Update on Life Issues - October 2024


Terminally Ill Adults (End of Life) Bill

Wednesday 16 October
This was a dreadful day for medical ethics and practice in England and Wales.  It was the day that Kim Leadbeater MP introduced her Terminally Ill Adults (End of Life) Bill in the House of Commons.  This was the First Reading of the Bill when its full title was announced as a ‘Bill to allow adults who are terminally ill, subject to safeguards and protections, to request and be provided with assistance to end their own life; and for connected purposes.’

 

The Bill’s Second Reading, set for Friday 29 November, is when the main principles of the Bill will be debated, amendments taken, and votes probably cast.

 

The main intention of the proposed Bill is both clear and ghastly.  People may, for the first time ever, be legally assisted to choose to end their lives prematurely.  This is assisted suicide, plain and simple.

 

According to its title, the Bill applies only to terminally ill adults.  So, will those who are non-terminally ill, but with incurable or intolerable suffering, be excluded?  Kim Leadbeater has stated, ‘This is about terminally ill people.  This is not about people with disabilities.  It's not about people with mental health conditions.  It is very much about terminally ill people.’  And yet jurisdictions around the world, where assisted suicide is legal, have consistently extended their eligibility criteria by both legislation and by practice to, for example, include minors and to introduce euthanasia.  This is the bioethical slippery slope, plain and simple.

 

MPs need to clarify a host of other issues.  What about a person’s minimum qualifying age?  What about their length of residence here?  What about their mental competence?  What about their prognosis of life expectancy?  What about the involvement of two doctors and a judge?  What about a medical practitioner or an amateur assisting?  What about doctors who refuse to participate?  What about palliative care?  What about realistic and workable safeguards and protections?  And so on.

 

This is the worst bioethical news for decades, perhaps since the introduction of the horrors of the Abortion Act 1967.  Legalising assisted suicide will achieve nothing praiseworthy.  Instead, it will bring about untold harm and hurt.  It will diminish our understanding of the preciousness of all human life and it will cause our compassion to sink to an all-time low.  Bad, bad, bad.
What can I do?
Three things.  First, get a grip.  This is truly a matter of life and death.  Second, meet with / contact your MP and explain your objections to the Bill and why he / she should vote against it.  Several pro-life organisations have online advice for meeting with and writing to MPs.  You have less than six weeks!  Third, pray that God would intervene and frustrate the progress of this Bill.  Good, good, good.


The General Election 2024

The results
 On Wednesday 22 May, in the pouring rain outside No 10 Downing Street, the then Prime Minister, Rishi Sunak, announced the date of the 2024 general election.  It was to be Thursday 4 July.  And by the next day, the results were declared – it had been a Labour landslide.  Of the 650 seats up for grabs Labour had won 404 with a whopping working majority of 167 allowing it to force through any of its proposed policies.  The Conservatives secured just 121 seats, the Liberal Democrats won 72 and the remainder were spread among the minor political groupings, such as the Scottish National Party and Reform.

Who's who?
But beyond their political affiliations, just who are these Members of Parliament who make our laws that govern our lives?  There are currently 387 men and 263 women MPs, 335 are newcomers, 69 identify as LGBT+, 27 are lawyers, 10 are doctors plus 3 are Olympic and 2 Paralympic athletes.  What makes these oldies and newbies tick?  Nobody quite knows about the latter group because they have yet to vote on any bioethical issue.  So will these MPs share our values?  A crude answer can perhaps be found in their religious connections.

Only 60% of the 650 MPs officially sworn in at Westminster during July chose to swear a religious oath of allegiance to the Crown.  That proportion is similar to the results of the 2021 census, which showed that 65% of UK adults have some religious affiliation.  We have therefore elected a Parliament, not only the most irreligious in history, but also one that is more godless than the nation.  Of all MPs, 338 swore on the Bible, 14 on the Quran and 3 on the Bhagavad Gita, the Hindu scripture.  The remaining 40%, around 249 MPs, made an affirmation without any reference to God.  Almost half (47%) of Labour MPs affirmed, compared with only 9% of Conservatives.  After the 2019 general election, only 24% of all MPs chose a non-religious affirmation.  Is the UK and its Parliament becoming a more secular jurisdiction?  Is it more than just a falling away of a cultural, nostalgic Christianity?  It certainly seems that Sir Keir Starmer ‘doesn’t do God’ as he becomes the first atheist Prime Minster in decades.

What does all this mean for the pro-life cause?  Here is the good news.  Several reliable pro-lifers, such as Sir Edward Leigh, Carla Lockhart, Jim Shannon, John Hayes and Mary Glindon were re-elected.  The bad news is that many MPs with a previously strong pro-life voting record lost their seats.  They include Fiona Bruce, Caroline Ansell, Miriam Cates, Sir Jacob Rees-Mogg, Maria Caulfield and Sir Liam Fox.
Why the concern?  Because in this Parliamentary session these 650 new and old MPs will likely be voting on key bioethical issues, such as the legalisation of assisted suicide, the decriminalisation of abortion and more permissive embryo experimentation.  Indeed, as an ominous portent, Keir Starmer has once again declared himself in favour of permitting assisted suicide and has promised to allocate Government time for a debate and a free vote on the issue.  In addition, the extremist pro-abortion MP, Diana Johnson, who has led multiple attempts to introduce a more radical abortion law up to birth, has already been appointed as a Home Office Minister in the new Labour Government.

This is going to be a tough and testing Parliament.  Are you ready?
Abortion

Abortion law changes
Earlier this year the abortion political lobby flexed its muscles at Westminster.  Those two Labour MPs, Stella Creasy and Diana Johnson, tabled two extreme abortion amendments, even up to birth.  Thankfully, both failed.  In addition, abortion's commercial lobby, led by BPAS (British Pregnancy Advisory Service) and MSI Reproductive Choices (formerly Marie Stopes International), spent huge sums of money supporting pro-abortion MPs in their lobbying and campaigning efforts to try and force through major changes to our abortion laws.

It is reported that BPAS has a yearly budget of over £50 million and MSI has an even bigger fund of over £300 million.  Abortion is a big and profitable industry.  And by vigorously lobbying and campaigning for more extreme abortion laws the industry intends to maintain and advance its trade.  These pro-abortion businesses, charities and organisations wield huge financial clout.

By contrast, pro-life groupings are poor, even destitute.  We are the church mice of bioethical issues.  The pro-life cause has no commercial funding.  It depends on individuals like us.  Do you give money to fight for the survival of the unborn?  Maybe it is time for many of us to review our giving.

Yet money is not the only issue.  More enthusiastic, well-informed women and men are also needed.  How will that come about?  Do you read, listen and watch, newspapers, podcasts, TV and more to become better educated?  For most of us, it is like Isaiah 28:10, ‘ … a little here, a little there.’  Abortion law is currently under threat of changing for the worse, we should be for changing ourselves for the better.

Abortion in Scotland
What is wrong with Scottish people?  For sure, they can be loud and opinionated, but many have charming accents, especially if they were brought up around Edinburgh (rather than Glasgow).  However, when it comes to abortion, there is a Caledonian sector that is extreme in both word and deed.

Herein are two complaints.  First, there are specifically troublesome members of the Scottish National Party (SNP).  On Sunday 1 September, at the SNP’s 90th Annual National Conference in Edinburgh, a motion was put forward by the Elgin SNP branch.  It was debated in session 11 under the title, ‘Enshrining the Right to Abortion in the Future Constitution of an Independent Scotland.’

Its strident agenda stated that, ‘Conference believes that women's rights are human rights, and access to safe, legal abortion is a fundamental aspect of healthcare and bodily autonomy.  The right to choose should not be subject to the changing tides of political or judicial decisions but should be a guaranteed and protected right within the highest legal framework of our nation.’  And ‘Conference resolves that the SNP would call for the right to abortion to be enshrined in the future constitution of an independent Scotland, safeguarding women's reproductive rights against any potential political or legal regression.’

This motion was almost certainly driven by the recent developments in the USA including the 2022 overturning of Roe v. Wade and the subsequent loss of a national right to abortion.  And, in 2023, France, similarly fearing a possible loss of access to abortion, took a proactive step by enshrining the right to abortion in its Constitution.  Spokesperson for Right To Life UK, Catherine Robinson, commented, ‘The Constitution of a country acts as its foundational document, defining, among other things, the country’s basic principles of government and law.  It is deeply disturbing that this SNP resolution proposes to make ending the lives of its unborn citizens one of those foundational principles.’

Kim Marshall, a former SNP candidate, defended the motion, despite concerns that it could alienate voters who hold pro-life views.  Apparently, a significant majority of SNP members at the Conference voted in favour of this call for a constitutional right to abortion.  Thankfully, the party holds only 9 of the 57 Scottish seats in the House of Commons.  And Scotland is not about to become independent and so this contentious motion, like the SNP and its membership, will likely wither.

The second complaint centres on the Abortion Services (Safe Access Zones) (Scotland) Bill, which passed in the Scottish Parliament by 118 votes to 1 on 12 June 2024, became an Act on 22 July 2024 and came into force on 24 September 2024.  These so-called buffer zones around clinics which offer abortion services are intended to prevent any protests or vigils from taking place within a 200m radius of the 30 abortion clinics throughout Scotland.  See what you have done, Scottish citizens?  You have set a sub-standard precedent because a few weeks later, on 31 October, buffer zones will be enforced around a 150m radius of abortion clinics in England and Wales under Section 9 of the Public Order Act 2023.  Even silent prayer may be under threat though it has not been specifically listed as an offence under the new rules.

Within the buffer zones, it will be a criminal offence to behave in ways that could influence the decisions of women and staff to access abortion services.  Stopping women and staff from entering the clinics or otherwise causing alarm, harassment or distress will also be an offence.  Anyone who breaks the new Safe Access Zone laws could be fined up to £10,000 or an unlimited amount in the most serious cases.

Scottish Green MSP Gillian Mackay, who originally tabled the Bill, said it was a ‘pivotal moment for reproductive rights in Scotland.’  However, opponents of the Act have claimed the legislation infringes on their freedom of religion and speech.  Of course, there can be no excuses for deliberately harassing or intimidating women on their way to abortion clinics.  Laws are already in place to punish such behaviours.  But the UK Government's response to clamp down on people’s speech and beliefs is dangerous and misguided.  It will only serve to limit ordinary people’s civil liberties.  There are some people who wish to think and pray silently outside such clinics.  Why should they be forbidden?

From the Update on Life Issues (February 2023), ‘Some pro-life activists argue that their work outside abortion clinics has helped women seeking practical support.  Some pro-choice activists say the move will stop women being ‘harassed’.  Is this new law really censoring and silencing help for women in delicate situations with vulnerable mindsets?  Maybe.  Christians can pray silently and undemonstratively elsewhere.  Is there some unhelpful self-satisfaction about being present where the action is?  This is a minority issue.  Where are the thousands of Christians rather than the dedicated few who stand in the rain?  What does that say about our understanding of abortion and this sort of public protest activity?  Are we complicit or cowardly?’

‘Whatever the arguments for and against standing outside abortion clinics, the approval of buffer zones has more sinister connotations.  First, it regards trespass where no intent to trespass exists.  The non-demonstrating public may freely ‘trespass’ within buffer zones.  Only those who seem to be praying, or leafleting, or engaging with likely abortion clinic clients will be barred.  Second, it infringes public engagement, stopping, for example, any opportunities for conversation.  Are we no longer allowed to chat freely with fellow citizens?  Third, it militates against free speech.  If conversation is banned, what about silent prayer?  What about freedom of religion?  What about a person’s private thoughts?  Where next, what next?  Street preaching is already under attack.  Is the poor Christian, who prays as he walks to the supermarket, or as he digs his garden, likely to be muzzled?  Of course not, you say.  Really?  Why are you so sure?’

People of Scotland, consider these two complaints.  First, there is a small group of extremists among you who wish to institutionalise abortion in a Scottish Constitution.  Second, your Parliament has overstepped the abortion line.  It has exceeded its powers and sought to encroach upon and ban the thoughts and opinions of others, including you.  That cannot be right.
IVF and ARTs

Opposing IVF
In vitro fertilisation (IVF) has been highly controversial even before the world’s first ‘test-tube’ baby, Louise Brown, was born in July 1978.  The Roman Catholic church has long been a prime opponent on at least three grounds.  First, IVF separates the procreative goal of marital sex from the goal of uniting married couples.  Second, IVF treats children as products rather than as gifts.  And third, IVF inevitably destroys human embryonic life.  However, while the Roman church opposes IVF, it does not oppose exploring treatments to help with infertility – there are licit means to enhance fertility and overcome obstacles to conception.

Those are the official, staunch and implacable position statements of the Roman Catholic church and its 1.3 billion adherents.  Now, what about the Protestant churches and their 1 billion members?  There is, and never has been, such a clear and agreed position on IVF.  Take, for example, the largest international grouping, the Anglican Communion, with its worldwide membership of 85 million.  To say it is confused in both doctrine and practice is a huge understatement.  Frankly, it is as disunited on IVF as on most other bioethical issues.  This is so disheartening.

But here is some heartening news.  With some 13 million members in 47,000 churches, the largest Protestant denomination in the USA, the Southern Baptist Convention, has at last nailed its IVF colours to the mast.  At its annual meeting in June at Indianapolis some 10,000 delegates voted overwhelmingly to oppose the use of IVF.  The relevant resolution asserted that ‘human being’ includes ‘frozen embryonic human being’.  It declared that ‘though all children are to be fully respected and protected, not all technological means of assisting human reproduction are equally God-honoring or morally justified.’

The catalyst for these bold assertions was the Rev Dr R Albert Mohler Jr, president of the Southern Baptist Theological Seminary in Louisville, Kentucky and, according to Time magazine, ‘the reigning intellectual of the evangelical movement in the US.’  Mohler stated that the Alabama Supreme Court got it right in its 16 February ruling on IVF when it said that human embryos should be protected as human life.  In other words, Alabama’s Wrongful Death of a Minor Act applies to all unborn children regardless of their location, whether in a human uterus or in a freezer used during IVF procedures.  The background to this lawsuit was outlined in the ‘USA and Elsewhere’ section of the Update on Life Issue (June 2024) here.

What now?  This anti-IVF declaration by the Southern Baptist Convention should galvanise other Protestant evangelical groupings to oppose IVF.  And it will push individuals to question their own stance on IVF.  So, where do you stand?  That notwithstanding, the bioethical mantra still stands – IVF is best avoided.

IVF trends in the UK
On 18 July 2024, the Human Fertilisation and Embryology Authority (HFEA) published its annual set of data and trends associated with the UK fertility sector.  The document is entitled Fertility Treatment 2022: Preliminary Trends and Figures and indeed most of its figures relate to 2022.  Here are some of the report’s main points.

During 2022, most fertility service activities increased on pre-pandemic levels from 2019.  In 2022, around 52,500 patients had IVF treatments at HFEA-licenced fertility centres in the UK.  IVF cycles (both fresh and frozen embryo transfers) increased by 8,000 to almost 77,000 cycles from around 69,000 in 2019.

However, the average age of first-time IVF patients has now risen to over 35 years, even though the success rates are known to decline with age.  There is therefore a large gap in the average age that women in England and Wales gave birth to their first child.  According to Office for National Statistics (ONS) figures, this was 29.2 years for natural conceptions compared with patients accessing IVF for the first time at 35.1 years.

Average IVF pregnancy rates increased nationally to 31% per fresh embryo transferred in 2022, up from 21% a decade before in 2012.  The highest birth rates (not pregnancy rates), at 35%, were among young patients, aged between 18 and 34.  Among older patients, aged between 43 and 44, this rate dropped to only 5%.

Multiple births from IVF treatments, with their well-known health risks to both mothers and babies, fell from 28% in the 1990s to their lowest ever level at just 4% in 2022.  The cost-of-living crisis, plus Covid-19 troubles, and increased waiting times within the NHS, have been among the factors that have resulted in a decline of NHS-funded IVF.  In 2012, 40% of treatment cycles were funded centrally compared with only 27% in 2022.

New ova and sperm donors, including those from abroad, increased by 21% from 2019 to 2022, however UK-based sperm donors decreased by 11%.  Some 90% of all IVF patients were in heterosexual relationships.  The number of IVF patients in female same-sex relationships increased by 35% from 1,628 in 2019 to 2,200 in 2022.  The number of single patients undergoing IVF increased by 82% from 1,953 in 2019 to 3,548 in 2022.

The take-home message?  If you really, really must try IVF, do it while young, and expect it to be largely a failure as well as costly, both financially and emotionally.  Otherwise, the bioethical mantra still stands – IVF is best avoided.

Two AIs and ARTs
This will display the extent of your bioethical engagement – this is an ageist segment.  Decades ago, one type of assisted reproductive technology (ART) was AI, artificial insemination, also known as IUI, intrauterine insemination.  According to the HFEA, AI ‘is a type of fertility treatment in which the better quality sperm are separated from sperm that are sluggish, non-moving or abnormally shaped.  These sperm are then injected directly into the womb.  It is most commonly used by people who are using donated sperm in their treatment, including single women and female couples, but can also be used by some heterosexual couples.’  It is regarded as more natural than IVF, but it is less successful.

Move on about 70 years and now, in 2024, the abbreviation, AI, has assumed another entirely different meaning, namely artificial intelligence.  And a recent research project has examined how well such an AI system can select IVF embryos most suitable for transfer compared with those chosen by an embryologist’s eye.

Researchers from 14 fertility clinics in Australia, Denmark, Sweden and the UK compared pregnancy rates and outcomes from embryos selected using either a deep learning AI system, known as intelligent Data Analysis (iDA), or using the standard assessment of the morphology of the embryo by embryologists.  The work was published as ‘Deep learning versus manual morphology-based embryo selection in IVF: a randomized, double-blind noninferiority trial’ by Peter J Illingworth et al., and published in Nature Medicine (2024, 9 August).

In the study, iDA was used to review the same embryonic data as assessed by an embryologist, and to score each embryo out of ten.  The embryo transfer procedures were then randomly allocated to the two arms of the study of 1,066 patients, with half having the embryologist-selected embryo transferred, and half having the embryo which scored highest using the AI system.

The clinical pregnancy rates (the detection of a foetus by ultrasound) were compared between the two groups.  The results were not significantly different, with the AI system slightly lower at 46.5% compared to 48.2% in the embryologist-selected group.  Overall, the AI system selected the same embryos as an embryologist 69% of the time.  However, the selection of the embryos using AI was ten-times quicker than selection by embryologists.  It therefore seems that use of this deep learning tool for embryo selection will not radically change the outcome of IVF treatments because it mostly chooses the same embryo as the embryologist would.  Nevertheless, having a reliable, automated tool of this sort may make embryology laboratories more efficient and consistent.

Perhaps, as feared by some, AI really could take over repetitive, time-consuming and subjective tasks and make skilled employees redundant.  As if IVF is not overly impersonal already.  And already you know the mantra .....
Euthanasia and Assisted Suicide

Assisted suicide in the Commons
Oh dear, this is such a miserable topic to write (and read) about.  The issue was pushed up the agenda last year when the TV presenter Dame Esther Rantzen announced that she had joined Dignitas, the assisted suicide clinic in Switzerland.  Words from our Prime Minister give no comfort.  Earlier this year, Sir Keir Starmer stated, ‘I am personally in favour of changing the law and I can give you my commitment … that if we are privileged enough to win the election, we will make time for this vote.’  Then on an LBC Radio interview this summer he maintained, ‘I will double down on that commitment [on assisted dying] – we will allow time for a Private Member’s Bill, and there will be a free vote.’  Starmer was a prominent supporter of the issue the last time it was voted on in the Commons nine years ago – and defeated 330 v. 118.

It is an issue that has split the Labour party.  Wes Streeting, the MP for Ilford North and the current Secretary of State for Health & Social Care has said the ‘time has come’ for a debate on the subject.  However, Streeting has his reservations and has declared, 'I am not sure as a country we have the right end-of-life care available to enable a real choice on assisted dying.’  Moreover, the Lord Chancellor, Secretary of State for Justice and MP for Birmingham Ladywood, Shabana Mahmood, has stated, ‘I don't intend to support it ... once you cross that line, you've crossed it forever.  If it becomes the norm that at a certain age or with certain diseases, you are now a bit of a burden … that's a really dangerous position.’

Indeed, these doubts and fears were reflected in a poll conducted this summer by Whitestone Insight.  It found that more people than not (46% v. 36%) thought that assisted suicide, even if desirable in principle, is not ‘a practical and safe option to implement in Britain.’  The truth is that most people are ambivalent and harbour serious concerns about assisted suicide.

So here is the BIG question – will there be a vote in the House of Commons on assisted suicide as early as this year?  Yes, probably, via a Private Member's Bill.  Potential sponsors soon appeared after the Private Member's Bill Ballot was drawn in September.  One such was Jake Richards, Labour MP for Rother Valley.  He came 11th and so missed out on the top seven spots, which would have guaranteed him a day’s Parliamentary debate on a Friday sitting for a Bill of his choice.  Richards has said, ‘I’ve campaigned for reforms to assisted dying laws for many years, and immediately upon finding out my name had been picked I was determined to bring this Bill forward.  However, his prospect of being given Government time in the Commons to change the Suicide Act 1961, which he has called ‘the archaic law’, have significantly dwindled, if not disappeared.

However, in the meantime, the Ballot winner, Kim Leadbeater, Labour MP for Spen Valley, and sister of Jo Cox, the MP who was murdered in June 2016, has declared herself.  On 3 October, she announced that she will use her coveted place in the Ballot to introduce a Bill to give terminally-ill people in England and Wales the right to choose to end their lives prematurely.  The details of her Bill are expected to be similar to Lord Falconer's currently in the House of Lords.  Kim Leadbeater's assisted suicide Bill is expected to be formally introduced in the Commons on Wednesday 16 October and then debated with a vote at Second Reading on Friday 29 November.

This is the worst bioethical news for decades, perhaps since the introduction of the horrors of the Abortion Act 1967.  Legalising assisted suicide will achieve nothing praiseworthy.  Instead it will cause untold harm and hurt.  It will diminish our understanding of the preciousness of all human life and allow our compassion to sink to an all-time low.  Bad, bad, bad.

What can I do?  Three things.  First, get a grip.  This is truly a matter of life and death.  Second, meet with / contact your MP and explain your objections to the Bill and why he / she should vote against it.  Third, pray that God would intervene and frustrate the progress of the Bill.  Good, good, good.

Assisted suicide in the Lords
And there is more.  Lord Falconer of Thoroton, is the former Labour justice secretary and a persistently determined advocate for assisted suicide which he has described as ‘the UK’s next great social reform’.  In July, he introduced his own Private Member’s Bill, entitled, the Assisted Dying for Terminally Ill Adults Bill, in the House of Lords.  It is similar to his previous four Bills that aimed at changing the law and permitting terminally ill adults, with six months left to live, the option of an assisted suicide.  Falconer has stressed that this current Bill would have strong safeguards, including the Pperson must be mentally able to make the decision, two doctors must approve the procedure, along with the consent of the High Court.  It will be debated and voted on at its Second Reading on Friday 15 November.  However, since the emergence of the Leadbeater Bill, Lord Falconer stated, on 10 October, that he would make way for the Commons' Bill.

Opposition to these assisted suicide Bills comes not only from the general public, but also specifically from disability rights organisations.  Major disability groups, including Disabled People Against Cuts (DPAC) and Not Dead Yet UK, have been vocal in their opposition.  For example, DPAC recently held a protest at Westminster urging the new Labour Government to reject any moves towards legalising assisted suicide.

Not Dead Yet UK has also expressed deep concern about the Falconer Bill, stating, ‘Like many disabled people, we are conscious that attempts to build legalised suicide into healthcare can be profoundly discriminatory – if a non-disabled person wants to die, their doctor does not give them the means to kill themselves.’  They added, ‘We want the same care and respect to be given to terminally ill people if they are suicidal.’

Instead of legalising assisted suicide, the group lobbies for improving access to palliative care and addressing the underlying issues of dignity and feelings of being a burden.  They also argue that the Bill’s proposed safeguards will fail to protect disabled people, saying, ‘In reality, these safeguards are virtually impossible to implement effectively.’

A recent poll, commissioned by the disability charity SCOPE, has shown that the majority of people with disabilities (64%), including nearly three-quarters of young disabled people, are concerned about legalising assisted suicide.  Many worry it could lead to pressure on disabled individuals to end their lives prematurely.

Catherine Robinson, spokesperson for Right To Life UK, commented, ‘It should come as no surprise that no major disability advocate groups in the UK support a change in the law to introduce assisted suicide.’  She emphasised that Parliament has consistently rejected Lord Falconer’s proposals, and that the focus should be on palliative care, not assisted death.

Ross Hendry, CEO of Christian Action, Research and Education (CARE), rightly maintains that assisted suicide ‘undermines human dignity and puts vulnerable groups at greater risk of abuse and harm.’  He added, ‘UK politicians should ensure that investment and infrastructure are in place to ensure high-quality palliative care for all people.  The UK has huge work to do in this area, given a chronic underfunding of this aspect of healthcare.  We’d also emphasise the need to enhance suicide prevention, and work towards a society where all lives are considered.’

Assisted suicide on the Isle of Man
Sweet, little offshore island, home of TT races and stubby-tailed cats, semi-independent as a British Crown Dependency, self-governing country and not part of the UK.  How could you?  How could you approve a law that would give terminally ill Isle of Man residents the right to choose to end their lives?  You and your MHKs (Members of the House of Keys) are guilty of having made a terrible mistake.

Here is the back story.  In Manx law, under section 2(1) of the Criminal Law Act 1981, assisted suicide is unlawful.  It is an offence, punishable by up to 14 years’ imprisonment, akin to section 2(1) of the UK’s Suicide Act 1961.  Nevertheless, proposals to approve assisted suicide go back at least to February 2015, when MHK Juan Watterson sought to introduce a Private Member's Bill aimed at changing Manx law.  That motion was rejected by 17 to 5.

It was not until 2022 that Dr Alex Allinson, GP and MHK for Ramsey, brought his Assisted Dying Bill 2023 to the House of Keys.  Its stated purpose was ‘To enable adults who are terminally ill to be provided at their request with specified assistance to end their own life; and for connected purposes.’  In effect it proposed that terminally ill, mentally competent adults should be able to request assisted dying, subject to approval from two independent doctors.  Alex Allinson, believes the proposed legislation would give ‘choice, autonomy and dignity.’  Opponents have variously described it as ‘irresponsible’, ‘unworkable’ and ‘unsafe’.

On 24 May 2022, MHKs voted by 22 to 2 to allow its introduction.  On 27 June 2023, it received its First Reading in the House of Keys, the lower House of the Tynwald, the Island’s Parliamentary assembly.

On 31 October 2023, the Bill passed its Second Reading by 17 to 7.  It has since been debated in its so-called critical Clauses stage.  On 7 and 14 May, two key changes were approved.  First, MHKs voted (14 to 10) to increase the required residency period on the Island from one year to five, amid concerns that it could encourage so-called ‘death tourism’.  Second, MHKs supported (15 to 9) a change to allow those with a prognosis of less than 12 months to live, the right to die, rather than six months as originally proposed.

The Clauses stage continued throughout June 2024.  MHKs rejected by 14 to 9 an amendment to postpone the debate until after the summer recess in November.  They also voted down further amendments to postpone debates on other clauses.  Further details of the Bill were approved including amendments to increase its safeguards by adding further offences to protect against the possibility of coercion as well as an opt-in model for doctors who wish to be part of the service.  In addition, MHKs voted 19 to 4 in favour of limiting the Bill to self-administration of the life-ending medications by the patient rather than involving a doctor, and thus they restricted the Bill to assisted suicide rather than the possibility of euthanasia.  On 9 July 2024, the House debated whether to subject the Bill to approval by referendum – that amendment was lost by a single vote, 12 to 11.

On 23 July it was reported that the Bill had passed its Third Reading as MHKs voted 16 to 8 in favour.  It now progresses to the Legislative Council, the Upper House of the Tynwald, for further debate and scrutiny over the summer recess, which runs until October.

It could then be passed, amended or rejected.  If the former, the Bill could receive Royal Assent as soon as next year, followed by consideration of how the legislation will be implemented.  Assisted suicide deaths could potentially become available for Manx residents as soon as 2027.  Thus, the Island could become the first part of the British Isles to pass assisted suicide legislation – it could have serious implications for the UK mainland.

The opinions of Manx residents have been mixed, even polarised.  In 2021, Dignity in Dying, the UK’s largest assisted dying organisation, reported that an opinion poll had found that 87% of residents backed a change in the law on assisted suicide.  By October 2023, a survey commissioned by Dignity in Dying found that 66% of 1,200 residents supported the Bill with 53% indicating ‘strong’ support.  In April 2023, according to results from the Manx Government’s own consultation, 49.6% of respondents disagreed with the proposed regime, with 49.0% in support.  A survey by the Isle of Man Medical Society reported in October 2023, that 74% of the 108 doctors who responded were against the introduction of the proposed laws.  Moreover, the survey reported that 34% of doctors would consider leaving the Island if the new legislation was introduced.

If this Manx Bill becomes law the door is pushed open, just a little, for similar legislation in the UK and elsewhere.  That would be a wretched landmark day for us all.  The doctor-patient relationship of respect and trust would be broken.  The ethics and practice of wholesome Hippocratic-Christian medicine would never be the same.  Healthcare workers as dedicated healers would become life terminators.  The elderly, disabled, poor, frail, sick and vulnerable would be at even greater risk.  Second-rate end-of-life care would become commonplace.  The inevitable trend in politics, ethics and practice would be from ‘soft’ assisted dying to ’hard’ euthanasia.  None of this would be praiseworthy or commendable.
Genetic Technologies

Guidelines for SCBEMs
New biological technologies, especially those with potentially dangerous consequences, require robust regulations, sometimes including ringfencing to curb their uses.  Take as an example, all techs that use (and inevitably destroy) human embryos.  Your bioethical alarm bells should now be ringing loudly.  And likewise for stem cell-based embryo models, or SCBEMs.  These are three-dimensional biological structures grown from stem cells that can mimic some aspects of human embryo development.  They have been used by scientists over many years for a range of research purposes.

In some countries such controversial research is like the Wild West – anything goes.  The UK has a little more mellow outlook.  Yet SCBEMs are problematic because they behave like human embryos, but they are not human embryos.  This type of research needs strenuously regulating.  Something needs to be done.

And, in July 2024, UK researchers took the first required step.  They published a voluntary code of practice for scientists working with these human-embryo models.  The 25-page document is entitled, ‘Code of Practice for the Generation and Use of Human Stem Cell-Based Embryo Models.’  It is intended to support the development of best practice for the generation and use of human SCBEMs for research in the UK.

Unsurprisingly, the Code is something of a gallimaufry.  For instance, it prohibits implanting SCBEMs into the uterus of a living person or other animal.  That is good.  However, it does not set a time limit on how long these models can be grown in the lab.  That is bad.  It is reminiscent of the various erstwhile prohibitions on, for example, reproductive germline editing, human hybrid production, plus the 14-day rule.  Look where they are today!  Such bans and seemingly robust regulations in biological experimentation have a predictable tendency to go soft with time.  Scientists plead, ’If only we could go a little further, a cure is surely just around the corner.’

This is dangerous ground.  For example, on p. 7 the Code admits, ‘A key difficulty, given the current state of SCBEM research, is that much is still unknown, in particular about whether at least some SCBEMs could ever have developmental potential equivalent to that of a human embryo.’  Moreover, the Code is bioethically feeble.  Again, on p. 7, ‘This current lack of knowledge itself has ethical implications.  Arguably, it implies the need for a cautious approach pending further knowledge: one which recognises the benefits the research may bring, but which balances this with the need to monitor the progress of that research carefully in light of ethical, legal and public attention to and concern about the entity that SCBEMs model, namely the human embryo.’  Yes, this is indeed dangerous ground.

Overall, the Code is a well-intentioned attempt to prohibit, limit and regulate SCBEM usage.  It needs strong words, and it contains some.  But we have been here before.  For instance, 40 years ago, the controversial Warnock Report (1984) was published.  It sought to regulate aspects of human embryo research, even though embryo destruction has always been the certain outcome.  Yet Warnock also failed on other fronts.  Above all, it signally failed to determine the legal, ethical and biological status of the human embryo.  How can governance be determined if the entity to be governed is unspecified?  Is such asininity going to be a model for the regulation of SCBEMs?

He Jiankui, again
You may remember He Jiankui, the Chinese scientist who, in 2018, was jailed for three years, fined three million yuan (£330,000) and fired from his university job for illegally using CRISPR to gene edit the DNA of three babies in the hope of giving them resistance to HIV.  They were the first gene-edited human babies ever born and their birth caused a firestorm of controversy.  He Jiankui had crossed the bioethical red line forbidding gene editing for reproductive purposes, the so-called germline genome editing that passes on genetic mutations to future generations.

In 2022, after serving his time and paying his fine, he was back in the lab.  JK, as he prefers to be called, has never been shy of promoting himself and has recently given interviews to the MIT Technology Review and the Japanese Mainichi Shimbun newspaper.  He has moved to Hainan, China’s southernmost island province, and started work there at a private laboratory in Sanya City, with funding from Chinese and US companies, though he has refused to identify these sources precisely.

This time, he is working on using gene-editing technology to cure various inherited conditions like Duchenne muscular dystrophy (DMD) and familial Alzheimer’s – his mother has the latter.  He has fatefully announced, ’So I’m going to have Alzheimer’s too, and maybe my daughter and my granddaughter.  So I want to do something to change it.’

At present his work is limited to adding modified genes to a living person’s somatic (non-reproductive) cells, but he wants again to work on human embryos.  In the online discussion organised by the MIT Technology Review, he stated that, ‘So my goal is we’re going to test the embryo gene editing in mice and monkeys and in human non-viable embryos.  We’re going to stop at human non-viable embryos.’  The aim is to prove whether or not the genetic precursors for Alzheimer’s can be prevented from being passed down to the next generation.

JK is still enamoured with gene editing.  He believes his current basic research will be finished within two years.  But the next phase – human trials – will be somebody else’s problem.  Moreover, JK has said, ‘I believe society will eventually accept that embryo gene editing is a good thing because it improves human health.  So I’m waiting for society to accept that.’

Meanwhile in July, and pertinent to He’s research, China's Ministry of Science and Technology issued new guidelines concerning the ethics of human genome-editing research.  According to the China Daily, ‘The guidelines reinforce a strict ban on altering germ cells and embryos where alterations may be inherited by future generations.  Moreover, research on somatic (non-reproductive) cells should only be carried out in order to prevent or treat disease – specifying that special attention should be paid to whether it might trigger alterations in germ cells.'  In other words, the new guidelines confirm that, ‘At present, any clinical research involving germline genome editing is irresponsible and not permitted.’  Indeed, implanting an edited embryo into a human in China, as He did, is now a crime subject to up to seven year’s imprisonment.

And what about those twins, Lulu and Nana, and the other gene-edited baby that were He’s downfall?  There was some fear because their targeted gene, CCR5, can also affect intelligence.  But according to JK, ‘They are perfectly healthy and have no problems with their growth.’  The twin girls, now aged at least 5, are both attending nursery school.  JK also revealed that the other baby born in 2019 was a girl.  He confirmed that, ‘I'm proud to have helped families who wanted healthy children.’  Indeed, he is giving one of the adults, now a single mother, some financial support.

OK, so JK got his comeuppance for transgressing bioethical and scientific boundaries.  And the three girls are apparently well, even thriving.  As JK has said, ‘They were healthy and are living a normal, peaceful, undisturbed life.’  But the girls’ outcomes could have been so very different, and indeed may yet be so.  Whatever, that whole farrago remains reckless and rather creepy.

But will germline genome editing be forever verboten?  Probably not.  A recent survey showed that 30% of people would edit their children’s genomes to improve their offsprings’ chances of attending a top university.  Children as commodities, ‘pick and mix’ offspring.  Help us!

Haemophilia B gene therapy
The UK’s National Institute for Health and Care Excellence (NICE) has recently approved a new gene therapy for haemophilia B.  Hemgenix (etranacogene dezaparvovec) is now available in eight specialist UK centres where it will be used to treat adults with moderately severe and severe haemophilia B.  This is a genetic condition caused by the partial or complete loss of factor IX, a protein essential to produce blood clots.  The therapy uses an engineered virus to ‘infect’ a patient’s liver with the gene required to express the factor IX clotting protein.

Approximately 2,000 people in the UK have the bleeding disorder and it is reckoned that about 250 patients will benefit from Hemgenix as it helps to reduce the frequency and symptoms of painful bleeds.  Current haemophilia B treatment involves infusions of factor IX once or twice a week.  These treatments can cost the NHS about £150,000 to £200,000 per patient per year for life.  By contrast, Hemgenix is administered as a one-off infusion carried out in just one or two hours.

NICE originally rejected approval of Hemgenix because of uncertainties about its long-term effectiveness and high cost.  However, a deal has subsequently been negotiated with the therapy’s manufacturer, CSL Behring, to bring down the official cost to £2.6m per treatment.

Elliott Mason is 34 and has severe haemophilia B.  He spent 29 years needing frequent infusions of factor IX, but five years ago he took part in the Hemgenix trials.  He has confirmed, 'My results were fantastic – it's been amazing for me.  I get tested every six months and so far, I haven't needed any factor IX injections.'  He now ‘feels cured’ and the gene therapy has given him a ‘new lease of life’.  He further acknowledged that, ‘I don't think you can go through something like that for 29 years, for it to completely disappear and not change someone mentally and physically.’  Wonderful news!

However, relevant research questions continue.  For example, in a trail of 54 men given Hemgenix, two patients still needed factor IX injections.  Why?  Moreover, there is the question of the Hemgenix’s long-term effectiveness.  And because haemophilia B is mostly passed from men to their daughters, who act as carriers, this genetic inheritance is not solved by Hemgenix therapy – can it therefore be regarded as a proper cure?  Nevertheless, here is a genuine example of seemingly successful somatic gene therapy.  Give thanks with a grateful heart!
Stem-Cell Technologies

The 2002 paper retracted
In Shakespeare’s Midsummer Night’s Dream, Lysander says, hoping to comfort Hermia, ‘The course of true love never did run smooth.’  And sometimes science travels rocky roads too.

Here is such a most regrettable example.  In 2002, the premier science journal, Nature, published a paper entitled, ‘Pluripotency of mesenchymal stem cells derived from adult marrow’ by Yuehua Jiang et al., Nature (2002, 418: 41-49).  The research team from The Stem Cell Institute, University of Minnesota Medical School was led by Catherine M Verfaillie.

As the article’s Abstract stated, ‘We report here that cells co-purifying with mesenchymal stem cells – termed here multipotent adult progenitor cells or MAPCs – differentiate, at the single cell level, not only into mesenchymal cells, but also cells with visceral mesoderm, neuroectoderm and endoderm characteristics in vitro.  When injected into an early blastocyst, single MAPCs contribute to most, if not all, somatic cell types.  On transplantation into a non-irradiated host, MAPCs engraft and differentiate to the haematopoietic lineage, in addition to the epithelium of liver, lung and gut.  Engraftment in the haematopoietic system as well as the gastrointestinal tract is increased when MAPCs are transplanted in a minimally irradiated host.  As MAPCs proliferate extensively without obvious senescence or loss of differentiation potential, they may be an ideal cell source for therapy of inherited or degenerative diseases.’

In other words, the article importantly claimed that a type of adult stem cell extracted from bone marrow of mice, called multipotent adult progenitor cells (MAPCs), could, under certain circumstances, contribute to nearly all the major somatic cell types of the body, including brain, heart, skin, blood and lung.

The report of this discovery in 2002 generated excitement because no other adult stem cells had shown such potential, similar to that of embryonic stem cells.  Moreover, the findings supported the claim that MAPCs 'engraft' in the bone marrow.  Specifically, they settle and integrate into the bone marrow, which is the body's factory for producing blood cells.  Once engrafted, these adult stem cells can start generating new, healthy blood cells, potentially helping treat diseases affecting blood and the immune system, such as leukaemia.

Then, some 22 years later, this very article was retracted by Nature on 17 June 2024.  The Retraction Note (Nature, 2024, 630: 1020) states that, ‘The Editors have retracted this article because concerns have been raised regarding some of the panels shown in Figure 6, specifically:

•    the lower half of Figure 6a (CD45/β-gal) appears to be identical to the upper half of Figure 6e (Gr-1/β-gal)
•    the upper right corner of Figure 6m appears to have two regions that are duplicated within the upper right corner itself

The original images for Figures 6a, 6e and 6m could not be retrieved by the authors; therefore the Editors no longer have confidence that the conclusion that multipotent adult progenitor cells (MAPCs) engraft in the bone marrow is supported.

Given the concerns above the Editors no longer have confidence in the reliability of the data reported in this article.’

Science does indeed sometimes travel rocky roads.  Retractions of articles have been growing – in 2009, there were less than 1,000, whereas in 2023, there were nearly 14,000.  Not all retractions are caused by flawed science and some researchers consider that retraction can be part of a healthy scientific process.  But what about other articles that have already cited the retracted article?  This 2002 paper has been cited almost 5,000 times, yet there is no mechanism to automatically alert the scientists who cited it.

Of course, the article in question has been closely examined by various scientific authorities.  There has been general agreement that while some minor errors occurred, ‘there was no scientific fraud.’  For instance, Professor Verfaillie, the team leader, was cleared of academic misconduct by the University of Minnesota, but criticised for insufficient oversight of the work.  However, the retraction now makes Jiang et al., 2002, the most-cited retracted paper ever.  That was not the sort of accolade Verfaillie and her colleagues were seeking, but it is confirmation that as Shakespeare did not write, ‘The course of true science never did run smooth.’

Stem cells to blood cells
Human stem cells, of the type that are used for blood stem-cell transplants, have been grown in a bioengineered gel designed to mimic their natural, cultural medium, bone marrow.

Researchers at the University of Glasgow have developed a method of culturing a specific type of human stem cell found in bone marrow, known as long-term haematopoietic stem cells (LT-HSCs), in a jelly-like gel which better mimics their natural microenvironment.  This encourages these notoriously difficult to culture cells outside their in vivo niche to replicate, rather than differentiate to other cell types or die.  This protocol potentially provides an enhanced source of these very low abundance LT-HSCs for drug testing and treatments for blood disorders, including leukaemia.

The work entitled, ‘Bioengineered niches that recreate physiological extracellular matrix organisation to support long-term haematopoietic stem cells’ by Hannah Donnelly et al., was published in Nature Communications (10 July 2024).

Stem-cell transplants can be used to treat a range of blood disorders, such as leukaemia and sickle cell disease.  These procedures require the patient's bone marrow stem cells to be depleted using chemotherapy, followed by replacement with immunologically-matched donor cells.  However, there is currently a greater clinical demand for these stem cells than can be supplied.  One of the major difficulties of stem-cell transplants is that the LT-HSCs most crucial for ensuring long-term donor cell engraftment are present as only a tiny percentage of the bone marrow cell population.  Moreover, they tend to differentiate rapidly.  Therefore, having a robust physiological extracellular gel as a matrix for culturing and retaining these cells outside the body could increase the number of successful transplantations.  Well done Glasgow University bioengineers!

Bend and stretch
According to Canadian researchers, physically bending and stretching stem cells can direct them to differentiate into particular cell types.

Because stem cells can replicate and develop into all types of somatic cells, they are useful research tools as well as potential treatments for diseases of cell loss, such as Alzheimer's and type 1 diabetes.  Traditionally, scientists have used various chemical signals to direct stem cells towards a particular cell type, but researchers at McGill University have demonstrated that mechanically manipulating stem cells can have a similar effect.

The work entitled, ‘Nuclear curvature determines Yes-associated protein localization and differentiation of mesenchymal stem cells’ by Ajinkya Ghagre and his colleagues was published in Biophysical Journal (2024, 123: 1222-1239).

The McGill research team investigated how mechanical stimuli can guide stem-cell differentiation, as their use in regenerative medicine depends on how precisely they can become their target cell type.  For their research, the scientists used mouse mesenchymal stem cell (MSCs), which can generate bone, fat and blood cells.  Specialist microscopes were used to study the shape of the MSCs and the nuclei inside, as well as the location of Yes-associated protein (YAP).  YAP is a mechanosensitive protein, that can relay mechanical information to the nucleus.

The team found that in MSCs with very round nuclei, YAP would remain outside the nucleus and the stem cells would become bone cells.  Whereas, when the researchers compressed the MSCs, their nuclei would elongate, YAP would then enter the nuclei, and the stem cells would become fat cells.

Like all radical discoveries in medicine both intensive and extensive work is required to transfer potential treatments from laboratory to clinic.  It is therefore likely to be several years to assess if bending and stretching stem cells can be used, for instance, to aid bone regeneration treatments in patients after traumatic incidents or those with osteoporosis.  The next steps for the McGill team will involve translating their research from 2D single cell layers to 3D cultures in order to assess how stem cells respond to mechanical stimuli in the human body.
Miscellaneous

Come dine with me?
I’ve just come back from a shopping trip and to my chagrin I did not wash my hands immediately.  Gone are the lessons and practices of those Covid-19 days when, it was through the front door and without delay to the kitchen sink for a rigorous 20-second handwashing session timed by singing two rounds of ‘Happy birthday’, or reciting The Lord's Prayer once.

But how can I be sure that this hot water and soap treatment is enough?  Have those 99.9% of bacteria, especially those pathogens, been killed.  I think my routine mostly works because I have suffered very few doses of D&V throughout the years.  Those nasty foodborne illnesses mostly occur from the spread of pathogens, primarily bacteria, like Salmonella, Campylobacter, Escherichia coli and Listeria and viruses, like norovirus or hepatitis.

OK, that is me hygienically justified, but what about other people?  I am particularly concerned about the staff of restaurants.  It is those chefs’ and waiters’ grubby hands and insanitary habits that cause me concern.  After all, eating out is sometimes followed by upset tummies and worse.  And it is not always that occasional oyster that is to blame for such gut-rot.  In fact, sickness from foodborne bugs may be more common than we realise.

Look to the USA, where more people, eat more food, and eat out more often.  Recently The Centers for Disease Control and Prevention (CDC) has published a Report, entitled, ‘Estimates of Foodborne Illness in the United States.’  I hope you are not about to embark on your dinner.  The Report estimates that foodborne illnesses affect roughly 48 million Americans each year.  A total of 128,000 are hospitalised and 3,000 die from such microbial infections.  Most (64%) of these cases can be traced back to restaurants.

Globally the situation is staggeringly worse.  According to the World Health Organization (WHO), each year worldwide, unsafe food causes 600 million cases of foodborne diseases and 420,000 deaths.  A third of these deaths occur among children under 5 years of age.  The WHO estimates that 33 million years of healthy lives are lost due to eating unsafe food globally each year, and that number is likely to be an underestimate.

The good news is that these illnesses are largely preventable, at least in the rich West.  At home, we are in charge – we are the culprits.  Eating out – others are the spreaders.  The CDC estimates that 90% of foodborne illnesses are directly related to poor handwashing or hygiene practices.  In the USA, already there are federal guidelines for how often and when food workers should wash their hands.  So how can this queasy situation be improved, monitored and enforced?  While restaurants display ‘Now wash your hands’ signs and organise staff training, some method, protocol or tool is needed to actually validate that hands were washed, properly.

Enter the PathSpot HandScanner.  In 2017, Christine Schindler, a biomedical engineer, created this device that checks freshly-washed hands of food workers and alerts them if invisible contaminants remain.  The PathSpot HandScanner is mounted on a wall next to the handwashing sink.  After scrubbing their hands, employees place them under the scanner.  If it signals green, they are cleared to return to work.  If it shows red, they must rewash and rescan.

These Scanners are now being used by a range of food service providers, including restaurants, grocery stores, food manufacturing and packaging facilities.  Some call it ‘a handwashing lie detector’ or ‘a co-manager’.  But as Schindler says, ‘People want to eat somewhere where they’re going to be protected, where the people serving the food are also confident, clean, safe.’  Too true.  But there is one drawback.  If you, like me, were thinking of buying one for your kitchen, probably forget it.  PathSpot HandScanners are available on a subscription basis from between $50 and $175 a month.  You can buy a lot of soap and hot water for that sort of money.

Come dine with me?  Yes, but I will first scrub up and swill those foodborne pathogens down the drain.  Please do the same.

Block my IL-11
Inflammation is bad.  Researchers have long known that chronic inflammation contributes to diseases associated with ageing.  As the body grows older and accumulates damaged proteins and other molecules, the immune system often sees these as signs of a possible infection.  This can trigger inflammatory responses that might cause further damage and contribute to diseases, such as cancers and autoimmune disorders, including type 1 diabetes, rheumatoid arthritis, Crohn’s disease and multiple sclerosis.

Laboratory mice lived longer when a protein that promotes inflammation, known as IL-11, was blocked.  In middle-aged mice blocking this protein boosted metabolism, reduced frailty and increased lifespan. 

This recent research, undertaken at the Duke–National University of Singapore Medical School, has been published as ‘Inhibition of IL-11 signalling extends mammalian healthspan and lifespan’ by Anissa A Widjaja et al., in Nature (2024, 632: 157-165).

The researchers tested a variety of samples from young and old mice and found that IL-11 was consistently more abundant in older mouse tissues, including skeletal muscle, fat and liver.  When they deleted the gene that codes for the IL-11 protein, some mice had improved healthspans and lived up to 25% longer than mice with normal levels of IL-11.  The team also obtained similar results when, for 25 weeks, they used an antibody against IL-11 to block the protein in mice who were 75 weeks old, roughly the equivalent of 55 years for a human.

Humans also possess IL-11.  Although the research team tested for these health benefits only in mice, could blocking IL-11 in humans offer hope for a longer and healthier life?  Currently, the field is crowded with numerous other such rejuvenation interventions.  Moreover, in the past, so many potential therapeutic candidates have shown promise in animal models only to disappoint in human clinical trials.

The anti-IL-11 responses reported here were similar to those seen in some studies where mice were treated with rapamycin, a well-known drug in the anti-ageing field.  However, rapamycin has been linked to unwanted side effects.  So rapamycin may be beneficial for extending lifespan, but not healthspan, whereas a drug that blocks IL-11 may be good for both healthspan and lifespan.

Nevertheless, these recent results are sufficiently striking to warrant further investigations.  For a start, various anti-IL-11 drugs should be tested in mice from diverse genetic backgrounds and across several laboratories.  Yet, if promising candidates are revealed, a major problem arises.  How can they be assessed for their impact on human lifespan in clinical trials?  Such trials would necessarily be long and expensive and perhaps confounded by other longevity factors.

Ageing research can be exciting, but also daunting.

The brain and religion
This is a topic not many readers will have thought much about – me too.  A helpful article by Partrick McNamara and colleagues from several US universities and entitled, ‘Neuroscientists must not be afraid to study religion’ appeared in a July edition of Nature (2024, 631: 25-27).  The following is a synopsis of this novel meeting of religion and science.  We need to understand current thinking, stretch our minds and identify future trends.  Don’t we?

Apparently, around 85% of the global population identifies as religious.  Of course, we immediately ask what is meant by ‘religious’ and can easily become testy when others control the definition.  But hang in there.

The overarching verdict of McNamara et al., is that ‘... religious or spiritual beliefs and practices can improve people’s health and well-being; increase social cohesion, empathy and altruistic behaviour; and protect people against cognitive decline or substance abuse.  But also, throughout history, religion and spirituality have amplified conflict, polarization and oppression.’  Yet ‘Despite the manifest importance of faith as an influencer of human behaviour, neuroscientists have tended to steer clear of studying how people’s beliefs affect their brains and vice versa.’

Why are we afraid?  Is it fear of questioning powerful religious institutions?  Or fear of promoting a particular religion?  Or fear of engaging in an unscientific enterprise?  Whatever the reasons these authors now ‘call on scholars from diverse disciplines to help establish a rigorous field: the neuroscience of religion.  Our goal is not to debunk or promote religion or spirituality, but to understand the neural mechanisms underlying their effects.’  After all, what we think, feel and do are ultimately controlled by our brain plus our belief system, even including the atheist’s supposed non-belief.  So brain and religion inevitably go together just like love and marriage, or that horse and carriage.

What is known so far?  Consider, for example, the work of US anthropologist George Murdock (no, I hadn’t either).  He has documented rituals directed at supernatural agents, or beliefs in magical powers, or supernatural agents in 168 cultures.  Such works provide basic knowledge and tools for neuroscientists.

Then there is the Mystical Experiences Questionnaire (MEQ), originally developed in 1969 by the US psychiatrist Walter Pahnke and updated in 2012.  He used a classification of mystical experiences derived from thousands of religious narratives, mainly collected between 1900 and 1950.  Using the MEQ, researchers can judge if reported experiences mention a positive mood, or ‘blissful state’, inner peace, or connectedness with others, a transformed sense of self, and so on.  Factors are graded and those with a high score are deemed religious or spiritual.

The MEQ and other psychological metrics have been used with brain-imaging techniques that allow neuroscientists to map the neural activity associated with all sorts of cognitive, social and emotional processes.  Trends are starting to emerge.  During the 1990s, mainstream media picked up on reports of a ‘God spot’ in one region of the temporal lobe.  Back then, so-called religiosity was sometimes drastically heightened in some people with temporal-lobe epilepsy.  More recently brain-imaging studies have shown that religious and spiritual experiences and practices, such as prayer, are associated with neural activity in multiple networking regions in the brain.

Further evidence for brain-religion connectedness is provided by brain lesions, such as those resulting from a stroke, or the removal of brain tumours.  The temporoparietal cortex has been noted as a particular neural network involved in self-awareness and social cognition linked with religious or spiritual beliefs and practices.  Other analyses, using functional magnetic resonance imaging (fMRI), indicate that people who regularly engage in spiritual or religious practices have measurable differences in their brains.

In a large 2023 study, researchers analysed neuroimaging and behavioural data from around 40,000 participants from the UK Biobank cohort. They found that connectivity in and between brain regions involved in self-reflection and in emotion regulation was greater in people who regularly engage in religious practices than in those who regularly engage in sports, or in those who regularly engage in social activities.  These variations in connectivity patterns between the three groups are strictly correlative.  Whether religious experience contributes to certain connectivity patterns, or whether people who have certain connectivity patterns are predisposed to affiliate with religious groups, is an interesting topic for future research.

Brain-imaging studies conducted over the past decade indicate that psychedelic drugs modulate activity in several specific brain regions.  These are the very regions that are also modulated during religious and spiritual experiences or practices, and that are associated with capabilities in social cognition.  Most psychedelic drugs are known to affect neural pathways that are modulated by serotonin, the neurotransmitter that affects mood, cognition, learning, and so on.  Altering the activity of circuits that are normally regulated by serotonin signalling can affect people’s sense of self, their feelings of connectedness with others, and the likelihood that they will report an encounter with a supernatural agent.  Indeed, the reported effects of psychedelics indicate that many people have what they describe as religious or spiritual experiences after taking these drugs.  In one survey, around 28% of the participants reported that they were atheists before taking the drug – only 10% said that they were atheists afterwards.

Such fascinating neuroscience-based findings have emerged despite there being very few researchers working on these topics.  McNamara et al. call for more investigators, more funding and more approaches, as seen in the three-year Cognitive Neuroscience of Religious Cognition (CNRC) project.  For instance, artificial intelligence (AI) could be used to identify brain-activity patterns associated with thinking about religious or spiritual concepts, or the performance of a religious task or practice.  Large language models (LLMs) and other computational tools could analyse vast swathes of text to systematically examine subjective reports of religious and spiritual experiences.  And virtual reality (VR) offers another way to create experiences in a controlled setting that might be similar to those considered to be religious or spiritual in the real world.

McNamara and his colleagues are not maintaining that VR or psychedelic-induced mystical experiences are equivalent to religious experiences.  Nor do they think that experiments involving such interventions could ever adjudicate religious statements, such as that a supernatural agent exists.  But if VR techniques and pharmacological manipulations can evoke experiences in the laboratory that have much in common with religious or spiritual experiences in the real world, then brain-imaging or brain-stimulation techniques could be used to map the neural activity associated with such experiences.  Likewise, systematically altering the environment could identify the conditions under which certain individuals report experiencing an encounter with a supernatural agent.

In closing.  What is the mere evangelical Christian to make of all this?  Should we dismiss this neuro-stuff as hocus-pocus and want nothing to do with it?  That would be an understandable, but limp, response.  So far, brain-religion research has undeniably shown that human affections, religious or otherwise, can light up certain areas of the brain.  That is no big deal.  What else would you expect ‘feelings’ to do?  So, let us not be afraid of this novel field of research.

Three conclusions can be drawn.  First, if 'religiousness' can similarly be evoked by the Holy Spirit or by psychedelic drugs, then there must be ‘true’ as well as ‘false’ religion.  However, their roots are like chalk and cheese, supernatural and natural, transcendent and absurd.  Second, Christianity is not merely a rag-tag collection of religious ‘feelings’.  It is true religion because it rests upon propositional truths – they are the touchstone of true Christianity.  They remain standing whether you believe them or not.  So come on neuroscientists, tell us more.  Don’t be afraid to study true religion.  And that invitation also applies to electricians, pilots, students, pensioners, children and many more.  Third, this brain-religion literature has a tell-tale hole.  Where is the Triune God?  In the article by McNamara et al, ‘God’ is mentioned just once, and that in a derogative sense.  ‘Jesus Christ’ and the ‘Holy Spirit’ are entirely absent.  What does that tell you?  For sure, not much about Christianity.

It is said that increasing numbers of people in high-income countries are leaving traditional religious affiliations.  Whereas in low-income countries, religious traditions are remaining strong or even expanding.  And meanwhile, more young people around the globe, classed as Gen Z (those born between 1997 and 2012), seem to be embracing highly traditional religious affiliations, such as reformed Protestantism and Roman Catholicism.

Perhaps such demographic movements really do call for a greater need for proper studies of brain-religion.  They could tell us more about understanding the human brain and thus, human life.  Why should we be afraid of such true truth?
USA and Elsewhere

Trump v. Harris
Yes, the USA is at it again.  On Tuesday 5 November, it is time to vote for the next President of the United States of America.  It is Trump v. Harris, ex-President Donald John Trump v. Vice President Kamala Devi Harris.  What a pair, what a choice!  Even their running mates, JD Vance and Tim Walz, have been described as ‘unusually weird’.  Do any of these leaders have the moral depth and intellectual strength to tackle the problems facing the US?  Or does a country get the leaders it deserves?

The race to the White House looks to be tight.  For the last few months, it has been about 45% v. 47% in favour of Harris in the seven so-called swing states.  And it is these, such as Pennsylvania, Michigan and Arizona, that will probably decide the result.

And how do the two contestants shape up bioethically?  ‘Weird again’.  Harris has historically and consistently been an extreme supporter of women’s reproductive rights, specifically abortion rights, meaning open access to abortion, on demand, and up to birth.  Central to her campaign has been an unalloyed championing of legislation that would enshrine reproductive rights nationwide.  If elected, the Harris-Walz duo would be the most radically pro-abortion presidential ticket in American history.  If elected, the Democrats would press to restore a federal abortion law across all states, similar to Roe v. Wade, and so ditch the more restrictive pro-life laws currently in place across many states.

Her campaign website states that abortion will be rebranded as ‘reproductive freedom’ and vows that as President, ‘... she will never allow a national abortion ban to become law.  And when Congress passes a Bill to restore reproductive freedom nationwide, she will sign it.’  As President Harris she may even have the opportunity to appoint progressive, pro-choice judges to the Supreme Court.  Harris is clearly intent on making the USA a more dehumanised USA.

Do you doubt her pro-abortion credentials?  In December 2023, the White House issued a press release demonstrating that Kamala Harris has been making abortion a top priority.  It stated that, ‘Since the Supreme Court's Dobbs decision, the Vice President has held more than 50 convenings in at least 16 states while bringing together hundreds of state legislators, state attorneys general, health care providers, faith leaders, students, and advocates who are on the frontlines of the fight for abortion.’

Also, in a first for a sitting President or Vice President, in March 2024, Vice President Kamala Harris toured a Planned Parenthood abortion clinic in Minnesota.  While there she told waiting reporters, ‘What we want is to put back in place the protections the Supreme Court took away, which is to codify, put into law, the protections of Roe v. Wade, that's what we want.’  Oh yes, Kamila Harris is a deeply, deeply pro-abortion person.

On the other hand, the once outspokenly pro-life Trump has recently struggled to present any consistent bioethical message.  When, during his Presidency, he appointed three conservative judges to the Supreme Court, he became the darling of the pro-life movement.  Those appointments were pivotal in overturning the constitutional right to an abortion, the 1973 ruling of Roe v. Wade.  Moreover, during his time in the White House, he issued clear pro-life statements on abortion and IVF.

Recently, instead of pushing for a federal ban on abortion he has stepped back and said that abortion law should now be decided by individual states.  Then he ruled out reinstating a law under which distributors of mail-order abortion pills could be prosecuted.  And during August, he pledged to provide free access to IVF.  ‘We want more babies’, he declared and, ‘Your Government will pay for – or your insurance company will be mandated to pay for – all costs.  We are pro-family.’  ‘Words, words, words’, as Hamlet said to Polonius.  Green-lighting abortion and subsidising embryo-destructive IVF – these are the policies of a confused, confusing and pro-abortion man.  Some experts say Trump’s abortion wavering could cost him the election.

Clearly, there are now no pro-life presidential candidates in this race.  So here is the big question – who do evangelical Christians and 'the morally sensitive’ vote for?  Either way, the pro-life cause in America, so energised a few months ago by the rulings in Dobbs and Alabama, is now in turmoil.

Only in America!
Every year, just as in the UK, the US political parties have a knees-up.  We call them Party Conferences and they occur every September for about three days.  They are generally staged, dull affairs and can be tedious to the point of mind-numbing.  By contrast, the Republican and Democratic parties in the US have four-day National Conventions, razzmatazz circuses with media stars, old statesmen, live and loud music, plus whooping and cheering and voting.

This year, from 19 to 22 August, the Democratic National Convention (DNC) was held in Chicago.  It was four days of sugary politicking that only Americans can start and sustain.  This Convention was extra special because it was a presidential nominating convention – Harris and Walz were officially elected by the delegates.

The agenda was long, but front and centre were abortion and women’s reproductive rights.  What else would be expected?  Some delegates even proudly wore golden ‘abortion’ badges.  This was the Democrats displaying their long-standing policies.  But this year, what was new and unexpected were the offers of free abortions.  Planned Parenthood, the US’s abortion giant, had deployed an abortion bus, or as they called it, ‘Our mobile health clinic’.  On board, they were offering drug-induced abortions.  They were also handing out so-called emergency contraception, the abortifacient morning-after pill, free and without an appointment.  And for the gentlemen, there were free of charge vasectomies.

This stunt did not go without outcry.  One of the largest pro-life organisations, the Susan B Anthony Prolife America, responded to the news with a press release labelling the DNC as an ‘Abortion Convention’.  It stated that ‘The Democratic National Abortion Convention puts the extremism of the Democrats on full display.  The days when the Democrats insisted abortion should be "safe, legal and rare" are history.  Today's Democrats under the Harris-Walz ticket are officially the Shout Your Abortion Party.’

And there was more.  A number of pro-choice demonstrations took place.  For example, a giant, 18-foot-tall inflatable, shaped like an intrauterine device (IUD), was displayed and dubbed ‘Freeda Womb’.  And during a pro-choice protest, several women marched down the streets dressed as abortion pills.

In addition, the Democrats took the opportunity of the DNC to outline their priorities through their new ’24 Democratic Party Platform’ document – 91 pages of policies.  The word ‘abortion’ is mentioned 13 times in the document.  ‘Reproductive freedom’ and ‘reproductive health’ are mentioned an additional 14 times.  And on other cultural issues, the term ‘LGBT’ is mentioned 37 times, ‘Donald Trump’ 150 times, and ‘God’ is mentioned once.  Only in America!

Poland and abortion
In mid-July, Polish Prime Minister Donald Tusk’s coalition Government failed to pass a law that would have decriminalised abortion.  It was a close result – Parliamentarians voted 215 in favour and 218 against with two abstentions.  Phew!  The day was saved largely by members of the Polish People’s Party – a conservative faction within the ruling alliance but with a base of mostly rural voters.  They had previously made clear they did not support the extreme measure.  Even so, it would have been unlikely that President Andrzej Duda, an ally of the nationalists, would have signed the Bill because he had already pledged to veto most aspects of Tusk’s liberal agenda.

During 2023, Tusk had run a successful election campaign on a pledge to restore so-called women’s reproductive rights.  The previous nationalist administration, the Law and Justice party, which had governed since 2015, had imposed one of the European Union’s most restrictive anti-abortion laws.

Tusk’s proposed decriminalisation legislation sought to scrap criminal liability, including potential prison sentences of up to three years for those helping women seeking to terminate pregnancies.  Among other measures it would also have lifted a prohibition on private individuals providing emergency contraception pills.  The Polish people presumably wanted a change and a more liberal approach to abortion.  Now Poland has it.  Tusk and his pro-abortion allies went for broke with a shot at decriminalisation.  It did not work.

Many readers will be well aware that a similar campaign to decriminalise UK abortion law is currently afoot at Westminster.  The MPs’ names to watch are Stella Creasey and Diana Johnson.  Decriminalisation may be a big word, but it is also a big deal.  It would technically shift abortion from a criminal offence to a mere medical issue.  It would allow abortions for any and every reason, no sanctions, no checks – just ask.

What can we learn from Poland?  We are now nearer to decriminalisation.  Poland has a governing coalition with a small majority that supports the checks and balances of true democracy.  By contrast, the UK now has a Government with a huge majority that creates a sterile democracy because it can likely win any of its policies.  The UK’s pro-life cause could soon be in serious danger.
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