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Bioethic information and analysis newsletter

Following Letter

N°49 - January 2004

Promising results for research into adult stem cells

The debate continues on research into embryonic stem cells, at both European and French levels where the discussions on the draft bioethics law is reopening in February in the French Senate.
However, as we are reminded by Jacques Testart, « Nobody seems to be considering the possibility that research on human embryos, which started in 1990 in the United Kingdom, has so far not yielded any useful result » (Le Monde, 26th January 2004).
On the other hand, the medical advances achieved with adult stem cells have continued during 2003, as reported in the scientific publications.

For instance, the Washington Times on 30th December 2003 quoted numerous examples :

- Five patients suffering from Parkinson's disease have benefited from cellular therapy. One year later, they had recovered 61% of their capacity for performing everyday activities (Nature Medicine, May 2003°.

- 250 patients suffering from diabetes were treated with pancreatic cells from dead donors, and their insulin level stabilised in 80% of cases.

- Adult cells have also kept their promise in the treatment of heart diseases. 14 patients showed a significant improvement in their heart functions for several months after injection of their own bone marrow stem cells. « This is very encouraging » according to Doctor James T. Willerson, Head of Cardiology at the Texas Heart Institute who conducted the study, « …there is a significant improvement in the blood flow » in those parts of the heart where the stem cells were injected.

- Adult bone marrow stem cells have been used to cure three patients suffering from chronic skin diseases (Archives of Dermatology, April 2003).

In ophthalmology, scientists in Toronto took stem cells from a damaged eye, in order to generate new cells and to re-implant them in the eyes of a patient (Canada’s Edmonton Journal, 30th November 2003).
« I believe that science will continue to achieve success in the treatments based on adult stem cells, whereas so far, no convincing results have yet been achieved using embryonic stem cells, and quite frankly, negative results with animal cloning » remarked David Prentice, from the Indiana State Hospital.

- In France also, a new therapeutic path for treating chronic heart deficiency has been opened up by transplanting adult stem cells. This involves transplanting into the hearts of patients suffering from infarction, their own muscle cells previously grown in culture. This study refers to the success achieved in France by Pr. P. Menasché, a heart surgeon at Hôpital Georges Pompidou.

Euthanasia, relentless therapeutic treatment… A few definitions

Euthanasia
Euthanasia is an action or omission whose prime purpose is to kill a patient in order to put an end to their suffering. Euthanasia is a forced death, as opposed to a natural death.

Active / Passive euthanasia
The distinction between active euthanasia and passive euthanasia has no reason for being and confuses the issue. Either there is euthanasia by action or by omission (by injecting a lethal product or by "forgetting" to give a drink...) i.e. a will to terminate the life of the patient), or there is a will to assist the patient by attenuating their suffering, (switching from relentless therapeutic treatment to palliative care).

« Exceptional euthanasia »
This is a notion suggested by the National Ethics Consulting Committee in order to allow, under certain exceptional circumstances, to induce the death of a patient. It must be remembered that abortions were only to be conducted in hospitals in order to cover exceptional situations. Today, in a large number of cases, it is used as a replacement for contraception, at the cost of the Sécurité Sociale. Such a misuse would be difficult to avoid in the practice of euthanasia, in a society where the life expectancy is ever increasing with its suffering and multiple dependency, which is weighing ever more heavily on the health care budget, whence certain inevitable temptations...

Assistance to suicide - assisted suicide
A method which consists in putting a poison in a syringe and having the patient press the plunger in order to avoid facing charges.

Relentless therapeutic treatment
Providing heavy treatment which is disproportionate in relation to the benefit obtained by the patient.

The distinction between euthanasia and ceasing disproportionate treatment is essential. « Doctors have no right to deliberately cause death » (art. 38 of the Medical Deontology Code) but have a duty to abstain from any unreasonable obstinacy. Instead of maintaining a treatment which has shown itself to be ineffective, the doctor must do everything possible to provide the patient with palliative care.

Palliative care
To assist a patient and use analgesics in order to relieve pain, even if this involves taking risks which may even be fatal.

Accompaniment at end of life
Accompaniment of people at the end of their life is the real challenge in the debate on euthanasia, as pointed out in the Hennezel report which states that if in the face of suffering, « practices are heterogeneous, the temptation to give in to a death request by a lethal act » is often revealing of a lack of training and of solitude on the part of medical staff when confronted with end of life situations which they do not know how to handle. « There is no law which can amend human conscience... On the other hand, one can fear that it hinders the efforts made by doctors to improve their practices, to imagine, and to invent a humble and human way to help those who we can no longer hope to cure ».(1)

(1) Hennezel report « End of life and accompaniment» 16th Oct. 2003
See laso Gènéthique No. 31 ; Israël : The dangers of euthanasia, Published by Syrtes,2002

Involuntary pregnancy termination offence : new proposal

The Senate has overruled the Garraud amendment which created the offence of involuntary pregnancy termination. However it is undeniable that women, who are victims of involuntary bodily harm, have their pregnancy terminated against their will and cannot undertake legal proceedings. The Penal Code does not in all cases protect the corporal integrity of pregnant women, as demonstrated by the appeals court in its annual report for 2001. Sixty-two Senators have signed a new draft law submitted by Pierre Fauchon, in the more general case of violence committed against women.

« Anti-Perruche » law and incorrect genetic counselling

The « anti-Perruche » law does not apply to children who are born handicapped as a result of incorrect genetic counselling.

A recent ruling by the Administrative Court of Appeals in Paris concerns the applicability of article 1 of the law dated 4th March 2002 (known as the « anti-Perruche law), which limits the responsibility of doctors and medical establishments in the event of birth of handicapped children following a medical error having prevented warning the parents of a handicap diagnosed in utero.

A couple, whose first child was born severely handicapped, had consulted a specialist centre in a hospital to know whether a new pregnancy involved any risk. Having been categorically assured that there was no risk, they gave birth to a second child suffering from the same disease and claimed for damages. On appeal, the Administrative Court of Appeals in Paris had to rule on the effect of the introduction of the law dated 4th March 2002 and decided that it is applicable « to compensation for handicaps caused by medical errors occurring during gestation of the child » and not prior to its conception. The parents are therefore justified in this case to claim for compensation for the trouble caused to their conditions of existence and the material damage caused with respect to the particular costs involved « throughout the child's entire life » due to its handicap, whereas this compensation is excluded under the new law.

This decision is staggering ; this literal interpretation of the law (which covers « handicaps not diagnosed during pregnancy ») leads to the establishment of two comparable situations for different legal circumstances. In each case, there is a birth of a handicapped child which the parents would not have conceived nor kept, had they been warned about the handicap or the risk which a medical error prevented them from being informed about. Why should the parents of a handicapped child born following incorrect genetic counselling be better compensated than those whose handicapped child is born following an incorrect prenatal diagnosis ?

CAA Paris, 3e ch. B, 24th June 2003,
No. 98PA3275 ; see also Permanent Dictionary of Bioethics and Biotechnologies, Bulletin 132 p.696