Update on Life Issues

Abortion

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Assisted Reproductive Technologies

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Genetic Engineering

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stem-cell Technologies

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

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

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

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

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

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

 

Euthanasia and Assisted Suicide

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

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

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

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

Withdrawal of clinical assistance

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

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

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

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

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

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

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

USA and Elsewhere

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

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

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

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

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

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

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

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

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

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

Miscellaneous


The Nuremberg Code
On 20 August 1947, just over 70 years ago, and just six weeks before I was born, the International Medical Tribunal in Nuremberg delivered its verdict on the crimes of 23 Nazi doctors and bureaucrats who had been involved in concentration camp medical experiments. As part of that judgment, it produced a 10-point set of rules now known as the Nuremberg Code.


The post-World War II years were dominated by an international push to formulate codes of human behaviour in attempts to ensure that the horrors of war were never to be repeated. Criteria were concocted for respect for human rights, individual autonomy, informed consent, and so on. The Nuremberg Code fitted this agenda.
Perhaps its greatest and most enduring rule concerns the ‘voluntary consent’ of every human research subject. This decree has become a (nearly) global benchmark for the ethical conduct of medical trials. Yet the Code was initially largely ignored. It took some 20 years to gain any significant impact. But even today it has not been officially accepted in law by any nation, or as the ethical guidelines by any medical association. The truth is that it was eclipsed by the World Medical Association Declaration of Helsinki in 1964.

For completeness, the principles of the Nuremberg Code can be summarised as:


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

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

 

John R Ling is a freelance speaker, writer and consultant bioethicist. He is the author of three books on bioethical issues – all published by Day One – including the latest, Bioethical Issues: Understanding and responding to the culture of death. His personal website is www.johnling.co.uk

 

(This article was originally published in the Affinity Social Issues Bulletin for March 2018.)


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