Update on Life Issues - February 2018

Abortion
Maria Caulfield – pro-life MP
When Teresa May reshuffled her cabinet in January she appointed Maria Caulfield, MP for Lewes, as the vice-chair for women at the Conservative Campaign Headquarters (CCHQ).

Miss Caulfield was a former senior nurse at the Royal Marsden Hospital in London and is a current member of the House of Common’s All-Party Pro-life Group (APPLG).  In March 2017, she led the charge against Labour MP Diana Johnson’s Ten-Minute Rule Bill, which sought to decriminalise abortion in the UK.  She stated that such a move would result in abortion on demand, leave young women less safe and ‘embolden’ men to force women into abortion.  It would, she said, become a ‘charter for extreme abortion practices’, including sex-selective abortion.

It did not take long before the feminist flak flew.  For example, Sophie Walker, Women's Equality Party leader, said Ms Caulfield could ‘never advocate effectively’ for women.  The British Pregnancy Advisory Service (bpas) accused her of holding views on abortion that were ‘out of step with members of the public and her own parliamentary party.’  Caulfield trenchantly replied to such criticism, ‘It’s a sad day in this country if you can’t have a different view to someone.  To say that someone who has a different view cannot represent women is absolutely ridiculous.’  And she Tweeted her answer to the bpas accusation as, ‘I, and many colleagues who share my views, will not be silenced as we seek to be a voice of the voiceless, and as we argue for more modern and humane abortion law that upholds not only the dignity and rights of women but the dignity and rights of the unborn child.’

Maria Caulfield has thus been branded a heretic.  In other words, she has become yet another victim of ‘illiberal liberalism’ and ‘intolerant tolerance’.  You cross swords with these so-called progressives and they will seek to deny you a voice.  We say, ‘Bravo.  Good on you, Maria!’

Good news for conscientious objectors
Last December, the Faculty of Sexual and Reproductive Health (FSRH) reversed its earlier decision and will now allow Christian doctors and nurses (and others who object on grounds of conscience) to train and work as sexual health professionals without having to provide abortifacient devices and drugs, such as the morning-after pill.

In April 2107, the FSRH had insisted that anyone who wanted to obtain a diploma to work in the sexual and reproductive health field must ‘prescribe all forms of contraception’.  The FSRH performed this welcome U-turn after the Christian Medical Fellowship (CMF) threatened legal action.  In June, a similar climb-down on grounds of conscience had been performed by the General Pharmaceutical Council (GPhC) in its revised guidelines on Religion, Personal Values and Beliefs for pharmacy workers.  On that occasion it was the Christian Institute that had warned the GPhC of an impending court case.

Conscientious Objection (Medical Activities) Bill [HL] 2017-19
Way back on 28 June, Baroness O’Loan introduced the first reading of her Bill in the House of Lords.  It is a landmark attempt ‘to clarify the extent to which a medical practitioner with a conscientious objection may refrain from participating in certain medical activities; and for connected purposes.’  More specifically, it covers three particular areas of medical practice (abortion, the withdrawal of life-sustaining treatment and treatment given under the Human Fertilisation and Embryology Act).  It also seeks to enshrine in law a provision to protect medical practitioners from being discriminated against if, as a matter of conscience, they have objected to conducting a particular medical procedure.’  The Free Conscience Campaign has been established to support the Bill – see here

On Friday 26 January, at its second reading, peers spent almost three hours debating general aspects of the Bill.  It now moves to the Committee stage - a line-by-line examination of the Bill - at a date to be announced.  But it has several more parliamentary obstacles to negotiate, including securing time for consideration and passage through the House of Commons, as it bids to become law.

Isle of Man Abortion Reform Bill
On Tuesday 23 January, Dr Alex Allinson, member of the House of Keys (MHK) for Ramsey, introduced his radical Abortion Law Reform Bill.  Under the current Isle of Man's 1995 Termination of Pregnancy Act, abortions are only permitted in a limited number of instances, such as a pregnancy resulting from rape, or because of a woman's mental health needs.  It is estimated that fewer than 10 terminations occur each year on the Island, with another estimated 100 women a year seeking private abortions in the UK.

The new Bill would allow abortions up to 14 weeks without the need to see a doctor or to provide any reason for the abortion.  Between 14 and 24 weeks abortion would be permitted for a ‘serious social ground’, which has yet to be defined.  The Bill would also allow abortion on the ground of disability up to birth.  If the Bill were passed it would give the Isle of Man the most liberal abortion law anywhere in the British Isles.  The Bill was given its second reading on Tuesday 30 January.  An attempt to send it to an investigating Select Committee was defeated by 18 votes vs. 5.  A vote to send it to the next stage, the Clauses stage, was passed by 22 vs. 0.  This will begin on Tuesday 13 February.

Marie Stopes out of NI
The 1967 Abortion Act does not extend to Northern Ireland.  That has generated a personal and a political battleground ever since.

In October 2012, amid huge controversy, Marie Stopes opened the first Northern Ireland private abortion clinic in the centre of Belfast.  The clinic has been constantly picketed, primarily by members of Precious Life.  Marie Stopes promised to provide terminations within Northern Ireland's current legal framework, namely if continuing a pregnancy would put a woman's life at risk, or pose serious long-term damage to her physical or mental health. 

In the six years prior to 2012, only 262 legal abortions had taken place in Northern Ireland.  Meanwhile, just over 1,000 women each year were travelling to England and Wales for terminations.  The Northern Irish pro-choice argument has always been that having to travel to the rest of the UK or further abroad to access safe, legal abortion, exacts an unfair financial and emotional cost on the Province’s girls and women.

Then the Province’s pro-life status began to be craftily dismantled.  In June, the Westminster government announced that Northern Ireland residents would be given access to free abortion services on the NHS in England.  And in October, the government said that women on low incomes – those on less than £15,300 a year – would also be entitled to help with their travel costs.

Finally, in December 2017, the Marie Stopes’ Belfast clinic closed.  The reason given was that local women could now have NHS-funded terminations in the rest of the UK.  Pro-life groups were delighted at the closure.  The director of Precious Life, Bernadette Smyth, described it as a ‘massive pro-life victory’.  They maintained that the Marie Stopes clinic was little more than a publicity stunt, and because of the Northern Irish strict abortion laws the clinic had actually performed very few abortions.

Bpas – bad losers
Last December, Both Lives Matter, a pro-life group based in Belfast, won the Northern Ireland Public Affairs Campaign of the Year award.  It was for its '100,000' billboard campaign, which referred to the 100,000 lives that have been saved because the 1967 Abortion Act has not been extended to Northern Ireland.

Despite bpas also being nominated for its campaign to reduce the price of the morning-after pill, it and other abortion providers were unhappy that a pro-life group had been invited to the awards ceremony, let alone won it.  Representatives from bpas, the FPA and the Abortion Support Network wrote to the hosting organisation, the Public Relations and Communications Association (PRCA), stating that it was ‘providing an endorsement for the denial of healthcare and human rights.’  And that ‘bpas was delighted to have been shortlisted for our campaign to reduce the inflated price of emergency contraception, but under the circumstances no longer wants recognition from an organisation which is also happy to celebrate the systematic suppression of the rights of women and girls to basic healthcare.  Please accept this letter as notice of the withdrawal of our entry.’

Francis Ingham, the director general of the PRCA, stood his ground and replied inter alia, ‘Whilst I appreciate that you disagree fundamentally with the work of Both Lives Matter, I would hope that you might consider that the Public Affairs Awards is recognising Both Lives Matter in the same spirit of democratic freedom within which that organisation may campaign as freely as organisations like bpas, FPA, Abortion Support Network …’  He concluded his reply with, ‘I note with regret the withdrawal of your entry.’

SofTouch – the new old
Among the New Year natter was the launch of a new abortion device called SofTouch.  It is reported to be nearly 100% effective and able to complete an abortion in 60 to 90 seconds if the patient is less than six weeks pregnant and in about two or three minutes if she is between six and ten weeks.

The device was apparently developed in 2011 by Dr Joan Fleischman, a Harvard-trained physician, who was inspired ‘to normalize the early abortion experience’ – ugh!  In essence, it is based on the old 'manual vacuum aspiration' (MVA) method.  Its only new feature is that it fits into the palm of a doctor's hand.  The SofTouch® website states that it is ‘noninvasive and natural’.  Neither of those statements is true.  Abortion is always invasive because to reach and extract the embryo or foetus the woman must be invaded internally and intrusively.  And all abortions are unnatural, they are the deliberate interruption of a natural pregnancy.

Furthermore, SofTouch is advertised as the least invasive form of abortion that does not require sedation, an operating room, fasting the night before, or an electric suction machine.  Big deal.  The heart, the be-all and end-all, of abortion is not the method, but the object of the method, namely the snuffing out of the life of an innocent unborn child.  SofTouch alters nothing.


Assisted Reproductive Technologies
IVF in the UK - 2016-17
In December 2017, the Human Fertilisation and Embryology Authority issued its first-ever State of the fertility sector: 2016-17 report.  It assessed the performance of fertility clinics and research laboratories in the financial year 2016-17 by reporting on inspection findings, incidents and patient feedback.  The full report may be accessed here.

In 2016-17, approximately 60,000 patients underwent a total 86,016 treatment cycles in 119 licensed fertility clinics across the UK.  These consisted of 76,469 IVF, 4,051 partner inseminations and 5,496 donor inseminations.

The publication’s style is upbeat.  It opens with, ‘Our vision for fertility services in the UK is high quality care for everyone affected by fertility treatment.  We want patients and donors to have access to safe, ethical and effective treatment with good outcomes.’  And it focuses on its apparent star indicator, ‘The report shows that fertility clinics perform very well on minimising multiple births: 86% of clinics have met our stretching target of no more than 10% multiple births.  Working together, we have reduced the national multiple birth rate from 24% in 2009 to 11% today without reducing birth rates.  This is a fantastic achievement which has increased the safety of IVF for mothers and their babies and reduced the burden on NHS ante- and neonatal services.’

However, all is not so jolly and bright.  True, the number of IVF treatments showed a 6% increase over those from 2015.  But during 2016, clinics reported 502 adverse incidents and 38 near misses – ‘a slight increase from those reported in 2015.’  Such incidents, though relatively rare at about 1% of all treatments, have increased by 8.5% from the previous year – hardly ‘a slight increase’.

Adverse incidents are graded from A to C.  There was only one grade A, which involved the birth of a baby with cystic fibrosis (CF) which occurred because of inadequate paperwork – the parents were not aware they were CF carriers and would have destroyed the embryo if they had known.

Comparing 2016 and 2015 data, there was a lower number of grade B incidents (serious harm to one person, such as the loss or damage of embryos, 176 vs. 200) and a higher number of the less serious grade C incidents (involves minor harm, such as one of many eggs being rendered unusable, 325 vs. 267).  Near misses are defined as ‘in which only luck [yes, that very word is used] prevented an incident from occurring’ (38 vs. 30).

These are a cause for grave concern, or they should be.  However, a sense of jauntiness exists in the industry.  For example, Adam Balen, Chairman of the British Fertility Society, stated, ‘We welcome the report, which shows the extraordinary commitment our specialty has to transparency ... We are confident that, in reality, there is no evidence that practices have changed or that there ought to be concerns about the sector.’  Well, Professor Balen, I can think of at least 10 concerns about the sector.

Surrogacy in India and Russia

Surrogacy has it supporters and its detractors.  But what can governments do?  An outright ban drives the practice underground or abroad.  A complete free-for-all diminishes motherhood, pregnancy and family, and abandons the vulnerable.  The UK has taken a middle road – commercial surrogacy is prohibited.

In India, the government is rethinking its regulations.  In 2012, gay couples were banned from using commercial surrogacy.  A loophole appeared – frozen sperm could arrive in Delhi where it fertilised ova from Indian donors and any resulting embryos could be transferred into Indian surrogates who were then moved across the border into Nepal for nine months.  So, in March 2017, the Indian government extended the commercial ban to everyone.  Now, only so-called ‘altruistic surrogacy’ – when a consenting female family member bears a child for a childless heterosexual Indian couple without pay – is allowed.

Meanwhile, surrogacy is booming in Russia.  The laws are vague and lax.  It is estimated that 2,000 children were born in Russia to surrogate mothers in 2016.  Nationwide there are around 100 surrogacy centres, including 40 in Moscow.  The financial incentive of commercial surrogacy is substantial.  Whereas Russian teachers, a common profession for women, earn about US$700 to 850 a month, the fee for a surrogate mother is about $14,000 – equivalent to roughly 18 months’ wages.

Another bizarre IVF story
We like to keep a record of the curiosities and oddities associated with ARTs.  And there are many.  Of course, we already know about grandmothers giving birth to their grandchildren.  And babies with two fathers and three mothers, and post-menopausal women having babies.

Here is another.  Emma Wren Gibson, conceived within a year of her mother, was born on 25 November 2017.  She is known as a ‘snowbaby’, an embryo frozen and stored for later possible later use.  In this case she was frozen on 14 October 1992, or 24 years before she was born, the longest known time between freezing and birth.  Emma and her mother Tina were conceived just a year or so apart.  Weird?

On 13 March, Carol Sommerfelt, IVF laboratory director at the National Embryo Donation Center at Knoxville, Tennessee, thawed the embryonic Emma and transferred her into Tina Gibson.  Emma was born a healthy baby, weighing 6 pounds 8 ounces and measuring 20 inches long.

Here is the backstory.  Seven years ago, in 2010, Benjamin and Tina Gibson were married.  He had cystic fibrosis so infertility was not unexpected.  They fostered several children and thought of adopting.  Then they heard about embryo adoption.  They had two weeks to go through the profiles of 300 possible embryo donors.  Looking at the characteristics of the anonymous donors they picked two – their first choice failed, so three embryos from their second choice were used.  Tina became pregnant with Emma.

What can possibly be wrong here?  After all the National Embryo Donation Center is a faith-based organisation, founded in 2003.  Its website states, ‘Christian faith is the overriding principle upon which we operate.’  And Tina has said, ‘We're just so thankful and blessed.  She's a precious Christmas gift from the Lord.  We're just so grateful.’  For more substantial answers, read the section on IVF in chapter 3 of my Bioethical Issues book.  There is even a piece there about embryo adoption on p. 94.

The cost of IVF
There are numerous costs to IVF – temporal, medical, psychological, relational, ineffectual, social, bioethical, and so on.  And of course, there is financial, the easiest of the costs to quantify.

The NHS is increasingly restricting free access to IVF.  Guidance from the National Institute for Health and Care Excellence (NICE) recommends three cycles of IVF on the NHS for women aged under 40 and one cycle for some women aged 40 - 42.  However, three cycles are currently offered by only 24 out of 208 clinical commissioning groups (CCGs) in England.  Seven CCGs offer no funding at all for IVF – the rest offer either one or two cycles.

The upshot is that more patients, currently 60%, are facing the cost of private treatment.  Opinium, the market research company, recently reported that the average market price for a single treatment cycle of IVF is £3,348.  The highest UK price was £4,195 and the lowest £2,650.  But that is not all.  Patients face additional charges for registration fees, sedation, blood tests and drugs.  Such costs vary between clinics from £655 to £2,335.  The total cost is therefore likely to be at least £4,000 per cycle.  And that is for a treatment that is only about 25% successful.

The shrinking family
The Office for National Statistics (ONS) has recently reported that the average size of families in England and Wales has fallen to a record low – the fertility rate has dropped to 1.9 children per woman.  And almost one in five do not have any children.

This low figure is partly linked to voluntary childlessness, women delaying motherhood for career prospects, financial reasons and later marriages.  The ONS compared two cohorts – a young group of 45 year olds and an old group of 72 year olds, somewhat equivalent to the mothers of the young group.  On average, the young had 1.9 children per family whereas the old had 2.2.  Families with four or more children have also decreased, 10% vs 20%.  Unsurprisingly, childlessness is also increasing with 18% (and 44% by the age of 30) vs. 11% among the older group.

The demographic pattern of families and childbearing are showing disappointing trends.  Having children is now regarded as less and less aspirational.  And delayed parenthood is causing unsolvable problems for more and more couples.  Such a situation may be good news for IVF practitioners, but for the socially-aware and the bioethically-sensitive the future looks grim.

IVF milestones in the UK
In early January 2018, in support of National Fertility Week, the HFEA published some interesting figures.  For example, the total number of treatment cycles carried out in UK clinics since records began passed the million barrier in 2015 (the year for the latest data).  The overall number of treatments carried out since 1991 was 1,034,601.

Since 1991, some 300,000 children in total have been born in the UK as a result of IVF and donor insemination treatments from licensed fertility treatments.  Fertility treatments have grown markedly since 2010, with almost a third of all IVF and DI babies since 1991 arriving in the last six recorded years, that is, from 2010 to 2015.

The number of treatments for women aged 18 to 34 remain the largest single group (28,101), accounting for 43% of all cycles, while women aged 40 and over account for just 20% (13,333), with very few treatments being provided to women over 45.

Sally Cheshire, chairwoman of the HFEA welcomed these new data as a sign of a thriving and successful fertility sector.  She said, ‘The figures we have released today show that the UK’s fertility sector continues to be one of the most vibrant and successful in the world.’  Not everyone would agree with Sally’s cheery sentiments.


Genetic Engineering
On cloning primates
The big biological news during January 2018 came from China, where scientists have created the first cloned primates, two macaques, with a technique similar to the one used to clone Dolly the sheep way back in 1996.  Though successful with several mammalian species, this somatic cell nuclear transfer (SCNT) method has failed to produce live primates until now.

This is the work of Zhen Liu et al., which appeared in Cell (24 January 2018) under the title, Cloning of Macaque Monkeys by Somatic Cell Nuclear Transfer.  The two identical, crab-eating cynomolgus monkeys (Macaca fascicularis), named Zhong Zhong and Hua Hua (they look seriously cute), were delivered by Caesarean section at the Chinese Academy of Sciences in Shanghai.

The research team started by removing the nuclei from fibroblasts from an aborted female macaque foetus, rather than an adult.  These were inserted into 129 macaque denucleated ova, which were then cultured and artificially stimulated to cause the zygotes to begin cell division.  At this point, novel culture conditions and chemical modulators, to switch on or off certain genes that were inhibiting embryo growth, were developed and used.  The outcome was 109 SCNT embryos.  A total of 79 of these were transferred into 21 surrogate monkeys, which resulted in six pregnancies but only two live birth survivors – they were born in December 2017.

Why did this team succeed where others had previously failed?  The paper states it was due ‘to the optimisation of the nuclear transfer protocol, the use of fetal cell nuclei, and epigenetic modifications.  All of them together greatly improved the quality of blastocyst development and pregnancy rate.’

Two immediate questions arise – why clone monkeys, and will humans be cloned?  First, Lui and his colleagues hope to use this revised SCNT technique to develop populations of genetically-identical non-human primates to provide improved animal models of human disorders, such as cancer, and for testing potential drug treatments.  This technology could, some say, also be combined with CRISPR–Cas9 to create genetically-engineered primate-brain models of human disorders, including Parkinson’s disease.

Second, this achievement inevitably raises concerns among scientists and the public that the technique might be used to create cloned humans.  Mu-Ming Poo, a co-author of the paper, has said, ‘Technically, there is no barrier to human cloning.  We want to produce genetically-identical monkeys.  That is our only purpose.’  Nevertheless, it is common knowledge that there are at least a handful of cloning mavericks around the world, who have already tried, and so far failed, to clone humans.  For them, this improved SCNT will be like sweets to a child.

This improved SCNT method works, but not very well.  Even so, the Shanghai lab is expecting the birth of another six macaque clones soon.  Some regard all this as the beginning of a new era for biomedical research.  And human cloning is again being discussed, if not pursued.  So where are the restraints?  There are no international agreements preventing human cloning.  It is not illegal in most of the USA, whereas it is currently prohibited in, for example, Germany and the UK.  The prudent strategy – human SCNT should be banned worldwide, and soon.

Gene editing – risks and dangers

How should we assess gene editing?  Nathan Gardels has considered some of the issues (Washington Post, 15 December 2017).  The application of this relatively new technology of gene editing to the human condition is full of both promise and peril.  The process certainly has the potential, and the emerging actuality, to eliminate some genetically-induced diseases, boost the immune system and extend longevity.  Then again, it can easily cross ethical boundaries.  For example, it can change the human genome forever by altering the germline and passing those changes down through the generations.  In short, gene editing can be good and bad.

Bioethically, the dangers are only too apparent.  Craig Venter, the man who led the team that first mapped the human genome and who remains at the forefront of synthetic biology, understands this.  For him, it is a red line.  He is fearful of the temptation to construct permanent germline fixes.  He warns that this red line should not be crossed because it can only be tested through experiments on humans.  He has stated, ‘The world agreed at the end of World War II to stop all direct human experimentation.  Human germline editing would cross that boundary and take us back into random human genome editing, just to see what happens.  We should not let this happen.’

Others worry that the science is outstripping the ethics.  But how are ethical boundaries to be built and maintained?  Already, in China during 2015, gene editing has modified the human embryo – that was once thought to be the red line.  Moreover, it has now been reported that as many as 86 patients in China have had their genes altered in clinical trials to treat a range of diseases.  Bioethical thinking and scientific practice must somehow come together and dialogue.  But that will prove to be more than difficult in a world where some are driven, despite the unknown risks and unintended consequences, to be the discoverers of the next scientific breakthrough and leaders of the next medical revolution.  Vainglory is not a trait found only in non-scientists.

The vast majority are convinced that gene editing needs regulating, but so far few have been able to suggest guidelines, not to mention rules and laws.  Yet effective regulation would minimize risks and reassure the public.  The accomplishment and reality of germline modification of human embryos and the subsequent threat of the ‘designer baby’ have rocked the scientific and public communities.  And this year comes evidence that the Cas9 component of the CRISPR-Cas9 system can have pre-existing cell-mediated adaptive immune responses in humans, which could potentially produce adverse effects in patients.
   Is science out of control?  Will the mavericks prevail?  Have they already conquered?  The future of safe, ethical human medicine can at times look pretty slippery.

Yet gene editing is not inherently evil, or wrong, or even amiss.  It can be both benign and beneficial.  For instance, look at the next article.

Goodbye inherited deafness?
When Ludwig van Beethoven realised, at the age of 32, that his hearing was failing, he wrote, ‘as the leaves of autumn wither and fall, so has my own life become barren’.  Hearing loss later in life is common and some is linked to inherited DNA changes.  Could gene editing provide a cure?

Xue Gao and his colleagues at Harvard University think so.  They have reported successfully using CRISP-Cas9 technology to treat a mouse model of inherited human deafness.  Their work was published as Treatment of autosomal dominant hearing loss by in vivo delivery of genome editing agents (Nature, 2017, 553: 217–221).

Hearing is a remarkable process.  In the inner ear are tiny cilia, hair-like structures, which respond to sound waves.  Ciliary movement produces an electrical signal via a protein assembly at the base of each hair which changes when motion occurs.  A protein, known as Tmc1 (transmembrane channel-like gene family 1) is part of that assembly.  Mutations of Tmc1 cause some people to lose their hearing.

Gao’s team used mice from the so-called Beethoven strain – these animals have a Tmc1 mutation that matches the human faulty gene and causes them to grow deaf over time.  The repair of this type of deafness is a delicate matter.  Two copies of the gene exist – the mutated gene must be disabled while preserving the good gene within the same cell.  In fact only one nucleotide of DNA distinguishes the two versions of the Tmc1 genes – adenine nucleotide (A) occurs in the mutant at a position that should be thymidine nucleotide (T).

The authors used CRISPR–Cas9 gene editing to solve the problem and cut out the mutant form of the gene.  Moreover they solved the tricky problem of delivery by encapsulating the CRISPR components in Cas9–guide RNA–lipid complexes to deliver it directly into the inner ears of the mice, rather than the more common use of a virus.  And it worked.  Eight weeks after the injection, untreated mice did not flinch at 120-decibel noise – roughly the volume of a rock concert or a chainsaw – whereas the treated were significantly startled by such noise.  As the authors elegantly put it, ‘Enhanced acoustic startle responses were observed among injected compared to non-injected Tmc1 mice.’

This research has provided a first step towards human clinical trials.  In mice, it is safe and effective.  Of course, much more needs doing, but gene-editing techniques have an astonishing habit of transferring apace to human patients.

Josiah Zayner, CRISPR showman
If you were present at SynBioBeta 2017, a biotech conference held at San Francisco last October, you might have seen the 36-year-old Dr Josiah Zayner inject his left forearm with supposedly CRISPR components in a bid to grow bigger muscles.  The audience was flummoxed, Zayner was in earnest.  The former NASA biochemist knew that myostatin is a protein that regulates muscle cell growth, so if CRISPR can destroy it, his muscle mass should increase.  The injection procedure was streamed live on the internet, of course.

However, that was not Zayner’s primary objective of his zany display.  As the founder and CEO of The ODIN – a biotech company that provides CRISPR home lab kits for the general public – he did it, ‘In order to show people how accessible this technology is, I needed to make a statement by attempting to engineer myself.’  Zayner believes the future is going to be dominated by genetic engineering and ‘consumer genetic design will be a big part of that.’  Moreover, he maintains that this ‘technology [CRISPR] can’t just be in the hands of wealthy corporations, it is too powerful and needs to be made available to everyone.’

He has his critics, not least the US government.  The US Food and Drug Administration (FDA) considers any use of CRISPR editing in humans to be gene therapy and the sale of DIY kits to produce gene therapies for self-administration is illegal.  To those opposers who consider his methods are unscientific and harmful, Zayner says, ‘I have written out the exact protocol and made available all information and DNA sequences used at Josiahzayner.com, including scientific papers that I based my work on.’

Is Dr Josiah Zayner a crackpot?  Yes and no.  He is known as a biohacker as well as a conventional scientist.  He is certainly a showman scientist with a technical cause and a financial case.  He says, ‘I want to help humans genetically modify themselves.’  His menace is that he has few, if any, bioethical moorings.  For example, he has no problem with the creation of ‘designer babies’.  He argues, ‘Sex is the worst form of genetic engineering and we allow it to wreak havoc on the lives of people.  It causes unpredictable genetic changes in the embryo that can lead to harmful traits.  I support and champion the ability to alleviate suffering, and if that means so-called ‘designer babies’, then I support it.  I don’t think you can stop it and so instead we should figure out ways to make it accessible and safe.’

Incidentally, there is no current report that his planned stunt in San Francisco worked.


Stem-cell Technologies
Early embryo development
We know so little about the details of early human embryo development.  One reason, of course, is that the processes are difficult to access experimentally.  The bioethical dilemmas associated with this sort of work are noted.  A recent paper by Shahbazi et al. (Nature, 2017, 552: 239–243) has revealed a little more information about this most remarkable biological progression.

About 6 days after fertilisation, the embryo forms a structure called the blastocyst, which contains a mass of pluripotent embryonic stem cells, which can give rise to any of the 200 or so different cell types in the impending adult body.  It is the blastocyst that implants into the uterus over a period of between the next 5 to 12 days.  Implantation can be put on hold by maternal hormones, which induce the blastocyst to secrete the protein called leukaemia inhibitory factor (LIF) and to enter a dormant or ‘native’ state.

When LIF is removed, these embryonic stem cells become ‘primed’ and can initiate their differentiation into the various cell types that build the body.  The role of these different states is not clear – it may be that LIF removal primes the embryo to resume development, therefore acting as a sort of checkpoint prior to implantation.

At implantation, the embryo undergoes a dramatic change in shape.  The amniotic cavity, which will contain the growing embryo and the fluids that surround it, begins to form within a circle of primed pluripotent cells.

Shahbazi et al. used human and mouse embryos to study the coordination between the loss of pluripotency and the formation of the amniotic cavity.  They found that first, the cells arrange into circular rosette structures, with their apical ends in close proximity.  Second, fluid-containing vesicles are trafficked towards the apical interfaces between cells, and tight junctions are formed.  Then negatively-charged, membrane-spanning apical proteins called sialomucins are produced to form a negatively-charged gap in the centre of the rosette.  Sialomucin production is induced after LIF removal.  The researchers next showed a potential role for the protein Oct4 in regulating sialomucin expression.  Indeed, Oct4 seems to have a crucial role in controlling early human development.  Furthermore, other proteins, such as the tight-junction protein cingulin, which is produced when LIF is removed, may also have a role in cavity formation.

This work has outlined a possible mechanism by which embryos coordinate the changes from the loss of pluripotency to the formation of the amniotic cavity.  It is fascinating stuff.  You too have passed through those changes.  Let no one say that we are not ‘fearfully and wonderfully made’.

Strimvelis and SCID
ADA-SCID (severe combined immunodeficiency) is a rare disorder caused by the lack of an enzyme, adenosine deaminase, which is required for the production of lymphocytes.  Children born with ADA-SCID have impaired immune systems, which sometimes force them to live in sterile plastic bubbles to protect them from possibly fatal bacterial or viral infections – they are sometimes known as ‘bubble babies’.

The first clinical trial of somatic gene therapy was aimed at this disease during 1990 in the USA.  It worked, sort of – the little girl required repeat doses of genetically-engineered T-lymphocytes.  Other similar experimental trials have since taken place, but their outcomes have been mixed, even fatal.

Now comes the first example of a commercially-available product, recently approved by NICE, and accessible from February on the NHS.  It is called Strimvelis and has been developed by GlaxoSmithKline.  It uses a virus to insert a healthy copy of the faulty gene into the patient’s extracted stem cells.  These engineered cells are then returned to the patients’ bone marrow.

Gene therapy was once excitedly hailed as a panacea for many disorders.  Failures and technical problems have slowed that excitement.  But Strimvelis could restore that enthusiasm.  It has already been successfully used to cure ADA-SCID in a four-year-old Belgian girl, Margaux Moreels.  The first UK patient may be the one-year-old Henry Vinen.

The cost of a Strimvelis one-time treatment is about £525,000.  There are concern that such drugs produced for rare genetic diseases are not always commercially viable and this may inhibit further investment in stem-cell gene therapy.  Then again, Susan Walsh, director of Primary Immunodeficiency Disorders UK, regards Strimvelis treatment and NICE’s approval as a breakthrough because, ‘This opens the way for treating many other rare genetic conditions that blight the lives of thousands of people.’


Euthanasia and Assisted Suicide
Conway continued
The latest development in the case of Noel Conway, the 68-year-old man suffering with motor neurone disease, occurred on 18 January 2018.  Two judges from the Court of Appeal granted him permission for a full hearing against an earlier decision, which rejected his challenge to the current law on assisted suicide.  This latest judgment was handed down following an oral hearing at the Royal Courts of Justice.  The case of Noel Conway vs. Secretary of State for Justice, which is supported by the Dignity in Dying organisation, was dismissed by the High Court on 5 October 2017 following a four-day hearing in July.  It will now proceed to the Court of Appeal later this year – the Court heard from his legal team that Mr Conway has ‘more than six months to live, but not much more’ and that an early hearing of the appeal would be welcome.

Mr Conway’s lawyers have previously argued that the current blanket ban on assisted suicide under the 1961 Suicide Act is incompatible with his rights under section 8 of the Human Rights Act, which ensures respect for private and family life.  Last October, three senior judges, Lord Justice Sales, Mrs Justice Whipple and Mr Justice Garnham rejected his case.  They concluded, 'It is legitimate in this area for the legislature to seek to lay down clear and defensible standards in order to provide guidance for society, to avoid distressing and difficult disputes at the end of life and to avoid creating a slippery slope leading to incremental expansion over time of the categories of people to whom similar assistance for suicide might have to [be] provided ... we find that section 2 (right to life) is compatible with the Article 8 rights (private and family life) of Mr Conway.  We dismiss his application for a declaration of incompatibility.’  Thus the Divisional Court refused him permission to appeal, so Mr Conway then filed an application in the Court of Appeal seeking permission directly.  This is what has now been granted.

It should be remembered that since 2003 there have been almost a dozen attempts to legalise assisted suicide through the Assemblies and Parliaments of the UK.  All have failed.  Most significantly, the last of these was the 2015 Marris Bill in the House of Commons.  It was roundly defeated by 330 votes vs. 118.  This failure of its cause through the various legislatures has led Dignity in Dying to switch its strategy to the courts.

It is to be hoped that the Court of Appeal will agree with the High Court’s decision of last October and dismiss this case again.

Withdrawal of clinical assistance
On 13 November yet another ground-breaking right-to-life case, NHS Trust vs. Y and Another was decided in the Court of Protection.  This time it was pronounced by Mrs Justice O’Farrell.

The case concerns a 52-year-old man, known as Y, who, in June 2017, suffered cardiac arrest after a heart attack.  It had not been possible to resuscitate him promptly and so he suffered severe cerebral hypoxia causing extensive brain damage.  Y lacked capacity to make decisions about his future treatment and care.  Two neurological rehabilitation experts agreed that Y had no awareness of self or his environment and that it was highly improbable that he would re-emerge into consciousness.

The London North West Healthcare NHS Trust’s clinical team and Y’s family were agreed that it would be in his best interests for so-called clinically-assisted nutrition and hydration (CANH – commonly called food and water) to be withdrawn, with the consequence that he would die within a period of two to three weeks.

The NHS Trust had sought a declaration that it was not mandatory to bring before the Court of Protection the proposed withdrawal.  The Official Solicitor, appointed to act on behalf of Y and represent his best interests, accepted that there was no statutory obligation to bring an application for such withdrawal, but submitted that it was good practice to ensure that Y’s human rights were not infringed and to provide independent scrutiny of the decision.

Mrs Justice O’Farrell ruled that it was not mandatory to bring before the Court of Protection this matter of the withdrawal of CANH from Y, who had a prolonged disorder of consciousness in circumstances, and where the clinical team and Y’s family were agreed that it was not in his best interests that he continued to receive that treatment.

This case resonates with that of Tony Bland, when, in 1993, the Law Lords made a momentous declaration that artificial nutrition and hydration (namely CANH) was to be regarded as medical treatment, rather than basic nursing care, and therefore could be withdrawn.  Tony Bland died nine days after the withdrawal of food and water and so became the ninety-sixth victim of the Hillsborough disaster.  This was considered by many to be ‘euthanasia coming in by the back door’.

Since 1993, all similar cases have sought prior approval from the court.  Mrs Justice O’Farrell’s judgement changes all this.  And it sets a dangerous precedent.  Indeed, the Official Solicitor has appealed this decision and a Supreme Court hearing will be before Lady Hale, Lord Mance, Lord Wilson, Lord Hodge and Lady Black at a date yet to be confirmed.  For reference, Case ID: UKSC 2017/0202.

Victoria legalises euthanasia
Victoria has become the first state in Australia to legalise voluntary euthanasia.  It came after marathon debates in both Houses, including two all-night sittings.  In October 2017, members of the Lower House voted 47 vs. 37 in favour of the mandating Voluntary Assisted Dying Bill.  The following month, the Upper House passed the legislation by 22 vs. 18.  Then a week later, on 29 November 2017, after a number of amendments were approved by the Lower House, the state parliament enshrined voluntary euthanasia in law.

This landmark legal change, to take effect in June 2019, will allow terminally-ill adult patients, who face intolerable suffering and with an estimated life expectancy of no more than 6 months, to apply for an assisted death.  Under this new Victorian law, a doctor will be permitted to administer a lethal injection only in cases where patients are physically incapable of doing it themselves.

Australia has tried it before.  In 1995, its Northern Territory introduced the world's first voluntary euthanasia law, but it was overturned by federal authorities in Canberra eight months later.  This new legislation in Victoria is significant because it marks the first time in the world that a parliament has gone through an extensive process to introduce voluntary euthanasia.  Other jurisdictions have introduced such laws through referendum or courts.

The news has divided doctors across Australia.  The Australian Medical Association Victoria issued a statement saying the new law would, ‘cause anguish for some members of our profession, as well as the public.’  Lorraine Baker, the group’s president, stated, ‘This is a significant change in medical practice and patient care and requires the strongest safeguards and protections.’

Italy move in the wrong direction
On 14 December, the Italian Parliament passed a controversial end-of-life bill by 180 votes vs. 71 with 6 abstentions.  The new legislation does not permit assisted suicide or euthanasia, but it is undoubtedly a move in the wrong direction.  Apparently this law is the result of 30 years of campaigning and 3,000 amendments.  But it was never enough for euthanasia enthusiasts.  Marco Cappato, a spokesman for the right-to-die movement, said, ‘Of course, we are still missing the legalisation of euthanasia – that we'll propose to the next parliament.’

Pope Francis may have, presumably inadvertently, given support to the new law, when in November he stated that only ‘ordinary’ care should be provided to the dying, not ‘extraordinary’ care that extends life at all costs.  The Roman Catholic official position is that food and drink are ‘ordinary’ care.  On the other hand, the new law regards clinically-assisted nutrition and hydration (CAHN) as medical intervention because it is administered through health devices and, consequently, can be rejected or suspended.  And Italians will now be able to write ‘living wills’ in which they can refuse not only medical treatment, but also CAHN.  Sadly, the new law does not provide doctors with the right to refuse participation via a conscientious objection measure.

Canadian ODE
ODE is the practice of organ-donation euthanasia.  It’s been discussed before, it’s been posited before and it’s even been practised before – in Belgium and the Netherlands.  Now Canada has seen the supposed value of such pragmatism.

Medical assistance in dying, or MAiD, became legal is Canada on 1 July 2016.  Since then, some of those opting for assisted suicide have also donated organs and tissues for transplant, but the numbers have remained small – for example, only 5 organ donations and 56 tissue donors in Ontario so far.  That number could rise soon.

Canadian doctors are seriously thinking about the logistics of ODE.  The ethics has presumably already been settled.  Dr Adrian Robertson is medical director of Transplant Manitoba’s Gift of Life scheme.  He has said, ‘We’re trying to reduce the impact of organ donation on the last few hours of their life.  We want it to be a time they enjoy with their friends and family and leaves everyone with lasting memories, not of a hospital.’

For successful ODE to happen, patients must be in a transplant-capable hospital, close to an operating room.  Robertson admits that, ‘Most patients would prefer to die at home.  So this [ODE] is an extra burden to the patient.  That’s explained to them, and in some ways signifies their interest in donation that they’re willing to forgo that part of the beauty of medical assistance in dying and take on this extra burden of donation.’  ODE has a clear message – your death has greater value than your life.


USA and Elsewhere
March for Life 2018
Friday 19 January just about the 45th anniversary of the Roe vs. Wade verdict, which legalised abortion throughout the USA.  Every year this is commemorated by a March for Life at Washington DC and at other locations across America.

This year’s theme was ‘Love Saves Lives’.  And this year, the crowds experienced a first.  As the first sitting President, Donald Trump addressed them directly from the Rose Garden of the White House.  Speaking via a live video-feed to the gathered pro-life supporters he declared, ‘The March for Life is a movement born out of love ... and you love every child born and unborn, because you believe that every life is sacred, that every child is a precious gift from God.’  ‘As you all know Roe vs. Wade has resulted in some of the most permissive abortion laws anywhere in the world.  For example, in the United States, it's one of only seven countries to allow elective late-term abortions along with China North Korea and others.’  ‘It is wrong,’ he said.  ‘It has to change.’  ‘Under my Administration, we will always defend the very first right in the Declaration of Independence and that is the right to life.’  ‘We are protecting the sanctity of life and the family as the foundation of our society.  But this movement can only succeed with the heart and the soul and the prayer of the people.’

Mr Trump has been called ‘a rampant narcissist and semi-literate man-child who listens to no one.’  Yet he has also become known as the ‘most pro-life president in American history’.  Since taking office, he has reinstated the Mexico City Policy, which prevents US foreign aid from going to organisations that commit or promote abortion abroad.  He has signed a law allowing states to defund the great abortion provider, Planned Parenthood, appointed a number of strong pro-life advocates to key Administration positions and ended Obama's Health and Human Services contraception and abortion pill mandate requiring employers to violate their consciences.  And on 18 January 2018, Trump created a new division within the Department of Health and Human Services (HHS), the Conscience and Religious Freedom Division of the Office of Civil Rights, to enforce ‘laws and regulations that protect conscience and prohibit coercion on issues such as abortion and assisted suicide’ for healthcare workers.  And he proclaimed Monday 22 January to be ‘National Sanctity of Human Life Day’ to juxtapose with the 45th anniversary of Roe vs. Wade.

As ever, the ‘Big 3’ television networks – ABC, CBS and NBC – largely ignored the March for Life.  They devoted only a combined 2 minutes and 6 seconds of coverage in their evening news’ programmes.  The very next day, perhaps predictably, these TV networks gave three times more airtime to coverage of the pro-abortion Women’s March in Washington.

More US pro-life legislation
During mid-December, in Ohio, a pro-life bill protecting preborn babies with a probable Down’s syndrome diagnosis was sent to Governor John Kasich’s desk for him to sign it into state laws.  The Down Syndrome Non-Discrimination Act was passed by the Ohio Senate 20 vs. 12 and by the Ohio House 63 vs.30 in November.  Later this year, Kentucky could become the first state in the US to have no abortion clinics.  The state's last remaining clinic, the EMW Women's Surgical Centre in Louisville, is facing closure after the state’s pro-life Republican governor argued it does not have the right licensing requirements.  Such pro-life laws have been enacted several times before across several states.  They are always fiercely disputed by pro-choice campaigners, challenged through the courts and usually eventually repealed.  Yet, if you don’t try …

Before the US Senate has been the Pain-Capable Unborn Child Protection Act.  This would prohibit abortion after 20 weeks of pregnancy based on the substantial scientific evidence that foetuses can feel pain by that stage of development.  On 3 October, the House of Representatives passed this bill by 237 votes vs. 189, for the third time in the last five years.  However, the legislation faced an uphill battle in the Senate, where Republicans did not have the 60 votes necessary to overcome a filibuster, a procedural blocking device, from Senate Democrats, who wreaked a similar bill in 2015.  And so on 29 January, as expected, the Democrats filibustered the bill in a 51 vs. 46 vote, so it failed.  And so an estimated 6,000 late-term abortions on babies older than 20 weeks will occur this year in the US.  And this is despite a recent Marist opinion poll which showed that 76% of Americans support stricter laws on abortion.  That poll also showed that in December 2017, 63% of Americans supported a ban on abortions after 20 weeks, an increase of four percentage points from January 2017.

Planned Parenthood faltering?
According to its own annual report, Planned Parenthood performed 321,384 abortions in the US during its 2016-2017 fiscal year. This is a slight decrease from the 2015-2016 figure of 328,348.  Moreover, it is the lowest number since 2007.  The organisation’s total revenue was $1.46 billion, with $543.7 million (37%) of that coming from taxpayers.  This represents a slightly lower contribution in government funding from $554.6 million the previous year.  Despite these decreases, its total number of customers was the same as last year, namely 2.4 million individuals.

The Trump Administration now has a golden opportunity during 2018 to show that its warm words about government defunding of Planned Parenthood become a reality.

US Supreme Court candidates
In mid-November, the Trump Administration announced the names of five new potential nominees for the Supreme Court.  They are Judges Amy Coney Barrett, Brett Kavanaugh, Kevin Newsom, Britt Grant and Patrick Wyrick.  They are considered to both conservative and pro-life.  Perhaps we will hear of them in the near future.

However, there are no current vacancies on the SCOTUS, but three of the nine justices are 79 years old or older.  Of the liberals, Ruth Bader Ginsburg is 84, Anthony Kennedy is 81 and Stephen Breyer is 79.  Pro-lifers hope that when a vacancy does arise, a Trump pro-life conservative will steer the Court away from the last four decades of liberalism, apparent in pronouncements on, for example, the legalisation of abortion, homosexuality and same-sex ‘marriage’.

The Dutch can march too
On 9 December, on a cold and windy Saturday, an estimated 15,000 Dutch men, women and children packed Malieveld Square in the centre of The Hague.  They were there for the 25th ‘Mars Voor Het Leven’, the Silent March for Life, to protest against abortion and to promote compassionate options.  Several pro-life organisations were in attendance as well as representatives from Roman Catholic, evangelical, Reformed and Pentecostal churches.

During 2017, four of the seven abortion clinics across the Netherlands have closed down, including those in Amsterdam and Maastricht – these closures were due to fraud allegations totalling over 15 million euros.  This has given the Dutch pro-life movement an unprecedented opportunity.  The remaining clinics are overbooked and pregnant women are looking elsewhere for help, so pro-lifers have been there to offer desperate women life-affirming alternatives.  Already many lives are reported to have been saved.

Pro-life win in Norway
In 2010, Dr Katarzyna Jachimowicz moved with her family from Poland to Sauherad in Norway to respond to the country’s shortage of medical professionals.  She had 20 years of experience and was a doctor of integrity and soon enjoyed good relationships with her patients – she was able to communicate with them in Polish, Russian and Norwegian.  Yet she would not refer them for abortions and she would not insert intrauterine devices (IUDs), which can act as abortifacients.  Her employer had known about her ethical stance and objections and accepted them before hiring her.  And none of these issues adversely affected the functioning at her health centre.

However, in 2015, the situation in Norway worsened after the government eliminated conscience protections for family doctors.  Then it became illegal for them to refuse to supply any form of contraceptive, including the insertion of IUDs, which are not considered to be abortifacient by the government.  Before firing her, in December 2015, her employer, the municipality of Sauherad, tried to persuade her to change her ethical stance.  She refused.  Thus she became the first medical professional in Norway to be sacked for exercising her conscience rights.

In June 2016, Jachimowicz sued the state on the grounds that her rights had been violated and because her dismissal from the state-run health care system was illegal.  In February 2017, she lost her first battle for the conscience protection of family doctors.  But on 24 November 2017, a Norwegian appellate court found in her favour.  This court at Skien agreed with her and reversed the previous decision of the court in Notodden.  Her employer was instructed to pay her fees of 600,000 Norwegian Krone (about £55,000).  Jachimowicz’s case is seen as a landmark in Norway, marking the country’s first legal victory for health carers’ freedom of conscience.  Even so, the municipality of Sauherad has appealed the ruling, moving it to the Supreme Court.  And Dr Jachimowicz has other costs – the stress and strain of the case has caused her to leave general practice and retrain as a psychological counsellor.

Abortion in Poland
The European Union (EU) has warned Poland not to pass any legislation banning the abortion of unborn children who are diagnosed with severe congenital disabilities.  On 15 November, the European Parliament (EP) adopted a resolution initiating the formal process for rebuking an EU Member State found to be in a ‘serious breach’ of their obligations under the Treaty on European Union (TEU).

The EP alleges that Poland may be in violation of core EU principles with respect to human rights and democratic values.  While the EP’s resolution primarily addresses the row over the independence of the Polish judiciary, it also condemns Poland for considering pro-life legislation that would protect unborn children with disabilities.  It also calls on Poland to repeal a recent law, signed by Polish President Andrzej Duda, which prohibited the over-the-counter sale of the morning-after pill without a prescription.

Meanwhile in early January, the Polish parliament rejected proposed legislation to liberalise its abortion laws, voting instead that proposals for tough, new restrictions should be passed to a parliamentary committee for further scrutiny.  If enacted, this so-called ‘stop abortion’ bill would outlaw abortions carried out because of congenital disorders of foetuses, such as Down’s syndrome.

The ruling Law and Justice party’s leader, Jarosław Kaczyński, confirmed that the government would continue to tighten the law.  He said, ‘We will strive to ensure that even in pregnancies which are very difficult, when a child is sure to die, strongly deformed, women end up giving birth so that the child can be baptised, buried, and have a name.’  Introducing the proposed legal restrictions on 10 January, Kaja Godek of the anti-abortion Life and Family Foundation told MPs that ‘we have come to parliament today because we don’t want our hospitals turning into abattoirs.’


Miscellaneous
Don’t say that
While free speech is at a premium in several sectors of UK life, such as universities, newspapers and social media, it has been tempting to look across to the Land of the Free with jealous eyes.  No more!

According to a report in the 15 December edition of The Washington Post, the Centers for Disease Control and Prevention (CDC), the US health protection agency, issued guidance banning or restraining the use of seven little words from government documents concerning the Centers’ US$7 billion budget.  Were they expletives or obscenities?  No, they are ordinary nouns and adjectives used in everyday speech.  Here they are: vulnerable, entitlement, diversity, transgender, fetus, evidence-based and science-based.

What is the Trump Administration thinking of?  A spokesperson for US Health and Human Services tried to quell the brewing storm and said that ‘recent media reports appear to be based on confusion that arose when employees misconstrued guidelines.’  Meanwhile, CDC officials defended the move by saying that it was not censorship but guidance on language that might be most effective in dealing with conservatives in Congress.  This is not a case of fake news, at least, I don’t think it is!

The Nuremberg Code
On 20 August 1947, just over 70 years ago, and just six weeks before I was born, the International Medical Tribunal in Nuremberg delivered its verdict on the crimes of 23 Nazi doctors and bureaucrats who had been involved in concentration camp medical experiments.  As part of that judgement, it produced a 10-point set of rules now known as the Nuremberg Code.
The post-World War II years were dominated by an international push to formulate codes of human behaviour in attempts to ensure that the horrors of war were never to be repeated.  Criteria were concocted for respect for human rights, individual autonomy, informed consent, and so on.  The Nuremberg Code fitted this agenda.

Perhaps its greatest and most enduring rule concerns the ‘voluntary consent’ of every human research subject.  This decree has become a (nearly) global benchmark for the ethical conduct of medical trials.  Yet the Code was initially largely ignored.  It took some 20 years to gain any significant impact.  But even today it has not been officially accepted in law by any nation, or as the ethical guidelines by any medical association.  The truth is that it was eclipsed by the World Medical Association Declaration of Helsinki in 1964.

For completeness, the principles of the Nuremberg Code can be summarised as:
    1]  Voluntary consent is essential.
    2]  The results must be for the greater good of society.
    3]  Should be based on previous animal experimentation.
    4]  Should be conducted by avoiding physical/mental suffering and injury.
    5]  No experiments should be conducted if they might cause death / disability.
    6]  Risks should never exceed the benefits.
    7]  Adequate facilities should be used to protect subjects.
    8]  Conducted only by qualified scientists.
    9]  Subject should always be at liberty to stop at any time.
    10]  Scientist in charge must be prepared to terminate the experiment when injury, disability, or death is likely to occur.

The Code is part of a long history of attempts to regulate the ethics and practice of medicine.  Though none has matched the robustness and durability of the ancient Hippocratic Oath with its signature ‘do no harm’, the Nuremburg Code has played its minor role.  The medical profession, with its propensity to do harm, still needs a tough, broadly-defined set of rules to protect the rights and well-being of human patients and research participants.

New Year’s honours 2018
I always scan the Honours lists at the New Year and on the Queen's official birthday in June – no, I’m not looking for my own name, though it is well known, at least within my family, that I will accept nothing less than a knighthood.  On the other hand, I am more concerned, and delighted, that my name is written in the Lamb’s book of life (Rev. 21: 27).

However, I like to see good people honoured.  I get a warm little glow when I see the names of lollipop ladies and couples who have fostered dozens, rather than the long-serving tax official or the career politician.  Yet rarely do I see anyone’s name who can be regarded as having worked, however remotely, in a pro-life position.  Having said that, and to expunge the thought that I am part of the ‘anti-Christian conspiracy-theory victim gang’, there have been a handful in the last decade or so.

This December, two notable ‘baddies’ were honoured.  First, there was the 64-year-old Professor Robin Lovell-Badge.  He works at the Francis Crick Institute in London as a Group Leader and Head of the Division of Stem Cell Biology and Developmental Genetics.  His CBE was awarded ‘for services to genetics, stem cell research and the public understanding of science'.  Nobody doubts his scientific skills – it is his ethical stance that is disputed.  He is a leading figure in UK scientific policies, regulatory matters and public debates concerning genetics, stem cells, human embryo research, gene editing, mitochondrial donation and so forth.  In February 2016, it was his team who were granted the first UK licence to edit the genomes of human embryos.  He regards human embryos as little more than biological material and is an ardent supporter of their experimental usage, and hence their inevitable destruction.

Second, there was Professor Cathy Warwick, who was elevated to DBE 'for services to midwifery'.  She has been described as ‘a Scottish midwife, trade union leader, and abortion rights activist.’  She was the chief executive officer of the Royal College of Midwives (RCM) and still is the chairwoman of trustees at the British Pregnancy Advisory Service (bpas), which describes itself as ‘the leading provider of abortion services in the UK with over 40 abortion clinics and sexual health centres in England, Wales and Scotland.’  Warwick made headlines on 6 May 2016, when the RCM issued a position statement explicitly supporting the aims of the We Trust Women campaign with its call to scrap the ‘cruel archaic’ abortion laws that ‘prevent women from making decisions about their own bodies.’  In addition, that campaign sought the limitation of conscience rights for midwives, and the extension of the 1967 Abortion Act to Northern Ireland.  This most extraordinary dual role did not go unchallenged.  There were numerous calls for Cathy Warwick to do the decent thing and resign from either the RCM or bpas, or both.  She retired from her RCM role on 1 September 2017.

'Discovery Day'
Here is an interesting little fact, with big implications.  Wednesday 17 January 2018 has been dubbed 'Discovery Day'.  On that day, more than at any other time of the year, more women found out that they were pregnant.  The date falls just over two weeks after ‘National Babymaking Day’ on 2 January, which is the most common day of the year for couples to try to conceive.  It is estimated that in the UK 10,000 women took pregnancy tests on that Wednesday to see if the two blue lines appeared.

It was also a wonderful day for pregnancy test manufacturers because, apparently, women take an average of six different pregnancy tests to ensure they really are expecting.  All this prenatal activity should act as a warning to the NHS to prepare for a bumper busy time during September and October in its obstetrics and gynaecology wards.


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