Update on Life Issues - June 2020.


 
Abortion

Abortion statistics – 2019
Brace yourself, these are the worst statistics ever, ever since the 1967 Abortion Act legalised the procedure.  Published on 11 June, the 2019 abortion figures for England and Wales record a total of 209,519, which is the sum for 207,384 residents plus 2,125 non-residents.  The rate of abortion during 2019 was the highest ever at 18 per 1,000 resident women aged 15-44.  Although most (82%) were performed under 10 weeks of gestation, 2% were at 20 weeks and over.  The number after 24 weeks (the normal legal limit) was 279.  And 126 abortions involved ‘selective reduction’ as a result of overzealous IVF treatments. 
The detailed data can be viewed here.

Then consider these weighty facts and figures.  Almost all (99%) of these abortions were NHS-funded with 74% sub-contracted to the independent sector clinics, such as Bpas and Marie Stopes.  Medically-induced (as opposed to surgical) abortions accounted for 73% of the total.

Numbers carried out under the different grounds were similar to previous years.  For example, 202,975 (98%) were performed under ground C, the comprehensive ‘social clause’ compared with 196,083 (97.7%) in 2018.  Of these 99.9% were again reportedly due to a risk to the mother’s mental health.  A further 3,183 (2%) were conducted under ground E (the ‘handicap clause') including 656 for Down's syndrome.

A total of 40% of women undergoing abortions in 2019 had had one or more previous abortions (88 women had already had 8 or more) and 55% were already mothers having had one or more previous pregnancies that resulted in a livebirth or a stillbirth.

It is instructive to compile an archetypal woman who aborted her unborn child during 2019.  She is 22 years old, white, unmarried, living in London with a partner.  She has never had an abortion before.  Now she is 6 weeks pregnant.  She attends an independent clinic for a medically-induced abortion, under ground C, funded by the NHS.


What should we think about all this?  These figures typically get worse and worse each year, but these are the gravest ever.  4,000 each week, 800 every MTWThF, on your doorstep.  Does it matter?  Isn’t it just the way things are?  Should we care?  Doesn’t abortion solve a problem?  After all, is it really a real child?  Who wanted it anyway?  We shame ourselves by such thoughts.  They are sub-standard Christian notions.  Each little number represents a now lifeless child and a childless mother.  What should be the proper Christian response?  Pray, educate, engage, care, support.  Have you?

Abortion in Northern Ireland
This sad and convoluted saga has rumbled on.  After a vote in July 2019, new regulations for the provision of abortion services were drawn up by Westminster that came into force in Northern Ireland on 31 March 2020.  The matter was meant to be debated by 17 May, but the coronavirus crisis intervened.  The new enactment date was moved to 14 May.  Many in Ulster were incensed – abortion is a devolved matter and therefore should be decided not by Westminster but by the newly-restored Stormont Assembly.

Wednesday 25 March was a sad day for Northern Ireland.  It was the day that the Northern Ireland Office (NIO) published the new legal framework for abortion services across the Province.  It means that abortion will be legal up to 12 weeks for any reason and up to 24 weeks in cases of risk to the mental or physical health of women.  It will mean essentially ‘abortion on request’ up until 24 weeks.  In addition, abortion on the grounds of serious disability, including ‘non-fatal disabilities’, will be permitted up to birth, namely, 40 weeks.  The door of entitlement has been flung wide open because sex-selective abortions, abortions for Down’s syndrome, abortions for cleft lip will all be sanctioned.

Moreover, these new regulations were approved contrary to the democratic rights of the people – 79% of respondents in a recent NIO consultation voted against the proposals.  On 2 June, the Assembly voted, 46 vs. 40, to reject ‘the imposition of abortion legislation’ formulated at Westminster.  The vote will have no effect on the new laws but it sent a strong message to Westminster that the regulations are not supported by Stormont.

Following that win at Stormont, momentum to undo some of the extreme abortion measures by Westminster continued to build.  On 4 June, Sir Jeffrey Donaldson MP was granted an urgent question in the House of Commons with other MPs putting pressure on the Government to hand back control of abortion law to the Assembly.  He argued that, ‘Since the Northern Ireland Assembly is sitting again, and has clearly expressed a view opposing the Westminster Government’s abortion regulations, they should be scrapped and the power to decide on this devolved matter returned to Stormont.’  However, the Secretary of State for Northern Ireland, Robin Walker MP, insisted that the Government had a legal duty to proceed with these abortion regulations.

Mr Walker also told the Commons that, ‘The Regulations are due to be debated in this House at the Delegated Legislation Committee on Monday 8 June, and in the Lords after that.’  Voting was expected when MPs and Peers would have the opportunity to vote down the regulations.  Ahead of those votes, Northern Irish Peer Baroness Nuala O’Loan and Northern Irish MP Carla Lockhart launched an open letter to Peers and MPs in England, Wales and Scotland to ask them to vote against the regulations.

On 8 June, a Delegated Legislation Committee sat to debate the Abortion (Northern Ireland) (No.2) Regulations 2020.  Despite excellent pro-life speeches by Carla Lockhart, Ian Paisley and others, the final vote was 15 vs. 2 in favour of imposing this Statutory Instrument.  On Monday 15 June, there was a 90-minute debate in the House of Lords.  Sadly, 355 Peers voted for the Regulations and 77 voted against.  Two members, Baroness O'Loan and Lord Shinkwin, proposed motions to decline the Regulations.  The former was rejected by 388 vs. 112 votes and the latter was 'not moved'.  Then on Wednesday 17 June, the Regulations proceeded to the House of Commons where 253 MPs voted in favour of them and 136 voted against.

The upshot - now the law in Northern Ireland allows for abortion, unconditionally, on demand up to 24 weeks.  Safeguards, such as as a requirement for two doctors to certify an abortion, have been abandoned.  Abortions up to 12 weeks can be signed off by only one doctor, nurse or midwife.  Sex-selective abortions are permissible.  Unborn children with disabilities can now be aborted up to birth.  In short, MPs from England, Wales and Scotland have imposed abortion laws on Northern Ireland that are more extreme than anywhere else in Great Britain.  The lovely pro-life Province is no more.  The decriminalisation of abortion across Northern Ireland is the sad and tragic end to this saga.

Abortion (Cleft Lip, Cleft Palate and Clubfoot) Bill (2019-21)
The 1967 Abortion Act generally allows abortions for any reason up to 24 weeks of pregnancy.  After that point, abortions are permitted if the mother’s health is at serious risk, or if the unborn child could be born ‘seriously handicapped’.  However, ‘seriously’ can be widely interpreted and can allow late-term abortions for unborn children with medical conditions, which can be easily corrected by surgery.

On 3 June, Fiona Bruce MP presented the above Private Members' Bill to the House of Commons.  Officially it is described as a ‘Bill to amend the Abortion Act 1967 to exclude cleft lip, cleft palate and clubfoot as qualifying physical abnormalities for the purposes of medical termination of pregnancy under section 1(1)(d).’

In other words, it seeks to clarify the 1967 Act so that these medical conditions cannot be used as grounds for abortion, as they currently are.  As it was the First Reading of the Bill there was no debate.  The Second Reading, where debate normally takes place, is scheduled for Friday 10 July 2020.

However, in the meantime, Carla Lockhart MP launched an early day motion (EDM #521, entitled, ‘UK law on disability-selective abortion’) in support of the Bill.  Both the Bill and EDM have the backing of a cross-party group of MPs from Parliament’s three largest parties.  The EDM wording is, ‘That this House notes with concern the discrimination inherent in current UK abortion law that allows abortion up to birth for children diagnosed with cleft lip, cleft palate and clubfoot; that such disability-selective abortion up to birth is underreported according to the Department for Health and Social Care; recognises that cleft lip, cleft palate and clubfoot are treatable after birth and are not life-limiting disabilities and thus a primary diagnosis of any of the aforementioned should not qualify as a grounds for abortion under the Abortion Act 1967; that the many testimonies of individuals and celebrities born with cleft lip, cleft palate or clubfoot demonstrate that these conditions do not hold people back in life; that allowing such individuals to be aborted up to birth is contrary to the Disability Discrimination Act 1995 and Equality Act 2010; that UK abortion law does not reflect the positive change in societal attitudes towards disability in the anti-discriminatory, disability progressive culture of 2020; and recognises that UK abortion law must be changed to provide a person diagnosed with cleft lip, cleft palate or clubfoot with the same legal protections as any other person.’

This issue of abortion for such minor and correctable conditions is of personal significance to Fiona Bruce as her son was born with a club foot.  Decades after his club foot was corrected by two surgical operations and a year of physiotherapy, her son is now studying for a doctorate at Oxford.

Coronavirus and ‘DIY’ abortions at home
The coronavirus pandemic has changed almost every aspect of our lives.  Even abortion has been hit.  On 30 March, the UK Government announced more permissive abortion legislation.  ‘DIY’ early medical abortions, that is, up to 10 weeks of a pregnancy, may now be performed at home by women on themselves without a doctor or other medical professional present.  The change was announced without public consultation or parliamentary debate.  A Government spokesperson insisted that, ‘This measure will be on a temporary basis and must follow a telephone or e-consultation with a doctor.’

This change is puzzling.  For years, abortion providers and their supporters have lobbied for such a ‘home abortion’ policy.  The Government has steadfastly resisted their calls.  Indeed, the week before this March announcement a Government minister said that, ‘We believe that it is an essential safeguard that a woman attends a clinic, to ensure that she has an opportunity to be seen alone and to ensure that there are no issues.’  Then this policy U-turn.  These are truly unusual times.

Previously, abortions could take place only in hospitals or abortion clinics approved by the Secretary of State for Health and Social Care.  Under this new temporary policy – part of the Coronavirus Bill – doctors will be able to prescribe the abortion pills (mifepristone and misoprostol) over the phone or by video, such as Facetime or Skype.  They will be delivered by post.

Women will then be able to perform their own abortions at home by taking both abortion pills, meaning they will be left to deliver their own dead unborn child at home without direct medical supervision.  What about the horrors of seeing and handling blood and tiny body parts?  What about unsuccessful ‘DIY’ abortions and the need for subsequent surgical abortions?  What about the increased ease by which women can be forced into an abortion by misguided peers or abusive partners?  Will these new regulations really be only temporary?  Questions, questions, questions.

Abortion in China
The chickens are coming home to roost.  It may not be a very appropriate or comforting analogy.  However, after years of China’s 1979 one-child policy and its rampant abortion rates to ensure compliance, the inevitable is occurring.  Birth rates have plummeted to a 70-year low.  In 2019, the birth rate was 10.48 per 1,000 – its lowest since 1949 when the People’s Republic of China was founded.  The number of newborn babies dropped to 14.65 million.  The country’s fertility rate is believed to have dipped below 1.5, far from the 2.1 needed to maintain its stable population of 1.439 billion.  The future Chinese population, especially among girls, will be inadequate to support business, taxation, brides and the elderly.

China has, at last, begun to understood the looming damage.  In 2015, families were allowed to have two, and sometimes more, children.  But young couples apparently have a mindset still fixed on one only.  So, China is now proposing inducements to cover much of the cost of childcare, from birth to college graduation, even payments for babysitting grandparents, plus income tax cuts to help reverse the decline.

Abortion in New Zealand
On 18 March, the New Zealand Parliament voted into law one of the most liberal abortion regimes in the world.  The charge was led by Prime Minister Jacinda Arden and Justice Minister Andrew Little.  MPs voted to remove the last legal vestiges of pro-life restraint.  The Abortion Legislation Bill passed its Third Reading by 68 votes to 51.  Thus, the 2020 Abortion Legislation Act was born.

Abortion in New Zealand is now decriminalised and therefore no longer covered by the 1961 Crimes Act.  Abortion is now termed as ‘healthcare’ provision.  Abortion is now freely available before 20 weeks.  After that, the only official requirement is for the abortionist to get a second opinion from an undefined ‘health practitioner’.

An amendment requiring the same care for babies surviving a botched abortion as that given to babies born alive was defeated by 80 MPs.  Other amendments including, limiting late-term abortions to extreme cases of foetal disability or risk to the mother, the probability of foetal pain in post-20-week abortions, a ban on abortions that discriminate on the grounds of sex and disabilities, such as Down’s syndrome, and protections for those with conscientious objections, were all defeated by large majorities.  Parental notification of minors and a requirement for the collection of accurate abortion statistics were also thrown out.  Finally, putting the Bill to a referendum was rejected by almost all MPs.  Kiwis, what have you done?

Conception statistics for England and Wales
Some interesting, though complex, 2018 conception data were released on 4 March by the Office for National Statistics (ONS).  These figures are calculated as the sum of the registration of births plus notifications of abortions.  This, of course, and importantly, excludes conceptions that are ended by so-called ‘emergency contraception’, such as morning-after pills.

First, during 2018, a record proportion of pregnancies ended in abortion, with almost a quarter (24%) of conceptions terminated.  This is up from 22.7% in 2017 and marked the highest percentage since records began three decades ago in 1990.

The ONS data also reveal that women aged in their early 20s are increasingly likely to have abortions.  In 2018, the percentage of conceptions leading to abortion for women aged 20-24 was 35% – up from 33.2% in 2017.  However, the figure has risen dramatically since 1990, when it was 22.3%.

Second, these latest data record that the number of conceptions of women of all ages in England and Wales fell for a third year running.  In 2018, there were an estimated 839,043 conceptions compared with 847,204 in 2017.

Although conception rates for women under 18 years have more than halved in the last decade, they remain twice as high in some of the more deprived areas of England than less deprived areas.

The Teenage Pregnancy Strategy, launched in 1999, along with other factors, such as a shift in aspirations of young women towards education, have led to this decline in conception rates for women aged 15 to 17 years.  In 2018, conception rates for under 18-year-olds in England and Wales declined from 39.9% in 2008 to 16.8% in 2018.  Meanwhile, since 1999, conception rates for all women aged under 18 years have decreased by 62.7%.  This decline has been particularly evident since 2007, which also coincided with the start of the global financial crisis.

However, the latest data also show that, for the first time since 2013, the percentage of conceptions leading to legal abortions increased for every age group.  In 2018, the highest increase was recorded among women aged 20 to 24 years (1.8 percentage points) and the lowest among those under 16 years (0.9 percentage points).  By contrast, for the third year running, women aged 40 and over were the only group where conception rates increased.  In 2018, there were 16.3 conceptions per 1,000 women aged over 40 years of age.

Overall, both the reduction in the calculated conception rate and the 1.3% increase in the abortion rate show that women are choosing to have fewer children.  This suggests that birth rates are likely to have continued to decline in 2019.

CofE on abortion
On 10 February, the Church of England, famously famous for its lack of decisiveness and unanimity concerning bioethical issues, delivered a rather stunning pro-life statement.

The House of Bishops’ statement came at a meeting of the General Synod.  The Bishop of Carlisle, James Newcome, said the Church’s policy was that, ‘In situations where the continuance of a pregnancy threatens the life of the mother a termination of pregnancy may be justified.’  Knowing that abortions after 24 weeks are permitted for ‘serious foetal handicap’, the Bishop explained that, ‘serious foetal handicap’ should be interpreted ‘strictly as applying to those conditions where survival is possible only for a very short period.’

In other words, based on the Government’s official data concerning the above grounds for abortion, it may be deduced that the Church regards just 1.7% of UK abortions justifiable.  So, in a typically CofE Byzantine argument, it may be concluded that the Church considers that 98% of abortions in the UK are morally illicit and legally prohibited.  Something seems out of kilter here!

IVF and ARTs

Surrogacy in Ukraine
Surrogacy is always a bad idea.  The coronavirus pandemic has made it even worse.  Consider the Ukraine, the hothouse for international commercial surrogacy.  It is legal there.  Also it is relatively cheap, medically advanced, and with plenty of willing, poor young women.  Unlike most Asian countries Ukraine still welcomes overseas couples.  Indeed, it recognises the commissioning parents as the biological parents.  In addition, it does not limit payments to the surrogates.

An estimated 500 couples a year come to Ukraine to collect their babies from its 50 or so surrogate clinics.  Enter the coronavirus.  Such surrogate traffic ground to a halt.  The babies and parents were trapped apart.  From early June some foreign commissioning parents have been allowed in.  But when will all parents meet their babies?  What about commissioning parents losing interest?  Who will pay for the babies’ extra accommodation costs?  Meanwhile, who will care for and cuddle these babies?  A calamity?  Yes, it is.

A baby girl for transgender parents
Be honest, you would never have predicted this predicament.  In May, a British couple, who are both transgender, announced the birth of their first child.  Hannah and Jake Graf's daughter was born in April via a surrogate.

Interviewed on ITV’s Good Morning Britain, Hannah Graf, who came out as a trans-woman in 2013, said, ‘I never thought I would be in this position to be in a relationship, or be married, or have kids.  The fact that I have found Jake, we got married and having our little baby is amazing.'

After getting ‘married’ in 2018, Hannah and Jake found a surrogate through the National Fertility Society.  The baby is genetically linked to Jake, who paused his testosterone therapy for six months during his transition in 2008, so that his ova could be harvested and frozen at a fertility clinic.  Donor sperm then was used.

The couple want to share their story to let other transgender people know that having a family is possible.  Hannah said, 'We have had such an outpouring of love coming towards us.  From the LGBT community, from people who aren't able to have babies and are thinking about the surrogacy option, and people who are in a very low place because of coronavirus and just want a bit of joy in their world.’  Well, who would have thought?  Look where 40 years of changing public mores and assisted reproductive technologies have landed us.

A baby boy for a male same-sex couple
Ross and Chris Muller from Edinburgh, the first male same-sex couple to receive IVF on the NHS, have announced they are expecting a baby son via a surrogate this summer.

The Scottish Government had banned using NHS funding for fertility treatment via surrogacy – that meant that homosexual men were excluded.  That ban was lifted in 2018.  The NHS initially said it would not consider treating a male same-sex couple.  But after intervention by their MP, the Edinburgh Royal Infirmary agreed to treat the Mullers.

The couple found their own surrogate in England.  Eight embryos were created from donated ova and Ross's sperm.  One was transferred to the surrogate last November, resulting in the pregnancy.

Chris hopes that sharing their experience will encourage other LGBTQ families to investigate their fertility treatment options.  He said, 'A lot has changed since what we went through – the forms don't say 'mother and father', they say 'parent A and B' – it's little things like that.  I think it will be a lot easier for people to go down this path if they want to.'

Man is still a mother
Freddy McConnell, born a woman, was, in 2017, issued with a Gender Recognition Certificate, which gave legal recognition to his male gender.  Later that year, he underwent fertility treatment, became pregnant, and gave birth to a son in January 2018.  But because he had given birth he had to be registered as his child's 'mother'.  In 2019, the High Court ruled that McConnell was a 'male mother' – a person of the male gender who has given birth.

That 2019 case, before Sir Andrew McFarlane, President of the Family Division, established an important opinion.  It stated, ‘The principal conclusion at the centre of this extensive judgment can be shortly stated.  It is that there is a material difference between a person’s gender and their status as a parent.  Being a ‘mother’, whilst hitherto always associated with being female, is the status afforded to a person who undergoes the physical and biological process of carrying a pregnancy and giving birth.  It is now medically and legally possible for an individual, whose gender is recognised in law as male, to become pregnant and give birth to their child.  Whilst that person’s gender is ‘male’, their parental status, which derives from their biological role in giving birth, is that of ‘mother’.’

In May 2020, the Court of Appeal upheld that 2019 decision.  In other words, McConnell again failed to be registered as the child’s ‘father’ on the birth certificate.  This trans-man, who gave birth, is still to be regarded as the child’s ‘mother’.  Had McConnell’s appeal been successful, his child would have been the first to be born in the UK without a legal mother.

McConnell has responded to the judgement, 'This isn't about a man having a baby.  This is about all trans-people retaining their autonomy and their right to start a family in whatever way they wish, and having their identity recognised in that, or at least respected.'  It is understood that he will seek permission to apply to the Supreme Court.

NHS must pay for US surrogacy
In April, the UK Supreme Court ruled, by a 3 vs. 2 majority that the NHS could be ordered to pay for surrogacy treatment abroad if a hospital’s negligence leaves a woman infertile.

The case concerns a woman, known only as XX, who is unable to have her own children after signs of cervical cancer were repeatedly missed by smear tests and scans from 2008 in the UK.  It was in 2013, when XX was 29-years-old, that her cancer was discovered.  Because of the delay, the woman's cancer progressed and she had to have surgery, radiotherapy and chemotherapy, which left her infertile.

The hospital, Whittington Hospital NHS Trust, admitted negligence and XX was awarded damages.  However, the UK courts had previously refused to allow the cost of commercial surrogacy to be included in those damage payments because commercial (as opposed to voluntary) surrogacy is not permitted under UK law.

In the 2020 ruling, the former president of the Supreme Court, Lady Hale, who presented the majority decision, said, ‘It is no longer contrary to public policy to award damages for the costs of a foreign commercial surrogacy.  The Government now supports surrogacy as a valid way of creating family relationships, although there are no plans to allow commercial surrogacy agencies to operate here.’  Lady Hale went on to contrast the surrogacy arrangements in California, where commercial surrogacy is legal, and the UK.  She described the latter as, ‘fragmented and in some ways obscure.’  Considering the dilemmas that frequently hound the practice of surrogacy, there may well yet be a cheerless addendum to this story.

Surrogacy US-style
Barrie Drewett-Barlow is a British expat.  He and his then-partner, Tony, were the first same-sex couple in Europe to have their names on the birth certificates of their children.  Now they live in a US$7-million mansion in Florida and run an international surrogacy agency.

Barrie and Tony have had a long partnership.  They also have an unusual family life with their four sons and a daughter created with the help of a variety of ova donors and surrogates.  In 2014, Barrie and Tony got ‘married’.  By October 2019, they had separated.  And Barrie had partnered with Scott Hutchinson, who was half his age, and who used to date Barrie’s 20-year-old daughter, Saffron.

This coming October, Barrie and Scott are expecting triplet daughters via a surrogate mother, selected because of her ‘gorgeous looks’ and high IQ.  They all plan to live under the same roof.  Tony has agreed to be godfather to the triplets.  As Barrie has said, ‘Tony is Dad, I'm Daddy and while at the moment Scott is stepdad, soon he's going to be Daddy Two.’  Even that is not all – Barrie has also donated sperm to a lesbian couple in the UK and both of the women are pregnant and due to give birth in September.

As already stated above, ‘Well, who would have thought?  Look where 40 years of changing public mores and assisted reproductive technologies have landed us.’

Euthanasia and Assisted Suicide        

MSP and euthanasia
A 34-year-old man, known only as MSP, was to be kept in intensive care at Barnsley Hospital in an induced coma and denied clinically-assisted nutrition and hydration (CANH) until he dehydrated to death.  Mr Justice Hayden at The Court of Protection in London made this decision on 1 June in the case of Barnsley Hospital NHS Foundation Trust vs. MSP [2020] EWCOP 26.

MSP had a history of serious depression, self-harming, mental illness and chronic bowel difficulties.  In October 2019, he had a temporary stoma inserted as doctors tried to overcome the bowel problem.  He ‘utterly loathed life with a stoma.’  MSP repeatedly expressed great horror at that prospect and his parents believed, given his “advance directive”, drawn up on 4 February 2020, and their many earlier and subsequent conversations, that he would commit suicide if released from hospital.  However, for reasons not entirely clear, the “directive” was produced only post-surgery by MSP’s parents and, because it was unwitnessed, it proved to be ‘legally invalid’.  Later in February 2020, he suffered a significant prolapse which he found distressing.  On 14 May, MSP insisted that this temporary stoma be removed.  A few days later, MSP was rushed to hospital with abdominal pain and sepsis.  But after an attempt at corrective surgery, Mr M, the on-duty consultant gastroenterological surgeon, decided, because MSP’s condition was life threatening, that the stoma would have to be permanent.  MSP consented, having apparently changed his mind, perhaps when faced with the possibility of an imminent death.  At that time MSP obviously had mental capacity.  On 27 May the stoma was formed.  The operation left MSP in intensive care, ventilated and heavily sedated.

Surprised by MSP’s apparent change of heart, the Barnsley Hospital made an urgent out-of-hours application to Mr Justice Hayden to decide if life-saving treatment should continue in MSP’s “best interests”.  On 1 June, Mr Justice Hayden made the order to withdraw life support.  Barnsley Hospital NHS Foundation Trust said that following the Court’s decision, ‘The Trust will now proceed, in discussion with the patient’s parents, to withdraw treatment.  The patient will be provided with palliative care to ensure that, as far as practicable, he retains the greatest dignity and suffers the least discomfort until such time as his life comes to an end.’  Lawyers for the Hospital reported on 10 June that MSP had died.

This case raises serious questions.  First, MSP was not terminally ill.  Second, on 27 May, he changed his mind by consenting to the permanent stoma operation.  Therefore his last wish was to live.  Third, he had a good 60% to 70% chance of surviving.  Fourth, though stomas can require emotional adjustment they are commonplace life-savers – some 200,000 people in the UK live with them.  Fifth, although MSP did have capacity enabling him to consent, he later lacked capacity because he was sedated.  Sixth, if allowed out of the coma, he would probably have been able to breathe and eat and drink.  Seventh, this was not medical treatment, this was not even “palliative sedation”, it was “terminal sedation”, a slow form of euthanasia commonly practised in the Netherlands by medical practitioners uneasy about administering a lethal injection.  Eighth, major medical crises regularly lead to suicidal thoughts, but given time, a majority of patients recover a buoyancy and are glad to live again.

Yet, despite all these arguments, Mr Justice Hayden, apparently disregarding MSP’s change of mind, and believing that MSP’s true intention was still his February “advance directive”, even though it was not legally valid, ruled that MSP should be allowed to die rather than live with a stoma bag.  He found that MSP had, ‘made a practical, utilitarian calculation that life in these circumstances is not what he wants.’  But was the withdrawal of food and water really in MSP’s “best interests”?  The Judge insisted that, ‘No amount of support, love or understanding could change MSP's mind.’  Was this true?  Was it ever tried?  Had MSP simply been denied, by the Hospital and the Court, any opportunity to recover?  This was not doing the right thing.  This was wrong.  Where is this type of medico-legal thinking and practice heading?  Are we not again somewhere down that road of killing patients deliberately?  The tragedy of MSP is a model case of non-voluntary euthanasia, where the patient is killed without an explicit request because he is incompetent, meaning he is senile, newborn or, of course, comatose.  This is beyond troublesome.

Germany approves assisted suicide
Assisted suicide is a fundamental right.  What?  What!  On 26 February, Germany's Federal Constitutional Court handed down a long-awaited judgement endorsing the legality of assisted suicide.  It ruled that a 2015 law banning suicide with professional assistance – ‘business-like facilitation’ Dignitas-style – was unconstitutional, as it deprived terminally-ill patients of ‘the right to a self-determined death’.  The move is deeply controversial given Germany’s record of human rights’ abuses under the Nazi regime.

The existing law, Paragraph 217 of Germany’s Criminal Code, was passed in 2015 to stop people from offering the kind of assisted suicide service that is legal in neighbouring Switzerland.  The Government now says it needs to study the ruling before redrafting the legislation.  The Court has conceded that some restrictions are still possible – as long as ‘sufficient space remains for the individual to exercise their right to a self-determined death and to pursue and carry out the decision to end their life on their own terms.’  As one observer summarised it, in Germany now ‘everyone has the right to [assisted] suicide, regardless of age and illness.’  So, its highest Court has not only decriminalised assisted suicide; it has described suicide as a fundamental human right.  And because most German doctors oppose it, there is obviously a legitimate need for commercial suicide-assistance services.

This is even more radical than legislation in Belgium and the Netherlands, where patients are supposed to be terminally ill.  In Germany any reason will be sufficient – fear of illness or old age, romantic disappointments, professional failure, or just the feeling that life is no longer interesting.

The Court’s press release stated that suicide ‘... must, in principle, be respected by state and society as an act of autonomous self-determination.’  This notion, the Court said is consistent with the European Convention on Human Rights and decisions by the European Court of Human Rights.  The German Court continued, ‘The right to a self-determined death is not limited to situations defined by external causes like serious or incurable illnesses, nor does it only apply in certain stages of life or illness.’  And, ‘This right is guaranteed in all stages of a person’s existence.  The self-determined act of ending one’s life is a direct, albeit final, expression of the pursuit of personal autonomy inherent in human dignity.’  In other words, autonomy is more important than life itself.

This is a serious paradigm shift in West European bioethical thinking and practice.  While there is no consensus across Europe on this issue, the Bundesverfassungsgericht’s decision will be a powerful influence on the judiciaries in other countries.  It is an astonishing capitulation to extreme libertarianism.

Protestant and Roman Catholic churches in Germany have united against the ruling and issued a joint statement.  It said, ‘We fear that allowing organised services for suicide could subtly place old or ill people under pressure.  The more natural and accessible options for assisted suicide become, the greater the danger that people in an extremely desperate situation will feel internally or externally pressurised … to put an end to their own lives.’  Das ist so wahr!

Dutch doctors and dementia patients
On 21 April, the Supreme Court of the Netherlands ruled that a doctor may act on a previously-written euthanasia request and end the life of a patient who, because of advanced dementia, can no longer express his or her wishes.  The Court determined that the doctor who, in 2015, had euthanised a 74-year-old woman in a nursing home, who had suffered severe cognitive decline, had acted lawfully.

The woman had drawn up a living will some years before her admission to the nursing home and had regularly stated that she wanted to die.  The nursing home doctor who euthanised her said she had spoken three times to the patient about her wish to die, but not about her living will because ‘she could not remember anything about it.’  The doctor also confirmed that the patient’s long and short-term memory was very poor and she no longer recognised her husband.’

This doctor was cleared of any wrongdoing last year, but prosecutors wanted a Court ruling to clarify the law and test the legal boundaries.  The Court declared that doctors must continue to abide by the legal requirements of euthanasia as enshrined in the 2002 Dutch law, namely, that the patient must be suffering ‘hopelessly and unbearably’ and that the request is ‘voluntary and well considered’.

Both this case and the Court’s judgement are examples of the Dutch euthanasia ‘slippery slope’.  Before this Supreme Court’s landmark ruling, euthanasia was allowed only for people who could confirm their wish to die in writing.  Can a mentally-incapacitated patient do this?  Probably not.  Thus, as time goes by, the Dutch eligibility criteria become just that little bit wider so they now include the young, the deaf, those fed up with life, husbands and wives, and so on.  Moreover, doctors can easily misjudge the so-called ‘quality of life’ of people with dementia.  How long will it be before Dutch citizens will be openly euthanised against their will – classic non-voluntary euthanasia?  And then what?  Involuntary euthanasia?

Canada also expands the criteria
As sure as night follows day, so Canada follows Holland.  Jean Truchon from Quebec has probably succeeded in changing his country’s already-liberal euthanasia law.  He suffered from cerebral palsy but it was his high-profile challenge that allowed him to receive so-called medical assistance in dying (MAiD).

Before Mr Truchon’s campaign, a patient’s death had to be ‘reasonably foreseeable’ for them to qualify for MAiD.  In other words, they had to be terminally ill.  In September 2019, the Quebec superior court agreed with Mr Truchon and his co-claimant, the 74-year-old Nicole Gladu, that the province’s law was too restrictive and infringed on the ‘life, liberty and security of the person’.  As a result, Mr Truchon, who was 51-years-old, and might have lived for another 20 years, albeit with pain and without control of his limbs, became eligible for euthanasia.  He underwent the procedure in Montreal on 8 April, two months ahead of schedule, because the coronavirus outbreak 'stole' his final months with friends and relatives.

Consequently, with ‘reasonably foreseeable’ out of the window, Justin Trudeau’s Liberal Government has tabled legislation to allow lethal injections to those who are not dying.  The measure, Bill C-7, would substantially relax Canada’s euthanasia laws.  In order to stop Canadians from ending their lives early in anticipation of mental decline, it would allow patients to request it at a later date when they have lost the capacity to consent.  If successful, the Bill would make Canada’s euthanasia laws among the loosest in the world.

According to the country’s justice department, more than 13,000 Canadians have received MAiD since legalisation in 2016.  Last year, it accounted for 1.89% of all deaths.  Most were cancer patients, followed by those with neurological conditions, such as dementia.

Euthanasia and coronavirus
Every cloud, silver linings, and all that.  In March, the only specialised euthanasia clinic in the Netherlands closed its doors during the coronavirus pandemic.  The Euthanasia Expertise Center, formerly known as the End of Life Clinic (Levenseindekliniek), is located in The Hague and provides counselling and euthanasia services for patients whose GPs refuse to authorise euthanasia.

According to its website, ‘In the interest of public health, our patients, their loved ones and employees of the Expertise Center, it is no longer responsible to continue our current care provision.’  No new patients will be admitted and care for current patients has been suspended.  If a euthanasia procedure has already been organised, it will proceed, provided that, ‘… the group of attendees is limited to those who are absolutely necessary.’

Similarly in Canada, from March, at least two clinics in Ontario have stopped providing euthanasia to prevent transmission and to free up health-care resources.  ‘It’s not a decision that we have taken lightly,’ said Andrea Frolic of Hamilton Health Sciences, which has closed its euthanasia facilities.  She continued, ‘It’s heart-breaking for us, as it is for patients and families seeking this care.’  And Chantal Perrot, a Toronto medical assistance in dying (MAiD) provider, said,’ I don’t understand how they could not see MAiD as an essential service for people who are at end-of-life.’  Amazing!

Genetic Engineering

Improved CRISPR-Cas9 genome-editing system
Conventional CRISPR systems include an enzyme called Cas9, which recognizes and cuts a target stretch of DNA – it is the ‘molecular scissors’.  To edit DNA sequences, the Cas9 enzyme must first detect a short genetic sequence, called a protospacer-adjacent motif (PAM), embedded in the target DNA.  The most commonly-used Cas9 variant does not work properly unless it detects a PAM that has a chemical makeup known as NGG.

Now Benjamin Kleinstiver and his colleagues at Harvard Medical School in Boston, Massachusetts, report that they have engineered Cas9 enzymes (named SpG and SpRY) that can recognize a wide variety of PAMs, not just the NGG sequence.  The authors used their new enzymes to edit the genomes of human cells in a laboratory, targeting many previously inaccessible regions of the genome.  This updated, improved system could aid the correction of mutations associated with conditions, such as heart disease, type 2 diabetes, osteoporosis and chronic pain.

The work is reported as, ‘Unconstrained genome targeting with near-PAMless engineered CRISPR-Cas9 variants’ by R T Walton et al., in Science (2020, 368: 290-296).

CRISPR-edited cells safe in humans
The first human phase 1 clinical trial of cells modified with CRISPR gene-editing technology appears to be generally safe and lasting.

A team led by You Lu at the West China Hospital in Chengdu took immune system T cells from people with aggressive lung cancer and applied CRISPR to them to disable a gene called PD-1.  Usually, this gene’s product, PD-1 protein, sends signals that keep immune cells from mounting an attack against the body’s own tissues, but active PD-1 can open the door to the spread of cancer.  In other words, knocking out PD-1 on T cells should confer antitumour activity against the lung cancer.

The team injected each of the study’s participants with edited versions of their own T cells.  Participants experienced only mild to moderate side effects, and potentially dangerous off-target mutations caused by gene editing – the researcher’s main fear – were limited.

This preliminary trial was significant, but also inevitably limited.  The modified cells remained in the blood for about 4 weeks, showing that the strategy could possibly have a prolonged effect.  And the trial involved only 12 people with cancer, and it did not lengthen the participants’ lives.

The work is reported as, ‘Safety and feasibility of CRISPR-edited T cells in patients with refractory non-small-cell lung cancer’ by You Lu et al., in Nature Medicine (2020, 26: 732-740).

Miscellaneous

Coronavirus and bioethics
Anyone and everyone seemingly has something to say about coronavirus.  Whatever.  But let no-one underestimate the global devastation caused by this wretched little virus – this invisible enemy with the strain name of severe acute respiratory syndrome coronavirus 2 (or SARS-CoV-2), which causes the coronavirus disease 2019 (or COVID-19).  And the costs of this pandemic are mounting.  Currently they include unexpected deaths, loss of jobs, family separations, doubting scientists, dishonest politicians, conspiracy theorists, business collapses, government U-turns, failed targets, disrupted education, food shortages, pulpit proclamations and so much more.  It’s enough to make the head ache and the heart faint.  The future costs will be even larger and largely unknown.  A long-lasting global recession is talked of, and, without an effective vaccine, COVID-19 may be with us, wreaking havoc, for many years to come.

Moreover, apart from the dire daily death data, the talk has mostly been about scientific and medical issues – the r values, social distancing, testing, tracking, tracing, vaccines, drug treatments, and so on.  But what about bioethical issues and coronavirus?  Not much of that from the media and the policymakers.  Even so, there is a connection, albeit, largely overlooked.  Take four such topics.

First – truthfulness and transparency.  These are the proper marks of decent government.  Anyone who has watched the daily TV updates from 10 Downing Street will know the failures on both of these counts.  Misinformation, fake numbers and an uneasy, affected bonhomie have been their characteristics.  How many people have been tracked and traced?  What about ibuprofen as treatment?  What about 1-metre social distancing?  Has the Joint Biosecurity Centre been established?  How many tests have been completed?  Have care home residents been neglected?  Just watch those scientists and politicians squirm.  Come on men (and women), tell the truth.

Second – resources.  When medical resources are overstretched, as they undoubtedly have been, how is patient care to be allocated?  In crude terms, who gets access to that last ventilator?  The previously-healthy 45-year-old man, or the 90-year-old lady with Parkinson’s from the local care home?  Not all patients are equal.  Or should the worst off have priority?  Who decides?  On what grounds?  Are we really ‘all in this together’?  When push comes to shove are we, disappointingly, all pragmatists?  Can money buy not just face masks, but also a jump up the queue?  Is there a proper pecking order – me, family, church, neighbour, stranger?

Third – assisted suicide and euthanasia.  What affect will the pandemic have on the debate around these issues?  If COVID-19 brings on unexpected deaths and tidies up the numbers of long-term sick, surely that is a decent and positive outcome?  After all, what’s wrong with survival of the fittest?  Are we not really all utilitarians at heart?  And should there be a ‘duty to die’?

Fourth – vaccines.  They are heralded as the way out of this crisis, the ultimate ‘exit strategy’.  Yet some past vaccines have been created using cells from (either recent or historic) aborted human embryos and foetuses.  Will ethical COVID-19 vaccines be produced and widely available?  We should be told.  And if only unethically-derived vaccine is available, are we morally obliged to use it, not only for our own safety but, importantly, for that of others?  Or is that just a convenient consequentialist argument?  And are vaccine trials acceptable, giving placebos alongside unfamiliar medicines of unknown efficacy?  When biology conflicts with social justice, what are we to do?

These are four issues and questions, and there are several more, mostly unasked and unanswered.  See, awkward bioethics creeps in everywhere.  After 2,000 years under the combined sway of the wholesome Judaeo-Christian doctrines and the Hippocratic Oath, medical ethics and practice, and us, have drifted way off course.  For human life to thrive, it is more than a matter of technology and money, deep bioethical thinking and practice are also required to ensure that everyone is valued and protected.  What about the disadvantaged and the vulnerable?  What has happened to freedom, fairness and public health?  Is bluster, obscurity and self-interest really the way to handle a pandemic?  Oh, for some global, truthful, bioethical leadership.

Francis Collins wins the Templeton Prize
In May, it was announced that Francis Collins was the recipient of this year’s Templeton Prize.  The Prize, established in 1972, by the investor and philanthropist Sir John Templeton, is an annual cash award of £1.1 million ($1.3 million) to a living person who has made ‘an exceptional contribution to affirming life’s spiritual dimension, whether through insight, discovery or practical works.’  Recently Dr Collins was interviewed by Jonah McKeown of the Catholic News Agency (CAN) – some extracts from that interview are included here.

Dr Francis Collins is, in his own words, a ‘serious Christian’.  Others would call him an evangelical Christian.  Since 2019, he has been the director of the US National Institutes of Health (NIH), the nation’s largest medical research agency, spread across 27 institutions and centres, and with an annual budget of some $41 billion.  He is currently overseeing the NIH’s collaboration with several pharmaceutical companies and government agencies to develop a vaccine against COVID-19.

He first came to prominence among the scientific community as professor of internal medicine and human genetics at the University of Michigan.  There he led research teams who discovered the genes responsible for diseases such as cystic fibrosis, neurofibromatosis and Huntington’s disease.

He first came to public attention in 1993 when he was appointed director of the National Center for Human Genome Research, overseeing the collaborative international Human Genome Project, which, in 2003, succeeded in sequencing the three billion DNA ‘letters’ in the human genome.

Apparently, his current vaccine project is one of the biggest challenges of his career and, when he is not working, he is finding solace in prayer and reading the Psalms.  He has said, ‘Like all crises, like all occasions of suffering, this is an opportunity where we can learn and grow.  And I'm glad that I worship a God who knows about suffering.’  Also, ‘I pray for wisdom, for guidance, I pray for forgiveness for making mistakes along the way.’

Francis Sellers Collins was born in Virginia and home educated until age 10.  He then studied chemistry at college and graduate level followed by his MD at Yale Medical School.  Until age 27 he swayed between agnosticism and atheism and was ‘… very happy with the idea that God did not exist and that he had no interest in me.’  Then he became a Christian, in part due to C S Lewis’ masterful book Mere Christianity, which lays out a rational case for God’s existence.

In particular, Collins was fascinated by Lewis’ examination of the basis of morality – why is there such a thing as good and evil, and why does it matter?  Collins claims, ‘This is where I think the most strict atheists find themselves in a real quandary.  Because if they try to argue that our ideas about good and evil are solely driven by evolutionary pressures that have helped us survive, the ultimate consequence of that are that those are fictional concepts – that we've all been hoodwinked into imagining that there is such a thing as good and evil, and that we should stop paying attention to that and do whatever we please.  And even the most ardent atheist has trouble with that conclusion.’

Today, Collins is outspoken about his Christian faith.  He wrote a book in 2006 entitled, The Language of God: A Scientist Presents Evidence for Belief in which he describes how religious faith can motivate and inspire rigorous scientific research.  From 2007, he and his wife, Diane, founded the non-profit BioLogos Foundation, which aims to foster discussion about harmony between science and biblical faith through articles, podcasts and other media.  He has declared, ‘I've found such joy in the ability to bring together the spiritual and the scientific perspectives that I feel this urge to share.  Not to turn it into too dry an intellectual, philosophical discourse, but to talk about the joy that I have experienced and by God's grace, in being able to read God's word in the Bible and understand God's works in nature.’

Collins is, of course, aware that some research teams in the global race to develop a vaccine for COVID-19 may employ the use of human embryonic and foetal tissue derived from abortions in their work.  Last year, the US Department of Health and Human Services imposed a moratorium on NIH foetal tissue research derived from elective abortions.  In a 1998 interview with Scientific American, Collins stated that he is, ‘… intensely uncomfortable with abortion as a solution to anything’ and does not ‘perceive a precise moment at which life begins other than the moment of conception.’  And now in 2020, Collins says he considers the question of whether it is ethical to use human embryos and aborted foetuses for research is an ‘… important issue to think through carefully.  I would be the first to say we should not be creating or destroying embryos – human embryos – for research, and we should not be terminating pregnancies for research.’  Yet he does display something of a utilitarian streak.  He has stated, ‘But if there are embryos that are left over after in vitro fertilization – and the hundreds of thousands that are never going to be used for anything, they'll be discarded – I think it is ethical to consider ways in which research might make it possible to utilize that information to help somebody.  And likewise, if there are hundreds of thousands of fetuses that are otherwise being discarded through what is a legal process in this country, we ought to think about whether it is more ethical to throw them away, or in some rare instance to use them for research that might be lifesaving.’

Collins says he has found it fascinating to observe how much the modern field of bioethics rests on a Judaeo-Christian foundation.  ‘The fact that we do value such things as benevolence, non-maleficence – that is, don't hurt somebody on purpose – as autonomy, as equity, as justice; all of those principles come directly out of the Bible’, Collins has declared.  ‘And so, a secular ethicist who adheres to those – and they will – may not have quite the same sense that I do about the foundation on which they rest, which for me is very much God-given.’

Moreover, Collins has said if he could go back in time to talk to his 27-year-old atheist former self, he would encourage that young man to begin contemplating questions like, ‘Why is there something instead of nothing?  Is there a God, and how would you know if there were?  What is love about?  What is beauty about?  Why are we here?  Those are not questions where the scientific approach is going to give you much of an answer at all.  Let's think about whether it's worth, before you die, giving a few minutes contemplation to that, and seeing if there's any other direction from which answers might come, other than the science lab.’

Finally, hearty congratulations, Francis, on winning the Templeton!  We might at times wish your views and answers to some bioethical issues were clearer and more consistent.  But we too are often muddled and the issues are thorny.  That notwithstanding, we are glad that a brother in Christ is in such a powerful, policy-making position and on the basis of 1 Timothy 2:1-2 we will give thanks for you and will pray for you.

Collins will be formally awarded the Templeton Prize in a virtual ceremony later this year.  A million quid, eh? – I wonder if he tithes to his church.

Norma McCorvey revisited
The Norma McCorvey story is central to the legalisation of abortion in the USA.  Her part is briefly told on pages 252-256 of my 2014 book Bioethical Issues.  She eventually became the Jane Doe, the plaintiff, in the landmark 1973 Roe vs. Wade lawsuit.  Originally, back in 1969, she was duped by two pro-abortion lawyers to pursue a claim that the anti-abortion law of Texas was unconstitutional.  After passing through lower courts, the case eventually arrived at the Supreme Court and the momentous constitutional right of US women to access abortion was granted.

Norma McCorvey came to regret her part in Roe vs. Wade.  In the 1990s, while she was working at a Dallas abortion clinic, she was befriended by some evangelical Christians and other pro-lifers.  And in 1995, she professed she had found God, left her job at the clinic and turned pro-life.  She stated, ‘I think abortion is wrong … I just have to take a pro-life position.’  Thereafter she became a warrior for the pro-life movement and joined Operation Rescue.  She even published a memoir, Won by Love, about her conversion to Christ.

McCorvey died of heart failure, aged 69, in 2017.  Prior to her death, she starred in a TV documentary film about her life entitled, AKA Jane Roe.  It was first shown in the US on 23 May 2020.  She called it her ‘deathbed confession’.  She claimed that she received at least $450,000 from conservative supporters in return for her defection to the anti-abortion lobby.  In the film, the visibly-ill McCorvey declared, ‘I was the big fish … I took their money and they’d put me out in front of the cameras and tell me what to say.  It was all an act.  I did it well too.  I am a good actress.’

Was she a fraudster?  Who knows?  Norma McCorvey was, for much of her chaotic life, a sad, mixed-up, single mother.  She was not well educated and easily manipulated.  Maybe she was played by both sides, those pro-abortion lawyers and those pro-life supporters.  Maybe she was also used by the TV film crew.  One person who knew her well was the pro-life leader, Father Frank Pavone.  He was Norma’s friend and mentor for 25 years.  Only a few hours before her death, they had spoken on the phone.  She told him, ‘I’ve got to make you promise that you’ve got to carry on this cause.’  That was perhaps her true ‘deathbed confession’.  Whatever.  The enigma surrounding this most controversial of US legal cases and its central star lives on.

Anosmia and ageusia
The COVID-19 pandemic has taught us these two new words, unless, of course, you are already some sort of New Testament Greek scholar.  While a new and continuous cough and a high temperature have long been recognised as possible symptoms of COVID-19, a loss of smell (anosmia) or taste (ageusia) were added to the list much later by the UK Government.

Lots of respiratory viruses can cause problems with smell receptors.  And in, for example, South Korea, where testing for COVID-19 has been extensive, 30% of patients testing positive have presented with anosmia as their major symptom in otherwise mild cases.  However, the onset of the hay fever season may well confuse such diagnoses.  Maybe using perfumed soap should be the order of the day for those frequent hand-washing sessions.  Warning – do not try eating it to test for ageusia.

Stem-cell Technologies

Stem cells and coronavirus
It was so predictable.  Someone had to claim that stem cells could overcome the virus.  And that person is Dr Dongcheng Wu, a professor at Wuhan University School of Basic Medical Science, China.  In March, he claimed to have treated nine, mostly elderly, COVID-19 patients with stem cells derived from bone marrow or umbilical cords.  He injected the stem cells directly into the patients’ veins and, within days, all had made complete recoveries.

A close collaborator of Dr Wu is Dr Brian Mehling.  He has stated, 'So our research found that stem cells are extremely effective in decreasing inflammation and also enabling the body to repair damaged tissue.  So we thought what the heck, let's give it a shot.  We gave nine patients, who were in hospital with severe, acute pulmonary dysfunction, we gave them core blood stem cells via IV and 100 percent of them got better, so of course we were astounded.'

We have been here before, many times.  Unpublished reports of stem-cell cures for legions of diseases are sadly commonplace.  Was this a carefully planned clinical trial?  Where are the follow-up details?  Where is the clear evidence of diagnosis, procedure and outcome?  Controversial?  What do you think?  Would you try it?

Stem cells and Parkinson’s
The idea of repairing the brain by replacing the neurons that die in Parkinson’s disease has been a long-standing dream for stem-cell researchers.  Over several decades many cell types have been suggested as candidates.  These include cells from the midbrain of aborted human foetuses and human embryonic stem cells, neither of which are bioethically acceptable to many.  Therefore there is particular interest in any treatment using adult or induced pluripotent stem cells (iPSCs).  Here is one such.

A team of investigators from the McLean and the Massachusetts General Hospitals has reported remarkable results in a recent issue of the New England Journal of Medicine.  The article entitled, ‘Personalized iPSC-Derived Dopamine Progenitor Cells for Parkinson’s Disease’ is by J S Schweitzer et al., (2020, 382: 1926-1932).

The researchers reprogrammed a 69-year-old Parkinson’s patient's skin cells to induced pluripotent stem cells (iPSCs), then differentiated them into dopaminergic progenitor cells and transferred them (six months apart) into the left and right hemispheres of the brain of the patient.  The idea is that the cells will implant and release the neurotransmitter dopamine, which is lacking in Parkinson’s patients.

The patient reported an improvement in his quality of life.  Routine activities, such as tying his shoes, walking with an improved stride, and speaking with a clearer voice, have become possible again.  Kwang-Soo Kim, the team leader, said, ‘Because the cells come from the patient, they are readily available and can be reprogrammed in such a way that they are not rejected on implantation.  This represents a milestone in “personalized medicine” for Parkinson's.’

Maybe.  But they are results from only a single patient.  And there are other peripheral problems.  For a start, the patient, Dr George Lopez, helped fund the research.  Would this have distorted his and the team’s judgements?  Is the patient above the science?  Should a wealthy patient jump the queue?  A proper clinical trial is called for.

Stem cells and heart disease
In May 2019, two men in China were reported to be the first in the world to receive an experimental treatment for heart disease based on ‘reprogrammed’ stem cells.  They were injected with heart muscle cells, known as cardiomyocytes, derived from induced pluripotent stem cells (iPSCs).  Now in May 2020, according to the surgeon who performed the procedures, the men have successfully recovered.

No results have yet been published, so there is no independent way to confirm whether the treatment has worked, including whether the reported benefits are due to the iPSCs or simply to the heart bypass that accompanied the treatment.  Nevertheless, the surgeon, Wang Dongjin from the Nanjing Drum Tower Hospital, has said that one of the men – Han Dayong, a 55-year-old electrician from Yangzhou in eastern China, who received the treatment alongside a heart bypass – says he is very satisfied with the outcome.  Before the surgery, Dayong remembers being tired and often out of breath.  Now he can go for walks, climb stairs and sleep through the night.  It was beyond my expectations,’ he says.

Details of the work are expected to be published later this year.  In addition, the research group has received approval to expand its study to include a further 20 patients.

Good news for fatties and baldies
Stem cells derived from fat can lead to hair regrowth for people with a common type of baldness, namely, androgenetic alopecia (AGA).  South Korean researchers showed that the use of extracts of fat tissue – termed adipose-derived stem-cell constituent extract (ADSC-CE) – increased both hair thickness and density in patients.  A double whammy for the obese and receding.

Dr Sang Lee from Pusan National University Yangsan Hospital and his colleagues conducted a randomised, placebo-controlled trial in middle-aged men and women to explore the effects and safety of ADSC-CE in AGA.

First, the team disrupted the membrane of stem cells found in fat tissues using a low-frequency ultrasound wave and enriched the secreted stem cells with protein.  They recruited 38 patients – 29 men and nine women – with AGA for the clinical trial.  One half of the patients applied the ADSC-CE lotion to their scalp with their fingers, and the other applied a placebo solution.  After 16 weeks, the group that used the ADSC-CE lotion showed a significant increase in hair density of 28.1% in comparison to 7.1% in the control group, and also hair thickness with 14.2% greater in comparison to 6.3% in the control group.  No side effects were recorded.

The research has been published as, ‘A randomized, double
blind, vehiclecontrolled clinical study of hair regeneration using adiposederived stem cell constituent extract in androgenetic alopecia by Young Jin Tak et al., in Stem Cells Translational Medicine (18 May 2020).

USA and Elsewhere

The race to the White House
It will certainly be on Tuesday 3 November.  And the winner will definitely be the 46th incumbent of the White House.  And  now we know it will either be a 74-year-old, Presbyterian, businessman, Donald Trump, or a 77-year-old Roman Catholic, lifetime politician, Joseph Biden unless, of course ….  What a choice – the Republican Twitter bully vs. the gaffe-ridden Democrat.  And bioethically they are oceans apart.  On bioethical issues there is no contest.  Trump has steered his administration in a positively pro-life direction, like no other previous president.  By contrast, Biden is a pro-choice extremist, wanting Roe vs. Wade as federal law, abortion up to birth and the restoration of federal funding for Planned Parenthood.  Then there is the not small matter of choosing running mates, potential vice-Presidents.  Will Trump again pick the thoroughly pro-life Mike Pence?  Will Biden pick the thoroughly pro-abortion Elizabeth Warren, or Kamala Harris, or even Michelle Obama?

Not long ago, this 2020 election looked as if the defining issue would be the value and protection of human life, especially unborn human life.  Now it looks as if tackling the coronavirus pandemic and the planned return to normal life and the recovery of the economy will be centre stage.  Or will racism trump all other issues?

Overturning Roe vs. Wade
The repeal of the 1973 Roe vs. Wade case is still the major aim of pro-life supporters in the USA.  Apart from Justice Clarence Thomas, it is not generally known where the other eight members of the Supreme Court of the United Sates (SCOTUS) stand on overturning Roe.  Hints are emerging.  For example, their support for overturning legal precedent, known as stare decisis, and Justice Kavanaugh’s recent decision citing the overturning of abortion precedent as one instance where the SCOTUS can go, and has gone, back on Roe, is an encouraging sign showing that the conservative Justices on the SCOTUS are open to reversing precedent and abortion precedent in particular.

There are nine members of the SCOTUS.  Most observers believe there are from 3 to 5 votes in favour of repealing Roe, with Justice Thomas firmly in support.  Justices Kavanaugh, Gorsuch and Alito are also likely to support reversal while and Chief Justice Roberts is a ‘maybe’.  Some pro-life legal scholars think it would be helpful to replace one of the four pro-abortion liberal Justices with another conservative to make it even more likely that there are enough votes to overturn Roe.  The only way to accomplish this is to secure a second term for President Donald Trump to have another four years enabling him to appoint more pro-life Justices and so move the Court away from its current abortion-on-demand ethos.

Justice Clarence Thomas and abortion
Who is Clarence Thomas?  He is a 71-year-old Justice of the Supreme Court, nominated by President George W Bush in 1991.  He is regarded as the most conservative member of the Court and he is its longest-serving participant.  He is one of five practising Roman Catholics currently serving.  He was born in Savannah and his family are descendants of American slaves.

In April, once again he went on record stating that Roe vs. Wade, the 1973 ruling that allowed virtually unlimited abortions, should be overturned.  He, Justice Brett Kavanaugh and other conservatives on the SCOTUS appear to have set up the legal rationale for someday overturning Roe vs. Wade.

For years, abortion activists and leading Democrats have attempted to turn Roe vs. Wade into some sort of ultra-precedent that cannot be overturned because, they say, it has been on the books for decades.  But that is despite the fact that the SCOTUS has previously overturned long-standing precedents, such as in cases relating to slavery and civil rights.

In a decision on 20 April, the Supreme Court ruled on a case unrelated to abortion – but one that could have a massive impact on Roe.  And its ruling, authored by Justice Kavanaugh, set out examples of cases that might be overturned and explained why overturning precedents is definitely allowable.  In his own concurring opinion, Justice Thomas listed three ‘incorrect decisions’ that he said used a faulty interpretation of the Fourteenth Amendment.  They were Obergefell vs. HodgesDred Scott vs. Sandford and Roe vs. Wade.

This is not the first time that Justice Thomas has indicated Roe vs. Wade needs to go.  In June 2019, he hinted at his willingness to overturn it.  Then again on 17 June 2019 in an unrelated gun rights case, he questioned the tendency of SCOTUS to rely on precedent for its decisions.  Thomas wrote, ‘When faced with a demonstrably erroneous precedent, my rule is simple, we should not follow it.’  He said the Court should not ‘elevate’ court precedent over the US Constitution, and some precedents are ‘demonstrably erroneous.’  At one point in his decision, he mentioned the abortion case Planned Parenthood vs. Casey.  This 1992 case, which upheld Roe, says that states cannot place an undue burden on women’s access to abortion.  Thomas dissented in that case.  Thomas said the SCOTUS should ‘restore’ its jurisprudence relating to precedents to ensure it exercises ‘mere judgment’ and focuses on the ‘correct, original meaning’ of laws it interprets.  He continued, ‘In our constitutional structure, our rule of upholding the law’s original meaning is reason enough to correct course.’

Speculation is growing about whether the Court will hear an abortion case in the future and overturn Roe vs. Wade.  In May 2019, the Justices refused to hear an Indiana case involving a law that protects unborn babies from discriminatory abortions based on their race, sex or a disability.  Though the ruling was disappointing, the SCOTUS did uphold a second part of the law that requires abortion facilities to cremate or bury aborted babies.

In his opinion, Thomas urged the Court to consider laws that protect unborn babies from eugenics.  He wrote, ‘… this law and other laws like it promote a State’s compelling interest in preventing abortion from becoming a tool of modern-day eugenics.  Although the Court declines to wade into these issues today, we cannot avoid them forever.  Having created the constitutional right to an abortion, this Court is duty-bound to address its scope.’  Thomas said he believes the Court needs to ‘percolate’ on the abortion issue more before hearing a major abortion case.

Louisiana law challenge
It has been a long time coming, but on Wednesday 4 March, the Supreme Court of the United States (SCOTUS) heard oral arguments in the most high-profile abortion rights case in decades.  Some have heralded it as ‘The beginning of the end for Roe.’

In a case known as June Medical Services vs. Russo, the nine SCOTUS Justices heard arguments on whether Louisiana can impose restrictions on abortion doctors.  The 2014 Louisiana law at the centre of the case requires abortion providers to have ‘active admitting privileges’ at local hospitals in order to treat patients with emergency complications should an abortion go seriously wrong.  The fundamental question was this, does the imposition of these safety requirements violate a woman’s access to abortion?

This current case is considered by the prosecution to be about legal precedent.  Just four years ago, the SCOTUS ruled that a Texas case, known as Whole Woman’s Health vs. Hellerstedt, was unconstitutional because ‘admitting privileges’ were seldom granted and rarely used and created obstacles for women to access abortion, a constitutional right established by Roe vs. Wade.  The Louisiana law at issue here is the Louisiana Unsafe Abortion Protection Act (Act 620).  It is similar to that Texas case.  If upheld, the law would leave Louisiana with just one clinic and one doctor, who already has admitting privileges, to perform the 10,000 or so abortions that Louisianan women procure each year.

The Louisiana law has important differences.  For example, the Texas law required abortionists to have admitting privileges and required abortion clinics to meet the same standard as ambulatory surgical centres.  However, the Louisiana law does not require clinics to meet the ambulatory centre requirements.

This is the first abortion-related case to be heard by both Justices Neil Gorsuch and Brett Kavanaugh, two recently-appointed Justices, who are considered conservative and thus give the SCOTUS a conservative majority.  Some abortion rights advocates believe the Court's majority may grant the opportunity from this case to overturn Roe vs. Wade.  The Louisiana judgement will be announced at a date yet to be decided, though it is expected to be before the end of the 2019-20 term.

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lsewhere additions
Where are these?  They're coming hopefully this week!

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