Update on Life Issues - October 2016


Forty-nine years of abortion
Thursday 14 July 2016 marked the forty-ninth anniversary of the passage of the Medical Termination of Pregnancy Bill following its third reading in the House of Commons.  The voting was a massive 262 for and only 181 against.  The Bill received the Royal Assent on 27 October 1967.

Under the aegis of what was to become known as the 1967 Abortion Act, the killing started six months later on Saturday 27 April 1968.  It is estimated that some 8.6 million abortions in England, Scotland and Wales have since been performed.  Next year is the Golden Anniversary of the Act – how should that be marked?

Marie Stopes and the CQC
As I wrote in my book, Bioethical Issues (2014, p. 68), ‘Evidence suggests that the Abortion Act 1967 is not being correctly enforced or adequately monitored.  Moreover, the Care Quality Commission (CQC), the NHS watchdog in England, which oversees the legal compliance of abortion services, patently has work to do.’

Well, surprise, surprise!  The CQC has done some work.  In August, CQC inspectors raised concerns about abortions being carried out at Marie Stopes clinics in England.  In particular, it uncovered poor governance arrangements and ‘specific immediate concerns’ about patient safety with respect to consent and safeguarding.  In addition, the CQC was not satisfied with training and competence for terminations that took place under general anaesthetic or conscious sedation.

Marie Stopes International’s response was to suspend abortions for under-18s and vulnerable groups of women, suspend abortions under general anaesthetic or conscious sedation and suspend abortions at its Norwich centre.  It estimated that about 250 women a week would be affected and it confirmed that they would be diverted to other abortion clinics.

The CQC has promised to publish its findings once its inspection reports are completed, sometime in the autumn.  This affair should send a shock wave throughout the abortion industry – abortion is a heinous business, but if it must persist, then it must be done within the law, ‘correctly enforced [and] adequately monitored.’

However, by early October, Marie Stopes had resumed performing abortions at several of its suspended clinics, with the expectation that all of them would be operational by the end of October.  Should Marie Stopes be allowed to restart before the CQC's official report into these serious failings has been published?  Apparently, yes.  The CQC has stated, 'Detailed reports will be published in due course and will be made available on our website.'  We shall be watching.

A Report into Freedom of Conscience in Abortion Provision
Back in 1966, when the Medical Termination of Pregnancy Bill was being debated in Parliament, abortion was still controversial, still divisive, still contested.  In an attempt partly to satisfy the many opponents of the Bill, a conscience clause was included as Section 4 (1) of the 1967 Abortion Act.  It reads, ‘… no person shall be under any duty … to participate in any treatment authorised by this Act to which he has a conscientious objection …’  In other words, doctors and nurses can opt out of involvement in abortions.

In recent years, discussions in medical ethics have been dominated by two topics – patient autonomy and patient consent.  A third emerging subject is that of conscientious objection (CO).  And the area in which CO has become most discussed is that of abortion.  How can freedom of conscience be balanced with the professional duty of healthcare bodies to provide access to abortion services under the 1967 Act?  More pointedly, how can those healthcare professionals with a moral objection to abortion exist and thrive in a workplace where abortion is legally provided?

Hence, the significance of this Inquiry, which was run by the All Party Parliamentary Pro-Life Group (APPLG) for four weeks between June and July 2016.  It took evidence from 150 witnesses, of whom about 30% were current or former healthcare professionals or healthcare bodies.  Testimony from the British Medical Association to the Inquiry confirmed that ‘some doctors have complained of being harassed and discriminated against because of their conscientious objection to abortion.’  The Report was published in July 2016 and is available at http://www.conscienceinquiry.uk/wp-content/uploads/2016/07/Final-report-Parliamentary-Inquiry-into-Freedom-of-Conscience-in-Abortion-Provision-All-Party-Parliamentary-Pro-Life-Group.pdf.pdf  It is a good read.

The Report makes 9 important and sensible Recommendations.  For  instance, Number 3, states, ‘The General Medical Council should maintain their current guidelines regarding referrals, thereby ensuring that no doctor who has a conscientious objection to abortion should be required to refer a patient to another practitioner.’  Number 9 states, ‘That consideration be given to the introduction of the principle of ‘Reasonable Accommodation’ into legislation in this country, in the form of an amendment to the Equality Act 2010.’

The response from bpas (the British Pregnancy Advisory Service) included, ‘…we would ask the MPs behind this ‘inquiry’ to extend the same respect to the many doctors, nurses and midwives who have a conscientious commitment to providing abortion services, and the women who decide abortion is the right decision for them.  They have a conscience too.

These issues of conscientious objection and freedom of conscience will not go away.  In fact, they will intensify.  Not only doctors and nurses, but also teachers, magistrates, cake makers and all ‘morally-sensitive’ people in the public square are set increasingly to become targets to conform under the heavy hand of equality, diversity and the State.  From that perspective, this Inquiry Report is an additionally welcome and timely piece of work.

Abortion for disability
Discrimination on the grounds of disability was made illegal 20 years ago when Parliament passed the 1995 Disability Discrimination Act.  Yet it persists as a reason, known as ground E, for abortion.  It starts with prenatal screening.  If the test results suggest the unborn has a disability, such as Down’s syndrome, then abortion is the common response.  About 90% of all such unborn children are aborted.  And abortion on the grounds of disability can occur right up to birth.  Yes, up to 40 weeks.  Disability is portrayed as a tragedy.  How can that be in the afterglow of the 2016 Paralympics?  Yet thankfully, people are beginning to respond positively.

First, there was the Don’t Screen Us Out campaign, which was initiated in response to UK National Screening Committee’s proposal to introduce NIPT – non-invasive prenatal testing – into the UK’s Fetal Anomaly Screening Programme.  The new technique is known as cell-free DNA (cfDNA) testing and is regarded as non-invasive because it relies on a blood test rather than the invasive nature of chorion villus screening and amniocentesis.  The maternal blood is then examined for abnormal foetal DNA.

While this new method is acknowledged to be safer, resulting in a projected 25 fewer miscarriages caused by the old invasive methods, it is also more accurate, resulting in a projected 92 more unborn children with Down’s syndrome being aborted each year.  This will have a profound and discriminatory effect upon the Down’s syndrome and other disability communities, their families, carers and pro-life supporters.  Less haste in implementation and more support for the disabled are the duties of a decent society.  Read more here, http://dontscreenusout.org/

Second, there is now the We're All Equal campaign.  This is run by people with disabilities, their families and supporters and has been introduced in response to Lord Shinkwin's Abortion (Disability Equality) Bill in the House of Lords.  The Bill proposes to remove s(1)(1)(d) from the 1967 Abortion Act, which allows abortion on the grounds of disability, right up to birth.

The aim of the campaign is to call on the Government to give Lord Shinkwin’s Bill enough time to proceed to the House of Commons and be voted on by MPs.  The second reading of the Bill is scheduled for 21 October.  Read more about the campaign at http://allequal.org.uk/   [Update – thankfully, the Bill had an unopposed second reading and it now proceeds to a Committee of the Whole House.  The debate can be read at https://hansard.parliament.uk/Lords/2016-10-21/debates/9B082E9E-8E7A-469B-8864-2D14FB44CCE2/Abortion(DisabilityEquality)Bill(HL)]

Also the moving and thought-provoking BBC2 documentary, A World Without Down’s Syndrome? by Sally Phillips was broadcast on 5 October.  It can be viewed on the BBC iPlayer
at http://www.bbc.co.uk/programmes/b07ycbj5  Phillips opens the programme by saying, 'It’s a film that asks the question – what kind of society do we want to live in, and who do we think should be allowed to live in it?'  She continues, 'Of course, I have a biased opinion because I have a child with Down’s syndrome who I love more than life.  And, 'My big question to the world is what is so very dreadful about Down’s syndrome?  It’s not a catastrophe.  Why is everyone behaving like it’s a catastrophe?'  Her 11-year-old son, Olly, was diagnosed with Down's 10 days after he was born.  She recalls that she was expecting tragedy.  Instead, she got comedy.  Watch this documentary – it is both compelling and revealing.

Abortion for cleft palate

It seems that abortions for cleft palate – an easily-fixed facial deformity – are rising.  According to figures from the Office for National Statistics, there were 4 such abortions in the UK to  during 2012.  The figure in 2015 was 11.

Fiona Bruce MP commented, ‘It is deeply disturbing if these figures reflect a worrying trend in society to disproportionately value the physically perfect and beautiful.’  And Lord Alton declared, ‘Aborting a baby with a cleft palate should be unconscionable.  For the law to allow this up to birth should be unthinkable.’

Unborn human rights in Ireland
On 4 August, a significant statement was handed down from the High Court in Dublin.  Mr Justice Richard Humphreys made the ruling when granting leave to a Nigerian man, his Irish partner and their now almost one-year-old child for a judicial review over the man’s intended deportation.

The judge referred to the Eighth Amendment of the Irish Constitution, which was approved by referendum on 7 September 1983.  It asserts, ‘The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.  In effect, it introduced a constitutional ban on abortion by recognising a right to life of an unborn child.  Mr Justice Humphreys ruled that the word ‘unborn’ in the Eighth Amendment means that an unborn child enjoys significant rights and legal position at common law, by statute and under the Constitution, which go well beyond the right to life alone, which must be taken seriously by the State.  He further added that Article 42a of the Constitution, inserted as a result of a 2012 referendum, obliges the State to protect all children and that because an unborn is clearly a child, Article 42a applies to all children, both before and after birth.

Furthermore, the judge held that when the Minister of Justice comes to resolve this case, he must consider the constitutional, statutory, EU and European Convention on Human Rights (ECHR) rights of the man, his partner and the child, including their family rights under Article 8 of the ECHR.  Mr Justice Humphreys dismissed the State’s arguments that the couple have no family rights under the Constitution because they are not married, no rights under Article 8 because their situation is ‘precarious’ and the only right their unborn child had was to life.

In other words, an unborn child is deserving of all the rights and protections to which every other person is entitled.  This judgement runs counter to the notion of those who seek to discriminate against children before birth and who argue that the pre-born child is not fully human, or entitled to human rights.  It was indeed a landmark ruling.

Abortion in Ireland
If ordinary politics can be opaque, Irish politics can be obscure.  The United Nations Human Rights Council has recently criticised Irish abortion law saying that the country needs to comply with international standards on abortion by making it available to women in cases of rape, incest and fatal foetal abnormalities.  Yet in early July, a bill to allow for abortions in cases of fatal foetal abnormality was defeated in the Dáil by 95 votes to 45.

In addition, there has been internal and external pressure to repeal the Eighth Amendment of the Irish Constitution (see above).  This has led the government to create a Citizen’s Convention to examine the controversial 2013 Protection of Life during Pregnancy Act, which has permitted abortion to save the life of the mother, but which also includes the risk of suicide as a threat to her life.  In late July, Supreme Court judge, Mary Laffoy, was appointed to chair this 100-member Citizens’ Convention tasked with examining the Eighth Amendment.  The Convention is to be established by October and the Eighth Amendment is the first issue it will examine.

Pro-life campaigners in Ireland hope that the crucial Humphreys’ ruling will cause the government to repeal the pro-abortion 2013 Protection of Life during Pregnancy Act and to oppose any moves to repeal the Eighth Amendment.  Irish politics can indeed be obscure.  Some commentators expect that yet another Irish referendum on abortion is inevitable and maybe imminent.

Gene editing

Most of us have only just got used to hearing about CRISPR–Cas9, the gene-editing tool, which enables scientists to alter genomes of bacteria, plants and animals, practically at will.  It was first mentioned in these Updates only in October 2015.  Well, it is already becoming a somewhat dated technology.

Now there is NgAgo.  It is an acronym for Natronobacterium gregoryi Argonaute – don’t blame me!  Basically, it is an enzyme that can break DNA at specific, gDNA, sites.  It was first reported as a possible gene-editing tool by Han Chunyu and his team from the Hebei University of Science and Technology in Shijiazhuang, China.  The report was published as Goa et al. in May 2016 in the journal Nature Biotechnology 34: 768–773.  They used NgAgo to edit eight different genes in human cells and to insert genes at particular points on chromosomes.

One disadvantage of the CRISPR-Cas9 system is that the enzyme Cas9 is too large to package into any of the viruses that are commonly used as vectors in gene therapy.  Enter an alternative, mini-Cas9, a smaller version derived from the bacterium Staphylococcus aureus.  Mini-Cas9 has already been used to correct the gene responsible for Duchenne muscular dystrophy in mice.

Cas9 has other limitations.  It will not cut everywhere because it requires a certain DNA sequence for that to occur.   Enter an enzyme called Cpf1 which is smaller than Cas9, with a different sequence requirement for cutting.  And there is yet other enzyme, called C2c2, which targets RNA rather than DNA.  This is just the very beginning of discovering and applying gene-editing tools – there is now talk about adding other types of enzymes, such integrases and recombinases, to the gene editor’s toolbox.

Does NgAgo actually work?
Oh no, is this another case of fraud at the forefront of hot science?  Han Chunyu, the senior author on the Nature Biotechnology paper, cited above, has been accused by several scientists because they cannot replicate his results with NgAgo.  An informal online survey found that 9 scientists said that NgAgo works, while 97 said it does not.

Han is convinced that his technique is sound and on 8 August, he submitted his protocol in detail to Addgene, an online genetic information repository, for all to see.  The stakes are high.  Time will tell.  Meanwhile, Nature Biotechnology has launched its own investigation.

The first human CRISPR trials
Chinese scientists are on the verge of being first in the world to inject people with cells modified using the CRISPR–Cas9 gene-editing technique. A team led by Lu You, an oncologist at Sichuan University’s West China Hospital in Chengdu, plans to start testing such cells in people with lung cancer now that the trial has been approved.

Lu’s team will enrol patients who have metastatic non-small cell lung cancer and for whom conventional treatments, like chemotherapy, radiotherapy and so on, have failed.  They will extract T-cells from the blood of the patients, and then use CRISPR–Cas9 technology to knock out a specific gene in those cells.  The gene encodes a protein called PD-1 which normally acts as a check on the cell’s capacity to launch an immune response, to prevent it from attacking healthy cells.  The gene-edited cells will then be multiplied in the laboratory and re-introduced into the patient’s bloodstream.  The engineered T-cells will, the team hopes, home in on the cancer cells and destroy them.

Meanwhile, Carl June, a clinical researcher in immunotherapy at the University of Pennsylvania in Philadelphia, has been granted approval for a similar human trial using CRISPR-Cas9 modified cells to treat cancer patients, which should also start before the end of 2016.  The US team’s protocol will similarly knock out the PD-1 gene, but also add NY-ESO-1, a tumour antigen, and disrupt TRAC and TRBC genes in order to enhance the proliferation and immune response of the T-cells before they are infused into the patients.  The 2-year trial will treat 18 people with myeloma, sarcoma or melanoma, who have stopped responding to existing treatments.

These phase I trials will seek to establish the safety and effectiveness of these proposed treatments, but because they are entirely novel, they are also inherently hazardous.  ‘Proceed with caution’ is the maxim.  Catastrophe could hinder human gene-editing technologies for decades.

 Assisted Reproductive Technologies

The saga of A and Mr & Mrs M
If you want a good reason to reject IVF, here it is.  IVF turns natural procreation on its head and often creates huge bioethical dilemmas.  Consider this case.

A young, single woman, known as A, suffered from bowel cancer.  During a period of remission, she underwent treatment to collect three ova, which were frozen and which she later referred to as ‘my babies on ice’.  Prior to storing the ova, A completed a form which asked what she wanted to happen in the event of her death.  She wrote YES to the ova being stored ‘for later use’, and NO to the ova ‘being allowed to perish’.  However, she did not give specific written consent about how she wanted the ova to be used after her death.

In June 2011, A died at the age of 28.  Her parents, Mr M and Mrs M, then sought to give effect to their daughter’s wishes by trying to conceive a child, with anonymous donor sperm, who Mrs M, now aged 60, would carry and who they would raise as their grandchild.

The UK clinic, IVF Hammersmith, where the ova were stored declined to offer them assistance, citing a lack of written consent to the treatment proposed by A’s parents.  Mr and Mrs M then sought to export the ova to the USA where a clinic, New York Fertility Services, was identified that was prepared to help.  The Human Fertilisation and Embryology Authority (HFEA) refused the UK clinic’s application to export the ova.  Mr and Mrs M sought a judicial review of that decision.  On 15 June 2015, Mr Justice Ouseley in the High Court said the HFEA was right to conclude that there was insufficient evidence of A’s wishes and was therefore entitled to refuse consent to export.

However, the Court of Appeal disagreed.  On 30 June 2016, Lady Justice Arden stated that the HFEA and Mr Justice Ouseley had erred.  Although A had not completed additional written consent forms explaining the terms of her initial consent, all available evidence indicated that A wanted the ova to be used by her mother after her death, and there was no evidence that A wanted the ova to be allowed to perish.

The ruling meant that the HFEA needed to reconsider whether to exercise its discretion to permit the export of the ova.  It did just that.  On 9 September 2016, the Statutory Approvals Committee of the HFEA reconsidered this case in the light of the Court of Appeal judgement.  It agreed, ‘in the exceptional and unique circumstances of this case, to grant special directions to export A’s eggs to the USA.’

Legal permission is one thing – biological reality is another.  A’s so-called ‘babies’ are ova, not even embryos, the three ova are frozen, they are 5 years old, Mrs M is post-menopausal and quite unlikely to become pregnant, if she does conceive any complications could be life-threatening, and there is, as yet, no identified sperm donor.  The entire proposal seems more like a grandparent’s emotional dream rather than a rational reproductive strategy.  Such is the disconcerting and dishonest power of IVF.

And another IVF tangle
Samantha Jefferies, aged 42 from East Sussex, is the widow of a Falklands war veteran.  She and her husband Clive had previously gone through two unsuccessful cycles of IVF funded by the NHS.  They were about to undergo their third when Mr Jefferies died suddenly of a brain haemorrhage in 2014, aged 51.

The couple had signed consent forms for 10 years' storage and posthumous use of their embryos.  But, in early 2015, Mrs Jefferies was told by the Sussex Downs Fertility Centre that the embryos must be destroyed because the 2 years of her NHS treatment would expire in that August.  Yet in 2012, the HFEA had urged all IVF clinics in the UK not to restrict storage times to less than 10 years.  And neither she nor her husband had signed any consent amendments.

Mrs Jefferies went to law and on 27 September, Sir James Munby, president of the family division of the High Court, stated, ‘I am just so sorry that people like you should have no idea that this can end up in court because of mistakes made by other people who should have known better.’  And, it is ‘obviously right’ that the embryos be stored for 10 years.  Mrs Jefferies revealed that she did not have any plans to use the embryos soon but added, ‘I would love to be a mum.’

Thus IVF has crafted itself yet another problem, a bureaucratic one.  IVF clinics are typically driven by financial considerations and if funding is not forthcoming, as in the Jefferies’ case, then they will override consent, as in the Jefferies’ case.  It is a shabby practice.

World’s first ‘three-parent’ IVF baby born
In February 2015, the UK government became the only country in the world to sanction the controversial technique known as mitochondrial replacement therapy (MRT), or ‘three-parent’ IVF.  Now American doctors have reportedly beaten the British in the race to use the technique.  The HFEA has still not given permission for any such usage in the UK.
The unnamed baby boy, with genes from two women, was conceived in a Mexican clinic last summer and was born on 6 April 2016.  The ‘primary’ mother, who is Jordanian and in her 30s, contacted the New Hope Fertility Centre in New York after learning that she carried the mitochondrial disease, Leigh syndrome.  She had already lost two young children to the disease and had suffered several miscarriages.

Because the couple are devout Muslims, they were opposed to the destruction of two embryos, as occurs in pronuclear nuclear transfer, the MRT protocol approved in the UK.  Instead the US-led team used spindle nuclear transfer, which involves cutting and pasting before fertilisation occurs.  The scientists removed the nuclei from several of the ‘primary’ mother’s ova and used them to replace the nuclei in ova obtained from a ‘secondary’ or donor mother.  These ‘new’ ova were activated and then fertilised with the father’s sperm.  Five embryos were created, but only one developed sufficiently to be transferred to the ‘primary’ mother.  The baby’s nuclear DNA is 99.8% from his parents with 0.2% of his mitochondrial DNA from his ‘secondary’ mother.  Less than 1% of the boy’s mitochondria carry the genetic mutation.

The procedure was carried out in a branch of the NY clinic in Guadalajara, Mexico because there are no fertility regulations there.  It is all a little Machiavellian.  The whole episode has again raised the many questions about the ethics and safety of the technique.  Dr John Zhang, who led the work, has no such qualms, he said, ‘To save lives is the ethical thing to do.’  Yet an additional fear is that doctors using such unregulated treatments will now exploit desperate couples.  One thing is sure – this will not be the last we hear of ‘three-parent’ IVF.

Babies without mothers?
Those UK tabloids of spin have overstepped the mark again.  The headline in the Daily Mirror was, ‘Fertility breakthrough means babies could be conceived from skin cells.’  Whereas the Daily Mail led with, ‘The babies with no mothers’ and ‘We can create babies without men, claim scientists.’

The science in question appeared in Nature Communications (2016, doi:10.1038/ncomms12676) by Suzuki et al. under the title, ‘Mice produced by mitotic reprogramming of sperm injected into haploid parthenogenotes.’  And the truth is that it was a small study, with no skin cells involved, and it was done in mice, not humans.

This is what Dr Perry and his colleagues at the University of Bath did.  They took unfertilised mouse ova, treated them chemically to trick them into dividing, and thus created so-called parthenogenotes.  In other circumstances these usually die within a few days.  These entities are haploid, that is, they contain only one set of chromosomes.  The Bath team then injected them with mouse sperm and transferred them to mouse uteruses.  About a quarter of them developed into newborn mouse pups.  These appeared healthy and were subsequently able to produce two or more generations of their own offspring.

These results challenge our previously-held understanding that mammalian embryo development requires the fusion of ova and sperm.  Furthermore, the authors suggest that their work, ‘calls into question the argument that parthenogenotes do not have the potential for full-term development and are accordingly a more acceptable source of human embryonic stem cells.’  But what next?  Could all this lead to future fertility treatments?  This is where Dr Perry went into hype mode, ‘It might one day mean that we could generate embryos from other cell types – perhaps even somatic cells, perhaps skin cells, for example’, he said.  At that, the tabloid press woke up and loved it, embroidered it and printed it.  Dr Paul Colville-Nash of the Medical Research Council was a little more understated.  He said, ‘This is an exciting piece of research … It may one day even have implications for how we treat infertility, though that's probably still a long way off.'

Dial a sperm donor
Ah, the wonders of online shopping!  London Sperm Bank Donors has just launched a phone app that allows women to choose sperm donors by race, education, height, weight, education, even eye colour.  Furthermore, users can sign up for alerts and ‘new arrivals’.

The service has been called, ‘digital dads’ as well as ‘the denigration of fatherhood’.  It is understood that around half of Britain's IVF clinics registered to use the service.  Once a woman has chosen her preferred sperm donor, she makes a payment of £950 via the app and the sample is delivered to the HFEA-approved clinic where the woman is being treated.

Sally Cheshire reappointed as head of the HFEA
The HFEA has announced that Sally Cheshire has been reappointed as its Chair for a further three years from 1 April 2017.  Commenting on her reappointment, Mrs Cheshire said, ‘We have a lot to be proud of, from licensing world firsts like mitochondrial donation and ground-breaking gene editing research, to regulating the day-to-day clinical and emotional journey our patients face as they try to have a much wanted family.’

She continued, ‘Our refreshed strategy for 2017-2020 will build on our success and will significantly raise the bar on providing high quality care.  We will do that by being clearer with patients about evidence-based treatment, being more transparent about the cost of that treatment, making better use of research and treatment data to improve patient care, and working to improve the quality of commissioning of IVF treatment.  We can only do this by continuing to place patients at the centre of what we do.’

This is neither the time nor place to rehearse the historic failings of the HFEA – scientific, ethical and bureaucratic – this website has traced and reported on those deficiencies for many years.  However, it is notable that in October, the HFEA published its latest report on adverse incidents in UK fertility clinics for 2015.  The total number of such events, 517, were up on the previous year.  While no Grade A incidents, the most serious, were reported, the number of Grade B was 200 compared with 165 in 2014.  Grade B incidents can include, somewhat understatedly, 'loss of embryos' and 'breaches of confidentiality'.  We wish Mrs Cheshire well and hope that she can both instil a better sense of responsibility as well as inject a dose of bioethical backbone into her charge.

Human-admixed embryos back on the agenda
After a decade of hype and failure it seemed that the story of human-admixed embryos had closed, but now they are back on the agenda.  Since September 2015, US scientists have been banned from receiving federal funding for adding human stem cells to animal embryos in order to create chimaeras, or human-admixed embryos.  Yet, in August, the US National Institutes of Health (NIH), after a public consultation, proposed lifting that funding moratorium.

Some say such research is essential.  It will lead to our greater understanding of human development and disease.  It could even lead to the production of transplantable human organs in livestock, such as human kidneys in pigs.

Others say it is a step too far.  Some US states may yet ban such research, review committees may block such projects, and public opinion may revive protests against such work.  These protesters say that these studies could result in chimaeric animals with human cellular and functional modifications to the central nervous system.  This, in turn, could elevate chimaeras to something approaching, or equalling, human moral status.  Proponents retort that this conflation of the biological humanisation of chimaeric animals with their moral humanisation is a fallacious argument.  They maintain that the moral status of humans – though they do define that – is not automatically granted by genetic composition or physical arrangement of our cells, but rather by a complex of mental traits.  In other words, we are back to the old wranglings over personhood designations, plus legal and moral definitions of the status of human beings.  Rather than seeking answers to these hot issues, the NIH’s new rules would merely set up review panels which would concentrate on animal welfare issues.  They might also prohibit extreme protocols, such as limiting the number of human cells in a chimera’s brain, or the birth of an animal more humanised than its parents.

Currently, all research subjects fall into two classes – human or non-human.  There are strict and different research guidelines for each.  Chimeric research introduces a third category for which there are no research guidelines.  Without the construction of a robust bioethical framework, this research will proceed on a ragbag basis with the currently unthinkable eventually becoming the acceptable norm.

For those, Christians and the ‘morally sensitive’, who draw a bright line between animals and human beings, these arguments are fundamental.  We have been here before.  If animal cells contain 0.1% of human DNA, are they animal or human?  What about 10%?  What about 50%?  Destruction of human embryos, creatures that are part human-part pig – do these constitute a bioethically-acceptable research pathway?

Dolly’s siblings are well
When Dolly was born on 5 July 1996, she was the first mammal to be cloned from an adult cell using a cloning technique known as somatic-cell nuclear transfer (SCNT).  She died at the relatively young age of 6.5 years raising the fear that cloned mammals may suffer from serious degenerative conditions

In July, Nottingham University announced that four of Dolly’s siblings, Debbie, Denise, Dianna and Daisy, which had been cloned from the same ewe as Dolly, had reached their eighth birthdays apparently in good health and ageing normally.

Now this cheery news raises at least two serious questions.  First, if human reproductive cloning is banned until it is safe, does this healthy animal report move us nearer its approval?  Second, if animal cloning is to be perfected, what will stop the demand for human cloning?

Trending in fertility
For the first time in England and Wales for nearly 70 years, women over 40 are having more babies than those under 20.  In 2015, there were 697,852 live births with 15.2 births per 1,000 women aged over 40, compared with just 14.5 per 1,000 women in their teens.  The last time the over-40s had the higher fertility rate was in 1947, in the wake of World War II – the very year I was born!

The current trend is two-fold.  The teenage pregnancy rate has more than halved from the 33 births per 1,000 teenagers in 1990.  And pregnancies in the older age group have rocketed from 5.3 per 1,000 in 1990.  The average age of having a child is now 30.3 – a figure that has been increasing since 1975.  And the cause of these trends?  Fertility treatment, women in higher education and careers, and the rising costs of housing and childbearing – these factors delay motherhood.  Female fertility starts to decline from the late 20s and especially from the mid-30s, so reproductive outcomes are poorer in older women.  Take note and beware you young married couples!

How to increase your fertility
First, get your appendix removed.  A 15-year study from the University of Dundee analysed the medical records of more than half a million British women.  The researchers found that women who have had their appendix or tonsils removed seem to be more fertile as shown by increased subsequent pregnancy rates.  That is, for every 100 pregnancies in women who had had no surgical procedures, there were 134 pregnancies in those who had had their appendix removed, 149 in those who had had their tonsils removed and 143 pregnancies in women who had had both removed.  In addition, surgery was associated with shorter times to pregnancy.  It is uncertain if the apparent increases in fertility were directly caused by the surgery, or if there is a ‘behavioural’ explanation to these numbers.

Second, get your endometrium scratched.  It will cost about £300, but a study of 1,180 women from New Zealand reported that women who used the technique had on average a 122% better chance of conceiving.  The theory behind the operation, which involves making four moderately-painful cuts to the inside of the womb, is that it prompts a repair reaction, which in turn gives the embryo a better chance of implanting.

Third, abandon any involvement with these and dozens of other (expensive) fertility add-ons.  Instead, eat a balanced diet, exercise frequently, sleep well, de-stress, recognise self-inflicted factors, such as alcohol and other drug abuse, STIs and smoking, to name but a few.  And remember 84% of couples who have regular sexual intercourse, say two or three times a week, without contraception, will achieve a pregnancy within a year.  And about 92% of such couples will conceive within two years.

Fourth, if all that fails, contact the Life FertilityCare Centre at http://lifefertilitycare.co.uk/   There you will find a pro-life, pro-woman, pro-child, alternative to IVF.  And the number of babies born there is steadily increasing.

Is IVF changing the human population?
Nowadays as many as 1 in 25 children born is an IVF-baby.  Is all this artificial procreation having an effect upon the wider population?  Certainly, IVF enables many people to reproduce who would not naturally be able to do so. 

By definition, IVF-couples come from a distinct subgroup, typically sub-fertile and often relatively rich.  And, for example, IVF-ova are different from normal ova, even biologically inferior.  Similarly, IVF-sperm are distinct, selected for their ability to swim short distances, whereas in a natural environment, successful sperm are long-distance swimmers.  Again, IVF-embryos have to endure unnatural freezing as well as the environment and culture media in laboratory Petri dishes.  And there may be differences in how IVF-embryos survive implantation and miscarriage.  And there is also a generational perspective - boys conceived by ICSI (intra-cytoplasmic sperm injection), the most common type of IVF, apparently inherit their fathers' infertility problems.  In adulthood, they have half the normal sperm count and half the number of good 'swimmers'.  This, according to research by Andr
é Steirteghem and his team and published in Human Reproduction http://humrep.oxfordjournals.org/content/early/2016/10/05/humrep.dew245.abstract is the upshot, 'In this cohort of 54 young adult ICSI men, median sperm concentration, total sperm count and total motile sperm count were significantly lower than in spontaneously conceived peers.'

So, because IVF supports the propagation of these sub-fertile couples, is that a disadvantageous development for the whole human population?  If the sub-fertile give birth to sub-fertile offspring and the sub-fertile pool increases, will we become more and more dependent on assisted reproductive technologies?  In other words, is IVF a retrograde step?  It is certainly not a cure, but merely a way of bypassing a problem.

Stem-cell Technologies

Where are the embryonic stem-cell treatments?

Bioethicists and others are, at last, beginning to realise that no field of biotechnology has promised more and delivered less than the overhyped and long-promised treatments from embryonic stem-cells.  A few human studies have been conducted with mostly unclear or insignificant results.  We were told that these embryonic stem cells were the gold standard of stem-cell technologies, capable of differentiating into any of the adult human tissues and organs and therefore able to regenerate and replace our ageing and diseased bodily parts.

The enterprise has been a flop.  Bioethically, it has failed because the harvesting of embryonic stem cells demands the destruction of human embryos.  Medically, it has failed because there are no forthcoming wonderful treatments.  Will the stubborn researchers now give up on their pet projects and move onto adult stem-cell technologies?  Probably not.

Yet, just in the USA, adult stem cells are currently being used in several thousand FDA-approved human clinical trials, involving tens of thousands of patients every year.  An estimated 1.5 million people have been treated to date.  Why have we not heard about these?  Why the information blackout?  The stem-cell science deniers, continue to disparage adult stem cells.  But for patients, adult stem cells are the true gold standard of stem-cell technologies.

And yet, caveat emptor
And now a word of caution.  Stem cells are increasingly being used in unproven therapies in clinics across the world.  Such activities are being reported in the USA, Australia, Japan, India, China and elsewhere.  The problem is two-fold.  First, there is an assumption that all stem-cell treatments work.  Yet, many are unproven, ineffective and maybe even dangerous.  Second, government regulations, including those issued by the FDA, are insufficient to sift the good from the bad.  The regulators cannot keep up and the sham clinics are exploiting loopholes.

The answer is the establishment of stringent assessments based on rigorous, double-blind, human clinical trials – the sort that are required before the marketing of new drugs.  An example of the problem is that numerous stem-cell treatments are currently being marketed for neuro-degenerative diseases, but no stem-cell treatment has ever been proved to be effective for these conditions.

Yet, counter-intuitively, some want a relaxation of regulations.  For instance, in the USA, the REGROW Act has been proposed.  It stands for the Reliable and Effective Growth for Regenerative Health Options that Improve Wellness Act.  Its supporters want less, not more, government oversight.  They say FDA regulations hamper the introduction of novel stem-cell treatments, patients deserve more rapid access to potential cures, and the USA is slipping behind other less-regulated countries in the stem-cell race.  Those lobbying for the REGROW Act seem to come from the more dubious sector of stem-cell clinicians.  Bioethically and medically, their agenda would be dangerous, if not lethal.  While it is beyond cavil that stem-cell treatments can be effective, we need to know which ones work.  Stem-cell technologies belong in mainstream medicine, not charlatanism.

Is Paolo Macchiarini a fraud?
Oh dear, we’ve been here before with Woo Suk Hwang, the South Korean stem-cell researcher, who, in 2004, claimed to have created stem cells from cloned human embryos.  He was later exposed to be a charlatan.

Paolo Macchiarini was a stem-cell researcher at Sweden’s world-famous Karolinska Institutet, just outside Stockholm.  In 2011, he announced that he had created an artificial windpipe by seeding a plastic tube with stem cells taken from a patient’s bone marrow.  The patient was 36-year-old Andemariam Beyene.  Five years later, Beyene was dead and Macchiarini has been charged with gross negligent manslaughter and grievous bodily harm – he denies all charges.  Macchiarini’s research has now been called corrupt and unethical, the reputation of the Karolinska Institutet has plummeted, its head has been sacked, its governing board has been asked to resign and a cloud hangs over the forthcoming Nobel Prize for Medicine or Physiology.  The whole affair has become the biggest scandal ever in Swedish medicine.

What has gone wrong?  Apparently, though a gifted surgeon, Dr Macchiarini managed to fool top people in the Swedish medical establishment.  Investigative journalism has begun to expose the truth.  Between 2011 and 2013, a series of three transplant operations using his artificial polymer trachea method ended in failure.  Two of the patients died and a third was keep alive only by extraordinary hospital care in the USA.

Reviews of Macchiarini’s published work have revealed errors and doubts as well as an embellished CV.  And the Karolinska has handled the crisis, which included allegations of scientific misconduct, badly – the medical establishment was blind or naïve.  All in all, this predicament created a ‘culture of silence’ in which the important questions were never asked.  Karolinska bosses also thought that the Nobel Prize for Medicine or Physiology was within Macchiarini’s grasp - it was not, because Yoshinori Ohsumi of Japan won it.  It is not incidental that a committee of 50 Karolinska professors is responsible for choosing the winners of this particular Nobel Prize.  An investigative report by the Swedish Council on Medical Ethics has been fiercely critical of the Karolinska.  The report’s chairman said that, ‘Macchiarini should not even have been employed at the hospital.  There was never a job interview.’  On 23 March 2016, the Karolinska Institutet fired Macchiarini.

During late October, BBC4 broadcast a three-part series on Paolo Macchiarini, who has been accused of using terminally-ill patients as human guinea pigs and falsifying his science.  The programmes are entitled The Fatal Experiments: The Downfall of a Supersurgeon.  Part 1 can be seen at http://www.bbc.co.uk/programmes/b080k2z4  The other two parts follow on.

N. B. None of the above is to be confused with the hugely successful pioneering work of Macchiarini and his University of Bristol colleague, Martin Birchall, and their team at the Hospital Clínic of Barcelona as reported in The Lancet (2008) 372: 2023 - 2030.  That work involved the use of a human donated trachea, rather than a polymer version, and the patient, Claudia Castillo, was reported five years later, in 2013, to be in good health.

Stem cells and 3D-printers
Here comes the combination of two recent and fascinating technologies – stem cells and 3D-printers.  Together they can produce artificial bone, called ‘hyperelastic bone’, to overcome skeletal defects and fractures.

As reported in the journal, Science Translational Medicine (2016, 358: RA127), a team of scientists, headed by Ramille Shah, at Northwestern University, Illinois have already used the twin technologies to repair bone in mice, rats and a monkey.  Testing the protocol in humans is expected within the next five years.  If successful, the printers could be installed in hospitals to produce patient-specific bones within 24 hours.  The ‘bones’ could even be impregnated with drugs and antibiotics to enhance recovery and reduce infection.

The scheme involves constructing a flexible scaffold consisting of hydroxyapatite, the major component of bone, and some added polymers.  The microscopic lattice of these scaffolds encourages the body’s stem cells to morph into bone cells and allow blood vessels to proliferate within weeks.  Eventually, when transplanted, this artificial bone is degraded and replaced by robust, natural bone.  Remarkable, or what?

Euthanasia and Assisted Suicide

Euthanasia in Belgium
Since legalising euthanasia in 2001, it seems as though Belgium cannot get enough of it.  The mentally disturbed, twins, the anorexic and even children are all willing, if not pressed, candidates.

Now, bizarrely, a Roman Catholic nursing home has fallen foul of the apparently all-embracing law.  The incident occurred at the Huize Sint-Augustinus home in Diest, in the northeast of Belgium.  According to its website, it is, ‘a dynamic elderly facility with 150 residents, located on the outskirts of the city in a quiet residential area.’

The occasion was in 2011.  The patient was Mariette Buntjens, a 74-year old, who was suffering from terminal metastatic lung cancer.  She and her family had made prior arrangements for her euthanasia to be performed by a doctor not connected to the home.  When he came, apparently, to give her a lethal injection, the directors of the home refused him access.

In June 2016, a civil court in Louvain ruled that ‘the nursing home did not have the right to refuse euthanasia on the grounds of conscientious objection.’  The three judges awarded €3,000 in damages to Mrs Buntjens on the grounds of the increased suffering she experienced, to be shared among her three children, as well as an additional €1,000 for each of them.

This case is important.  First, it extends the reach of Belgian euthanasia practice.  Second, it does not allow an institution, albeit a religious home doctrinally opposed to euthanasia, to refuse euthanasia.  Third, a nursing home, with a remit to provide care for its residents, cannot come between them and their doctors.

Marieke Vervoort – Belgian gold medallist

The end-of-life wishes of a Paralympic medallist have again raised the question of what constitutes eligibility of a Belgian citizen for euthanasia.  Almost anything, it seems.

Marieke Vervoort won a silver in the 200-metre wheelchair sprint and a gold in the 100-metre event in the London 2012 Paralympic Games.  But she told the media that she may request euthanasia after competing at Rio.  She signed her euthanasia papers in 2008.  She has said, ‘Rio is my last wish, hopefully I can finish my career on the podium.’  She had her wish – she won a silver in the T52 400-metre wheelchair race.

She suffers from an incurable degenerative disease which causes her such great and constant pain that she barely sleeps, though she can still compete at a high level in a range of sports, including basketball, swimming and triathlons.  Yet also says, ‘Sport is my only reason for living.  But after Rio I will have nothing to live for.’  At a news conference after her victory she rejected media speculation saying that the time to be euthanized was not yet.

First Belgian child euthanasia

In Belgium in mid-September, a terminally-ill child became the first minor to be helped to die since the country voted to allow voluntary euthanasia for children, without any age limit, in 2014.  Parental consent is required.

The head of Belgium’s Federal Control and Evaluation Committee on Euthanasia, Wim Distelmans, gave no details, such as name, age, ailment or location, other than to say it was an exceptional case of a child with a terminal illness.  Subsequent reports suggest that the child was 17-years-old and from the Flemish-speaking area of Belgium.

Assisted suicide challenges in Canada

On 17 June 2016, the Canadian Parliament passed a bill to legalise and regulate ‘medical assistance in dying’ throughout Canada.  It did not take long before challenges were raised to extend the eligibility of the new law.  It is always the case – proponents always want more and more.

On 27 June, Julia Lamb, aged 25, became one of the first challengers.  She has a progressive neurodegenerative disease and is currently ineligible for medical assistance because she is not terminally ill – the Canadian law states that in order to qualify for death by lethal injection, a person's ‘natural death must be reasonably foreseeable’.  Ms Lamb was diagnosed with spinal muscular atrophy when she was 16 months old and she may live for many more years, even decades.  She has filed her constitutional challenge in the British Columbia Supreme Court with the backing of the British Columbia Civil Liberties Association.

Similarly, Quebec’s Health Minister, Gaétan Barrette, wants more.  A palliative care unit at the McGill University Health Center did not permit euthanasia on its premises.  Patients who want to be killed could simply be moved out of the palliative unit and into the adjoining hospital.  Yet the palliative care unit was reluctantly forced to change its policy.  Minister Barrette was ‘shocked’ by the unit’s apparent intransigence.

The Euthanasia Prevention Coalition believes that the Canadian euthanasia lobby is wanting to extend euthanasia to ‘mature’ minors, to people with dementia and for people with psychiatric conditions alone.  Where will it end?  Should someone who is blind be eligible?  Should someone who has autism be entitled?  Will Canada outdo the Netherlands, or even Belgium, in extending the qualifying boundaries?

How many Canadians have been euthanized?

In early September, the Canadian Broadcasting Corporation (CBC) reported that more than 120 Canadians have already died as a result of the new assisted suicide law enacted in June.  Official numbers are unavailable because the government has yet to implement a protocol to collect the required data.

The actual number of deaths is probably significantly higher than 120 because several provinces, when asked by the CBC, could not, or would not, provide figures.  For example, Québec provided no official data whatsoever, but the disability rights group Toujours Vivant - Not Dead Yet, has reported that from December 2015 to June 2016, there were 166 euthanasia deaths in Québec.  Where numbers were returned they amounted to 49 assisted deaths in Ontario, 46 in British Columbia, 15 in Alberta, 8 in Manitoba and with fewer in other provinces.

The truth is that, like everywhere else where euthanasia and assisted suicide has been legalised, official figures are hard to come by, and when they are published, nobody believes that they are accurate – they are always underestimates.

My Death, My Decision (MDMD)
This is yet another right-to-die campaigning group attempting to legalise assisted dying in the UK.   In truth, it is not a new organisation, but a rebranding and relaunching of the old Society for Old Age Rational Suicide (SOARS), which was established in the UK in 2009, by Michael Irwin, a former chairman of the Voluntary Euthanasia Society.  The latter was founded in 1935 as the Voluntary Euthanasia Legalisation Society, then it became the Voluntary Euthanasia Society in 1969, Exit in 1979, before reverting to the Voluntary Euthanasia Society in 1982 and eventually, in 2006, it renamed itself Dignity in Dying – come on, keep up!  Unlike the latter, MDMD thinks that assisted dying should not be restricted to those who are terminally ill with a prognosis of 6 months or less.

The MDMD website states that it, '... wants to see a more compassionate approach to dying in the UK, including giving people the legal right to a medically assisted death if that is their persistent wish.'  In other words, it wants assisted suicide legalised for the non-terminally ill.  As such it has a focus on, '... in particular those suffering from long term degenerative diseases such as MS, MND and dementia.'  Of course, MDMD wants 'safeguards' and 'personal autonomy'.  It wants, '... to agree a workable set of safeguards which will protect vulnerable people' and, of course, it wants to accomplish this '... while allowing personal autonomy to those who feel their life is complete and no longer wish to endure their worsening conditions, prefering [sic] the option of assisted dying.'  We have heard these seemingly laudable aspirations before – many times before.  They are both dangerous and unachievable.

USA and Elsewhere

The USA Presidential election
The run-up to the November election always has its own momentum and drama.  But what could the future incumbent mean for bioethical issues, particularly abortion, in America?  Of course, nobody knows – politicians have a habit of promising lots and delivering little.

But what have the candidates said so far?   Hillary Clinton, best friend of Planned Parenthood, the largest abortion agency in the US, has promised to ‘put Christianity at the heart of her presidency if she is elected.’  She has said she had a ‘deep and abiding Christian faith and practice’ and her aim is ‘to reflect the love of God and follow the example of Jesus Christ to the greater good of God's beloved community.’  Those are nice words, but with little bioethical content.

Her running mate is Tim Kaine, a senator from Virginia.  He is also a Roman Catholic, but also pro-choice.  Previously he has admitted to having ‘a faith-based opposition to abortion’ but he also has said that, ‘Roe vs. Wade is ultimately about saying that there is a realm of personal liberty for people to make this decision’ and ‘I don’t think ultimately we ought to be criminalizing abortion.’  The Clinton-Kaine ticket is bioethically vague, but undoubtedly pro-choice.

On the other hand, Donald Trump has been more explicit.  He has attacked, ‘Hillary Clinton’s unwavering commitment to advancing taxpayer-funded abortion on-demand.’  Furthermore, he has pledged to nominate pro-life justices to the US Supreme Court, sign into law the Pain-Capable Unborn Child Protection Act, which would end painful late-term abortions nationwide, reallocate funding to community health centres that provide comprehensive health care for women, and make the Hyde Amendment permanent law to protect taxpayers from having to pay for abortions.’  They too may be just pretty words, but they are also pretty specific.

Meanwhile, Trump’s running mate, Mike Pence, governor of Indiana, has repeatedly declared, ‘Well, I'm pro-life.  I don't apologize for it.  I’d like to see Roe vs. Wade overturned and consigned to the ash heap of history.’

In late September, Trump announced a team of pro-life heavyweights to act as his brains trust on life issues, the Pro-Life Coalition.  There are 32 national co-chairs of the group, including several evangelicals, whose remit is to speak in support of the Trump-Pence ticket and drive the campaign’s pro-life message to individual voters.  The other side is not sitting on its hands.  Planned Parenthood has committed at least $18 million to the 2016 election.  And NARAL Pro-Choice America recently announced a $300,000 digital advertising campaign to target Trump and some Republican senators on the issue of abortion.

Come Tuesday 8 November, the votes will be cast.  What then will the 45th President of the United States do, as opposed to merely say, about bioethical issues?  Only time will tell.

Watch out, here comes China
China has already become a great manufacturing hub – we all have Chinese products in our homes.  The country is also determined to become a biological superpower.  For instance, it was in April 2015 that Chinese scientists accomplished a world first by successfully using gene-editing techniques with human embryos.

As a step towards its desired goal, China is now preparing to become the world’s largest biological information centre.  BGI, formerly known as the Beijing Genomics Institute, had developed the China National Genebank, located in the south of the country.  It hopes to identify genes linked to diseases and thereby increase the average human lifespan by five years.

The facility already had 10 million samples.  And it is already storing, sequencing and handling data to boost its own genetics industry.  Nevertheless, doubts have been raised about the ethical nature of some of the centre’s activities – they would not be sanctioned in other parts of the world.  Bioethical sensitivity is not one of China’s strong suits.  Be that as it may, watch out, China is planning to be a big player in the world of genetic research.

Abortion in France
Laurence Rossignol, the French minister for Families, Childhood and Women’s Rights celebrated the Global Day of Action for Access to Safe and Legal Abortion on 28 September by announcing plans to suppress websites that ‘mislead’ women about the methods and outcomes of abortion.

She plans to criminalise those sites that aim to dissuade women from obtaining a ‘voluntary interruption of pregnancy’, a procedure that is state-funded in France during the first 12 weeks of gestation.  Offenders will incur sentences of up to two years imprisonment and fines up to 30,000 euros (about £26,000).  Rossignol has announced that the government will propose a legal amendment to be presented to the French Senate on 4 October.  Nobody supports the dissemination of misinformation, but there are those who deny that abortion takes the life of an unborn child and that it can physically and psychologically damage women.  M. Rossignol must be careful to separate fact from fiction and reality from ideology.

Abortion in Poland
On 23 September, the Lower House of the Polish parliament voted to reject a ‘Save Women, Not a Step Further’ bill, which proposed legalising abortion-on-demand.  At the same time it voted to continue the legislative process on a ‘Stop Abortion’ measure, which could result in a near-total ban on abortion in Poland.

The ‘Save Women’ proposal, presented by abortion advocates and which sought inclusions for the health of the mother and foetal deformity up to 24 weeks, was defeated by 230 votes to 173.  Meanwhile, the ‘Stop Abortion’ bill passed by a majority of 267 votes to 154.  Backed by the governing conservative Law and Justice Party, the bill now moves to the Committee stage for final drafting before returning to the House for approval.  The wide voting margin is seen as a sign that the final bill will pass.  Could Poland design the blueprint for other European countries?  Apparently not - on 6 October, Poland’s Sejm, the lower house of Parliament, surprisingly voted 352-58 to reject the abortion ban proposed by the 'Stop Abortion' Committee.  Who can understand politics, especially abortion politics?

Abortion in Russia
Abortion has long been a recognised social practice in Russia.  In 2015, there were, according to official figures, 930,000 abortions performed in that country – some say the real figure is perhaps twice that.  At the end of September, Russia reopened its abortion debate.  Significantly, the head of the Russian Orthodox Church, Patriarch Kirill, endorsed an anti-abortion petition.

The petition calls for a ban on any surgical or therapeutic interruption of pregnancy, as well as the use of contraceptives with abortion-inducing effects throughout the country.  In addition, it requests that the moment of conception be recognised as the beginning of human life and stresses that the human embryo should be legally protected.

The goal of the petition organisers is a million signatures, which will allow them access to President Putin.  More than 300,000 people have already signed it.  While the Kremlin generally supports the social conservatism propagated by the church, officials have largely ignored its previous calls to reduce access to abortion.

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