News Review

Couple fight to choose sex of child

A British couple have had their bid to decide the sex of their next child rejected by the Human Fertilisation and Embryology Authority (HFEA) intensifying an already fierce ethical debate.

Alan and Louise Masterton, whose three-year-old only daughter Nicole died in a bonfire accident in July 1999, want another girl - and say that following the ban they will go to court in order to invoke the new Human Rights Act. The Mastertons, who have four sons, insist they are not seeking a designer baby, but that they need to restore their family’s ‘female dimension’ for the sake of their psychological health.

The HFEA currently outlaws choosing the sex of a baby, except when a baby of a particular sex would carry a hereditary disease or condition. Ruth Deech, the HFEA chairman said that the rules would not be changed. However, the Mastertons plan to cite a clause in the Human Rights Act which guarantees respect for private and family life. The couple, who are both 42, tried for 15 years to have a daughter but Nicole, aged three, suffered horrific burns in a bonfire accident at their home last year and died two months later.

The Mastertons had asked the HFEA to be allowed to use pre-implantation genetic diagnosis to decide the sex of their next baby. However, they claim not to have been given a fair hearing, as apparently only the chairman of a 21-member committee who considered the case was given a copy of their submission.

The couple, who claim that they are definitely not trying to replace Nicole, also plan to call on Article 6 of the Human Rights Act, which guarantees a fair hearing from public authorities. However, Mr Masterton said the HFEA had told him their case could be considered only if they can find a willing clinic to re-apply on their behalf. However, all five clinics in the UK that have the necessary expertise have refused to help with an application so clearly against current policy. (Evening Standard 2000;5 October), (Times 2000; 18 October)

Haemophilia avoided by sex selection

In the first case of its kind, Spanish doctors have created a further ethical dilemma by engineering the sex of a couple’s children in order to avoid genetic diseases in their grandchildren. Doctors from the Cefer Institute and the Universidad Autonoma of Barcelona said that they had selected the sex of the couple’s twins, both of whom are male, in order to avoid daughters who might pass on the father’s haemophilia.

Haemophilia is an X-linked condition and is therefore capable of skipping a generation if the father is the sufferer because men pass on only their Y chromosome to their sons. Their daughters, however, become carriers and can then transmit the disease to their own sons - the grandsons of the original, male carrier. Using pre-implantation genetic screening to ensure that the twins, who were born in Madrid in May, were male, the doctors said that they had stamped out the disease in that family forever.

The couple originally chose assisted reproduction because the father, 35, had become an HIV and hepatitis C carrier after a blood transfusion. Doctors were able to wash the semen in order to eradicate the HIV virus and managed to create three embryos. They planned to implant only the male ones but, in fact, ended up with three male embryos anyway. All three were implanted into the mother’s uterus, though the couple later asked for one of them to be removed after all three were found to be growing normally. Doctors said that the operation resulted in the mother and twins being free of the HIV virus while the boys would no longer pass on the haemophilia gene. (Times 2000; 17 October)

Fetal Pain Debate Reopened

Prof Vivette Glover of Queen Charlotte’s and Chelsea Hospital in London has reopened the debate about fetal awareness by calling for abortions performed between 17 and 24 weeks to be carried out under anaesthetic. Over 90% of terminations take place before week 13 but concern has resurfaced about the next eleven weeks. Prof Glover said, ‘It is incredibly unlikely that the foetus could feel anything before 13 weeks because there is no linking to the brain at all. After 26 weeks it is quite probable. But between 17 and 26 it is increasingly possible that it starts to feel something and that abortions done in that period ought to use anaesthesia.’

The issue of fetal awareness has been previously reviewed in Nucleus. A 1997 report by the Royal College of Obstetricians and Gynaecologists (RCOG) suggested that fetuses cannot experience pain before 26 weeks’ gestation. This received substantial media attention. However, the report of the Commission of Inquiry into Fetal Sentience (the Rawlinson Report) suggested that pain may be experienced from as early as 5.5 weeks. Predictably, this received far less publicity. (Telegraph 2000; 29 August), (Nucleus 1998; January:2-3)

Anaesthesia in organ removal

A leading anaesthetist has called for all patients who are about to have organs removed for transplant purposes to be given an anaesthetic to ensure that there is no possibility of them feeling pain. The editorial in Anaesthesia, the journal of the Royal College of Anaesthetists, called for anaesthesia to be given routinely during operations to remove the heart, lungs, liver and pancreas - all procedures carried out whilst the donor is still being ventilated.

The absence of brainstem function is regarded as evidence of death in Britain and a patient’s ventilator can only be switched off once this is confirmed. However, it is clear now that some brain dead patients still have evidence of electrical activity. The increase in heart rate and blood pressure in patients who have organs removed is also regarded by many as indicative of distress. In addition, many anaesthetists apparently also admit to lingering doubts about what is happening in the brains of donors. This is despite absence of response to brain stem tests and no question of their survival without a ventilator for more than a few days.

In a joint statement with the Association of Anaesthetists of Great Britain and Ireland, Prof Peter Hutton, president of the Royal College of Anaesthesia, gave assurance that brain dead donors cannot feel pain during operations to remove their organs. Sporadic EEG waves emitted from the brain surface do not necessarily indicate the perception of pain.

The Department of Health also issued a statement to say that brain dead donors feel no pain but there are now fears that there could be a further decrease in the number of people coming forward as donors as a result of the debate. The current level of donors continues to fall because of the decrease in the number of heart attacks and fatal road accidents. (Guardian 2000; 19, 20, 22 August)

PVS patients allowed to die

In the first right to life case to go to the High Court since the introduction of the Human Rights Act, doctors were given the go-ahead to withdraw artificial feeding from two patients in a state of ‘living death’. The landmark case was mounted by the families and doctors of the two unrelated women. It involved two women from the North of England who, as the court heard from John Grace QC, were in a ‘twilight zone of suspended animation where death commences though some form of life continues’. He was seeking consent on behalf of two unnamed health authorities to cease life-sustaining treatment. The plea was opposed on the grounds that stopping tube feeding would breach the patients’ right to life, guaranteed by article 2 of the new act which makes the European Convention on Human Rights part of UK law. The test case was tried before Britain’s most senior family judge, Dame Elizabeth Butler-Sloss, who decided that the termination of feeding would not infringe the patients’ rights, clearing the way for courts to continue sanctioning such decisions in the future.

The first of the two women who have since died peacefully, was a 49 year old known only as Mrs M, who had been in a persistent vegetative state (PVS) since an anaesthetic mishap during a gynaecological operation overseas. The other, a 36 year old severe epileptic, Ms H, had been in near PVS since last January after her brain was deprived of oxygen following a heart attack in hospital. Since the case of Hillsborough survivor Tony Bland in 1993, the courts have sanctioned the withdrawal of feeding from around twenty patients in PVS and two in near PVS. In justifying her decision Dame Butler-Sloss said that the removal of a feeding tube was not ‘a deliberate act’. (Guardian 2000; 17 September, 7 October), (Times 2000; 26 October)

Acupuncture for drug users

The NHS has come under renewed pressure to abandon its perceived antagonism towards alternative medicine following two studies which suggest that both that heroin and cocaine addicts could be successfully treated with acupuncture.

Janine Scofield of Sheffield’s Rockingham Project, where the research into acupuncture and cocaine was carried out, said: ‘This works not just to help people come off drugs, but also in preventing them from relapsing. The cost is tiny in comparison with drug rehabilitation.’ The average cost of residential rehabilitation for hard drug users is £350 a week. The cost of each acupuncture session is estimated to be less than £10. Sessions last 45 minutes and end with a cup of herbal tea.

Acupuncture came to Europe 400 years ago but there have been numerous problems obtaining funding. It has been dismissed as a health intervention on the grounds that it is not conventional. However, a British Medical Association report published earlier this year said that the NHS should provide it. Vivienne Nathanson, BMA head of policy, said ‘It is mainstream complementary medicine’. (Guardian 2000; 20 August), (Times 2000; 15 August)

Abortion pill may be sold as contraceptive

An abortion pill that is given to women who are up to nine weeks pregnant could be marketed as a contraceptive, after trials have shown it efficient at preventing pregnancy. Mifepristone (RU-486), which was only recently approved for use in the USA, starves the embryo of progesterone and is taken in pill form followed two days later by a prostaglandin which stimulates contractions and causes the abortion.Researchers, who carried out a four-month trial on 90 women, claim that the drug was largely successful in preventing ovulation and was 100 per cent effective in preventing pregnancy. They believe it could be marketed as an alternative form of contraception for women who are at risk from side-effects of the pill, such as thrombosis. They are now trying to persuade a drugs manufacturer to carry out a large-scale trial of the drug, which could lead to it becoming available commercially. However Pro-life campaigners argue that marketing an abortion pill as a contraceptive was misleading. ‘If it does not stop ovulation in all cases and actually stops an embryo from growing to full term then it causes abortion. That is not contraception’. (Telegraph 2000; 22 September).

Morning-after pill ‘a success’

Since the launch of a campaign in Manchester last year, figures suggest that over 3,000 women have requested the morning-after pill over the counter. More than 70 chemists in Greater Manchester are offering the emergency pill free of charge as part of a pilot scheme. Critics such as anti-abortion groups had voiced concern that the scheme would encourage young people to have unprotected sex, but the figures show that 55 per cent of the women requesting the drug are aged 20 to 29. (Times 2000; 9 August)

Cambridge students reject National Abortion Campaign

Students of Cambridge University have voted overwhelmingly to reject the affiliation of their student union to the National Abortion Campaign (NAC). The referendum in November achieved the highest ever turnout in the university and 3,341 students voted against affiliation whilst 1,827 voted in favour.

The NUS and many other student unions remain affiliated to the NAC despite similar referenda at the Universities if York, Warwick and East Anglia which have rejected the affiliation. The pro-life organisation Student Life Net (www.studentlifenet.org.uk) is now planning a campaign to encourage more student unions to disaffiliate from the NAC. (Rupert Beale, Clinical Student, Cambridge University)

Christian groups welcome new employment directive

Churches and other Christian organisations have welcomed the final text of the new European Equal Treatment Directive which was agreed by the Council of Ministers on 17th October. The Directive will be translated into national legislation within the next three years and will allow churches and religious associations or communities to ‘maintain or lay down specific provisions on genuine, legitimate and justified occupational requirements which might be required for carrying out an occupational activity’. It also states that in the case of churches and other organisations whose ethos is based on religion or belief ‘a difference of treatment based on a person’s religion or belief shall not constitute discrimination’ thereby allowing Christian groups to employ only those in agreement with the ethos of their organisation. A spokesman for the Evangelical Alliance described the changes as ‘a substantial improvement in the original text’, mainly as the scope has been considerably widened beyond its original focus on churches and church schools. (Personal Correspondence with the EA)

Cannabis ‘to be legal as pain killer in two years’

Cannabis will be legalised for medical use within two years because clinical trials of the drug have show that it has few side effects, the chief scientist of the Royal Pharmaceutical Society believes. Professor Tony Moffat says his view is based on a number of small trials already done, showing that cannabinoids are very potent compounds for relaxing muscles, and the anecdotal evidence from MS sufferers who smoke cannabis and say it is ‘absolutely wonderful’. It is believed that its main uses will be for relaxing muscles in the treatment of MS, and as a painkiller. However, he stated, medicinal cannabis would not give people a drug induced ‘high’, and would not take the form of a cigarette with its attendant health risks. Research shows that swallowing the drug was not effective as 90 per cent of it was broken down by the liver before having much effect. But a mouth spray or even a suppository would deliver 50 per cent of the drug into the user’s system. (Telegraph 2000; 15 October)

Genetic tests to determine insurance premiums

Britain is to be the first country to allow insurers to use the results of genetic tests to identify people with hereditary illnesses. The government has gone against advice given by the Human Genetics Advisory Commission, and has given the go-ahead for insurers to use the results from genetic tests. Approval will be given first for testing for the neurological condition Huntington’s Chorea. Hereditary breast cancer and Alzheimer’s disease are expected to follow. Ministers have decided that insurers should be able to use the results subject to the Genetics and Insurance Committee agreeing a test’s technical reliability. Concerns that such tests would create a genetic underclass led Holland, France and Norway to ban the use of tests by insurers. (Telegraph 2000; 13 October).

Genetic offspring for gays

The team that cloned ‘Dolly the sheep’ is researching a way of enabling male homosexual couples to have children that are their genetic descendants. The main problem that they are encountering is a way of manipulating ‘imprinting’, a process whereby the parental origin of a gene is marked. However it may be possible to replace DNA from a donated egg with that of a sperm and then maternally imprint it. It would then be able to develop if fertilised with sperm from the partner. (Telegraph 2000; 26 September)

Are you thinking about IT enough?

The Government has launched a £2 million advertising campaign to raise the image of virginity. The campaign aims to slow the headlong rush into sexual experience. They plan to start by telling teenagers the average age that girls and boys actually lose their virginity, showing them that they are not as far behind the rest of the pack as they thought. This initiative is part of a larger campaign to prevent teenage pregnancies, and aims not to lecture children, but rather cause them to think more thoroughly about sex. (Telegraph 2000; 10 October)

Beyond Jubilee 2000...

Jubilee 2000 have answered fears that third world debt may soon loose the spotlight, by announcing that their plans to shut down on 31 December 2000 may be postponed. Supporters and staff have greeted the impending closure with concern, knowing that the campaign’s ultimate goal - to win 100% cancellation of the debts of the worlds poorest countries - is far from won. The next phase of the long-term campaign should go forward under the banner of ‘Jubilee Plus International’. ensuring that the end of the Millennium campaign will not see a lessening of pressure on the creditors. (Guardian 2000; 4 October)

Cult plans to clone humans

US scientists say that little can be done to stop a UFO-worshipping cult from pursuing a plan to clone a human being, after finding it had both the money and the medical knowledge to carry out the act. The ‘Raelians’ claim to be on the verge of cloning an embryo from cells grafted from a 10-month-old girl who died as a result of a medical mistake. The girls parents are paying $500,000 for the procedure. US law only prevents federal funds being used for human cloning, and has no clear regulations on the work of private groups. Scientists say that a cult is an ideal place for such an operation, because of the large number of women surrogates required due to the high failure rate. The leader of the cult, who calls himself ‘Rael’ said he had 50 women willing to act in this role. (Guardian 2000; 11 October)

And finally...

If you have sat frustrated behind dusty textbooks revising while your old school friends graduate and commence their chosen career in ‘Pizza Hut’, curse no more. A seventy year old book shop owner recently achieved academic recognition after studying for twenty-eight years to get a degree. Stuart Baldwin’s career as an undergraduate began when he enrolled for a BSc with the Open University on the day it opened in 1971. Mr Baldwin now plans to tackle a doctorate at breakneck speed. ‘I think there is an eight year limit on PhDs so I will be in no danger of breaking my own record!’ (Telegraph 2000; 19 October).