Euthanasia update

Moves are afoot to widen Swiss regulations on assisted dying. Current law only allows terminally ill patients to access physician assisted suicide. The moves are supported by Ludwig Minelli, founder of Dignitas, the Swiss clinic that has helped 54 Britons to die. The Supreme Court will hear a case on October 27 of a person suffering from bipolar disorder who is seeking assisted suicide. The ruling could be significant for Europe.

Mr Minelli was speaking in the UK for the first time since founding Dignitas. 'If you accept the idea of personal autonomy, you can't make conditions that only terminally ill people should have this right', he said in a fringe meeting at the Liberal Democrat conference. The Liberal Democrats voted for physician assisted suicide in 2004 but they do not support the current legal action taken by Dignitas.

The Disability Rights Commission responded: 'This confirms the suspicions of many disabled people that legalising assisted suicide would be the start of a slippery slope that would lead to anyone, whatever their condition, being helped or even coerced into opting for death.'

Deborah Annetts, chief executive of Dignity in Dying, is clearly worried that their cause could be undermined by the change in Swiss law proving the slippery slope argument. She said, 'Any law in the UK must be based around choice for competent adults who are terminally ill. This is a fundamental safeguard to ensure that it is the patient who chooses, fully informed and aware of the decision they take. We are totally opposed to allowing people with chronic depression to have help to die.'

The British Medical Association voted to reverse its policy on assisted dying during its Annual Representatives Meeting in June. Two thirds of the doctors rejected both physician assisted suicide and voluntary euthanasia. 94% rejected non-voluntary euthanasia. The BMA policy is now to oppose attempts to legalise euthanasia.

Since the Joffe Bill was rejected by the House of Lords in May, Lord Joffe has promised to reintroduce his Assisted Dying for the Terminally Ill Bill in the upcoming session of Parliament. Keep praying! (news.bbc.co.uk 2006; 29 June; 20 September, timesonline.co.uk 2006; 29 June; 21 September)

Morning after pill without prescription in US

Women over 18 can now purchase the emergency contraceptive pill without a prescription in the USA. The Food and Drug Administration (FDA) gave its approval after deliberating for three years. The morning after pill, called Plan B, will be available over the counter in pharmacies where the age can be verified. Younger women can only purchase it with a prescription.

Public opinion is clearly divided. Many are concerned that the increased ease of access will increase promiscuity, while women's advocacy and other groups believe it will reduce the three million annual unplanned pregnancies by half. This is despite the fact that abortion rates have not fallen in the UK since the morning after pill was sold in pharmacies without prescription from 2001.

Barr Pharmaceuticals, the manufacturer of Plan B, believe the drug should be available without prescription for all ages. There were disagreements even within the FDA as to whether adolescents can safely use the morning after pill. Barr will check enforcement by pharmacies of the age restriction by sending anonymous shoppers.

The emergency contraceptive pill comprises a high dose of a progestogen used in regular oral contraceptive pills. It can reduce the chance of pregnancy by up to 89% if taken within 72 hours of sexual intercourse. The mechanism by which it works is to stop or delay ovulation, prevent fertilisation or to stop implantation. (news.bbc.co.uk 2006; 24 August, 15 September, msnbc.msn.com 2006; 24 August)

Cut-price IVF for egg donors

The Human Fertilisation and Embryology Authority (HFEA) has issued a licence to the Newcastle NHS Fertility Centre to permit them to ask women undergoing IVF to donate eggs for therapeutic cloning research in return for cheaper treatment.

The Newcastle-based team who created the world's first cloned human embryo in 2005 will be the first centre where payment can be given for IVF eggs used in research. Up until now, researchers have been granted permission to ask women to donate for research any eggs that have failed to fertilise. But researchers say that the eggs collected via this scheme were too few and of poor quality. The HFEA licence will now permit researchers to offer couples who need IVF, but cannot afford it, the opportunity to have some of their care funded in return for donating eggs. There were concerns that women could feel pressured to donate their eggs, but Professor Alison Murdoch, from the Newcastle NHS Fertility Centre denied this, saying that paying women would not make any difference to their treatment.

Meanwhile, the HFEA has also announced a public consultation on egg donation for research by women not undergoing IVF. Donna Dickenson, on the ethics committee of the Royal College of Obstetricians and Gynaecologists, said that there are risks to donors from the hormonal drugs, and the longer-term risks are not yet known. (news.bbc.co.uk 2006; 27 July, Guardian 2006; 28 July)

Biennial international AIDS conference

The 16th International AIDS Conference took place in Toronto in August. Key issues addressed included treatment targets, funding and new research. Scientists continue their search for a vaccine.

6.8 million people suffering from HIV in low and middle income countries need to begin anti-retroviral therapy. Only 1.6 million have access. In 2003, the WHO set a target of delivering antiretroviral therapy to three million living in low and middle income countries by 2005. Much has been done, but the target was not met. In 2005, anti-retroviral prophylaxis was only available to 9% of HIV positive pregnant women compared to the target of 80%.

Funding is a key issue. Bill Gates pledged $500 million to the Global Fund to Fight AIDS, TB and Malaria. At the same time Gordon Brown and Tony Blair admitted that the 'amount of money promised for AIDS by 2010 will not be there.' This was after the G8 group of industrialised nations committed to funding universal access to treatment by 2010. Other hindrances to treatment include infrastructure, staffing and stigma.

Microbicide gels are currently being trialled. These can be applied by women before sex for the prevention of HIV if their partners are unwilling to use a condom. This is important given that 70% of the predicted 45 million new cases between 2002 and 2010 will be in women in developing countries. A large trial has shown that male circumcision could reduce HIV infection rates. (Nature 2006; 24 August, BMJ 2006; 19 August, guardian.co.uk 2006; 17,18 August, aids2006.org 2006; 18 August)

Government advisers suggest free condoms for children

The Independent Advisory Group on Teenage Pregnancy, the panel that provides advice to ministers and monitors government strategy, has suggested free condoms be given to children in sports halls, shops and swimming baths as part of a campaign to tackle teenage pregnancy.

The panel's recommendations come amid a debate about how to cut the teenage pregnancy rate, the highest in western Europe. In their report, the panel says that condoms should be 'easily accessible to young people' and that 'new and creative approaches of getting condoms into the community would be the next logical step'. They also recommended that five year olds have compulsory 'relationship lessons' to help lower the number of teenage pregnancies and added that longer-lasting contraceptives, such as injections and implants, should also be widely available. The report went on to say that it is 'critical' for the government to 'be brave' and make sex education (personal, social and health education) compulsory in schools 'at all key stages'.

Robert Whelan, of the Civitas think tank, responded: 'Up until now we have always taken a dim view about people who go to swimming baths to talk to little boys about sex. Now it seems to be government policy. This is not progress.' (Telegraph 2006; 11 September)

New organ donation laws

Organ donation and tissue retention laws are being changed. The recently implemented Human Tissue Act will legally enable doctors to follow patients' wishes despite objections from relatives. Transplants and research could be carried out more easily. A three-year jail sentence for removing and storing human tissue without consent will act as a safeguard.

Doctors will now be able to use organs from patients who have given consent even if family members object. But transplant surgeons will still have to consult family members before making their decision. Chris Rudge, UK Transplant managing director, says that families currently overturn one in ten
potential donations.

The new Human Tissue Authority will issue licences for post mortems, anatomy classes, tissue storage for research, and museums. This act was triggered by the Alder Hey Hospital and Bristol Royal Infirmary scandals. Organs from thousands of children's corpses were removed without parental consent. Since then, permission to store human tissue for important research became hard to obtain. The new act should facilitate research, but there are worries about the bureaucracy costing time and money (news.bbc.co.uk 2006; 31 August, guardian.co.uk 2006; 2 September)

Human rights for great apes?

Chimpanzees, gorillas, and other great apes may soon be granted basic rights in Spain. The parliament is asking the government to approve a resolution guaranteeing the right to life, to freedom and to protection from torture.

If the resolution is passed, this will be the first case of non-humans being granted such rights by a national government. Spanish law may need to be amended to place great apes under 'moral guardianship' as 'wards of the state' instead of 'ownership'. This is the status of children in care, severely handicapped people, and the comatose.

The resolution is based on the Great Ape Project (GAP). The GAP is not seeking human rights for great apes, but recognition of their similarity to humans. Peter Singer, philosopher and founder of the GAP, says, 'There is no sound moral reason why possession of basic rights should be limited to members of a particular species'.

There may be pressure on other European countries to follow Spain's precedent. This legal protection could be extended to other animals.

Fernando Sebastian, archbishop of Pamplona and Tudela in Spain, said: 'We don't give rights to some people - such as unborn children, human embryos, and we are going to give them to apes'. He qualified this afterwards saying the remarks were taken out of context and that he now supports the resolution. (telegraph.co.uk 2006; 10 June, guardian.co.uk 2006; 7 June, scotsman.com 2006; 28 June, aljazeera.net 2006; 27 June)

Poisoning our children

A group of teachers, psychologists, authors and other children's experts have protested against the harmful influence of junk food, mass marketing, competitive schooling and electronic entertainment on children. A letter to the Daily Telegraph has 110 signatories. They are 'deeply concerned at the escalating incidence of childhood depression and children's behavioural and developmental conditions.'

'Today's children are expected to cope with an ever-earlier start to formal schoolwork and an overly academic test-driven primary curriculum.' It continues, 'They are pushed by market forces to act and dress like mini-adults and exposed via the electronic media to material which would have been considered unsuitable for children even in the very recent past.'

Sue Palmer, former head teacher and author of Toxic Childhood, circulated the letter along with Dr Richard House, senior lecturer at the Research Centre for Therapeutic Education at Roehampton University.

Mrs Palmer quoted research from Professor Michael Shayer of Kings College London, showing that the results of cognitive tests taken by eleven year olds are 'on average between two and three years behind where they were 15 years ago'. She says 'a child's physical and psychological growth cannot be accelerated' and that 'childhood is not a race'. The letter argues for public policy to be guided by a public debate on 'child-rearing in the 21st Century'.

The authors argue against junk food and screen based entertainment. They believe children need real food and real play as part of their development. Patrick Holford, a psychologist and nutritionist who leads the Food for the Brain Foundation, says, 'There is absolutely no question that there is a profound link between children, their poor performance and a poor diet.' (telegraph.co.uk 2006; 12 September, news.bbc.co.uk 2006; 12 September)

13 million English obese by 2010

The Department of Health predicts that twelve million adults and one million children will be obese by 2010. This comprises a third of men and 28% of women. Children of overweight or obese parents are five times more likely to be obese compared to children of parents who are not overweight or obese.

The government considers this report 'the most accurate estimate so far'. It is based on the 2003-2004 Health Survey for England, which showed obesity rates of 24% for both men and women in 2004. From 2003 to 2010, the obesity rate among boys is predicted to rise from 17% to 19%. Among girls, the predicted rise is from 16% to 22%.

Patricia Hewitt, the health secretary, said, 'These days our health depends much more on what we do for ourselves than on what the NHS does for us. That's why each of us needs to think about how we can lead healthier lives.'

Obesity costs the NHS one billion pounds and 9,000 premature deaths a year. (guardian.co.uk 2006; 24 August, BMJ 2006; 2 September, news.bbc.co.uk 2006; 25 August)

And finally… US academy warns of risks of shopping trolleys

The American Academy of Paediatrics has recommended that healthcare professionals educate their patients about the risks of sitting their children in shopping trolleys. The recommendation follows the finding by the academy that over 24,000 children were treated in emergency departments in the States in 2005 with injuries resulting from shopping trolleys.

According to the report, 80% of the injuries were due to children falling from trolleys, or trolleys tipping over. In addition to these, 80% of shoppers leave their children unattended at some point during their shopping trip.

Along with healthcare professionals educating their patients, the academy also urged stores to improve the safety of their trolleys as well as to adopt other safety strategies for young children. (BMJ, 2006; 19 August)