An update on bioethical issues

The latest issue of Affinity's Social Issues Bulletin is out now. It is free to download (as are all previous editions). In one of the current articles bioethicist Dr John Ling surveys the news of many different issues relating to abortion, stem-cell research, euthanasia, genetic engineering and a whole lot more...

Abortion

Decriminalisation in Northern Ireland – the bioethical change

Is this not the worst bioethical news of the century? Northern Ireland, that great bastion of pro-life sentiment and deed, has had abortion-on-demand foisted on it by the government in Westminster. The people of the Province did not request it, nor did the Stormont government choose it. The sheer audacity, the democratic disdain, the moral decay, the destructive outcome, the inescapable sorrow – they all beggar belief. What have we done?

Perhaps the raw truth is we have done nothing, or at least, not enough. We have let a few stark, bigoted voices overrule the truth. Did we object? Did we fight? Everyone knows that the most enduring human right is the right to life. It is written on paper for all to read – Article 2 of the European Convention on Human Rights declares, “Everyone’s right to life shall be protected by law”. Therefore abortion, the taking of human life, is always legally and morally wrong, whatever the gestational age.

Now the people of Northern Ireland will suffer like those of us in Great Britain with the long-term fallout of our wretched 1967 Abortion Act. Yet the law in the Province is set to be worse because there will be no such restraining law there. Abortion is to be decriminalised, which means no-one will be prosecuted, no-one will be refused, abortion will be lawful for any woman, anywhere, for any (and no) reason, at any gestational age. Is this not the worst bioethical news of the century? As we trample on the tiniest of those made in the image of God, may God forgive us all. “Righteousness exalts a nation, but sin is a disgrace to any people” (Proverbs 14:34).

Decriminalisation in Northern Ireland – the political process

The abortion policy of the Province has long been a devolved political issue. In January 2017, the Stormont Assembly collapsed in a row between Sinn Féin and the Democratic Unionist Party (DUP). In July 2019, a few extreme pro-abortion MPs at Westminster seized on this impasse and succeeded in passing the Northern Ireland (Executive Formation) Bill through its final stages in the House of Lords and the Commons. That Bill, which was primarily concerned with budgets and elections, had been cunningly amended so that sections 58 and 59 of the 1861 Offences Against the Person Act would be repealed. The ensuing Act set the decriminalisation enactment date for 21 October 2019. Stormont remained stubbornly non-operational and so, on that day, abortion was automatically decriminalised across Northern Ireland, that is, abortion was removed from the criminal law and placed under mere medical regulations. Furthermore, the 2019 Act necessitated access to abortion to start by 31 March 2020.

The Act not only insisted that from 22 October abortion was decriminalised in Northern Ireland, but it also placed a moratorium on abortion-related criminal prosecutions. As a bioethical crumb, since 22 October, the abortion of a child “capable of being born alive” remains unlawful, except when the purpose is to preserve the life of the mother.

In the meantime, last November the UK government launched a public consultation on its proposed framework for abortion in Northern Ireland. It closed on 16 December. The government intends to publish its response and details of the action it will take within 12 weeks, that is, before early March.

These details of the proposed practice of abortion in Northern Ireland are now awaited. Will it be unconditional up to 12 or 14 weeks? Or 22 or 24 weeks? Or later under some circumstances? Will foetal abnormality and risk to the life of the mother be up to birth? Will the “two-doctor rule” be abandoned? Will patient-doctor abortion consultations be conducted over Skype? Will healthcare workers other than medical practitioners be allowed to procure abortions? What about protection of those who conscientiously object to abortion? Whatever, the proposed changes will certainly not be, as an editorial in the British Medical Journal declared, “Toward healthier abortion…” How can killing the unborn ever be described as health-giving?
And while the current focus is on Northern Ireland, the momentum of decriminalisation is expected to spread across to England, Wales and Scotland. And with such a pro-death ideology taking hold across the UK, how long before those ugly sisters of assisted suicide and euthanasia are legalised? Is this not the worst bioethical news of the century?

The world’s biggest killer

What was the cause of most deaths globally in 2019? Cancer? HIV/AIDS, smoking, various diseases?  No, none of those. It was abortion with an estimated 42.3 million. Those other causes account for 8.2 million, 1.7 million, 5 million and 13 million respectively. Worldometers (https://www.worldometers.info/) estimates that there were 58.6 million deaths worldwide in 2019. But that total does not include the 42.3 million aborted unborn because Worldometers perversely fails to recognise their human being status.

If I Could Speak: Letters from the Womb
This is the title of a 72-page booklet written by Mark Jones, the minister of Faith Reformed Presbyterian Church (PCA) in Vancouver, Canada. It was released in the UK on 10 January 2020 by Christian Focus and costs £9.99.

The publisher’s blurb commences, “Dear Mommy… So begins the correspondence from an unborn baby to her mother. Making an impassioned plea to her mother to not abort her, she shares her hopes and fears with the woman who can control whether she lives or dies. These letters are an appeal to all who read them to choose life.”

Assisted Reproductive Technologies

Surrogacy revisited and updated

As with all assisted reproductive technologies (ARTs), surrogacy is weird and never a good idea. Not only is it unnatural, it is also morally problematic and personally troublesome – a can of bioethical worms. True, it is less commonly practised than IVF, but there are moves afoot to make it more readily-available and less bound by regulations.

The Warnock Report (1984, p. 42) gave this definition: “Surrogacy is the practice whereby one woman carries a child for another with the intention that the child should be handed over after birth.” The main legislation concerning surrogacy is the 1985 Surrogacy Arrangements Act and the 2008 Human Fertilisation and Embryology Act.

There are several variations on this theme. First, there is traditional, partial, or straight surrogacy. This is the most common type when a husband is fertile, but his wife is unable to sustain a pregnancy, possibly because of illness, or because she has had a hysterectomy or maybe she is a “new” career woman and just too busy to be pregnant. The hired surrogate woman, a friend, a family member is then inseminated, artificially or naturally, with the husband’s sperm. Because she is using her own ova, she is the biological, genetic and legal mother of the child.

Second, there is full, gestational, or “host IVF” surrogacy. Embryos are created by IVF using gametes either from the commissioning/intended parents, or sperm and ova donated by others. The resulting embryos are then transferred to the surrogate and because she does not provide any ova, she has no genetic relationship to the child, but she is still the biological and, by birth, the legal mother.

Under current UK law, the surrogate woman who gives birth to a child is automatically regarded as the child’s legal mother. A parental order obtained from a court is the means by which legal parenthood is transferred from the surrogate to the intended parent or parents. Applications for parental orders must normally be made in the first six months after birth. Commercial surrogacy is banned in the UK so surrogates can be reimbursed only for “reasonable expenses”, which typically range from £12,000 to £15,000. And no surrogacy agreements are legally binding.

Surrogacy has already changed during the last decade. For instance, the number of parental orders has tripled from 121 in 2011 to 368 in 2018. And there are increasing numbers of gay men wanting children and inevitably having to hire a surrogate woman. Since 2010, gay male couples have been allowed to apply for parental orders. Since January 2019, single persons can also become legal parents through surrogacy. Since 2015, mitochondrial donation, commonly known as 3-parent IVF (mother, father plus surrogate), has been legal in the UK.

Perhaps not surprisingly, surrogacy is a practice ripe for litigation. Here is the recent, strange and tangled case of the Whittington Hospital NHS Trust. A 29-year-old woman, known only as XX, developed cervical cancer which went undetected for several year despite smear tests and biopsies. The Trust admitted negligence. She and her partner wanted children and she had delayed chemo-radiotherapy to undergo procedures to collect 12 ova which were then cryopreserved. The subsequent cancer treatment caused her to become infertile and unable to sustain a pregnancy. XX therefore hoped to use surrogacy in either America or the UK. She preferred the former since commercial surrogacy is illegal in the UK and pre-birth orders, giving her legal status as the mother, are not available here. She took the Trust to court to cover the costs for the Californian option.

In June 2017, the High Court awarded her £580,000 in negligence damages, but denied her the cost of four surrogacies in the USA. In December 2018, the Court of Appeal overturned the High Court ruling and unanimously awarded her another £560,000 to cover the US surrogacy costs. On 16 December 2019, the NHS Trust appealed that decision saying that paying for commercial surrogacy would be “contrary to public policy”. Five Supreme Court justices, in what was Lady Hale’s last hearing, heard the case. Their judgement is awaited.

Surrogacy has even surfaced on that Radio 4’s guardian of traditional countryfolk’s values, The Archers. Aleksandra “Lexi” Viktorova, a Bulgarian fruit picker on Home Farm, became a surrogate for the “married” gay couple, Adam Macy and Ian Craig. The pregnancy was conceived by an ovum donor and Adam’s sperm – Ian was discovered to be infertile. Jennifer Aldridge, Adam’s mother, is convinced that Lexi will flee with baby Alexander Macy-Craig (or Xander for short) to Bulgaria. Well I never! Of course, it is fictional, but…

These are some examples of changing attitudes towards surrogacy. They have created a head of steam declaring that the UK’s surrogacy laws are out of date and need amending.

The government has asked the Law Commission to review UK surrogacy law. Its aim is to make surrogacy laws work for the parents, the surrogate and, most importantly, the child. A public consultation, contained in a 502-page document, entitled Building families through surrogacy: a new law, ran from 6 June to 11 October 2019. It is expected that a final report with recommendations for reform of the law, and a draft Bill, will be forthcoming in 2021.

The Law Commission has already proposed that parental rights should commence at birth. However, it also wants the surrogate mother to retain a right to object for a short period. Furthermore, it calls for specific regulation of surrogacy arrangements to include safeguards, such as counselling and independent legal advice, to reduce the risk of arrangements breaking down. And it proposes that all advertising restrictions, including social media, should be lifted. And it thinks that international surrogacy arrangements should be recognised. Critics fear that these proposals would target women as young as 18, who had not previously had a baby, to become surrogates. Would students use surrogacy to pay off their debts? Would surrogacy become more commercialised? Would it become more mainstream, more common?

Surrogacy UK, an organisation which represents about 150 active surrogates and 500 intended parents, of which almost 50% are same-sex couples, broadly agrees with the Law Commission’s proposals, but wants any surrogate’s objections to be tested in court. It also wants the surrogate to lose all rights over the child. This, it says, would protect surrogates from the risk of intended parents abandoning a child with a disability, or not paying the medical bills. Surrogacy UK is also calling for safeguards so that payments cannot be disguised as expenses. And intended parents should pay for a surrogate’s life assurance, legal bills and IVF treatment, often resulting in a total cost of between £30,000 and £40,000.
Sarah Jones, chairwoman of Surrogacy UK and four times a surrogate, has said, “We are pleased to see that there has been no movement towards permitting commercial profit-making surrogacy organisations. We hope that the Law Commission will resist any movement away from an expenses-only model. Surrogacy should be about making families, not money.”

Surrogacy, whether it is traditional or gestational, is an attack on the biblical pattern of family, where children are conceived, born and nurtured within the family unit of mother and father. Because surrogacy is fundamentally wrong, tinkering with the concept and tweaking its legal status will not make it right. It is best avoided.


Euthanasia and Assisted Suicide

World Medical Association declaration

You might think that the world is rushing headlong into legalising euthanasia and assisted suicide. You would be wrong. True, in June and December 2019 the Australian states of Victoria and Western Australia respectively became the latest jurisdictions to legalise assisted suicide, joining Switzerland, Belgium, Canada, Colombia, Luxembourg, the Netherlands and a handful of US states.

What about the UK? Are we inching towards legalisation? Not so. Assisted suicide remains illegal in the UK because of the robust 1961 Suicide Act. Yet in March 2019, the Royal College of Physicians (RCP) rigged a poll (which is currently being contested through the courts) and moved its stance of opposition to one of neutrality. In November, the Royal College of General Practitioners (RCGP) similarly consulted its 53,000 members with a 13 December 2019 deadline. The results are awaited. And on 6 February 2020, the British Medical Association (BMA) started to survey its 160,000 members on whether its official position should change from opposition. The outcome will be announced in advance of the BMA’s Annual Representative Meeting in June at Edinburgh.

Let’s get some perspective. Apart from those jurisdictions listed above, the practice of assisted suicide is repudiated nearly everywhere else around the world. Resounding evidence to support such a statement comes from the recent meeting of the World Medical Association (WMA), which has had a long-standing policy opposing euthanasia and assisted suicide.

During October 2019, at its 70th Annual General Assembly in Tbilisi, Georgia, the WMA adopted a revised Declaration on Euthanasia and Physician-Assisted Suicide. It contains three bold statements. First, “The WMA reiterates its strong commitment to the principles of medical ethics and that utmost respect has to be maintained for human life. Therefore, the WMA is firmly opposed to euthanasia and physician-assisted suicide.”

Second, the WMA affirmed, “No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end.”

And third, “Separately, the physician who respects the basic right of the patient to decline medical treatment does not act unethically in forgoing or withholding unwanted care, even if respecting such a wish results in the death of the patient.”

Of course the WMA, with its membership of 114 national medical associations and more than 10 million doctors, will now be under pressure to change its policy. With that in mind, the WMA issued this strong proclamation in May 2019, “Only a small minority of physicians support E&PAS [euthanasia and physician-assisted suicide]. The vast majority of doctors around the world wish only to foster the will to live and to cope with illness and suffering, not to facilitate acts of suicide or to create ambiguity around what constitutes a medical treatment.”

Assisted suicide on the Isle of Man

On 21 January, members of the House of Keys on the Isle of Man debated the motion, “That Tynwald is of the opinion that legislation to allow for voluntary assisted dying should be introduced.” It was proposed by Alex Allinson MHK and debated for five hours. In the end, an amendment “to note the debate” received unanimous support.  If there had been sufficient backing for his motion, Dr Allinson had planned to bring forward a private member’s bill in March followed by a public consultation in the summer. The issue was last debated on the Isle in February 2015, when a similar bid was thrown out by members of the House of Keys by a majority of 17 v. 5.

Assisted suicide in Westminster Hall

On the following Thursday, 23 January, in Westminster Hall, MPs discussed the motion, “That this House has considered the law on assisted dying.” The 90-minute debate was secured by Christine Jardine, the Liberal Democrat MP for Edinburgh West. She said, “It’s to spark discussion and public debate about where we are and what we want to do, look at what other countries have discussed and what they have done - with the aim of changing the law eventually, but that’s a long way off.” There were no firm proposals. The Government resisted a call to hold an inquiry into the current law and its workings - as Chris Philp (Parliamentary Under-Secretary for the Ministry of Justice) announced, “The Government do not have any plans at the moment to initiate any review or call for evidence.”

But just three days later, on Sunday 26 January, it was reported that the Justice Secretary, Robert Buckland, though personally against legalising assisted suicide, has said he will, over the next few months, consider whether to instruct the Ministry of Justice to review the evidence. Then on 2 February, after pressure from pro-life opponents, Mr Buckland rowed back, saying that the Government has “no plans” to hold a review of the law.
 
Belgium’s first euthanasia trial

On 12 January, the process of choosing a jury began for the trial of three Belgian doctors - two GPs and a psychiatrist - who stand accused of the unlawful killing of a patient in the country’s first long-awaited euthanasia criminal prosecution. Drs Joris van Hove, Frank de Greef and Godelieve Thienpont are charged after Tine Nys, 38, a patient with a history of suicide attempts, was given a lethal injection of barbiturates on 27 April 2010. The case has been brought by Ms Nys’s sisters, Lotte and Sophie, and other family members who say she was suffering from depression after a failed relationship, not a “serious and incurable disorder”, as is required by Belgian law. In addition, they maintained that Tine’s death was a botched affair.

More than 10,000 Belgians have been killed by doctors since the country legalised euthanasia in 2002. According to public data, during 2018, there were 2,357 such deaths. In only one other case has a legal issue been raised concerning the procedure, and this was summarily dismissed. The current charge of unlawful killing by poisoning carries a possible life sentence. This high-profile and controversial trial continued for three weeks until Friday 31 January when, after more than eight hours of deliberation, the jury in Ghent cleared the accused doctors - and the courtroom burst into applause.

Mr. Van Steenbrugge, a lawyer for one of the doctors, said the acquittal had sent a strong, reassuring message to doctors. “It was not manslaughter, it wasn’t a crime,” he said. “It was euthanasia.” Mr. Van Cauter, the lawyer for the family, said of the decision, “It’s a bit disappointing”, adding that the way Tine Nys was treated, “was very sad”.

Genetic Engineering

He Jiankui imprisoned

Back in November 2018, the Chinese scientist He Jiankui shocked the world by claiming to have created the first gene-edited human babies using the germline altering techniques of CRISPR-Cas9. Then mystery descended on the whole affair. He disappeared with his two co-workers, his work remained unpublished and the whereabouts and health of the twin babies, Lulu and Nana, plus a previously unconfirmed third baby, were unknown.


Then on 30 December 2019, the People’s Court of Nanshan District of Shenzhen announced that He and his two colleagues had flouted regulations as well as research and medical ethics by altering genes in human embryos that were then transferred to two women. According to the State news agency, Xinhua, the Court declared that, “The three accused did not have the proper certification to practise medicine, and, in seeking fame and wealth, deliberately violated national regulations in scientific research and medical treatment.” All three pleaded guilty. He was sentenced to three years imprisonment and fined 3 million yuan (£300,000). His collaborators, Zhang Renli was sentenced to two years in prison, while Qin Jinzhou received an 18-month sentence, suspended for two years. They were also fined 1 and 0.5 million yuan respectively. In addition, they have all been banned for life from ever again working in the field of human reproductive technologies and from applying for research funding. That chilling news should deter most other germline mavericks.

The Chinese Academy of Science released a statement, saying it “firmly opposed” germline editing in humans. It added, “Under current circumstances, gene editing in human embryos still involves various unresolved technical issues, might lead to unforeseen risks, and violates the consensus of the international scientific community.”

Gene-editing successes

Patients with sickle-cell disease (SCD) and beta-thalassemia are the first beneficiaries of some innovative gene-editing treatments. Victoria Gray, a SCD patient in the US, has been pain free since July 2019. Using CRIPR-Cas9 techniques her bone marrow stem cells have been tweaked into producing foetal haemoglobin, which effectively reverses her symptoms. A similar process has been used on a thalassemia patient in Germany, who has been symptom free since March 2019.

This is cutting-edge medicine. Whether the improvements are permanent or temporary remains to be seen. But they are both bioethical heralds of somatic cell gene therapy rather than the unethical germline variety.

Miscellaneous

The General Election – before and after

The UK held a general election on 12 December 2019. The result provided the Conservative Party with a landslide majority of 80 seats. In contrast to the USA, bioethical issues play very little part in UK elections. But the likelihood is that two extreme matters, namely, the decriminalisation of abortion and the legalisation of assisted suicide, will be raised in the new Parliament.

How do the three major political parties view these two issues? Prior to the election they revealed their stance in their manifestos. They are worthy, as a matter of historical record, to be retained (with thanks to CARE).

The Conservative Party

Abortion. The manifesto contained no policy that specifically addressed the issue of abortion.
Assisted suicide. “We will support our precious hospices, developing the plans already announced by Boris Johnson to secure their future, with a £25 million cash injection in August to support 200,000 people at the end of their lives.”

The Labour Party

Abortion. “We will uphold women’s reproductive rights and decriminalise abortions.” And “Women in Northern Ireland should have access to abortions in Northern Ireland.”
Assisted suicide. The manifesto contained no specific policy with regard to assisted suicide or end of life issues.

The Liberal Democrat Party

Abortion. “We believe that everyone has a right to make independent decisions over their reproductive health without interference by the state, and that access to reproductive healthcare is a human right. We will:
- Decriminalise abortion across the UK while retaining the existing 24-week limit and legislate for access to abortion facilities within Northern Ireland.
- Enforce safe zones around abortion clinics, make intimidation or harassment of abortion service users and staff outside clinics, or on common transport routes to these services, illegal.
- Fund abortion clinics to provide their services free of charge to service users regardless of nationality or residency.”

Assisted suicide. “Provide more choice at the end of life, and move towards free end-of-life social care, whether people spend their last days at home or in a hospice.”
“Regard every suicide as preventable. We will take an evidence led approach to prevention, making it easier for people at risk to get the help they need, and equipping more members of the public with the skills and confidence to talk about suicide.”

The bioethical shape of the new Parliament

Of course nobody yet knows if and when these issues will appear on the Parliamentary order papers. But there is no doubt they are already being discussed unofficially outside the chamber.

How might MPs vote? Again, nobody knows. Interestingly, it is reckoned that no prominent pro-life MPs on the mainland lost their seats. On the other hand, pro-choice MPs, such as Anna Soubry, Paula Sherriff, Chuka Umuna and Dennis Skinner did. The new intake of 140 MPs are largely untried. However, James Grundy, Ruth Edwards, Anthony Mangnall, Greg Smith and Carla Lockhart are among those known to be pro-life. They will be tested soon.

Principles of Biomedical Ethics at 40

No self-respecting bioethicist has not owned, or at least not read chunks of, Tom Beauchamp and James Childress’ 1979 masterpiece, Principles of Biomedical Ethics. It must rank as the most influential bioethical textbook of the twentieth century. It has given rise to the philosophical school of principalism, a practical approach to ethical dilemmas that is widely accepted, but which is also not without its critics.

The book argues for a framework consisting of four major principles that should universally govern medical ethics and practice. They are autonomy, beneficence, non-maleficence and justice. From these big four, several minor rules have arisen to include veracity, confidentiality, privacy and fidelity. Yet for some 40 years these major principles have helped to stabilise the rush towards an unprincipled medicine as well as engender a more thoughtful and practical approach to the subject. We have all benefitted.

Beauchamp and Childress, or Tom and Jim, first met in the mid-1960s at Yale University where their education in religious studies overlapped for three years. After graduation both started doctoral research – Tom in philosophy at Johns Hopkins and Jim in religious studies at Yale. It was not until in the mid-70s that they met again and cooperated as faculty members at Georgetown University. It was then and there, in the associated Kennedy Institute, that the world’s first academic course in bioethics was started. They shared six lectures. Tom favoured a consequentialist approach, whereas Jim favoured deontology. Nevertheless, from these two approaches the common idea of applying basic moral principles to biomedical ethics was sown. Principles of Biomedical Ethics was conceived – ethical theory and practical problems were conjoined. Oxford University Press excitedly guided its first bioethical project. The book is now in its eighth edition (October 2019) of 512 pages at £56.23 paperback, or £226.19 hardback from Amazon.

In an editorial in the October edition of the American Journal of Bioethics (2019, 19: 9-12) to mark the book’s ruby anniversary, the authors describe how the concept of a principles-based approach to bioethics came about. “We appreciated the need for an approach that recognized the value of ethical theory for practical judgments but that did not fetishize a single type of theory or promote a single principle over all others. We became convinced that several moral principles provide significant common ground relevant to judgments in the biomedical sciences, medicine, and health care and that these principles could not be convincingly ranked a priori in a hierarchical order.” In other words, they considered their four principles to be part of a “common morality”, a mix of unphilosophical common sense and tradition.

Critics have variously argued that the four principles are too vague, too narrow, or just downright simplistic. Beauchamp and Childress have counter-argued, “We do not suppose that our principles and rules exhaust the common morality; we argue only that our framework captures major moral considerations that are essential starting points for biomedical ethics. Some critics contend that the principles in “principalism” are merely clusters of moral concepts too abstract, general, and vague to guide judgments about actions. In response, we show how processes of specification and balancing link broad principles and rules to the concrete moral judgments needed in practical ethics.”

Furthermore, Beauchamp and Childress maintain that their principalist approach is relevant, flexible and workable. “Because our principles are universally applicable, we defend a global bioethics and not merely customary, regional, or cultural rules. Our principles correlate with basic human rights and establish what is ethically acceptable for all societies. Nonetheless, the principles allow for justified differences in the ethics of professional practice in societies and cultures through processes of specification and balancing.”

There can be no doubt, Principles of Biomedical Ethics is a great book, now in its eighth English edition and translated into six languages. It is secular in nature yet it jostles along with biblical ethics. Why? Because biblical ethics are uniquely original, universally applicable, ethically consistent and totally true. Principles is, by contrast, derivative. So be warned, “These [rules] are all destined to perish with use, because they are based on human commands and teachings” (Colossians 2: 22).

Stem-Cell Technologies

Stem-cell therapy for the heart

Stem-cell therapies are complex. Even when they seem to work, their biological mechanisms remain largely unknown. For example, when stem cells are infused into patients who have suffered heart attacks, any improvements are thought to be caused by the stem cells differentiating into beating heart-muscle cells, called cardiomyocytes. This is now in doubt.

A team of researchers, led by Jeffery Molkentin, a cardiovascular biology researcher working at the Cincinnati Children’s Hospital Medical Center in Ohio, has demonstrated that stem-cell benefits can occur without this differentiation. Instead, the stem cells can trigger cells of the immune system, known as CCR2+ and CX3CR1+ macrophages, which help to repair connective tissue in the damaged area of the heart, which, in turn, improves the organ’s function. In addition, they discovered that zymosan, a chemical which is known to elicit an immune response, could initiate the repair. This work was reported as “An acute immune response underlies the benefit of cardiac stem-cell therapy” by Vagnozzi et al., in Nature (2020, 577: 405–409).

The experimental results were quite unexpected. Two types of stem cells were injected into artificially-damaged, so called ischemia/reperfusion (I/R) injured, areas of mice hearts to mimic the conditions of a heart attack. One type was mononuclear cells taken from bone marrow, as commonly used in human clinical trials, and the other was cardiac mesenchymal cells. Both stem-cell types improved heart function of the mice significantly better than when a placebo was injected. And when macrophage activity was supressed no repair occurred in the mice that received the stem cells or in those that received zymosan. Yet even when the team injected fragments of dead stem cells this too improved heart function.

So, could it be that local and acute inflammation, induced by the immune system, is what drives the repair mechanism of stem-cell therapies, rather than the regenerative capacity of the stem cells themselves? And could this immune response be the underlying mechanism that brings about health benefits seen in successful stem-cell treatments for other diseases?


Stem-cell therapy for MS

From October 2019, a stem-cell therapy has, for the first time, been recommended for use on the NHS for multiple sclerosis (MS) sufferers in Scotland. This country has one of the highest rates of MS in the world with an annual incidence rate of 8.64 cases per 100,000 people and with around 85% of patients having the relapsing-remitting (RRMS) form of the disease.

Autologous haematopoietic stem-cell transplantation (AHSCT) has been described as a “game-changer” for MS after an international clinical trial showed that it could reboot patients’ immune systems and halt the progress of the disease.

The Scottish Health Technologies Group (SHTG) said there is now sufficient evidence for it to recommend making AHSCT available on the NHS in Scotland to MS patients who have highly active relapsing-remitting (RRMS), rather than the progressive, form of the disease, and who were not responding to drug treatments. A number of high-efficacy drug treatments have previously been approved but these therapies do not always work. The theory is that the novel stem-cell treatment works by enabling patients to “reset” their immune system to stop it attacking the central nervous system – as is the case in MS.

However, the SHTG has warned that potential patients must be made aware of the “demands, risks and uncertainties” of the treatment, which uses chemotherapy to wipe out a patient’s faulty immune system before replenishing it with a transplant of stem cells harvested from their own bone marrow. This pre-treatment can put patients at high risk from infections, which can be fatal. Nevertheless, some patients, who had been in wheelchairs prior to undergoing the stem-cell treatment, said their condition improved so dramatically it was like they had never been diagnosed with MS. Everyone likes a good story with a happy ending.

USA and Elsewhere

Presidential election year

2020 is election year for US presidential candidates. At the time of writing there is only one certain candidate – the current and 45th President, Donald J Trump. Whatever the personal, political and economic attributes of the man, one thing is certain – Trump has so far been a seriously good ally of the pro-life movement in America. On 22 January, the 47th anniversary of Roe v. Wade, the 1974 landmark Supreme Court judgment that legalised abortion in the USA, President Trump declared it to be National Sanctity of Human Life Day. The associated proclamation read, “Every person - the born and unborn, the poor, the downcast, the disabled, the infirm, and the elderly - has inherent value ... As a Nation, we must remain steadfastly dedicated to the profound truth that all life is a gift from God, who endows every person with immeasurable worth and potential.” By contrast, if a Democrat were to win the election, he/she would undoubtedly be a poor ally, even an enemy of the cause. Each of the six Democrats currently running for nomination supports abortions up to birth.

March for Life 2020

On 24 January the US held its annual March for Life with its main rally in Washington DC but with other gatherings in several satellite cities across the country. It is the world’s largest annual human rights demonstration. The theme for the 2020 March for Life was “Life Empowers: Pro-Life is Pro-Woman”. The main event began with a rally at noon in downtown Washington, followed by a march to the US Supreme Court building. 

The line-up of speakers included President Trump, the first sitting US president ever to attend the March for Life. Mr Trump declared to the crowds of tens of thousands, “We’re here for a very simple reason: to defend the right of every child born and unborn to fulfil their God-given potential.” The annual event marks the anniversary of Roe v. Wade, the 1974 Supreme Court ruling that constitutionally allowed legal abortion for basically any reason. Since then, approximately 61 million unborn children have been legally aborted in the US.


Kentucky pro-life law stands

In 2017, the state of Kentucky passed a law, The Kentucky Ultrasound Informed Consent Act, that requires doctors to “display and describe” her foetus to a woman who wants an abortion. In other words, she must undergo an ultrasound scan and a description of what it depicts and hear the sound of the unborn child’s heartbeat. However, women can avert their eyes and cover their ears to avoid seeing the images or hearing the foetal heartbeat. The State Governor, Matt Bevin said, “We’re a pro-life state, we’re a pro-life administration and I’m a pro-life governor, and we won.”

The American Civil Liberties Union (ACLU) challenged the law on behalf of Kentucky’s only remaining abortion clinic. The ACLU argued that ultrasound laws violate physicians’ speech rights under the First Amendment. In June 2019, the federal sixth circuit Court of Appeals in Cincinnati, Ohio, upheld the Kentucky law and denied a review. That decision was further challenged. Lawyers for Kentucky argued against a review because, “Nothing can better inform a patient of the nature and consequences of an abortion than actually seeing an image of the fetus who will be aborted and receiving a medically-accurate description of that image.” On 9 December 2019, the US Supreme Court refused to review the Appeals Court decision. The move is seen as a significant victory for the pro-life movement.

Three other US states currently have similar “heartbeat laws”. The Supreme Court will hear arguments in March in a different abortion case. It concerns a Louisiana law that requires abortion providers to have admitting privileges at a nearby hospital. Pro-lifers are hopeful the Louisiana case, June Medical Services LLC v. Gee, could be the catalyst to overturn Roe v. Wade.

Slovakia almost followed suit

In late November, lawmakers in Slovakia debated a proposed law that would compel women seeking an abortion to first have an ultrasound and listen to the heartbeat of their foetus. This is akin to the Kentuckian law.

Many will decry such a move. It’s cruel, it’s against women’s rights, and so on. Those are logical responses if, if, if the unborn child were not a real, live human being. What is kind and gentle about abortion, where are the unborn child’s rights? How conditioned we have become by the encompassing attitude of progressive liberalism concerning the whole abortion issue. Slovakian women will still be able to go ahead and abort. All the proposed law would do is, “ensure that women are informed about the current stage of their pregnancy.” The authors of the bill have stated, “the proposed draft law has positive impacts on marriage, parenthood and family” and that “society does not consider the induced termination of pregnancy a good solution.” See how easily liberalism’s call for rights, privacy and autonomy can nowadays transcend all other concerns. Christians and others can be so confused, afraid and gullible.

The proposed bold bill narrowly failed on 5 December. A total of 59 MPs voted in favour, which was just 4 short of the simple majority of 62 MPs present. Only 24 MPs voted against and 40 abstained. If passed, this law would have been the first of its kind in the European Union. Across Europe, 39 countries have legalised abortion on request, on an industrial scale. Five countries – Andorra, Liechtenstein, Malta, Poland and San Marino – allow abortion only in rare instances, such as if the woman’s life is at risk.

John Ling is a freelance speaker, writer and consultant bioethicist. He is the author of three books on bioethical issues. He regularly updates his personal website. A fuller version of John’s regular update of bioethical news and views can be found on his website.

(This article was originally published in the Affinity Social Issues Bulletin for February 2020. The whole edition can be found at www.affinity.org.uk)


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