Submission to Public Consultation :

MEDICAL COUNCIL REVIEW OF A GUIDE TO  ETHICAL CONDUCT AND BEHAVIOUR

SECTION 24.1

EMBRYONIC STEM CELL RESEARCH

Over the last decade or so human embryonic stem cell research has become one of the most controversial developments in the international bioethical debate.

Experimenting on Human Life

The fundamental ethical problem with research on human embryos is that this type of research will assure the destruction of many early human lives. It is not possible to extract stem cells from the living human embryo without destroying him/her in the process. International documents such as the Nuremburg Code, the World Medical Associations Declaration of Helsinki and, the United Nations Declaration of Human Rights reject the use of human beings in experimental research without their consent, and permit research only if there is therapeutic benefit for the human subject. Clearly, this is not the case in embryonic stem cell research as the embryo as no consent can be given by/for the embryo and the embryo is destroyed in the process. Therefore an ethic which condones research using human embryos violates the standards set out by these documents. It also undervalues human life, damages the integrity of science and medicine and degrades society.

Inefficiencies of Embryo Research

The cost of the life of the embryo is not the only problem with embryo research. Firstly, generating stem cells from embryos is an extremely inefficient process, and it means that countless human lives will be lost to acquire just a few stem cell lines for researchers to experiment with. A May 2003 study found that biotechnologists still had no more than a 2.5% success rate of getting usable stem cell lines from human embryos.

There are two major problems with using embryonic stem cells as treatments for patients: these are tumour formation and tissue rejection. A number of animal studies have found evidence that using embryonic stem cells results in tumour formation due to the stem cells reproducing themselves indefinitely.

The second major problem with embryonic stem cells is the worry that the patient’s immune system will reject the cells extracted from the embryos, just as the body tries to destroy transplanted organs. This problem does not exist for adult stem cells, as these are genetically identical to the patient’s own cells. Researchers have attempted to develop solutions to this problem such as genetically engineering the cells so as not to cause an immune response. Another approach is to manufacture cloned embryos using the patient’s own cells in a procedure inappropriately referred to as ‘therapeutic cloning’. Both of these solutions, however, do not appear to have overcome this problem. 

No Cures

To date there have been no successful therapies using stem cells derived from human embryos. On the other hand, up to 65 successful treatments have been carried out using non-embryonic or adult stem cells. Giving false hope to people by allowing them to think that cures using embryonic stem cells are just over the horizon – when we don’t even know if they are coming at all – is a bad practice.

Youth Defence recommend that Ireland take a leading role in the area of adult stem cells which to date have been offering all of the cures. Adult stem cells have been isolated from numerous tissues, umbilical cord, and other non-embryonic sources, and have demonstrated surprising ability to transform into other tissues and cell types and to repair damaged tissues. Adult stem cell therapies have received intense scrutiny over the past few years due to their previously unknown cures for certain diseases. Adult stem cells have been successful in treating up to 65 different conditions, while not a single successful treatment has come from the use of embryonic stem cells. For this reason, most biotech companies are not engaging in embryonic stem cell research, and not because of ethical problems, but because adult stem cells seem more likely to provide effective medical treatments to suffering patients.

Those who advocate the destruction of the human embryo in order to extract its stem cells for experimentation will often try to downplay the therapeutic successes of adult stem cells. The commonest argument used against adult stem cells is that they are not pluripotent, meaning that they are unable to transform into every tissue type in the human body, as embryonic stem cells are.

This is not entirely true, however, and as various clinical trials and studies continue, we are realising that the pluripotent nature of adult stem cells is far greater than was previously considered. It is not in the remit of this submission to go into every example of adult stem cells exhibiting pluripotent qualities suffice it to say here that adult stem cells do in fact exhibit pluripotent abilities and more and more of these abilities are being realised and developed.

Regardless of whether embryonic stem cells are more pluripotent or not, what is important in this debate is to review the evidence. Medically and scientifically, adult stem cells appear to be far more efficient than embryonic stem cells, as their therapeutic applications have been tried and tested, and have been proven to work.

Conclusion

Research on human embryos is morally, ethically, scientifically and medically wrong, and should be outlawed in every country. This research destroys early human lives and undervalues the embryonic human being to the moral status of penicillin mould. Furthermore this controversial research is unnecessary as ethically acceptable alternatives to the destruction of human embryos exist. Moreover, it would be completely unethical to redirect funds and resources needed to develop the successes of ethical stem cell research towards destructive research that is not yielding any results.

Recommendation

Youth Defence strongly recommend that destructive embryo research be banned in Ireland and that we do not fund this type of research elsewhere. We also recommend that we take a leading role in the promotion and development of ethically legitimate adult stem cell therapies for the treatment of degenerative diseases.

SECTION 24.5

IVF

Success rates

Although Youth Defence acknowledge that over 1 million babies have been born worldwide using IVF, there continues to be much debate surrounding the success rates, and indeed the safety, of this and other assisted human reproductive technologies.

In the 2005 report of the Irish Commission on Assisted Human Reproduction (CAHR), the authors cite success rates for IVF of 25.1% per treatment cycle for the period between 1 April 2000 and 31 March 3002 for clinics in the UK. However, although this figure may be the national average for IVF treatment facilities in the UK, more than half of the clinics the CAHR refers had success rates of below 25.1%. Some of the fertility treatment centres had rates as low as 10.5% per treatment cycle.

Human Assisted Reproduction in Ireland (HARI) which is based in the Rotunda Hospital and is the main assisted reproduction technology centre in Ireland currently places its IVF success rate at 27%.

From an ethical point of view an IVF treatment cycle can only be regarded as completely successful when an embryo is transferred into a mother’s womb and grows and develops into a healthy baby. Every human embryo represents a human life, and, even when one embryo is successfully implanted, the others formed in the IVF process are often lost or, in some jurisdictions, destroyed.

The national statistics from the UK, to which the CAHR refer, state that out of 22,116 embryo transfers, 5,615 implanted giving a “success rate” of 25.4%. This then means that for every 100 embryos transferred from the Petri dish to the mother’s womb, only 25 are likely to see the light of day as born children and the other 75 will die. However, the real figure of embryos lost will in fact be much higher as these figures only represent the number of embryos transferred and not the number of embryos formed.

HARI were unable to provide the authors of this submission with information on whether this agency includes the number of embryos formed per treatment cycle when they are calculating their success rates.

Youth Defence call for a full investigation into the success rates of all IVF practices in Ireland and the findings of this investigation should provide information on the actual number of embryos created for the purposes of IVF that do not result in a newborn child. This report should be made readily available to the general public.


Risks to children born through IVF

It has to be acknowledged that many thousands of healthy babies have been born through assisted human reproduction. However, it also has to be acknowledged that serious doubts continue to be raised about the safety of this procedure in relation to women’s health, and in relation to the effects on children who are conceived and born through this technology.

Youth Defence would like to draw the Council’s attention to a major Australian study conducted in 2002 concerning IVF and consequent birth defects. This startling research found that IVF children are twice as likely to suffer from birth defects as compared to children conceived in the conventional manner. The researchers adjusted the study for obvious problems of multiple births and factors relating to a mother’s age, yet they still found that there were twice as many birth defects in IVF children.

The birth defects that have been associated with IVF include lower birth weight, babies being born premature and an increased risk of the neurological condition cerebral palsy in the child. An increased risk of retinoblastoma in children born through IVF has also been found in one particular study. Tragically, the miscarriage rate, and perinatal death rate also appear to be higher for children conceived through IVF.

Risks to the mother from IVF procedures.

IVF has inherent risks for the woman received treatment and most of these dangers arise from the abnormal process of extracting ova from the woman’s ovaries by superovulation. Ovarian Hyperstimulation Syndrome (OHSS) is one of the commonest complications of IVF, and it arises from over stimulation of the woman’s ovaries. We are aware that some women have died as a result of IVF and would like to draw the Council’s attention to the case of Mrs Jacqueline Rushton  who died on 14th of January 2003 while receiving fertility treatment at the Rotunda Hospital in Dublin. Studies have also shown that the over-stimulation of ovaries in superovulation have caused non-fatal stroke, heart attacks and cases of thrombosis.

Youth Defence recommends that IVF treatment facilities take note of these

Ethical problems

The most fundamental ethical problem with IVF is that more human embryos are formed in the process than are required for treatment. This then results in so called “surplus embryos” which are either cryopreserved or, in some jurisdictions, destroyed. This storage, loss or destruction of human embryos is unethical and immoral.


Ethical Alternatives

Artificial Reproductive Technology (ART) involves a number of different methods namely, In-Vitro Fertilisation (IVF), Intra-Cytoplasmic Sperm Injection (ICSI), and Gamete Intra Fallopian Transfer (GIFT). However, these are not the only techniques available in helping couples who are having difficulty conceiving children.

Natural Procreative Technology, of the abbreviated NaPro Technology is a new, safe, and effective means of treating infertility that can avoid the perceived need for ART in many cases. NaPro Technology is a couple-centred, disease-based approach to investigate, diagnose and treat infertility. This technology is called “natural” because it refers to the method of conception through a natural act of intercourse as opposed to any artificial intervention that replaces intercourse. Studies conduced in the area of NaproTechnology, and the clinical experience of those who practice it show great promise for this method.

NaPro Technology treatment aims to restore fertility naturally, by identifying, and then correcting the underlying causes of the couple’s fertility, rather than bypassing them, as in the case of artificial technologies such as IVF. NPT holds a number of significant advantages over other methods of Assisted Procreative Technology, including IVF. Significantly, there is no loss of human life using this technology. This is not the same for IVF, where, for every single child that is born through the procedure and average of 19 embryos will die. Because the formation of human life in such an unnatural manner is avoided, there can never be any “excess” or “spare” embryos formed, thus eliminating the unethical practice of embryo storage and destruction.

Youth Defence recommend that the Council put further study and resources into the development of NaPro Technology services in Ireland as an ethical alternative to IVF.

Conclusion

IVF is far from being a simple, safe and successful procedure as proclaimed by it’s proponents. Research shows that IVF has serious health implications for the child it produces and for the women availing of this technology. We must also consider the human cost of the loss of so many child embryos. Every decent person feels compassion for those who are inexplicably unable to conceive their own children. The end, however does not always justify the means and, with IVF and other assisted reproductive technologies, we can see that some people have very different ends in mind for some embryonic human beings. We have a duty as a society to defend human life, and that responsibility is no less for the tiniest human lives being formed through assisted reproductive technology.


Recommendation

Youth Defence recommend that the Council acknowledge that IVF is not a completely safe and successful procedure and look further into the promotion of NaPro Technology as a safer and ethical alternative. We also strongly recommend that IVF clinics in Ireland do not allow “surplus” embryos to be formed as this creates more ethical problems such as embryo freezing / destruction etc

CONCLUSION

Youth Defence are acutely aware that there exists for the Committee a great temptation to base its recommendation concerning abortion on short-term political considerations, such as the calculation of numbers in the current Oireactais. You may also have the inclination to pay excessive attention to the kind of media coverage that the recommendation may receive. There is, further, the tendency to found the decision on the precedent of laws in other jurisdictions, to be like everyone else. While these things are understandable pressures, they cannot, however, be acceptable ones.

It is not possible to stress too strongly that the act of abortion is a crime so heinous as to beggar belief, and yet, believe it we must because it happens every day, legally sanctioned by otherwise civilised countries around the world. We could elaborate at length on the damage it is doing to those countries by spreading the culture of disposable humanity and violent problem solving throughout their societies. This however is sociological and vague. Abortion, on the other hand, is very personal, unique even, in the serious violence it is committing against the women who suffer it and the children who are butchered by it. It is always really about one woman and one baby, no matter how many times that is multiplied. Our own Gaelic language is not circumspect or evasive on what is involved, it has no words to describe it clinically cleansed of its enormity; it is ginmhilleadh.

The responsibility the Committee bears is similarly personal and unique. For in the end it comes down to this: when a woman becomes pregnant whatever the circumstances, she becomes a mother to a child, which became a child at the very moment of conception. And the question before us is whether we are willing to walk down that road to the death culture, whether we are willing for the sake of some false notion of freedom, or just because it is easier, to say to these women in crisis pregnancy, that it is your choice and therefore your problem, that we are willing to let loose the madness of abortion which reaches into the womb to tear limb-from-limb a living baby. Whether in an attempt to crush conservatism or Catholicism the Liberal mind has become so warped as to permit crushing the skull of a child with the fiendish blessing of corrupted law. It is as simple as that. It is not as easy as that, as there is much more to be done than just passing a Constitutional amendment to restore the respect for life and the dignity of the human person, but it is that simple, because, somewhere, a beginning must be made.

It is not possible to adopt the pro-choice position here, as if somehow by saying that in leaving it to individual women to bear the burden and consequences of the decision we are thereby cleansed of responsibility as a society. The law is necessarily a statement of who we are as a people and what we believe as a nation. Legalised abortion says we are cowards, unable to bear the responsibilities of freedom without descending to barbarity. Legalised abortion says that as a nation we believe that those who have no power have no rights.
 
The position we have taken is straight forward and, whatever the media may say, without extremism. Youth Defence wants our children protected, our women safe, and the soul and conscience of the nation preserved, that we may stand before the world not as a perfect people but at least as a people determined not to do the worst thing because it is by way of the path of least resistance. We are not submitting a document for your consideration so much as submitting the fragility of life for your decision.

Can your conscience bear the blood of the innoccents

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Youth Defence 60a Capel Street Dublin 1  Tel : (353) 1 873 0463
Fax : (353) 1 873 0464
E-mail :
Web : www.youthdefence.ie

TO

Medical Council
Dublin 2

Prepared and submitted by Youth Defence for submission to the Medical Council