Update on Life Issues – October 2012
Bioethical Issues in the UK
UK Government reorganization and bioethics
Three other appointments at the Department of Health are notable. One was that of the new Minister of State, the Liberal-Democrat MP for North Norfolk, Norman Lamb, and there were two Parliamentary Under Secretaries of State, Anna Soubry, Conservative MP for Broxtowe andDaniel Poulter, Tory MP for Central Suffolk and North Ipswich. Mrs Soubry and Dr Poulter, a former obstetrician, had both opposed Mrs Milton’s proposals to take away the counselling role of abortion clinics and give it to independent organizations.
Within two days of her appointment Mrs Soubry was promoting her views on assisted suicide. One might reasonably have thought that her first duty as a new minister was to grasp the financial and staffing turmoil within the NHS, but no, she opted for assisted suicide. In an interview with The Times, she said it was ‘ridiculous and appalling’ that British people had to travel abroad to end their lives. She further criticised the present law for criminalising assisted suicide and called for greater honesty over when people would be prosecuted for assisting. Two days later, during a BBC Radio interview on the issue, Mr Lamb stated that, ‘Mypersonal view is that there is a case for reform.’
The only other piece of good(ish) news is that Maria Miller, MP for Basingstoke, has become secretary of State for Culture, Media and Sport and as if that were not enough, she is also Minister for Women and Equalities.She did support the pregnancy counselling amendment last year and in 2008 voted for reducing the abortion limit to 20 weeks and for an amendment requiring assessment of the need for a father prior to IVF treatments. However, her position on same-sex marriage looks poor, though she is apparently less enthusiastic than her predecessor, Lynne Featherstone. Mrs Miller will certainly have plenty of paperwork coming across her desk from both pro-abortion advocates and from those opposed to redefining marriage.
Adverse effects of abortion
A study by Klemetti and colleagues, published in the August online edition of Human Reproduction, examined the medical records of 300,858 first-time Finnish mothers between 1996 and 2008. It found a positive association between induced abortions and the risk of preterm birth. In other words, the more abortions a woman had, the more likely it was that her first birth would be premature. If a woman had had three or more abortions, the risk that she would have a very premature baby, born before 28 weeks, was three times higher, with the risk of allied health problems for the baby, such as brain injury, permanent disability and even death. Though the study’s positive correlation does not prove causality, and though the overall risk is small, the large numbers of abortions performed each year mean that the poor birth outcomes must be regarded as significant. As the authors state, ‘In terms of public health and practical implications, health education should contain information of the potential health hazards of repeat IAs [induced abortions], including very preterm birth and low birthweight in subsequent pregnancies.’ In this context, it should be noted that repeated abortion are on the increase – over a third of the women (36 per cent, or more than 68,000) undergoing an abortion in England and Wales during 2011 had had one or more previously.
Similar results were confirmed in a study from Scotland by Bhattacharya and co-workers published online at BMJ Open during August. They examined the records of 120,033 women who had abortions in Scotland between 1981 and 2007. These data showed that the risk of preterm birth after induced abortion was higher than that in a first pregnancy or after a previous live birth, though they did not find that the risk increased for women who had undergone two or more consecutive abortions. They also reported that preterm births were associated with surgical rather than medical terminations of pregnancies.
A report by Reardon and Coleman in the September issue of Medical Science Monitor examined the medical records of 463,473 Danish women, who had their first pregnancy between 1980 and 2004. A total of 2,238 of these women died during this period. Significantly higher maternal death rates were associated with abortion compared with childbirth. Women having abortions up to 12 weeks gestation were twice as likely to die in the following 180 days, compared with those who gave birth, while women having abortions after 12 weeks were four times as likely to die in the succeeding year. The authors concluded that, ‘Compared to women who delivered, women who had an early or late abortion had significantly higher mortality rates within 1 through 10 years.’ The authors offer three possible reasons for the observed differences in maternal deaths. First, it could be that healthier women are more likely to be able to conceive and carry a pregnancy to term. Second, it may be that pregnancy, especially one carried to term, produces health benefits which reduce the risk of death. Third, pregnancy loss may contribute to physiological or psychological effects which increase the risk of death. Indeed, the observed effects may be caused by a combination of these three and other, as yet unidentified, factors.
The disturbing case of Sarah Catt
Sarah Catt, from Sherburn-in-Elmet, North Yorkshire, aborted her own baby when she was 39 weeks pregnant. She obtained the necessary drug, the labour-inducing misoprostol, from India over the internet. Catt was charged under section 58 of the Offences Against the Person Act 1861. This states, ‘Every woman, being with child, who, with intent to procure her own miscarriage, shall unlawfully administer to herself any poison or other noxious thing, or shall unlawfully use any instrument or other means whatsoever with the like intent, ... shall be guilty of felony.’ The maximum penalty is life imprisonment.
The judge at Leeds Crown Court, Mr Justice Cooke, said Catt had made a ‘deliberate and calculated decision’ to end her pregnancy and that her crime lay between manslaughter and murder. He sent her to prison for eight years, for ‘administering a poison with intent to procure a miscarriage.’
Catt was a disturbed woman. She dropped out of university. She gave up a previous child for adoption. She had already had another abortion. Though she had two children with her husband, he knew nothing of this pregnancy, which apparently was the result of a seven-year affair with a work colleague. She claimed the baby boy was stillborn and that she had buried him, though the body has never been found. She also claimed that she had legitimately aborted him at a clinic in Manchester. She showed no remorse for her actions.
None of this mitigates her dreadful deed. Yet the case exposes a strange paradox. All abortions are wrong and late abortions are particularly gruesome. During 2011, there were 29 abortions at 32 weeks and over legally performed in England and Wales. Nevertheless, the law of the land allows medical practitioners to abort unborn children up to birth, namely 40 weeks, with no penalties. Such abortionists are not punished – on the contrary, they are highly paid for their deeds. On the other hand, a mixed-up woman, who commits the very same act, is jailed for several years.
There is a final twist to this case. Some pro-choice commentators have criticized the judge, Mr Justice Jeremy Cooke. They have complained that, during his summing-up, he expressed the view that abortion law was being wrongly and liberally construed in practice so that abortion is available essentially ‘on demand’. The complainants were given added impetus when it emerged that Sir Jeremy Cooke had recently been vice-president of the Lawyers’ Christian Fellowship, with its strap line of ‘applying God’s justice on the ground.’ How they hate Christianity, Christians and the Christ.
IVF and ARTs
Of course, it may be argued that by responding to this Consultation, you first, at least tacitly, approve of IVF. This sort of predicament is becoming commonplace, as, for example, in the recent Consultation on increasing payment for sperm and ova donors – a practice that puts a price on trading human gametes and encourages third-parties in reproduction, let alone diminishes the status of marriage. But what is the alternative – to say nothing? Using that line of reasoning would mean that Christians and the ‘morally sensitive’ would soon be excluded from every bioethical debate, discussion and consultation.
At the Consultation’s launch, the BBC News website ran an online ‘Your comments section’. I read several, but was struck by these two, which I have lightly edited:
‘Natural Selection should be Natural (not contrived, not enhanced, not circumvented). Yes, it is sad not to have perfect anything, yet people do live with limitations, disabilities, wishes denied (poverty, education limits, social circumstances). Society is not obligated to give Anyone (much less Everyone) 100% of all they may wish for including perfect health. Accept you can't have it all & Adapt, Adopt.’
‘I lost a 3yr old son to mitochondrial disease, if technology were available then to help avoid this from happening I wouldn’t opt for it. Even though his life was short, I knew he had a happy life. If you can’t raise and comfort sick, disabled child then should you really have children? A parent’s love should be unconditional!’
So, toughen up, think about the issue and then respond to the Consultation’s questions. Go on, have a go, it will do you good!
PGD and the new eugenics
Some may have considered it good news to learn that preimplantation genetic diagnosis (PGD) has been declared safe. PGD begins with IVF and then the removal of one cell typically from a three-day, eight-cell embryo, which is then analysed for genetic abnormalities. The list of detectable diseases now includes a hundred and more
Sonja Desmyttere and her colleagues at the University Clinic in Brussels University examined the outcomes of 995 IVF-PGD babies born between 1993 and 2008. The risks of low birth weight, premature birth, major malformations and rates of perinatal death were found to be the same as for standard IVF. Therefore the research team declared that, ‘Embryo biopsy does not adversely affect the health of newborn PGD children.’
This may seem like good news, but in reality it is bad news. This approval of PGD makes it an acceptable part of the new eugenics. It joins the techniques of amniocentesis, chorion villus sampling (CVS) and ultrasound screening, which are the current weapons in the eugenic ‘search-and-destroy’ armoury. This is not about medical cures for medical conditions– it is destruction of those so affected.
Julian Savulescu and the 'new eugenics'
But this new eugenic ‘advance’ for the few may become even worse
Julian Savulescu is the Uehiro Professor of Practical Ethics at the University of Oxford – he is almost as outrageous in his bioethical statements as his ex-mentor, the infamous Peter Singer. Savulescu’s latest outburst appeared in the August edition of the Reader’s Digest. He believes that creating so-called designer babies could be considered a ‘moral obligation’ as it makes them grow up into ‘ethically better children’.
Recognizing the advances in our genetic understanding, he proposes that genetic screening of embryos is the rational approach to influence the intelligence and psychological well-being of our future children. He wrote, ‘Surely trying to ensure that your children have the best, or a good enough, opportunity for a great life is responsible parenting?’ And, ‘If we have the power to intervene in the nature of our offspring – rather than consigning them to the natural lottery – then we should.’ In other words, parents have a ‘moral obligation’ to use genetic screening. Eugenics never went away – it subsided in the post-Nazi era, but it looks about to return con brio in the early twenty-first century.
We are a pensioner!
In early October, I officially became an old-age pensioner.
Have you got wrinkles?
Me too! A Glasgow-based biotech company, Pharmacells, may have the answer for us. It announced in September that it owns the patent on a method of harvesting, isolating and storing a newly-discovered type of adult stem cell derived from a person’s blood. And these stem cells may be a cure for wrinkles. Next year, the company plans to begin human clinical trials. Athol Haas, the company’s chief executive, explained that, ‘The skin has a natural elastic property which comes from cells known as fibroblasts. The ability of the body to produce this elastic material slows down with age because the number of these fibroblasts decreases. By introducing large numbers of stem cells into the right place, we are increasing the ability of the body to produce this material.’ Well, just think of the market potential for such a product among all those desperately trying to evade the inevitable.
Eat less, stay healthy
The beneficial effects seem to be mediated by a complex called mTORC1.Calorie restriction inhibits mTORC1 activity, which in turn is known to extend the lifespan of various organisms. Rapamycin is a drug that inhibits mTORC1 and it also promotes longevity in several organisms. The hypothesis is that the regulation of mTORC1 signalling could be crucial for maintaining stem-cell functions, in particular self-renewal, during ageing. Questions remain – is the effect long lasting, does it occur in other adult stem-cell niches, would it occur in humans? Certainly, stem cells are emerging as key functionaries in more and more locations. This is all exciting stuff and further expounds King David’s paean of praise, ‘I praise you because I am fearfully and wonderfully made’ (Psalm 139:14).
Cancers and stem cells
For many people, increasing age brings with it the onset of various cancers. Although cancerous tumours can usually be effectively treated, they often regrow. Why is this? Stem cells may be the answer. It seems that the various cancer treatments, such as chemotherapy and radiotherapy, fail to eradicate a small sub-set of stem cells that cause the growth of cancerous tumour cells, just as normal stem cells produce normal tissues – they are known as cancer stem cells. If they could be destroyed, the tumour may be eliminated for ever.
The existence of these so-called cancer stem cells has been disputed. Now, three separate research groups – from Belgium, the USA and the Netherlands – have reported, in Nature and Science, good evidence not only for their existence, but also for their ability to drive tumour growth in skin, brain and gut cancers, at least, in mice. Such knowledge may lead to new therapeutic approaches, specifically targeting these cancer stem cells. However, these newly-identified cells are very similar to the healthy stem cells that continually renew various tissues in the body. Prospective therapies will need to distinguish between these good and bad stem cells. Nevertheless, these new studies have been heralded as a ‘paradigm shift’ in developing future cancer treatments.
Induced pluripotent stem cells in Japan
The man who first created human induced pluripotent stem (iPS) cells in 2007, Shinya Yamanaka of Kyoto University, has taken the bull of their potential therapeutic value by the horns. He plans to build an iPS cell bank.
Yamanaka’s iPS Cell Stock project received a bureaucratic boost in September when the Japanese authorities granted him the go-ahead to create iPS cell lines from the thousands of samples of umbilical cord blood already stored in that country. His iPS cell bank also received a financial boost when Japan announced that it was pouring vast sums of money into eight long-term projects to translate iPS cell therapies into clinical treatments. For example, one of these projects, aimed at relieving Parkinson’s disease, will be funded at US$2.5-million per year. However, that particular programme is at least three years away from human trials. So far, iPS cells have never been used therapeutically, but the Japanese are planning their first human clinical trial, to repair diseased retinas, in 2013. If any of these iPS cell trails produces positive results, worldwide demand for these cells will take off.
The significance of Yamanaka’s iPS cell work has been rightly recognised and rewarded by his winning the 2012 Nobel prize for medicine or physiology for the discovery that mature cells can be reprogrammed to become pluripotent. The Nobel committee stated that his research has ‘revolutionized our understanding of how cells and organisms develop.’ Yamanaka has previously explained the driving force behind his landmark discovery, ‘When I saw the embryo, I suddenly realized there was such a small difference between it and my daughters. I thought, we can’t keep destroying embryos for our research. There must be another way.’ And so he set about producing iPS cells.
Embryonic stem-cell research funding in Europe
The embryonic vs. adult stem-cell bioethical battle is still raging. It has recently become a hot issue in Europe. It has erupted because the next round of the European Union’s science funding, with a
The European Parliament’s legal committee has recently recommended that any research involving human embryonic stem cells should receive no such funding. The committee’s decision was based not primarily on ethical criteria, but on the October 2011 ruling by the European Court of Justice, which declared that biological products derived from such cells were not patentable. It is because the aim of Horizon 2020 is to boost Europe’s economic competitiveness, and because such human embryo research outcomes cannot be patented and sold, that such science should not be financially supported, says the committee. OK, right result, wrong reasons.
Embryonic stem-cell research funding in the USA
The same bioethical battle has been raging in the USA for many years. Much of the focus has centred on the wording of a government bill known as the Dickey-Wicker Amendment. This is a law, originally implemented in 1995 and approved each year, which bans the federal government from funding research in which human embryos are destroyed. In March 2009, President Obama issued an executive order which lifted the ban. That move was challenged by two pro-life scientists, James Sherley and Theresa Deisher, who took the National Institutes of Health (NIH), the USA’s medical research agency, to court in August 2010. The case has been ping-ponged among the lawyers and courts ever since.
On 24 August 2012, the case reached yet another milestone. In a unanimous verdict the three-judge panel, at the US Court of Appeals in Washington DC, upheld the April 2011 ruling from a lower court, permitting the use of federal funds for research involving human embryonic cells. The Court decided that the NIH's interpretation of Dickey-Wicker Amendment, as allowing federal funding for projects that use existing embryonic stem-cell lines, because they are not themselves embryos and so the ‘no embryos destroyed’ rule is satisfied, was ‘reasonable’. Even so, the creation, and destruction, of human embryos has always been permitted in the USA if funded non-federally, that is, by private monies.
Drs Sherley and Deisher have yet to announce if they intend to appeal to the US Supreme Court. However, less than one per cent of cases referred to that Court are actually heard. So this current verdict may be the final action of a legal challenge that began back in 2009.
Euthanasia and Assisted Suicide
MPs oppose euthanasia legislation
The cases of Tony Nicklinson and ‘Martin’
The sad case of Tony Nicklinson has come to a sad, but not unsurprising, end. The 58-year-old suffered a stroke in 2005 which left him with locked-in syndrome. He was paralysed from the neck down, but his mind was undimmed. As a proud atheist, he described his life as ‘a living nightmare’. He wanted to be killed by someone. This was therefore not a request for assisted suicide, but for full-blown euthanasia. In other words, he was challenging the provisions of the Murder Act 1965. And because he was not terminally-ill, Dignity in Dying distanced itself from his case.
On 16 August, he lost his High Court case to allow doctors, or anyone else, to end his life without fear of prosecution. According to his wife, Jane, he was ‘crestfallen, totally devastated and very frightened’ by the Court’s decision, and a few days later he began to refuse food and fluids. He died on 22 August from pneumonia at his home in Melksham, Wiltshire.
The three High Court judges, Lord Justice Toulson, Mr Justice Royce and Mrs Justice Macur, unanimously agreed it would be wrong for the court to depart from the long-established legal position that, ‘voluntary euthanasia is murder, however understandable the motives may be.’
On the same day, the High Court also refused the application by the 47-year-old ‘Martin’. He too suffered from locked-in syndrome and was challenging the Director of Public Prosecution’s 2010 policy guidelines on assisted suicide. He wanted prosecution exemption for professionals, namely, doctors and lawyers, who might ‘assist’ him in the preparation of medical and legal arrangements in order for him to die at the Dignitas ‘clinic’.
Lord Justice Toulson commented further. He stated that both cases were ‘deeply moving’, but that, ‘A decision to allow their claims would have consequences far beyond the present cases. To do as Tony wants, the court would be making a major change in the law. It is not for the court to decide whether the law about assisted dying should be changed and, if so, what safeguards should be put in place. Under our system of government these are matters for Parliament to decide.’
The British Medical Association claimed that the court had made ‘the right decision’. Dr Tony Calland, from the BMA's medical ethics committee, said, ‘The BMA does not believe that it would be in society's best interests for doctors to be able to legally end a patient's life. The BMA is opposed to the legalisation of assisted dying and we are not lobbying for any change in the law in the UK.’
Our response to these distressing cases must be that of compassion – they should evoke the deepest sympathy. Yet these tragic cases must not become a wedge leading to the wholesale disruption of our laws regarding euthanasia and assisted suicide – hard cases still make bad law. These cases are very few in number – single figures compared with the 500,000 or so natural deaths that occur in the UK each year.
These court rulings and additional legal and medical comments are robust and good. They hold the line against causing unnatural death, and we should be thankful for that. And they give us hope that assisted suicide will not be legalised in the near future. All laws, by definition, hedge us about and limit our apparent freedom. The Ten Commandments say you must not covet, however strong the temptation. Motorway speed limits say you must not drive at 100mph, however much you want to. The Suicide Act 1961 and the Murder Act 1965 say that a man must not engineer the death of another, however compassionate it may seem. Such good laws have a dual purpose – they punish the wrongdoer and they protect the vulnerable.
These sorts of test cases test the law and they test us – we need to steady our emotions and understand anew the Bible’s teaching on life and death. If human life is a gift from God (and it is, Ecclesiastes 5:18), it requires careful nurturing and protection. We are to be good stewards of our lives. And good stewardship never involves premature termination. Therefore suicide and euthanasia can never been regarded as the marks of good stewardship.
News from America
US Presidential election
Less is known about Mr Romney, the conservative, Mormon millionaire. He seems to be genuinely pro-life, but there are doubts in some quarters.He has stated, ‘I am pro-life and believe that abortion should be limited to only instances of rape, incest, or to save the life of the mother.’ And, ‘Do I believe the Supreme Court should overturn Roe vs. Wade? Yes I do,’ Romney is quoted as saying. And, ‘As President, I will protect the sanctity of life. I will honor the institution of marriage.’
By the time you read this, the US people will have spoken and a President, new or old, will have been elected. Whichever, and whatever his true political stripe, the USA is in for another four years of a bioethical rollercoaster.
Obamacare and evangelicals
What do Wheaton College, a conservative evangelical educational institution, founded in 1860, located just outside Chicago, and Hobby Lobby, a popular arts and crafts franchise, founded in 1972 by David Green and other evangelical Christians, with over 500 stores and 13,000 employees, have in common? Answer: they have both fallen foul of the Obama administration’s Department of Health and Human Services (HHS) mandates.
On 23 March 2010, President Obama signed into law the 2,700-pagePatient Protection and Affordable Care Act, commonly known as Obamacare. It represents the most significant overhaul of US healthcare for more than a generation. Its principal aim is to bring health insurance coverage to more Americans. Although it has been divisive and hotly contested – a June poll showed that 56% of Americans were against this law – on 28 June 2012, the US Supreme Court upheld its constitutionality.
In January 2012, the HHS issued a mandate under the Act. It required nearly all employers – the exceptions included churches and houses of worship – to pay for health insurance plans to provide their employees with free contraceptives, sterilizations and abortion-inducing drugs, regardless of any moral or religious objections. Now that was dynamite in the Land of the Free.
Dozens of religious organizations, universities and businesses objected, including Wheaton College and Hobby Lobby, by filing lawsuits against the government. As the President of Wheaton College, Philip Ryken, stated, ‘We're very clear on the sanctity of life, and this insurance mandate goes against our conscience.’ Ryken is especially concerned about being forced to offer morning-after pills because of their abortifacient properties. Hobby Lobby’s David Green affirmed, ‘We simply cannot abandon our religious beliefs to comply with this mandate. By being required to make a choice between sacrificing our faith or paying millions of dollars in fines, we essentially must choose which poison pill to swallow.’ In response, the HHS has given religious employers an additional year to comply with the mandate. That is just a silly delaying tactic that will change nothing. Or is the expectation that evangelicals, Roman Catholics and others will abandon their staunchly-help bioethical beliefs during the next twelve months? The US fight for religious freedom continues.