New Bioethics journal launched focussing on interface of technology and the human body

A new journal in the rapidly expanding field of bioethics has been launched this week.

The New Bioethics seeks to reclaim bioethics as a diverse and multidisciplinary project. It provides a space for dialogue between different perspectives on biotechnology and offers the chance to find new kinds of common ground.

The journal is not concerned primarily with the traditional professional ethics of doctors such as confidentiality and data protection, but will focus specifically on the interface of technology and the human body. 

It covers issues such as assisted reproduction, genetics, regenerative medicine (including the use of stem cells), cognitive enhancement and those technologies that have allowed human tissue to be taken, stored, manipulated and used for biomedical purposes.

The journal invites contributions from a range of perspectives, from the social and political sciences, from feminist perspectives, from the traditions of European Continental philosophy, Anglo-American analytic philosophy and Eastern philosophies and diverse religious perspectives.

The new journal is the successor to Human Reproduction and Genetic Ethics (HRGE).There will be two issues per year.

This first edition contains nine articles two of which, the editorial by Trevor Stammers and Matt James, and a guest editorial by Aaron Parkhurst are available free on line.

Stammers and James write:

‘We hope that these papers will not only engage and interest the readers of the parent journal but also attract an even wider readership as we maintain our emphasis on a wide multidisciplinary approach but expand the range of bioethical areas under discussion.’

As Aaron Parkhurst explains, most of the nine papers from the first edition come from a one-day conference ‘The 21st Century Body’.

I note that some of the contributors, and both editors, are committed Christians who are also academics in bioethics.

I wish them well and look forward to the new journal’s contributions to vital debates on new biotechnologies. 

Philip Nitschke (aka Dr Death) launches ‘Voluntary Euthanasia Party’ to fight Australian Federal Election

The following review was written by Paul Russell (pictured left), Executive Director of HOPE, which works to prevent euthanasia and assisted suicide. It is reproduced from his website. I have appended links to some of my own previous articles on Philip Nitschke (pictured below right). 

You’ve got to give Dr Philip Nitschke some credit for telling it like it really is. Whilst Australia’s state-based euthanasia lobby groups and their state-based MP supporters argue for limited legislation with so-called safeguards, Nitschke has consistently advocated for legalisation of euthanasia in a virtually unrestricted fashion - save only for the exclusion of minors and people with mental incapacity.

Some of the state-based groups have formally distanced themselves from Nitschke and Exit because of this; while for others, the relationship is a little less clear.  While they work to make their approach seem palatable to the public and polity alike, Nitschke’s presence is a source of frustration because his is the logical end of even the most minimalistic approach.

So when, in the midst of the Australian Federal Election campaign Nitschke argues, on the pages of the Canberra Times newspaper, that euthanasia makes sense on the basis of economics – that older Australians choosing to die would help restrain the health budget – it must have these other groups cringing.

“…no one is saying we should put people down against their will, we are suggesting it is a worthwhile debate to have - especially if hundreds of thousands, if not millions, of dollars in the health budget could be saved…”

Nitschke is busily promoting his latest venture, The Voluntary Euthanasia Party. He is standing as a Senate candidate in the Australian Capital Territory. Pundits give the party little chance of success. Like other micro-parties, it’s really about promotion of a cause.

But when Nitschke (right) says, “hundreds of thousands, if not millions” saved from the health budget, he’s talking about a lot of people dying by lethal injection. Again, this runs contrary to the state-based organisations assertions that euthanasia is only really there for the few. When he observes, that the economic argument is, “so vexed that advocates have dared no mention its name” he’s really only stating the obvious.

His is a very dangerous utilitarian argument that’s only likely to be genuinely interesting to those who see a possible economic gain of another kind – the early exit of a loved one and the early distribution of their estate. In terms of Elder Abuse this is El Dorado! But it also casts the state as an abuser – not to make money but to save it. Heaven knows what affect this kind of news has on the elderly!

The day before the Canberra Times article was published, the Australian Greens Party announced their own push for euthanasia. The Greens have pushed more euthanasia bills in Australian parliaments than anyone else. In the last Federal Parliament, Green’s Senator, Richard Di Natale tabled yet another bill to try and overturn the Euthanasia Laws Act 1997 which, as a consequence, would allow euthanasia & assisted suicide debates to resurface in the ACT and The Northern Territory.

The Federal Senate has shown no mood for this kind of debate stretching back for many years now – but that’s no guarantee that the reticence will continue. This time, however, the Greens are taking a decidedly different attack.

Since the time of the operation of theRights of the Terminally Ill Act in the Northern Territory, a side debate has surfaced from time-to-time about the Federal Parliament’s powers in relation to euthanasia & assisted suicide and whether these powers could be extended beyond the territories to all states. It has been commonly accepted that, because the Criminal Codes in relation to homicide are state-based codes, that any exceptions (euthanasia & assisted suicide) are matters for the states.

Senator Di Natale is drawing a very long bow when he claims that the Commonwealth does hold powers to legislate under Section 51. The Guardian reports that, “the party had received legal advice from Senate clerks and constitutional experts saying that it was possible under section 51(xxiiiA) ofthe constitution, which allowed the Commonwealth to legislate for the provision of medical services.” Possible? Yes: but hardly likely.

To make such a claim, Di Natale would need to argue that euthanasia & assisted suicide are medical services when the reality is that they’re simply plain old killing! But we’ve seen this all before; the QuebecParliament is currently looking to legalise under the same false gambit for precisely the same reason – that they don’t have the necessary constitutional powers.

Of course, Nitschke applauded the Green’s initiative and, of course, both Nitschke and the Greens have said that there will be safeguards. But when both seem bent more on the publicity than the substance, it’s difficult not to be cynical.

Other articles on Nitschke on this blog

The question that the police have not asked and Nitschke has not answered

Why is the Home Secretary allowing Philip Nitschke back into Britain?

Philip Nitschke is back in the British Isles but is not finding a warm reception for his ‘how to commit suicide’ seminars

Nitschke announces to the media his latest scheme to help more Australians kill themselves

Police arrest in Chichester should serve as a reminder of why assisted suicide is against the law

A 65-year-old woman and her son from the Chichester area have been arrested after police suspected they were planning to take her husband to the Dignitas clinic in Switzerland to commit suicide, sources said.

The pensioner and the 25-year-old were held on suspicion of encouraging or assisting a suicide.

Details about the condition of the 71-year-old man have not been disclosed and none of the family have been named by Sussex Police.

But the force confirmed that officers were having the mental capacity of the ‘vulnerable’ man assessed to determine how able he is to make decisions for himself.

There have been suggestions that the man was in the early stages of dementia, something which - according to Dignitas’ own guidelines - would require an assessment by a psychiatrist of the patient’s mental capacity to make the decision to end their life and has led to the pair’s motives being questioned.  There has only been one previous case of a British person with dementia travelling to Switzerland to end their life, in May 2013.

Both the woman and her son have been freed on police bail until October 8 following their arrest on August 8.

It is an offence to encourage or assist suicide under the Suicide Act 1961 (as amended by the Coroners and Justice Act 2009) with the offence carrying a prison sentence of up to 14 years.

However prosecutions can only proceed on the authority of the Director of Public Prosecutions (DPP) who has to decide, on the basis of a police investigation, whether there is enough evidence to bring a successful prosecution and whether it is in the public interest to proceed.

In order to decide on the latter the DPP brings his 22 prosecution criteria into play. These were established in 2010 following a public consultation in the wake of the Debbie Purdy case.

In practice, when assistance of a suicide is judged to be ‘wholly motivated by compassion’ a prosecution is unlikely. He decision in this particular case will depend on how he weighs up the facts against his prosecution criteria.

A number of public figures – including euthanasia campaigner Michael Irwin, TV star Melvyn Bragg and novelist Terry Pratchett – have controversially spoken in support for a change in law to allow those with early dementia to kill themselves.

This latest case may fuel further calls for a change in the law so it is worth reminding ourselves why the law is as it is and why it does not need changing.

Euthanasia (being killed by a doctor) and assisted suicide (being helped to kill oneself) are illegal for good reason.

The first duty of Parliament is to protect its citizens and British parliaments have rejected decriminalisation three times since 2006 by large majorities on public safety grounds – in the House of Lords in 2006 and 2009 (by 148-100 and 194-141 respectively) and in the Scottish Parliament in 2010 (by 85-16).

The vast majority of UK doctors remain opposed to legalisation along with the British Medical Association, the Royal College of Physicians, the Association for Palliative Medicine and the British Geriatric Society.

Similarly all major disability rights groups in Britain have resisted any change in the law believing it will lead to increased discrimination towards them and increased pressure ‘to seek help to die’.

Any change in the law to allow assisted suicide or euthanasia would place subtle pressure on vulnerable people to end their lives, for fear of being a financial, emotional or care burden upon others. Those who are disabled, elderly, sick or depressed would be particularly at risk. The right to die, in other words, can so easily become the duty to die.

Elder abuse and neglect by families, carers and institutions is real and dangerous and a law allowing the active ending of life in limited circumstances could be so easily exploited and abused. This is why strong laws are necessary.

Developments overseas are disturbing. Assisted suicides have increased 450% in the US state of Oregon and 700% in Switzerland in the last fifteen years and in the Netherlands the number of euthanasia cases has almost doubled since 2006 from 1,923 to 3,695 with increases of 15-20% each year.

In the Netherlands one in eight deaths is due to ‘deep continuous sedation’, dementia patients are euthanised, mobile euthanasia clinics operate and the ‘Groningen protocol’ allows euthanasia for disabled babies.  In Belgium organs are harvested from euthanasia patients and 32% of all euthanasia deaths are ‘without consent’.

Once a ‘right’ to assisted suicide or euthanasia is established for restricted groups there will be inevitable incremental extension to others through the application of case law in ‘hard cases’.

Our current law with its blanket ban does not need changing. The penalties it holds in reserve act as a strong deterrent to those who stand to gain from another person’s death. It also gives discretion to prosecutors and judges to apply mercy in genuinely hard cases.

It also works. The number of Britons travelling abroad to commit assisted suicide has been very small (about 200 in ten years). But according to a House of Lords enquiry, with an ‘Oregon’ law we would have 1,200 deaths a year and with a ‘Dutch’ law 13,000.

Persistent requests for euthanasia are extremely rare if people are properly cared for. Our priority must be to make good care – killing pain without killing the patient - accessible to all. This is the best way of safeguarding vulnerable people and addressing patients’ physical, psychological, social and spiritual needs. 

Over 850,000 people have signed the petition to protect human embryos in Europe. Have you?

The ‘One of Us’ campaign underlines the moment of conception as the beginning of human life, and aims to prevent any funding of activities which result in the destruction of human embryos, particularly focusing on areas of research, development aid and public health (see previous CMF update by Philippa Taylor  for more detail). 

It was launched in January 2013 by leaders in twenty European countries and follows a European Court of Justice ruling in 2011, in a lawsuit brought by Greenpeace, that human life begins at conception and deserves legal protection (See my previous blogs on the ruling here and here).

‘One of Us’ is a European Citizen Initiative, a new method provided in the Treaty of Lisbon for proposing legislation in the European Union.

Such an initiative must have the support of at least 7 of the 27 member states and each individual state involved must collect a minimum number of signatures based on its overall population. 

If the campaign gathers one million signatures, the European Parliament is duty-bound to schedule a debate on the issue.

So far 180,000 signatures have been gathered, leaving only 150,000 more required by November 2013.

Currently, European policies are at odds with the European Court of Justice decision.

Europe today is funding scientific research that destroys and manipulates embryos and funds international groups touting abortion.

With the recognition of life from the moment of conception, Europe’s policies would shift in favour of unborn life.

How to sign

To take part in this campaign you must be resident in a EU State, be 18 or over and eligible to vote in the European Elections.

To sign the petition you need to go to the ‘One of Us’ website (click here) and follow the few simple instructions.

It takes about two minutes from start to finish.

The ‘One of Us’ campaign reminds us that we were all embryos once. 

But some scientific research activities destroy human embryos.

Further background

3.8 million human embryos created to produce 122,000 live births – success rate of 3.2%

The moral status of the human embryo – when is a person?

3.8 million human embryos created to produce 122,000 live births – success rate of 3.2%

The Daily Telegraph this weekend reports on a new expert study which has raised fears that some clinics may be offering techniques that put the embryo at risk for their own profit.

The review, carried out by Dr Justin McCracken, the former head of the Health Protection Agency, highlighted a new technique, known as Pre-Implantation Genetic Screening (PGS), as one which is possibly being offered inappropriately for commercial reasons.

For a fee, which can run into thousands of pounds, clinics can check embryos created by a successful IVF cycle for certain genetic abnormalities and only implant those that appear normal.

The process is becoming especially popular for older couples seeking IVF, because embryos created from their sperm and eggs have a higher chance of abnormalities. As it involves the removal of a cell from an embryo (see picture) it carries some risk for the embryo being tested.

Dr McCracken said the jury was still out on whether PGS improves the chances of having a baby and warned there is a risk of harm to the foetus. He said it was vital that the regulator checks that clinics are not simply recommending it to boost profits.

 ‘I understand that there is no clinical consensus regarding its efficacy, but there is a real risk to the embryo in carrying it out.’ (emphasis mine)

This is a somewhat curious statement. Dr McCracken seems (appropriately) concerned about the risk of damage to a few hundred embryos each year undergoing PGS.

But he is curiously silent (or perhaps unaware) that over three million embryos have perished or been deliberately destroyed since 1990 as a result of procedures made legal by the Human Fertilisation and Embryology Act.

Liberal Democrat Peer Lord Alton recently asked in parliament how many embryos have been created in each year since the commencement of the Human Fertilisation and Embryology Act 1990, and how many of these have resulted in live births.

Figures given in reply by the Under-Secretary of State at the Department of Health Earl Howe showed that 3,806,699 embryos have been created since 1990. Between 1992 and 2006 a total of 122,043 live births occurred according to figures from the HFEA given alongside his reply (see also here).

122,043 live births from 3,806,699 embryos represent a success rate of 3.21% (1 in 30). Or, to put it another way, 3,684,656 embryos never made it to birth. CMF has highlighted this ratio of 1 in 30 before.

These figures make McCracken’s concern about PGS embryos alone look like what Jesus called ‘straining a gnat whilst swallowing a camel’ (Matthew 23:23-24).

In a letter to the Telegraph, as yet unpublished, disability rights advocate Ann Farmer has highlighted the fact that, in addition to the vast wastage of embryos, some women have also died from complications of infertility treatments such as OHSS. She comments:

‘The whole point of the infertility industry is to manufacture babies out of embryos… A car factory that managed to accumulate 3,684,656 surplus models between 1990 and 2012 and in addition killed some of its customers would surely have gone out of business long ago.’

In 1948 the World Medical Association adopted the Declaration of Geneva which included the affirmation, ‘I will maintain the utmost respect for human life from the time of conception, even against threat’.

Today’s doctors, it seems, take a contrary view.

If you agree with today’s doctors that early human life can be treated as a disposable commodity then the figures that Lord Alton has uncovered (not much short of the current population of New Zealand!) will probably not bother you much at all.

But if, like me, you believe that they are special creations made in God’s image, which should be granted respect, wonder, empathy and protection you will no doubt be very concerned indeed.

See also ‘The moral status of the embryo. When is a person?’

New study adds further fuel to debate about link between induced abortion and breast cancer

Is there a link between induced abortion and breast cancer?

Any such link has been hotly denied by official bodies but a new study has added further fuel to this ongoing controversy.

The Bangladesh study published in the Journal of Dhaka Medical College on risk factors for breast cancer, led by Dr Suraiya Jabeen, found a statistically significant 20.62-fold increased risk among women with abortion histories.

This is by far the highest risk elevation reported among 73 publishedabortion-breast cancer studies.

Professor Joel Brind, a professor at Baruch College, City University of New York who is an expert on the abortion-breast cancer link, has observed that women in Bangladesh have very traditional childbearing patterns that reduce breast cancer risk. He first explains why abortion might increase the risk of breast cancer:

‘First, it is universally accepted that having a child decreases a woman’s risk of breast cancer, because the maturation of the cells in the breast into milk-producing cells renders them less susceptible to becoming cancerous. Second, pregnancy hugely increases the number of breast cells vulnerable to cancer. A live birth provides enough time for these “progenitor cells” to differentiate into more mature, more cancer-resistant cells. Therefore, abortion leaves a woman’s breasts with more places for cancer to start than were there before the pregnancy began.’

He then goes on to explain why the relative risk in Bangladesh might be so high:

‘Why such a high relative risk? That’s because almost all women in Bengladesh get married and start having children before they are 21, and breast-feed all their children as well. Consequently, breast cancer has been almost unheard of in Bengladesh, until recently.’

Of 73 worldwide studies since 1957 (including this latest) on the association of induced abortion and subsequent development of breast cancer: 53 studies show an association, and 15 studies show no association. See specifics here.

And yet many official bodies continue to deny categorically any link between abortion and breast cancer.

The Royal College of Obstetricians and Gynaecologists in their 2011 review ‘The Care of Women requesting induced abortion’ (see full report and summary) stated with a heady degree of certainty:

‘5.10 Women should be informed that induced abortion is not associated with an increase in breast cancer risk.’

Their lengthier summary concludes as follows:

‘WHO has concluded that induced abortion does not increase breast cancer risk. Similarly, in a recent review of the evidence, ACOG concluded that ‘The relationship between induced abortion and the subsequent development of breast cancer has been the subject of a substantial amount of epidemiologic study. Early studies of the relationship between prior induced abortion and breast cancer risk were methodologically flawed. More rigorous recent studies demonstrate no causal relationship between induced abortion and a subsequent increase in breast cancer risk.’

There is an overview of existing studies on the American Association of American Prolife Obstetricians and Gynaecologists (see AAPLOG website). It summarises as follows:

‘The possibility of this association has been persistently and vigorously attacked and denied by the major medical groups in the country since l994. The ACOG and the NCI have been particularly strong in opposing any suggestion that there is an association. In so doing, they have taken certain liberties with their interpretation of the scientific literature. AAPLOG feels that these liberties lack basic fairness and balance in reaching their “no association” conclusion.’

It goes on to discuss why such a link might be biologically plausible:

‘There are two pregnancy related independent risk factors for breast cancer established in the medical literature:

The first is the protective effect of an early first full term pregnancy. The landmark study establishing this protective effect [MacMahon, et al, (1970) Bull WHO 43:209-221] is widely accepted in the medical world. Obviously, aborting a first pregnancy eliminates the protective effect against breast cancer for that woman.

The second independent risk factor for breast cancer is induced abortion. As of 2004, 41 studies had been published in the worldwide medical literature (including 16 American studies) reporting data on the risk of breast cancer among women with a history of induced abortion. 29 (70%) of these studies report increased risk. Thirteen of the 16 (81%) American studies report increased risk, 8 with statistical significance (at least 95% probability that the result is not due to chance) irrespective of age at first full-term pregnancy. The relative risk increase of the 41 studies combined is 30%. (Note: this means that among aborted women there would be a 30% increase in breast cancer cases over what would normally be expected).’

In a 2007 CMF File we summarised the available evidence as follows (see source for references):

‘Breast cancer rates have been rising in Europe and North America for several decades and are projected to rise further. There is evidence suggesting that having an abortion may increase a woman's risk of breast cancer in later life. A 1997 review that pooled 23 studies found that the risk increased by 30% but authors of a 2001 review have denied a link. There are clearly powerful vested interests on both sides of this debate and space precludes the necessary in-depth review. However, it is undisputed that a full term pregnancy protects against subsequent breast cancer, and that significantly preterm deliveries make it more likely. The link is therefore biologically plausible.

While it may be prudent to acknowledge that “the jury is out” with regard to a possible link between abortion and risk of subsequent breast cancer, further research is needed to conclude the debate. In the meantime, and in the interests of informed consent, every woman considering abortion should be offered as much information about the possible risks as she wishes.’

The issue has also been previously covered in the CMF Journal Triple Helix but not since 2003.

This is clearly a debate that will run and run and in which huge vested interests are involved.

In the meantime women should not be fobbed off with the unjustified absolutism of the summary sentence from the RCOG, as most presently are.

Rather they should be made aware that a link between abortion and breast cancer is biologically plausible but that the evidence is still hotly disputed by researchers, obstetricians and gynaecologists.  

World Medical Association reaffirms its strong opposition to euthanasia

The World Medical Association has reiterated its strong opposition to euthanasia. From the WMO Resolution on Euthanasia:

Euthanasia, that is the act of deliberately ending the life of a patient, even at the patient’s own request or at the request of close relatives, is unethical. This does not prevent the physician from respecting the desire of a patient to allow the natural process of death to follow its course in the terminal phase of sickness.

The WMO similarly opposes assisted suicide:

Physicians-assisted suicide, like euthanasia, is unethical and must be condemned by the medical profession. Where the assistance of the physician is intentionally and deliberately directed at enabling an individual to end his or her own life, the physician acts unethically. However the right to decline medical treatment is a basic right of the patient and the physician does not act unethically even if respecting such a wish results in the death of the patient.

From ancient times doctors have sought moral guidelines both to guide members of the profession and to safeguard patients. The earliest of these was the Hippocratic Oath which was written about 600BC and has become the basis for all subsequent ethical codes.

Its moral requirements are broadly consistent with the Judeo-Christian ethic and at one time all graduating doctors had to sign it before they could commence practising.

Among other things the Oath states ‘I will give no deadly medicine to anyone if asked nor suggest such counsel’.

After the Second World War, and primarily because of human rights abuses by doctors in Nazi Germany, the World Medical Association adopted two modernised forms of the Oath - the Declaration of Geneva in 1948 and the International Code of Medical Ethics in 1949.

The Declaration of Geneva states, ‘I will maintain the utmost respect for human life from the time of conception' and the International Code of Medical Ethics says that 'a doctor must always bear in mind the obligation of preserving human life from the time of conception until death’.

A 2011 study showed that doctors in the UK have opposed both euthanasia and assisted consistently over the past two decades. Researchers from Limerick, Ireland, used 16 key studies into doctors' attitudes between 1990 and 2010. The findings appeared in the journal Palliative Medicine and further confirmed the fact that those doctors who favour a change in the law, constitute a small vocal minority.

Sir Richard Thompson, past President of the Royal College of Physicians, responded to the launch of the small pressure group Healthcare Professionals for Assisted Dying in 2010, by eloquently outlining the reasons why a clear majority of the College’s members still do not support a change in the law.

The Royal College of Physicians is in good company. Other official UK doctors’ bodies opposing any change in the law to allow assisted suicide or euthanasia are the British Medical Association (BMA), the Association for Palliative Medicine (APM), the British Geriatric Society (BGS) and the Royal College of General Practitioners (RCGP).

The British Geriatric Society in 2010 issued a strong statement on assisted suicide which outlined its concerns about how a change to the law would remove protection from vulnerable elderly people. The full statement is most worthy of study by all who take an interest in this debate. 

Britain would be wise to listen to its doctors and to learn from this strong international precedent when Charles Falconer and Margo Macdonald bring their bills seeking decriminalisation later this year.