Update on Life Issues - February 2020

Abortion

Decriminalisation in Northern Ireland – the bioethical change
Is this not the worst bioethical news of the century?  Northern Ireland, that great bastion of pro-life sentiment and deed, has had abortion-on-demand foisted on it by the government in Westminster.  The people of the Province did not request it, nor did the Stormont government choose it.  The sheer audacity, the democratic disdain, the moral decay, the destructive outcome, the inescapable sorrow – they all beggar belief.  What have we done?

Perhaps the raw truth is we have done nothing, or at least, not enough.  We have let a few stark, bigoted voices overrule the truth.  Did we object?  Did we fight?  Everyone knows that the most enduring human right is the right to life.  It is written on paper for all to read – Article 2 of the European Convention on Human Rights declares, 'Everyone’s right to life shall be protected by law.'  Therefore abortion, the taking of human life, is always legally and morally wrong, whatever the gestational age.

Now the people of Northern Ireland will suffer like those of us in Great Britain with the long-term fallout of our wretched 1967 Abortion Act.  Yet the law in the Province is set to be worse because there will be no such restraining law there.  Abortion is to be decriminalised, which means no-one will be prosecuted, no-one will be refused, abortion will be lawful for any woman, anywhere, for any (and no) reason, at any gestational age.  Is this not the worst bioethical news of the century?  As we trample on the tiniest of those made in the image of God, may God forgive us all.  'Righteousness exalts a nation, but sin is a disgrace to any people' (Proverbs 14:34).

Decriminalisation in Northern Ireland – the political process
The abortion policy of the Province has long been a devolved political issue.  In January 2017, the Stormont Assembly collapsed in a row between Sinn Féin and the Democratic Unionist Party (DUP).  In July 2019, a few extreme pro-abortion MPs at Westminster seized on this impasse and succeeded in passing the Northern Ireland (Executive Formation) Bill through its final stages in the House of Lords and the Commons.  That Bill, which was primarily concerned with budgets and elections, had been cunningly amended so that sections 58 and 59 of the 1861 Offences Against the Person Act would be repealed.  The ensuing Act set the decriminalisation enactment date for 21 October 2019.  Stormont remained stubbornly non-operational and so, on that day, abortion was automatically decriminalised across Northern Ireland, that is, abortion was removed from the criminal law and placed under mere medical regulations.  Furthermore, the 2019 Act necessitated access to abortion to start by 31 March 2020.

The Act not only insisted that from 22 October abortion was decriminalised in Northern Ireland, but it also placed a moratorium on abortion-related criminal prosecutions.  As a bioethical crumb, since 22 October, the abortion of a child ‘capable of being born alive’ remains unlawful, except when the purpose is to preserve the life of the mother.

In the meantime, on Monday 4 November 2019, the UK government launched a public consultation on its proposed framework for abortion in Northern Ireland.  It closed on Monday 16 December.  The government intends to publish its response to this consultation and details of the action it will take within 12 weeks after 16 December.  That is, before early March.

These details of the proposed practice of abortion in Northern Ireland are now awaited.  Will it be unconditional up to 12 or 14 weeks?  Or 22 or 24 weeks?  Or later under some circumstances?  Will foetal abnormality and risk to the life of the mother be up to birth?  Will the ‘two-doctor rule’ be abandoned?  Will patient-doctor abortion consultations be conducted over Skype?  Will healthcare workers other than medical practitioners be allowed to procure abortions?  What about protection of those who conscientiously object to abortion?  Whatever, the proposed changes will certainly not be, as an editorial in the British Medical Journal declared, ‘Toward healthier abortion …’  How can killing the unborn ever be described as health-giving?

And while the current focus is on Northern Ireland, the momentum of decriminalisation is expected to spread across to England, Wales and Scotland.  And with such a pro-death ideology taking hold across the UK, how long before assisted suicide and euthanasia are legalised?  Is this not the worst bioethical news of the century?

Repeat abortions
It is now reckoned that 1 in 3 UK women will have had an abortion by the time they are 45 years old.  Many will have found the experience traumatic and will not want to repeat it.  But many do.  In fact, during 2018, as many as 172 women had their seventh abortion.  This is according to data obtained by Sky News from the Department of Health for England and Wales and from NHS Scotland under the 2000 Freedom of Information Act.

There is worse.  Overall, 84,258 repeat abortions were performed in Britain in 2018.  And that included 3,332 on teenagers.  Shockingly, 5 teenagers had suffered their sixth abortion in 2018.  Why?

Surely these girls and women are crying out for help.  Surely many of them are in abusive situations and are coerced into abortion.  Why is no-one asking relevant questions whenever a teenager repeatedly comes for an abortion?  Where are the social workers and medical staff?  Are they deaf and blind?  Are they happy to repeatedly betray the vulnerable?

Goodbye Calthorpe
The Calthorpe Clinic in Edgbaston, Birmingham closed in December 2019.  It was the oldest abortion clinic in the UK having performed terminations for the last 50 years since it opened its doors in 1969.  By 2007 it was the largest single abortion clinic in the UK performing about 10,000 abortions annually.

This abortion facility had a long history of unethical and dangerous practices.  For example, in November 2000, one of the abortionists there, Dr Andrew Gbinigie caused horrific injuries, on his first day at work, to a young woman seeking an abortion.  While performing the operation on the 21-year-old he tore a hole in her womb, removed an ovary, ripped away part of a kidney and pulled down a piece of her bowel before questions from the assisting theatre nurse eventually caused him to realise his catalogue of mistakes.  In 2012, The Daily Telegraph caught one of Calthorpe’s abortionists, Dr Palaniappan Rajmohan, agreeing to perform an illegal sex-selection abortion on an unborn baby girl.  And Calthorpe doctors were also found to be illegally pre-signing abortion consent forms.  In the same year the Care Quality Commission (CQC) inspection report found that the Clinic had not met the required standard in both ‘staffing’ and ‘quality and suitability of management’.

Also in 2012, the privately-owned Calthorpe was taken over by the global abortion provider Marie Stopes International (MSI).  But the problems continued.  For instance, in 2016, MSI Birmingham, as it was now known, along with other MSI centres in the UK, had some of their ‘services’ suspended due to concerns raised by the CQC.  Between March 2018 and February 2019 there were 18 ‘incidents’ when patients had to be transferred to a nearby NHS hospital.

News of Calthorpe’s closure came to public attention on 12 December when its manageress came and spoke to one of the prayer vigil volunteers outside.  She handed him a doughnut and told him that the centre was shutting at the end of the month and that consequently staff would be looking for new jobs.  The backstory is that MSI Birmingham had had its NHS abortion contract cancelled and that all three of its abortion facilities in the Birmingham area had closed permanently.  Sadly, that local NHS contract has since been awarded to the British Pregnancy Advisory Service (BPAS).  The killing continues.

Simon Cooke
And talking of Marie Stopes International (MSI), its CEO has been in the news again recently.  In 2018, Simon Cooke’s annual pay packet increased from £300,000 to £434,500.  The Charity Commission on 20 December delivered a severe rebuke to MSI.  The watchdog gave ‘formal advice’ to MSI to change how it decides earnings of its senior employees.  MSI has 39 staff on salaries of over £100,000.  The Commission’s warning was the first shot in a campaign to curb the pay excesses of some charity bosses.

The MSI charity performs around 70,000 terminations a year in its 60 or so clinics across the UK – almost all are funded by the NHS, aka UK taxpayers.  In 2018, MSI was awarded nearly £50 million for its contraception and abortion work in the developing world, funded from the UK’s foreign aid budget, aka UK taxpayers.

The world’s biggest killer
What was the cause of most deaths globally in 2019?  Cancer?  HIV/AIDS, smoking, various diseases?   No, none of those.  It was abortion with an estimated 42.3 million.  Those other causes account for 8.2 million, 1.7 million, 5 million and 13 million respectively.  Worldometers (https://www.worldometers.info/) estimates that there were 58.6 million deaths worldwide in 2019.  But that total does not include the 42.3 million aborted unborn because Worldometers perversely fails to recognise their human being status.

If I Could Speak: Letters from the Womb
This is the title of a 72-page booklet written by Mark Jones, the minister of Faith Reformed Presbyterian Church (PCA) in Vancouver, Canada.  It was released in the UK on 10 January 2020 by Christian Focus and costs £9.99.

The publisher’s blurb commences, ‘Dear Mommy …  So begins the correspondence from an unborn baby to her mother.  Making an impassioned plea to her mother to not abort her, she shares her hopes and fears with the woman who can control whether she lives or dies.  These letters are an appeal to all who read them to choose life.


Assisted Reproductive Technologies

Surrogacy revisited and updated
As with all assisted reproductive technologies (ARTs), surrogacy is weird and never a good idea.  Not only is it unnatural, it is also morally problematic and personally troublesome – a can of bioethical worms.  True, it is less commonly practised than IVF, but there are moves afoot to make it more readily-available and less bound by regulations.

The Warnock Report (1984, p. 42) gave this definition: ‘Surrogacy is the practice whereby one woman carries a child for another with the intention that the child should be handed over after birth.’  The main legislation concerning surrogacy is the 1985 Surrogacy Act and the 2008 Human Fertilisation and Embryology Act.

There are several variations on this theme.  First, there is traditional, partial, or straight surrogacy.  This is the most common type when a husband is fertile, but his wife is unable to sustain a pregnancy, possibly because of illness, or because she has had a hysterectomy or maybe she is a ‘new’ career woman and just too busy to be pregnant.  The hired surrogate woman, a friend, a family member is then inseminated, artificially or naturally, with the husband’s sperm.  Because she is using her own ova, she is the biological, genetic and legal mother of the child.

Second, there is full, gestational, or 'host IVF' surrogacy.  Embryos are created by IVF using gametes either from the commissioning/intended parents, or sperm and ova donated by others.  The resulting embryos are then transferred to the surrogate and because she does not provide any ova, she has no genetic relationship to the child, but she is still the biological and, by birth, the legal mother.

Under current UK law, the surrogate woman who gives birth to a child is automatically regarded as the child's legal mother.  A parental order obtained from a court is the means by which legal parenthood is transferred from the surrogate to the intended parent or parents.  Applications for parental orders must normally be made in the first six months after birth.  Commercial surrogacy is banned in the UK so surrogates can be reimbursed only for ‘reasonable expenses’, which typically range from £12,000 to £15,000.  And no surrogacy agreements are legally binding.

Surrogacy has already changed during the last decade.  For instance, there are increasing numbers of gay men wanting children and inevitably having to hire a surrogate woman.  Since 2010, gay male couples have been allowed to apply for parental orders.  Since January 2019, single persons can also become legal parents through surrogacy.  Since 2015, mitochondrial donation, commonly known as 3-parent IVF (mother, father plus surrogate), has been legal in the UK.

Perhaps not surprisingly, surrogacy is a practice ripe for litigation.  Here is the recent, strange and tangled case of the Whittington Hospital NHS Trust.  A 29-year-old woman, known only as XX, developed cervical cancer which went undetected for several year despite smear tests and biopsies.  The Trust admitted negligence.  She and her partner wanted children and she had delayed chemo-radiotherapy to undergo procedures to collect 12 ova which were then cryopreserved.  The subsequent cancer treatment caused her to become infertile and unable to sustain a pregnancy.  XX therefore hoped to use surrogacy in either America or the UK.  She preferred the former since commercial surrogacy is illegal in the UK and pre-birth orders, giving her legal status as the mother, are not available here.  She took the Trust to court to cover the costs for the Californian option.  In June 2017, the High Court awarded her £580,000 in negligence damages, but denied her the cost of four surrogacies in the USA.  In December 2018, the Court of Appeal overturned the High Court ruling and unanimously awarded her another £560,000 to cover the US surrogacy costs.  On 16 December 2019, the NHS Trust appealed that decision saying that paying for commercial surrogacy would be ‘contrary to public policy’.  Five Supreme Court justices, in what was Lady Hale’s last hearing, heard the case.  Their judgement is awaited.

Surrogacy has even surfaced on that Radio 4’s guardian of traditional countryfolk’s values, The Archers.  Aleksandra ‘Lexi’ Viktorova, a Bulgarian fruit picker on Home Farm, became a surrogate for the ‘married’ gay couple, Adam Macy and Ian Craig.  The pregnancy was conceived by an ovum donor and Adam’s sperm – Ian was discovered to be infertile.  Jennifer Aldridge, Adam’s mother, is convinced that Lexi will flee with baby Alexander Macy-Craig (or Xander for short) to Bulgaria.  Well I never!  Of course it is fictional, but ….

These are some examples of changing attitudes towards surrogacy.  They have created a head of steam declaring that the UK’s surrogacy laws are out of date and need amending.

The government has asked the Law Commission to review UK surrogacy law.  Its aim is to make surrogacy laws work for the parents, the surrogate and, most importantly, the child.  A public consultation, contained in a 502-page document, entitled Building families through surrogacy: a new law, ran from 6 June to 11 October 2019.  It is expected that a final report with recommendations for reform of the law, and a draft Bill, will be forthcoming in 2021.

The Law Commission has already proposed that parental rights should commence at birth.  However, it also wants the surrogate mother to retain a right to object for a short period.  Furthermore, it calls for specific regulation for surrogacy arrangements and safeguards, such as counselling and independent legal advice, to reduce the risk of arrangements breaking down.  And it thinks that international surrogacy arrangements should be recognised.

Surrogacy UK, an organisation which represents about 150 active surrogates and 500 intended parents, of which almost 50% are same-sex couples, broadly agrees, but wants any surrogate’s objections to be tested in court.  It also wants the surrogate to lose all rights over the child.  This, it says, would protect surrogates from the risk of intended parents abandoning a child with a disability, or not paying the medical bills.  Surrogacy UK is also calling for safeguards so that payments cannot be disguised as expenses.  And intended parents should pay for a surrogate’s life assurance, legal bills and IVF treatment, often resulting in a total cost of between £30,000 and £40,000.

Sarah Jones, chairwoman of Surrogacy UK and four times a surrogate, has said, ‘We are pleased to see that there has been no movement towards permitting commercial profit-making surrogacy organisations.  We hope that the Law Commission will resist any movement away from an expenses-only model.  Surrogacy should be about making families, not money.’

Surrogacy, whether it is traditional or gestational, is an attack on the biblical pattern of family, where children are conceived, born and nurtured within the family unit of mother and father.  Because surrogacy is fundamentally wrong, tinkering with the concept and tweaking its legal status will not make it right.  It is best avoided.

Another IVF disaster
The Court of Protection in London is often required to decide complex cases about people who are incapable of looking after their own interests.  Here is another such case curiously coupled to IVF.

In 2012, a woman was hit by a bus while studying in London.  She suffered reduced mental capacity and other health problems and was awarded £2.5 million in compensation after suing the bus company.

In October 2019, she came to the Court of Protection with her request.  Mrs Justice Nathalie Lieven granted this severely brain-damaged woman, now in her thirties, permission to pay for IVF treatment, even though she is not married and lives in China with her parents.  Mrs Lieven noted that the unnamed woman, ‘feels that having a baby will give more meaning and purpose to her life.’  The judge has never met or spoken to the woman, but said, ‘It seems that she can communicate quite clearly, including in English, and she can articulate her wishes and feelings.’

Apparently no-one opposed the woman's request, but she needed a judge's permission because she was deemed incapable of deciding whether to spend the money on IVF by herself.  The woman now plans to have IVF treatment in the United States.

Is having a baby a justifiable action to give ‘meaning and purpose’ to a potential mother?  Can anyone assess the capabilities of an unknown woman with serious disabilities, without meeting her?  IVF fails more than it succeeds.  This is a puzzling case of two-handed confusion – a double whammy of legal pronouncement and bioethical choice.

Another IVF first - AneVivo
It just gets more bizarre.  Jasmine and Donna Francis-Smith are a lesbian couple.  They have become the first in the world to carry the same baby in both their wombs as part of a novel process called ‘shared motherhood’.

The women used the AneVivo procedure, also called In Vivo Natural Fertilisation, pioneered by the Swiss technology company Anecova, and carried out at the London Women’s Clinic.  According to Martin Velasco, its founder and CEO, Anecova ‘enhances the emotional value for the couple.’

It involved collecting ova by IVF from the biological mother, Donna.  These were placed inside a miniature capsule with donor sperm and inserted into her womb, where they were incubated for 18 hours.  Fertilisation and early embryo development can thus occur in a more natural in vivo environment rather than the artificial situation of an IVF laboratory.  A resulting embryo was then removed and transferred into the womb of Jasmine, the gestational mother, who carried the baby to term.  As a result, baby Otis was born in September 2019.

Preimplantation Genetic Testing for Aneuploidy (PGT-A)
Fertility clinics have recently faced severe criticism for offering numerous IVF treatment add-ons which can be ineffective for the patient, but effective money-making schemes for the clinics.

Each year the HFEA conducts a review to assess the most commonly used of these add-ons.  One of them is preimplantation genetic testing for aneuploidy (PGT-A, also known as preimplantation genetic screening, PGS).  It checks for genetic abnormalities in the number of chromosomes of 5-day-old embryos.  Aneuploid embryos are less likely to develop to term and more likely to suffer from various genetic conditions.  Embryologists remove a cell from the embryo and analyse its chromosomal status before transferring it to the woman.  Embryos which exhibit aneuploidy are destroyed.

The HFEA has devised a traffic light rating system to allow patients to assess the effectiveness of add-ons.  In December 2019, PGT-A was downgraded from amber to red, ‘meaning that there is no evidence to show that the treatment is effective and safe.’  PGT-A typically costs around £1,000.


Euthanasia and Assisted Suicide

Philippe Newby
Mr Newby is 49 years old, of French and English descent and, in 2014, was diagnosed with motor neurone disease (MND), an incurable, progressive and life-shortening condition which will eventually lead to his death.  He is the latest in a high-profile line, of mainly men, including Noel Conway, Paul Lamb, ‘Martin’, Tony Nicklinson and Diane Pretty, who have fought for the right to die.

Backed by Dignity in Dying, Mr Newby started a CrowdJustice funding campaign to help pay for a legal challenge to the law criminalising assisted dying.  He raised over £44,000.

His challenge was considered to be different from previous cases because in a new approach it would ask the courts to look at the evidence on assisted suicide in more detail than the English courts have ever done before.  This would include detailed cross-examination of expert witnesses and information from countries where assisted suicide is legal, allowing judges to test the strength of the evidence and whether the law is incompatible with his human rights.

But on 19 November 2019, Lord Justice Irwin and Mrs Justice May, sitting in the High Court, did not grant permission for the case to be heard.  They said, ‘It is impossible not to have very great sympathy for the situation in which Mr Newby finds himself.  His clear and dignified statement compels admiration and respect.’  However, both judges declared that the Court is ‘not an appropriate forum for the discussion of the sanctity of life.’

Lord Justice Irwin further explained, 'In the context of repeated and recent parliamentary debate, where there is an absence of significant change in societal attitude expressed through Parliament, and where the courts lack legitimacy and expertise on moral – as opposed to legal – questions, in our judgment the courts are not the venue for arguments which have failed to convince Parliament.  Even if there was very widespread examination of evidence in these proceedings, the court process is in our view unlikely to provide reliable answers so as to determine this issue.’

In a statement after the ruling, Mr Newby said, ‘The High Court's decision not to hear my case, and not to test the evidence for and against assisted dying, is disappointing to me and the many hundreds of others who support my case.  With their support, I will be fighting on to bring attention to a law that is widely thought to be cruel, so that it can be replaced by something more humane and compassionate.’

Alistair Thomson from the Care Not Killing organisation responded, ‘Parliaments across the UK have looked at this issue more than a dozen times since 2003.  And in both Scotland and Westminster they have rejected any changes on grounds of public safety.  If you change the law, vulnerable people will feel pressured into ending their lives.’

Mr Newby intends to contest the High Court’s ruling, though if and when an appeal will be allowed in currently not known.  There is no prospect that Parliament will consider the issues.  In October 2019, the then Secretary of State for Justice, Robert Buckland, stated that the Government ruled out a public consultation on changing the law on assisted dying.

Paul Lamb
On 19 December 2019, Paul Lamb’s case came to an end.  He is the 63-year-old severely paralysed ex-builder from Leeds, who has argued that the 1961 Suicide Act is discriminatory and breaches his human rights.  He lost his case at the Supreme Court in 2014.

In 2019, he mounted another legal challenge maintaining that public opinion had changed since then and so he asked the High Court to allow a new hearing.  But Lord Justice Dingemans and Mrs Justice Elisabeth Laing said his case was ‘unarguable’ and should not proceed to a full hearing.  Mrs Justice Laing said that allowing exemptions to the law on assisted dying would remove protection of ‘very vulnerable people’, some of whom would not wish to take their own lives but may be subjected to ‘pressure’ to do so.

World Medical Association declaration
You might think that the world is rushing headlong into legalising euthanasia and assisted suicide.  You would be wrong.  True, in June and December 2019 the Australian states of Victoria and Western Australia respectively became the latest jurisdictions to legalise assisted suicide, joining Switzerland, Belgium, Canada, Colombia, Luxembourg, the Netherlands and a handful of US states.

What about the UK?  Are we inching towards legalisation?  Not so.  Assisted suicide remains illegal in the UK because of the robust 1961 Suicide Act.  Yet in March 2019, the Royal College of Physicians (RCP) rigged a poll (which is currently being contested through the courts) and moved its stance of opposition to one of neutrality.  In November, the Royal College of General Practitioners (RCGP) similarly consulted its 53,000 members with a 13 December 2019 deadline.  The results are awaited.  And later this year the British Medical Association (BMA) will survey its 160,000 members on whether its official position should change from opposition.

Let’s get some perspective.  Apart from those jurisdictions listed above, the practice of assisted suicide is repudiated nearly everywhere else around the world.  Resounding evidence to support such a statement comes from the recent meeting of the World Medical Association (WMA), which has had a long-standing policy opposing euthanasia and assisted suicide.

During October 2019, at its 70th Annual General Assembly in Tbilisi, Georgia, the WMA adopted a revised Declaration on Euthanasia and Physician-Assisted Suicide.  It contains three bold statements.  First, ‘The WMA reiterates its strong commitment to the principles of medical ethics and that utmost respect has to be maintained for human life.  Therefore, the WMA is firmly opposed to euthanasia and physician-assisted suicide.’

Second, the WMA affirmed, ‘No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end.’

And third, ‘Separately, the physician who respects the basic right of the patient to decline medical treatment does not act unethically in forgoing or withholding unwanted care, even if respecting such a wish results in the death of the patient.’

Of course the WMA, with its membership of 114 national medical associations and more than 10 million doctors, will now be under pressure to change its policy.  With that in mind, the WMA issued this strong proclamation in May 2019, ‘Only a small minority of physicians support E&PAS [euthanasia and physician-assisted suicide].  The vast majority of doctors around the world wish only to foster the will to live and to cope with illness and suffering, not to facilitate acts of suicide or to create ambiguity around what constitutes a medical treatment.’

Assisted suicide on the Isle of Man
On 21 January, members of the House of Keys on the Isle of Man debated a motion put forward by Alex Allinson MHK on legalising assisted suicide. 
If there is support for his motion, Dr Allinson plans to bring forward a private member’s bill in March followed by a public consultation in the summer.  The issue was last debated on the Isle in February 2015, when a similar bid was thrown out by members of the House of Keys by a majority of 17 v. 5.  If the motion on Tuesday passes, the impact will be felt across the rest of the UK.  It will be interpreted by supporters of assisted suicide and euthanasia as further evidence of growing support.

It is striking that on the following Thursday, 23 January, in Westminster Hall, MPs will also be debating the current law on assisted suicide.  It seems clear that pressure to change our current law is growing.

Dutch go even further
As if euthanasia in Holland is not bad enough in its extent and numbers.  Now there is pressure to go even further.

A recent report entitled, Medische beslissingen rond het levenseinde bij kinderen (1-12) [Medical end-of-life decisions in children (1-12)], from three Dutch teaching hospitals claims that 84% of Dutch paediatricians who were surveyed want euthanasia for children between 1 and 12 years old.  This proposal has been tabled in the lower house of the Dutch parliament.  Currently euthanasia is reserved for Dutch newborns, up to 12 months old, and for children between 12 and 16 years old as long as they have the consent of their parents.

And at the other end of the age spectrum, a recent survey shows, for the first time, that a majority of Dutch citizens (55%) support the idea that euthanasia is legitimate for those who say they are healthy but ‘tired of life’.  This year, controversial new legislation is to be tabled in the Dutch parliament by the centre-left party, known as D66.  It would make euthanasia available to citizens over 75 who believe their lives are ‘complete’.

There were 6,126 deaths by euthanasia in 2018, amounting to 4% of the people who died in the Netherlands last year.  Anyone like to wager this proportion will not increase this year?

New Zealand’s referendum on euthanasia
In mid-November, the New Zealand parliament, after eight debates and a record 39,000 submissions from the public, passed its ‘End of Life Choice’ euthanasia bill by 69 to 51 votes.  But the battle is not over.  During the months of prior debate, in October 2019, the New Zealand First political party inserted an amendment into the bill requiring a national binding referendum on the euthanasia bill, before it can become law.  The date of the euthanasia referendum, and the next general election, is not yet determined, but it is likely to occur in the autumn of 2020.


Genetic Engineering

He Jiankui imprisoned
Back in November 2018, the Chinese scientist He Jiankui shocked the world by claiming to have created the first gene-edited human babies using the germline altering techniques of CRISPR-Cas9.  Then mystery descended on the whole affair.  He disappeared with his two co-workers, his work remained unpublished and the whereabouts and health of the twin babies, Lulu and Nana, plus a previously unconfirmed third baby, were unknown.

Then on 30 December 2019, the People’s Court of Nanshan District of Shenzhen announced that He and his two colleagues had flouted regulations as well as research and medical ethics by altering genes in human embryos that were then transferred to two women.  According to the State news agency, Xinhua, the Court declared that, ‘The three accused did not have the proper certification to practise medicine, and, in seeking fame and wealth, deliberately violated national regulations in scientific research and medical treatment.’  All three pleaded guilty.  He was sentenced to three years imprisonment and fined 3 million yuan (£300,000).  His collaborators, Zhang Renli was sentenced to two years in prison, while Qin Jinzhou received an 18-month sentence, suspended for two years.  They were also fined 1 and 0.5 million yuan respectively.  In addition, they have all been banned for life from ever again working in the field of human reproductive technologies and from applying for research funding.  That chilling news should deter most other germline mavericks.

The Chinese Academy of Science released a statement, saying it ‘firmly opposed’ germline editing in humans.  It added, ‘Under current circumstances, gene editing in human embryos still involves various unresolved technical issues, might lead to unforeseen risks, and violates the consensus of the international scientific community.’

He’s unpublished manuscript
So where are the experimental details of He’s alleged ‘ground-breaking’ work?  The 3 December edition of the MIT Technology Review contained an article by Antonio Regalado called, ‘China’s CRISPR babies: Read exclusive excerpts from the unseen original research.’  It included extracts from a previously unpublished manuscript entitled, ‘Birth of Twins After Genome Editing for HIV Resistance.’  It was 4,699 words long and authored by He Jiankui and nine others.  This manuscript had previously been submitted to Nature and The Journal of the American Medical Association
, but both refused to publish it.

The draft text claims a medical breakthrough that ‘can control the HIV epidemic’.  It includes references to ‘success’ and ‘novel therapy’, but contains no convincing proof that the twins really are resistant to the virus.  Indeed, evidence from the draft’s data which suggests that the gene-editing procedure went wrong, is mostly ignored by the authors.

Experts who have assessed the manuscript have condemned the work and its claims.  For example, Rita Vassena, scientific director of a fertility clinic in Barcelona, said, ‘Approaching this document, I was hoping to see a reflective and mindful approach to gene editing in human embryos.  Unfortunately, it reads more like an experiment in search of a purpose, an attempt to find a defensible reason to use CRISPR/Cas9 technology in human embryos at all costs, rather than a conscientious, carefully thought through, stepwise approach to editing the human genome for generations to come.’

Denis Rebrikov
This Russian biologist, from the Pirogov Russian National Research Medical University in Moscow, is bullish about ethical guidelines.  In June 2019, he informed Nature by email that he intended to create gene-edited babies resistant to HIV using CRISPR-Cas9, despite the global opposition to He’s analogous work.  Another email in October confirmed that Rebrikov had started a second project, gene-editing ova donated by a hearing women in order to understand how deaf couples might be able to give birth to children without a genetic mutation that impairs their hearing.  Rebrikov is already in discussion with several deaf couples.  He insists that his intention is not to create such a baby, yet.

Instead, Rebrikov expects to publish, in the near future, this work which involves assessing the capability of CRISPR to repair a gene linked to deafness called GJB2.  People with two mutated copies of GJB2 cannot hear well without hearing aids or cochlear implants.  Rebrikov says these results will lay the groundwork for future clinical trials.

The benefits and ethics of this procedure have been called into question because deafness is not a fatal condition.  For example, Jennifer Doudna, the pioneer of CRISPR gene-editing has said, ‘The project is recklessly opportunistic, clearly unethical and damages the credibility of a technology that is intended to help, not harm.’

Though Rebrikov has insisted that he will follow all the Russian regulators’ guidelines, his long-term plans appear to be unchanged – he will create and transfer gene-edited human embryos into women’s wombs.

Designer babies
The arguments are decades old – what is a designer baby, is it ethical, when will one be born?  The answer to the latter, much simpler, question is probably 2020.  But this baby will not be stereotypically blonde, sporty, musical, beautiful and brainy.

This first ‘designer baby’ has been conceived, the embryo transferred to a surrogate mother (the ‘parents’ are a US male couple) and the pregnancy confirmed.  This is the result of enhanced IVF conducted by the US firm Genomic Prediction, based in New Jersey.  The ‘designer’ label is because the embryo has been selected after genomic analysis in order to decrease the risk of contracting 11 diseases, including certain types of cancer and diabetes.

Such screening techniques would be illegal in the UK.  Here preimplantation genetic diagnosis (PGD) screening of human embryos is allowed only for specific diseases caused by a single gene, such as cystic fibrosis.  Genomic Prediction has extended this procedure to test for diseases caused by multiple genes and called it polygenetic preimplantation genetic testing, or PGT-P.  Genomic Prediction is understood to intend to apply for a licence with the UK fertility watchdog, the Human Fertilisation and Embryology Authority (HFEA). 

Questions abound.  Is this going to be a real designer, or just a mildly genetically-tinkered, baby?  We already have PGD babies.  Is this a case of stretching the legal boundaries?  Where will this sort of work lead?  Will such gene technologies eradicate genetic diseases?  Or will they eradicate human differences?  Are we heading down the road of ‘eugenics’ or ‘science fiction’?

Gene-editing successes
Patients with sickle-cell disease (SCD) and beta-thalassemia are the first beneficiaries of some innovative gene-editing treatments.  Victoria Gray, a SCD patient in the US, has been pain free since July 2019.  Using CRIPR-Cas9 techniques her bone marrow stem cells have been tweaked into producing foetal haemoglobin, which effectively reverses her symptoms.  A similar process has been used on a thalassemia patient in Germany, who has been symptom free since March 2019.

This is cutting-edge medicine.  Whether the improvements are permanent or temporary remains to be seen.  But they are both bioethical heralds of somatic cell gene therapy rather than the unethical germline variety.

Prime editing
This a major upgrade for the CRISPR genome-editing technique.  It is touted as a better, more precise, more predictable method of correcting disease-causing mutations.  Its novelty is primarily because it can add and delete short DNA sequences.  It can even change just one DNA letter.  And it gives rise to fewer unwanted side effects.  No wonder it has been described a ‘genetic word processor’.  Andrew Anzalone and his co-workers at the Broad Institute, Massachusetts, headed by David Liu, have been responsible for its discovery as described in ‘Search-and-replace genome editing without double-strand breaks or donor DNA’ (Nature, 2019, 576: 149-157).

CRISPR is typically used in conjunction with Cas9.  This protein seeks out problem sequences of DNA.  Cutting DNA is one thing, repairing DNA is quite another.  This has proved to be not only an inefficient process, but sometimes the ‘novel’ DNA gets spliced into the wrong place so that uncontrolled insertions and deletions occur, which can cause dangerous mutations.

Anzalone and his colleagues have altered Cas9 by fusing it with an engineered reverse transcriptase enzyme to enable it to work more accurately and more efficiently.  ‘Old’ Cas9 cuts both double strands of DNA, which can lead to those mistakes and unwanted mutations.  ‘New’ Cas9 allows a single strand to be added and then cuts the opposite strand so the faulty DNA can be repaired using the added strand as a template.

This new prime editing method has already been used to correct mutations in human cells in the laboratory.  It has produced fewer off-target edits.  However, it has, so far, only allowed short sequences – only as large as 44 DNA letters – to be changed.  In other words, both ‘old’ and ‘new’ Cas9 techniques will currently be required, as well as any other inevitable newcomers.  Nevertheless, prime editing looks like becoming a stimulus for the development of gene therapies.  Already it has been estimated that it could, in principle, help tackle 89% of the 75,000 known human disease-associated DNA variants.


Miscellaneous

The General Election – before and after
The UK held a general election on 12 December 2019.  The result provided the conservative Party with a landslide majority of 80 seats.  In contrast to the USA, bioethical issues play very little part in UK elections.  But the likelihood is that two extreme matters, namely, the decriminalisation of abortion and the legalisation of assisted suicide, will be raised in the new Parliament.

How do the three major political parties view these two issues?  Prior to the election they revealed their stance in their manifestos.  They are worthy, as a matter of historical record, to be retained (with thanks to CARE).

The Conservative Party
Abortion.  The manifesto contained no policy that specifically addressed the issue of abortion.
Assisted suicide.  ‘We will support our precious hospices, developing the plans already announced by Boris Johnson to secure their future, with a £25 million cash injection in August to support 200,000 people at the end of their lives.’

The Labour Party
Abortion.  ‘We will uphold women’s reproductive rights and decriminalise abortions.’  And ‘Women in Northern Ireland should have access to abortions in Northern Ireland.’
Assisted suicide.  The manifesto contained no specific policy with regard to assisted suicide or end of life issues.

The Liberal Democrat Party
Abortion.  ‘We believe that everyone has a right to make independent decisions over their reproductive health without interference by the state, and that access to reproductive healthcare is a human right.  We will:
- Decriminalise abortion across the UK while retaining the existing 24-week limit and legislate for access to abortion facilities within Northern Ireland.
- Enforce safe zones around abortion clinics, make intimidation or harassment of abortion service users and staff outside clinics, or on common transport routes to these services, illegal.
- Fund abortion clinics to provide their services free of charge to service users regardless of nationality or residency.’
Assisted suicide.  ‘Provide more choice at the end of life, and move towards free end-of-life social care, whether people spend their last days at home or in a hospice.’
‘Regard every suicide as preventable.  We will take an evidence led approach to prevention, making it easier for people at risk to get the help they need, and equipping more members of the public with the skills and confidence to talk about suicide.’

The bioethical shape of the new Parliament
Of course nobody yet knows if and when these issues will appear on the Parliamentary order papers.  But there is no doubt they are already being discussed unofficially outside the chamber.

How might MPs vote?  Again, nobody knows.  Interestingly, it is reckoned that no prominent pro-life MPs on the mainland lost their seats.  On the other hand, pro-choice MPs, such as Anna Soubry, Paula Sherriff, Chuka Umuna and Dennis Skinner did.  The new intake of 140 MPs are largely untried.  However, James Grundy, Ruth Edwards, Anthony Mangnall, Greg Smith and Carla Lockhart are among those known to be pro-life.  They will be tested soon.

New Year Honours
I always read through the list, just in case there is anyone I know who is worthy of recognition beyond the call of duty.  I am never enamoured by awards for those merely doing their duties, such as Inland Revenue workers and ladies-in-waiting.  And it is well-known that I would accept nothing less than a knighthood.

However, this time there were three stand-outs that, IMHO, do not deserve prizes.  First, there was Alison Saunders DCB, erstwhile Director of Public Prosecutions (DPP).  She was granted a damehood ‘for services to criminal justice.’  She has been branded, by others, as ‘toxic’, ‘disastrous’ and ‘the worst DPP in living memory’.  Bioethically, she will be remembered as the DPP who, in October 2014, controversially and unilaterally amended the UK’s guidelines on assisted suicide so that doctors and nurses would be less likely to be prosecuted for assisting.  Moreover, at that very time, the Supreme Court had declared that Parliament was the place to debate this issue, and indeed Parliament was doing just that.  Which made it even more worrying that the DPP had decided to step in and relax the law.  All this raised serious questions about Alison Saunders’ motives, judgement and impartiality.  Vulnerable people in our society deserve the safeguards of the 1961 Suicide Act, a law against assisted suicide that offers them strong and unambiguous protection.  Mrs Saunders clearly did not understand this.

Second, there was Professor Lesley Regan DBE, who in December stepped down as president of the Royal College of Obstetricians and Gynaecologist (RCOG).  She was made a dame ‘for services to women’s healthcare.’  And we all know what that is a euphemism for.  Indeed, she was a driving force behind the move to decriminalise abortion in Northern Ireland and beyond.  She managed to persuade the RCOG’s council – but not its membership – to back decriminalisation in a ballot.  And she is the one who famously argued that the practice of abortion should be no more restricted by the law than the practice of going to ‘get your bunions sorted’.

Third, there was Diana Johnson DBE, Labour MP for Hull North.  She too becomes a dame ‘for charitable and political service.’  It was in March 2017 that her ten-minute rule Abortion Bill 2017-19 was set to decriminalise abortion in England and Wales and Northern Ireland.  Alarmingly, it passed its first reading on 23 October 2018 by 208 votes to 123.  However, because Parliament was dissolved, it made no further progress, but by then the damage had been done, the direction of that rocky and dangerous road had been set.

Maybe these women did some wonderful deeds deserving of such high honours.  But their bioethical breaches will not be forgotten.

A short history of bioethics
Where was bioethics conceived?  In the USA.  When was bioethics born?  In the 1970s.  Why was bioethics born?  Because of harmful treatment of humans.  One key example that generated widespread moral outrage occurred in 1972 when the topic of a US Public Health Service project at Tuskegee University, Alabama came to light.  It involved more than 400 black US men, mostly poor share-croppers.  They were subjected to untreated syphilis between 1932 and 1972.  As many as half of them died, and 60 of their wives and children contracted the disease.

In response the US government passed the 1974 National Research Act and established the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research.  By 1976, the Commission had drafted a report outlining the ‘basic ethical principles and guidelines that should assist in resolving the ethical problems that surround the conduct of research with human subjects.’

In 1978, this draft was published as The Belmont Report with its three abiding rules for undertaking future human research, namely, respect, beneficence and justice.  In addition, informed consent and ethical oversight were incorporated.  Also in 1978, bioethics’ first hefty tome was published as the Encyclopedia of Bioethics by the theologian Warren T Reich.  He was a founding member of the Georgetown University’s Kennedy Institute of Ethics.  Furthermore, 1978 was the year in which Louise Brown was born in the UK, the first baby conceived through IVF.  Modern bioethics was up and running.

The 1980s saw the subject blossom as it became central to broader issues, such as public health and medicine, yet it always remained sensitive to the protection and welfare of vulnerable people.  The HIV crisis of the mid-1980s also allowed bioethics to develop a strategic role in governmental and medical responses.

As bioethics grew it took on an even more important say about the ethics and practices of ‘new’ biomedical procedures.  These novel technologies included organ transplantation and in vitro fertilisation, but there were also the ‘old’ issues, like abortion and euthanasia.  Medicine was changing.  The ethical governing certainties of the Hippocratic Oath and the Judeo-Christian doctrines with their ‘do no harm’ and ‘love your enemy’ were under fire.  Medicine was now being judged by a new guideline, not just the preservation of human life, but the quality of that life.

The 1990s brought a further challenge to bioethics – the Human Genome Project (HGP), which sequenced the 3 billion letters of the human genome.  What might it lead to?  Altering the very genetic basis of man, gene therapies, designer babies, scary sci-fi stuff?  Would such enterprises be good, indifferent, or bad?  In the hope of answering such questions, bioethicists were recruited into every university, research centre and hospital.

These medico-legal-socio folk made little difference.  That longstanding, fundamental ethical basis of medicine had been contested and downgraded.  Human life had lost its uniqueness and dignity.  Medical tinkering was de rigueur.  Previously established boundaries and bans – embryo experimentation, abortion limits, human cloning, assisted suicides, germline editing – were ridden over roughshod, if not immediately, then later as a consequence of scientific hype and political lobbying.  Bioethics was losing its utility.

Yet new techniques, especially those associated with human reproductive and developmental biology, like 3-parent IVF, stem-cell technologies and organoid production, require arbitration and judgement.  Who will assess what is right and wrong?  Who will bridle the scientific imperative and the propaganda of researchers?  There is undoubtedly still a place for principled bioethicists.  Who else will bridge the bioethical ravine between science and society?

Principles of Biomedical Ethics at 40
No self-respecting bioethicist has not owned, or at least not read chunks of, Tom Beauchamp and James Childress’s 1979 masterpiece, Principles of Biomedical Ethics.  It must rank as the most influential bioethical textbook of the twentieth century.  It has given rise to the philosophical school of principalism, a practical approach to ethical dilemmas that is widely accepted, but which is also not without its critics.

The book argues for a framework consisting of four major principles that should universally govern medical ethics and practice.  They are autonomy, beneficence, non-maleficence and justice.  From these big four, several minor rules have arisen to include veracity, confidentiality, privacy and fidelity.  Yet for some 40 years these major principles have helped to stabilise the rush towards an unprincipled medicine as well as engender a more thoughtful and practical approach to the subject.  We have all benefitted.

Beauchamp and Childress, or Tom and Jim, first met in the mid-1960s at Yale University where their education in religious studies overlapped for three years.  After graduation both started doctoral research – Tom in philosophy at Johns Hopkins and Jim in religious studies at Yale.  It was not until in the mid-70s that they met again and cooperated as faculty members at Georgetown University.  It was then and there, in the associated Kennedy Institute, that the world’s first academic course in bioethics was started.  They shared six lectures.  Tom favoured a consequentialist approach, whereas Jim favoured deontology.  Nevertheless, from these two approaches the common idea of applying basic moral principles to biomedical ethics was sown.  Principles of Biomedical Ethics was conceived – ethical theory and practical problems were conjoined.  Oxford University Press excitedly guided its first bioethical project.  The book is now in its eighth edition (October 2019) of 512 pages at £56.23 paperback, or £226.19 hardback from Amazon.

In an editorial in the October edition of the American Journal of Bioethics (2019, 19: 9-12) to mark the book’s ruby anniversary, the authors describe how the concept of a principles-based approach to bioethics came about.  ‘We appreciated the need for an approach that recognized the value of ethical theory for practical judgments but that did not fetishize a single type of theory or promote a single principle over all others.  We became convinced that several moral principles provide significant common ground relevant to judgments in the biomedical sciences, medicine, and health care and that these principles could not be convincingly ranked a priori in a hierarchical order.’  In other words, they considered their four principles to be part of a ‘common morality’, a mix of unphilosophical common sense and tradition.

Critics have variously argued that the four principles are too vague, too narrow, or just downright simplistic.  Beauchamp and Childress have counter-argued, ‘We do not suppose that our principles and rules exhaust the common morality; we argue only that our framework captures major moral considerations that are essential starting points for biomedical ethics.  Some critics contend that the principles in “principalism” are merely clusters of moral concepts too abstract, general, and vague to guide judgments about actions.  In response, we show how processes of specification and balancing link broad principles and rules to the concrete moral judgments needed in practical ethics.’

Furthermore, Beauchamp and Childress maintain that their principalist approach is relevant, flexible and workable.  ‘Because our principles are universally applicable, we defend a global bioethics and not merely customary, regional, or cultural rules.  Our principles correlate with basic human rights and establish what is ethically acceptable for all societies.  Nonetheless, the principles allow for justified differences in the ethics of professional practice in societies and cultures through processes of specification and balancing.’

There can be no doubt, Principles of Biomedical Ethics is a great book, now in its eighth English edition and translated into six languages.  It is secular in nature yet it jostles along with biblical ethics.  Why?  Because biblical ethics are uniquely original, universally applicable, ethically consistent and totally true.  Principles is, by contrast, derivative.  So be warned, ‘These [rules] are all destined to perish with use, because they are based on human commands and teachings’ (Colossians 2: 22).

Traits of the religious
Scientific literature is not always a great place to understand human thinking and actions.  Yet, if science is true why should it not chime with evidence from the Bible?  What is our true nature?  Do we all have a religious streak?  And ‘religious’ is undefined here.  There follows two pieces of general interest – one metaphysical, one biological.  Can you spot yourself?

First, Jesse Bering is a psychologist now at the University of Otago, New Zealand.  He has told a particular story many times.  The audiences’ response is surprising.  Bering’s tale is about Richard Waverly, a 37-year-old history teacher.  Driving to work one day, tired and hungry and in a bad mood, he loses control of his car, crashed into a telegraph pole and is thrown through the windscreen.  The paramedics said he was dead before he hit the pavement.

The story is fictitious, but when asked questions, such as ‘do you think Richard knows he is dead?’ and ‘do you think he wishes he had told his wife he loved her before he died?’, large numbers of volunteers answered, Yes.  These are unsurprising answers from those who had already professed a belief in the afterlife.  But, even people who totally rejected the idea of life after death – so-called extinctivists – also often answered, Yes.  In other words, confronted with the finality of death, the majority of people cling on to the belief that it is not the end – most people believe in life after death.

Second, what else do the religious have in common?  According to a recent study, they have more children.  Apparently it is because we have greater ‘fitness’ to reproduce and pass on our genes.  Or is it that we obey the commands of Genesis 1:28 and 9:7, ‘Be fruitful and increase in number’?

Some scientists have argued that religious belief might help people to cooperate, and so have helped to provide us with a sense of common purpose.  Others consider that it may help the individual.  In addition, most religions are ‘pro-life’ and therefore encourage family life.  Some also discourage the use of contraception.

Of course some want to explain it all in evolutionary terms.  For example, Janko Međedović, is from the Department of Applied Psychology, Singidunum University, Belgrade.  Writing in the November 2019 issue of the Journal of Biosocial Science, has states, ‘If individuals with higher religiosity have elevated reproductive success, then natural selection could actively propagate [genetic variations] that contribute to the expression of religious affiliation.  In this case it could be reasonably assumed that religiousness does have an adaptive function in contemporary humans.’  Whatever that means.

Easier to understand is the key result of his study.  He asked 461 parents of psychology students at Singidunum University how many children they had and also how many they had planned to have when they were young adults.  The more religious the parents were, the more children they originally desired and the more they ended up having – an effect particularly marked among men.

Interestingly, Međedović’s results confirm the work of others.  In 2016, a review of census data, from almost 4 million women across 32 countries, found that those who were religious were less likely to be childless.

Deaths over births
The UK’s industrious Office for National Statistics (ONS) quietly hums away in the background.  Its workers are busy crunching the numbers about our lives – employment, internet access, marriage, smoking, death, baby names (yes, it’s Oliver and Olivia), travel and much more.  Ultimately they produce regular statistical reports.  It’s all rather fascinating.

New ONS figures for 2018 point to a possible new trend for England and Wales.  The number of deaths of people, who were born in the UK, was higher than the number of births to UK-born mothers.  The figures were 471,476 live births to UK-born mothers and 487,618 deaths of UK-born persons.  This represents the first natural decrease of population, with the exceptions of 1976 and 1977, since the publication of such statistics began in 1838.

This 180-year demographic trend has been one of a natural increase of births over deaths, apart from those 1970’s blips.  However, when the overall totals for all UK-born and non-UK-born people are considered, they tell the customary story.  Non-UK born mothers are typically from countries like Poland, Pakistan and Romania.  2018 saw an overall total of 657,076 live births in England and Wales and 541,589 deaths.  In other words, all births still outnumber all deaths.

Yet there is another unexpected statistic here.  These data demonstrate the lowest birth rate since records began 50 years ago in 1938.  It is also a 9.9% decrease from the recent peak in 2012.  The 2018 total fertility rate (TFR, the number of children per woman, aged 14 to 44) decreased from 1.76 to 1.70.  A TFR of 2.1 is regarded as the necessary replacement rate for a stable population.  Why the decrease?  People staying in education, fewer teenagers having children and easier access to contraception are the standard reasons given.  Nobody seems to mention abortion, which accounts for a loss of about 200,000 children each year.

Does it matter?  Yes.  A TFR below 2.1 means a country has a skewed demographic pattern – lots of seniors and fewer youngsters.  If fewer workers are generating fewer taxes, who will pay for the pensions and care of an aging population?  Some call this the ‘demographic cliff’.

Is 70 the new 65?
And the ONS has hit the headlines again recently.  Its November 2019 report entitled, Living longer: is age 70 the new age 65? suggests that it may be time to rethink how we measure and define old age in the UK.  The reason?  Because more people are surviving and living more heathy lives into their late 80s and beyond.  This is the positive outcome of improved medicine, public health, cleaner water and air, the decline in heavy industry, campaigns against smoking, and so on.

Traditionally, 65 has been taken as the entry point into ‘old age’.  For decades this has been the official retirement age for men, when they can start drawing their state pension and get free flu jabs.  But working patterns are shifting and the pension age is rising for both men and women – it will reach 66 in 2020 and 67 by 2028.  Longevity patterns are also shifting.  Many who reach their 70th milestone birthday can expect to live for another 15 years.

The ONS looked back at population data on health and life expectancy to compare trends over time.  If you take ‘15 years of remaining life’ as a marker, the average age when a person will hit this point has changed over the last century.  In 1951, men and women around the age of 60 could expect to live another 15 years.  By the 1990s, it had shifted to 65 and currently it is the 70-year-olds who can expect another 15 years of life.  In 2057, it is predicted this average age will rise again to 75.  So the ONS proposes that ‘remaining life expectancy’ may be a better marker of ‘old age’ than mere chronological age.  That means we should consider the years people have ahead of them, not just their actual age when deciding to define what ‘old’ looks like.

If only we knew exactly how many years we had left.  It would probably spur us on.  Yet we must be content with this great unknowable.  He is the Creator (Genesis 1:27), the Sustainer (Psalm 54:4) and the Taker of human life (1 Samuel 2:6).


Stem-Cell Technologies

Stem-cell fraudster dies
The disgraced stem-cell maverick, Davide Vannoni, died on 10 December 2019 after a long illness.  He was 53.  Vannoni had treated hundreds of people in Italy with his unproven, unpublished remedies.  Health authorities and academic researchers fought to halt his work which they considered to be pseudoscience and harmful.

Vannoni was born in Turin.  He was neither a trained scientist nor a doctor, but in 2007 he claimed to have invented a stem-cell therapy that could cure neurological conditions, such as Parkinson’s disease and muscular dystrophy.  The procedure, he said, converted stem cells taken from a person’s bone marrow into neural stem cells, which were then infused back into the patient.  He marketed this therapy through his organisation, the Stamina Foundation.

In 2012, the Italian Medicines Agency banned his therapy.  But Vannoni had a host of passionate celebrity, and often desperately-ill, supporters, who repeatedly persuaded the courts to permit the use of the ‘Stamina Method’.  In May 2013, the Italian health ministry even agreed to finance a €3 million clinical trial to assess the Method.  The contract was quickly cancelled in October 2013.

In 2015, courts in Turin convicted Vannoni on conspiracy and fraud charges.  He was sentenced to 22 months in prison, suspended on condition that he halted all further treatments.  Then in 2017 he was rearrested and charged with offering the Stamina Method in other countries.  He was jailed, but released last year because of his ill health.

So ends a long saga, which made one man rich, but many patients poor.  It also highlighted the ease by which stem-cell ‘treatments’ can be hyped while damaging the reputation of proper, proven stem-cell technologies.

Another one bites the dust
The controversial and shamed surgeon Paolo Macchiarini, who faked research relating to dangerous and largely discredited tracheal transplants, was, in November 2019, handed a 16-month prison sentence. This was handed down by an Italian court in Florence for his forging of documents and abuse of office while he had worked at the Careggi University Hospital in that city between 2009 and 2012.

From 2010, Macchiarini made headlines around the world after claiming a major breakthrough for patients with failing tracheas.  He pioneered a novel procedure of regenerative medicine by ‘seeding’ a prepared donated bio-scaffold with a patient’s own stem cells, to generate a functioning trachea which could be transplanted into the patient.  Seven of the eight patients who received one of his bioengineered tracheal transplants have died.

Macchiarini’s subsequent time as a visiting researcher at the prestigious Karolinska Institutet in Sweden was first greeted with great excitement at the prospect of a genuine medical advance.  It then turned into an embarrassing scandal when it emerged that Macchiarini had falsified some of his academic credentials as well as his experimental results and knowingly misled hospital authorities.  The Karolinska was dismayed.  It conducted interminable enquiries, suffered the resignation of senior staff, retracted several of Macchiarini’s research papers and eventually dismissed the chief troublemaker.  He then went to work at the Kazan Federal University in Russia until in 2017 it effectively fired him.

Stem-cell therapy for the heart
Stem-cell therapies are complex.  Even when they seem to work, their biological mechanisms remain largely unknown.  For example, when stem cells are infused into patients who have suffered heart attacks, any improvements are thought to be caused by the stem cells differentiating into beating heart-muscle cells, called cardiomyocytes.  This is now in doubt.

A team of researchers, led by Jeffery Molkentin, a cardiovascular biology researcher working at the Cincinnati Children’s Hospital Medical Center in Ohio, has demonstrated that stem-cell benefits can occur without this differentiation.  Instead, the stem cells can trigger cells of the immune system, known as CCR2+ and CX3CR1+ macrophages, which help to repair connective tissue in the damaged area of the heart, which, in turn, improves the organ’s function.  In addition, they discovered that zymosan, a chemical which is known to elicit an immune response, could initiate the repair.  This work was reported as ‘An acute immune response underlies the benefit of cardiac stem-cell therapy’ by Vagnozzi et al., in Nature (2020, 577: 405–409).

The experimental results were quite unexpected.  Two types of stem cells were injected into artificially-damaged, so called ischemia/reperfusion (I/R) injured, areas of mice hearts to mimic the conditions of a heart attack.  One type was mononuclear cells taken from bone marrow, as commonly used in human clinical trials, and the other was cardiac mesenchymal cells.  Both stem-cell types improved heart function of the mice significantly better than when a placebo was injected.  And when macrophage activity was supressed no repair occurred in the mice that received the stem cells or in those that received zymosan.  Yet even when the team injected fragments of dead stem cells this too improved heart function.

So, could it be that local and acute inflammation, induced by the immune system, is what drives the repair mechanism of stem-cell therapies, rather than the regenerative capacity of the stem cells themselves?  And could this immune response be the underlying mechanism that brings about health benefits seen in successful stem-cell treatments for other diseases?

Stem-cell therapy for MS
From October 2019, a stem-cell therapy has, for the first time, been recommended for use on the NHS for multiple sclerosis (MS) sufferers in Scotland.  This country has one of the highest rates of MS in the world with an annual incidence rate of 8.64 cases per 100,000 people and with around 85% of patients having the relapsing-remitting (RRMS) form of the disease.

Autologous haematopoietic stem-cell transplantation (AHSCT) has been described as a ‘game-changer’ for MS after an international clinical trial showed that it could reboot patients’ immune systems and halt the progress of the disease.

The Scottish Health Technologies Group (SHTG) said there is now sufficient evidence for it to recommend making AHSCT available on the NHS in Scotland to MS patients who have highly active relapsing-remitting (RRMS), rather than the progressive, form of the disease, and who were not responding to drug treatments.  A number of high-efficacy drug treatments have previously been approved but these therapies do not always work.  The theory is that the novel stem-cell treatment works by enabling patients to 'reset' their immune system to stop it attacking the central nervous system – as is the case in MS.

However, the SHTG has warned that potential patients must be made aware of the ‘demands, risks and uncertainties’ of the treatment, which uses chemotherapy to wipe out a patient’s faulty immune system before replenishing it with a transplant of stem cells harvested from their own bone marrow.  This pre-treatment can put patients at high risk from infections, which can be fatal.  Nevertheless, some patients, who had been in wheelchairs prior to undergoing the stem-cell treatment, said their condition improved so dramatically it was like they had never been diagnosed with MS.  Everyone likes a good story with a happy ending.


USA and Elsewhere

Presidential election year
2020 is election year for US presidential candidates.  At the time of writing there is only one certain candidate – the current and 45th President, Donald J Trump.  Whatever the personal, political and economic attributes of the man, one thing is certain – Trump has so far been a seriously good ally of the pro-life movement in America.  If a Democrat were to win the election, he/she would undoubtedly be a poor ally, even an enemy of the cause.  Each of the six Democrats currently running for nomination supports abortions up to birth.

March for Life 2020
On 24 January the US holds its annual March for Life with its main rally in Washington DC plus in several other satellite cities across the country.  It is the world’s largest annual human rights demonstration.  The line-up of speakers includes abortion survivors Melissa Ohden and Claire Culwell, as well Democrat lawmaker and African American pro-life leader Katrina Jackson, a US Representative from Louisiana.  Others include US Representatives Ann Wagner and Chris Smith, who recently introduced the Born-Alive Abortion Survivors Protection Act in Congress.

The main event will begin with a rally at noon in downtown Washington, followed by a march to the US Supreme Court building.  The theme for the 2020 March for Life is ‘Life Empowers: Pro-Life is Pro-Woman’.  The annual event marks the anniversary of Roe v. Wade, the 1974 Supreme Court ruling that constitutionally allowed legal abortion for basically any reason up to birth.  Since then, approximately 61 million unborn children have been legally aborted in the US.

The Golden Globes
What?  What’s this doing here?  The Golden Globe Awards are the annual bash for the Hollywood glitterati honouring the best in film and American television.  But they also mirror the chattering of the liberal left, especially in America.  Michelle Williams (no, me neither) was accepting an award in a Best Actress category and, though pregnant, she turned her acceptance speech into a diatribe in support of abortion.

Here are some extracts that were interspersed with the customary inebriated cheers and applause.  ‘I’m grateful for the acknowledgement of the choices I’ve made and I’m also grateful to have lived in a moment in our society where choice exists, because as women and as girls, things can happen to our bodies that are not our choice.  I wouldn’t have been able to do this without employing a woman’s right to choose.  But thank god or whomever you pray to that we live in a country founded on the principle that I am free to live by my faith and you are free to live by yours so, women, 18 to 118, when it is time to vote please do so in your own self-interest it’s what men have been doing for years.’  The luvvies loved it.

Christian pre-pregnancy centres
The choice for poor pregnant women in the US can be typically stark.  Abortion at a Planned Parenthood clinic, or pregnancy at a Christian counselling centre.  Now a third option is opening.  Get clients before they get pregnant.

Earlier this year, eight independent Texas-based pregnancy crisis centres merged to form a chain called The Source.  Based in Houston, Dallas, San Antonio and Austin, this non-profit organisation plans to offer a full array of medical services, including testing for sexually-transmitted diseases, first-trimester prenatal care and, most controversially, contraception choices.  Ironically, the business model they are using is similar to that of hundreds of Planned Parenthood clinics.

The Source group, which will not refer patients for abortion, will provide a range of contraception including pills, injections, intrauterine devices (IUDs) and other contraceptive methods.  However, Plan B, the morning-after pill, will not be offered.  This venture represents a huge cultural shift for Christian centres that normally do not offer contraception.  But it represents what some in the pro-life movement say is a much-needed rebranding for pregnancy centres – away from the emphasis of ending abortion and towards placing women’s healthcare as the focus.

This new approach is not without risks.  Many leading pro-lifers  are Roman Catholics and evangelical Christians, who are either averse to contraception or at least think it should be reserved for married couples.  Others consider that offering contraceptives will simply encourage promiscuity.  And some regard trying to compete with the Planned Parenthood model to be a futile exercise.  Will such key supporters be lost?  Will the scheme work?  Can providing abortion counselling and medical services be mixed successfully?  Yet there is a groundswell, particularly among young pro-life supporters, that pregnancy centres should concentrate on the needs of both babies AND their mothers rather than just avoiding abortion.

Kentucky pro-life law stands
In 2017, the state of Kentucky passed a law, The Kentucky Ultrasound Informed Consent Act, that requires doctors to ‘display and describe’ her foetus to a woman who wants an abortion.  In other words, she must undergo an ultrasound scan and a description of what it depicts and hear the sound of the unborn child’s heartbeat.  However, women can avert their eyes and cover their ears to avoid seeing the images or hearing the foetal heartbeat.  The State Governor, Matt Bevin said, ‘We’re a pro-life state, we’re a pro-life administration and I’m a pro-life governor, and we won.’

The American Civil Liberties Union (ACLU) challenged the law on behalf of Kentucky’s only remaining abortion clinic.  The ACLU argued that ultrasound laws violate physicians’ speech rights under the First Amendment.  In June 2019, the federal sixth circuit Court of Appeals in Cincinnati, Ohio, upheld the Kentucky law and denied a review.  That decision was further challenged.  Lawyers for Kentucky argued against a review because, ‘Nothing can better inform a patient of the nature and consequences of an abortion than actually seeing an image of the fetus who will be aborted and receiving a medically-accurate description of that image.’  On 9 December 2019, the US Supreme Court refused to review the Appeals Court decision.  The move is seen as a significant victory for the pro-life movement.

Three other US states currently have similar ‘heartbeat laws’.  The Supreme Court will hear arguments in March in a different abortion case.  It concerns a Louisiana law that requires abortion providers to have admitting privileges at a nearby hospital.  Pro-lifers are hopeful the Louisiana case, June Medical Services LLC v. Gee, could be the catalyst to overturn Roe v. Wade.

Slovakia almost followed suit
In late November, lawmakers in Slovakia debated a proposed law that would compel women seeking an abortion to first have an ultrasound and listen to the heartbeat of their foetus.  This is akin to the Kentuckian law.

Many will decry such a move.  It’s cruel, it’s against women’s rights, and so on.  Those are logical responses if, if, if the unborn child were not a real, live human being.  What is kind and gentle about abortion, where are the unborn child’s rights?  How conditioned we have become by the encompassing attitude of progressive liberalism concerning the whole abortion issue.  Slovakian women will still be able to go ahead and abort.  All the proposed law would do is, ‘ensure that women are informed about the current stage of their pregnancy.’  The authors of the bill have stated, ‘the proposed draft law has positive impacts on marriage, parenthood and family’ and that ‘society does not consider the induced termination of pregnancy a good solution.’  See how easily liberalism’s call for rights, privacy and autonomy can nowadays transcend all other concerns.  Christians and others can be so confused, afraid and gullible.

The proposed bold bill narrowly failed on 5 December.  A total of 59 MPs voted in favour, which was just 4 short of the simple majority of 62 MPs present.  Only 24 MPs voted against and 40 abstained.  If passed, this law would have been the first of its kind in the European Union.  Across Europe, 39 countries have legalised abortion on request, on an industrial scale.  Five countries – Andorra, Liechtenstein, Malta, Poland and San Marino – allow abortion only in rare instances, such as if the woman’s life is at risk.

Hungary’s push for babies
Like most European countries, Hungary’s birth rate is in decline.  Its population is shrinking by about 40,000 people a year.  In an attempt to reverse the problem, prime minister Viktor Orbán’s government is offering loans of £26,000 – roughly two years’ average salary – to any heterosexual, newly-wed couple in which the woman is under 41.  If they have a child within five years, the interest is cancelled.  If they have three children, the loan is written off.

Perhaps not unsurprisingly, Hungary is currently experiencing a wedding boom.  The number of new marriages is the highest since the fall of communism 30 years ago.  The figure has risen by 29% in the 12 months to last September.  Bribery, carrot, or social engineering, it will be fascinating to watch the outcome.

China’s two-child policy
In 2016, China replaced its draconian one-child policy with a two-child policy.  If couples had more than two, they could be punished by the loss of their jobs.  Now that policy has been relaxed.  From January 2020, Chinese couples wishing to have more than two children can now do so without the threat of being sacked from state employment.  Offenders may be warned or demoted or fined, but no longer fired.  Fines have also been drastically cut.

Nearly 40 million Chinese people have state jobs, and another 40 million work for state-owned companies.  Many people who broke the law had previously lost their state jobs, while others hid their children who had been born without authorisation for fear of losing their employment.  This new loosening of birth restrictions is in response to China’s demographic decline.  Decades of its one-child policy have resulted not only in slow population growth, but also in a rapidly ageing sector.  This is a potent recipe for creating and fuelling a social and economic crisis.  China, at last, has come to recognise that.

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