Update on Life Issues - February 2021

Abortion

‘DIY’ abortions at home
The Covid-19 pandemic has caused untold loss, trauma and upset.  Such harms have been exacerbated by poor decisions, lack of clear thinking and transparency at all levels – personal, parliamentary and public.  We have all suffered.

In its efforts to encourage people to stay at home and to protect the NHS, the UK government approved emergency measures to allow ‘pills-by-post’ and ‘DIY’ abortions.  Since the end of March 2020, these measures have allowed consultations with a single doctor or nurse over the phone, after which, if considered appropriate, both sets of abortion pills (mifepristone and misoprostol) would be sent to the woman’s home for her, in effect, to perform an abortion on herself up to 10 weeks of her pregnancy.

These new ‘DIY’ provisions are not in women’s best interests.  The procedure is not without complications – some women suffer from this type of early medical abortion (EMA).  And any abortion away from a clinical environment and in the absence of any medical professionals overseeing the abortion process is likely to increase potential problems.  And there is the disposal of the dead embryo or foetus – an unprecedented procedure for all women and perhaps traumatic for many.

Now the focus has changed from arguments about granting permission for these new ‘DIY’ measures to whether this emergency provision, initially promised to be temporary for two years, should be made permanent, even when the Covid-19 pandemic is sufficiently over so that it is no longer the reason for the original provision.

The various UK governments have published public consultations on the matter.  Once the deadlines have been reached, the results will be awaited, as will be the subsequent actions by politicians.  Public consultations are a part of the democratic process.  However, when it comes to implementing the public responses, especially on bioethical topics, the records of action have not always been satisfactory.

Plan C abortions
If Plan A is straightforward abortion of a confirmed pregnancy and Plan B is administration of the morning-after pill with its abortifacient mode of action, what is Plan C?  It is an alleged new type of ‘contraception’ for women who do not want to know if they are pregnant or not.  Called the Missed Period Pill (MPP), it is a uterine evacuation medication that induces bleeding, similar to a menstrual period.  It would therefore terminate a pregnancy for nearly all pregnant women users.  Its USP (unique selling point) is that it fills the gap between emergency ‘contraception’ and straightforward abortion.  Moreover, users would not know whether or not they were pregnant.  Hence, its advocates claim, it would avoid the burden of that knowledge and take away any stigma or shame associated with abortion.  This is a ploy to introduce moral ambiguity.

Here is the real surprise.  Missed Period Pill is a euphemism for abortifacient drugs or herbal concoctions.  In fact, it turns out that Plan C could be that old combination of mifepristone, which blocks the effects of progesterone, the hormone without which the lining of the uterus begins to break down and thus prevents implantation and so the embryo or foetus dies, while the second drug, misoprostol, causes the uterus to contract and expel its contents, including the dead embryo or foetus if present.

The promotion of Plan C might seem a little archaic and weird, but at least it provided a research project for a team of women investigators.  They surveyed women’s interest in the MPP across two US states.  In all, of the 678 people surveyed, 42% indicated interest in MPPs.  Interest was greatest (70%) among those who would be unhappy if pregnant.  In other words, it would suit those who despite the ubiquity of home pregnancy testing kits, they would prefer not to know.

These somewhat humdrum results were reported in the journal Contraception under the title, ‘Exploring potential interest in missed period pills in two US states’ by Wendy Sheldon et al., (2020, 102: 414-420).  The authors concluded that, ‘If missed period pills were available in the United States, demand might be substantial and wide-ranging across demographic groups.’

But let’s not overlook the fact that the first author of the study, Wendy Sheldon, is on the staff of Gynuity Health Projects, the ‘reproductive and maternal health’ group that partners with Planned Parenthood and other abortion providers from which funding for the study in Contraception came.

In short, the results may be regarded as both unnerving and also consoling.  Unnerving, because some women do not apparently want to listen to and understand their own bodies, whether they are pregnant or not.  Consoling, because some women are still unsure about the moral conflicts and rightness of abortion – it is not easily destigmatised.  Perhaps, above all, the work demonstrates that extreme abortion activists in the reproductive rights movement are not entirely in tune with the rest of the sisterhood – a significant sensitive and diffident faction still exists.

Can abortion history be changed?
‘Pull down their statues’ is the modern cry.  Architects of slavery must be erased from the streets and the history books.  The names of various benefactors of universities and other public buildings must be expunged.  Their dark histories will no longer be tolerated.  History must be changed, it must be purified, or at least airbrushed.  Support our cancel culture.

We all live and benefit from the exploits of both good and wicked men and women.  A selective view of a deleted history serves no noble purpose.  We must face the truth, both rough and smooth.  Unmanipulated history teaches us valuable truths – read your Bible for explicit examples!

Try telling that to Planned Parenthood, the largest abortion agency in the US and around the world.  It has had to face the link between its founder, Margaret Sanger, and the modern eugenics movement.  She campaigned for, ‘the gradual suppression, elimination and eventual extinction, of defective stocks – those human weeds which threaten the blooming of the finest flowers of American civilization’ as she so indelicately put it.

Then there is the very British Marie Stopes.  Her name is associated with the British charity with 12,000 employees which claims to be ‘one of the world’s largest providers of high quality, affordable contraception and safe abortion services.’  Each year it helps around 5 million women procure an abortion.  It has clinics in 37 countries around the world.

The problem is that Mrs Stopes, pioneer of birth control, was also an ardent devotee of eugenics, advocate of compulsory sterilisation, a devotee of eugenics, an enthusiast of social Darwinism and admirer of Adolf Hitler.  How to bury that despicable history?  Simple, in November 2020, they expunged her by renaming Marie Stopes International as MSI Reproductive Choices.  It is called PR, public relations.  Problem solved.  Except that renaming or denaming is not the right way to address historical wrongs.  After all, does abortion now have neither contemporary nor historic connections with eugenics?  Hide the truth and you fool yourself.

Down’s syndrome facts and figures
Since 2012, Down’s syndrome (DS) births is the UK have fallen by 54%.  That is the year that controversial non-invasive prenatal testing (NIPT) became available in the UK.

NIPT involves a blood test claimed to be 99% accurate for detecting the condition as early as week 9 of a pregnancy.  Opponents of such testing have argued that it would inevitably lead to more abortions, and a fear that Down’s children could be eradicated altogether.  Those fears are now being realised.

The relevant data are contained in a report, published in the European Journal of Human Genetics (2020, 31 October) by de Graaf et al., under the title, ‘Estimation of the number of people with Down syndrome in Europe’.  They are derived from Europe-wide statistics from countries’ registries and databases between 2011 and 2015.  The figures show that in Southern Europe, Down’s syndrome births fell by 71% due to abortion.  In Northern Europe, the number of births fell by 51% and by 38% in Eastern Europe.

The senior author of the study, Brian Skotko, said that the findings would aid ‘deep discussions’ on how countries implement NIPT and its ‘impact on the country’s Down’s syndrome population’ and ‘supporting couples who receive a prenatal DS diagnosis.’  Currently in the UK, approximately 92% of those prenatally diagnosed with Down’s syndrome are aborted.

Poland and abortion

Tougher restrictions on abortion in Poland were introduced on 22 October 2020.  The very next day thousands of protesters took to the streets in Warsaw and other Polish cities to oppose the ruling by the country’s Constitutional Court that banned abortions for unborn children who have congenital defects.  A 1993 law allowing abortion in cases of severe and irreversible foetal abnormalities was declared to be unconstitutional.  The Court’s judges voted 11 vs 2 in favour.

The Court’s president, Julia Przylebska, said that allowing abortions in cases of foetal abnormality legalised, ‘eugenic practices with regard to an unborn child, thus denying it the respect and protection of human dignity.’  And because the Polish Constitution guarantees a right to life, she added, terminating a pregnancy based on the health of the foetus amounted to ‘a directly forbidden form of discrimination.’

Poland is a predominantly Roman Catholic country and the demonstrators’ rage has been directed at the Church – protesters have disrupted Masses, verbally abused priests, defaced buildings and vandalised memorials to Pope John Paul II.  At the same time, right-wing groups have responded by defending churches and disrupting some demonstrations.

Poland already had one of Europe's most restrictive abortion laws and the new ruling will result in a near-complete ban on abortion.  The only other legal sanctions for abortion are for cases of rape or incest or if the pregnancy threatens the woman's life or health.  Almost all legal abortions in Poland are performed on the grounds of foetal defects, so this ruling, which is final and binding, effectively bans pregnancy terminations.

In the middle of the fury was Poland's president, Andrzej Duda.  He initially supported the ban on abortion for foetal abnormality, but now appears to have changed his mind.  Now he believes that women should have the right to abortion in some cases though he still favours outlawing abortion if a foetus has a non-lethal congenital defect.

Then after two weeks of demonstrations by hundreds of thousands of Poles, who defied coronavirus restrictions, the right-wing government drew back and delayed implementation of the new law – the ruling remained unpublished and therefore it had no legal power.  Parliamentarians called for a time of dialogue.  President Andrzej Duda proposed new legislation that would allow the abortion of foetuses with life-threatening defects, but ban them for non-lethal disorders such as Down's syndrome.

Then at the end of January 2021, the Polish government announced that the new October-approved law would come into force from midnight on Wednesday 27 January.  Abortion is now allowed only in cases of rape or incest or when the pregnancy threatens the life of the mother.

The arguments remain polar opposites.  One protestor, Gabriela Stepniak said, ‘I want us to have our basic rights, the right to decide about our bodies, the right to decide what we want to do and if we want to bear children and in what circumstances to have children.’  A defender of the unborn, Karolina Pawlowska, declared, ‘We are very happy that this judgement has been published.  It is a great step towards the realisation of human rights of all human beings.  This also means there will no longer be discrimination against children who are sick or disabled.’

Argentina and abortion
The homeland of Pope Francis has legalised abortion.  It happened on 30 December 2020, when the Argentine Senate voted to decriminalise abortion in the first 14 weeks of pregnancy.  The voting was 38 vs 29 with 1 abstention.

In other words, abortion will be allowed in the first trimester for any or no reason.  Thereafter, it will be allowed if the pregnancy is the result of a rape, or if the mental health of the mother is at risk.

Argentina’s legal change may create a domino effect on abortion access in South and Central America.  Abortion is already legal in Uruguay, Guyana, and Cuba, as well as parts of Mexico, but in El Salvador, the Dominican Republic, Nicaragua, and Honduras abortions remain illegal.

And conscientious objection may become problematic in Argentina, where many Roman Catholic doctors are likely to refuse abortion requests.  Under the new law, doctors are legally bound to either perform an abortion, or, if they are conscientious objectors, they must immediately refer the woman to a compliant doctor.

According to recent polls, less than 30% of Argentinians supported this legalisation of abortion on request.  After the Senate announcement, Karina Marolla, a 49-year-old opponent of the new law, said, ‘What was voted for today is the death penalty for the most innocent.  Today in Argentina there’s no law giving the death penalty to rapists or murderers.  So we’re feeling sad, to put it lightly.’


IVF and ARTs

The 14-day rule
‘For the past 40 years, the 14-day rule has governed and, by defining a clear boundary, enabled embryo research and the clinical benefits derived from this.  It has been both a piece of legislation and a rule of good practice globally.’  That is how Sophia McCully opened her article entitled, ‘The time has come to extend the 14-day rule’ in the Journal of Medical Ethics published online on 2 February 2021.  She continues, ‘In this paper, I argue that the current limit for embryo research in vitro should be extended to 28 days to permit research that will illuminate our beginnings as well as provide new therapeutic possibilities to reduce miscarriage and developmental abnormalities.’

None of this is new.  Since 1984, when the Warnock Committee cobbled together some arbitrary and specious arguments to recommend limiting human embryo research and destruction to an upper limit of 14 days, scientists have complained that it is too restrictive.  On the other hand, many said it was too liberal.  Eventually, the 14-day rule became part of the 1990 Human Fertilisation and Embryology Act.  Now, as part of their case for extending the limit, proponents are even claiming that Warnock’s arguments were random and spurious.  Well I never!

The current calls for change centre on scientists’ probable ability to culture human embryos beyond 14 days – a sort of ‘if we can, why not?’ reasoning.  The popular bid is now for 28 days – just as arbitrary and compromising as Warnock’s original.  But the hook is, 28 days would ‘permit research that will further explore our origins as well as potentially provide new therapeutic possibilities to reduce developmental abnormalities and miscarriage’ as McCully has written elsewhere  In other words, it would allow exploration of the so-called ‘black box’ period of human development.

Will just one slice of pizza satisfy the hungry teenager?  And so how long will 28 days satisfy?  This is where robust bioethics should be at its best.  Everyone knows that life is not a free for all – boundaries are needed for people and civilisations to thrive.  Just as the limit of 24 weeks is not enough for abortionists, and transferring just two embryos is not enough for IVF practitioners, so 28 days would ultimately become inadequate.  If the deliberate destruction of human life is to be avoided, then abortion and embryo experimentation should be illicit.  The boundary should not be 14 or 28 days, it should be zero.

Expect a UK government consultation on the issue in 5 years’ time, maybe sooner.

A 27-year-old embryo is born
Mess with biology and that is the sort of strapline you get.  Molly Gibson was conceived in 1992, transferred to a womb in February 2020 and born in October 2020.  Accordingly, she has set a new world record for the longest-frozen embryo to result in a live birth.

Tina and Ben Gibson of Knoxville, Tennessee, struggled with infertility for nearly five years.  They approached the National Embryo Donation Center (NEDC) in Knoxville.  The NEDC is a Christian, non-profit organisation that stores ‘spare’ frozen embryos donated by IVF patients.

Families, like the Gibsons, can then 'adopt' a stored embryo and use IVF to maybe give birth to a child that is not genetically related to them.  Both Molly's and her sister Emma's embryos were donated by the same couple and frozen simultaneously.  Emma was born in 2017 and had held the previous record for 24 years as a frozen embryo.

After the whoops of delight caused by Molly’s birth had subsided, a serious issue arose.  Currently, the UK has a ten-year storage limit for frozen human gametes and embryos as defined by the 2008 Human Fertilisation and Embryology Act.  At the end of the storage period, the woman must decide whether to become a mother, or have her ova and/or embryos destroyed.  An extension can only be granted for medical reasons and premature infertility.

Molly’s birth in the USA has sparked calls for this time limit to be scrapped in the UK.  Sarah Norcross of Progress Educational Trust commented, ‘It's time for the Government to change this arbitrary law which damages women's chances of becoming biological mothers and limits their reproductive choices.'  That’s all very highfalutin jargon, but IVF is a bioethical and practical ‘can of worms’ and its legal boundaries are there for a reason.

The NEDC is one of several embryo adoption agencies in the USA.  Like others it has a strong Christian ethos – its website states, ‘The NEDC firmly believes in the sanctity of life beginning at conception and recognizes marriage as a sacred union between man and woman as defined by scriptures of the Holy Bible.’ Since its inception in 2003, NEDC has assisted in over 1,000 births and received more than US$3.9 million in federal funding.  But the concept and practice of embryo adoption poses thorny bioethical problems.  For more details, read Chapter 3 and especially pages 94-95 of my 2014 Bioethical Issues book.

IVF children and cancer
This is a recurring theme.  Children conceived by IVF have a higher risk of developing cancer than those conceived naturally.  This fact has been reconfirmed recently by a team of scientists and statisticians from across America and published as, ‘Assessment of Birth Defects and Cancer Risk in Children Conceived via In Vitro Fertilization in the US’ by Luke et al., in JAMA Network Open (2020, 29 October).

The researchers used birth data from Massachusetts, New York, Texas and North Carolina recorded between 2004 and 2016.  They cross-referenced these with various birth defect and cancer registries.  They considered only IVF babies conceived with their parents' gametes, excluding frozen gametes, to get as close as possible to the conditions used by the natural conception cohort.  In all, the study covered 1,000,639 children born to fertile women and 52,776 children conceived via IVF.

The authors stated that, ‘The increased risk was 2-fold higher for children conceived via in vitro fertilization than for children conceived naturally.’  But as ever in these sorts of studies the authors raise the key issue as, ‘An unresolved question in assisted reproduction research remains the contribution of parental versus treatment factors to adverse outcomes.’  In short, do the cancers arise from the parents, or the IVF procedures, or both, or neither?

Among the notable differences between the two groups were 1.8% of babies conceived naturally had congenital malformations, compared with 2.4% in the group of babies conceived by IVF.  And all babies with non-chromosomal abnormalities had a higher risk of cancer.  The risk was multiplied by 2.07 for babies conceived naturally and by 4.04 for IVF babies.  There is food for further thought and investigation here.

IVF and the stupid
Paris Hilton, the 39-year-old American heiress, media personality, businesswoman, socialite, model, singer, actress and DJ, wants a baby or two.  More precisely, she wants a boy and a girl.  So, as recommended by the famous Kim Kardashian, she is undergoing IVF treatment with her boyfriend, Carter Reum.

She wants to start the process now to ensure she could have ‘twins that are a boy and a girl’ since parents can, for an added cost, sex select which embryos they want to use.  ‘I think it's something most women should do just to have and then you can pick if you want boys or girls’, Ms Hilton added somewhat dimwittedly, and ‘The only way to 100% have that is by doing it that way.’

Apparently, many felt Hilton's comments were ‘out of touch’ and insensitive to people struggling with infertility who cannot afford IVF, a procedure that can cost upwards of $12,000.  A celebrity website, Insider, commented on some ethical problems associated with choosing the sex of IVF children.  And, ‘In addition to being an expensive procedure many people in the US can't afford, the idea of ‘picking’ a child's gender before they are born may present some problems.  Since a child could be transgender, and may not identify with the gender they are assigned at birth, no one truly knows what gender their child will be.’

If Paris Hilton thinks that IVF plus PGD (preimplantation genetic diagnosis) will fulfil her baby dreams, she has yet to face some harsh realities.  Sometimes I feel I don’t belong in this world.


Euthanasia and assisted suicide

Canada goes for broke
Here is a bioethical truth – open a permissive door a little and soon it will swing wide open.  Here is proof from Canada.  In June 2016, the Parliament of Canada passed federal legislation that allowed eligible Canadian adults to request ‘medical assistance in dying’ (MAiD).  On 5 October 2020, the Minister of Justice and Attorney General of Canada introduced Bill C-7 with proposals for a major expansion of the country’s 2016 euthanasia laws.  Critics say that the amendments will make Canada’s law the most permissive in the world.

Bill C-7 would give access to MAiD to people whose natural death is not reasonably foreseeable.  It would also establish more relaxed eligibility rules for those who are near death, including a form of advance directives.

Critics insist that C-7 will change MAiD ‘from a procedure to facilitate dying into a terminal therapy for life’s suffering.’  In particular, the Bill would do away with a doctor’s traditional ‘standard of care’, which obliges ‘physicians to apply their skills and intricate knowledge to a patient’s particular clinical circumstances.’  Instead patient choice, effectively self-diagnosis, of ‘enduring and intolerable suffering’ would become the criterion for deciding whether or not he or she is eligible for MAiD and the prescription of the remedy, death.

It gets worse.  On 17 February 2021, Senators overwhelmingly approved a revised version of Bill C-7 by a vote of 66-19, with three abstentions.  In addition, Senators approved five amendments, two of which would expand access even more than the government proposed.  One amendment would allow people who fear losing mental capacity to make advance requests for assisted death.  The other would impose an 18-month time limit on the Bill's proposed blanket ban on assisted dying for people suffering solely from mental illnesses.  The revised Bill will now be sent back to the House of Commons for MPs to decide whether to accept or reject some or all of the amendments.  The government wants the Bill passed by 26 February.

Parliamentary critics have expressed alarm at the haste with which the Canadian law is changing.  But that is what happens with bad laws – they become slippery slopes.  Consider the figures from Ontario, Canada’s largest province.  In 2020, there were 2,378 cases of MAiD, up from 1,789 the previous year, 1,499 in 2018, 841 in 2017 and 189 in 2016.  Is that not a slippery slope?

And Spain
Spain is set to become the sixth country in the world to legalise euthanasia.  After decades of social debate and four previous failed attempts, a euthanasia Bill has been passed with cross party support from leftist and conservative parliamentarians.  The vote on 17 December 2020 by the Congress of Deputies, the nation’s lower house of parliament, passed by 198 votes to 138 with two abstentions.  If the Bill gets its expected approval in the Senate, it could be passed into law as early as spring 2021.
The new law is designed to allow the patient to decide between euthanasia, performed by a healthcare professional, or assisted suicide, which could take place at home by taking a fatal dose of prescribed medication.

Under the proposed legislation, public and private healthcare professionals will be able to assist patients who no longer wish to suffer ‘a serious and incurable disease’, or a ‘debilitating and chronic condition’ that is ‘unbearable.’  They would also need to be Spanish citizens or residents, over the age of 18, who can make rational decisions, and who have asked to die on four different occasions during the process, which must be no less than a month.  The first two requests must be written and submitted two weeks apart, while the third must come after consulting a doctor.

New Zealand legalises euthanasia
The latest jurisdiction to legalise euthanasia is New Zealand.  In 2019, the New Zealand Parliament had passed an End of Life Choice Act, which included criteria, such as the patient must be 18 or over, a New Zealand citizen, suffering from a terminal illness that will end their life within six months, ‘have a significant and ongoing decline in physical capability’, ‘enduring unbearable suffering that cannot be eased’ and in a position to make an ‘informed decision’ about their death.

But the Act had to be ratified by a national referendum – the first time anywhere that the issue has been settled this way.  It appeared as an additional question on the 17 October general election ballot paper.  It simply read, ‘Do you support the End of Life Choice Act 2019 coming into force?’

The final results showed that 65.1% of people supported the Act while 33.7% were opposed.  Because the referendum result is binding, the law is expected to come into effect on 6 November 2021, one year after the final results were announced.

Lockdown and Dignitas
Recently, the various countries of the UK have entered into various Covid-19 lockdowns.  Under the banner of ’Stay at Home’, travellers have only been exempted for the purposes of work, education, or other legally-permitted reasons.  Certainly, holiday travel overseas has been banned.

Yet there was another exemption, another ‘reasonable excuse’ as Matt Hancock, Secretary of State for Health and Social Care told Parliament on 5 November.  He explained, ‘The new coronavirus regulations which come into force today place restrictions on leaving the home without a reasonable excuse.  Travelling abroad for the purpose of assisted dying is a reasonable excuse, and so anyone doing so would not be breaking the law.  The question of how we best support people in their choices at the end of their life is a complex moral issue that, when considered, weighs heavily upon us all.’

In other words, you cannot travel to hug your grandchildren, or visit your lonely mother, but you can travel abroad to Dignitas, or any other such ‘clinic’, to have your life deliberately ended.  Is that not a little odd?

Palliative care provision
Oh, for something life-affirming and positive!  Here it is.  The Covid-19 pandemic has stretched the UK’s provision of palliative care.  According to researchers from Cicely Saunders International, the predicted capacity of about 0.5 million people in England and Wales needing such care by 2040 has already been reached.

Their 2020 Report, which makes an urgent call for reforms to the UK’s palliative care system, is entitled, You matter because you are you: an action plan for better palliative care.  It asserts that too many people who had life-limiting illnesses, or were approaching death, were spending unnecessarily long periods in hospital without being offered alternatives, when most would prefer to die at home.  Around 80% of people would prefer to die at home, or in their place of residence, but in some parts of England and Wales less than 50% do so.

To help meet people’s needs the authors call for face-to-face care, including symptom management, seven days a week access to hospitals, as well as 24/7 support and advice in the community.  Prompt access to therapeutic, nursing, and pharmacy services to support people in their homes are also needed.  Other recommendations in the Report’s seven-point action plan include increased investment in social and community care services, a strategic approach to training, and a system of continuous learning and improvement.  And it draws attention to a government-commissioned review, which estimated that £150m is needed to provide a ‘national choice offer’ to patients and carers for end-of-life care.

Irene Higginson, scientific director at Cicely Saunders International, commented, ‘The Covid-19 pandemic has made it clear that, when the demand for health and social care services goes up, the provision of palliative care falls short.  It’s vital that we learn from this experience and implement the changes necessary to secure high quality palliative care for all patients.’

And Kathryn Mannix, a palliative care physician, said, ‘Access to support for wellbeing, person-centred care, and excellent symptom management should be seen as a human right throughout life.  It is time to recognise that people approaching death have the same rights and to fund the services that will allow them to live well for the remainder of their lives.’  Could all that not be a positive outcome from the Covid-19 pandemic?


Genetic technologies

Anti-CRISPRs
In the last decade, the world of experimental biology has been transformed by the discovery and application of the CRISPR-Cas gene-editing procedure.  Simply by changing a little of an organism’s genetic code, it has been successfully applied to curing human diseases as well as improving crops and livestock.

But sometimes a good thing needs controlling, even stopping.  What if gene-editing cannot be halted, could it have disastrous consequences?  What we need is an off-switch, an anti-CRISPR mechanism.  And several have recently been discovered.

When bacteria are invaded by viruses the latter are susceptible to the bacterial CRISPR-Cas defence system.  But sometimes the invading viruses survived.  How come?  It turns out that viral genes were somehow capable of shutting down the CRISPR-Cas system so the bacteria became susceptible.  Anti-CRISPRs were realised.  Now more than 50 anti-CRISPR proteins have been characterised.

Scientists now have a toolkit for keeping gene-editing in check.  But it is early days.  As Jennifer Doudna, one of the pioneers of CRISPR gene-editing, has asked, ‘How do you actually use these in a way that will provide meaningful control?’

Here is one such example of progress.  In 2017, biologists at the Harbin Institute of Technology in China deciphered the molecular mechanism by which one anti-CRISPR protein, called AcrIIA4, can shut off Cas9 activity.  A few months later, Doudna and colleagues, demonstrated that anti-CRISPRs have practical value.  They showed that delivering AcrIIA4 into human cells could not only halt gene-editing activity, but also limit those dreaded ‘off-target’ effects of gene-editing.  That was back in 2017.  [Dong et al., Nature, 2017, 546: 436–439.  Shin et al., Science Advances, 2017, 12 July].

Two years later in 2019, a US team, led by Erik Sontheimer, at the RNA Therapeutics Institute, University of Massachusetts Medical School, demonstrated that the approach can work in mice – so far the only demonstration that anti-CRISPR proteins can work in a living animal, and not just cells.

Sontheimer and his colleagues wanted to allow editing in the liver while suppressing it in all other tissues of the mouse.  So they designed an anti-CRISPR protein that would be active everywhere except in the presence of microRNA-122, which is found only in the liver.  In the mice, the anti-CRISPR successfully blocked Cas9 editing throughout the body, except in that one organ.  [Lee et al., RNA, 2019, 25: 1421-1431].

This is remarkable, even exciting, progress.  CRISPR-Cas9 and the other techniques of gene-editing have proved to be revolutionary.  Now to have a start-stop control mechanism of the system is phenomenal.  Biology will never be the same.

Gene therapy for eyes
Leber hereditary optic neuropathy (LHON) is a rare inherited form of vision loss which generally affects young men.  Its first symptoms are typically a sudden but painless blurring and clouding of sight.  If vision loss starts in one eye, the other eye is usually affected within several weeks or months.  Most sufferers are severely impaired after 3 or 4 months.

Gene therapy, using adeno-associated viral (AAV) vectors, has been a promising strategy for treatment of various eye diseases.  LHON is caused by a mutation in the eye’s mitochondrial DNA (mtDNA).  This in turn destroys cells of the retina, the tissue at the back of the eye that turns light into electrical signals.  A recombinant AAV, rAAV2/2-ND4, has been therapeutically effective in a mouse model of LHON.

In a phase 3 clinical human trial, 37 LHON patients were given either a single injection of rAAV2/2-ND4 or a sham injection in their right eye. The left eye received the treatment not allocated to the right eye.  Unexpectedly, sustained visual improvement was observed in both eyes over the 96-week follow-up period.  A total of 25 subjects had a clinically relevant recovery in best-corrected visual acuity (BCVA) in at least one eye, and 29 subjects had an improvement in vision in both eyes, even in the sham-treated eyes.

How had visual improvement occurred in both eyes?  The team conducted a primate study of the therapy in three macaque monkeys.  They found evidence of transfer of the viral vector DNA from the injected eye to the anterior segment, retina and optic nerve of the non-injected eye.  These findings suggest that the virus used the optic nerves to travel between the treated and untreated eyes.

However, the phase 3 experimental design was faulty.  The original strategy was to compare vision in the treated eye against that in the untreated eye.  This was not possible in this trial because the untreated eye may also have received the therapy.  Future trials are needed to compare people given the gene therapy with others who receive a placebo.

This study was published as ‘Bilateral visual improvement with unilateral gene therapy injection for Leber hereditary optic neuropathy’ in Science Translational Medicine (9 Dec 2020) by Patrick Yu-Wai-Man et al.

More gene therapy for more eyes
Several common eye diseases damage the retina, the light-sensitive tissue in the back of the eye.  Age-related macular degeneration and retinitis pigmentosa are among these diseases that damage photoreceptors, leading to vision loss.  There are currently no cures for these diseases, though a gene therapy that could restore the fading sight of the elderly is being tested in humans for the first time after positive results were obtained in blind mice.

The team from Nanoscope Technologies of Bedford, Texas has modelled and synthesised a gene that produces a more photosensitive form of opsin.  Opsins are the light-sensitive proteins that can convert photons of light into electrochemical signals.  This MCO1 opsin gene was then tested in mice that were completely blind from retinal degeneration.  The gene was added to a harmless virus and injected into the animals’ eyes.  This one-time injection therapy restored retinal function and vision to the blind mice.  Post-treatment these mice were significantly faster in standardized visual tests, such as navigating mazes and detecting changes in motion.

Human trials of the treatment have begun in India and are expected to start in the United States soon.  Team leader, Subrata Batabyal, has said that, ‘A clinical study in people will help us understand how signalling through bipolar cells affects vision quality; for example, how well treated eyes can pick out fast-moving objects.’

This work entitled, ‘Sensitization of ON-bipolar cells with ambient light activatable multi-characteristic opsin rescues vision in mice’ by Bababyal et al., was published online in Nature Gene Therapy (2020, 22 October).

Brains in a dish
Where are the bioethical boundaries of human genetic technologies?  We already have genetically-engineered babies, three-parent human embryos and novel family combinations.  Now consider this – human brains in a dish, created from stem cells.

Not only is that physical prospect unnerving, but could these clumps of cells, these disembodied brain organoids, become conscious?  Electrical activity in these structures has already been reported.  A review article by Sara Reardon in Nature (2020, 27 October) entitled, ‘Can lab-grown brains become conscious?’ included this statement, ‘The studies have set the stage for a debate between those who want to avoid the creation of consciousness and those who see complex organoids as a means to study devastating human diseases.  [Alysson] Muotri and many other neuroscientists think that human brain organoids could be the key to understanding uniquely human conditions such as autism and schizophrenia, which are impossible to study in detail in mouse models.  To achieve this goal, Muotri says, he and others might need to deliberately create consciousness.’

Where are the boundaries?  So far, they have been little more than voluntary guidelines.  And, after all, what is unethical – what does that mean?  It is easy to be soothed by talk of ‘essential research’ and prospects of overcoming serious diseases.  Should we not be appalled by these trends?  Is human dignity at stake?

Alysson Muotri, a world leader in this field at the University of California, San Diego, remains indifferent.  As Reardon states, ‘For his part, Muotri sees little difference between working on a human organoid or a lab mouse.  “We work with animal models that are conscious and there are no problems,” he says.  “We need to move forward and if it turns out they become conscious, to be honest I don’t see it as a big deal.”’

Not everything about genetic technology is wonderful.


Stem-cell technologies

California Institute for Regenerative Medicine (CIRM)
The election of the President of the United States was not the only question on recent US ballot papers – in California on 3 November, Proposition 14, the Stem Cell Research Institute Bond Initiative (Prop 14), was on the ticket too.  This ballot initiative would allow CIRM to borrow US$5.5 billion in the form of bonds.  Californian taxpayers would have to repay this sum with interest over the next 30 years.  Prop 14 divided the residents of the Sunshine State, but on the day it sneaked passed by 51% to 49%.

CIRM was opened in 2004 with typical West Coast zest and zeal and with an allocation of $3 billion funding.  It was controversial for many reasons including its major intent of destroying human embryos to create embryonic stem cells.  But its record has been mixed.  True, CIRM research has led to two approved cancer drugs and a host of prospective therapies, but the promised ground-breaking stem-cell cures and therapies have been wanting.  More than half the original funding went on buildings and other infrastructure, education and training.

By 2019 the CIRM was running out of money and it suspended applications for new research projects.  It had also been dogged by a string of political and bureaucratic wrangles.  Nowadays California is suffering from huge budget deficits, a largely uncontrolled Covid-19 pandemic as well as housing and unemployment crises.  This time round taxpayers, investors and scientists will be keen to see some solid returns from their US$5.5 billion venture.  If CIRM still insists on funding major embryonic and fetal stem-cell research projects, they will probably be very disappointed.  Adult stem-cell therapeutics have already won the day.

Stem-cell organoids and Covid-19
The virus that causes Covid-19 infection, SARS-CoV-2, attacks primarily the lungs.  Two teams of scientists have recently reported the successful growth of 3-D lung models in order to study the progression of Covid-19.  The models, called organoids, act like ‘mini-lungs’ and may also be used to screen potential therapies for treating Covid-19 cases.

The teams from the Wellcome-MRC Cambridge Stem Cell Institute and Duke University in Durham, North Carolina, independently reached the same conclusions.  Their studies relied on a technique for isolating specific stem cells called AT2s, or alveolar type 2 cells, from healthy human lung alveoli.  These AT2s were grown into 3-D organoids and then infected with SARS-CoV-2.

Shortly after infection, these AT2 cells began producing interferons, molecules that create distress signals to the immune system.  After 60 hours of infection the lung cells began to die, resulting in tissue damage.

Genetic comparisons between infected organoids and lung tissue from Covid-19 patients showed them to be similar.  In short, these stem-cell organoids appear to be a reliable model for studying SARS-CoV-2 infection with wide-reaching implications for Covid-19 research and treatments.

Senior author of the Duke University study, Purushothama Rao Tata, considered the potential of the 3-D model goes beyond Covid-19 research.  He has stated, 'This is a versatile model system that allows us to study not only SARS-CoV-2, but any respiratory virus that targets these cells, including influenza.'  Some of this work has been described by
Katsura et al., as 'Human lung stem cell-based alveolospheres provide insights into SARS-CoV-2 mediated interferon responses and pneumocyte dysfunction, in Cell Stem Cell (2020, 21 October).

A drug to improve stem-cell treatments
Scientists at the Sanford Burnham Presby Medical Discovery Institute, La Jolla, California have created a drug that could improve current stem-cell therapies designed to treat neurological disorders, such as spinal cord injury, stroke and other neurodegenerative disorders as well as heart disease or arthritis.  It could represent a major advance in the field of regenerative medicine.

One of the outstanding issues in stem-cell treatments is how to direct the cells to the damaged tissue.  Stem cells are naturally drawn to inflammation, a biological ‘fire alarm’ that signals damage has occurred.  However, using inflammation as a lure for stem cells is not a sensible strategy because an inflammatory environment can be harmful to the body.

In the present study, the scientists modified CXCL12 – an inflammatory molecule – to create a drug called SDV1a, a peptide chemoattractant.  This new drug works by enhancing stem-cell binding and minimizing inflammatory signalling.  It can be injected anywhere to lure stem cells to a specific location without causing inflammation.

To demonstrate that the new drug is able to improve the efficacy of a stem-cell treatment, the team implanted SDV1a and human neural stem cells, derived from human induced pluripotent stem cells (hiPSC), into the brains of mice with a neurodegenerative disease called Sandhoff disease.  They showed that SDV1a helped the human neural stem cells to migrate and perform healing functions, which included extending lifespan, delaying symptom onset, and preserving motor function for much longer than the mice that did not receive the drug.  Importantly, inflammation was not activated, and the stem cells were able to suppress any pre-existing inflammation.  Current work is investigating the ability of SDV1a to improve stem-cell therapy in a mouse model of ALS, also known motor neurone disease (MND).

The original findings have been published as ‘Chemical mutagenesis of a GPCR ligand: Detoxifying “inflammo-attraction” to direct therapeutic stem cell migration’ by Jean-Pyo Lee et al., in the Proceedings of the National Academy of Sciences (2020, 117: 31177-31188).

BitBio
Stem cells are biological wonders, capable of becoming any of the body’s 120 or so types of adult cells.  But they are often uncontrollable rascals.  Now a British company, Bit.Bio, has announced a procedure that it claims can more reliably reprogramme stem cells, producing a ‘cellular vending machine’ to make any human cell required.

Mark Kotter, the Cambridge neurosurgeon, who founded the company, and incidentally the co-founder of the cultured meat start-up called Meatable, has said, that if successful it will mean, ‘you can turn cells into computers where you can just invoke a new programme and force them to take up a new identity.  That’s a huge paradigm shift.’

According to a report in The Times (2020, 27 October), the technology, which is already being applied for more than ten cell types, could be used for better drug discovery, therapies based on human cells, and eventually, in building organs directly from the cells of a person needing a transplant.  But the idea that living cells can be permanently programmed in this way, as if DNA is merely a computer language, remains controversial in biology circles.

Conventionally, scientists have tried to reverse engineer this process, by recreating the environment seen by stem cells during their development into the target cells.  This is a laborious process.  Another approach is to activate the transcription factors that identify the target cell type, for instance using viruses.  The problem is that cells typically fight back by ‘gene silencing’ the newly-activated genes.

BitBio’s technology embeds these transcription-factor programmes into specialised areas of the genome, which seems to circumvent this ‘gene silencing’.  Then using machine-learning technologies and rapid cell screening, the transcription factors to make different cells can be identified.  BitBio has now entered into a commercial partnership with a non-profit research institution, the London Institute of Mathematical Sciences (LIMS).  Their approach is a fusion of biology and mathematics for the reprogramming of human cells.

Is this the power to make human cells to order and therefore take regenerative medicine to a new level?  Let’s not get too excited, too soon.


Miscellaneous

Updating the Hippocratic Oath
It was the Hippocratic Oath together with the Judaeo-Christian doctrines that created wholesome human medicine and guarded it for over 2,000 years.

The Oath has often been tinkered with and inevitably watered down.  Some examples are given on pages 24-25 of my 2014 book, Bioethical Issues.  Now comes the newest revision from first-year medical students at the University of Pittsburgh School of Medicine.  It is a thin affair.

The traditional Oath is concerned with the big and bold topics of bioethics, such as abortion, conscience, euthanasia, confidentiality and sexual abuse.  This new version instead champions diversity in medicine and society, being a friend to the poor and marginalised, and restoring trust in the healthcare community.

Here are extracts from the new and the old.  Can you guess which is which?  ‘I will be an ally to those of low socioeconomic status, the BIPOC community, the LGBTQIA+ community, womxn/women, differently-abled individuals and other underserved groups in order to dismantle the systemic racism and prejudice that medical professionals and society have perpetuated.’  And ‘I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect.  Similarly I will not give to a woman an abortive remedy.  In purity and holiness I will guard my life and my art.’

Thankfully, the medical students took the traditional Oath as well as their new-fangled rendering.  Such novelties as students creating their own versions suggest that medical ethics and medical practice are flimsy, fashionable issues rather than those built on robust, historic foundations.

Bioethics and the Covid-19 pandemic
In February 2020, the World Health Organization (WHO) arranged a meeting in Geneva to discuss the pandemic.  During the two-day gathering, some ethical principles were considered.  These were published under the title, ‘Key Ethical Concepts and Their Application to COVID-19 Research’ by Dawson et al., in Public Health Ethics, 2020, 13: 127-132.

Bioethical principles are typically summarised under four headings, namely, autonomy, beneficence, non-maleficence and justice, as devised by Tom Beauchamp and James Childress in their famous 1985 textbook, Principles of Biomedical Ethics.  The new Genevan principles are quite different, moving away from autonomy towards community and the common good.  Here, according to Michael Cook of BioEdge (2020, 6 December) is a summary of the new six:

Solidarity.  ‘The practice of standing up together and acting in common.’  ‘Just as infection spreads through connection, our ethical response requires us to act together to ensure recognition of our common nature, needs and value.’

Equal Moral Respect.  ‘There can be no room for disagreement regarding the equal moral respect that is owed to every individual.  In short, equal moral respect serves as a fundamental precondition for fair and equitable treatment.’

Equity.  ‘Treating people equitably means treating like cases alike, e.g. treating people in accordance with their unique needs.’

Autonomy.  ‘An autonomous individual is able to control what happens to their bodies and lives.  Autonomous people may also forego making choices.’

Vulnerability.  ‘Its core ethical function is to mark out the need for additional ethical consideration, or heightened ethical scrutiny in the context of research towards the risks and threats faced by a person or group regarded as potentially vulnerable.’

Trust.  ‘During public health emergencies, such as COVID-19, action is required to ensure the maintenance of trustworthiness in those given responsibility for the response.’

James Randi (1928 – 2020)
I like a sceptic.  After all, Christians are warned, ‘Do not be deceived’ (1 Corinthians 6: 9), and 1 Thessalonians 5: 21 rings out, ‘Test everything.  Hold on to the good’ and similar directives elsewhere in Scripture.  Moreover, scientists are typically sceptical – they can spend a lifetime trying to disprove a null hypothesis.  So it was with the illusionist James Randi, who devoted much of his career to debunking frauds and pseudoscientific claims, which he called ‘woo-woo’.  He spent a lifetime confronting superstition and magical thinking with science and rationality.

He had two world-famous confrontations.  The first occurred in 1988 when the then-editor of Nature, John Maddox, asked Randi to investigate a claim by the French immunologist, Jacques Benveniste, who professed to have found recurrent biological activity in a solution of antibodies diluted well past the point at which any active ingredient should remain.  This alleged ‘memory of water’, published in Nature in 1988, seemed to offer support for homeopathy.  Randi, Maddox and Walter Stewart, a specialist in scientific misconduct, went to Benveniste’s laboratory near Paris to witness a repeat of the experiments.  Benveniste was unable to replicate his original findings, though he refused to retract his controversial Nature article.

Randi’s second celebrated confrontation was with the British-Israeli illusionist and self-styled psychic, Uri Geller.  A regular on TV during the 1970s, Geller would demonstrate his skills memorably by his ‘psychokinetic’ spoon-bending.  The two men became something of a double act – Randi exposed Geller’s deceptions in his 1975 book The Magic of Uri Geller, while Geller regarded their sparring as good publicity.

Randall James Hamilton Zwinge was born in Toronto in 1928, the son of Marie Alice (née Paradis) and George Randall Zwinge.  He was a precociously gifted child and he soon developed an enthusiasm for magic.  In his teens he dropped out of school and actually ran away to join the circus, or at least, a carnival roadshow, as a stage magician, ‘mind reader’ and escapologist.  He was an unapologetic showman.  He posed as a mentalist in local nightclubs and as an astrologer in a Canadian tabloid.  In the 1970s, James ‘The Amazing’ Randi spent time touring with the theatrical rock star Alice Cooper, whom he ‘executed’ at the end of each show.  In 1976 he appeared in a Canadian TV special when he escaped from a straitjacket while suspended upside-down over Niagara Falls.  When accused of being a fraud, Randi replied, ‘Yes, indeed, I'm a trickster, I'm a cheat, I'm a charlatan, that's what I do for a living.  Everything I've done here was by trickery.’  Randi always denied having any psychic power, though not everyone believed him.

For much of his life, he played the sceptic, the gentle debunker, rather than the dark destroyer.  With his trademark wizard-style hats and sage-like beard, Randi followed in the tradition, so popular in the nineteenth century, that stage magic can be used to expose superstition and psychic fraud.  Thus he challenged faith-healers, psychics and believers in UFOs.  From the 1960s, he had offered substantial sums of cash to anyone who could demonstrate paranormal or psychic powers.  From 1996, until the prize was terminated in 2015, the James Randi Educational Foundation raised the stakes to US$1 million.  He had no takers.

In 1976, he joined with mathematician Martin Gardner, planetary scientist Carl Sagan and science-fiction author Isaac Asimov to found the Committee for Skeptical Inquiry.  The organisation still publishes the Skeptical Inquirer, a magazine devoted to the scientific investigation of the paranormal and other such extraordinary claims.

James Randi was a lifelong atheist.  He wrote that, compared to the Bible, ‘The Wizard of Oz is more believable.  And much more fun.’  He also wrote, ‘I've said it before: there are two sorts of atheists.  One sort claims that there is no deity, the other claims that there is no evidence that proves the existence of a deity; I belong to the latter group, because if I were to claim that no god exists, I would have to produce evidence to establish that claim, and I cannot.’

I do not recall that Randi directed his charm and brain to matters bioethical.  Nevertheless, there are still many thespians in science and medicine, always ready to tell half a story with overegged claims.  And there are still crowds who are credulous, be they anti-vaxxers, believers in sham stem-cell treatments, conspiracy theorists, con artists, snake oil sellers, falsifiers, fabricators and modifiers of data, or just plain deceivers.  And who does not want counterfeit Christians with their pseudo-religious claims to be exposed?

In 2010, on his blog, Randi revealed his gay sexuality.  In 2013, he ‘married’ the Venezuelan artist José Alvarez.  On 20 October 2020, James Randi died in Florida, aged 92.  His central message is as important for scientists as for everyone else, ‘Don’t be too sure of yourself.  No matter how smart or well educated you are, you can be deceived.’  In our age of disinformation, we need individuals like James Randi to keep us ever a little sceptical and ever prepared to hunt down the truth.


USA and Elsewhere

DJ Trump’s pro-life legacy
Whatever you think of the man, it cannot be denied that Donald Trump’s four years as President of the USA were marked by major pro-life gains.  There are, according to Katey Price of the Lozier Institute, at least four:

1]  Mexico City policy.  This programme, begun under the Reagan Administration, bars taxpayer funding for organisations that provide abortion or involuntary sterilisation overseas.  Its renewal was the first pro-life action of the Trump administration in 2017.

2]  Title X of the Public Health Service Act (PHSA).  In 2018, the Trump administration supported rules affecting Title X family planning programs, which impact low-income and uninsured Americans, specifically women and girls.  Title X grantees receiving federal funding could no longer provide or refer for abortions.

3]  Appointing judicial nominees.  As well as appointing over 200 judges across the country, Tump appointed three to the Supreme Court.  They were Justices Amy Coney Barrett, Brett Kavanaugh and Neil Gorsuch.  These are considered to be pro-life and could affect any consideration of Roe vs. Wade.

4]  Recent pro-life actions.  In 2020, the Trump administration took action to protect individuals with disabilities.  In his last week of office the President issued a draft rule to protect infants born alive with disabilities.

Joe Biden, though a declared Roman Catholic, is also an ardent pro-abortionist.  With his inauguration as the 46th President of the USA, it is expected that his administration will seek to repeal many of the pro-life gains of Trump’s time in office.  For example, on 28 January 2021, President Biden signed an executive order revoking the Mexico City policy.  He has also called for a review of the Title X rule.  And he wants to dismantle Trump’s proposals that would have cut taxpayer’s funding of Planned Parenthood by hundreds of millions of dollars.

Perhaps the one enduring bright spot of the Trump legacy is that the balance of the Supreme Court now appears to be decidedly pro-life.  Local and federal laws and regulations imposing the Biden’s administration’s extreme policies on abortion may yet be struck down.

The March for Life 2021
Every year, on 22 January, pro-life Americans commemorate the day that Roe vs. Wade legalised US abortion 48 years ago, by joining in the March for Life.  The event has always centred on Washington DC, but this year it had to go virtual on 29 January.

This year one of the keynote speakers was former NFL star Tim Tebow.  He encouraged pro-lifers not to lose hope or give up the fight but to continue advocating for life at all stages, born and unborn.  He continued, ‘You know, I’ve given so much of my life for sports … but that’s for trophies that rust …’  ‘But you see, being passionate about Jesus … and passionate about those that have been thrown away and neglected and forgotten?  That is worthy.’  ‘You see, when you’re pro-life, I believe that we’re called to be pro-life in every area – for the unborn, for the hurting, for the orphan, for the thrown-away, for the special needs, for the trafficked, for all of humanity.’  He encouraged pro-lifers to always be pro-life, ‘… all the time, everywhere, no matter what.’

Is the USA pro-life?
The group, Students for Life of America, recently released results of a poll conducted during January 2021 among 800 registered voters aged 18 to 34, namely Millennials and Gen Z.

Asked about reversing Roe vs. Wade, returning the issue of abortion to the individual states, most Millennials and Gen Z supported the proposal by a margin of 44 % in favour to 36 % opposed with 18 % unsure.  These first two figures changed to 57 % and 30 % when respondents learned that Roe vs. Wade allows for abortion through all 9 months.  In addition, almost half (47%) of those questioned supported banning abortion after a heartbeat was detected.

Also in January, a new nationwide poll, conducted by Marist College, found that a majority of all-aged Americans are pro-life and opposed to all or virtually all abortions that take place in America today.  For example, 51% of Americans self-identified as pro-life.  Legal limits on abortion were supported by 76% of those polled, while 77% opposed taxpayer funding of abortions.  And only 19% of Americans either ‘support’ or ‘strongly support’ funding abortions outside the US.

These findings are significant because they are contrary to President Biden’s and Planned Parenthood’s position that abortion should be freely available at any time during a pregnancy, either in the US, or anywhere else.

China’s demographic crisis
Despite its 1.4 billion people, China is experiencing a population catastrophe.  And despite its recent introduction of a two-child policy, the number of Chinese registered births continues to fall.  Only 10 million were recorded in 2020, a decrease of 15% compared with 2019.  Moreover, the sex ratio of boys to girls was 1.11 to 1 – indicating that sex selection, in favour of boys, is still occurring.

And all predictions point to a worsening situation.  Not only are the 2020 data the lowest in recent decades, it seems likely they will be the highest for the next few decades.  China’s current fertility rate is lower than its replacement rate, meaning the population is shrinking and bringing with it the problems of an aging citizenship and a lack of young workers.

Abortion ban in Croatia?
Currently, abortion in Croatia is permitted up to 10 weeks of a pregnancy and for longer under limited circumstances.  From 1 February, Croatian politicians from the Sovereignist party have been collecting parliamentary signatures to press for a discussion of a proposed new Bill, which would protect life from conception.

Under the Bill, abortion would be permitted only if a mother’s life were in danger.  An additional focus would be on education, counselling and prevention.  The party’s leader, Hrvoje Zekanović, said, ‘This is a chance for all those who call themselves Christian Democrats to prove that they are indeed prepared to protect human life from its conception.’  The exercise will at least tell the Croatian people which members of the Sabor are truly pro-life.

Croatia’s current abortion law was adopted in 1978.  In 2017, the Constitutional Court ordered parliament to pass a new law on abortion within two years.  The Sovereignists have been waiting since March 2019 for their proposal to be put up for parliamentary debate.  Maybe 2021 will be their year.

Abortion ban in Honduras
In late January 2021, the Honduran National Congress strengthened its pro-life legislation by amending the national Constitution to declare that unborn children have the same legal rights as born human beings.  The revised Constitution now reads, ‘The unborn shall be considered as born for all rights accorded within the limits established by law.  It is prohibited and illegal for the mother or a third party to practice any form of interruption of life on the unborn, whose life must be respected from conception.’

Since Argentina legalised abortion last December, there is a fear that other South American countries would follow suit.  However, Hondurans have been spurred to take action to create a ‘shield against abortion’ in their homeland, where most people support unborn babies’ right to life.  Moreover, the Congress of Honduras voted 88 to 28 in favour of legislation that would increase the voting threshold to 75% in order to repeal the constitutional right to life of the unborn.


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