Post Date: 10/8/2015

ABORTION: NEW ETHICAL CHALLENGES

Humans have argued for centuries over when human life begins and what its value is. Ancient Middle Eastern law codes: Ur Nammu (Sumer, reigned 2047-2030 BCE) to Hammurabi (Babylon, reigned 1792-1750 BCE) considered the fetus to be equivalent to a body part of the mother, both of which belonged to the father. Ur Nammu's law code prescribed that someone who caused the loss of a fetus would have to pay money for it. Even causing an intentional miscarriage was not a capital crime. The value of a fetus ranged somewhere between the fine for a slap in the face to loss of a limb in a fight. Hammurabi's Code was similar, probably taken from Ur Nammu. The Bible followed this tradition. Exodus 21: 22, probably first written down several hundred years after Hammurabi, also prescribes a fine for an accidental miscarriage caused when men who are fighting bump into a pregnant woman and cause her to miscarry. Intentional abortion is not discussed. To reinforce the point that the life of a fetus was not of the same worth as that of its mother, both Hammurabi and the Bible prescribe life for life, eye for eye, tooth for tooth.....when the mother is injured in the above altercation.

The Orthodox Jewish view is that life begins at the first breath after birth, when the soul enters the body. This idea derives from Genesis 2:7, "Yahweh Elohim fashioned a human, dust from the ground, and blew into his nostrils the breath of life, and the human became a living being." (translation from Commentary on the Torah by Richard Elliot Friedman) Several hundred years later the Pythagorean Greeks taught that the soul entered the body at the moment of conception (although they had no idea when that was.) The Roman Catholic Church subsequently adopted this view. The Greek Stoics taught, as does the Bible, that the soul entered the body at the first breath. Hebrew, Greek, and Roman societies all equated the soul with breath. This ancient certainty about the soul entering the body is notable since the human egg was first identified by Karl Ernst von Baer (1792-1876) and sperm were first identified by Anton Leeuvenhoek (1632-1723.) This latter gentleman also invented the microscope, which was a necessary instrument to make both of these discoveries. Fertilization gained some concrete meaning only after these discoveries were made.

In American society today, religious viewpoints on when human life begins range from conception (when the sperm fertilizes the egg) to when the newborn takes its first breath, to the Reform Jewish concept that life begins when the child is accepted to medical school. Our understanding of fertilization, implantation, development, and delivery have all improved compared to our understanding thousands of years ago when our holy books were written. Do our ethical principles regarding conception and birth require similar updating?

Human life cannot be simply defined although many try to do so. Let's review the complexity.

At present, to begin a new human life, a sperm must fertilize an egg. The most common way to do this is through sexual intercourse. Fertilization may also be accomplished in vitro (IVF) by taking sperm from a man and an egg from a woman, and mixing them together. This has been done hundreds of thousands, if not millions of times. Resulting embryos may then be implanted in a woman, not necessarily the egg donor, and brought to delivery. There are millions of frozen embryos in the United States today that may never be implanted. These meet a religiously conservative definition of "life." Do they have a "right to life," a "right to be born?" In the near future new humans may also be cloned from older humans. Sperm and egg will be bypassed, so the soul, if there is a new one, would have to enter at the first breath after birth. Cloning has already been accomplished in several mammalian species. In humans the cloning technique is now basically an engineering and ethical problem.

To return to sexual intercourse: this interaction may be enthusiastic, willing, accepting, reluctant, or horrifying. All, in spite of what some politicians believe, can produce pregnancy. A child conceived under each of the above circumstances may be viewed quite differently by either or both parents. Some are wanted, loved and nurtured. Some are not. Some are despised because of the circumstances of their conception. Particularly in the case of rape, the pregnant woman may become mentally ill because of the fetus growing in her.

Fertilization takes place in the fallopian tubes. Cell division begins as the fertilized egg moves down the fallopian tube to the uterus. There, implantation can take place in the endometrium and pregnancy tests become positive. This is the medical definition of pregnancy. Rarely, implantation takes place in the fallopian tube. This is an obstetric emergency. The developing embryo will die because a normal placenta cannot develop. But the mother's life is also threatened because of bleeding at the implantation site. Surgery is required to save her life. A sizeable percentage of fertilized eggs never implant. Various contraceptive methods work either by preventing ovulation, preventing implantation, or, in the case of condoms, preventing the sperm from entering the vagina. People with different religious views object to some or all of these contraceptive methods. The Roman Catholic Church objects to all except the "rhythm method," confining intercourse to times when the woman is supposedly not ovulating. Couples who practice only the rhythm method are called "parents."

After implantation, the embryo begins developing and differentiating. Recognizable body parts such as limbs appear. During this time the fetus is totally dependent on the interaction of the mother's endometrium and the fetal placenta for oxygen, nutrition, and the removal of wastes. Also, during this time of development, a number of fetal abnormalities and diseases that could cause lifelong suffering for the baby and parents may be diagnosed through amniocentesis. This procedure involves insertion of a needle through the mother's abdomen into the amniotic sac of the developing fetus and aspirating fluid that contains fetal cells. These can then be analyzed for genetic defects. Many diseases that plagued children and parents in the past can now be eliminated by abortion. Genetic counseling can inform the parents of the likelihood of a recurrence which may be preventable by IVF, embryo testing and selection, and implanting only disease-free embryos. Life threatening or life altering diseases such as Sickle Cell Anemia, Tay-Sachs, and Hemophilia can be eliminated from a family line in one generation.

Fetuses aborted during these developmental stages can provide tissues for medical research. This is routine at University Medical Centers throughout the United States and Europe. Researchers with programs approved by institutional research ethics committees allow departments of pathology to release tissues from aborted fetuses for medical research. Administrative fees are usually charged as they are when other organizations such as Planned Parenthood provide them. Abortions are never performed just to sell the fetal tissues to researchers, as has occasionally been charged by politicians. Advances made using fetal tissues include the development of vaccines for Polio, Rubella, and Shingles. These viruses grow particularly well in fetal, not adult tissues. Fetal stem cells are also much more versatile than adult stem cells and can be used to study the normal and diseased development of essentially all human organ systems.

At our current level of medical knowledge, the fetus develops to the point that it can survive outside the mother after about six months of gestation. This time period varies and will probably shorten as our medical sophistication improves. But, survival outside the mother does not mean independence. It means that some fetuses after six or more months of gestation have lungs that are mature enough to provide enough oxygen that the fetus does not require a placenta and endometrium. Such a six to seven month fetus is absolutely dependent on highly sophisticated, very expensive, medical technology to survive and mature. Many don't survive. Many who do have lifelong medical disorders that resulted from their prematurity. Many fetuses are spontaneously lost along the way for a variety of reasons, largely developmental abnormalities. Many children are, however, still born with such preventable diseases. Probably less than half of the fertilized eggs make it all the way from implantation through normal delivery.

If a fetus is carried to term, about nine months, it is ready for normal delivery. With modern obstetric care, normal delivery is pretty safe for the mother although abortion is statistically safer. Humans have very large heads and the human female pelvis is barely able to accommodate such a large head in the birth canal. Caesarean section may be a lifesaving treatment in severe cases of cephalo-pelvic disproportion. Before the current era, lots of women died in childbirth from bleeding, or afterward, from infection. Modern medicine has improved, but not eliminated both of these problems.

After birth the child is still totally dependent on the parents (mostly the mother) for everything: food, shelter, prevention (vaccination!) and treatment of infectious diseases, treatment of any congenital abnormalities, and so forth. It then enters a decades-long process of learning to walk, learning to talk, learning to read, learning to think, becoming physically (but not necessarily mentally) mature enough to reproduce, learning a trade, etc. Human life, from fertilization to death in old age, passes through many different stages. The beginning is promise and potential; actualization of hopes and dreams comes later and gradually, if at all.

So, human life in utero is not simple. Fertilized eggs, implanted embryos, developing fetuses, normal and diseased, are all separate stages of human life. There is a lot of loss along the way, even under normal circumstances. Pregnancy for a woman is also a highly variable experience. Some pregnancies result from love. The baby is wanted. Some are accidents, but the baby still loved or, at least, accepted. Some accidents result in a pregnancy that is definitely not wanted. Some pregnancies make the mothers mentally as well as physically ill. Some threaten the lives of mothers, such as when the fetus causes toxemia of pregnancy, a potentially fatal complication for which the only definitive treatment is abortion.

An unwanted pregnancy and birth is very likely to result in a child whose life is a burden to the mother and unfair to the child. Shouldn't a child be wanted, loved, and nurtured? The Earth has too many people right now. Most infants do not have an opportunity to make the most of him/herself. For those of us who are privileged, the prevalence of misery among our fellow humans should be shameful. Abortion, both here and abroad, is one way to assure that most children who are born will be wanted, will be disease free, and can be given a good chance to make the most of themselves. And, the best way to make abortion rare is to make the whole variety of effective contraceptive methods available to all women worldwide. Two to four thousand years ago, when some of our early thoughts about the worth of a fetus were first written down, our ancestors could do little to regulate our reproductive process and assure that all children born were wanted and could be adequately nurtured. Now we can do both. What new ethical obligations do these new capabilities give us?
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