News Review

Dutch vote to 'legalise' euthanasia

Dutch MPs have voted to end 20 years of uncertainty for doctors by effectively legalising euthanasia, making Holland the first democratic country to do so. The practice has been decriminalised since a landmark court case in the early 1980's. A doctor currently performing euthanasia must first report what is still an illegal act to a regional review committee, who only drop the case if they believe he has followed the criteria established through case law. Under the new bill the doctors' actions will 'not be treated as a criminal offence if the criteria are followed'.

The decision split the country with strong opposition from the Dutch Church and the hospice movement, who fear that choosing to die will become a 'normal' practice. This decision follows an earlier example in Australia's Northern Territory when 'physician assisted suicide' was temporarily allowed in 1996-7.

Opposition MPs were appalled at the Dutch verdict, fearing that the bill would 'open the floodgates'. They cited examples whereby families might use this law to get rid of ailing relatives. Also under the new bill, children as young as twelve will be eligible for euthanasia if they receive parental permission. Currently less than 50% of an estimated 3,600 cases of physician assisted suicide are reported each year in Holland. (Telegraph 2000; 4 December), (BMJ 2000; 321:1433, 9 December)

Shipman faces public inquiry

A public inquiry is to be held into the serial killer Harold Shipman. The families of Shipman's victims won a legal battle to overturn an earlier decision by Alan Milburn, the Health Secretary, to hold the investigation in private. Dame Janet Smith, a High Court judge was appointed to chair the inquiry that started in January. (Telegraph 2001; 9 January)

GM primate created

Scientists have created the world's first genetically modified primate, a baby rhesus monkey called ANDi, in a bid to hasten the development of new treatments for a range of diseases from diabetes and breast cancer to Parkinson's and HIV. Animal rights campaigners condemned the practice as unethical. Church groups fear the work also raises the issue of whether similar techniques could be used to create GM humans. ANDi received an extra marker gene, from a jellyfish, while he was still an unfertilised egg.

The technique used to make ANDi could pave the way to the creation of laboratory monkeys that carry human genes, offering the opportunity for medical researchers to make more realistic models of human disease, such as by introducing the gene for Alzheimer's disease. However clinicians say that although primates have a greater genetic similarity to humans than mice do, GM monkey models of human disease have limitations, as for example some of the work on cognitive diseases, such as schizophrenia, can only be carried out in people. (Telegraph 2001; 12 January)

MMR not to be given as single dose vaccines

Health officials have announced that single dose vaccines for measles, mumps or rubella will not be made available to British children, as they begin a new drive to reassure parents of the safety of the all-in-one vaccine.

Calls have been growing for single vaccines to be made available to the minority of parents who refuse to let their children have the triple jab, but Ministers said the single dose alternative was more dangerous.

Three years ago, researchers suggested a link between the MMR vaccine, introduced in 1988, and autism and Crohn's disease in children. This link has not been supported by subsequent research. However, 500 parents are planning to sue the Department of Health over damage to their children allegedly caused by the vaccine.

Vaccination levels have fallen from 92% to an average 88% and as low as 75% in some parts of the South East. The Department of Health has already issued a warning of a measles outbreak when infected children who have not been protected return to school.

Ministers refer to a 14-year study from Finland that was published in the journal Paediatric Infectious Disease last December. It confirmed the results of an earlier analysis of 1.8 million vaccinated children published in the Lancet in 1998. The report said that serious side-effects related to MMR vaccine were rare 'and greatly outweighed by the risks of natural MMR diseases'.

The researchers found an adverse reaction rate of 3.2 per 100,000 doses of vaccine. However, another study, published in the BMJ, said that about half of health professionals had reservations about giving children a second dose of MMR vaccine before they started school. (Telegraph 2001; 12 January), (Lancet 1998; 351:611-2), (Lancet 1998; 354:949), (Department of Health website: www.dh.gov.uk), (Guardian 2001; 21 January; 23 January), (BMJ 2001; 322:129)

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)

vCJD victims get compensation

Families of victims of the human form of BSE are expected to be awarded interim compensation payments that may run to £25,000 each. This compensation will be paid to the relations of the eighty-three people in Britain who have so far died from new variant CJD. Ministers have accepted the need for 'no-fault' compensation to avoid courtroom battles, and as a possible model their advisers point to a trust that compensates people with AIDS or HIV - a fund that since 1987 has paid out nearly £100m. Supporters of the victims point out the millions that have been paid to farmers that have been affected by the BSE crisis. (Times 2001; January 22)

Drug companies to sue South Africa over AIDS

The world's biggest pharmaceutical companies, including the UK based GlaxoSmithKline, are suing South Africa over an alleged violation of intellectual property rights. The action will bring the African AIDS crisis, where 25 million people are infected by the HIV virus, to the forefront. Only 25,000 of these have access to the drugs they need to stay alive. In a case to be heard at the Pretoria High Court in March, the pharmaceutical companies will try to prevent South Africa from making or buying abroad huge quantities of cheap, generic drugs, such as anti-retroviral drugs, to treat patients. Such drugs from countries like Thailand can cost as little as a tenth of the price of buying them from the multinationals. Drug firms refuse to grant price cuts to developing countries until their health systems are deemed 'sophisticated'. Whichever side loses this case will incur costs amounting to millions of pounds. The action will tarnish recent progress made by African governments and the pharmaceuticals industry in relieving this massive health crisis.(Observer 2001; 14 January) (Guardian 2001; 16 January)

Foreign nurses to get HIV screen

The Royal College of Nurses has criticised Government plans to revise its admission procedure whereby foreign student nurses would be screened for HIV. They claim it contravenes the law,as it is illegal in Britain to test for HIV unless an individual has consented.

Derek Bodell, chief executive of the National Aids Trust, said: 'Given everything we know about how difficult it is for HIV to be transmitted, the public does not have a right to know if someone is HIV positive except under the most unusual circumstances'. (Guardian 2001; 13 January)

More cases of HIV were diagnosed in Britain last year than in any year since testing began. The rate of diagnosis was up 7 percent on the figures for 1999. (Times 2001; 25 January)

Gay rights code to be shelved

New measures, aimed at outlawing any discrimination against gays in the workplace is to be put on hold by the government until after the next election in order to avoid a political row. The advisory code of practice has already been drawn up by a taskforce from the equal opportunities commission, in cooperation with the Confederation of British Industry and gay rights groups. This law is designed to allow Britain to conform to an EU directive that will require governments to introduce laws within three years banning discrimination against gays. (Guardian 2001; 27 October)

Britain scraps Caribbean anti-gay laws

Britain has repealed laws prohibiting homosexual acts in its five Caribbean territories, acting after legislators of the islands refused to do so on biblical grounds. Leaders on the islands were angered by London's move, saying that 'homosexuality is immoral and goes against the grain of our culture and religion'. Christian leaders and local politicians said the disagreement over homosexuality reveals a widening cultural rift between what they condemned as an increasingly atheist Britain and its faraway Caribbean territories.

The order from the British Privy Council, which acts as the highest court for the territories, decriminalises homosexual acts between consenting adults in private. (Guardian 2001; 6 January)

France bans blood from visitors to UK

The French government have joined the Swiss Red Cross in announcing that it will ban blood donations from people who spent more than a year in Britain from 1980 to 1996, a precautionary measure against health risks related to BSE. The move is aimed at screening out donors with a higher risk of exposure to meat tainted with BSE. This is despite no accepted scientific proof that new variant Creutzfeldt-Jakob Disease can be transmitted though the blood.

Fears about BSE and its health risks to humans have surged in France since October, when potentially infected beef was discovered on the country's supermarket shelves. Since then, the government has taken stringent measures to prevent the disease's spread.

The safety of donated blood has been a key concern in France since the 'tainted blood' affair of 1985, in which more than 4,000 people contracted the HIV virus from blood transfusions. Many have since died, and several government officials stood trial over the affair. (Guardian 2001; 19 December)

Radical shake-up of mental health laws

The Government's White Paper Reforming the Mental Health Act was published in December and will allow individuals with severe and untreatable personality disorders to be detained indefinitely if experts believe they pose a danger to the public. The reforms will give doctors powers to lock up people even if they have not committed a crime and to detain prisoners who remain dangerous even after serving their sentence.

In the biggest overhaul of mental health laws for more than 40 years, care in the community patients who refuse to take their medication could also be forcibly detained and the victims of violent crime by mentally ill people will also be given the right to know when their attacker is released.

The changes are intended to close legal loopholes and meet public concern at the failings of care in the community. They have been drawn up in the wake of a series of murders by mentally ill people living in the community, such as that of Jonathan Zito who was killed by Christopher Clunes, a schizophrenic, in 1992.

More than 2,000 people in the UK are believed to have a dangerous personality disorder. An estimated 1,400 are in jails, 400 in hospitals and up to 600 are in the community. (Times 2000; 20 December) (Times 2000; 21 December)

Morning-after pill on sale

Alan Milburn, the Health Secretary, paved the way for emergency 'contraception' to be available without prescription for the first time by laying an order in Parliament in December. Since January 1, pharmacists have been able to sell emergency contraception, in the form of the drug Levonorgestrel, for £20 to anyone over 16. Britain has the highest level of teenage pregnancies in Europe and the Government has declared its determination to halve the number by 2010.

Under the new regulations chemists will only be allowed to sell the morning-after-pill to women over the age of 16; younger girls must still see a doctor. Some doctors have urged the Government to extend the rules and allow girls under 16 the morning-after-pill over the counter. However, a pilot scheme being conducted in a number of schools across Britain to allow students under 16 free access to emergency contraception has sparked controversy. But Michael Crane, head teacher at John Port School in Etwall, Derbyshire which is taking part in the pilot scheme considers the availability of the morning after pill as 'part of a bigger package of pastoral support, offered in the context of health education, for the 2,000 students at our school'. The school nurse, Val Oborn, emphasises, 'I take their blood pressure and discuss their family medical history before I give it. And, unlike a pharmacist, I offer a follow-up service'.

However, the nursing and medical professions have mixed views about the availability of the morning-after pill to under-16s. The Royal College of Nursing has said that it would like to see emergency 'contraception' available in all schools. Whilst the BMA has raised concerns about 'fragmentation' of medical records if GPs are not informed when it is given. The BMA GP committee has stated that the morning-after pill should be supplied by pharmacists without prescription to anyone who needed it. (Times 2000; 10 December), (Times 2000; 12 December), (Times 2001; 11 January)

Teenager wins damages for 'wrongful birth'

Judges from the highest French appeal court ruled that a handicapped teenager was entitled to damages for having been born. In a decision that opened the way to suits for 'wrongful birth', the court accepted the argument of Josette and Christian Perruche that doctors should have advised the abortion of Nicolas, their 17-year-old son, who was born deaf, badly mentally handicapped and nearly blind.

The couple from Paris launched their case more than a decade ago after it emerged that Mme Perruche had suffered from rubella during pregnancy in 1982, causing her son's disabilities. A doctor and a laboratory accepted that their tests on her had failed to diagnose the disease. She had requested an abortion in the event that she had been suffering from rubella. The ruling was denounced last night by France's main pro-life group as a dangerous precedent that created 'institutional eugenics'. The court was 'implying to all handicapped people that their life is worth less than their death', the Alliance for the Right to Life said. Some medical authorities were also appalled by the implications of the decision, which they said would expose doctors to the threat of American-style lawsuits after the birth of handicapped children. Several US courts have awarded damages against doctors after the birth of handicapped children. (Times 2000; 18 November)

Bush to block abortion funding

In one of the first policy moves of the new Republican Administration, President Bush has decided to block US funds to international family-planning groups that offer abortion and abortion counselling. The action, which reverses a Clinton Administration stance, was leaked on the same day that abortion opponents staged their annual march on Washington. The President's press secretary said: 'The President does not support using taxpayer funds to provide abortions.' Bush has also nominated a staunch abortion opponent for Attorney General, former Senator John Ashcroft, and signalled swift action to reverse Clinton policies supporting access to abortion.

In the UK it has emerged that a growing number of the Shadow Cabinet, including the Tory leader, now favour more restrictions on abortion. Liam Fox, the Shadow Health Secretary, who engineered meetings between William Hague and George W. Bush before he became President, is a prominent supporter of banning abortion. In the Conservative Christian Fellowship's prayer diary, he asks members 'to pray that there would be a huge restriction, if not abolition, of our pro-abortion laws'. However, a spokesman for Mr Hague said that any move to restrict abortion would continue to be subject to a free vote and would not become official party policy. (Times 2001; 24 January)

15 year-old refused breast implants

A consultant surgeon refused to perform breast enhancement surgery for a 15 year-old girl because of the risk of psychological and physical problems later in life. Jenna Franklin, who is a size 34A, wanted to increase her cup size to a C or D as she felt that larger breasts would make her 'successful' as well as boosting her self-confidence.

Her parents, Kay and Martin Franklin, who run their own plastic surgery business, had agreed to pay the £3,250 bill for the operation as a present for her 16th birthday in August. However, after the criticism Mr and Mrs Franklin received from medical experts and politicians, Jenna's mother said that they would respect surgeon Anthony Erian's decision and wait until their daughter was eighteen. She added, 'I'm sure she may not be happy with that but if we were to do anything else then we wouldn't be responsible parents and we want only the best for her'. (Times 2001; 4 January)

Human genome contains fewer genes than expected

The first analysis of the human genome was published in February, revealing far fewer genes than expected. Scientists also found that these genetic instructions were strikingly similar across all ethnic groups, with every person sharing 99.99% of their genetic code with all others.

The team working at the Sanger Centre near Cambridge, the main institution with public support, have pointed out in the journal Nature that all current drugs on the market are based on just 483 biological 'targets' in the human body and that the research has hopefully uncovered many more. But the surprise is that this vast diversity is described by as few as 26,000 genes - far fewer than previously estimated. They also discovered that we share many genes with more humble organisms - about half with the fruitfly and the nematode worm, and about a fifth with yeast.

According to Dr Craig Venter, of Celera Genomics, the other, privately funded team, only 1.1% of the genome consists of genes - the rest appears to be mostly repetitive 'junk' - so the biological differences that influence everything from our looks to our intellectual ability boil down to differences between 1,000 and 10,000 genetic letters. (Telegraph 2001; 12 February)