A discussion on bioethics in Germany, and a paper of useful explanatory nature on
the differences in the formerly East and West German abortion laws is in the BME
(Sept. 1990), 13-23. The German customs officers investigate abortions by Germans
in countries such as the Netherlands, that have easier access; BMJ
302: 677. A comment on the Polish abortion law changes, and Polish public opinion
to them is in the BME
(Oct 1990), 3-4 & Issue 66 (March 1991), 23-4. There is also a mention of abortion
in Lithuania. In a general review of Greek medical ethics there is mention of abortion
and reproductive technology in BME
66 (March 1991), 28-31. A comment on the possible changes to Irish contraceptive
legislation is Lancet
337 (1991), 607.
A background to the recent defeat of the Government abortion Bill in Canada is in
Lancet 337 (1991), 543-4. Some earlier comments on fetal rights and the abortion
bill are in the Canadian Medical J.
143 (1990), 404-5, 1220.
The issue of homosexual behaviour and reproductive control is discussed by T.F.Murphy
(1990) "Reproductive controls and sexual destiny", Bioethics
4: 121-42. There is discussion of individual reproductive choice.
Addressing the issue of abortion and enforced prenatal care and cesareans is L.M.Purdy
(1990) "Are pregnant women fetal containers?" Bioethics
4:273-91. Although women are where the fetus belongs, the call is made for more
humane consideration of the issue. A paper arguing for less use of repeat cesareans
(which make up about one third of cesareans) is; M.G.Rosen et al. (1991) "Vaginal
birth after cesarean: a meta-analysis of morbidity and mortality", Obstetrics & Gynecology
77: 465-70.
In the U.K. the question of when a fetus is a dead baby depends on the law, but emotionally
it is not so clear; Lancet
337 (1991), 526. In Japan prayers are said for all fetuses, whether aborted or miscarried,
and a visit to the temple will find many little statuettes with red cloths which
are placed there to represent the fetuses, for mizuko prayers. This may be useful
in the griefing process and recovery from abortions.
A series of papers on the topic of "Unfinished feticide", are in J. Medical Ethics
16: 61-70. They comment on the situation where a fetus survives an abortion, which
can occur with some methods of abortion. There is also comment on selective feticide
and eugenics. There is much attention given to the legal problems for the physician, and ethical debate.
The transplant of fetal organs is still a contentious issue. A recent paper is D.G.Jones
(1991) "Fetal neural transplantation: placing the ethical debate within the context
of society's use of human material", Bioethics
5: 23-43. This is a different perspective, and putting the issue into the framework
of other medical uses of human tissue makes it easier to support such transplants.
Another paper with an opposing perspective is R. Barry & D.Kesler (1990) "Pharaoh's
Magicians: The ethics and efficacy of human fetal tissue transplants", Thomist
54: 575-607. The US federal ban on funding such research is being challenged by another
Bill introduced to their government; Nature
350 (1991), 367.
The transplant of organs from anencephalics, is discussed by L.R.Churchill & R.L.Pinkus
(1990) "The use of anencephalic organs: Historical and ethical dimensions", Millbank Quarterly
68: 147-69. They discuss the recent history of the consensus on the definition of
death in the USA, and after discussing the arguments used in the debate on anencephalic
organs conclude that a compelling case for their use has yet to be made. A paper
that argues that we can use such newborns as organ donors is R.D.Truog & J.C.Fletcher
(1990) "Brain death and the anencephalic newborn", Bioethics
4: 199-215. The relationship between brain life and death is debated in J.Downie
(1990) "Brain death and brain life: rethinking the connection", Bioethics
4:216-26.
RU-486, mifepristone, is likely to be marketed in the U.K. soon. Cardinal Hume has
written a little to Hoechst, with the standard argument that the introduction of
more efficent means of procuring abortions will encourage the greater use of abortion
as an easy form of birth control; The Tablet
4.5.91, BME
(May 1991), 4-6. However, the introduction of RU-486 may not lead to the increased
use of abortion as a form of birth control. Women still regard abortion as a traumatic
event, one not to be taken easily, and would prefer birth control. Rather, the use of RU-486 could be said to be more preferable than later abortions when the fetus
has sentience. He said it was in the child's best interests. Also on RU-486 NS
(20 April 1991), 7.
A comment on a judge's decision to allow a 12 year old child to have an abortion against
her mother's wishes (whom she was not living with) is in the Times
(21 May 1991), 3; Lancet
337: 1337. Also on abortion see Lancet
337: 856-7. Also see B.Wennergren, "Human rights of an embryo", IJB
2: 46-9.
In the USA, the American Association for the Advancement of Science has made a resolution
encouraging pharmaceutical companies and the FDA to make RU-486 available for medical
use and research; Science
252: 587. Comment on the experimental results, and medical trial results, presented
at the AAAS meeting is presented in JAMA
265: 1628-9. See comment on this issue also in Time
(20 May 1991), 42; Nation's Health
(Jan 1991), 24.
The public attitudes to abortion in the USA is growing. A recent survey found that
81% thought it was permissible if there was a strong chance of infant disease, 43%
if a married woman did not want more children, and 42% approved of abortion on demand;
USA Today
(1 March, 1&2 May 1991). However 83% of all counties in the USA have no abortion clinic.
See also the question of whether federally-funded abortion clinics can offer abortion
counseling in Nation's Health
(Jan 1991), 1,8. This issue was recently voted on by the Supreme Court in the USA, who
held that it was lawful for federally funded clinics not to discuss abortion with
people; Lancet
337: 1337. This inspired further US Government voting, to reverse this ban. The
issue has become even more political in view of the recent retirement of a liberal
judge from the supreme court, suggesting that President Bush may install another
anti-abortion judge to make the abortion decisions completely conservative in the USA. An
extensive article on the problem and possible improvements in decision-making about
selective government funding on abortions is M.W. McConnell, "The selective funding
problem: abortions and religious schools", Harvard Law Review
104: 989-1050.
The US fetal tissue research ban is also under continued challenge; Science
252: 365; Nature
350: 543. The political debate in Washington regarding this is also discussed in
HCR
(March/April 1991), 5-6. Comment on changes in the method of abortion in order to provide
fetal tissue suitable for donation is in NS
(18 May 1991), 11.
The worldwide attitudes to abortion are discussed in a paper S.Downe, "The price of
motherhood", Nursing Times
87: 33-5. The maternal mortality in Africa is at a rate of about 4%, every year
about half a million women die related to childbirth. The social pressures are discussed.
A report on bioethics in poland, in French, including the use of birth technologies is in IJB
2: 51-5.
In Canada (see also EEIN
1: 36) there has been recent debate on the abortion law, and a recent supreme court
decision; CMAJ
144: 1154. The CMA told the senate committee to reject proposed legislation; CMAJ
144: 496-9, and abortion may be quieter following recent debate; CMAJ
144: 780-4.
The recent US Supreme Court ruling to say that federally funded clinics could not
mention the word abortion was widely criticised by many, including journals; BMJ
302: 1422-3. Fortunately, this has been overturned by emergency bills pushed through
the Senate and House of Representatives. A further issue is the new Louisiana abortion
ban; Lancet
337: 1595. The Supreme Court also supported a gag order for any foreign organisation
that lobbies for abortions of for family planning organisations that perform abortions;
SA (Aug 1991), 8-9. Meanwhile France pushes for the acceptance of RU-486 in developing countries, and the USA supports some WHO research using RU-486; Science
253: 29.
The abortion rate in the UK is still increasing; BMJ
302: 1559-60. In 1989 25% of terminations were performed on women who had already
had one abortion, compared with only 7% in 1977. Part of this increase is blamed
on the lack of emergency contraception in the UK. On the general fertility rate see
BMJ
303: 178-181. The trends in abortion rate in Australia are discussed by F. Yusuf
& D. Briggs, "Abortion in South Australia, 1971-86: an update", J. Biosocial Science
23: 285-296.The rate among younger and unmarried women may be rising, counseling
and education is needed. On the situation in the abortion debate in Poland see Lancet
338: 108-9, where the abortion rate is falling. On abortion rules in the USSR see
BME
(June 1991), 20-1, though the situation will no doubt become more varied as Republics
enforce different laws.
A comment on maternal rights versus fetal harm is in Hastings Center Report
(May/June 1991), 21-3.
The August issue of the journal Trends in Neurosciences
is devoted to reviews of neural transplantation; TINS
14: 319-88. It includes papers on fetal neural transplants in animals, in humans,
and a paper on the ethical issues, p. 384-8. A report on how the fetal tissue research
ban in the USA is slowing research is in Biotechnology
9: 615-8. It includes mention of the first fetal to fetal transplant, to safe the
life of a fetus.
A philosophical discussion of abortion law is M.C. Kaveny, "Toward a Thomistic perspective
on abortion and the law in contemporary America", Thomist
55: 344-96. It looks at the Supreme Court Webster decision, and the concerns that
"pro-life" judges should consider when making abortion laws. Another look at abortion
is R. Hursthouse, "Virtue theory and abortion", Philosophy & Public Affairs
20: 223-46.
On the US ban on federally-funded family counselling clinic staff discussing abortion
with patients see Lancet
338: 303. A critic of that decision by G.J. Annas is in NEJM
325: 362-4. On US abortion politics see Lancet
338: 435-6; and "Abortion Inc.", in New Dimension
(Oct 1991), 35-65. On the Louisiana ban on abortion see Science
253: 379. The state of Pennsylvania also has introduced a restrictive abortion law,
recently upheld by a federal appeals court; Washington Post
(22 Oct 1991), A1, 12. The actual restrictions involve a 24 hour waiting period, and
discussion of alternatives, which are seen by many as not introducing any undue burden
on women seeking an abortion.
A book review of Decoding Abortion Rhetoric: Communicating Social Change,
by Celeste Condit (1990), is in the HCR
(Jul/Aug 1991), 41-2. A book review of Embryo Experimentation,
P. Singer et al., is in HCR
(Sept/Oct 1991), 41. The abortion rate in the U.K. is still rising; BMJ
303: 579. On the European abortion debate see R.H. Nicholson, "Abortion remains
a live issue", HCR
(Sept/Oct 1991), 5-6.
On legal doubts in the U.K. on the practice of using anencephelic babies as heart
donors see BMJ
303: 538-9. On fetal tissue research see W. Kerney et al., "Fetal tissue research
and the misread compromise", HCR
(Sept/Oct 1991), 7-12. On the use of cells for transplants see H. Green, "Cultured cells
for the treatment of disease", SA
(Nov 1991), 64-71. In Japan, Wakayama Prefectural Medical University has reported that
a Parkinson's patient who had part of her sympathetic nervous system transplanted
into her brain, is progressing well and does not need medicine to treat Parkinson's
symptoms, after 3 months.
The European Court of Justice has recently ruled that member states have the right
to prohibit the distribution of information about obtaining abortions in other EC
states. In Ireland abortions are still illegal, and students had distributed information
about obtaining abortion in the U.K.; BME
(Oct 1991), 6; Lancet
338: 1006. On free speech and the Rust v. Sullivan case restricting abortion counseling
in the USA see Nursing Outlook
39: 238-9. Pregnancy tests and abortion counseling are discussed in Nursing Outlook
5: 240.
The prescription of RU-486 to women over 35 years of age, and for those who have been
smoking regularly for more than two years, has been banned in France; IJB
3: 263. There is still discussion on how to make the method for RU-486 abortions
safer; Science
254: 198-200; BMJ
303: 914. There is still debate in the USA about the use of RU486 for research,
and for abortions, in the USA; Washington Post
(9 Dec 1991), Health 7. On reviews on the use of RU486 for abortion see O.M. Avrech et
al., "Mifepristone (RU486) alone or in combination with a prostaglandin analogue
for termination of early pregnancy: a review", Fertility & Sterility
56: 385-393; see also p. 394-5; J.E. Norman et al., "Uterine contractility and induction
of abortion in early pregnancy by misoprostol and mifepristone", Lancet
338: 1233-6, see also 1241-2. Germany is also debating whether to allow RU486 and
on the prospects for a unified abortion law; Lancet
338: 1323-4.
On the use of human fetal tissue, see a paper by D.E. Vawter, et al., "The use of
human fetal tissue: Scientific, ethical, and policy concerns (January 1990)", IJB
3: 189-96. It summarises the findings of a report by people at the Center for Biomedical
Ethics, Minnesota, USA, and copies of the full 270pp. report are available from Center
for Biomedical Ethics, UMHC Box 33, 420 Delaware St. S.E., Minneapolis, MN 55455, USA. On fetal grafts techniques; Science
254: 1108-9. Neuroscientists had talked of boycotting Louisiana to hold their conference
because of that states ban on abortion; Science
254: 514, but it went ahead this year, with a decision not to return in 1996. The
Louisiana abortion law is passing through the courts, a federal judge struck it down
as unconstitutional, but this decision is being challenged. On some recent US court
cases on abortion see Amer. J. Law & Medicine
XVII: 313-4, 317, 319-20.
On the antiabortion protests in the USA see D.A. Grimes et al., "An epidemic of antiabortion
violence in the United States", Amer. J. Obstetrics & Gynecology
165: 1263-8. It looks at the period 1977 to 1988, in 1991 there was also increased
protest. On ethics of abortion see J. Medical Ethics
17: 136-7; Lancet
338: 1200. See also R.V. Grazi & J.B. Wolowelsky, "Multifetal pregnancy reduction
and disposal of untransplanted embryos in contemporary Jewish law and ethics", Amer. J. Obstetrics & Gynecology
165: 1268-71.
A checklist of questions to ask during perinatal research (research involving pregnant
women and their fetuses, prepared by the standing joint committee of the British
Paediatric Association and the Royal College of Obstetricians and Gynaecologists
is in BME
(Oct 1991), 10-11.
The abortion rate in the U.K. is commented on in BMJ
303: 992-3. A recent opinion poll has found that most British do not want to use
sex selection; BMJ
303: 1276.
A report on
Australian
attitudes to human embryo research following opinion polls conducted by Dr. Karen
Dawson of Monash University, Australia, may soon be available; Australian Health Ethics Committee Newsletter
1
(October 1991), 9.
Improvement of culture media for longer in vitro human embryo growth is described
in Fertility & Sterility
57: 641-7; and reducing ethical and legal problems from use of cryopreservation are
discussed in Fertility & Sterility
57: 278-84.
One of the more notorious cases in recent times involving AID is the court case of
Dr. Cecil
Jacobson
in the USA. It has been alleged that he inseminated many women, and may have fathered
75 children with his own semen, saying that it was from donors. He also misled women
into making them believe that they were pregnant to encourage them to come to his
clinic where they paid for further "treatment"; Independent
(12 Feb 1992). He has been convicted of 52 counts of fraud and perjury in a Virginia
court; Times
(5 March 1991). On
sperm banking
for chloranbucil-induced infertility see Lancet
339: 420. Under the proposed new bioethics law in France, AID will only be available
for medical (including infertility) reasons; BMJ
304: 798-9.
Making news headlines across the world was the case of an Italian lady of 62 years
of age, who is 6 months pregnant with a fetus, conceived from a donated oocyte and
her husband's sperm. We can wonder when similar cases will appear of women in their
60's being made pregnant with the use of IVF, and whether it is ethical. She was made
sterile after tuberculosis. Psychological studies on oocyte donation are discussed
in Human Reproduction
7: 51-4. Scientific studies using
oocyte donation
are Fertility & Sterility
57: 362-5, 439-41.
In
Japan
infertility services are only available for married couples. There is a
surrogate mother
information center in Tokyo, which arranges for people to go to the USA for surrogacy.
They have recently arranged for a single 40 year old women to go to the USA, to
use sperm from a San Francisco sperm bank, and use infertility services in the USA;
Asahi newspaper
(30 April 1992), 27. On surrogacy see BMJ
304: 839.
A substantial review of international regulations on
infertility
services is B.M. Knoppers & S. LeBris, "Recent advances in medically assisted conception:
legal, ethical and social issues", AJLM
XVII (1991), 329-61. The areas of consensus and differences between various reports
from 1987 to 1991 are identified. Ways that assisted conception techniques might
be simplified to make them universally available, from an
Indian
viewpoint, is in Human Reproduction
7: 49-50.
It has been suggested that howler monkeys may choose the sex of their offspring by
selected foraging which alters the electropotential at the cervix compared to vagina;
NS
(22 Feb 1992), 9.
Recent law cases in the UK suggest that it may be possible for physicians in the UK
to disclose some details of their patients to those who need to know; D. Morgan &
R. Lee, "Disclosure is possible under HFEA", BME
(Feb 1992), 25-8.
A study of
zona pellucida
drilling is Fertility & Sterility
57: 591-6. There have been several reports in Japanese newspapers about a birth and
several pregnancies established by this technique in Japanese hospitals; Asahi newspaper
(26 March 1992), 1; (9 April 1992), 30. The relationship between embryo quality and multiple
pregnancy has been investigated, and it was found that embryos which could lead to
multiple pregnancy may be predictable; Fertility & Sterility
57: 626-30. See a review; M.T. Zenzus & R.F. Casper, "Cytogenetics of human oocytes,
zygotes, and embryos after in vitro fertilisation", Human Genetics
88: 367-75. Such studies may aid the avoidance of multiple pregnancies and avoid
causing genetic and chromosomal abnormalities. A study shows that smoking in women
increases the incidence of infertility; Fertility & Sterility
57: 565-72.
In
Japan
, the case of a baby born at 21 weeks who has been raised, but will probably have
other health problems, makes us ask why such experimentation should be allowed.
The girl weighed 398g at birth in July 1991, and dropped below 300g. She left the
hospital in April, after 9 months, weighing 2.6kg; Asahi newspaper
(10 April 1992), 31. Techniques for growth of fetuses in artificial wombs have been developed
at Tokyo University Hospital, and a goat raised for the last three weeks of gestation
in an artificial womb was born; Asahi newspaper
(10 April 1992), 5. The goat fetus was cut by cesarian at 120 days, of the normal 150
day gestation, equivalent to a 30 week human fetus though because goats have slow
lung development it is said to be equivalent to a 23 week old human fetus.
The abortion rate in France, Spain, U.K. and Canada is about 25%, in Japan 39% and
in the USA 42%; IJB
3: 39. The Polish code of ethics that was recently adopted under controversial circumstances
(EEIN
2: 22) is reviewed in BME
(May 1992), 17-9. There is still no retraction of the code, and court actions have failed,
apparently due to pressure by the catholic church to maintain the ban on induced
abortion that the code established. The abortion controversy in Poland is also discussed in BMJ
304: 1399; Lancet
339: 1221-2.
The Irish abortion contorversy is discussed in BMJ
304: 1004, there will be several referendums over the next few months considering
the issue. The referendum on joining the EC fully, and the Maastricht treaty was
supportive; Guardian
(20 June 1992), 11, and the prochoice lobby has been strengthened by the public support.
There must be pressure put on the Vatican to bend its policy on abortion, in special
circumstances, such as rape victims; Lancet
339: 1340-41. A paper supporting the right for obtaining induced abortions in the
USA is K.J. Ryan, "Abortion or motherhood, suicide and madness", Amer. J. Obs & Gyn
166: 1029-36. Another case of cross-country abortion is seen with women who cross
from Hong Kong to China to obtain easier abortions; Lancet
339: 996.
The case for introducing RU-486 to the USA is being increasingly made in the USA,
amongst the upsurge in abortion politics; Lancet
339: 1161-2. A cost estimate of the use of RU-486 in the U.K. is debated in BMJ
304: 1380, suggesting that it will not be any cheaper than surgical abortion. Of
course cost should not be the principle determinant. On ethical issues of embryo
status see S.J. Heaney, "Aquinas and the presence of the human rational soul in the
early embryo", Thomist
56: 19-48.
The fetal tissue debate in the USA, where there is still a ban on federal funding
of research on the use of fetal tissue transplants has heated up during the last
few months, coming to the expected anticlimax, a presidential veto of bills to remove
the ban. There was some move by President Bush to lower the voting margin in support of
those bills by saying that the government will establish fetal research banks with
fetal tissue from miscarriages, but this would not provide enough tissue; Lancet
339: 1404-5; NS
(30 May 1992), 5; Science
256: 1274. The margin of votes in the Senate, however, suggests that the vote in
Congress will be sufficient to overcome the veto, a vote of 87 to 10 in the Senate;
Science
256: 172-3; Nature
356: 467. They also backed proposals to allow sexual activity surveys in the USA,
which had previously been banned. See also Nature
356: 652; 357: 267. A conference report on a recent cell transplantation conference
in the USA is in Science
256: 1522. The transplantation of cells rather than organs, is a development of
recent technology aimed at restoring specific functions to treat disease.
The US Supreme Court's decision in the Pennsylvania abortion law case,
Planned Parenthood versus Casey,
has had a mixed reception, and was not as conservative as expected. The court did
not appear to want to overturn Roe versus Wade abortion decision, and opinions expressed
suggest that it may not. The court may allow states to legislate restrictions which do not provide an "absolute obstacle or severe limitation on the abortion decision".
Women were not required to tell their husbands, but they supported a 24 hour waiting
period, and a requirement for approval from a court judge or parent for unmarried
women until 18 years of age; Lancet
340: 44; BMJ
305: 73 Financial Times
(30 June 1992), 18.
Letters on how the doctor got gagged in the USA for abortion counseling are in JAMA
268: 50-1. Security at Ontario abortion clinics is tightening, with provincial financing,
following a petrol-bombing; Lancet
340: 168-9. Letters on abortion include Lancet
339: 1544-5; BMJ
305: 187-8.
A review of the concepts of
personhood
, and several books on the topic, which are relevant to many areas of medical ethics
is R. Elliot, Bioethics
6: 41-60. A criticism of brain life ideas for ethical consideration of embryo status
is M. Moussa & T.A. Shannon, "The search for the new pineal gland. Brain life and
personhood", HCR
(May/June 1992), 30-7.
The legality of use of
RU-486
in Britain is debated in Dispatches
2(3): 1-3. On the use of RU-486 in Canada see comments in Globe & Mail
(22 July 1992), A13, where Ontario supports tests on its use. Potential contraceptive
uses of RU-486 are reported in AJOG
167: 60-5. The US Supreme Court has judged that women cannot bring RU-486 into the
USA on their own; Lancet
340: 229.
The legal situation regarding abortion in Ireland may need further clarification,
following the exemptions made for abortion in the case of the 14 year old rape victim
(EEIN
2: 36); HCR
(May-June 1992), 2. The new German abortion law respecting a woman's choice during the
first three months of pregnancy, may still face some challenges; Lancet
340: 43-4; BMJ
305: 385.
A review of the results from studies using fetal tissue banks is Science
257: 868-70. On the topic of fetal tissue research see: Science
256: 1619, 1741; 257: 24-5; Biotechnology
10: 824; Nature
358:93, 533. The US population supports fetal tissue experiments and federal funding
of them, and results are in SA
(Aug 1992), 9-10.
The Casey
Pennsylvania abortion
case decision is debated in J.A. Robertson, "Casey and the resuscitation of Roe v.
Wade", HCR
(Sept.-October), 22: 24-28, and p. 28-9. It is called a victory for women's choice.
Related, consider a case of maternity leave in p. 30-31. Other state laws under
review include Mississippi and Louisiana abortion restrictions, which are both expected
to be considered by the Supreme Court. Currently, the
Louisiana
ban has been struck down as unconstitutional, but the state is expected to appeal
this decision by the Fifth Circuit Appeal Court, and the Mississippi restrictions
requiring a 24hour delay and counseling before abortions has been enacted, after
a Fifth Circuit Court of Appeals considered it was constitutional. In
Mississippi
there are very few abortion clinics, so opponents of the restrictions say that the
delay imposes undue burden on women seeking an abortion. News of the varying and
changing abortion law situation in the different US states is available in Reproductive Freedom News (RFN),
The Center for Reproductive Law and Policy, 120 Wall Street, New York, NY 10005,
USA. In the Nov. 3 election day in Arizona, a referendum on an abortion ban is being
voted upon; RFN
(16 Oct 1992), 5.
An essay on the topic is G.J. Annas, "The Supreme Court, liberty, and abortion",
NEJM
327: 651-4. A nurse's view on the gag-rule is in Nursing Outlook
39: 238-9. The views of some 'pro-life' perinatologists in the USA are seen in NEJM
327: 812-4; Nursing Outlook
39: 240. A series of comments on abortion is in Harper's
(Nov 1992), 43-52. Other papers include: D.A. Grimes, "Clinicians who provide abortions:
The thinning ranks", Obs & Gyn
80: 719-23.
The confused state of
Irish abortion
laws (EEIN
2: 64, 36) is discussed in BMJ
305: 436. The Dublin High Court has gagged 14 students who were distributing information
to women about abortion; BMJ
305: 442. A legal paper is D.R. Phelan, "Right to life of the unborn v. promotion
of trade in services: The European Court of Justice and the normative shaping of
the European Union", Modern Law Review
55: 670-89. A referendum will be held in Ireland on abortion on December 3; RFN
(16 Oct 1992), 6.
The recently decided abortion law in
Germany
has been legally frozen in the courts, and further debate will occur on whether it
is constitutional; Lancet
340: 419. The situation in
India
is discussed in Lancet
340: 120, 676-7. The government provides counseling and abortions free of charge
for people, but in many states there is still a problem of illegal and dangerous
abortions.
The negative effects on
maternal mortality
of restricting abortions by law is reported in P. Stephenson et al., "Commentary:
The public health consequences of restricted induced abortion - lessons from
Romania
", AJPH
82: 1328-31. A letter on the number of deaths due to illegal abortions in the USA
is in Amer. J. Obs & Gyn
167: 854-5. Papers on the use of
RU 486
include: S.S. Banwell & J.M. Paxman, "The search for meaning: RU 486 and the law
of abortion", AJPH
82: 1399-1406; AJPH
82: 1325-6; A.L. Grand, "The abortion pill: a solution for unsafe abortions in developing
countries?", SSM
35: 767-776, in which it is suggested that the current lack of administrative structure
and support in developing countries may mean that it is not so useful.
The role of the community in preventing
teenage
pregnancy is the subject of a presidential address in Amer. J. Obs & Gyn
167: 299-302. There has been a slight gain over the last 15 years in reducing recurrent
abortions in the USA, but more efforts are called for in Amer. J. Obs & Gyn
167: 313-21. On induced abortion and health as a value see AJPH
82: 1323-4.
Although
fetal tissue
transplant research is worthwhile, in the longterm it would be better to develop
cell lines that can be grown in vitro, in any quantity, as donor cells. Research
in this area is discussed in GEN
(1 Sept 1992), 1, 16; Science
257: 1342. Cell lines may avoid the possible transfer of viruses and would ensure
a constant quality. The fetal tissue debate (EEIN
2: 64) and supply is addressed in Science
257: 1189-90; BMJ
305: 440-1.
The US ban on federal funding of
fetal tissue
research may be expected to end soon after President-elect Clinton takes office.
Assuming this is so, the legal suit filed against the government on 21 October in
a Washington DC district court (Science
258: 738) will no longer be important. One of the features of the US system is that
president's appoint federal judges. In the last 12 years, President's Bush and Reagan
have appointed 65% of all federal judges (846 total positions). There will be about 100 positions waiting action by Clinton when he takes office. One hopes that the
judiciary and govt are separate! A review of the Supreme Court's Casey versus Pennsylvania
decision is in AJPH
82: 1556-62.
In the
USA
, restrictive provisions on abortion are being debated in courts in North Dakota,
Tennessee and Mississippi; Reproductive Freedom News
(30 Oct 1992), 2-4; (13 Nov 1992), 6-7; (25 Nov 1992), 2-3. In Tennessee a circuit court judge has
found a 72 hour waiting period to be unconstitutional. Two recent court decisions
supporting abortion
choice
in the USA were: a federal appeals court decision voiding the gag rule on abortion
counseling; Washington Post
(4 Nov 1992), A3; Lancet
340: 1215; and a Supreme Court clarification of a constitutional right to abortion,
refusing to reconsider a federal appeal court rejection of Guam's anti-abortion law
(a law which has never been enacted due to legal challenges); New York Times
(1 Dec 1992), A1, A22; Washington Post
(1 Dec 1992), A1, A9. A book review of a book discussing the abortion controversy is
in Nature
360: 379-80.
The
Irish
referendum on abortion has been held. The referendum vote approved travel abroad
for abortions, and the distribution of information about abortions, however it rejected
abortion in the case where the mother's life was in danger. The reversal of a ban
on providing abortion advice follows an earlier European Court of Human right's decision
that the Irish ban was illegal; Lancet
340: 1153; and the Irish government's legalising of abortion advice; BMJ
305: 1117. Also see BMJ
305: 907-8. In Northern Ireland public opinion was found to be supportive of abortion
services being established there, however, there are no legislative signs of allowing
it so women must travel to other parts of the UK; BMJ
305: 1099.
Poland
seems likely to introduce a ban on abortions, while a Constitutional Tribunal has
reported that the Physician's Code ban on abortions is conflicting with the current
law; Lancet
340: 963-4. A world map of ease of abortions in different countries is in BMJ
305: 976.
The results of a survey by S.K. Henshaw & K. Kost of women under 18 years of age who
have abortions in the USA is in Family Planning Perspectives
(Sept/Oct 1992); Reproductive Freedom News
(30 Oct 1992), 5. They surveyed 1,519 women at 46 clinics across the USA in states that
do not require women to notify a parent. Younger women had greater tendency to talk
with their parents, and mother's were told in 59% of cases while father's were only
told in 26% of cases. In some cases parents forced their daughters to have an abortion
against their wishes. Statistics released by the US Centers for Disease Control
at the end of November show increasingly young women (<15 years old) are giving birth
rather than having an abortion. In the 1989 there were 1.4 million abortions reported
in the USA. In a referendum held on the 3 November, Maryland joined Connecticut,
Nevada and Washington state in guaranteeing continuing access to early term abortions.
Letters on the misuse of neonatal homicide statistics in abortion debates are in JAMA
268: 2033.
RU-486 is currently licensed in France, U.K., Sweden and China. Moves to allow it
for research use in the USA can be expected soon; Science
258: 1075.
An editorial supporting abortion choice in BMJ
305: 967-8, resulted in many letters on the subject; BMJ
305: 1221-2. A commentary entitled "The myth of the abortion trauma syndrome" is
in JAMA
268: 2078-9. It argues that this is not a real syndrome, and motherhood may provide
more trauma.
The US ban on federal funding of
fetal tissue
research; abortion counseling in federally-funded clinics; on overseas aid to international
family planning programs that included abortion; on abortions in overseas military
hospitals, have all ended; and the ban on RU486 is being reviewed, now that President Clinton has taken office. A discussion of the now anulled "gag" rule is in
J. Health Politics, Policy & Law
17 (1992), 163-75.
Three papers in the NEJM
report successful trials of
fetal tissue
transplants for treatment of the symptoms of
Parkinson's
disease; D.D. Spencer et al., "Unilateral transplantation of human fetal mesencephalic
tissue into the caudate nucleus of patients with Parkinson's disease", NEJM
327 (1992), 1541-8; C.R. Freed et al., "Survival of implanted fetal dopamine cells
and neulogic improvement 12 to 46 months after transplantation for Parkinson's disease",
NEJM
327 (1992), 1549-55; H. Widner et al., "Bilateral fetal mesencephalic grafting in
two patients with Parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine
(MPTP)", NEJM
327 (1992), 1556-63; reviews on pp. 1589-95; Nature
361: 405-6. A rat experiment using donor cells encapsulated in a plastic capsule
was positive, as reported in NS
(6 Feb 1993), 20. Arguments against using fetal tissue transplants, are in In Keeping with the Trends
(Jan 1993), 1-2. Positive notes are in Newsweek
(7 Dec 1992), 46; Science
258 (1992), 1865.
A review of the recent changes in US
state laws
is in Reproductive Freedom News
(5 Feb 1993), 6-7. Proposed changes to make abortions more difficult to obtain have occured
in Alaska, Indiana, Montana, Nebraska, North Dakota, South Dakota, Utah and Wyoming.
A review of the January 13 US Supreme Court decision reversing an earlier federal court decision that used a 1871 civil rights statute to stop blockades of abortion
clinics is in Reproductive Freedom News
(5 Feb 1993), 2-7; BMJ
306: 231. The AMA Council on Ethical and Judicial Affairs is against mandatory parental
consent to abortion; JAMA
269: 82-6. US training in contraception, abortion and sterilisation is reviewed
in O&G
81: 311-4. On abortions and ethics see O&G
81: 318-20.
The 1990
US
abortion figures were 1,429,577 legal abortions, to make a ratio of
344 abortions per 1000 live births
; JAMA
269: 333. The incidence of mistimed or "unwanted" pregnancies is also reported.
A book review on the issue of abortion are in J. Health Politics, Policy & Law
17 (1992), 177-80; and a review of Bonnie Steinbock, Life before Birth: The moral and legal status of embryos and fetuses
(Oxford University Press, 256pp., 22.50), is in NS
(16 Jan 1993), 41. In
Japan
, there has been some debate about selective termination of multiple pregnancies induced
by superovulation; Yomuiri Shinbun
(11 Feb 1993), 13. There have been about 30 cases reported, and it is being accepted
as a consequence of reproductive technology.
In
Poland
, a law banning abortion for most reasons has been signed into law by President Walesa
(EEIN
3: 8). They failed to use a public referendum, following polls suggesting that 60%
of the public were opposed to such a law; BMJ
305 (1992), 1451-2; 306: 165. A paper by two Polish authors, E. Zielinska & J. Plakwicz,
"Strengthening human rights, in particular the freedom of choice for women in matters
relating to sexual behaviour and reproduction", IJB
3: 243-51, calls for recognition of choice for women - yet the new law in Poland
has restricted such a choice significantly. This paper gives some of the background
to the Polish situation. Three papers on the Polish code of medical ethics are in
the Kennedy Institute of Ethics Journal
2 (1992), 361-84.
The question of whether causing fetal death in utero by assault on a pregnant woman
should be a legal charge has been debated in Canada recently, following a stabbing
of a woman that killed her fetus; In Keeping with the Trends
(Dec 92), 1-2. pregnancy reduction in Jewish law is discussed in AJOG
168: 278-9.
The medical management of missed abortion using RU486 is discussed in BMJ
305 (1992), 1399. On abortion techniques for 15-34 week fetuses, O&G
81: 301-6.
At the end of July one of the anti-abortion judges on the US Supreme Court, Byron
White, intends to retire. A new justice may be appointed by October 1993; Reproductive Freedom News
(9 April 1993), 2-3. He was the author of the dissenting opinion in Roe v. Wade. The
US Congress is considering several bills that allocate federal funds to family planning
clinics, impose heavy criminal sentences on those obstructing entrance to clinics,
Reproductive Freedom News
(9 April 1993), 5-6. President Clinton has also said that federal funds can be used for
low income woman's abortions, and that funds for population control agencies overseas
will be made available, above the current US$430 million given to international population programs.
On March 10 in Florida, a doctor was shot to death by a "pro-life" demonstrator; Reproductive Freedom News
(19 March 1992), 2-3; Time
(22 March 1992), 40; Lancet
341: 747-8. A report from a 12 week training camp for pro-life protesters is in
Time
(19 April 1993), 36. Meanwhile, a leader of the US pro-choice movement was arrested as
an undesirable alien in the UK after trying to become involved in protests in the
UK against abortion clinics. Let us hope that other countries do not reach the same
intensity of debate as the USA.
A review of the new abortion law in
Poland
(EEIN
3: 21), is in BME
(Feb 1993), 23; and comments in BMJ
306: 813-4; and of the new law in
Hungary
; BME
(Feb 1993), 24-5. In both countries abortion can be obtained for reasons of probable
harm to the fetus, in addition to reasons such as rape or maternal life. The law
in Hungary allows more choice, with committee interviews required for abortions not
related to "health". The problems of the abortion law in
Croatia
, which especially concerns many raped war victims from Bosnia, and the issues of
adoption of babies, are reviewed in BME
(Feb 1993), 26-7. The
Pope
has appealed to women who were raped in Bosnia to bear the children; Time
(22 March 1992), 25. The French situation is discussed in Lancet
341: 485-6; and Irish in BMJ
306: 675.
A paper looking at female
infanticide
in
China
is S.K. Hom, "Female infanticide in China: The Human Rights specter and thoughts
towards (an)other vision", Columbia Human Rights Law Review
23 (1992), 249-314.
A book review of Life Before Birth: The Moral and Legal Status of Embryos and Fetuses,
is in Nature
362: 421. A review on the issues in abortion is N.A. Davis, "The abortion debate:
The search for common ground, part i". Ethics
103: 516-39. On the dropping of the fetal tissue experiment ban in the USA see Science
259: 592. The legal issues involved in fetal tissue research from fetuses of induced
abortions are discussed in GEN
(1 April 1993), 3, 20. Since then, applications for research funding have been made to
the NIH; JAMA
269: 1086. A hospital in California intends to import aborted fetuses from Russia
for medical research on diabetes. Papers on the medical management of miscarriages
are BMJ
306: 876, 894-5.
French researchers have reported that the use of an oral hormone to increase the effectiveness
of
RU-486
as an abortion method, R. Peyron et al., "Early termination of pregnancy with mifepristone
(RU 486) and the orally active prostaglandin misoprostol", NEJM
328: 1509-13. A review of RU486 from a 1990 issue is in SA
(Medicine), 38-44. On the use of RU486 in the USA see NEJM
328: 1560-1; Lancet
341: 1015. An abortion rights group has started making its own RU486 in the
USA
. The use of RU486 and "illegal" abortion in
Brazil
is reported in Lancet
341: 1258-61, 1261-3.
The
Pennsylvania
abortion court case, Planned Parenthood of Southeastern Pennsylvania v.
Casey
has reopened. The US Supreme Court ruled the 24 hour mandatory waiting period was
not an undue burden on women in Pensylvania, but a U.S. District Court in the Eastern
District of Pennsylvania has admitted new evidence that attempts to show that it
is an undue burden and is unconstitutional; Reproductive Freedom News
(21 May 1993), 2. A legal paper is J. Benshoof, "Planned Parenthood v. Casey: The impact
of the new undue burden standard on reproductive health care", JAMA
269: 2249-57. The US federal government moves to promote the "Freedom of Choice
Act" continue through the route towards a law. In another state, West Virginia's
ban on abortion funding is being challenged; Reproductive Freedom News
(18 June 1993), 4. On the abortion issue in the USA, US News & World Report
(19 April 1993), 74.
Fetal tissue
transplants are now able to be supported by government funds in the USA. A review
on what type of research is scientifically best is in Nature
363: 12. There will no doubt continue to be ethical debate; Newsweek
(22 Feb 1993), 46-7. As reported last issue EEIN
3: 34, a Moscow abortion clinic has started selling fetuses to a clinic in Santa
Barbara, California, to provide enough tissue for 40 Parkinson's patients; BMJ
306: 1433-4. A study suggests that a nerve growth factor produced in our brain could
treat Parkinson's, stimulated by the introduction of a transplant; NS
(29 May 1993), 16. In Russia about 4000 patients have received fetal transplants for
diabetes treatment. On adding neurons to the adult mammalian brain see PNAS
90: 2101-2. The debate over anencephelic tissue transplants in Canada is in The Candian Nurse
(May 1993), 36-8.
The
German
constitutional court voted 6-2 on May 27 to declare unconstitutional a compromise
between the East and West German abortion laws. The law was passed in June 1992
by the unified parliament. While abortion, except for medical conditions is judged
illegal, it also said that no abortion prior to three months will be punished. However, state
hospital funding for abortions is withdrawn; Lancet
341: 1467; BMJ
306: 1566. In
Japan
almost no state funding is given for anything to do with pregnancy and childbirth,
as it it not classed a medical disease problem!
In the
Netherlands
draft bills on medical research and embryo research are being discussed; Network
(Feb 93), 4-5. The bill will not allow destruction of embryos after research, and
pre-implantation diagnostic research. A report on birth control and abortion in
Romania
is in Lancet
341: 875-8;BME
(May 1993), 6-7. In 1991 there were 275,000 live births and 789,096 legal abortions.
A relaxed law has led to a decline in maternal mortality resulting from abortions,
from 447 deaths in 1989 to 142 deaths in 1990. A book review on maternal mortality
in childbirth is in BMJ
306: 1278. On the
Polish
abortion restrictions see Lancet
341: 1083-4. Abortion politics is also entering the Council of Europe, as women
move to liberal countries to obtain abortions; Lancet
341: 1271-2. The recent
Irish
health act affecting abortion is in Int. Digest of health Legislation
44: 41-2, in addition to legal changes in
Mongolia
(where open access in the first trimester is the law, and after that a list of diseases
that abortion can be obtained for is to be issued.
A discussion of whether the early embryonic tissue that develops into placenta and
embryo are ethically different, by D.G. Jones, is in Otago University Bioethics Research
Centre Newsletter
2(2), 4-5. A review of Life before Birth
is in Lancet
341: 1139. Letters on the trauma of abortion are in JAMA
269: 2209-10.
A review of the use of RU486 is in NEJM
404-12. A call to deregulate emergency contraception is in BJOG
100: 611-2.
Papers on the philosophical debate over whether a spare embryo can be used for research
and is different to one specially made are in Health Care Analysis
1: 63-8. Another ethical debate in the UK now is whether it is ethical to use the
eggs from aborted fetuses for research, Nature
364: 372.
A vote in the US House of Representatives approved Medicaid funds for
abortion
to rape or incest victims, but did not broaden further coverage; Reproductive Freedom News
(2 July 1993), 2. The US abortion debate seems destined to continue, though it is often
unethical, CMAJ
148: 2189-90. Church power and sex education and abortion in
Poland
are in Newsweek
(5 July 1993), 44. The abortion law in
Northern Ireland
is very unclear, though about 80% of the public support legal abortions.
Letters on abortion ethics are CMAJ
148: 2110-2. The development of a questionnaire to seek more honest answers on personal
experiences of abortion is in Studies in Family Planning
24: 120-4. Book reviews on ethics and abortion are in NEJM
329: 512-3.
A report of 200 cases of multifetal pregnancy reduction is in AJOG
169: 17-21. A report on the number of triplet and quadruplet pregnancies in Victoria,
Australia, is in MJA
158: 659-63.
A review of the UK Polkinghorne Report on
Fetal
Research is JME
19: 114-20. It agrees with the conclusions but attacks the reasoning.
Swedish
guidelines on disposal of aborted fetuses and the ethical issues are debated in JME
19: 32-6; see also MJA
158: 637-9; Lancet
342: 354.
The use of lower levels (200mg single dose) of
mifepristone
for abortions is reported in BMJ
307: 532-7. Also on abortion methods preferred by women see BMJ
307: 714-7. About 50 million abortions are carried out every year in the world,
and a half are under illegal and unsafe conditions; BMJ
307: 756-7.
The second part of a review of
ethical
issues in abortion is N. Davis, "The abortion debate: The search for common ground,
Part 2", Ethics
103: 731-78. Also on ethical issues of abortion is Lancet
342: 499, 915-6. A recent US District Court has made a surprising decision to support
aggressive treatment to keep an
anencephalic
baby alive; Lancet
342: 919. Background on the US Supreme Court considerations of woman's access to
abortion is in Reproductive Freedom News
(8 Oct 1993), 2-3. The US Senate voted against lifting a ban on abortion-funding for
low income women on 28 Sept. Earlier the Senate overturned a ban on abortion-funding
for federal employees, Reproductive Freedom News
(3 Sept 1993), 2. A report on infanticide in the UK is Medicine, Science & Law
33: 328-39.
A background report on human embryo experiments is in Bioethics News
12(4), 33-42. The prospects for neural transplants for stroke patients are discussed
in Annals of Neurology
34: 322-3. A general report on drug therapy for
Parkinson's
is in NEJM
329: 1021-7.