Nombre record d’IVG en 2004

Une récente étude de la DREES¹ indique que le nombre d’avortements ne cesse d’augmenter en France, pour atteindre 210 664 en 2004 (dernière année recensée), soit une hausse régulière de 1,8% par an depuis 1995. La part des IVG médicamenteuses continue de croître (elles représentent 42% en 2004, 38% en 2003) et surtout le nombre d’avortements chez les mineures est en constante augmentation depuis 1990 et atteint 11 500 en 2004, soit une jeune fille de 15-17 ans sur cent.

De la contraception à l’IVG

En parallèle, les méthodes contraceptives sont largement utilisées. 71% des personnes concernées y ont recours, 68% des 15-19 ans déclarent prendre la pilule et 56% recourir aux préservatifs. En outre, la « contraception d’urgence » s’est très fortement développée depuis 1999, date à laquelle elle est devenue accessible en pharmacie sans prescription médicale. Depuis 2000, elle peut être distribuée par les infirmières scolaires ; et depuis 2002, elle est gratuite en pharmacie pour les mineures. Plus d’un million de comprimés de Norlevo ont été vendus en 2005, soit six fois plus qu’en 1999 ; mais dans 7,5% des cas, la prise d’une « contraception d’urgence » n’a pas suffi à éviter une grossesse. Rappelons que selon la période du cycle féminin où elle est prise, soit elle empêche que la fécondation ne se réalise et a un effet contraceptif, soit, comme certains le pensent, elle agit en empêchant la nidation de l’embryon déjà conçu et a alors un effet abortif.

La hausse du nombre d’IVG ne semble donc pas s’expliquer par une moindre utilisation des contraceptifs, bien au contraire. Et  une étude de l’Inserm, De la contraception à l’avortement, sociologie des grossesses non prévues², le confirme en indiquant que ¾ des grossesses non prévues sont interrompues par une IVG.

Il est donc illusoire de croire que la contraception comme la « pilule du lendemain » peut endiguer l’avortement ; bien au contraire, cette étude confirme que le développement d’une mentalité contraceptive conduit à toujours plus d’avortements. 

1. Les IVG en 2004, DREES (Direction de la recherche, des études, de l’évaluation et des statistiques), Ministère de la santé, Etudes et résultats n°522, sept. 2006

2. De la contraception à l’avortement, sociologie des grossesses non prévues, Questions en santé publique, N. Bajos, M. Ferrand et équipe GINE, Inserm, 2002.

The number of abortions is increasingly growing in France. What is thus the psychological impact of abortion for all the people involved in this practice?

Investigation in hospitals

During several months, Sabine Faivre conducted an investigation within the hospital; she observed in a “neutral” way and listened to people, from social worker to physicians, from women and couples concerned to marriage guidance counsellors and to nurse team; thus she retranscribed the reality experienced today by each actor¹.

Isolated actors

Each actor is the isolated link of a chain, over which it often has the feeling to have no hold, and which can restrict it to choices that go against its freedom of conscience. Each one also intends to protect itself worthy of its means, most often by toughening beyond a wall of silence and lies in order not to recognise the failure of the law on voluntary termination of pregnancy (VTP). At all levels, testimonies are often poignant and if most people have the feeling to do well, the general atmosphere that prevails is one of a site where despair and death have finally the last word. Some physicians confess, “We, physicians think to be useful, while we dug into a deeper hole”, “the voluntary termination of pregnancy can completely destroy a woman (…) but we have no choice”…

Which accompaniment?

The investigation conducted by Sabine Faivre particularly shows the immense loneliness and the lack of information for women who abort: wanting to dissuade a woman from aborting, only by presenting alternatives to abortion, the possible assistances… it runs the risk to be liable for prosecution. If everybody intimately knows that “the after-period of VTP” will be painful, the social worker who would take the risk to deal with the matter, for information purposes, could be accused of dissuading the woman, while this lack of information is felt as a hindrance to freedom of choice. “A pregnant woman in distress who hesitates, it is like a sand grain likely to block the gears; in this conditions, it is better not to loose time”, says a social worker. Since the law has included the hindrance to VTP in the criminal code, social workers know that they do not have the right to intervene. The difficulty is growing with a provision in the last law: since 4 July 2001, women can even go to abort without previous interview with social workers.

To the limit of maltreatment

The author tells the pain of minor girls who aborted under the constraint and the pressure of their family or third person, while they wanted to keep their baby; since incitation to abortion is not any more a reprehensible act, how to distinguish the incitation from the constraint when it deals with a vulnerable and dependant person?

Lies and taboo

At all levels, we have to deal with a big lie:

– Lie about the reasons: women put forward the economic aspect not to recognise that they are unable to manage their sexuality and their fecundity;

– Lie about the reality of the act: some teams prefer surgical VTP because they see the woman going to the operating block and going back almost in the same state; they did not see or hear something, this enables them to erase the event. “Women who have voluntary termination of pregnancy using RU 486 have an even bad experience because they assist to their abortion in live; they collect themselves the pieces of the abortion “;

– Lies about the consequences: the pain associated to abortion is taboo; it is not recognised in our society. Nevertheless, women who go to the doctor to have a post VTP follow-up know that to overcome their pain and to reconstruct themselves, they will have to name the lost child.

In summary, voluntary termination of pregnancy is experienced as a very isolated drama: isolated before the alternatives which could enable avoiding it, and isolated after the listening and accompanying proposals which could enable curing it. As it is conceived, the plan looks like a kind of descendant spiral into which individuals have no other choice but to fall. All recognise that the contraceptive failure leads undoubtedly towards abortion. Faced with the emergency to act, would the solution be found in the education of a responsible sexuality which would have the benefit to be at men service, about whom we do not talk a lot, as well as women?

1. La vérité sur l’avortement aujourd’hui, Sabine Faivre, ed. Téqui, 2006

An exceptional progress

Pr McGuckin’s and Dr Forraz’s team (University of Newcastle) achieved to create a model of tiny liver from stem cells taken from umbilical cord blood. Umbilical cord blood is taken after the delivery without danger neither for the mother nor for the child. Scientists have placed these cord blood stem cells taken from newborn babies in a bioreactor designed by Nasa. The reproduced effects of weightlessness enabled cells to develop more rapidly and to transform with growth factors into 3D liver tissues. Thus, this team would be the first to made tissues of non-negligible size (few millimetres) in 3D from umbilical cord blood stem cells.

Significant impacts

According to specialists, this discovery could have significant impact on pharmaceutical industry because within two years the “mini-livers” could be used for drug trials, offering an appropriate tool to better forecast toxically side effects of a developing drug, thus reducing animal experiments. In the medium term, this technology could evolve to use hepatic tissues to create “artificial livers” and treat patients waiting for hepatic graft or for a regeneration of their liver; within 15 years, we could envisage to transplant “hepatic fragments” to compensate some liver impairments.

2006 sees the 20^th edition of the Téléthon. This year, for the first time, it will enjoy 30 hours of live television coverage. However, more and more people refuse to be involved in this vast operation that invites them to transgress fundamental rules of ethics. Without doubting the good will of many participants and the success of some of the Téléthon’s projects, we provide transparent answers to those who ask questions.

When the Téléthon rejoices in having led for the last 20 years “the battle for citizenship of people with a disability, who have long been excluded from our society “, we have to ask: to what extent is this true?

Certain research projects show no respect for human life

The use of embryos for research: I-STEM Centre

• The Téléthon financed the creation of the first French large-scale test centre for research on human embryos: I-STEM. It should be remembered that research on human embryos does not mean finding means to cure diseased embryos, but rather that cells are taken as research material from the embryo, which is destroyed.  I-Stem is managed by Pr. Marc Peschanski.
• The 2004 bioethics Law authorised research on “supernumerary embryos with no parental project”. But while awaiting the enactment orders for this Law, certain researchers financed by the Téléthon became impatient. So in February 2005 they obtained special authorisation from the Ministers of Health and Research to import embryonic cells in order to begin research straightaway, inside I-STEM ¹. Another authorisation was signed in September 2005 2.
• In June 2006, the first effective authorisations for research on human embryos were signed in France; the 1^st team in France to attempt the creation of cell lines from human embryos is led jointly by Mr. Peschanski and Mr. S. Viville.

The selection of embryos according to genetic criteria: Pre-implantation diagnosis (PID)

In 2006, the Téléthon is congratulating itself on one of its greatest “victories” of the last 20 years: “Thanks to the genetic council and the possibilities made available by antenatal diagnosis, even families affected by disease are able to expand 3“. How far is this true?

Scientific teams financed by the Telethon select embryos using a method based on the genetic characteristics of those embryos called pre-implantation diagnosis. When a couple carries a genetic disease, an in vitro fertilisation is suggested.  The embryos obtained are separated into those that carry the disease and those that do not. Only an embryo that does not carry the disease is implanted; the others are destroyed. It was in this way that baby Valentin was born (in good health, of course); his brothers and sisters died at the embryonic stage. This declaration was the driving force of the publicity campaign for the Telethon 2000 4. Indeed, it was said that “the AFM [French Myopathy Association] has some major therapeutic successes partially to its credit 5”, notably “the birth in France of the first healthy child following a pre-implantation diagnosis (PID) 6”. In fact, children who escaped this embryonic sorting are not cured as they have never been treated – they had never even been ill. This is therefore a triple counter-truth. Public opinion was wrongly persuaded that if Valentin was in good health, it was thanks to the Téléthon.

It was through the lobbying of the State by the AFM (French Myopathy Association) that the enactment order was obtained for pre-implantation diagnosis. Eric Molinié, former president of the AFM, explained: “For example, in 1997, we adopted a resolution on pre-implantation diagnosis (PID) to demand the government to vote in the enactment orders for the bioethics law concerning PID 7”. In 2000, after the birth of the 1^st baby born following PID, the association rejoiced: “this result (…) rewards the militancy of the AFM on this subject 8”.

Research using aborted foetuses

Work on Parkinson’s and Huntingdon’s diseases involves the grafting of neural cells from aborted foetuses. In general, 3-10 foetuses are needed for one patient ⁹ and for the graft to succeed, these must be foetuses the neural cells of which are still alive. A trial for Huntingdon’s disease was carried out on 5 patients in 2000. Another on 100 patients began in 2002 ¹⁰. From 2002, the team announced that they lacked foetal cells: “We are looking for new sources of cells for the grafts and hope notably to be able to experiment on human embryonic stem cells ¹¹”. This research is one of the programmes highly mediatised by the association.

The AFM supports lobbying to obtain human cloning

In December 2005, Pr Peschanski declared: “the current situation is desperate and we nearly need to envisage a commando-style operation to obtain the means to work properly on embryonic stem cells”. (Le Point 01/12/05)

In 2005 a bill demanding the authorisation of cloning for research was presented to the Senate and another to the National Assembly. This was supported by four scientists, including Pr. Peschanski who declared: “The law now needs to be changed very quickly; otherwise we will be 5 years behind. We really need this technique because it is viable ¹²”

Going out of the ethical dilemma

Whereas pressures in favour of research on human embryos intensify, an article by Gregory Benichou, professor and the Essec and titular of the bioethics and therapeutic innovation chair comes to clarify the debate¹. He explains that the use of umbilical stem cells in regenerative medicine could offer an alternative to embryonic stem cells without embryo manipulation or cloning.

Big therapeutic promises

Since the first global graft performed in France in 1987 by the professor Eliane Gluckman, umbilical cord blood was transplanted to more than 6,000 patients worldwide, to treat some cancers and blood diseases. Umbilical cord blood cells already allow realising successfully transplants even in case of tissue incompatibility, which is not the case with a bone marrow graft. For that reason, in 2004 Japan was the first country in the world to perform more cord blood graft than bone marrow graft. Moreover, the plasticity of umbilical stem cells is almost like the one of embryonic stem cells, without inducing oncogenic effect after transplantation. Collected by low quantities at birth, they reached to regenerate in vitro and in vivo from the bone, cartilage, vessels, muscle, liver and heart cells and neurones. It seems that their therapeutic applications could be much extended.

Public and private banks

Since 2000, a lively competition develops in the world between cord blood banks. Public banks, without purpose of gain and profit and financed by public health funds, have stored free and non-directed grafts (allogenic graft). Private banks, with purpose of gain and profit, reserve the frozen cord to the exclusive use of the baby is from (autolog graft). In April 2006, we noted 134 private banks worldwide, gathering 740,000 units and 54 public banks having a total stock of 230,000 units and limited by public financings they depend on. Prohibited in France, in Spain and in Italy, private banks develop quickly in Belgium, Great Britain and Germany; their growth shoots up in Asia, aux United States and in Australia.

United States: to encourage ethical researches

In December 2005, American Congress voted the Stem Cell Therapeutic and Research Act, allocating a 265 million dollars budget to researches on bone marrow progenitor cells as well as umbilical cord blood cells.

Sanitary independence

The development of cord blood banks allows countries concerned not to be dependant on bio-resources from other countries.

In France, between 1994 and 2005, 63% of transplantations performed came from imported grafts; France ranks 16^th worldwide in number of units per habitant. Faced with an internationally growing competition, France will have to increase the capacity of its bank, by maintaining the excellent quality of its grafts. This is the challenge of Eurocord Foundation supported by professors Eliane Gluckman and Gregory Katz-Benichou.

European Parliament members adopted on 15 June 2006 a 50 billion euro program for research (7^e PCRD, 2007-2013). This Framework Program for Research and Development allocates 2 billion euros to biotechnologies and life science, which was subject to long debates to decide whether Europe had to finance embryonic research.

A very weak majority

Parliament Members approved with 284 votes for and 249 against, the community financing of research on human stem cells, either adult or embryonic. The debate showed strong division on this question: Polish and Italian voted against in majority, French and British for, German was really divided. German Green MEP, Hiltrud Breyer noted: ”if embryos are considered as real transformation materials, maybe we are in a ethical rupture”, denouncing also the risks of drift towards human cloning.

Three positions

Three positions emerged around the lodged amendments: 

• the support for financing any research on human, adult and embryonic stem cells, this position was lead by Philippe Busquin, ex European Research Commissioner, member of the Committee on Industry Research and Energy (socialist – Belgium).
• The refusal for financing any research which uses human embryos supported by Peter Liese (PPE – Germany) and Hiltrud Breyer (Green Party – Germany).
• The so-called position of compromise, consisting in limiting the financing of embryonic lines obtained before 31 December 2003.

Why working hard at financing?

The use of embryonic stem cells do not give today any result, either in man nor in animal; from now scientists talk about research interest and not about therapeutic objective. Why from now this relentlessness for financing these works? Undoubtedly we have to find an answer in the fascination for the beginning of life and the will to control them as well as in the choice of free material research, which are supernumerary embryos.

The COMECE ” stunned “

The COMECE, European bishops’ assembly, was “stunned” by this vote. It reminds that to be opposed to the instrumentalisation of human life and to its use as raw material is not “only a catholic position” because “scientifically, there is no moral reason to distinguish an embryo at the beginning of its life to an embryo after its implantation in uterus or after 14 days”. Any human life begins from the conception and deserves a particular protection when it is created outside women body.

A decisive step in autumn

During next meeting of ministers for research, on 24 July 2006, European Council will examine the question of financing. Several Member-states let know that they are opposed to the recommendation of European parliament members (Austria, Malta, Poland, Portugal, Slovakia…) because they refused to finance a research they prohibit in their country. Then, European Parliament will adjudge, at the second reading, in autumn, before a final joint decision

Vivisection of the embryo

The Biomedicine Agency announced on 20 June 2006 having delivered the first authorisations for research on embryo to six French teams working in public structures. Among the accepted teams, five come from INSERM and Pasteur Institute and will work on imported embryonic stem cell lines. For the first time in France, the sixth team will intend to create stem cell lines from human embryos conceived in the country. This team is co-directed by Marc Peschanski (Istem, Evry) and Stéphane Viville (Strasbourg CHU). Marc Peschanski, financed by Telethon funds (see Gènéthique No 71), actively militated to obtain authorisation for research on embryo and today asks for cloning.

Beyond the bioethics law

The law of 6 August 2004 only foresees an authorisation for research on embryo by derogation and for a five-year period, only “when they are susceptible to allow major therapeutic advances and provided that they cannot be followed by an alternative method of comparable effectiveness, in the current state of scientific knowledge” (art. L.2151-5). Yet, the decree of 6 February 2006 passed silence over the legislative prohibition of research on embryo authorised “by derogation” and erases the conditions established by the law on this research (see Gènéthique n°74). Today, the examination of the files of the six teams shows that none of them undertake these researches with therapeutic purposes but all for fundamental and pharmacological purposes.

Non-therapeutic interest

The use of human embryo cells is by no means a scientific necessity in that researchers are aware of umbilical and adult stem cells present promising  characteristics; and the sample in adult do not pose ethical issues because it does not endanger its life. Consequently, the use embryonic stem cells is only motivated by economical interest. The same researches could be carried out on animal embryo but they are more expensive because breeding has to be maintained whereas human embryos without “parental project” are free.

Ethical frame?

We can worry about the praetorian policy of the Biomedicine Agency which sacrifices human being interests for economical interests and is content with a pseudo ethical frame which is based on secondary points. “What kind of ethics are we talking about when the only ethics laid down involve wearing regulation shoes and masks to sacrifice human beings correctly?” questioned J-M Le Méné, president of Jérôme Lejeune Foundation.

Protestation

In a Statement of 29 June 2006, the president of the French Bishops’ Conference, denounced this transgression: « …so the process of reducing the human being to a resource carries on, which is a serious ethical violation. We have to say again that human embryo can be considered as a mere laboratory material (…) Any embryo is already a human being. Then it is not an object available for man. It is not possible to decide a limit beyond which an embryo is a human being and below which it is not. Nobody has the power to fix humanity limits of a singular existence… »

Every year, 12,000 in vitro fertilizations are performed in Belgium, between 2,500 and 3,000 children are born with these techniques and 3,700 out of 10,000 couples concerned, come from abroad. However, until now, reproductive medicine and human genetics were not object of a specific legislation, except two royal orders concerning standards of the centres for medically assisted procreation (AMP) and reimbursement modalities for in vitro fertilizations. The Belgian Senate has just voted the first law which organizes the MAP and the text should be definitive before the end of the current legislature.

To supervise the practices

The bill deals with ” author(s) of the parental project “, a vague notion concerning all couples, married or not, heterosexual or homosexual as well as singles. It fixes an age limit for women: 45 years maximum for oocyte sample and implantation; 47 years for embryo implantation and insemination. Minor patients (under 16) are excluded, unless medical exception (for instance, a young woman with cancer who wants to preserve her oocytes before a chemotherapy treatment). It authorizes pre-implantation diagnosis and the conception of “designer baby”.

Then, the text authorizes implantation and post-mortem implantation of supernumerary embryos if the father agrees as long as he lives.

Children: subject of a convention

The law foresees a convention between patients and centres for MAP, specifying their identity, age, address and the method used. The status of supernumerary embryos is mentioned, especially to settle awkward situations as a separation, an insolvable difference of opinion between the authors of the parental project, the death of one of them: cryopreservation during 5 years (except derogation), affectation to research or donation. 24,000 supernumerary embryos are frozen each year. In fact, research on supernumerary embryos and the creation of embryos for research are authorized in Belgium since May 2003.

The costs of MAP in Belgium

The cost of IVF is covered for people with complementary private health insurance in Belgium, including for homosexual persons. Each treatment costs 1,587 euros per cycle of which €170 must be paid by the patient. A woman can have a maximum of 6 IVF treatments. For 2001, medically assisted reproduction cost 20 million euros for 9,462 cycles with “fresh” embryo transfer and 2,410 cycles with frozen embryo transfer, 452 oocyte donations and 48 embryo donations. The success rate of an IVF is 20%. Regarding inseminations, 800 sperm inseminations with donor have been reported in 2002; the financial compensation is 50 euros per donation and the global price to access the sperm bank is 600 euros.

The limits

Besides limits related to women age, the bill bans the simultaneous implantation of embryos coming from different donors of supernumerary embryos. It foresees that supernumerary embryos of a same donor or couple of donors cannot lead to childbirths in more than six different women. On the other hand, the law does not limit the number of oocytes that can be fertilized and even promotes the production of supernumerary embryos needed for research.

The questions in discussion concerning the rule of anonymity of the donor that opposes the “right” of the child to know its origins and the possibility of pairing (consisting in researching physical characteristics close to foster parents) which could not be considered as a practice with eugenic character. Finally, surrogate maternity (surrogate mother) is not mentioned nor prohibited.

Abortion in Switzerland

In 1982, abortion reimbursement was imposed to private health insurance companies on presentation of a double medical opinion. Since 1 October 2002, a mere signature of the mother allows abortion until the 12^th week and further, a single medical opinion is enough until the day before birth. Moreover, minors under 16 can abort without parents’ agreement.

The real cost of abortion

Since 1988, Pro Life, an association from Switzerland, made an economical demonstration that members are real risks for health insurance companies. This way, Helvetian health insurance companies propose to reduce from 10 to 40% premiums of complementary insurance for policyholders who refuse abortion and eventually medically assisted reproduction. The demonstration is made: people attached to respect of life have behaviour that enables savings from 30 to 40% in health field. Actually, the cost of abortion does not only consist of the act itself. International scientific studies recently published deserve attention. After abortion, women’s mortality rate globally increases by 160% in the following years, high prematurity increases by 170%, other researches indicate a high recidivism rate for abortion¹.

A responsible behaviour

Pro Life members are aware faced with the trivialization of abortion and the rise of health expenditures: they commit themselves to refusing their right to a possible abortion reimbursement offered by the base obligatory insurance and to promoting respect of life at every stage.

Besides savings directly linked to abortion refusal, it was observed that generally pro-life members smoke less, drink less and are less depressed. The two more important Swiss health insurance companies are interested in pro-life members with a number continuously increasing.

Since 2004, Helsana and CSS groups offer them, via their partner funds SANSAN and Auxilia, their non-obligatory complementary insurances, with a preferential price.

Conscientious objection

Josef Zisyadis, national counsellor of the Popular Worker’s Party (POP), this spring, submitted an urgent proposal aimed at banning the insurers to concede « ethical » discounts. The Federal Council (Swiss high political authority) has just declared, on 30 May 2006, that there is no way of calling the principle of conscientious objection into question; as it happens, anybody has the right to refuse for himself a benefit from base obligatory insurance. In another hand, it confirms the liberty for health insurance companies to retrocede savings coming from a more responsible behaviour at least for private complementary insurance companies. 

1. Deaths associated with Pregnancy Outcome: a Record Linkage Study of Low Income Women, Reardon et al. Southern Medical Journal, vol. 95, n°8, August 2002.

The Committee on Legal Affairs of the European Parliament opposed any European funding for research on embryo by a decision adopted on 5 May 2006 with 16 votes (Poland, Germany, Austria…) against 6 and 3 abstentions¹.

Recalling that “Member States should not be forced to indirectly co-finance, by their financial contribution to the budget of the European Union, research activities which are prohibited in their country because of fundamental and essential ethical objections”, the Committee also mentions that “following the Hwang’s affair in South Korea, it is more important than ever to interpret the principle of subsidiarity in a very strict way”.

Excluded financing

The following research activities cannot be subject of financing according to the 7^th framework-program: Research activity aimed at human cloning for reproductive purposes, to modify the genetic heritage of human beings, to create human embryos solely for the purpose of research or for the purpose of stem cell procurement, and research activity using the cells from such embryos; research activities which destroy human embryos or using human embryonic stem cells.

Researches to be promoted

The Community must give priority to research projects enabling to replace controversial technologies on an ethical level by research on adult stem cells and umbilical stem cells, the resolution of fertility problems without creating supernumerary embryos and genetic trials linked with the therapy.

1. Proposal of Decision of the European Parliament and of the Council concerning the 7^th framework-programme of the European Community research, technological development and demonstration activities, adopted by the Committee on Legal Affairs on 5 May 2006.

Regenerative therapy using stem cells holds great hope for millions of patients with degenerative diseases or injuries. Repair of damaged organs or tissues using stem cells could address the needs of the patient.

Beyond the emotion caused by the false hopes, it is imperative that a complete review of the scientific results and promises clarifies the debate.

Stem cell characteristics

A stem cell has two chief characteristics: it continues to proliferate so that a pool of cells is always available and it responds to appropriate signals by differentiating into one or several specialized cell types. The sources of human stem cells are varied: they can come from early embryos (from 5-7 day post-conception), foetal tissue, blood and umbilical cord matrix, placental tissues and from most of body tissues. Adult stem cells come from post-natal sources. The plasticity of a stem cell, in other words its ability to form differentiated cell types ranges from unipotent (able to form only one differentiated type), to multipotent (able to form multiple cell types), to pluripotent (able to form most of all tissues of the adult body) to totipotent (able to form all postnatal or extraembryonic tissues, potentially able to regenerate a complete new embryo).

Embryonic stem cells

Mouse embryonic stem (ES) cells were first grown in culture in 1981, but human ES cells were not successfully cultured until 1998. Isolation of embryonic stem cells requires the disaggregation of the early embryo, hence the ethical debate regarding these cells. These stem cells, considered the archetypal pluripotent stem cell, they are capable to form any type of tissues, have to face many scientific hurdles to overcome before they might be used clinically, specifically tumour formation and immune rejection. In order to overcome potential rejection of ES cells,  various solutions have been proposed, including establishing “banks” of ES cell lines to match potential recipients, but we do not know the number of stem cells needed to match all the patients (undoubtedly from 250 to 10 000 lines). Therapeutic cloning has been hailed as a potential panacea for overcoming immune rejection. But, and this, despite the fraudulent claim from Korean researchers, at this point no human cloning have been successful; In a previous experiment in mice, the cells from cloned embryos were rejected by the genetically matched host.

Adult stem cells

Recent researches showed remarkable flexibility of adult stem cells. Evidence was presented that a single adult bone marrow stem cell could contribute not only to marrow and blood but also to formation of liver, lung, digestive tract, skin, heart, and muscle². Several examples now exist of some adult stem cells with pluripotent flexibility, including cells from bone marrow, peripheral blood, the inner ear, umbilical cord blood, nasal mucosa, amniotic fluid, and the placental amniotic membrane. Many of these published studies also document that these particular pluripotent adult stem cells can multiply in culture for extensive periods of time while still retaining their ability to differentiate and providing sufficient numbers of cells for clinical treatments.

There have been numerous reports of the effectiveness of adult stem cells in treating animal models of disease.

In some experiments, the cells showed a “homing” ability to the site of tissue damage. For spinal cord injury, adult stem cells have promoted neuronal growth and therapeutic benefit in rodent models.

In animal models of Parkinson’s disease, adult stem cells have shown effectiveness at stimulating dopamine secretion and decreasing behavioural symptoms. One patient received a transplant of his own neural stem cells, resulting in decreasing the symptoms of Parkinson’s disease. Regarding diabetes, several examples now exist showing generation of insulin-secreting cells from adult stem cells, including the liver, bone marrow, and pancreas.

Adult stem cells have also been used in bone repair protocols.

Repair of cardiac damage in patients has also moved to the clinical trials stage, with several reports of early success in repair of infarct damage.

Even if the mechanism for these regenerative results is still unclear, the flexibility and the enormous potential of adult stem cells are now shown.

1. Current Science of Regenerative Medicine with Stem Cells, David A. Prentice, Journal of Investigative Medicine, vol. 54 number 1, January 2006.

2. Multi-organ, multi-lineage engraftment by a single bone marrow-derived stem cell, Krause DS, Theise ND, Collector MI et al. Cell 2001 ; 105 ; 369-77.

What is most intimate to life than life itself, the story of our first and last moments? This life we received, we can transmit it. And then, one day, this life will go by, our life and the one of those we love …

Today, science enables to give life as well as death. But how do not be wrong? Until where can we go with the control of life, at its beginning and at its end? Here is the stake of the BIOethics Manual for Young People ¹: to train to this immense responsibility, in order not to improvise in an emergency situation.

7 chapters to understand

The Manual deals with the essential bioethics themes: the story of a small human being, abortion, prenatal diagnosis, medically assisted reproduction, preimplantation diagnosis, stem cells and cloning and finally euthanasia. A clear definition, the methods used, the French legislation, the ethic questions and the thoughts as well as accounts are presented for each of these themes.

The ethical stakes

The BIOethics Manual for Young People puts in full perspective the reality of the biological acts and their ethical implications and begins by « removing the doctoring » of words. This way, when a woman is proposed an embryonic reduction or a preimplantation diagnosis, what do they talk about? What is a « designer baby » or a nuclear transfer? What are the consequences of these new possibilities the medicine offers us in the field of life sciences?

If the medical assistance for reproduction enables some sterile couples having a baby, it also generates in France the conception of a stock of more than 120,000 frozen embryos commonly named supernumerary because they do not correspond anymore to a parental project. They can be destroyed or be subject to experiments… This is the way everything begins and that the frontier of ethics pushes back constantly.

To understand before acting

To decide to think, to train before to be faced with urgent decisions which leave no more time to stand back. How many young people today are faced with abortion and decide urgently, subject to the pressure of relatives and time limits to respect, without realizing the consequences of their act all their life long? Can we talk about a free choice? After an unfavourable even uncertain prenatal diagnosis, how many women do attest of the pressure of the medical profession to resort to so-called «therapeutic» abortion and had it without realizing what was happening? Towards which society does this policy of systematic screening for abnormalities and handicap? It is urgent to think about it.

A immense responsibility

The law often is after the technique, pressed for the scientists to authorize in the law what is enabled by the technique. Is it ethical for all that? What does the power of life and death on somebody mean because the law authorizes it? Which freedom are we talking about? And which future does a society enable us where the female model intends to build its identity by killing its children and where does scheduled murder of oldest and more injured people appear as a heights of compassion?

 The purpose of this BIOethics Manual for Young People is to discover the immense responsibility of men and women faced with the transmission of life, to think before being faced with these terrifying questions, to improve knowledge by helping everybody to perceive its own mission.

1. Manuel BIOéthique des Jeunes, by Jérôme Lejeune Foundation: freely available on request at lesgratuits@fondationlejeune.org or 31 rue Galande, 75005 Paris – 01 55 42 55 15. 

The enforcement decree relative to research on embryo and embryonic cells was signed on 6^th February 2006 and published in the French Official Journal of 7^th February. It implements the bioethics law of 4^th August 2004 which authorized research on human embryo. This text – very expected or very feared – is not a surprise, to the following reserves.

Silence about the principle of research prohibition on embryo

Everybody may have forgotten it but the law of 2004, in its article L. 2151-5, first paragraph, stated: “the research on human embryo is prohibited”.

It is only at the end of the third paragraph that, “by derogation to the first paragraph (…), researches can be authorised on embryos and embryonic cells when they are susceptible to allow major therapeutic progress and provided that they cannot be followed by an alternative method of comparable effectiveness, in the current state of scientific knowledge“.

But, the decree totally passes in silence over the principle of this prohibition which made this research on embryo a subsidiary research. Without reference to the principle of prohibition, the decree just rules the exception (the authorization of the research on embryo) which, for that reason, appears as a rule.

Silence on conditions laid down for research on embryo

The law laid down – we have just seen it – two cumulative conditions: prospects of major therapeutic progress and an impossibility to carry on researches by an alternative method of comparable effectiveness, in the current state of scientific knowledge (for instance the researches on adult stem cells or taken from umbilical cord).

But, from one hand, the decree does not mention anymore the condition which is due to the absence of alternative method of comparable effectiveness. That shows how scientists will not be much encouraged to work on adult stem cells or taken from umbilical cord. On the other hand, the decree, in its article R. 2151-1, gives a tautological and incantatory definition of the condition relative to major therapeutic progress: “are particularly susceptible of enabling major therapeutic progress (…) the researches on embryos and embryonic cells with a therapeutic purpose for the treatment of particularly serious or incurable diseases, as well as the treatment of embryo or foetus affections.”

But it is not by repeating that researches for therapeutic purpose are therapeutic that the therapeutic certainty increases, nor by detailing the list of potential beneficiaries that research on embryo will become more therapeutic.

Silence on the prohibited conception of embryos for research

The article L. 2151-2 of the law states that in vitro conception of embryo for research purposes is prohibited.

But, the modalities of the couple consent, or of a surviving member of a couple, for the research on his embryos, as they are detailed by the article R. 2151-4 of the decree, allow the creation of embryos for research.

• First, when the couple has no parental project with his supernumerary embryos, he can consent to the research on this latest. This could be the case for the 120,000 frozen human embryos.
• Then, when in vitro embryos have been diagnosed to be (by preimplantatory diagnosis) carriers of an anomaly, they can be given to the research.
• Finally, in the framework of a medically assisted procreation (MAP), the couple can “consent in writing at the same time that the embryos, which could not be susceptible to be transferred or preserved, are object of a research“.

Thus this a priori consent allows very clearly in vitro conception of embryos for research purposes which was prohibited by the law of 2004.

Is the Biomedicine Agency a machine to produce transgression?

The articles R. 2151-2 and R. 2151-15 state that “the chairman of the Biomedicine Agency can authorise a research protocol on the embryo or on the embryonic cells (…)” and “authorises the import and the export of embryonic or foetal tissues and cells for research purposes (…)“.

In the eyes of the great discretion of the decree on restrictive conditions stipulated by the law which we have just reminded – and particularly of the subsidiarity of the research on embryo – the freedom of the Biomedicine Agency to authorise or not some projects will apply thus in the field of the research on the embryo. The Agency will be able to authorise some research projects on the embryo rather than other research projects on the embryo.

Also when the chairman explains that “the mission of the Biomedicine Agency is to guarantee that researches on embryo are performed with all ethic guarantees”, it has to be understood: destroying the embryo – with competence and without polluting the environment – is globally the only ethic of the decree.

The evidence is that the Agency, to the terms of the decree, limits itself to appreciating the feasibility of the protocol, the continuity of the organisation and the research team as well as a quantity of material and procedure details which go from diplomas of the researchers to the respect of the environment, going through the registration number allocated to each embryo which will allow guarantying its traceability, as for any other commercialised product. 

In an opinion published on 26^th January 2006, the National Consultative Bioethics Committee (CCNE), which acted on its own initiative four years ago, divulges its thoughts and recommendations about the issue of anonymity, parentage secret and access to the origins in a society where the biologic parentage and the social or emotional affiliation are more and more dissociated.

Increasing dissociation of biological parentage and social affiliation

Today, 5 to 7% of children, representing 40,000 to 58,000, are born every year in “unusual conditions” (anonymous birth, medically assisted procreation with donors of gametes or donation of embryos, etc). Thus, more and more often the question of the secret relative to the mode of conception, the anonymity of the biological parent(s) and the demand to the access of the origins arises. In addition, the CCNE extends its thoughts to tackle the surrogate motherhood and the access to MAP (medically assisted procreation) or the adoption by homosexual persons.

Secret removal and maintenance of anonymity

The CCNE encourages the secret removal for the mode of conception as soon as possible by the parents themselves and invites them to be aware of the “devastating effects of delaying in revealing this secret”. In the other hand, the removal of anonymity is not recommended for the gamete or embryo donors, (gametes are not parents), but the CCNE is in favour of a child being able to access “non-identifying” information, once he/she is of age. Regarding anonymous birth, the CCNE sees a major progress in the creation of the CNAOP (National Council for Access to Information about Personal Origins) and encourages the extension of its competences. Actually, since the law of 22^nd January 2002, relative to the access of personal origins for adopted persons and children in state care, a child who is of age can have access, if he/she asks for it, to identifying information about his/her origin, after express agreement of his/her biological mother if she left information in sealed envelop.

Homoparentality and surrogate motherhood

Regarding the desire of homosexual couples to have children, “a very current issue but maybe excessive in its significance”, members of the Committee are not opposed to adoption. In the other hand, they are hesitant about the resort to the MAP which is limited by the law to a medical purpose and to the treatment of couple sterility. At least, regarding the surrogate pregnancies or surrogate motherhood, the CCNE still emits great reserves because of the body merchandizing and the confusion risks of motherhood for the child.

Availability of gametes and embryos

In appendix I of opinion No 90, the CCNE proposes an international approach of the regulation aspects. If some countries, like United Kingdom, accept surrogate mothers and gamete and embryo donation, they often encourage the removal of the anonymity in the child’s interest. Everywhere, we can feel anxiety, relative to the consequences for the child, for gamete availability. This anxiety explains that in numerous countries, oocyte donation and embryo implantation are prohibited as in Switzerland, Austria, Italy, Norway, Germany…

Anonymity to prevent infanticides 

Anonymous childbirth, which was for a long time a French exception of a legislation controlling secret motherhood and which does not impose to the biological parents to declare their identity during the recording of the baby, is followed abroad. The obligation to indicate the name of the mother generated an increase of illegal abandonment of babies, indeed infanticides, and today several countries are thinking about childbirth anonymity. Germany, Switzerland, Austria among others, established “Babyklappen”, transparent baby boxes installed in the street. A self heating bed allows collecting the baby and a seal is at mother’s disposal to leave fingerprints enabling her to be identified. As soon as a child is left, an electronic alarm alerts staff which will take care of the baby.

Protecting the baby life, encouraging the right to know one’s origins, encouraging the dissociation of affiliations by encouraging gamete and embryo donations? Is not the defence of baby’s interest the only question?