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ss nucleus - summer 2008,  News Review

News Review

HFE Bill update

As Nucleus went to press the Human Fertilisation and Embryology (HFE) Bill was going through its crucial final parliamentary stages, and the outcomes should be known by the time you read this, or soon after.

The bill's main worrying aspects are:

  • allowing animal-human hybrid embryos for research;
  • permitting saviour siblings for an increased range of illnesses;
  • removing the requirement to consider a child's need for a father in IVF, and;
  • potential further widening of abortion law through pro-abortion amendments.

All attempts to modify the bill to make it more ethically acceptable sadly failed, both in the House of Lords in January, and in the House of Commons on 19/20 May. This included the 20 Weeks Campaign to try to reduce the upper limit for social abortion from 24 to 20 weeks. Widespread media coverage suggested that MPs may have been out of step with mainstream public opinion in retaining the upper limit. The bill is currently at report stage and soon to come back for its final, third reading, likely in early July.

Further liberalising amendments will be voted on – this time to remove the need for two doctors' signatures for abortion up to 24 weeks (making it like any other procedure such as appendicectomy), and to allow nurses and midwives to perform abortion. These have been laid down by the Lib Dem MP Dr Evan Harris, a long term campaigner for easier access to abortion. A summer of similar efforts is lined up, with pro-abortion motions planned at the British Medical Association's annual meeting on 6-10 July in Edinburgh. BPAS, one of the UK's biggest abortion providers, will host a conference on the Future of Abortion on 26,27 June, with the health minister, Dawn Primarolo, opening the conference.

Despite Parliament's headlong rush to make Britain an ethical oddity by legalising animal-human hybrids to obtain embryonic stem cells, when so many countries have deemed it unacceptable, the reality behind the hype is worth bearing in mind. Dr Peter Saunders, CMF General Secretary, writes:

As of March this year, the US National Institute of Health counted 1,987 trials using adult stem cells, 106 using cord blood stem cells and none using embryonic stem cells. Adult stem cell therapies are now used in over 70 diseases; cord blood cells in over 40; whilst embryonic stem cells treat none. (;; Triple Helix 2008; Summer:3)

link between abortion and crime?

A controversial theory states that the legalisation of abortion has lead to a reduction in crime in the USA. This was first proposed by Donohue and Levitt in 2001, then popularised in Levitt's bestseller, Freakonomics. A new study provides evidence against the theory.

Three economists (Kahane et al) looked at the impact of abortion on UK crime. They explain that abortion has been legal for longer in the UK and the 'data on (legal) abortions are complete and of high quality' because all abortions are reported to the government, unlike in the USA. Their study found that the timing of changes in UK crime was not consistent with the legalisation of abortion.

In addition, the authors argue that abortion does not reduce the number of unwanted children more likely to commit crimes. They say that, 'prior to the legalisation of abortion, unwanted babies did not necessarily become unwanted children'. Many of these were adopted. Currently, abortion may be causing a shift in society such that adopting 'unwanted' children is discouraged. ( 2008; 10 April, 2008; 8 April)

say no to free lunches

A ban on handing out pharmaceutical freebies to medical students has been strongly recommended by the Association of American Medical Colleges (AAMC). Free drug samples, pens, sponsored lunches and gifts are seen by many as bribery. The AAMC believes 'patients need to be assured that their doctors are prescribing what's best for them, not what's best for companies'.

Nevertheless, the New York Times criticised the report for not going far enough. It 'stopped short of calling for a complete ban on the highly dubious practice' of medical school faculty members participating in industry sponsored speaker bureaus. Nor did the report 'call for an end to industry subsidies of continuing medical education programs that doctors must take to retain their licenses'. ( 2008; 20 May, 2008; 30 April, 5 June, 2008; 30 May)

Burmese cyclone and Chinese earthquake

The death toll of the 12 May Sichuan earthquake in China is approaching 70,000 and that of Cyclone Nargis in Burma on 2-4 May probably exceeds 130,000. Experts warn that people remain at risk due to the lack of safe drinking water and poor sanitation. This is particularly acute in Burma, where the government has been reluctant to receive international help. Aid agencies have found it difficult to reach those hit hardest in the Irrawaddy Delta.

Surface water has been contaminated with sewage, creating effective breeding grounds for cholera, typhoid and shigella. The lack of nutrition and exposure to the elements weaken the immune system and given the high temperatures, diarrhoea and dehydration can kill quickly.

After the initial trauma based response in China, there has been an increasing need for psychosocial support, particularly for children who were affected. In comparison to Burma, the Chinese government's willingness to accept international help has had a significant impact on the health and survival of victims. ( 2008; 17 June, 2008; 17 June, 2008; 6 June, 2008; 17 May, 2008; 27 May, 2008; 4 June, 2008; 2 June)

'right to die' card

Wallet sized cards announcing 'Advance Decisions to Refuse Treatment' (ADRT) are now available in Manchester. These instruct medics to withhold specified treatments if the patient becomes incapacitated. The pilot project is being run by Salford City Council.

Patients sign an advance directive (formerly known as a living will) that is also signed by two witnesses. Doctors are legally bound to adhere to the patient's wishes. But in a North American study, 61% of patients carrying an ADRT thought doctors should sometimes override them.

Dr Andrew Fergusson, CMF Head of Communications, fears that pressure on doctors to avoid prosecution may cause delays to emergency treatment if the directive is not located. CMF recommends appointing a proxy able to express the current wishes of the patient, as these can change over time.

Fergusson believes that 'individual autonomy must have limits, set in ethics and law, for the protection of others in the complex inter-related society we live in'. He is concerned that ADRTs may become a back door route into euthanasia. ( 2008; 21 May, 2008; 24 May, 2008; May)

challenge to assisted suicide law

A multiple sclerosis sufferer is seeking legal assurance that her husband will not be prosecuted if he travels with her to an assisted suicide clinic in Switzerland.

Dignitas has helped almost 100 Britons commit suicide. But none of the relatives that travelled with them have been prosecuted, despite the law stating that any individual aiding or abetting a suicide can face up to 14 years' imprisonment.

Debbie Purdy, 45, was diagnosed with the disease 13 years ago. She is currently 'extremely happy' and does not want to die. But she would choose to die early without her husband's assistance rather than risk him being prosecuted by accompanying her to Switzerland later. She filed a legal challenge against the Director of Public Prosecutions' (DPP) decision not to disclose what factors are taken into account in deciding whether to prosecute. The judicial review of the DPP's decision will take place in October.

Care Not Killing, the UK-based alliance, argues that 'hard cases make bad law'. They believe that a change in the law to allow assisted suicide would 'place vulnerable people – the sick, elderly, depressed and disabled – under pressure, whether real or imagined, to request early death.' ( 2008; 7,12 June, 2008; 11 June, 2008; 7, 12 June, 2008; 6 June)

Dignitas settles next to brothel

The Swiss village of Schwerzenbach can now boast both the country's largest brothel, and an assisted suicide clinic. Dignitas, the Swiss based group, was forced to find new premises after being evicted from their flat in Zurich. The clinic received complaints of dead bodies in a lift; one resident called it the 'house of horrors'.

The eviction led to three unsuccessful attempts at relocation, due to complaints from local councils and residents. During the interim period, four individuals committed suicide in a mobile unit. Two of those took place in public car parks at scenic spots. Ludwig Minelli, Secretary-General of Dignitas, even offered his own living room for those who wanted to die.

Schwerzenbach 'fought the decision tooth and nail' but eventually lost, according to Karl Rütsche, a spokesman for the local council. Local officials estimate that 200 people will visit to commit suicide each year; somewhat less than the brothel's average of 300 visitors per day. (Observer 2008; 16 March, 2008; 17 March, BMJ 2007;335:1176)

a pregnant 'man'?

A man from Oregon, USA is pregnant. Thomas Beatie, born Tracy Lagondino, became legally male after a transgender change. Married to his wife for ten years, he is now pregnant with their first child.

They decided that he would carry the child because, while his wife has had a hysterectomy, he retained his female reproductive organs. Sterilisation is not a requirement for gender reassignment. Mr Beatie argues that 'wanting to have a biological child is neither a male nor female desire but a human desire'.

The couple faced resistance from doctors at their request for insemination with donor sperm, so they resorted to home insemination. After an ectopic pregnancy, he became successfully pregnant; a baby girl is due on 3 July.

The couple insists that their child is being born into a normal family. But one wonders how she will react on discovering that it was her father who gave birth to her. ( 2008; 26 March, 2008; 27 March)

60 years of the NHS

The NHS will celebrate its 60th year of public service on 5 July. Events will mark major achievements since its launch in 1948. The NHS has changed hugely over the decades and largely continues to fulfil the vision of a public health service that is 'free for all at the point of delivery'. This is despite some of the high-profile failures of the last decade, such as the Bristol heart deaths enquiry, long waiting lists and hospital superbugs.

David Cameron, the Conservative leader, spoke warmly of a principle embodied by the service:

That something is equity, the founding value of the NHS: the spirit of fairness for all, of dignity in age and in pain and weakness; the idea of our equality as human beings and the equal right of everyone to care and comfort when they are born, when they are ill, and when they are dying.

The NHS has witnessed huge technological advancement in its 60 years yet faces constant challenges and reforms – such as Modernising Medical Careers and current proposals to coalesce GP surgeries into huge polyclinics. It runs the continued risks of being a political football and reform for the sake of reform.

The NHS is a great British institution that we can give thanks to God for despite its many challenges. ( 2008: 2 Jan;

Jenny Chui, Siôn Glaze, Norris Igbineweka, Sarah MacLean, Mark Pickering, Sheldon Zhang

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