stem cell developments

Embryonic stem cells (ESCs) remain controversial due to the resultant destruction of human embryos. However, recent developments have shifted the debate considerably.

Human skin cells have been reprogrammed to become cells similar to ESCs (induced pluripotent stem cells), which were then used to form brain and heart tissue. Findings were published in 2007 by two teams, Professor Yamanaka's in Japan and Professor Thomson's in the USA. This may remove the need for embryos in this field of research.

Professor Ian Wilmut, knighted for leading the team that created Dolly the sheep, believes these findings represent such a significant advance that he will be abandoning the cloning of human embryos to pursue the Japanese method. Josephine Quintavalle, of Comment on Reproductive Ethics said, 'For once we have better science coinciding with better ethics.'

Several questions surrounding the use of transformed skin cells remain. The technique requires the use of viruses to introduce genetic material into the skin cell, which could potentially trigger tumour growth. It is also unclear to what extent these reprogrammed skin cells are able to mimic stem cells. Dr John Gearhart, from Johns Hopkins School of Medicine, said that whilst the findings were exciting, uncertainties regarding safety meant that scientists 'shouldn't abandon embryonic stem cell research'.

Scientists who heed Gearhart's advice may soon be able to extract ESCs without destroying the embryo itself, thanks to research in Massachusetts. Dr Robert Lanza extracted ESCs with a technique currently used to screen embryos for genetic diseases. In his experiment, the parent embryos were frozen, with the potential to be thawed and used for IVF techniques.

(timesonline.co.uk 2008; 11 January, medicalnewstoday.com 2008; 3 January, news.bbc.co.uk 2007; 17, 20 November, 29 December, DailyTech 2007; 8 December)

Human Fertilisation and Embryology Bill

The word's first 'test-tube baby' was born in 1978. After much discussion and building on the 1984 Warnock report, Parliament passed the Human Fertilisation and Embryology (HFE) Act in 1990. This set up the HFE Authority to police research and treatment related to assisted human reproduction.

Science moved on rapidly, and with changing public expectations, new ethical dilemmas arose, so that in 2008 a new HFE Bill is being debated. Sadly, this threatens individual, family and societal life more than any other piece of legislation for decades. There are three areas of concern:

animal-human hybrids

Seeking sources for more human embryonic stem cells (ESCs) and aiming to facilitate research, the government proposes to create:

• True hybrids – embryos from mixing human and animal gametes
• Cytoplasmic hybrids – human nuclei into enucleated animal eggs
  
• Human transgenic embryos – human embryos with added animal DNA
  
• Human-animal chimera embryos – human embryos with animal cells added

Originally planning a total ban because of public concern, in 2007 the government caved in to pressure from scientists, the biotechnology industry, and patient pressure groups. Ironically, new research, which has successfully reprogrammed adult skin cells back to produce cells with all the potential of ESCs, makes these plans obsolete.

commodifying children and creating them fatherless

Pre-implantation genetic diagnosis (PGD) is given almost unqualified sanction. While sex selection for non-medical reasons such as family balancing remains banned, other worrying consequences remain. The indications for 'saviour siblings' will be extended radically and this will further commodify children, using them as a means to an end.

The requirement to consider the potential child's need for a father will be removed and this will further damage families and society. If two lesbians enter a civil partnership, both will be considered legal parents. Research shows that children with fathers, in stable families, are healthier and do better in education and employment. CMF upholds God's ideal for families and argues no-one has an absolute right to manufacture a child of their choosing, in their way, at their time, and for their own purposes.

liberalising abortion law

Although not mentioned explicitly, the 2008 HFE Bill opens the 1967 Abortion Act (last modified in 1990's HFE Act) to amendments. Since 1967 there have been 6.7 million abortions, with almost one in four pregnancies ending in abortion and one English woman in three having an abortion.

Liberalisers want to bring in abortion on demand in the first trimester by ending the requirement for two doctors' signatures, and they want nurse-led abortions ultimately being completed in women's homes. By contrast, CMF seeks reasonable restrictive amendments like reducing upper time limits, ending discriminatory abortion of the disabled, and providing balanced evidence-based counselling independently of the abortion service.

The bill was passing through the House of Lords as Nucleus went to press. Readers should consult www.cmf.org.uk for current information.

(www.cmf.org.uk/index/current_abortion_review.htm)

Muslim students refuse to learn about alcohol or STIs

Some Muslim medical students are refusing to learn about alcohol-related illnesses or sexually transmitted diseases, claiming it conflicts with their faith. This extends to declining to answer exam questions. 'Examples have included a refusal to see patients who are affected by diseases caused by alcohol or sexual activity, or a refusal to examine patients of a particular gender', said Professor Peter Rubin, chairman of the General Medical Council's (GMC) education committee.

The British Medical Association (BMA) and GMC confirmed they were aware of such religious objections, and they were quick to express their disapproval. The BMA has received reports of Muslim students who did not want anything at all to do with alcohol or its effects. The GMC has received requests for guidance over whether Muslim students could 'omit parts of the medical curriculum and yet still be allowed to graduate'.

The Muslim Council of Britain and the Muslim Doctors and Dentists Association are aware of students opting out, but do not support them. Dr Abdul Majid Katme, of the Islamic Medical Association, said: 'It is obligatory for Muslim doctors and students to learn about everything. The prophet said, “Learn about witchcraft, but don't practise it”.'

(timesonline.co.uk 2007; 7 October; telegraph.co.uk 2007; 15 October)

too many teenage pregnancies

The government is failing targets to halve teenage pregnancy rates in England by 2010. There has only been an 11.4% decrease since 1998. The total number of pregnancies in under-18s is also higher in England than all of Western Europe, prompting proposals for five-year olds to be taught 'safe sex'.

The initiative to lay down the 'groundwork to help them and empower them to make decisions and turn things down' is vital to see the fall of teenage pregnancy and sexually transmitted disease, says Dr Charles Saunders, chairman of the BMA's Consultants' Committee in Scotland.

Norman Wells, of the Family Education Trust, insists that handing out contraceptives to teenagers as part of sex education, as is current practice in certain parts of the UK, will not resolve the problem of teen pregnancy. The Catholic Church is of the view that sex education at five is as 'pointless' as a talk on alcohol although, 'at the age of 15 it's a different matter.'

(news.bbc.co.uk 2007; 31 December, telegraph.co.uk 2007; 31 December)

hospital chaplaincy services cut

Large cuts have been made to hospital chaplaincy services by almost 25% of NHS trusts, according to a study by the theology think tank Theos. On average 19 chaplaincy hours were lost per week, but some trusts reported losing 77.

At present, there are about 400 full time and 3,000 part time chaplains in NHS trusts. They are of different faiths and denominations including Anglican, Roman Catholic, Jewish and Muslim. They offer 'a service of spiritual care to all patients, their carers, friends and family as well as the staff'.

These cuts were made by managers who view chaplains as a soft target, says Rev Dr Chris Swift, president of Unite and the College of Health Care Chaplains. He argues that, 'Chaplaincy is a flagship service in delivering care that meets the diverse needs of patients in modern Britain. It is available to all and personal to each.'

But the National Secular Society believes that all state funded chaplaincy provision should be abolished, calling it 'a waste of NHS resources'.

(guardian.co.uk 2007; 8 October, ekklesia.co.uk 2007; 9,17 October)

easier access to alcohol

In England, alcohol caused 31% more hospitalisations in 2006 compared to 2003. 147,659 admissions included alcohol as a cause in 03-04; 170,130 in 04-05,and 193,637 in 05-06.

In accident and emergency departments, the rising awareness of alcohol as a cause of health problems may account for some of the increase. But the figures do suggest an increase in binge drinking. Longer pub opening hours and a supermarket price war have been blamed for cheaper and easier access to alcohol.

Figures from the National Treatment Agency showed children as young as ten suffering illnesses usually seen only in aging alcoholics; the numbers entering rehabilitation programmes are ever increasing. Lager can be bought for 22p per pint at the major supermarkets, even cheaper than cola and mineral water, allowing children to get drunk easily on their pocket money.

(dailymail.co.uk 2007; 10 November, news.bbc.co.uk 2007; 31 December)

Hippocratic Oath irrelevant?

Senior medical figures in Italy want to scrap the Hippocratic Oath on the basis of passages forbidding abortion and euthanasia being outdated. Giorgio Iannetti, professor of surgery at Rome University, wants the oath to be 'radically modified' at the very least, as newly qualified doctors will not be able to respect certain parts of it. Abortion was legalised in Italy in 1978, and debate continues as to whether or not to follow the Netherlands and Belgium in legalising euthanasia.

98% of American and nearly 50% of British medical students swear some kind of oath regarding their conduct as doctors. While oaths are not legal obligations, they have been found to increase integrity under duress on the wards. Imperial College, London, and the Lancet have produced their own versions of the oath. But these do not mention honouring the sanctity of life – neither of the adult or the fetus – instead referring to the patient's best interests as the ultimate goal.

Hippocrates would define the doctor's role as preserving patients' lives, protecting them from harm, and dealing with them morally. Society's values are changing; but doctors' responsibilities should stay the same.

(timesonline.co.uk 2007; 11 December, Nucleus 2003; October:14-21, Lancet 2002; 9 February, bmj.com 2001; 22 December)

Jenny Chui, Andrew Fergusson, David Jack, Sophie Marnham, Jemima Tagal and Sheldon Zhang