Update on Life Issues - June 2021



Abortion

Abortion statistics for England and Wales 2020
The latest figures for abortions performed in England and Wales during 2020 were published by the Department of Health and Social Care on 11 June.  They are statistically abhorrent and ethically reprehensible – the highest ever recorded.  There is nothing commendable about these data.  They are hideous and heinous.  They mock us.  They can be accessed at https://www.gov.uk/government/statistics/abortion-statistics-for-england-and-wales-2020

In total there were 210,860 abortions with the vast majority (99.6%) performed on resident women.  The total for the previous year (2019) was 209,519.  There is nowhere to hide.  Even the somewhat opaque measure of ‘the age-standardised abortion rate (ASR)’ was 18.2 per 1,000 resident women aged 15 to 44.  This too was the highest rate ever documented, exceeding the previous peak of 18.0 from 2019.  Or simply consider that there were on average 810 abortions every weekday – every Monday, Tuesday, Wednesday …..

Is there any comfort in the fact that the abortion rate for women under 18 decreased compared with 2019 (from 8.1 to 6.9 per 1,000 teenagers)?  Not really.  After all, there was an opposing increase for those over 35 (from 9.7 to 10.6 per 1,000 women).  And the latest figures even show a rise in women undergoing repeat abortions from 83,624 in 2019 up to 87,926 in 2020.  But perhaps the most bizarre datum of all recorded that 131 resident women undergoing abortions in 2020 had already had 8 or more previous abortions.

In 2020, 88% of all abortions were performed under 10 weeks of gestation, increasing from 82% in 2019 and 77% in 2010.  But are abortions less traumatic and more acceptable if they are carried out earlier?

Other grim statistics show that 99% of abortions in England and Wales were funded by the NHS (that is, by taxpayers), with 77% of these abortions sub-contracted out to the independent sector using organisations such as the British Pregnancy Advisory Service (BPAS).  And 85% of all abortions were medically induced (as opposed to surgically performed), within the first 10 weeks of a pregnancy – an increase from 73% in 2019.

Of the seven grounds for abortion, ground C, the so-called ‘social reason’, accounted for 205,930 (98.1%) of the total.  The vast majority (99.9%) of these ground C abortions carried out because of an alleged risk to the woman's mental health.  A further 3,083 (1.5%) were carried out under ground E, the suspected handicap reason, which accounted for 100 less than in 2019.  Could this small sparing of life be the only comforting glimmer in the whole wretched shebang?

And of course, the Covid-19 pandemic has skewed abortion practice and statistics.  As a result, the UK government gave temporary approval for women and girls to take both early medical abortion pills (mifepristone followed by misoprostol within the first 10 weeks of the pregnancy) at their own homes.  The drugs were delivered by mail and became the so-called ‘pills by post’ or ‘DIY abortion’ procedure.  Taking both abortion pills at home accounted for 47% of all abortions undertaken between April and December 2020.

But there are two caveats concerning these statistics.  First, there is no recorded proof that the ‘pills by post’ were actually taken, or taken correctly.  Second, the government data exclude early abortions caused by administration of the morning-after pill with its abortifacient mode of action.

And for Scotland 2020
According to figures from Public Health Scotland there were 13,815 abortions performed in Scotland during 2020.  This was the second highest total since record-keeping began in 1968 – the worst year was in 2008, when 13,908 abortions took place.  The latest Scottish rate amounted to 13.4 abortions per 1,000 women aged 15 to 44.

Thinking about the whole of England, Wales and Scotland, the grand total of abortions for 2020 was 224,675.  That is within a whisker of a quarter of a million – a new peak.  Statistics are helpful in illustrating the extent of abortion across our countries.  But statistics must never be allowed to hide the barbaric and bloody realities of abortion.

Dobbs v. Jackson Women’s Health Organization
This legal case could become the biggest abortion story in the USA for almost 50 years.  At issue is a 2018 Mississippi law that bans abortions after 15 weeks of pregnancy, but lower US courts have decided to block this legislation.  The central question has become, ‘whether all pre-viability prohibitions on elective abortions are unconstitutional.’

The big deal is that on 17 May, the Supreme Court of the United States (SCOTUS) announced that it will hear the Dobbs case and pronounce a judgement on abortion.  Such an exciting prospect has been simmering for years.  The US pro-life camp has long hoped to appear before the highest court of the land to test the constitutionality of the 1973 Roe v. Wade ruling (and that of the 1992 Planned Parenthood v. Casey), in which the Supreme Court ruled that the Constitution protects the right of every American woman to have an abortion before her foetus becomes viable, namely, during the first and second trimesters.  That legislation has since resulted in more than 62 million abortions in the US.  The SCOTUS is expected to hear arguments in October and to issue a ruling in the summer of 2022.

This Dobbs case – Thomas Dobbs, as the State Health Officer of the Mississippi Department of Health, is merely the name on the court papers – has already been promoted as, ‘the most consequential case for reproductive rights in decades.’  And newspaper headlines have stated, ‘alarm bells are ringing: activists brace for US abortion case that could rip up Roe v. Wade.’  Indeed, many believe that Dobbs could become a direct challenge to the colossus of Roe v. Wade and could even be used to overturn it.  This is truly big, unprecedented, bioethical stuff.  And if the SCOTUS rules favourably it could have implications for the practice of abortion around the world.

A lot has changed since 1973.  For example, our understanding about unborn children’s development has advanced greatly, including the beginnings of heartbeats and brainwaves, plus their detection, and the rapid development of lungs, nerves, organs, muscles and so on.  By 15 weeks these are all developing and becoming functional at phenomenal rates.  Medical science, and specifically embryology, was quite primitive in 1973 but is amazingly sophisticated in 2021.  Meanwhile, the pro-life camp has moved from defence to offence, exposing the absurdity of the so-called ‘woman’s right to choose’ mantra.  Moreover, and not least, the SCOTUS now has a 6 to 3 conservative majority.

If the SCOTUS were to dispense with the ‘viability’ definition, abortion activists predict that half of the US states may ban all, or almost all, abortions.  Pro-lifers therefore hope that the justices will allow states to protect the lives of unborn children for the first time in decades.  In essence, abortion control would shift from one monolithic federal law to numerous state laws.

And what is the thinking about abortion among the US population?  The majority of Americans (53%) describe themselves as pro-choice versus 43% as pro-life.  Yet opinion polls consistently show that most Americans want abortions to be either illegal or strongly limited.  A May 2020 Gallup poll found that 55% said abortion should be legal ‘only in a few circumstances’ (35%) or ‘illegal in all circumstances’ (20%).  Similarly, a January 2021 Marist poll found that 76% of Americans (including 55% who self-identified as pro-choice) support significant restrictions on abortion.  In fact, most Americans want the courts to reinterpret Roe either by stopping legalised abortion or by returning the issue to the states.

This is just the beginning of Dobbs v. Jackson Women’s Health Organization.  It is likely to roll on for many months, even years.  It also has the potential to change our world – for the better.


IVF and ARTs

Fertility treatment 2019: trends and figures
This is the title of the latest annual statistical release, compiled by the Human Fertilisation and Embryology Authority.  It was published in May.

In many ways the data are similar to those recorded for 2018.  In 2019, almost 53,000 women underwent 68,679 IVF cycles.  The previous annual increases in IVF cycles have plateaued since 2017.  Successes with IVF, measured as the live birth rate per embryo transferred (PET), averaged 23% across all ages.  These birth rates for patients under 35 were 32% compared with less than 5% for patients aged over 43.

During 2019, the multiple birth rate fell to 6%, from 8% in 2018 and 28% in the 1990s.  Single embryo transfer has now become common practice and in 2019, just one embryo was transferred in 75% of IVF cycles.

Most IVF treatments (86% of IVF cycles in 2019) involved the use of patient ova and partner sperm, but the use of donor gametes increased.  Although the use of donor ova considerably increases the chance of a live birth to over 30% of women in all age groups, only 17% of patients aged over 40 used donor ova in 2019.  The proportion of IVF cycles undertaken by patients aged 40 and over has more than doubled from 10% (689 cycles) in 1991 to 21% (14,761 cycles) in 2019.

Besides IVF this HFEA document includes statistics on donor insemination (DI) of which there were 5,694 cycles in 2019.  There have been significant changes in partner type, with DI cycles more likely to involve a female partner (44%) than a male partner (38%) and those with no partner (18%).

2021 is the HFEA’s 30th birthday, its pearl anniversary.  It was set up in 1991 as the UK Government’s independent regulator overseeing fertility treatment and research.  In the three decades since its establishment, the fertility sector has experienced massive growth and change.  In 1991, there were around only 6,700 IVF cycles recorded at licensed fertility clinics in the UK.  By 2019, that number of cycles had increased tenfold to approximately 69,000.

Throughout the last three decades, almost 595,000 people have had around 1.3 million IVF cycles and 260,000 DI cycles.  This has resulted in just over 390,000 babies born as a result of these fertility treatments.

Julia Chain heads the HFEA
The Secretary of State for Health and Social Care has appointed Julia Chain as the new chairwoman of the HFEA from 1 April 2021 for a period of three years.  The appointment will involve a time commitment of 2-3 days per week and remuneration at a rate of £47,360 per annum.  She replaces Sally Cheshire.

Mrs Chain, attended Cheltenham Ladies’ College and has a law degree from Girton College, Cambridge.  As a qualified corporate lawyer, she has over 30 years’ experience in legal and managerial roles in both private practice and industry.  Among many senior roles she became the first woman managing partner of a top 100 law firm, Andersen Legal, and most recently led the UK and European operations of Advanced Discovery Inc.  She is also active in the charitable and public sector, especially with Jewish organisations.  She is currently deputy chairwoman of Norwood, the largest Jewish learning disability and children’s charity in the UK.  She is also a governor of the Rimon Jewish Free School and chairwoman of the board of Sadeh, a Jewish farm and environmental community centre.

Mrs Chain is obviously a talented and industrious person.  She should reserve considerable time for sorting out the problems at the HFEA in terms of its unbridled practices and lack of conservative bioethics.

When IVF goes wrong
Lots goes wrong with IVF.  Indeed, it could be argued that nothing much goes right.  After all, the average success, measured as the birth rate per embryo transferred (PET), in clinics across the UK is only 23%, or a 77% failure rate.

The Pacific Fertility Center in San Francisco suffered an unexpected IVF failure.  In 2018, one of its cryopreservation tanks failed and unknown numbers of its 3,500 cryogenically-stored human embryos and ova were thawed and destroyed.

The incident occurred in the USA, so litigation predictably followed.  On 10 June, five patients of the Center were awarded a total of $15m.  The thaw may have been accidental, but the manufacturer of the tank, Chart Industries Inc, had previously known about the defect which prevented accurate monitoring of the tank’s -196⁰C internal temperature.

Jurors at the trial found that Chart was 90% and Pacific Fertility 10% responsible for the failure to safeguard the IVF material.  Damages were awarded for the destruction of ova and embryos.  Laura and Kevin Parsell, a couple, who had four frozen embryos that were lost, were awarded $7.2m.  Rosalynn Enfield, a 43-year-old mother of two, who lost 18 ova, was awarded $2.6m.  Adrienne Sletten, a 43-year-old woman, who lost two ova, was awarded $2.075m.  And Chloe Poynton, a 39-year-old woman, who lost nine ova, was awarded $3.1m.  Those compensation sums are high.

Yet these claims are but the first to come to trial out of about 200 other Pacific Fertility Center patients who are awaiting their day in court or in arbitration proceedings.  A second trial involving about five other plaintiffs is scheduled to begin later this year.  Other, similar losses have also been reported.  For example, in 2019, some 4,000 embryos and ova were lost at the University Hospitals Fertility Clinic in Cleveland.  About 150 families have already settled compensation claims with that Clinic.

Of course, for some patients, this type of criminal negligence and subsequent loss of their stored embryos and ova is a tragedy.  They may be irreplaceable and longed-for children.  On the other hand, there is a certain paradox that unknown thousands and thousands of human embryos, ova and sperm samples are destroyed each day, every year, around the world, with hardly a second thought.  That’s IVF.

Twins, twins, twins
There is a global surge of twins.  Of course, the advent of IVF and other fertility treatments are the major causes.  Since the 1980s, the global twinning rate has increased by a third, from 9.1 to 12.0 twin deliveries per 1,000 deliveries.  About 1.6 million twin pairs are born each year worldwide – that means that approximately one in every 42 children born nowadays is a twin.  These changes have been primarily driven by increases in twin birth rates in North America (+71%), Europe (+58%) and Asia (+32%), relatively rich countries with significant numbers of fertility clinics.  On the other hand, there are regions with already high twinning rates, such as relatively poor West and Central Africa.

Twins, whether fraternal (dizygotic) or identical (monozygotic), are a fascinating and bewildering part of our social fabric.  For example, most of the increase in twinning rates comes from dizygotic twins, while there has been little change in the rate of monozygotic twins, which has remained stable at about 4 per 1,000 deliveries worldwide.  Yet nobody knows why.  However, what is known is that twin deliveries are associated with higher infant and child mortality rates and with increased complications for mother and child throughout pregnancy and during and after delivery.

The actual frequency of twin births in the UK is thought to have fallen since 2007 when the HFEA launched its One at a Time campaign to tackle the high multiple birth rate associated with IVF.  At that time one in four IVF births was a multiple birth – 20 times higher than with natural conception.  The One at a Time target of 10% was first met in 2017 and by 2019 it had dropped to 6%.  At the heart of the One at a Time policy was the transfer of only one embryo per treatment cycle.  This has now become common UK practice and in 2019, one embryo was put back in 75% of IVF cycles, compared to just 13% in 1991.

Halima Cissé
This 25-year-old Malian woman deserves a mention.  In May, she gave birth to a record nine babies, yes nonuplets, and almost died from blood loss during the delivery.  She was struggling under the strain of the 40kg weight of her children and her amniotic fluid.  She suffered a haemorrhage of her uterine artery during the Caesarean section, 30 weeks into her pregnancy, at a specialist clinic in Morocco.  She was tended by a team of 10 doctors and 25 paramedics as they scrambled to stem the blood flow while 18 nurses put the nonuplets into incubators.

At birth, the babies weighed between 500g and 1kg (1.1lb to 2.2lbs) and were a surprise to the family and doctors – only seven babies had been spotted on prenatal scans.  All of them, five girls and four boys, would need at least 12 weeks in specialist care before they could breathe and suckle independently.  In addition, some of their livers and kidneys were undeveloped and all were immunodeficient.

Such high-order multiple gestation, carrying four or more babies, occurring without some form of fertility treatment, is extremely rare.  However, a friend of the wife and husband insisted that the pregnancy was natural.  Youssef Alaoui, the director of the Ain Borja specialist clinic in Casablanca, where the children were born, said as far as he was aware Cissé hadn't used any fertility treatments.  Should all the babies thrive, their birth will break the current record for the most babies born in a single delivery to survive. That record was set in 2009 by Nadya Suleman, an American mother of octuplets who underwent IVF.
Euthanasia and Assisted Suicide

Assisted Dying Bill [HL]
On 26 May, Baroness Meacher’s Assisted Dying Bill received its first reading in the House of Lords.  In accordance with Parliamentary procedure, there was no discussion or vote.  Its full second reading with a debate is likely to occur in the autumn.

Baroness Meacher, who, not coincidentally is chairwoman of the Dignity in Dying organisation (formerly the Voluntary Euthanasia Society), won seventh place in the recent private member’s ballot.  Hers is the first euthanasia-type bill to appear at Westminster for five years.  The last was the Assisted Dying (No. 2) Bill introduced in 2015 by Bob Marris MP – it was roundly defeated by 330 v. 118.

The Meacher Bill’s intent is, ‘… to legalise assisted dying in England and Wales as a choice for terminally-ill, mentally competent adults in their final six months of life.  Two independent doctors and a High Court judge would have to assess each request, which if granted would enable a patient to die in a manner and at a time and place of their choosing.’
After tabling her new bill, Baroness Meacher predicted that assisted dying will be legal within 18 months.  She believed public sentiment was now behind changing the 1961 Suicide Act.

Assisted suicide bill in Scotland
The longest day, 21 June, and yet another assisted dying bill has arrived at the Scottish Parliament.  This time the proposals were presented by Liberal Democrat MSP Liam McArthur.  Previous attempts, such as those made by Margo MacDonald (2013) and Patrick Harvie (2015), to change the law in Scotland have failed.  The most recent, the Assisted Suicide Scotland Bill, was rejected by 82 votes to 36 votes in 2015.

The new proposals would mean that terminally-ill people, who have lived in Scotland for 12 months or more, would gain the right to access assisted dying if two doctors were satisfied that safeguards, including a mental competency test, were met.

Supporters claimed that the bill’s arrival was ‘a watershed moment, not only for the dying Scots but for the whole of the UK’.  Detractors claimed there were ‘no adequate safeguards’ and that terminal prognoses were ‘fraught with uncertainty.’  A consultation on the bill’s contents is expected to take place in the autumn.

The Sunday Times and assisted suicide
This well-respected newspaper has sustained a long history as a campaigning broadsheet, not least in its fight for compensation of the victims of the thalidomide scandal and the opioid drug crisis.

Sadly, on Sunday 23 May, it announced that it was throwing its weight behind campaigning for a change of the law with regard to assisted suicide.  More specifically, it was teaming up with Dignity in Dying.  As it stated, ‘We believe passionately that everyone should be entitled to dignity in death and choice at the end of life, regardless of status.’

This is very disappointing news.  It is a pity that The Sunday Times did not instead use its considerable influence to campaign for bigger and better palliative care.  That would assist far more of the 600,000 or so people who die each year in Britain, rather than the 50 or so who are annually enamoured with a Dignitas-style death in Switzerland.

Noel Conway (1950 – 2021)
Noel Conway, the ex-college lecturer from Shrewsbury has died.  He was diagnosed to be suffering from motor neurone disease (MND) in November 2014.  He wanted the option of a legal assisted suicide when he has reached the final six months of his life.  He partnered with Dignity in Dying and went to court.  On 27 June 2018, the Court of Appeal rejected Mr Conway’s request on the grounds that it is for Parliament to decide the issue.  On Thursday 22 November, his legal team appeared in an appeal before three Supreme Court judges.  On 27 November, their judgement was delivered – permission to appeal was refused.  Noel Conway’s legal case therefore could proceed no further.

It was a landmark decision, not least because Mr Conway had been supported in his court appearances by the Dignity in Dying organisation.  Its chief executive, Sarah Wootton commented, ‘We will now turn our attention [away from individual court cases] back to Parliament and demonstrate to our MPs the strength of feeling on assisted dying.’

After his final court case, Noel Conway responded, ‘The only option I currently have is to remove my ventilator and effectively suffocate to death under sedation.  To me this is not acceptable, and for many other dying people this choice is not available at all.  All I want is the option to die peacefully, with dignity, on my own terms, and I know that the majority of the public are behind me.’

On Wednesday 9 June, Mr Conway died at his home in Garmston, Shropshire, after making the decision to remove his ventilator with the support of his family and local hospice staff.  His wife, Carol Conway, said her husband had died peacefully and that the hospice team and ventilation nurses had shown empathy and concern, and ensured he had a painless and dignified death.

It is reassuring to know that Noel Conway died well, without pain, in control, surrounded by his support team and his loved ones.  It was the very manner of death he had asked for.  His ventilator had enabled him to live for several extra years.  It is always a patient’s right to refuse treatment and disconnecting his ventilator was his legitimate choice.

Of course, we are all moved by those who suffer long-term disabilities.  But we are also glad to know that right thinking and palliative care can make for a good death.  There was never any need for an assisted death.  We can express deep sympathies at the death of Noel Conway and genuine condolences to his family and friends.

The Religious Alliance for Dignity in Dying
This is a recently-formed grouping under the umbrella of the Dignity in Dying organisation.  Its website headline reads, ‘We are a group of religious people from across the country who are fighting for a change in the law on assisted dying.  Together we can change the narrative on religion and assisted dying.  We exist to change the perception that religious people are universally against assisted dying.  Far from it.’

According to its banner, ‘The Religious Alliance for Dignity in Dying brings together followers of the Church of England, Church of Scotland, Church of Wales, Catholicism, Baptism, Evangelism, Methodism, Unitarianism, United Reformed Church, Quakerism, Liberal Judaism, Reform Judaism and Sunni Islam.’  That list tells a lot!

The Alliance’s chairman is Rabbi Dr Jonathan Romain, writer, broadcaster and director of the Maidenhead Synagogue.  He is a dyed-in-the-wool liberal, in favour of same-sex marriage, the legalisation of brothels and, of course assisted suicide.  He has stated, ‘We must puncture the myth that religious people oppose assisted dying.  Anti-choice religious leaders and groups don’t speak for the majority, we must work together to make the compassionate case for assisted dying.’

This Religious Alliance will command little clout and it will not prosper.  Already it is a ragtag collection of well-meaners and do-gooders who believe very little in terms of orthodox religious doctrinal truths.

New Mexico legalises assisted suicide
On 8 April, New Mexico became the 11th US state to permit assisted suicide.  As the Governor, Michelle Lujan Grisham, signed the End-of-Life Options Act, she declared that, ‘Dignity in dying is a self-evidently humane policy.’  The new law took effect on 18 June.

Apparently, New Mexico is the second assisted suicide state after New Jersey with a third or more of its population identifying as Roman Catholics.  That demographic fact did little to protect the whole state’s population, which has now chosen to legalise assisted suicide.  It should have made the difference.

The associated rules and regulations are by now broadly familiar.  The patient must be terminally ill, with six months or less to live and request lethal medication.  The diagnosis must be agreed upon by two medical experts and the patient must pass a mental competency screening.  After a 48-hour waiting period, the patient may take their own life by administering the lethal prescription themselves.  Thus is the starkness and severity of assisted suicide.

And Tasmania goes too
In late March, Tasmania passed The End of Life Choices Bill, making it the third state in Australia to permit assisted suicide procedures, after Victoria and Western Australia.

First, there is to be an 18-month implementation period during which a Commission of Voluntary Assisted Dying will be set up.  Second, doctors will need to complete a special training course, or as the Tasmanians call it, ‘get credentialed’.  Third, the new law will come into operational effect by the middle of 2022.

Again, the criteria are familiar.  To be eligible to access voluntary assisted dying, someone must be 18 or over, have decision-making capacity, be acting voluntarily and be suffering intolerably from a medical condition that is advanced, incurable, irreversible and will cause the person's death in the next six months, or 12 months for neurodegenerative disorders, such as MND or MS.

They must also be an Australian citizen or have resided there for at least three continuous years, and for at least 12 months in Tasmania immediately before making the first request to access assisted dying.  However, people with mental illness or disability will not quality.

This may seem to be a neat and tidy scheme.  It will not be.  On the basis of all other euthanasia and assisted suicide schemes around the world, serious problems will arise.  There will be mistakes, misdiagnoses, financial and emotional burdens, regrets, lack of real choices, lack of palliative care options – the list goes on and on.

Of course, not all Tasmanians are in favour of the new Act.  Some critics say it is the world’s most expensive euthanasia law, with an estimated $2.4m annual cost to assist the death of a predicted 10 people a year.  Some favour using such funds to help provide a world-class standard of palliative care.  They have a serious point.

Assisted suicide and the slippery slope
The slippery slope again?  Yes!  Because it is an inevitable consequence of modern bioethics and medicine.  For illustrative purposes pick any jurisdiction where euthanasia or assisted suicide is legal.  Take for example, that land of fruit and nuts, California.

In 2015, California became the fifth US state to enact a law permitting assisted suicide called the End-of-Life Option Act.  Just five years later, the Californian legislature is recommending major amendments to the Act.  These would remove some safeguards and make it harder for doctors to refuse to participate.

The relevant Bill is SB 380 and its sponsor is Senator Susan Eggman.  She maintains that the original law is administratively burdensome and unnecessarily cumbersome with ‘too many roadblocks for many dying patients to access the law.’

SB 380 will reduce the time between the required two oral requests from a minimum of 15 days to at least 2 days and would no longer require just one doctor to be the sole recipient of the requests.  It will also effectively force doctors with conscientious objections to refer the request for assisted suicide to a more compliant doctor.  It will also make it more difficult for institutions to refuse to comply with a request.  And it will repeal the sunset date of the Act, originally set for 1 January 2026

So far, since the inception of the 2015 Act, some 2,000 Californians have received medical aid-in-dying medication.  Here is the question.  If SB 380 is approved what effect do you think it will have on assisted suicide numbers?  See, a slippery slope!  Now pick another euthanising authority, Canada, Belgium, the Netherlands, or any.  Up pops that slippery slope again – guaranteed.

To prove the point, the government of the Netherlands intends to extend the criteria for euthanasia to children under the age of 12 and to people who have no medical issues but who are ‘tired of living’.  According to the latest Dutch euthanasia report there were a record 6,938 euthanasia deaths in 2020, up by 9% from 6,361 in 2019.  When the revised law is enacted, will the numbers go up or down?  Sometimes a slippery slope becomes a slippery precipice.
Genetic Technologies

The human genome completed
Most of us probably thought this task had already been finalised way back in June 2000 when Tony Blair and Bill Clinton memorably announced the results of the gigantic Human Genome Project (HGP) in a teleconference from the Rose Garden of the White House.

Started in 1990, the HGP had been the culmination of ten years work by hundreds of scientists around the world.  Sequencing the genetic alphabet of the human genome was truly a scientific marvel.  Apart from the original 2000 ‘basic’ version, there has been an ‘advanced’ version published in 2003, a ‘major update’ in 2013 and a ‘patch’ in 2019.  But there were still incomplete sections, estimated to be 8% of the whole, among those 3 billion base pairs hiding somewhere amid the 23 chromosomes.  In particular, the centromeres located in the middle of the chromosomes had remained unsequenced.

One of the problems is that human DNA contains large repeating patterns of bases and the earlier HGP technology relied on making DNA fragments, sequencing them and then joining them together to reconstruct the whole.  But some such repeating fragments were indistinguishable from one another.

The newer sequencing technologies no longer fragment DNA into smaller pieces.  Instead, using novel procedures developed by Pacific Biosciences and Oxford Nanopore, the so-called Telomere-to-Telomere (T2T) consortium has successfully sequenced the missing portions of the genome.  The researchers describe it as ‘the first truly complete 3.055 billion base pair (bp) sequence of a human genome.’

The results, have been published online as a preprint, that is, before peer review, as Nurk et al., ‘The complete sequence of a human genome’, bioRxiv, (27 May 2021).  Until peer reviewed and published in a journal the data are regarded as ‘pending’.

Gene therapies – SMA
In June 2021, Arthur Morgan was five months old.  Three weeks earlier he had been diagnosed with spinal muscular atrophy (SMA).  SMA is a muscle-wasting disease caused by a faulty gene and, if left unchecked, it can lead to the disintegration of motor neurons at the base of the brain, resulting in a slow deterioration in muscles and a life expectancy of just two years.

Arthur was promptly treated on the NHS and given a dose of Zolgensema at the Evelina London children’s hospital in late May.  Zolgensema, manufactured by Novartis Gene Therapies, is a one-off gene therapy, which costs £1.79 million per dose – it may be the world’s most expensive drug.

How does it work?   Patients with SMA have a missing, or non-working, gene known as SMN1.  It encodes a protein essential for the normal functioning of nerves that control muscle movements.  The active ingredient in Zolgensema is onasemnogene abeparvovec.  This contains a new, functional copy of the SMN1 gene, which requires a vector, known as AAV9, to deliver it into the patient’s somatic cells.  Once inside the nuclei of the motor neuron cells it instructs them to synthesise the SMN1 protein and restore nerve function.

The wonders of simple, somatic gene therapy!

Gene therapies – ADA-SCID
SCID (severe combined immunodeficiency) is a disease caused by a functional lack of the enzyme, adenosine deaminase (ADA).  It is a rare, but life-threatening disorder that leaves children with no effective immune system – they are the archetypal ‘babies in bubbles’.

Over the years several SCID children have been treated with various gene therapies with varying successes.  One of the most famous was Ashanti De Silva, who, in 1990, was the first SCID child to be effectively treated with genetically-engineered T-cells – it was a watershed in genetic-based medicine.  Since then limited progress has been made with gene therapies, including some disasters that caused leukaemias and deaths, until 2021 when a different approach using ‘adult’ (non-embryonic) stem cells was pioneered.

Fifty ADA-SCID patients were treated in three joint UK and US gene therapy trials at Great Ormond Street Hospital (GOSH) and at the University of California, Los Angeles.  Samples of haematopoietic stem cells were collected from the children’s bone marrow or blood.  A non-harmful viral vector was used to deliver a functional copy of the ADA gene into the stem cells’ nuclei.  These cells were then infused into the patients where they reintegrated into the stem cells of their bone marrow and subsequently expressed ADA.

All the patients survived the 24 and 36-month trials and 48 out of 50, that is 96%, showed no future signs of ADA-SCID and were able to discontinue their previous therapies.  ADA expression increased dramatically within three months of treatment and it was sustained at healthy levels.  In addition, elevated immunoglobin production was recorded signifying a functional immune system.

Claire Booth, from GOSH and co-lead author of the study, said, 'If approved in the future, this treatment could be standard for ADA-SCID, and potentially many other genetic conditions.'  This work has been published as Kohn et al., ‘Autologous Ex Vivo Lentiviral Gene Therapy for Adenosine Deaminase Deficiency’, The New England Journal of Medicine, 2021; 384: 2002-2013.

Monkey-human embryos
Scientists have successfully grown monkey embryos containing human cells for the first time.  The work was published by Tan et al., and entitled, ‘Chimeric contribution of human extended pluripotent stem cells to monkey embryos ex vivo’ in the journal Cell (2021, 184: 2020–2032).

The researchers fertilised ova from cynomolgus monkeys (Macaca fascicularis).  Six days after fertilisation, 132 blastocysts were injected with human pluripotent stem cells and observed while the human and monkey cells divided and then grow together in vitro.  Development was seemingly random – each of the embryos developed with unpredictable combinations of human and monkey cells and deteriorated at varying rates.  For example, 11 days after fertilisation, 91 were alive, but at day 17, just 12 remained.

Only three embryos survived until 19 days after fertilisation.  Bioethically, this is dreadful news of appalling experimentation, but here comes the inevitable sweetener.  The researchers claim that these human-animal hybrids – known as chimaeras – might someday provide better models for drug testing, or various regenerative medicine applications including the generation of organs and tissues for transplantation.

Nevertheless, this latest work has already divided developmental biologists and bioethicists.  Some maintain that this sort of work is beyond the bioethical red line of acceptable human experimentation.  Some object to the creation of morally ambiguous entities.  Some complain because it uses non-human primates.  Some claim that if chimaeras are to become a source of organs and tissues then experiments with livestock animals, such as pigs and cows, are more promising and do not risk challenging ethical boundaries.

According to Juan Carlos Izpisua Belmonte, lead author of the work, the team does not intend to implant any hybrid embryos into monkeys.  Indeed, there are still serious problems growing other species configurations, such as human-mouse hybrids.  It seems as though such hybrids have trouble thriving because the two species are biologically distinct and distant, so their cells communicate poorly and unpredictably.

So, perhaps these diverse species were never intended to be genetically mixed in the first place?  Should such biologically unnatural experiments even be licit?

‘I also said to myself, "As for humans, God tests them so that they may see that they are like the animals.  Surely the fate of human beings is like that of the animals; the same fate awaits them both: As one dies, so dies the other.  All have the same breath; humans have no advantage over animals.  Everything is meaningless.  All go to the same place; all come from dust, and to dust all return."'  [Ecclesiastes 3:18-20].
Stem-cell Technologies

The 14-day rule
Back in 1984, the Warnock Committee, charged with drawing up regulations for human embryo research, was faced with the impossible task – if it recommended that experimentation on human embryos should be legalised, then it was obliged to specify an upper time limit after which research would not be permitted.  After all, embryo experimentation could not go on for weeks or months, either technically or bioethically.

The Committee duly came up with one of the greatest biological fudges of the twentieth century – the 14-day rule.  Ostensibly, that is when the so-called primitive streak conveniently appeared and disappeared, as a sort of ephemeral and insignificant marker.  Nevertheless, the primitive streak, the initiation of organogenesis, the start of gastrulation, the last stage at which twinning may occur, or at which two embryos may merge (so-called tetragametic chimerism) were sold to quell the morally anxious.  But such qualms were of little practical consequence and were mostly shelved because no-one in the 1980s could culture human embryos for even a few days – the eight-cell stage was just about the pinnacle of scientific achievement.  Nevertheless, the 14-day rule was formalised and legalised in the 1990 Human Fertilisation and Embryology Act.

But unsurprisingly the issue came back to bite the scientists.  And like all bioethical endeavours it brought with it a slippery slope.  Define some boundary, be it 14 days or 24 weeks, and it will soon be called insufficient and requiring an essential extension.  Rumblings in favour of a ‘14-plus day’ rule had been overheard among the scientific undergrowth for several years.  For example, during 2016, two research teams announced independently that they had managed to grow human embryos for 13 days.  Then in May 2021, came the most important and coordinated pressure to extend that old pragmatic 14-day rule, or even abandon it.  It was driven by the International Society for Stem Cell Research (ISSCR) and its updated Guidelines for Stem Cell Research and Clinical Translation.

An ISSCR task force had been set up to rewrite its previous, now seemingly restrictive, Guidelines under the chairmanship of Robin Lovell-Badge of the Crick Institute, London.  He argued in an interview with Nature that the current rule, ‘prevents study of a critical period, between 14 and 28 days, when the beginnings of tissues are established.’  This coincides with the so-called ‘black box' period of human reproduction, between approximately day five and day 28.

The ISSCR has made clear that it has proposed no time limit nor do the Guidelines carry any legal force.  But would even 28 days suffice?  Of course not, a few years down the technological track and, like 14 days, 28 days will also prove to be insufficient.  Just wait until artificial human wombs are functional.  However, the 42 members of the Guideline Revision Task Force have produced a summary of the key updates and issues of the ISSCR Guidelines in Stem Cell Reports (8 June 2021, 16: 1398-1408).  From the following extract it is obvious that the 14-day rule is doomed.

‘It has been possible to culture macaque embryos up to about 20 days, well beyond the 14-day equivalent and gastrulation in human embryos.  This has not been done with human embryos because of the “14-day rule” that has been adopted in some guidelines, including those from the ISSCR, and enshrined in law in several countries, such as in the UK since 1990.  There is now building pressure to extend or even abolish this limit in order to permit research into very important stages of human embryo development, about which we know little, but where many cases of miscarriage or birth defects are likely to have their origins.’

As with all initially unpalatable, ethically-contentious proposals, be they, for example, the use of aborted foetal material or destructive embryo experimentation, there must be an accompanying sweetener, an inducement to assuage our doubts and fears.  To aid the acceptance of its radical proposals, the ISSCR adds that, ‘Understanding the primitive streak, early germ layer development and primordial germ cell formation in humans is crucial to improve our understanding of and interventions for infertility, in vitro fertilization, pregnancy loss, and developmental disorders that occur or originate soon after implantation.’  Got the sweetened message?  How could anyone be so mean as to oppose such proposals?

Although these new ISSCR Guidelines have no legal authority in any jurisdiction, they will convey enormous weight in any discussion of the practices and bioethics of human embryo-related research, be they human embryo experimentation, embryonic stem-cell technologies, mitochondrial-replacement therapies, organoids, embryo models, chimeras, genome editing and so forth.

Of course, the principal subject of the Guidelines is stem-cell research – it is even in the document’s title.  But that is somewhat misleading because the front and centre of the discussion is the human embryo, the ineluctable source of embryonic stem cells.  And human embryos must be destroyed to harvest embryonic stem cells.  So why is there no acknowledgement in the Guidelines of the financial, technical and bioethical advantages of using ‘adult’ stem cells in experimental research and medical treatments?

One commentator has insisted that the Society’s framework, ‘proactively sets the stage for a thorough public deliberation.’  Who is kidding who?  Any deliberation, debate or consultation will be masterminded by the experimenters.  After all, the ISSCR task force signally failed to engage with the public while rewriting its Guidelines.  Joe Public will also not be privy to the future discussions of the few and certainly not able to effectively challenge them.  Debates among the like-minded are not proper debates.  This is woke science – public engagement is a myth, public support is inevitable.  The favoured outcome is almost already set in regulatory concrete.  And what will these experimenters wish for?  OK, 28 days will do, but no time barrier would be even better.

Instead of calling for a specific time limit, the ISSCR Guidelines suggest that research proposals to grow human embryos beyond the 14-day limit are considered on a case-by-case basis and subjected to local policies.  Then, if approved, ‘a specialized scientific and ethical oversight process could weigh whether the scientific objectives necessitate and justify the time in culture beyond 14 days, ensuring that only a minimal number of embryos are used to achieve the research objectives.’  In other words, scientists will review each other’s projects and assess their progress and appropriateness and even determine at what point such experiments must stop.

What is the likely outcome of these new ISSCR Guidelines?  We are now in a different world to that of 1984, the Warnock Report’s publication year.  Not only are we now more scientifically advanced but we are also more bioethically backward – human embryos are generally regarded as little more than biological material.  It should give morally-sensitive people only a little comfort that the Guidelines advise against germline editing of human embryos intended for reproductive purposes, as well as prohibiting any attempt to use human stem cell-based embryo models to establish a pregnancy.  Stop!  We need to pause and think.  Does human life have any dignity, any intrinsic value?  Are there any limits to destructively experimenting with unborn human life?  Destructively experimenting with human embryos up to and beyond 14 days exploits extremely vulnerable human lives.  The boundary should not be 14 or 28 days, it should be zero.  To do it for longer, whatever the imagined benefits, is tantamount to wrong.  History shows that science adrift from a robust bioethical framework rapidly becomes monstrous.

Stem-cell failure in New York
In 2007, similar to that of California, the state of New York created a fund for stem-cell research, including human embryonic stem cells.  The New York State Stem Cell Science program (NYSTEM) was smaller than California’s US$3 billion package, but still substantial, at $600 million over 11 years.

In April, came news that NYSTEM funding had been cancelled in the budget for 2022.  The scheme has experienced difficulties recently and has distributed only $400 million so far.  Moreover, bureaucratic problems, such as failed board meetings, poor communications and stopped grant monies have contributed to the disarray.

A New York government official shrewdly announced that stem-cell science should ‘advance within academic and private research communities rather than the Department of Health.’  It is thought that human embryonic stem-cell research will be particularly affected by the cancellation.

Could it simply be that, like its sister funding scheme in California, the New York programme concentrated too much on supporting human embryonic stem-cell research, which produced few significant results?  Go ‘adult’ stem-cell research!

Crying over stem cells
Tear glands should keep the eyes lubricated and protected, but when they become dysfunctional, they can cause several conditions, such as Sjögren’s syndrome and ‘dry-eye disease’.  The latter disorder affects about a quarter of over 65-year-olds causing discomfort and damage.  A Dutch research team has used stem cells to construct human tear gland organoids, or mini-organs, which actually produce tears that may yet provide a cure.

The research has been published as, Bannier-Hélaouë et al., ‘Exploring the human lacrimal gland using organoids and single-cell sequencing’, Cell Stem Cell (online 16 March 2021).

The team determined the growth conditions required for the production of mouse and human lacrimal gland organoids from adult stem cells.  In addition, they demonstrated that noradrenaline stimulated tear secretion, though because the organoids contained no ducts, the tears accumulated.  But after engrafting organoids into mice, they did produce ‘mature tear products’.  However, such success was not achieved with human subjects.  But the work was considered to be a good starting platform for the eventual transplantation of lacrimal glands – human tears will be shed later, maybe.
Miscellaneous

When is death?
In the olden days, a doctor pronounced death when a person stopped breathing and/or their heartbeat failed.  It was subjective but reliable. 
Then came the criterion of brain death.  It was objective but debatable.

So in 1981, came the Uniform Determination of Death Act (UDDA), a law adopted by most US states.  Its aim was ‘to provide a comprehensive legal basis for determining death in all situations.’  It states that ‘an individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.’  In other words, it was hoped that the UDDA would become the uniform legal standard across the USA for determining ‘death by neurologic criteria’ (DNC).

The UDDA therefore provides criteria for deciding whether a severely brain-damaged person is dead or not.  Most US states have adopted it, but only two-thirds have applied the full language of the act.  Further complicating this quest for a state-wide uniformity have been court decisions, additional legislation and technological developments.  As a result, a person can be dead in one state and alive in another.

This unsatisfactory situation needed revision, hence the RUDDA, the Revised Uniform Determination of Death Act.  It was proposed by three academics, Ariane Lewis, Richard Bonnie and Thaddeus Pope, and published on 21 January 2020 in the Annals of Internal Medicine (172: 143-144) under the title, ‘It's Time to Revise the Uniform Determination of Death Act.’  Not everyone agrees.  D. Alan Shewmon, a paediatric neurologist at UCLA, has written an article in the Journal of Medicine and Philosophy (14 May 2021) entitled ‘Statement in Support of Revising the Uniform Determination of Death Act and in Opposition to a Proposed Revision.’  The Statement concluded, ‘that while the UDDA needs revision, the RUDDA is not the way to do it.’  His analysis was endorsed by 107 experts from a variety of academic backgrounds and diverse bioethical perspectives.  They include John Finnis, of Oxford; Robert P. George, of Princeton; Peter Singer, also of Princeton; Robert C. Tasker, editor of Pediatric Critical Care Medicine; Helen Watt, of the Anscombe Bioethics Centre and Robert D. Truog, of Harvard.

The 35-page Statement reads, ‘While the UDDA needs revision, the RUDDA is not the way to do it.  Specifically, (1) the Guidelines have a non-negligible risk of false-positive error, (2) hypothalamic function is more relevant to the organism as a whole than any brainstem reflex, and (3) the apnea test carries a risk of precipitating BD [brain death] in a non-BD patient, provides no benefit to the patient, does not reliably accomplish its intended purpose, and is not even absolutely necessary for diagnosing BD according to the internal logic of the Guidelines; it should at the very least require informed consent, as do many procedures that are much more beneficial and less risky.’

The anti-RUDDA folk contend it is their right not to have DNC imposed upon them against their judgment and conscience.  Therefore they call for any revision of the UDDA to contain an opt-out clause for those who accept only a circulatory-respiratory criterion.

This may be fascinating stuff, as much metaphysics as medicine, but it touches on a key aspect of life, namely, when it stops.  There is already debate and confusion about the beginning of human life, when it starts.  Now the other end of the spectrum is under renewed practical and bioethical fire.  Doctors must get it right to give comfort and certainty to grieving relatives.  If they get it wrong, they will be killing their patients -- and probably appropriating their organs too.  Few issues are more important.

Conscientious objection
This is bad news.  The World Medical Association (WMA) is revising the International Code of Medical Ethics (ICoME) to limit the scope of conscientious objection.  Conscientious objection has long been under fire – why should one doctor live by a bioethical framework that is different from the majority?

According to a WMA press release, ‘Workgroup members and observers representing more than 15 countries have reviewed the document carefully to determine what might be missing from the ICoME, what might be superfluous, what could potentially be organised differently.’

The principal change would be to make referral a duty for a doctor who has a conscientious objection. The current Code says, ‘Physicians have an ethical obligation to minimise disruption to patient care.  Conscientious objection must only be considered if the individual patient is not discriminated against or disadvantaged, the patient’s health is not endangered, and undelayed continuity of care is ensured.’  The proposal is to add at the end the short, but significant, clause, ‘[… is ensured] through effective and timely referral to another qualified physician.’

There are at least three serious concerns.  First, this addendum would force doctors who object to legal abortion or legal euthanasia to refer patients to a more compliant doctor.  Second, it would fail to establish the duty of doctors to object to practices and procedures that are unconscionable because harmful, discriminatory, unjust or unethical.  The right to conscientious objection is based on the duty to be conscientious which is fundamental to medical ethics.  Third, ‘conscientious objection’ is presented as conflicting with ‘patient care’.  This overlooks the fact that there can be no adequate patient care without conscientious healthcare professionals. 

If a doctor objects in conscience to participation in say, torture, or capital punishment, or to force feeding of a prisoner who is on hunger strike, it would be unprincipled for her to simply find another doctor with fewer scruples to do the deed for her.  That would be a direct attack on the doctor’s conscience and moral integrity, and should therefore be regarded as a serious harm to her.

It would be much better if the WMA said nothing about conscientious objection.  By imposing a requirement for ‘effective and timely referral’ in a revised ICoME, the WMA undermines the very concept.

Daytime napping
Some are in favour, some are against.  Some can, some can’t.  For the record, I’m a real fan of the so-called ‘Winston’, reminiscent of Churchill’s daily forty winks.  I can drop off for 20 minutes almost anywhere, any afternoon.

Anyway, napping during the day is now known to be partly controlled by a person's genetics and is not simply a behavioural choice.  Thanks, Mum.  Thanks, Dad.  When people are sleep deprived, daytime naps can have short-term benefits on performance and alertness.  I’ll second that.

To understand better the causes and consequences of daytime napping, researchers at the Centre for Genomic Medicine at Massachusetts General Hospital (MGH) performed a genome-wide association study (GWAS) to analyse the entire genomes of nearly half a million people using the UK Biobank dataset of European ancestry.

All participants were asked whether they nap during the day 'never/rarely,' 'sometimes' or 'usually'.  A subset of participants wore activity monitors, which provided more objective data about daytime sedentary behaviour, which can be an indicator of napping.

The study was published as Dashti et al., ‘Genetic determinants of daytime napping and effects on cardiometabolic health’ Nature Communications, (2021, 12: 900).  The researchers discovered a total of 123 regions in the human genome that were associated with increased daytime napping, with many of the gene regions already known to play a role in sleep and sleep disorders.  They also reported that, ‘Mendelian randomization shows potential causal links between more frequent daytime napping and higher blood pressure and waist circumference.’  Err, I don’t think so.

Further analysis revealed several distinct clusters of genes that are associated with napping, which allowed the researchers to suggest that at least three separate mechanisms are involved in promoting daytime napping.

One mechanism is related to 'disrupted sleep', whereby a daytime nap could make up for a poor quality night-time sleep.  A second was related to 'early morning awakening', as some people who rise early may need to catch up on sleep with a nap.  The third mechanism was related to 'sleep propensity', meaning that some people simply need more sleep than others.  Personally, I delight in all three mechanisms!
USA and Elsewhere

From Trump to Biden
There is little doubt that Donald Trump was the most pro-life US president ever.  There is little doubt that Joe Biden is the most pro-abortion president ever.  Apparently, since taking office on 20 January 2021, President Biden has yet to use the word ‘abortion’ in public.

The Biden administration has been busy dismantling some of the pro-life legislation instituted by previous presidents.  For example, the Hyde Amendment, originally passed in 1976, when Gerald Ford was President, is a provision that bars the use of tax-payers dollars, as federal funds, to pay for US abortions.  On 28 May, President Biden announced his proposed 2022 budget, but with no mention of the Hyde Amendment.

For most of his political career, Joe Biden supported the Hyde Amendment.  But while campaigning for the presidency in 2019, he promised the most radical pro-abortion groups in America that he would scrap it and force Americans to fund abortions.  It is reckoned that the Hyde Amendment has saved at least 2.5 million unborn children from abortion and it enjoys the support of a majority of Americans, including even people who favour abortion.

President Biden is at the centre of another, more personal, storm.  Joe Biden is a Roman Catholic.  He attends Mass every week and regularly speaks about his Catholic faith.  Yet, while the Catholic Church considers abortion to be a grave sin, Biden maintains a liberal stance in support of radical abortion.

Can an openly Catholic President openly oppose Catholic teaching?  Will the Catholic Church act?  Bishops are incensed that Biden opposes Catholic teaching specifically on abortion.  In mid-June, the US Conference of Catholic Bishops (USCCB) debated the issue and voted by 168 to 55, with six abstentions to begin to work on a document that could ban the President from receiving Mass.  The Vatican has already indicated its opposition to the bishops' move.  The President responded, ‘That's a private matter and I don't think that's gonna happen.’  The document will return for debate at the next bi-annual US Catholic Bishops Conference in November.  This story has legs, it will run and run.

Texas does it differently
The Lone Star state does things differently – we all know that.  For example, in mid-May, Texas embraced one of the strictest anti-abortion bills in the United States, after Governor Greg Abbott signed a ‘heartbeat bill’.  As Abbot announced, ‘The life of every unborn child with a heartbeat will be saved from the ravages of abortion.’  The new law will become effective from September.

Like that of other similar states’ laws, the Texas legislation will prohibit abortions beginning at six weeks of pregnancy.  But there is one big difference.  Texas officials are forbidden to enforce the ban – instead this will be left to private citizens.  Anyone who knows someone who has had an abortion can sue the abortion provider or anyone who helped the person get the termination.  Even people from outside Texas can sue doctors and seek up to US$10,000 in damages.

Clearly this law will be challenged in the courts.  Alexis McGill Johnson, president of Planned Parenthood Action Fund, has said, ‘The goal is clear: to relentlessly attack our reproductive rights until abortion is a right in name only.’  Even the White House has weighed into the debate.  President Biden’s press secretary, Jen Psaki has declared, ‘This is the most restrictive measure yet in the nation, and the most restrictive recent assault on women’s fundamental rights under Roe v. Wade.  And critical rights continue to come under withering and extreme attack around the country.’

The Texas law is one of a number passed recently in an effort to effectively nullify Roe v. Wade.  These moves have succeeded in drawing in the US Supreme Court.  As already noted, the SCOTUS has agreed to hear a challenge to a restrictive Mississippi law in which it will examine ‘whether all pre-viability prohibitions on elective abortions are unconstitutional.’

If Roe v. Wade is overturned
With the case of Dobbs v Jackson Women’s Health Organization appearing before the Supreme Court and the possibility that Roe v. Wade may be overturned abortion activists are worried.

The Guttmacher Institute, the leading pro-abortion research group in the USA, has predicted that nearly two dozen states would protect unborn babies through laws that they already have in place.  According to the Guttmacher Institute, these states would either widely restrict or prohibit abortions immediately through old abortion bans that predate Roe or newer so-called ‘trigger laws’ that would come into effect and ban abortions once Roe is repealed.

The 21 states currently on the Guttmacher list are Idaho, Utah, Arizona, Texas, Oklahoma, North Dakota, South Dakota, Minnesota, Iowa, Wisconsin, Michigan, Missouri, Ohio, West Virginia, Kentucky, Tennessee, Arkansas, Mississippi, Louisiana, Alabama and Georgia.  In contrast, 14 states and Washington DC have laws that would allow abortion on demand to continue if Roe is overturned.

China’s new three-child policy
For decades, China has aggressively instituted a population control policy that has been responsible for killing hundreds of millions of babies in abortions and subjugating women to forced abortions and sterilisations.

This coercive population control program began in 1979 with the infamous one-child policy that was later modified in 2016 to a two-child policy.  Now in June 2021, China’s communist authorities have announced another change, by allowing couples to have three children.  Why the changes?  Because China has at last realised that its demographic is badly skewed.  According to the new 2020 census data, there were only about 12 million births during 2020, the lowest number since 1961.  There are already insufficient young Chinese people to support production, an ageing population and a distorted boy:girl ratio of 118:100.

But will the Chinese population of reproductive age want three children?  The uptake at the two-child policy has been minimal.  And can anyone believe that such seemingly-benign policies will decrease China’s rampant abortion rates?

IVF in France
France has a new bioethics bill.  In July, new legislation will extend access to fertility treatment to all French women, making it free under the country's public healthcare system.  So single women and those in same-sex partnerships will be able to access such treatments as soon as September.

Until now, French law has only allowed heterosexual married couples to access fertility treatment.  Every year thousands of lesbian and single women from France travel to other countries, such as Spain and Belgium, to access fertility services.

This reform fulfils a promise made by President Emmanuel Macron to legalise IVF for single women and lesbian couples in his 2017 election campaign.  This new legislation was threatened early this year when, supported by right-wing politicians and the Catholic Church, senators voted to remove single and lesbian women from the new bioethics bill.  However, the majority of French people appear to be in favour of extending access because LGBTQ groups and others successfully protested the senate's decision.

A spokeswoman for Les Collages Lesbiens, who held a march in April protesting the senate's change to the bill, stated, 'We demand, among other things, anonymous assisted reproduction by default, free and reimbursed for all, without any conditions.’  And they got it.  However, the bill does not cover fertility treatment for trans people, and it will not help male same-sex couples become parents, as surrogacy remains illegal in France.
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