Joffe bill set to return

75 members of the House of Lords spoke during a nine hour debate on the Select Committee’s report on Lord Joffe’s Assisted Dying for the Terminally Ill Bill on 10 October. The report, released in April this year, was the result of nine months of deliberations during which the Select Committee heard from more than 140 witnesses, received 60 written submissions and more than 14,000 letters and emails from individuals. In the final analysis, they were divided, but effectively recommended that Parliament discuss physician assisted suicide. Lord Joffe’s bill ran out of time in the last parliamentary session, but he proposes to introduce an amended version later this year. There was no vote on the report at the debate. Health Minister Lord Warner told peers that the government remained neutral on the issue, adding that the bill raised ‘profound and complex ethical questions’.

Meanwhile, ex-chairman of the Voluntary Euthanasia Society (VES), Dr Michael Irwin, was struck off by the General Medical Council (GMC) for actions ‘likely to bring the profession into disrepute’. Dr Irwin prescribed sleeping pills in his own name that he planned to give to his terminally ill friend, Patrick Kneen. The plan was never carried through as Mr Kneen became too ill to take the pills. Dr Irwin has claimed to know of several doctor members of the VES who had ‘twinning’ arrangements – a formal agreement to help each other commit suicide if a painful death threatens. He added that such formal arrangements were not that common, but that doctors regularly eased other doctors’ deaths. He argues that it would be hypocritical to refuse to do the same for a friend or long term patient. (Guardian 2005; 17, 28 September, Nucleus 2005; April:13-18, July:10)

Poll fuels calls for new abortion limits

A Daily Telegraph poll on the nation’s attitudes to current ethical issues reveals wide support for a lowering of the abortion time limit.

The You Gov poll, which assessed public opinion on issues including assisted dying, abortion, cloning and stem cell research, found that only 27% of those questioned support the current 24-week limit. 58% said the limit should be 20 weeks. Women were more likely than men to support tighter controls, with one in three women favouring a limit of twelve weeks or under.

The results have fuelled calls from a cross party group of MPs pushing for a review of the abortion time limits. This follows on from recommendations made by the Commons’ Science and Technology Committee earlier this year. The call for a change has also been stimulated by Professor Stuart Campbell’s ‘walking in the womb’ 4D ultrasounds, and reports of babies surviving terminations.

The effects of any new limit may be small however, with 98% of abortions already occurring in the first twelve weeks of pregnancy. Some have commented that a review of the laws may actually be detrimental to the pro-life cause since abortion advocates are expected to push for easier abortion access in the first trimester as ‘compensation’ for restrictions at the upper end. Suggestions include that only one doctor’s signature should be necessary, if that, and that the RU-486 abortion pill should be more readily available on request. Dr Evan Harris MP, who is spearheading the campaign, has said that there is a ‘good case’ for combining lowering the limit with more permissive laws for the first twelve weeks of pregnancy. (Times 2005; 17 July, Telegraph 2005; 7 July, 29 August, SPUC 2005; 5 July)

BPAS’ knuckles rapped by CMO

The Chief Medical Officer (CMO) has described the British Pregnancy Advisory Service’s (BPAS) response to women seeking late terminations as ‘superficial and lacking in rigour’ and ‘extremely inappropriate’ in a report, released on 21 September this year.

The CMO was called upon to investigate BPAS after the Sunday Telegraph revealed that BPAS call centre staff referred women to a clinic in Spain for late terminations that would be illegal in the UK. A journalist from the newspaper posed as a woman seeking a termination at 22, and later 25 weeks. The BPAS were unable to deal with the 22 week request due to capacity limitations. They provided the number for a clinic in Spain instead, and again when she said she was 25 weeks, saying ‘they can do over what we can do here’. Questions were raised about whether such late abortions were legal in Spain. The Catalan Health Department is still investigating, but state that so far, ‘there is no evidence of the clinic having acted outside Spanish abortion law’.

The CMO concluded that overall BPAS has not broken UK law, but made a number of criticisms. He described their protocol for staff answering calls from women seeking late terminations as ‘an extraordinarily poor document’. He recommended that they develop procedures for monitoring call centre standards, improve training, and called for a national best practice protocol for dealing with late abortion cases. He also expressed concerns about the lack of counselling and information provided and says that such calls should be referred to an experienced abortion counsellor immediately.

Peter Saunders, CMF’s general secretary, commented: ‘The integrity of the BPAS is called into question by their eagerness to circumvent the time limits set by the 1967 Abortion Act. This particular referral may not have been contrary to the letter of the law, but it was certainly against the spirit of the law.’ (DoH press release 2005; 21 September, CMF press release 2005; 21 September)

Fetal pain debate re-ignited

Fetuses do not feel pain in the first six months of gestation, according to a controversial paper published in an August edition of the Journal of the American Medical Association (JAMA). The authors conclude that this negates the use of anaesthesia during most late term abortions.

The authors from the University of California reviewed several hundred scientific papers on fetal pain, and concluded that nerve connections in the brain are not sufficiently developed for the fetus to feel pain before 29 weeks. ‘The circuitry is not there,’ said Dr Henry Ralston, a neuroscientist who helped write the paper: ‘without the connections, the sensation can’t take place.’

The paper has placed a direct challenge against the US states – including Arkansas, Georgia, and Minnesota - that have passed laws requiring doctors to inform women seeking abortion that the fetus may feel pain, and to offer fetal anaesthesia. A number of other states are debating similar requirements, and Congress is considering enforcing fetal anaesthesia for terminations after 22 weeks’ gestation. Across the US and the UK only 1-2% of abortions are performed at these late stages.

However, concerns have been raised about the reliability of the paper. Dr KS Anand, a fetal pain researcher at the University of Arkansas, commented, ‘This is going to inflame a lot of scientists who are very, very concerned and are far more knowledgeable in this area than the authors appear to be.’ Most scientists agree that the fetus cannot feel pain in the first trimester, but disagree widely on whether the fetal brain is developed enough to process pain in later pregnancy. As Dr David A Grimes, a former head of abortion surveillance at the Center for Disease Control and Prevention, said, ‘This is an unknowable question. All we can do in medicine is to infer.’

Further controversy has surrounded the paper after conflicts of interest came to light. The first author, Susan Lee, is a medical student and an attorney who once worked for NARAL Pro-Choice America. Another author, Dr Eleanor Drey, is medical director of the abortion clinic at San Francisco General Hospital.

These interests were not disclosed in the paper, but JAMA editor in chief Catherine DeAngelis stated that she would still have published it as the methods were sound. (BMJ 2005;331:532, JAMA 2005; 24:947-54, New York Times 2005; 24 August)

Further research licensed while fertility law faces rewrite

The Human Fertilisation and Embryology Authority (HFEA) has granted a new research licence to a group working on a novel way to make embryos, despite the Department of Health launching a consultation into the UK’s fertility laws – with suggestions of redrafting the laws that the HFEA supposedly regulates.

The licence was granted to researchers at the University of Nottingham who want to develop methods to help women carrying mitochondrial diseases to have children without the disease. They plan to remove the genetic material from a fertilised egg and place it into an empty unfertilised egg. This would, in effect, be like replacing the mitochondrial DNA, which resides in the outer layer of the egg. The HFEA has been criticised for granting the licence. Josephine Quintavalle of Comment on Reproductive Ethics accused the HFEA of ‘turning the UK into the wild west’, adding, ‘Wherever they see a law they jump over it’. The HFEA originally rejected the proposal as the HFE Act forbids ‘altering the genetic structure of any cell while it forms part of an embryo’.

This development comes in the wake of an address given by Lord Winston to the British Association for the Advancement of Science in which he criticised the over-hyping of the potential therapeutic benefits of stem cell research by researchers and the media. Whilst backing research using stem cells as a valid scientific endeavour in certain fields, he said the hype surrounding ‘cures’ for Alzheimer’s, Parkinson’s and diabetes could result in political and public backlash in future years when research fails to find cures. (BioNews 2005; 12 September)

Women playing ‘Russian Roulette’ with their fertility

Doctors writing in the British Medical Journal have issued a warning to women not to leave childbearing too late. They state that the best age for pregnancy is up to 35 years of age, stressing that ‘It always was, and it always will be’.

The three London based fertility specialists write that the average age for pregnancy has increased over the last 20 years from 26 to 29. They see a lot more women in the older age brackets that are having trouble conceiving, and are ‘saddened’ by the problems they experience.

They argue that ‘the availability of IVF may lull women into infertility while they wait for a suitable partner and concentrate on their careers and achieving security and a comfortable living standard.’ But IVF carries no guarantees, and when an older woman does achieve pregnancy the outcomes for both mother and child are poorer. The authors call on doctors and healthcare planners to encourage and support women in achieving pregnancy in these earlier years, noting how there is a strong movement to target teenage pregnancy while ignoring the ‘epidemic’ in the middle aged group. (bbc.co.uk 2005; 15 September, BioNews 2005; 19 September, BMJ 2005;331:588,9)

Abstinence TV highlights defects in sex education

The BBC’s No Sex Please, We’re Teenagers series, following twelve teenagers as they investigate abstinence and ‘old fashioned courting rituals’, has highlighted the absence of abstinence teaching in school classrooms.

The three part observational documentary follows the teenagers as they take up the challenge of staying celibate for five months and attend weekly sessions with youth workers at the ‘Romance Academy’ – a special five month project run by trained youth workers that aims to deliver the ‘complete sex education package’ in a process of peer-led sex education. The BBC program effectively follows the first ever group of teenagers to be part of the project. The teenagers selected for the program cover a cross-section of 15 – 17 year olds; some who lost their virginity at a very young age, others who remain virgins. They also come from various religious and cultural backgrounds. A BBC spokeswoman said the young people described the Romance Academy as ‘life changing’. The project leaders hope that it will expand from its origins in Harrow, where all the teenagers are from, to be UK wide.

The program has raised questions about the current state of Britain’s sex education policies. An article in the Times highlighted that despite the government’s promise to halve teenage pregnancy by 2010, rates continue to rise. Similarly there are concerns about rising STI rates among teenagers. Concerns about schools’ involvement in teenagers’ sex lives were also raised; some parents want schools to take more responsibility while others are angry that schools ‘encourage casual promiscuity by distributing condoms like candy’. A Guardian article by Catriona Martin of Oasis Esteem, the largest Christian sex education program in England, argued that abstinence has become a ‘dirty word’ in the classroom with teachers skimming over it and focussing primarily on the ‘safe sex’ message. ‘This approach is loaded with unhelpful assumptions about the sexual behaviour of young people… Oasis Esteem have found that the message of abstinence is actually very liberating for young people facing peer pressure to become sexually active,’ says Ms Martin. (bbc.co.uk 2005; 28 July, 25 August, Guardian 2005; 21 September, Times 2005; 11 September, www.romanceacademy.org)

Hatred bill threatens freedom of speech

The Racial and Religious Hatred Bill had its third reading in the Commons on 11 July and was passed by a majority of 72. The Bill is now set to go through the Lords, with the first debate on 11 October.

The Bill will amend Section 18 of the Public Order Act 1986 so that it will read:

‘A person who uses threatening, abusive or insulting words or behaviour, or displays any written material which is threatening, abusive or insulting, is guilty of an offence if a) he intends thereby to stir up racial or religious hatred, or b) having regard to all the circumstances the words, behaviour or material are likely to be heard or seen by any person in whom they are likely to stir up religious or racial hatred.’

The government claims the offence is only aimed at curbing extreme words or behaviour. However, the requirement of ‘threatening, abusive or insulting’ behaviour is the same as that in Section 5 of the Public Order Act under which Harry Hammond, a 67 year old street preacher, was prosecuted for holding a placard saying ‘Stop Immorality, Stop Homosexuality, Stop Lesbianism’. The threshold for ‘threatening, abusive or insulting’ behaviour seems dangerously low. The second part is also of concern as no intention is required on behalf of the speaker, only that there was likely to be present a person in whom religious hatred was likely to be stirred up.

Two Christian pastors have been prosecuted under a law in Victoria, Australia passed in 2001. Daniel Scot, an expert on Islam, held a seminar on 9 March 2002 in which he lectured members of his congregation about the Qur’an and Muslim belief. Muslims infiltrated the group and reported Pastor Scot to the authorities. Pastor Nalliah was similarly reported for his involvement in writing articles published in a church newsletter and on the internet. Both men were found guilty of vilifying Muslims. Judge Michael Higgins’ judgment on 22 June 2005 orders the two men to apologise, and never again to make such statements, in any media. The pastors have refused to apologise and are expected to appeal to the Australian Supreme Court.

Christians are concerned about the Bill, fearing it will endanger their freedom to preach the gospel and to make exclusive claims regarding Christianity. The penalty for falling foul of the law is currently set at seven years’ imprisonment – two years more than that for grievous bodily harm. (www.religioushatredlaw.info, www.lawcf.org/lawreform.php, www.christian.org.uk)