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.

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.

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.

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.