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ss nucleus - autumn 1997,  News Review

News Review

Japanese Parliament recognises concept of 'Brain Death'

The lower house of the Japanese Parliament has voted to recognise the concept of brain death, thus paving the way for heart transplants to occur in the country for the first time. In the past there has been cultural resistance to organ donation but the Health and Welfare Ministry now estimate that more than 8,000 'brain dead' patients could become potential donors and be taken off artificial support.

If approved by the upper house, the ruling would leave only Poland and Pakistan among major countries not designating brain death as actual death in law or practice. The Declaration of Sydney (1968), to which most World Medical Association members adhere, makes it possible to cease resuscitation and to remove organs once the process of death 'has become irreversible'. (BMJ 1997; 314:1298)

Shortage of organs for transplants continues

Despite public education, donor cards and the success and low cost of surgery, the number of transplants in Britain still falls short of the 6,000 patients awaiting new organs. Part of the problem is that the 1961 Human Tissue Act gives donor cards equivocal status and does not adequately define death. In addition, as many as 45% of potential donors are not detected. This is in part due to the failure of critical care teams to communicate with bereaved relatives.

The organ supply could be increased by training in communication skills or the introduction of an opt-out system whereby consent is assumed unless otherwise specified. This would lessen the need for animal organs and reduce pressure for procuring human organs by unethical means. (The Times Jan 21 1997, p37; BMJ 1997; 314:697)

Worldwide ban on human cloning

The European Parliament has called for a worldwide ban on the cloning of human beings but has declined applying a similar ban to animal cloning. However, it has encouraged the European Union to introduce strict guidelines to guarantee human health and safeguard animal species and biodiversity. (Student BMJ 1997; 5:94)

Meanwhile, in an editorial in the British Medical Journal, London-based professor of fertility studies Robert Winston has extolled the virtues of the practice. Cloning, he claims, should be seen as an exciting challenge rather than a moral threat, offering prospects for research into fertility treatments, genetic disease, xenotransplantation and the preservation of endangered species. (BMJ 1997; 314:913)

E.coli genome sequence unravelled

The genome sequence of Escherichia coli has just been completed and is the third bacterial genome to be published after Haemophilus influenzae and Mycoplasma genitalium. As many as 100 further microbial genomes are likely to be sequenced in the next few years. Work on the Human Genome Project proceeds more slowly. However, an on-line database on the internet already contains information on over 8,000 inherited disorders. (BMJ 1997; 314:578)

First artificial human chromosome

Researchers in Ohio have created the first artificial human chromosome, following it through 240 successful divisions in a human cell line. The procedure became possible after DNA sequences integral to the centromere were unravelled. While numerous obstacles need still to be overcome, the artificial chromosome is being hailed as a replacement for virally mediated gene transfer and a possible treatment for inborn errors of metabolism. (BMJ 1997; 314:1070)

Hillsborough survivor emerges from persistent vegetative state

A survivor of the Hillsborough football ground disaster has emerged from the persistent vegetative state (PVS) to the extent of being able to signal yes and no using a touch sensitive pad. Andrew Devine sustained his injuries in the crush which lead to the deaths of 95 soccer fans including fellow PVS victim Tony Bland. Tony died after a House of Lords ruling to stop feeding him in 1993. Since then, at least ten further patients have died in similar circumstances in England and Wales, following High Court decisions to sanction the withdrawal of artificial nutrition and hydration. (Daily Telegraph 27 March 1997, p7)

The news has fuelled calls for review of the BMA guidelines which stipulate a waiting time of only 12 months before treatment withdrawal decisions can be made. A recent paper by Dr Keith Andrews, consultant in disability medicine at the Royal Hospital for Neurodisability in London, showed that over half of 40 patients admitted to his unit with the PVS label were misdiagnosed. (BMJ 1996; 313:13-16) There are estimated to be over 1,000 patients in the UK with PVS.

BMA revises Hippocratic oath to sanction abortion

The BMA has produced the first draft of a revised Hippocratic Oath which it hopes will be adopted by the World Medical Association in 1998. The original Hippocratic Oath, which has guided doctors since 500BC, states 'I will... not give to a woman a pessary to produce abortion'. The new version signals the recent shift in ethics with the affirmation: 'Where abortion is permitted, I agree that it should take place only within an ethical and legal framework'.

In 1983 the WMA revised the 1948 Declaration of Geneva which read 'I will maintain the utmost respect for human life from the time of conception'. The new version employs instead the phrase 'life from its beginning' with 'beginning' being left conveniently undefined.

Britain was the first Western European country outside Scandinavia legally to sanction abortion in 1967. The BMA has recently endorsed its support for the Abortion Act as 'a humane piece of legislation'. Some 175,000 abortions are performed under the Act every year. (BMA Annual Report of Council 1996-97, p10, 11, 26)

In contrast, the Finnish Medical Association's draft 'Declaration on the Rights of the Unborn Child' was circulated by the WMA to its membership last October. It stipulates that 'the life of an individual human being begins with conception...' and says that 'the right to life is the most basic of all rights and belongs also to the fetus in a mother's womb....' (Humanity April 1997, p9)

Northern Territory euthanasia law overturned

The Australian Federal Parliament has overturned the Northern Territory's controversial euthanasia legislation. The Rights of the Terminally Ill Act, under which four patients have died since it was enacted last year, was defeated by a 88-35 vote in the House of Representatives and finally by a 38-33 vote in the Senate on March 25.

Doctors on both sides of the ethical divide have joined forces to call for an increase in government funding for palliative care; the Australian Medical Association has welcomed the passing of the new bill. The Prime Minister John Howard -who supported the anti-euthanasia bill - last year cut funding for palliative care.

Dr Philip Nitschke, who developed a 'computer death machine' for use under the defunct Act, has accused the Australian Senate of betraying the terminally ill and has symbolically burnt copies of the new bill in the streets. In a similar vein, Rodney Syme, Melbourne urologist and Voluntary Euthanasia Society president, has said that he will continue to 'help patients to die', even if it means going to jail. (BMJ 1997; 314:994; Humanity, April 1997, p3)

Roussel-Uclaf drop production of 'abortion pill'

Warnings of boycotts by American pro-lifers have led the French pharmaceutical company Roussel-Uclaf, subsidiary of the German company Hoechst, to stop production and distribution of mifepristone (RU486), the 'abortion pill'.

RU486 was introduced as a medical abortifacient in France in 1987 and is currently opted for by about a quarter of French women seeking abortions. The drug is also freely available in the UK and Sweden and is produced in China. Approaches to American firms had been unsuccessful.

Hoechst have transferred patent rights, without charge, to Dr Edouard Sarkiz, one of the pill's developers. He has formed a small non-profit company, Exelgyn, to continue production and distribution. The discoverer, Professor Etienne Baulieu, thinks it may have applications in wound and burn treatment and as a male contraceptive. (BMJ 1997; 314:1150)

Folic acid awareness campaign mounted

The Health Education Authority mounted a massive campaign to promote folic acid awareness in May this year, following the finding that the vitamin reduces the incidence of neural tube defects (one of the commonest indications for abortion).

The principal objective is to increase folic acid intake in women who may become pregnant. Folic acid supplements, folate-rich foods and foods fortified with folic acid are to be encouraged.

The key messages to women of childbearing age will be always to choose folic acid fortified foods (carrying the 'flash'), eat leafy green vegetables and take 400mcg of supplemental folic acid daily after stopping contraception.

The move is a welcome sequel to the US FDA decision to fortify bread and pasta products. This was reported in the last edition of Nucleus.

MoD payout on missed Down's Syndrome diagnosis

The British Ministry of Defence (MoD) have paid £300,000 in an out of court settlement to the mother of a boy with Down's syndrome. Lawrence Roberts, a doctor at the Louise Margaret Maternity Hospital in Aldershot, Hampshire, had allegedly informed her that the abortion risk as a result of amniocentesis was 1%, and that she was in no more danger of having a Down's syndrome child at 35 than at 26. The real risks are 0.3% and three and a half times respectively.

Sandra Hurley, now aged 42, blames the break up of her marriage on the strain of looking after her son Matthew. Having had three previous abortions, she claims that she would have had another one, had she known the facts. (BMJ 1997; 314:1368)

Down's syndrome births in England and Wales fell from 764 in 1989 to 615 in 1993. 92% of cases diagnosed prenatally now end in abortion. (BMJ 1995; 310:1546)

British hypocrisy over birds' eggs

Anyone in Britain who breaks a wild bird's egg can be liable for a fine of up to £2,000. By contrast, human embryos can be experimented upon and destroyed quite legally. Under Old Testament Law, Israelites were permitted to take birds' eggs (or young) for food but were forbidden from sacrificing their own children. (Lev 20:4,5; Dt 22:6,7) While Jesus affirmed God's love and provision for the 'birds of the air' it was only in the context of emphasising the much greater importance of human beings. (Mt 6:26, 10:29-31)

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