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ss nucleus - winter 2005,  News Review

News Review

BPAS controversy

The British Pregnancy Advisory Service (BPAS), Britain’s leading abortion provider, has become the subject of controversy after a Telegraph exposé revealed that they have referred women to Spain for abortions after the UK legal limit of 24 weeks.

A heavily pregnant reporter contacted BPAS for information about terminations, asking whether she could obtain a late abortion in this country. In one telephone conversation with an adviser, having said that she was 25 weeks pregnant, she was told to contact the Ginemedex clinic in Barcelona. When questioned about the legality of post 24-week abortions in Spain, the adviser answered, ‘it’s not unillegal’.

However, Spain’s laws on late abortion are stricter than the UK. Here, an abortion can be carried out before 24 weeks for ‘social’ reasons; after 24 weeks there must be a serious fetal abnormality or grave danger to the mother’s life or health. In Spain, an abortion after 22 weeks is only legal where the mother’s health is in grave danger. Staff at Ginemedex admitted to the reporter that they ‘play with the laws a little bit’. When she travelled there under the pretence of wanting a termination, a member of staff told her they ‘put on the paper that there was a gynaecological emergency, that is [covered] under the law’. She also said that 80% of their patients were British - the majority referred by BPAS, with whom the clinic have ‘very, very close contact’.

BPAS have been keen to defend themselves against the allegations. Chief Executive Ann Furedi compared referring women abroad with Irish women who travel to England for terminations. Her logic is fallacious, however, as the referrals to Spain were against both UK and Spanish law. She argued that BPAS did not run the clinics, or encourage women to use them, and asserted that they were not ‘breaking [English] law in any way’. BPAS see it as part of their service to provide the woman with access to abortion whenever they legally can. One of Ann Furedi’s frequent comments is that abortion should be available ‘as early as possible and as late as necessary’.

Health Secretary John Reid has launched an investigation into the actions of BPAS: ‘If there is evidence that the will of Parliament is being thwarted and that the law of a fellow European country is being broken by an organisation in receipt of public money this would be a very serious situation indeed.’ Conservative MP Ann Widdecombe has also called for BPAS to be closed down.

Speaking at a London conference in November, Ann Furedi said that access to 20-24 week abortions needs to be improved. BPAS carries out 80% of post 20-week terminations, but is often unable to meet demand so refers people abroad instead. She said that health professionals were becoming increasingly reluctant to carry out such procedures. (Telegraph 2004; 10 October, Guardian 2004; 25 November, 2004; 26 November)

‘Do not resuscitate’ baby rulings

The High Court has given permission to doctors in separate cases to withhold life-saving resuscitation from two babies. Luke Winston-Jones, a nine-month old with Edwards’ syndrome, has since died. Charlotte Wyatt, born at 26 weeks and suffering from severe lung disease of prematurity, is still alive in neonatal intensive care.

Both sets of parents took their cases to the court asking that the babies should receive full resuscitation if needed but the judges ruled that this would not be in their best interests.

Charlotte Wyatt has previously stopped breathing and been resuscitated on three occasions. Her parents, both committed Christians, had pleaded with the court not to give up on their baby, saying, ‘when you get to the stage when you grow to love someone, you can’t just throw them away like a bad egg’.

Peter Saunders, CMF’s General Secretary, said the case showed that doctors ‘don’t have an absolute moral duty to use every treatment for every baby and sometimes the burden of intensive care may outweigh its benefits.’ A BMA spokesman also agreed with the outcome of the case, saying that the judge made the decision in the best interests of Charlotte. 

In a separate development, the Nuffield Council on Bioethics has established an independent review about the ethics of prolonging the life of very premature babies. While the working party was not set up in response to the Wyatt case, it will take into account the ruling handed down by the judge. The committee of the investigation aims to give clearer guidance to doctors on dealing with such complex problems.

Chairing the committee, a professor of law at Manchester University, Margaret Brazier said she approached the task ‘with trepidation’, as there were many difficult issues and strong opinions. She also added that the question arose as to how much these babies should be treated given that the means to do so is now available. Currently, doctors make decisions regarding newborn resuscitation on the ‘viability’ of the baby. ( 2004; 12 November, AFP 2004; 8 October, Times 2004; 8 October, Independent 2004; 8 October)

Second pregnancy at 15

A teenager who made national headlines by having an abortion at 14 years old without her mother’s knowledge has become pregnant again. Melissa Smith, now 15, is determined to keep this baby, which is believed to have the same father.

Melissa is currently in her final GCSE year, and is due to give birth in July, shortly after her exams. Her mother, Maureen, maintains that it was wrong for Melissa to have an abortion. She had previously launched a case at the European Court of Human Rights, claiming that her rights as a parent had been breached because care workers did not inform her about the secret termination. Mrs Smith also lashed out at those critics who claimed she failed as a mother, saying, ‘I can’t follow Melissa around with a camcorder 24 hours a day or tie her down to her bed.’

The pro-life charity, Life, welcomed the latest pregnancy. A spokesman said that it is common for women to have an ‘atonement baby’after an abortion.

Meanwhile, the Department of Health’s (DoH) guidance to health professionals about the provision of sexual health services has come under fire. The DoH recommends complete confidentiality over provision of abortion services, using the same guidelines employed for contraception. However, Mrs Sue Axon, a mother from Manchester is seeking High Court permission for a judicial review of the guidance, saying that it is in the interests of most children to have their parents involved in these decisions. (Guardian 2004; 18 November, Telegraph 2004; 18 November, Times 2004; 23 October, Nucleus 2004; July:5)

Landmark PGD licence

The Human Fertilitisation and Embryology Authority (HFEA) has granted a licence to a London clinic to screen embryos for an inherited form of bowel cancer.  This landmark decision could lead to mass screening of embryos for genetic mutations that predispose carriers to late onset disease.

Four couples have now had pre-implantation genetic diagnosis (PGD) for the familial adenomatous polyposis (FAP) gene at the assisted conception unit at University College Hospital, London. Up until now, only untreatable conditions, eg Huntington’s chorea, or those affecting children, such as cystic fibrosis, could be screened for.

There is a 50% chance that children of affected couples will have the FAP gene.  The only option previously was to test for the gene during pregnancy, with abortion being offered if positive.  FAP affects between 1 in 26,000 and 1 in 44,000 people in the UK.  It causes multiple rectal and colonic polyps, leading to malignant tumours in most affected people.  Prophylactic colectomy is commonly performed during teenage years.

Critics disagreed with the decision made by a three-member HFEA licensing committee without public consultation.  GeneWatch UK pointed out the lack of proper debate on the principles of such a move. The director, Dr Sue Mayer, criticised the HFEA for not waiting for the outcome of a consultation on these issues by the Human Genetics Commission.

Mohammed Taranissi, of the Assisted Reproduction and Gynaecology Centre in London, a leader in the field, agreed that the HFEA should have consulted more widely.  He said that any condition that has got a genetic marker can now be screened for in principle. (BMJ 2004;329:1061, Guardian 2004; 2 November)

Donor sibling treatment on the NHS

Three UK health authorities have agreed to fund controversial ‘saviour sibling’ treatment on the NHS, with another eight or nine considering a similar move.

The process will be used to treat children suffering mainly from genetic blood disorders. It involves couples creating embryos through in vitro fertilisation (IVF). Embryos carrying the disorder are discarded whilst healthy embryos without the disease are implanted in the woman’s uterus. At delivery, umbilical cord blood is taken to obtain stem cells with which to treat the older sibling.

The move follows the relaxation of laws in July 2004. Julie Fletcher  is currently carrying the UK’s first designer baby.  Her two year old son Joshua suffers from Diamond Blackfan Anaemia, a pure red cell anaemia. 

In another high profile case, the parents of Zain Hashmi, a five year old b-thalassaemia sufferer, are continuing attempts to create a saviour sibling for him. They have spent tens of thousands of pounds, but despite six attempts at IVF have failed to conceive.

The traditional route for treating such children is through finding bone marrow donors, but despite many attempts a match for Zain has not been found. On 24 November the Hashmis launched a foundation to help recruit ethnic minority bone marrow donors. At the press conference, Zain told reporters, ‘I have a broken bone marrow and I have had more than 100 transfusions… Please help me and other children who have broken bone marrows.’

Josephine Quintavalle from Comment on Reproductive Ethics commended the moves to encourage more people to donate umbilical cord blood and bone marrow. She had previously launched a lawsuit against the Hashmis in 2002 to prevent them creating a designer baby, which ultimately failed. (Telegraph 2004; 25 November, Guardian 2004; 25 November, 2002; 20 December)

High Court allows suicide trip

A 66 year old British woman with cerebellar ataxia has travelled to Zurich for physician assisted suicide.  Mrs Z died there after a landmark case did not prevent her husband from accompanying her, as she was too ill to go alone.

The local council caring for Mrs Z brought the case to court requesting a ban to prevent her travelling to Switzerland.  The temporary ban granted to the council was overturned by the High Court. But Mrs Z’s husband could face prosecution on returning to the UK.  Assisting suicide is a criminal offence with a maximum jail term of 14 years. 

‘The court should not frustrate indirectly the rights of Mrs Z.  The role of Mr Z is now a matter for the criminal justice agencies,’ said Justice Mark Hedley in his ruling.

Deborah Annetts of the Voluntary Euthanasia Society said, ‘the police and the CPS [Crown Prosecution Service] did not take any action to stop this, which shows that the Suicide Act is now unenforceable.’  She is pushing for euthanasia in the UK to save people travelling abroad.

Patrick Leahy of the ProLife Alliance said, ‘We look forward to the time when the UK offers palliative care to everyone to remove any desire for people to end their lives in this tragic way.’

Physician assisted suicide is legal in Finland, Sweden, The Netherlands, Oregon (USA) and Switzerland. The Swiss authorities are concerned at the number of euthanasia tourists: there were over 90 such visitors in 2003 compared with three in 2000.

Dignitas is a non-profit organisation assisting terminally ill patients like Ms Z in suicide.  Swiss founder Ludwig Minelli’s view is that ‘we are all terminally ill.  Life is an illness spread by sexual contact.  You die at the end 100%.’  He said that most patients are in a celebratory mood hours before death, citing an instance where he shared wine with twelve relatives escorting a patient to death. ( 2004; 6 December, Guardian 2004; 4 December)

A healthier nation

The government has pledged a healthier nation in its ‘Choosing Health’ white paper, which has targeted smoking, obesity and alcohol as well as sexual and mental health.

Health secretary John Reid plans to cut the number of smokers in England by two million in five years. ‘We will ensure that people will be able to go to their workplace, or choose to go out for a meal or a drink without the damage, inconvenience or pollution from second-hand smoke,’ he said. He proposes to stop people ‘lighting up’ in all enclosed public places and workplaces by 2008. Pubs and bars serving only snacks and private clubs may choose whether or not to ban smoking.

The BMA has adopted a more hardline approach, campaigning for a complete ban in enclosed public places. Dr Vivienne Nathanson, BMA Head of Science and Ethics, said that Dr Reid’s plan, ‘will be letting down every infant, child and adult in England’.

Additionally, the government aims to implement a food labelling system highlighting fat, sugar and salt contents.  Broadcast advertising of alcohol will be curtailed and physical education in school increased to encourage a healthy lifestyle from a young age.

With respect to sexual health, chlamydia screening across England will begin in 2007. ( 2004; 16 November)

UK supports new malaria vaccine

The government has promised £300 million over six years for the development of a new malaria vaccine. The disease kills two million people every year.

Development of the vaccine, aimed mainly at malaria stricken countries in Africa, has been delayed by the uncertainty of financial reward for the companies making the product.

The vaccine could be reaching its final stages of development: the Lancet documents a trial in Mozambique conducted on 2,000 children in October 2004. Vaccinated children were 30% less likely to have been infected by malaria for at least six months compared with unvaccinated children.

The UK has committed to bulk buying the vaccine in advance to generate the market. The French government and the Gates Foundation are also expected to contribute.

The pharmaceutical industry believes that £1.6 billion is required for the final trials in up to 20,000 patients. ( 2004; 25 November, Independent 2004; 15 October)

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