Course notes for students of the Edexcel syllabus on Medical Ethics Part 1: beginning of life issues

From the Paper 2 syllabus for Religion and Ethics:

6.1 Issues in medical ethics with a focus on beginning and end of life debates

(4) a) The status of the embryo, concepts of sanctity and value of life from religious and secular perspectives, embryo research, pre-implantation genetic diagnosis (PGD), stem cells and cord blood, fertilisation in vitro and destruction of embryos, abortion.

With reference to the ideas of P Singer and J Glover

DEFINITION OF ABORTION (REQUIRED FOR DISCUSSION ABOUT THE STATUS OF THE EMBRYO)

• Abortion can be defined as the expulsion of the fetus from the uterus before it can survive on its own.
• Spontaneous abortion during the early stages of pregnancy is called ‘miscarriage’.

STAGES OF FETAL DEVELOPMENT

Before looking at ethical aspects of embryology, it is helpful to know something about how an unborn child develops, as some ethicists draw a line between what is morally acceptable and what isn’t when it comes to beginning of life issues at various points in the development of either the embryo or the fetus.

• Day 1 – an ovum or egg is penetrated by sperm and one cell is formed. The newly fertilized egg is called a zygote. Note that a newly pregnant woman will be unaware that fertilization has taken place at this stage or, if an early miscarriage takes place, that the conception was lost.
• Days 2-3 – the zygote passes through the fallopian tube as cell division increases.
• Days 7-10 – the zygote reaches the uterus and is henceforth known as a blastocyst (though the term ‘embryo’ is also appropriate); it has now become a ball of cells. In many cases of ectopic pregnancy, a potential medical emergency, the embryo implants outside the uterine cavity.
• Note that the cells that will become the embryo proper are, at this stage, indistinguishable from the cells that will become the placenta and the amniotic sac.
• Up to about 14 days after fertilization, we cannot even tell if the embryo is going to be one or two individuals, because splitting can take place, leading to the formation of identical twins.
• Day 14 – the first anatomical feature, the so-called ‘primitive streak’, appears in the position in which the backbone will later develop, at about the time that it is also implanted into the uterine wall. At this point, the embryo could not possibly be conscious or feel pain.
• Weeks 2-8 : organ systems such as the brain, spinal cord, heart and digestive tube, and certain structural features such as arm and leg buds begin and then continue to develop.
• Weeks 6-8 – Brain waves become detectable; the embryo is now approximately 1 inch long.
• Weeks 12-16 – ‘Quickening’ occurs and the mother can feel the fetus’s movements; the fetus is approximately 51/2 inches long.
• Week 18 – the cerebral cortex in the fetus is sufficiently mature for pain signals to be possibly be perceived.
• Weeks 20 – 28 – the process of ‘viability’ takes place and the fetus is able to live apart from its mother, depending on its size and lung development.
• Week 40 – Birth.
• Note that the term ‘fetus’ usually applies from the 8^th week onwards.

ABORTION METHODS

There are a number of different methods for performing an abortion and the one chosen may depend on how many weeks pregnant someone is. These methods include:

• Early medical abortion (up to nine weeks). This method involves taking two tablets, one two days after the other, and together they will induce cramping that will result in the uterus breaking down and the embryo being flushed out. This may also be called medical abortion or using the abortion pill.
• Vacuum aspiration abortion (five to fifteen weeks). This method involves a tube being inserted into the vagina and using suction to remove the embryo from the uterus. This is sometimes also called the suction method.
• Dilation and evacuation (fifteen to nineteen weeks). This method involves stretching the cervix open with forceps and using suction to remove the embryo from the uterus. This may also be called D&E and be considered the suction method.
• Late Abortion (twenty to twenty four weeks). At this stage there are two options. 1 – surgical two stage abortion, which is carried out over two days or 2- medically induced abortion, both options require an overnight stay in hospital.
• Today, late abortions are likely to be carried out by the use of prostaglandin, a synthetic hormone that causes contractions similar to those experienced by a woman in labour, but which may also cause convulsions and can result in live births. To prevent the risk of live births, digoxin can first be injected into the heart of the fetus, which kills it rapidly.

THE STATUS OF THE EMBRYO/FETUS – THE LEGAL ASPECT

• See the section on the Primitive Streak (below) for a description of UK law in relation to research on human embryos.
• Before 1968 abortion was illegal in England and in most of the Western democracies except Sweden and Denmark.
• Since the 1968 Abortion Act abortion has been legal in Britain if two doctors agree that it is needed, it is carried out on registered premises and the fetus is not yet capable of surviving outside the womb (the legal term for this is ‘viable’).
• In deciding if an abortion is needed doctors typically consider whether the physical or mental health of the prospective mother is at risk, the effect of the pregnancy on her existing family and the possibility that the child will be born handicapped.
• In 1968 the latest possible termination date was set at 28 weeks. In 1990 this was reduced to 24 weeks due to improvements in modern methods of infant intensive care. There is, however, no time limit in cases of risk to the mother’s life or health or when the baby may be born handicapped.

THE SITUATION IN THE UK PRIOR TO THE LEGALIZATION OF ABORTION WAS POWERFULLY BUT EVEN-HANDEDLY DEPICTED IN THE ACCLAIMED 1966 MOVIE ALFIE. THE RELEVANT SCENES BEGIN JUST AFTER THE 5 MINUTE POINT IN SCENE 10 AND CONTINUE ON INTO PART 12.

• In 1973, in the case of Roe v. Wade (in which a pregnant woman from Texas, who was given the fictitious name Jane Roe, appealed the denial of a legal abortion), the US Supreme Court held that women have a constitutional right to an abortion in the first six months of pregnancy i.e. before the fetus becomes viable. Since then, this court has continued to uphold the core of its original decision while allowing some US states to restrict access to abortion in various minor ways.
• This meant that states could no longer make abortion a crime, as 29 of them still did in one form or another. Prior to this judgement, the options for women determined to end their pregnancy were limited. Some were able to procure an abortion from a licensed doctor who was willing to perform a termination surreptitiously. Some states also permitted abortion for pregnancies that were the result of rape, or that put the mother’s life at risk, with this latter category extending to women who were declared to be at risk of suicide by a sympathetic psychiatrist. Others travelled as far afield as Mexico, Japan and Europe to obtain an abortion.
• Unsurprisingly, there was a significant decline in maternal mortality and obstetric injury following the ruling.
• In recent decades, European nations, including Italy, France and Spain have liberalised their abortion laws. Even Ireland and Poland now permit abortion in some circumstances, though at the time of authoring these notes that situation may be about to change with regard to Poland.
• Worldwide, only a handful of countries, mostly in Latin America, prohibit abortion entirely.

THE STATUS OF THE EMBRYO/FETUS – THE MORAL ASPECT

Many writers on this issue have tended to identify a point in the development of the embryo or fetus beyond which experimentation (in the case of embryology) or abortion (in the case of the unborn child) becomes morally wrong. This section of these notes will look at these morally significant dividing lines whilst introducing the concepts of the sanctity and value of life from both religious and secular perspectives.

Before Conception

• In the Old Testament book of Jeremiah Chapter 1 verse 5 we find the phrase, ‘Before I formed you in the womb I knew you.’ This passage could be used to argue that the Bible teaches that God knows and plans the existence of every person even before they are born. Therefore some Christians believe that it is wrong to spoil this plan by preventing the unborn child from being born by having an abortion.
• However, this passage only concerns the birth of the prophet Jeremiah specifically and may therefore not be meant to apply to all human beings.

Conception

• Another important Biblical passage that is sometimes appealed to by Christians to show that abortion is always wrong is found in the book of Genesis, where humans are described as having been made in the ‘image of God’ (imago dei).
• This is understood by Christians like this to be a teaching about the sanctity of life, the idea that human life is sacred and special to God.
• The word ‘image’ refers to idea that each human life is unique, in both an individual and collective sense. Individually, there is no one quite like us. Collectively, we are the only creatures made by God that have a soul (and the ability to reason according to Christian philosophers like Aquinas). This sets us apart from the animal kingdom and means that all human life, at whatever stage of development, should always be preserved where this is possible.
• NOTE: Jonathan Glover has defined the sanctity of life in a non-religious manner, referring to it as the principle that ‘taking human life is intrinsically wrong.’ This is a principle that Glover thinks we should abandon. Instead, he supports the more qualified view that taking human life is normally directly wrong when someone’s life is deemed to be worth living and they are in possession of a level of consciousness that allows them to appreciate this for themselves. For example, on page 138 his influential book Causing Death and Saving Lives, he states that, ‘there is nothing intrinsically good in a person merely being alive and…the idea of a ‘right to life’ should be rejected. The alternative view proposed is that ‘the objections to killing…are two: it is wrong to reduce the amount of worthwhile life, and it is wrong to override someone’s autonomy when he wants to go on living’. Glover regards this approach as one ‘to be identified with what creates…the best total outcome’ (page 186). In other words, as his Wikipedia entry states, Glover’s ‘approach is broadly consequentialist (utilitarian), though he gives significant weight to questions of individual autonomy, the Kantian notion that we ought to treat other people as ends in themselves rather than merely as means.’ In developing his views, Glover is critical of the principle of double-effect and the acts/omissions doctrine. Note that double-effect is discussed below and the acts/omissions doctrine in part two of these notes (on end of life issues).
• He also regards all attempts to identify a morally significant dividing line in the development of an unborn child as ‘futile’. More will therefore be said about these aspects of Glover’s overall thesis at various points in the notes that follow.
• Moving on to church teachings about the sanctity of life in relation to the embryo and fetus, the Roman Catholic Church teaches that it is always very wrong to kill an unborn child, at whatever stage of development, because it is a sacred human life. Even if the pregnancy is the result of rape, the Catholic Church would not support an abortion, because it is thought that the fetus should not have to pay the price for someone else’s crime.
• Roman Catholics therefore try to encourage women not to have abortions if they really cannot cope with bringing up the child.
• The Roman Catholic Church has also made several statements opposing abortion, including Humanae Vitae, a papal encyclical (letter from the Pope sent to all Catholic bishops) in which Pope Paul VI emphasised that ‘human life’ is sacred. However, Humanae Vitae  is not regarded as an ex cathedra expression of papal infallibility that has to therefore be accepted by all Catholics.
• Nevertheless, Roman Catholic thinking in this area has also been influenced by the medieval philosopher Thomas Aquinas.
• According to Aquinas’s principle of double-effect, an action may be permitted if: 1)the action is moral 2) the person doing it intends the main effect of the action to be good rather than bad and 3) there is another, unavoidably bad effect which also results from the same action.
• In cases of abortion, the principle of double effect might justify a Catholic doctor who is morally opposed to abortion performing an operation on a pregnant woman who will die if her cancerous womb is not removed. As long as the doctor intends to save the mother’s life and there is no other way to do so apart from having the operation the secondary effect (abortion) is allowable in these circumstances.
• However, our intentions are hidden from others and so this principle makes it possible for us to conceal what might be our malicious intentions from others.
• This may be particularly significant if the principle of double effect comes into play where euthanasia is concerned. For example, a doctor who wishes to prevent pain in a dying patient may give that patient a drug which the doctor knows will shorten the patient’s life. As long as the Doctor’s main intention is to relieve pain, the secondary effect (eventual euthanasia) is allowable.
• However, it the doctor stands to benefit from the will of their patient, this principle may be compromised.
• Jonathan Glover devotes several pages of Causing Death and Saving Lives to an extended critique of the double effect principle. One memorable example he cites is that of a man trapped in the cabin of a blazing lorry with no hope of being freed who asks a bystander to shoot him so as not to suffer an agonising death. Glover notes with disapproval that adherence to the principle would prevent the bystander from doing so, as it rules out intentional killing as morally wrong.
• Another possible position that a Christian opposed to abortion might take is that the newly fertilised egg is a potential human individual and that it is wrong to kill any being with this potential.
• An atheist might also oppose abortion from the point of conception on these grounds, given that one human life is all we are going to ever get to enjoy and that to deny a fertilized ovum that possibility is wrong because that potential human being will never get to experience what is, in effect, a rare and precious opportunity to experience human existence.
• However, there is a problem with this idea. Most students of Religious Studies have the potential to become Prime Minister, at which point they will receive special rights and privileges e.g. police protection/bodyguards. But it would be absurd to say that right now they have the right to bring a bodyguard to the lesson because they are a potential Prime Minister. So even if a fetus is potential human being this does not mean that it should be entitled to the same rights that we have.
• On the issue of potentiality, Jonathan Glover has this to say: ‘The problem with using the foetus’s potential for developing into a person as an anti-abortion argument is that this suggests that the person it will become is what is really valued. It is hard to see how this potential argument can come to any more than saying that abortion is wrong because a person who would have existed in the future will not exist if an abortion is performed. I would not be here if my mother, when pregnant with me, had opted for abortion. But equally I would not be here if my parents had used an effective contraceptive. It is hard to see how the potential argument can succeed against abortion without also succeeding against contraception. And even those who are against both normally want to say that abortion is worse than contraception.’
• The Anglican Church (Church of England) also opposes abortion but recognises that there can be circumstances when abortion would be morally acceptable, such as when the pregnancy threatens the life of the pregnant woman, where the pregnancy is the result of rape, or when the foetus may be born severely handicapped.
• Supporters of a weak sanctity of life stance realise that the advances of medical science have meant that the boundaries between life and death are far more flexible than previously thought and so would allow exceptions to the general sanctity of life position. If it is not clear what constitutes independent ‘life’ or when independent life begins then there may be certain situations in which abortion is morally justified. Christian proponents of a weak sanctity of life stance tend to balance the Bible’s pro-life teachings with Jesus’ emphasis on love and compassion as a justification for abortion in certain cases. 
• The utilitarian philosopher Peter Singer and utilitarians more generally would not consider the zygote to have any moral status because it is not conscious and has not yet developed a nervous system that would make it capable of experiencing pain.

The Primitive Streak

• The primitive streak, which appears at a time two weeks after fertilisation, describes the point when a groove appears on the surface of the developing embryo. It marks the point at which the embryo begins to differentiate itself into what will eventually be a multi-layered organism.
• It could be said to be morally significant because it marks the beginning of individuality, as if the zygote turns into twins this almost always happens before this point.
• It also has legal significance: the UK Human Fertilisation and Embryology Act of 1990 only allows research to be carried out on human embryos up to this 14 day point in time.
• As already noted above, this development has no moral significance for utilitarians as the embryo is neither conscious and has no nervous system that might cause it to be capable of experiencing pain if it was aborted at this stage.

Consciousness/Detectable brain wave activity

• Brain activity has been found to begin between the sixth and eighth week of pregnancy.
• For supporters of abortion who appeal to the absence of a capacity for consciousness as a basis for their argument, this development undoubtedly creates a problem.
• However, it could be argued that brain activity develops gradually, and that at this stage the brain is too primitive to be capable of experiencing pain.
• It is difficult to know if there can be any pain or genuine consciousness of any kind without a fully functioning cerebral cortex.
• In humans, prior to about 18 weeks of gestation, the cerebral cortex is insufficiently developed for synaptic connections to take place within it.
• In other words, the signals that give rise to pain in an adult are not being received.
• Between 18 and 25 weeks, the brain of the fetus reaches a stage where there is some nerve transmission in the parts of the cortex associated with consciousness. In other words, some signals are starting to be received.
• However, even at this stage, the fetus appears to be in a persistent state of sleep, and therefore may still be unable to perceive pain.
• The fetus begins to ‘wake up’ at around the 30 week point, well beyond the stage of viability.
• Overall, this suggests that 18 weeks of gestation as the earliest time at which the fetus can feel pain.
• Prior to this point, to believe that the fetus is conscious we would have to hold that the fetus has some way of feeling pain that does not require synaptic connections in the cerebral cortex. This is possible but we have no evidence of it.
• The overwhelming majority of abortions (over 85% of those performed in the USA, for example) are performed in the first trimester, that is, when the fetus is less than 13 weeks old.
• Therefore, most abortions are unlikely to involve any experience of pain for the fetus.
• For utilitarians, the capacity for the fetus to possibly experience pain at the 18 week point has moral significance. For example, Peter Singer has commented that the interests of the fetus in not suffering should be taken into account at this stage.
• However, this does not mean that abortion automatically becomes wrong for all types of utilitarian at this point. It just means that the potential suffering of the fetus would have to be taken into account as far as an act utilitarian is concerned, while a rule utilitarian might have to consider whether a rule about not causing unnecessary harm to a fetus that might be able to experience pain would have to be considered.

Quickening

• This term refers to the point in a pregnancy when the mother-to-be can feel the fetus move inside her for the first time.
• Usually, this happens in the middle of a pregnancy, at about the 18 to 20 week point, though women who have already had more than two children report being able to sense movement between the 15^th and 17^th week of pregnancy.
• The Catholic Church, following the teachings of Thomas Aquinas, used to teach that this was the time when the fetus received its soul.
• However, ultrasound scans have shown that fetuses start to move as early as 6 weeks after fertilization, long before this movement can be detected by the mother.
• And the teaching about ‘ensoulment’ has subsequently been abandoned by modern Catholic theologians.
• In addition, it is hard to see how the capacity for physical movement – or the lack of it – can have any bearing on the moral status of the fetus. For example, when someone loses their ability to move through paralysis, this does not mean that they suddenly lose a right to life that they previously enjoyed.

Viability

• This term refers to the point at which the fetus is capable of surviving outside the womb.
• Until the development of modern methods of intensive care, it was generally accepted that a baby born more than two months premature could not survive.
• Now a six month old fetus – three months premature – can often be pulled through, thanks to sophisticated medical techniques, and fetuses born as little as five an a half months after gestation have survived.
• In the UK, the Human Fertilisation and Embryology Act of 1990 gives the fetus legal protection from the 24^th week onwards. This is intended to roughly correspond with the point of viability.
• Viability is also where the US Supreme Court drew the line in the case Roe v. Wade. This was ‘because the fetus then presumably has the capability for meaningful life outside the mother’s womb.’
• However, the judges who wrote the decision did not say why the ability to exist outside the womb makes such a difference.
• One possibility is that a capacity for independent existence apart from its mother might be of moral significance.
• However, no premature baby delivered at this time would survive without medical assistance.
• The notion of completeness might be another way to think about viability. The idea would be that although the fetus is not fully formed at the point of viability because there is still much development still to take place, it is sufficiently complete for us to think of it as a new being that is deserving of moral status.
• However, if we think of the fetus as a potential human life from the moment of conception, then critics of abortion could argue that the fetus has this potentiality both before and after the point of viability, which makes viability an arbitrary point at which to draw any legal or moral boundary.
• Critics of viability can also point to the gradual nature of development, which again makes it arbitrary to think of one stage of completeness as being crucially different from others.
• Finally, up to the point of viability, a supporter of abortion might argue that that the fact that the fetus is totally dependent on the mother for survival means that it has no right to life independent of her wishes.
• However, in other cases where one person is totally dependent on another, we do not think that the person they are dependent on may decide whether they should live or die. For example, in a case where a hiker breaks her leg five days’ walk from the nearest road and may die without help from a travelling companion, we do not believe that it is right for the companion to take the life of their injured friend.
• So if dependence does not justify making viability into a morally significant dividing line, it is hard to see what does.

Birth

• Birth may be thought to be morally significant as it is the point at which a baby no longer relies totally on its mother for its survival.
• We also tend to be less disturbed by the destruction of a fetus we have never seen than by the death of a being we can see, hear and cuddle.
• However, the philosopher Colin McGinn has pointed out that if a fetus was scheduled to be aborted on a certain day but then the mother gave birth prematurely before her appointment, that it seems strange to think that it was now suddenly wrong to do what was previously seen as acceptable, simply because the baby has left the womb.
• From this we can conclude that what matters as far as the abortion issue is concerned is not where the fetus is killed but what it is: its stage of biological and mental development, or the potential it has to mature and develop into a human being.

Personhood

• According to the utilitarian philosopher Peter Singer, a person is someone who is self-aware (sentient), has some kind of ability to reason,  and knows that they have a future. According to Singer, this entitles them to moral consideration: it is more morally wrong to do bad things to persons.
• But for Singer, we only become like this quite a long time after we have been born.
• So for Singer, a fetus is therefore not a person at any stage in the pregnancy.
• Given that it is not until many months after we have been born that we start to think of ourselves as persons, Singer is in favour of infanticide in certain situations.
• For example, he thinks that it is not wrong in some cases to kill severely disabled infants or to not make strenuous efforts to keep them alive e.g. if they had suffered such severe bleeding in the brain when being born that they would never be able to breathe without a respirator or were anencephalic (born without major parts of the brain, skull and scalp) and therefore would never become conscious.
• The capacity to suffer is another important consideration for Singer, so that if a child is severely disabled but not in pain this may rule out withdrawing treatment.
• Although he thinks that personhood confers full moral status upon the being that develops it (and considers some animals to be in possession of personhood), Singer still believes that from the 18 week point of gestation, when the fetus may acquire the capacity to experience pain, ‘the interests of the fetus in not suffering should be taken into account in the same way that we should take into account the interests of sentient, but not self-conscious, non-human animals.’

Jonathan Glover and Peter Singer compared

• Both offer secular but somewhat different perspectives on the issues that are mentioned in this part of the syllabus. Interestingly, Singer was taught by Glover
• Glover describes all attempts to draw moral dividing lines when it comes to stages in the development of the fetus as ‘futile’. For example, viability is demonstrably a shifting boundary (due to advances in medical technology) and is therefore too arbitrary as a cut-off point, and he has this to say about birth: ‘If we could see the foetus from the outside, would we still be so sure about the immense difference between the foetus-baby just before and just after birth? If we would not, this suggests that enthusiasm for this boundary is more the result of the foetus being out of sight than any real ‘onset of personality’ at birth. Additionally, he is sceptical about personhood, as he considers there to be no single feature or features (e.g. being conscious, being capable of some degree of thought, having a sense of one’s own identity) that can be readily identified as indicative of this status and there is no special reason to to think that they all appear at the same time and at the same rate. In this respect, Glover’s views differ markedly from those of Peter Singer.
• However, like Singer, Glover does not consider abortion to be morally wrong. For example, in cases where a fetus may be deemed to be incapable of living a worthwhile life, due to, say, a severe genetic abnormality identified through amniocentesis, or as a result of a woman contracting German measles early in her pregnancy, then it may not be morally wrong to abort the unborn child. The claim that killing is directly wrong because it overrides someone’s autonomy is one that does not arise for Glover in relation to both abortion and the killing of a new born baby as, ‘However much one may regard a new-born baby as a person, it would be absurd to suppose that it has any desire not to die, or even the concepts of being alive or dead on which such a desire depends.’
• In this respect, Glover’s views might be said to converge with those of Singer, as autonomy implies personhood. And like Singer, Glover is also not opposed to infanticide.

JUDITH JARVIS THOMSON – THE UNCONSCIOUS VIOLINIST

• Note the unusual spelling of ‘Thomson’ – there’s no ‘P’
• A discussion of Thomson’s famous thought experiment would go very well with any question that mentions rights – the fetus’s right to life or a pregnant woman’s right to decide what happens to her body.
• In her famous example, Thomson asks you imagine that you find yourself hooked up to a famous unconscious violinist. If he can’t use your kidneys for nine months, he’ll die. You are in this position not because you agreed to be but because the Society of Music Lovers kidnapped you. All the same, the violinist himself is perfectly innocent; he played no part in putting you in this situation.
• Thomson thinks that someone in this position would not be morally required to allow the violinist to use their kidneys for nine months. The violinist’s right to life does not, she says, entail a right to the use of someone else’s body because you had not consented to save the violinist.
• The parallel with any pregnancy that results from rape is apparent here. But Thomson intends her thought experiment to apply more widely, to any pregnancy that was not deliberately planned e.g. through ignorance, carelessness or contraceptive failure.
• Having said this, Thomson does not argue that every pregnant woman has a right to an abortion, even if a fetus is a person, but only that some do. For example, she recognises that a woman who voluntarily risks pregnancy may not have such a right.
• Suppose someone found themselves hooked up to the violinist as the result of a case of mistaken identity. Perhaps they were visiting a sick friend but got lost in the hospital and the team of doctors treating the violinist thought they were someone who had volunteered to be connected. In this case, Thomson’s argument still seems relevant, as ending up in this situation seems to be a high price to pay for the ignorance and carelessness that caused it.
• However, a critic of Thomson might argue that in all these circumstances there is the possibility of adoption. Giving up a newborn baby for adoption might be psychologically more demanding than parting from the violinist, as would carrying and eventually giving birth to a child that was the result of an act of rape, but these demands arguably still do not trump the innocent fetus’s right to life.
• And the feminist law professor Catherine MacKinnon has argued that the relationship between a pregnant woman and the fetus she is carrying is not like an impersonal relationship between a woman and a sick violinist she has become connected to, a connection between separate beings where the sovereign rights of one party trump those of the other. It is far more intimate. As MacKinnon writes, the fetus is ‘in her and of her, and is hers more than anyone’s.’ So Thomson’s analogy is not helpful or relevant when it comes to moral decision-making about abortion because it is too far removed from the actual experience of being pregnant for a woman.
• Note that Thomson is arguing that we are not always obliged to take the best course of action or to do what has the best consequences. Her argument is based on a theory of rights that allows pregnant women to justify their actions quite independently of their consequences.

EMBRYOLOGICAL RESEARCH, IVF, AND PRE-IMPLANTATION GENETIC DIAGNOSIS, STEM CELLS AND CORD BLOOD

• Firstly, as previously noted, the UK Human Fertilisation and Embryology Act of 1990 only allows research to be carried out on human embryos for up to 14 days. This is the point at which the primitive streak appears (see above), which is taken as the first sign of human individuality.
• Embryo research can be of considerable medical value because it can lead to greater understanding of genetic diseases and may also help to improve the treatment of infertility.
• In Vitro or ‘in glass’ Fertilisation (IVF) is a form of fertility treatment which is designed to assist couples who may not be able to conceive naturally. Up to five people may be involved in this process. Sperm may be taken from either a donor or the prospective father, and eggs from a donor or the prospective mother. The sperm is then used to fertilise the eggs in a laboratory (hence the expression ‘test tube baby’), and the resulting embryo or embryos are then implanted in the womb of either the prospective mother or a surrogate. Embryos left over from this process may also be used for medical research.
• Pre-Implantation Genetic Diagnosis is a more specialised form of IVF. After a number of embryos have been produced, they can be checked for the presence of the genes that are responsible for severe, inheritable genetic conditions, such as cystic fibrosis, Huntington’s disease and Tay-Sachs disease. Embryos that are found to be free of these devastating conditions can them be implanted into the womb.
• Tay-Sachs disease is a rare inherited condition that mainly affects babies and young children and is usually fatal. It used to be most common in people of Ashkenazi Jewish descent (most Jewish people in the UK), but many cases now occur in people from other ethnic backgrounds. The symptoms first become apparent at around three to six months of age, with the baby gradually losing the ability to turn over, sit, or crawl. This is then followed by seizures, hearing loss and eventual paralysis, with death usually occurring by the age of four. Prenatal genetic testing is available for Tay-Sachs but can only be performed during pregnancy. That can leave parents with the difficult choice of having to terminate the pregnancy of a Tay-Sachs afflicted fetus.
• In the USA, PGD was deployed to help Renee and David Abshire, a couple who are not Ashkenazi Jews but who had previously lost a daughter to this disease. Although the Abshires oppose abortion, they were reluctant to have more children until they knew that the offspring would be unaffected. So the Abshires agreed to try this form of IVF treatment. This was the first time that it had been deployed to detect Tay-Sachs. Accordingly, four of Renee Abshire’s eggs were fertilized in a lab dish with her husband’s sperm and allowed to grow to eight cells. One cell was then removed from each embryo and tested to see if it carried the two copies of the Tay-Sachs gene which make the eventual onset of that disease inevitable. 
• Laboratory tests showed that three of four fertilized eggs were unaffected by Tay-Sachs. All three embryos were then implanted in Renee Abshire but only one developed into a fetus. Brittany Abshire, who carries no gene for Tay-Sachs disease, was eventually born by Caesarean section.
• NOTE: The case of Philippa Handyside in the BBC Horizon Documentary Who’s Afraid of Designer Babies? serves as another example of how PGD works. It can be viewed HERE and the relevant sequence begins just after the 3 minute point.
• Some Christians nevertheless disapprove of IVF treatment because it results in the creation of spare embryos that are viewed as potential human beings and are therefore opposed to the use of these embryos in medical research. Additionally, the involvement of donor sperm and eggs, and the possible use of a surrogate mother are regarded as introducing additional people into the relationship, something which is deemed to be unacceptable. Catholics therefore see this as a form of ‘technological adultery’ , which also explains their disapproval of AID (Artificial Insemination by Donor sperm).
• Infertility may additionally be regarded as having been willed by God. But does not exclude the possibility of adoption.
• However, fertility treatments may be perceived as opening up further possibilities as far as observing the Biblical injunction to ‘be fruitful and multiply’ are concerned.
• When Christian teaching about agape is foregrounded, the possible alleviation of suffering caused by the most devastating illnesses might then be seen as justifying research on embryos and stem cells, as well as procedures like PGD, with the case of the Abshires serving as an especially compelling example.
• AND: the bioethicist George Annas has suggested that if a fire was to break out in a fertility clinic and we had time to save either a 5 year old girl or a tray of twenty frozen human embryos, we would think it odd if someone thought that the embryos were more deserving of rescue.
• From this we see that just because the embryos have the potential to develop into a human being this does not mean that they should enjoy the same right to life that the 5 year old girl does. So we should not accept that a potential person should enjoy the same rights as a person.
• On the other hand, an opponent of embryo research might still argue that in non-emergency situations, it would still be wrong to deprive the world of a future human being.
• Embryo research may also be perceived as a form of ‘playing God’ on the part of those undertaking the research, especially when it involves the use of stem cells.
• Stem cells are found in embryos and the material of which they consist has the capacity to develop into the more specialised cells that play an important role in the functioning of the body e.g. ‘liver’ and ‘brain’ cells. There is hope that research on stem cells might lead to the eventual emergence of treatments for a range of currently incurable medical conditions.
• Some Christians may also be opposed to the use of stem cells taken from embryos because they think that an embryo has a moral status conferred by church teachings about the sanctity of life.
• Cord Blood refers to the umbilical cord. Stem cells taken from cord blood can be used to treat medical conditions that might develop in the child or other family members. If held by the NHS in a public blood bank rather than privately, cord blood additionally becomes available for any patient who might benefit from its use.
• Storing cord blood does not involve the destruction of embryos and is therefore not vulnerable to the objections that are raised on the basis of teachings about the sanctity of life with respect to IVF, PGD and embryo research.
• However, concerns have been expressed about medical staff failing to monitor the health of the mother when the child is delivered in their eagerness to preserve cord blood. Some private companies also charge parents heavily if they wish to have cord blood stored in case it is ever needed for the treatment of the child later on in life (the chances of this are rare but the fee is expensive).

EXTENSION MATERIAL: PRO-LIFE VERSUS PRO-CHOICE IN AMERICA/RONALD DWORKIN

In the USA abortion is fiercely and bitterly debated in everyday politics. For example, Republicans have traditionally been pro-life and Democrats pro-choice. Donald Trump was a Republican president, and many were concerned that it would become more difficult for women to get abortions when Amy Coney Barrett was appointed to serve as an Associate Justice of the Supreme Court, the highest court in the country.

Trump had repeatedly promised to nominate Supreme Court justices who would overturn Roe v. Wade. This becomes possible when cases in the lower courts concerning abortion are referred to the Supreme Court, where rulings are then made through majority decisions resulting from deliberations among its nine serving members. Barrett is strictly Catholic and a member of the religious group People of Praise. Her presence on the Supreme Court is thought to have tipped the balance towards those favouring a reversal of Roe v Wade.

As abortion is such a controversial issue (approximately 47% of Americans are pro-choice and 46% pro-life), this has given rise to some startling recent historical facts about the subject. So if there is an opportunity to include one or two of these in your answers, it could improve them. Be careful though. You will need to be absolutely spot-on with the details.

NOTE: the information below is taken from this publication, which is possibly the most important contribution to the ongoing abortion debate in recent years:

• In the 1980’s and 90’s, a fundamentalist anti-abortion Christian organisation called the Army of God were responsible for 8 murders, 41 explosions and 173 arson attacks at abortion clinics.
• According to Army of God beliefs, abortion is murder and the killing of hundreds of thousands of defenceless babies in those clinics is nothing less than a government approved ‘Holocaust.’ The doctors who work in them are viewed as committing crimes against humanity.
• The attacks caused many clinics to close and scared off many doctors and nurses from working in them.

• Some abortion statistics: In 2015, approximately 700,000 women in the USA had an abortion. Of those, more than 1/3^rd will already have had children.
• By the age of 45, approximately 1/3^rd of American women will have undergone an abortion procedure.
• Although abortion has been legal in America since 1973, abortion is the most regulated procedure in the US, and some states force women to have a compulsory ultrasound scan and to listen to a doctor describe what can be seen in the scan before they can get an abortion.  Some US states also require women to wait an extra 48 hours for an abortion after they have formally requested it.
• During the 1980’s, one US state forced doctors performing the procedure to tell their patients that ‘the unborn child is a human life from the moment of conception’.
• A famous American cartoonist called Gary Trudeau had his popular cartoon strip called ‘Doonesbury’ temporarily banned from some US newspapers when he took on the topic of abortion. The cartoon’s story line focused on a law introduced in Texas and other states requiring a woman who wants to have an abortion to be compelled to undergo a sonogram, which shows an image of a foetus and other details, in an attempt to make her reconsider. The strip portrayed a woman who turns up at an abortion clinic in Texas and is told to take a seat in “the shaming room”. A state legislator asks whether she has been at the clinic before, and when she says she has been to get contraceptives he replies: “Do your parents know you’re a slut?” Later, she says she does not want an intrusive vaginal examination but is told by a nurse: “The male Republicans who run Texas require that all abortion seekers be examined with a 10-inch shaming wand.” The nurse adds: “By the authority invested in me by the GOP base, I thee rape.” NOTE: ‘GOP’ stands for ‘Grand Old Party’, another name for the Republican Party. The cartoons can be seen by following this LINK and scrolling down the page.
• In 2005, Hurricane Katrina struck the city of New Orleans in Louisiana with devastating effects. Some pro-life Christians saw this natural disaster as a punishment from God because Louisiana has 10 abortion clinics and 5 are in New Orleans. The shape of the Hurricane was also compared to a 6 week old fetus. For more on this, see this ARTICLE.
• Abortion has also been mentioned in connection with the ‘Black Lives Matter’ campaign, with one pro-life supporter declaring, ‘Planned Parenthood kills over 266 unarmed black lives every day.
• Abortion has also been the subject of provocative rap video lyrics. For example e.g. a song by Nick Cannon called ‘Can I live?’ is sung to his abortion-minded mother as she lies on a clinic table next to a tray of surgical instruments and features the lines, ‘Hopefully you’ll make the right decision and don’t go through with the surgical incision.’

• Catholic politicians in the USA who are pro-choice have been severely criticised for their views and it has been suggested that they should be denied an opportunity to celebrate Mass.

Ronald Dworkin on the Sanctity of Life, Abortion and Euthanasia

The late Ronald Dworkin was a philosopher who specialised in the philosophy of law. He is also a very famous philosopher and therefore might be worth mentioning in student answers, provided that what he has to say is relevant to the question that has been set, which it would in most cases, since he has interesting things to say about the religious concept of the sanctity of life, personhood, and the legality of abortion.

In his 1993 book Life’s Dominion, Dworkin attempts to resolve the abortion and euthanasia debates (more detail about his thoughts about euthanasia is included in the separate course notes on this topic) by first of all identifying a point of agreement between the opposing sides. He cites polls indicating that a large part of the citizenry, both in America and abroad, believe both that abortion should be legal and that abortion is, in one sense or another, morally wrong.

Since reasonable people could not hold that abortion is murder and that it should be legal, Dworkin concludes that most people believe that abortion is morally wrong for reasons that are nothing to do with whether the fetus is regarded as a person or not.

What is shared by opponents in both debates, according to Dworkin, is the idea that life is in some way sacred and therefore merits protection. A secular (non-religious) conception of the idea of the sanctity of life can be found, for example, in the view that a human being is the most important creature that Nature has produced. This is echoed in Shakespeare, as when Hamlet declares ‘What a piece of work is a man!’, and when the character James Tyrell, having arranged the murder of the princes in the tower for Richard III, quotes a killer as being appalled that he has ‘smothered the most replenished sweet work of Nature that from the prime creation e’er she framed.’ This non-religious understanding of what a human being is can explain why we might feel moral revulsion about the act of murder, without having to involve God.

However, like Peter Singer, Dworkin forcefully rejects the claim that fetal human beings have a right not to be killed, on the ground that beings who are not, and have not yet been, conscious cannot have any interests of their own that can be impeded through a withholding of this right. So although he does not think that the issue of personhood is central to the debate about abortion, Dworkin is still of the view that a fetus is not a person.

Nevertheless, the failure of those arguments that maintain that the fetus is a person does not settle the question of the legality of abortion; there remains the question whether the argument from the sacredness of life is sufficient to justify legal restrictions on this practice.

Dworkin argues that the state has a duty, grounded in its obligation to protect liberty of conscience, to respect the different, reasonable opinions about the sacredness of life held by citizens on both sides of the abortion and assisted suicide debates.

Hence the state is barred from prohibiting either practice, though it may encourage citizens to reflect seriously about seeking abortion or assisted suicide, but only if it leaves the individual free, in the end, to make the choice to seek or refuse either procedure. 

A minor criticism of Dworkin’s position is that his arguments to ground the rights to abortion and assisted suicide in religious and secular liberty of conscience (freedom of thought/belief) would be more effective if they were slightly recast as arguments grounded directly in a more general principle of autonomy (freedom of action – the ability to make your own, independent decisions), according to which rational, mature beings are allowed to choose for themselves what to do if they become pregnant or terminally ill. Glover, of course, appeals to autonomy in developing his own position on beginning and end of life issues.

This too might be given both a religious and a non-religious basis. For example, most Christians believe that, having been created imago dei, God has given them free-will to make moral decisions, and they also believe that they will eventually be judged on the basis of those decisions. So why withhold that freedom when it comes to crucial, life and death choices? Surely the choices we make in these situations are the ones that most define us. And from a non-religious point of view, the ‘pro-choice’ position assumes an ability to make mature, responsible decisions from the outset.

Another criticism is that it is possible to rationally believe both that abortion is murder, and that it should be legal, on the grounds that the consequences of it not being legal might be that women would then put their lives in danger by seeking back street abortions. So keeping abortion legal would be the lesser of two evils. This is the position taken by the US politician and minister, the Reverend Jesse Jackson.