After months of consultation, the British government has released a draft overhaul of its contentious fertility legislation. Many significant changes have been made, but the bellwether issue is the creation of chimeras, or hybrid animal-human embryos. Although there had been signs that the government would ban these, the proposed legislation allows them. Health Minister Caroline Flint denied that it had caved in to pressure from scientists and patient groups. She said that the government always wanted to leave the door open to such research and that scientists had made a strong case for it.
Scientists were pleased, although Dr Stephen Minger, head of the stem cell team at King's College London, lamented that Parliament was too involved. Only scientific and ethical experts were competent to regulate the fast-moving field of embryonic research. "This system of a panel of scientists, bioethicists, lawyers and informed lay members... has always worked perfectly well. It's the only way to do it. What we definitely want to avoid is government trying to legalise science," he commented.
Opponents were scathing. Josephine Quintavalle, of the lobby group Comment on Reproductive Ethics, said bluntly: "It is appalling that the government has bowed to pressure from the random collection of self-interested scientists and change its prohibitive stance. This is a highly controversial and terrifying proposal, which has little justification in science and even less in ethics. Endorsement by the UK government will elicit horror in Europe and right across the wider world."
The possibility of creating hybrid embryos was just one amongst many proposals which would have seemed radical when the 1991 decision was first made to permit embryo research and establish the Human Fertilisation and Embryology Authority. These include:
* A child can be created without a legal father, but two legal mothers. Children do not necessarily need a father in IVF procedures.
* Embryos can be screened for serious medical conditions.
* Eggs or sperm can be removed from incompetent persons without their consent.
* Not-for-profit surrogacy agencies will be able to charge reasonable expenses for organising surrogate mothers.
Although the list of procedures which the government proposes to legalise and regulate is long, a few are explicitly banned. Sex selection is still on the black list, as are artificial gametes, genetic modification of IVF embryos and deliberately selecting a disease or disorder (such as deaf parents choosing to have a deaf child). ~ BBC, May 17; Guardian, May 17
CHINESE WRESTLE WITH BIOETHICS STANDARDS
A leading Chinese social scientist has praised his country's efforts to create and implement bioethical standards for research involving human subjects. Qiu Renzong, of the Chinese Academy of Social Sciences, in Beijing, says that new principles adopted in January "successfully fit ethical review within the country's own laws and regulations while also abiding by international bioethical principles. They clearly state that the process of ethical review should be independent, objective, just and transparent."
Mr Qiu says that some of his countrymen wanted to do their research without constraints in order to catch up to more developed countries and ethicists. But, he says, this is both wrong and dangerous. Wrong, because ethics do not necessarily impede progress; and dangerous because science could lose public support if it tramples on ethics. Interestingly, the ethical principles he praises seem to be a fusion of Confucian principles with American pragmatism -- not Marxism.
A shrill opponent of the regime, the Epoch Times newspaper, which is supported by the Falun Gong, points out that vast swathes of Chinese medicine are exempt from bioethical regulation. It is particularly concerned about military hospitals where, it claims, executed prisoners and Falun Gong practitioners are being stripped of their organs to treat wealthy Taiwanese.
It claims that record-keeping for organ transplants in these hospitals is very poor. Many of the patients use fake names and addresses and it appears that all organ transplant records in Chinese hospitals are destroyed. If true, this would make it difficult for the government to monitor whether or not high-sounding ethical principles are being observed. ~ SciDevNet, May 18; Epoch Times, May 19
COMMERCIAL SURROGACY IN CHINA
In the absence of clear legislation, a Chinese entrepreneur has set up a nationwide network of surrogacy offices, with more than 120 surrogate mothers. Liu Baojin, the 28-year-old founder of daiyun.com, says that surrogacy is ethical and legal in China. He says that he gets at least 10,000 yuan for each successful match. The surrogate mother, if educated, could earn about 70,000.
However, since Chinese law does prohibit IVF clinics from engaging in surrogacy, Mr Liu's surrogate pregnancies are achieved in the old-fashioned way, leaving him open to criticism for immorality. Liu Zhijun, a sociologist at Zhejiang University, says that surrogacy corrupts social morals and violates human rights. It often ends in tragedy, with extra-marital affairs, family disputes and even crime. ~ China Daily, May 15
PARENTS OF DOWN SYNDROME CHILDREN WORRY ABOUT
THEIR FUTURE IN PERFECT WORLD
With 90% of pregnant women aborting a Down syndrome child after a positive prenatal test, American parents of Down syndrome children are turning into activists to protect their children's future. According to a special report in the New York Times, a dwindling Down syndrome population -- now about 350,000 in the US -- could mean less institutional support and reduced funding. Even though many of these parents describe themselves as pro-choice, they oppose eugenics. "For me, it's just faces disappearing," says a New Jersey mother. "It isn't about abortion politics or religion; its a pure ethical question." A number of people are asking doctors to send them couples who an abortion so that they can meet their children.
They have a greater sense of urgency after the American College of Obstetricians and Gynecologists recommended in January that all women, regardless of age, be offered a new screening test to detect Down syndrome early in a pregnancy. Although critics term this a "search and destroy" mission, some doctors see nothing wrong with it. Cute as they may be in childhood, they claim, Down syndrome children may be at risk of early-onset Alzheimer's disease, thus saddling ageing parents with even more onerous responsibilities.
There are many couples who do not want to have a baby with Down syndrome," said Deborah A. Driscoll, of the University of Pennsylvania, an author of the recommendations. "They don't have the resources, don't have the emotional stamina, don't have the family support. We are recommending this testing be offered so that parents have a choice."
But as the Times points out, doctors often paint too gloomy a picture. "She may be able to count change for the bus," one doctor told a pregnant Delaware woman. "But what's going to happen when the bus doesn't come?" Her Down syndrome daughter, now 5, does not yet take the bus, but she does ride horses. ~ New York Times, May 9
... AND PRO-CHOICE ADVOCATES WORRY, TOO
Genetic testing is shaking the mindset even of abortion advocates, says the New York Times. Although 70% of Americans would support women who terminate a pregnancy if a child has a serious genetic defect, all but the staunchest supporters of pro-choice policies question whether any defect whatsoever is reason enough. The problem is that the pro-choice stand is colliding with a commitment to tolerance of human difference. And now that tests make it possible to select for late-onset diseases like breast cancer or arthritis, and may some day make it possible to select for intelligence or eye colour -- not to mention sex -- pro-choice disability advocates are finding hard to draw the line.
"It so buys into this consumer perspective on our children," says Marsha Saxton, of the World Institute on Disability, in Oakland, an abortion-rights supporter.
Some religious conservatives say that they trust God to give them the child that is meant to be," wrote Ann Althouse, a law lecturer at the University of Wisconsin, on her legal blog. "But isn't there something equivalent for social liberals? Shouldn't they have moral standards about what reasons are acceptable for an abortion?" ~ New York Times, May 13
SHOOTOUT AT TRANSPLANT HOSPITAL LANDS
ISRAELI SURGEON IN JAIL
To the great embarrassment of the Israel Transplantation Society, one of the country's leading surgeons was arrested in Istanbul in the aftermath of a shootout with police. Some reports said that five people died in the gun battle at an illegal organ transplant clinic, although this is unclear. The incident occurred when police stormed a private hospital to capture four gunmen who had tried to steal cash from black market organ dealings.
As they were being bundled into police cars, the gunmen told local reporters that the hospital had promised to pay a friend for donating some of his organs, but never did.
Professor Zaki Shapira was just a bystander in the gun battle, but he was arrested for participating in illegal organ trading. Police found four patients, two of them apparently Israeli Arabs suspected of selling their kidneys, plus an Israeli and a South African who had bought the kidneys.
Professor Shapira was a pioneer of organ transplants in Israel, but he has been out in the cold since 1996, when he was banned from performing live donor transplantation after being accused of organ trafficking. Since then he has been escorting patients to Turkey. It seems that he was working with a leading Turkish surgeon with a similar record of shady deals, Dr Yusuf Sönmez. The hospital has been shut down. ~ BMJ, May 12, and Israeli and Turkish news services
CAESAREANS RISE IN AUSTRALIA
More and more Australian women are having elective caesarean sections for "lifestyle" reasons, according to a major survey. A study of more than 430,000 births over 20 years found that the rate of caesareans had doubled between 1984 and 2003, even when other factors were taken into account. Study co-author Fiona Stanley, from the Telethon Institute for Child Health Research in Perth, said that these figures "suggest there's some social or lifestyle factors that may be influencing women".
First-time mothers were 4.5 times more likely to have an elective caesarean than in the 80s.
"If women are following this as a lifestyle choice, because they don't want to damage their perineum or because some celebrity has had one, and pressure is being put on obstetricians for these lifestyle reasons, then women need better advice," said Dr Stanley.
The trend is often blamed on women who are "too posh to push", in the memorable coinage of some British sub-editor, and significantly, the rate is highest amongst women who need them least, including women with private health cover. However, it is more than a matter of character. Doctors are also concerned about rising costs and small but significant health risks.
A Brisbane GP, Sarah Buckley, commented in an op-ed in The Australian that rates of caesareans were rising because of "our cultural over-confidence in medicine". She also referred to research showing that women have fewer subsequent children after caesarean births. ~ news.com.au, May 17; Australian, May 22
TEN YEARS OF CLONING
A review of the state of cloning science in the journal Science by an American expert concludes that "our understanding is stalled at a fundamental level". Jose Cibelli, of Michigan State University, supports therapeutic cloning, but points out that the basic science is still not well understood. Scientists, he says, have focused too much on "goal-directed" experiments and not on understanding how cloning actually works. They still do not know, for instance, which genes are responsible for reprogramming a cell when it is cloned.
"Unveiling the genes and pathways involved in the cloning procedure is the first step to creating reasonable approaches for generating human cells that can later be used in therapy," he writes. "Only then will so-called (and still hypothetical) therapeutic cloning become obsolete." ~ Science, May 18
IN BRIEF: euthanasia; democracy
UK euthanasia: A poll by a British magazine for doctors has found that two-thirds of general practitioners oppose the legalisation of euthanasia. And less than half -- 42% -- would be prepared to assist a suicide. Spokespersons from both sides of the euthanasia debate used the figures to support their stand. ~ Daily Mail, May 18
Democracy: The proportion of doctors who vote in US elections has declined over the past few decades. A study by researchers at Johns Hopkins Medical School found that about 25% of doctors did not vote in the last presidential election. They were less likely to vote than lawyers, teachers and farmers. ~ Washington Post, May 18
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