over the counter, without a prescription. Early in January 2015, the European Commission issued its so-called Implementing Decision. These new guidelines will gently try to cajole five countries to conform. Italy may resist, Germany is not keen and Hungary has already ignored the directive, ensuring that the MAP remains prescription only. These countries are concerned not only about the MAP’s abortifacient action, but also the prospect of a lack of any medical consultation with potential users.
One of those other countries is Poland. Poland is sometimes regarded as one of the last bastions of rugged pro-life legislation in Europe. Abortion is illegal there and the Polish Constitution states that human life begins at conception.
Now, following this EU ruling, Poles may be able to buy the EllaOne version of the MAP over the counter, with no prescription. The decision has polarised the country. The Polish Federation for Women and Family Planning stated, ‘We do not want to be a bargaining chip on the political and ideological stage. Access to contraception is our right.’ And Stanislaw Wawrzeszak, the chaplain of the national health care association, declared, ‘The availability of the so-called morning-after pill for sale without a prescription is an ideological action. It takes away people’s responsibility for procreation.’
Which way will Poland go? As Anna Zalewska MP noted, the European Commission directive was merely a ‘recommendation’ and it was up to the individual governments to decide. She continued, ‘I'm surprised that the Polish government and the [Health] Ministry want to thoughtlessly submit to this decision.’
Nobody in the UK should be surprised by this European bioethical downgrade. The MAP was introduced into the UK in 2000, as a prescription-only drug. By 2001, it could be obtained over the counter by girls 16 years old and above. By 2004, it could be brought from pharmacies for about £25, or obtained free from NHS clinics. Now it is available via the Internet. Poland has long wanted to be a member of the EU – apparently that membership comes with a bioethical price.
Obituaries of Two Pro-Choice Campaigners
Tim Black, 1937 - 2014
In the mid-1960s, Dr Tim Black was a young doctor working in the jungles of Papua New Guinea. After successfully operating on a three-month-old baby he excitedly realised that he had just saved the boy’s life. He gave him back to his mother only to realise her anguish – here was another mouth to feed, with no father, no education and no future. It was a pivotal moment. Tim Black suddenly believed that it was as important to prevent a life as it was to save it.
He resolved to change his practice of medicine. In 1975, with the help of his wife and £3,000, he rescued the Marie Stopes Foundation (MSF) from bankruptcy and bought the lease of the famous clinic at 108 Whitfield Street, London, where the birth-control pioneer Marie Stopes had opened her Mothers’ Clinic in 1925. He transformed MSF into a money-making business selling contraception, pregnancy testing, vasectomies and abortion. His medicine became marketable. His patients became his customers. The Foundation became Marie Stopes International (MSI).
Dr Black was MSI’s CEO from 1976 until 2006. He moved the organisation away from the stuffy NHS and provided his services promptly and in a friendly, nurse-led environment. He never had a business plan. He hated group meetings. His management mantra was that, ‘the best committee is made up of two people – with one away sick.’
Today the business is worldwide and flourishing with over 600 clinics and programmes in 41 countries. In 2013, MSI reported an annual global income of £211.9m. Part of this was spent on contraception, in its own words, ‘averting 5.3 million unintended pregnancies’ and part on abortion, again in its own words ‘preventing 2.1 million pregnancies’. Around £14 million of its income came from UK NHS contracts. Thirty-three employees of MSI earned between £60,000 and £100,000, with the highest at £300,000. Above all, MSI has become a massive supplier of mass abortion.
Timothy Rueben Ladbroke Black was born in Sussex in 1937. In 1962, he qualified as a doctor at St George’s Hospital Medical School, London, and also married his childhood sweetheart, Jean. They set out combining global travel, adventure and a deep medical commitment to needy people, especially vulnerable women.
He was a forceful, irascible character who delighted in controversy, especially with his pro-life detractors. In 1979, his clinics introduced the abortifacient intrauterine device (IUD) in contravention of the 1967 Abortion Act. In 1997, he instituted the ‘lunchtime’ abortion for £285. He relaxed by sitting in a treehouse at his home. He worked from his garden shed rather than his central London HQ, except on Fridays when he visited there to perform vasectomies – it is reckoned that he completed the four-minute procedure 15,000 times and once live on TV. In 2004, he and one of his daughters, Julia, made a landmark documentary for Channel 4 entitled, My Foetus. It was the first time that an abortion had been shown on British TV.
He collapsed and died on 11 December just after completing one of his favourite walks through the woods near his house. To the end he was driven by his belief that, ‘Women don’t lease their bodies from the State or Church. They own them.’ Every businessman has a business slogan – Tim Black’s was ‘Children by choice, not chance.’ He thought that aborting millions of unborn children every year was a praiseworthy enterprise. He was wrong – it is entirely blameworthy.
Debbie Purdy, 1963 - 2014
Deborah Purdy was born, on her parents’ bedroom floor, in south London, the youngest of five children. She joined the Liberal Party as a teenager and left home to become a squatter with a stockbroker and a Buddhist. She tried studying humanities at Birmingham University, working for Yellow Pages in Edinburgh, selling jewellery in Oslo and learning to ski. Her nomadic lifestyle took her to Houston, Tokyo and Hong Kong before she returned to the UK in 1990 to nurse her dying mother.
In 1994, she was writing adventure travel brochures for a company in Singapore. It was there that she met her husband-to-be, Omar Puente, a Cuban-born violinist, who was playing with his band in the same city. They communicated badly in French, Spanish and English. At about that time she felt something was wrong with her health. While dancing it was as if she ‘was wearing trainers and they were sticking to chewing gum.’ She flew home briefly to the UK to see a neurologist who instantly diagnosed her, aged 31, with primary progressive multiple sclerosis.
For some time after her diagnosis she continued her wanderlust – she became the manager of Omar’s band, she bought a walking stick, she gave up tea and coffee, but her symptoms were gradually worsening and she had to buy a wheelchair. On one occasion, she managed the 10-hour flight back to the UK but promptly burst into tears when she was stranded at a railway station with no wheelchair exit.
Debbie and Omar married in 1998 at a ceremony that cost £110 and they settled in Bradford. They were poor – one Christmas her present was a song he had composed. She had previously been sterilised but managed to become pregnant by IVF, only to miscarry their baby after 11 weeks.
It was in 2001 that Diane Pretty, who had motor neurone disease, lost her long legal battle to win the right to die with the help of her husband, Brian. It caused Purdy to think about her own future. Her voice was going, so was her dexterity and she was now permanently confined to her wheelchair. In 2003, she heard about the Dignitas ‘clinic’ in Zurich and Lord Joffe’s Patient (Assisted Dying) Bill in the House of Lords. In 2005, she contacted the Voluntary Euthanasia Society (now called, Dignity in Dying) to ask for help. It supported her to initiate her own legal challenge.
The Suicide Act 1961 had made it a criminal offence for ‘A person who aids, abets, counsels or procures the suicide of another …’ If Omar helped her to go to Dignitas to commit suicide, would he be faced with prosecution and a possible 14-year prison sentence? ‘But I love him and, however remote the chance, I won’t let that happen’, was her response. So, in 2008, she challenged the government to clarify the circumstances under which an ‘assister’ would be prosecuted. At the High Court hearing in June 2008, her case failed. And in February 2009, it failed again in the Court of Appeal. In July 2009, her case was adjudicated at the House of Lords. The Law Lords agreed that the law was unclear and ordered Keir Starmer, the then Director of Public Prosecutions (DPP), to spell out the likely circumstances for prosecution.
The DPP duly published the mandated interim guidelines, a public consultation period ensued, and a final document, Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide, was released in February 2010. This consisted of sixteen ‘public interest factors’ likely to favour a prosecution, and six factors against taking any legal action. Keir Starmer stated, ‘The policy does not change the law on assisted suicide. It does not open the door for euthanasia. It does not override the will of Parliament.’ As a result, assisted suicide remained illegal. Every suspected assisted suicide would still be investigated. No one would be guaranteed immunity from prosecution. However, the new policy did state that, for example, a prosecution where ‘the suspect was wholly motivated by compassion’ is less likely to proceed than, say, when a doctor or other healthcare professional is involved. All this conveyed a subtle message – it tells people in advance that, if certain conditions are met, assisting in suicide can be legally acceptable, that is, you are not likely to be prosecuted.
That was a move in the wrong direction. And so assisted suicide has continued to slide down the slippery slope by, for example, the 17 October 2014 decision of the new DPP, Alison Saunders, that doctors and nurses will henceforth be less likely to be prosecuted for assisting, and by the pressure being exerted by Lord Falconer’s Assisted Dying Bill in the House of Lords. The fact is that Debbie Purdy did change the law on assisted suicide, just a little, but still too much.
From 2003, when she first heard about the Dignitas ‘clinic’, she began to become obsessed with assisted suicide. Her resolute wish was that she wanted to die, but not quite yet. Then in 2014, the news broke that she had become too poor and too disabled to make the trip to Switzerland. Instead, she booked into the Marie Curie Hospice in Bradford and eventually began deliberately refusing to eat. She died there on 23 December 2014, aged 51.
Debbie Purdy was an amazing woman in many ways – smiley, full of enthusiasm and wit. Perhaps strangely, I found her quite inspirational. What a pity she took the wrong path. I fear that, like many before and after her, she became a pawn of the euthanasia movement. Even so, it was palliative care that won the final argument. Her husband Omar could say after her death, ‘We would like to thank the Marie Curie Hospice in Bradford for the care the staff gave her, which allowed her last year to be as peaceful and dignified as she wished.’