Hazel McHaffie

Human Fertility and Embryology Authority

Everyday ethics

Wow! We’re only five plus weeks into 2022, and already the papers seem to have been full of stories centred around ethical questions. Time to share a few by way of illustrating their prevalence in our everyday lives.

A survey of almost 300 members by the Association of Palliative Medicine, published on 26 January, has shown that doctors are concerned over the focus on negative and traumatic deaths, while ignoring good palliative care leading to gentle easeful deaths. They believe the public are being scared into supporting assisted dying. The timing of this is significant, given that the Government’s Health and Care Bill to legalise assisted dying within a year of the Act coming into force, is currently being processed in the House of Lords.

Current guidance for the forthcoming Scottish census is that transgender people can select their preferred sex/gender identity even in the absence of a gender recognition certificate. A feminist group, Fair Play for Women, have brought a case against this to a top civil court, calling on the judges to strike down this advice. Under present rules, a person must have a medical diagnosis of gender dysphoria, live in their acquired gender for two years, and have their application approved by an expert panel to officially claim a new gender identity; under the SNP plans, self declaration would suffice.

A call has been made for compensation for the approximately 40,000 care workers who lost their jobs because of the mandatory vaccination against Covid policy, now that the measure has been deemed no longer proportionate.

The Medicine and Healthcare Regulatory Agency is proposing to reclassify a vaginal oestrogen tablet – Gina 10; a form of HRT costing as little as £2.50 per week – so that women over the age of 50 can purchase it over the counter. A consultation, seeking the views of GPs, pharmacists and members of the public, is scheduled to take place. Until now such medication has required consultation with a doctor. The proposed new arrangement might still require the input of a pharmacist.

The ongoing debate about inequality where female transgender athletes compete in women’s sport has been revisited in the case of a University of Pennsylvania swimmer who has broken records in women’s races after transitioning from male to female.

The Health and Social Care Secretary has set out a vision to make Britain a world leader in cancer care. It includes the introduction of new technologies, including vaccines, designed to boost survival rates, as well as new ways to boost early diagnosis. Even before the pandemic Britain’s survival rates lagged behind many other Western nations; since the pandemic the figures for missed diagnoses and delayed treatment have plummeted still further.

The world’s most expensive drug, Libmeldy – a gene therapy that costs £2.8 million per treatment – is to be offered on the NHS to young people suffering from a rare genetic condition called metachromatic leukodystrophy, following a landmark deal. The condition causes severe damage to the nervous system and organs, and carries a life expectancy of 5-8 years.

Recently, No10, the Treasury, the Department of Health and the NHS have been discussing a multi-million pound National Recovery Plan to tackle the NHS backlog exacerbated by the pandemic. Now the Treasury has put on ice an announcement about it, which was due to be made on Monday this week. This comes at a time of mounting unrest in Government following a series of revelations about broken Covid rules in Downing Street and unfortunate statements by the Prime Minister.  Speculations abound.

The Children’s Commissioner has revealed that more than 100,000 children (1 in 4) referred with mental health issues were discharged before receiving treatment. This was the finding in a survey of more than half a million children. The Department of Health and Social Care have now committed an additional £79 million this year for children’s mental health services.

The Human Fertilisation and Embryology Authority have advised doctors to stop providing wholly inappropriate treatment to infertile couples who request unproven add-on therapies in a bid to improve their chances of having a baby. Increasing numbers of couples are asking for them after misleading claims made in marketing or internet forums.

There is certainly no shortage of topics for exercising the brain when it comes to medicine today, is there? Every one of these issues raises so many fascinating and challenging questions. Were I to continue writing novels in the area of medical ethics (still under review incidentally) there would be plenty to keep me occupied for the next twenty years!

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Father to thirty?!

Wow! The garden has gone from nought to sixty in one fell swoop. Everything is burgeoning and sprouting and bursting into colour, the birdsong has racheted up to symphony standard, the sunshine exceeding the benefits of any pharmacological tonic.

I’ve been alternating writing indoors with reading outside (when I’ve not been weeding and pruning and artistically directing, or course!) and loving the exhilaration of both. So it’s probably not surprising that, surrounded by all this new life and activity, my mind instantly latched onto a report about a different form of creation: babies.

This week it’s been revealed that a diminishing number of sperm donors are fathering eye-watering numbers of children. Now, as long ago as sixteen years (can it really be?!) I wrote a novel about the risks of this phenomenon: Paternity, so it’s a subject I’ve thought about long and hard. But even for me the statistics were like a cold water douche.

Figures from the Human Fertilisation and Embryology Authority (HFEA) show that, in a period of 24 years (1991-2015):
17 British men have fathered at least 30 babies each,
a further 104 have fathered between 20 and 29,
1,557 between 10 and 19,
and more than 6,000 have created up to 9 babies.

Though these men are offering hope to many many childless women/couples, huge risks are inherent in such practices. Obvious ones are passing on undetected hereditary diseases and risks, and half-brothers and -sisters forming sexual relationships and procreating together. Donated sperm are currently tested for diseases such as HIV, hepatitis B and C, CJD, Huntington’s and cystic fibrosis, but not for genes indicating increased risk of cancers or Altzheimer’s. In the face of the latest statistics, campaigners are calling for more stringent enhanced screening to try to reduce the incidence of faulty genes being passed on, but representatives from the world of assisted conception caution that further screening could reduce the number of donors coming forward or being deemed eligible to donate, already worryingly low.

Research in this area is complicated, not only by the powerful emotions and opinions and ethics around infertility, but also by the fact that sometimes the full consequences of what is permitted in this area are not fully apparent until a generation or more has gone by – which is why I felt compelled to write a sequel to Paternity: Double Trouble. And once you start tinkering with genes it can be impossible to repair any damage done.

So, what d’you think? Just how much control or interference should there be? What are the rights and interests of the babies as well as the parents, donors and recipients? What makes a man a father? Which diseases are worse than non-existence? Who decides?

Now there’s a little package of ethical conundrums to conjure with while you watch birds and animals multiplying prolifically all around you! Welcome to my world!

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