Abortion
10
million too many
There are many signposts for celebrating life – births,
graduations, weddings and even funerals. But never,
never abortions. How can anyone rejoice at the
deliberate taking of a tiny life before his head has even
been kissed? That is why we say that 10 million
abortions are 10 million too many.
Yet that is the almost unimaginable number of abortions that
have been performed in the UK since the 1967 Abortion Act
came into force. That is why many held a minute of
silence on Friday 23 September 2022 at 11:41am. That
was the projected time at which the 10 millionth unborn
child would be aborted somewhere in the UK. The other
9,999,999 were also remembered.
Official abortion statistics tell the sad annual story – a
record 214,869 abortions took place in England and Wales
during 2021 with another 13,758 in Scotland in the same
year. One every 2.5 minutes.
None of us thought this awful landmark day would ever
come. In the 1980s, as the pro-life constituency
developed and expanded, there was an optimism that abortion
could, even would, be beaten as pro-life education projects,
political action and support groups sprang up and
thrived. Nowadays there is a more sedate acceptance
that abortion is here to stay.
So we mourned in late September and we will continue to
lament this vast loss of unborn life – all those sweet
little individuals. And we will remember our
collective cruelty that has allowed, even endorsed, this
slaughter. May the memory of the 10 million urge us to
renew our efforts to save more lives from abortion in the
future. God have mercy on us!
Thérèse Anne Coffey
We have a new Secretary of State for Health and Social Care,
Thérèse Coffey. How long she will remain in office –
weeks, months, or years – is anyone’s guess. She is a
Lancashire lass who grew up in Liverpool. She attended
Somerville College, Oxford, studied chemistry and
rowed. She then went on to University College London,
where she graduated and was later awarded a PhD in
chemistry. Her career started with a number of jobs in
finance. Eventually, at the 2010 general election,
Coffey was elected for Suffolk Coastal, becoming the
constituency's first female MP. She held several minor
posts at Westminster before joining the Cabinet as the
Secretary of State for Work and Pensions in 2019. In
September 2022, she was appointed as Deputy Prime Minister
and as Health and Social Care Secretary. Apparently
she is an avid LFC fan, likes a drink, a bit of karaoke and
even the odd cigar. Moreover, she is best friends with
the Prime Minister, Liz and Tiz, as they are known in
Westminster.
All the above seems like a jolly respectable and commendable
CV. However, in the eyes of some, Coffey has a deep
flaw. Not only is she a Roman Catholic but she is
steadfastly pro-life. The latter really grates with
pro-abortionists.
How has she displayed her pro-life colours in Parliament and
elsewhere? In 2010, she tabled a motion calling for
mental health assessments for those seeking abortions.
The motion read, ‘In its 14th March 2008 statement the Royal
College of Psychiatrists advised that healthcare
professionals who assess or refer women who are requesting
an abortion should assess for mental disorder and for risk
factors that may be associated with its subsequent
development.’
In 2019, she voted against extending abortion laws to the
people in Northern Ireland (and against same-sex marriage as
well as the extension of same-sex marriage to Northern
Ireland). During the Covid-19 crisis, she voted
against extending access to abortion by allowing women to
take abortifacient pills at home, instead of in a clinical
setting. During a media interview in June 2022, Coffey
confirmed her opposition to abortion by stating that she
would, ‘… prefer that people didn't have abortions but I am
not going to condemn people that do.’ And she
acknowledged the reality that ‘Abortion law isn't going to
change in this country’ at least, not in the near future
during her reign as Health Secretary.
Those activities have been red rags to
pro-abortionists. Among those who have criticised
Coffey’s views on abortion has been Clare Murphy, CEO of the
British Pregnancy Advisory Service. In a statement,
the BPAS said, ‘Every politician is entitled to hold their
own opinion on abortion. But what matters is whether
they would let their own personal convictions stand in the
way of women’s ability to act on their own.’
Murphy continued, ‘Earlier this year, the new Health
Secretary voted to revoke access to at-home abortion care,
and recriminalise women who end their own pregnancies
without the approval of two doctors. In doing so,
Thérèse Coffey voted against the advice of leading medical
bodies including the Royal College of Obstetricians and
Gynaecologists, the Royal College of Midwives and the
BMA. To have a Health Secretary who would place their
personal beliefs above expert clinical guidance is deeply
concerning.’
Murphy concluded, ‘We are a pro-choice country, and we have
a pro-choice Parliament. BPAS, alongside other women’s
charities and healthcare bodies, will continue to work with
Parliamentarians to advance abortion rights regardless of
which MPs form the next Cabinet.’
The coming months for Thérèse Coffey might well be
reminiscent of the 1990s, when that other Roman Catholic,
Ann Widecombe, was Shadow Health Secretary. She
survived and was always happy to express her pro-life
credentials whenever anyone asked.
Upon her new appointment I sent Miss Coffey a congratulatory
and supportive email. It read, ‘Hearty congratulations
on your appointment as Secretary of State for Health and
Social Care. And with grateful thanks for your
pro-life stance.’ Yep, we all like a little
recognition and kindness from time to time.
The two irrefutable abortion facts
– revisited
Here is a revised and updated section from my 2014 book, Bioethical
Issues - Understanding and Responding to the Culture of
Death. When it comes to abortion, there are two
irrefutable facts we need to grasp – nobody doubts or
disagrees with these.
First, the numbers. For England and Wales, these
official statistics are published by the Office for Health
Improvement and Disparities. Historically, legalised
abortion started here on 27 April 1968 – six months after
the 1967 Abortion Act had received the Royal Assent – so the
first full-year’s total relates to 1969 and amounted to
54,819. Abortion numbers rose inexorably to around
180,000 by the late 1980s and then, for the next twenty or
so years, they more or less plateaued in the region of
190,000. They breached the egregious 200,000 boundary
three times between 2006 and 2008. That is the
historic overview.
Now consider the latest contemporary picture. During
2021, the total number of abortions performed in England and
Wales, on residents plus non-residents, was 214,869 – the
highest ever. Moreover, according to Public Health
Scotland, the total figure there for 2021 was 13,758.
Only recently has the 1967 Act been extended to Northern
Ireland and no figures have yet been published. In
other words, the grand 2021 total for Great Britain was well
in excess of 200,000; to be precise, it was 228,627.
This is similar to the entire population of cities like
England’s York, Wales’s Swansea or Scotland’s
Aberdeen. It also means that over 4,000 abortions
occur in Great Britain every week. That is
approximately 880 every weekday – every Monday, every
Tuesday, every Wednesday … Can you believe that?
Sometimes I have to do the arithmetic again, just to check
that huge daily figure. It is equivalent to about
thirty classrooms, or eighteen coachloads, of children each
day. If a blazing catastrophe or appalling road
accident killed that number of children, think of the shock,
the graphic newspaper headlines and the constant TV news
bulletins. Yet 880 daily abortions evoke none of
these.
And remember, we are not talking about faraway places, like
Kenya, the USA, or China. This is happening in Great
Britain, where you live and work, and go to hospital and
church – in truth, it is on your doorstep. Nowadays, 1
out of every 5 pregnancies in England and Wales ends in
abortion. And an estimated 1 in 4 women in England and
Wales will have had an abortion by the time they are
forty-five years old. Think about that as you push
your shopping trolley around your local supermarket.
Since the implementation of the 1967 Abortion Act, the total
number of abortions performed in the UK, from 1968 to 2021,
has recently reached 10 million. Some 15 per cent of
our population is missing. But maybe you do not live
in the UK. Abortion still occurs on your doorstep, in
your neighbourhood, in your homeland – it is a worldwide
practice. For example, about 0.9 million abortions
occur in the USA each year, 0.5 million in Japan, and an
estimated 11 million in India and 13 million in China.
The global total is now reckoned to be approximately 42
million every year. Just pause, sit back and try to
absorb something of the enormity of abortion. These
data are official, staggering and condemnatory.
The second set of irrefutable facts relates to what is
aborted. The ‘favourite’ time for abortion is under
ten weeks’ gestation – 89 per cent of abortions in England
and Wales during 2021 occurred within this developmental
period. Such an unborn child would fit snugly into the
palm of your hand; she has eyes, fingernails and
fingerprints, she moves, she swallows, she digests, she
sucks her thumb. Blood has been coursing through her
body for several weeks – her rudimentary heart began to beat
on about day 21. We have been told that this is just a
vague collection of undifferentiated cells, or a little
piece of poorly defined tissue. What tosh! We
have been duped.
Most abortions in the UK are lawful up to twenty-four
weeks. Have you ever seen an unborn child of that
gestational age? Such an early-bird daughter was born
to friends of mine – it would have been unthinkable to ever
contemplate harming, let alone killing, her. Though
babies of this age often struggle, most of them survive and
thrive. What a topsy-turvy world of medical ethics we
live in – doctors and nurses can be fighting to preserve the
life of such a premature child in the intensive care unit,
while down the corridor, in the same hospital, their
colleagues can be deftly destroying an unborn child of a
similar age. And if some form of handicap is
suspected, not necessarily proved, then there is no time
limit – abortion is lawful up to birth, yes, up to forty
weeks.
In the UK we probably have the most savage abortion law in
the whole world – we have been officially aborting just
about the longest (since 1968), the latest (up to birth) and
the laxest (easy access). Grammatically, these three
little words – longest, latest, laxest – may be adjectival
superlatives, but, when they are linked to the termination
of the unborn, they become bioethically most pitiable.
These are the two irrefutable facts about abortion.
What are you going to do about them? Snub them or fess
up to them? Ignore or respond? You decide.
IVF
and ARTs
Overhauling the UK’s fertility and
embryo laws
The UK regulator, the Human Fertilisation and Embryology
Authority (HFEA), is still hankering after liberalising the
UK’s laws relating to fertility treatments and embryo
research. As the Guardian newspaper has
recently noted, the plans will be ‘the biggest overhaul of
fertility laws in 30 years’, namely since the 1990 Human
Fertilisation and Embryology Act. The HFEA also wants
to ‘future proof’ legislation so that scientists will not be
held back by supposedly out-of-date regulations. The
HFEA had planned to launch a consultation in September
before making recommendations on amending the 1990 Act with
the hope that they would be enacted before the end of this
year. Alas, the HFEA failed to meet its own
consultation deadline. ‘It should be available later
in the year’, a spokeswoman told me.
Apparently there are at least four new and radical fertility
treatments that the HFEA wants to become legal. First,
there are laboratory-grown ova and sperm. Though
already accomplished in mice (see under Genetic Technologies
below), it is currently not possible in human beings, both
technically and legally, but there is a push by some
scientists to make it happen. Second, there is human
genome editing. Though somatic genome editing is
lawful, human germline editing is not. It makes
permanent changes to a family’s genomes and evidently public
opinion opposes it.
Third, there is ‘three-parent’ IVF. UK legislation was
amended in 2015 to permit mitochondrial donation with
genetic material from a third party to overcome
mitochondrial diseases. Two techniques were permitted
– maternal spindle transfer (MST) and pronuclear transfer
(PNT). The HFEA wants to widen the scope of these
procedures. Fourth, there are synthetic embryos.
These are embryo-like structures which are produced from
stem cells (again, see under Genetic Technologies
below). And as an extra, a fifth, there is the
long-standing pressure to relax and extend the 14-day rule
for experimenting with human embryos (see, below).
Why are there demands for such radical changes in
reproductive biology and ART treatments and embryo
experimentation? There is a fear among some of the
UK’s scientific community that it will be left behind.
The thinking is that an Act as old as 1990 is bound to be
outmoded. Yet, for example, the Offences against the
Person Act 1861 is much older but still relevant and
required. Every Act draws bright lines. Why
should vulnerable people be abused? Why should human
embryos be destroyed on an industrial scale? The drive
to revise and loosen laws that protect all people, including
the youngest and most vulnerable, is a dangerous enterprise.
Overhauling the Dutch fertility and
embryo laws
We in the UK are not alone. The Netherlands is also
keen to overhaul its 2002 Dutch Embryos Act. In fact
the Act stipulates that its provisions are to be evaluated
every five years. The third evaluation was conducted
in 2021. Apparently, the Report ‘shows that the law
functions well in general.’
However, there are five major recommendations. First,
the legal definition of 'embryo' needs to be revised in
order to keep pace with the development of human embryo-like
structures. Second, the ban on creating embryos for
research needs to be lifted. Third, increasing the
14-day upper limit for embryo experimentation needs to be
considered, possibly to 28 days. Fourth, provisions
regarding the creation of hybrids and chimaeras need
revising. Fifth, the current ban of germline genome
editing needs to be reconsidered.
Three comments. First, it is not surprising that the
Dutch are wrestling with the same issues as the UK and most
other developed countries. We are all in this
together. And depending on the worldview of their
citizens we are without national, let alone global,
consensus. Second, the major issue always
concerns the definition of a human embryo. Third, the
14-day rule is exercising most governments.
How has the Dutch Report been received? The government
announced a revision of the 2002 Act within the present
parliamentary period. This would include 'the
adaptation of the definition of “embryo” also in the light
of the developments in the field of embryo-like structures
[ELS].' The lifting of the ban on research embryos was
again postponed and despite attempts by minority parties to
present reformist bills, the government is adamant they will
not be voted on in this Parliamentary period.
This is curious. Whereas Holland is usually portrayed
as a liberal country, when it comes to human embryos, it has
laws that are significantly more protective than those of
the UK. Shame on us!
14 or 28 days?
This is becoming a persistent topic for discussion among the
embryo-concerned community, namely those for and those
against the deliberate destruction of human embryos.
These debates are against a backdrop of calls for the
updating or replacing of laws, such as the UK’s Human
Fertilisation and Embryology Act (1990 as amended).
And the hottest item for re-examination would be the current
regulations for research on human embryos and especially
that 14-day rule as the upper limit for experimenting on
them.
The 14-day rule was always
nonsense. During the early 1980s, the UK’s Warnock
Committee was faced with devising some upper time limit for
embryo experimentation. Warnock said, ‘… some precise
decision must be taken.’ Why? Warnock answered,
‘… in order to allay public anxiety.’ So, though this
was admittedly absurd and arbitrary, fourteen days will keep
the British public happy, even though it is pulling the wool
over their eyes. Thus, the appearance of the primitive
streak as ‘a heaping-up of cells at one end of the embryonic
disc on the fourteenth or fifteenth day after fertilisation’
became embedded in embryological law and folklore. It
has since spread to other countries.
Of course, it was never going to be enough. Like the
boy who pined for more pie, as embryo experimentation
advanced, so did the demand for more headroom. And the
clamour has recently intensified because it is now
technically possible to cultivate embryos for almost 14
days.
Another reason given for extending the time limit is that we
already have good scientific knowledge about how embryos
develop beyond 28 days. Our greatest knowledge gap is
therefore said to be between 14 and 28 days.
Conflictingly, one of the UK’s foremost embryologists,
Magdalena Zernicka-Goetz, has said concerning days 1 to 7,
the first week after fertilisation, ‘This period of human
life is so mysterious.’ Whatever. Research in
this 14 to 28-day lacuna would apparently allow better
understanding of the formation of primitive tissues, the
development of the nervous system, early organ development,
and so on.
Then there are also the pregnancy-related arguments –
gaining answers as to why some pregnancies end in
miscarriage or stillbirth, why some do not, and why some
birth defects occur. Think how this might benefit
parents and potential parents and their future offspring and
might alleviate their sufferings and anxieties.
Maintaining the 14-day rule stultifies such
possibilities. Really?
Furthermore, we have recently entered a ‘new age’ of
embryology. Nowadays we read about gametes and embryos
derived in vitro from stem cells, not just from
old-skool ovaries and testes. Are these among the
HFEA’s so-called ‘permitted’ entities and if so, how should
research using them be regulated? Then there are novel
synthetic entities, such as synthetic human entities with
embryo-like features (SHEEFs) plus some forms of
organoids. Back when the 1990 Act was introduced, such
beings were entirely unknown. The embryological
landscape has changed and so have the needs of medicine,
science, technology and society.
From the above, it may seem as though an upgrade to 28 days
would be beneficial – it certainly would not. A decade
later the call would be for 36 days, or why not go the whole
hog and bid for abortion’s upper limit of 24 weeks?
There is an incongruity here that is, for example,
highlighted by the proposed HFEA consultation. The man
on the Clapham omnibus may be against 28 days, but he has
little knowledge, time, or occasion to express that
view. Pitched against the full-time, professional
giants of embryology it turns into a David versus Goliath
battle. One can only hope and labour (and pray) that
David wins again.
IVF children and cancer
Almost every edition of these Updates details some serious
drawback associated with ARTs and specifically the use of
IVF. Here is one of the latest. It concerns the
use of frozen human embryos. Such frozen embryo
transfers (FETs) are becoming more popular, and in some
countries they outnumber the use of fresh embryos. It
is already known that children born after these FETs may
have higher short-term risks of certain adverse medical
conditions compared with children born after fresh embryo
transfers. However, the incidence of long-term risks
has been less clear.
In a new study to resolve the latter, Nona Sargisian and her
colleagues from the University of Gothenburg, Sweden
analysed the medical records of 7,944,248 children in Nordic
countries, namely Denmark, Finland, Norway and Sweden.
Some 171,744 were born after the use of IVF and of these
22,630 were born after FETs.
Their findings were published as ‘Cancer in children born
after frozen-thawed embryo transfer: A cohort study’
by Nona Sargisian et al., in the 1 September 2022
issue of the open-access journal PLOS
Medicine.
Cancer diagnosis before 18 years of age was the primary
considered parameter. Statistical analysis of the data
from national health registries indicated that children born
after FETs were at higher risk of cancer than children born
after fresh embryo transfers and those born after natural
conception. The most common types of cancer seen in
this study were leukaemia and tumours of the central nervous
system. However, the researchers warned that their
results should be treated with caution because so few FET
children, only 48, developed cancer. Statistically,
that small number could weaken any conclusions.
Nevertheless, this study should be taken seriously and
should encourage further research into the long-term health
outcomes in all ART children. In particular, causal
factors other than FETs, such as parental contributions, and
different experimental approaches, such as sibling
comparisons, need investigating.
Euthanasia and Assisted Suicide
Assisted suicide legislation in
Scotland
Will Scotland become the first of the UK’s home countries to
legalise euthanasia? It seems to be heading that
way. This is the third attempt to introduce such
legislation in Scotland. The last attempt was by the
late MSP Margo MacDonald. She died in 2014, but in
2015, her bill, promoted by Patrick Harvie, was rejected by
82 votes to 36 following a debate at Holyrood. Opinion
now seems to be shifting in favour of a law change.
In early September, Liam McArthur, a Liberal Democrat MSP
introduced his Assisted Dying for Terminally Ill Adults
(Scotland) bill in the Scottish Parliament. In
December 2021, a public consultation on his original scheme
was concluded. It attracted considerable
support. Just over three quarters (76%) of the 14, 038
responses received were fully supportive of the draft
proposals to enable anyone aged 16 or over, who is deemed by
two doctors to be terminally-ill and mentally-competent and
who has been resident in Scotland for 12 months to be
entitled to receive help to end their lives. There
were 81 responses from large organisations with 47 of them
fully opposed to the proposals. Arguments from groups
representing disabled people highlighted concerns that the
bill would undermine palliative care and would put pressure
on vulnerable patients to see their lives as a burden.
Responding to the consultation’s results McArthur said, ‘As
well as thoughtful perspectives on how an assisted dying law
would work in Scotland, I have been particularly struck by
many harrowing accounts from people who witnessed their
loved ones endure a bad death. They sent a clear
message that, even with excellent palliative care, the
option of an assisted death would have made such a
difference in terms of reducing unnecessary suffering.’
Opponents have criticised the bill, calling for more support
for living and improved palliative care. A coalition
of 175 health care professionals from a variety of medical
specialities has outlined their concerns to the Scottish
Health Secretary, Humza Yousaf. In addition, a
campaign against the bill has been launched by a group
called Our Duty of Care (ODOC). It has stated, ‘The
shift from preserving life to taking life is enormous and
should not be minimised. The prohibition of killing is
present in almost all civilised societies due to the
immeasurable worth of every human life. Everyone has a
right to life under Article 1 of The Human Rights Act 1998
such that no-one should be deprived of that life
intentionally.’
Dr Gordon Macdonald, CEO of Care Not Killing, called the
bill ‘very dangerous’. He said, ‘Evidence from other
countries shows that when assisted suicide or euthanasia are
legalised, the safeguards promised are quickly removed and
the law is extended to include more and more vulnerable
people. People will come under pressure from others to
end their lives for fear of being a financial or care
burden. People with depression won’t get the proper
psychiatric support they need and palliative care services
will continue to be underfunded.’
Dr Naomi Richards, Director of the End of Life Studies Group
at the University of Glasgow, added that the bill’s
definition of terminal illness is ‘unworkable’, as it is
overly broad and could lead to ‘unintended consequences’.
Euthanasia in Canada
Here is an indisputable trend among life issues. See
how, once a country approves any sort of assisted suicide
legislation, it inevitably begins to grow like Topsy.
Canada is a case in point. This trend is attested by
its Third Annual Report on Medical Assistance in Dying in
Canada 2021 which was published in July 2022.
Canada’s Medical Aid in Dying (MAiD) programme, which allows
both euthanasia and assisted suicide, was introduced in
2016. In that year, 1,018 such deaths were
recorded. Latest official figures show the unremitting
surge reached a staggering 10,064 deaths in 2021. That
figure was up from 7,603 in 2020 and it represents 3.3% of
all deaths in Canada. The total number of deaths from
legalisation in 2016 to 31 December 2021 now stands at
31,664.
And, as in other jurisdictions with legal provisions for
assisted deaths, there are fears that Canadian numbers will
increase even more rapidly as eligibility boundaries are
extended to include other groups of people. For
instance, the law has recently been amended to ensure that
people with chronic and disabling conditions will now
qualify for assisted suicide or euthanasia. From 2023,
people with mental illnesses will also be able to
apply. The so-called ‘strict guidelines to protect
against abuse’ have been relaxed, even ignored.
The Report records that the two most common reasons for
requesting MAiD were the loss of ability to engage in
meaningful activities (86.3%) and the loss of ability to
perform activities of daily living (83.4%). Contrary
to popular belief, pain was relegated to the third reason –
inadequate control or fear of pain was cited by 57.6% of
people. In 35.7% of cases, patients believed that they
were a ‘burden on family, friends or caregivers’ and 17.3%
cited ‘isolation or loneliness’ as a reason for wanting to
die.
Euthanasia in Spain
The act of euthanasia is always ghastly. Now comes
news of a grisly adjunct from Spain. The case centres
on Marin Eugen Sabau, a 46-year-old Romanian security guard,
who went berserk in December 2021 and shot three fellow
employees and wounded an officer during the ensuing gun
battle with police. Sabau was shot several times and
was left a tetraplegic. He subsequently had one leg
amputated and was in constant chronic pain that could not be
satisfactorily relieved. He claimed that his life had
become unbearable.
While awaiting trial, he applied for euthanasia under the
Spanish law which had been enacted just over a year ago in
June 2021. It states that adults with serious and
incurable conditions that cause ‘unbearable suffering’ can
choose to end their lives. A court in Tarragona ruled
that it was Sabau’s fundamental right to request euthanasia
considering his circumstances. His request was granted
and he was euthanised in prison on 23 August 2022.
That procedure was held up by appeals from his victims, who
argued that Sabau should first face justice. However,
the courts ignored their pleas. The Constitutional
Court refused to consider the case, reasoning that there had
been no violation of fundamental rights.
Before Spain’s new law was passed, helping someone to die in
Spain carried a jail term of up to 10 years. Now a few
weeks or months after a request has been made the act of
euthanasia can be performed with no punishments. But
the Spanish parliamentarians never envisaged such a case as
that of Marin Eugen Sabau where the right to death with
dignity must prevail over the right of victims to
justice. Sabau was satisfied by the outcome, but his
victims certainly were not. For them, justice was not
done. Euthanasia can be like a spanner in the works of
a civilised society.
Euthanasia in Uruguay
Where is this country with a name that is difficult to
spell? Of course, it’s in South America, squeezed
between the colossi of Brazil and Argentina. Small it
maybe but it is currently bidding to behave like some of the
giants of euthanasia.
In September, the Health Committee of Uruguay’s Lower House
passed a bill approving euthanasia. The entire House
is now to debate the issue in a plenary session, probably in
October.
The bill, which was first introduced in 2020, has languished
because of the Covid-19 pandemic. Uruguay’s president,
Luis Lacalle Pou, and the Roman Catholic Church are strongly
opposed to the measure. However, a recent poll
indicated that 55% of Uruguay’s citizens are in favour of
euthanasia. Another country is probably about to bite
the bioethical dust – how sad.
Genetic
Technologies
Synthetic embryos – no ova, no sperm, no uterus
Herein, a major advance in embryology, though it prompts the
question, is it really an advance? The age-old recipe
for kick-starting mammalian life is simple – take an ovum,
mix it with sperm, place it in a cosy uterine environment
and wait. But two recent research papers have
demonstrated that there is another way. Using only
embryonic stem cells from mice and an artificial incubator,
synthetic embryos (sEmbryos) have been created that are
physically and functionally close to the natural model.
First, the Israeli way. Using only stem cells, without
sperm, ova, or even a womb, researchers at the Weizmann
Institute of Science in Rehovot, Israel, created mouse
embryos with beating hearts, circulating blood, brain
tissues and rudimentary digestion systems. The
Institute’s website heralds the discovery as ‘The method
opens new vistas for studying how stem cells self-organize
into organs and may in the future help produce
transplantable tissues.’
The Washington Post described the
research as, ‘a fascinating, potentially fraught realm of
science that could one day be used to create replacement
organs for humans.’ So the technique is being hyped
for its potential to create material for organ transplants,
eventually, for human use. This was confirmed by the
lead scientist, Dr Jacob Hanna, who stated, ‘We are really
facing difficulties making organs and in order to make stem
cells become organs, we need to learn how the embryo does
that.’ Is this just clever PR and marketing? Or
is there something more sinister going on?
The work was reported under the title, ‘Post-gastrulation
synthetic embryos generated ex utero from mouse naive ESCs’
by Shadi Tarazi et al., and published in Cell (2022,
185: 3290-3306).
The scientists started with in vitro cultured
embryonic stem cells (ESCs) from mice and injected them into
pre-implantation mouse embryos. Could such naive stem
cells independently give rise to entire gastrulating
embryo-like structures with both embryonic and
extraembryonic compartments? The answer is,
‘Yes’. The technique produced what are called
synthetic whole embryo models (sEmbryos). With some
deft biological tweaking and novel culture procedures, these
sEmbryos grew for up to 8.5 days through the gastrulation
stage into multi-layered structures and onto
organogenesis. In other words, starting with only ESCs
they can be coaxed to self-organise and develop into
functional mammalian embryos ex utero with developing
brains, beating hearts, and so on.
Second, there is the UK-USA way. Researchers from the
University of Cambridge and the California Institute of
Technology similarly grew so-called 'integrated stem
cell-based embryo models' for 8.5 days. Normal mouse
gestation is typically between 18 and 21 days. At 8.5
days, beating hearts, circulating blood, brain tissues and
rudimentary digestion systems were observed.
This research was reported under the title, ‘Synthetic
embryos complete gastrulation to neurulation and
organogenesis’ by Gianluca Amadei et al., and
published in Nature (2022,
12 August).
These sEmbryos were created by combining three different and
specific types of embryonic stem cells – one that will
develop into the embryo, with the other two developing into
extraembryonic structures including the placenta and yolk
sac which provide the early embryo with nutrients.
When combined in an artificial incubator, the stem cells
were found to signal to each other via touch and chemical
messengers, allowing them to spontaneously self-organise
into embryos. These sEmbryo models also reached the
point where the entire brain, including the anterior
forebrain, began to develop. They are the closest any
model has ever come to resembling a naturally-developing
embryo in a uterus.
Lead researcher in the Cambridge group, Magdalena
Zernicka-Goetz, maintains, 'The stem cell embryo model is
important because it gives us accessibility to the
developing structure at a stage that is normally hidden from
us due to the implantation of the tiny embryo into the
mother's womb.' In contrast to the Israeli research,
Zernicka-Goetz declares a quite different USP (unique
selling point) for her team’s work. It is using early
embryos to understand infertility, common developmental
disorders and miscarriage and to devise suitable
therapies. Who could be against such mouse
research? However, both teams have announced they are
also working towards developing human embryo models, but
stress that these efforts are considerably further behind
given the differences in understanding between early human
and mouse development. But here it is – mice to men.
Where is all this going? sEmbryos are now here.
Ask some questions. First, what is their origin?
These novel technologies use embryonic stem cells. So
far, these have been obtained from mice, but human sources
are undoubtedly on the distant horizon – after all, from
mice to men is the trajectory of most biological science
research. This raises the old, but still valid,
objection that the harvesting of embryonic stem cells
inevitably destroys embryos, whether murine or human.
Why could not the researchers have used non-embryonic stem
cells, such as adult stem cells, or induced pluripotent stem
(iPS) cells from mice?
Second, though both studies found the creation of mouse
sEmbryos highly error-prone, with only one in 100 attempts
being successful, there is that knotty question that if, and
when, these techniques do construct human sEmbryos, would
they really be human? Currently the consensus seems to
be that though sEmbryos are similar to, they are not
equivalent to real, natural embryos. For the time
being they remain outside the restrictions of human embryo
experimentation laws, such as the UK’s Human Fertilisation
and Embryology Act 1990, because they are not classed as
‘permitted embryos’. That may need to be changed
soon. Though sEmbryos have not been conceived
naturally, might they not continue to grow from embryo to
foetus if transferred into a womb? But that would be
unlawful to use them to establish a pregnancy in a woman,
because they are not (yet?) ‘permitted embryos’.
Third, the question of why should be asked. What is
this technology for? The word ‘for’ is
significant. Is it just for the legitimate
accumulation of scientific knowledge? Or is it
ultimately for the illegitimate use of tiny human beings for
the good of larger human beings? Such
‘means-to-an-end’ exploitation of humans, at any stage of
their development, is reprehensible. History shouts
that, loud and clear.
Fourth, should the bigger picture of creating of human
sEmbryos for the purpose of harvesting their organs be
necessary and permissible? Of course there are
thousands of people worldwide who are currently waiting for
life-saving or life-enhancing donations of transplantable
organs. The bioethical agnostics say, ‘Yes, go for it,
whatever the consequences.’ The bioethical sensitive
say, ‘No, go by non-controversial, bioethically sound
routes. For example, somatic gene therapy can be the
curative answer to a growing number of illnesses and
diseases. It is commonly judged to be a part of good
medicine, namely that often elusive so-called culture of
life. If you generally approve of bone-marrow
transplants and a little light genetic engineering, this
branch of medicine will cause you little or no bioethical
unrest. However, gene therapy of the germline variety
is quite another issue. Moreover, it is reasonable to
assume that the need for organ donation and transplantation
will decrease in the future. First, because, as time
goes by, larger and more comprehensive tissue-donor
registers will be compiled, so that tracking down suitable
bone-marrow or umbilical-cord donors will become
easier. And second, because advances in stem-cell
technologies will provide additional banks of stored,
compatible, transplantable stem cells ready to create the
required tissues and organs.
Fifth, there is an additional USP embedded here. Sarah
Norcross, the director of PET (Progress Educational Trust),
has used these studies to lobby for another hobby-horse of
human embryo experimenters, namely the 14-day rule that
forbids destructive experimentation of human embryos after
that upper time limit. She has said, 'Unlike actual
human embryos, stem-cell-based embryo models [sEmbryos] in
humans and other organisms are not restricted by a 14-day
rule. These models are extremely helpful for research,
but there still remains a case for changing the law to
extend the 14-day rule, so that we can continue to learn
from the precious embryos that have been kindly donated by
fertility patients following their treatment.'
There should always be bioethical bright lines in
medicine. Obtaining and creating organs for human
transplants is generally a worthy pursuit. Similarly,
understanding and devising treatments for infertility and
miscarriage. But even these enterprises have no-go
areas. The deliberate destruction of human embryos in
one such zone. Any therapeutic use of human sEmbryos
is in the distant future. Its bioethical legitimacy
has yet to be fully debated and determined. Given that
the nature and status of natural human embryos are still
largely unresolved, that of sEmbryos is unlikely to be
resolved soon. Nevertheless, now is not too soon to
start and rekindle those bioethical and legal conversations.
Gene therapy and ‘bad’ cholesterol
High levels of low-density lipoprotein (LDL) cholesterol,
commonly known as ‘bad' cholesterol, can cause arteries to
clog and harden over time, resulting in atherosclerotic
cardiovascular disease (ASCVD), which can lead to heart
attacks and strokes.
Verve Therapeutics is a biotechnology company located in
Cambridge, Massachusetts. VERVE-101 is its single
course, life-long, gene-editing medicine that uses CRISPR
base editing to make a single base change in liver
DNA. The change consists of switching an adenine to a
guanine. That alteration then permanently turns off
the PCSK9 gene in liver cells. It is this gene that
can cause high levels of ‘bad’ cholesterol in some people.
The first patient in a Phase 1 clinical trial, currently
being conducted in New Zealand, has been recently treated
with VERVE 101. This is part of a larger ongoing trial
for patients with familial hypercholesterolemia (HeFH),
which causes them to have abnormally high levels of LDL
cholesterol that do not respond to lifestyle interventions,
such as diet and exercise. Moreover, HeFH is a
prevalent and potentially life-threatening subtype of
ASCVD. The overall plan is eventually to enrol 40 such
patients in order to evaluate the safety and tolerability of
this treatment.
However, there are hazards ahead. For example, the
therapy uses nanoparticles to transport the genetic
instructions into the liver cells. Such minute
particles can cause muscle pain. And while the
administration of ordinary medicines can be halted if
problems arise, gene therapies, once commenced, are
unstoppable and irreversible.
But if the therapy works, it could impact the lives of
millions. Dr Eric Topol, a cardiologist and researcher
at Scripps Research Institute in California, has said, 'Of
all the different genome editing ongoing in the clinic, this
one could have the most profound impact because of the
number of people who could benefit.' As the company
website states, ‘VERVE-101 has the potential to change the
way cardiovascular disease is cared for by lowering LDL-C as
low as possible for as long as possible after a single
treatment.
Stem-cell
Technologies
Paolo
Macchiarini
The rise and fall of this most famous of Italian surgeons
has been followed in these Update pages for a decade and
more. He was a stem-cell technology pioneer. In
2008, he was feted as an international celebrity after he
had performed the world’s first windpipe transplant at the
Karolinska Institute in Sweden. He used a patient’s
own stem cells to create a ‘new’ trachea.
Then it all began to go wrong. Subsequent patients
died prematurely, while allegations of fraud and scientific
misconduct were made. He denied all charges but, by
2016, he was finally dismissed. In addition,
Macchiarini later emerged to be philander, fabulist and an
open liar.
His latest brush with the law involved the reopening of some
of his surgical cases and charges of ‘aggravated
assault’. Macchiarini’s trial ended on 23 May 2022,
and he was found guilty of causing bodily harm, but not
guilty of two charges of assault. On 16 June 2022, he
received a two-year suspended sentence.
This Macchiarini saga has been a loathsome scandal.
The man has proved to be ghastly in both medical occupation
and personal character. Moreover, he has tarnished the
reputation of stem-cell technologies. Sadly, the
latter have been subjected to relentless hype and
unrealistic expectations by the media and others besides
Macchiarini. On the other hand, some stem-cell
therapies have quietly delivered amazing treatments and
cures. Yet Paolo Macchiarini has managed to
single-handedly besmirch such good medicine.
Stem-cell trials in Japan
Over the last few years, Japan has invested heavily in
stem-cell technology research, specifically using the
non-controversial induced pluripotent stem (iPS) cells,
first discovered by their very own Nobel Prize winner,
Shinya Yamanaka of Kyoto University.
This technique of reprogramming mature human cells to
produce these iPS cells, which in turn are used to repair
damaged tissues and organs, appears to work. For
example, in January 2022, it was reported that the first
person in Japan given a transplant of heart muscle cells
made from iPS cells had experienced improved heart
function. Then, in April, another Japanese research
group announced that several people’s vision had been
improved after their diseased corneas were transplanted with
corneal cells produced from iPS cells.
According to Wolfram-Hubertus Zimmermann, a pharmacologist
at the University Medical Centre Göttingen, ongoing trials
in Japan are, ‘delivering encouraging first insights into
the evolution of iPS-cell-based therapies, from lab to
patient.’ And Kapil Bharti, a translational stem-cell
researcher at the US National Eye Institute in Bethesda,
Maryland, maintains that these iPS cell trials in Japan,
‘give people confidence all over the world that it is
doable.’
Yet all is not going exactly swimmingly. Despite
several clinical trials showing iPS cell technologies are
safe, their beneficial effects have been demonstrated only
in small clinical trials with small numbers of
patients. And apparently the Japanese public
enthusiasm for this type of regenerative medicine has begun
to wane. In other words, the next round of Japanese
future research funding, due to begin in 2023, may be
problematic. To be successful, trials need to
demonstrate significant improvements for patients so that
industry, as well as government, will invest.
Stem cells and motor neurone
disease
If proof were needed that some stem-cell technologies can be
functionally beneficial, here is a novel example that has a
firm scientific basis. Motor neurone disease (MND,
amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s
disease) is a fatal neurodegenerative disorder that consists
of the progressive loss of motor neurons, leading to
paralysis and death usually within 3 to 5 years of
diagnosis. Drugs, such as riluzole and edaravone, have
been approved for use in the USA, but they result in only a
modest slowing of the disease.
This new research has been published as, ‘Transplantation of
human neural progenitor cells secreting GDNF into the spinal
cord of patients with ALS: a phase 1/2a trial’ by Robert H
Baloh et al., in Nature
Medicine, 2022, 28: 1813-1822.
Basically, it is a combined stem-cell and gene therapy that
promotes the survival of motor neurons in MND
patients. It involves transplanting engineered
protein-producing stem cells, known as human neural
progenitor cells, into the central nervous system (CNS),
where the compromised motor neurons are located. There
these stem cells can be transformed into new supportive
glial cells, known as astrocytes, as well as release a
protein known as glial cell line-derived neurotrophic factor
(GDNF). GDNF can protect and promote the survival of
motor neurons, which are essential in order to pass signals
from the brain or the spinal cord to the muscles to enable
bodily movement. It is these motor neurons that die in
MND. But GDNF alone cannot cross the blood-brain
barrier so transplanting the stem cells directly into the
CNS, where they can deliver GDNF, is this study’s innovative
approach to MND treatment.
First and foremost, Baloh and his colleagues at the Cedars
Sinai Medical Centre in Los Angeles, demonstrated that a
one-time treatment with this new product (known as
CNS10-NPC-GDNF) derived from the combined treatment of
stem-cell technology and gene therapy is safe in
humans. The Phase 1/2a trial recruited 18 MND
patients. None experienced serious side effects after
transplantation of the engineered protein-producing
cells. Tissue analysis of 13 participants, who died of
MND progression, showed transplanted graft survival and GDNF
production for up to 42 months post-transplantation in all
but one case. However, there were minor
drawbacks. For instance, some of the transplants were
placed too high in the CNS, patient numbers were small and
too many of them were late-stage MND sufferers. Future
planned trials should obviate such shortcomings.
Oh no! A more careful reading of this 10-page complex
Nature Medicine article reveals that the stem cells
used were derived from ‘A single human fetal cortical sample
…’ Be warned, beware, the destructive use of human
embryos and foetuses as sources of experimental material is
occurring in research laboratories around the world.
In this case it was foetal brain. Why could the
researchers not have used adult stem cells or iPS
cells? Why indeed?
Stem-cell ruling in the USA
Who oversees and regulates stem-cell technologies and
treatments in the USA? Why, the Food and Drug
Administration (FDA) of course. Not so. Now no
longer so according to a recent court decision.
In a recent judgement in the case of the FDA versus the
California Stem Cell Treatment Center et al.,
(CSCTC), it was ruled that the FDA’s powers do not extend to
the regulation of some stem-cell treatments. The
federal judge, Judge Jesus Bernal of the central district of
California, entered a judgement in favour of the defendants,
the CSCTC. In other words, the court decided that the
defendants' medical procedure that uses patients' stem cells
to treat different diseases and medical conditions does not
fall within the FDA's authority.
Stem-cell treatments in the USA are already like a Wild West
affair – medically unproven and even risky treatments are
legion. This court judgement could increase that
number.
The case alleges that the CSCTC manufactured stromal
vascular fraction (SVF) products from patient’s adipose
tissue without first receiving FDA's formal approval for a
new drug. SVF cells consist of multiple cell types
found within fat tissue; including mesenchymal stem cells,
haematopoietic cells and progenitor cells among
others. In essence, SVF cells are the
naturally-occurring part of the adipose tissue that does not
contain the fat cells.
CSCTC held that the patient’s stem cells are not drugs and
therefore cannot be regulated by the FDA. The FDA
disagreed. The court disagreed with the FDA saying
that the surgical procedure does indeed not create a new
drug. It stated that 'The SVF cells are not altered,
chemically or biologically, at any point during the SVF
surgical procedure. There are no genes added to or
removed from the SVF cells during the SVF surgical
procedure. The SVF surgical procedure does not change
the size or genetic makeup of the SVF cells’, and so
on. Therefore, these procedures cannot be regarded as
drugs within the meaning of the 1938 Federal Food, Drug, and
Cosmetic Act (FDCA).
Judge Bernal's decision has now caused regulatory
uncertainty. It is inconsistent with other similar
cases. Clinics providing stem-cell therapies must
provide the FDA with evidence-based details and the FDA, as
the government regulatory agency, has an obligation to
gather this information. A prominent stem-cell
association, the International Society for Cell & Gene
Therapy (ISCT), issued a response to the court’s ruling,
stating that the judge's decision has widespread
consequences for the stem-cell and gene therapy field.
The likely upshot is that this ruling will create
opportunities for unscrupulous for-profit private clinics to
provide purported stem-cell treatments that are
scientifically unproven and potentially dangerous for
vulnerable patients. Potential stem-cell therapies
require full independent review by regulatory agencies like
the FDA to ensure they are safe and effective. Judge
Bernal, you have made a bad and wide-ranging decision.
A judiciary should protect its citizens, not allow them to
be thrown under the bus driven by the unscrupulous.
Miscellaneous
Gregor Johann Mendel (1822-1884)
If he had lived, Gregor Mendel would have been 200 this
year. Happy birthday Gregor for 20 July – sorry I am a
bit late.
Mendel was an Augustinian secluded monk, an amateur
scientist, meteorologist, mathematician and more
besides. We all know about Gregor because he famously
messed about with pea plants in his two-hectare monastery
garden. And in about 1860, he reported something of
the mechanisms of genetic inheritance after crossbreeding
thousands of his plants and observing and recording whether
the peas were round or wrinkly, green or yellow, and so on.
He coined the terms ‘recessive’ and ‘dominant’ with
reference to certain of these genetic traits.
His contribution to science has been enormous. Indeed,
human genetic engineering rests upon three pieces of
remarkable research spanning over 160 years of scientific
endeavour. First, there was Gregor Mendel in the
1860s. Second, in 1953, James Watson and Francis Crick
described, in a two-page article in Nature, the
three-dimensional structure of the double helix of
deoxyribonucleic acid (DNA), the carrier of the genetic
code. Third, in 2000, a huge team of international
scientists working on the Human Genome Project ‘cracked’
this human genetic code, that is, they sequenced the 3.3
billion (3.3 x 10⁹ ) chemical ‘letters’ of our DNA.
These are three of the most wondrous feats of genetics – we
should never overlook their significance. And nor
should we forget Mendel singly labouring away on his own
enthusiasm in Moravia, which is now part of the Czech
Republic.
His work was initially overlooked but eventually he became
to be regarded as the ‘father of genetics’. His
insights revolutionised our understanding of biological
inheritance which were subsequently applicable to human
health and disease, modern-day genomics and even
personalised medicine. To this day, biologists, and
especially geneticists, still speak of 'Mendelian'
inheritance and 'Mendelian' disorders that obey the laws
proposed by Mendel. What a legacy!
And his contribution to science lives on in a facility
called the Online Mendelian Inheritance in Man (OMIM).
This is a comprehensive, authoritative compendium of human
genes and genetic phenotypes that is freely available and
updated daily. The full-text of OMIM contains
information on all known Mendelian disorders and over 16,000
genes.
Happy bicentennial birthday, Greg.
Autonomy revisited
This is a strange word describing an even stranger
concept. Its meaning from the Greek (autos,
self, and nomos, law) is simple – ‘self-government’
which can readily transmogrify to a twenty-first century
notion of ‘personal freedom’. It therefore ranges from
a stiff stoicism to a liberal free-for-all.
When properly applied, autonomy can rightfully stress the
moral responsibility that each of us should exercise.
For example, medicine has, in recent times, seen a welcome
movement away from some of the awful medical paternalism of
the past – ‘I’m the doctor, and I know what’s best for you –
towards a more reasonable patient autonomy – ‘But I’m the
patient, so please explain it to me.’ Such an
appropriate application of conditional autonomy can only be
beneficial to all concerned.
However, like several other decent bioethical words and
concepts, autonomy has now taken on a more malevolent
meaning. By claiming it to be unconditional, it now
carries a connotation of ‘lawlessness’. As one of the
buzzwords of modern bioethics, ‘autonomy’ now expresses the
idea that we have the right, and even the duty, to do
whatever we want with our own lives, that there should be no
limits, legal or otherwise, to our individual freedom.
Therefore, we can set our own personal rules and our own
private standards for morality and behaviour. This, of
course, is social dynamite. As members of any society,
we all accept certain boundaries to our freedom, such as
observing speed limits, paying taxes and, where indicated,
keeping off the grass. In the realm of bioethics,
misapplied, unconditional, absolute autonomy produces
self-centred responses like, ‘It’s my life, it’s my body,
and it’s my decision’ and ‘I will choose to die when, where
and how I want to’.
But what does a person mean when he or she proclaims, for
instance, ‘It’s my life’? If a woman says, ‘It’s my
book’, we all understand that she bought it, she read it,
she put it on her shelf, and so on. But ‘my book’ is
in an entirely different category from ‘my life’, unless, of
course, you hold that everything – human life, society, a
book and the entire universe – is just a mechanistic
phenomenon, a matter of merely the atomic and the
molecular. Such an overdose of autonomy can be
disastrous. It allows the individual to take centre stage,
to be the prima donna or the leading man. So, for
example, it excludes others from what would best be
relational, family-based or even society-centred
decisions. It can sideline family, friends, wise
counsellors and – perhaps most importantly in, for example,
the case of aborting the unborn child – the father.
Autonomy, as a key feature of modern bioethics, puts the
individual above all others, and it puts self, rather than
even God, at the very centre – a defining characteristic of
secular humanism. Think of all those unattractive,
un-Christian words like self-aggrandizement, self-assertion,
self-centred, self-contained, self-indulgent, self-reliant,
self-righteous, self-seeking and self-sufficient, and you
will begin to understand both the meaning and the end
product of unconditional autonomy.
Population numbers in China
Data show that China is facing a demographic crisis, with an
ageing population and young couples having fewer
children. Last year, China's population increased by
less than half a million people to 1.41 billion. When
will it peak and decline?
There are several answers to that question. For a
start, after years of falling birth rates, the country’s
National Health Commission announced in August 2022 that
total growth has slowed significantly and that numbers will
peak and begin to shrink between 2023 and 2025. Others
think it could happen much sooner. For example, in
2022, Yong Cai, a demographer at the University of North
Carolina, Chapel Hill has said, ‘I won’t be surprised if
population decline is reported at the end of this
year. The turning point is right around the
corner.’ Or, according to Wei Chen, a demographer at
Renmin University in Beijing, on the basis of national
census data released in 2020, China’s population might have
already peaked in 2021
In the light of these decreasing statistics, the Chinese
government has been making significant efforts to boost
birth rates for the past decade. How strange this
policy shift is. After decades of population control
programmes, including the infamous one-child policy, now the
young are being encouraged, even induced and rewarded, to
reproduce. Two children were allowed in the 2010s, now
the talk is for three.
But, after nearly four decades of proscribed families, the
young are not so easily persuaded towards extended
parenthood. That former child-limiting policy has
shifted attitudes about marriage and childbearing with young
people delaying these events. And with more women
pursuing higher education and careers, they are starting
families later in life, if ever. That trend is
expected to persist and the population dilemmas have
refocused to the challenges caused by China’s growing
elderly population.
Here is the oldie’s story. The Chinese baby boomers,
born in the 1960s, are now reaching their 60s. In the
next 10 to 20 years, China will see a surge in its older
population, which will become a major test for the
society. Currently, more than 18% of China’s
population is over 60 years old. That proportion is
expected to increase to 30% by 2050, accounting for 300
million people. Their increasing numbers, greater
longevity and burgeoning medical costs, plus the growth of
fragmented families means less societal cohesion and more
expensive social care, while fewer workers mean less tax
payers and a contracting national treasury.
As already mentioned, last year, China’s total population
increased by only 480,000 people, to just over 1.41
billion. This means the natural growth rate – the
difference between the numbers of births and deaths – was
close to zero. And the country’s birth rate declined
for the fifth consecutive year to 7.5 births per thousand
people, the lowest since 1949.
Looking at both young and old, the demographic trends in the
Chinese population appear to be in troublesome waters.
That is worrying.
Life expectancy in the UK and US
For the last four decades, life expectancy in the UK nations
has been increasing. That trend has now come to a
halt, even a ‘statistically significant’ halt. For
example, life expectancy at birth in the UK in 2018 to 2020
was 79.0 years for males and 82.9 years for females.
This represents a fall of 7.0 weeks for males though almost
no change for females.
Perhaps unsurprisingly, the latest data from the Office for
National Statistics show that the greatest falls in life
expectancy are in the poorest areas of the UK. And men
in these areas are now expected to live about 10 years less
(73.5 years) than those in the richest areas (83.2 years),
and women eight years less (78.3 versus 86.3).
Moreover, those living in the most deprived area are also
living more of their lives in ill health. For
instance, girls born in the poorest areas of England live 19
years less in good health than those born in the wealthiest
regions. The government’s levelling-up agenda has a
long way to go.
The UK is not alone. In the US, the average life
expectancy of Americans also fell somewhat precipitously in
2020 and 2021 from 77.0 to 76.1. The expected gender
differences were evident. Life expectancy at birth for
men dropped one whole year, from 74.2 years in 2020 to 73.2
in 2021 and for women it dropped 0.8 years from 79.9 in 2020
to 79.1 in 2021.
Why these falls in the UK and USA? The declines have
coincided with the onset of the Covid-19 pandemic. And
the decreases in life expectancies have been largely driven
by Covid-19 deaths. For instance, the virus has killed
at least 1 million Americans and it is reckoned to account
for 50% of these declines. Now that Covid-19 effects
on mortality have begun to lessen, will life expectancies
return to an upward trend? Maybe. Yet other
major causes of death, such as influenza and pneumonia,
strokes and heart disease, cancers and Alzheimer’s disease,
are expected to reappear as principal effectors. Again
– only time will tell.
USA
and Elsewhere
Post Roe v
Wade USA
Rarely has there ever been a judicial decision like that of
Friday 24 June 2022 when the Justices of the Supreme Court
of America to overturned Roe v Wade, the 1973 ruling
that supposedly gave American women the constitutional right
to abortion. While that judgement has not banned all
US abortions, it has proved to be a mightily significant
move in the life-affirming direction.
In the last few months, the abortion landscape across the US
has changed drastically. Post Roe, decisions
about whether or not abortions are permissible have been
handed to the individual States to decide. The country
has been split in two – the principles of justice and equity
are under fire, the right to life and access to so-called
‘essential healthcare’ are up for debate. These
personal and political ramifications will continue but,
above all, many, many unborn children now have a restored
dignity and greater protection – they will now live instead
of ending up in the hospital waste.
Some States have taken a liberal stance and permitted
abortions up to viability at around 24 to 26 weeks, others
have imposed various restrictions, while others have banned
abortions under all circumstances. For instance, at
the end of September, almost all abortions became illegal in
Arizona. A new law banning abortions after the 15th
week of pregnancy took effect and then, in a surprise move,
a judge lifted an almost 50-year-old injunction that blocked
a near-total ban on abortions from being enforced in the
State. Overall, from September, at least 13 States are
now abortion-free and 62 abortion businesses have stopped
performing terminations. Several more States have
similar bans that are temporarily gridlocked by legal
wrangling over whether or not they can be enforced.
Over 78 million US citizens are now living in abortion-free
States. That is nearly a quarter of the US
population. That proportion is likely to swell in the
coming months.
Abortion is a profound bioethical issue, not just a legal
matter. It tests our understanding of who we are, what
is right and wrong, and so on. May this historic
striking down of Roe v Wade drive us to reconsider
these most fundamental issues.
John MacArthur tells it like it is
In late September, John MacArthur, the evangelical pastor of
Grace Community Church in Sun Valley, California, published
an open letter to California’s Governor Gavin Newsom.
MacArthur was outraged that Newsom had quoted Jesus Christ
on billboards promoting abortion of the unborn.
Newsom, a pro-abortion Democrat, had been working
aggressively to expand abortion by signing a dozen
pro-abortion bills into law and announcing a budget that
included $200 million specifically for new abortion
projects. During September, the Governor had shocked
Christians and others by paying for billboards in pro-life
States that quote Scripture to encourage women to come to
California for abortions.
One billboard read, ‘Need an abortion? California is
ready to help.’ Beneath these words was the text of
Mark 12:31, ‘Love your neighbor as yourself. There is
no greater commandment than these.’ It also advertised
a new, taxpayer-funded, Californian government website that
promotes abortion.
MacArthur wrote, ‘My concern, Governor Newsom, is that your
own soul lies in grave, eternal peril. You will stand
in the presence of the Holy God who created you, who is your
Judge, and He will demand that you give an account for how
you have flouted His authority in your governing, and how
you have twisted His own Holy Word to rationalize it.’
He continued, ‘In mid-September, you revealed to the entire
nation how thoroughly rebellious against God you are when
you sponsored billboards across America promoting the
slaughter of children, whom He creates in the womb (Psalm
139:13–16; Isaiah 45:9–12). You further compounded the
wickedness of that murderous campaign with a reprehensible
act of gross blasphemy, quoting the very words of Jesus from
Mark 12:31 as if you could somehow twist His meaning and
arrogate His name in favor of butchering unborn infants.’
MacArthur told Newsom that Jesus’ greatest command was to
‘love God’ and no one can follow that command while ‘aiding
in the murder of His image-bearers.’ MacArthur said he
and many others are praying for Newsom to repent and turn
his life to Christ. MacArthur concluded, ‘Please
respond to the gospel, forsake the path of wickedness you
have pursued all your life, turn to Christ, ask for
forgiveness, and use your office to advance the cause of
righteousness (as is your duty) instead of undermining it
(as has been your pattern).’
California is an abortion hot spot. It has the highest
number of abortion facilities in the country standing at
168. In 2020, approximately 154,000 abortions were
performed there. The Sunshine State already has very
few limits on abortion, and it forces taxpayers to pay for
them. Moreover, a new law, expected to come into force
next year, will insist that all public colleges and
universities provide abortions on campus.
Well said John MacArthur. Now all you other ministers
of the Gospel, speak up and speak out.
Global fallout from Roe
v Wade
Repercussions of the Roe v Wade decision have
travelled way beyond the USA. It has provoked protests
across the world. Major international bodies have
condemned the ruling, with the World Health Organization
(WHO) and the British Medical Association (BMA) strongly
opposing the change. Somewhat predictably, the UK’s
Royal College of Obstetricians and Gynaecologists (RCOG) and
the Faculty of Sexual and Reproductive Healthcare (FSRH)
issued a statement renewing calls for the UK Government to
decriminalise abortion in the UK.
In addition to rhetoric, political action has already
occurred. For example, François Braun, the French
health minister has signalled that France will soon enshrine
the right to abortion in its Constitution. This is
widely seen as a deliberate attempt to bolster women’s
rights in the aftermath of the US Supreme Court’s
pronouncement. According to a recent poll, 83% of
French voters are already in favour of the right to
abortion. Nevertheless, the move is also regarded as a
slighting of conservative EU states, such as Poland and
Hungary, where abortion is severely restricted.
Has the Roe v Wade verdict
sent France bioethically reckless? After all, from
January 2023, it is to make emergency contraception, the so
called morning-after pill (MAP), available free of
charge. Moreover, sperm and ovum donors in France have
recently lost their right to anonymity. Critics of the
move say that the French, who are already reluctant to
donate compared to their UK counterparts, will be even more
reticent now that they can be contacted by people conceived
with their sperm and ova. France currently has only
half as many sperm and ovum donors as the UK. The
change in the law, implemented by President Macron, will
bring France in line with the UK, which legislated in 2005
to allow people conceived through gamete donations to access
the identity of their donors after turning 18. Will it
cause a collapse in French donations? Only time will
tell.
Chile and abortion
The voters of Chile have recently overwhelmingly rejected a
new constitution that would have stripped away unborn
babies’ right to life and legalised abortion on
demand. The Washington Times reported that
just 38% of voters supported the ‘progressive’ constitution,
while 62% rejected it. As a result of the vote, Chile
will continue to protect unborn children from
abortion. Exceptions are allowed when the mother’s
life is at risk, or she is a victim of rape.
Constanza Saavedra, with the Chilean pro-life group
Testimonios por la Vida, celebrated the news, saying the
vote gives her hope for the future. She continued,
‘With joy and hope in a better Chile, with changes that
unite us, seeking to improve the quality of life for all,
surpassing ourselves and moving forward. Leaving
setbacks, divisions and hatred behind. A Chile in
which we can all continue to proudly say, Viva Chile!’