News Review

Diane Pretty dies

Diane Pretty has died less than a fortnight after losing her final court appeal, seeking her husband’s help to end her life. She passed away at a hospice near her home in Bedfordshire. Her husband was at her side.

Mrs Pretty, 43, had suffered from motor neurone disease for three years and had been fighting a long legal battle which finally ended in the European Court of Human Rights. She had been seeking the right to her husband’s help in dying before the onset of the choking and asphyxia which mark the final stages of her condition.

Suicide is not a crime in the UK but Mrs Pretty was physically unable to take her own life. Without a court sanction, her husband could have faced a possible prosecution for aiding and abetting suicide, which carries a prison term of up to 14 years. However, the European Court of Human Rights ruled that the state was not obliged to sanction steps to avoid the inhuman and degrading effects of a disease. Afterwards she said: ‘The law has taken all my rights away.’

However, speaking to the Guardian, Rachel Hurst, director of Disability Awareness in Action, said her organisation stood by its support of the European court’s decision. ‘The issue about Diane Pretty is that she wanted to kill herself, but I am afraid it would be very wrong for justice to say in certain circumstances people can die. It would be a slippery slope and many people who did not want to die could be affected. Palliative care does take away a great deal of the problem and was her death any worse than someone in the Potters Bar crash?’

(Guardian 2002; 13 May. See also report in Triple Helix 2002; Summer)

Peaceful end for Ms B

A woman paralysed from the neck down who won a legal battle to allow her to have medical treatment withdrawn has died peacefully in her sleep. A High Court judge ruled that the 43 year old, known as Ms B, had the ‘necessary mental capacity to give consent or to refuse consent to life-sustaining medical treatment’, granting her the right to be transferred to another hospital and have her ventilator switched off, after her original hospital refused to do so. The former social worker was also to be treated in accordance with her wishes and be given the medication and care necessary to ease her suffering and allow her to die in dignity.

Following her death, the Department of Health issued a statement saying: ‘Ms B has chosen to have all artificial ventilation which she is receiving as part of her medical treatment withdrawn. She has died peacefully in her sleep after being taken off the ventilator at her request.’

In the wake of the case, the General Medical Council has published provisional guidelines to help doctors decide when it might be appropriate to withhold or withdraw a patient’s treatment. Professor David Hatch, who chaired the working group that drew up the guidelines, said they had consulted widely on the proposals, receiving more than 700 responses. ‘I think that the overriding principle, which was confirmed in the Miss B case, is that one must respect the wishes of the patient and make sure they are fully informed about all the options and free to make their own decisions,’ he said.

(Guardian 2002; 29, 30 April)

Dutch legalise euthanasia

The Netherlands has become the first country in the world to officially legalise euthanasia. After considerable debate, the change to the law was agreed at the end of last year. However, it has only now come into force.

For the past two decades, the authorities have turned a blind eye to the practice but doctors still risked prosecution, even when they had obtained the consent of the dying patient.

The new legislation will permit doctors to administer euthanasia only to those patients who are in a state of continuous, unbearable and incurable suffering. However, they must obtain a second opinion, the patient must be judged to be of sound mind and their request to die must be entirely voluntary and independent.

There are already thought to be between 2,000 and 3,000 recorded cases of euthanasia in the country each year and more than 90% of the Dutch population support it. However, the new law has inevitably provoked controversy. The UN Human Rights Committee has warned that mercy killing in the Netherlands risks becoming routine and insensitive. Concerns have also been raised that the initiative will trigger a wave of ‘euthanasia tourism’ but a clause insisting on a well established relationship between the doctor and patient is designed to prevent this.

(Guardian 2002; 1 April)

Australian family may face jail for watching suicide

The family of Australian woman Nancy Crick face possible prosecution after watching her commit suicide. Mrs Crick, 69, who had allegedly been suffering from colorectal cancer for three years swallowed an overdose of drugs, washed it down with Bailey’s liquer and lit a final cigarette, having decided she could no longer go on with life. Her friends and relatives who were with her at her home in Queensland are now faced with the possibility of life imprisonment.

Mrs Crick had made no secret of her desire to end her life but did not want to die alone. However, she knew that assisting a suicide was illegal so prior to her death she recorded a video statement aimed at protecting those with her in which she declared, ‘It’s my death, I’m doing it and no-one else.’

The local police declared her house a crime scene and sealed it off shortly after her body was carried out to an ambulance. It is believed that she had obtained the necessary drugs after an appeal on the internet.

Mrs Crick had campaigned vociferously for a change in the country’s euthanasia laws and her death has re-ignited the whole debate. Australia’s Northern Territory became the first place in the world to legalise voluntary euthanasia in 1996 but the law was overturned just nine months later.

(Independent 2002; 24 May)

In a bizarre twist a post mortem examination revealed that Mrs Crick did not have any visual signs of cancer at the time of her death, despite her claim to have been suffering from the complications of colorectal cancer for three years.

(Sydney Morning Herald 2002; 27 May)

SPUC fail to get morning-after pill banned

Pro-life campaigners have failed in their attempt to have the morning-after pill banned. The Society for the Protection of the Unborn Child sought a judicial review to prevent the medication being sold over the counter without a prescription. The group argued that it was not a contraceptive but an abortifacient as it does not prevent the act of fertilisation but stops a fertilised egg implanting in the uterus. This constitutes a miscarriage according to the Offences Against the Person Act 1861. Therefore, if the court had agreed that it was an abortifacient, the morningafter pill would be regulated by the Abortion Act 1967, and should not be available without the written consent of two doctors.

However, the claim was categorically rejected by a High Court judge who made it clear that he felt the issue should not be decided in court. Mr Justice Munby pointed out that decisions about contraception must be left up to the individual and were not the business of Government, judges or the law. He also felt that the SPUC’s legal argument was wrong as the definition of miscarriage used in the 1861 Act is no longer applicable today. It is now accepted that a miscarriage marks the end of a viable pregnancy in which the fertilised egg has implanted in the uterus.

Even though the SPUC claimed that it was only targeting the morning-after pill, such a ban could also have had a big impact on the use of other forms of contraception including intrauterine devices which also prevent implantation.

(Guardian 2002; 19 April)

BBC wrong to ban Prolife broadcast

The BBC has been heavily criticised for refusing to show a party political broadcast that contained images of abortions. Three senior judges accused the corporation of censorship following its decision to ban the Prolife Alliance video before the 2001 election.

The decision came as something of a surprise as the Alliance has already been unsuccessful in court on several occasions. Attempts to win a showing before the 1997 election failed and the European Court of Human Rights had also refused to take on the issue. A High Court ruling had refused them the right to seek a judicial review of the BBC’s decision, although this has now been overturned.

Three versions of the video were rejected by the BBC, as well as other television companies, because they contained images deemed to be offensive.

In his summing up Lord Justice Laws noted that the case was ultimately about the censorship of political speech. Quoting from the Prolife Alliance’s own facts relating to abortion, he said: ‘Each year approximately 200,000 abortions are carried out in the United Kingdom, some 70% of them funded by the taxpayer.’

He described the first of the three rejected videos to the court and noted: ‘It shows the products of a suction abortion: tiny limbs, bloodied and dismembered, a separated head, their human shape and form plainly recognisable. They are, I think, disturbing to any person of ordinary sensibilities. But if we are to take political free speech seriously, those characteristics cannot begin to justify the censorship.’

(Guardian 2002; 15 March)

Gay couples allowed to adopt

MPs have voted in favour of giving same sex and unmarried heterosexual couples adoption rights equal to married couples. The Commons voted by a majority of 155 in favour of opening adoption to all couples. At present only single people and married couples are allowed to adopt.

Tony Blair fully supported the measure and declared a free vote for Labour MPs. However, the Conservative party leader, Iain Duncan- Smith, declared unmarried couples ‘unfit to adopt’. He cited figures which show that cohabiting couples are four to five times more likely to break up than married couples; he maintained that he was not making a moral judgement but a practical one as the children in question have already faced difficulties and are in need of a stable home.

In the past, one member of an unmarried couple has been forced to adopt as a single person, leaving their partner with no legal rights over the child. Campaigners claim that the restriction can cause problems where the legal adopter becomes unable to care for the child. According to Felicity Collier, chief executive of the pressure group British Association of Adoption & Fostering, the new ruling will encourage more people to put themselves forward as adoptive parents.

Although more than 4,000 children were successfully adopted last year, only 2,700 of them came from the 58,000 in institutional care. There is also evidence that many who are not adopted end up on the streets. Ms Collier believes that an extra 5,000 adoptive families are needed each year to meet demand. However, it can take years from applying to adopt through to a successful adoption. One in ten children in care waits more than three years before an adoptive family is found.

(Guardian 2002; 17 May, Times 2002; 17 May)

HFEA grants stem cell research licences

UK authorities have granted the first licenses for scientists to conduct research involving the development of human embryonic stem cell lines. In the past researchers have only been licensed to study embryos up to 14 days gestation with the intention of improving fertility treatments. However the Human Fertilisation and Embryo Authority (HFEA) approved applications from two groups, allowing them to produce human embryonic stem cell lines and maintain them long term.

One group, based at Edinburgh University, has been licensed to develop embryonic stem cell lines to be used in studies aimed at developing new therapeutic approaches to Parkinson’s disease. The other team, from King’s College, London, will be able to use stem cells to investigate neural disorders, infertility, and miscarriage.

In the past stem cell research has focused on cells from animals or on adult stem cells but the new legislation involves the development of stem cell lines from ‘spare’ embryos created for infertility treatment. However, the HFEA, which oversees all research related to human fertilisation in the UK, said that its license committee had carefully considered all the scientific, medical and ethical issues of the applications.

The licences were granted soon after the House of Lords Select Committee on Stem Cell Research gave the go-ahead for the research uses of human embryos to be further extended. The move has not only received widespread support from the scientific community but has made the UK regulations on the subject more liberal than those in other countries, including the United States.

(BMJ 2002; 324:562)

Outrage at latest human cloning claims

News that controversial Italian fertility expert Severino Antinori may be on the verge of cloning the first human baby has provoked outrage amongst medical groups. Dr Antinori, who runs a clinic in Rome, has been quoted in an Arab newspaper as claiming that one of his patients is eight weeks pregnant with a cloned embryo.

Dr Antinori refused to comment but has made no secret of the fact that he hopes to produce a viable cloned embryo in the next two years. He would also not reveal information about the pregnant woman. However, he works with women from around the world and claims to have three or four British women on his shortlist. Cloning humans is currently illegal in Britain although many doctors admit that it is almost inevitable unless there is a worldwide ban. Researchers are also banned from cloning humans in Italy or the US but Antinori is thought to be conducting his experiments in Israel and Cyprus.

(Guardian 2002; 7 April, BMJ 2002; 324:868)

High court battle over HIV positive girl

A High Court judge has been asked to make an urgent decision about the future of an HIV-positive toddler whose father has refused to allow her to be treated with antiretroviral drugs.

The three year old girl is currently in hospital undergoing tests to ascertain what treatment she will require. She and her father were forced to return to the UK from Australia; her parents fled there in 1999 after a court ruled that their daughter should be tested for the AIDS virus as her mother was HIV positive. Her mother has died and her father, an alternative health practitioner, subsequently became involved in a battle with Australian social services. He was refusing to allow her to be treated with antiretroviral drugs as he believed them to be toxic. He claimed that it was a parent’s right to decide what treatment their child should receive.

However, on their return, the girl was made a ward of court by the London borough of Camden, where the family previously lived, which means that all parental decisions must now be taken by the High Court.

(Guardian 2002; 11 May)

Number of HIV patients in the UK set to double...

Public health officials have warned that the number of people living with HIV in the UK is set to rise by almost 50% by 2005. Recent projections suggest that the number of patients with the virus will rise from 23,000 in 2000 to 34,000 in 2005. The number of new diagnoses reached a new high in 2001, rising by 17% on figures from the previous year.

Gay and bisexual men remain the largest risk group but this is the third consecutive year when the number of heterosexual diagnoses has exceeded diagnoses in gay men. HIV infection picked up abroad is thought to account for three-quarters of the new cases, both in those who have gone to live abroad and those who have come to live in the UK from countries of higher prevalence.

According to a spokesman for the Public Health Laboratory Service, latest estimates suggest there were 33,500 people living with HIV at the end of the year 2000, just under a third of whom were undiagnosed.

(Guardian 2002; 31 January)

...Whilst cases in India could overtake South Africa

Experts have also warned that the number of cases of HIV and AIDS in India is likely to overtake even South Africa. Peter Piot, executive director of UNAIDS, said that within ten years there could be tens of millions infected with the virus in India. However, the crisis is not likely to be on the same scale as that affecting Africa because the population is huge and the proportion of affected adults is likely to be tiny in comparison.

There are currently 3.8m infected adults in India, compared to 4.7m in South Africa. However, this is just 0.7% of the billion-strong population, compared with 20% of adults in South Africa.

Although the Indian Government has launched a nationwide programme to prevent the spread of the disease, there is still an enormous stigma attached to the illness. The infection is currently rampant in large areas of rural India. It is thought to have spread from urban areas. AIDS has become the fourth biggest killer worldwide, with an estimated 40m carrying the virus.

(BBC 2002; 2 May)

Tough new Government drugs policies

Most illegal drugs cause no harm to users, according to a Commons committee report. Currently around four million people are involved with drugs each year. However, the report says that a hard core of around 250,000 users are dependent on cocaine or heroin and are often involved with crime.

The report also claims that the efforts of police and customs officers have had little effect on the availability of illegal drugs. It is believed that the need for addicts to buy drugs is behind one third of all property crimes.

In the first major parliamentary study of drug use in Britain, the Government rejects the legalisation of drugs. It concedes that there is some weight behind arguments for legalisation but does not support such a ‘drastic step’ at this time. It does however advocate the downregulation of both Ecstasy and Cannabis from class A to class B and from class B to class C respectively. Other key points include the introduction of safe injecting centres for heroin users and the prescribing of heroin to addicts. Teaching about drug misuse would also become a key part of doctor’s training.

On the same day the report was released, education secretary Estelle Morris recommended that every secondary school receive a copy of Rachel’s Story, a video depicting the life and graphic death of a heroin addict. The film includes pictures of the body of 21 year old Rachel Whitear, who died following a heroin overdose in a bedsit in Devon. It is aimed at warning teenagers of the dangers of drugs.

Other new measures to combat drug abuse amongst young people, include automatic expulsion for children caught dealing in drugs at school, with no chance of a reprieve, whilst drug dealers who deliberately target children and tout at school gates will face the prospect of longer jail sentences.

(Guardian 2002; 21 May, Times 2002; 22 May)