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.