Abortion: government website video stirs up controversy

by | November 13, 2015 | Maternity, News

In an on-line video on the government’s website which professes to advise women about abortion, an obstetrician gynecologist, Dr Philippe Faucher, affirms that abortion does not lead to long-term psychological side-effects, speaking of studies but neglecting to cite them.

However the High Authority on Healthcare, cited in the (IGAS) report on the prevention of non-desired pregnancies (2010), indicated that “Abortion often remains a difficult event from a psychological viewpoint. This dimension lacks objective and scientific evidence. “ 

No studies have been conducted since this observation by the public authorities. Interrogated in 2010 on the lack of data by at least forty deputies requesting an epidemiological study be conducted on the psychological side-effects of abortion, the Health Minister flatly said “No”: “Measuring the psychological impact of abortion by means of surveying women having had recourse to this act meets with obstacles which appear difficult to overcome.”

For years, renowned professionals have been warning that the psychological impact should not be ignored, such as Professor Nisand or physchoanalyst Sophie Marinopoulos, specialized in abortion. Authors such as psychiatrist Stéphane Clerget (How old would he be today? The taboo of interrupted pregnancies, Fayard, 2007) or sociologist Luc Boltanski (The fetal condition, Gallimard 2004) have equally ascertained for a long time that women can have psychological side-effects.

According to the survey OpinionWay for Nordic Pharma in March 2013, 85% of women declared to have suffered during medically-induced abortion, including moral suffering for 82% of them, or physical suffering for 67%. This confirms a preceding survey carried out by IFOP in 2010 on women and abortion: 83% of women thought that abortion left psychological impacts which are difficult to live with.

In France, post-abortion accompaniment is rarely proposed: 16% of health establishments declare systematically proposing a post-abortion appointment within their establishment and 3% elsewhere. (study of DREES (French Department for Research, Studies, Evaluation and Statistics) on professional establishments performing abortions).

Denying the psychological suffering that numerous women experience long after an abortion is harmful and lacking compassion. Such is the experience of Alliance VITA, who has accompanied women for over twenty years, with its listening service hotline SOS Baby, where women confide their suffering following an abortion, sometimes many years later.

The government’s choice to have a controversial doctor as spokesman, who is accustomed to denying the psychological impacts of abortion, confirms the direction of its’ political agenda: the willfulness to trivialize abortion in contradiction to women’s experience, their expectations and their needs.

Donations of gametes: State Counsel rejects request to reveal donor identity

by | November 13, 2015 | Bioethics, Medically Assisted Procreation

On November 12, 2015, the State Counsel refused the request of a 35-year-old woman to obtain information concerning her biological father. Conceived by artificial insemination with donor sperm, Audrey Kermalvezen, has been fighting a judiciary battle for years to obtain a partial lifting of the confidentiality of her birth background. The young woman appealed to the administration in 2009 after having discovered, at age 29, that she had been conceived by artificial insemination.

But she was continuously confronted with the refusal of the Public Assistance – Paris Hospitals, since French law protects donor anonymity. Her requests being refused by the administrative court, then by the court of administrative appeal, she seized the highest administrative jurisdiction, arguing that the French law violated Article 8 of the European Convention on Human Rights on “right to the respect of private and family life”.

In a 1992 judgment, the European Court of Human Rights (ECHR) reiterated that people in the position of an applicant “have a vital interest in obtaining information which is indispensable for discovering the truth of an important aspect of their personal identity”.

In its judgment, the State Counsel concluded that the anonymity of sperm donors, as provided by French law, “is not incompatible with the European Convention on Human rights”, and that “the rule of anonymity meets the objective of protecting the donor’s private life”.

The State Counsel adds that this rule « does not entail in itself any invasion in the private and family life of the person thus conceived, especially as it is for the parents alone to decide whether or not to unveil the confidentiality on the conception”.

Nevertheless, it has been recalled that there are exceptions to the confidentiality, notably for doctors to access data, in cases of therapeutic necessity, or for preventive measures, especially in the case of a couple both born from donated gametes who wish to insure that they do not have the same donor. This is exactly the case for Audrey and her husband, also « born from unknown spermatozoid ». The applicant pointed out the potential risk of consanguinity.

She has thus been refused in spite of another point of major importance: the State Counsel stated that if the administrative jurisdiction rejected her request to access this information, it’s on the grounds that she had presented it directly and not by the intermediary of a doctor, which made it impossible for them to comply with her request.

Audrey Kermalvezen denied this point and explained that when she formulated her request before the Public Assistance-Paris Hospitals, to have the confidentiality lifted, she specified that the data should be given to her “or else to a doctor she had named”.

Mme Kermalvezen announced her intention to file an appeal in Strasbourg at the ECHR. If the non-conventionality were established, the legislator should review his position, but the lifting of confidentiality will most certainly only concern children to be born.

Funeral care and embalming, banned at home soon?

Funeral care and embalming, banned at home soon?

by | November 12, 2015 | End of life, News, Publications, Reports

Funeral care preservation could be outlawed at home, following an amendment filed in context with the Health Care bill currently being discussed in Parliament. The reasons given by the Health Minister to forbid embalming at home refer to four official reports, considered to be in agreement:

– Report of the Supreme Counsel of Public Health in December 2012 and November 2009

– Report of the Human Rights Defender in October 2012

– Joint report of the General Inspectorate of Social Affairs (IGAS) and the General Inspectorate of Administrative Affairs (IGA) in July

The main arguments are repeated from one report to another, however they stand on some assumptions or incomplete, even biased assessments.

A)    Is home-based passing doomed to disappear?

Of an average of 550,000 annual deaths, those occurring at home represented 27% in 2008, thus about 150,000 deaths (compared to 70% in the 50’s, but with a tendency to stabilize since the 90’s.)

Furthermore, of the 200,000 embalming acts reported (one third of the deaths), 23% were performed at home according to a study published in 2000, thus representing 46,000 acts.

Similar proportions exist by statistics: ¼ of deaths occur at home, as well as ¼ of embalming acts.

Therefore, it’s an exaggeration to state that « the principle place for funeral care preservation has forsaken the home for collective spaces» (IGAS/IGA Report of 2912, p.15)

In addition to that, the statistics are not very reliable. For example the percentages of embalming acts compared to the number of deceased vary considerably from one report to another: 25-30 % (Public Health Supreme Counsel) to 40-50 % (Human Rights Defender). This figure might be 15% in Paris and 43% in the provinces. The number of embalmers vary between 888 (Review of Employment and Health) to 1586 (Health Minister).

On a structural basis, it seems that a part of the population, (about ¼ ), especially in the rural regions, remain attached to keeping their loved ones at home until death and to performing the traditional funeral rites of the country at home : those rites usually entail funeral preparation, viewing of the deceased in the bedroom or a common room the evening before burial, having family members and neighbours visit the deceased before the closing of the casket. The deceased person thus stays “in his place of residence”, and can be visited without the time and organizational constraints of public places like funeral homes.

B)     Do embalming acts pose non-negligible health risks?

In December 2012, the French Public Health Counsel gave a detailed analysis of the risks of infection which menace the embalming profession, principally biological and chemical infection, in its report which constitutes the basis of all public powers’ recommendations.

A close reading of the data put forward to justify the risks demonstrate that in reality, these studies and analysis are quite dated (more than 20-25 years), and mostly are situated in foreign countries, principally in the United States. The results are internationally controversial, often with non-significant differences between the control populations and the professionals involved.

Ultimately, the members of the technical work group appeared to be divided on the advisability of banning embalming acts at home. They concluded their report by saying: “It thus appears that the debate rests in fact on the acceptability of the risk by the embalmers, compared to the benefit expected for the families of the deceased, which is a societal consideration.”

It’s precisely a societal debate that’s lacking, and at no moment have the different reports considered the sociological, cultural or religious stakes of keeping the deceased at their home. Only sanitary arguments and administrative controls have been taken into account.

As far as the July 2014 IGAS-IGA consolidated report goes, it cites the principle of precaution and standardizing practices, faced with a “high-risk occupation”. Nevertheless, even if this profession is at more risk than others, it has not been proven that accidents occur, and above all, that they would have more chance of occurring at home rather than on other sites. The French Institute for Health Watch “recognizes that they have no data on the accidents with blood exposure for embalmers, nor concerning professionally acquired viral contaminations.”

The Senator, Isabelle Debré, during the parliamentary debates of October 1, 2015, hence summarized the situation: “The principle of precaution? I don’t believe so, since we have interrogated the actors involved in this practice, as well as the order of doctors: they assure us they have never had a case of contamination”.

Conclusion

It is certainly possible to organize the embalming profession better and to maintain a high level of sanitary protection, as the government rightly wishes, without banning home embalming, by improving the initial training and continuing to train all professionals, wherever their place of practice might be.

Likewise, it is possible to authorize care of people affected with HIV or hepatitis, without banning home-care, but with reinforced sanitary regulations, such as vaccinating embalmers. A compromise measure might be to reserve treatment to specific sites whenever the death certificate mentions one of these infections.

Uterus transplant now authorized in France

by | November 9, 2015 | Bioethics, Fertility and pregnancy, Medically Assisted Procreation

 

The National Safety Agency for Medicine and Health Products has just authorized a clinical trial for uterine transplant at the Limoges University Medical Center. The team working on this subject since 1999 has proposed a clinical trial protocol including eight women, which was approved by the Committee for Protecting People for the region.

Uterine transplants may benefit women suffering from a congenital absence of the organ (Rokitansky-Küster-Hauser Syndrome) which affects one woman out of 4500) or those having had a surgical ablation. To attain pregnancy, a uterine transplant must necessarily be preceded by In Vitro Fertilization with freezing of the embryos with the ovocytes of the woman grafted or with those from a donor. For the moment, the National Health and Safety Agency wishes to limit the trial to women who have not yet had children.

« At the earliest, the first graft will be performed by the end of 2016, with the unknown input of when a compatible graft can actually be found. Then, we must wait one year for the graft to be stable, before starting a pregnancy using in vitro fertilization. Therefore, the first birth won’t be before the end of 2018” explains Tristan Gauthier, obstetrical gynecologist at the Limoges university hospital and principal investigator for the trial.

The graft of a uterus is different from all other grafts. “Although not a vital organ, it is the one by which life is given”, recalled the authors of a report published by the Medical Academy in June 2015. In the report, they insisted on the “complexity of the surgical act, the dilemma of choosing between a donor in a state of cerebral death or deceased, and a living donor and the specifications of the recipient. They continued by describing the immunosuppressive therapy before and during pregnancy, the complications more or less severe which could occur during pregnancy and the necessity for specifically attentive surveillance. They questioned the future of the child, in the medium and long-term, his psychomotor development, and that of his immune system and went through the numerous and delicate ethical questions which uterine transplantation presents, the risks for the recipient, the physiological and psychological outcome of the child, and finally the question of the choice between uterine transplant and surrogate motherhood, and the potential drifts.

As for the choice of procuring uteri from donors in a state of cerebral death, « it is the result of an ethical approach, to avoid invasive surgery on healthy patients to procure a non-vital organ for recipients.” But the doctors also hope that “by giving preference to deceased donors, they will be able to use younger uteri, and consequently more effective than those of living donors, who are generally women who do not wish to have children anymore”, underlined Dr. Piver. Other sources of donor might be possible, as Foch hospital mentioned for transsexual women who have become men.

A uterine graft performed in Sweden in October 2014, allowed the world’s first birth of a child from uterine transplant. The team had tempted 9 transplants performed in the context of a project initially refused by the Swedish Ethical Committee. Among the 9 women, 8 had the MKRH syndrome and the ninth had cervical cancer which led to the removal of the uterus. Most of the grafts were performed with uteri taken from living mothers for their own daughters. Out of the nine grafts, two failed (infections, thrombosis), four have not yet given rise to pregnancy. But three were successful. “Three births out of nine trials is almost as good as medically assisted reproduction techniques”, thus analyzed Dr Tristan Gauthier.

Assisted suicide business forbidden in Germany

by | November 6, 2015 | End of life, Laws, surveys, protagonists, News

The Bundestag voted on November 6, 2015 a law forbidding assisted suicide in exchange for monetary remuneration.

For the past year, Germany has opened the debate on the question of assisted suicide due to grey areas in the law. Assisting suicide is not penalized although unauthorized by the code of medical deontology and could lead to a ban from the General Medical Council, in certain länders, for doctors who practice it.

Assisting suicide is not illegal as long as it remains passive (for example procuring medicine for the person who wants to end her life, or accompanying the person to Switzerland to specialized organizations). The grey zone in the legislation (neither forbidding nor explicitly authorizing) could have allowed the development of business activities, such as practiced in Switzerland.

Several debates have been held at the Bundestag since November 2014. The civil society is divided on the subject.

Four propositions for a law, already presented in first reading last July 2nd, were submitted for vote:

The outlawing of assisted suicide, proposed by Patrick Sensburg and Thomas Dörflinger (CSU / CDU –Christian democratic party).

  • The outlawing of any commercially assisted suicide, a project supported by Michael Brand (CDU), Kerstin Griese (SPD, social democratic party), Kathrin Vogler (Linke : left front ) et  Elisabeth Scharfenberg (Grüne : the greens). This project is supported by the Chancellor, Angela Merkel.
  • The authorization of assisted suicide, performed by doctors under certain conditions, presented by Peter Hintze and Carola Reimann, both members of the SPD.
  • The suppression of all legal obstacles to obtain assisted suicide under certain conditions, a proposition by the greens Renate Künast and Kai Gehring with Petra Sitte (Linke).

During the past year, several authorities have opposed changes in the law.

Professionals for suicide prevention (DGS and NaSpro) deplore the orientation of this debate, which underestimates the decision capacity in complete liberty of appreciation of a candidate for suicide: for them the answer lies in dialog, listening and appropriate treatments.

The majority of German doctors are opposed to this act: for the president of the Order of Doctors, Frank Ulrich Montgomery, the German doctors do not want to become “professionals of death”. En December 2014, the German Ethic Counsel also rejected any legislative change related to assisted suicide.

Last July, a joint statement from the Catholic and Protestant churches was published to express their opposition to assisted suicide: “In a human society, the major preoccupation should be to insure that people finish their life well-taken care of and accompanied to die in dignity”. On November 2, the German Jewish community reiterated its firm opposition to any modification of the law.

The evening before, the German parliament voted a law to enlarge and facilitate recourse to palliative care.