Update on Life Issues - October 2022
Abortion
10 million too many
There are many signposts for celebrating life – births, graduations, weddings and even funerals.  But never, never abortions.  How can anyone rejoice at the deliberate taking of a tiny life before his head has even been kissed?  That is why we say that 10 million abortions are 10 million too many.

Yet that is the almost unimaginable number of abortions that have been performed in the UK since the 1967 Abortion Act came into force.  That is why many held a minute of silence on Friday 23 September 2022 at 11:41am.  That was the projected time at which the 10 millionth unborn child would be aborted somewhere in the UK.  The other 9,999,999 were also remembered.

Official abortion statistics tell the sad annual story – a record 214,869 abortions took place in England and Wales during 2021 with another 13,758 in Scotland in the same year.  One every 2.5 minutes.

None of us thought this awful landmark day would ever come.  In the 1980s, as the pro-life constituency developed and expanded, there was an optimism that abortion could, even would, be beaten as pro-life education projects, political action and support groups sprang up and thrived.  Nowadays there is a more sedate acceptance that abortion is here to stay.

So we mourned in late September and we will continue to lament this vast loss of unborn life – all those sweet little individuals.  And we will remember our collective cruelty that has allowed, even endorsed, this slaughter.  May the memory of the 10 million urge us to renew our efforts to save more lives from abortion in the future.  God have mercy on us!

Thérèse Anne Coffey
We have a new Secretary of State for Health and Social Care, Thérèse Coffey.  How long she will remain in office – weeks, months, or years – is anyone’s guess.  She is a Lancashire lass who grew up in Liverpool.  She attended Somerville College, Oxford, studied chemistry and rowed.  She then went on to University College London, where she graduated and was later awarded a PhD in chemistry.  Her career started with a number of jobs in finance.  Eventually, at the 2010 general election, Coffey was elected for Suffolk Coastal, becoming the constituency's first female MP.  She held several minor posts at Westminster before joining the Cabinet as the Secretary of State for Work and Pensions in 2019.  In September 2022, she was appointed as Deputy Prime Minister and as Health and Social Care Secretary.  Apparently she is an avid LFC fan, likes a drink, a bit of karaoke and even the odd cigar.  Moreover, she is best friends with the Prime Minister, Liz and Tiz, as they are known in Westminster.

All the above seems like a jolly respectable and commendable CV.  However, in the eyes of some, Coffey has a deep flaw.  Not only is she a Roman Catholic but she is steadfastly pro-life.  The latter really grates with pro-abortionists.

How has she displayed her pro-life colours in Parliament and elsewhere?  In 2010, she tabled a motion calling for mental health assessments for those seeking abortions.  The motion read, ‘In its 14th March 2008 statement the Royal College of Psychiatrists advised that healthcare professionals who assess or refer women who are requesting an abortion should assess for mental disorder and for risk factors that may be associated with its subsequent development.’

In 2019, she voted against extending abortion laws to the people in Northern Ireland (and against same-sex marriage as well as the extension of same-sex marriage to Northern Ireland).  During the Covid-19 crisis, she voted against extending access to abortion by allowing women to take abortifacient pills at home, instead of in a clinical setting.  During a media interview in June 2022, Coffey confirmed her opposition to abortion by stating that she would, ‘… prefer that people didn't have abortions but I am not going to condemn people that do.’  And she acknowledged the reality that ‘Abortion law isn't going to change in this country’ at least, not in the near future during her reign as Health Secretary.

Those activities have been red rags to pro-abortionists.  Among those who have criticised Coffey’s views on abortion has been Clare Murphy, CEO of the British Pregnancy Advisory Service.  In a statement, the BPAS said, ‘Every politician is entitled to hold their own opinion on abortion.  But what matters is whether they would let their own personal convictions stand in the way of women’s ability to act on their own.’

Murphy continued, ‘Earlier this year, the new Health Secretary voted to revoke access to at-home abortion care, and recriminalise women who end their own pregnancies without the approval of two doctors.  In doing so, Thérèse Coffey voted against the advice of leading medical bodies including the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the BMA.  To have a Health Secretary who would place their personal beliefs above expert clinical guidance is deeply concerning.’

Murphy concluded, ‘We are a pro-choice country, and we have a pro-choice Parliament.  BPAS, alongside other women’s charities and healthcare bodies, will continue to work with Parliamentarians to advance abortion rights regardless of which MPs form the next Cabinet.’

The coming months for Thérèse Coffey might well be reminiscent of the 1990s, when that other Roman Catholic, Ann Widecombe, was Shadow Health Secretary.  She survived and was always happy to express her pro-life credentials whenever anyone asked.

Upon her new appointment I sent Miss Coffey a congratulatory and supportive email.  It read, ‘Hearty congratulations on your appointment as Secretary of State for Health and Social Care.  And with grateful thanks for your pro-life stance.’  Yep, we all like a little recognition and kindness from time to time.

The two irrefutable abortion facts – revisited
Here is a revised and updated section from my 2014 book, Bioethical Issues - Understanding and Responding to the Culture of Death.  When it comes to abortion, there are two irrefutable facts we need to grasp – nobody doubts or disagrees with these.

First, the numbers.  For England and Wales, these official statistics are published by the Office for Health Improvement and Disparities.  Historically, legalised abortion started here on 27 April 1968 – six months after the 1967 Abortion Act had received the Royal Assent – so the first full-year’s total relates to 1969 and amounted to 54,819.  Abortion numbers rose inexorably to around 180,000 by the late 1980s and then, for the next twenty or so years, they more or less plateaued in the region of 190,000.  They breached the egregious 200,000 boundary three times between 2006 and 2008.  That is the historic overview.

Now consider the latest contemporary picture.  During 2021, the total number of abortions performed in England and Wales, on residents plus non-residents, was 214,869 – the highest ever.  Moreover, according to Public Health Scotland, the total figure there for 2021 was 13,758.  Only recently has the 1967 Act been extended to Northern Ireland and no figures have yet been published.  In other words, the grand 2021 total for Great Britain was well in excess of 200,000; to be precise, it was 228,627.  This is similar to the entire population of cities like England’s York, Wales’s Swansea or Scotland’s Aberdeen.  It also means that over 4,000 abortions occur in Great Britain every week.  That is approximately 880 every weekday – every Monday, every Tuesday, every Wednesday …  Can you believe that?  Sometimes I have to do the arithmetic again, just to check that huge daily figure.  It is equivalent to about thirty classrooms, or eighteen coachloads, of children each day.  If a blazing catastrophe or appalling road accident killed that number of children, think of the shock, the graphic newspaper headlines and the constant TV news bulletins.  Yet 880 daily abortions evoke none of these.

And remember, we are not talking about faraway places, like Kenya, the USA, or China.  This is happening in Great Britain, where you live and work, and go to hospital and church – in truth, it is on your doorstep.  Nowadays, 1 out of every 5 pregnancies in England and Wales ends in abortion.  And an estimated 1 in 4 women in England and Wales will have had an abortion by the time they are forty-five years old.  Think about that as you push your shopping trolley around your local supermarket.

Since the implementation of the 1967 Abortion Act, the total number of abortions performed in the UK, from 1968 to 2021, has recently reached 10 million.  Some 15 per cent of our population is missing.  But maybe you do not live in the UK.  Abortion still occurs on your doorstep, in your neighbourhood, in your homeland – it is a worldwide practice.  For example, about 0.9 million abortions occur in the USA each year, 0.5 million in Japan, and an estimated 11 million in India and 13 million in China.  The global total is now reckoned to be approximately 42 million every year.  Just pause, sit back and try to absorb something of the enormity of abortion.  These data are official, staggering and condemnatory.

The second set of irrefutable facts relates to what is aborted.  The ‘favourite’ time for abortion is under ten weeks’ gestation – 89 per cent of abortions in England and Wales during 2021 occurred within this developmental period.  Such an unborn child would fit snugly into the palm of your hand; she has eyes, fingernails and fingerprints, she moves, she swallows, she digests, she sucks her thumb.  Blood has been coursing through her body for several weeks – her rudimentary heart began to beat on about day 21.  We have been told that this is just a vague collection of undifferentiated cells, or a little piece of poorly defined tissue.  What tosh!  We have been duped.

Most abortions in the UK are lawful up to twenty-four weeks.  Have you ever seen an unborn child of that gestational age?  Such an early-bird daughter was born to friends of mine – it would have been unthinkable to ever contemplate harming, let alone killing, her.  Though babies of this age often struggle, most of them survive and thrive.  What a topsy-turvy world of medical ethics we live in – doctors and nurses can be fighting to preserve the life of such a premature child in the intensive care unit, while down the corridor, in the same hospital, their colleagues can be deftly destroying an unborn child of a similar age.  And if some form of handicap is suspected, not necessarily proved, then there is no time limit – abortion is lawful up to birth, yes, up to forty weeks.

In the UK we probably have the most savage abortion law in the whole world – we have been officially aborting just about the longest (since 1968), the latest (up to birth) and the laxest (easy access).  Grammatically, these three little words – longest, latest, laxest – may be adjectival superlatives, but, when they are linked to the termination of the unborn, they become bioethically most pitiable.

These are the two irrefutable facts about abortion.  What are you going to do about them?  Snub them or fess up to them?  Ignore or respond?  You decide.
IVF and ARTs

Overhauling the UK’s fertility and embryo laws
The UK regulator, the Human Fertilisation and Embryology Authority (HFEA), is still hankering after liberalising the UK’s laws relating to fertility treatments and embryo research.  As the Guardian newspaper has recently noted, the plans will be ‘the biggest overhaul of fertility laws in 30 years’, namely since the 1990 Human Fertilisation and Embryology Act.  The HFEA also wants to ‘future proof’ legislation so that scientists will not be held back by supposedly out-of-date regulations.  The HFEA had planned to launch a consultation in September before making recommendations on amending the 1990 Act with the hope that they would be enacted before the end of this year.  Alas, the HFEA failed to meet its own consultation deadline.  ‘It should be available later in the year’, a spokeswoman told me.

Apparently there are at least four new and radical fertility treatments that the HFEA wants to become legal.  First, there are laboratory-grown ova and sperm.  Though already accomplished in mice (see under Genetic Technologies below), it is currently not possible in human beings, both technically and legally, but there is a push by some scientists to make it happen.  Second, there is human genome editing.  Though somatic genome editing is lawful, human germline editing is not.  It makes permanent changes to a family’s genomes and evidently public opinion opposes it.

Third, there is ‘three-parent’ IVF.  UK legislation was amended in 2015 to permit mitochondrial donation with genetic material from a third party to overcome mitochondrial diseases.  Two techniques were permitted – maternal spindle transfer (MST) and pronuclear transfer (PNT).  The HFEA wants to widen the scope of these procedures.  Fourth, there are synthetic embryos.  These are embryo-like structures which are produced from stem cells (again, see under Genetic Technologies below).  And as an extra, a fifth, there is the long-standing pressure to relax and extend the 14-day rule for experimenting with human embryos (see, below).

Why are there demands for such radical changes in reproductive biology and ART treatments and embryo experimentation?  There is a fear among some of the UK’s scientific community that it will be left behind.  The thinking is that an Act as old as 1990 is bound to be outmoded.  Yet, for example, the Offences against the Person Act 1861 is much older but still relevant and required.  Every Act draws bright lines.  Why should vulnerable people be abused?  Why should human embryos be destroyed on an industrial scale?  The drive to revise and loosen laws that protect all people, including the youngest and most vulnerable, is a dangerous enterprise.

Overhauling the Dutch fertility and embryo laws
We in the UK are not alone.  The Netherlands is also keen to overhaul its 2002 Dutch Embryos Act.  In fact the Act stipulates that its provisions are to be evaluated every five years.  The third evaluation was conducted in 2021.  Apparently, the Report ‘shows that the law functions well in general.’

However, there are five major recommendations.  First, the legal definition of 'embryo' needs to be revised in order to keep pace with the development of human embryo-like structures.  Second, the ban on creating embryos for research needs to be lifted.  Third, increasing the 14-day upper limit for embryo experimentation needs to be considered, possibly to 28 days.  Fourth, provisions regarding the creation of hybrids and chimaeras need revising.  Fifth, the current ban of germline genome editing needs to be reconsidered.

Three comments.  First, it is not surprising that the Dutch are wrestling with the same issues as the UK and most other developed countries.  We are all in this together.  And depending on the worldview of their citizens we are without national, let alone global, consensus.   Second, the major issue always concerns the definition of a human embryo.  Third, the 14-day rule is exercising most governments.

How has the Dutch Report been received?  The government announced a revision of the 2002 Act within the present parliamentary period.  This would include 'the adaptation of the definition of “embryo” also in the light of the developments in the field of embryo-like structures [ELS].'  The lifting of the ban on research embryos was again postponed and despite attempts by minority parties to present reformist bills, the government is adamant they will not be voted on in this Parliamentary period.

This is curious.  Whereas Holland is usually portrayed as a liberal country, when it comes to human embryos, it has laws that are significantly more protective than those of the UK.  Shame on us!

14 or 28 days?
This is becoming a persistent topic for discussion among the embryo-concerned community, namely those for and those against the deliberate destruction of human embryos.  These debates are against a backdrop of calls for the updating or replacing of laws, such as the UK’s Human Fertilisation and Embryology Act (1990 as amended).  And the hottest item for re-examination would be the current regulations for research on human embryos and especially that 14-day rule as the upper limit for experimenting on them.

The 14-day rule was always nonsense.  During the early 1980s, the UK’s Warnock Committee was faced with devising some upper time limit for embryo experimentation.  Warnock said, ‘… some precise decision must be taken.’  Why?  Warnock answered, ‘… in order to allay public anxiety.’  So, though this was admittedly absurd and arbitrary, fourteen days will keep the British public happy, even though it is pulling the wool over their eyes.  Thus, the appearance of the primitive streak as ‘a heaping-up of cells at one end of the embryonic disc on the fourteenth or fifteenth day after fertilisation’ became embedded in embryological law and folklore.  It has since spread to other countries.

Of course, it was never going to be enough.  Like the boy who pined for more pie, as embryo experimentation advanced, so did the demand for more headroom.  And the clamour has recently intensified because it is now technically possible to cultivate embryos for almost 14 days.

Another reason given for extending the time limit is that we already have good scientific knowledge about how embryos develop beyond 28 days.  Our greatest knowledge gap is therefore said to be between 14 and 28 days.  Conflictingly, one of the UK’s foremost embryologists, Magdalena Zernicka-Goetz, has said concerning days 1 to 7, the first week after fertilisation, ‘This period of human life is so mysterious.’  Whatever.  Research in this 14 to 28-day lacuna would apparently allow better understanding of the formation of primitive tissues, the development of the nervous system, early organ development, and so on.

Then there are also the pregnancy-related arguments – gaining answers as to why some pregnancies end in miscarriage or stillbirth, why some do not, and why some birth defects occur.  Think how this might benefit parents and potential parents and their future offspring and might alleviate their sufferings and anxieties.  Maintaining the 14-day rule stultifies such possibilities.  Really?

Furthermore, we have recently entered a ‘new age’ of embryology.  Nowadays we read about gametes and embryos derived in vitro from stem cells, not just from old-skool ovaries and testes.  Are these among the HFEA’s so-called ‘permitted’ entities and if so, how should research using them be regulated?  Then there are novel synthetic entities, such as synthetic human entities with embryo-like features (SHEEFs) plus some forms of organoids.  Back when the 1990 Act was introduced, such beings were entirely unknown.  The embryological landscape has changed and so have the needs of medicine, science, technology and society.

From the above, it may seem as though an upgrade to 28 days would be beneficial – it certainly would not.  A decade later the call would be for 36 days, or why not go the whole hog and bid for abortion’s upper limit of 24 weeks?  There is an incongruity here that is, for example, highlighted by the proposed HFEA consultation.  The man on the Clapham omnibus may be against 28 days, but he has little knowledge, time, or occasion to express that view.  Pitched against the full-time, professional giants of embryology it turns into a David versus Goliath battle.  One can only hope and labour (and pray) that David wins again.

IVF children and cancer
Almost every edition of these Updates details some serious drawback associated with ARTs and specifically the use of IVF.  Here is one of the latest.  It concerns the use of frozen human embryos.  Such frozen embryo transfers (FETs) are becoming more popular, and in some countries they outnumber the use of fresh embryos.  It is already known that children born after these FETs may have higher short-term risks of certain adverse medical conditions compared with children born after fresh embryo transfers.  However, the incidence of long-term risks has been less clear.

In a new study to resolve the latter, Nona Sargisian and her colleagues from the University of Gothenburg, Sweden analysed the medical records of 7,944,248 children in Nordic countries, namely Denmark, Finland, Norway and Sweden.  Some 171,744 were born after the use of IVF and of these 22,630 were born after FETs.

Their findings were published as ‘Cancer in children born after frozen-thawed embryo transfer:  A cohort study’ by Nona Sargisian et al., in the 1 September 2022 issue of the open-access journal PLOS Medicine.

Cancer diagnosis before 18 years of age was the primary considered parameter.  Statistical analysis of the data from national health registries indicated that children born after FETs were at higher risk of cancer than children born after fresh embryo transfers and those born after natural conception.  The most common types of cancer seen in this study were leukaemia and tumours of the central nervous system.  However, the researchers warned that their results should be treated with caution because so few FET children, only 48, developed cancer.  Statistically, that small number could weaken any conclusions.

Nevertheless, this study should be taken seriously and should encourage further research into the long-term health outcomes in all ART children.  In particular, causal factors other than FETs, such as parental contributions, and different experimental approaches, such as sibling comparisons, need investigating.
Euthanasia and Assisted Suicide

Assisted suicide legislation in Scotland
Will Scotland become the first of the UK’s home countries to legalise euthanasia?  It seems to be heading that way.  This is the third attempt to introduce such legislation in Scotland.  The last attempt was by the late MSP Margo MacDonald.  She died in 2014, but in 2015, her bill, promoted by Patrick Harvie, was rejected by 82 votes to 36 following a debate at Holyrood.  Opinion now seems to be shifting in favour of a law change.

In early September, Liam McArthur, a Liberal Democrat MSP introduced his Assisted Dying for Terminally Ill Adults (Scotland) bill in the Scottish Parliament.  In December 2021, a public consultation on his original scheme was concluded.  It attracted considerable support.  Just over three quarters (76%) of the 14, 038 responses received were fully supportive of the draft proposals to enable anyone aged 16 or over, who is deemed by two doctors to be terminally-ill and mentally-competent and who has been resident in Scotland for 12 months to be entitled to receive help to end their lives.  There were 81 responses from large organisations with 47 of them fully opposed to the proposals.  Arguments from groups representing disabled people highlighted concerns that the bill would undermine palliative care and would put pressure on vulnerable patients to see their lives as a burden.

Responding to the consultation’s results McArthur said, ‘As well as thoughtful perspectives on how an assisted dying law would work in Scotland, I have been particularly struck by many harrowing accounts from people who witnessed their loved ones endure a bad death.  They sent a clear message that, even with excellent palliative care, the option of an assisted death would have made such a difference in terms of reducing unnecessary suffering.’

Opponents have criticised the bill, calling for more support for living and improved palliative care.  A coalition of 175 health care professionals from a variety of medical specialities has outlined their concerns to the Scottish Health Secretary, Humza Yousaf.  In addition, a campaign against the bill has been launched by a group called Our Duty of Care (ODOC).  It has stated, ‘The shift from preserving life to taking life is enormous and should not be minimised.  The prohibition of killing is present in almost all civilised societies due to the immeasurable worth of every human life.  Everyone has a right to life under Article 1 of The Human Rights Act 1998 such that no-one should be deprived of that life intentionally.’

Dr Gordon Macdonald, CEO of Care Not Killing, called the bill ‘very dangerous’.  He said, ‘Evidence from other countries shows that when assisted suicide or euthanasia are legalised, the safeguards promised are quickly removed and the law is extended to include more and more vulnerable people.  People will come under pressure from others to end their lives for fear of being a financial or care burden.  People with depression won’t get the proper psychiatric support they need and palliative care services will continue to be underfunded.’

Dr Naomi Richards, Director of the End of Life Studies Group at the University of Glasgow, added that the bill’s definition of terminal illness is ‘unworkable’, as it is overly broad and could lead to ‘unintended consequences’.

Euthanasia in Canada
Here is an indisputable trend among life issues.  See how, once a country approves any sort of assisted suicide legislation, it inevitably begins to grow like Topsy.  Canada is a case in point.  This trend is attested by its Third Annual Report on Medical Assistance in Dying in Canada 2021 which was published in July 2022.

Canada’s Medical Aid in Dying (MAiD) programme, which allows both euthanasia and assisted suicide, was introduced in 2016.  In that year, 1,018 such deaths were recorded.  Latest official figures show the unremitting surge reached a staggering 10,064 deaths in 2021.  That figure was up from 7,603 in 2020 and it represents 3.3% of all deaths in Canada.  The total number of deaths from legalisation in 2016 to 31 December 2021 now stands at 31,664.

And, as in other jurisdictions with legal provisions for assisted deaths, there are fears that Canadian numbers will increase even more rapidly as eligibility boundaries are extended to include other groups of people.  For instance, the law has recently been amended to ensure that people with chronic and disabling conditions will now qualify for assisted suicide or euthanasia.  From 2023, people with mental illnesses will also be able to apply.  The so-called ‘strict guidelines to protect against abuse’ have been relaxed, even ignored.

The Report records that the two most common reasons for requesting MAiD were the loss of ability to engage in meaningful activities (86.3%) and the loss of ability to perform activities of daily living (83.4%).  Contrary to popular belief, pain was relegated to the third reason – inadequate control or fear of pain was cited by 57.6% of people.  In 35.7% of cases, patients believed that they were a ‘burden on family, friends or caregivers’ and 17.3% cited ‘isolation or loneliness’ as a reason for wanting to die.

Euthanasia in Spain
The act of euthanasia is always ghastly.  Now comes news of a grisly adjunct from Spain.  The case centres on Marin Eugen Sabau, a 46-year-old Romanian security guard, who went berserk in December 2021 and shot three fellow employees and wounded an officer during the ensuing gun battle with police.  Sabau was shot several times and was left a tetraplegic.  He subsequently had one leg amputated and was in constant chronic pain that could not be satisfactorily relieved.  He claimed that his life had become unbearable.

While awaiting trial, he applied for euthanasia under the Spanish law which had been enacted just over a year ago in June 2021.  It states that adults with serious and incurable conditions that cause ‘unbearable suffering’ can choose to end their lives.  A court in Tarragona ruled that it was Sabau’s fundamental right to request euthanasia considering his circumstances.  His request was granted and he was euthanised in prison on 23 August 2022.

That procedure was held up by appeals from his victims, who argued that Sabau should first face justice.  However, the courts ignored their pleas.  The Constitutional Court refused to consider the case, reasoning that there had been no violation of fundamental rights.

Before Spain’s new law was passed, helping someone to die in Spain carried a jail term of up to 10 years.  Now a few weeks or months after a request has been made the act of euthanasia can be performed with no punishments.  But the Spanish parliamentarians never envisaged such a case as that of Marin Eugen Sabau where the right to death with dignity must prevail over the right of victims to justice.  Sabau was satisfied by the outcome, but his victims certainly were not.  For them, justice was not done.  Euthanasia can be like a spanner in the works of a civilised society.

Euthanasia in Uruguay
Where is this country with a name that is difficult to spell?  Of course, it’s in South America, squeezed between the colossi of Brazil and Argentina.  Small it maybe but it is currently bidding to behave like some of the giants of euthanasia.

In September, the Health Committee of Uruguay’s Lower House passed a bill approving euthanasia.  The entire House is now to debate the issue in a plenary session, probably in October.

The bill, which was first introduced in 2020, has languished because of the Covid-19 pandemic.  Uruguay’s president, Luis Lacalle Pou, and the Roman Catholic Church are strongly opposed to the measure.  However, a recent poll indicated that 55% of Uruguay’s citizens are in favour of euthanasia.  Another country is probably about to bite the bioethical dust – how sad.

Genetic Technologies

Synthetic embryos – no ova, no sperm, no uterus
Herein, a major advance in embryology, though it prompts the question, is it really an advance?  The age-old recipe for kick-starting mammalian life is simple – take an ovum, mix it with sperm, place it in a cosy uterine environment and wait.  But two recent research papers have demonstrated that there is another way.  Using only embryonic stem cells from mice and an artificial incubator, synthetic embryos (sEmbryos) have been created that are physically and functionally close to the natural model.

First, the Israeli way.  Using only stem cells, without sperm, ova, or even a womb, researchers at the Weizmann Institute of Science in Rehovot, Israel, created mouse embryos with beating hearts, circulating blood, brain tissues and rudimentary digestion systems.  The Institute’s website heralds the discovery as ‘The method opens new vistas for studying how stem cells self-organize into organs and may in the future help produce transplantable tissues.’

The Washington Post described the research as, ‘a fascinating, potentially fraught realm of science that could one day be used to create replacement organs for humans.’  So the technique is being hyped for its potential to create material for organ transplants, eventually, for human use.  This was confirmed by the lead scientist, Dr Jacob Hanna, who stated, ‘We are really facing difficulties making organs and in order to make stem cells become organs, we need to learn how the embryo does that.’  Is this just clever PR and marketing?  Or is there something more sinister going on?

The work was reported under the title, ‘Post-gastrulation synthetic embryos generated ex utero from mouse naive ESCs’ by Shadi Tarazi et al., and published in Cell (2022, 185: 3290-3306).

The scientists started with in vitro cultured embryonic stem cells (ESCs) from mice and injected them into pre-implantation mouse embryos.  Could such naive stem cells independently give rise to entire gastrulating embryo-like structures with both embryonic and extraembryonic compartments?  The answer is, ‘Yes’.  The technique produced what are called synthetic whole embryo models (sEmbryos).  With some deft biological tweaking and novel culture procedures, these sEmbryos grew for up to 8.5 days through the gastrulation stage into multi-layered structures and onto organogenesis.  In other words, starting with only ESCs they can be coaxed to self-organise and develop into functional mammalian embryos ex utero with developing brains, beating hearts, and so on.

Second, there is the UK-USA way.  Researchers from the University of Cambridge and the California Institute of Technology similarly grew so-called 'integrated stem cell-based embryo models' for 8.5 days.  Normal mouse gestation is typically between 18 and 21 days.  At 8.5 days, beating hearts, circulating blood, brain tissues and rudimentary digestion systems were observed.

This research was reported under the title, ‘Synthetic embryos complete gastrulation to neurulation and organogenesis’ by Gianluca Amadei et al., and published in Nature (2022, 12 August).

These sEmbryos were created by combining three different and specific types of embryonic stem cells – one that will develop into the embryo, with the other two developing into extraembryonic structures including the placenta and yolk sac which provide the early embryo with nutrients.

When combined in an artificial incubator, the stem cells were found to signal to each other via touch and chemical messengers, allowing them to spontaneously self-organise into embryos.  These sEmbryo models also reached the point where the entire brain, including the anterior forebrain, began to develop.  They are the closest any model has ever come to resembling a naturally-developing embryo in a uterus.

Lead researcher in the Cambridge group, Magdalena Zernicka-Goetz, maintains, 'The stem cell embryo model is important because it gives us accessibility to the developing structure at a stage that is normally hidden from us due to the implantation of the tiny embryo into the mother's womb.'  In contrast to the Israeli research, Zernicka-Goetz declares a quite different USP (unique selling point) for her team’s work.  It is using early embryos to understand infertility, common developmental disorders and miscarriage and to devise suitable therapies.  Who could be against such mouse research?  However, both teams have announced they are also working towards developing human embryo models, but stress that these efforts are considerably further behind given the differences in understanding between early human and mouse development.  But here it is – mice to men.

Where is all this going?  sEmbryos are now here.  Ask some questions.  First, what is their origin?  These novel technologies use embryonic stem cells.  So far, these have been obtained from mice, but human sources are undoubtedly on the distant horizon – after all, from mice to men is the trajectory of most biological science research.  This raises the old, but still valid, objection that the harvesting of embryonic stem cells inevitably destroys embryos, whether murine or human.  Why could not the researchers have used non-embryonic stem cells, such as adult stem cells, or induced pluripotent stem (iPS) cells from mice?

Second, though both studies found the creation of mouse sEmbryos highly error-prone, with only one in 100 attempts being successful, there is that knotty question that if, and when, these techniques do construct human sEmbryos, would they really be human?  Currently the consensus seems to be that though sEmbryos are similar to, they are not equivalent to real, natural embryos.  For the time being they remain outside the restrictions of human embryo experimentation laws, such as the UK’s Human Fertilisation and Embryology Act 1990, because they are not classed as ‘permitted embryos’.  That may need to be changed soon.  Though sEmbryos have not been conceived naturally, might they not continue to grow from embryo to foetus if transferred into a womb?  But that would be unlawful to use them to establish a pregnancy in a woman, because they are not (yet?) ‘permitted embryos’.

Third, the question of why should be asked.  What is this technology for?  The word ‘for’ is significant.  Is it just for the legitimate accumulation of scientific knowledge?  Or is it ultimately for the illegitimate use of tiny human beings for the good of larger human beings?  Such ‘means-to-an-end’ exploitation of humans, at any stage of their development, is reprehensible.  History shouts that, loud and clear.

Fourth, should the bigger picture of creating of human sEmbryos for the purpose of harvesting their organs be necessary and permissible?  Of course there are thousands of people worldwide who are currently waiting for life-saving or life-enhancing donations of transplantable organs.  The bioethical agnostics say, ‘Yes, go for it, whatever the consequences.’  The bioethical sensitive say, ‘No, go by non-controversial, bioethically sound routes.  For example, somatic gene therapy can be the curative answer to a growing number of illnesses and diseases.  It is commonly judged to be a part of good medicine, namely that often elusive so-called culture of life.  If you generally approve of bone-marrow transplants and a little light genetic engineering, this branch of medicine will cause you little or no bioethical unrest.  However, gene therapy of the germline variety is quite another issue.  Moreover, it is reasonable to assume that the need for organ donation and transplantation will decrease in the future.  First, because, as time goes by, larger and more comprehensive tissue-donor registers will be compiled, so that tracking down suitable bone-marrow or umbilical-cord donors will become easier.  And second, because advances in stem-cell technologies will provide additional banks of stored, compatible, transplantable stem cells ready to create the required tissues and organs.

Fifth, there is an additional USP embedded here.  Sarah Norcross, the director of PET (Progress Educational Trust), has used these studies to lobby for another hobby-horse of human embryo experimenters, namely the 14-day rule that forbids destructive experimentation of human embryos after that upper time limit.  She has said, 'Unlike actual human embryos, stem-cell-based embryo models [sEmbryos] in humans and other organisms are not restricted by a 14-day rule.  These models are extremely helpful for research, but there still remains a case for changing the law to extend the 14-day rule, so that we can continue to learn from the precious embryos that have been kindly donated by fertility patients following their treatment.'

There should always be bioethical bright lines in medicine.  Obtaining and creating organs for human transplants is generally a worthy pursuit.  Similarly, understanding and devising treatments for infertility and miscarriage.  But even these enterprises have no-go areas.  The deliberate destruction of human embryos in one such zone.  Any therapeutic use of human sEmbryos is in the distant future.  Its bioethical legitimacy has yet to be fully debated and determined.  Given that the nature and status of natural human embryos are still largely unresolved, that of sEmbryos is unlikely to be resolved soon.  Nevertheless, now is not too soon to start and rekindle those bioethical and legal conversations.

Gene therapy and ‘bad’ cholesterol
High levels of low-density lipoprotein (LDL) cholesterol, commonly known as ‘bad' cholesterol, can cause arteries to clog and harden over time, resulting in atherosclerotic cardiovascular disease (ASCVD), which can lead to heart attacks and strokes.

Verve Therapeutics is a biotechnology company located in Cambridge, Massachusetts.  VERVE-101 is its single course, life-long, gene-editing medicine that uses CRISPR base editing to make a single base change in liver DNA.  The change consists of switching an adenine to a guanine.  That alteration then permanently turns off the PCSK9 gene in liver cells.  It is this gene that can cause high levels of ‘bad’ cholesterol in some people.

The first patient in a Phase 1 clinical trial, currently being conducted in New Zealand, has been recently treated with VERVE 101.  This is part of a larger ongoing trial for patients with familial hypercholesterolemia (HeFH), which causes them to have abnormally high levels of LDL cholesterol that do not respond to lifestyle interventions, such as diet and exercise.  Moreover, HeFH is a prevalent and potentially life-threatening subtype of ASCVD.  The overall plan is eventually to enrol 40 such patients in order to evaluate the safety and tolerability of this treatment.

However, there are hazards ahead.  For example, the therapy uses nanoparticles to transport the genetic instructions into the liver cells.  Such minute particles can cause muscle pain.  And while the administration of ordinary medicines can be halted if problems arise, gene therapies, once commenced, are unstoppable and irreversible.

But if the therapy works, it could impact the lives of millions.  Dr Eric Topol, a cardiologist and researcher at Scripps Research Institute in California, has said, 'Of all the different genome editing ongoing in the clinic, this one could have the most profound impact because of the number of people who could benefit.'  As the company website states, ‘VERVE-101 has the potential to change the way cardiovascular disease is cared for by lowering LDL-C as low as possible for as long as possible after a single treatment.
Stem-cell Technologies

Paolo Macchiarini
The rise and fall of this most famous of Italian surgeons has been followed in these Update pages for a decade and more.  He was a stem-cell technology pioneer.  In 2008, he was feted as an international celebrity after he had performed the world’s first windpipe transplant at the Karolinska Institute in Sweden.  He used a patient’s own stem cells to create a ‘new’ trachea.

Then it all began to go wrong.  Subsequent patients died prematurely, while allegations of fraud and scientific misconduct were made.  He denied all charges but, by 2016, he was finally dismissed.  In addition, Macchiarini later emerged to be philander, fabulist and an open liar.

His latest brush with the law involved the reopening of some of his surgical cases and charges of ‘aggravated assault’.  Macchiarini’s trial ended on 23 May 2022, and he was found guilty of causing bodily harm, but not guilty of two charges of assault.  On 16 June 2022, he received a two-year suspended sentence.

This Macchiarini saga has been a loathsome scandal.  The man has proved to be ghastly in both medical occupation and personal character.  Moreover, he has tarnished the reputation of stem-cell technologies.  Sadly, the latter have been subjected to relentless hype and unrealistic expectations by the media and others besides Macchiarini.  On the other hand, some stem-cell therapies have quietly delivered amazing treatments and cures.  Yet Paolo Macchiarini has managed to single-handedly besmirch such good medicine.

Stem-cell trials in Japan
Over the last few years, Japan has invested heavily in stem-cell technology research, specifically using the non-controversial induced pluripotent stem (iPS) cells, first discovered by their very own Nobel Prize winner, Shinya Yamanaka of Kyoto University.

This technique of reprogramming mature human cells to produce these iPS cells, which in turn are used to repair damaged tissues and organs, appears to work.  For example, in January 2022, it was reported that the first person in Japan given a transplant of heart muscle cells made from iPS cells had experienced improved heart function.  Then, in April, another Japanese research group announced that several people’s vision had been improved after their diseased corneas were transplanted with corneal cells produced from iPS cells.

According to Wolfram-Hubertus Zimmermann, a pharmacologist at the University Medical Centre Göttingen, ongoing trials in Japan are, ‘delivering encouraging first insights into the evolution of iPS-cell-based therapies, from lab to patient.’  And Kapil Bharti, a translational stem-cell researcher at the US National Eye Institute in Bethesda, Maryland, maintains that these iPS cell trials in Japan, ‘give people confidence all over the world that it is doable.’

Yet all is not going exactly swimmingly.  Despite several clinical trials showing iPS cell technologies are safe, their beneficial effects have been demonstrated only in small clinical trials with small numbers of patients.  And apparently the Japanese public enthusiasm for this type of regenerative medicine has begun to wane.  In other words, the next round of Japanese future research funding, due to begin in 2023, may be problematic.  To be successful, trials need to demonstrate significant improvements for patients so that industry, as well as government, will invest.

Stem cells and motor neurone disease
If proof were needed that some stem-cell technologies can be functionally beneficial, here is a novel example that has a firm scientific basis.  Motor neurone disease (MND, amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease) is a fatal neurodegenerative disorder that consists of the progressive loss of motor neurons, leading to paralysis and death usually within 3 to 5 years of diagnosis.  Drugs, such as riluzole and edaravone, have been approved for use in the USA, but they result in only a modest slowing of the disease.

This new research has been published as, ‘Transplantation of human neural progenitor cells secreting GDNF into the spinal cord of patients with ALS: a phase 1/2a trial’ by Robert H Baloh et al., in Nature Medicine, 2022, 28: 1813-1822.

Basically, it is a combined stem-cell and gene therapy that promotes the survival of motor neurons in MND patients.  It involves transplanting engineered protein-producing stem cells, known as human neural progenitor cells, into the central nervous system (CNS), where the compromised motor neurons are located.  There these stem cells can be transformed into new supportive glial cells, known as astrocytes, as well as release a protein known as glial cell line-derived neurotrophic factor (GDNF).  GDNF can protect and promote the survival of motor neurons, which are essential in order to pass signals from the brain or the spinal cord to the muscles to enable bodily movement.  It is these motor neurons that die in MND.  But GDNF alone cannot cross the blood-brain barrier so transplanting the stem cells directly into the CNS, where they can deliver GDNF, is this study’s innovative approach to MND treatment.

First and foremost, Baloh and his colleagues at the Cedars Sinai Medical Centre in Los Angeles, demonstrated that a one-time treatment with this new product (known as CNS10-NPC-GDNF) derived from the combined treatment of stem-cell technology and gene therapy is safe in humans.  The Phase 1/2a trial recruited 18 MND patients.  None experienced serious side effects after transplantation of the engineered protein-producing cells.  Tissue analysis of 13 participants, who died of MND progression, showed transplanted graft survival and GDNF production for up to 42 months post-transplantation in all but one case.  However, there were minor drawbacks.  For instance, some of the transplants were placed too high in the CNS, patient numbers were small and too many of them were late-stage MND sufferers.  Future planned trials should obviate such shortcomings.

Oh no!  A more careful reading of this 10-page complex Nature Medicine article reveals that the stem cells used were derived from ‘A single human fetal cortical sample …’  Be warned, beware, the destructive use of human embryos and foetuses as sources of experimental material is occurring in research laboratories around the world.  In this case it was foetal brain.  Why could the researchers not have used adult stem cells or iPS cells?  Why indeed?

Stem-cell ruling in the USA
Who oversees and regulates stem-cell technologies and treatments in the USA?  Why, the Food and Drug Administration (FDA) of course.  Not so.  Now no longer so according to a recent court decision.

In a recent judgement in the case of the FDA versus the California Stem Cell Treatment Center et al., (CSCTC), it was ruled that the FDA’s powers do not extend to the regulation of some stem-cell treatments.  The federal judge, Judge Jesus Bernal of the central district of California, entered a judgement in favour of the defendants, the CSCTC.  In other words, the court decided that the defendants' medical procedure that uses patients' stem cells to treat different diseases and medical conditions does not fall within the FDA's authority.

Stem-cell treatments in the USA are already like a Wild West affair – medically unproven and even risky treatments are legion.  This court judgement could increase that number.

The case alleges that the CSCTC manufactured stromal vascular fraction (SVF) products from patient’s adipose tissue without first receiving FDA's formal approval for a new drug.  SVF cells consist of multiple cell types found within fat tissue; including mesenchymal stem cells, haematopoietic cells and progenitor cells among others.  In essence, SVF cells are the naturally-occurring part of the adipose tissue that does not contain the fat cells.

CSCTC held that the patient’s stem cells are not drugs and therefore cannot be regulated by the FDA.  The FDA disagreed.  The court disagreed with the FDA saying that the surgical procedure does indeed not create a new drug.  It stated that 'The SVF cells are not altered, chemically or biologically, at any point during the SVF surgical procedure.  There are no genes added to or removed from the SVF cells during the SVF surgical procedure.  The SVF surgical procedure does not change the size or genetic makeup of the SVF cells’, and so on.  Therefore, these procedures cannot be regarded as drugs within the meaning of the 1938 Federal Food, Drug, and Cosmetic Act (FDCA).

Judge Bernal's decision has now caused regulatory uncertainty.  It is inconsistent with other similar cases.  Clinics providing stem-cell therapies must provide the FDA with evidence-based details and the FDA, as the government regulatory agency, has an obligation to gather this information.  A prominent stem-cell association, the International Society for Cell & Gene Therapy (ISCT), issued a response to the court’s ruling, stating that the judge's decision has widespread consequences for the stem-cell and gene therapy field.

The likely upshot is that this ruling will create opportunities for unscrupulous for-profit private clinics to provide purported stem-cell treatments that are scientifically unproven and potentially dangerous for vulnerable patients.  Potential stem-cell therapies require full independent review by regulatory agencies like the FDA to ensure they are safe and effective.  Judge Bernal, you have made a bad and wide-ranging decision.  A judiciary should protect its citizens, not allow them to be thrown under the bus driven by the unscrupulous.
Miscellaneous

Gregor Johann Mendel (1822-1884)
If he had lived, Gregor Mendel would have been 200 this year.  Happy birthday Gregor for 20 July – sorry I am a bit late.

Mendel was an Augustinian secluded monk, an amateur scientist, meteorologist, mathematician and more besides.  We all know about Gregor because he famously messed about with pea plants in his two-hectare monastery garden.  And in about 1860, he reported something of the mechanisms of genetic inheritance after crossbreeding thousands of his plants and observing and recording whether the peas were round or wrinkly, green or yellow, and so on. He coined the terms ‘recessive’ and ‘dominant’ with reference to certain of these genetic traits.

His contribution to science has been enormous.  Indeed, human genetic engineering rests upon three pieces of remarkable research spanning over 160 years of scientific endeavour.  First, there was Gregor Mendel in the 1860s.  Second, in 1953, James Watson and Francis Crick described, in a two-page article in Nature, the three-dimensional structure of the double helix of deoxyribonucleic acid (DNA), the carrier of the genetic code.  Third, in 2000, a huge team of international scientists working on the Human Genome Project ‘cracked’ this human genetic code, that is, they sequenced the 3.3 billion (3.3 x 10⁹ ) chemical ‘letters’ of our DNA.  These are three of the most wondrous feats of genetics – we should never overlook their significance.  And nor should we forget Mendel singly labouring away on his own enthusiasm in Moravia, which is now part of the Czech Republic.

His work was initially overlooked but eventually he became to be regarded as the ‘father of genetics’.  His insights revolutionised our understanding of biological inheritance which were subsequently applicable to human health and disease, modern-day genomics and even personalised medicine.  To this day, biologists, and especially geneticists, still speak of 'Mendelian' inheritance and 'Mendelian' disorders that obey the laws proposed by Mendel.  What a legacy!

And his contribution to science lives on in a facility called the Online Mendelian Inheritance in Man (OMIM).  This is a comprehensive, authoritative compendium of human genes and genetic phenotypes that is freely available and updated daily.  The full-text of OMIM contains information on all known Mendelian disorders and over 16,000 genes.

Happy bicentennial birthday, Greg.

Autonomy revisited
This is a strange word describing an even stranger concept.  Its meaning from the Greek (autos, self, and nomos, law) is simple – ‘self-government’ which can readily transmogrify to a twenty-first century notion of ‘personal freedom’.  It therefore ranges from a stiff stoicism to a liberal free-for-all.

When properly applied, autonomy can rightfully stress the moral responsibility that each of us should exercise.  For example, medicine has, in recent times, seen a welcome movement away from some of the awful medical paternalism of the past – ‘I’m the doctor, and I know what’s best for you – towards a more reasonable patient autonomy – ‘But I’m the patient, so please explain it to me.’  Such an appropriate application of conditional autonomy can only be beneficial to all concerned.

However, like several other decent bioethical words and concepts, autonomy has now taken on a more malevolent meaning.  By claiming it to be unconditional, it now carries a connotation of ‘lawlessness’.  As one of the buzzwords of modern bioethics, ‘autonomy’ now expresses the idea that we have the right, and even the duty, to do whatever we want with our own lives, that there should be no limits, legal or otherwise, to our individual freedom.  Therefore, we can set our own personal rules and our own private standards for morality and behaviour.  This, of course, is social dynamite.  As members of any society, we all accept certain boundaries to our freedom, such as observing speed limits, paying taxes and, where indicated, keeping off the grass.  In the realm of bioethics, misapplied, unconditional, absolute autonomy produces self-centred responses like, ‘It’s my life, it’s my body, and it’s my decision’ and ‘I will choose to die when, where and how I want to’. 

But what does a person mean when he or she proclaims, for instance, ‘It’s my life’?  If a woman says, ‘It’s my book’, we all understand that she bought it, she read it, she put it on her shelf, and so on.  But ‘my book’ is in an entirely different category from ‘my life’, unless, of course, you hold that everything – human life, society, a book and the entire universe – is just a mechanistic phenomenon, a matter of merely the atomic and the molecular.  Such an overdose of autonomy can be disastrous. It allows the individual to take centre stage, to be the prima donna or the leading man.  So, for example, it excludes others from what would best be relational, family-based or even society-centred decisions.  It can sideline family, friends, wise counsellors and – perhaps most importantly in, for example, the case of aborting the unborn child – the father.

Autonomy, as a key feature of modern bioethics, puts the individual above all others, and it puts self, rather than even God, at the very centre – a defining characteristic of secular humanism.  Think of all those unattractive, un-Christian words like self-aggrandizement, self-assertion, self-centred, self-contained, self-indulgent, self-reliant, self-righteous, self-seeking and self-sufficient, and you will begin to understand both the meaning and the end product of unconditional autonomy.

Population numbers in China
Data show that China is facing a demographic crisis, with an ageing population and young couples having fewer children.  Last year, China's population increased by less than half a million people to 1.41 billion.  When will it peak and decline?

There are several answers to that question.  For a start, after years of falling birth rates, the country’s National Health Commission announced in August 2022 that total growth has slowed significantly and that numbers will peak and begin to shrink between 2023 and 2025.  Others think it could happen much sooner.  For example, in 2022, Yong Cai, a demographer at the University of North Carolina, Chapel Hill has said, ‘I won’t be surprised if population decline is reported at the end of this year.  The turning point is right around the corner.’  Or, according to Wei Chen, a demographer at Renmin University in Beijing, on the basis of national census data released in 2020, China’s population might have already peaked in 2021

In the light of these decreasing statistics, the Chinese government has been making significant efforts to boost birth rates for the past decade.  How strange this policy shift is.  After decades of population control programmes, including the infamous one-child policy, now the young are being encouraged, even induced and rewarded, to reproduce.  Two children were allowed in the 2010s, now the talk is for three.

But, after nearly four decades of proscribed families, the young are not so easily persuaded towards extended parenthood.  That former child-limiting policy has shifted attitudes about marriage and childbearing with young people delaying these events.  And with more women pursuing higher education and careers, they are starting families later in life, if ever.  That trend is expected to persist and the population dilemmas have refocused to the challenges caused by China’s growing elderly population.

Here is the oldie’s story.  The Chinese baby boomers, born in the 1960s, are now reaching their 60s.  In the next 10 to 20 years, China will see a surge in its older population, which will become a major test for the society.  Currently, more than 18% of China’s population is over 60 years old.  That proportion is expected to increase to 30% by 2050, accounting for 300 million people.  Their increasing numbers, greater longevity and burgeoning medical costs, plus the growth of fragmented families means less societal cohesion and more expensive social care, while fewer workers mean less tax payers and a contracting national treasury.

As already mentioned, last year, China’s total population increased by only 480,000 people, to just over 1.41 billion.  This means the natural growth rate – the difference between the numbers of births and deaths – was close to zero.  And the country’s birth rate declined for the fifth consecutive year to 7.5 births per thousand people, the lowest since 1949.

Looking at both young and old, the demographic trends in the Chinese population appear to be in troublesome waters.  That is worrying.

Life expectancy in the UK and US
For the last four decades, life expectancy in the UK nations has been increasing.  That trend has now come to a halt, even a ‘statistically significant’ halt.  For example, life expectancy at birth in the UK in 2018 to 2020 was 79.0 years for males and 82.9 years for females.  This represents a fall of 7.0 weeks for males though almost no change for females.

Perhaps unsurprisingly, the latest data from the Office for National Statistics show that the greatest falls in life expectancy are in the poorest areas of the UK.  And men in these areas are now expected to live about 10 years less (73.5 years) than those in the richest areas (83.2 years), and women eight years less (78.3 versus 86.3).  Moreover, those living in the most deprived area are also living more of their lives in ill health.  For instance, girls born in the poorest areas of England live 19 years less in good health than those born in the wealthiest regions.  The government’s levelling-up agenda has a long way to go.

The UK is not alone.  In the US, the average life expectancy of Americans also fell somewhat precipitously in 2020 and 2021 from 77.0 to 76.1.  The expected gender differences were evident.  Life expectancy at birth for men dropped one whole year, from 74.2 years in 2020 to 73.2 in 2021 and for women it dropped 0.8 years from 79.9 in 2020 to 79.1 in 2021.

Why these falls in the UK and USA?  The declines have coincided with the onset of the Covid-19 pandemic.  And the decreases in life expectancies have been largely driven by Covid-19 deaths.  For instance, the virus has killed at least 1 million Americans and it is reckoned to account for 50% of these declines.  Now that Covid-19 effects on mortality have begun to lessen, will life expectancies return to an upward trend?  Maybe.  Yet other major causes of death, such as influenza and pneumonia, strokes and heart disease, cancers and Alzheimer’s disease, are expected to reappear as principal effectors.  Again – only time will tell.
USA and Elsewhere

Post Roe v Wade USA
Rarely has there ever been a judicial decision like that of Friday 24 June 2022 when the Justices of the Supreme Court of America to overturned Roe v Wade, the 1973 ruling that supposedly gave American women the constitutional right to abortion.  While that judgement has not banned all US abortions, it has proved to be a mightily significant move in the life-affirming direction.

In the last few months, the abortion landscape across the US has changed drastically.  Post Roe, decisions about whether or not abortions are permissible have been handed to the individual States to decide.  The country has been split in two – the principles of justice and equity are under fire, the right to life and access to so-called ‘essential healthcare’ are up for debate.  These personal and political ramifications will continue but, above all, many, many unborn children now have a restored dignity and greater protection – they will now live instead of ending up in the hospital waste.

Some States have taken a liberal stance and permitted abortions up to viability at around 24 to 26 weeks, others have imposed various restrictions, while others have banned abortions under all circumstances.  For instance, at the end of September, almost all abortions became illegal in Arizona.  A new law banning abortions after the 15th week of pregnancy took effect and then, in a surprise move, a judge lifted an almost 50-year-old injunction that blocked a near-total ban on abortions from being enforced in the State.  Overall, from September, at least 13 States are now abortion-free and 62 abortion businesses have stopped performing terminations.  Several more States have similar bans that are temporarily gridlocked by legal wrangling over whether or not they can be enforced.  Over 78 million US citizens are now living in abortion-free States.  That is nearly a quarter of the US population.  That proportion is likely to swell in the coming months.

Abortion is a profound bioethical issue, not just a legal matter.  It tests our understanding of who we are, what is right and wrong, and so on.  May this historic striking down of Roe v Wade drive us to reconsider these most fundamental issues.

John MacArthur tells it like it is
In late September, John MacArthur, the evangelical pastor of Grace Community Church in Sun Valley, California, published an open letter to California’s Governor Gavin Newsom.  MacArthur was outraged that Newsom had quoted Jesus Christ on billboards promoting abortion of the unborn.

Newsom, a pro-abortion Democrat, had been working aggressively to expand abortion by signing a dozen pro-abortion bills into law and announcing a budget that included $200 million specifically for new abortion projects.  During September, the Governor had shocked Christians and others by paying for billboards in pro-life States that quote Scripture to encourage women to come to California for abortions.

One billboard read, ‘Need an abortion?  California is ready to help.’  Beneath these words was the text of Mark 12:31, ‘Love your neighbor as yourself.  There is no greater commandment than these.’  It also advertised a new, taxpayer-funded, Californian government website that promotes abortion.

MacArthur wrote, ‘My concern, Governor Newsom, is that your own soul lies in grave, eternal peril.  You will stand in the presence of the Holy God who created you, who is your Judge, and He will demand that you give an account for how you have flouted His authority in your governing, and how you have twisted His own Holy Word to rationalize it.’

He continued, ‘In mid-September, you revealed to the entire nation how thoroughly rebellious against God you are when you sponsored billboards across America promoting the slaughter of children, whom He creates in the womb (Psalm 139:13–16; Isaiah 45:9–12).  You further compounded the wickedness of that murderous campaign with a reprehensible act of gross blasphemy, quoting the very words of Jesus from Mark 12:31 as if you could somehow twist His meaning and arrogate His name in favor of butchering unborn infants.’

MacArthur told Newsom that Jesus’ greatest command was to ‘love God’ and no one can follow that command while ‘aiding in the murder of His image-bearers.’  MacArthur said he and many others are praying for Newsom to repent and turn his life to Christ.  MacArthur concluded, ‘Please respond to the gospel, forsake the path of wickedness you have pursued all your life, turn to Christ, ask for forgiveness, and use your office to advance the cause of righteousness (as is your duty) instead of undermining it (as has been your pattern).’

California is an abortion hot spot.  It has the highest number of abortion facilities in the country standing at 168.  In 2020, approximately 154,000 abortions were performed there.  The Sunshine State already has very few limits on abortion, and it forces taxpayers to pay for them.  Moreover, a new law, expected to come into force next year, will insist that all public colleges and universities provide abortions on campus.

Well said John MacArthur.  Now all you other ministers of the Gospel, speak up and speak out.

Global fallout from Roe v Wade
Repercussions of the Roe v Wade decision have travelled way beyond the USA.  It has provoked protests across the world.  Major international bodies have condemned the ruling, with the World Health Organization (WHO) and the British Medical Association (BMA) strongly opposing the change.  Somewhat predictably, the UK’s Royal College of Obstetricians and Gynaecologists (RCOG) and the Faculty of Sexual and Reproductive Healthcare (FSRH) issued a statement renewing calls for the UK Government to decriminalise abortion in the UK.

In addition to rhetoric, political action has already occurred.  For example, François Braun, the French health minister has signalled that France will soon enshrine the right to abortion in its Constitution.  This is widely seen as a deliberate attempt to bolster women’s rights in the aftermath of the US Supreme Court’s pronouncement.  According to a recent poll, 83% of French voters are already in favour of the right to abortion.  Nevertheless, the move is also regarded as a slighting of conservative EU states, such as Poland and Hungary, where abortion is severely restricted.

Has the Roe v Wade verdict sent France bioethically reckless?  After all, from January 2023, it is to make emergency contraception, the so called morning-after pill (MAP), available free of charge.  Moreover, sperm and ovum donors in France have recently lost their right to anonymity.  Critics of the move say that the French, who are already reluctant to donate compared to their UK counterparts, will be even more reticent now that they can be contacted by people conceived with their sperm and ova.  France currently has only half as many sperm and ovum donors as the UK.  The change in the law, implemented by President Macron, will bring France in line with the UK, which legislated in 2005 to allow people conceived through gamete donations to access the identity of their donors after turning 18.  Will it cause a collapse in French donations?  Only time will tell.

Chile and abortion
The voters of Chile have recently overwhelmingly rejected a new constitution that would have stripped away unborn babies’ right to life and legalised abortion on demand.  The Washington Times reported that just 38% of voters supported the ‘progressive’ constitution, while 62% rejected it.  As a result of the vote, Chile will continue to protect unborn children from abortion.  Exceptions are allowed when the mother’s life is at risk, or she is a victim of rape.

Constanza Saavedra, with the Chilean pro-life group Testimonios por la Vida, celebrated the news, saying the vote gives her hope for the future.  She continued, ‘With joy and hope in a better Chile, with changes that unite us, seeking to improve the quality of life for all, surpassing ourselves and moving forward.  Leaving setbacks, divisions and hatred behind.  A Chile in which we can all continue to proudly say, Viva Chile!’
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