by: Paul Ranalli, MD

There are serious grounds for believing that induced abortion creates an increased risk of breast cancer, and that this risk may be more significant for women with a positive family history. Research studies in this field have been hampered by the omission of key information, imprecise gathering of data, and the politicized nature of the subject, all of which conspire to create significant barriers to a true understanding of the risk.

According to the Canadian Cancer Society, more than 18,000 Canadian women will develop breast cancer annually. Because it tends to occur earlier in life than other cancers and than other major causes of death, breast cancer has been shown to be the greatest cause of years of life lost by Canadian women. Despite intense interest in the public and medical research community to seek possible genetic, dietary, and environmental risk factors for breast cancer, the findings of studies linking abortion with breast cancer have generally been either minimized or questioned by the medical and research establishments.

In 1994, Dr. Janet Daling, a research epidemiologist at the Fred Hutchison Cancer Institute in Seattle, published a study in the Journal of the National Cancer Institute revealing that women who underwent an induced abortion had a 50% greater chance of developing breast cancer than matched control women who had not previously aborted. Importantly, Daling separated out women who had suffered a spontaneous abortion, and found they had no increased risk of breast cancer.

Her findings were not unique. In fact, of 14 U.S. studies to date, looking specifically at the risk of breast cancer in women with a history of induced abortion, 13 of these studies have shown an increased risk. These studies of American women reinforce earlier and subsequent international investigations that now total 33 epidemiological studies worldwide, of which 27 show a higher risk of breast cancer in women who have chosen abortion.

One of the researchers whose work has been most questioned is Dr. Joel Brind, a professor of endocrinology at Baruch College, City University of New York. At the same time Daling was publishing her results, Dr. Brind and his team were sifting through decades of published data on the epidemiology of breast cancer. Using the technique of meta-analysis to look at data from previous studies, Brind found a significant connection between induced abortion and the later development of breast cancer.

Brind and biostatistician Vern Chinchilli pooled together patients and control subjects from 28 original published reports, establishing stringent and conservative criteria to select data in which exposure to induced abortion could be separated clearly from spontaneous abortion. The overall odds ratio, for any abortion exposure, of the risk of breast cancer was found to be 1.3, a 30% increased risk (where 1.0 represents no risk).

A crucial feature of Brind's study was his careful separation of the independent effects of abortion on a woman's breast cancer risk from the previously-known risk of delaying her first full-term completed pregnancy. Brind and his colleagues argued that the two effects -delayed childbirth and abortion- are additive. A young pregnant woman who opts for an abortion relinquishes the benefit of an early completed pregnancy and, in addition, adds the independent increased risk from the abortion.

Some in the scientific community have maintained that even a 30% increased risk of breast cancer from abortion is quite small compared to, for example, the tenfold increase in lung cancer with smoking. On the other hand, the typical smoker with lung cancer has acquired his risk by smoking a pack of cigarettes a day for anywhere from 10 to 40 years, which represents 73,000 to 292,000 cigarettes. And even after thousands of cigarettes, the risk can be partly reversed if a person quits early enough. But a measurable increased risk of breast cancer comes after just one "exposure" to abortion, and abortion is not reversible.

Commenting on her 1994 study, Daling said "We don't know how this exposure is going to affect women's risk over age 45, because it has only been since 1970 that abortion has been legal in Washington state. We do know that one in four women of reproductive age in this country has had an induced abortion. So this is a very frequent exposure and only future studies are going to tell us what happens to these women that have had induced abortions as they reach the ages of highest breast cancer incidence."

For women considering abortion to have the benefit of a truly informed choice, a major shift in the medical paradigm is required. It has long been observed that the medical establishment is slow to respond to emerging data. The smoking-lung cancer link, and the relationship between diet and health, are but two examples of concepts which have taken years, even decades, to become accepted, indeed form part of conventional medical wisdom.

Fortunately, the internet age is likely to increase the availability and transparency of medical information to the public, ultimately liberating primary data linking abortion and breast cancer from the government and medical hierarchies who may be subject to political and ideological influence. Women will thus be allowed to directly inform themselves of the risks to their health posed by induced abortion.

At the dawn of the 21 st century, breast cancer has emerged as a major threat to women in the Western world. In posing a lifetime risk of greater than one in 10, breast cancer now strikes over 170,000 American women and over 5,000 Canadian women every year (Ries, 1999; Cancer Centre Update, 1997). Intense interest in the search for possible genetic, dietary, and environmental risk factors is shared by the medical research community and the public at large.

Possible Abortion and Breast Cancer Link

Pathophysiology

The observed association between induced abortion and an increased risk of the later development of breast cancer is congruent with our understanding of the hormonal effects of pregnancy on a woman's breast tissue. Prior to her first pregnancy, a woman's breast is composed largely of connective tissue linking ducts which contain few milk-producing cells. Upon conception, a surge of oestradiol reaches 20-fold in the first trimester, triggering an explosive growth of breast tissue, a period when breast cells are most likely to be affected by carcinogens. When a woman completes her first full pregnancy, further hormonal changes propel these newly produced breast cells through a state of differentiation, a natural maturing process which greatly reduces the risk of future breast cancer (Kelsey, 1979, 1981; Ewertz and Duffy, 1988).

A n abrupt, premature termination of a first pregnancy by abortion arrests this process before the cancer-reducing evolution of hormone release later in pregnancy can occur, leaving a large population of dangerously-stimulated breast tissue cells in place, enormously raising future cancer risk. On the other hand, ". . . an early first full-term pregnancy would provide the greatest protection against breast cancer by drastically reducing, early on, the presence of undifferentiated and hence vulnerable breast cells, thereby decreasing the risk of subsequent transformation." (Krieger, 1989)

Animal studies support this model. Russo and Russo (1980) exposed two groups of rats to a chemical carcinogen. One group, who mated and carried a first pregnancy to term, developed mammary tumours at a rate of 6%. The other group, who mated, became pregnant, then were aborted (via hysterectomy), developed mammary tumours at an incidence of 78%; virgin rats also developed tumours at a high rate, but not as high as those aborted.

Evidence of Risk in Humans

In 1994, Dr. Janet Daling, a research epidemiologist at the Fred Hutchison Cancer Institute in Seattle, published a study in the Journal of the National Cancer Institute (Daling, 1994) revealing that women who underwent an induced abortion had a 50% greater chance of developing breast cancer than matched control women who had not previously aborted. Importantly, Daling separated out women who had suffered a spontaneous abortion (miscarriage), and found they had no increased risk of breast cancer.

Her findings were not unique. In fact, of 14 U.S. studies to date, looking specifically at the risk of breast cancer in women with a history of induced abortion, 13 of these studies have shown an increased risk. The first of these, a study by Pike and colleagues (1981), initially funded by the U.S. National Cancer Institute (NCI) and published in the British Journal of Cancer , uncovered a 137% increased risk of breast cancer. They concluded that "a first-trimester abortion . . . before first full-term pregnancy appears to cause a substantial increase in risk of subsequent breast cancer. Our finding makes biological sense if one considers breast tissue as merely proliferating in early pregnancy; the protective effect of a first full-term pregnancy is then brought about by a combination of cell differentiation and possibly permanently altered hormone levels."

These studies of American women reinforce earlier and subsequent international investigations that now total 33 epidemiological studies worldwide, of which 27 show a higher risk of breast cancer in women who have chosen abortion. The original report of Segi in 1957 (Segi, 1957) based on Japanese women diagnosed with breast cancer between 1948-52 found a 163% increased risk. A later Japanese investigation (Nishiyama, 1982) of women with breast cancer in Tokushima prefecture found a nearly identical 152% increased risk. Along with two other positive Japanese studies, women who have undergone abortion were found to have an increased risk of breast cancer in Russia (71% increase) (Dvoirin, 1978), France (32% increase) (Le, 1984), Greece (51% increase) (Lipworth, 1995), and the Netherlands (90% increase) (Rookus, 1995).

Exposure

Some in the scientific community have maintained that even a 30% increased risk of breast cancer from abortion is quite small compared to, for example, the tenfold increase in lung cancer with smoking. On the other hand, the typical smoker with lung cancer has acquired his risk by smoking a pack of cigarettes a day for anywhere from 10 to 40 years, which represents 73,000 to 292,000 cigarettes. And even after thousands of cigarettes, the risk can be partly reversed if a person quits early enough. But a measurable increased risk of breast cancer comes after just one "exposure" to abortion, and abortion is not reversible.

The overall exposure of women to abortion is enormous. Of 1,500,000 abortions in the U.S. each year, 800,000 are performed on women with their first pregnancy. At a baseline rate of development of breast cancer of 10%, a 30% increased risk above this could result in 24,000 extra cases of breast cancer per year as these women age through the next few decades. In Eastern Europe, the phenomenon may underlie the recent alarming increase in the incidence of breast cancer in younger women. While the typical breast cancer patient in Western Europe presents in her 40s and 50s, a marked increase in breast cancer onset in the late 20s and early 30s has been observed in Lithuanian women (Rich, 1994), many of whom may have had five or six abortions by their mid-20s.

Response in North America

Despite intense interest in the public and medical research community to seek possible genetic, dietary, and environmental risk factors for breast cancer, the findings of both North American and international studies linking abortion with breast cancer have generally been ignored by North American cancer research authorities. The official website of the U.S. National Cancer Institute (cancernet.nci.nih.gov) minimizes the abortion-breast cancer link, as do other national cancer institutes, such as in Canada (cancer.ca), and among public health information groups (healthlinkusa.com). Until recently (Armstrong 2000), authoritative medical reviews of breast cancer risks have not even mentioned induced abortion.

Where a connection between abortion and an increased risk of breast cancer has been discovered, researchers have often found their findings either minimized or questioned by the medical and research establishments. Before the 1994 publication in the United States of the Daling research, the Journal of the National Cancer Institute (JNCI), stated about earlier studies: ". . . recently, foes of abortion and some scientists have been pointing to a few studies that suggest that an aborted pregnancy increases the risk for the disease." Since Daling's and other research scientists' publication of data linking abortion and breast cancer, the controversy over their findings has been discussed in the mass media, including a newspaper article in the Wall Street Journal entitled "The Politics of Breast Cancer"(1997). In this article, John McGinnis noted: "Recently . . . several respected, supposedly impartial scientific researchers have been brushing aside . . . evidence of a link between abortion and breast cancer, thus allowing the politics of abortion to discourage at least one area of breast cancer research."

A clarifying meta-analysis

One of the researchers whose work has been most questioned by the cancer establishment is Dr. Joel Brind, a professor of endocrinology at Baruch College, City University of New York. At the same time Daling was publishing her results, Dr. Brind and his team were sifting through decades of published data on the epidemiology of breast cancer. Using the technique of meta-analysis to look at data from previous studies, Brind found a significant connection between induced abortion and the later development of breast cancer.

Brind and biostatistician Vern Chinchilli pooled together patients and control subjects from 28 original published reports, establishing stringent and conservative criteria to select data in which exposure to induced abortion could be separated clearly from spontaneous abortion. The overall odds ratio, for any abortion exposure, of the risk of breast cancer was found to be 1.3, a 30% increased risk (where 1.0 represents no risk). The study is so statistically powerful that the 95% confidence interval was a tight 1.2 to 1.4 (20% to 40% increased risk), meaning there is less than a one in 20 likelihood that the increased risk of breast cancer could be anything less than 20%. Statistically, Brind's study is virtually unassailable, and its publication ignited a storm of controversy.

Effect of Delayed Childbirth

A crucial feature of Brind's study was his careful separation of the independent effects of abortion on a woman's breast cancer risk from the previously-known risk of delaying her first full-term completed pregnancy. Some critics in the medical community assert that this delayed first-birth effect is the only explanation for a claimed increased risk of breast cancer. Brind's study conclusively demonstrates that abortion is an independent risk factor in its own right. This conclusion was achieved in two ways: (1) By including studies in which the control group (women without breast cancer) included nulligravid women (women who had never been pregnant); and (2) In studies where some women had given birth, at various ages, a calculation was performed to subtract out the effect of age at first live birth. The result? The independent risk of induced abortion was still significant.

Brind and his colleagues argued that the two effects - delayed childbirth and abortion -- are additive. If it is assumed, conservatively, that an average woman's lifetime risk of breast cancer is 10% (one in 10), it is known that an early full-term pregnancy reduces this risk, from 10% to about 7%. If a young pregnant woman opts instead for an abortion, she relinquishes the benefit of an early completed pregnancy and, in addition, adds the independent 30% increased risk from the abortion, raising her risk from 10% to 13%. Thus the decision to abort her first pregnancy will nearly double her lifetime risk of breast cancer, from 7% to 13%. A second abortion will add further risk, both from the abortion itself and by further delaying the protective effects of a first completed pregnancy.

Despite the statistical power of Brind's study (or, perhaps, because of it), many in the medical and scientific community were quick to rebut his findings. The New England Journal of Medicine published a remarkably flawed Danish study (Melbye, 1997) which explained away a 44% increased risk of breast cancer in women with a history of abortion as being based on an otherwise unexplained global increase in breast cancer incidence. The JNCI offered a generic criticism of the technique of meta-analysis, stating (JNCI 1997) that "biased studies entered into a meta-analysis produced biased results."

With time, however, the quality of Brind's study has gradually begun to win grudging acceptance among important sectors of the world medical community. In April 2000, Britain's Royal College of Obstetricians and Gynecologists (RCOG) published Evidence-based Guideline No. 7: The Care of Women Requesting Induced Abortion , which said of two of the most thorough reviews of the abortion-breast cancer literature, one being Brind's meta-analysis: "These two meta-analyses were independently assessed for the RCOG Group. The assessor concluded that both were carefully conducted reviews and that the Brind paper had no major methodological shortcomings and could not be disregarded."

Even more significant was the inclusion, for the first time, of abortion as a risk factor for breast cancer in a February 2000 review of the subject by Katrina Armstrong and colleagues in the New England Journal of Medicine (Armstrong, 2000). Although abortion was downplayed as one of four "risk factors . . . less consistently associated with breast cancer", its inclusion in such a short list represents a significant acknowledgement. A 1992 review in the same journal (Harris, 1992) did not mention abortion, despite 45 years of evidence at that point.

Recall Bias

One way of explaining a clear emerging worldwide trend linking abortion with an increased risk of breast cancer, is the concept of recall bias, proposed by Harris and colleagues (1989). These authors postulated that "a woman with cancer is perhaps more likely to remember and report a previous abortion than a healthy control". If this was true, a falsely elevated apparent risk in breast cancer patients might result. The only support for this notion rests with a set of Swedish data (Harris, 1989; Meirik, 1986) which shows that, rather than non-cancer patients under-reporting abortions, several women with cancer seemed to over -report abortions, that is, apparently they declared abortions they never had (based on discordance between a computerized registry and interview data). Few workers in the field accept this concept, which raises questions about the quality of data reporting in that study. Indeed, the Swedish authors of this study eventually retracted their claim (Meirik, 1998). In any event, there are now four studies (Watanabe, 1968; How, 1989; Daling, 1994; Lipworth, 1995) whose design has conclusively ruled out any evidence of recall bias.

The importance of identifying precise studies

Over two dozen other studies of the association of abortion and breast cancer since 1960 are betrayed by various confounding factors which prevent an examination of uncontaminated data related to induced abortion. The most common error is the failure to separate data from women who have suffered miscarriages ("spontaneous abortion") from those who underwent induced surgical abortion. Spontaneous abortion has long been recognized to offer no increased risk of subsequent breast cancer, and there are clear biological reasons for this. It appears that miscarriage pregnancies are doomed from the earliest days after conception by a failure to develop the expected estrogen hormonal surge, thus these women are never exposed to the powerfully high estrogen levels of a healthy pregnancy that is abruptly terminated by abortion. The low maternal estradiol surge in spontaneous abortion was first observed by Kunz and Keller in 1976 (Kunz and Keller, 1976), and has recently been confirmed by Stewart and colleagues (1993). This biological difference between spontaneous and induced abortion underlies the flaw inherent in epidemiological studies that pool data from both groups, and points out the value of a meta-analysis such as the one carried out by Brind (Brind, 1996), which isolates and studies data from induced abortion alone.

A study that mixes spontaneous abortion cases with induced abortion is imprecise, and results in a falsely low apparent risk of subsequent breast cancer. For example, in a 1996 study by Newcombe and colleagues, which garnered prominent attention after its publication in the Journal of the American Medical Association (Newcombe, 1996), the actual increased breast cancer risk of women exposed to induced abortion was 23%, but by mixing in women who had suffered miscarriages, the risk was watered down to 12%. It was this 12% figure that was most quoted in press reports, misleading the public into believing the study showed only a minimal risk of breast cancer from abortion. It is clear that further human studies are needed which separate miscarriages from induced abortions in order to further our understanding of this important area of women's health research.

Age at First Abortion

Only a few studies (Howe 1989; Daling 1994) have looked at the question of whether a woman who is aborted at a very young age faces a significantly higher risk of developing breast cancer. In noting that the rate of cell proliferation is likely to be highest in the youngest subjects, Daling and her colleagues have suggested that the greater risk for women younger than 18 at the time of their first abortion may be real, and should be further investigated.

Family History

Although data on this subject is limited, the observations are ominous. In the Daling study of 2,000 women, 12 women had a combination of a positive family history of breast cancer and an abortion before age 18. All 12 women went on to develop breast cancer before the age of 45. The risk in this study was, therefore, incalculably high.

Summary

There are serious grounds for believing that induced abortion creates an increased risk of breast cancer, and that this risk may be more significant for women with a positive family history. Research studies in this field have been hampered by the omission of key information, imprecise gathering of data (mixing miscarriages with induced abortions), and the politicized nature of the subject, all of which conspire to create significant barriers to a true understanding of the risk. Many North American researchers who study breast cancer are unwilling to accept induced abortion as a factor worthy of study.

For women considering abortion to have the benefit of a truly informed choice, a major shift in the medical paradigm is required. It has long been observed that the medical establishment is slow to respond to emerging data. The smoking-lung cancer link, and the relationship between diet and health, are but two examples of concepts which have taken years, even decades, to become accepted, indeed form part of conventional medical wisdom. Fortunately, the internet age is likely to increase the availability and transparency of medical information to the public, ultimately liberating primary data linking abortion and breast cancer from the government and medical hierarchies who may be subject to political and ideological influence. Women will thus be allowed to directly inform themselves of the risks to their health posed by induced abortion.

World epidemiological studies on the association of breast cancer with induced abortion.

Risk of abortion presented in terms of Odds Ratios (OR), ie. OR=1.3 represents a 30% increased risk of breast cancer; OR=0.9 represents a 10% reduced risk; OR=1.0 represents no particular risk. Variability of the data is represented by the 95 per cent Confidence Intervals (95% CI), ie. The true result has a 95% cnace of falling within the described range. If the range is beyond 1.0, the data in that particular study are statistically significant.

Study		Year	OR	95% CI
United States
Pike MC, Henderson BE et. al.		1981	2.37	0.85 - 6.93
Brinton LA, Hoover R et. al.		1983	1.2	0.6 - 2.3
Rosenberg L, Palmer JR et.al.		1988	1.2*	1.0 - 1.6
Howe HL, Senie RT et. al.		1989	1.9*	1.2 - 3.0
Moseson M, Koenig KL et. al.		1993	1.0	0.7 - 1.4
Laing AE, Demenais FM et. al.		1993	3.1*	2.0 - 4.8
Laing AE, Bonney GE et. al.		1994	2.44*	1.0 - 6.0
Daling JR, Malone KE et. al.		1994	1.36*	1.11 - 1.67
White E, Malone KE et. al.		1994	---	------
Brinton LA, Daling JR et. al.		1995	0.99	0.81 - 1.21
Newcomb PA, Storer BE et. al.		1996	1.23*	1.00 - 1.51
Palmer J, Rosenberg L et. al.		1997	1.20*	-------
Lazovich D, Thompson JA et. al.		2000	1.10	0.8 - 1.21
Japan
Segi M, Fukushima I, et. al.		1957	2.63*	1.85 - 3.75
Watanabe H and Hirayama T et. al.		1968	1.51	0.91 - 2.53
Nishiyama F		1982	2.52*	1.99 - 3.20
Hirohata T, Shigematsu T et. al.		1985	1.51	0.93 - 2.48
France
Le M-G, Bachelot A, et. al.		1984	1.32	0.97 - 1.77
Andrieu M, Clavel F et. al.		1994	1.1	0.7 - 1.8
Russia
Dvoirin VV and Medvedev AB		1978	1.71	0.80 - 3.64
Yugoslavia
Burany B		1979	0.50	0.33 - 0.74
Denmark
Ewertz M and Duffy SW		1988	2.91	0.77 - 16.2
Sweden/Norway
Hoarris B-M L, Eklund G et. al.		1989	0.9	0.5 - 1.3
Adami H-O, Bergstrom R et. al.		1990	---	------
Italy
Parazzini F, La Vecchia C, et. al.		1991	0.92	0.80 - 1.06
La Vecchia C, Negri E et. al.		1993	---	------
Tavani A., La Vecchia C et. al.		1996	1.3	1.0 - 1.6
Talamini R, Franceschi S et. al.		1996	---	------
Greece
Lipworth L, Katsouyammi K et. al.		1995	1.51*	1.24 - 1.84
Netherlands
Rookus MA and van Leeuwen FE		1995	1.9*	1.2 - 3.1
Meta-Analysis
Brind J, Chinchilli VM, et. al.	1996	1.3*			1.2 - 1.4

For further information on this topic, see Women have a right to know...

Dear Editor:

I am a second year medical student. and hope to specialize in Maternal-Fetal Medicine or the new Royal College accredited Medical Genetics specialty.

I often feel alone and isolated from my profession because my values seem to be so different from those of my peers and professors. I think that the other 10-20 pro-life students in my class often feel the same way. Having active and well-known pro-life physicians in the community provides hope and reassurance; I thank you from the bottom of my heart for the work that you do.

I often worry about my future. I wonder whether I will not be accepted into Obstetrics and Gynaecology or Medical Genetics because I refuse to take part in abortions. Even if I somehow get into these programs, I'm positive I'll be facing moral dilemmas consistently. Already, with my research, I'm faced with moral issues like experimentation on leftover IVF embryos (I would never do it, but it would be so much better for my research than using mouse embryos).   PY, British Columbia

. I refuse to be intimidated by the lynch mob mentality that exploits disgusting attacks on abortion doctors as a means of smearing pro life folk as assassins and murderers, guilty until proven otherwise. Anyone who thinks abortion is non violent is not living in the real world. Do women in Canada need more than 100,000 abortions every year ? Is pregnancy a disease that make women "patients"? What is clear- and so little is in this debate- is that what we are doing now is not working. More polarization, more abortions, more hurt, loss and damage and no one is winning . Folk of good faith on both sides do have a common ground. We both want the best for women and their children. Is it possible for us to use this tragedy [Romalis attack] to come together to begin to examine new ways to understand one another and perhaps to reduce abortion rates in Canada? The Netherlands has a very low rate. Can we learn something from them? Parliament and society have tossed abortion into the laps of physicians. I don't think any of us were prepared for the consequences. Can we begin to build tentative bridges between the 2 solitudes before more harm is done?? LR, Ontario

Please use the enclosed donation to support the cause of equal access to medical service/treatments for the infertile across Canada. I believe Physicians for Life should be supporting efforts to achieve life in safe, reasonable and reliable ways, as well as arrest the destruction of life via abortion. Where are we with supporting invitro fertilization/ICSI which is fast becoming the treatment of choice for infertile couples (1 in 9)? Thank you for your efforts in 2000. Best wishes for 2001 . CC, New Brunswick

The Editor - The Globe and Mail - Monday, January 22, 2001

As a surgeon, I am called to both alleviate pain and to inflict pain upon my patients. I have observed- and empathized with- hundreds of people with severe pain. These thoughts thus emerge.

In the public conversation about Tracy and Robert Latimer, I detect three fallacies, as follows: that pain equals suffering, that pain is an inevitable consequence of surgery, and that chronic pain is necessarily intolerable.

A great person said, "Life is suffering." Pain is but one way to know suffering. Depression, disability, poverty, injustice, abuse (in all its forms), bereavement- these and other realities of life bring suffering to us all sooner or later. In my experience, even significant chronic pain rarely brings people to the point of self-harm.

Mr. Latimer seems convinced that Tracy's pain stemmed from her previous operations. Those operations were in fact performed (by a compassionate surgeon who has children of her own) to relieve pain and deformity. The vast majority of patients who have surgery for painful conditions obtain relief, either in the short or the long term.

Finally, it seems rather odd that some medicinal remedy could not be found to alleviate Tracy's pain. With the plethora of anti-seizure and analgesic drugs available, surely some safe combination must exist. Continuing pain of the degree described by Mr. Latimer simply need not- and must not- be allowed.

While it is tempting to accuse Mr. Latimer of killing his daughter to relieve his own suffering, it somehow seems more appropriate for me to examine my own heart. Do I have my eyes open to see the Robert Latimers in my own community? How careful am I to take all available measures to relieve pain for my patients, even the severely disabled? Could I walk a mile in the Latimers' shoes?

Randy Friesen, M.D. - Prince Alberta, SK

The Editor - Obstetrics and Gynecology Canada - March 6, 2001 Re: Fraudulent counselling centres put pregnant women at risk. 

"providing information on all health care options with integrity and compassion" means being sure that women understand that abortion is not a simple solution and does have long term consequences. I do my very best to provide contraceptive information to prevent unplanned pregnancies. However, I feel that it is important for women to remember that no method is 100% effective and that a choice to be sexually active needs to take responsibility for the possibility of pregnancy.

I feel that it is "fraudulent" to present abortion without dealing with the reality of post-abortion grief and depression. I agree that "women deserve access to unbiased, complete information to allow them to make a timely, independent decision on their pregnancy." I would submit that they do not receive that "complete" information if morals are excluded from the discussion.

At the very least it is inflammatory to call these centres "fraudulent" and I would ask you to apologise to those of us who believe that people are emotional and spiritual beings- not just physical ones.

Karen E. Mason, MD - Langley, B.C.

Active for many years in safe motherhood initiatives, Dr. Robert Walley founded Matercare International (MCI) in 1995. MCI is an organization of obstetricians, midwives, and other professionals whose mission is to improve maternal health internationally. These are new initiatives in service, training, research, and also advocacy.

According to Dr. Walley, it is clear from an evaluation of maternal mortality and morbidity and abortion statistics that the world cares very little for mothers and their unborn children. Simply put, mothers, most of whom are poor, young and uneducated, have no political voice to speak on their behalf. MaterCare International intends to speak loudly on their behalf.

An example of a current Matercare project is the Post-Partum Haemmhorage Research currently in progress to develop misoprostol as an effective, safe and low cost method which could be used by untrained traditional birth attendants. The first part of this project was undertaken at the Korle-Bu Teaching Hospital. A double-blind randomized clinical trial comparing oral misoprostol with i/m oxytocin on patients without any risk factor for PPH found that both medications function safely and efficiently. The results of this study have been accepted for publication by the British Journal of Obstetrics and Gynecology. A second phase is being prepared which will evaluate the use of oral misoprostol by nurse or midwives in small hospitals and rural clinics in Ghana.

An international workshop sponsored by MaterCare International and the World Federation of Catholic Medical Associations - Rome - June 17th to 20th, 2001 The future of obstetrics and gynecology: the fundamental right to practice and be trained according to conscience... Open to all pro-life doctors who are involved in obstetrical care: specialists, general practitioners or other specialities including midwifery and neonatology, etc. For further information on this conference or Matercare International, visit their excellent Website at www.matercare.org

Write Dr. Walley at MaterCare International, 8 Riverview Avenue, St. John's, NF A1C 2S5

Dr. Walley is a Professor of Obstetrics and Gynaecology at Memorial University in St. John's Newfoundland. In 1998 he was awarded the prestigious Man of Faith and Science Award by the International Federation of Catholic Medical Associations. Dr. Robert Walley is Past-President of Canadian Physicians for Life.

By Jonathan Imbody

Jonathan Imbody is Senior Policy Analyst for the Christian Medical Association.

Henk Reitsema had come to grips with the fact that his grandfather, a devout Dutchman who had fought the Nazi invasion of his country, would likely at some point in the future die from the cancer invading his lymph nodes. What Henk still has not come to grips with is that a Dutch doctor unilaterally robbed his grandfather and their family of the remainder of his life. Henk's grandfather unwillingly became one of what Dutch health surveys reveal are thousands of victims of involuntary euthanasia.

Dutch euthanasia practitioners have, under promise of anonymity and immunity, admitted to a thousand involuntary deaths by injection a year. Even so, involuntary deaths by lethal injection represent a narrow subsampling of the total death toll. Statistics published in the Netherlands and reported in the New England Journal of Medicine reveal that in three of four Dutch deaths involving medical intervention with the intent to end life (i.e., physician-assisted suicide, lethal injection, opioid overdose and withdrawing or withholding treatment), only 24 percent involved an explicit patient request for death.

Embarrassed by such revelations and intoxicated by the power of regulation, Dutch euthanasia proponents now figure they can legitimize medical killing just like prostitution and drug abuseB by making it legal. Never mind that each of the current regulations sanctioned by the courts and the KNMG (the Dutch equivalent of the American Medical Association) are violated with impunity.

As is typical with euthanasia and assisted suicide legislation, the main beneficiaries of any protections afforded are doctors- not patients. The new legislation will revise the Dutch penal code to grant euthanasia doctors a lone exemption from homicide statutes. Already deferred to by virtually submissive judges, Dutch doctors will now officially rise above the rule of law that applies to normal citizens.

The new legislation will also protect euthanasia practitioners by removing legal prosecutors from individual case reviews. Such case reviews are presently a sham, since physicians write up their own reports of what happened in euthanasia cases in which they may have been the only witness to the death. Chances are slim that a review by any board including colleagues will result in a serious challenge, much less a conviction in court. The Dutch medical autocracy is so entrenched in euthanasia that physicians who oppose it on moral and ethical grounds are finding themselves blocked from practices.

Why do polls in the Netherlands suggest widespread public acceptance of euthanasia? The Dutch tend to view as a virtue their ability to accommodate radical ideas. Their lonely position as the euthanasia capital of the world is more a matter of pride than embarrassment. The Dutch have also traditionally maintained a sublime faith in regulation, having literally regulated the sea into dry land. Such regulations, they trust, will prevent the Dutch euthanasia experiment from taking on the horrific dimensions of the Nazi euthanasia experiment.

Yet the practice remains anathema to many discerning Dutch, including the Reitsema family and others I recently interviewed in the Netherlands as a part of an ongoing research project. These are the tragic stories of a nation that has opened the door to death by doctors:

A young Dutch woman told me how her sick father-in-law had requested euthanasia after his embittered wife offered no hope of reconciliation. The daughter-in-law watched in horror as he sat up in bed after the euthanasia doctor's first injection and cried out, "I don't want to die!" The doctor continued with the second injection and he died.

A young couple, morally opposed to euthanasia, related how a doctor opined that their baby, suffering from an undiagnosed disease, might be better off left by an open window so he would catch pneumonia and die. During one of the baby's particularly difficult nights, the same doctor administered successive high doses of morphine, and the baby died within moments.

An internist told how an elderly woman patient had begged him not to admit her to the hospital, where she feared involuntary euthanasia. He calmed her fears, admitted her and began a treatment program that began to improve her condition. The internist left for the weekend. When he returned, he discovered that a colleague on call had decided the crowded hospital needed the bed and had euthanized the woman without her consent.

Ironically promoted as the ultimate in self-determination, euthanasia and assisted suicide have proven to be the fastest way to lose autonomy. Once trusted to "do no harm," a medical autocracy now kills with impunity.

Reality tends to rust the rhetorical glitter of "death with dignity" and "compassion in dying." As a still-grieving son told me of his father's death at the hands of a euthanasia doctor, "It doesn't matter how you make the decoration around it. It's just a killing."

The U.S. Christian Medical Association conducted a two month research project in the Netherlands in 2000, documenting how this nation has come to accept medical killing while just a generation ago Dutch physicians risked their lives resisting the Nazi euthanasia campaign.

According to CMA Research Assistant Michelle Wingfield, "In the intensifying battle over physician-assisted suicide (PAS), the weapons have not been equal. PAS advocates have showcased what patients fear mostC suffering, pain and isolationC offering an idyllic "death with dignity." In response PAS opponents have tried to convey true compassion, respect and hope with . statistics and dry moral codes."

The CMA is compiling video news releases, educational kits, national print media , and a book from this groundbreaking work to better equip opponents of euthanasia to take the offensive.

For more information, visit their website at www.cmda.org

CANADIAN STEM CELL RESEARCH

A discussion paper on proposed guidelines for funding of human embryonic stem cell research in Canada was released March 29, 2001 by a committee of the Canadian Institutes of Health Research (CIHR). Human Stem Cell Research: Opportunities for Health and Ethical Perspectives recommends that CIHR fund research on existing human embryonic stem cells, deriving new cell lines from fetal tissue and human embryos that remain after infertility treatments. The creation of human embryos for the purpose of deriving stem cell lines is not supported.

The Working Group recommends establishing a national oversight body to provide ethical review, in addition to that provided by local research ethics boards, of all publicly and privately funded research of this nature.

ACTION: The CIHR Working Group on Stem Cell Research is inviting comments and submissions from individuals and organizations on these proposed guidelines . The complete report and contact information is available at http://www.cihr.ca/news/forums/stem_cell/issues_e.shtml

ONCOLOGISTS REJECT EUTHANASIA

"Physicians who are better informed about end-of-life issues feel less need to use euthanasia and physician-assisted suicide," concludes the largest physician survey ever on the subject. The study findings of Dr. Ezekiel J. Emanuel, from the National Institutes of Health in Bethesda, Maryland, and colleagues, were published in the October 3 issue of the Annals of Internal Medicine . Of the 3,300 US oncologists surveyed, 15.6% indicated a willingness to provide physician-assisted suicide and only 2% to administer euthanasia to their patients.  Reuters Health, October 5, 2000

NO DOUBLE EFFECT

A study published in The Lancet concluded that the use of opium-based painkillers such as morphine does not shorten the lives of terminally ill patients. Nigel Sykes and Andrew Thorns of St Christopher's Hospice in London analysed the use of such painkillers on 238 patients in the last week of life and found that those patients who received markedly increased doses did not have shorter survival periods than those who received no increases. Nigel Sykes observed: "This study dispels the myth that good pain control at the end of life means killing the patient. People should not fear that taking morphine for pain need shorten life ... There is no connection between competent symptom control and euthanasia." Yahoo Health News - July 29, 2000

ABORTION'S NEGATIVE EFFECTS

Results of a prospective cohort study comparing the prevalence of emotional distress in women undergoing induced abortion and their partners and a control group of couples from Quebec were published in the October 2000 Canadian Family Physician . The study concluded " Being involved in a first-trimester abortion can be highly distressing for both women and men."

MIFEPRISTONE EFFECTS

A series of articles in the March 2001 issue of the Annals of Pharmacotherapy discuss the abortion drug RU486. Dr. Daniel A. Hussar, Professor of Pharmacy at the University of Sciences in Philadelphia, begins the series by discussing the controversial U.S. approval of the drug, describing how the FDA's approval decision contradicts its own pregnancy/drug risk category system. Hussar delves into the prescribing restrictions and legal ramifications of mifepristone's use, from the rights and responsibilities of pharmacists, to Searle/Pharmacia's warning regarding the risks for pregnant women of their anti-ulcer drug misoprostol, which is required to be used in conjunction with mifepristone.

Dr. Gene Rudd considers the implications of RU486 use. "The fervor of many moral objectors has led them to focus on the drug's physical adverse effects. Although these adverse effects (e.g., cramping, vaginal bleeding, risk for surgical intervention) are valid concerns, the physiological and spiritual distress of chemical abortion and the threat to the integrity of our medical profession are greater dangers."

Dr. Rudd says that in his OB/Gyn practice, he "learned that for many women, the experience of abortion has a lasting and deleterious impact on health", an impact that could be compounded by the patient's "autonomy over the experience of bleeding, cramping, and the passage of tissue.

GUILTY OF MURDER, BUT NO PENALTY

A Dutch GP, found guilty of murdering a dying 84 year old patient, has not been penalised for his action. The Amsterdam court that tried him said that Dr Wilfred van Oijen had made an "error of judgment" but had acted "honourably and according to his conscience," showing compassion, in what he considered the interests of his patient.

Van Oijen, who featured in the 1994 euthanasia television documentary, Death on Request , argued that he chose "to let his patient die in the most ethical manner."

The Royal Dutch Medical Association (KNMG) has defended his action as having "complete integrity," claiming a "huge emotional gulf" between it and the offence of murder.

The case turned on whether the injection of 50 mg of the anaesthetic drug alloferine into the patient, soon after which she died, could be considered part of palliative treatment. Expert witnesses said that it could not. Observers suggest that had the GP chosen a different drug this could have been considered normal medical practice.

The condition of Van Oijen's patient, for whom he had been a GP for 17 years, was described in court as "wretched." She was in "the very last stage of dying." She lay in a coma in a bed soaked in urine, her room stinking from bed ulcers and necrosis in her heel.

The court accepted that the "criteria of care" required to avoid prosecution in euthanasia cases had not been followed. She had made no request for euthanasia and had said that she did not want to die, there had been no second medical opinion. Van Oijen also incorrectly reported that her death was from natural causes. British Medical Journal, March 3, 2001

Culture of Death: The Assault on Medical Ethics in America

In his compelling new book, Wesley J. Smith steps boldly into the heart of battle over the American conscience. This noted author demonstrates how an obscure cadre of intellectualsB bioethicistsB has suddenly gained the upper hand in American courts and legislatures and, consequently, over each of our lives. While most Americans believe all people are created equally valuable, prominent bioethicsts now claim the value of each human life can be traded off in complex cost-benefit ratios. Incredibly, members of the bioethics elite have quietly convinced many of our judges, hospital administrators, and doctors that some human lives have relatively less value, and therefore have less right to equal protection.

Culture of Death is a clarion call to defend the fragile, yet enduring principle upon which this great country is basedB that all people are created inherently and equally valuable. Culture of Death is a book any one should buy, read and discuss with family, friends and neighbors. It is a call to action. Reviewed by N. Gregory Hamilton, MD Published in September 2000 by Encounter Books

Meeting Death: In Hospital, Hospice, and at Home

Following her father's death, author Heather Robertson sets out to examine the state of dying in Canada and finds it sadly wanting. What comes through loud and clear is that it does not have to be this way.

Confirming the findings of the Senate Special Committee on End-of-Life Care, Robertson finds that exemplary palliative care and hospice services are possible and available, but only a small minority of Canadians have access to them. Conversations with well-known Canadian palliative care physicians, such as Henteleff, Librach, Mount, Pereira, Scott, Seely, and Swift, find their way into her stories making them both educational and inspirational.

Her book includes fascinating accounts of her hospice volunteer experiences, meeting with Dame Cicely Saunders of St. Christopher's Hospice in London, and a visit to a hospice in Uganda surrounded by the ravages of AIDS and poverty.

Of her views on euthanasia, Ms. Robertson has little to say, other than that she's firmly opposed to it. The topic does come up throughout the book, as it should in any serious discussion of end-of-life issues. Ms. Robertson writes well and gives new insights into a topic of compelling and universal importance. Reviewed by Janet Les  Published in October 2000 by McClelland & Stewart

The Ethical Canary: Science, Society and the Human Spirit

This is an excellent book by Margaret Somerville who is the founding director of the Centre for Medicine, Ethics and Law at McGill University. She gives consideration to the ethical problems facing medicine today. Abortion, euthanasia, withholding and withdrawing treatment as well as several aspects of health care are among the areas presenting serious ethical problems. The chapter on Xenotransplantation (the transplantation of organs between different species) is particularly enlightening. The potential, unknown, serious problems which could eventuate are elaborated upon.

In her book, Somerville offers two litmus tests. Does the new technology in question demonstrate profound respect for life? And does it pose any kind of threat to the human spirit? The latter, she argues, is "the intangible invisible immeasurable reality that we need to find meaning in life and to make life worth living." Reviewed by Paul Adams, MD Published in November 2000 by Penguin Books Of Canada, Limited

by Wesley J. Smith

"Cloning presents humankind with the postmodernist version of the Faustian bargain."

Brave New World has arrived at last, as we always knew it would. On January 22, 2001, Britain's House of Lords voted overwhelmingly to permit the cloning and maintenance of human embryos up to 14 days old for the purposes of medical experimentation, thereby taking the first terrible step toward the legalization of full-blown human cloning. Meanwhile, an international group of human-reproduction experts announced their plans to bring cloned humans to birth in order to provide biological children to infertile couples. They expect to deliver their first clone within 18 months. The ripple effect on human history of these and the events that will inevitably follow may well make a tsunami seem like a mere splash in a playground puddle.

Human cloning is moving slowly but surely toward reality despite intense and widespread opposition throughout the world. Many resisters worry that permitting human cloning would remove us from the natural order. As the venerable Leon R. Kass has so eloquently put it, cloning brings conception and gestation "into the bright light of the laboratory, beneath which the child-to-be can be fertilized, nourished, pruned, weeded, watched, inspected, prodded, pinched, cajoled, injected, tested, rated, graded, approved, stamped, wrapped, sealed, and delivered."

Kass's point is that once human life is special-ordered rather than conceived, life will never be the same. No longer will each of us be a life that is unique from all others who have ever lived. Instead our genetic selves will be molded and chiseled in a Petrie dish to comply with the social norms of the day. And if something goes wrong, the new life will be thrown away like some defective widget or other fungible product. So long, diversity. Hello homogeneity.

Perhaps even worse, widespread acceptance of cloning would be a deathblow to the sanctity/equality of life ethic- the cornerstone of Western liberty from which sprang our still unrealized dream of universal human rights. The premise of the sanctity of life ethic is that each and every one of us is of equal, incalculable, moral worth. Whatever our race, sex, ethnicity, stature, health, disability, age, beauty, or cognitive capacity, we are all full moral equals within the human community- there is no "them," only "us."

Cloning stands in stark opposition to this equalitarian dream. It is- and always has been- the quintessential eugenic enterprise.

Today's eugenicists are not racist or anti-Semites but they exhibit every bit as much hubris as their predecessors by assuming that they- that we- have the right to direct the future evolution of humanity, only now rather than having to rely on clunky procreative planning they literally grasp the human genome in their hands. Cloning plays a big part in these plans as the patriarch of the modern bioethics movement, Joseph Fletcher, a wild eugenicist, well knew when he wrote nearly 30 years ago that cloning would "permit the preservation and perpetuation of the finest genotypes that arise in our species."

Eugenics, as awful as it is, is only the beginning of the threat posed to the natural order by human cloning. Some cloners have decided that if they are going to "play God"; they might as well do it all the way by creating altogether new life forms. Indeed, scientists have already used cloning techniques to add jellyfish genetic material to a cloned monkey embryo, manufacturing a monkey that glows in the dark. Nor is human life itself immune from such "Dr. Meraux" forms of manipulation. For example, some in bioethics and bioscience support the creation of chimeras- part human and part animal- beings Joseph Fletcher called "parahumans" who he hoped would "be fashioned to do dangerous and demeaning jobs." The bioethics patriarch wrote in his typically snobbish fashion, "Now, low grade work is shoved off on moronic and retarded individuals, the victims of uncontrolled reproduction. Should we not program such workers 'thoughtfully' instead of accidentally, by means of hybridization?"

Fletcher's dark dream of human/animal chimeras is well on its way to reality. Not too long ago Australian scientists announced they had created a "pig-man" through cloning techniques, and allowed the hybrid to develop for more than two weeks before destroying it. Last year, a biotech company took out a Europe-wide patent on embryos containing cells both from humans and from mice, sheep, pigs, cattle, goats, or fish. Where such manipulations will lead may be beyond comprehension.

Cloning presents humankind with the postmodernist version of the Faustian bargain. Through cloning, we are told, our greatest dreams can be realized: the barren can give birth, genetic anomalies and disabilities can be eliminated at the embryonic level, near immortality will be within our grasp as replacements, for worn out organs can be grown in the lab for transplantation without fear of bodily rejection. But the devil always demands his due -- the higher the "value" of the bargain, the greater the price.

In cloning technologies we may face the highest price of all: the end of the perception of human life as "sacred" and the concomitant increase in the nihilistic belief that humans are mere biological life; an increasing willingness to use and exploit human life as if it were a mere natural resource; eventually, the loss of human diversity itself- and these are just the foreseen consequences. The unforeseen consequences of mucking around in the human genome may be worse than we can imagine. As Leon Kass has written, "shallow are the souls that have forgotten how to shudder."

Excerpted from "Cloning Reality: Brave New World Here We Come" National Review , February 2, 2001. Used with permission.

Wesley Smith's latest book is Culture of Death: The Assault on Medical Ethics in America

University Faculty for Life PRO VITA VOLUME X, No. 4

An article by Norah Vincent in The Village Voice (April 26-May 2, 2000) told of the pro-life scene on the college campus. It tells of institutions of higher learning bending over backward to valorize feminists, blacks, gays, and the handicapped, while they overlook another highly vulnerable minority: mothers.

The article informs us that the basic health plan at Yale, funded in part by student tuition, pays for an unlimited number of abortions, but does not include obstetric care (available with supplementary insurance). According to statistics provided by Feminists for Life, two health centers associated with a Northeast university had 600 pregnancy tests; 300 came back positive, and only 6 of the girls had babies. The Voice asks why so many women want to abort and suggests it is because, without financial and personal support, they are pressured to believe they have no alternative.

The article, written with much assistance from Feminists for Life, tells of a Gallup Poll showing that the college experience profoundly affects women's views on abortion: 37% of women with a high-school education being pro-choice, while those who finished college are 73% pro-choice. Women tell of biased counseling: when one graduate student thought she might be pregnant, she went to the women's health center at the university for a pregnancy test: "When it came back positive, the nurse practically pounced on the phone to refer me for what she called a 'termination.' She didn't even pause to let me absorb this life-altering news, let alone ask what I wanted to do." Another told of hearing she was pregnant as the counselor reached for a Planned Parenthood card in her Rolodex. When a women's studies professor found her graduate assistant was pro-life, she denounced the assistant as purposely deceiving her.

But being pro-life can also be a liability for professors: The Voice quotes Elizabeth Fox-Genovese, a women's studies professor at Emory University: "While I was still director of women's studies, I accepted an invitation to speak for Feminists for Life in Rochester, New York. When word reached Emory, people were apparently appalled, and shortly thereafter, a group of my colleagues in women's studies went to the dean behind my back to complain about my work as director. I resigned as a result of those complaints."

The article ends by suggesting it is time for a hot new field: "maternity studies," or a lecture series: "Revisionist Herstory: Why Your Women's Studies Professors Don't Want You to Know That Susan B. Anthony, Elizabeth Cady Stanton, Sarah Norton, and Victoria Woodhull Thought Abortion was Murder."

Abortion Fare Wars
Washington Times Editorial, January 3, 2001

The number of abortions in this country has declined by 17.4 percent, dropping from a high of 1.608 million abortions in 1990 to a low of 1.328 million in 1997, the most recent year for which figures are available. That's good news; encouraging, anyway- unless you happen to be running an abortion clinic.

The New York Times came out with an unknowingly Swiftian front page story over the weekend about hard times in the abortion business. With patients fewer and clinics more plentiful- "there are not too few abortion providers, as abortion proponents have lamented for years," the newspaper wrote- competition is fierce, with price wars and one-upmanship in what you might call the amenity department becoming common practice.

Take Renee Chelian, who runs three abortion clinics in the Detroit suburbs. In an effort to draw patients, Ms. Chelian now offers a "spa-like atmosphere at her offices, with low light in her rooms, aroma therapy, candles and relaxing music." Anything to be competitive in the tight Detroit market, where two dozen clinics (plus nine more within a two-hour drive of the city) struggle to stay in business. "As altruistic as women and feminists want to be, the reality is that we can only stay in business if we earn enough to keep our door open," she says. What Ms. Chelian calls altruism would seem to have its limits.

It's not easy being an entrepreneur, but there's something mind-bendingly perverse about these bland, matter-of-fact dissections of the bottom line in the abortion industry - about offering mifepristone, the so-called abortion pill formerly known as RU-486, as "a loss leader." About mergers to offset the decline in women seeking to terminate their pregnancies; about the problems independent clinic owners have with Planned Parenthood clinics and their bargain-basement price scale. "I would sort of compare them to Wal-Mart coming in and taking over from the mom and pops," said Dr. William West of Dallas, choosing a most unfortunate metaphor. Then there's Dr. Warren Hern of Boulder, a man who found his "niche" performing second- and third-term abortions. "But now even that niche is starting to erode," he said- wistfully?- explaining that many doctors now perform late-term abortions. "Twenty years ago, there were just two or three doctors in the country doing late abortions."

That's progress for you: Second- and third-term abortions are not only not uncommon, but they can be cut out of their moral and physical context to be examined only in the driest terms of the bottom line. Why not? When anything goes, anything really does go. As Dr. William Ramos of Las Vegas put it, "I find this" - performing abortions- "to be a very rewarding practice, emotionally and financially." The only thing keeping more doctors from entering what the newspaper labels "the abortion arena," he says, is "the social stigma." Reading this story, one has to wonder, What social stigma?

Copyright © 2001 News World Communications, Inc. Reprinted with permission of The Washington Time