News Review

Controversy over 14 year old’s abortion

The case of a 14 year old girl who had an abortion without her mother’s knowledge has provoked outrage in the media. Melissa Smith opted for a termination after talking to a school health worker.

Her mother claims that the first she knew of the situation was when the school contacted her to ask why Melissa was not in school. They telephoned her subsequently and claimed to have made a mistake, but Mrs Smith later discovered that she had been at the hospital having a scan.

Once she found out about the pregnancy she talked to her daughter, together with her boyfriend and his mother. They decided to keep the baby and contacted the local hospital, as Melissa had only taken the first of two pills as part of a chemical abortion. However, they learnt that the fetus would already have been damaged.

Mrs Smith told the BBC that her daughter had been too afraid to say she wanted to keep the baby until they had talked. She believed that her daughter had been talked into having a termination by school staff, violating her rights as a mother.

The ‘Fraser guidelines’, laid down by Lord Fraser in Gillick v West Norfolk and Wisbech AHA (1986), allow a doctor to give contraceptive advice and treatment to a minor without consulting their parents - although the practitioner should be satisfied that the young person cannot be persuaded to inform them. The guidelines are widely construed to cover termination procedures as well. (bbc.co.uk 2004; 13 May)

Baby born using 21 year old sperm

A baby has been born using sperm frozen for 21 years. Doctors at St Mary’s Hospital, Manchester, believe that this may be a world record. The father’s sperm was frozen prior to testicular cancer treatment when he was 17. The couple have waited ten years and undergone three previous attempts at in vitro fertilisation.

Dr Virginia Bolton, consultant embryologist at King’s College Hospital in London, said, ‘From animal studies the only damage it seems that could occur to frozen sperm is through background radiation.’ However, little is known about the long term effects of human sperm freezing.

Sperm can be stored for ten years under UK regulations. This can be extended if the man is under 55 and remains infertile. (bbc.co.uk 2004; 25 May, Guardian 2004; 25 May)

Legal status of the fetus altered in the US

President George W Bush has signed legislation making it a separate offence to harm an unborn child during a violent attack on a pregnant woman. The new rule has been dubbed ‘Laci and Conner’s Law’ after the highly-publicised murder of a pregnant Californian woman.

The legislation was overwhelmingly supported by the US Senate, but has been fiercely criticised by pro-choice activists who believe it is a move towards a ban on abortion. Gloria Feldt, president of the Planned Parenthood Federation of America, said that the law was ‘part of a deceptive anti-choice strategy to make women’s bodies mere vessels by creating legal personhood for the foetus’. Campaigners were particularly angered by the bill’s definition of the fetus as ‘a member of the species homo sapiens at any stage of development who is carried in the womb’. It effectively establishes in criminal law that a fetus injured during an assault is just as much a victim of the crime as the expectant mother. In the UK, the fetus has no rights before birth. (bbc.co.uk 2004; 2 April, Washington Post 2004; 2 April)

Surrogate mother jailed for internet fraud

A surrogate mother has been jailed for three years, having deceived three couples with the fraudulent internet sale of her baby. Moira Greenslade advertised on a website for surrogate mothers and targeted up to five respondents.

She had made £2,500 before her successive attempts to sell her baby were discovered. One of the couples, who paid a £1,500 deposit on a £9,000 contract for the child, had suffered 13 miscarriages and eight failed attempts at in vitro fertilisation treatment. She took a second deposit of £1,000 from another couple and had started negotiations with a third after cancelling successive agreements by email. Police officers believe that she may have had contact with two other couples who have not been traced.

Greenslade was arrested in December at the Princess Anne Hospital in Southampton after giving birth to a daughter and the child is now in the care of social services. She already has a six year old son and is said to have previously conducted a successful surrogacy agreement. It is not illegal to offer genuine surrogate mother services over the internet but Greenslade’s planned sale of her child directly contravened adoption law. (Guardian 2004; 22 May)

Chlamydia threatens male fertility

Male infection with chlamydia, the most common sexually transmitted infection in England, Scotland and Wales may reduce the success rates of fertility treatment by a third. Female infection has long been known to affect fertility, but research from Sweden’s Umea University shows that males are also affected.

Chlamydia in women results in pelvic inflammatory disease, which damages fallopian tubes, making it the most common cause of infertility. The link between male infertility and chlamydia is being investigated; researchers cite sperm motility as a possibility.

This study, published in Human Reproduction, involved 244 couples at a fertility clinic. Antibodies indicating past or present chlamydia infection were used as markers. Testing of urine for chlamydial DNA, indicating active infection, was also carried out if these antibodies were present. The results suggest that neither infection nor the presence of chlamydia antibodies put spontaneous or IVF pregnancies at risk once they have been achieved.

35,500 men and 45,500 women are infected every year in the UK and the infection is often asymptomatic. An NHS screening programme aimed at women under 25 began last year. However, Jan Olufsson, head of the Swedish research team, said, ‘Men need to be aware it is potentially serious for them too.’ (Guardian 2004; 29 April, bbc.co.uk 2004; 29 April)

Another loophole in the HFE Act?

The creation of human-animal hybrids falls outside the remit of the Human Fertilisation and Embryology Authority and is currently unregulated in the UK.

At least one such experiment has taken place in the UK. A team at Cambridge University fused the nuclei from human adult cells with eggs from Xenopus frogs. The aim of such research is to produce ‘rejuvenated’ human cells that would have the ability to grow into replacement human tissues. Such studies could enable a patient to be treated with cells of their own genetic constitution and circumvents the destruction of human embryos involved in other similar projects. Professor John Gurdon, who led the study, said that the resultant cells ‘did not produce anything that could vaguely be described as an embryo… I cannot imagine any possible way that anybody would object to this on ethical grounds.’

Concerns about regulation of hybrid research were raised by Dr Calum MacKellar of the Scottish Council on Human Bioethics. Suzi Leather, chair of the HFEA, has confirmed that these studies fall outside their remit. Under current legislation the HFEA only regulates hybrid embryos formed by direct fusion of human and animal gametes, or those that have the potential to develop into ‘human beings’. The act outlaws placing a live embryo that is not a human embryo inside a woman. (Times 2004; 1 June, Scientist 2004; 2 June)

New donor gamete register

People conceived using donor gametes will be able to identify their parents following the launch of a new pilot voluntary register. Where both parties agree to contact, UK DonorLink will bring together parents and their adult children.

The information will cover people conceived through donor eggs and sperm and their donor parents, as well as their half-siblings. It could include identities and addresses, or just details such as age, jobs and interests.

The government’s aim is to bring legislation for the donor-conceived into line with that for adopted people, giving them access to their genetic origins. However, at present, the register only applies to donor-conceived people over the age of 18 and those who donated gametes in the UK prior to the 1990 Human Fertilisation and Embryology Act coming into effect in 1991.

The government has also agreed to end the anonymity guaranteed to sperm donors from 2005. This will take effect when the first children conceived in this way reach 18. It has raised concerns that men will be less keen to donate sperm if there is a chance they may be contacted by their resulting offspring later in life. (bbc.co.uk 2004; 21 April)

Mice produced by ‘virgin birth’

Two mice have been created using only cells from female parents for the first time. Scientists at Tokyo University of Agriculture used eggs to make the animals, with no sperm or other male cells.

This process is similar to parthenogenesis, in which an egg re-recruits its polar body and becomes the sole source of genetic material for the embryo. Parthenogenesis occurs naturally in some species, but not mammals. It has long been thought impossible in mammals due to the biological phenomenon known as imprinting. During gamete formation in mammals, certain genes necessary for embryo development are shut down with a series of chemical markers, or imprints, some in sperm and others in eggs. Only when sperm and egg meet are all the key genes available. Mammalian parthenotes have been produced, but have not survived more than a few days.

The Japanese team circumvented the imprinting barrier by genetically modifying female mice to produce eggs with a more ‘male’ imprinting pattern. The nuclei from modified eggs were then transferred into regular eggs taken from normal mice. With two genomes present, the eggs proceeded to grow and divide.

The news has inevitably sparked debate about the future redundancy of men, as well as the potential impact of the technique on reproductive science and fertility treatments. However, like the reproductive cloning technique that produced Dolly the sheep in 1997, parthenogenesis is extremely inefficient at present: only two mice resulted from 457 reconstructed eggs. One was sacrificed for testing whilst the other, named Kaguya, has been allowed to grow into an adult. (New Scientist 2004; 21 April)

HFEA considers first human cloning project

The Human Fertilisation and Embryology Authority (HFEA) is considering the first licence application to create human clones using cell nuclear transfer.

Professor Alison Murdoch’s team at the International Centre for Life in Newcastle intend to create cloned embryos from which they will harvest stem cells. They will also research the use of parthenogenesis. The research is linked to developing treatments for diabetes. Cloning embryos for therapeutic purposes was made legal by the HFE (Research Purposes) Regulations 2001 amendment to the HFE Act.

The news has been welcomed by patient groups: Alastair Kent, of the Genetics Interest Group, claimed that millions could potentially be helped by the research. He rejected concerns about the destruction of embryos, saying, ‘It is a matter of balancing the rights and needs of those people who are alive now with a very remote potential future person.’ However, there is strong opposition to the move from a variety of quarters, including pro-life groups.

Professor Ian Wilmut, who cloned Dolly the sheep, has also expressed intentions to apply for a human cloning licence. Based at the Roslin Institute in Edinburgh, he would create cloned embryos with motor neurone disease and then destroy them after a few days. The Roslin Institute already holds a licence to use parthenogenesis for the creation of human clones followed by stem cell harvesting. (bbc.co.uk 2004; 21 April, 16 June, hfea.gov.uk 2004; 16 June)

Death decisions given legal clearance

A multiple sclerosis (MS) sufferer has won the ‘right’ to be left to choke to death. The former teacher made a living will to ensure that carers will not intervene if she starts to choke on her food, a situation that often arises in the later stages of MS due to eating difficulties. Durham County Council has made a decision to uphold the living will and instructed carers not to intervene personally in the case of an emergency, although they will be expected to call the emergency services. Mark Slattery of the Voluntary Euthanasia Society said that the woman was, ‘expressing the will that it would actually be more painful for her to be revived or to be given this treatment than it would be for her to choke and to die’.

This is thought to be the first decision of its kind, and the council now plans to introduce a policy on living wills. It is likely that other local councils will follow suit. Previously, medical staff have been legally bound by living wills, but it was not clear whether this extended to social carers. Anyone who physically handles the patient in a way that has been refused in advance could be liable to charges of assault.

The Mental Capacity Bill, currently under discussion in the House of Lords, will seek to clarify the legal situation regarding living wills. It will state that the treatments being refused must be specified and that doctors must be satisfied that there has been no change in mind or circumstances to negate the living will. Additionally, if there is any doubt, this should be resolved in favour of preserving life.

A report from the University of Michigan published in the Hastings Center Report has indicated that living wills don’t work. The authors reviewed hundreds of studies of living wills, end-of-life decisions and the psychology of decision making. They recommend that Durable Powers of Attorney (DPA), allowing people to name someone to make decisions on their behalf, be used instead. DPAs are also cheaper than living wills. Starting up the administration of living wills in America cost an estimated $101.5m, and demands countless hours from hospital staff annually.

The UK equivalent, Lasting Powers of Attorney, are also covered in the Mental Capacity Bill. (Hastings Center Report 2004;34:2, BMJ 2004;328:1035, bbc.co.uk 2004; 24 May, Guardian 2004; 26 May)

Euthanasia campaigner jailed

One of New Zealand’s leading euthanasia campaigners has been sentenced to 15 months in jail for the attempted murder of her mother. Lesley Martin wrote a book in which she described injecting her 69 year old mother with morphine. Joy Martin had been suffering from colorectal cancer and died the following day.

Police decided to investigate the case on reading the book, entitled To Die Like a Dog, in which Martin also described trying to suffocate her mother with a pillow in an attempt to relieve her suffering. She is a former intensive care nurse and cared for her mother in the five months prior to her death in 1999.

Lesley Martin helped found Exit New Zealand, a lobby group fighting to see voluntary euthanasia legalised. Following the trial she insisted that she would go to jail. ‘Not a single day’ went by when she felt guilty about her actions, she declared. However, her lawyer has said he will appeal the sentence, as a conviction would prevent her from travelling overseas to promote euthanasia. (bbc.co.uk 2004; 30 April, New Zealand Herald 2004; 30 April, Sydney Morning Herald; 30 April)

Surgeons to practice on animals?

UK surgeons may have to practise their skills by operating on pigs and sheep. The Royal College of Surgeons wants laws that currently only permit such procedures to be carried out on rodents, to be relaxed.

The move follows proposed changes to surgical training that will reduce the amount of time junior doctors spend in operating theatres. According to European legislation, no trainee is supposed to work more than 56 hours a week, and by 2009 the limit will be 48 hours.

The animals would be terminally anaesthetised during the procedures, but anti-vivisection campaigners claim the plans are ‘ethically and scientifically’ wrong, as pigs are not anatomically close enough to humans to be useful. (bbc.co.uk 2004; 23 March)

And finally…

Following news that the number of chlamydia cases amongst young people in Sweden has doubled, public health workers have resorted to drastic measures: condom ambulances. The vehicles will be on standby three days a week in Gothenburg, Stockholm and Malmo. For 50 Kronor (~£4) the cars will deliver ten condoms to any address in the city.

According to the RFSU, the Swedish health trust that came up with the idea, only 25% of Swedes between the ages of 16 and 25 use condoms, but 50% would not mind doing so. It is hoped that the Condom Express will be a step towards reaching those potential customers.

Sexual health experts in Stockholm have welcomed the project. The organisers are also keen to point out that although the campaign is targeted at young people, anyone is welcome to call the Condom Express hotline: ‘We won’t look at someone’s age and turn around! When it comes to sex, you’re only as old as you feel.’ (bbc.co.uk 2004; 5 June)