Update on Life Issues – November 2010
and Informed Consent
The dual issue of abortion and informed consent has suddenly surfaced, with an unexpected impetus. Whenever we are about to undergo any medical treatment, we should always be properly and fully informed of both real and potential risks. We can all agree with that. And the same should apply to all women seeking an abortion.
There is growing evidence from the UK, and from around the world, that women's health (mental and otherwise) can be put at risk by abortion. Abortion agencies typically deny the existence of any such dangers, since to recognise them would obligate them to deal with such sequelae. Hence, women are often, or even generally, not fully informed. This issue has been highlighted from at least four quarters.
1] At the end of October, an opinion poll was conducted by ComRes for Christian Concern. Incidentally, it showed that only 2% of those questioned knew that the annual number of abortions in the UK was between 150,000 and 200,000. But more importantly in the current context, 90% of women questioned agreed with the proposition that it should be, ‘A woman's right, enshrined in law, to be informed of all the physical, psychological and emotional risks associated with abortion.’
2] Currently, there is an Early Day Motion (EDM) entitled, Informed Consent For Abortion, which has been tabled in the House of Commons by Therese Coffey, a new Conservative MP. The exact wording of EDM 834 is:
‘That this House notes that in its 14 March 2008 statement the Royal College of Psychiatrists advised that healthcare professionals who assess or refer women who are requesting an abortion should assess for mental disorder and for risk factors that may be associated with its subsequent development; further notes that the Royal College also states that informed consent must be on the basis of adequate and appropriate information on the potential risks to mental health associated with abortion; calls on the Government to give its full backing to mental health assessments for women presenting for abortion as well as the provision of professional counselling where mental health issues are identified; and further calls on the Government to make available information on the possible mental health risks to women of an induced abortion.’
EDMs rarely make much progress at Westminster, but if enough MPs sign, they can alert the government to a significant issue that needs further attention. It is important to understand that EDM 834 is NOT an anti-abortion statement, rather it is a pro-woman declaration, since it seeks to protect women’s health. Perhaps your MP would sign it – have you asked him or her?
3] Late on the evening of 2 November, Nadine Dorries, MP for Mid-Bedfordshire, raised the same issue in an adjournment debate under the title, Termination of Pregnancy (Information Provided). Ms Dorries declared, ‘When it comes to a decision of such magnitude, it is vital for women to receive information that is absolutely accurate and is given calmly, without coercion or a principled bias and, in particular, without political ideology.’ For the government, Anne Milton, Parliamentary Under-Secretary of State for Health, replied and concluded, ‘Having in place informed consent, appropriate counselling and the right support for women at this vulnerable time will ensure that we do not fail them for the future.’
4] The very next day (3 November), a letter, signed by six consultant psychiatrists, was published in the Daily Telegraph. They stated, ‘As consultant psychiatrists we strongly urge Parliament to introduce legislation ensuring that women seeking abortion are fully informed about the possible consequences of their abortion decision.’
This collision of concern has surfaced quite unexpectedly and spontaneously. The hope is that the momentum generated will eventually lead to a change in the law and practice of abortion. The Government has announced that it will publish a report on the mental health consequences of induced abortion in Spring 2011. We will be waiting and watching.
Marie Stopes International (MSI)
Of the 195,743 abortions carried out during 2009 in England and Wales, 38% were performed in NHS hospitals and 56% under NHS contracts in approved independent sector places. Thus 94% of these abortions were funded by the NHS, while the remaining 6% were funded privately.
One of the major NHS contractors providing abortions in the UK is Marie Stopes International (MSI). Last year it terminated over 65,000 UK pregnancies. And this is big business. Last year in the UK, MSI made in excess of £36 million – £30 million of which was financed by UK taxpayers for its NHS agency work.
Profits from its UK business are invested in its overseas work. The ‘International’ part of its moniker encompasses 41 other countries, ranging from Afghanistan to Zimbabwe. In 2009, MSI performed 557,000 abortions worldwide.
MSI has come under heightened public scrutiny during the last few months. Some harsh, albeit well-deserved, criticism has been levelled at its operations.
During June 2010, MSI funded those 30-second TV advertisements for its abortion clinics. If those commercials were effective, presumably the UK abortion numbers will rise. Is that what we want? Will girls (and boys) ever take sex seriously when the answer to a problem pregnancy is trivialised by an advert on TV claiming that the answer is just a phone call or a click away? Girls buying into the abortion industry is neither trifling nor nice.
Over a thousand outraged viewers complained. During August, the Advertising Standards Authority dismissed those objections as groundless. MSI counter-complained that the ‘A’ word was never mentioned and the commercials were for its ‘post-conception advice services’.
Nice lexical engineering, MSI. Despite its website claim that, ‘We always support a woman's choice’, MSI can never be regarded as a genuine pregnancy advisory service. It is an abortion provider, pure (though that is not the right word) and simple. What alternatives to abortion do those nice people at MSI ‘advise’ and how do they ‘support’ pregnant girls and women? Do they, for example, provide accommodation and practical help for the woman who makes the ‘choice’ to keep her baby?
There appears to be only one alternative at MSI. If you want a posh abortion, you can go as a private client. If you are up to 12 weeks pregnant, the cost will be £510. From 19-24 weeks, the cost rises to £1720. But the MSI website obligingly gives this advice to potential customers, ‘You can choose to pay by cash, Mastercard, Visa, Switch, Delta, Solo, or Electron.’ Now is that what they mean by ‘advice’, ‘choice’ and ‘support’?
MSI took another drubbing in August 2010. It was revealed that MSI’s 430 employees, or ‘team members’ as they prefer to be called, at any of its nine centres across the UK, (as well as their partners and children), are entitled to free abortions as part of their staff benefits package. Apparently this job ‘perk’ has been on offer for several years. But that is not all. Another of MSI’s employment benefits is a reduction in gym membership fees. Abortion and bodily fitness do not sit together easily in the mind – harm and health in one package, a contract of blood and sweat. It’s not right. Clearly, MSI does not think, or act, like most people.
Stem Cell Technology
Non-embryonic Stem Cells March On
This third way, this phenomenon of cellular reprogramming, is truly exciting. If it can be harnessed, these iPS cells could become the hottest ‘hot-button’ topic in regenerative medicine. Used in conjunction with current adult stem cell treatments, it appears that we already have a daunting therapeutic armoury. The writing must be on the wall for destroying human embryos to harvest those embryonic stem cells. Bioethically, we should rejoice!
However, we are not there yet. Routine and reliable therapies using adult stem cells plus iPS cells may still be several years away. Serious hurdles remain. Work, such as the translation from animal to human models, human clinical trials and safety tests, will have to be completed first. And one of the key areas that is still far from understood is that of directed differentiation, namely, how do stem cells become, for example, only neurons or only cardiac muscle cells, and then, how can this process be directed efficiently and with precision within the body? Until these pieces of the biological jigsaw are understood and controlled there will be no widespread cures for our recalcitrant diseases.
In addition, two major problems arise with the Yamanaka-type approach. First, the required transforming genes are introduced into the somatic adult cells by way of viruses as vectors, the genes ‘hitch a ride’. But these viruses can hang around and maybe cause tumours and cancers. Second, the genes used, especially c-Myc, are known to be associated with various types of cancer. Several research groups have already attempted, with some success, to devise protocols to obviate these obstacles.
But in October 2010, Derrick Rossi and his group at Harvard published the details of a new technique that is apparently cleaner, safer, faster, and more efficient than any of these other methods for reprogramming adult cells. Instead of transforming the cells’ DNA, it uses messenger RNA (a cousin of DNA)to reprogram the cells, which Rossi has called RNA-iPS (RiPS) cells. The use of mRNA should be safe in treating patients because while it carries genetic instructions, it does not penetrate the DNA of the target cells as do all other current procedures for creating iPS cells. On hearing of this novel development, Robert Lanza, the celebrated stem cell researcher at Advanced Cell Technology of Worcester, Massachusetts, exclaimed, ‘All I can say is 'wow' – this is a game changer. It would solve some of the most important problems in the field.’
Who would dare guess what the next leap forward will be?Whatever it is and whenever it comes, it seems that non-embryonic stem cell technology is getting nearer and nearer to producing effective treatments for use in human regenerative medicine. That is good news for us and for human embryos.
The American Bioethical Tangle
The Americans love a good old legal-political imbroglio and stem cell technology has produced a plum instance. It centres on the so-called Dickey-Wicker Amendment. Back in 1995, the Clinton administration’s Human Embryo Research Panel recommended some federal funding for embryo research. But in the same year, Jay Dickey, Representative from Arkansas and Roger Wicker, Representative from Mississippi, sponsored an Amendment to a finance
This Amendment has beenattached to the Health and Human Services Appropriations Bill every subsequent year. But in March 2009, President Obama issued an executive order that removed this restriction against funding embryonic stem cell research with federal money. On 23 August 2010, two adult stem cell researchers, Drs James Sherley and Theresa Deisher, backed by several pro-life groups, challenged Obama’s action. The case went to court. There, Judge Royce C. Lamberth granted an injunction against federally-funded embryonic stem cell research on the grounds that it, ‘clearly violated the Dickey-Wicker Amendment.’
On 28 September 2010, the Obama administration contested that decision and the Court of Appeals temporarily lifted Lamberth’s injunction while the courts determine the Amendment’s legal meaning. Meanwhile, Sherley and Deisher have been savaged by the media. They have been accused of stopping the competition to their own adult stem cell research, putting ethics before cures, slowing down life-saving research, etc., etc. The legal outcome is awaited.
Assisted Reproductive Technologies
Robert Edwards, Nobel Laureate
As if IVF has not opened enough cans of bioethical worms, Edwards’ research alsoopened the door that has led to the practice and general acceptance of destructive human embryo research, including of course, pre-implantation genetic diagnosis and embryonic stem-cell research. Humanly speaking, Professor Edwards is now a frail old man; biologically speaking, he was a persistent pioneer; experimentally speaking, he was a meticulous worker; bioethically speaking, he has been a tragedy.
Human Fertilisation and Embryology Authority
Its unelected membership has consisted almost entirely of poachers-turned-gamekeepers – it has been stuffed with those who either practise IVF and destructive human embryo research, or who approve of such activities.They have been like foxes guarding chickens. Where have been the dissenting or doubting members to challenge the HFEA’s pro-experimentation ethos? In an age of enforced ‘diversity’, the HFEA’s composition has been signally lacking in this very attribute. What is more, its decisions have been typically liberal and utilitarian. When it has tried to play tough and prohibitive, it has, often within a few months, completed a bioethical U-turn. We remember, for example, the debacle over the issue of saviour siblings. Nor has the HFEA been particularly good at listening to the general public. For example, in 1994, it issued a consultation paper to which most respondents expressed opposition to the creation of human embryos from the cadavers of adults or fetuses. The HFEA disregarded the public’s opinion and approved the measure anyway. As for its so-called ‘stringent control of research’, the truth is that the HFEA has never refused to grant a research licence. Moreover, its governance and accountability have been questionable. It has been plagued by internal staff and policy wrangles. And as for its record on publishing information and data, this has been confused and semi-secretive, anything but transparent.
The HFEA's fundamental flaw was that it lacked any clearly-thought out, coherent bioethical foundation. It was therefore incapable of making consistent judgements and applying commendable actions. It bobbed along like a cork on the sea. Its members were like the infants of Ephesians 4:14, '... tossed back and forth by the waves, and blown here and there by every wind of teaching and by the cunning and craftiness of men in their deceitful scheming.'
So we say, ‘Good riddance, HFEA.’However, there is one fundamental question hanging in the air, ‘What is to replace it?’ The word is that its functions will be transferred and split between the Health and Social Care Information Centre and a new research regulator, the Care Quality Commission. This is a cause for concern. The novel issues raised and the tight regulation required to control the manipulation of human embryos are too important to be divided and hived off (and mislaid?) into the turmoil of two other mega-committees. It appears to be a recipe for future mismanagement and an even greater ‘falling between the gaps’.
The main argument for scrapping the HFEA had much to do with the now general acceptance of IVF and related practices by a once sceptical and nervous general public.In other words, it is now considered that human embryos do not need their own watchdog because researchers have proved themselves to be responsible and can now be largely left alone to do whatever they please with such biological material. We certainly do not agree.
The landmark Warnock Report of 1984 examined the status of the human embryo and feebly concluded that, 'We recommend that the embryo of the human species should be afforded some protection in law.’ Many still consider this statement to be utterly senseless – how can anyone profess respect and protection for something they are about to destroy? For that reason alone, we, and human embryos, need a watchdog with both bioethical teeth and a Parliamentary bark.
The Unnaturalness of IVF
To the already well-documented health problems affecting IVF babies (like heart defects, digestive tract disorders, Angelman andBeckwith-Wiedemann syndromes and certain cancers, like retinoblastoma) comes another candidate – autism. Research from the Assaf Harofeh Medical Center in Israel suggests that IVF children are three times more likely to suffer from mild to moderate autism. Apparently 10.5 % of the children diagnosed with a disorder on the autism spectrum were conceived using IVF. This is significantly higher than the 3.5% rate of autism in the general Israeli population.
Why this long list of problems occurs more frequently in IVF babies remains uncertain. Could it be that the parents already have such disorders, or are they, at least, genetically predisposed to such disorders? Presumably the cause(s) of their infertility has some medical basis. Another reason could be the increasing trend of IVF among older women with their ‘low quality’ ova. Certainly IVF produces an inordinately high proportion (23% versus 1.5% of those naturally-conceived in the UK) of multiple pregnancies with their attendant problems of survival, low birth weights and poor health outcomes. Or could it be that IVF’s unnatural physical and environmental manipulations, plus its fertility drug regimes, affect the developing child?
IVF also appears to have an unnatural demographic effect. Researchers at the University of New South Wales examined 14,000 births from IVF clinics in Australia and New Zealand between 2002 and 2006. Their recent report in the British Journal of Obstetrics and Gynaecology came to a surprising conclusion. Women using straightforward IVF procedures are more likely to have a boy than a girl. True, the swing is small – 56 boys per 100 births compared with the naturally-conceived ratio of 51 per 100.
Moreover, when intracytoplasmic sperm injection (ICSI), as opposed to standard IVF, is used, the ratio swings the other way, in favour of girls. Nobody can explain these observations. Though they are unlikely to upset national sex ratios, these results do represent a skew in the natural order of things.
South Korea Joins the Club
South Korea has recently expressed its desire to fall in with that bad lot of countries which have already legalised euthanasia. Doctors there will soon be allowed to remove life support from terminally-ill patients who have confirmed their wish to die.
The 18-member committee, which drew up the necessary guidelines, agreed that doctors could stop prolonged life-sustaining treatment, but only when patients had made prior written or oral statements. So while voluntary euthanasia may soon be legalised in South Korea, the committee failed to agree about legalising non-voluntary euthanasia for mentally-disabled and other patients, who cannot express such a wish.
Herein lies the danger. Legalisation of voluntary euthanasia is inevitably followed by the practice of the non-voluntary variety. For proof of this assertion, look at the frightening example of Dutch law and the subsequent outcomes in Holland.
Britain is Still Under Threat
Euthanasia remains illegal in Britain, but for how much longer?
Meanwhile, Dignity in Dying is still planning and vigorously campaigning to permit euthanasia in England and Wales. It has recently launched a new specialist group called,Dignity in Dying: Healthcare Professionals for Change. Its aim is to challenge the BMA and a number of Royal Colleges in their stance against assisted dying for terminally ill people and to push for a change in the law.
But there is a huge irony in these drives for the legalisation of euthanasia within the UK. A recent report, entitled, The Quality of Death Index, has been published by the Economist Intelligence Unit. It found that the UK comes top of 40 countries in terms of its hospice care network and statutory involvement in end-of-life care. After all, it should not be forgotten that St Christopher's Hospice in London, founded in 1967 by Dame Cecily Saunders, was the first dedicated palliative care hospice in the world. And the work of that wonderful medical advance remains as a beacon. In other words, the UK’s palliative care service, though far from perfect, continues as the best in the world. Why then should we now adopt the defeatist position of prematurely killing our elderly and terminally-ill citizens?
To bolster opposition to this threat of euthanasia, a new public policy ‘think tank’ called, Living and Dying Well, has been launched by two members of the House of Lords, Lord Alex Carlile and BaronessIlora Finlay. Its aim is, ‘to promote reasoned discussion and to publish evidence-based information on the laws relating to what is euphemistically called ‘assisted dying’ – i.e. euthanasia and assisted suicide.’ It is neither ‘neutral’ nor ‘a campaigning pressure group’, but will seek to present ‘hard evidence, rather than spin … to Parliament and the public in an objective and informative manner.’ Welcome, new organisation!
One of it first reports, issued to politicians in October, warned of the imminent danger if UK law were changed to fall in line with Oregon’s assisted suicide law. This law was introduced in 1997 as the Oregon Death with Dignity Act, and is much admired by euthanasia proponents in the UK. Living and Dying Well believes that a total of 1,052 deaths each year in the UK would be likely to follow. Lord Carlile stated, ‘We are convinced that changing the law to allow these practices would pose serious dangers to large numbers of seriously ill or disabled people.’ Baroness Finlay, professor of palliative medicine at Cardiff University, said, ‘With the expert knowledge British doctors have to relieve suffering, there is no need for anyone in this country to die in pain or distress.’ There is no place, and no need, for euthanasia here.