Update on Life Issues - June 2018

Abortion

Abortion statistics for Great Britain, 2017

The annual abortion figures for England and Wales plus those for Scotland were published on 7 June and 29 May 2018 respectively.  Both sets are worse than the previous year's.  The England and Wales statistics can be studied at here.


There were 189,859 abortions for women resident in England and Wales during 2017 and 194,668 abortions when non-residents are included.  This is an increase of 2.3% over 2016.  The rate of abortion was 16.5 per 1,000 resident women compared with 16.0 per 1,000 women in 2016.  65% of abortions were medically induced rather than surgically performed.  This is higher than in 2016 (62%) and almost double the proportion a decade ago in 2007 (34%).  Of all the women who had an abortion in 2017, 39% had had one or more previously.  This is slightly higher than in 2016 (38%), but an increase of 7% since 2007.  With respect to age, there were 1,300 abortions for girls aged under 16 (0.7% of the total).  Of these, 333 were girls aged under 15 (0.2% of the total).  There were also 724 for women aged 45 and over (0.4%).

In 2017, 98% of abortions (185,448) were performed under ground C, the so-called ‘social clause’.  A further 2% were carried out under ground E (3,165 abortions for foetal abnormality, or so-called handicap) with 1% (1,062 abortions) under ground D.  Grounds A and B together accounted for very few abortions (176).  The remaining 8 cases were performed under grounds F or G.

Also recently released (29 May 2018) were the 2017 figures for Scotland.  They can be read here.  The number of terminations in Scotland was at a five-year high in 2017 when there were 12,212 abortions. This was 106 more than reported in 2016
an increase of just under 1%. The number of terminations remained below the 2008 high of 13,908.

In other words, during 2017 the total for the whole of Great Britain was 206,880 abortions.  That is an egregious figure, nothing of which to be proud.  You do the maths – it’s almost 4,000 every week, or 795 every weekday.

Abortion in Ireland
The plain fact is that on Friday 25 May 2018, Ireland voted overwhelmingly in a referendum to repeal the Eighth Amendment of that country’s constitution. The result was 66.4% for and 33.6% against.  The Eighth, originally approved by a referendum on 7 September 1983 and signed into law on 7 October 1983, famously declares, ‘The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.’

Ireland can no longer lay claim to being one of the few, very few, European countries that has a semblance of a pro-life ethos – only Poland and Malta come to mind.  The rest have succumbed to secularisation and progressive liberalism and adopted abortion as ‘a woman’s right’, or some such slogan.  It marked a sad day, and an even sadder future, for the Republic.
 
The Irish cabinet will now discuss draft legislation to allow terminations within the first 12 weeks of pregnancy, and up to 24 weeks in exceptional circumstances.  The Taoiseach, Leo Varadkar, has promised a new liberal abortion law will be on the Statute Book by the end of the year, with access to terminations from January 2019.

The Irish people’s decision will echo around the world.  Not least in Northern Ireland, where abortion is permitted only if a woman's life is at risk or there is a permanent or serious risk to her mental or physical health, not for cases of rape, incest or fatal foetal abnormality.  Already the UK's Women and Equalities Minister, Penny Mordaunt, has said that the landslide Irish vote has given ‘hope’ to Northern Ireland.  She is not alone – her voice has been joined by her predecessors from the sisterhood, Amber Rudd, Justine Greening, Nicky Morgan and Maria Miller.  However, Theresa May has stated that the Irish vote will have no impact on Northern Irish abortion law.  However, her situation has little wiggle room because she depends on the support of 10 Democratic Unionist Party (DUP) MPs, who strongly oppose any such reform.  We shall see.

Thus Ireland had changed.  They were dancing in the Dublin streets now that they could legally kill their unborn children.  The moral credibility of the once-dominant Roman Catholic Church has been battered by recent sex scandals and cover-ups.  Divorce is no longer banned, neither is same-sex ‘marriage’.  In addition, the economy is flourishing – Google, Amazon and Facebook have relocated there.  The old Ireland has indeed gone.  But this is not a time to reminisce, it is a time to mourn for innocent bloodshed.  True, this was a referendum and we lost, but we all know the real losers – though poignantly, we shall never actually come to know them.  And here is a big question - will the legalisation of euthanasia be on the cards next for Ireland?

Abortion politics in the UK and Northern Ireland
Decriminalisation is the current watchword of many pro-abortion lobbyists, medical organisations and politicians.  They want all legal restrictions removed from the Abortion Act 1967.  The cunning plan is to repeal sections 58 and 59 of the Offences Against the Person Act 1861.  This would allow abortion on demand, the dream of many, such as Ann Furedi, the CEO of our largest abortion provider, Bpas.  She is well remembered for stating last year,
'I want to be very, very clear and blunt - there should be no legal upper limit.'

Yet a recent opinion poll shows how many of our MPs are increasingly out of touch with their constituents on this issue.  This latest ComRes poll (conducted in October 2017 and published in November) of over 2,000 UK adults showed that 72% of the public think abortion should continue to be subject to a legal framework, including the requirement to get the consent of two doctors and not allowing abortions after 24 weeks unless the child is disabled or the mother’s life in danger.  Just 12% disagreed.

Yet the Parliamentary momentum for changing the law remains.  During the afternoon of 5 June, there was an emergency debate in the House of Commons entitled, 'Offences Against the Person Act 1861 (Standing order No. 24)'.  As many as 22 back-bench MPs had put their names down to speak.  The debate was flying on the coattails of the abortion referendum in Ireland the previous week.  It was initiated by Stella Creasy (Labour/Co-op MP for Walthamstow East), who made a two-pronged attack arguing first for the repeal of sections 58 and 59 of the
Offences Against the Person Act 1861, which would be equivalent to the decriminalisation of abortion, and second for a reform of abortion law in Northern Ireland, which would then become equivalent to the rest of the UK.

Others spoke against.  For example, DUP chief whip Sir Jeffrey Donaldson stated that there were 100,000 people alive in Northern Ireland today because the law had not been reformed.  ‘I am proud of that pro-life position, I am proud of the fact that there are so many people alive in Northern Ireland today because we have a law that respects the rights of both women and of the unborn child and we will maintain that position,’ he said.  Sir Jeffrey added, ‘There are strong voices on both sides of this debate, this is a devolved issue – it should be left to the people of Northern Ireland to decide.’

Karen Bradley, the Northern Ireland secretary said, ‘This is a matter of conscience: a free vote on this issue in this House would be afforded if the matter of abortion comes before the House again, and the same applies in Northern Ireland.  That is why the government, like its predecessors, believes that the best forum to debate and resolve these and many other matters is a locally-elected Northern Ireland Assembly, so the government’s priority remains to urgently re-establish strong, inclusive, devolved government at the earliest opportunity.'

Three hours later, the debate was brought to a conclusion by Stella Creasy, ‘Let me be clear to all Members of this House, the members of the campaign, the MPs who already stand convinced and those who want to hear more arguments – that we will also make a choice: not to give up fighting for equality, not to give up fighting for the 21st century and not to give up fighting for choice for all.  We trust all women.  Now is the time for Northern Ireland.’

And Hansard recorded the debate finally as, ‘Question put and agreed to.  Resolved, That this House has considered the role of the UK Parliament in repealing sections 58 and 59 of the Offences Against the Person Act 1861.’  This time there was no vote in the House, but the issue will come back, again and again.  Indeed, the latest plan is to put pressure on the new Home Secretary, Sajid Javid, to bring forward the draft Domestic Abuse Bill to Parliament early, so they can hijack it and introduce a decriminalisation amendment to cover England, Wales and Northern Ireland.


Supreme Court decision on NI abortion
It is an understatement to say that the political situation is tense and complex – perchance it has always been so.  However, part of the current problem is that it has had no working devolved government since January 2017, when Sinn Fein withdrew from the governing coalition.  In order to create some political movement the Northern Ireland Human Rights Commission (NIHRC) managed to engineer a hearing of the current abortion law at the UK’s Supreme Court in an effort to overturn it.

In April, the Court sat for the first time in Belfast.  Two days after the Westminster abortion debate, on 7 June 2018, the Court’s judgment was handed down.  It was unusual.  By a 4 to 3 vote, the justices dismissed the appeal on the basis that they could not rule in the case because the NIHRC had no standing to bring the proceedings.  Nevertheless, they further explained how a legitimate challenger, such as a pregnant woman carrying a disabled baby, could have standing and ought to succeed.  In other words, the case needed an actual or potential victim.

Of the seven justices, five agreed that the current law violated Article 8 of the European Convention on Human Rights which protects privacy and family life.  Two thought that it was incompatible with Article 3, which prohibits torture.  The judgement was complicated and exposed disagreements, but the Court sent a strong signal that as the law now stands it is incompatible with human rights law.  Something must give – their lordships argued that the matter requires urgent democratic consideration.

Despite the claim’s failure, David Russell, chief executive of the NIHRC said, ‘This is a victory, a historic landmark for women’s rights in Northern Ireland.  It has been clear that Northern Ireland’s laws are incompatible with human rights and there needs to be a political solution.’

All this leaves the UK’s Prime Minister in a quandary.  After the referendum result in the Republic, she is under pressure to see that Northern Ireland also liberalises its law on abortion.  However, her majority in Parliament depends on the support of the 10 Northern Ireland’s Democratic Unionist Party members and its leaders have declared that the North ‘should not be bullied into accepting abortion on demand.’

Abortion on the Isle of Man
Tuesday 1 May was a red-letter day on the Isle of Man.  It was when the Abortion Reform Bill commenced its passage through the Upper House of the Isle of Man Parliament, the Legislative Council.  The Bill proposes to liberalise abortion law on the Island and become the most permissive abortion regime in the British Isles.  The move follows a public consultation which received the Island’s biggest ever response with more than 3,600 respondents giving feedback.

The new legislation will allow abortion up to 14 weeks ‘on request’, up to 24 weeks in cases of foetal anomaly or on ‘serious social grounds’, and after 24 weeks in rare circumstances where the life of the mother or baby is at risk.  Counselling must be offered before and after the termination, and a clause allows medical professionals to opt out if it clashes with their personal views.

So on 1 May, the Bill was passed by members of the House of Keys by a margin of 22 to 2.  As expected, the Bill passed its Second Reading on 12 June.  Further debates and votes on amendments will take place on 26 June.  If approved, the Bill will be submitted for Royal Assent and accordingly become law.

Abortion in the USA
President Trump has often been an outspoken opponent of abortion and has threatened to withdraw federal funding, which is of course ultimately taxpayer’s money, from more than 4,000 family planning clinics if they also provide abortions.  His aim is particularly directed at the largest such provider, known as Planned Parenthood.

The US operates a so-called Title X program by which the government has previously funded family planning and abortion clinics.  On 22 May, the Trump administration announced its plans to separate funding of these two functions.  Speaking at a dinner for an anti-abortion group, President Trump said, ‘My administration has proposed a new rule to prohibit Title X funding from going to any clinic that provides abortions.’  If enacted, the new regulation, which is being called the Protect Life Rule, will cause Planned Parenthood to lose an expected $60 million a year.  This is part of the Trump administration’s plans to restrict abortions throughout the USA.

Abortion in China
China’s infamous one-child policy was introduced in 1979.  It is about to be scrapped.  Forty years ago the concerns were feeding the world’s largest population – today the concerns are a falling birth-rate and an ageing populace.  China is now home to 1.38 billion people.  But, though its fertility rate was falling before the introduction of the one-child policy, it has now reached an average of only 1.62 babies per woman of reproductive age.  This is below the critical figure of 2.1 required to maintain a viable population.  Moreover, the numbers of pensioners are now outpacing those of younger generations and creating a funding crisis in looking after the elderly – less workers, less taxes, less caring.

Will the new, unrestricted policy work?  State-sponsored population controls have a terrible history from European colonialism to the Nazi programmes.  Will the Chinese now reduce their previous strategies of enforced abortions and sterilisations?  Yet China faces a novel demographic challenge – are the young even interested in larger families?  In 2016, when the one-child policy was first relaxed, the birth rate jumped by 8% – the following year it fell to 3.5%.  A declining birth rate is not all good news, not even in China.

El Salvador says ‘No’
Despite a massive campaign by the United Nations, Amnesty International and major international media organisations El Salvador failed to legalise abortion at the end of April.  Pro-abortion groups have called it a ‘terrible blow’ to their cause.  They did not even secure a congressional debate over the proposed legislation, and now the current legislative session is closed.

Both the constitution of El Salvador and its civil legislation prohibit all abortions, and the law is defended strongly by the country’s principal medical association, the Medical College of Nicaragua, which includes 37 different medical organisations.  In a statement issued in mid-April, the doctors declared, ‘No situation exists in current medical practice in which human life must be intentionally destroyed by means of an abortion for the purpose of saving the life of the mother.  Never can a doctor kill by action or omission.  This is applicable also to induced abortion, which is a grave ethical and deontological violation.  Biology indicates that the human person is “the subject of the absolute right to life from his conception.”’



Assisted Reproductive Technologies

IVF at 40
Wednesday 25 July 2018 is the 40th anniversary of the first successful IVF treatment – Louise Brown was born at the Oldham and District Hospital in Greater Manchester.  Since then at least 5 million IVF-babies have been born worldwide.  In the UK the total figure is some 250,000 – and now accounting for almost 2% of all UK births.

With such numerical achievements maybe it is becoming harder to dispute IVF.  Nevertheless, the major objection remains the fate of the inevitable excess, or supernumerary, human embryos.  Tens of thousands are deliberately destroyed every year, they are the leftovers, of no further use, the not needed anymore scraps.  Of course any such objection is predicated on the status of the human embryo – itself a constantly and resolutely contentious issue.  If it is merely a clump of a few cells, then who cares about its fate?  If it is a real and nascent human being, then its deliberate and wanton destruction must be illicit.  There are other good reasons for objecting to IVF, but this is not the place to rehearse them – I’ve already done that in my Bioethical Issues book, pp 82 - 99.

Infertility is a symptom that there is something medically wrong.  The approach of IVF is to bypass the underlying causes of infertility.  IVF is therefore not a cure but a ‘strained treatment’.  Forget, for a moment, the bioethical costs, consider the cash costs instead.  These are somewhat tricky to calculate accurately because of the differences between patients and clinics and treatment add-ons, plans, options, and so on.  But a ballpark figure would be £5,000 per cycle at a UK private IVF clinic.

For instance, look at the costs from CAREfertility, the website of which states that it provides, ‘The reassurance of a world leading IVF group, the support of a dedicated team.’  The following figures are medians of their ranges given.  First, there are pre-treatment costs with an initial consultation at £200, a scan at £150, semen analysis at £160 and fertility assessments at £395.  Second, there are treatment costs.  CAREfertility states that, ‘Prices are indicative only but include monitoring, egg collection, embryo culture and transfer.  Prices do not include drugs or other optional costs.’  So for straightforward IVF, the mean figure is £3,225 plus required drugs and other costs at £750.  Third, there is the option for an endometrial scratch to increase the success rate at £260 and there is embryo freezing and storage to ease the process next time at £975.

The sum of these amounts to a whopping £6,115.  Yet this is not the cost of a baby-in-arms.  The success of one such treatment cycle is typically less than 30%.  In other words, one or two more cycles may be required to yield that bouncing new-born baby.

IVF on the NHS
Most IVF in the UK is performed outside the NHS.  Apparently both practitioners and patients want clearer information about the costs and benefits of treatments – that seems reasonable since some IVF clinics have previously come under fire for milking vulnerable couples by overcharging for drugs, using unproven procedures, and hyping success rates.

It is now estimated that the annual IVF spend by the NHS is £68m.  Since 2013, NICE (the National Institute for Health and Care Excellence) has stipulated that eligible women should be offered three free cycles.  By 2017, however, only 27 of England’s 200 CCGs (Clinical Commissioning Groups) had complied.  No wonder the majority of women seeking infertility treatment go to the private sector.

First UK womb transplant
Transplanting wombs is not a new procedure – they have been carried out in at least 10 countries including Saudi Arabia, Turkey, Sweden, US, China, Czech Republic, Brazil, Germany, Serbia and India.  The first successful operation was in Sweden in 2014 when a woman in Gothenburg gave birth to a baby boy.  The 36-year-old mother received the donated womb from a friend in her 60s.

Now Richard Smith, clinical lead at the charity Womb Transplant UK, plans to carry out the first UK transplant before the end of 2018, using a living donor.  In 2015, approval was given for 10 womb transplants in the UK, but these were from deceased donors, whose hearts are still beating.  Around 6,000 women in the UK have been born without a womb, while others lose their uterus to cancer.  At present, their only chance of having a genetically-related child is through surrogacy.  Around 750 women in the UK have approached the team to enquire about transplantation.  Womb Transplant UK says it currently has enough funds to pay for three such transplants.
 
Baroness Mary Warnock
Nobody has been as influential in the field of assisted reproductive technologies as Mary Warnock.  As the chairwoman of the Committee of Inquiry into Human Fertilisation and Embryology and the lead author of the so-called 1984 Warnock Report, she has set the ethics and practice of IVF and embryo experimentation within the UK and further afield.  Elsewhere, I have called the Report ‘… a dog’s breakfast.  It’s thinking was in too many places muddled and shallow, and it often avoided the major issues, or simply fudged them.’  Nevertheless, most of its recommendations were incorporated into the Human Fertilisation and Embryology Act 1990.

In May, Baroness Warnock received a Dan David Prize, which ‘rewards research and achievements that have an outstanding scientific, technological, cultural or social impact on our world.’  For this she received US$1 million, 'for her leading role in the development of practical bioethics and specifically for her progressive and unparalleled contribution to the ethics of embryology and genetics and their ethical and philosophical implication, reproductive technologies, and disability studies.’

The previous month, in April 2018, at the age of 94, she was interviewed by BioNews, a publication of the Progress Educational Trust.  Given her liberal progressive stance on most issues, two of her answers were surprisingly conservative.  A third was appalling.

First, she was asked, With the benefit of hindsight, would you [now] have reached a different conclusion in your Report?
She answered, ‘Rather on the contrary – I think the most important thing really, and the only reason it managed to get through Parliament, was that we had the 14-day cut-off rule.  If we hadn't had a definite number of days beyond which it would be a criminal offence to keep an embryo alive in the lab – that was immensely important [in getting through].  I personally wouldn't want it to change.

There's talk now to extend it, but I hope that won't happen.  It's only very recently that the embryo has been kept alive longer than five days [in the lab].  There's no reason to change it at the moment.  I'm perfectly sure that if we had tried to describe a stage of development of the embryo which would be the cut-off that would not have worked.  Everybody can count up to 14, and everybody can keep a record.  It was the simplicity of that rule that made it successful.’

Second, Some say that as IVF is now routine it no longer needs so much specialised legislation and regulation, nor does it need its own special regulator.  What do you think of this argument?
‘I think it's a very dangerous argument.  The first recommendation in our Report was to set up the HFEA to inspect and monitor infertility treatment.  I believe that is very important because it has more or less ruled out rogue practitioners.  People who are infertile and want to start a family are very desperate and therefore very vulnerable.  I wouldn't want that [protection] changed for anything.  People say it's over-regulated – I think that's a fault on the right side.’

The third question, and her appalling answer were, Are there any other issues in the field on your mind?
‘I think the whole field of genetic intervention and the possibilities of performing therapeutic interventions on embryos – either when they have been implanted, or in the lab – is still developing and is extremely exciting.  The one thing I do deplore is the attitude of what I think of as the disability lobby who think it's wrong to try and eliminate hereditary diseases because it is suggesting that they are unworthy of life.  That is an absolutely terrible argument.  The disability lobby is very vocal on this subject and it does form a real obstacle on progress.’

It seems that the Baroness has mellowed a little in her old age.  Nevertheless she is still proud to have mistress-minded embryo destruction on an industrial scale.  And she is still keen to weed out the disabled.

Human ova grown in the laboratory
Yet another potential fertility treatment has been reported – for the first time, immature human ova cells have been coaxed to develop fully in the lab.  Still unclear is whether the resulting in vitro ova, which reached maturity in just 22 days compared with 5 months in vivo, are physiologically normal and whether they can be fertilised with sperm to make healthy embryos.  Potential patients include women who have gone through chemotherapy, which can damage ova and cause infertility.  Also girls with cancer, who have not reached puberty and so have yet to produce mature ova, could likewise benefit.

In 2008, reproductive biologist Evelyn Telfer and her colleagues at the University of Edinburgh achieved the first half of the developmental process.  They started with primordial follicles from ovarian tissue and cultured them into a semi-developed state.  Then in 2015, a group at Northwestern University in Chicago, Illinois, completed the second leg – they created mature ova from partially-developed follicles.

Now the Edinburgh team, Telfer et al., have reported a procedure for creating fully-developed ova in Molecular Human Reproduction (2018, 24: 135 - 142) under the title, ‘Metaphase II oocytes from human unilaminar follicles grown in a multi-step culture system.’  They took small samples from the ovaries of 10 women undergoing elective Caesarean sections, and isolated 87 follicles.  From these, they extracted immature ova and some surrounding cells from the follicles, and allowed them to further mature on a special membrane in the presence of growth-supporting proteins.  Finally, just nine of these ova passed a crucial test for maturity – they were able to divide and halve their chromosomes so they were ready to unite with sperm during fertilisation.

However, there are some serious reservations about the work.  For instance, the laboratory process was inefficient with only about 10% reaching maturity.  There have been no genetic analyses of the final ova that confirms they are healthy.  The shortened maturation process in the laboratory is quite unlike natural, in vitro development.  The polar bodies of these ova are abnormally large, suggesting that the ova may not have matured properly.  Maybe the ova are abnormal.  The ultimate test would be to try to fertilise them to create healthy human embryos.  And since there are currently no plans to try to generate a pregnancy with them, it is obviously too soon to consider this as a potential fertility treatment.

‘Three-parent’ IVF – the latest
Scientists at the Newcastle Fertility Centre have now selected two women to whom they wish to transfer embryos created from genetic material collected from three parents.  Both women carry gene mutations which can cause a rare condition known as myoclonic epilepsy with ragged red fibres, or Merrf syndrome for short.  It is a progressive neurodegenerative disorder, the symptoms of which occur at an early age, generally childhood or adolescence.

The procedure of mitochondrial replacement technology (MRT) aims to prevent such diseases being passed through mitochondrial DNA by transferring the mother’s nuclear DNA to a donor ovum in which the nucleus has been removed, but the mitochondria remain.  This controversial process was legalised by Parliament in 2015.  Newcastle University received the required licence from the HFEA in March 2017.  And the women were approved for treatment by the HFEA in February 2018.  Now the experiment is ready to begin despite crossing that bioethical red line of germline modification.

The UK is not alone in permitting MRT.  It is already available in the Ukraine and it has recently been legalised in Singapore in its aim of fostering cutting-edge biological science.  Thailand is the only country that does not explicitly prohibit altering the human genome, while Italy and Israel permit it under certain conditions.


Genetic Engineering
Gene therapy – in trouble again
The great therapeutic dream of gene therapy has often been dashed – it has had a troubled, albeit short, history.  The crisis started in 1999, when Jesse Gelsinger, a US teenager, suffered a severe reaction to the infused viral vector, he underwent multiple organ failure and died.  Other disasters followed amid clinical trials in France and the USA.

So last year it looked like good news when high doses of viruses were used to carry healthy genes to unhealthy cells and when they brought relief to 15 babies suffering from a lethal neuromuscular condition called spinal muscular atrophy type 1 (SMA1), a genetic disease that gradually paralyses babies.  As the first human trial using a particular adeno-associated virus serotype 9, known as AAV9, its success gave a welcome boost to the gene-therapy field.  This hopeful study was conducted at the Nationwide Children's Hospital in collaboration with the Ohio State University College of Medicine.  It was reported in The New England Journal of Medicine (2017, 377: 1713 - 1722) as ‘Single-Dose Gene-Replacement Therapy for Spinal Muscular Atrophy.’

However, this year brought chilling news.  A study entitled, ‘Severe Toxicity in Nonhuman Primates and Piglets Following High-Dose Intravenous Administration of an Adeno-Associated Virus Vector Expressing Human SMN’ appeared in Human Gene Therapy (2018, 29: 285 - 298) by James Wilson and colleagues at the Perelman School of Medicine, University of Pennsylvania.  They also used high-dose AAV9 infusions, but these severely affected several animals.  Three young rhesus macaque monkeys developed liver failure and three piglets had motor neurone damage.  Some of them had to be euthanised.  The cause was not immediately apparent.

However, additional alarm bells rang because this study was overseen by James Wilson.  It was he who conducted the gene-therapy experiment which resulted in the death of Jesse Gelsinger in 1999.  He has since resigned his position as a scientific advisor to Solid Biosciences, the company whose product apparently cured the 15 aforementioned babies.  It is a timely reminder that much of medicine is experimental with both known and unknown risks.

Human-animal hybrids

Hybrids and human-admixed embryos and chimeras – what bioethical dilemmas they throw up.  Now for the first time human-sheep hybrids have been created by scientists with the aim of generating an unlimited supply of human organs for use in transplants, or to cure diabetes.

In January 2017, some serious foundational work was reported by a team led by Juan Carlos Izpisua Belmonte at the Salk Institute, California and published as ‘Interspecies Chimerism with Mammalian Pluripotent Stem Cells’ in Cell (2017, 168: 473 - 486).  They created human-pig embryos, by injecting human stem cells into early-stage pig embryos.  These resulted in more than 2,000 hybrids that were transferred to surrogate sows.  More than 150 of the embryos developed into chimeras that were mostly pig, but with a tiny human contribution of around one in 100,000 cells.  These human-pig embryos were allowed to develop to 28 days before being removed from their mothers.

Now, on 17 February 2018, many of the same team members reported another major breakthrough at a meeting of the American Association for the Advancement of Science in Austin, Texas.  There the scientists announced that they have fine-tuned their techniques and managed a similar feat with sheep embryos, achieving an even higher ratio of human to animal cells of about one in 10,000 cells.  One of the lead scientists, Pablo Ross from the University of California, Davis said, ‘We think that that's still not probably enough to generate an organ.  About 1% of the embryo would have to be human for the organ transplant to work.  And to prevent immune rejection, extra steps would be needed to ensure that leftover bits of animal viruses are struck from the pig or sheep's DNA.  But the work shows progress toward more viable organs.’

This work appears to be a realistic first stage towards growing an unlimited supply of human organs for transplants and even providing a cure for Type-1 diabetes.  The next step for the team is to implant human stem cells into sheep embryos which have been genetically modified so they can grow a pancreas.  If successful a human pancreas would appear inside the animal’s body.  The team now has to apply for permission from regulators to lengthen their experiments to 70 days to see if the human cells really can create a viable, functioning organ.

These studies inevitably reignite bioethical concerns.  If 1 human in 10,000 animal cells is acceptable, what proportion isn’t?  What about the spectre of intelligent animals with humanised brains?  What about the potential for bizarre hybrid creatures accidentally being released into the wild?  And so on.  Such questions tend to be overshadowed by the clinical promise of organ production and donation.  Why?  Because in 2016, over 450 people in the UK died waiting for transplant organs to become available.

The 100,000 Genomes Project
On the back of the ground-breaking Human Genome Project, which, in 2000, first sequenced the human DNA genetic code consisting of 3.3 billion letters, the UK Government announced in December 2012, the 100,000 Genomes Project with the setting up of Genomics England to oversee it.

The aim is to sequence the genomes of 100,000 NHS patients suffering from rare diseases, some common types of cancer and various infectious disorders.  Participants, and sometimes their family members too, will have their genomic data linked to their medical conditions and health records so that researchers can improve knowledge of the causes, treatment and care of these diseases.

As of May 2018, the Project had completed the sequencing of 60,679 whole genomes in England and results are in the process of being returned to the 13 Genomic Medicine Centres (GMCs) and ultimately back to the participants.  Patients in Scotland, Wales and Northern Ireland will be invited to take part at later dates.

The ‘organizer’
At last, the hunt for the human ‘organizer’ may be over.  This is the process by which embryonic stem cells are sifted and shaped to drive the development of new cells, ultimately allowing them to become the various organs and tissues of fully-formed humans.  It has been known to exist in amphibians for decades, but the human equivalent has proved elusive.  Now, it has been found, according to a paper in Nature (2018, 558: 132 - 135), entitled, ‘Self organization a human organizer by combined Wnt and Nodal signalling’ by Ali Brivanlou and colleagues at the Rockefeller University, New York.

This is complex
very complex.  Perhaps the opening paragraph of the research paper best describes the work, ‘In amniotes, the development of the primitive streak and its accompanying ‘organizer’ define the first stages of gastrulation.  Although these structures have been characterized in detail in model organisms, the human primitive streak and organizer remain a mystery.  When stimulated with BMP4, micropatterned colonies of human embryonic stem cells self-organize to generate early embryonic germ layers.  Here we show that, in the same type of colonies, Wnt signalling is sufficient to induce a primitive streak, and stimulation with Wnt and Activin is sufficient to induce an organizer, as characterized by embryo-like sharp boundary formation, markers of epithelial-to-mesenchymal transition and expression of the organizer-specific transcription factor GSC.  Moreover, when grafted into chick embryos, human stem cell colonies treated with Wnt and Activin induce and contribute autonomously to a secondary axis while inducing a neural fate in the host.  This fulfils the most stringent functional criteria for an organizer, and its discovery represents a milestone in human embryology.’

In other words, these authors discovered the ‘organizer’ by introducing human stem cells into chicken embryos and observing how the human cells responded to various signals and began to assemble into what was identified as a primitive streak, the precursor of a spine.  That is, the embryonic chicken cells obeyed new signalling pathway instructions to turn them into nervous-system tissue.

For the last two years, similar experiments have been reported in pigs and sheep embryos.  Their purpose is not only to understand the fundamentals of early developmental biology, but also to investigate the potential for growing human organs in these animals for later harvest and use in human transplants.  Sure, the basic science is complex, but the future outcome may be quite simple – a human liver ready for transplanting.

Can CRISPR-Cas9 cause cancer?
The great hope of using CRISPR-Cas9 technology in gene-editing procedures to provide treatments and cures in human medicine has taken a knock.  Two recent research papers suggest that CRISPR-edited cells may have a role in triggering certain cancers.  It seems that some CRISPR applications are successful because they disrupt the p53 gene.  It is known that p53 can assist the repair of cells which have damaged DNA, as occurs in cancer cells.  In other words, it may be that p53 dysfunction can cause cancer.   In fact, p53 mutations are responsible for nearly half of ovarian cancers, 43% of colorectal cancers, 38% of lung cancers and nearly one-third of pancreatic, stomach and liver cancers and one-quarter of breast cancers.

Both papers were published in Nature Medicine (online, 11 June 2108).  The first was entitled, 'CRISPR-Cas9 genome editing induces a p53-mediated DNA damage response' by Jussi Taipale and colleagues at the Karolinska Institute in Sweden.  The second as, 'p53 inhibits CRISPR-Cas9 engineering in human pluripotent stem cells' by Ajamete Kaykas and colleagues from the Novartis Institutes for Biomedical Research in Cambridge, Massachusetts.  The warning for CRISPR-Cas9 researchers is, proceed with caution.
 


Stem-cell Technologies

Placental stem cells
When, and if, you need stem cells to treat a disease or bodily complaint, where will you get them from?  Your bone marrow, adipose tissue, or induced pluripotent stem cells?  For most of us it’s too late to plunder one of the best sources – your placenta, discarded long, long ago.

Placental stem cells have advantages.  First, they are incredibly young.  Second, they are most unlikely to be corrupted – they are like quick-frozen fruit straight from the tree.  Third, such cryopreservation can ensure they are useful for decades.  Fourth, they are versatile, meaning they can be engineered into any of the 200 or so cell types of the adult human body.  But, no regrets that your mother passed over the option, other sources will suffice.

So what about embryonic stem cells?

They have long been touted as a suitable, even superior, type of stem cells.  Ethically, they are unsuitable because their harvesting destroys a human embryo.  Moreover, their clinical application has been staggeringly limited, especially when compared to the myriad of treatments involving adult stem cells.

Why is this?  Blame has been attributed to the lack of serious funding, over-regulation by governments and ethical hurdles.  But even so, the early uses of embryonic stem cells were unsuccessful, even dangerous.  For example, it was not until January 2009, after several false starts because of safety fears, that the US Food and Drug Administration (FDA) gave the Geron Corporation, a Californian-based biopharmaceutical company, clearance for the world's first clinical trial of an embryonic stem cell-based treatment with human patients.  In October 2010, the so-called phrase 1 trial – regarded as a proof-of-concept test – began with four patients suffering from spinal cord injuries.  Its primary purpose was to assess the safety of Geron's oligodendocyte progenitor cells, known as GRNOPC1, which had been derived from human embryonic stem cells.

The first-year assessment results were eagerly anticipated – the world was waiting. Then on 14 November 2011, Geron abruptly announced that it was abandoning the trial.  Geron blamed the decision on, ‘… capital scarcity and uncertain economic conditions.'  Others claimed that the trial was both poorly-designed and over-ambitious – spinal cord injuries were judged to be too complex and effect too few people, and so returns, both curative and economic, might take up to 10 years.  But maybe GRNOPC1 was simply not working – therefore continuing the trial would be futile.  Or worse, had some negative side effects occurred subsequently or, perhaps more likely, were they about to occur, if the trial continued?  Perhaps the truth will never out.

Subsequent global trials, focussed particularly on eye diseases, like macular degeneration, have not been illustrious in terms of numbers or curative outcomes.  Success is scarce, but some is coming.  An example is the trial with two people suffering from age-related macular degeneration (AMD) who had patches made from embryonic stem cells implanted into their retinas at a London hospital.  The scientists behind that therapy reported on the patients’ progress earlier this year (Nature Biotechnology, 2018, 36: 328 – 337).  The patients’ eyesight had improved considerably – a visual acuity gain of 29 and 21 letters in the two patients, respectively, over 12 months.  This is a very small, but notable, example of progress.

Yet a recent editorial in Nature (16 May 2018) interprets this slow progress as, ‘The steady and careful development that has guided treatments using embryonic stem cells should be applied to therapies derived from adult stem cells.’  Nobody doubts that some adult stem-cell ‘treatments’ have been badly misused by unscrupulous charlatans out to make a quick buck by exploiting vulnerable patients in unregulated countries.  But numerous adult stem-cell treatments have been surprisingly successful when carefully employed.  To suggest that most adult stem-cell treatments have been subjected to poor practice and hype is a step too far.  In the early days of stem-cell technologies it was embryonic stem cells that were branded as the gold standard.  That gold is now hard to find.  And never forget that bone-marrow transplants are adult stem-cell therapies, and think how successful they have been for the last 60 years for tens of thousands of patients.

And induced pluripotent stem cells?
On 16 May, Japan’s health ministry gave scientists permission to take wafer-thin sheets of tissue derived from induced pluripotent stem cells (iPSCs) and graft them onto human diseased hearts.  This is only the second clinical application of iPSCs.

The team, led by cardiac surgeon Yoshiki Sawa at Osaka University, says that the tissue sheets can help to regenerate heart muscle when it becomes damaged by heart disease or by a heart attack.  The technique uses iPSCs to create a sheet of 100 million heart-muscle cells.  From studies in pigs, the team has shown that grafting these sheets of heart-muscle cells – each 0.1 mm thick and 40 mm long – onto a heart can improve the organ’s function.  Sawa says that the cells do not seem to integrate into the heart tissue.  He thinks that instead they release growth factors that help to regenerate the damaged cardiac muscle.

The treatment will initially be given to three people over the next year.  If successful, the team will then seek approval to conduct a clinical trial with about ten patients.  If that proves safe, the treatment could then be sold commercially under Japan’s controversial fast-track system for potentially life-saving procedures of regenerative medicine – critics of this system say that the rigorous standard of randomized, controlled clinical trials for demonstrating efficacy in medical research is being ignored in the rush to bring products to market.  The ultimate question is, ‘Does it work?’  We may know in 2019.

However, there is a detracting complication here.  Sawa already has another fast-track treatment under way.  Approved in September 2015, patients received a sheet of muscle cells made from their own leg tissue, rather than from iPSCs.  Called HeartSheet, the muscle sheet is attached to weakened heart muscles.  Half way through its scheduled 5-year plan, fewer than 10 patients have been recruited and received the treatment.  Moreover, as yet, no convincing results have been published.  Perhaps iPSCs should have been used from the beginning.

The end of reproduction with gametes?
Scientists have created ‘synthetic’ mouse embryos using just stem cells rather than sperm and ova.  Scientists from Maastricht University, led by Dr Nicolas Rivron, combined two types of mouse stem cells to create structures resembling blastocysts or early embryos, called blastoids.  Instead of traditional gametes, they used embryonic and trophoblast stem cells, which have the ability to form an embryo and a placenta.  These structures, although not bona fide embryos, were able to implant and grow for a few days in the uteri of female mice.

The study was reported in Nature (2018, 557: 106 - 111), under the title, ‘Blastocyst-like structures generated solely from stem cells.’  It is thought this new research may advance human infertility treatments, especially studies into the early implantation stages of development.  However, the blastocyst-like structures produced in this study did not have the ability to develop into further embryonic stages.  This is because they contained only two of the three cell layers normally present in an embryo.  Or could this stem-cell method lead to the testing of new medicines because it could create an infinite number of early embryos?

How bioethically challenging stem-cell technologies can be.  How informed and judicious we need to be.


Euthanasia and Assisted Suicide
Noel Conway’s judicial review on assisted suicide
Dignity in Dying is supporting Noel Conway, the 68-year-old former lecturer from Shropshire, to bring a judicial review challenging the current ban on assisted suicide in England and Wales.  He was diagnosed with amyotrophic lateral sclerosis (ALS), a form of motor neurone disease (MND), in November 2014.  His condition is incurable and terminal.

Mr Conway is bringing this case against the Ministry of Justice to fight for his right to have the option of an assisted death when he is judged to be in his final six months of life.  The latest phase of his case was heard at the Court of Appeal on 1 to 3 May 2018.  A written judgment is expected in early summer.

Assisted suicide in Scotland
Yet another bid to introduce assisted suicide in Scotland has commenced.  It is being led by the Liberal Democrat health spokesman, Alex Cole-Hamilton MSP.  Such a proposal was originally brought forward by the late Independent MSP Margo MacDonald, but it was twice rejected by the Scottish Parliament, the last time was three years ago, when it was fronted by the Green Party’s co-leader, Patrick Harvie.

Guernsey rejects assisted suicide
On Friday 18 May, after a three-day debate, the Parliament of Guernsey, a British Crown dependency off the coast of Normandy, voted 24 to 14 to reject an Oregon-style bill for assisted suicide.  If the proposal had passed, Guernsey would have become the first place in the British Isles to offer euthanasia for people with terminal illnesses.

The measure was a private member’s bill, or requête, proposed by Guernsey’s chief minister, Gavin St Pier.  After the defeat, he stated, ‘We, of course, accept that decision.  We remain of the view that this is an inevitable change which in the fullness of time Guernsey will one day adopt.  However, that is a matter for our parliamentary successors, not us.’  The proposal was supported by Dignity in Dying, but opposed by Christian leaders on the Island, the British Medical Association and the Guernsey Disabilities Alliance.

Euthanasia in the Netherlands
The latest annual Report of the RTE, the Regionale Toetsingscommissies Euthanasie, indicates that 6,585 assisted deaths were recorded in 2017, an increase of 8% from the 6,091 reported deaths in 2016.  The number of assisted deaths for dementia or psychiatric patients also increased in 2017, with 169 people suffering with the former conditions and 83 for the latter.

The Report states that virtually all such deaths were committed within the law.  This is doubtful.  For a start, the Netherlands euthanasia review committees simply do not know how many assisted deaths occur outside of the law.  The New England Journal of Medicine (2017, 377: 492 - 494) published a study entitled, ‘End-of-Life Decisions in the Netherlands over 25 years.’  It maintained that even in 2015 there were 7,254 assisted deaths (6,672 euthanasia deaths, 150 assisted suicide deaths, 431 terminations of life without request) throughout the Netherlands.  The official Report for 2015 indicated only 5,561 deaths – suggesting that at least 1,693 (23%) of the assisted deaths were not reported and therefore outside of the law.

Part of the problem is that Dutch doctors operate a voluntary code of reporting.  The system is a bureaucratic disaster.  For example, the 431 terminations of life without request were probably not reported.  Yet there has not yet been a single prosecution of a doctor involved despite growing concerns that assisted death is becoming normalised.  Recent, more vigorous, assessments by regional euthanasia committees have resulted in four cases being investigated by the Dutch prosecutor’s office.  The outcomes will be eagerly watched.

Finland and Spain consider euthanasia
In early May, a citizens’ initiative to legalise euthanasia was rejected by Finland’s national parliament, the Riksdag.  The voting was a resounding defeat of 128 to 60.  However, parliamentarians agreed to set up a working group to investigate legislation surrounding end-of-life care.

Meanwhile, Spain’s parliament has voted to consider a bill that would legalise euthanasia and assisted suicide in the country.  Parliamentarians voted 175 to 136 in favour of examining the bill, with 32 abstentions. The ruling Partido Popular opposed even considering the bill, while a series of smaller, left-leaning parties supported it.  The bill has little chance of succeeding.

Euthanasia in Portugal
At the end of May, a bill to legalise euthanasia failed narrowly – thus Portugal did not become the sixth country (behind Belgium, Canada, Colombia, Luxembourg and the Netherlands) to approve the measure.  The bill, proposed by the ruling Socialist party, was defeated by 110 votes for versus 115 against, with 4 abstentions.

It was a close-run thing.  Portugal is emerging from the heavy influence of the Roman Catholic Church – abortion on demand was legalised in 2007 and same-sex ‘marriage’ was approved in 2010.  This is becoming a familiar European pattern.  Portuguese right-to-die activists had claimed that legalising euthanasia would be an expression of an individual’s autonomy, religious freedom and conscience – yet another rehearsal of those common and false arguments.  In addition, the vote was the culmination of a two-year campaign, including an 8,000-signature petition.  These activists were earnest.  And they will return.

Assisted suicide in Oregon
According to the latest Report from the Oregon Health Authority, during 2017 a total of 218 people received lethal prescriptions under its Death with Dignity Act (DWDA).  As of 19 January 2018, as many as 143 people had died in 2017 from ingesting these prescribed medications, including 14 who had received the prescriptions in preceding years.  The comparable death figure for 2016 was 138.  A decade earlier, in 2007, it was only 49.

As in previous years, most patients were aged 65 years or older (80.4%) and had cancer (76.9%).  Moreover, a significant proportion (55%) cited one of the reasons for opting for assisted suicide was not a concern about pain or adverse symptom control, but about being a burden on family, friends or caregivers.  Under the terms of the DWDA, one of the eligibility criteria is that the patient must have been diagnosed with a terminal illness that will lead to death within six months.  However, the Report notes that the time from first request until the patient’s death ranged from 15 days up to 603, which is almost 20 months.  This emphasises the problems associated with accuracy of prognoses and whether some patients should have ever been regarded as eligible for assisted suicide.

Assisted suicide in California
There's trouble in the Sunshine State.  On 19 May, Judge Daniel A. Ottolia of the Riverside County Superior Court, ruled that the 2015 End of Life Option Act was passed in an unconstitutional manner.  The California Attorney, General Xavier Becerra, was given five days to file an appeal to allow the law to stay in place while the 'appeals process' proceeds.  But the 4th District Court of Appeal refused that request.  Apparently this means that the law has been overturned, at least, for now.  Expect legal busyness in the coming weeks.

Assisted suicide throughout the USA
Assisted suicide and euthanasia practices seem to be gathering acceptance across the USA.  There are now 8 states where such activities are legal, thus an estimated 18% of the US population can now be offered the options.

So, is it the doctors leading or colluding in these ethics and practices?  Not so, apparently.  The American Medical Association (AMA) is the largest association of US doctors and medical students, with nearly a quarter of a million members.  It recently issued a statement by its Council on Ethical and Judicial Affairs (CEJA), squarely opposing such procedures.

In its Report 5-A-18, the CEJA declared that, ‘In its current form the Code offers guidance to support physicians and the patients they serve in making well-considered, mutually respectful decisions about legally available options for care at the end of life in the intimacy of a patient-physician relationship.  The Council on Ethical and Judicial Affairs therefore recommends that the Code of Medical Ethics not be amended.

The Report also discusses the key issue of terminology.  ‘Ethical deliberation and debate is best served by using plainly descriptive language.  In the Council’s view, despite its negative connotations, the term “physician assisted suicide” describes the practice with the greatest precision.  Most importantly, it clearly distinguishes the practice from euthanasia.  The terms “aid in dying” or “death with dignity” could be used to describe either euthanasia or palliative/hospice care at the end of life and this degree of ambiguity is unacceptable for providing ethical guidance.’

The AMA has been under pressure to modify its stand of opposition.  The American Academy of Hospice and Palliative Medicine has already adopted a position of ‘studied neutrality’.  Doctors from Oregon are lobbying within the AMA for neutrality, if not outright endorsement.  The heat is on for the AMA, but principled ethics can/should beat false arguments every time.  And the heat is indeed on - on Monday 11 June, delegates at the AMA's annual meeting in Chicago voted by 56% to 44% to reject its current opposition to medically-assisted death.  Although the AMA’s guidance remains unchanged for now, the organisation is pledged to continue reviewing its current guidance on the issue.


USA and Elsewhere
Faith and Opportunity Initiative
In early May, President Donald Trump signed an executive order creating this new White House office to represent the rights of religious Americans and to involve their perspective in future policymaking.  The White House press release stated that the order will, ‘... ensure that the faith-based and community organizations that form the bedrock of our society have strong advocates in the White House and throughout the Federal Government.’

Trump signed the order during the annual National Day of Prayer ceremony in the White House’s Rose Garden on 2 May.  He said, ‘Prayer has always been at the centre of the American life.  America is a nation of believers, and together we are strengthened by the power of prayer.  We take this step because we know that in solving the many, many problems and our great challenges, faith is more powerful than government and nothing is more powerful than God.’

Hawaii becomes the seventh
The tropical Aloha State has become the seventh American jurisdiction where assisted suicide is legal.  On 6 March, the Our Care, Our Choice Act was passed by the Hawaii House of Representatives by a 39 to 12 vote, and cleared the Senate on a vote of 23 to 2 a few days later.  Governor David Ige signed the bill into law on 5 April.  ‘It is time for terminally ill, mentally competent Hawaii residents who are suffering to make their own end-of-life choices with dignity, grace and peace,’ he said.  The law will take effect on 1 January 2019.

The legislatures of Hawaii, Oregon, Washington State, California, Colorado, Vermont and the District of Columbia have now passed laws permitting assisted suicide.  In Montana, a court decision found that it was legal, but there has been no associated legislation.  On the other hand, ten US states have passed laws explicitly banning assisted suicide.  The latest has been Utah, where on 6 February the criminal code was clarified to include the illegality of assisted suicide.

Abortion in Mississippi
In March, Mississippi became the first state in the US to ban abortion after 15 weeks, earlier than any other state in America.  Phil Bryant, the State’s governor said the new legislation will help bring Mississippi closer to his goal of making the State ‘the safest place in America for an unborn child.’  Mississippi now has just one abortion clinic remaining.

The new law passed the House of Representatives by 80 votes to 31 on 2 February and the Senate by 35 to 14 on 6 March.  It forbids abortions from being performed beyond 15 weeks for any reason other than a ‘medical emergency’, defined as a physical complication threatening the woman’s life or ‘substantial and irreversible impairment of a major bodily function’, or ‘severe foetal abnormality’, defined as a physical condition that renders the pre-born baby ‘incompatible with life outside the womb.’  It does not make exceptions for rape or incest.  The law took effect immediately.

Everyone knew this new law would be contested.  That came quickly.  Within an hour of the signing, the pro-abortion Center of Reproductive Rights filed a lawsuit on behalf of the Women’s Health Organization (WHO) in Jackson.  Within 24 hours, a federal judge had blocked the new ban.  US District Judge Carlton Reeves granted a temporary restraining order against the enforcement of the law for 10 days while he heard more arguments.  He then extended that order until 23 April, and then for several more months.

Abortion in Kentucky and other states
In mid-March, the Kentucky House of Representatives voted 71 to 11 to ban dismemberment abortions.  Euphemistically called Dilation and Evacuation (D&E) by abortionists, this method of abortion is commonly used during the second trimester of pregnancy.  The Dismemberment Abortion Ban would prohibit this procedure for ending a unborn child’s life.  According to State data, 537 of Kentucky’s 3,312 abortions in 2016 were dismemberment abortions.  If the bill becomes law, abortionists could face felony charges and up to five years in prison for violating it.  Mothers would face no penalty.

A similar bill was passed by the Florida House on 1 March and South Carolina’s ban bill is soon going before its State Senate.  Alabama, Arkansas, Kansas, Louisiana, Mississippi, Oklahoma, Texas and West Virginia have passed dismemberment abortion bans – nearly all are being contested through the courts.  The fight goes on.

Wheaton College victory
At long, long, long last in late February, Wheaton College was granted a permanent injunction providing it with unending protection from a Department of Health and Human Services mandate.  The latter’s ‘contraceptive mandate’ imposed under the Affordable Care Act (ACA) requires companies and universities to provide contraception, including abortifacient drugs such as the morning-after pill, in their health insurance plans.  Wheaton, and many others, went to court to defend their religious freedoms – it has taken 5 years for this case to be resolved.

Philip Ryken, president of Wheaton College, said, ‘We are grateful to God that the court recognized Wheaton’s religious identity and protected our ability to affirm the sanctity of human life.  The government should never have tried to force us to provide drugs and services against our faith, but that episode is now behind us.’

Abortion in Poland
The Polish government is still pushing to enact the toughest abortion laws in Europe.  The proposed restrictions suit the social conservatism of the governing Law and Justice (PiS) party.  Already abortions are allowed under only three circumstances – pregnancy from rape or incest, danger to the woman’s life or health, or severe foetal damage.  The proposed law would strike out that last exception.  If passed, it would effectively amount to a virtual total ban.

The battle lines have been drawn.  The proponents are influenced either by the powerful Roman Catholic Church, or by the women’s groups who have organised street protests, some involving as many as 55,000 people.  A poll in January showed that 37% of Poles supported the liberalisation of the present abortion law, 43% supported the status quo and only 15% backed a total ban.  There is no doubt that the government is in trouble.

Such legislation can seem strict, even harsh to us.  But that is mainly because we have become so used to living with liberal, permissive abortion laws – it is a sign that we too have been infected.  If you are not an absolutist, then you favour abortion under some circumstances and those circumstances always prove to be so fluid.



Miscellaneous
When is a mother not a mother?
The answer, of course, is when she is a transgender man.  Can you believe that?  I defy any reader to have thought of this as even a remote possibility.  Be honest, this is well out of your stream of bioethical consciousness.

The law requiring the person who gave birth to be registered as the baby’s mother may have to be changed.  The Times (8 June 2018) reported under the headline ‘Trans parent wants baby to be motherless’, that, ’A baby could become the first person born in England or Wales not legally classed as having a mother if a transgender man wins a human rights battle.’  The young child’s single parent was born a woman but now lives as a man after undergoing surgery.  He wants to be named as the child’s father or parent on the birth certificate.  Lawyers told a preliminary High Court hearing in London that the birth registrar had told the man that the law required people who gave birth to be registered as mothers.

The man claims that forcing him to register as the child’s “mother” breaches his human right to respect for private and family life, and that such “interference” is not proportionate or necessary in the light of changes which have “evolved in society”.  Mr Justice Francis said that the issue had never been raised in a court in England and Wales before.  He said that if the man won his case, ministers might have to consider changing the law.  A judgement is due in September.

You may have an organ you never knew about
Name your organs – liver, heart, kidneys, brain, and so on.  Yes, all present and correct.  But you also have one you’ve never heard of.  This is according to a recent paper in Scientific Reports (2018, 8: 4947) by Neil Theise et al., from the New York University School of Medicine and entitled, ‘Structure and Distribution of an Unrecognized Interstitium in Human Tissues.’

The researchers begin their Discussion section as, ‘We propose here a revision of the anatomical concepts of the submucosa, dermis, fascia, and vascular adventitia, suggesting that, rather than being densely-packed barrier-like walls of collagen, they are fluid-filled interstitial spaces.’  While examining tissues around the human gut, and especially the bile duct, Theise’s team found not the usual, expected, hard, dense wall of tissue, but rather a network of fluid-filled channels that may be a previously-unknown organ.

Newer approaches to their routine endoscopy procedures enabled the scientists to examine the in vitro tissues microscopically.  In fact, they found these novel fluid-filled channels everywhere, including up Theise’s nose.  Why are they novel?  Because the standard approaches for processing and visualising human tissue causes these channels to drain, and the collagen fibres, which give the network its structure, to collapse and appear as hard walls of dense protective tissue, instead of a fluid-filled cushion.

Moreover, Theise’s team think the network of interstitial fluid channels may also facilitate the spread of cancer.  When they examined samples, taken from people with invasive cancers, they found evidence that cancer cells that had worked their way out of their original tissues could find their way into these channels, which allowed direct access into the lymphatic system.  As Theise proposed, ‘Once they get in, it’s like they’re on a water slide.  We have a new window on the mechanism of tumour spread.’

Are you really a genetic parent?
In Through the Looking Glass, chapter 6, we read, ‘When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean – neither more nor less.’  That is sadly all too true!

So, what is a parent?  The meaning of ‘parent’ seems simple enough, but is it?  We may think of a parent in the genetic sense, namely, sharing half of one’s genes with another person to create a baby, who thus has parents, a mother and a father.  That is true, but that meaning is not complete.  Imagine you have an identical twin, and your twin had a baby.  The child of your identical twin would share half of your genes.  But, of course, intuitively we reckon that we are not the parent, genetically or otherwise, of this baby.  So clearly sharing genes is not enough to describe the parent-offspring relationship.

Monika Piotrowska of the University at Albany, USA has tackled this question in an article entitled, ‘Is “Assisted Reproduction” Reproduction?’, which appeared in The Philosophical Quarterly, (2018, 68: 138 - 157).  In her article, which spans almost 20 pages, Piotrowsha offers what she calls a principled account of reproduction.  This consists of three criteria that must be met to define true genetic parenthood – they are the Overlap, Development and Persistence (ODP) accounts, which she believes capture the true meaning of ‘genetic parenthood’.  Even so, her answer does not even mention genes, which is surely odd.

Readers who wish to study Piotrowska’s theory in detail know where to find it.  For the rest of us, it merely confirms the problems bioethically, medicinally, sociologically and linguistically that accompany assisted reproductive technologies.  And if you think defining ‘genetic parenthood’ is problematic, try ‘personhood’.

Who was responsible for the first test-tube baby?
Your answer is, of course, the obstetrician and gynaecologist, Patrick Steptoe, and the physiologist, Robert Edwards.  Well, have half a mark.  The alternative answer is Lillian Lincoln Howell.  She was the eccentric American millionairess who secretly funded the work, which culminated in the birth of Louise Brown on 25 July 1978.

Howell was a television executive, who founded a TV station in the US catering for Chinese and Japanese Americans, and an amateur poet living in California.  It is only recently, approaching the 40th anniversary of the event, that her identity has been revealed.  She stumped up $95,000 – about £0.5m in today’s money – because the two scientists had been unable to obtain public funding for their controversial work.  Her money, which was promised in a shock telephone call to Edwards, paid for essential laboratory equipment and travel, while much of the basic IVF research was funded by the Henry Ford Foundation.

Vienna – city of weird museums
Some regard it as the world’s most liveable city.  The home of Sigmund Freud, Ludwig van Beethoven, Johannes Mozart, Johann Strauss, Gustav Klimt and others.  The city where croissant, snow globe and PEZ confectionery were born.  The city that has a coffee culture and is famed for that sweet Sacher torte and tasty schnitzel.  And don’t forget its unusual museums.

And one of those institutions is the Museum of Contraception & Abortion.  In the two-roomed building, founded in 2003 by Dr Christian Fiala, the Museum narrates the history of birth control and bizarre methods of terminating unwanted pregnancies.  In a glass cabinet knitting needles, thorns, bicycle spokes which were used as abortion tools before abortion was legalised, are displayed.  The Abortion Room also has a Victorian kitchen set-up for a DIY abortion.

Asked about why he established this Museum, Fiala explained, ‘As a doctor I can only reach and educate a limited number of people about their fertility and how to best deal with it.  As a scientist and lecturer it is a bigger number, but only through the Museum is it possible to spread the knowledge about reliable contraceptives and medically-safe abortions on a global scale.’  A group guided tour costs €12 per person – go and have a slice of that scrummy torte instead.


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