More on Abortion and Mental Health

Michael Cook at BioEdge is making the mistake I blogged about briefly last week!

Here's the issue: This review study from the National Collaborating Centre for Mental Health (NCCMH) finds that while unwanted pregnancies have a negative effect on women's mental health, the mental health of women with unwanted pregnancies was no different whether they had an abortion or gave birth.

Now, 98% of all UK abortions are performed to preserve the physical or mental health of the mother; of those, 99.96% involve mental health. Should we infer, with BioEdge and with the Christian Medical Fellowship, that those abortions are inappropriate, because the NCCMH study proves that abortion doesn't preserve mental health after all?

We should not. NCCMH looked at rates of mental health problems among women who had had unintended pregnancies, some of whom had chosen to terminate them with abortion, and some of whom had given birth. It found similar rates of mental health in those two populations. But the women in those populations were in them by choice. The study does show that women who choose abortion have no better or worse mental health than those who do not. But it certainly doesn't show that their mental health would have been the same if the option to abort had been denied them, and they had been forced to give birth. The study, in other words, leaves open the question whether abortions are good for the mental health of the women who choose them.

The Meaning of Geron's Stem-Cell Decision

Michael Cook at BioEdge says the decision by Geron to end its human embryonic stem cell spinal-therapy research is a huge blow to those who believe in the therapeutic potential of hES cells. I have to disagree. It's true that the tissue-generating potential of hES cells was overblown in the battle to secure funding for hESC research. But I don't think Geron's move stands for anything greater than what it was: the decision of a single firm that its cancer research was more profitable than its stem-cell research. University-based work with hESCs and induced-pluripotent cells have shown real progress toward the tissue-generation goal; and, additionally, researchers are using stem cells as tools for drug-testing and for the analysis of diseased cells--work which is quite apt to have short-term therapeutic payoff.

Note, too, that while Geron had secured funding from the California Institute for Regenerative Medicine for its trial, it has given the money back with full interest, so there's no story here of wasting public funds.

Deadish Donors

BioEdge is reporting on a proposal made this summer in AJOB, and repeated this year at the ASBH meeting, to do away with the dead donor rule. The basic argument is that 1) the legal definition of "brain death"--total cessation of all upper-brain and brain-stem function--seldom applies to people we term "brain dead," because there's typically a little bit of residual functioning left; and the cardiac-death criteria depend, often, upon a decision being made not to revive someone who, in other circumstances, might be considered revivable (e.g., someone whose heart stopped 90 seconds ago). So, given that we're already harvesting organs from people who are only problematically "dead" according to our current, flawed, definitions, why not just tell the truth, do away with the dead donor rule, and substitute a regime of honesty about the complexity of death, and informed consent? The difficulty, of course, is with the politics and public understanding of the rule. No matter what kind of public education you attempt to do, if you were to announce the end of the dead-donor rule, a certain segment of the population would flee from being organ donors because of fear that they'd be "killed" for their organs.

Note: Harvard's Bob Truog has been making very similar arguments against the dead donor rule for years.