The annual abortion
figures for England and Wales plus those for Scotland
were published on 7 June and 29 May 2018
respectively. Both sets are worse than the
previous year's. The England and Wales statistics
and commentary can be studied here.
There were 189,859 abortions for women resident in
England and Wales during 2017 and 194,668 abortions when
non-residents are included. This is an increase of
2.3% over 2016. The rate of abortion was 16.5 per
1,000 resident women compared with 16.0 per 1,000 women
in 2016. 65% of abortions were medically induced
rather than surgically performed. This is higher
than in 2016 (62%) and almost double the proportion a
decade ago in 2007 (34%). Of all the women who had
an abortion in 2017, 39% had had one or more
previously. This is slightly higher than in 2016
(38%), but an increase of 7% since 2007. With
respect to age, there were 1,300 abortions for girls
aged under 16 (0.7% of the total). Of these, 333
were girls aged under 15 (0.2% of the total).
There were also 724 for women aged 45 and over (0.4%).
In 2017, 98% of
abortions (185,448) were performed under ground C, the
so-called ‘social clause’. A further 2% were
carried out under ground E (3,165 abortions for foetal
abnormality, or so-called handicap) with 1% (1,062
abortions) under ground D. Grounds A and B
together accounted for very few abortions (176).
The remaining 8 cases were performed under grounds F or
G.
Also recently released (29 May 2018) were the 2017
figures for Scotland. They can be read here. The number of
terminations in Scotland was at a five-year high in 2017
when there were 12,212 abortions. This was 106 more than
reported in 2016 – an increase of just under 1%. The
number of terminations remained below the 2008 high of
13,908.
In other words, during 2017 the total for the whole
of Great Britain was 206,880 abortions. That
is an egregious figure, nothing of which to be
proud. You do the maths – it’s almost 4,000 every
week, or 795 every weekday.
Abortion in Ireland
The plain fact is that on Friday 25 May 2018, Ireland
voted overwhelmingly in a referendum to repeal the
Eighth Amendment of that country’s constitution. The
result was 66.4% for and 33.6% against. The
Eighth, originally approved by a referendum on 7
September 1983 and signed into law on 7 October 1983,
famously declares, ‘The State acknowledges the right to
life of the unborn and, with due regard to the equal
right to life of the mother, guarantees in its laws to
respect, and, as far as practicable, by its laws to
defend and vindicate that right.’
Ireland can no longer lay claim to being one of the few,
very few, European countries that has a semblance of a
pro-life ethos – only Poland and Malta come to
mind. The rest have succumbed to secularisation
and progressive liberalism and adopted abortion as ‘a
woman’s right’, or some such slogan. It marked a
sad day, and an even sadder future, for the Republic.
The Irish cabinet will now discuss draft legislation to
allow terminations within the first 12 weeks of
pregnancy, and up to 24 weeks in exceptional
circumstances. The Taoiseach, Leo Varadkar, has
promised a new liberal abortion law will be on the
Statute Book by the end of the year, with access to
terminations from January 2019.
The Irish people’s decision will echo around the
world. Not least in Northern Ireland, where
abortion is permitted only if a woman's life is at risk
or there is a permanent or serious risk to her mental or
physical health, not for cases of rape, incest or fatal
foetal abnormality. Already the UK's Women and
Equalities Minister, Penny Mordaunt, has said that the
landslide Irish vote has given ‘hope’ to Northern
Ireland. She is not alone – her voice has been
joined by her predecessors from the sisterhood, Amber
Rudd, Justine Greening, Nicky Morgan and Maria
Miller. However, Theresa May has stated that the
Irish vote will have no impact on Northern Irish
abortion law. However, her situation has little
wiggle room because she depends on the support of 10
Democratic Unionist Party (DUP) MPs, who strongly oppose
any such reform. We shall see.
Thus Ireland had changed. They were dancing in the
Dublin streets now that they could legally kill their
unborn children. The moral credibility of the
once-dominant Roman Catholic Church has been battered by
recent sex scandals and cover-ups. Divorce is no
longer banned, neither is same-sex ‘marriage’. In
addition, the economy is flourishing – Google, Amazon
and Facebook have relocated there. The old Ireland
has indeed gone. But this is not a time to
reminisce, it is a time to mourn for innocent
bloodshed. True, this was a referendum and we
lost, but we all know the real losers – though
poignantly, we shall never actually come to know
them. And here is a big question - will the
legalisation of euthanasia be on the cards next for
Ireland?
Abortion politics in the UK and
Northern Ireland
Decriminalisation is the current watchword of many
pro-abortion lobbyists, medical organisations and
politicians. They want all legal restrictions
removed from the Abortion Act 1967. The cunning
plan is to repeal sections 58 and 59 of the Offences
Against the Person Act 1861. This would allow
abortion on demand, the dream of many, such as Ann
Furedi, the CEO of our largest abortion provider,
Bpas. She is well remembered for stating last
year, 'I want to be very, very clear and blunt -
there should be no legal upper limit.'
Yet a recent opinion
poll shows how many of our MPs are increasingly out of
touch with their constituents on this issue. This
latest ComRes poll (conducted in October 2017 and
published in November) of over 2,000 UK adults showed
that 72% of the public think abortion should continue to
be subject to a legal framework, including the
requirement to get the consent of two doctors and not
allowing abortions after 24 weeks unless the child is
disabled or the mother’s life in danger. Just 12%
disagreed.
Yet the Parliamentary momentum for changing the law
remains. During the afternoon of 5 June, there was
an emergency debate in the House of Commons entitled,
'Offences Against the Person Act 1861 (Standing order
No. 24)'. As many as 22 back-bench MPs had put
their names down to speak. The debate was flying
on the coattails of the abortion referendum in Ireland
the previous week. It was initiated by Stella
Creasy (Labour/Co-op MP for Walthamstow East), who made
a two-pronged attack arguing first for the repeal of
sections 58 and 59 of the Offences
Against the Person Act 1861,
which would be equivalent to the decriminalisation of
abortion, and second for a reform of abortion law in
Northern Ireland, which would then become equivalent to
the rest of the UK.
Others spoke against. For example, DUP chief whip
Sir Jeffrey Donaldson stated that there were 100,000
people alive in Northern Ireland today because the law
had not been reformed. ‘I am proud of that
pro-life position, I am proud of the fact that there are
so many people alive in Northern Ireland today because
we have a law that respects the rights of both women and
of the unborn child and we will maintain that position,’
he said. Sir Jeffrey added, ‘There are strong
voices on both sides of this debate, this is a devolved
issue – it should be left to the people of Northern
Ireland to decide.’
Karen Bradley, the Northern Ireland secretary said,
‘This is a matter of conscience: a free vote on this
issue in this House would be afforded if the matter of
abortion comes before the House again, and the same
applies in Northern Ireland. That is why the
government, like its predecessors, believes that the
best forum to debate and resolve these and many other
matters is a locally-elected Northern Ireland Assembly,
so the government’s priority remains to urgently
re-establish strong, inclusive, devolved government at
the earliest opportunity.'
Three hours later, the debate was brought to a
conclusion by Stella Creasy, ‘Let me be clear to all
Members of this House, the members of the campaign, the
MPs who already stand convinced and those who want to
hear more arguments – that we will also make a choice:
not to give up fighting for equality, not to give up
fighting for the 21st century and not to give up
fighting for choice for all. We trust all
women. Now is the time for Northern Ireland.’
And Hansard recorded the debate finally as,
‘Question put and agreed to. Resolved, That this
House has considered the role of the UK Parliament in
repealing sections 58 and 59 of the Offences Against the
Person Act 1861.’ This time there was no vote in
the House, but the issue will come back, again and
again. Indeed, the latest plan is to put pressure
on the new Home Secretary, Sajid Javid, to bring forward
the draft Domestic Abuse Bill to Parliament early, so
they can hijack it and introduce a decriminalisation
amendment to cover England, Wales and Northern Ireland.
Supreme Court decision on
NI abortion
It is an understatement to say that the political
situation is tense and complex – perchance it has always
been so. However, part of the current problem is
that it has had no working devolved government since
January 2017, when Sinn Fein withdrew from the governing
coalition. In order to create some political
movement the Northern Ireland Human Rights Commission
(NIHRC) managed to engineer a hearing of the current
abortion law at the UK’s Supreme Court in an effort to
overturn it.
In April, the Court sat for the first time in
Belfast. Two days after the Westminster abortion
debate, on 7 June 2018, the Court’s judgment was handed
down. It was unusual. By a 4 to 3 vote, the
justices dismissed the appeal on the basis that they
could not rule in the case because the NIHRC had no
standing to bring the proceedings. Nevertheless,
they further explained how a legitimate challenger, such
as a pregnant woman carrying a disabled baby, could have
standing and ought to succeed. In other words, the
case needed an actual or potential victim.
Of the seven justices, five agreed that the current law
violated Article 8 of the European Convention on Human
Rights which protects privacy and family life. Two
thought that it was incompatible with Article 3, which
prohibits torture. The judgement was complicated
and exposed disagreements, but the Court sent a strong
signal that as the law now stands it is incompatible
with human rights law. Something must give – their
lordships argued that the matter requires urgent
democratic consideration.
Despite the claim’s failure, David Russell, chief
executive of the NIHRC said, ‘This is a victory, a
historic landmark for women’s rights in Northern
Ireland. It has been clear that Northern Ireland’s
laws are incompatible with human rights and there needs
to be a political solution.’
All this leaves the UK’s Prime Minister in a
quandary. After the referendum result in the
Republic, she is under pressure to see that Northern
Ireland also liberalises its law on abortion.
However, her majority in Parliament depends on the
support of the 10 Northern Ireland’s Democratic Unionist
Party members and its leaders have declared that the
North ‘should not be bullied into accepting abortion on
demand.’
Abortion on the Isle of Man
Tuesday 1 May was a red-letter day on the Isle of
Man. It was when the Abortion Reform Bill
commenced its passage through the Upper House of the
Isle of Man Parliament, the Legislative Council.
The Bill proposes to liberalise abortion law on the
Island and become the most permissive abortion regime in
the British Isles. The move follows a public
consultation which received the Island’s biggest ever
response with more than 3,600 respondents giving
feedback.
The new legislation will allow abortion up to 14 weeks
‘on request’, up to 24 weeks in cases of foetal anomaly
or on ‘serious social grounds’, and after 24 weeks in
rare circumstances where the life of the mother or baby
is at risk. Counselling must be offered before and
after the termination, and a clause allows medical
professionals to opt out if it clashes with their
personal views.
So on 1 May, the Bill was passed by members of the House
of Keys by a margin of 22 to 2. As expected, the
Bill passed its Second Reading on 12 June. Further
debates and votes on amendments will take place on 26
June. If approved, the Bill will be submitted for
Royal Assent and accordingly become law.
Abortion in the USA
President Trump has often been an outspoken opponent of
abortion and has threatened to withdraw federal funding,
which is of course ultimately taxpayer’s money, from
more than 4,000 family planning clinics if they also
provide abortions. His aim is particularly
directed at the largest such provider, known as Planned
Parenthood.
The US operates a so-called Title X program by which the
government has previously funded family planning and
abortion clinics. On 22 May, the Trump
administration announced its plans to separate funding
of these two functions. Speaking at a dinner for
an anti-abortion group, President Trump said, ‘My
administration has proposed a new rule to prohibit Title
X funding from going to any clinic that provides
abortions.’ If enacted, the new regulation, which
is being called the Protect Life Rule, will cause
Planned Parenthood to lose an expected $60 million a
year. This is part of the Trump administration’s
plans to restrict abortions throughout the USA.
Abortion in China
China’s infamous one-child policy was introduced in
1979. It is about to be scrapped. Forty
years ago the concerns were feeding the world’s largest
population – today the concerns are a falling birth-rate
and an ageing populace. China is now home to 1.38
billion people. But, though its fertility rate was
falling before the introduction of the one-child policy,
it has now reached an average of only 1.62 babies per
woman of reproductive age. This is below the
critical figure of 2.1 required to maintain a viable
population. Moreover, the numbers of pensioners
are now outpacing those of younger generations and
creating a funding crisis in looking after the elderly –
less workers, less taxes, less caring.
Will the new, unrestricted policy work?
State-sponsored population controls have a terrible
history from European colonialism to the Nazi
programmes. Will the Chinese now reduce their
previous strategies of enforced abortions and
sterilisations? Yet China faces a novel
demographic challenge – are the young even interested in
larger families? In 2016, when the one-child
policy was first relaxed, the birth rate jumped by 8% –
the following year it fell to 3.5%. A declining
birth rate is not all good news, not even in China.
El Salvador says ‘No’
Despite a massive campaign by the United Nations,
Amnesty International and major international media
organisations El Salvador failed to legalise abortion at
the end of April. Pro-abortion groups have called
it a ‘terrible blow’ to their cause. They did not
even secure a congressional debate over the proposed
legislation, and now the current legislative session is
closed.
Both the constitution of El Salvador and its civil
legislation prohibit all abortions, and the law is
defended strongly by the country’s principal medical
association, the Medical College of Nicaragua, which
includes 37 different medical organisations. In a
statement issued in mid-April, the doctors declared, ‘No
situation exists in current medical practice in which
human life must be intentionally destroyed by means of
an abortion for the purpose of saving the life of the
mother. Never can a doctor kill by action or
omission. This is applicable also to induced
abortion, which is a grave ethical and deontological
violation. Biology indicates that the human person
is “the subject of the absolute right to life from his
conception.”’
Assisted
Reproductive Technologies
IVF at 40
Wednesday 25 July 2018 is the 40th anniversary of the
first successful IVF treatment – Louise Brown was born at
the Oldham and District Hospital in Greater
Manchester. Since then at least 5 million IVF-babies
have been born worldwide. In the UK the total figure
is some 250,000 – and now accounting for almost 2% of all
UK births.
With such numerical achievements maybe it is becoming
harder to dispute IVF. Nevertheless, the major
objection remains the fate of the inevitable excess, or
supernumerary, human embryos. Tens of thousands are
deliberately destroyed every year, they are the leftovers,
of no further use, the not needed anymore scraps. Of
course any such objection is predicated on the status of
the human embryo – itself a constantly and resolutely
contentious issue. If it is merely a clump of a few
cells, then who cares about its fate? If it is a
real and nascent human being, then its deliberate and
wanton destruction must be illicit. There are other
good reasons for objecting to IVF, but this is not the
place to rehearse them – I’ve already done that in my Bioethical
Issues book, pp 82 - 99.
Infertility is a symptom that there is something medically
wrong. The approach of IVF is to bypass the
underlying causes of infertility. IVF is therefore
not a cure but a ‘strained treatment’. Forget, for a
moment, the bioethical costs, consider the cash costs
instead. These are somewhat tricky to calculate
accurately because of the differences between patients and
clinics and treatment add-ons, plans, options, and so
on. But a ballpark figure would be £5,000 per cycle
at a UK private IVF clinic.
For instance, look at the costs from CAREfertility, the
website of which states that it provides, ‘The reassurance
of a world leading IVF group, the support of a dedicated
team.’ The following figures are medians of their
ranges given. First, there are pre-treatment costs
with an initial consultation at £200, a scan at £150,
semen analysis at £160 and fertility assessments at
£395. Second, there are treatment costs.
CAREfertility states that, ‘Prices are indicative only but
include monitoring, egg collection, embryo culture and
transfer. Prices do not include drugs or other
optional costs.’ So for straightforward IVF, the
mean figure is £3,225 plus required drugs and other costs
at £750. Third, there is the option for an
endometrial scratch to increase the success rate at £260
and there is embryo freezing and storage to ease the
process next time at £975.
The sum of these amounts to a whopping £6,115. Yet
this is not the cost of a baby-in-arms. The success
of one such treatment cycle is typically less than
30%. In other words, one or two more cycles may be
required to yield that bouncing new-born baby.
IVF on the NHS
Most IVF in the UK is performed outside the NHS.
Apparently both practitioners and patients want clearer
information about the costs and benefits of treatments –
that seems reasonable since some IVF clinics have
previously come under fire for milking vulnerable couples
by overcharging for drugs, using unproven procedures, and
hyping success rates.
It is now estimated that the annual IVF spend by the NHS
is £68m. Since 2013, NICE (the National Institute
for Health and Care Excellence) has stipulated that
eligible women should be offered three free cycles.
By 2017, however, only 27 of England’s 200 CCGs (Clinical
Commissioning Groups) had complied. No wonder the
majority of women seeking infertility treatment go to the
private sector.
First
UK womb transplant
Transplanting wombs is not a new procedure – they have
been carried out in at least 10 countries including
Saudi Arabia, Turkey, Sweden, US, China, Czech
Republic, Brazil, Germany, Serbia and India. The
first successful operation was in Sweden in 2014 when
a woman in Gothenburg gave birth to a baby boy.
The 36-year-old mother received the donated womb from
a friend in her 60s.
Now Richard Smith, clinical lead at the charity Womb
Transplant UK, plans to carry out the first UK
transplant before the end of 2018, using a living
donor. In 2015, approval was given for 10 womb
transplants in the UK, but these were from deceased
donors, whose hearts are still beating. Around
6,000 women in the UK have been born without a womb,
while others lose their uterus to cancer. At
present, their only chance of having a
genetically-related child is through surrogacy.
Around 750 women in the UK have approached the team to
enquire about transplantation. Womb Transplant
UK says it currently has enough funds to pay for three
such transplants.
Baroness Mary Warnock
Nobody has been as influential in the field of assisted
reproductive technologies as Mary Warnock. As the
chairwoman of the Committee of Inquiry into Human
Fertilisation and Embryology and the lead author of the
so-called 1984 Warnock Report, she has set the ethics and
practice of IVF and embryo experimentation within the UK
and further afield. Elsewhere, I have called the
Report ‘… a dog’s breakfast. It’s thinking was in
too many places muddled and shallow, and it often avoided
the major issues, or simply fudged them.’
Nevertheless, most of its recommendations were
incorporated into the Human Fertilisation and Embryology
Act 1990.
In May, Baroness Warnock received a Dan David Prize, which
‘rewards research and achievements that have an
outstanding scientific, technological, cultural or social
impact on our world.’ For this she received US$1
million, 'for her leading role in the development of
practical bioethics and specifically for her progressive
and unparalleled contribution to the ethics of embryology
and genetics and their ethical and philosophical
implication, reproductive technologies, and disability
studies.’
The previous month, in April 2018, at the age of 94, she
was interviewed by BioNews, a publication of the
Progress Educational Trust. Given her liberal
progressive stance on most issues, two of her answers were
surprisingly conservative. A third was appalling.
First, she was asked, With the benefit of hindsight,
would you [now] have reached a different conclusion in
your Report?
She answered, ‘Rather on the contrary – I think the most
important thing really, and the only reason it managed to
get through Parliament, was that we had the 14-day cut-off
rule. If we hadn't had a definite number of days
beyond which it would be a criminal offence to keep an
embryo alive in the lab – that was immensely important [in
getting through]. I personally wouldn't want it to
change.
There's talk now to extend it, but I hope that won't
happen. It's only very recently that the embryo has
been kept alive longer than five days [in the lab].
There's no reason to change it at the moment. I'm
perfectly sure that if we had tried to describe a stage of
development of the embryo which would be the cut-off that
would not have worked. Everybody can count up to 14,
and everybody can keep a record. It was the
simplicity of that rule that made it successful.’
Second, Some say that as IVF is now routine it no
longer needs so much specialised legislation and
regulation, nor does it need its own special
regulator. What do you think of this argument?
‘I think it's a very dangerous argument. The first
recommendation in our Report was to set up the HFEA to
inspect and monitor infertility treatment. I believe
that is very important because it has more or less ruled
out rogue practitioners. People who are infertile
and want to start a family are very desperate and
therefore very vulnerable. I wouldn't want that
[protection] changed for anything. People say it's
over-regulated – I think that's a fault on the right
side.’
The third question, and her appalling answer were, Are
there any other issues in the field on your mind?
‘I think the whole field of genetic intervention and the
possibilities of performing therapeutic interventions on
embryos – either when they have been implanted, or in the
lab – is still developing and is extremely exciting.
The one thing I do deplore is the attitude of what I think
of as the disability lobby who think it's wrong to try and
eliminate hereditary diseases because it is suggesting
that they are unworthy of life. That is an
absolutely terrible argument. The disability lobby
is very vocal on this subject and it does form a real
obstacle on progress.’
It seems that the Baroness has mellowed a little in her
old age. Nevertheless she is still proud to have
mistress-minded embryo destruction on an industrial
scale. And she is still keen to weed out the
disabled.
Human ova grown in the laboratory
Yet another potential fertility treatment has been
reported – for the first time, immature human ova cells
have been coaxed to develop fully in the lab. Still
unclear is whether the resulting in vitro ova,
which reached maturity in just 22 days compared with 5
months in vivo, are physiologically normal and
whether they can be fertilised with sperm to make healthy
embryos. Potential patients include women who have
gone through chemotherapy, which can damage ova and cause
infertility. Also girls with cancer, who have not
reached puberty and so have yet to produce mature ova,
could likewise benefit.
In 2008, reproductive biologist Evelyn Telfer and her
colleagues at the University of Edinburgh achieved the
first half of the developmental process. They
started with primordial follicles from ovarian tissue and
cultured them into a semi-developed state. Then in
2015, a group at Northwestern University in Chicago,
Illinois, completed the second leg – they created mature
ova from partially-developed follicles.
Now the Edinburgh team, Telfer et al., have
reported a procedure for creating fully-developed ova in Molecular
Human Reproduction (2018, 24: 135 - 142)
under the title, ‘Metaphase II oocytes from human
unilaminar follicles grown in a multi-step culture
system.’ They took small samples from the ovaries of
10 women undergoing elective Caesarean sections, and
isolated 87 follicles. From these, they extracted
immature ova and some surrounding cells from the
follicles, and allowed them to further mature on a special
membrane in the presence of growth-supporting
proteins. Finally, just nine of these ova passed a
crucial test for maturity – they were able to divide and
halve their chromosomes so they were ready to unite with
sperm during fertilisation.
However, there are some serious reservations about the
work. For instance, the laboratory process was
inefficient with only about 10% reaching maturity.
There have been no genetic analyses of the final ova that
confirms they are healthy. The shortened maturation
process in the laboratory is quite unlike natural, in
vitro development. The polar bodies of these
ova are abnormally large, suggesting that the ova may not
have matured properly. Maybe the ova are
abnormal. The ultimate test would be to try to
fertilise them to create healthy human embryos. And
since there are currently no plans to try to generate a
pregnancy with them, it is obviously too soon to consider
this as a potential fertility treatment.
‘Three-parent’ IVF – the latest
Scientists at the Newcastle Fertility Centre have now
selected two women to whom they wish to transfer embryos
created from genetic material collected from three
parents. Both women carry gene mutations which can
cause a rare condition known as myoclonic epilepsy with
ragged red fibres, or Merrf syndrome for short. It
is a progressive neurodegenerative disorder, the symptoms
of which occur at an early age, generally childhood or
adolescence.
The procedure of mitochondrial replacement technology
(MRT) aims to prevent such diseases being passed through
mitochondrial DNA by transferring the mother’s nuclear DNA
to a donor ovum in which the nucleus has been removed, but
the mitochondria remain. This controversial process
was legalised by Parliament in 2015. Newcastle
University received the required licence from the HFEA in
March 2017. And the women were approved for
treatment by the HFEA in February 2018. Now the
experiment is ready to begin despite crossing that
bioethical red line of germline modification.
The UK is not alone in permitting MRT. It is already
available in the Ukraine and it has recently been
legalised in Singapore in its aim of fostering
cutting-edge biological science. Thailand is the
only country that does not explicitly prohibit altering
the human genome, while Italy and Israel permit it under
certain conditions.
Genetic
Engineering
Gene
therapy – in trouble again
The great therapeutic dream of gene therapy has often been
dashed – it has had a troubled, albeit short, history.
The crisis started in 1999, when Jesse Gelsinger, a US
teenager, suffered a severe reaction to the infused viral
vector, he underwent multiple organ failure and died.
Other disasters followed amid clinical trials in France and
the USA.
So last year it looked like good news when high doses of
viruses were used to carry healthy genes to unhealthy cells
and when they brought relief to 15 babies suffering from a
lethal neuromuscular condition called spinal muscular
atrophy type 1 (SMA1), a genetic disease that gradually
paralyses babies. As the first human trial using a
particular adeno-associated virus serotype 9, known as AAV9,
its success gave a welcome boost to the gene-therapy
field. This hopeful study was conducted at the
Nationwide Children's Hospital in collaboration with the
Ohio State University College of Medicine. It was
reported in The New England Journal of Medicine
(2017, 377: 1713 - 1722) as ‘Single-Dose
Gene-Replacement Therapy for Spinal Muscular Atrophy.’
However, this year brought chilling news. A study
entitled, ‘Severe Toxicity in Nonhuman Primates and Piglets
Following High-Dose Intravenous Administration of an
Adeno-Associated Virus Vector Expressing Human SMN’ appeared
in Human Gene Therapy (2018, 29: 285 - 298)
by James Wilson and colleagues at the Perelman School of
Medicine, University of Pennsylvania. They also used
high-dose AAV9 infusions, but these severely affected
several animals. Three young rhesus macaque monkeys
developed liver failure and three piglets had motor neurone
damage. Some of them had to be euthanised. The
cause was not immediately apparent.
However, additional alarm bells rang because this study was
overseen by James Wilson. It was he who conducted the
gene-therapy experiment which resulted in the death of Jesse
Gelsinger in 1999. He has since resigned his position
as a scientific advisor to Solid Biosciences, the company
whose product apparently cured the 15 aforementioned
babies. It is a timely reminder that much of medicine
is experimental with both known and unknown risks.
Human-animal hybrids
Hybrids and human-admixed embryos and chimeras – what
bioethical dilemmas they throw up. Now for the first
time human-sheep hybrids have been created by scientists
with the aim of generating an unlimited supply of human
organs for use in transplants, or to cure diabetes.
In January 2017, some serious foundational work was reported
by a team led by Juan Carlos Izpisua Belmonte at the Salk
Institute, California and published as ‘Interspecies
Chimerism with Mammalian Pluripotent Stem Cells’ in Cell
(2017, 168: 473 - 486). They created human-pig
embryos, by injecting human stem cells into early-stage pig
embryos. These resulted in more than 2,000 hybrids
that were transferred to surrogate sows. More than 150
of the embryos developed into chimeras that were mostly pig,
but with a tiny human contribution of around one in 100,000
cells. These human-pig embryos were allowed to develop
to 28 days before being removed from their mothers.
Now, on 17 February 2018, many of the same team members
reported another major breakthrough at a meeting of the
American Association for the Advancement of Science in
Austin, Texas. There the scientists announced that
they have fine-tuned their techniques and managed a similar
feat with sheep embryos, achieving an even higher ratio of
human to animal cells of about one in 10,000 cells.
One of the lead scientists, Pablo Ross from the University
of California, Davis said, ‘We think that that's still not
probably enough to generate an organ. About 1% of the
embryo would have to be human for the organ transplant to
work. And to prevent immune rejection, extra steps
would be needed to ensure that leftover bits of animal
viruses are struck from the pig or sheep's DNA. But
the work shows progress toward more viable organs.’
This work appears to be a realistic first stage towards
growing an unlimited supply of human organs for transplants
and even providing a cure for Type-1 diabetes. The
next step for the team is to implant human stem cells into
sheep embryos which have been genetically modified so they
can grow a pancreas. If successful a human pancreas
would appear inside the animal’s body. The team now
has to apply for permission from regulators to lengthen
their experiments to 70 days to see if the human cells
really can create a viable, functioning organ.
These studies inevitably reignite bioethical concerns.
If 1 human in 10,000 animal cells is acceptable, what
proportion isn’t? What about the spectre of
intelligent animals with humanised brains? What about
the potential for bizarre hybrid creatures accidentally
being released into the wild? And so on. Such
questions tend to be overshadowed by the clinical promise of
organ production and donation. Why? Because in
2016, over 450 people in the UK died waiting for transplant
organs to become available.
The 100,000 Genomes Project
On the back of the ground-breaking Human Genome Project,
which, in 2000, first sequenced the human DNA genetic code
consisting of 3.3 billion letters, the UK Government
announced in December 2012, the 100,000 Genomes Project with
the setting up of Genomics England to oversee it.
The aim is to sequence the genomes of 100,000 NHS patients
suffering from rare diseases, some common types of cancer
and various infectious disorders. Participants, and
sometimes their family members too, will have their genomic
data linked to their medical conditions and health records
so that researchers can improve knowledge of the causes,
treatment and care of these diseases.
As of May 2018, the Project had completed the sequencing of
60,679 whole genomes in England and results are in the
process of being returned to the 13 Genomic Medicine Centres
(GMCs) and ultimately back to the participants.
Patients in Scotland, Wales and Northern Ireland will be
invited to take part at later dates.
The ‘organizer’
At last, the hunt for the human ‘organizer’ may be
over. This is the process by which embryonic stem
cells are sifted and shaped to drive the development of new
cells, ultimately allowing them to become the various organs
and tissues of fully-formed humans. It has been known
to exist in amphibians for decades, but the human equivalent
has proved elusive. Now, it has been found, according
to a paper in Nature (2018, 558: 132 - 135),
entitled, ‘Self organization a human organizer by combined
Wnt and Nodal signalling’ by Ali Brivanlou and colleagues at
the Rockefeller University, New York.
This is complex – very complex.
Perhaps the opening paragraph of the research paper best
describes the work, ‘In amniotes, the development of the
primitive streak and its accompanying ‘organizer’ define the
first stages of gastrulation. Although these
structures have been characterized in detail in model
organisms, the human primitive streak and organizer remain a
mystery. When stimulated with BMP4, micropatterned
colonies of human embryonic stem cells self-organize to
generate early embryonic germ layers. Here we show
that, in the same type of colonies, Wnt signalling is
sufficient to induce a primitive streak, and stimulation
with Wnt and Activin is sufficient to induce an organizer,
as characterized by embryo-like sharp boundary formation,
markers of epithelial-to-mesenchymal transition and
expression of the organizer-specific transcription factor
GSC. Moreover, when grafted into chick embryos, human
stem cell colonies treated with Wnt and Activin induce and
contribute autonomously to a secondary axis while inducing a
neural fate in the host. This fulfils the most
stringent functional criteria for an organizer, and its
discovery represents a milestone in human embryology.’
In other words, these authors discovered the ‘organizer’ by
introducing human stem cells into chicken embryos and
observing how the human cells responded to various signals
and began to assemble into what was identified as a
primitive streak, the precursor of a spine. That is,
the embryonic chicken cells obeyed new signalling pathway
instructions to turn them into nervous-system tissue.
For the last two years, similar experiments have been
reported in pigs and sheep embryos. Their purpose is
not only to understand the fundamentals of early
developmental biology, but also to investigate the potential
for growing human organs in these animals for later harvest
and use in human transplants. Sure, the basic science
is complex, but the future outcome may be quite simple – a
human liver ready for transplanting. Can CRISPR-Cas9 cause cancer? The great hope of using
CRISPR-Cas9 technology in gene-editing procedures to
provide treatments and cures in human medicine has taken
a knock. Two recent research papers suggest that
CRISPR-edited cells may have a role in triggering
certain cancers. It seems that some CRISPR
applications are successful because they disrupt the p53
gene. It is known that p53 can assist the repair
of cells which have damaged DNA, as occurs in cancer
cells. In other words, it may be that p53
dysfunction can cause cancer. In fact, p53
mutations are responsible for nearly half of ovarian
cancers, 43% of colorectal cancers, 38% of lung cancers
and nearly one-third of pancreatic, stomach and liver
cancers and one-quarter of breast cancers.
Both papers were published in Nature Medicine
(online, 11 June 2108). The first was entitled,
'CRISPR-Cas9 genome editing induces a p53-mediated DNA
damage response' by Jussi Taipale and colleagues at the
Karolinska Institute in Sweden. The second as,
'p53 inhibits CRISPR-Cas9 engineering in human
pluripotent stem cells' by Ajamete Kaykas and colleagues
from the Novartis Institutes for Biomedical Research in
Cambridge, Massachusetts. The warning for
CRISPR-Cas9 researchers is, proceed with caution.
Stem-cell Technologies
Placental
stem cells
When, and if, you need stem cells to treat a disease or
bodily complaint, where will you get them from? Your
bone marrow, adipose tissue, or induced pluripotent stem
cells? For most of us it’s too late to plunder one of
the best sources – your placenta, discarded long, long ago.
Placental stem cells have advantages. First, they are
incredibly young. Second, they are most unlikely to be
corrupted – they are like quick-frozen fruit straight from
the tree. Third, such cryopreservation can ensure they
are useful for decades. Fourth, they are versatile,
meaning they can be engineered into any of the 200 or so
cell types of the adult human body. But, no regrets
that your mother passed over the option, other sources will
suffice.
So what about embryonic stem cells?
They have long been touted as a suitable, even superior,
type of stem cells. Ethically, they are unsuitable
because their harvesting destroys a human embryo.
Moreover, their clinical application has been staggeringly
limited, especially when compared to the myriad of
treatments involving adult stem cells.
Why is this? Blame has been attributed to the lack of
serious funding, over-regulation by governments and ethical
hurdles. But even so, the early uses of embryonic stem
cells were unsuccessful, even dangerous. For example,
it was not until January 2009, after several false starts
because of safety fears, that the US Food and Drug
Administration (FDA) gave the Geron Corporation, a
Californian-based biopharmaceutical company, clearance for
the world's first clinical trial of an embryonic stem
cell-based treatment with human patients. In October
2010, the so-called phrase 1 trial – regarded as a
proof-of-concept test – began with four patients suffering
from spinal cord injuries. Its primary purpose was to
assess the safety of Geron's oligodendocyte progenitor
cells, known as GRNOPC1, which had been derived from human
embryonic stem cells.
The first-year assessment results were eagerly anticipated –
the world was waiting. Then on 14 November 2011, Geron
abruptly announced that it was abandoning the trial.
Geron blamed the decision on, ‘… capital scarcity and
uncertain economic conditions.' Others claimed that
the trial was both poorly-designed and over-ambitious –
spinal cord injuries were judged to be too complex and
effect too few people, and so returns, both curative and
economic, might take up to 10 years. But maybe GRNOPC1
was simply not working – therefore continuing the trial
would be futile. Or worse, had some negative side
effects occurred subsequently or, perhaps more likely, were
they about to occur, if the trial continued? Perhaps
the truth will never out.
Subsequent global trials, focussed particularly on eye
diseases, like macular degeneration, have not been
illustrious in terms of numbers or curative outcomes.
Success is scarce, but some is coming. An example is
the trial with two people suffering from age-related macular
degeneration (AMD) who had patches made from embryonic stem
cells implanted into their retinas at a London
hospital. The scientists behind that therapy reported
on the patients’ progress earlier this year (Nature
Biotechnology, 2018, 36: 328 – 337). The
patients’ eyesight had improved considerably – a visual
acuity gain of 29 and 21 letters in the two patients,
respectively, over 12 months. This is a very small,
but notable, example of progress.
Yet a recent editorial in Nature (16 May 2018)
interprets this slow progress as, ‘The steady and careful
development that has guided treatments using embryonic stem
cells should be applied to therapies derived from adult stem
cells.’ Nobody doubts that some adult stem-cell
‘treatments’ have been badly misused by unscrupulous
charlatans out to make a quick buck by exploiting vulnerable
patients in unregulated countries. But numerous adult
stem-cell treatments have been surprisingly successful when
carefully employed. To suggest that most adult
stem-cell treatments have been subjected to poor practice
and hype is a step too far. In the early days of
stem-cell technologies it was embryonic stem cells that were
branded as the gold standard. That gold is now hard to
find. And never forget that bone-marrow transplants
are adult stem-cell therapies, and think how successful they
have been for the last 60 years for tens of thousands of
patients.
And induced pluripotent stem cells?
On 16 May, Japan’s health ministry gave scientists
permission to take wafer-thin sheets of tissue derived from
induced pluripotent stem cells (iPSCs) and graft them onto
human diseased hearts. This is only the second
clinical application of iPSCs.
The team, led by cardiac surgeon Yoshiki Sawa at Osaka
University, says that the tissue sheets can help to
regenerate heart muscle when it becomes damaged by heart
disease or by a heart attack. The technique uses iPSCs
to create a sheet of 100 million heart-muscle cells.
From studies in pigs, the team has shown that grafting these
sheets of heart-muscle cells – each 0.1 mm thick and 40 mm
long – onto a heart can improve the organ’s function.
Sawa says that the cells do not seem to integrate into the
heart tissue. He thinks that instead they release
growth factors that help to regenerate the damaged cardiac
muscle.
The treatment will initially be given to three people over
the next year. If successful, the team will then seek
approval to conduct a clinical trial with about ten
patients. If that proves safe, the treatment could
then be sold commercially under Japan’s controversial
fast-track system for potentially life-saving procedures of
regenerative medicine – critics of this system say that the
rigorous standard of randomized, controlled clinical trials
for demonstrating efficacy in medical research is being
ignored in the rush to bring products to market. The
ultimate question is, ‘Does it work?’ We may know in
2019.
However, there is a detracting complication here. Sawa
already has another fast-track treatment under way.
Approved in September 2015, patients received a sheet of
muscle cells made from their own leg tissue, rather than
from iPSCs. Called HeartSheet, the muscle sheet is
attached to weakened heart muscles. Half way through
its scheduled 5-year plan, fewer than 10 patients have been
recruited and received the treatment. Moreover, as
yet, no convincing results have been published.
Perhaps iPSCs should have been used from the beginning.
The end of reproduction with
gametes?
Scientists have created ‘synthetic’ mouse embryos using just
stem cells rather than sperm and ova. Scientists from
Maastricht University, led by Dr Nicolas Rivron, combined
two types of mouse stem cells to create structures
resembling blastocysts or early embryos, called
blastoids. Instead of traditional gametes, they used
embryonic and trophoblast stem cells, which have the ability
to form an embryo and a placenta. These structures,
although not bona fide embryos, were able to implant and
grow for a few days in the uteri of female mice.
The study was reported in Nature (2018, 557:
106 - 111), under the title, ‘Blastocyst-like structures
generated solely from stem cells.’ It is thought this
new research may advance human infertility treatments,
especially studies into the early implantation stages of
development. However, the blastocyst-like structures
produced in this study did not have the ability to develop
into further embryonic stages. This is because they
contained only two of the three cell layers normally present
in an embryo. Or could this stem-cell method lead to
the testing of new medicines because it could create an
infinite number of early embryos?
How bioethically challenging stem-cell technologies can
be. How informed and judicious we need to be.
Euthanasia and Assisted Suicide
Noel
Conway’s judicial review on assisted suicide
Dignity in Dying is supporting Noel Conway, the
68-year-old former lecturer from Shropshire, to bring a
judicial review challenging the current ban on assisted
suicide in England and Wales. He was diagnosed with
amyotrophic lateral sclerosis (ALS), a form of motor
neurone disease (MND), in November 2014. His
condition is incurable and terminal.
Mr Conway is bringing this case against the Ministry of
Justice to fight for his supposed 'right' to have the
option of an assisted death when he is judged to be in his
final six months of life. The latest phase of his
case was heard at the Court of Appeal on 1 to 3 May
2018. A written judgment is expected in early
summer.
On 27 June, the Court of Appeal - Sir Terence
Etherton Master of the Rolls, Sir Brian Leveson President
of the Queen’s Bench Division and Lady Justice King -
dismissed his case. See here.
But it reaffirmed the High Court’s previous judgment that
the current law, namely, the 1961 Suicide Act, is
compatible with human rights legislation.
Sir Terence said the Court concluded that it was not as
well-placed as Parliament to determine the 'necessity and
proportionality of a blanket ban'. He also said the
High Court had seen evidence that Mr Conway's proposed new
legal framework for terminally-ill people was 'inadequate
to protect the weak and vulnerable.' Finally,
the Justices agreed that, 'the prohibition in section 2 of
the 1961 Act achieves a fair balance between the interests
of the wider community and the interests of people in the
position of Mr Conway.' In other words, assisted
suicide remains illegal in the UK. Noel Conway and
his legal team will now appeal to Britain’s most senior
judges, the Supreme Court.
Assisted suicide in Scotland
Yet another bid to introduce assisted suicide in Scotland
has commenced. It is being led by the Liberal
Democrat health spokesman, Alex Cole-Hamilton MSP.
Such a proposal was originally brought forward by the late
Independent MSP Margo MacDonald, but it was twice rejected
by the Scottish Parliament, the last time was three years
ago, when it was fronted by the Green Party’s co-leader,
Patrick Harvie.
Guernsey rejects assisted suicide
On Friday 18 May, after a three-day debate, the Parliament
of Guernsey, a British Crown dependency off the coast of
Normandy, voted 24 to 14 to reject an Oregon-style bill
for assisted suicide. If the proposal had passed,
Guernsey would have become the first place in the British
Isles to offer euthanasia for people with terminal
illnesses.
The measure was a private member’s bill, or requête,
proposed by Guernsey’s chief minister, Gavin St
Pier. After the defeat, he stated, ‘We, of course,
accept that decision. We remain of the view that
this is an inevitable change which in the fullness of time
Guernsey will one day adopt. However, that is a
matter for our parliamentary successors, not us.’
The proposal was supported by Dignity in Dying, but
opposed by Christian leaders on the Island, the British
Medical Association and the Guernsey Disabilities
Alliance.
Euthanasia in the Netherlands
The latest annual Report of the RTE, the Regionale
Toetsingscommissies Euthanasie, indicates that 6,585
assisted deaths were recorded in 2017, an increase of 8%
from the 6,091 reported deaths in 2016. The number
of assisted deaths for dementia or psychiatric patients
also increased in 2017, with 169 people suffering with the
former conditions and 83 for the latter.
The Report states that virtually all such deaths were
committed within the law. This is doubtful.
For a start, the Netherlands euthanasia review committees
simply do not know how many assisted deaths occur outside
of the law. The New England Journal of Medicine
(2017, 377: 492 - 494) published a study
entitled, ‘End-of-Life Decisions in the Netherlands over
25 years.’ It maintained that even in 2015 there
were 7,254 assisted deaths (6,672 euthanasia deaths, 150
assisted suicide deaths, 431 terminations of life without
request) throughout the Netherlands. The official
Report for 2015 indicated only 5,561 deaths – suggesting
that at least 1,693 (23%) of the assisted deaths were not
reported and therefore outside of the law.
Part of the problem is that Dutch doctors operate a
voluntary code of reporting. The system is a
bureaucratic disaster. For example, the 431
terminations of life without request were probably not
reported. Yet there has not yet been a single
prosecution of a doctor involved despite growing concerns
that assisted death is becoming normalised. Recent,
more vigorous, assessments by regional euthanasia
committees have resulted in four cases being investigated
by the Dutch prosecutor’s office. The outcomes will
be eagerly watched.
Finland and Spain consider
euthanasia
In early May, a citizens’ initiative to legalise
euthanasia was rejected by Finland’s national parliament,
the Riksdag. The voting was a resounding defeat of
128 to 60. However, parliamentarians agreed to set
up a working group to investigate legislation surrounding
end-of-life care.
Meanwhile, Spain’s parliament has voted to consider a bill
that would legalise euthanasia and assisted suicide in the
country. Parliamentarians voted 175 to 136 in favour
of examining the bill, with 32 abstentions. The ruling
Partido Popular opposed even considering the bill, while a
series of smaller, left-leaning parties supported
it. The bill has little chance of succeeding.
Euthanasia in Portugal
At the end of May, a bill to legalise euthanasia failed
narrowly – thus Portugal did not become the sixth country
(behind Belgium, Canada, Colombia, Luxembourg and the
Netherlands) to approve the measure. The bill,
proposed by the ruling Socialist party, was defeated by
110 votes for versus 115 against, with 4 abstentions.
It was a close-run thing. Portugal is emerging from
the heavy influence of the Roman Catholic Church –
abortion on demand was legalised in 2007 and same-sex
‘marriage’ was approved in 2010. This is becoming a
familiar European pattern. Portuguese right-to-die
activists had claimed that legalising euthanasia would be
an expression of an individual’s autonomy, religious
freedom and conscience – yet another rehearsal of those
common and false arguments. In addition, the vote
was the culmination of a two-year campaign, including an
8,000-signature petition. These activists were
earnest. And they will return.
Assisted suicide in Oregon
According to the latest Report from the Oregon Health
Authority, during 2017 a total of 218 people received
lethal prescriptions under its Death with Dignity Act
(DWDA). As of 19 January 2018, as many as 143 people
had died in 2017 from ingesting these prescribed
medications, including 14 who had received the
prescriptions in preceding years. The comparable
death figure for 2016 was 138. A decade earlier, in
2007, it was only 49.
As in previous years, most patients were aged 65 years or
older (80.4%) and had cancer (76.9%). Moreover, a
significant proportion (55%) cited one of the reasons for
opting for assisted suicide was not a concern about pain
or adverse symptom control, but about being a burden on
family, friends or caregivers. Under the terms of
the DWDA, one of the eligibility criteria is that the
patient must have been diagnosed with a terminal illness
that will lead to death within six months. However,
the Report notes that the time from first request until
the patient’s death ranged from 15 days up to 603, which
is almost 20 months. This emphasises the problems
associated with accuracy of prognoses and whether some
patients should have ever been regarded as eligible for
assisted suicide.
Assisted suicide in California
There's trouble in the Sunshine State. On 19 May,
Judge Daniel A. Ottolia of the Riverside County Superior
Court, ruled that the 2015 End of Life Option Act was
passed in an unconstitutional manner. The California
Attorney, General Xavier Becerra, was given five days to
file an appeal to allow the law to stay in place while the
'appeals process' proceeds. But the 4th District
Court of Appeal refused that request. Apparently
this means that the law has been overturned, at least, for
now. Expect legal busyness in the coming weeks.
Assisted suicide throughout the
USA
Assisted suicide and euthanasia practices seem to be
gathering acceptance across the USA. There are now 8
states where such activities are legal, thus an estimated
18% of the US population can now be offered the options.
So, is it the doctors leading or colluding in these ethics
and practices? Not so, apparently. The
American Medical Association (AMA) is the largest
association of US doctors and medical students, with
nearly a quarter of a million members. It recently
issued a statement by its Council on Ethical and Judicial
Affairs (CEJA), squarely opposing such procedures.
In its Report 5-A-18, the CEJA declared that, ‘In its
current form the Code offers guidance to support
physicians and the patients they serve in making
well-considered, mutually respectful decisions about
legally available options for care at the end of life in
the intimacy of a patient-physician relationship.
The Council on Ethical and Judicial Affairs therefore
recommends that the Code of Medical Ethics not be amended.
The Report also discusses the key issue of
terminology. ‘Ethical deliberation and debate is
best served by using plainly descriptive language.
In the Council’s view, despite its negative connotations,
the term “physician assisted suicide” describes the
practice with the greatest precision. Most
importantly, it clearly distinguishes the practice from
euthanasia. The terms “aid in dying” or “death with
dignity” could be used to describe either euthanasia or
palliative/hospice care at the end of life and this degree
of ambiguity is unacceptable for providing ethical
guidance.’
The AMA has been under pressure to modify its stand of
opposition. The American Academy of Hospice and
Palliative Medicine has already adopted a position of
‘studied neutrality’. Doctors from Oregon are
lobbying within the AMA for neutrality, if not outright
endorsement. The heat is on for the AMA, but
principled ethics can/should beat false arguments every
time. And the heat is indeed on - on Monday 11 June,
delegates at the AMA's annual meeting in Chicago voted by
56% to 44% to reject its current opposition to
medically-assisted death. Although the AMA’s
guidance remains unchanged for now, the organisation is
pledged to continue reviewing its current guidance on the
issue.
USA and Elsewhere
Faith
and Opportunity Initiative
In early May, President Donald Trump signed an executive
order creating this new White House office to represent the
rights of religious Americans and to involve their
perspective in future policymaking. The White House
press release stated that the order will, ‘... ensure that
the faith-based and community organizations that form the
bedrock of our society have strong advocates in the White
House and throughout the Federal Government.’
Trump signed the order during the annual National Day of
Prayer ceremony in the White House’s Rose Garden on 2
May. He said, ‘Prayer has always been at the centre of
the American life. America is a nation of believers,
and together we are strengthened by the power of
prayer. We take this step because we know that in
solving the many, many problems and our great challenges,
faith is more powerful than government and nothing is more
powerful than God.’
Hawaii becomes the seventh
The tropical Aloha State has become the seventh American
jurisdiction where assisted suicide is legal. On 6
March, the Our Care, Our Choice Act was passed by the Hawaii
House of Representatives by a 39 to 12 vote, and cleared the
Senate on a vote of 23 to 2 a few days later. Governor
David Ige signed the bill into law on 5 April. ‘It is
time for terminally ill, mentally competent Hawaii residents
who are suffering to make their own end-of-life choices with
dignity, grace and peace,’ he said. The law will take
effect on 1 January 2019.
The legislatures of Hawaii, Oregon, Washington State,
California, Colorado, Vermont and the District of Columbia
have now passed laws permitting assisted suicide. In
Montana, a court decision found that it was legal, but there
has been no associated legislation. On the other hand,
ten US states have passed laws explicitly banning assisted
suicide. The latest has been Utah, where on 6 February
the criminal code was clarified to include the illegality of
assisted suicide.
Abortion in Mississippi
In March, Mississippi became the first state in the US to
ban abortion after 15 weeks, earlier than any other state in
America. Phil Bryant, the State’s governor said the
new legislation will help bring Mississippi closer to his
goal of making the State ‘the safest place in America for an
unborn child.’ Mississippi now has just one abortion
clinic remaining.
The new law passed the House of Representatives by 80 votes
to 31 on 2 February and the Senate by 35 to 14 on 6
March. It forbids abortions from being performed
beyond 15 weeks for any reason other than a ‘medical
emergency’, defined as a physical complication threatening
the woman’s life or ‘substantial and irreversible impairment
of a major bodily function’, or ‘severe foetal abnormality’,
defined as a physical condition that renders the pre-born
baby ‘incompatible with life outside the womb.’ It
does not make exceptions for rape or incest. The law
took effect immediately.
Everyone knew this new law would be contested. That
came quickly. Within an hour of the signing, the
pro-abortion Center of Reproductive Rights filed a lawsuit
on behalf of the Women’s Health Organization (WHO) in
Jackson. Within 24 hours, a federal judge had blocked
the new ban. US District Judge Carlton Reeves granted
a temporary restraining order against the enforcement of the
law for 10 days while he heard more arguments. He then
extended that order until 23 April, and then for several
more months.
Abortion in Kentucky and other
states
In mid-March, the Kentucky House of Representatives voted 71
to 11 to ban dismemberment abortions. Euphemistically
called Dilation and Evacuation (D&E) by abortionists,
this method of abortion is commonly used during the second
trimester of pregnancy. The Dismemberment Abortion Ban
would prohibit this procedure for ending a unborn child’s
life. According to State data, 537 of Kentucky’s 3,312
abortions in 2016 were dismemberment abortions. If the
bill becomes law, abortionists could face felony charges and
up to five years in prison for violating it. Mothers
would face no penalty.
A similar bill was passed by the Florida House on 1 March
and South Carolina’s ban bill is soon going before its State
Senate. Alabama, Arkansas, Kansas, Louisiana,
Mississippi, Oklahoma, Texas and West Virginia have passed
dismemberment abortion bans – nearly all are being contested
through the courts. The fight goes on.
Wheaton College victory
At long, long, long last in late February, Wheaton College
was granted a permanent injunction providing it with
unending protection from a Department of Health and Human
Services mandate. The latter’s ‘contraceptive mandate’
imposed under the Affordable Care Act (ACA) requires
companies and universities to provide contraception,
including abortifacient drugs such as the morning-after
pill, in their health insurance plans. Wheaton, and
many others, went to court to defend their religious
freedoms – it has taken 5 years for this case to be
resolved.
Philip Ryken, president of Wheaton College, said, ‘We are
grateful to God that the court recognized Wheaton’s
religious identity and protected our ability to affirm the
sanctity of human life. The government should never
have tried to force us to provide drugs and services against
our faith, but that episode is now behind us.’
Abortion in Poland
The Polish government is still pushing to enact the toughest
abortion laws in Europe. The proposed restrictions
suit the social conservatism of the governing Law and
Justice (PiS) party. Already abortions are allowed
under only three circumstances – pregnancy from rape or
incest, danger to the woman’s life or health, or severe
foetal damage. The proposed law would strike out that
last exception. If passed, it would effectively amount
to a virtual total ban.
The battle lines have been drawn. The proponents are
influenced either by the powerful Roman Catholic Church, or
by the women’s groups who have organised street protests,
some involving as many as 55,000 people. A poll in
January showed that 37% of Poles supported the
liberalisation of the present abortion law, 43% supported
the status quo and only 15% backed a total ban. There
is no doubt that the government is in trouble.
Such legislation can seem strict, even harsh to us.
But that is mainly because we have become so used to living
with liberal, permissive abortion laws – it is a sign that
we too have been infected. If you are not an
absolutist, then you favour abortion under some
circumstances and those circumstances always prove to be so
fluid.
Miscellaneous
When is a mother not a
mother?
The answer, of course, is when she is a transgender
man. Can you believe that? I defy any reader
to have thought of this as even a remote
possibility. Be honest, this is well out of your
stream of bioethical consciousness.
The law requiring the person who gave birth to be
registered as the baby’s mother may have to be
changed. The Times (8 June 2018) reported
under the headline ‘Trans parent wants baby to be
motherless’, that, ’A baby could become the first person
born in England or Wales not legally classed as having a
mother if a transgender man wins a human rights
battle.’ The young child’s single parent was born a
woman but now lives as a man after undergoing
surgery. He wants to be named as the child’s father
or parent on the birth certificate. Lawyers told a
preliminary High Court hearing in London that the birth
registrar had told the man that the law required people
who gave birth to be registered as mothers.
The man claims that forcing him to register as the child’s
“mother” breaches his human right to respect for private
and family life, and that such “interference” is not
proportionate or necessary in the light of changes which
have “evolved in society”. Mr Justice Francis said
that the issue had never been raised in a court in England
and Wales before. He said that if the man won his
case, ministers might have to consider changing the
law. A judgement is due in September.
You may have an organ you never
knew about
Name your organs – liver, heart, kidneys, brain, and so
on. Yes, all present and correct. But you also
have one you’ve never heard of. This is according to
a recent paper in Scientific Reports (2018, 8:
4947) by Neil Theise et al., from the New York
University School of Medicine and entitled, ‘Structure and
Distribution of an Unrecognized Interstitium in Human
Tissues.’
The researchers begin their Discussion section as, ‘We
propose here a revision of the anatomical concepts of the
submucosa, dermis, fascia, and vascular adventitia,
suggesting that, rather than being densely-packed
barrier-like walls of collagen, they are fluid-filled
interstitial spaces.’ While examining tissues around
the human gut, and especially the bile duct, Theise’s team
found not the usual, expected, hard, dense wall of tissue,
but rather a network of fluid-filled channels that may be
a previously-unknown organ.
Newer approaches to their routine endoscopy procedures
enabled the scientists to examine the in vitro
tissues microscopically. In fact, they found these
novel fluid-filled channels everywhere, including up
Theise’s nose. Why are they novel? Because the
standard approaches for processing and visualising human
tissue causes these channels to drain, and the collagen
fibres, which give the network its structure, to collapse
and appear as hard walls of dense protective tissue,
instead of a fluid-filled cushion.
Moreover, Theise’s team think the network of interstitial
fluid channels may also facilitate the spread of
cancer. When they examined samples, taken from
people with invasive cancers, they found evidence that
cancer cells that had worked their way out of their
original tissues could find their way into these channels,
which allowed direct access into the lymphatic
system. As Theise proposed, ‘Once they get in, it’s
like they’re on a water slide. We have a new window
on the mechanism of tumour spread.’
Are you really a genetic parent?
In Through the Looking Glass, chapter 6, we read,
‘When I use a word,’ Humpty Dumpty said in rather a
scornful tone, ‘it means just what I choose it to mean –
neither more nor less.’ That is sadly all too true!
So, what is a parent? The meaning of ‘parent’ seems
simple enough, but is it? We may think of a parent
in the genetic sense, namely, sharing half of one’s genes
with another person to create a baby, who thus has
parents, a mother and a father. That is true, but
that meaning is not complete. Imagine you have an
identical twin, and your twin had a baby. The child
of your identical twin would share half of your
genes. But, of course, intuitively we reckon that we
are not the parent, genetically or otherwise, of this
baby. So clearly sharing genes is not enough to
describe the parent-offspring relationship.
Monika Piotrowska of the University at Albany, USA has
tackled this question in an article entitled, ‘Is
“Assisted Reproduction” Reproduction?’, which appeared in
The Philosophical Quarterly, (2018, 68: 138
- 157). In her article, which spans almost 20 pages,
Piotrowsha offers what she calls a principled account of
reproduction. This consists of three criteria that
must be met to define true genetic parenthood – they are
the Overlap, Development and Persistence (ODP) accounts,
which she believes capture the true meaning of ‘genetic
parenthood’. Even so, her answer does not even
mention genes, which is surely odd.
Readers who wish to study Piotrowska’s theory in detail
know where to find it. For the rest of us, it merely
confirms the problems bioethically, medicinally,
sociologically and linguistically that accompany assisted
reproductive technologies. And if you think defining
‘genetic parenthood’ is problematic, try ‘personhood’.
Who was responsible for the first
test-tube baby?
Your answer is, of course, the obstetrician and
gynaecologist, Patrick Steptoe, and the physiologist,
Robert Edwards. Well, have half a mark. The
alternative answer is Lillian Lincoln Howell. She
was the eccentric American millionairess who secretly
funded the work, which culminated in the birth of Louise
Brown on 25 July 1978.
Howell was a television executive, who founded a TV
station in the US catering for Chinese and Japanese
Americans, and an amateur poet living in California.
It is only recently, approaching the 40th anniversary of
the event, that her identity has been revealed. She
stumped up $95,000 – about £0.5m in today’s money –
because the two scientists had been unable to obtain
public funding for their controversial work. Her
money, which was promised in a shock telephone call to
Edwards, paid for essential laboratory equipment and
travel, while much of the basic IVF research was funded by
the Henry Ford Foundation.
Vienna – city of weird museums
Some regard it as the world’s most liveable city.
The home of Sigmund Freud, Ludwig van Beethoven, Johannes
Mozart, Johann Strauss, Gustav Klimt and others. The
city where croissant, snow globe and PEZ confectionery
were born. The city that has a coffee culture and is
famed for that sweet Sacher torte and tasty
schnitzel. And don’t forget its unusual museums.
And one of those institutions is the Museum of
Contraception & Abortion. In the two-roomed
building, founded in 2003 by Dr Christian Fiala, the
Museum narrates the history of birth control and bizarre
methods of terminating unwanted pregnancies. In a
glass cabinet knitting needles, thorns, bicycle spokes
which were used as abortion tools before abortion was
legalised, are displayed. The Abortion Room also has
a Victorian kitchen set-up for a DIY abortion.
Asked about why he established this Museum, Fiala
explained, ‘As a doctor I can only reach and educate a
limited number of people about their fertility and how to
best deal with it. As a scientist and lecturer it is
a bigger number, but only through the Museum is it
possible to spread the knowledge about reliable
contraceptives and medically-safe abortions on a global
scale.’ A group guided tour costs €12 per person –
go and have a slice of that scrummy torte instead.