Update on Life Issues - October 2014
Premature baby survival rates
New figures show that during the last four years at least 120 babies born in the UK during week 23 of a pregnancy have survived. The upper limit for most abortions is 24 weeks. These new data have prompted a call for the limit to be reduced. In 2013, 519 babies were aborted at 23 weeks and another 190 at over 24 weeks.
Sure, these survival rates were achieved mostly in large hospitals. Sure, these neonates often have disabilities. Sure, their extra care is expensive. But are these decent arguments for continuing to kill such unborn children?
Fiona Bruce MP has said, ‘I do not understand why there is not more outcry about the fact that viable babies are being aborted. The new figures support what we have known for a while; that advances in prenatal care make a mockery of our 24-week abortion limit.’
Dawkins and Down’s
Clinton (yes, that’s right!) Richard Dawkins has long been a foe of evangelical Christians, pro-lifers and everyone else who disagrees with him. He is the man who has declared that, ‘Unless you are a vegan (most Pro-"Lifers" are not) you are in no position to object to abortion.’ Now he has managed to antagonise another section of the general public – Down’s syndrome sufferers plus their carers and advocates.
On 20 August, Dawkins made a comment on Twitter that, ‘Ireland is a civilised country except in this 1 area.’ And that area referred to Ireland’s strict anti-abortion policy. Aidan McCourt tweeted back, ‘994 human beings with Down's Syndrome deliberately killed before birth in England and Wales in 2012. Is that civilised?’ Dawkins replied, ‘Yes, it is very civilised. These are fetuses, diagnosed before they have human feelings.’ Another Twitter user, known as InYourFaceNewYorker, joined the conversation and wrote, ‘I honestly don’t know what I would do if I were pregnant with a kid with Down Syndrome. Real ethical dilemma.’ To which Dawkins advised the writer to ‘Abort it and try again. It would be immoral to bring it into the world if you have the choice.’
Dawkins continued to reveal his true neo-eugenic nature, ‘The question is not "is it 'human'?" but "can it SUFFER?"’ And, ‘Yes. Suffering should be avoided. Cause no suffering. Reduce suffering wherever you can.’ In other words, the issue of who should be allowed to live is determined by the perceived degree of suffering they and others experience.
Thus, according to Dawkins,parents have a moral responsibility to abort babies diagnosed in utero with Down’s. According to Dawkins, it is ‘civilized’ to abort Down’s babies, and it would be ‘immoral’ not to abort babies diagnosed with the condition. These are weasel words that display a new callousness from the Renaissance man. Yet, his nasty remarks are echoed by many others. For example, in England and Wales during 2010, of the 1,188 pregnancies prenatally diagnosed with Down’s syndrome, 943 were terminated – an abortion rate of almost 80%.
Let no-one underestimate the difficulties of raising a child with any major disability, including Down’s. Suffering is inevitable. And if the unborn child is really a human being, and although abortion may be legal, is it really a licit act?
Thousands joined the debate. Some called Dawkins ‘sick and twisted’. A more measured response came from Carol Boy, chief executive of the Down’s Syndrome Association. She said that, ‘We at the Down’s Syndrome Association do not believe Down’s syndrome in itself should be a reason for termination. People with Down’s syndrome can and do live full and rewarding lives, they also make a valuable contribution to our society.’ Indeed, it is time to counter that old wives’ tale that people with Down’s syndrome and their carers are doomed to a life of suffering. In 2012, the American Journal of Medical Genetics reported results from three large surveys which showed that 99% of respondents with Down’s syndrome described themselves as ‘happy’ and 99% of parents said they loved their Down’s child, with only 4% regretting having a Down’s baby.
By late August, even Dawkins recognised that he had overstepped the mark. He tweeted, ‘I apologise for impugning the morality of the approximately ten percent of women who deliberately choose NOT to abort a Down's fetus.’
Abortion in Ireland
On 1 January 2014, the Protection of Life During Pregnancy Act 2013 came into force in Ireland. It permits an abortion if the mother is judged to be ‘at risk of suicide’. This vague criterion was always going to be unsatisfactory. And so it has proved.
A young and vulnerable woman recently asked for an abortion. She was assessed by a panel of three medical experts as being ‘at risk of suicide’. Nevertheless, her request was refused. She went on a hunger strike, but later agreed to a Caesarean section at about 25 weeks and gave birth to her child. The details of the case are sketchy not least because a court order is protecting the mother’s and child’s identity. It seems that no-one is satisfied with the outcome.
Dr Ruth Cullen of the Dublin-based Pro Life Campaign said, ‘Reports that an unborn baby was recently delivered at 25 weeks, citing provisions in the new abortion Act, underlines the horror and deep-seated flaws of the government's legislation. To induce a pregnancy at such an early stage inevitably puts the baby at risk of serious harm, such as brain damage, blindness or even death.’
And the pro-abortion organisation Doctors for Choice also expressed concern. They said this current case highlights problems with the expert panel system that assesses the mental health of suicidal pregnant women. The inclusion of an obstetrician to adjudicate on mental health matters, with no training, was a deep flaw in the system. Their website states, ‘It appears that the obstetrician in line with the Protection of Life During Pregnancy Act 2013 was allowed to veto the woman’s request for an abortion despite two psychiatrists certifying a risk of suicide as a ground for abortion.’
Abortion continues to divide wherever it is practised. Whatever the legal position, it satisfies nobody. And Ireland is no exception.
Abortion in France
On 5 August, France embraced abortion-on-demand. A new law scrapped the remaining requirement that a woman seeking an abortion during the first 12 weeks of a pregnancy must be in a ‘state of distress’.
The original French abortion law of 1974 included several stipulations to protect the life of the unborn child. These included counselling and advice about publically-available help for the mother to keep her child. For many years, the ‘distress’ requirement has become merely a token restraint, but the women’s rights minister, Najat Vallaud-Belkacem, has campaigned for its removal from the French legal code. So while its removal was a symbolic gesture, it was also a sign of the French socialist government’s priorities.
This repeal of the abortion ‘distress’ element is but one aspect of a new
French ‘law for real equality for women and men’ aimed at banning ‘sexist
stereotypes’ and ‘unfair distribution of domestic and parental tasks’, enforcing
equal pay, women as company directors, and so on. This is not primarily
about inequality and injustice, the overall aim is to eradicate any differences
between men and women. Such a policy is doomed simply because we are
different – ‘… male and female he created them’ (Genesis 2:17). In
other words, God created men and women to be similar, but forever
different in identity, purpose and function. No law can abolish that.
IVF and Assisted Reproductive Technologies
On 1 September, as Parliament returned from the summer recess, it debated the issue. Fiona Bruce MP told the House of Commons that there was scientific evidence of abnormalities in embryos produced by this technique. She said, ‘Two peer-reviewed articles in Nature have suggested that mitochondrial transfer is inherently risky, one of them citing a figure of 52 per cent of embryos created through MST [maternal spindle transfer, one of two MD techniques] having chromosomal abnormalities.’ She maintained that, ‘More research ought to be undertaken and a full assessment conducted of the potential risk to children born as a result and that the UK Government should not approve it until further research had been carried out.’
And according to a ComRes poll, commissioned by CARE and published to coincide with the Commons debate, the public is becoming less supportive of the idea. It found that only 19% of the general population now supports the creation of three-parent IVF babies, which represents a significant drop from the 35% who backed the idea in a similar poll in February this year. Opposition to the draft legislation has grown to 46%, while another 35% remain as ‘don’t knows’.
Now comes news that a US fertility clinic has seemingly already carried out three-parent IVF. Apparently some 15 years ago, 17 children were born using similar controversial techniques at the Saint Barnabas Medical Centre in New Jersey. It is only in 2014 that the hospital has decided to check if these children, who were born using cytoplasmic transfer, have had any adverse health problems. It is estimated that around 30 babies worldwide have been born as a result of this technique, which is similar, but also different, from the proposed UK procedures of maternal spindle transfer (MST) and pro-nuclear transfer (PNT). The US examples of cytoplasmic transfer were carried out simply in the hope of improving the success rate of IVF treatment, possibly by boosting the mitochondrial content of the ovum.
The US technique involved taking a small quantity of cytoplasm, including mitochondria, from a healthy donor ovum and injecting it into an ovum of the mother, producing a mix of mitochondria from the two women. The ovum was then fertilised with the father’s sperm using standard IVF methods. The US Government banned the technique in 2002, as it involves transferring genetic material ‘by means other than the union of’ sperm and egg.’
Though no long-term studies have followed the 17 teenagers, it is known that there were two pregnancies where embryos had a missing sex chromosome – a condition known as Turner’s syndrome – one miscarried and the other was aborted. There was also a case where one of the babies developed a ‘pervasive developmental disorder’ in the first year of life. As with all IVF procedures, it is not known if these anomalies were related to the procedure per se, or to the parent’s infertility.
The three-parent IVF issue returns to Westminster on Wednesday 22 October when the House of Commons Science and Technology Select Committee will host a one-off evidence session to consider the science of mitochondrial donation. Witnesses will include experts in the field and the Parliamentary Under-Secretary of State for Health, Jane Ellison.
Surrogacy and Down’s
Surrogacy is often thought of as a peculiar, but tolerable, sort of assisted reproductive technique (ART). At least, it is argued, there is no primary intention to destroy another human being. But think again. Yes, surrogacy does exploit vulnerable women. Yes, it is womb-renting. Yes, it does demean children as items to be traded.
An example of this malevolence is seen in yet another case of surrogacy gone wrong. This time it involved an Australian couple, David and Wendy Farnell and a Thai surrogate, Mrs Pattaramon Chanbua, a 21-year-old food vendor. Incidentally, David Farnell has spent several years in jail for twenty-two convictions of sex offences against young girls – but that is not the issue here. The issue here is that the surrogate became pregnant with twins. On learning that one of the babies was Down’s, the couple asked the surrogate to abort him. She refused. The pregnancy continued to term. When the twins were born, the couple took the little girl, Pipah, back to Australia but rejected her twin brother, Gammy, and left him in Thailand. Amid accusations and denials by all the adults, the Thai government has responded by imposing new restrictions on taking children born to surrogates out of the country. It has also banned commercial surrogacy. Horses and stable doors come to mind.
Whatever the true facts about this complex and sad episode, one trend is becoming obvious – all ARTs are increasingly not about having just a baby, but rather about having a baby of the right sort. To put it another way, if the product is deemed to be defective, it can either be returned to the supplier or destroyed.
IVF adverse incidents
All ART procedures involve risks of a biological nature, such as multiple pregnancies, malformations and manifest failure. These are recorded in the UK by the Human Fertilisation and Embryology Authority (HFEA). It also records mistakes caused by human error. Its July 2014 report, ‘Adverse incidents in fertility clinics: lessons to learn’, showed that 1% of women undergoing IVF experienced some form of ‘adverse incident’, though most were considered to be minor consequence.
For the three years from 2010 to 2012, there were 1,679 such adverse incidents reported to occur in UK fertility clinics. The HFEA has warned all clinics that too many mistakes are being made and that avoidable errors should be eradicated.
Three of the incidents were in the most serious, or grade A, category. In one case a woman, using donor sperm in order to have a genetically-related sibling, was provided with sperm from a different donor, resulting in a child with a different genetic father. In another grade A case, embryos of 11 patients were observed to be contaminated with cellular debris, possibly sperm. And in the third incident a member of staff removed frozen sperm from storage while it was still within the consent period for storage.
There were 714 grade B incidents, which included the loss of embryos or equipment malfunctions affecting embryo quality. The 815 grade C errors involved, for example, ova left unusable, women's ovaries being ‘over-stimulated’ to produce ova, and breaches of confidentiality.
We all commit and experience human errors. Car accidents, banking slip-ups, misdialled phone calls, missed appointments, and so on. They can be serious but mostly they are annoying and can be corrected. Errors in ARTs are in a different category – they are dealing with matters of life and death.
A perk at work?
‘Don’t freeze my pay, freeze my eggs instead’ is the new cry from the switched-on sisterhood. Human biology dictates that human ova have a limited shelf life, whereas sperm tends not to. Women are not men. Hence a woman’s fertility clock has a restricted tick. How to cope in the frenzied, demanding world of top women at work? Facebook and Apple and other hi-tech industries (mostly based in Silicon Valley, of course) are now offering the solution – they will pay for their talented women employees to freeze and store their ova so they can keep on working for said companies. It could only happen in California? Don’t be so naïve.
An Apple spokesman (note the gender) said, ‘We want to empower women to do the best work of their lives.’ So instead of seeking to control their workers’ pregnancies and at the same time offering to diminish their fertility, why don’t these corporations create career structures and working practices that encourage women to have babies at the peak of their fecundity, namely in their late 20s and early 30s? And before signing up to any such freezing perks, women should study the dismal success rates of IVF for those in their late 30 and early 40s – we are talking single figure percentages. There is no empowerment there. But why target only women? Reversible vasectomies for men employees would also help keep the workforce childfree and job-focused.
And when such cryopreservation of ova schemes fail – and they are often far from effective – why not have a womb transplant? It has been tried before, but in early October, a woman in Sweden became the world’s first person to give birth after a womb transplant. The 36-year-old woman received a womb from an unrelated 61-year-old donor last year. The recipient's first menstruation occurred 43 days after transplantation. The woman conceived via IVF and gave birth to a healthy baby boy by Caesarean section after 32 weeks gestation.
This woman is one of seven who have undergone successful womb transplants, mainly donated by their mothers, at the University of Gothenburg in Sweden. Following IVF treatment, the rest of the group is now more than 28 weeks pregnant. The details of this work have been reported in The Lancet under the title, ‘Livebirth after uterus transplantation.’ Already doctors at Queen Charlotte’s & Chelsea Hospital in London are hoping to offer the procedure to five women early next year. Such women typically lack a uterus because of genetic defects or because of removal due to cancer or other medical conditions.
This new procedure has its limitations. Administration of strong
immunosuppression drugs are required to prevent the transplanted womb being
rejected. And because of the dangers posed by the long-term use of such
suppression medication, the womb has to be removed after birth. In other
words, the transplant is temporary.
The STAP cell story continued
Second, there was Professor Yoshiki Sasai, the 52-year-old and highly-regarded stem-cell scientist, who supervised the now disgraced work. The investigating panel cleared Sasai of direct involvement, but criticized him for his lack of oversight. In August, he was found dead in his laboratory at RIKEN's Centre for Developmental Biology at Kobe, in an apparent suicide. A bag found at the scene contained three letters – one addressed to the RIKEN management, one to his laboratory members and one to Obokata.
What are the lessons to be learned? There are areas of science where the competition is extremely fierce and the temptation to be ‘the first’ can be overly compelling. Stem-cell technology is one of these areas. Science is about truth. Novel and surprising results can be thrilling, but they need hard-headed, not emotional, assessment and verification. The rush to publish needs the restraining reins of integrity and responsibility. When truth goes out of the window, it is not just science that loses, or even just the scientists, we all do.
Adult stem cell success
Though stem-cell technologies have now been tainted by several scandalous studies, successes using adult stem cells are still astonishingly bright. It is not difficult to find them – several appear in print each month. Here is just one, almost unbelievable, example.
Stem Cell Translational Medicine has published details (online on 8 August 2014) of a pilot study conducted at Imperial College London, whereby researchers harvested stem cells from the bone marrow of hips of five people who had recently suffered acute ischemic strokes. It is a quite simple procedure to collect patient-specific adult stem cells. These cells were then infused into the brains of each individual. Again, a relatively simple procedure.
The patients were then monitored for six months. By the end of the trial most patients were able to walk and look after themselves, despite having suffered serious strokes. Four of them had experienced particularly severe strokes, resulting in loss of speech and marked paralysis down one side of their bodies. Such strokes have a high fatality and disability rate. But three of the four patients were able to walk and look after themselves independently by the end of the six-month period. And with some help, all five were mobile and able to take part in everyday tasks. It is thought that much of the success of this trial was because the patients were treated early, within one week of their stroke occurring.
The therapeutic mechanism is unclear but the stem cells probably encouraged new blood vessels to grow in the parts of the brain damaged by the stroke. It has been previously established that the particular type of stem cells isolated, and known as CD34+, have the ability to stimulate such growth. The simplicity of the trial and its positive results are most encouraging. The lead scientist of the study, Dr Soma Banerjee, has stated, ‘Now we need to look at a larger group of patients and hope eventually to develop a treatment based on this approach.’
Embryonic stem cell success – perhaps
Embryonic stem cells – harvested with the inevitable destruction of the embryo – have long been regarded as the ‘gold standard’ of stem cells, considered to be superior to both adult and iPS cells. Yet despite their surrounding hype and substantial funding, their successful therapeutic use in human regenerative medicine is still awaited. Perhaps that wait is over.
Here is a possible ‘maybe’. A report in Nature Cell Biology (16: 902-908, 2014) by researchers at the University of Edinburgh described the first production from embryonic stem cells of a whole functional organ, a thymus, inside an animal. Some hope that this kind of technology might one day be used as an alternative to current organ transplantation procedures, but any such human therapies are recognised to be years away. And there are at least three caveats. One, this current work was done in a mouse – and mice are not men, neither nominally nor biologically. Two, because the stem cells were embryonic the developing thymus would not be a tissue match to the patient. Three, there are already healthy patients with lab-grown blood vessels, windpipes and bladders produced by seeding bio-scaffolds with the patient’s own adult stem cells. Why cannot a functional thymus be constructed with a similar injection of adult or iPS cells?
Embryonic stem cell success
And now, at last, comes what may be the long-awaited and first real therapeutic success using embryonic stem cells. Details of two joint clinical trials were published in the 15 October 2014 online edition of The Lancet as ‘Human embryonic stem cell-derived retinal pigment epithelium in patients with age-related macular degeneration and Stargardt’s macular dystrophy: follow-up of two open-label phase 1/2 studies.’
The US research team, headed by Robert Lanza of Advanced Cell Technology, had transplanted different doses of retinal pigment epithelial cells, derived from human embryos, into one of the eyes of nine young patients with Stargardt’s macular dystrophy and another nine elderly patients with age-related macular degeneration. The untreated eyes had served as controls. The patients were followed up for approximately 22 months.
The team found, ‘… no evidence of adverse proliferation, rejection, or serious ocular or systemic safety issues related to the transplanted tissue.’ In other words, the treatments appeared to be tolerated and safe – this had been a major concern because previous studies with embryonic stem cells had reported tumour formations, immune rejections and differentiation into unwanted cell types. However, there were some adverse events, such as four of the eyes developing cataracts and two becoming inflamed – perhaps because of the patients’ ages and continued immunosuppression – but visual acuity improved in the treated eyes of ten of the patients, remained the same in seven, and decreased in one.
The researchers concluded that, ‘Our results suggest that hESC-derived [human embryonic stem cell-derived] cells could provide a potentially safe new source of cells for the treatment of a variety of unmet medical conditions caused by tissue loss or dysfunction.’ A larger clinical trial is already planned.
This reversal of partial blindness in about half of the treated patients might be sufficient to awaken renewed interest in the therapeutic use of human embryonic stem-cell technologies. On the other hand, doubts remain about the efficacy and ethical nature of using human embryos in these ways. The outcome of a Japanese clinical trial, to start in 2015, using iPS cells to treat similar eye diseases will be eagerly awaited.
Embryonic and iPS cell success – probably
On 9 October came yet another significant breakthrough. The paper was published in the journal Cell under the title of ‘Generation of Functional Human Pancreatic β Cells In Vitro.’ The scientific team, lead by Doug Melton at Harvard University, had, after 23 years of tedious application, managed to create mature insulin-secreting β-cells from human stem cells, that can be grown in unlimited quantities, and that behave like the real thing.
This work is bioethically bad and good, since they used both embryonic and iPS cells. And so far, it has been tested only in diabetic mice, though, of course, human clinical trials are expected soon. The expectation is that these manufacturedβ-cells could be implanted into type-1 diabetic patients – of which there are an estimated 400,000 in the UK alone – and so make the daily trauma of insulin injections a thing of the past. But the realisation of that hope is still years away.
First, there is a more immediate technical hurdle to overcome – how to shield theβ-cells from immune attack thus freeing patients from the repetitive taking of immunosuppressant drugs. One solution might be to encapsulate the cells in some sort of resistant packaging. Another might be to use iPS cells which would obviate the problem because the reprogrammed β-cells would be patient specific.
Moreover, this work raises a novel bioethical issue. Imagine that the above protocol comes to therapeutic fruition. Imagine it employs not iPS cells but only human embryonic stem cells. Image you are a type-1 diabetic. Would you use it? Now there’s a test of your bioethical fortitude.
Failed Geron trial resurrected?
Way back in 2010, a biotech company called Geron Corp. of Menlo Park California started a phase 1 human trial of its spinal cord injury treatment. It was the world’s first human study of a possible embryonic stem-cell therapy. In November 2011, Geron suddenly halted the trial. Financial issues were the given explanation, but some suspect it was biological failure.
Now on 27 August 2014, Asterias Biotherapeutics Inc. also of Menlo Park received clearance from the US Food and Drug Administration to proceed with a 13-person trial using oligodendrocyte progenitor cells (OPCs) derived from human embryonic stem cells. The idea is to stimulate the growth of new nerve cells around the spinal cord and thus help paralysed patients regain movement. Haven’t we been here before?
Indeed, it is notable that Michael West, founder of the Geron Corp., is currently vice-president of technology integration at Asterias Biotherapeutics. Nevertheless, Asterias’ trial differs in detail from Geron’s. For example, patients will be given doses up to 10 times greater than the Geron patients. It also will focus on patients with complete spinal cord injuries originating in the neck, rather than in the back, as in Geron’s trial. Asterias’ patients will be treated with the cells 14 to 30 days after the injury, whereas in Geron’s study, patients were treated more quickly. It is expected that patients will start to be enrolled in early 2015. As before, the world will be watching.
Olfactory ensheathing cells (OECs)
Tuesday 21 October must have been a glum day for the scientists at Asterias Biotherapeutics – they were probably wondering if their proposed embryonic stem-cell treatment is a complete waste of time. The news media were full of the story of Darek Fidyka, a 38-year-old Bulgarian fire-fighter, who had been paralysed from the chest down after a knife attack in 2010 had completely severed his spinal cord. His pioneering treatment, published in Cell Transplantation, involved harvesting olfactory ensheathing cells (OECs) from his nasal cavity and transplanting them into his damaged spinal cord. After a year, the man could walk with the aid of a frame and even drive his car! The surgery was carried out by a team led by Dr Pawel Tabakow, from Wroclaw Medical University, in collaboration with Professor Geoffrey Raisman, whose group at University College London’s Institute of Neurology first proposed the technique. Raisman said, that for him, what had been achieved was 'more impressive than man walking on the moon.'
OECs cover the nerves that convey the sense of smell to the brain. They are not stem cells, but similarly they can continually regenerate themselves, in fact, they are the only part of the nervous system with this property. An initial operation removed one of the patient's olfactory bulbs and its OECs were harvested. Two weeks later these, together with nerve cells taken from Fidyka's ankle, which acted as a scaffold, were grafted to his spinal cord injury site allowing nerve cells, guided by the OECs, to grow and join together to form a bridge across the damaged gap.
Before this remarkable story of recovery, severed spinal cord injuries were regarded as permanent and unrepairable. This work could herald a new era in the treatment of paralysis. It offers hope to millions of people disabled by either partial or complete cord damage. Of course, this is just one report with one patient. Full clinical trials are needed before this protocol becomes a proven therapy and that will take another estimated five to ten years. But perhaps the scientists at Asterias Biotherapeutics are already looking for other jobs.
Fraud seems to pay
Remember the disgraced Korean stem-cell scientist, Woo Suk Hwang, who in 2004 and 2005 claimed to have cloned human embryos and harvested embryonic stem cells? This golden boy of human cloning was eventually declared to be a charlatan. Now a film, a fictional version of this tragic episode of scientific fraud and Hwang’s downfall, has been produced. It is entitled Whistleblower, it is in Korean only, but apparently it has been a roaring success at the box office, making about $4.3 million on the first weekend of its release.
Meanwhile, Hwang continues in gainful employment at his Seoul-based
laboratory, most famously bringing comfort to bereaved (and rich) pet owners by
cloning about 15 puppies each month. And his appetite for publicity also
persists unabated. In 2012 he claimed he would attempt to clone a woolly
mammoth from ancient tissue found in Siberian permafrost. Nothing yet, but
then that’s the very basis of propaganda.
Euthanasia and Assisted Suicide
The Assisted Dying Bill 2014-15
Proponents of the Bill continue to argue that because it is based on Oregon’s Death with Dignity Act 1997 it would be kind-hearted, workable and infrequently used. And because the Bill includes some supposed safeguards, they sneer at any warnings of ‘slippery slopes’. Their ideological drivers are a false compassion and an overbearing autonomy.
Opponents of the Bill fear that, if enacted, it would put vulnerable citizens, including the aged, lonely and bereaved, at risk. And it may even escalate to a Netherlands-style euthanasia epidemic. One such doomster is Professor Theo Boer, a bioethicist at the University of Utrecht. He worries that euthanasia deaths in the Netherlands have doubled in the past six years, and may reach a record 6,000 during 2014. And he is concerned that, as in the Netherlands, proposed changes to UK law will be manipulated and that any degree of suffering will become a common criterion for assisted suicide. He has said, ‘I used to be a supporter of the Dutch law. But now, with 12 years of experience, I take a very different view. Pressure on doctors to conform to patients’, or in some cases relatives’, wishes can be intense.’ He warned the UK government, ‘Don’t do it.’
The Assisted Suicide (Scotland) Bill
Since the death of its sponsor, Margo MacDonald in April, this Bill has been taken on by Patrick Harvie MSP as the ‘member in charge’. The call by the Health and Sports Committee for written evidence closed on 6 June. It received a total of 894 submissions. Of these, 467 were unique, 419 were identical ‘templates’ submitted by individuals in support of the My Life, My Death, My Choice group and 8 were duplicates. Not surprisingly, because of the ‘template’ responses, the results were skewed – 73% of respondents supported the Bill, 24% were opposed and 3% were either neutral or made no comment.
Interestingly, though a majority of individuals appear to support the Bill, it is doctors’ organisations and the like that largely oppose it. Still more interestingly, is that while a massive 82% of private individuals appeared to be in favour, when the ‘template’ individuals are removed, that figure fell to only 35% supporting the Bill.
The next step for the Scottish Parliament is the taking of oral evidence at the end of 2014. Then, perhaps in late February 2015, the Health and Sport Committee will debate and vote at the Bill’s crucial Stage 1.
One every two weeks
Research from the University of Zurich has recently shown that between 2008 and 2012 a total of 126 Britons travelled to Switzerland’s assisted suicide ‘clinics’ to die. That is equivalent to about one every fortnight.
During this five-year period, 611 people from 31 countries died there. Britons formed the second largest group of European residents travelling to Switzerland to die – Germans were the most numerous. There are six so-called ‘right-to-die’ facilities in Switzerland, but all the Britons, except 4, went to the Dignitas ‘clinic’ on the outskirts of Zurich. Dignitas is said to charge between 9,000 and 10,500 Swiss francs (about £6,000 to £7,000) for its services.
Pro-euthanasia campaigners, like Dignity in Dying members, may opine the fact that Britons are ‘forced’ to travel abroad to die and that therefore British law, specifically the Suicide Act 1961, needs amending. But some context is needed. There are about 25 Britons dying in Switzerland each year. How many people die each year in Britain? Go on, guess. Yes, it is well over 0.5 million – to be precise, in 2013 it was 506,790 in England & Wales and 54,700 in Scotland, making a grand total of 561,490.
Put another way, the ‘Dignitas argument’ affects only a tiny, tiny minority. It is being irresponsibly used as a lever in an attempt to achieve greater autonomy and choice, namely the legalisation of full-blown euthanasia.
UK doctors and assisted suicide
If Lord Falconer’s Bill were to succeed, it would set up huge practical obstacles. Not least among these would be, ‘Who will do the dirty deed?’ The task would inevitably fall to doctors. But most doctors want no part in assisting their patients to kill themselves.
A recent poll of 600 doctors conducted by Medix Consultancy, showed that only 19%, less than 1 in 5, would be willing to assist. Moreover, 56% would refuse while 25% remain unsure. In addition, 58% of these doctors oppose the legalisation of assisted suicide. Significantly this latter figure represents a 17% increase from the answer to the same question in a similar poll in 2004. Opposition among the medical profession seems to be hardening.
In addition, most of the Royal Colleges, in particular the Royal College of Physicians and the Royal College of General Practitioners, are opposed to a change in the law. Tellingly, it is their members who would be at the ‘coalface’ of assisted suicide. Dr Tony Calland, chairman of the British Medical Association’s ethics committee, said, ‘Many doctors have first-hand experience of caring for dying patients and believe that rather than deliberately ending a patient’s life, we should instead be focusing on building the very best of palliative care for those in distress.’ And as Alistair Thompson, a spokesman for Care Not Killing, stated, ‘Doctors know that this is not needed, will take money away from palliative care, and it will damage the relationship they have with their patients. The fact that so few doctors want to have any part in this macabre change in the law shows it is unworkable and would lead to the slippery slope we have seen in other countries.’
But how many unethical, maverick doctors would it take to implement a policy of assisted suicide? As Sarah Wootton, the chief executive of Dignity in Dying has noted, ‘If one in five doctors was willing to assist that would provide around 7,000 registered GPs willing, within the legal safeguards, to help a patient.’
UK public and assisted suicide
The dominant statistic in the assisted suicide debate is that used by Dignity in Dying. It promotes the figure, derived from its 2010 survey, that ‘80% of the British public support a change in the law on assisted dying for the terminally ill.’
This datum has now been seriously challenged. A poll in July, commissioned and published by the Christian charity CARE (Christian Action Research and Education), showed that public opposition to assisted suicide rose from 12% to 43% when those surveyed were presented with additional information about the nature of assisted suicide.
In other words, opposition to assisted suicide grows dramatically when people are more informed about the arguments. The survey also showed that many of those who initially expressed support for assisted suicide switched to opposing it when presented with evidence from places where the practice has already been legalised. One in five changed their minds when informed that there had been a steady annual increase of assisted suicide cases in countries like Belgium, the Netherlands and Switzerland and also a widening of the net to include people with chronic but not terminal illnesses.
The poll, undertaken by ComRes, found that 28% of British adults who had supported the proposals switched to opposition when informed that vulnerable people may feel pressurised to end their life so as not to be a ‘burden’. The need for informed education is obvious.
Australia and euthanasia
Every country has its own Dr Death, its own euthanasia champion. In Australia it is Dr Philip Nitschke. He has tempted the medical and legal authorities in his homeland and those around the world to prosecute him for his hideous activities. Recently he got his just desserts.
Though Nitschke has had a string of complaints filed against him it is the specific case of Nigel Brayley that has stuck. Brayley was a healthy 45-year-old man, who was depressed after apparently being harassed by police following the suspected murder of his wife, Lina Suria Brayley, who was found dead at the bottom of a high cliff in Perth on 27 February 2011. In May 2014, Brayley died after taking a euthanasia drug he had illegally imported from China. It is alleged that Nitschke had instructed Brayley how to commit suicide.
In July, an ABC TV programme triggered the Brayley-Nitscke link. The Medical Board of Australia investigated and determined that Dr Nitschke posed‘a serious risk’ to the health and safety of the public and promptly suspended his medical registration. Investigations are continuing but the Board’s current recommendation is that Nitschke’s interim suspension should become permanent.
Meanwhile, Nitschke has said that the case against him has led to increased interest in his Exit International organisation, unprecedented numbers signing up to his suicide workshops and sales of his euthanasia handbook to‘reach an all-time high.’ In October, he opened the UK’s first Exit International office or ’suicide club’ in London.
And as a grand gesture of support for Philip Nitschke, up popped fellow Australian and professor of bioethics at Princeton University and uber-utilitarian, Peter Singer. He declared, ‘I think suicide can be rational in the absence of terminal illness and I think I could find you dozens or hundreds of philosophers who would think that.’ The solution, according to Singer, is to legalise euthanasia and assisted suicide, so that Nitschke will no longer be forced to go over the head of the law. Now you know what a ‘uber-utilitarian’ is.
Euthanasia in the Netherlands
The latest Dutch figures bring no comfort. Apparently, during 2013, there were 4,829 reported cases of euthanasia – an increase of 15% over the previous year. Most of these cases involved patients with cancer, but there were 97 cases of dementia and 42 of psychiatric cases. Euthanasia now represents just over 3% of all Dutch deaths. But these official figures are certainly underestimates because of significant underreporting by doctors, Holland’s ambiguous definition of euthanasia, the use of terminal sedation and several other euphemistic reasons.
And make no mistake, once any dubious bioethical issue is legalised, the flood gates open. In Holland, voluntary euthanasia has inevitably led to non-voluntary euthanasia. As Lord Carlile of Berriew QC has stated, ‘Laws aren’t like precision-guided missiles. Once a Statute, they can quickly be used to encourage acts they were designed to enable and control.’
Softening on assisted suicide
Right on cue with regard to Lord Carlile’s comments about slippery slopes, comes news on 17 October that the Director of Public Prosecutions (DPP), Alison Saunders, has unilaterally amended the UK’s guidelines on assisted suicide so that doctors and nurses will now be less likely to be prosecuted for assisting.
Back in 2010, the then DPP, Keir Starmer, issued guidelines that those assisting another to die ‘wholly out of compassion’ would be less likely to face prosecution. Those same guidelines also stated that all healthcare professionals who assisted would face a greater likelihood of prosecution. This was challenged by 'Martin', the man suffering from locked-in syndrome, who wanted prosecution exemption for such professionals who assisted his case. On 16 August 2012 'Martin' lost his legal challenge. However, on 31 July 2014, the Court of Appeal upheld his case and instructed the DPP to clarify the role and degree of support that healthcare professionals might play. Now that sensible 2010 stipulation has been dropped. This new guideline appliesonly to those doctors and nurses who are not directly involved in a person’s care. In other words, my caring family GP must not kill me, but some unknown locum or a pro-euthanasia maverick doctor can do the dirty deed and probably get away with it.
According to the DPP, these changes have been precipitated by the recent
‘right-to-die’ cases of Tony Nicklinson, 'Martin' and Paul Lamb that went before the Supreme
Court. That Court insisted that it was Parliament, and not the judiciary,
that must resolve such issues. Which makes it even more worrying that the
DPP has now decided to step in and relax the law – an action seemingly well ‘above her pay grade’
– at the precise time that euthanasia is officially being debated within
Parliament. All this must be music to the ears of
pro-euthanasia doctors like Michael Irwin and Philip Nitschke – now they can
take people to Dignitas, supply the drugs for suicide, run euthanasia classes
and websites without having to look over their shoulders for fear of the long
arm of the law. All this raises serious question about Alison Saunders’
motives, judgement and impartiality. Vulnerable people in our society
deserve the safeguards of the Suicide Act 1961, a law against assisted suicide
that offers them strong and unambiguous protection. The new guidelines
have weakened this a little further, just like Lord Carlile said.
USA and Elsewhere
In July, the pro-choice Guttmacher Institute issued its regular half-yearly report on abortion policies across the 50 US states. It noted that only 21 pro-life state laws had been passed during the first six months of 2014 and suggested that this indicated that the nation’s pro-life ambitions were slowing down. This is probably not the right interpretation.
First, a number of state legislatures have not been in session so far this year. Second, the years between 2011 and 2013 were exceptionally productive in pro-life activities – more so than the entire previous decade. Highlights so far this year include Mississippi becoming the thirteenth state to pass a 20-week abortion ban and the governor of Louisiana requiring abortionists to have hospital ‘admitting privileges’. The pace of reform may have slowed but protective laws are still being enacted.
Everyone knows that pro-life sentiment is greater in the US than in the UK. A recent poll has confirmed that abortion remains a hot issue, both personally and politically, in America. A national telephone survey of a 1,000 people was conducted by Rasmussen Reports and its findings were published in July. It found that 48% of likely US voters now consider themselves pro-choice, while 44% self-identify as pro-life – this latter figure is an all-time high. Pro-life sentiment was found to be somewhat higher among men, the elderly and low-income earners – that certainly chimes with me!
The annual poll conducted by Gallup, and published in May 2014 showed a similar split – 47% pro-choice with 46% pro-life. The national trend had been a clear pro-choice majority up until 2009. But since then the swing has been towards pro-life, so that for the last few years the figures have been roughly evenly split.
The 44% figure from the Rasmussen poll may seem unremarkable, but the organisation’s figures consistently show lower pro-life sentiment than Gallup polls. This is partly because Gallup surveys all adults, whereas Rasmussen surveys only likely voters. On average, voters earn higher incomes and are better educated than non-voters, so this likely skews Rasmussen’s results in a more ‘pro-choice’ direction.
What is the overall conclusion? Simply this, despite having the US government, the media and academia against them, it is the pro-life camp that is winning the war for US hearts and minds. Come on Britain!
A snapshot of abortion in Texas
In July 2013, the Texas governor, Rick Perry, signed a law which barred abortions across the Lone Star State after 20 weeks. It also required abortionists to have ‘admitting privileges’ to hospitals within 30 miles of their clinics by 1 November 2013, in case their patients required medical care.
What effect has this new state law had? The clinics have reported that between November 2013 and April 2014, they performed 30,800 abortions – some 4,600 fewer than in the same period the previous year. That represents a 15% decrease, which would translate to an annual decrease of 9,200 fewer abortions. In addition, medical or chemical, as opposed to surgical, abortions have declined by 70%. And the number of abortion facilities has dropped from 41 to 22. It is estimated that there may be only six abortion facilities operating in Texas by 1 September 2014 when new and tougher health and safety regulations come into effect.
The pro-choice camp is upset. One spokesperson said, ‘We have reduced women's access to safe and legal abortion but not decreased the need for it.’ The pro-life camp is delighted. One spokesperson said, ‘The more Texans know about the truth of the life-ending procedure of abortion, they are stepping up and turning away from choosing to take the life of a baby.’
The situation has become fluid. Court challenges abound. By mid-October, the US Supreme Court had stepped in, and by a 6 to 3 decision, granted the request from abortion clinic owners to suspend the enforcement of parts of the Texas pro-life law until a federal appeals court can rule on its constitutionality.
The Hobby Lobby case
The momentous decision by the US Supreme Court on 1 July, when it pronounced in favour of Hobby Lobby by a 5 to 4 margin, is still reverberating around the other country. The Court’s majority said that a federal law protecting religious liberty requires the government to find another way to provide free birth control for employees and dependents insured by closely held companies with religious objections. Late in August, the Obama administration proposed similar relief for other closely held, for-profit companies with religious objections to all or some forms of contraception. This should mean other companies will not have to go through the protracted exercise of suing the federal government to avoid paying for government-mandated coverage that violates the religious beliefs of these companies’ owners. Much of the outcome will depend upon the definition of ‘closely held’.
The Court’s decision to side with the evangelical Christian business owners against the Obama administration has apparently boosted the Court’s image in the eyes of many Americans, especially among the ‘swing voters’, those who will determine the outcome of the next US presidential race in November 2016. As many as 53% of them say they are pleased with the Court’s performance, compared to just 37% who expressed displeasure.
On the whole, 47% of Americans say they approve of the Hobby Lobby decision, while 41% oppose it. While Republicans and Democrats are split largely along party lines – 80% of Republicans support the ruling, while 63% of Democrats oppose it – political independents, the so-called ‘swing voters’, say they support the ruling by a margin of 53% to 36%. That’s enough political analysis!
The Race to the White House 2016 and 10 Downing Street
The USA has a Presidential Election on Tuesday, 8 November 2016. Already candidates are jockeying for poll position in the US. The Republicans severely blew it last time and got the worst pro-choice president ever, Barack Obama.
Already names are in the US hat. Current favourite is Ted Cruz, the Cuban-American senator for Texas with his trademark cowboy boots. He annoys some leaders within the Republican Party, but he connects with the grassroots, conservative, anti-Obamacare, anti-same-sex marriage, pro-life hardliners. Second current favourite is Ben Carson, a retired African American neurosurgeon. Then there are the names of Paul Rand, Chris Christie and Jeb Bush.
Many conservative Christians favour a Cruz-Carson Republican ticket to confront the expected Hillary Clinton challenge in 2016. Time will tell. But first are the mid-term elections on Tuesday 4 November when Republicans could well seize control of the Senate.
The UK has a General Election on Thursday 7 May 2015. The British
electorate is faced with a broken coalition of Tories and Liberals, an
indistinct Labour party and an unknown bunch of UKIP candidates. Many
Christians still feel aggrieved that last year the major parties allowed the
legalisation of same-sex marriage – voting patterns and the outcomes in May will
not only be interesting, they will be fascinating.
Obituaries of Three Pro-life Champions
Sandra Cano (1948 –2014)
According to Cano, her lawyer, Margie Pitts Hames, twisted her wish to take back her children into a crusade to legalise abortion. One afternoon, her mother and Hames announced that her bags were packed ready for an abortion the next day. Cano was so alarmed that she fled her home state of Georgia to live in Oklahoma. Yet the legal case continued. Eventually it arrived at the Supreme Court as Doe v. Bolton. The defendant was Arthur K. Bolton, the Attorney General of Georgia.
The Supreme Court pronounced on January 22, 1973 – the same day as the better known case of Roe v. Wade. The latter, by a majority of 7 to 2, overruled all US state regulations and allowed abortions before viability. In the Doe v. Bolton case, the Court found Georgia’s existing ‘procedural requirements’ – which stipulated, for example, that abortions must be performed in certain hospitals and only on residents of Georgia – to be unconstitutional. It also declared that a woman could obtain an abortion after viability, if necessary to protect her health. In practice, the Doe ruling allowed abortions until the moment of birth on the grounds of maternal ‘health’, a definition so subjectively broad that it justified any and all abortions. In other words, while Roe v. Wade struck down all state restrictions on abortion pre-viability, Doe v. Bolton extended the right to abort throughout all nine months of pregnancy. In effect, Roe v. Wade and Doe v. Bolton together declared abortion to be a constitutional right and transferred abortion from the numerous restrictive laws of individual states into one big, liberal, federal law.
Both Norma McCorvey (Jane Roe) and Sandra Cano (Mary Doe) believed that they had been ‘set up’ by the pro-choice movement and especially by their female lawyers. Both women came to regret their part in legalizing US abortion. Norma McCorvey subsequently stated, ‘I think abortion is wrong … I just have to take a pro-life position.’ Sandra Cano also declared, ‘I am against abortion. Abortion is murder.’ Furthermore, in 1997, Sandra Cano avowed, ‘I pledge that as long as I have breath, I will strive to see abortion ended in America.’ Sadly, she did not live long enough to see that great day – she died of cancer on 30 September.
Jim Dobbin (1941 – 2014)
Jim Dobbin was a Labour MP driven by his devout Roman Catholicism, his Scots mistrust, his scientific thirst for proof and his left-leaning socialism. He became a leader of a group of politicians at Westminster who wished to maintain their Roman Catholic heritage and stance against the tide of social reform and secular humanism.
As such he bravely defied the Labour whip and voted against his party’s leadership on issues like abortion, embryonic stem-cell technology, euthanasia, gay marriage and so forth. While frequent refusal to toe the party line may have angered some, he earned the respect of many at Westminster for his principled stand and courteous engagement with those of opposing views. Even John Bercow, the Speaker, had to admit that Dobbin was ‘a deeply principled and independent-minded parliamentarian.’
For 12 years, he was chairman of the All Party Parliamentary Pro-life Group (APPPLG). Though he was neither a particularly charismatic spokesman, nor an inspiring leader, he was tough and persistent. His core belief was that human life demanded protection from conception to natural death. He was a tireless supporter of the pro-life cause.
Born in Scotland, the son of a coalminer, James Dobbin completed his National Service before studying bacteriology and virology at Napier College, Edinburgh. He then moved south and worked as a microbiologist at the Royal Oldham Hospital. His life in local politics began in Rochdale and in 1992 he narrowly missed election as MP for Bury. In 1997, he was elected as Labour MP for Heywood and Middleton with a majority of 17,542. He held this seat until his sudden death on 6 September while on a visit to Poland. Sadly, it was later revealed that Dobbin had died as a result of food in his lungs and excess alcohol (399 mg per 100 ml of blood, nearly five times the UK's driving limit) - he had taken a shot of spirits with each course of a dinner. The post-mortem verdict was death by misadventure.
Rev. Ian Paisley (1926 – 2014)
Everyone has heard of Ian Richard Kyle Paisley, Baron Bannside, Member of Parliament for North Antrim, founder of the Democratic Unionist Party (DUP), Member of the European Parliament, Member of the Northern Ireland Assembly, Protestant evangelical minister and co-founder of the Free Presbyterian Church of Ulster. He died on 12 September. He had been a Gospel minister for 60 years.
Ian Paisley was a big man (he was 6’ 5’’) with a big voice (with that scouring rasp of vowels). He never failed to share his opinions with his audiences. He provoked both allegiance and hatred. Though he appeared forthright and resolute on all matters, politically the bigot eventually became the peacemaker. Whatever one’s judgement of the man, none could doubt his pro-life credentials. His Parliamentary speeches and voting record on bioethical issues such as abortion, embryo experimentation and euthanasia, as well as other matters such as same-sex marriage, Sunday trading and gambling, were second to none.
And though his aversion to all things Roman Catholic was legendary, it was abortion that somewhat softened his posture. For instance, in 2007, when some Ulster politicians were hoping to introduce the 1967 Abortion Act into the Province, Ian Paisley met for the first time with the leader of Ireland’s Catholics, Archbishop Sean Brady, and they gladly expressed their united opposition to abortion. Paisley, as First Minister, pledged to continue the fight to exclude the Act. In that same year, he reversed his opposition to the Ulster peace process and entered into a power-sharing administration with his previous Sinn Féin enemy, Martin McGuiness – because of their jovial friendship they were nicknamed the Chuckle Brothers. Paisley had learned to ‘love his enemies’. Indeed, many, both Protestants and Catholics, can recall his personal kindness to them as their MP.
Speaking in 2008 about his Christian faith, he declared, ‘I am a sinner, saved by the grace of God. I have my faults, which are many, which I lament. I want to do the best for my country.’ My favourite Paisley quotation is his reply to a reporter who was seeking an interview, ‘Is that the Devil’s buttermilk on your breath?’
The current political moves to introduce abortion legislation into Northern Ireland and eventually to extend the Abortion Act into the Province would have received that same old staunch Paisley rebuff, ‘Never, never, never!’We shall miss ‘Honeybunch’ as his wife always called him.