Update on Life Issues

In this article from the recent Bulletin of the Affinity Social Issues Team, John Ling summarises many important developments and news items in the field of biomedical ethics and research:

Update on Life Issues

Abortion

Statistics for 2018

The abortion statistics for 2018 for England and Wales were published on 13 June 2019. They offer no comfort – they are the worst ever. They can be viewed here

In total, there were 205,295 abortions performed on residents and non-residents in England and Wales during 2018. Of these 200,608 were for residents of England and Wales – it is the first time this figure has ever breached the 200,000 boundary. This represents an age-standardised abortion rate of 17.4 per 1,000 resident women aged 15-44. This 2018 rate has increased since 2017 when it was 16.7 per 1,000, but it is lower than the peak in 2007 of 17.9 abortions per 1,000 resident women. 

In 2018, 97.7% of abortions (196,083) were performed under ground C, the infamously comprehensive ‘social clause’. Of these, the vast majority (99.9%) were reported as being performed because of a risk to the woman’s mental health. 3,269 abortions were because of the risk that the child might be born seriously handicapped, that is, performed under ground E. This represents 2% of the total number of abortions and is similar to the 2017 figure of 3,314. 90% of all abortions were carried out at less than 13 weeks of gestation. 1,856 abortions were performed at 22 weeks and over. 111 abortions involved ‘selective reduction’ mostly to reduce two foetuses to one foetus as a result of overzealous IVF treatments. 71% of all abortions were medically induced. This is higher than in 2017 (66%), and almost double the proportion in 2008 (37%). The remainder were surgical abortions of which 24% were vacuum aspiration and 5% were dilatation and evacuation (D&E).

The 2018 abortion statistics for Scotland were published by the Scottish Government on 28 May 2019. They can be viewed here.

The numbers and rates of terminations of pregnancies in Scotland during 2018 were at a ten-year high. There were 13,286 abortions, which is a rate of 12.9 per 1,000 women aged 15-44. The 1967 Abortion Act does not extend to Northern Ireland – abortion remains largely illegal there. Therefore, the grand total number of abortions performed in Great Britain during 2018 was a tragic 218,581.

Decriminalisation of abortion

There is still pressure in Parliament and elsewhere to make abortion a free-for-all medical procedure without any legal or criminal boundaries. A few staunch Westminster MPs continue to concentrate on imposing abortion (and same-sex marriage) on Northern Ireland. In early March, a group of Labour MPs attempted to add amendments on these two controversial issues to the entirely unrelated Northern Ireland Budget (Anticipation and Adjustments) (No. 2) Bill. Both failed to pass. However, pro-abortionist Stella Creasy MP said the group would, ‘take every single opportunity’ to carry on its campaign.

Too many vocal healthcare professionals, as well as politicians, are supporters of decriminalisation. On 22 February, the Royal College of General Practitioners (RCGP) declared its support for abortion being regulated by medical regulatory frameworks rather than the criminal law. The RCGP’s UK Council announced that 62% of respondents to a poll said they support decriminalisation. This email poll was sent to 53,724 of its members – a total of only 4,429 responded, amounting to a meagre 8.2% response rate. Nevertheless, the RCGP now joins the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists, the British Medical Association and the Royal College of Nurses in calling for the decriminalisation of abortion in the UK. Can it get much worse?

Assisted Reproductive Technologies

Fertility Trends 2017

The latest figures from the HFEA were published in May 2019 under the title, Fertility treatment 2017: trends and figures. It can be viewed here.

These are the basic data. Total number of IVF treatment cycles was 75,425 (up by 2.5% on 2016) with 54,760 women patients. The number of ‘take home’ babies was 20,500 and the multiple birth rate was 10%. Overall, the success rate, measured as birth rate per 100 embryos transferred (PET), was 22%, or a 78% failure rate.

Some of the trends identified by the HFEA include the reaching of the target of 10% multiple birth rate. It was 24% in 2008. Multiple births are the biggest single health risk to mothers and babies, yet even at 10% they are still way above the natural rate of 1.6%. More embryos transferred, more twins and triplets born – simple. The obverse is simple too.

Embryo freezing techniques have improved. Therefore treatment cycles using frozen embryos have continued to increase and these now result in success rates similar to those with fresh embryos.

Though heterosexual partners comprised 90.7% of all treatments, the reasons why people use fertility clinics are changing. The numbers of patients, though still small, from same-sex partnerships and singles are increasing. Female same-sex couples were 5.9% and single parents or surrogates were 3% and 0.4% respectively. This, according to Sally Cheshire, chairwomen of the HFEA, ‘ … reflects society’s changing attitudes towards family creation, lifestyles and relationships and highlights the need for the sector to continue to evolve and adapt.’

More IVF downsides

There are numerous downsides to IVF – many of them are detailed in my book, Bioethical Issues (2014). Here are four more to add to the list.

First, older women, according to the HFEA, are now being exploited by some IVF clinics, which are ‘trading on hope’ and using ‘blatant sales tactics’. In 2017, there were 10,835 women in their 40s going for fertility treatments. Between 2004 and 2017, there were 2,406 embryos transferred to women over 44 years, but only 25 ‘take-home’ babies – a success rate of 1%.

Second, a few clinics are profiteering. This is nothing new. But some, says the HFEA, are charging up to £20,000 per treatment cycle – roughly four times the average cost. There have been several reports of costly IVF add-ons that are of unproven efficacy but easily sold to desperate couples. They include pre-implantation genetic screening, the transfer of a ‘mock’ embryo, time-lapse imaging and various drug treatments for blood clotting and immunity.

Third, while fertility clinics charge large, sometimes excessive, fees to help women conceive, they can also leave large bills for taxpayers. It is now estimated that private fertility clinics present the NHS with costs of about £120 million each year for treating sick and premature babies born to their clients and also conditions, such as ovarian hyperstimulation syndrome (OHSS), for the hopeful mothers-to-be. The private fertility industry in the UK is worth about £300 million a year, but it effectively gets £120 million annual subsidy via the UK taxpayer. This latest four-year study of 350,000 fertility patients was led by Dr Gulam Bahadur of Homerton University Hospital. He said, ‘The people operating these clinics are taking the profits and not paying anything for the mess they are making.’

Fourth, there is this common question, ‘Do ARTs, such as IVF, have medical consequences for the mother and the conceived and born child? There has been a long history of adverse disorders. Here are some more. A study, led by Natalie Dayan at McGill University in Montreal and St Michael's Hospital in Toronto, Canada, compared 11,546 women in Ontario, who had received fertility treatments with 47,553 women, who had received no treatments, between 2006 and 2012. The ARTs included ovulation induction, intrauterine insemination (IUI) and IVF, with and without, intracytoplasmic sperm injection (ICSI).  The researchers found that 30.8 per 1,000 of the women who received an ART treatment experienced a severe pregnancy complication. This compared with 22.2 per 1,000 experiencing a severe complication in the untreated group. Complications included bleeding, serious infections, intensive care admissions and, in rarer cases, death. Whether these effects are a reflection of underlying maternal health issues rather than IVF itself remains uncertain.

Genetic Engineering

Gene edited babies – the latest

The worlds of science and bioethics are still transfixed and deeply troubled by the human reproductive germline editing work of He Jiankui, the Chinese researcher, who last November claimed to have created the world’s first genetically-engineered human babies – the twins, Nana and Lulu. The global repercussions are still reverberating.

Dr He’s original intention was to protect the babies from HIV infections by targeting, mutating and thereby disabling the CCR5 gene, which codes for a protein that allows some common strains of HIV, the virus that causes Aids, to enter a cell. Now comes news that his approach may have caused more harm than good.

These conclusions are based on work by Xinzhu Wei and Rasmus Nielsen and published as, ‘CCR5-∆32 is deleterious in the homozygous state in humans’ in Nature Medicine (2019), 25: 909–910. They analysed the genetic and health data of 409,693 British individuals from the UK Biobank research project. And they estimated that people with two disabled copies of the CCR5 gene are 21% more likely to die before the age of 76 than people with only one working copy.

Deleting part of the gene can disable it so that it mimics a naturally-occurring mutation, CCR5-Δ32. It is this that confers resistance to HIV. But researchers are also concerned that the CCR5-Δ32 mutation can make people more susceptible to the effects of infections, such as influenza and West Nile virus. Indeed, previous studies have suggested that two mutated copies of the CCR5 gene are associated with a fourfold increase in the death rate after influenza infection. Furthermore, the protein that CCR5 codes for, and which no longer works in those having the mutation in both copies of the gene, is involved in many other body functions. Genetic tinkering is never simple – we are ‘fearfully and wonderfully made.'

More gene-edited babies?

Of course it was bound to happen. A Russian molecular biologist is now seeking approval from the Russian health ministry and other agencies to genetically modify human embryos. But scientists are still concerned the technology is not ready.

Denis Rebrikov, head of the genome-editing laboratory at the fertility clinic at Moscow's Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, has told Nature that he plans to make the same genetic changes as He Jiankui did, but using an improved methodology. Researchers are still concerned.

Rebrikov's plan is to recruit HIV-positive wives from HIV clinics in Moscow – He Jiankui used HIV-positive husbands. Then Rebrikov intends to tweak the notoriously finicky CRISPR editing technique so that unintended gene edits do not occur outside its target area. His target is still the same CCR5 gene and he plans to disable it in embryos before transferring them to HIV-positive mothers, so reducing the risk of passing on the virus to their in utero babies. Rebrikov claims his technique will offer greater benefits, pose fewer risks and be more ethically justifiable and acceptable to the public.

A global moratorium?

The gene-editing of human embryos is so controversial that a global moratorium has been suggested by some of the world's foremost CRISPR experts and bioethicists. Editing an embryo introduces genetic changes into the gene pool but the science remains inchoate. For instance, according to Gaetan Burgio, a geneticist at the Australian National University, ‘The technology is far from ready. I don't see any gene worth targeting to date and for the next couple of years as long as the technology is not ready.’

Meanwhile, China is apparently tightening its research rules. Already He’s type of gene-editing experiments have been halted. Anyone who manipulates human genes in adults or embryos will be responsible for adverse outcomes. And draft laws, ensuring that clinical trials would face closer scrutiny and stricter requirements, have been presented to China’s legislature.

The surprisingly permissive publication from the UK's Nuffield Council on Bioethics entitled, 'Genome Editing and Human Reproduction: Social and Ethical Issues' (July 2018) concluded that germline genome editing could be allowed under certain circumstances. These included that, ‘… interventions must be intended to secure the well-being of the relevant person (and their descendants), and there must be regard for “social justice and solidarity”.’ OK, that may sound nice, but it is debatable and quite unenforceable.

On 24 April, a group of 62 doctors, scientists and bioethicists from the American Society of Gene and Cell Therapy sent a letter to Alex Azar, the US Secretary of Health and Human Services, urging a moratorium. They stated, ‘Although we recognize the great scientific advancement represented by gene editing technologies and their potential value for an improved understanding and possible treatment of human disease, we strongly believe the editing of human embryos that results in births carries serious problems for which there are no scientific, ethical, or societal consensuses. As a result, we contend that such human genetic manipulation should be considered unacceptable and support a binding global moratorium until serious scientific, societal, and ethical concerns are fully addressed.’

So, what chance of a worldwide ban, or even a moratorium? Improbably remote. Would prohibition simply drive it underground? Can you think of any successful global agreement, on anything? I’m still waiting! 

CAR-T therapy

Chimeric antigen receptor T-cell therapy (CAR-T therapy) may be a mouthful, but it may also be a wonderful remedy. It came to prominence last August when the US Food and Drug Administration (FDA) approved its use in America for the treatment of acute lymphoblastic leukaemia (ALL) in patients up to the age of 25 years old. Now the treatment has been approved in the USA for the treatment of certain adulthood lymphomas.

Basically, it a type of gene therapy that genetically reprograms the patient’s immune system in order to fight cancers. The patient’s own white blood cells, known as T-cells, which are part of the human immune system, are removed from the patient’s blood. Then the gene for a special receptor that binds to a protein in the patient’s particular cancer cells is added to the T-cells using genetic engineering procedures. This receptor is called a chimeric antigen receptor (CAR). Large number of these modified CAR-T cells are grown in the laboratory and finally infused into the patient. These ‘new’ CAR-T cells are able to start an immune response which destroys tumour cells.

The treatment has been called a ‘living drug’, because of its long-term persistence in the body. It is also a totally personalised medicine because each treatment is patient specific – this is known as autologous CAR-T therapy. But there are drawbacks. It is costly because the tricky genetic manipulations are carried out by biotech companies in the US and take about a month. And the official price tag is about £280,000 per patient. There can be serious side effects, such as short-term neurotoxicity, where the brain and nerves are affected, which can lead to confusion, difficultly speaking and a loss of consciousness. And fever, vomiting and diarrhoea can also occur. But it is also seemingly effective, though only small numbers of patients have been using it for relatively short times. Nevertheless, so far, in one clinical trial, 40% of patients have had all signs of previously untreatable, terminal lymphoma eliminated from their bodies after 15 months of treatment. Whether it is effective for solid tumours, such as lung cancers and melanoma, has yet to be established.

Nevertheless, the future of CAR-T therapy looks bright. Certainly by June 2019, doctors at King’s College Hospital, London have been impressed. Victoria Potter, consultant haematologist there, has said, ‘It's amazing to be able to see these people, who you may have not been able to give any hope to, actually achieving remission. And that is a situation we have never seen before and it's an incredibly impressive change in the treatment paradigm.’

Stem-cell Technologies

Placental stem cells

Stem-cell technologies can often surprise – here is another unexpected example. Researchers at the Icahn School of Medicine at Mount Sinai, Israel have demonstrated that stem cells derived from the placenta, known as Cdx2 cells, can regenerate healthy heart cells after heart attacks in animal models. The findings have been published in the Proceedings of the National Academy of Sciences (2019), 116: 11786-11795, under the title, ‘Multipotent fetal-derived Cdx2 cells from placenta regenerate the heart.’

First of all, this has been done only in mice – humans will have to wait several years, but it might become a treatment for regenerating the human heart. Second, these stem cells remarkably migrated to the site of the injured heart. Third, when these cells were injected into the tail veins of male mice not only did they home to the heart, they became differentiated and incorporated as heart cells and blood vessels. Fourth, these incorporated heart cells began to spontaneously beat. Amazed? So am I.

This amazement was shared by the lead author, Sangeetha Vadakke-Madathil. She commented, ‘These results were very surprising to us, as no other cell types tested in clinical trials of human heart disease were ever shown to become beating heart cells in Petri dishes, but these did and they knew exactly where to go when we injected them into the circulation.’

Another new adult stem-cell treatment

Alessandro Montresor, who was born in London to Italian parents, was given only weeks to live by doctors at Great Ormond Street Hospital (GOSH). He was suffering from haemophagocytic lymphohistiocytosis (HLH), a rare autoimmune disease that affects white blood cells. His experimental drug treatment at GOSH was becoming ineffective. A worldwide appeal for a bone marrow donor failed.

So, in November 2018, Alex was taken to the Bambino Gesù Pediatric Hospital in Rome. There he was treated with a pioneering technique using specially-treated stem cells derived from his father’s blood. In April 2019, two-year-old Alex was discharged from hospital and he returned to London, cured and with a healthy immune system. Hooray for adult stem-cell treatments!

iPS cells and transplants

Japan, world leaders in induced pluripotent stem (iPS) cell technologies, has taken the controversial step to allow research that involves incorporating human stem cells into animals, producing so-called chimeras. Such human-admixed embryos are subject to numerous bioethical questions.

The Japanese technique will involve implanting embryonic animals – probably pigs at first – with human iPS cells which can transform into any part of the 200 or so tissues and organs of the adult body. The idea is that the iPS cells will grow into transplantable human organs inside the growing animal.

Japan had previously required researchers to terminate animal embryos implanted with human cells after 14 days. These old regulations also banned the transfer of mixed embryos into animal wombs to allow them to develop. Both restrictions have now been repealed. Researchers will now, for instance, be allowed to create a pig embryo with a human pancreas and transfer it into the womb of an adult pig, which could in theory result in the birth of a baby pig with a human pancreas, suitable for transplantation.

iPS cells and cancers

Natural killer (NK) cells are part of the immunotherapy armoury. In November 2018, a pioneering clinical trial began testing stem-cell derived NK cells for people with incurable solid tumour cancers. Researchers at the University of California San Diego Medical School together with Fate Therapeutics are using a NK cell product derived from induced pluripotent stem (iPS) cells and called FT500. Since FT500 does not need to be matched to a patient, like other T-cell therapies, researchers say FT500 can be administered in the out-patient setting as an ‘off-the-shelf’ cell product.

This phase 1 trial involves 64 people and seeks to answer three questions. First, is the treatment safe? Second, do tumours respond to this NK cell therapy? Third, how long do the NK cells remain effective in the body? Dr Dan Kaufman, the lead scientist, has stated, ‘This is a landmark accomplishment for the field of stem cell-based medicine and cancer immunotherapy. This clinical trial represents the first use of cells produced from human induced pluripotent stem cells to better treat and fight cancer.’

It’s not all good news

Stem-cell technologies, and especially their putative ‘cures’, should always come with a caveat – the following may be fake science. And so it comes to pass. The Lancet has recently retracted yet another stem-cell research paper. This time it is a 2011 paper reporting clinical trial data using cardiac stem cells isolated in Dr Piero Anversa's former laboratory at Harvard Medical School. The paper in question is by Bolli et al., under the title, ‘Cardiac stem cells in patients with ischaemic cardiomyopathy (SCIPIO): initial results of a randomised phase 1 trial’ and published in The Lancet (2011), 378: 1847-1857. Anversa’s work is unreliable – he has already had 16 papers retracted, and there are more in the pipeline.

Anversa is not the only stem-cell faker. Sadly, too many stem-cell quacks and their ‘clinics’ the world over are offering sham treatments to desperate and vulnerable patients. All these mountebanks give this amazing branch of regenerative medicine such a bad name.

Euthanasia and Assisted Suicide 

Royal College of Physician’s sham

Until recently the Royal College of Physician’s (RCP) position on assisted suicide was one of opposition to the practice. Then, for no good reason, in February, the RCP’s Council, undoubtedly under pressure from campaigners for the legalisation of assisted suicide, conducted an online poll of its UK fellows and members to ensure that opposition was still the wanted policy.

The results, published in March, showed that only 6,885 (19%) of its 36,000 members had voted. And while 32% of these respondents thought the RCP should support the legalisation of assisted suicide, 43% were opposed. In addition, though 40% personally supported assisted suicide, 49% were personally opposed. Because this was a sham poll, which required a ludicrous and politically-motivated supermajority of 60% in order to maintain the RCP’s original opposition, it now means that the RCP has gone ‘neutral’ on assisted suicide. This has connotations of RCP support, a green light for assisted suicide, though in fact, none exists. The RCP’s balloting procedure may yet be challenged through the courts. And it gets worse because the Royal College of General Practitioners (RCGP) announced in June that it too will ballot its 53,000 members on whether to drop its opposition to assisted suicide. Is there an ominous theme here? 

This change of heart by the RCP, bogus though it is, is all the more poignant because one of the largest medical organisations in the US has recently voted to retain its long-standing opposition to assisted suicide. In June, the leaders of the American Medical Association (AMA) voted 65 vs. 35 to hold the line.

Euthanasia in Belgium

It comes as no surprise to learn that the latest official figures show that euthanasia is increasing in Belgium. Euthanasia was first legalised there in 2002 and the Belgians have enthusiastically embraced it ever since. From 2010, there has been a 247% increase.

During 2018, there was a total of 2,357 reported euthanasia cases, up from 2,309 in the previous year. The majority of patients were aged 60 to 89 years old and suffering from cancers and co-morbidities. While there were no children euthanased in 2018, there were 14 people aged between 18 and 29 who were put to death.

At last, the practice is evidently coming under some sort of scrutiny. The European Court of Human Rights in Strasbourg has agreed to hear the case brought by a man who unexpectedly heard that his mother had been euthanased in 2012 for depression. In addition, three Belgium doctors are facing trial for certifying that a heartbroken woman, who falsely stated that she was autistic, was eligible to meet the criteria to be euthanased.

Euthanasia in Canada

It seems that about 3,000 Canadians were euthanased in 2018. The approximation is because according to the Fourth Interim Report on Medical Assistance in Dying there were 2,614 ‘medically-assisted deaths’ for the 10 months between January 1 and October 31.

Canada’s MAID (medical assistance in dying) was legalised only in June 2016, but has proved to be increasingly popular – it now accounts for an estimated 1.12% of all deaths in Canada. Since its inception in 2016, there have been at least 6,749 medically-assisted deaths. However, all these figures are underestimates because they do not include data from the Yukon, Northwest Territories, Nunavut and some from Quebec.

Most people who were euthanased were cancer patients (64%) and were between 56 and 90 years old, with an average age of 72. Most deaths occurred in a hospital (44%) or in a patient's home (42%). Doctors were the main euthanasiasts (93%), with nurse practitioners providing the remainder.

And Canada seems keen to take the next step. There is a growing interest in euthanasia coupled with organ donation, commonly known as ODE. Or ‘kill and cull’. Though it is currently illegal, experts in euthanasia and organ transplantation have already published guidelines for the practice in the June 2019 edition of the Canadian Medical Association Journal. After all, why waste all those lovely pink organs?

USA and Elsewhere

Abortion bans across USA

Abortion has again become one of the hottest issues across the USA. Despite the 1973 Roe vs. Wade ruling for a constitutional right to abortion, states have enacted more than 1,200 abortion restrictions during the past 46 years. Already this year, some 26 abortion bans have been passed across 12 states, and many more are in the pipeline. These sanctions have typically been based on gestational age. For example, all abortions have been banned in Alabama and at 6 weeks of gestation in Louisiana, Georgia, Kentucky, Mississippi and Ohio and at 8 weeks in Missouri and at 18 weeks in Arkansas and Utah. However, as yet, none of these bans is currently in operation because of challenges through the courts.

In addition, there have been bans on specific abortion methods, such as dilatation and evacuation (D&E) used after 14 weeks, or abortions performed for certain reasons, such as the sex of the foetus or genetic anomaly. These bans have been enacted in Arkansas, Indiana, Kentucky, Missouri and Utah. And ‘trigger laws’, which would ban abortion in the event that Roe vs. Wade is overturned, have been enacted in Arkansas, Kentucky, Missouri and Tennessee. The abortion battle is hotting up.

How pro-life is the USA?

‘Significantly’ is the short answer. A national poll of 2,200 respondents, conducted during May, by Morning Consult, found that 58% of Americans wanted all or almost all abortions made illegal. Typically, exceptions were made for rape, incest and the life of the mother. Another 27% of Americans believed that abortion should be illegal only after viability. And 12% did not know where they stood on abortion. And there was little difference in the abortion attitudes of women and men as 60% of women favoured making all or almost all abortions illegal, while 61% of men agreed.

The poll also found that 51% of Americans believed human life either begins at conception or when an unborn baby’s heartbeat is capable of being detected at 6 weeks. Only 13% of Americans believed human life begins at birth. And 47% of the respondents said abortion goes against their moral beliefs and 39% said it does not go against their moral beliefs. These results may appear to be somewhat mixed and confusing but they do show America to be a largely pro-life country. Figures from the UK would probably be less heartening.

And there is extra proof for the existence of this US pro-life sentiment. The results of Gallup's annual Values and Beliefs poll were published in May. It showed that half (50%) of Americans believe abortions to be morally wrong – the highest percentage for seven years. And 42% said they are morally acceptable. The poll examined the moral acceptability across a range of issues, such as gambling, divorce and assisted suicide. Abortion was the most divisive, with just 23% of conservatives versus 73% of liberals considering it morally acceptable – that equates to a 50% gap.

And there is even more. Reactions to Georgia’s new heartbeat law were assessed by a Hill-HarrisX survey conducted during May. Overall, it found that 55% of voters do not think laws banning abortions after six weeks are too restrictive. Specifically, 21% said six-week abortion bans are ‘too lenient’, 34% said they are ‘just right’ and 45% said they are ‘too restrictive.’

Miscellaneous

Sesquizygotic twinning  

This may be only tangential to bioethical issues associated with assisted reproductive technologies (ARTs), but nevertheless it is enthralling. We are all fascinated by twins. We all know there are two types – or so medical doctrine has long told us.

First, monozygotic or identical twins occur when a single ovum is fertilised by a single sperm and the zygote or early embryo divides into two. The twins will be the same sex and share the same genes and similar physical features. Second, dizygotic or fraternal or non-identical twins occur when two separate ova are fertilised by two different sperm. These twins may be of the same or different sexes, share approximately 50% of the DNA and are no more alike than any brothers or sisters.

Third, and strangely, there are sesquizygotic or semi-identical twins. These occur when an ovum has been fertilised by two sperm before the early embryo divides. This results in three sets of chromosomes – one from the mother and two from the father. When this occurs it is generally thought to be incompatible with life and the embryos do not survive.

The first documented case of sesquizygotic twins was in 2007 in the USA. They came to the attention of doctors because of their ambiguous genitalia. They are rare, very rare. A 2019 paper reported on the genetic data from 968 fraternal twins, plus other global studies, and revealed the existence of no other sesquizygotic cases. In the same paper, published in February 2019, came the report of the discovery of a second case of semi-identical twins. The boy and girl, then aged 4, are from Brisbane and are identical on their mother’s side. They share only 78% of their father’s DNA. Thus, genetically, they are somewhere between fraternal and identical twins. This reported was by Frisk et al., and published in the New England Journal of Medicine (2019), 380: 842-849, under the title, ‘Molecular Support for Heterogonesis Resulting in Sesquizygotic Twinning.’

They were discovered when their 28-year-old mother, who conceived naturally, went for a routine pregnancy scan at the Royal Brisbane and Women’s Hospital in 2014. The ultrasound showed a single placenta and amniotic sacs suggesting identical twins. A 14-week scan showed the twins were male and female, which is not possible for identical twins.

Non-identical twins are more common in some families. Older mothers are more likely to have them because they sometimes release more than one ovum during ovulation. On the other hand, identical twins do not run in families. Then, of course, IVF can commonly lead to twins if more than one embryo is transferred to the womb. Or the physical manipulations associated with IVF is also thought to increase the likelihood of twinning. Fascinating! 

Mary Warnock (1924 – 2019)

In its death announcement columns of the 23 March 2019, The Times pithily reported, ‘WARNOCK Mary, Baroness Warnock of Weeke, Companion of Honour, died on 20th March 2019, aged 94.  Private funeral.’

Tributes and obituaries have been much more fulsome because Mary Warnock was a luminary of the British Establishment.  Indeed, her achievements were stellar.  She was not only a former Mistress of Girton College, Cambridge, but also a favourite appointee on all sorts of government committees and official inquiries.  These included subjects as diverse as children’s education, pollution, animal experiments and the management of the Royal Opera House.  She was acknowledged to be the ‘philosophical plumber to the Establishment.’  However, she was most famous for her chairmanship of the Committee of Inquiry into Human Fertilisation and Embryology, which was set up in 1982 and which published its 103-page Report in July 1984, commonly known as the Warnock Report.

She was born Helen Mary Wilson in 1924 at Winchester in Hampshire, where her father had been a housemaster at the famous College.  He died before she was born.  Her mother was the daughter of the émigré Jewish wool merchant Felix Schuster, who set up what was to become the National Westminster Bank.  She was educated at St Swithun’s School, Winchester, where, she recalled, ‘All the cleverest girls were doing classics and I was jolly well going to be one of them.’  She was.  She won a place to study philosophy at Lady Margaret Hall, Oxford.  There, as chairwoman of the philosophy society, she met Geoffrey Warnock.  They married in 1949.  He later became Principal of Hertford College Oxford while she was Mistress of Girton College, Cambridge – the first husband and wife to be Oxbridge heads at the same time.

They had five children, Kitty, Felix, James, Maria and Fanny.  Meanwhile, Mary was a working mother as a lecturer at St Hugh’s College, Oxford.  Her first book, Ethics Since 1900, appeared in 1960.  She became enamoured with the existentialism of Jean-Paul Sartre which led to Existentialist Ethics (1966) and the bestselling Existentialism (1970).

In 1966, she was appointed headmistress of Oxford High School.  She was becoming somewhat annoyingly good at everything – when the school orchestra was short of players, Warnock taught herself the French horn and joined up.  In 1972, she became a fellow at Lady Margaret Hall.  In 1974, Margaret Thatcher, as education secretary, chose her to lead an inquiry into the education of children with disabilities.  The recommended outcome was that such children should be educated in mainstream rather than special schools.

She retired from Girton College in 1991 when she and her husband bought a house in Wiltshire.  They enjoyed gardening together and she liked a cigarette and a glass of single malt whisky as well as the novels of Jane Austen and Anthony Trollope.

Mary Warnock was undoubtedly a clever woman.  But she was also a mixed up woman.  She relished the Book of Common Prayer and though ‘a communicant Anglican’, she did not believe in God, or an afterlife, yet she naively believed that, ‘… when somebody dies they do continue to live in a way, because there are lots of people ... who have loved them and who think about them all the time.’

Bioethically, she was a disaster on almost every issue from womb to tomb.  She advocated smothering deformed babies at birth.  ‘What used to happen when people had babies at home and they were severely deformed was that the doctor or midwife would “cause” the baby to die by turning it over or smothering it.’  She added that if parents wanted to keep premature babies with unviable lives on life-support machines, they should stump up the cost.

After the death of her husband in 1995, she admitted that she had been complicit in his death.  He was suffering from a rare lung disease, and a GP gave him a ‘peaceful and dignified’ death by increasing his morphine dose, ending his life two weeks before he would have died.  Moreover, she was an ardent advocate of assisted dying.  She stated, ‘I couldn’t bear hanging on and being such a burden to people.’  In 2008, she courted controversy for arguing that people with dementia should be given the option of euthanasia if they felt that they were ‘a burden to their family, or the state’.  Indeed, she suggested that there was nothing wrong in such circumstances with feeling one had a ‘duty to die’.

But her greatest bioethical calamity was as chairman of the Committee of Inquiry into Human Fertilisation and Embryology, set up by the Conservative Government in 1982 and with its Report published in 1984.  Louise Brown, the world’s first test-tube baby, had been born in 1978 as a result of the novel process of in vitro fertilisation (IVF), and grandmothers were beginning to give birth to their grandchildren, post-menopausal women were also getting pregnant.  All this and much more was producing a complex, novel, fast-moving technology.  Society’s thinking morally, ethically, legally, sociologically and theologically was not keeping pace.

Enter Dame Mary Warnock and her team of 15 Committee members.  Their task was ‘To consider recent and potential developments in medicine and science related to human fertilisation and embryology; to consider what policies and safeguards should be applied, including consideration of the social, ethical and legal implications of these developments; and to make recommendations.’

The Report was, and still is, a pig’s ear, even a dog’s dinner.  Though skilfully written it lacked robust thinking.  In too many places it was shallow and muddled, and it often avoided the major bioethical issues, or simply fudged them.  For instance, it eschewed basic questions like, ‘When does human life begin?’ and, ‘What is the moral status of the human embryo?’  The Warnock Report thus became one of the most influential examples of unprincipled, utilitarian thinking of the twentieth century.  Yet its reach has sadly extended comprehensively and internationally into the twenty-first century.  Indeed, I still judge it to be the most formidable bioethical document of the last century.  It has adversely changed almost everything that is human.

I never met her, but we did correspond, albeit briefly.  After reading her 2006 book, An Intelligent Person’s Guide to Ethics, I sent her a letter.  In the book she had written about how unpredictable the flight patterns of the goldfinches in her garden were. I told her the collective noun for goldfinches was a ‘charm’.  She thanked me kindly. I think she already knew!

She died after a fall at home in Wiltshire on 20 March, aged 94. She leaves daughters Kitty and Maria and sons Felix and James. She was predeceased by Fanny.

David Paintin (1931 – 2019)

David Bernard Paintin has been a lesser-known figure in bioethics, yet his contribution was still significantly sinister.  I spotted him years ago and included him in my 2014 Bioethical Issues book.  In a discussion of the practice and extent of illegal abortion prior to the 1967 Act, I wrote that it is still a matter of conjecture, with estimates varying from 10,000 to 250,000, though a 1966 report from the Royal College of Obstetricians and Gynaecologists estimated it to be 14,000.  Similarly, the numbers of women who died, or who were severely injured, at the hands of criminal abortionists are contested data.  Contrary to much of the propaganda from pro-abortionists, one of their chief exponents, David Paintin, considered that, ‘... that side of abortion has to some extent been exaggerated.  Most illegal abortionists in the 1960s were really quite skilful' (David Paintin, 2007, Abortion Law Reformers: Pioneers of Change. Stratford-upon-Avon: bpas), p. 35.

David Paintin entered Bristol University to read medicine in 1949 and qualified in 1954.  From September 1956, he specialised under the supervision of Professor Dugald Baird in Aberdeen.  Baird convinced him that women with unwanted pregnancies should be able to have safe abortions provided by doctors.  As he later wrote, ‘I was persuaded by Dugald Baird’s reasons for providing safe abortion and agreed with him that the moral value of the foetus was small when compared with the health and wellbeing of the woman and her children.  Years later, I realised that he had been influenced as a young man by the eugenic ideas expressed by intellectuals such as Bertrand Russell and Julian Huxley.  As a gynaecologist, his concern was the needs of individual women with unwanted pregnancies but, as a social scientist, his objective was to improve the health of the community as a whole.’

In 1963, Paintin became a reader in obstetrics and gynaecology at St Mary’s Hospital Medical School, London and he also joined the Abortion Law Reform Association (ALRA).  From 1963 to 1991, based at St Mary’s Medical School, he organised the teaching of medical students and also, as an honorary consultant, provided NHS abortion services for Paddington and North Kensington.  He advised Lord Silkin and then David Steel during the debates that led to the Abortion Act 1967.  He was a chairman of the Birth Control Trust (1981-1998) and a trustee of the Pregnancy Advisory Service (1981-1996) and the British Pregnancy Advisory Service (1996-2003).  During his career, he lectured on the delivery of legal abortion to medical students, family planning doctors and gynaecologists throughout the country.

As he stated, ‘The provision of legal abortion slowly became the central interest of my professional life.'  He once said, albeit with inconsistent logic and a certain coldness, ‘I rejected the view that a woman, once pregnant, had an obligation to society to continue her pregnancy.  It seemed to me that if you really felt that women should have equal status and rights then they should have total control over their fertility, and that this was only really possible if there was legal abortion.’

Ann Furedi, the chief executive of bpas, enthusiastically sung Paintin’s praise in a recent obit piece.  She, somewhat characteristically, overstated her case, ‘All women owe a debt to David Paintin for his work with parliamentarians to achieve a liberal abortion law, and with his profession to increase abortion’s acceptability and promote innovative good practice.’  Though Paintin described his contribution to abortion law reform as ‘modest’, Furedi considers that he was a Champion of ‘reproductive choice’, and ‘we are all grateful for his lasting contribution to abortion rights in this country.’  Indeed, for 27 years he had performed hundreds, thousands, of terminations.  This passionate advocate for women’s reproductive rights retired in 1990 as emeritus reader in Obstetrics and Gynaecology, University of London.  In 2015, bpas published his book, Abortion law reform in Britain 1964-2003: a personal account by David Paintin.

Little has been recorded about his personal life.  His father was a Methodist minister, and Paintin himself used to be ‘a religious man’.  Later he called himself an ‘almost atheist’ and a humanist.  He was married to Avril for over 50 years and their family included daughters Sarah and Anne, son-in-law Andy and granddaughters Freya and Rotha.

He died, aged 88, on 30 March 2019 after a long illness. His funeral was held in the Milton Chapel, Chilterns Crematorium, Amersham, on Friday 26 April.

Ian Craft (1937 – 2019)

Professor Craft was one of the original IVF pioneers. In 1976, at the age of 39, he was appointed professor of Obstetrics and Gynaecology at the Royal Free Hospital in London. In 1977, he started working on infertility, founding the UK’s first IVF service within the NHS.  His team there achieved the world's first IVF twins in 1982, followed by triplets in 1984. In 1986, he was responsible for the UK's first GIFT (gamete intra-fallopian transfer) babies, and in 1987, for Europe's first donor-ovum birth. He was granted the first UK licence to perform ICSI (intracytoplasmic sperm injection), and he achieved the UK's first ICSI birth.

He was a maverick, who liked to push the boundaries. His controversial practices often made the headlines.  He transferred multiple embryos, which sometimes resulted in dangerous multiple pregnancies and he introduced the horrible procedure of selective abortion to minimise those dangers. He defended ova donation, the birth of twins to a 56-year-old patient and a son to a 60-year-old grandmother who had told him she was only 49.  His private clinic welcomed menopausal women, lesbian couples and homosexual men using surrogates, as well as younger heterosexual couples.  The only people he turned away were those without funds.

And he was undaunted by the Establishment. In defiance of the Human Fertilisation and Embryology Authority’s guidelines he continued to transfer multiple embryos.  But in April 2002, the General Medical Council (GMC) decided not to proceed with a disciplinary case against him – ‘None of us wanted triplets’ was his defence. In 2006, the GMC’s fitness to practise panel cleared him of allegations that he charged patients for services they did not need, but his record-keeping was said to have fallen short of good practice.

He also clashed with many in the world of assisted reproductive technologies, where he was known as ‘Crafty’. ‘I’m just very innovative,’ he would declare. ‘You pay a price for being a pioneer.’ Once famously described as looking like ‘an anthropomorphised otter’, it was his charm and intelligence that made him bearable.

Ian Logan Craft was born in Wanstead, east London, in 1937, the son of Reginald Craft and his wife, Lois (née Logan), who both worked at Barclays bank.  He had a twin sister, who was stillborn, and two younger brothers.  His father was an eager Methodist.  ‘I went to Sunday school, and my parents wanted me to be a believer,’ he recalled, ‘but I came to the reluctant conclusion that it’s beyond me.  We come in alone and we go out alone.’

Surprisingly, he had been a shy and sensitive boy.  He was hopeless at exams and failed his 11-plus.  Extra coaching got him through the 13-plus, but at Dame Alice Owen’s School in Islington he achieved only two O-levels at his first attempt.  Everything changed when he met 13-year-old Jackie Symmons in Epping Forest when he was 16 – she gave him self-belief.  With her encouragement he got good O-levels the second time round, then enough A-levels to get into Westminster Medical School. He and Jackie, who worked for a stockbroker, married in 1959, but the marriage was dissolved in 1998.

Craft’s first job was in radiotherapy at Westminster Hospital, working with terminally-ill patients, including children. ‘One little baby died in my arms, which I’ve never forgotten’, he recalled during an interview in 1997.  He transferred to obstetrics at Queen Charlotte’s Hospital, London, before becoming a professor at the Royal Free Hospital.  Later he became director of gynaecology at the private Cromwell Hospital, and then director of fertility and obstetric studies at the Wellington Hospital in north London. In 1990, he opened the London Gynaecology and Fertility Centre, a stone’s throw from Harley Street. He had a staff of 30, charged patients £10,000 for a treatment cycle and paid himself £2.5 million a year.

He loved the arts, especially music – he was a patron of British art at Tate Britain and one summer he went to more than 40 Proms concerts at the Royal Albert Hall. A train set ran around his kitchen, while piles of unopened junk mail were stacked around the room. Football and cricket were also his passions.

In the early 2000s, he bought a dilapidated house in Devon, which came with the working farm he had craved as a young man.  He eventually returned to his residential home in Esher.  And it was there on 3 June that he collapsed when he came down for breakfast and could not be resuscitated.

A memorial to celebrate his life will be held on 19 September at St James's Church, Piccadilly at noon.

John Ling

This article was originally published in the Affinity Social Issues Bulletin for July 2019. The whole edition can be found here. A PDF of this article (minus the obituaries) is available to download here.

The Social Issues Team publishes The Bulletin three times each year, containing information about current issues relevant to churches and Christians.


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