Update on Life Issues – June 2013



Abortion statistics 2012
The annual abortion statistics for England and Wales are usually published in May, but this year they have been delayed until July.  Why?  Are the authorities nervous after last year’s exposure of doctors failing to complete the legally-required returns, the practice of pre-signing authorisation forms, and so on?  Is the system being abused?  After the apparent discrepancies over the numbers of ground E (the handicap clause) abortions performed, can the official figures even be regarded as accurate?

Nevertheless, as promised, on 11 July, the statistics for 2012 were released.  They are presented, somewhat subtly, bearing in mind the above suspicions, as, '... information from the abortion notification forms returned to the Chief Medical Officers of England and Wales.'  A new little caveat there!

They are available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/211790/2012_Abortion_Statistics.pdf  The headline figure, the total of 190,972 abortions (composed of 185,122 residents plus 5,850 non-residents), represents a drop of 5,110 (2.6%) over the previous year.  All such decreases are to be welcomed.  It is part of a downward trend that started in 2007.  Some have interpreted this decline as evidence of a shift towards a more pro-life mindset among the public, with more women choosing to continue their pregnanciesMaybe.  However, this apparently good news must be tempered by the fact that the increased use of morning-after pills (MAPs), with their abortifacient mode of action, means that unknown numbers of early abortions are not recorded in these Department of Heath statistics.  In other words, MAPs mask the true numbers of abortions government figures will inevitably be underestimates.

A cursory assessment of the 2012 figures offers no comfort.  The vast majority of abortions for residents (97% or 180,117) continued to be sanctioned under ground C, the infamous 'social clause'.  Those performed under ground E, the 'handicap clause', were worryingly up from 2,307 in 2011 to 2,692 during 2012.  This is a nearly 17% rise and confirms that eugenic abortion is on the increase.  The number of late abortions also rose slightly with 2,860 terminations performed after 20 weeks.  Another concern is the rise in women repeaters.  Nearly 37% of all abortions were performed on women who had already had at least one previously.  It is hard to believe that 33 women had had as many as 8 or more abortions.  Abortion for some women is looking like a form of contraception.  These are all disconcerting trends.

One tiny glimmer of hope teenage abortions were down.  For girls under 18, the figure was 12,873 compared with 14,599 the previous year.  However, numbers were up for older women.  For those in the age range of 30 to 49, the numbers were 57,275 in 2012 and 56,755 in 2011.

None of these figures can be regarded as pleasant news.  They symbolise a bioethical black hole, a stubborn blot on our civilization.  Abortion has become the routine response to a crisis pregnancy.  The simple fact that in England and Wales, on average, 734 unborn children lose their lives every weekday remains a most disturbing truth.  It is a cruel datum.  It is deliberate killing on an industrial scale.  It confirms that something is seriously wrong in the land.  It says something dreadful about us all.

Savita Halappanavar
The investigations into the sad case of Savita Halappanavar, the 31-year-old dentist, who was 17-weeks pregnant and who died at Galway University Hospital in October 2012, have come to a legal close with a report published on 13 June by the Health Service Executive.  The official inquest into her death returned a verdict of death by medical misadventure, caused by a combination of septic shock, E. coli in the bloodstream and a miscarriage.  In other words, her death was a result of clinical mistakes, including inadequate assessment and monitoring, rather than the strict abortion law of Ireland.  Her family, and many others, believed she would have survived had she had an abortion.  However, the inquest did not establish that lack of access to abortion was a contributing factor to Mrs Halappanavar's death.  Abortion would not have saved her life.

The coroner, Dr Ciaran McLoughlin, proposed nine recommendations, mostly concerned with medical procedures and case management.  One recommendation called for clearer guidelines to be issued to doctors and midwives concerning the circumstances in which a pregnancy might legally be terminated under Irish law.  This has predictably been seized upon by pro-choice campaigners calling for a liberalisation of Irish abortion law.  Nevertheless, what is generally misunderstood is the fact that current Irish abortion law would not have prevented Mrs Halappanavar being treated had her life been directly threatened by her pregnancy – the law has always allowed treatment, such as the premature induction of labour, to save the mother’s life.

The Irish abortion Bill
The above case has been used as a battering ram to bring about changes to abortion law as enshrined in the Irish Constitution.  In June, a proposal called The Protection of Life During Pregnancy Bill was published.  Its central feature is that a woman may obtain an abortion if she is at risk of suicide.  No psychiatrist presented evidence at the hearings that abortion is needed to save the life of a suicidal woman.  And the fear is that women will be coached to appear suicidal.  It is reminiscent of the pre-1967 doctor’s advice for obtaining an abortion in England and Wales, ‘Bring your daughter back when you find her with her head in the gas oven.  And a suicide note would help!’

On 2 July, the first vote on the Bill in the Dáil produced an overwhelmingly 138 votes to 24 in its favour, thus sanctioning abortion, through all nine months of pregnancy – no upper time limit is stipulated in the Billif the mother threatens suicide.  The Irish Prime Minister, Enda Kenny, claimed this was simply clarifying the existing law, which already allows abortion as an unintentional result of medical procedures to preserve the mother’s life if it is at risk.  Pro-life campaigners claim the Bill is the first step towards an abortion regime for ‘social reasons’, similar to that of Great Britain.  Early on 12 July, after a marathon two-day long and often acrimonious debate, the Dáil voted 127 votes to 31 to allow abortions if a panel of three doctors deems there is a credible risk of maternal suicide.  The Bill now passes to the Upper House.

One casualty of the Bill is Lucinda Creighton, the Minister of State for European Affairs and tipped as a possible future leader of the Fine Gael party.  She had the moral strength to vote against the suicide amendment and was promptly sacked for exercising her conscientious objection.  She believed that the amendment was unworkable and that it, '... has the potential to normalise suicidal ideation by enshrining suicide on our statute book for the first time.'  She went on, 'When it comes to something that is essentially a matter of life and death, I think it is not really possible to compromise.'  The pity is that more politicians did not have the courage to vote according to their consciences, rather than the party line.

Poor Ireland.  Is it about to begin the journey travelled by most of the Western world towards the free supply of abortion, abortion-on-demand?  That would be sad and ironic.  Sad, because easy abortion solves nothing.  Ironic, because Ireland is currently one of the safest countries in the world to be a pregnant woman, with a maternal mortality rate that is half that of the UK.

A vote against abortion in the USA
To the surprise of many, the US House of Representatives voted on 18 June in favour, by 228 votes to 196, of banning most abortions after 20 weeks.  The vote was taken on the so-called Pain-Capable Unborn Child Protection Act, sponsored by Representative Trent Franks of Arizona.  However, there is not a hope of this becoming law because Congress is Democrat-dominated and the Obama administration is decidedly pro-abortion.  The President considered the Act to be, ‘… an assault on a woman’s right to choose’ as well as ‘… a direct challenge to Roe vs. Wade’ and he promised that if it ever passed into law, he would veto it.

The premise of the Bill was simple.  Growing scientific and medical evidence now shows that unborn babies feel pain.  As explained during the debate, ‘By 8 weeks after fertilization, the unborn child reacts to touch.  After 20 weeks, the unborn child reacts to stimuli that would be recognized as painful if applied to an adult human, for example, by recoiling.’  Therefore the unborn child of 20 weeks plus would feel pain during an abortion.  As former abortionist Anthony Levatino added during his testimony before the House, ‘If you refuse to believe that this procedure inflicts severe pain on that unborn child, please think again.’  And, according to a recent Gallup poll, as many as 80% of Americans consider that third trimester abortions should be illegal.  The battle goes on.

The Glasgow midwives
Last April, Mary Doogan and Concepta Wood won their landmark case for their conscientious objection (CO) to abortion.  The judges stated that the midwives could refuse to delegate, supervise or support staff involved in abortions, that is, CO extends beyond direct involvement in abortion.  It was the first time that CO in the context of the 1967 Abortion Act had been clarified.  Now the NHS Greater Glasgow and Clyde has declared that its health board intends to appeal the decision of the Inner House of the Court of Session.  It looks as though the two brave midwives will be taken to the Supreme Court.  CO is such a valuable and delicate flower, but some see it as an ugly weed and are determined to trample it underfoot.

No case to answer
This is hard to believe.  The UK Department of Health has recently concluded that there is no evidence of sex-selective abortion in the UK.  This is despite the facts uncovered by The Daily Telegraph investigators last year and the skewed ratio of boys to girls born in certain area of the UK.  The Department’s investigation did find that some groups of immigrant mothers gave birth to fewer female babies than is considered ‘normal’, but, the Department decided, there was no ‘statistically significant’ difference in the gender ratios between these groups and the general population.  Calls from Fiona Bruce MP, Lord David Alton and other Parliamentarians for the gender of aborted babies to be recorded have fallen on deaf ears.


Assisted Reproductive Technologies

Three-parent IVF
On 28 June, the UK government announced that it was going to proceed with draft regulations to allow mitochondria replacement techniques, or what has become known as three-parent IVF, to be used for patient treatment.  This historic decision follows on from the Medical Frontiers: Debating mitochondria replacement public consultation run by the Human Fertilisation and Embryology Authority (HFEA) during 2012, and to which Affinity wrote a submission.  The HFEA insists that there was ‘broad support’ for the technique.  This conclusion was flawed.  The majority of submissions opposed the legalisation of the technique, but the HFEA gave unwarranted credence to opinions expressed during a limited number of its own ‘public engagement’ sessions, where the attendees were addressed by pro-three-parent IVF experts.

The arguments in favour of three-parent IVF were summarised by the UK's Chief Medical Officer, Professor Dame Sally Davies, when she stated that, ‘Scientists have developed ground-breaking new procedures which could stop these diseases being passed on, bringing hope to many families seeking to prevent their future children inheriting them.  It's only right that we look to introduce this life-saving treatment as soon as we can.’  The counter-arguments are, first, the techniques are unproven and possibly unsafe – an element of experimentation may be the precursor of all medical advances, but these are about radical germline therapy.  Second, these will not be cures – they are about preventing affected embryos from living.  Third, the emotional petitions of a few – perhaps 10 families per year – have trumped the ethical objections of the many.  Fourth, because we ‘can’, does not mean we ‘ought’.  Fifth, these techniques will provide no relief for current sufferers of mitochondrial diseases.  Sixth, some say that less than 1% DNA from a maternal donor hardly justifies the pejorative term ‘three-parent’ – yet these remain novel and previously-banned techniques.  Seventh, the methods will require large numbers of human ova – these will be unnaturally and often hazardously obtained from impecunious female students and the like.  Eighth, this hurry to legislate is strongly linked to ensuring that the UK maintains a worldwide scientific (and financial) foothold on this sort of technology.  Ninth, did anyone mention bioethical considerations?

Whatever the bias of the public consultation results, or the rushed impetus to exploit the methods, the predictable upshot is that the creation of three-parent, genetically-altered embryos is likely to go ahead and a related therapy will become available on the NHS in 2014.  If so, the Rubicon of ‘germline’ (as opposed to the bioethically-acceptable ‘somatic’) gene therapy will be crossed.  No other country allows this.  When implemented, the genetic alterations will be permanent and transferred to subsequent generations.  In other words, eugenics will again be advanced, just a little, under the guise of respectable medical treatment.  It will set a precedent for more, and greater, genetic manipulations – the designer baby is on the horizon.

IVF and developmental problems
There is already substantial evidence that IVF babies, especially those conceived after intracytoplasmic sperm injection (ICSI) treatment, are more likely to suffer from conditions such as retinoblastoma, Angelman or Beckwith-Wiedemann syndromes, heart valve defects, cleft lips and palates, than their naturally-conceived counterparts.  Now an additional link between IVF and developmental problems has been reported, especially when babies are born prematurely.  An Australian study involving 10 neonatal intensive care units examined neurodevelopmental outcomes in 1,473 infants, born at less than 29 weeks gestation, between 1998 and 2004.  A total of 217 were conceived after IVF treatment and compared with 1,256 babies conceived naturally.

Abdel-Latif and colleagues found that those very premature babies born after IVF were more likely to have some functional disability at ages between 2 and 3 years than the babies who were conceived naturally.  The disabilities included developmental delays, cerebral palsy, deafness and blindness.  These differences were not evident when the babies were born at between 27 and 28 weeks gestation.

‘Safer’ IVF
While the incidence and extent of adverse effects of IVF on mothers and their children is often disputed, there is universal agreement that IVF procedures are unsuccessful – typically, one treatment cycle results in only a 25% probability of a live birth.  Some IVF practitioners dismiss this high (75%) failure rate as merely similar to that of ‘natural’ conception.  Nevertheless, techniques that might improve IVF success rates are continually being sought.  Any positive outcomes are often promoted as ‘safer’ IVF, and three such cases follow.

For example, doctors at the Hammersmith Hospital and Imperial College in London have recently developed ‘kisspeptin treatment’.  Conventional IVF methods superovulate women with fertility drugs, but in a third of women these medications can cause ovarian hyperstimulation syndrome (OHSS), with 5% suffering from what are classified as moderate or severe forms, and in a very few women it has proved fatal.  Treatment with the hormone kisspeptin apparently stimulates the ovaries more gently rather than pushing them into overdrive.  The first ‘kisspeptin’ IVF baby was born in London during April.

A crucial part of IVF is the production of multiple embryos, followed by their scrutiny and selection in their first few days of life.  This selection process is fairly subjective – picking the biggest and the best-looking.  Now, scientists at a few IVF clinics, including the CARE fertility clinic in Manchester, are using time-lapse embryo imaging to follow the development of embryos in order to track the most likely ‘best’ ones to transfer to their mothers.

And to assist all those women, who are just too busy with their careers to have children, or who have yet to meet Mr Right, there is now the possibility to not just freeze their ova for future IVF use, but to freeze-dry them and keep them in a sealed packet, in dry and dark conditions, in a kitchen cupboard.  Think of the savings accrued by not having to store them in liquid nitrogen – from cryopreservation to ‘on shelf’ conservation.  And when the woman is ready to conceive, the ova can be brought to life by just adding water – from instant coffee to instant baby!  This is the concept reported by Amir Arav, founder and chief technology officer of an Israeli company, Core Dynamics, which, as stated on its website, ‘brings science fiction to life.’  According to Dr Arav, the procedure already works for ova from cows, so why not for women?  ‘Safer’ IVF – I doubt it.

Same-sex ‘marriage’ and surrogacy
This is not the place to discuss the most contentious issue of the moment, namely, same-sex ‘marriage’.  Countries of the Western world are too busy legislating to give much thought about its future adverse effects.

One such negative outcome will be an increase in surrogacy arrangements.  Surrogacy already has a long and twisted, mainly clandestine, history.  Whenever and wherever same-sex ‘marriage’ is granted legal status the demand for surrogate mothers will proliferate.  Although India has recently tightened its rules about gay couples from foreign countries seeking surrogacy arrangements, the trade will shift easily to other places like Cyprus, Guatemala and the Ukraine, and of course, for the ultra-rich, to California.

Surrogacy is dehumanizing because it treats a woman in her most intimate and unique physiological role of a mother as merely a paid, or unpaid, nine-month incubator, who will then hand over her child.  She becomes a reproductive appliance.  Surrogacy is then little different from renting out her sexual-reproductive organs, as in prostitution.  She is exploited physically and emotionally.  Surrogacy deliberately breaks the deep relationship between birth mother and baby, with money usually as the accepted salve for a wounded heart and conscience.  Moreover, it is frequently the poor, who are cajoled into selling their generative potential because surrogacy tends to be one class exploiting another it is nearly always the hard-up student or domestic worker, who bears the child for the wealthy architect or accountant.  While it is entirely right and proper to pay for goods and services, childbearing should never become part of such trading deals.

Same-sex ‘marriage’, in particular that between two men, with their biological impossibility of procreation, will inevitably drive an increased demand for surrogacy, or as it is more politely known, ‘outsourced pregnancy’.  Have governments thought about that yet?


Stem-Cell Technologies

Human embryonic stem cells and SCNT
After several false starts, some fraud, and lots of over-hyped publicity generated by cranks and charlatans, it does appear that human embryonic stem cells have now been genuinely created by cloning.  It is a feat that has eluded scientists for more than a decade.  Shoukhrat Mitalipov and his research team, mostly from the Oregon Health and Science University, published an article entitled, Human Embryonic Stem Cells Derived by Somatic Cell Nuclear Transfer in the May edition of the journal, Cell (153:1228-1238).

The technique was basically that of Ian Wilmut and his colleagues which they used to create Dolly the sheep clone, namely, somatic cell nuclear transfer (SCNT).  The Oregon team spent years tweaking some key factors in the Wilmut protocol and finally they optimized the procedure and successfully reprogrammed human somatic cells to a pluripotent state.  The method thus allows patient-specific stem cells, which could then be further tweaked into brain, heart, kidney and suchlike cells, to be generated from ordinary somatic cells, including those from the patient’s skin.

The Oregon results are highly controversial.  Some say it is a giant leap forward in stem-cell technology.  Some say this sort of work will demand a supply of scarce ova to be donated by women and obtained by a medically-risky procedure.  Some say it is bioethically unjustified because it involves the deliberate destruction of human embryos in order to harvest the embryonic stem cells.  Some say that the exploitation of this sort of ‘therapeutic cloning’ will lead to cures for diseases including the big four, namely, diabetes, Parkinson’s, Alzheimer’s and various cancers.  Others say why bother because ‘adult’ stem cells and induced pluripotent stem (iPS) cells are already available, ethical, cheaper and effective.  Some say it will lead to ‘reproductive cloning’, since the two types of cloning have a common starting point.  Already Ian Wilmut has cautioned, ‘The new work may encourage some people to attempt human reproductive cloning but the general experience is that it still results in late foetal loss and the birth of abnormal offspring.’  And he added, ‘It would be cruel to cause this in humans until techniques had been vastly improved.’  Caveat – never say ‘Never’, as Wilmut’s comments indicate.  Some say we need laws now to stop researchers crossing the line between generating embryonic stem cells and trying to bring a cloned human embryo to term.  The only way to accomplish this effectively is to ban all human SCNT.

Human induced pluripotent stem (iPS) cell trial
We have already witnessed the success of numerous therapies based on the use of ‘adult’ stem cells.  Now the world’s first human induced pluripotent stem (iPS) cell trial is set to begin in Japan.  Masayo Takahashi, an ophthalmologist at the RIKEN Center for Developmental Biology in Kobe, hopes to start recruiting patients as early as this September.  She hopes initially to treat around six people who have severe age-related macular degeneration, a common cause of blindness that affects people aged over 50.  This phase 1 safety trial is expected to be approved by the Japanese authorities for commencement in early 2014.

Takahashi proposes to use small skin samples from the upper arms of her patients.  She will use the Yamanaka procedure to reprogram these skin cells into iPS cells and then she will transform the iPS cells into retinal cells.  Small sheets of these iPS-retinal cells will be placed under the damaged area of the patients’ retinas, where they should grow and repair the damaged pigment epithelium.

The world will be watching.  Success will allay the fears about the medical safety of such a ground-breaking venture.  Will the iPS cells provoke an adverse immune reaction?  Will they multiply uncontrollably and form tumours?  Preliminary data suggest not.  Takahashi’s primary concern is to prove that the procedure is safe.  The Japanese government’s hope is that the trial is safe and effective and thus it will feel justified in its vast funding of iPS-cell technology.

Another triumph for induced pluripotent stem (iPS) cells
In July, an online paper in Nature by Takanori Takebe and colleagues at the Yokohama City University Graduate School of Medicine reported that they had grown human tissue ‘resembling the adult liver’ in a laboratory mouse.  This is the first report of the generation of a complex, human, three-dimensional, functioning, vascularised organ – a process known as organogenesis – from induced pluripotent stem cells.  It may mark a major step forward in alleviating the critical shortage of donor organs.

The research team first created induced pluripotent stem (iPS) cells, which they mixed in vitro with two other stem cell types – endothelial stem cells from umbilical cord blood, which can produce the lining of blood vessels, and mesenchymal stem cells, which can produce bone, cartilage and fat tissues.  And, amazingly, the cells self-organized into ‘liver buds’, the precursor clusters that later develop into mature livers.  When these approximately 5 mm buds were transplanted into mice suffering from liver failure the buds were transformed into 'functional human liver' complete with the necessary blood vessels and they kept the mice alive.  This proof-of-concept of organ-bud generation and transplantation is a novel and promising advance for regenerative medicine – and not a human embryo in sight.

Stem cells and 3D printing
This is nearly unbelievable.  While most people have become familiar with stem cells, 3D printing is a new and curious technology.  It is a process for making three-dimensional solid objects from a digital model.  3D printing has recently made headline news after reports of its use to manufacture printable weapons, such as handguns.  A downloadable computer file and a 3D printer can together create deadly weapons, relatively cheaply in what has been described as an ‘emerging worldwide threat.’  Biologically, 3D printing has been previously reported to ‘print’ embryonic mouse cells.  Now a group of researchers at the Heriot-Watt University, Edinburgh, led by Alan Faulkner-Jones, have, for the first time, succeeded in developing a 3D printing technology that generates living, human embryonic stem cells – each a copy of a human stem cell ‘template’.  The research was published in the March issue of the journal, Biofabrication under the title, Development of a valve-based cell printer for the formation of human embryonic stem cell spheroid aggregates.

The article concludes (in a grammatically shaky manner), ‘The ability to print hESCs [human embryonic stem cells] for the generation of 3D structures will allow us to create more accurate human tissue model, which is essential to the in vitro drug development and toxicity-testing.  Additionally, this may also pave the way for human stem cells to be incorporated into clinical protocols either for patient implantation of in-vitro regenerated organ or direct in-vivo cell printing for tissue regeneration.’

Fascinating, yet also weird.  Could this process also signal the beginning of the end of traditional organ donation and transplantation?


Life Issues in the USA

The House of Horrors
This is the name given to the abortion clinic in Philadelphia run by Dr Kermit Gosnell since 1972.  He was arrested in January 2011 and charged with eight counts of murder for allegedly snipping the spinal cords of newborn babies with scissors and causing the death of one woman patient.  For decades he had run this unspeakably squalid facility and performed the most horrid late-term abortions, amid gruesome and insanitary conditions – a fuller description would make most people feel sick.

In May 2013, after a lengthy trial, Kermit Gosnell was at last convicted on three murder charges and one count of involuntary manslaughter.  He waived his right to appeal in order to avoid the death penalty and was duly sentenced to life imprisonment without parole.

One peculiar aspect of this ghastly case was the almost complete absence of the trial’s coverage by the mainstream media worldwide, but especially in America.  Could the liberals not face the truth about abortion practice, legal and illegal, in the Land of the Free and elsewhere?  Was the outcome of Roe vs. Wade, namely, the constitutional right to abortion up to the moment of birth, too much for the American public to stomach?  Why did the regulatory inspection system of abortion clinics by the Pennsylvania State Health Department fail to uncover and stop Gosnell's activities?  Was there fear that the Gosnell case was the tip of a terrible iceberg?  Indeed, in the same week as Gosnell’s conviction, prosecutors in Houston, Texas launched a criminal investigation into the activities of Douglas Karpen, another late-term abortionist, who, according to his former employees, twisted the heads off newborn babies with his bare hands.  The Texas Department of State Health Services is currently investigating.

As Albert Mohler, president of Southern Baptist Theological Seminary, wrote, ‘The trial of Dr. Kermit Gosnell revealed the truth about this homicidal doctor and his house of horrors, but it also revealed the moral house of mirrors behind which America hides.  Dr. Gosnell is not alone in having the blood of babies on his hands.’

The Morning-after pill
Morning-after pills (MAPs) have always been contentious wherever they have become available.  In the UK, the commonly-used brands are Levonelle and ellaOne, said to be effective after three and five days of unprotected sex respectively.  In the US, they are known as Plan B One-Step and ella.  In the US, the battle to move the MAP from prescription-only to over-the-counter status has continued for over a decade.

In 2011, the US Food and Drug Administration (FDA) recommended that the MAP should be available on prescription to girls over 17.  It later advised that the MAP should be available for purchase over-the-counter by women and girls of all ages.  Then the Obama administration’s Health and Human Services secretary, Kathleen Sebelius, in an unprecedented move, overruled the FDA’s recommendation to revoke the age restriction. She said she was worried that girls as young as 11 could obtain and use the MAP without supervision.  President Obama echoed that concern in relation to his two teenage daughters.

On 5 April, District Court Judge Edward Korman set the cat among the pigeons by ordering that MAPs must be made available without a prescription, over-the-counter, without point-of-sale or age restrictions.  He stated that the government's decision to restrict sales of the MAP was, ‘politically motivated, scientifically unjustified and contrary to agency precedent.’  The US government promptly appealed against the Judge's ruling.  It initially looked like a strong ethical stance by the White House, but on reflection it realized it had got itself into a messy, no-win position.

So on 10 June, the Department of Justice notified Judge Korman that it was reversing its objection and seeking the FDA’s approval that the MAP may be purchased at local pharmacies, on open shelves, by anyone, regardless of age or gender.  On 12 June, Judge Korman granted the Obama administration’s proposal to make the MAP available to all ages without a prescription.  So 13-year-old American girls can now buy the MAP.  Liberals argue that easier access to the MAP will cut unintended pregnancies.  Conservatives refute that claim and further maintain the move undermines the rights of parents and could endanger young girls.  Time will tell who is right.

Obamacare and Hobby Lobby
The Hobby Lobby saga continues.  Hobby Lobby together with its sister company, Mardel, is a Christian-owned arts and crafts business, employing 13,000 people in more than 500 stores across the USA.  It, and specifically, its founder and CEO David Green, have objected to the enforcement of health insurance provisions under the Affordable Care Act, otherwise known as Obamacare, for its employees which include abortifacient ‘contraceptives’ – the company offers 16 forms of true, pre-fertilisation contraception in its health insurance plans.

Hobby Lobby has been in and out of various courts, seeking exemption from this mandate on religious grounds, since September 2012.  The latest pronouncement was that of the District Court in Oklahoma, which ruled that Hobby Lobby was not exempt.  However, on 28 June, the Tenth Circuit Court of Appeals in Denver overturned that ruling, stating, ‘Because the contraceptive-coverage requirement places substantial pressure on Hobby Lobby and Mardel to violate their sincere religious beliefs, their exercise of religion is substantially burdened.’  The Court therefore issued a temporary restraining order on the US Government not to enforce the Obamacare abortion-drug mandate against Hobby Lobby while the case continues.  So while the legal proceedings are in progress, Hobby Lobby will not incur fines for non-compliance, which have been threatened and which would amount to $1.3 million per day.  The case is scheduled to continue on 19 July in Oklahoma City.

19 July update: US district judge Joseph Heaton temporarily exempted Hobby Lobby from the 2010 federal health care law.  He put the case on hold until 1 October to give the federal government time to decide whether to file an appeal to the US Supreme Court.

Texas and abortion
There is little doubt that pro-life sentiment is growing in the USA.  A 2012 Gallup poll showed that a new high of 50% of Americans identified themselves as 'pro-life'.  The 'pro-choice' camp registered just 41%, its lowest figure since this annual survey began in 1995.  Gallup has described this move towards a personal pro-life stance as 'the new normal'.  Moreover, more and more US states are introducing pro-life legislation and closing more abortion clinics.  In the first six months of 2013, at least 30 abortion clinics have closed as a result of new enforcement measures and a lack of business.  In 1991, there were 2,176 abortion clinics in America – by mid-2013, there were only 630 left.

One example of this ‘new normal’ has been the Bill HB5 brought before the Texas legislature in the State House, Austin during June.  The Bill sought to ban abortions after 20 weeks and impose stricter regulations on abortion clinics.  Opponents maintained it would force the closure of 37 of the State’s 42 abortion facilities.

In a last ditch attempt to prevent the Bill’s passage through the Texan Senate, senator Wendy Davis spoke for a marathon 11 hours on the final day of debate, thereby filibustering the Bill and preventing a decisive vote from being taken.  Nevertheless, a few days later, the Texas governor, the pro-life Republican, Rick Perry brought back the Bill and declared a special 30-day session of the legislature which should ensure sufficient time for the Bill’s success.  On 12 July, the Bill was approved in the Texas Senate by a 19 to 11 vote – it now goes to Governor Perry to sign.  The Bill is likely to be enacted, but it will undoubtedly face legal challenges.  Nevertheless, the pro-life trend, in Texas and elsewhere in the US – with similar laws already passed in Mississippi, Ohio, Oklahoma, Alabama, Kansas, Wisconsin and Arizona – is clear and determined.

On 18 July, Governor Rick Perry signed the Bill into law.  At the brief ceremony he declared that, 'Today's signing builds on our continued commitment to protecting life for more than a decade.  This is an important day for those who support life and the health of women in Texas.  Signing HB2 further solidifies the foundation on which the culture of life in Texas is built.' 


Euthanasia and Assisted Suicide

Euthanasia and assisted suicide in the UK
From 13 to 15 May, the Court of Appeal heard the cases of Jane Nicklinson, wife of the late Tony Nicklinson, the locked-in syndrome sufferer who sought a change in the law, Paul Lamb, paralyzed as a result of a road accident, plus a man known as ‘Martin’, who also suffers from locked-in syndrome.  The cases focus on the right of those who are incurably suffering, but not terminally ill, to receive assistance to end their lives.  They are challenging the High Court decision of last August that ‘voluntary euthanasia is murder.’  The British Humanist Association is supporting the appeals.

At the beginning of the hearing, sitting with the Master of the Rolls, Lord Dyson and Lord Justice Elias, the Lord Chief Justice, Lord Judge stated that, 'We are acutely aware of the desperate situation in which the appellants find themselves and we are very sympathetic.  But we know, and they surely know, that we cannot decide this case as a matter of personal sympathy.  We have to decide it as a point of law.’  Judgement is awaited.

The Falconer Bill
Lord Charlie Falconer is at it again.  In a carefully orchestrated ploy, the day after the final day of the Nicklinson, Lamb and ‘Martin’ Court of Appeal hearing, Lord Falconer tabled his Assisted Dying Bill in the House of Lords.  This first reading of the Bill received virtually no press attention, and there is no date scheduled for its second reading.  The Bill is a modified version of the conclusions of his sham 2010 Commission on Assisted Dying and that of Oregon’s Death with Dignity Act.  It would allow doctors to provide a lethal dose of drugs to patients judged to have less than six months to live and to assist the patients if they could not lift or swallow the drugs.  It is no surprise that the Falconer Bill is backed by the All Party Parliamentary Group (APPG) on Choice at the End of Life as well as the Dignity in Dying organization.

Assisted suicide in Switzerland
The slippery slope of bioethics – denied by some, but evident to most.  Here is another example.  In March, an 83-year-old man, a retired professor of petroleum engineering, became the first known Briton to end his life by assisted suicide at the Dignitas clinic in Switzerland because he had been diagnosed with dementia, rather than a terminal illness, such as cancer, or severe physical disabilities.  He was in only the early stages of the condition.

Apparently Michael Irwin, a retired general practitioner and campaigner for the legalisation of euthanasia, assisted him in making the necessary arrangements, including a psychiatrist's report attesting to his mental competence because he was originally refused by Dignitas.  Dr Irwin has claimed to have helped at least 50 terminally-ill patients to die – he is a dangerous man.  Irwin has been sometime chairman of the Voluntary Euthanasia Society and President of the World Federation of Right to Die Societies.  In 2003, he was arrested following his confession that he had tried to assist a terminally-ill friend to die.  No charges followed, but in 2005 he was struck off the medical register after an inquiry by the General Medical Council.

Euthanasia in Belgium
The situation in Belgium, the next-door neighbour of euthanasia-friendly Holland, is getting worse. Belgium legalised euthanasia in 2002.  In 2011, there were 1,133 cases of euthanasia officially reported, which is equivalent to about 2% of the total Belgian deaths in that year.  The following year, in 2012, there were 1,432, an increase of 26% over the previous year.  Bear in mind, that like those from Holland, these Belgian figures do not include unreported assisted deaths, a generally recognised, though illegal, feature of both countries.

But such data are never enough for euthanasia enthusiasts.  Now a Bill has been presented in Belgium which would sanction euthanasia for patients with Alzheimer's, other diseases leading to advanced dementia, and general incompetence.  And even that is not enough.  Now the talk is about allowing children to access euthanasia.  Doctors would assess whether or not a child is mature enough to make the decision to end his or her own life.  Is it not perverse that a child might be allowed to choose to die, but still be disallowed to drive a car, vote in an election, or drink alcohol until they are 18 years old?

Euthanasia and assisted suicide worldwide
On 23 May, the Upper House of New South Wales in Australia rejected The Rights of the Terminally Ill Bill 2013, which would have permitted euthanasia, by 23 votes to 13.  On 31 May, the House of Representatives in the US state of Maine rejected an assisted suicide bill entitled, An Act for Patient-directed Care at the End of Life, by 94 votes to 43.  Three days later, the Maine Senate endorsed the Bill’s rejection.  However, Vermont has now become the third US state to approve assisted suicide.  The legalisation process in Vermont differed from that used in Oregon and Washington.  The laws in the latter were adopted after voter referendums, whereas Vermont is the first to pass such a law by means of a vote in a state legislature.  The new law is based on the Oregon model, but with fewer safeguards.

And on 12 June, Bill 52 was tabled in Québec’s national assembly.  The Bill has a subtitle, An Act Respecting End-of-Life Care, which anti-euthanasia campaigners claim is a euphemism for euthanasia, because, they maintain, the Bill will not relieve suffering so much as kill the people who are suffering.  Then on 1 July, President Francois Hollande of France reaffirmed his election pledge of last year to legalise voluntary euthanasia, even though France's national ethics committee advised him not to let doctors help the terminally-ill take their lives.  The President insists that the country will hold a national debate on the issue in the coming months and his government will submit a bill in the French parliament by the end of the year.


The Lives and the Deaths of the Bioethically Good and Bad

C Everett Koop
In February 2013, at the age of 96, C Everett Koop, the US surgeon general extraordinaire during the Reagan and Bush administrations from 1982 to 1989, died.  He was always controversial.  He looked like a bearded Old Testament prophet and he often sported his admiral’s uniform of office.  Yet he was widely regarded as a voice of compassion and reason, while many considered him to be the most influential public health administrator in American history.  For example, in 1986, he published a seminal report, ‘… written personally by me to provide the necessary understanding of AIDS’ and he repeatedly warned against the dangers of tobacco smoking.  Though he often managed to incur the wrath of liberals and conservatives, he changed public attitudes to both these health issues and became affectionately known as the Nation’s Family Doctor.

Charles Everett Koop was born on Oct. 14, 1916 and grew up in South Brooklyn, surrounded by relatives – his grandparents, uncles, aunts and cousins lived on the same street.  He was an only child and he could trace his ancestry to the seventeenth-century Dutch settlers of New York.

His interest in medicine started early.  He practised complex tasks with both hands and operated on rabbits, rats and stray cats during his teenage years.  Soon after graduating from medical school he was offered the post of surgeon-in-chief at the Children’s Hospital in Philadelphia at the tender age of 29.  He became famous for innovative surgery, such as separating conjoined twins and operating on premature infants, especially those with oesophageal atresia, a previously fatal condition.  He provided extraordinary care for the most helpless of patients.  His 1976 book, The Right to Live; The Right to Die, set out his thinking on the issues of abortion and euthanasia.  Such medical fame and pro-life stance inevitably brought controversy.  Though parents had the legal right to withhold treatment from their severely-impaired children, Koop believed that the medical and legal establishments had a duty to protect citizens against such neglect and discrimination, no matter what their age.

Koop’s evangelical, biblical Christianity was central to his life.  It helped him cope with the death of his 19-year-old son when he was killed in a climbing accident.  And it formulated his opposition to abortion, which he maintained was a violation of God’s law.  Nevertheless, while in public office, much to the disappointment of many within the pro-life movement, he failed to speak out publically against abortion – he considered it to be a moral and religious issue, not a health issue and he refused to use his public office as a pulpit from which to preach against it.

But I will always remember Dr Koop as the medical collaborator with the theologian Francis Schaeffer in their film and book project, Whatever Happened to the Human Race?  The book sits on my shelves and, from time to time, I still consult it.  It introduced me, and many others, to serious bioethical issues and it certainly changed my life – indeed, for me, Koop’s legacy is the reason why I am writing this piece now.

Edith Schaeffer
In March 2013, Edith Schaeffer, wife of Francis, died at her home in Switzerland, aged 98.  She was born in Wenzhou, China to George and Jessie Seville, missionaries serving with the China Inland Mission.  She met Francis at Beaver College, Pennsylvania and they were married in 1935 – they had four children.

In 1948, the Independent Board for Presbyterian Foreign Missions sent them to Switzerland.  And in 1955 they began L’Abri, a unique community where people from around the world came to seek intellectually honest and culturally informed answers to questions about God and the meaning of life.

She wrote numerous books, including The Hidden Art of Homemaking – which sits on my shelves and greatly influenced my wife’s thinking on domesticity and motherhood.  In 2000, Edith was listed among the 100 Christian Women Who Changed the Twentieth Century.

Edith Schaeffer was a driven woman.  Anecdotes abound.  When cooking, she strived to make everyone’s favourite meal.  She would garden by torchlight at the end of a demanding day.  But it was her unwavering belief in the God of the Bible, the beauty of his creation and the dignity of every bearer of the imago Dei that were the real drivers of her extraordinary life.  Her contribution to twentieth-century evangelical Christianity, womanhood, creativity and the pro-life cause still resonates today.

Barbara Willkie
In April 2013, the pro-life movement lost one of its trailblazers, Barbara Willke.  She died in Cincinnati, Ohio at the age of 90.  She was the wife of Dr John Willke and together, as nurse and doctor, they educated hundreds of thousands of people around the world about the evils of abortion and its terrible after-effects.  With her husband she co-authored twelve books on human sexuality and abortion – I have one, Abortion – Questions & Answers, on my shelves.  This was regarded as essential reading in the early years of the pro-life movement.  In addition, the Willkes produced audio and visual teaching materials, which have been translated into 30 languages and they appeared together on TV and radio shows in 64 different countries.

Among the many tributes was this from Paula Westwood, Executive Director Right to Life of Greater Cincinnati, ‘Mrs Willke was a woman of courage and intelligence whose lifelong commitment to preserving the sanctity of human life is a moving legacy.  No one can fill her shoes.’

Margaret White
Yet another stalwart of the pro-life movement has died – Margaret White died in April 2013, aged 93.  She was born in Whitby, North Yorkshire and qualified as a doctor at Sheffield Medical School.  Soon after marriage and a move to Lowestoft, she started sex education discussion groups in local youth clubs as well as a local authority family planning clinic.  The Whites later moved to Croydon, where Margaret served as an Assistant Medical Officer of Health for 12 years before going into general practice with her husband.  She became the central vice-president of the Mothers’ Union, a magistrate, a member of General Synod of the Church of England and among several other commitments, she was later elected to the General Medical Council.

But she will be best remembered for her voluntary work as vice president of the Society for the Protection of the Unborn Child (SPUC) and her anti-euthanasia stance.  At times these resulted in television and radio debates where she was a fierce upholder of the pro-life cause – in one such encounter on BBC Radio in 1997, she even left the historian Dr David Starkey lost for words.  She was in constant demand to address conferences worldwide.  When one of her granddaughters, Anna, was born with Down’s syndrome, she set up the Lejeune Clinic in London offering tests, counsel, therapy and advice.  In her free time, she was a talented painter.  Dr White was a get-up-and-go woman, determined yet sweet.

She campaigned against abortion from the beginning in 1966.  In 1987, her book, Two Million Silent Killings was published – it too is on my shelves and makes for a gritty read.  For example, a random flick through chanced on p. 123, ‘If 470 baby rabbits were killed each day instead of 470 unborn babies, there would be riots in the street.’  We have lost a doughty, compassionate pro-life campaigner.

Robert Edwards
To date, some 5 million people worldwide can attribute their lives to Robert Edwards.  He, together with Patrick Steptoe, was the pioneer of in vitro fertilisation (IVF).  On the other hand, the failure of Edwards’ and Steptoe’s techniques has led to the death of perhaps 100 million human embryos.

Edwards, who died in April 2013, was born in Batley, West Yorkshire in 1925.  He studied at Bangor University and managed only a pass degree in agriculture and zoology, followed by a diploma in animal genetics and a PhD at Edinburgh, on the control of ovulation in mice.  After some post-doctoral studies in the US, he returned to a post at the National Institute for Medical Research in London.  There he dabbled in the causes of the ripening of ova, a prerequisite of IVF.  During the 1960s, research into human IVF was banned at the NIMR, so Edwards moved to the University of Cambridge to continue working on ova in vitro.  As a mere physiologist, he needed a medical collaborator in order to obtain human ova.  At a gathering of the Royal Society of Medicine in London, he met Patrick Steptoe, a gynaecologist from Oldham and a specialist in laparoscopy, a technique able to collect the human ova that Edwards needed.

In 1969, Edwards and colleagues produced the first evidence of human fertilisation in vitro.  He was fêted by the media and condemned by scientists, politicians and many others.  Edwards and Steptoe were refused Medical Research Council funding.  They persisted on limited resources for almost another decade, then in 1978, Louise Brown the world’s first test-tube baby was born.

Everyone likes a bouncing baby and much of the earlier criticism quickly disappeared.  Edwards and Steptoe founded Bourn Hall as a private fertility clinic just outside Cambridge.  Edwards, though himself the father of five daughters, was concerned to help the infertile.  He retired in 1989 and by then IVF had become part of mainstream medicine.  In 2010, he was awarded the Nobel Prize in Physiology or Medicine and in 2011, he was honoured with a knighthood.

I do not doubt that many infertile couples are enormously grateful to Robert Edwards for alleviating their infertility.  But for me, Edwards opened a Pandora’s Box of bioethical issues.  His work not only instigated IVF, it also sanctioned and encouraged the onset of 'inside-out' science – Edwards allowed the formerly, strictly 'inside' human embryo to be latterly relocated 'outside'.  Now it could be used and abused.  As a result, countless millions of human embryos around the world, have been knowingly wiped out.  IVF has been a modern scientific venture of irrecoverable loss.  Human embryos once enjoyed respect, protection, wonder and status.  Now those attributes are all gone, with barely an opposing voice, and all within a generation.  The human embryo should never be regarded as product, object, or means to an end.  In short, IVF has further encouraged the trivialization of human life, sanctioned and accomplished the destruction of human embryos on an immeasurable, industrial scale.  The human embryo as 'raw material' is a troubling concept – intuitively something seems wrong.  Essentially, it was the development of IVF as a treatment that bequeathed the human embryo to research scientists for experimentation.  What had previously been internal, IVF made external  – it was the realization of a novel 'inside-out' science.  We could now see it, study it, manipulate it, analyse it, store it, even create it, and finally destroy it.  This unprecedented access to the human embryo has not only revolutionized the ARTs, it has also ushered in this wholly destructive discipline of human embryo experimentation.  Edwards’ lifetime work did just that.

And there was another dark side to Edwards’ life.  He was a card-carrying member of the Eugenics Society, now known as the Galton Institute – he served on its Council and he was a trustee on three separate occasions.  Disability was clearly an issue for him – selecting the 'best' embryos was part and parcel of his IVF.  But he went further.  In 1974, he stated that, 'Any [scientific] method of potential value in raising human standards should be considered, and [human reproductive] cloning might contribute towards this end by providing pools of talent.'

Henry Morgentaler
In May 2013, Henekh ‘Henry’ Morgentaler, militant atheist and ‘Canada’s Father of Abortion’, died aged 90.  Morgentaler was a Polish-born Canadian physician and pro-choice advocate who fought numerous legal battles aimed at expanding abortion rights across Canada.

During World War II, Morgentaler, as a young man in Poland, was imprisoned at the Łódź ghetto and later at the Auschwitz and Dachau concentration camps.  In 1950, he and his wife, Chava, emigrated to Canada, but by his own admission, he was a proud womanizer and their marriage ended in divorce in the mid-1970s.  He married twice more.  Much later he stated in an interview that, ‘I’d say my whole life has been devoted to doing things to get me the love of women.’

In 1953, he graduated in medicine from the Université de Montréal and from 1955 he worked as a general practitioner though he soon began specializing in family planning.  He was the first Canadian doctor to perform vasectomies and to insert intrauterine devices (IUDs) and to provide contraceptive pills to unmarried women.  In 1969, he opened his first abortion clinic in Montreal and became a pioneer in the use of vacuum aspiration as an abortion method.  In all, he opened 20 abortion clinics and was responsible for training over a hundred abortionists.

In 1967, Morgentaler addressed the Canadian House of Common’s Health and Welfare Committee on the issue of illegal abortion – he declared that women should have the right to safe abortion.  He had not anticipated the subsequent avalanche of requests from women asking for his help in procuring abortions for them.

At that time, Canadian abortion was strictly against the law, but eventually, at personal risk of losing his career and the prospect of long-term imprisonment, he started performing abortions.  By 1973, Morgentaler claimed to have performed over 5,000 illegal terminations.  In 1983, he opened the first abortion clinic in Toronto and he was charged with procuring illegal abortions.  By 1986, his case reached the Supreme Court of Canada and in 1988 the Supreme Court ruled in his favour in the landmark decision of R vs. Morgentaler.  By this so-called Morgentaler Decision, the Court removed the few remaining protections for the unborn in the 1969 Criminal Law Amendment Act, which already sanctioned permissive abortion.  While the Morgentaler Decision did not give women a constitutional ‘right’ to abortion, it simply declared as ‘unconstitutional’ Section 251 of the Criminal Code that governed the entirety of Canadian abortion.  Thus the Court left the abortion question to Parliament to ‘pronounce on and to direct social policy.’  To date the Canadian Parliament has failed to pass any such abortion-related legislation and so any pregnant Canadian woman can legally terminate the life of her unborn child, during all nine months of pregnancy, for any reason whatsoever.  Canada remains one of the few countries with no legal restrictions on abortion.  In 2008, he was honoured with the award of the Order of Canada for securing the right to legal abortion on-demand for Canadian women.

His legacy is is one of great harm.  It is also ironic that he, as a Jew, escaped the horrors of the Holocaust in Europe, only to bring the horrors of abortion to the Gentile population of Canada.  To be described as ‘the arch-abortionist’ of that country is no honour.  Morgentaler clearly had no understanding, or fear, of Genesis 9:6.

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