50 years of abortion

Nearly 50 year ago, on Friday 27 October 1967, the 1967 Abortion Act received its royal assent.  The killing started six months later on Saturday 27 April 1968.  This year, 2017 is therefore the 50th anniversary, the golden anniversary, the semicentennial of the most cruel and perverse piece of legislation still on our Statute Book.  Under its precepts at least 8.6 million unborn lives have been snuffed out.  How will you be marking this woeful event?  ‘Righteousness exalts a nation, but sin condemns any people’ (Proverbs 14:34).

Abortion (Disability Equality) Bill [HL] 2016 -17

Lord Shinkwin's Bill seeks to remove section 1(1)d from the Abortion Act 1967, which shamefully permits abortion up to birth on the grounds of disability.  On 27 January, the Bill passed its committee stage in the House of Lords.  An amendment was added by Baroness Massey of Darwen, which she said, ‘Simply seeks a review of the impact of this Act on disabled children, their families and carers, and it talks about support services being appropriate.’  The Bill now moves on to the report stage – no date has yet been set.  Liz Sayce, CEO of Disability Rights UK, confirmed, ‘We are in support of this Bill and congratulate Lord Shinkwin on raising this issue.  The Bill is not about the rights and wrongs of abortion, fundamentally it is about equality.  Wherever Parliament sets the number of weeks after which abortion is not permitted, it should be exactly the same whether the pregnancy is likely to result in a disabled or a non-disabled child.  All lives are equal.’  If this Bill becomes law, what a cornucopia of joy it would be to mark the 50th anniversary.

Abortion law reform in the UK
Just eight days before the start of 2017, an editorial entitled Reforming abortion services in the UK: less hypocrisy, more acknowledgment of complexity appeared in the 23 December 2016 edition of the Journal of Family Planning and Reproductive Health Care.  It was written by its editor-in-chief, Sandy Goldbeck-Wood.  She is also clinical lead for abortion services at Cambridge University Hospitals.

Dr Goldbeck-Wood opines that, ‘Among many challenges women seeking abortion face, inequitable access, inadequate numbers of appropriately trained staff, stigmatisation, and a culture of exceptionalism, or ghettoization.’  And, ‘Problems of access and stigma, familiar worldwide, are compounded in the UK by an abortion law that is now widely seen as not fit for purpose.’  And, ’UK law is out of step with technical advances in safe medical abortion, the trend away from paternalism towards patient-centred and nurse-led services, and current UK social values.  Hence, while many women now attend our services in early pregnancy believing they have a right to make their own choice, as they would in most of Europe – British law still requires the identification of serious physical or mental health risk by two doctors not necessarily qualified in psychological disciplines, who may not know the woman personally.  There is broad consensus among practitioners that this is hypocritical and anachronistic.’

The article closes with, ‘And 2017 is an excellent time for practitioners to be challenging hypocrisy and exceptionalism in UK abortion care, and leading respectful debate centred on women's needs, with complexity acknowledged.’  The article should be seen as the opening pro-choice shot in ‘celebrating’ the 50th anniversary of the 1967 Abortion Act.

A spokeswoman for the charity Life responded to Goldbeck-Wood’s editorial, ‘We agree the law is not fit for purpose.  It needs to be stricter when it comes to the abortion industry with their eye on maximising profits.  In particular the wanton abuse of the mental health clause under which most abortions are performed needs to be addressed as a matter of urgency.’

The Moral Case for Abortion
This is the hollow title of a new book by Ann Furedi, CEO of BPAS, the UK's largest independent abortion provider.  Published in August 2016, it too is part of the 50th anniversary ‘celebrations’.  I have not read it, and at £19.99 I’m unlikely to.  Furthermore, because the blurb states that, ‘The author, a provider of abortion services in the UK, asserts that true respect for human life and true regard for individual conscience demand that we respect a woman’s right to decide, and that support for a woman’s right to a termination has moral foundations and ethical integrity’, I don’t think I need to.

The Marie Stopes continuing saga
In August 2016, inspectors from the Care Quality Commission (CQC), the NHS watchdog in England, raised some serious concerns about abortions being carried out by Marie Stopes International (MSI) clinics in England, especially in Norwich.  Initially, these concerns were related to governance, consent, training and safeguarding.  More specifically, the CQC noted that, for example, ‘there were no effective systems to monitor and manage risks’, ‘staff were not trained to recognise and respond to a deteriorating patient’, ‘bulk signing of HSA1 consent forms took place’ and ‘there were no effective systems in place for equipment maintenance’.  In addition, the CQC insisted, for example, that MSI must ‘review the practice of open storage of multiple surgical termination products in a single container’ and ‘amend policy and guideline to ensure good infection control practice’.

As a result of the above, on 19 August 2016, MSI Norwich voluntarily halted several of its abortion procedures, including the suspension of all surgical terminations at its Norwich Centre.  By 7 October, MSI had apparently responded to most of these serious patient safety concerns so that CQC lifted the restrictions on its termination of pregnancy services.  On 20 December 2016, the CQC published its full report – it amounted to a damning catalogue of errors.  The 30-page document [https://www.cqc.org.uk/sites/default/files/new_reports/AAAG0115.pdf] lists dozens and dozens of inadequate levels of training and standards in surgical safety, anaesthesia, reporting of incidents, life support and the safeguarding of those with learning difficulties.  MSI Norwich reads like an incompetent, third-world medical outfit.

In January 2017, the NHS in Norfolk announced that it had transferred its three-year contract for abortion and related services to the British Pregnancy Advisory Service (BPAS) instead of MSI.  It that an improvement?  Of course not!  Each and every abortion clinic is horrid.  There is a section (pp. 64 - 69) in my 2014 book, Bioethical Issues, that is entitled, Abortion Unregulated, Unlawful and Undercover? – I think MSI Norwich supports my contention.

UKIP and abortion
The UK Independence Party (UKIP) has a new leader.  He is Paul Nuttall.  And in a recent interview on LBC Radio he said he would want to cut the abortion limit by half, suggesting a new upper limit of 12 weeks, which is the same as proposed by the Health Secretary, Jeremy Hunt.  Nuttall said that scientific and medical advances meant children could now survive if born before the current limit of 24 weeks. 

He also declared that, ‘I've been pretty open about my views on abortion for many, many years.’  Indeed, in the past Nuttall has said there would be a referendum on changing abortion law if ‘enough people required it’ and if UKIP was in power.  Mr Nuttall has the opportunity to begin that long Parliamentary march because on 23 February he is UKIP’s candidate in the Stoke-on-Trent Central by-election.

Abortion law in Scotland
Currently, Scottish women who want an abortion beyond 18 to 20 weeks for non-medical reasons, such as a delay in realising they are pregnant, or due to a change in life circumstances, must travel to England for a termination, with NHS Scotland covering the cost of referrals.

However, last year abortion law was devolved to the Scottish Parliament at Holyrood.  It has since emerged that members of the Abortion Care Providers Group are pressing for, ‘a potential model for providing a termination service at up to 24 weeks.’  Although abortion is legal up to 24 weeks, these so-called late-stage abortions are carried out on the NHS in Scotland only for urgent medical reasons, such as a risk to the mother's life, or a fatal foetal condition.  It is thought that the non-availability of abortions later than 20 weeks for non-medical reasons is because medical staff in Scotland are reluctant to perform these late-stage terminations.  Moreover, there has been speculation that the Scottish Government might seek to reduce the upper legal limit to less than 24 weeks.

Abortion law in Northern Ireland
On 2 November 2016, the UK’s Supreme Court heard an appeal to allow women from Northern Ireland to access NHS-funded abortion.  The challenge was brought by a mother and daughter who travelled to England for the girl to have an abortion when she was aged 15.  Last year, the Court of Appeal ruled that there is no legal obligation on health services in England and Wales to provide publicly-funded abortions which would be unlawful within NI.  The complainants were subsequently granted permission to appeal to the Supreme Court.

The Supreme Court granted six pro-abortion organisations the right to intervene in the case – these included the British Pregnancy Advisory Service, the Family Planning Association and the British Humanist Association.  If the Court approved the case, it would increase abortions for NI women and it would also have serious implications for the rule of law and the value of NI’s devolved institutions.  Judgement in the case has been reserved until a later date.

Meanwhile, a new pro-life organisation in Northern Ireland, Both Lives Matter, has published a report entitled, One Hundred Thousand.  Using a statistically cautious approach, it estimates that there are 100,000 people alive today, who would not be, had the 1967 Abortion Act been introduced in NI.  If the Act had been introduced, there would have been, on a low estimate, 163,760 abortions in NI.  Set against that, the highest estimate for the number of women from NI who have travelled to England for an abortion over the last 50 years is 61,311.  Simple subtraction means an estimated 102,449 abortions have been prevented in NI.  Given that some of those would have by now died of natural causes, but also adding in figures for 2016, the report thus estimates that more than 100,000 people are alive today because the Act has not applied to NI.  Quod erat demonstrandum!

Mitochondrial donation approved
In February 2015, the UK Parliament passed regulations permitting maternal spindle transfer (MST) and pronuclear transfer (PNT) to be used as techniques for mitochondrial donation (MD).  Since October 2015, the regulatory framework has been in place since.  Then on 15 December 2016, the Human Fertilisation and Embryology Authority (HFEA) approved the use of mitochondrial donation in certain, specific cases.  This means that specialist IVF clinics wanting to offer the techniques to patients may now apply to the HFEA for permission to do so.  It is understood that the first application was on the HFEA’s desk within one hour of the announcement.

The HFEA’s Licence Committee has the responsibility to assess a clinic’s suitability, looking at existing staff expertise, skill and experience, as well as its equipment and general environment.  Once this stage has been passed, licensed clinics may apply to the HFEA’s Statutory Approvals Committee for permission to treat individual patients.  Only when these Committees have both approved the application can the final stage – treatment – begin.  The first such child could be born, at the earliest, by the end of 2017.

Dr David King, from the campaign group Human Genetics Alert, said, ‘This [HFEA’s] decision opens the door to the world of genetically-modified designer babies.  Already, bioethicists have started to argue that allowing mitochondrial replacement means that there is no logical basis for resisting GM babies, which is exactly how slippery slopes work.’

Extending the 14-day rule
The campaign has already started.  A recent YouGov poll revealed that 48% of respondents were in favour of extending the current 14-day limit up to 28 days; 23% did not know; 19% wanted to keep the present limit and 10% favoured a complete ban.  Now the ‘experts’ have begun their asserting.  For example, in January 2017, Simon Fishel, the founder of the CARE Fertility Group, stated that increasing the current limit to 28 days would be good for furthering scientific understanding.  He said, ‘I believe the benefits we will gain by eventually moving forwards when the case is proven will be of enormous importance to human health.  Observing how the embryo changes over weeks could shed light on why some early miscarriages occur.’

The case for extension is not helped by ignorant pseudoscientific statements from, for example, the BBC.  Its website stated (17 January) that, ‘Embryos normally implant in the wall of the uterus at around day seven and still resemble a ball of cells at that stage.  It takes weeks of rapid cell division and growth before it begins to resemble something more baby-like, with a beating heart, developing eyes and budding limbs.’  Passing over the fact that the heart begins to beat at about day 21, the BBC has fallen into the anthropomorphic trap that just because the early embryo doesn’t look like a baby, it can’t have much value, hence why not use it for destructive experimentation?

Thankfully, a voice of reason has come from David Jones, founder of the UK’s Centre of Bioethics and Emerging Technologies.  He has said, ‘In the original act [1990 Human Fertilisation and Embryology Act] a lot of things were prohibited – the creation of hybrid embryos, the cloning of embryos and the genetic modification of embryos.  These have all been swept away, so I wouldn’t be surprised if they did shift the 14-day limit.  And ‘In any case the 14-day limit is not philosophically defensible.  I don’t think there is a difference between a 10-day-old embryo and a 20-day embryo in terms of its moral status.’  And, ‘It [changing the limit] would be a stepping stone to the culturing of embryos and even foetuses outside the womb.  You are really beyond the stage when the embryo would otherwise implant and that is a step towards creating a womb like environment outside.  People will then ask why can't we shift it beyond 28 days?’

And Melanie Phillips wrote a forceful piece in The Times (6 December 2016) entitled, Where do we draw line on the right to life? with a tagline, ‘Calls to double the length of time that embryos can be experimented on must be rejected.’  Phillips stated, ‘In the [1984 Warnock] report, Baroness Warnock outlined the 14-day limit, saying that neural development did not begin until after this time, and that this was the latest stage where identical twins could occur.  Phillips noted that this, ‘… unilaterally changed the definition of an embryo.  Until that point, it was generally assumed that an embryo was created at conception.  The Warnock report declared that, on the contrary, an embryo only became an embryo at 14 days’ gestation.  Hey presto, all the revulsion at experimenting on an embryo was thus, during this 14-day window of opportunity, simply magicked away.’  Phillips continued, the 14-day limit is an, ‘… arbitrary construct based on nothing more than the desire to move the moral goalposts to allow scientists to experiment on embryos.  Treating it as merely a bundle of cells that is disposable is to instrumentalise and dehumanise not just the embryo but ultimately all of us.’

And the Government has also spoken sensibly.  At the beginning of December 2016, Lord Alton of Liverpool submitted a written question asking, ‘Her Majesty’s Government whether they intend to extend the 14-day limit beyond which destructive experiments on human embryos may not take place to 28 days.’  Later in December, Lord Prior of Brampton replied on behalf of the Government saying, ‘The Government has no plans to amend the time limit in the Human Fertilisation and Embryology Act 1990 on the use of human embryos for research.’

In vitro gametogenesis (IVG)
Science fiction becomes reality (again).  IVG is a new variant of fertility treatment which uses sperm and ova created from adult skin cells.  The technology has so far only been demonstrated in mice.  It would currently be illegal to attempt this with humans in the UK and the US.  However, it may just be a matter of time before scientists are able to make ordinary human skin cells revert to induced pluripotent stem (iPS) cells, which could then be transformed into human sperm and ova.  If perfected with human cells, such a procedure could supply scientists and embryologists with an almost inexhaustible supply of human gametes.  Human IVG could be capable of producing hundreds of embryos with the subsequent selection of the best according to customer demand.  It would open the spectre of ‘embryo farming’.

The mind boggles at the biological, medical, social and cultural changes that IVG could spawn.  Procreation, parentage, hereditary and much more would require redefinition.  For some more ideas of the possible repercussions, read the paper by Cohen, Daley and Adashi entitled, Disruptive reproductive technologies and published in the journal Science Translational Medicine (10.1126/scitranslmed.aag2959).

‘Three-parent’ IVF– the continuing saga
It was bound to happen.  Following the birth of the world’s first ‘three-parent’ IVF baby boy, Abrahim Hassan, in Mexico on 6 April 2016, it was inevitable that some other mavericks would give it a go.  Yes, doctors at a fertility clinic in Ukraine announced that such a baby girl had been born on 5 January 2017.  There are significant differences between the two events.  First, there was no hint that the latter was used to obviate the possibility of any mitochondrial diseases, which has always been the great selling-point of ‘three-parent’ IVF.  The Jordanian woman in the Mexican scenario suffered from Leigh syndrome.  In the Ukrainian scenario, the couple were simply infertile and had been unsuccessful with conventional IVF.  Second, the techniques used were different.  An ovum from the 34-year-old woman and one from a donor were fertilised with her partner’s sperm.  The pronuclei from the couple’s embryo were then used to replace those in the donor’s embryo.  That embryo was then implanted in the mother's womb.  Thus, the mother’s ‘bad’ mitochondria were replaced by the donor’s ‘good’ mitochondria – though in this example no ‘bad’ mitochondria ever existed.  This technique is known as pronuclear transfer as opposed to spindle nuclear transfer used in Mexico.

This latest Ukrainian event is thought by some to open a new era in IVF.  Valery Zukin, who led the team at the Nadiya clinic in Kiev, considers this treatment would help women whose embryos consistently stop growing before implantation, a condition known as embryo arrest, which affects about 1 in 150 IVF patients.  He also believes the method could be used to ‘revive’ the ova of women in their 40s.

Yet ‘three-parent’ IVF still raise controversies over deliberately mixing unrelated genes plus issues of safety.  This news from the Ukraine has worryingly demonstrated that ‘three-parent’ IVF has already shifted from a specific technology designed to avoid the birth of children with rare mitochondrial diseases to an unorthodox remedy for unexceptional infertility – ‘three-parent’ IVF has rapidly tumbled down that well-known slippery slope of bioethics.  Who could blame the entrepreneurial IVF industry for such a move?  After all, there are more potential patients with infertility problems than with mitochondrial diseases.

And there is another issue.  It is a cause for concern that the Ukrainian-born baby was a girl – the genetic modifications produced in her could be passed onto her children.  According to Lori Knowles at the University of Alberta School of Public Health, ‘Boy babies carrying donor mitochondria cannot pass their modified genetics onto any future children because once a sperm fuses with an ovum to form an embryo, the masculine mitochondria wither and die leaving the resulting embryo with only mitochondria from the mother's ovum.  Knowles further stated, ‘I do think it's highly significant that this is a girl because we know for sure that she will be passing on her mitochondrial DNA through her maternal line.  If in the future this baby girl has genetic children, they will inherit her genetic modifications.’  Zukin understood this.  Indeed, he has acknowledged that it would have been better to transfer a male embryo, but he admitted that the IVF technique did not produce a ‘suitable male embryo’, so they used a female embryo instead.

And there is more.  Zukin's procedure has been criticised because it used a virus protein to fuse the mitochondrial DNA into the host ovum.  This is regarded by some as an out-of- date method.  As Zhang, the researcher behind the Mexican birth, explained, ‘We used an electronic system which is much cleaner.’  He further explained that a virus will permanently integrate into the future baby's DNA, whereas electronic transfer leaves no lasting genetic mark.

This is all worrying.  These one-off reproductive experiments employ untested and unpublished methods, with no control trials, with no generational assessments and occur in far-flung, unregulated locations with the fear of a growing medical tourism.  But as Zukin has declared, ‘In Ukraine, the situation is very simple – it's not forbidden.  We have not any regulation concerning this.’  Knowles takes a different view.  She has asserted that, ‘Anytime that there is a real push on the side of need and fertility [and] disease relief, we find that the skipping of steps becomes more and more politically and scientifically acceptable until something goes wrong.’

Human-pig 'chimera embryos'
An article entitled, Interspecies Chimerism with Mammalian Pluripotent Stem Cells and published in Cell (26 January 2016) by Izpisua Belmonte and his colleagues from the Salk Institute of Biological Studies in California has been heralded as a breakthrough.  It reports that, for the first time, human-pig hybrids have been created with the distant expectation that animals could be used to grow human organs for transplantation.  Animal rights campaigners were outraged.

The process proved to be very, very complex.  As a first step to gain a better understanding of the likely problems, the team introduced pluripotent stem cells from rats into mouse embryos to create rat-mouse chimeras – mice with pancreatic or heart tissue derived from rat cells.  They used CRISPR-Cas9 genome-editing to delete genes critical for organ, say heart or pancreas, development in mice embryos and then inserted rat stem cells to see if heart or pancreas cells would develop and occupy the organ niches.  In other words, because the rat cells had a functional copy of the missing mouse gene, they could outcompete mouse cells and allow the ‘rat’ organ to form and mature.  This strategy is known as a CRISPR-Cas9 mediated interspecies blastocyst complementation platform.  Yes, I said it was complex.

The team's next step was to introduce human stem cells into an organism.  The stem cells called induced pluripotent stem cells (hiPSCs) derived from human foreskin fibroblasts.  Initially cow and pig embryos were used because their mature organs more closely mimic the physiology, size and anatomy of their human counterparts.  Cow embryos were more complex and costly so the team eventually decided to use pigs.  The researchers underestimated the work required -- it took them four years, 1,500 pig embryos and contributions from over 40 people.  And because pig and human reproductive physiologies are so different it was necessary, and problematic, to match the timing of the introduction of the human cells with the relevant development of the pig.

Several different forms of human stem cells were injected into pig embryos to see which would survive best. The most suitable cells were ‘intermediate’ human pluripotent stem cells, which are developmentally somewhere between early ‘naïve’ and later ‘primed’ stem cells, but which are still pluripotent.  Between 3 and 10 human iPSCs were injected into each blastocyst.  After in vitro embryo culture, a total of 2,075 embryos (1,466 for hiPSCs and 477 for rodent PSCs) were transferred to surrogate sows.  The levels of chimerism in the pig embryos were much lower than obtained with rodent chimeras.  A total of 41 surrogate sows received 30 to 50 embryos each, resulting in just 18 pregnancies which were allowed to develop for between three and four weeks before 186 embryos were harvested.  More than half of these showed retarded growth.

The scientists argued that this relatively short development time of less than four weeks was sufficient to study the chimera biology but not long enough to raise bioethical concerns.  In addition, because the human contribution was so low -- only about one out of every 100,000 cells in the hybrid embryos -- critics would not be concerned the chimeras were too human, as if human brains, sperm or ova might start to develop.  Apparently, this did not occur in the study, rather the human cells developed into muscle cells and precursors of other organs. 

And there are other bioethical concerns.  It is most difficult to determine the exact origin of all the stems cells used in this study.  There are numerous references to ESCs, iPSCs, hPSCs and hiPSCs.  Indeed, the report’s use of the term ‘human pluripotent stem cells’ is ambiguous – they could be generated from adult cells or acquired directly from embryos.  Nevertheless, any experiments that use human stem cells obtained by the destruction of human embryos will always be unacceptable to the ‘morally sensitive’.  Moreover, while their work has demonstrated ‘proof of principle’, the Salk Institute team admits that any such therapeutic applications, such as animal drug testing platforms, or insights into human diseases, and ultimately generating xenotransplantable human tissues and organs, are still a long way off.  However, if successful, the method would use a patient’s own stem cells and the resulting organs would be patient specific and not subject to immunological rejection.  Whatever the putative benefits, serious bioethical concerns remain.  Or as some wag has commented online, ‘I have no problems turning pig cells into human organ tissue.  It’s easy.  First step, grill the bacon…’

A story you will hardly believe
Assisted reproductive technologies continue to create the most unlikely narratives.  Here is another.  Hayden Cross is an unemployed British woman living in Gloucester.  Three years ago at the age of 17, she began living as a man.  Now she has stopped her male transition process because she wants to have a child.

The NHS refused to freeze her ova.  So she joined a Facebook group where she found a sperm donor.  Now, in January 2017, she is four months pregnant although she has no idea who the father of her child is.  As reported in The Sun, ‘The man came to my house, he passed me the sperm in a pot and I did it via a syringe.  I don’t know who the bloke was.  To be honest I can’t remember anything about him.  He wouldn’t even tell me his name.  He didn’t want any contact.  He said he was just doing it to help people.  It was the first attempt and it worked.’

Cross is now being touted as 'the first British man to give birth'.  After the birth, she plans to have her breasts and ovaries removed and to continue transitioning to become a male.  She has promised, ‘I’ll be the greatest Dad.’  Now dear reader say, 'I hardly believe it!'


CRISPR at the cutting edge
CRISPR is a naturally-occurring bacterial defence mechanism that scientists have, within the last four years, harnessed to alter DNA sequences in animals, plants and microorganisms.  It is uncomplicated, but it has become the latest hot topic in the world of the biological sciences.  At a Progress Educational Trust conference held in December 2016, CRISPR at the cutting edge was the title of a paper given by Bruce Whitelaw of the University of Edinburgh's Roslin Institute.  He stated that, ‘For around 50 years, it has been possible to “read” the human genome.  Now, we can “rewrite” the genome.  Any sequence, in any genome.  That is quite an unbelievable power to have.'

He explained that though genome editing has long since been technically possible by previously-available techniques those have now been vastly superseded by easier, faster and more precise CRISPR techniques.  How these should be used is for society to decide, he argued.  For example, CRISPR methodology could be used to introduce useful genetic variation into livestock, to produce animal offspring of just one gender, to introduce rat pancreatic cells into mouse embryos, to place human cells into animal embryos, or to search for potential medical treatments.  Some of the ideas offered by science will be taken forward, while others will be rejected.  In order to make sound judgements, the public needs to know the potential of this technology, especially in human embryo research.

Nobody in the UK has yet edited human embryos, but Kathy Niakan’s team at the Francis Crick Institute in London has been granted the first UK licence to use CRISPR-Cas9 for such a trial – its time will come.  And beyond gene editing for improving human health, the fear is that it ‘could start us down a path towards non-therapeutic genetic enhancement’.  As others have warned, ‘Scientists in Britain are embarking on work that could decide the future of humanity, whether the world is ready or not.’  CRISPR-cows are one thing, CRISPR-children are quite another.

The evangelical Christian director of the National Institutes of Health (NIH) in the USA, Francis Collins, has serious ethical concerns about research into gene modification in human embryos.  He said in a July 2016 interview with Buzzfeed News, ‘I do believe that humans are in a special way individuals and a species with a special relationship to God, and that requires a great deal of humility about whether we are possessed of enough love and intelligence and wisdom to start manipulating our own species.’  That is a most remarkable and thought-provoking comment.

Another Chinese first
On 28 October 2016, a team led by oncologist Lu You at Sichuan University in Chengdu became the first to inject a human patient with cells that contain genes edited by the CRISPR-Cas9 technique.  The patient had aggressive metastatic non-small cell lung cancer.  The researchers removed immune system T-cells from the patient’s blood and then, using CRISPR-Cas9, knocked out the gene that codes for a protein called PD-1.  The latter inhibits the cells’ immune response so allowing cancer cells to proliferate.  The edited cells were cultured and injected into the patient.  The idea is that without the inhibiting influence of PD-1 the immune cells will attack and beat the cancer.  The team plans to treat a total of ten people, who will each receive either two, three or four edited-cell injections.  These human trials are designed primarily to test the safety and the proof of principle of such potential therapies, but they also mark the start of the race to exploit gene-edited cells as human clinical treatments.

Currently, there are only two declared competitors in the race – China and the United States.  In June, a planned US human trial, aimed at using CRISPR-Cas9 to target three genes in patients’ cancerous cells, received official ethical approval.  The trial, devised by Carl June’s team at the University of Pennsylvania, is expected to start in early 2017.  Meanwhile, in March 2017, a group at Peking University in Beijing plans to start three clinical trials using CRISPR-Cas9 to tackle bladder, prostate and renal cancers.  The starter’s gun has most certainly been fired.


Stem-cell technologies – caution
Shinya Yamanaka is the Japanese researcher who won the 2012 Nobel Prize in Physiology or Medicine for discovering that mature cells can revert to stem cells, the so-called ‘induced pluripotent stem cells’, or iPS cells.  The New York Times (16 January 2017) published an interview with him.  He has become sceptical about the hype that stem-cell technologies would rapidly lead to ‘personalised medicine’.  His answers to the following questions are as insightful as they are instructive.

Was the promise of stem cells overstated?  He replied, ‘In some ways, yes, it is overstated.  For example, target diseases for cell therapy are limited.  There are about 10 – Parkinson’s, retinal and corneal diseases, heart and liver failure, diabetes and only a few more – spinal cord injury, joint disorders and some blood disorders.  But maybe that’s all.’  How many compatible donor cell lines do you expect will be needed to cover the Japanese population?  He replied, ‘Not that many.  One particular line – just one – can work for 17 percent of the Japanese population.  We estimate that altogether about 100 lines will suffice for the 100 million people in Japan.  The number of human diseases is enormous.  I don’t know how many.  We can help just a small portion of patients by stem-cell therapy.’

Why so few?  ‘We have more than 200 types of cells in our body.  But the diseases I described are caused by loss of function of just one type of cell.  Parkinson’s disease is caused by failure of very specialized brain cells that produce dopamine.  Heart failure is caused by loss of function of cardiac heart cell.  So, that’s the key.  We can make that one type of cell from stem cells in a large amount, and by transplanting those cells, we should be able to rescue the patient.  But many other diseases are caused by multiple types of cell failures, and we cannot treat them with stem-cell therapy.’

What are your biggest concerns about the future of stem cell treatments?  ‘I think the science has moved too far ahead of talk of ethical issues.  When we succeeded in making iPS cells, we thought, wow, we can now overcome ethical issues of using embryos to make stem-cell lines.  But soon after, we realized we are making new ethical issues.  We can make a human kidney or human pancreas in pigs if human iPS cells are injected into the embryo.  But how much can we do those things?  It is very controversial.  These treatments may help thousands of people.  So getting an ethical consensus is extremely important.’

What is needed before patients can receive stem cell treatments for the 10 or so diseases you identified?  ‘Time and money.  You know, my father had a small factory.  He injured his leg in the factory when I was in junior high.  He had a transfusion, and he got hepatitis C.  He passed away in 1989.  Twenty-five years later, just two years ago, scientists developed a very effective cure.  We now have a tablet.  Three months and the virus is gone – it’s amazing.  But it took 25 years.  iPS cells are only 10 years old.  The research takes time.  That’s what everybody needs to understand.’

Stem-cell technologies – bad
In March 2015, Davide Vannoni, an Italian entrepreneur was convicted on charges of conspiracy and fraud relating to his unproven stem-cell treatments, which have been declared dangerous by the Italian Health Authority (AIFA).  Vannoni was sentenced to 22 months in prison, but this sentence was suspended by a plea bargain which banned Vannoni from offering further therapies in either Italy or abroad.

Back in 2009, Vannoni founded the Stamina Foundation.  Vannoni claimed that stem cells collected from human bone marrow could be transformed into neural cells by exposure to retinoic acid and, when injected into patients, they could be used to treat diseases as diverse as Parkinson's, muscular dystrophy and spinal muscular atrophy.  Vannoni has not been trained as either a scientist or a doctor, nor has he published any peer-reviewed scientific articles.

Then in November 2016, Vannoni was once more under investigation by public prosecutors in Turin because of suspicions that he was again offering his treatments, this time in Eastern Europe, specifically in Georgia.  Recent cases of similar treatments have led to cancers.  Elena Cattaneo, a neuroscientist at Italy’s University of Milan, who was among those who worked to stop Vannoni, and who is now an Italian senator, has said that if Vannoni has started again it is ‘… a disgrace.  Governments and health institutes should do more to inform patients about these sorts of therapies.’

Stem-cell technologies – good
Some stem-cell treatments carry a risk of tumour growth and immune rejection.  Scientists from the USA and China have developed a synthetic version of a cardiac stem cell.  The lead researcher in this work, Ke Cheng, from North Carolina State University, fabricated a cell-mimicking microparticle (CMMP) from poly (lactic-co-glycolic acid) or PLGA, a biodegradable and biocompatible polymer.  The researchers then harvested growth factor proteins from cultured human cardiac stem cells and added them to the PLGA.  Finally, they coated the particles with cardiac stem-cell membranes.  These stem cells do not carry the same adverse health risks because of their partially synthetic composition.

Moreover, there is mounting evidence that stem cells exert their beneficial effects mainly through secretion of regenerative factors and membrane-based cell-cell interactions with the injured cells.  When tested in vitro, both the CMMP and cardiac stem cells promoted the growth of cardiac muscle cells.  When the CMMP was tested in a mouse model with myocardial infarction, it bound to cardiac tissue and promoted growth after a heart attack – this action was comparable to that obtained with regular cardiac stem cells.

This work was published in Nature Communications (26 December 2016) under the title of Therapeutic microparticles functionalized with biomimetic cardiac stem cell membranes and secretome.  Ke Cheng has said, ‘We are hoping that this may be a first step towards a truly off-the-shelf cell product that would enable people to receive beneficial stem-cell therapies when they’re needed, without costly delays.’  Indeed, this type of approach may be the forerunner which brings the therapeutic benefits of stem-cell therapy without the potential risks.  Human heart attack victims may yet be helped.


Noel Conway – the latest challenger
Who does not have deep pity for a terminally-ill man with motor neurone disease (MND)?  But Noel Conway wants more than our compassion.  He wants a doctor to be able to prescribe him a lethal dose.  This 67-year-old, former college lecturer from Shropshire, who is not expected to live beyond the next 12 months, has become the latest challenger to the 1961 Suicide Act backed by the Dignity in Dying organisation.  He is seeking a judicial review of the Act.

It was back in November 2014 that Mr Conway was first diagnosed with amyotrophic lateral sclerosis, a form of MND.  He is now dependent on a ventilator overnight, requires a wheelchair and needs help to dress, eat and with personal care, though he is not in pain.  He lives with his wife Carol and son Alex, and he used to be very physically active and enjoyed climbing, skiing, walking and cycling.  He has already signed up with the Swiss assisted-suicide group Dignitas, but is concerned that when he is ready to die he might be too ill to travel.  He has stated, ‘I want to live and die in my own country.  The current law here condemns people like me to unimaginable suffering – I'm heading on a slow, slippery slope to hell.’  His case is expected to be heard at the High Court within a few months.

We have been here before.  In June 2014, three such right-to-die campaigners, including Tony Nicklinson, argued before the Supreme Court that the current law was not compatible with the 1998 Human Rights Act, which confirms that individuals should have respect for a private and family life.  They lost their bid.  In other words, the 1961 Suicide Act remained intact and doctors were not allowed to assist in suicide.  Nevertheless, Lord Neuberger, president of the Court, warned that if Parliament failed to consider the issue, there was a ‘real prospect’ of a successful future legal challenge.  And so it came to pass that in September 2015, the democratically-elected Parliament did consider this very issue.  And MPs overwhelmingly rejected the Assisted Dying (no. 2) Bill 2015-16, by 330 votes to 118, a majority of 212.  Nevertheless, there is still an unrelenting pressure to bring the assisted suicide issue back to the courts.  Parliamentarians may have pronounced, but what about the judiciary?

Paul Briggs – the latest victim
Paul Briggs was 43 years old when he suffered severe brain injury and five spinal fractures in a crash on his way to work for Merseyside Police.  He has been diagnosed to be in a permanent vegetative state since 2015.  His wife Lindsey told the Court of Protection that treatment should be stopped ‘given his previously expressed wishes’ and he should be allowed to die.  Doctors treating him at the Walton Centre in Liverpool opposed the application to withdraw treatment and advised the judge to be cautious.  An independent specialist maintained that Mr Briggs was in a minimally-conscious state from which there was ‘potential’ to emerge with a possible life expectancy of up to 10 years.  The Court was also told that doctors had noticed some signs of improvement in Briggs’s condition, though his wife maintained that when she looked into his eyes she saw ‘at best, nothing there, or at worst, distress or suffering’.

On 20 December 2016, having heard the case at Manchester on 28 November in the Court of Protection, Mr Justice Charles agreed that it was not in Mr Briggs’s ‘best interests’ for treatment to continue and ruled that his doctors should stop providing life-support treatment and that he should be transferred onto a palliative care regime at a hospice in Wirral, where experts could gradually withdraw his life support, keeping him pain free.  The Official Solicitor was expected to seek leave to appeal against the Court’s decision, but eventually decided not to.

On 22 January 2017, Paul Briggs died.  His wife tweeted, ‘I am so sorry to say Paul died this morning as a result of his RTC.  We're devastated and trying to come to terms with all he's been put through.’  Previously she has said, ‘He read the Bible, he believed in a better place, he deserves a peaceful death.’

Assisted Dying Bill [HL] 2016-17
Lord Hayward presented this Bill at its first reading on 9 June 2016.  In summary, it is, ‘A Bill to enable competent adults who are terminally ill to be provided at their request with specified assistance to end their own life; and for connected purposes.’  The date for its second reading has yet to be announced.

Organ donation euthanasia (ODE)
We are familiar with matching pairs – peaches and cream, love and marriage, and so on.  Now comes organ donation euthanasia (ODE).  After all, given a recently dead body, it’s a shame to waste a good liver and kidneys.  The two procedures are already occurring simultaneously with executed prisoners in China and euthanased patients in the Netherlands and Belgium.  Now Canada wants to rush in to be ‘on trend’.  Euthanasia only became legal in Canada in June 2016, but by December, Julie Allard and Marie-Chantal Fortin, bioethicists from the University of Montreal, had published an article in the Journal of Medical Ethics calling for organ donation after euthanasia.

From the article (published online, 28 December 2016) entitled, Organ donation after medical assistance in dying or cessation of life-sustaining treatment requested by conscious patients: the Canadian context, the authors state, ‘MAID (medical aid in dying, as Canadian legislation terms euthanasia) has the potential to provide additional organs available for transplantation.  Accepting to procure organ donation after MAID is a way to respect the autonomy of patients, for whom organ donation is an important value.  Organ donation after MAID would be ethically acceptable if the patient who has offered to donate is competent and not under any external pressure to choose MAID or organ donation.’

There you have it – so-called organ donation euthanasia, ODE.  What is wrong with that?  Surely it is respecting a patient’s choice both for euthanasia and for organ donation.  Surely both are praiseworthy acts of autonomy and compassion.  Picture and ponder.

Suicide – assisted and otherwise
On 19 December 2016, the House of Commons Health Committee published an interim report on Suicide Prevention.  It stated that, ‘The scale of the avoidable loss of life from suicide is unacceptable.  4,820 people are recorded as having died by suicide in England in 2015, but the true figure is likely to be higher.  The 2014 suicide rate in England (10.3 deaths per 100,000) was the highest seen since 2004, and the 2015 rate was only marginally lower at 10.1.  Suicide disproportionately affects men, accounting for around three quarters of all suicides, but rates are rising in women.  It remains the biggest killer of men under 49 and the leading cause of death in people aged 15–24.’

In other words, recent governmental strategies to reduce the number of suicides in England have failed, and a new drive to tackle the problem must be backed by a clear implementation strategy.  The MPs called for better training for GPs in identifying and dealing with suicide risk, better support services for the vulnerable, more timely and consistent data and a more rigorous application of media guidelines relating to the reporting of suicides.

Every suicide is a tragedy and the Committee’s recommendations to the Government are commendable and welcome.  But there is an absurd contrdiction here.  How can we press GPs and others to implement a suicide prevention programme while other groups in society are calling for legislation to allow assisted suicide?

Nitschke on suicide
Philip Nitschke is one of the world’s most famous advocates for euthanasia.  He helps people to kill themselves via his books, DVDs and his organisation, Exit International.  He considers that campaigning for the legalisation of euthanasia is an out-of-date approach with its bureaucratic rules, complex paperwork and practical restrictions.  He believes that suicide is not a benefit to be granted by the State, but a fundamental human right for people who are in pain, or who are simply tired of life.

In December 2016, he announced a subsidiary to his Exit International called Exit Action, which will take ‘a militant pro-euthanasia position’.  Apparently many of his supporters were angry after the narrow defeat (24 votes v. 23) of an assisted suicide Bill in South Australia on 17 November and wanted to be more active in promoting the right to die.  He said that, ‘Exit Action is critical of the “medical model” that sees voluntary euthanasia as a privilege given to the very sick by the medical profession.  The standard approach for years has been to get the very sick to tell their stories of suffering to the public and politicians, in the hope that politicians might take pity and change the law.  Exit Action believes that a peaceful death, and access to the best euthanasia drugs, is a right of all competent adults, regardless of sickness or permission from the medical profession.’  How Exit Action will operate is unclear, but it seems to involve supplying people of all ages with drugs purchased on the internet, possibly in defiance of the law.

Some say that Nitschke has given killing people a bad name by advocating that every adult should not only be given unquestioned access to assisted suicide and euthanasia, but should also be issued with a fatal dose of Nembutal, to be used whenever it seemed opportune.  But Nitschke’s position on what he calls ‘ration suicide’ flies directly in the face of the social and medical view that suicidal people should automatically receive psychological counselling on the presumption that they are irrational because of depression or some other mental illness.

The outrageous Nitschke now lives in the Netherlands.  He recently spoke at a right-to-die conference in Amsterdam where he described his latest suicide machine, ‘Sarko’.  He hopes to begin constructing them in early 2017.

A year of euthanasia in Québec
December 2016 marked the first anniversary of the start of Québec’s legalised euthanasia programme.  Serious questions about compliance with the law are already emerging.  Quebec’s health minister, Gaetan Barrette, expected there would be about 100 euthanasia deaths in the first year.  By 31 August 2016 – at the 9-month mark – 262 euthanasia cases had been reported by Québec doctors.  In addition, by 30 June 2016 – at the 6-month mark – 263 continuous palliative sedations had been reported by institutions.  And there is good evidence that not all doctors are registering every case of euthanasia.

This is all too reminiscent of the Belgian situation, where numbers are higher than expected and doctors are lax in reporting cases.  Perhaps that is not surprising since the Québec euthanasia law is based on that of Belgian law where nearly half of the assisted deaths are not reported.

And Colorado makes it six
On 8 November 2016, Colorado voters gave their doctors the right to assist in their patients’ suicides.  The vote in favour of Proposition106 was more than 2 to 1.  Prop 106 has created the Colorado End of Life Options Act, which allows doctors to prescribe lethal drugs to patients aged 18 and over, who have been diagnosed with a terminal illness and have been assessed to have six or fewer months left to live.

Colorado, known as the Centennial State, thus becomes the sixth state to permit assisted suicide, and the third to do so by a ballot initiative.  Oregon and Washington legalised assisted suicide through ballot initiatives, Vermont and California through legislation, while in Montana the Supreme Court has ruled that assisted suicide was permissible.  That notwithstanding, several states have recently rejected assisted suicide legislation, including Arizona, Colorado, Hawaii, Iowa, Maryland, Nebraska, New Jersey and Utah.


President Donald J Trump
Well, who’d a thunk it?  Donald J Trump, having won the election, but lost the popular vote, is now the 45th President of the United States.  His inaugural speech on Friday 20 January 2017 was different, disturbing and determined.  Although he did not specifically mention bioethical issues, such as abortion and same-sex ’marriage’ in his address, he has made major promises on these issues during his campaign.  Here are three:

First, he promised to appoint pro-life judges to the Supreme Court.  The death of Justice Antonin Scalia in February 2016 created a vacancy.  On several occasions Trump had promised, if he were elected, to put pro-life justices to the bench.  There are currently eight Justices with one to be chosen.  The current balance, with respect to abortion, is thought to be 4 v. 4.  So the next appointee is crucial if the 1973 abortion decision Roe v. Wade is to be challenged, even overturned.  During the final presidential debate on 19 October 2016, Trump was asked if he wanted the Court to annul Roe v. Wade.  He replied, ‘Well, if we put another two or perhaps three justice on, that's really what's going to be,¬¬ that will happen.  And that'll happen automatically, in my opinion, because I am putting pro-life justices on the Court.  A few days later, on 27 October in a TV interview, he was challenged again, ‘You weren’t always pro-life, but you now are determinedly and decidedly pro-life?’  Trump replied, ‘Yes, I am pro-life.’

Second, he promised to repeal Obamacare.  Many, including evangelical and Roman Catholic individuals and communities, have robustly opposed Obama’s Affordable Health Care Act, which has forced employers to pay for contraception, including abortifacients and sterilisations, for their staff.  Trump has stated, ‘We’re also going to repeal and replace disastrous Obamacare, which gives the government control over the lives of everyday citizens.  It is a disaster.  It’s a disaster, and everybody knows it.  And it’s going to die of its own weight anyway, but we’re going to get rid of it and we’re going to replace it with some great, great alternatives – much better healthcare at a much lower price.’

Third, he promised to defund Planned Parenthood.  After the infamous 2015 videos that uncovered evidence of Planned Parenthood's involvement in the illegal sale of aborted baby body parts, asked, during a 14 September interview, if he would vote to defund the abortion giant, Trump replied, ‘Yes, I’ve seen it, and I think you know my stance on it.  I’ve said it before, but … I’ve seen the videos.  I think it’s a disgrace, and the answer is I would vote to defund.’  Again on 18 October, he stated that, ‘Planned Parenthood should absolutely be defunded.  I mean if you look at what's going on with that, it's terrible.’

We have all become too aware of the political gap between campaign promises and enacted policies.  Now let’s see if Trump is an honourable man who can truthfully deliver on his pledges.  He seems to have started well.  On the evening of his inauguration, he signed an order to begin rolling back Obamacare.  On 23 January, his first full day in office, and a day after the 44th anniversary of the Roe v. Wade ruling, Trump signed another executive order reinstating the so-called ‘Mexico City Policy’.  This bans US government funding, which in 2016 amounted to $400 million, for the foreign efforts of organisations that perform abortions overseas or lobby for legalising them in foreign nations, like Planned Parenthood and Marie Stopes International.  And on 27 January, Trump sent his vice-president, Michael Pence, to address the annual March for Life rally in Washington.  Pence told the crowd, that the Trump administration is determined to advance the fight against abortion.  ‘We will not grow weary,’ he said.  ‘We will not rest, until we restore a culture of life in America for ourselves and our posterity.’  So far, so good!  It does seem that the USA has a new pro-life President.

Neil M Gorsuch
Then on Tuesday 31 January, President Trump increased his pro-life ratings by announcing that his Supreme Court nominee was the 49-year-old conservative from Colorado, Neil Gorsuch.  Gorsuch’s academic record is impeccable having excelled at Columbia University, gained a doctorate in legal philosophy from the University of Oxford and a law degree from Harvard University.  His judicial performance, on the US Court of Appeals for the Tenth Circuit, is highly regarded.  It has been said that, ‘his opinions are exceptionally clear and routinely entertaining; he is an unusual pleasure to read, and it is always plain exactly what he thinks and why.’  He has a good track record of defending Christians in religious liberty cases, including those in the Hobby Lobby and the Little Sisters of the Poor saga.  He has written a 2009 book called The Future of Assisted Suicide and Euthanasia which included the line, ‘To act intentionally against life is to suggest that its value rests only on its transient instrumental usefulness for other ends.’  He is reputed to be anti-abortion, though he has yet to decide in any such specific case.

If approved by the Senate, and the Democrat minority there has promised to prolong proceedings, Gorsuch, as an Episcopalian, will become the only Protestant judge on the Supreme Court – five current members are Roman Catholic and three are Jewish.  But more significantly, if Roe v. Wade comes before the Court, the balance would be decidedly pro-life.  Moreover, because of his relatively young age, Gorsuch could serve on the Court for 30 years and more and thus significantly reshape the legal, political and social culture of the US.

Neil Gorsuch, lives with his wife, Marie Louise, commonly known as Louise, who was born in the UK, and his two daughters, Emma and Belinda, in Boulder, Colorado where they attend St. John's Episcopal Church, a liberal congregation led by the pro-LGBT rector, Rev. Susan W Springer.  The couple met while he was studying at Oxford.  They are outdoors people – they enjoy fishing and they also raise horses, chickens and goats.  Trump had long promised that his nominee for the Supreme Court would be one that, ‘… evangelicals, Christians, will love.’  We await hopefully to prove the President right.

China’s one-child policy’s protracted catastrophe
The success of any governmental policy can be judged by its effective legacy.  Abandoning its one-child policy after more than three decades, China is now faced with the demographic aftermath.  Since January 2015, couples have been allowed to have a second child.  And in 2016, Chinese parents welcomed almost 18 million babies – an increase of 1.3 million on 2015.  But this is still far short of the population boost hoped for.  Moreover, it seems as though many couples are not keen on having more children – the concept of bearing children has changed.

The new relaxed policy is certainly too little too late to reverse China’s inevitable transformation into an ageing society with a shrinking workforce.  The Communist Party said that it hoped for an additional 3 million babies a year over the next five years.  But in 2016, the world’s most populous country recorded 9.8 million deaths yet grew by only 8.1 million people to 1.383 billion.  However, the Chinese workforce, measured as those aged between 16 and 59, fell by 3.49 million, while the number of people aged 60 or over increased by 10.86 million to 230.9 million, or 16.7 per cent of China’s total population.  Decades of a devastating policy of controlled procreation plus forced abortion and gendercide has created a legacy of protracted catastrophe.

Abortion in Poland
Poland’s ruling Law and Justice party is still waiting for a vote to take place on a new Bill that would ban abortion in Poland.  It has become stalled.  It was presented to the Parliament in September 2016 and supposed to face a vote on 12 January.  That never happened.

The Bill was drafted as a result of a citizens’ initiative by the Polish Federation of Pro-Life Movements in September 2016.  It garnered a 450,000-signature petition.  The Bill reached the Sejm, the lower house, was passed onto the Sejm’s Commission on Petitions, but has yet to be discussed.  An earlier version of the Bill included a provision by which the prosecution of women who had abortions was left to the discretion of judges – this was officially rejected in October 2016.  This new Bill would protect all unborn children and it would ban the sale, free distribution and advertising of abortifacients.  No date has been set for debate.  The struggle continues.

Abortion laws in the USA
The pro-life surge across America started the New Year well.  For example, the personhood of the pre-born from the moment of conception has now been recognized by the Supreme Court of Alabama.  In Kentucky, the Pain-Capable Unborn Child Protection Act has become law.  It protects preborn babies from abortion from the time they can experience pain, at about 20 weeks or earlier.  In Texas, Planned Parenthood has officially been cut off from state government funding through the Texas’ Medicaid program.  And on 24 January, the US House of Representatives voted 238 to 183 to ban permanently any taxpayer funding of abortion across the nation.  The No Taxpayer Funding of Abortion Act has made the so-called Hyde Amendment, which had to be debated and enacted annually, permanent.  It is estimated that it has saved the lives of 2 million since it was first enacted in 1976.  And there’s more to come, I’m sure.


On post-truth
Recently, Oxford Dictionaries published its 2016 Word of the Year – post-truth.  It was defined as, ‘relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief.’  The word should be alien to many, including scientists and especially Christians.  Both should have a resolute understanding that truth is essential to the acquisition of true knowledge and true religion.  Post-truth does not deny the existence of truth – that would create a frighteningly dystopian world.  No, the sun will still set in the West and a boiled egg will still take 3.5 minutes to cook nicely.  Rather, a post-truth society is one in which truth takes a back seat to emotion – where feelings can replace facts.

Where did it all begin?  Like most of mankind’s troubles it started in the Garden of Eden.  The first post-truth statement was the serpent’s question to Eve, ‘Did God really say, “You must not eat from any tree in the Garden”?’ (Genesis 3:1).  That was a post-truth enquiry, and they all knew it.  And they all knew the real, truthful, factual answer.  But, oh, that apple was so red and viscerally attractive, so ‘pleasing to the eye’ (Genesis 3:6).  And bingo – their hearts ruled their heads!  See, post-truth is nothing new.

However, during the last decade or so, this old concept of post-truth has gained renewed momentum.  Tell-tale signs might be the publication in 2004 of the influential book, The Post-Truth Era: Dishonesty and Deception in Contemporary Life, by Ralph Keyes and the current irrational phenomenon of so-called fake news.  Consequently, in this post-truth era we still have truth and lies, but also an uneasy third category – not exactly the truth, and not exactly a lie.  Some, like Keyes, call it ‘enhanced truth’, ‘neo-truth’, ‘soft truth’, ‘faux truth’ or ‘truth lite’.  We can certainly recognise post-truth in the contexts of the Brexit referendum and the Trump election, namely, as ‘post-truth politics’.  Sadly, we have come to expect that politicians will shy away from plain facticity and instead adopt an ‘economical with the truth’ stance.  Why?  Because they understand that people prefer to make judgements based on their feelings.  Much of the public uncritically hears what it wants to hear.  It is a form of style over substance, a subtle scheme of self-deceit.  And we are all, to varying degrees, guilty of tapping into this culture of deception with self as the principal player.  And do not think that evangelical Christians are immune – they can be among the worst offenders.  For example, for some, even for many, Sunday corporate worship has become a short excursion of escapism in order to massage their emotions – ‘Don’t give me that doctrinal, cerebral stuff, just give me a warm feeling, an emotional tingle.’  When worship is no longer God-centred but self-centred, we have lost the plot.  We have then denigrated our brains and validated our hearts.

Alas, Christians have been travelling down the crooked pre-post-truth path for far too long.  Some have called it a postmodern, post-Christian, meta-modern, even a post-postmodern pathway.  We have all drifted down it.  Consider bioethics.  Think abortion, IVF and euthanasia.  Abortion is ‘a woman’s right, simple, progressive and enlightened’, ‘human embryo destruction is OK because they are only very early embryos’ and ‘modern-day euthanasia is proper medical treatment’.  We have thus lived through a time when traditional bioethical foundations and boundaries have been uprooted, and time-honoured customs and conduct are under attack.  As a consequence, ours is an age uncomfortable with absolutes.  The children of postmodernism no longer seek truth in terms of objective absolutes – relativism rules their reasoning.  But Christians are not unfamiliar with absolutes – we weave words such as almighty, infallible, pure, inerrant, omniscient and perfect into our everyday language.  And how can the one true God be absolutely other than ‘a spirit, infinite, eternal, and unchangeable, in his being, wisdom, power, holiness, justice, goodness and truth’?  Yes, Christians ought easily to live and breathe absolutes and truths.

I first became aware of these post-truth dangers by reading Francis Schaeffer.  In his 1968 book The God Who Is There, he wrote, ‘The present chasm between the generations has been brought about almost entirely by a change in the concept of truth.  This change in the concept of the way we come to knowledge about truth is the most crucial problem, as I understand it, facing Christianity today.’  This notion was so important to Schaeffer that he coined the clumsy, but entirely memorable, phrase ‘true truth’ to ensure readers understood that Christianity was absolute truth and absolutely true.  Indeed, the only reason to believe and become a Christian is because Christianity is true truth.  Of course, Christians are emotional beings, but those emotions must be predicated on truth, not the other way round.

Where does this leave us?  It leaves us in exactly the position of our forefathers.  Post-truth is just the latest fad and fudge to challenge twenty-first century Christians.  I don’t want to live in a post-truth society.  And nor should you!  Resist post-truth.  Don’t let your emotions be the arbiter of truth.  Hear the truth, speak the whole truth and live nothing but the truth.  We should love true truth – because the Lord Jesus Christ is truth (John 14:6).

The sanctity of life
‘The sanctity of life’ is a phrase I very rarely use.  OK, so it appears seven times in my 2014 book Bioethical Issues, but all those citations are quotations belonging to others.  For me, the expression sounds sanctimonious and I don’t care for it.  For me, its meaning is uncertain, though I know it denotes something special and holy.  And of course I believe that human life is special and different from all other created forms because we bear the imago Dei (Genesis 1:27).

Yet ‘the sanctity of life’ is a concept employed by many – beloved by some in the pro-life camp and scorned by those in the pro-choice community.  Among the latter is that most famous of current utilitarian philosophers, Professor Peter Singer.  In 2005, he wrote an article entitled The Sanctity of Life, which was published in the September/October edition of the American magazine, Foreign Policy.  There he characteristically asserted that, ‘During the next 35 years, the traditional view of the sanctity of human life will collapse under pressure from scientific, technological, and demographic developments.  By 2040, it may be that only a rump of hard-core, know-nothing religious fundamentalists will defend the view that every human life, from conception to death, is sacrosanct.’

So I am not the only one who finds ‘the sanctity of life’ an awkward empty slogan.  In addition, the Roman Catholic philosopher, Professor David Albert Jones, director of the Anscombe Bioethics Centre in Oxford, has also recently come to my rescue and exposed the term’s weaknesses.  He has written a scholarly and absorbing article, entitled An Unholy Mess: Why ‘The Sanctity of Life Principle’ Should Be Jettisoned, which was published online on 11 November 2016 in The New Bioethics.

Where did this knotty phrase originate?  You might have thought it was in common parlance among ancient Christian theologians and philosophers.  And you’d be wrong!  Jones shows that its modern appearance emanates from the publication of a 1957 book by Glanville Williams, entitled The Sanctity of Life and the Criminal Law.  I am sorry to say that Williams, regarded by some as ‘one of the greatest academic lawyers of the twentieth century’, read law as a student at the University of Wales, Aberystwyth – my old employer!  The book is still available as a hefty 361 pages on Amazon at a similarly hefty price of £67.50 for the hardback version, though I recently bought my paperback edition there for a mere £4.63.  The title and the theme of the book thus entered the bioethical vernacular during the 1970s.

You, like me, initially, may think that Williams was making the legal case for the protection of human life.  Wrong!  As David Jones points out, Williams’ two-fold aim was to make the case for legal abortion, infanticide, suicide and euthanasia and to attack religious, especially Roman Catholic, views on the nature and value of human life.  Williams and more recent bioethicists, like Peter Singer, insist that any arguments opposing the killing of the vulnerable, born and unborn, must not only be irrational but also based solely on religious convictions.  In other words, they consider ‘the sanctity of life’ to be some feeble churchy belief with pious overtones.  Accordingly, they say it has no place in our secular world, much less as a principle for constructing a robust framework for tackling bioethical issues.  I concur.  Jones’ evaluation is that, ‘The connotations of this language are part of a deliberate attempt to distract from fundamental issues of justice, solidarity and human rights and falsely to imply that the legal protection which is due to vulnerable human beings is based only on religious sentiment.’  Jones further reasons that because ‘the phrase is neither rooted in the traditions it purports to represent nor is it used consistently in contemporary discourse’ it should be scrapped.  So perhaps strangely, Singer, Jones and I agree.  Sometimes we collect strange bioethical bedfellows.

David Jones concludes that, ‘It is better, in summary, to jettison the language of a “principle” of “the sanctity of human life” in favour of clearer and more traditional ethical concepts: the prohibition on killing the innocent and the prudential consideration of burdens and benefits, integrating distinct virtues and distinct practical principles in pursuit of the human good of the particular individual in the context of medical treatment.’  In other words, our overall response must be one of principled compassion, whereby we protect, defend and cherish all human life, whether pre-born, born, or approaching its natural end.  For evangelical Christians our motivation is not found in the vagaries of ‘the sanctity of life’ ethic, but rather in the truth that we are all special, that we are all made in the image of God, that we all bear the imago Dei.  When that becomes our bedrock, we can start to apply solid, truthful, often costly answers, to deep and serious human dilemmas.

Lennart Nilsson (1922 – 2017)
Lars Olof Lennart Nilsson, the innovative Swedish photographer, died in Stockholm on 28 January 2017, aged 94.  His father, a technician with the Swedish railway, and his uncle were both keen photographers so it is not surprising that Lennart was given his first camera at the tender age of 11.  Three years later he saw a documentary about Louis Pasteur which kindled his interest in microscopy.  A little later he acquired his own microscope and was soon making microphotographs of insects.  He progressed to taking environmental portraits of people in their everyday locations, at home or at work.

By the mid-1940s, Nilsson had become a freelance professional specialising as a war photographer, documentary-maker and portraitist.  He completed books on the world of ants and undersea creatures.  But it was not until 1951 that his real work began.  He was on an assignment to photograph a professor at the Karolinska Institute in Stockholm.  He spotted a row of tiny bottles on a laboratory shelf, each containing a two-month-old human foetus.  ‘I had no idea the embryo was so mature so early.  In that same second’, he later recalled, ‘I knew I would concentrate on the early development of the human.’

During the 1950s he began experimenting with new photographic techniques to make extremely close-up photographs.  His use of ultra-fine tubes, called endoscopes, combined with macro-lens cameras and inventive lighting allowed him to take ground-breaking magnified images of human cells, tissues and blood vessels, in colour and with startling clarity.  It was these creative skills that were to bring him global recognition.

In 1953, Nilsson won his first assignment with Life magazine.  While working on this, he showed some of his initial pictures of the human foetus to the magazine’s editors.  It took another 12 years of labour before, on 30 April 1965, Life published Nilsson’s astounding images of the beginnings and development of unborn human life.  They featured on both the cover and sixteen additional pages for the magazine’s story entitled The Drama of Life before Birth.  The entire print run of 8 million copies sold out in a few days.  In the same year, his book, A Child is Born, was published – it was to become one of the most successful photography albums ever.  It has sold tens of millions of copies, been translated into more than 20 languages and printed in five editions, reaching readers and viewers worldwide, and becoming an iconic work for the pro-life movement.

Only later did it become widely known that many of the embryos and foetuses used in his work were not alive, as many readers had thought, but had been aborted or miscarried, and obtained from several women’s clinics in Sweden.  In the accompanying prose, Life explained that, ‘The embryos … had been surgically removed for a variety of medical reasons.’  And, of course, in his later work using scanning electron microscopes, which allowed him to take pictures at a magnification of hundreds of thousands, the human samples could not have been alive because they had to be fixed and coated with a layer of gold.  That notwithstanding, nothing can take away the breath-taking beauty of the unborn.  But his subjects were not always lifeless.  In an interview with NOVA, the American PBS prime-time science series, Nilsson stated, ‘We make a kind of laparoscopy through the uterine wall.  You know when the doctors are checking the genes with amniocentesis?  We have done a few cases here in Sweden and in Europe during amniocentesis.  And there we have the opportunity to take wonderful pictures of the foetuses.’  And later he excitedly recalled, ‘But the piece I just worked on in Göteborg was unbelievable.  The foetus was moving, not really sucking its thumb, but it was moving and you could see everything – heartbeats and umbilical cord and so on.  It was extremely beautiful, really beautiful!’

Perhaps Nilsson’s most famous image, which did not appear in the 1965 issue of Life, but is included in A Child is Born, is that of a 20-week-old foetus sucking his thumb.  This stunningly beautiful image has appeared in innumerable pro-life publications, postcards and posters, over the years, and around the world.   Nilsson never did any of those photo-nasties, those shock images that are now placarded by a few pro-life organisations along our streets and in our shopping centres.  He had a different purpose.  Nilsson wanted to shock people not by aborted human bits and pieces, but by the sheer beauty of the human form from conception to birth, from day 1 to day 277.

Not surprisingly, Nilsson received numerous awards from both scientific and photographic establishments.  For instance, he became a member of the Swedish Society of Medicine in 1969, received an honorary doctorate in medicine from the Karolinska Institute in 1976 and was presented with the first Hasselblad Foundation International Award in Photography in 1980.  In 1985, Swedish television produced and showed his documentary, The Miracle of Life, which received an Emmy Award and was the first filmed record of human conception.  Much of Nilsson’s work is still on permanent show in many locations, including the British Museum in London.

But what of the man himself?  Though he has been called a genius, a legend and a pioneer, his obituaries contain little about the real Lennart Nilsson.  He is survived by his second wife, Catharina Tjornedal, a stepson, Thomas Fjellstrom and three grandchildren.  A son, Kjell, from his first marriage to Birgit Svensson, died in 2013.  Ms Svensson died in 1986.  Nilsson’s death was announced by his step-daughter, Anne Fjellstrom, but the cause was not given.  There again, did he have hobbies?  Was he generous?  Did he support causes?  Was he grumpy or cheerful?  Had he been seriously ill?  Where was his faith – in men or in God?  This dearth of personal information portrays him as a rather two-dimensional character, so unlike his pictures.  He never took a public stand on abortion.  Nor would he ever be drawn on the question of when human life begins.  He would typically reply, ‘I cannot tell you.  I am a reporter, I am a photographer.  I want to educate people and also increase their reverence for life.’  He acknowledged that his favourite part about his work was surprising people by showing them something familiar – human reproduction, the body, nature – in a new way.  And certainly, he succeeded.  Nilsson’s images have forever changed the way that people think about human pregnancy, mothers, embryos and foetuses.  Never again could anyone argue that the unborn was merely a 'clump of cells' or nothing more than ‘a blob of tissue’.  Once seen, no-one could ever forget his remarkable pictures.  For many they have become bioethical game-changers.  His photographs brought those arcane mysteries of human pregnancy to an end – the human embryo and foetus really are one of us.  Lennart – we thank you!

Nat Hentoff (1925 - 2017)
Nathan Irving Hentoff was born in Boston and was to become a noted novelist, jazz and country music critic as well as a newspaper columnist.  He died on 7 January 2017 in Manhattan.  Numerous obituaries have been published, but on 16 January, The Times printed a surprising facet of his later life in a little piece entitled Lives Remembered by David Manly.  He wrote, 'Without doubt Nat Hentoff’s lifelong writing on jazz will be by what many will remember him (obituary, January 28).  He was also a public intellectual of courage, always willing to unmask what he saw as hypocrisy and favouritism in friend and foe.  In the Eighties he decided to become pro-life for purely philosophical and scientific reasons, in particular as found in the writings of medical scientists.  For this decision many of his erstwhile admirers were outraged and parted company from him because of his apostasy from one of the main tenets of today’s liberal orthodoxy.  He subsequently paid a high price for his switch, but never regretted choosing it.'  Hentoff described himself as 'a Jewish, atheist, civil libertarian, left-wing pro-lifer.'  Wesley J Smith, a US bioethicist, said of Hentoff, 'As an atheist, Nat took much heat from his fellow liberals and rigid fundamentalists among the “free thinking” crowd for standing against abortion, euthanasia, and opposing protocols that would leave babies with spina bifida and other disabilities to die without attempts at curative treatment.'

Norma McCorvey (1947 - 2017)
Abortion legalisation in the USA was decided in 1973 by the Supreme Court in the landmark case of Roe v. Wade.  The outcome was the creation of a new liberty, namely, the constitutional right of a woman to obtain an abortion.  Norma Leah McCorvey was the plaintiff, named as Jane Roe.  The following includes an edited excerpt from my 2014 book, Bioethical Issues, because everyone should understand the significance of Roe v. Wade.

The key events begin here.  In the summer of 1969, Norma McCorvey, a twenty-one-year-old mother of two, became pregnant again, but this time she wanted an abortion.  Texas law prohibited abortion, except to save a woman’s life, so McCorvey sought one illegally, but without success.  In the meantime, she had met two lawyers, Linda Coffee and Sarah Weddington, who were looking for somebody – anybody - to further their own pro-abortion legal ambitions.  McCorvey agreed to become the plaintiff, under the alias of Jane Roe, in a test case alleging that the Texas anti-abortion law of 1859 was unconstitutional.  On 3 March 1970, a complaint was filed naming Dallas County District Attorney Henry B. Wade as the defendant.  On 10 October 1972, after a journey through the lower courts, the Roe v. Wade case finally arrived at the Supreme Court.  The plaintiffs emphasised the constitutional right to personal privacy, while the state of Texas claimed a compelling interest to protect both prenatal life and the mother’s health.  Some three months later, Justice Harry Blackmun delivered the 7-to-2 majority decision of the Supreme Court in favour of Roe.  The Court decided that the right of personal privacy, including restrictions upon state intrusion, as contained in the Ninth and Fourteenth Amendments of the Constitution, was broad enough to encompass a woman’s decision to terminate her pregnancy.  Moreover, the word ‘person’, as used in the Constitution and the Fourteenth Amendment, did not include the unborn.  The Court also found that it could not decide on the question of when human life begins.  However, it did hold that neither the lack of a right to protection for a foetus by the state, nor a woman’s right to privacy, was absolute.  It is noteworthy that McCorvey never appeared in Court and that the judgement came too late for McCorvey – she gave birth to her third child, a daughter, in 1970.

To state that Norma McCorvey was a mixed-up woman is an understatement.  Her childhood and teen years were dreadfully unstable – her father, Olin, a TV repairman and a Jehovah’s Witness minister, left the family when she was 13 years old and her parents subsequently divorced.  She and her older brother were raised by their mother Mary, a violent alcoholic.  McCorvey attended a Catholic boarding school and was soon in trouble – at 10 years old, she robbed the cash machine at a garage and ran away with a girlfriend.  She was quickly declared a ward of the state.  She continued to have minor brushes with the law and alleged that she had been repeatedly raped by a cousin and sexually assaulted by a nun.  She found work in a restaurant and there met Elwood ‘Woody’ McCorvey – they were married while she was 16 and separated soon after.  By 1965 she gave birth to her first child, Melissa.  She developed a serious drinking and drugs problem, was often homeless, declared herself to be a lesbian and was tricked by her mother into giving Melissa up for adoption.  McCorvey became pregnant again and that baby was also placed for adoption.  And then in the summer of 1969, she was pregnant again and the story of the above paragraph begins.

There was an unexpected postscript to the Roe v. Wade verdict.  Fearing for her safety, she initially hid her ‘Roe’ identity.  She then went to work in a Dallas abortion clinic.  During that time, some evangelical Christians and others picketed her workplace; some screamed at her, while others befriended her.  One day, Emily, the seven-year-old daughter of such a pro-life friend, asked her, ‘Why do you let them kill the babies at the clinic?’  The child’s artless question pierced McCorvey’s heart and prompted the great change.  In 1995, she professed to have found God as a born-again Christian, was baptised, left her job at the Texan abortion clinic and turned pro-life.  Norma McCorvey believed she had been ‘set up’ by the pro-choice movement and especially by their two women lawyers.  She came to regret her part in legalising US abortion.  She subsequently stated, ‘I think abortion is wrong … I just have to take a pro-life position.  I'm 100% pro-life.  I don't believe in abortion even in an extreme situation.  If the woman is impregnated by a rapist, it's still a child.  You're not to act as your own God.’

A few weeks after her conversion to Christ, she explained her abortion epiphany like this: ‘I was sitting in O.R.’s [Operation Rescue’s, a pro-life group] offices when I noticed a fetal development poster.  The progression was so obvious, the eyes were so sweet.  It hurt my heart, just looking at them.  I ran outside and finally, it dawned on me. 'Norma', I said to myself, 'They're right.’  I had worked with pregnant women for years.  I had been through three pregnancies and deliveries myself.  I should have known.  Yet something in that poster made me lose my breath.  I kept seeing the picture of that tiny, 10-week-old embryo, and I said to myself, that's a baby!  It's as if blinders just fell off my eyes and I suddenly understood the truth – that's a baby!  I felt crushed under the truth of this realization.  I had to face up to the awful reality.  Abortion wasn't about 'products of conception'.  It wasn't about 'missed periods'.  It was about children being killed in their mother's wombs.  All those years I was wrong.  Signing that affidavit [as Jane Roe] I was wrong.  Working in an abortion clinic, I was wrong.  No more of this first trimester, second trimester, third trimester stuff.  Abortion – at any point – was wrong.  It was so clear.  Painfully clear.’

She wrote two books.  The first, I Am Roe, was a 1994 autobiography about her sexual orientation.  Her second, published in 1998, was Won By Love in which she explained her change on abortion thinking.  Later she renounced her lesbianism and was received into the Roman Catholic church.  She also formed her own advocacy group, Roe No More Ministry, and continued to speak out against abortion.  In 1973, she petitioned, unsuccessfully, the Supreme Court to overturn its 1973 decision.  She supported pro-life candidates and demonstrated against pro-abortion speakers, including Barack Obama, and was arrested for such actions.

For much of her life, Norma McCorvey was indeed a seriously mixed-up woman.  Her formative years were disastrous and she continued to make huge mistakes.  But who can gainsay her later pro-life stance?  Yes, she was a participant in the most infamous legal case in US history, which has since paved the way to an estimated 58 million abortions.  But, yes, she confessed her errors and sought to make amends.  She died from heart failure at a care home in Texas on 18 February, aged 69.  Sadly, she did not live long enough to see a longed-for legal challenge, even the overthrow, of the colossus that still bears her name, Roe v. Wade.