Preface (Full Text, less acknowledgements)
- In this book I address the status of the unborn, a matter that has been, in the past decade or two, highly contentious with respect to abortion1. By declaring the unborn to be persons from the moment of conception, antiabortion2 forces have sought to outlaw the procedure, in hopes of protecting unborn lives against termination by maternal choice. Their opponents, with equal vigor, have insisted on the right of women to control their reproduction, without challenge by opposing rights of the unborn.
- In 1973 the United States Supreme Court, in Roe v. Wade, a landmark case, denied the antiabortion3 position on constitutional grounds. While staking out a firm legal foundation, the Court's decision did little to relieve the political battle. Instead, the decision led to trench warfare that continues today.
- Meanwhile, other developments in reproductive biology and medicine have raised new questions about the status of the unborn. It has become increasingly clear that public policy in this area needs firmer definition if continuing controversy is not to inhibit scientific and medical advances in the public interest.
- I chose to write about science and the unborn because I am a biological scientist with a background of research in mammalian embryology4 who has had considerable exposure to medical affairs. During the past decade my professional activity has focused on the impacts of advancing biomedical science on such public policy questions as regulation of genetic technology and of external human fertilization and preembryo5 transfer (in vitro fertilization, or IVF). I have come to believe that in this general area, no matter needs more scientific clarification and greater public understanding than the nature of the unborn.
- Of course, scientific facts alone cannot dictate resolution of such emotionally wrenching issues as abortion6 — any more than can a decision of the Supreme Court. But abortion7 is no longer the only issue on which the moral, legal, and social status of the unborn weighs heavily. Moreover, further issues can be expected to arise in the not too distant future, driven by the dramatic advance of biomedical science during the second half of this scientifically enormously productive century. The advances are exciting and satisfying to those who look to knowledge as a source of human progress. But new knowledge also brings new questions and new risks, as this century is also demonstrating. Among other things, new knowledge is bringing us ever more frequently into face-to-face confrontation with the previously almost entirely covert unborn.
- How should we regard and treat the unborn? In other words, what should their status be? Should they be treated like the rest of us — in provision of medical care, in human rights, in level of social investment? Or should they remain in an ambiguous policy limbo, as if waiting in the wings (actually the womb) for their appointed entrance but with no role in the already ongoing play?
- Their ambiguity is reflected by the fact that they have no name and one does not usually know whether to refer to her, him, or it. However they may be called or referred to, almost everyone tends to be vague as to any detail of their state at any given time. From a fertilized egg (a single cell) to the enormous complexity of the late fetus8, they lie hidden in the womb (or are part of an anonymous but perhaps embarrassingly obvious pre-natal bulge). "Unborn" is a thoroughly negative, non-communicative, black-box kind of term. It does not say a thing about what is, only about what is not. The remarkable, almost fantastic, transformation of a single cell into a newborn babe — the whole seeming miracle of becoming — is concealed and obscured in the cloistered and segregated existence of the unborn.
- That is almost more than an embryologist9 can bear. It is like hiding the Mona Lisa under a shroud. In this book I want to dispel the darkness of the womb to illuminate what is within — not because that will resolve the abortion10 dilemma but rather to reveal the true nature of the process of becoming that unfolds unseen. In turn, a clearer view may offer a clearer definition of how to treat the unborn when decisions about them are required.
- However, this book does not describe all there is to know about human embryology11. To do so would require a far more detailed and much longer work. Rather, I attempt selectively to review what we know about human development (often derived from analogy with other animals) and to apply this knowledge to the question of the status of the unborn in terms of public policy. I emphasize that during the unborn period the individuality that we so prize in our society, and that is so central to the concept of a person, is progressively emerging. In truth, just as we can trace the genesis of the heart, we can trace the genesis of individuality. The matter is more difficult with personal individuality because the phenomenon and the concept are more complex.
- The full course of development encompasses at least six reasonably different aspects: genetic, developmental, functional, behavioral, psychic, and social. Each must be distinguished and considered separately and then together, in order to understand the whole process of which they are part. We shall see that they are all involved in the controversy over status, with different perspectives (the developing entity, the mother, the scientist, the judge) making one or another of the aspects, or their combination, especially significant to status.
- As an embryologist12, I cannot imagine that appropriate assignment of moral and social status can ignore the nature and developmental course of individuality. On the other hand, our purposes and objectives in assigning status are at least equally fundamental. The question of human status does not arise as an abstraction, it arises in specific contexts where the question is: How may I treat these embryonic13 cells, this embryo14, this fetus15? Whose interests must be regarded, whose is the responsibility? More specifically, should externally fertilized eggs be discarded when they can no longer be transferred to the donor's uterus? Should corrective surgery be attempted on a malformed fetus16 in the uterus, even if there is significant risk to the welfare or life of the mother?
- It is to be emphasized again that scientific facts alone cannot answer such questions. They may arise in a laboratory or clinic, but they have another dimension in the domains of morality and social purpose. But abstract moral principle or bloodless constitutional dogma are no better by themselves. In practice, these and all other relevant considerations must be applied to particular people in particular situations and in particular states of being. The matter ends up as a multiplex human judgment, with many factors having their role.
- The general policy question thus becomes one of the nature of the decision process, especially identification of the roles of all participants. Yet the decision process and its result must not offend the overall public ethos. That is the demanding requirement properly imposed by a moral society, no matter how pluralistic.
- As previously noted, it is the recent advance of reproductive science and technology that has markedly raised consciousness about the unborn and their treatment. This advance has put physicians, scientists, and technologists in a conspicuous role in relation to decision making. Yet their role cannot be that of final arbiters in reaching decisions. The questions involved extend far beyond particular expertise or any single perspective. What is needed is a widely accessible public policy process to define the shape of the permissible, even reflecting significant societal uncertainty where it exists. Without this, the connectedness of ethos and public action may be lost, leaving public policy without moral foundation.
- Given its prominence as an agent of change, the special role and contribution of science is to make generally available the most reliable relevant knowledge. Even though such knowledge alone is not sufficient to resolve heavily value-laden issues, it can at least provide a commonly shared foundation. Even if full agreement is not achieved, better-informed perspectives may offer openings for accommodation and consensus. At the least, policy based on such information is less likely to be challenged for nonconformity with established knowledge.
- It is vital that we attempt such an approach at the present time. Differences over abortion17 have aroused conflicts so deep that the effects spread and inflame many other areas of public policy. Almost unnoticed in the din, however, the battleground is shifting under the entrenched contestants over abortion18. New technological innovations have brought the unborn into more general view and in contexts other than the termination of pregnancy19. The importance of establishing a wider and sharper perception of the unborn period is thereby increased.
- For example, IVF has laid bare in a laboratory dish the primordial step in initiating a new individual — the union of sperm and egg in fertilization. The first few divisions of this primordial zygote20 cell are routinely available for examination and are accessible to manipulation. The subsequent transfer of such early entities to the maternal uterus has enabled several thousand otherwise barren couples around the world to produce a child; a small number of these transfers have occurred after frozen storage and thawing of preembryos21.
- This new accessibility of the earliest stages of human development, together with the ability to transfer them into the uterus, raises the question of status in a very different context from that of abortion22. The purpose and result of IVF is not to terminate life but to continue it. It is not a procedure of mixed benefit and harm, but one that brings unalloyed joy to the couple involved. Abortion23 aside, therefore, we must now ask how we should relate to these earliest stages in the human life history as we confront them for the first time outside the human body and on the very threshold of becoming. Who is responsible for them if they cannot be returned to the maternal uterus? Who is empowered or required to make decisions about them if their biological parents cannot or will not? Are they already individuals in the sense of human rights? What does their potential to become individuals, in the human rights sense, mean, and to what does it entitle them?
- IVF and other recent advances have raised these tough issues anew. Current U.S. policy on the status of the unborn provides no definitive answers. The questions require that the nature of the unborn, as currently understood, be specified with greater clarity and force. How can one do this when not only the questions but the substantive matters involved are so fundamental, complex, and often deeply contentious?
- The book proceeds as follows:
- It first examines the significance of status, viewing it as a thumbnail designation of how we should treat individual members of our society. The discussion highlights the special status problem presented by the unborn — that they are rapidly passing through fundamental transformations that are not fully understood but involve a progression of states that increasingly mobilizes interest and concern about individuals as persons.
- The next step outlines what we know about four major phases of human development: preembryo24, embryo25, fetus26, and neonate. Emphasis is placed on the major characteristics of each phase with reference to the kind of treatment each appears to warrant. This requires confronting not only the immediate issues raised but the wider and longer-range objectives that are the source of moral tension and conflict. At stake, therefore, is the political feasibility of specific policy options in the light of our heterogeneous collective ethos.
- Finally, I attempt an overall preliminary approach to policy formation. My approach relies heavily on stepwise assignment of status during the developmental progression of the unborn as well as on a policy process that permits continuing evaluation and modification as new issues emerge. Such an approach takes into account both the gradual elaboration of fundamental human characteristics during development and the differing degrees of urgency in the policy issues that can be expected to come into future focus. The rationale assumes,
- First, that development generates new properties central to status and that, therefore, its definition would best proceed stepwise prenatally as it does postnatally.
- Second, it assumes that our knowledge of critical characteristics that are fundamental to status — for example, sentience — is still incomplete but growing. Continuing rather than definitive decision processes are, accordingly, in order. Especially required is greater understanding of the functional maturation of the brain in relation to the emergence of inner subjective life, a subject that is inherently difficult.
- One additional general observation is worth making about the general thrust of the book. The last several decades have witnessed a steady rise in the number and importance of major policy issues that are closely tied to scientific and technological advances. Examples appear in virtually all aspects of such public policy concerns as health, environmental protection, food safety, and military security. In a society that is increasingly technologically oriented, public policy cannot be shaped effectively without judicious fusion of the perspectives derived from science and technology with those of the general culture, particularly its value structure. In this sense, science and technology must be fully interactive with values, aspirations, and purposes. Nowhere, certainly, is this more the case than in considering the status of emerging members of the human family. Here it is especially clear that scientific fact is value-laden27 and morality must be science-aware. Though morality and science may each — for some purposes — have its own distinct primary realm, neither can be excluded in considering the course of a human future.
- I don’t think this is well-put. Scientific fact has ethical consequences, but our values have no place in determining what these facts are.
- So, for example, if our reason for opposing abortion were (partly) that it is painful for the fetus, then scientific evidence that an early-term fetus cannot feel pain would undermine the argument – though others might be found.
Text Colour Conventions (see disclaimer)
- Blue: Text by me; © Theo Todman, 2018
- Mauve: Text by correspondent(s) or other author(s); © the author(s)