Coronavirus – where to start?  And when to stop?  Our news screens are full of it, our lives are subject to it, and the misinformation is troubling.  So, if vaccines are the answer, what are the questions?  How are vaccines made?  How are they tested?  Are they medically safe?  Are they ethically sound?  Are some bioethically dubious?  What should we think and do?  This year a few of us will be infected by Covid-19, next year all of us will be faced with a Covid-19 vaccine.  We need knowledge and understanding.  Here goes:

In summary, we live in a complex, but not morally-neutral, world where we stand to benefit from the present and past actions of both virtuous and vicious men and women.  How can we apply bioethical, even biblical, principles to negotiate these complexities without losing our moral integrity?  In the current pandemic, citizens of good conscience may use Covid-19 vaccines derived with the aid, but not as current, active ingredients, of historically-obtained human fetal cell lines.  In addition, such men and women should avoid public scandal by first making their opposition to abortion absolutely clear.  The upshot of understanding these issues has been an increased global call for unimpeachably bioethical ‘clean’ vaccines.  That would be good.  People should not be forced to make the choice between being vaccinated against Covid-19 and acting against their consciences.

What are we to do?  It would be nice to live ethically pure lives.  But we live in the real world that is perforated with evil and sin.  We cannot go out and live in this world without interacting and being tainted by things and people we consider immoral or unethical.  Our thinking and our actions are often wrong and naïve.  When Boots the chemist started selling the morning-after pill, we boycotted its stores.  It did little except temporarily salve our consciences.  We now creep back to shop there occasionally.  Like many disasters, this Covid-19 pandemic is highlighting weaknesses in ourselves, in our worldviews, skill sets and systems.  What are we to do?  Live dangerously, but in the hands of God.

BPAS and IVF
Here are two abbreviations nobody ever thought they would see juxtaposed.  The British Pregnancy Advisory Service (BPAS) is the UK’s leading provider of abortions.  According to its website, ‘We are the leading specialists of abortion advice and treatment in the UK, taking care of almost 80,000 women each year in over 70 reproductive healthcare clinics nationwide.’

 

BPAS is a not-for-profit charity, but its trade is abortion.  Ann Furedi, its CEO, is an abortion zealot.  She has said, ‘People talk about it as the lesser of two evils, and I think it’s important to recognise that what we do is actually a good thing; it’s good.’

 

BPAS makes its money by terminating the lives of the unborn.  Therefore who is not stunned to learn that BPAS is planning to open a clinic in London for fertility services, such as IVF – starting beautiful lives – in Spring 2021?  BPAS and IVF are the oddest of bedfellows.  Making unborn children and also killing unborn children is a bizarre industry.  The parents of the very same IVF-aborted child could even be double-charged.

 

Furedi asks, ‘So how can a charity, known internationally for its advocacy and provision of abortion services, argue for, and offer, IVF?’  Unsurprisingly in Furedi’s mind there is no conflict.  She answers, ‘Everything is contingent, everything depends on context, and everything is personal.  As an organisation, our core value is choice: the self-determination to decide if, when and with whom to have a child.  We have helped women to exercise that choice to end pregnancy, now we will help women to achieve pregnancy.’

 

If you regard abortion services as an acceptable part of women’s reproductive healthcare, then maybe BPAS-IVF is not such a weird project.  If you regard fertility care and abortion as antitheses, then BPAS-IVF will alarm you.

 

‘DIY’ abortions at home
Will the temporary become permanent?  Way back on 30 March, the UK Government announced a change to abortion legislation.  A ‘DIY’ early medical abortion (EMA), that is, up to 10 weeks of a pregnancy, could now be performed using mifepristone and misoprostol, as ‘pills by post’, entirely at home, by a woman on herself, without a doctor or another medical professional being present.  The change was announced without public consultation or proper parliamentary scrutiny.  A Government spokesperson insisted that, ‘This measure will be on a temporary basis and must follow a telephone or e-consultation with a doctor.’  Yet there are known dangers with such a policy.  For example, instances are known of severe bleeding, infections, undiagnosed ectopic pregnancies, unknown stages of gestation, a lack of mental health assessments, checks for correct dosages, patient identity, the presence of coercion, and so on.

 

During a House of Commons debate on 6 July, Victoria Atkins MP, Parliamentary Under Secretary of State at the Home Office, announced, ‘The Government consider that the right way forward is to undertake a public consultation on whether to make permanent the current Covid-19 measure allowing for home use of early medical abortion pills up to 10 weeks’ gestation for all eligible women’ and ‘I can confirm that we will keep the current Covid-19 measures in place until the public consultation concludes and a decision has been made.’

 

In the House of Lords on 9 July, in reply to a searching question tabled by Baroness Stroud on 30 June, Lord Bethell, Minister for Innovation, who also leads on Covid-19 policy, replied, ‘The Department is carefully monitoring the impact of and compliance with the temporary approval of home administration of both sets of abortion medication during the COVID-19 pandemic.  Officials have regular meetings with the Royal College of Obstetricians and Gynaecologists, the Care Quality Commission and abortion service providers to discuss the impact and any issues arising.’  And, ‘The Department is keeping under review when the temporary approval will be removed.’

 

Initially, the Government had promised only to keep the new regulations in place during the Covid-19 lockdown, but this was later extended to two years.  Now, ministers are considering keeping the current system permanently in place after it expires in 18 months’ time.

 

On 7 September, Lord Bethel, in answer to another question tabled on 28 July by Baroness Stroud, reaffirmed that, the Government has committed to undertake a public consultation on making permanent the Covid-19 measure allowing for home use of both pills for early medical abortion up to 10 weeks gestation for all eligible women.  The current Covid-19 measure will be kept in place until the public consultation concludes and a decision has been made.  Work to develop the consultation will begin soon and further details will be available in due course.

 

Here’s the thing.  Were these new measures introduced only for the period of Covid-19 emergencies and will they be only temporary?  There is still no date set, or content proposed, for that promised public consultation.

IVF and ARTs

Fertility treatments 2018
On 30 June, the HFEA published its annual Report entitled, Fertility treatment 2018: trends and figures.  UK statistics for IVF and DI treatment, storage, and donation.  The Report analysed data from all fertility treatments across the UK during 2018.  Overall, it reported that during 2018 about 54,000 patients underwent 68,724 fresh and frozen in vitro fertilisation (IVF) cycles and 5,651 donor insemination (DI) cycles at HFEA-licensed fertility clinics throughout the UK.  Other headline findings included a surge in ova and embryo freezing, increasing IVF success rates for some, a decrease in multiple births and a decrease in NHS funding for fertility treatments.

Since 2013, the number of ova and embryo storage cycles HAVEincreased five-fold (523%) from 1,500 to just under 9,000 cycles in 2018 as freezing techniques improved and became more commonplace, and patients looked to future use as age, career and marriage prospects impacted on their options.  Frozen embryo transfer is rapidly gaining on fresh as the favoured transfer protocol – fresh transfers decreased by 11% (48,391 to 42,835) between 2013 and 2018, while frozen transfers almost doubled (13,421 to 25,889) accounting for 38% of all IVF cycles in 2018.  Vitrification is the new IVF snow queen.

The average birth rate per embryo transferred for all IVF patients was 23% – a stubbornly static statistic.  Even so, rates have steadily increased for all patients aged under 43.  Age is still a key factor in IVF outcomes, with younger patients reporting higher success rates.  Birth rates for patients under 35 years old were 31% per embryo transferred, compared with below 5% for patients aged 43 and above when using their own ova.

The live birth rate per embryo transferred remains above 20% for each of the first three cycles of IVF treatment.  Using donor ova increased considerably the chance of a live birth to above 25%, but only 18% of patients aged 40 and older used donor ova.

The multiple birth rate decreased to 8% in 2018 for the first time – a record low.  Fertility clinics have been working towards a target of 10% of women who become pregnant with twins or triplets – multiple births are still the biggest health risk to IVF mothers and their babies.  Transferring more than one embryo has no significant impact on the chance of a live birth but results in a 32% multiple birth rate for patients under 35.

The level of NHS funding for fertility treatment varies across the UK with 60% of cycles funded by the NHS in Scotland.  This compares with 45% in Northern Ireland, 41% in Wales and 35% in England.

 
Family formations 2018
In September, the HFEA published another Report, Family formations in fertility treatment 2018.  It examines IVF and DI statistics for heterosexual, female same-sex and single patients in the UK.  The major findings are reported here.

During 2018, fertility treatments were mostly (90%) used by patients in heterosexual relationships, followed by patients in female same-sex relationships (6.4%) and single patients (3.2%).

Patients in female same-sex relationships and single patients used IVF in 45% and 57% of their treatments respectively during 2018.  These were the highest proportions ever recorded. The remaining treatments used donor insemination (DI).

IVF success rates, measured as births per embryo transferred were highest for patients in female same-sex relationships (31%), followed by patients in heterosexual relationships (23%) and single patients (17%).

DI birth rates per treatment cycle were highest for patients in female same-sex (15%) and heterosexual (14%) relationships, and lowest for single patients (9%) likely due to age differences.  Most patients freezing ova had no partner (55%), followed by patients in heterosexual relationships (44%).  Patients thawing their own frozen ova for treatment were most commonly (88%) in heterosexual relationships.

NHS-funded IVF cycles were more common for patients in heterosexual relationships (39%) compared with patients in female same-sex relationships (14%) and single patients (6%).  Heterosexual couples had the highest NHS funding for DI (16%), though they were least likely to use DI (3% of treatments).  DI funding was 13% for patients in same-sex couples and 2% for single patients.  IVF ova-sharing programmes were used by patients in same-sex relationships (8%) and single patients (7%) compared with patients in heterosexual relationships (1%).

What should we conclude?  IVF was originally intended only for married couples, meaning a man and a woman.  IVF practice then followed the trend for cohabiting couples.  Now almost anyone and everyone, including same-sex couples and singles, is eligible to use IVF.  Of course, IVF remains a treatment mainly for infertile heterosexual couples, but it entails costs, and not only the £5k per treatment cycle, but also the psychological, relationship and disappointment costs.  This HFEA Report highlights the correlation, though not necessarily causation, between IVF usage and the decline in marriage plus the breakdown of traditional family structures.  IVF always entails a high price.

‘Fertility equality’
This is the new slogan coined to reflect an emerging trend in the advance of so-called reproductive freedom.  According to the New York Times (22 July), ‘Still in its infancy, this movement envisions a future when the ability to create a family is no longer determined by one’s wealth, sexuality, gender or biology.’

 

What has driven this new cause?  Until April it was illegal in New York State to pay a surrogate to carry a baby.  The change in law was the result of a decade-long legislative battle which some activists have termed ‘fertility equality’.

 

One of its leading proponents is Ron Poole-Dayan, the founder and executive director of Men Having Babies, a New York non-profit organisation that helps gay men become fathers through surrogacy.  He has stated that, ‘This is about society extending equality to its final and logical conclusion.  True equality doesn’t stop at marriage.  It recognises the barriers LGBTs face in forming families and proposes solutions to overcome these obstacles.’

 

Poole-Dayan and others believe that infertility should not be defined as merely a physical disorder, but a social one.  They argue that people – gay, straight, single, married, male, female – are not infertile because their bodies refuse to cooperate with baby making.  Rather, their specific life circumstances, like being a man with a same-sex partner, have rendered them unable to conceive or carry a child to term without medical intervention.  A novel category of ‘social infertility’ would provide those who are biologically unable to form families with the legal and medical mechanisms to do so.

 

According to Catherine Sakimura, of the National Center for Lesbian Rights, ‘We have this idea that infertility is about failing to become pregnant through intercourse, but this is a very hetero-centric viewpoint.  We must shift our thinking so that the need for assisted reproductive technologies is not a condition, but simply a fact.’

 

‘Fertility equality’ obviously has significant financial implications.  If it were recognised, US medical insurance companies, or the NHS in the UK, would be asked to cover procedures like sperm retrieval, ova donation, embryo creation and surrogacy, for heterosexual and gay couples and singles.  Legislators, such as Liz Linehan from Connecticut, recognise this but insist, ‘It’s a social justice issue.  It’s also a fiscal issue, this is also about fiscal injustice.  How will young LGBTs form families if they cannot afford it?’

Stop and think.  Have we been overtaken by this drive for equality on all levels and aspects of life?  Does not ‘fertility equality’ erase women and deny them their essential biological role?  Does it not depend largely upon the power of men, especially gay men to purchase the bodies of women?  Does it not eradicate womanhood and motherhood as we know it?
 

Ellie Anderson
She was a 16-year-old transgender girl, who lived in Stirling and died in July of ‘unascertained’ causes after commencing female hormone therapy.

 

Two years earlier, Ellie had her sperm frozen at Glasgow Royal Infirmary Fertility Clinic so that she could, one day, have her own biological children with the help of donor ova and a surrogate.  According to her mother, Louise, ‘As a teenager she delayed hormone blockers to save her sperm to enable her to have her own biological children.  She had made me promise that if anything were to happen to her, her children would be brought into the world.  I am going to do everything I can to honour her wishes.’

 

However, this is not legally possible in the UK – the HFE Act (1990) requires the sperm sample to be destroyed. The Act contains provision for stored gametes to be retained for use by a partner in the event of the patient's death, but not for anyone else.  If Ellie had been in a relationship when she died, her partner would have had the right to ask for her sperm to be retained.  Her mother does not have that right.  Nevertheless, solicitors are planning to take the case to the Court of Session in Edinburgh to reverse this.

 

Her lawyer described Mrs Anderson’s request as an ‘unusual, interesting, important and complex legal issue.’  ‘What we're trying to achieve would be to get an order from the Court that Ellie's mum would be entitled to make use of her sperm for the purpose that Ellie intended – that being to create a genetic child of hers and a grandchild for Mrs Anderson.'

As of September, the Scottish NHS agreed to continue storing the dead teen's frozen sperm until her mother can bring the case to Court.  A Court date has been set for 30 November.  If Mrs Anderson is successful, a legal precedent could be established for other parents to use their deceased children's gametes.
 

Who could have predicted such a sad and complex bioethical dilemma consisting of transgenderism, posthumous sperm donation, ova donation, IVF, surrogacy and grand-motherhood?

 

Frozen ova storage limits
Sperm can be frozen and stored indefinitely.  The same is not true for ova.  Currently in the UK, there is a 55-year limit for storing ova for medical reasons, such as prior to cancer treatment to protect their survival.  But for social reasons the storage limit is 10 years, after which the ova must be destroyed.

 

There is now a push to change this latter limit.  At the end of September, the Nuffield Council on Bioethics published a Briefing Note entitled, Egg freezing in the UK.  It maintains that a longer storage period would give more people more time and more options.  The Government is currently assessing the 10-year rule.

Yet according to HFEA 2018 data, 85% of frozen ova are never thawed and used.  And not all thawed ova survive.  Moreover, only around a fifth of IVF treatments using a patient's own frozen ova result in the birth of a baby, with greater success for those aged under 35.  And there are the inevitable extra financial charges – ova collected and frozen for social reasons cost on average £3,350, with additional £500 to £1,500 costs for medication, plus storage costs at between £125 and £350 per year.

 

The Nuffield Council maintains that there appear to be few arguments against increasing the storage limit for social ova freezing.  Yet is does warn against the strategies of clinics that exploit women’s reproductive anxieties, including prosecco-fuelled marketing events and computer algorithms which target women with online advertisements.  Another of its concerns is ova freezing paid for by companies as an employment benefit.

 

Among the Nuffield Council’s conclusions is this statement, ‘There are few arguments against increasing storage limits for SEF [social egg freezing].  Those that are put forward are primarily against SEF per se rather than against an increase to the time limit.’  However, it may be argued that such a statement grossly underestimates the latent bioethical dilemmas of the technique.

In February 2020, a public consultation began into how long frozen ova, sperm and embryos can be stored.  The Government is still considering the evidence and has said it will publish its findings in due course. 

Euthanasia and Assisted Suicide

UK doctors vote for assisted suicide?
In 2006, members of the British Medical Association (BMA), the UK’s largest union, adopted a policy of opposition to assisted suicide.  Now, after a February 2020 survey of its members, that opposition has declined.  Of the nearly 29,000 responding doctors and medical students (19% of all BMA members), for the first time, 50% believe the law should be changed to allow them to prescribe life-ending drugs for patients to self-administer.  That is an approval of assisted suicide rather than euthanasia.  A further 39% opposed this and 11% were undecided.

Asked whether the BMA should campaign for a change in the law, 40% said it should, 33% said it should maintain its policy of opposing a law change, and 21% said the BMA should change to a neutral stance and 6% were undecided.

Asked whether they would personally support a law change to allow doctors to deliver the fatal doses, 46% opposed such a change, 37% supported it and 17% were undecided.

Asked whether they would be personally willing in any way to participate in the assisted suicide process, 54% were opposed, 26% were supportive and 20% were undecided.  In other words, most of the doctors surveyed did not want to administer the life-ending drugs themselves, meaning they would be committing euthanasia.  However, at least a quarter would be willing to presumably prescribe, obtain, prepare and hand over the lethal dose within the definition of assisted suicide.
 
BMA members from Northern Ireland, those registered with a licence to practise in the UK (rather than those unlicensed retired and medical students), GPs (as opposed to medical students), and those working in anaesthetics, obstetrics & gynaecology, emergency medicine, intensive care, oncology and palliative care were more opposed to assisted suicide.  Significantly, these latter groups are those who work in branches of medicine involving frequent contact with, and experience of, terminally-ill patients.

The BMA emphasised that the poll was not a vote and did not commit the BMA to any change in its formal opposition to assisted dying, explaining, ‘These detailed findings will make for an in-depth, considered debate on the future of the BMA’s policy when our members meet at the association’s next annual meeting in the summer 2021.  It is possible that doctors will then call for a formal change in the union’s stance on assisted suicide.

Unsurprisingly, the interpretation of the poll’s results have been varied.  Humanists UK, which supports the legalisation of assisted dying, described the survey as a ‘landmark’ moment and said, ‘The BMA looks like it must end its policy of opposing assisted dying.’  Dignity in Dying responded, ‘This is a historic vote and shows the majority of doctors support greater choice at the end of life.  The BMA’s official opposition to assisted dying is completely unrepresentative of its members.’  On the other hand, the Care Not Killing group said, ‘We are seeing strongest opposition to changing the law from those medics actually working most closely with terminally ill, elderly and disabled patients, compared to those who work in other non-related fields.’  And Baroness Finlay, professor of palliative care, has written, ‘Whatever view as a society we may take on this complex subject, one thing is clear: assisting people to take their own lives is not a role for doctors.  Decisions that involve balancing rights for some against protection for others are for the courts, not the consulting room.’

Last year, the Royal College of Physicians (RCP) faced criticism and a legal challenge from its members after it moved from a stance of opposition to one of neutrality based on the results of an online survey.  Its poll found that 43.4% of respondents said it should oppose the legalisation of assisted suicide, 31.6% said it should support legalisation, and 25% said it should be neutral.  Robert Buckland, the justice secretary, told the House of Commons last year that, ‘A change to the law in this sensitive area is a matter of conscience and a matter for Parliament rather than one of Government policy.’

RCGP legal challenge
The Royal College of General Practitioners (RCGP) has been threatened with legal proceedings unless it reconsiders its ‘irrational’ decision to continue to oppose any change in UK law to permit assisted dying.

The College had said on 21 February 2020 that its 2019 membership survey did not present a mandate to change its stance opposing assisted dying.  Critics have argued that most respondents voted for the College to change its policy from opposition to a neutral position, which would best reflect the results.

The survey, run by Savanta ComRes from 29 October to 15 December 2019, had 6,674 respondents, a response rate of just 13%.  Of these, 47% said that the RCGP should maintain its opposition to a change in the law, 40% supported a change in the law with safeguards, 11% favoured a neutral position and 2% abstained.  Dignity in Dying interpreted this as 51% in favour of a move from opposition.

In September 2020, two eminent members of the RCGP issued a letter calling for the RCGP Council to review urgently its decision to maintain its opposition to assisted dying.  Professor Aneez Esmail and Sir Sam Everington, high-profile members of the RCGP, have, in conjunction with the Good Law Project, issued a legal challenge that raises serious concerns that the decision taken by the Council at their meeting on 21 February 2020 was ‘irrational, failed to take into account relevant factors and took into account irrelevant factors.’  The legal challenge has been prepared by solicitors at Bindmans LLP with support from Dignity in Dying.

In the meantime, the RCGP commissioned medeConnect to conduct a poll of 1,000 GPs.  The results, released in September, showed that most GPs believe the College should not oppose legalisation of assisted suicide.  A total of 37% voted for adoption of a neutral position, 20% favoured supporting a law change and 35% agreed with retaining the position opposed to legalisation.

Professor Esmail stated, ‘[The medeConnent] poll shows most GPs disagree with Council’s decision on this issue, giving further evidence that the Council’s decision was out of touch.  It’s time for the College to reconsider its unrepresentative position, listen to the membership and adopt a neutral position so that they can truly represent their members and GPs’ views as a whole.’

Professor Everington declared, ‘All of us in general practice face the most challenging times we have ever known and we need more openness and accountability from our representative body.  It is imperative that the leadership at the RCGP gets its house in order, listens to the voices of its members and revisits this undemocratic decision.  GPs deserve better than a defensive, opaque establishment that protects a harmful status quo at all costs and without justification.’

The RCGP plans to survey its members on the assisted suicide issue in five years’ time.  Who could guess what will happen in the interim?

Assisted suicide in Ireland
Meanwhile, Ireland is still rushing madly to shed its traditional bioethical conservatism.  First, there was the legalisation of same-sex marriage, then abortion and now euthanasia.  Not so long ago, Ireland was ranked as the most charitable country in Europe and the second most charitable nation in the world.  What has happened?  Its people seem to dislike, even despise, both its most vulnerable young and old citizens.

Thus in early October, members of the Dáil Éireann, the lower house of the Irish Parliament (known as TDs), voted 81 to 71 to progress a private member’s Bill which would allow the option of ending one's life when terminally ill.  This was a significant defeat for the Government as the Dying with Dignity Bill 2020 passed its second stage.

A Coalition attempt to defer the issue to a special committee for a year was also defeated by 86 votes to 65, with most members having a free vote on this Bill as a matter of conscience.  The Dying with Dignity Bill 2020 will now go to the committee stage to be discussed in more detail.

The Irish Catholic Bishops’ Conference has responded by rightly saying, ‘Once assisted suicide is accepted in principle, it becomes very difficult to draw a line’ and referred to it as ‘always gravely sinful.’

If the Bill becomes law, it would allow Irish residents, living in Ireland for more than a year, and over the age of 18, to be assisted to die by a medical professional if they had stated that was their wish.  They must have an incurable and progressive illness which cannot be reversed by medical treatment and where they are likely to die as a result of their illness or issues related to it.  Bad news all round.

Assisted suicide in Victoria
More bad news.  The law in the Australian state of Victoria permitting assisted suicide was passed on 29 November 2017.  There was an 18-month implementation period before it came into force.  More bad news.  The publication of the third sixth-monthly report from the Voluntary Assisted Dying Review Board (VADRB) entitled, Report of operations January–June 2020 was published in August.  It allows an assessment of the first full year of deaths (19 June 2019 – 30 June 2020) since legalisation.

More bad news.  The Report’s key message – ten times more people than expected have chosen to end their lives under Victoria's landmark legislation in its first year of operation.  State Government-sanctioned lethal medication was used to end the lives of 124 terminally-ill Victorians in the 12 months to June 2020.  This far surpasses the original estimates of just 12 people.  In 2019, Victoria’s premier, Daniel Andrews stated, ‘We anticipate in the first 12 months, based on overseas experience, around a dozen people that will access voluntary assisted dying.’  It has now been estimated that that number will stabilise at between 100 to 150 people annually.  Who knows?

As in other jurisdictions, unbearable pain was not a major factor among the reasons for requesting assisted dying.  In fact, the word ‘pain’ was mentioned only once.  Instead, the Report stated, ‘Loss of autonomy was frequently cited by applicants as a reason for requesting voluntary assisted dying.  Other reasons … included being less able to engage in activities that make life enjoyable, losing control of body functions, and loss of dignity.’

Assisted suicide in New Zealand
On 17 October, the Kiwis held a referendum on voluntary euthanasia (as well as voting in a general election and on the legality of personal use of cannabis).  Earlier in the year, Parliament had already approved its End of Life Choice Act 2019, but the final binding decision rested with the public.

The question on the referendum paper (the first such use of a national ballot to determine a country's assisted suicide law) was a simple, ‘Do you support the End of Life Choice Act coming into force?’  If approved, it will come into effect after 12 months, in October 2021.

The Act specifies the usual criteria – over 18, competent, terminal illness, 6 months to live, two doctors, and so on.  Yet the wording remains unavoidably vague.  For example, there is confusion over the meaning of ‘assisted dying’.  The Act talks about doctor- and self-administration, meaning both voluntary euthanasia and assisted suicide.  And the patient must ‘experience unbearable suffering that cannot be eased.’  That is impossible to define sufficiently tightly, nor is it necessarily equivalent to a ‘terminal illness’.
     
What is wrong with New Zealanders?  They seem to have lost their bioethical heads.  It was only in March that the country passed its Abortion Legislation Act 2020.  This did not tinker with niceties, such as weeks of pregnancy, or who is qualified to perform abortions.  Instead, it went for total decriminalisation.  In other words, abortion was no longer an action defined and governed by protective legal statutes.  It was a mere healthcare matter.  Full stop.  Abortion in New Zealand is now available, without restrictions, to any woman, who is not more than 20 weeks pregnant.  Now euthanasia is heading in that same unfettered direction.  The results of the referendum are expected on 30 October.

On 30 October, preliminary results showed that 65.2% of NZ voters supported the End of Life Choice Act becoming law.  The final outcome will be confirmed on 6 November.  Another sad, sad day for the care, protection and dignity of all human life.

Child euthanasia in the Netherlands
Doctors in the Netherlands can already legally euthanise babies up to 12 months old (with parental consent, of course) as well as children over 12 years old, (with patient and parental consent).  But what about those in between, those in the age gap?  They may soon be allowed.

In mid-October, the Health Minister, Hugo de Jonge, told the Dutch Parliament that it would soon be possible for, ‘a small group of terminally-ill children who agonize with no hope, and unbearable suffering’ to be lawfully euthanised.  He estimated that this change in the law would affect between five and ten children a year.  This, de Jonge implied, would be better than the current treatment of ‘terminal sedation’.  Apparently doctors want legal certainty rather than this ‘grey area’ between palliative care and life termination.

A report, published last year by three Dutch teaching hospitals, claimed that 84% of paediatricians in Holland agree with the Government’s proposal.  Yet the issue has proven to be extremely controversial and has resulted in months of robust debate within the four-party ruling coalition Government.  Opponents have argued, for instance, that, of course, such young children cannot give proper consent.  And there has also been strong opposition from conservative Christian groups.  The intended policy is still under discussion.

Belgium is already worse.  From 2014, it became the first country to permit voluntary euthanasia of children.  Two Belgian children, aged 9 and 11, were the first to be euthanised in 2016 and 2017.

Assisted suicide and the CPS
On 17 August 2020, the UK’s Crown Prosecution Service (CPS) published its latest figures about prosecutions of those involved with assisted suicide, namely, those who may have aided, abetted, counselled or procured and therefore breached the Suicide Act 1961.  The CPS policy on assisted suicide was originally published following a consultation exercise commenced in September 2009.  It provides guidance to prosecutors on the public interest factors to take into account in reaching decisions in cases of encouraging or assisting suicide.

From 1 April 2009 to 31 July 2020, there have been 162 cases referred to the CPS by the police that have been recorded as assisted suicide.  Of these, 107 were not proceeded with by the CPS and 32 cases were withdrawn by the police.

As of 31 July 2020, there are currently seven ongoing cases.  Three cases of encouraging or assisting suicide have been successfully prosecuted.  One case of assisted suicide was charged and acquitted after trial in May 2015 and nine cases were referred onwards for prosecution for homicide or other serious crimes.

Genetic Technologies

CRISPR babies still too risky
Editing genes in human embryos could one day prevent some serious genetic disorders from being passed down to future generations.  Maybe.  But for now, the technique is too risky to be used in embryos destined for reproductive purposes.  So concludes the Report of a high-profile international body, The International Commission on the Clinical Use of Human Germline Genome Editing.

 

The Commission was formed after the Chinese biophysicist Dr He Jiankui shocked the world in 2018 by announcing that he had edited human embryos that were then reproductively implanted in an effort to make the resulting children resistant to HIV infection.  That work, which led to the birth of twin girls, was widely condemned by the scientific community and resulted in prison sentences for He and his two colleagues.

 

On 3 September, the Commission published Heritable Human Genome Editing, a hefty 212-page document containing 11 Recommendations.  It is the result of discussions by experts from 10 countries convened by the US National Academy of Medicine, the US National Academy of Sciences and the UK Royal Society.  Overall, it agrees with other recent reports that have argued against deploying gene editing in the clinical setting until researchers are able to address safety worries, and also when the public has had a chance to comment on bioethical and societal concerns.

The Associated Press release stated, ‘Human embryos whose genomes have been edited should not be used to create a pregnancy until it is established that precise genomic changes can be made reliably without introducing undesired changes – a criterion that has not yet been met by any genome editing technology.  Heritable genome edits can be passed down to future generations, raising not only scientific and medical considerations but also a host of ethical, moral, and societal issues.  Extensive societal dialogue is needed before any country decides whether to permit clinical use of heritable human genome editing – making alterations to genetic material of human eggs, sperm, or any cells that lead to their development, including the cells of early embryos – with the intention of establishing a pregnancy.’

It continues, ‘If a nation decides that heritable human genome editing (HHGE) is permissible, initial uses should be limited to the prevention of serious monogenic diseases, which result from the mutation of one or both copies of a single gene – for example, cystic fibrosis, thalassemia, sickle cell anemia, and Tay-Sachs disease’, the Report says.  For these cases, HHGE should only be considered when prospective parents who are at known risk of transmitting a serious monogenic disease have no option or extremely poor options for having a biologically related child who is not genetically-affected without the editing procedure, due to genetic circumstances or the combination of genetic circumstances and fertility issues.’

In other words, the CRISPR-Cas9, and similar technologies, is not presently ready for clinical application.  Though such techniques offer a fairly precise way to edit the genome, they have been shown to generate some unwanted, off-site changes to genes as well as a range of different outcomes even within cells of the same embryo.  Furthermore, the Report – which reviewed the scientific and technical state of heritable gene editing, rather than strictly bioethical questions – advocates the formation of an international committee that evaluates developments in the technology and advises political leaders and regulators on its safety and utility.

Heritable Human Genome Editing is a scholarly approach to a complex issue.  It is readable, international in content and conservative in tone.  It is to be cautiously welcomed.  However, its great lacunae is any in-depth discussion of the bioethical aspects of heritable genome editing – they are numerous, complex and essential.  If, and when, the scientific and technical aspects are sorted out, the human editing project must not be allowed simply to go ahead without vigorous discussion of its ethics.  Another report, anticipated by the end of 2020 and coordinated by the World Health Organization, is expected to deal more fully with the issues of ethics and governance.

Gene-editing can wreak havoc
In June, a series of preprint papers, not yet peer-reviewed, detailed experiments that confirmed that gene-editing by CRISPR-Cas9 can make large, unwanted changes to the human genome, at or near the target site.  They showed that CRISPR-Cas9 can make not only already-known off-target gene mutations, but also what appear to be underrated risks involving nearby on-target changes.  These are missed by standard assessment methods and could be more difficult to eliminate.

These studies add to the safety concerns in the ongoing debate about whether scientists could/should conduct germline editing of human embryos to prevent diseases.  These latest research papers underscore how little is known about how human embryos repair DNA that is cut by genome-editing tools, such as CRISPR-Cas9.

The first preprint was posted online on 5 June by Kathy Niakan and colleagues from the Francis Crick Institute in London.  They used CRISPR–Cas9 to create mutations in the POU5F1 gene, which is important for embryonic development.  Of 18 genome-edited embryos, about 22% contained unwanted changes affecting large swathes of the DNA surrounding POU5F1.  They included DNA rearrangements and large deletions of several thousand DNA letters – much greater than typically intended by researchers using this approach.

A second group, led by stem-cell biologist Dieter Egli of Columbia University in New York City, studied human embryos created with sperm carrying a blindness-causing mutation in a gene called EYS.  The team used CRISPR-Cas9 to try to correct that mutation, but about half of the embryos tested lost large segments of the chromosome – and sometimes the entire chromosome – on which EYS is situated.

A third group, led by Shoukhrat Mitalipov of Oregon Health & Science University in Portland, studied human embryos made using sperm with a mutation that causes a heart condition.  This team also found signs that editing affected large regions of the chromosome containing the mutated gene.

And the cause of these problems?  When CRISPR-Cas9 cuts both strands of DNA, the cell’s repair mechanism heals the gap.  The problems apparently occur during that repair because the sealing process uses an error-prone mechanism that can insert or delete a small number of DNA letters.  If a DNA template is provided then a true rewrite can occur.  But the presence of broken DNA can cause shuffling or a loss of a large region of the chromosome.

The results from these three papers are extra causes for concern – as if germline editing of human embryos is not already a bioethically dubious endeavour.  Such editing can wreak havoc to embryo integrity.  And the damage appears to be commonplace and unpredictable rather than just an exceptional happenstance. 

And it needs to be said, all of these research efforts used human embryos and then destroyed them – dozens of them.  This sort of science can be reported and discussed, but not approved.

Human X chromosome sequenced
A complete DNA sequence of the human X chromosome has been reported – the first time a human chromosome has been read in its entirety, from end-to-end.  It is a great achievement.  Next, the whole human genome!

The research has been published as 'Telomere-to-telomere assembly of a complete human X chromosome' by K H Miga et al., in Nature (2020, 585: 79–84).  The authors state, ‘After two decades of improvements, the current human reference genome (GRCh38) is the most accurate and complete vertebrate genome ever produced.  However, no single chromosome has been finished end to end, and hundreds of unresolved gaps persist.  Here we present a human genome assembly that surpasses the continuity of GRCh38, along with a gapless, telomere-to-telomere assembly of a human chromosome.’

 

According to the study co-leader of the US team, Dr Adam Phillippy from the National Human Genome Research Institute in Bethesda, Maryland, mapping whole chromosomes is like trying to solve an almost impossible puzzle.  He suggests, 'Imagine having to reconstruct a jigsaw puzzle, but each tiny piece contains less context for figuring out where it comes from.  The same is true for sequencing the human genome.  Until now, the pieces were too small, and there was no way to put the hardest parts of the puzzle together.’

 

According to Dr Karen Miga, the project’s co-leader from the University of California, Santa Cruz Genomics Institute, completing the human genome is now of great importance.  She reckoned, 'We're starting to find that some of these regions where there were gaps in the reference sequence are actually among the richest for variation in human populations, so we've been missing a lot of information that could be important to understanding human biology and disease.’

 

The results of this study show that finishing chromosome sequences, and therefore those of the human genome, is now within reach.  However, huge challenges remain.  For example, chromosomes 1 and 9 have repetitive DNA segments that are much longer than those found on the X chromosome.  But scientists thrive on challenges.

Editing mitochondria
US scientists have developed a method of making precise edits to mitochondrial DNA within living cells.  Researchers from the Broad Institute of MIT and the University of Washington School of Medicine have created a new approach that combines features of CRISPR-based base editing with an older approach known as TALENS, to correct point mutations in the mitochondrial genome.

The research has been published as, ‘A bacterial cytidine deaminase toxin enables CRISPR-free mitochondrial base editing’ by B Y Mok et al., in Nature (2020, 583: 631–637).  Professor Vamsi Mootha, one of the paper’s authors said, 'It's a quantum leap forward.  This is the first time in my career that we've been able to engineer a precise edit in mitochondrial DNA.'  Mitochondria are the self-contained organelles found in almost every cell in the human body, where they generate the energy to power the cell.  Mitochondria contain their own genomes – circular pieces of DNA completely separate from the chromosomes in the cell's nucleus.  CRISPR-Cas9 editing does not work in mitochondria because the guide RNA molecules cannot cross the membrane that surrounds each mitochondrion.  In addition, the DNA repair mechanisms that mend the double-stranded breaks caused by Cas9 are not present in mitochondria.

This new approach employed a novel interbacterial cytidine deaminase toxin, named as Ddda, which can change a cytosine base in the DNA code to a thiamine, and so has the potential to correct some point mutations in the mitochondrial genome.  The team constructed a CRISPR-free, RNA-free base editor that cancelled Ddda's toxicity and paired it with a TALE (a Transcription Activator-Like Effector), which unlike CRISPR RNA can cross the mitochondrial membrane.

According to Professor Mougous, a team member from the University of Washington, 'A mitochondrial genome editor has the long-term potential to be developed into a therapeutic to treat mitochondrial-derived diseases, and it has more immediate value as a tool that scientists can use to better model mitochondrial diseases and explore fundamental questions pertaining to mitochondrial biology and genetics.’

CasΦ – the new enzyme

CRISPR-Cas9 has become the standard gene-editing tool.  Now another and smaller CRISPR-associated enzyme, which may improve the efficacy of editing, has been discovered by US scientists.  This new enzyme is called CasΦ (that is, Cas-phi) and is described as, 'a hypercompact addition to the genome-editing toolbox.’  The work was reported in Science (2020, 369: 333-337) as ‘CRISPR-CasΦ from huge phages is a hypercompact genome editor’ by P Pausch et al.

According to Jennifer Doudna, CRISPR pioneer and group leader at the University of California, Berkeley, the large size of the Cas9 enzyme and hence difficulties with delivering it is, ‘really one of the most important bottlenecks to the field right now.’  And, ‘We think this very tiny virus-encoded CRISPR-Cas system may be one way to break through that barrier.’

The study tested the function of the CasΦ protein on both human and plant cells in vitro.  The research team found that due to its small size, CasΦ was able to access and cut more DNA regions of human and plant genomes than other common Cas proteins.  And they found that CasΦ cleaves double-stranded DNA like that found in human cells.  These properties could make CasΦ a better alternative than other CRISPR-Cas systems currently used for genome editing.

While common Cas proteins, such as Cas9, rely on accessory proteins to work, CasΦ can perform all necessary functions on its own.  As Doudna has remarked CasΦ, '... is actually very good at what it does, but it is a lot smaller, about half the size of Cas9.’  The discovery of CasΦ earlier this year was the first evidence that Cas proteins can exist within viruses rather than just bacteria.  These viruses, known as bacteriophages, may explain the unusual properties of CasΦ.  Bacteriophages may yet become gene-editors new best friends.

Stem-cell Technologies

3D printing cardiac organoids
Here is a fascinating incongruence – the physicality of 3D printing and the corporeality of a beating human heart.  After years of trying, a research group at the University of Minnesota has finally achieved the implausible.

Previously the scientists had followed a sensible protocol.  They used human induced pluripotent stem cells (iPSCs) and differentiated them into cardiac cells.  They then used 3D printing technology to graft them onto an extracellular matrix to give them structure.  Sensible, but ineffective.  The cells never reached a critical density to allow for the formation of beating organoids.

The research team was ready to abandon the project.  Then, according to Professor Brenda Ogle, the lead researcher at the Department of Biomedical Engineering in the University of Minnesota College of Science and Engineering, the unexpected occurred.  Two of her biomedical engineering PhD students, Molly Kupfer and Wei-Han Lin, suggested trying printing the stem cells first.  Eureka!

By 3D printing the stem cells and allowing them to reach a critical density before they were differentiated into heart cells, the team was able to demonstrate that it is possible to grow 1.5cm beating-heart organoids in less than a month.  Professor Ogle declared, 'I couldn't believe it when we looked at the dish in the lab and saw the whole thing contracting spontaneously and synchronously and able to move fluid.'  Some call it scientific serendipity.

Of course, these lab-grown, mini, beating, heart organoids are nowhere near as complex as a fully developed human heart, but this work should advance cardiac research and treatments.  Moreover, as Ogle has said, 'We can introduce disease and damage to the model and then study the effects of medicines and other therapeutics.'

Details of this ground-breaking discovery were published as ‘In Situ Expansion, Differentiation, and Electromechanical Coupling of Human Cardiac Muscle in a 3D Bioprinted, Chambered Organoid’ by M Kupfer et al., in Circulation Research (2020, 127: 207–224).

Stem-cell treatments – bad
Stem-cell treatments can be good, bad or terrible.  Proponents of the good sort should continually warn against the bad and the terrible.  As has the US Food and Drug Administration (FDA), in a recent, strongly-worded paper entitled, ‘Identifying the Risks of Unproven Regenerative Medicine Therapies’ by P W Marks & S Hahn in the Journal of the American Medical Association (2020, 324: 241-242).

 

The authors are Stephen Hahn, the FDA’s new commissioner, and Peter Marks, the director of the Center for Biologics and Evaluation and Research (CBER).  They wrote, ‘... these [stem cell] products, whether autologous or allogeneic, are not inherently safe and may be associated with serious adverse consequences.’  They specifically referred to unscrupulous clinics in the US advertising treatments for diseases and conditions ranging from autism to ageing.  But the safety and efficacy of their products are yet to be proven.  For instance, in 2017, three women became blind after receiving untested stem-cell treatment on their eyes at a Florida clinic.

 

They also warn that, ’... the increasing number of adverse events being reported following the widespread use of unapproved regenerative medicine therapies at hundreds of clinics across the country make it necessary for the FDA to act to prevent harm to individuals receiving them.’

 

To evaluate whether a particular cellular product complies with FDA regulations, the authors make practical recommendations for potential patients.  For people considering therapies involving a cellular product, the following three steps are suggested.  First, the patient should verify whether the product is FDA-approved or whether an investigational new drug (IND) application has been filed with the regulatory body.  Second, the patient must provide written informed consent to participate in a clinical trial under that IND and compliance with institutional review board (IRB) requirements.  Third, patients enrolled in a clinical trial should receive a summary of results after the clinical trial is completed.  In addition, Marks and Hahn strongly encourage patients (and their families, friends and doctors) to report adverse events.  Such reports will help the FDA to get a better picture of the full spectrum of adverse events.

 

On the other hand, there is good evidence that more and more patients, especially those with neurological disorders, such as multiple sclerosis (MS), motor neurone disease (MND) and Parkinson's disease, are increasingly seeking information about stem-cell treatments as therapeutic options for their illnesses.

 

Of course there are clinics that will attempt to fly under the FDA’s radar.  The authors therefore request engagement, ‘... to help to ensure that instead of remaining unintentionally or intentionally hidden, potentially harmful unapproved regenerative medicine therapies are identified and then removed from the market.’

 

Such strong warnings are sadly necessary.  The stem-cell treatment industry is riddled with cowboys and their snake-oil products.  They give legitimate clinics and effective products a bad name.  Stem-cell treatments in Europe and elsewhere may be decently regulated, but across much of the rest of the world, especially in China and India, there is a dangerous free-for-all bonanza.  Watch out for stem-cell treatments, good, bad and terrible.

 

How to mend a broken heart
US researchers have developed a new way to heal damaged heart tissue by implanting capsules containing stem cells near to the damaged heart.   During a heart attack, cardiac cells can die when deprived of oxygen.  The body can repair some of the damage with scar tissue, but this does not function in the same way as the original heart muscle and can lead to complications including further heart attacks.

Stem cells can be transformed into any of the body’s cell types, and in addition they can produce therapeutic molecules that can help to regenerate damaged tissues.  These are potentially promising treatment options.  However, when introduced into a body, stem cells can be recognised by the immune system and many can be destroyed.

How to decrease or overcome this stem-cell destruction?  That was the task tackled by Ravi Ghanta and his team from Baylor School of Medicine in Texas.  The team shielded about 30,000 stem cells in 'hydrogel' capsules.  The stem cells used were mesenchymal stem cells (MSCs), a type of stem cell produced in the bone marrow that had previously been shown to repair tissue after a heart attack.

Several of the tiny 1.5mm capsules were implanted into rats that had experienced a heart attack.  After 28 days, animals treated with these capsules of shielded stem cells had 2.5 times more heart healing capacity than rats treated with unshielded stem cells that had been injected directly into the heart.

The study’s other lead author, Dr Omid Veiseh from Rice University in Texas, explained, 'The immune system doesn't recognise our hydrogels as foreign, and doesn't initiate a reaction against the hydrogel.  So we can load MSCs within these hydrogels, and the MSCs live well in the hydrogels.  They also secrete the same reparative factors that they normally do, and because the hydrogels are porous, the wound-healing factors just diffuse out.'  And Dr Ghanti claims that, ‘With further development, this combination of biomaterials and stem cells could be useful in delivering reparative therapy to heart attack patients.’  OK, only rats so far, humans next (maybe).

This work has been reported as, ‘Immune-modulatory alginate protects mesenchymal stem cells for sustained delivery of reparative factors to ischemic myocardium’ by R K Ghanta et al., in Biomaterials Science (2020, 8: 5061-5070).

Miscellaneous

Ruth Bader Ginsburg (1933 - 2020)
Ruth Bader Ginsburg was a pioneering lawyer, a libertarian advocate for equality, especially for women’s rights, and a pro-abortionist.  She was only the second woman ever to serve on the Supreme Court of the United States (SCOTUS) and for several years she was its only woman member – imagine, eight burly men and little her.  On 18 September, she died at her home in Washington from complications of metastatic pancreatic cancer.  She was 87.

 

Though barely five feet tall and weighing about 45 kg, she was a toughie, legally and medically.  She beat colon cancer in 1999 and early-stage pancreatic cancer in 2009.  In 2014, she had a stent fitted to clear a blocked artery.  In December 2018, two small tumours were found on one of her lungs.  A medical scan in February 2020 revealed growths in her liver.  In July 2020, she released a statement saying that her liver cancer had returned and she was undergoing chemotherapy.  Would she retire early?  No way!  She planned to stay ‘as long as I can do the job full steam.’

 

She was as precise in her appearance as in her approach to her work.  She wore her dark hair pulled back and wore tailored suits by Giorgio Armani.  On the court bench she was an active and persistent questioner, but in social settings she tended to say little letting her more outgoing husband speak for her.  Yet, into her ninth decade she remained a most unlikely cultural icon.  She became known as the Notorious R.B.G., a play on the name of the Notorious B.I.G., a famous Brooklyn-born rapper.  The name caught on, as did her image – her serene yet severe expression, that frilly lace collar over her black judicial robe and her eyes framed by those oversized glasses.  Young women had her image tattooed on their arms and ‘You Can’t Spell Truth Without Ruth’ appeared on bumper stickers and T-shirts.  Biographies of her became bestsellers, documentary films were box office hits.  She was an internet sensation.  Hers was a late-life rock stardom.

 

Joan Ruth Bader was the Brooklyn-born daughter of Ukrainian Jews.  Her father, Nathan Bader, immigrated to New York with his family when he was 13.  The family owned small retail stores, including a fur store and a hat shop – money was never plentiful.  Her mother, Celia (née Amster), was born four months after her family’s own arrival.  Ruth, as she was formally known, though nicknamed Kiki, was born on 15 March 1933.  She grew up in Flatbush, a low-income district of New York.  She was essentially an only child – an older sister, Marilyn, died of meningitis at the age of 6 when Ruth was 14 months old.  Her mother died of cancer, aged 47, on the day before Ruth’s graduation from James Madison High School.

 

In 1950, Ruth Bader arrived at Cornell University on a scholarship.  During her first year, she met a second-year student, Martin (aka Marty) Ginsburg.  For the 17-year-old Ruth it was love at first sight.  ‘He was the only boy I ever met who cared that I had a brain’, she frequently recalled in later years.  By her third year, they were engaged, and they were married after her graduation in 1954.  Theirs was a lifelong romantic and intellectual partnership of opposites – she was reserved, choosing her words carefully, he was an ebullient raconteur.

 

Following their marriage, they moved to Oklahoma where Marty Ginsburg served for two years as an Army officer.  Ruth applied for a government job at the local Social Security office.  She was offered a position as a claims examiner, but when she informed the personnel office that she was pregnant with her first child, the offer was withdrawn.  Instead she accepted a lower-paid clerk-typist job.  Years later, such adverse employment incidents and ingrained assumptions that limited women’s opportunities were to become the focus of Ginsburg’s life work.

 

Meanwhile, law studies took her to Harvard University.  When her husband found work in New York City, she transferred to Columbia Law School.  Despite coming top of her class she struggled to find employment there.  ‘I was Jewish, a woman and a mother,’ she explained.  Eventually she found work as secretary to a federal judge in New York, but only by reassuring him that she would never wear trousers to work.

 

By 1963, she was a professor at Rutgers Law School.  While undertaking a study of Swedish civil law at Lund University she was impressed by Scandinavian thinking on gender equality.  Feminism was flourishing in Sweden, and it was commonplace for women to combine work and family obligations.

 

In addition to teaching, she began volunteering to handle discrimination cases for the New Jersey affiliate of the radical American Civil Liberties Union (ACLU).  These cases included complaints by school teachers who had lost their jobs when they became pregnant.  In 1972, the ACLU created a Women’s Rights Project and hired Mrs Ginsburg as its first director.  It was under the auspices of this ACLU project that she developed her strategy to persuade the courts that official discrimination on the basis of sex was a harm of Constitutional dimensions.  It was a daunting uphill task.  Yet between 1973 and 1978, Ginsburg presented six sex discrimination cases before the SCOTUS, and won five.

 

Though ardently in favour of a woman’s right to choose, she was a critic of Roe v. Wade, the Supreme Court’s 1973 decision establishing a constitutional right to abortion.  In a speech at New York University Law School in 1993, several months before her nomination to the Supreme Court, she criticised the ruling as having ‘halted a political process that was moving in a reform direction and thereby, I believe, prolonged divisiveness and deferred stable settlement of the issue.’  She maintained that the SCOTUS should have issued a narrow rather than a sweeping ruling, one that left States with some ability to regulate abortions without prohibiting them.  Nevertheless, on abortion she stubbornly declared that ‘the Government has no business making that choice for a woman.’

 

In 1993, President Clinton had a seat to fill on the SCOTUS.  It was his first nomination to the Court and he carefully searched for the right candidate – some turned him down.  Then there was Ruth Bader Ginsburg.  After a 90-minute meeting with her on 13 June, the President has made up his mind.  He phoned her with the news later that night.  The next day, at the announcement ceremony in the Rose Garden of the White House, Clinton said, ‘I believe that in the years ahead she will be able to be a force for consensus-building on the Supreme Court, just as she has been on the Court of Appeals.’  Judge Ginsburg replied with a tribute to her mother.  She declared, ‘I pray that I may be all that she would have been had she lived in an age when women could aspire and achieve and daughters are cherished as much as sons.’  It brought tears to Clinton’s eyes.

 

During her SCOTUS nomination hearings, addressing the Senate Judiciary Committee, Ginsburg said her approach to judging was neither ‘liberal’ nor ‘conservative’.  She did, however, make clear that her support for the right to abortion, despite her criticism of Roe v. Wade, was unequivocal.  Her subsequent appointment was confirmed on 3 August 1993.

 

Again, on abortion, Justice Ginsburg invariably displayed her true colours.  In 2020, in June Medical Services v. Russo, she voted to strike down a Louisiana pro-life law that would save the unborn from abortion and protect women’s health by requiring abortionists to have hospital admitting privileges for patient emergencies.  She questioned the necessity of the law, arguing that most women who get abortions do not require medical treatment afterwards.  On 29 June, the SCOTUS announced, in a 5 v. 4 decision, that the 2014 Louisiana law was unlawful.

 

In 2016, she joined the majority for Whole Woman's Health v. Hellerstedt, a case which struck down parts of a 2013 Texas law regulating abortion providers.  She claimed the law in question was not aimed at protecting women's health, but rather to impede women's access to abortion.  In 2007, she was in the minority of a 5 to 4 decision in Gonzales v. Carhart which upheld a federal law restricting partial-birth abortions – she considered that the procedure was not safe for women.  In 2000, in Stenberg v. Carhart, she joined in the Court's majority opinion striking down Nebraska’s partial-birth abortion law.  Ginsburg’s unbounded pro-abortion ideology paraded itself finally in 2020, when she voted to force the Little Sisters of the Poor to pay for abortion drugs within their healthcare insurance plan.

 

Her husband, Martin, became a highly-successful tax lawyer yet he happily gave up his lucrative New York law practice to move with her to Washington DC in 1980 when she was appointed to the United States Court of Appeals for the District of Columbia Circuit.  He taught tax law at Georgetown University’s law school.  He was also a talented cook compared with his wife who was, by her own admission, terrible – apparently her children forbade her from entering the kitchen.

 

The Ginsburgs lived next to the John F Kennedy Center for the Performing Arts, where they frequently attended the opera and ballet.  Their 56-year marriage ended with his death from testicular cancer in 2010 at the age of 78.  In his final days, he left a note, handwritten on a yellow pad, for his wife to find by his bedside.  It began, ‘My dearest Ruth.  You are the only person I have loved in my life, setting aside, a bit, parents and kids and their kids, and I have admired and loved you almost since the day we first met at Cornell.  What a treat it has been to watch you progress to the very top of the legal world!!’  Their two children, Jane, a professor at Columbia Law School, and James, a record producer of classical music and the founder of Cedille Records in Chicago, survive their parents, along with four grandchildren.

 

Ruth Ginsburg was a non-observant Jew.  After the two days in repose at the Supreme Court building, she lay in state at the Capitol.  She was the first woman and first Jew to lie in state there.  On 29 September, she was buried beside her husband at the Arlington National Cemetery.  What a gifted and strong-minded woman she was.  Yet one thing she lacked ... (Mark 10:21).

Suicide numbers
Numbers of deaths by suicide are increasing in England and Wales – and probably elsewhere too.  The Royal College of Psychiatrists has recently called for more research to understand the reasons why.

 

Figures published in September by the Office for National Statistics refer to deaths in 2019.  Overall 5,691 suicides (4,303 in men and boys) were registered in England and Wales during 2019.  That is up from a total of 5,420 in 2018.  And that means there was 1 suicide every 90 minutes, with an estimate of 1 attempted every 5 minutes.  And these figures are probably underestimates.

The figures also show that the suicide rate among men and boys was 16.9 deaths per 100 000, the highest since 2000 and slightly above the 2018 rate of 16.2 per 100 000.  The suicide rate among women and girls was 5.3 deaths per 100 000 in 2019, up from 5.0 per 100 000 in 2018 and the highest since 2004.

This is just about the grimmest and saddest issue to review.  We are all affected.  The suicidal and the para-suicidal are nearby.  As mental health is becoming a more widely discussed topic, how much do we understand?  Why, for example, is the highest suicide rate among middle-aged men?  Surely they are now established in their careers, families and communities.  Surely they are now relatively healthy and wealthy.  If so, such factors are not the key drivers of suicide.  Indeed, suicides are more frequently linked to isolation after divorce, or separation from a spouse, or partner and their children, as well as alcoholism, and lost employment.  Men in this group are also often less willing, or too proud, to seek help.

 

But all of us, including switched-on bioethicists cannot afford to ignore the topic.  It can cause untold grief for those ‘left behind’, but it can also inform our thinking about assisted suicide.  Why, for instance, do those doctors who campaign for the legalisation of assisted suicide also run campaigns in their GP practices to help their suicidal patients avoid it?

 

And figures are expected to be even higher in the coming months and years.  Think for example of those with increasingly fragile mental health caused by the negative effects of the Covid-19 pandemic.  The take-home message?  Watch out for those middle-aged men especially and other suicidal people in your family, church, workplace and community.  It’s a Mark 12:30-31 affair.
 

USA and Elsewhere

Amy Coney Barrett
With the recent death of Supreme Court judge Ruth Bader Ginsburg, the opportunity for President Trump to nominate a new member of the 9-person Supreme Court of the United States (SCOTUS) occurred.  The rush was on – the uncertain presidential election was on 3 November.  Would his candidate be approved in time?

The President went for it.  On Saturday 26 September he nominated Amy Coney Barrett.  This was bold on several levels.  Whereas Ginsburg was a radical abortion activist, Barrett was known to be radically pro-life.  If appointed, Barrett would tilt the SCOTUS towards a conservative balance of 6 to 3.  Potential challenges to Roe v. Wade were openly discussed, with dread by some, but with joy by others.

Who is she?  Born in New Orleans, Louisiana, into a family of devout Roman Catholics, she studied English at Rhodes College, Tennessee and then law at Notre Dame Law School, Indiana.  She is the 48-year-old wife of Jesse Barrett, mother of seven children, including two adopted from Haiti, and her youngest biological child has Down’s syndrome.  She tested positive for Covid-19 this summer, but has since recovered.  She is a law professor at the University of Notre Dame Law School, where she has taught civil procedure, constitutional law, and statutory interpretation.  And she is a judge on the Seventh Circuit Court of Appeals.

She is a staunch Roman Catholic and member of the parachurch charismatic renewal organisation People of Praise, which holds, for example, that sexual relationships should occur only between married, heterosexual couples.  She believes life begins at conception and has noted how both pro-life and pro-abortion legal experts have criticised Roe v. Wade as a bad decision.  She also has made several statements about the value of babies in the womb, signed a public letter in 2015 that emphasised ‘the value of human life from conception to natural death’ and has called abortion ‘immoral’.

 

In a 2006 speech to graduates at Notre Dame Law School, she previously declared, ‘...if you can keep in mind that your fundamental purpose in life is not to be a lawyer, but to know, love, and serve God, you truly will be a different kind of lawyer.’

 

On 12 October, she began her Senate Judiciary Committee nomination hearings.  Before, during and after those hearings she has been aggressively attacked by Democrats, mainstream media, abortion activists, humanists, Planned Parenthood, LGBT activists and many more for her conservative personal and political views and her faith.  She would make a great member of the SCOTUS!

And indeed, she will.  On 26 October, the US Senate voted 52 v. 48 to confirm Judge Amy Coney Barrett to be the next Associate Justice on the Supreme Court.  She took the oath of office later that night.  A conservative, constitutionalist, pro-life woman at the Supreme Court.  Whatever next?  We wait expectantly.
 

Heartbeat laws overturned
On 13 July, a federal judge overturned the 2019 Georgia law that would have banned abortions after a fetal heartbeat was detected.  Practically, this would have limited abortions to the first six weeks of a woman’s pregnancy.  Exceptions for rape and incest were also included if a police report had been filed.

 

District Judge Steve C Jones ruled that the law violated precedence set under the 1973 decision in Roe v. Wade and the 1992 decision in Planned Parenthood v. Casey and because it ‘infringes upon a woman’s constitutional right to obtain an abortion prior to viability.’  Judge Jones further argued that it was the court’s duty and in the ‘public interest’ to ensure a woman’s right to get an abortion ‘prior to viability’ was kept intact in the state of Georgia.

In response, Georgia Governor Brian Kemp said of his administration that, ‘We will appeal the Court’s decision.  Georgia values life, and we will keep fighting for the rights of the unborn.’  It is expected that the case will head to the 11th Circuit Court next, and then possibly on to the US Supreme Court.  Some speculate that this case could be the impetus for another conversation on Roe v. Wade in the highest US Court.

On the day that the Georgia law was overturned, a federal judge temporarily blocked a bill in Tennessee that would ban most abortions after the detection of fetal cardiac activity.  At least seven other US states, including Nebraska, Arkansas and North Dakota, have passed similarly restrictive ‘heartbeat’ abortion laws – and they are all currently mired in the courts.

 

US abortion polls
Every year Gallup conducts a US national poll on the issue of abortion.  The results of the 2020 survey show that 53% of US adults believe abortion should be legal ‘only under certain circumstances’, far more than the 25% who were in favour of it being legal with no restrictions, and the 21% who think it should be completely illegal.  These results are similar to those found most years since 1975 when Gallup began tracking these attitudes.

 

In other words, there is a continuing pro-life sentiment across the United States as a majority of people say they are opposed to all or most abortions, as Americans have said for years.  That is, most Americans are pro-life.

Yet, and somewhat confusingly, 58% of Americans said they would oppose a ban on abortions after a fetal heartbeat can be detected, while 40% are in favour of such laws and 3% were undecided.  In addition, 60% of adults do not want the Supreme Court to overturn Roe v. Wade.  And finally, Gallup found that the two major political parties have become more polarised on the issue, with a larger proportion of Democrats identifying as pro-choice and more Republicans identifying as pro-life.  Also true is that Americans in both abortion camps are inclined to make abortion a litmus test for their political vote.

Sayings of Donald J Trump
The Donald is well known for speaking first and thinking second.  Some call him sexist, a racist, just plain bizarre, or a great President.  Yet it is hard to ignore the wholesomeness of some of his statements.  Here is a short selection.

On Amy Coney Barrett, she is 'a woman of unparalleled achievement.’  A ‘stellar scholar and judge’ with ‘unyielding loyalty to the Constitution.’

‘Every person – the born and unborn, the poor, the downcast, the disabled, the infirm, and the elderly – has inherent value.  Although each journey is different, no life is without worth or is inconsequential; the rights of all people must be defended.  On National Sanctity of Human Life Day [21 January 2020], our Nation proudly and strongly reaffirms our commitment to protect the precious gift of life at every stage, from conception to natural death.’

At a political rally in Michigan, he asked the crowd how many had read his own 2015 book, The Art of the Deal.  He declared, 'It's my second favourite book of all time.  Do you know what my first is?, he asked. 'The Bible!  Nothing beats the Bible!'

France goes bioethically mad
At 04:00 in the morning on the first Saturday in August, members of the National Assembly of France voted on a number of radical amendments to its bioethical laws.  The vote in favour was only 60 v. 37 with 4 abstentions out of a total of 577 Assembly members.  In particular, the Assembly approved liberal abortion laws, the creation of genetically-modified embryos, chimeras (animal-human hybrids), saviour siblings, plus state-funded assisted reproductive technologies for lesbian couples and single women as well as ‘shared motherhood’, meaning the donation of ova or embryos between lesbian partners.

This bill, first adopted in October 2019, was a flagship commitment by President Emmanuel Macron at his 2017 election.  His position is unequivocal – earlier this month he declared, ‘Everywhere, women’s rights are under attack, starting with the freedom for women to control their own bodies, and in particular the right to abortion.’

This latest political episode has not been an example of sensible democracy.  For instance, the debate was held in the middle of summer, discussion time was reduced, and a last-minute, extreme pro-abortion legislative rider was added, which would permit abortion up to birth for the so-called unverifiable criterion of ‘psychosocial distress’ of the mother.

Currently in France, around 220,000 legal abortions are performed every year, though in 2019 the figure rose to a record number of 232,000 abortions, 8,000 more than the previous year.  Most of these are performed as medical abortions.  Late-term abortions (after 12 weeks of gestation) require medical approval that is legally limited to cases of severe malformation, or supposed unviability outside the womb, or when a mother’s life is endangered.  In effect, the proposed legal changes would introduce a ‘right’ to abortion, for any reason, fully funded by the French Social Security.

These revised bioethical regulations will now be returned to the Senate for a second reading, where they will probably be heavily amended, perhaps before the end of this year.  The modified law will then be voted on by a joint committee of the two houses.  If a consensus cannot be reached, the National Assembly’s decision will be final.

 

But that is not all.  On 8 October, a bill extending the abortion time limit from 12 to 14 weeks without conditions, some to be performed by midwives, and the restriction of conscientious objection, passed its first reading in the French Assembly.  A sparsely attended lower house backed the proposed law change by 102 votes to 65.  The following weekend, on 10 October, saw thousands join 61 nationwide demonstrations against this draft ‘Law Concerning Bioethics’.  ‘Marchons Enfants!’ was their cry.

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