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ss nucleus - spring 1999,  News Review

News Review

Euthanasia Fears

More than 10,000 Dutchmen now carry anti-euthanasia passports because of fears that they may be killed prematurely by over-enthusiastic doctors if they become ill. The cards say ‘I request that no medical treatment be withheld on the grounds that the future quality of my life will be diminished, because I believe this is not something human beings can judge. I request that under no circumstances a life-ending treatment be administered because I am of the opinion that people do not have the right to end life.’ These cards are being distributed by pro-life groups throughout Holland as the Dutch government pushes through a bill which will legalise physician-assisted suicide. Doctors in Holland are increasingly practising non-voluntary euthanasia and are ending patients’ lives without their approval. Every year, up to 25,000 people die when their treatment is terminated on medical grounds. An official survey shows that 23% of doctors have ended a patient’s life without his or her explicit request. Although euthanasia of any kind is currently illegal in Holland, these doctors rarely face prosecution. A group of predominantly Christian members of the Dutch Physicians’ Association are afraid to speak out against euthanasia for fear of losing their jobs, and members are being encouraged not to mention their views when applying for jobs.[1]

In England however, a new campaign against any relaxation of the euthanasia laws was recently launched by doctors. There are fears that any change in the law would lead to a slippery slope where many thousands of people would be at risk if doctors were legally allowed to hasten death by administering or withholding drugs, food and drink. One doctor said he was frightened by the attitude of younger doctors who seem to be losing their sense of the sanctity of human life.[2]

Prostitution

Child prostitutes will be treated as victims of crime, rather than as criminal offenders if new Home Office guidelines are implemented. There are also plans to strengthen links between courts, social services, schools and health services, which will hopefully help to combat the commercial sexual exploitation of children.[3]

Italian prostitution is now on the decline after a minor change was made to the highway code; it is now illegal to stop your car by the side of the road with the intention of picking up a prostitute, and fines of a million lire are being implemented. The results have been very encouraging, however, nine million Italians still regularly use prostitutes; 43% requesting unprotected sex. An estimated 50,000 prostitutes work the Italian streets, and the act of prostitution does not legally constitute a crime.[4]

A study carried out in South Africa, Thailand, Turkey, the United States and Zambia has revealed that post-traumatic stress disorder is common in prostitutes and the vast majority would leave the profession if they could. Most of the prostitutes had histories of childhood abuse and are themselves often victims of violent crime.[5]

Students' Views on Abortion

A study of 300 university students has found that most of them believe that it is morally wrong to abort a baby that would be born disabled. According to the Pro-Choice Forum survey, abortion of Down’s syndrome babies was perceived as especially wrong. However, 75% believe the current abortion laws are not liberal enough and say that abortion should not be restricted by legal means, and only a few disapprove of abortion for convenience. 76% of students were in favour of abortion in general, with only 4% against.[6]

On the other hand, the Spanish have rejected an abortion bill that would have allowed abortion on demand within the first twelve weeks of pregnancy.[7]

Fetuses to be given painkillers

The Government is considering drawing up new guidelines that would require the administration of pain-killing drugs to fetuses before abortion or intra-uterine surgery. The new guidelines would deal with a legal anomaly that protects unborn animals against scientific experiments, but allows operations and abortions to be performed on human fetuses. Under the 1968 Animal (Scientific Procedures) Act, experiments cannot be carried out on animal fetuses from mid-gestation to specifically protect ‘any living vertebrate other than man’.[8]

Contraception Update

The British manager of Durex has signed a deal to build a factory and produce up to 200 million condoms a year for 1.2 billion Chinese people. China has recently seen a sexual revolution, with sex-parlours springing up in many cities.[9]

In America, a special contraceptive kit has been approved by the Food and Drug Administration, in the hope that this will reduce the number of unwanted pregnancies. The Preven Emergency Contraceptive Kit costs about $20 and contains four birth control pills (levonorgestrel and ethinyl oestradiol). The kits are 75% effective in preventing pregnancy.10 Pregnancy among American teenagers has fallen to a 20 year low.11 A survey by the Centers for Disease Control and Prevention (CDC) has shown that the percentage of American teenagers, especially males, who have had sex has declined in the 1990s. Teenagers are also more likely to use condoms now than in the early 1990s.[12]

Smoking News

The British Medical Association’s Annual Festival of Science has been told that tobacco use will kill four million people in the year 2000, and ten million in the year 2030. Tobacco is still the biggest killer in Britain,[13] and many teenage girls are taking up smoking to control their weight. Normal body changes at menarche are perceived as fatness and smoking helps them to lose the ‘extra weight’.[14]

In the USA, it has been ruled that the Food and Drug Agency does not have the power to regulate cigarettes or smokeless tobacco. This is a big blow to those who saw the regulation as a way of reforming the industry.[15]

A government minister in South Africa has proposed a bill introducing tough anti-smoking legislation, despite strong opposition from the tobacco companies. The bill would greatly reduce tobacco advertising, in effect ending sporting event sponsorship, and would ban smoking in public places and at work.[16]

Smoking causes Cancer in Fetuses

Recent research has found that one of the strongest carcinogens in tobacco smoke is passed on to the developing fetuses of pregnant women who smoke. The carcinogen (NNK) is taken up and processed by the fetus and has been found in alarming quantities postnatally. Hopefully these findings will encourage more women to give up smoking, as currently 60% do not give up during pregnancy. [17]

Furthermore, maternal exposure to passive smoke is sufficient to induce deleterious genetic deletion mutations in the developing fetus. These mutations are potentially carcinogenic.[18]

Genetic Selection

In the USA, a genetics professor has asked an ethics committee for permission to experiment on human fetuses destined for abortion. Left to nature, the babies would either be stillborn or born with severe diseases such as Tay-Sachs or SCIDS, and the mothers have already decided to terminate their pregnancies. Professor Anderson of the University of Southern California hopes to attempt gene therapy on the fetuses and then examine them after abortion to see how successful the treatment was. This has caused world-wide ethical uproar and clerics say scientists are losing their respect for life. There is a deluge of ethical issues over the proposal, including the possibility that if the therapy worked, the mother would learn that she had aborted a healthy baby. There are questions about what kind of baby would be born if the mother decided after the therapy not to have the abortion.

In Britain, legislation permits experimentation only on laboratory-produced human embryos up to the age of 14 days, under very strict controls.[19]

The nuchal translucency test for Down’s syndrome claims a detection rate of 80%, and has a false positive rate of 8%. However, 40% of fetuses with trisomy 21 die between twelve weeks of gestation and term, so the detection rate is nearer 60%, and about 30 invasive tests are required to identify a single affected fetus.[20]

The recent and frequent discovery of genes associated with various diseases has led to fears that people with mental disorders may be subjected to inappropriate genetic testing. Most mental illness is multifactorial and genes play variable roles; bulimia has a genetic component of only 5%, while the genetic contribution to schizophrenia is 50-70%.

Although it is now possible to test for Alzheimer’s disease, this is being discouraged as few people would benefit from this predictive test.[21]

Accordingly, the Nuffield Council on Bioethics has recommended that unless there is a clear medical benefit, genetic testing, especially in children, embryos and fetuses, should be strongly discouraged. [22]

Choosing your Baby's Sex

A commercial genetics and infertility centre in the US is allowing clients the chance to choose the sex of their child. The technique used is the Microsort technique of sperm selection, developed by researchers at the Genetics and In Vitro Fertilization Institute in Virginia. The sperm is labelled with a DNA fluorescent dye (bisbenzimide) and then sorted by laser spectrophotometry. Success rates of 85% and 65% have been reported for the X and Y chromosomes, respectively. Only a few of the choices made had a medical justification. There are worries that the ‘designer family’ is just around the corner and that fetuses of the ‘wrong’ sex will be aborted.[23]

Alternative Treatments are Harmful

According to a report in the New England Journal of Medicine, people who attempt to cure their own ills with poorly-tested herbal medicines have suffered severe illnesses, and calls have been made to subject these alternative treatments to the same rigorous standards which conventional medicine is subjected to. Some of the disorders suffered as side- effects of the medicines are: lead poisoning, impotence and abnormal heart rhythms. These are thought to due to the unknown mixing of potent drugs with ‘natural’ products.[24]

Drug Abuse and Testing

Four-fifths of a sample of secondary schoolchildren were found to be drinking regularly by the age of 16, according to a report in the journal Addiction.25 Alcohol is a gateway to other substance abuse, and a report from the Home Office Police Research Group shows that British teenagers are taking heroin in increasing numbers, especially in smaller towns.26 More than 100 leading schools have introduced random drug testing, as 25% of GCSE pupils have tried illegal drugs, and 10% take them regularly. A Blue Peter presenter was recently sacked for taking cocaine.[27]

Over a quarter of junior house officers take cannabis and two thirds of the 93% who drink exceed safe limits. 21% of men and 45% of women house officers may be suffering pathological anxiety, leading to the misuses. [28]

Organophosphate Testing on Students

The Inveresk laboratory near Edinburgh has recruited students and unemployed men to act as guinea pigs for testing dangerous organophosphate pesticides in order to determine the dose at which side-effects are observed. There are fears that vulnerable people will be induced to volunteer by the high financial remuneration, and the experiments are not regulated by any government department.[29]

Human Genome Project

This attempt to identify the DNA sequence of the entire human genome is due to be finished in 2003, two years ahead of schedule. A draft version containing about 90% of the total genetic information will be ready by 2001, and most of the DNA sequencing work is being carried out at the Sanger Centre in Cambridgeshire. Part of the project’s aim is to study the ethical implications of genome research, as genetic information will be linked with personal identity, race and religion in a huge database.[30]

Rising Student Debt

Medicine is in danger of becoming ‘the domain of the privileged’ the BMA has warned, due to the increasing levels of student debt and the introduction of tuition fees as this academic year began. Medical students are especially affected by the new system as they study for five or six years, and the short holidays make finding employment difficult. A BMA survey of medical student finances for the past year showed that debts are at the highest ever, with final years owing £7738 on average (a rise of over £2500 compared with three years ago).[31]

Arm and Face Transplants

The world’s first arm transplant was performed in France on 23 September 1998. A brain-dead man’s hand and forearm was sewn onto a New Zealand businessman’s amputated stump (due to a chainsaw accident) in a 13-hour operation. There has been some hostile questioning, by leading surgeons, of the ethics of risking a patient’s life and health in order to replace a non-vital organ.32 In addition to the risks of surgery, the patient is now beginning years of powerful immunosuppressant therapy to prevent his body from rejecting the donor hand.

Meanwhile, American doctors say it may be possible to have a complete face transplant in a few months. This would involve removing the face of a dead donor and giving it to someone who has been deeply disfigured through illness or accident.[33]

Controlling Computers by Thought

An American team of surgeons from Emory University in Atlanta, Georgia, has produced brain implants that allow the control of computers by thought alone. The implant fuses with brain cells and totally paralysed people can express their thoughts by moving a screen cursor to different icons to trigger a computer voice. In the future, the team hopes to be able to use the implant to move paralysed limbs and control artificial limbs.[34]

AIDS Death Trends

For the first time since 1990, AIDS is no longer one of the top ten causes of death in America. The number of Americans dying of AIDS has fallen to almost half the 1996 number, across sexes and races. 45 people are dying every day, compared to 166 a day last year. This improvement is probably due to increased access to new and improved drug treatment and reduced mortality from infections after AIDS develops. Rates of HIV infection have remained constant.

However, in Africa, the rate of infection with HIV is the highest in the world. Epidemic figures are reaching alarming proportions; last year 16% of women attending antenatal clinics were HIV positive, and about 8% of the South African population (three million) are living with the disease. The plans that the government has drawn up to combat AIDS have been criticised as ineffective, and there is world-wide outrage over its refusal to supply zidovudine to pregnant women even though this drug helps prevent HIV transmission to the babies during birth.[35]

References
  1. The Telegraph 1998; (15 October)
  2. The Telegraph 1998; (15 October)
  3. The Telegraph 1998; (7 October)
  4. The Telegraph 1998; (9 September)
  5. BMJ 1998;317:558 (29 August)
  6. The Telegraph 1998; (26 August)
  7. BMJ 1998;317:902 (3 October)
  8. The Telegraph 1998; (9 August)
  9. The Telegraph 1998; (11 October)
  10. BMJ 1998;317:697 (12 September)
  11. The Telegraph 1998; (17 October)
  12. BMJ 1998;317:834 (26 September)
  13. The Telegraph 1998; (8 September)
  14. BMJ 1998;317:366 (8 August)
  15. BMJ 1998;317:490 (22 August)
  16. BMJ 1998;317:698 (12 September)
  17. BMJ 1998;317:555 (29 August)
  18. BMJ 1998;317:903 (3 October)
  19. The Telegraph 1998; (8 October)
  20. BMJ 1998;317:368 (8 August)
  21. BMJ 1998;317:422 (8 August)
  22. BMJ 1998;317:903 (3 October)
  23. BMJ 1998;317:768 (19 September)
  24. BMJ 1998;317:833 (26 September)
  25. BMJ 1998;317:482 (15 August)
  26. BMJ 1998;317:431 (15 August)
  27. The Telegraph 1998; (19 October)
  28. Lancet 1998;352:785-6 (5 September)
  29. BMJ 1998;317:430 (15 August)
  30. BMJ 1998;317:834 (26 September)
  31. BMJ 1998;317:558 (29 August)
  32. The Telegraph 1998; (25 September)
  33. The Telegraph 1998; (1 October)
  34. The Telegraph 1998; (15 October)
  35. BMJ 1998;317:1032 (17 October)
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