Going Back to the Beginning

By now, everyone who pays attention to the news has heard about the mandate from the Department of Health and Human Services, requiring that all employers, including religious employers, provide coverage without copay for contraceptives, birth control devices, the "morning after pill" and sterilization procedures. This decision has been greeted with outrage, petitions, vows of civil disobedience, and possibly protests in the streets. However, some people seem to be strangely puzzled about all this public outcry. "It's just birth control, it's just women's preventive care, what's the big deal?" they say. Well, I will be happy to explain. Before I can address "the big deal" about birth control and the morning after pill etc, I have to make sure we all start on the same page. This is the first in a series of blogs which will show the many problems with this mandate.

To begin with, we need to establish a basic common understanding of sexual reproduction. In the human, there are two types of gametes, or sex cells, which unite (under most circumstances) within the fallopian tubes of the woman in a process called fertilization. As we all know, one type resides within the woman and is called the ovum, or egg; the other, called the spermatozoa, or sperm, resides in the man and can be of the genetic type to produce either a male or female phenotype (physical expression of the genes) when united with the ovum. The spermatozoa penetrates the protective layer around the ovum, and essentially injects its cellular contents into the ovum. Among most ethicists, for simplicity's sake, that is considered the point of conception. There is some fairly esoteric debate about whether conception actually occurs at penetration, or at syngamy (the point of unity of the genetic contents) or at the first mitosis of the new cell's genetic contents. In any case, when the sperm injects its cellular contents into the egg, the egg's nucleus dissolves, and the sperm's genetic content unites with that of the egg. At that point, there is no longer a sperm and an egg, but an entirely new cell, a new genetic code, a new human...a zygote.

Now, starting with a zygote, we have a single celled, living, individual human. Here is where the arguments generally begin. So far, we have been talking about basic biology. Nobody argues about that anymore; it has been observed and reproduced (if you'll pardon the pun) in the lab. As the zygote is a living cell, with a unique human genetic code, separate and individual from either of his or her parents, it is a human person, possessing human rights. This is the point I intend to argue from here on.

There are many ethicists who advance different criteria for personhood of the human organism. Some, for instance, argue that the zygote (blastocyst, etc) is not a person until he implants as an embryo into the uterine wall and sends hormonal signals to the woman's body, announcing his presence, as it were. However, this argument is akin to the old philosophy joke question "if a tree falls in the woods, and nobody hears it, does it make a noise?" The answer is yes, of course, because the vibration of the air is independent of whether anyone is there to perceive it. The same is the case with the zygote. He is present, whether anyone knows it or not, and awareness of someone's presence does not alter his essential nature.

Other ethicists, taking a gradualist approach, argue that personhood is something that is either built up gradually or achieved at various points of development: a heartbeat, human appearance, sentience, brain wave activity, self awareness, or the sense of a future to name a few. All of these criteria for "achieving" personhood are silly; and accepting any "gradual personhood," or "achievement of personhood," particularly in the case of some of those criteria, have very serious ethical consequences when carried to their logical conclusion. As for the presence of a heartbeat, sentience, brainwave activity, and self awareness, all of these may be temporarily absent or suspended in a born human, of whatever age, as in a medical emergency or a coma or in anaesthesia, or even sleep. Very few people argue that someone who has been in a coma and reawakens is not the same person she was before, despite any loss of faculties that might have occurred. I'm not writing a book here, so I won't get into the weeds of the debates back and forth about hypotheticals regarding people in comas unless someone brings it up to me in a comment, in which case I'll be happy to. By the same token, nobody would say that someone who was briefly clinically dead and has had the luck to be restored to life is not the same person they were before. Or that someone asleep is not a person, and someone awake is.

Now, of course, the other side argues that the pre-born person has not yet acquired these traits and therefore is not a person; while the comatose, sleeping, anaesthetised, or temporarily dead and resuscitated have already acquired personhood and merely have their faculties suspended, but still intrinsically present in a latent state. Aha! That's the point. For example, a pre-born baby girl is unable, depending on her developmental stage, to emit detectable brainwaves (this begins around day 40, post conception) but she has the latent potential to do so, if she is left alone to develop. Would you expect a five year old to be able to understand and write equations for thermodynamics problems? No, of course not. It's beyond her stage of development...but she could do it in a few years if she's left alone to grow up and is taught properly. In other words, she has the innate capacity for higher intellectual processing but is not yet developmentally ready to exercise it. The same is the case for every other criterion for personhood that the gradualist can put forth. Every time, the answer is the same: the pre-born baby (or neo-nate) may not have the developmental capacity to do x but does have it innately, as a part of their nature as a human.

This is apparent in the example of Tom Brady, quarterback for the New England Patriots. Had he not been taught how to play football as a young boy, or had he chosen to go to Hillsdale College in Michigan, rather than the University of Michigan, we might never have heard his name: but he would be the same person in himself, with the same innate, latent, though undeveloped, talent for passing a football and marrying supermodels. I'm not saying his personality would be completely the same, but that his humanity, his personhood, his Tomness would be the same, regardless of whether he were an unheard of economics major from Hillsdale or the quarterback that almost all my guy friends have a man-crush on.

Let me present the two most cogent and logically consistent points of view on personhood. First of all, the point of view of the well known bioethicist Peter Singer (and Micheal Tooley, and others): personhood is an acquired trait, requiring at least the following--self-awareness, sentience, consciousness, and a sense of future. He argues that a baby is not a person until most likely around 18 months to 2 years of age. He suggests that parents be allowed to kill their babies, if they are disabled or the "wrong" gender or for whatever reason, up to about age two months to be "conservative," as he puts it. By the same criteria for personhood, he advocates euthanasia for the severely disabled and those with dementia who, according to his definition, are no longer human persons. While I completely disagree with him, and find his point of view despicable, I can't help but admire his logical consistency. He agrees with pro-life people who ask what the difference is between a 28 wk fetus in the womb, who is being aborted legally because her mother doesn't want her, and the pre-term baby, born at 28 wks, in the NICU fighting for her life and receiving all medical care possible whose parents do want her. He agrees that if the only difference is a matter of location, it is logically ridiculous. His logic is chilling, but consistent. It denies personhood, human rights, the benefits of humanity to large segments of the population: the disabled, the elderly, the very young, the comatose, victims of traumatic brain injuries, etc.

Imagine a world where people with Alzheimer Disease are no longer granted human rights...we could quickly find out exactly what's going on in their brains just by doing some craniotomies, we could test medications on them the way we do on monkeys, we might find the cure for cancer or AIDS! Just think! Wouldn't it be wonderful to have living human bodies to experiment on with all the latest drugs? It would shorten the FDA approval process for new medications! Wait a minute, that's what some very bad people tried back in the bad old days before the Civil Rights movement in Tuskegee. That's what Josef Mengele was charged with crimes against humanity for. So, maybe this isn't such a great idea after all. It has been used before, to justify all kinds of atrocities. It never ends well.

Now, to the other side of the coin: the other, logically consistent and coherent, uncomfortable idea of personhood. Personhood is an intrinsic part of being a living human. As soon as you are a living human individual, you are also a human person, with human rights. This means that from the moment that a zygote comes into existence, whether in the fallopian tubes of a woman or in a petri dish in a lab, there is a unique living human person with human rights at a particular stage of development. How can a single cell be a person? Well, she's human...living, unique (not in the sense of genes, but in the separateness from the parental gametes, because she may twin and recombine or may be a result of SCNT, or somatic cell nuclear transfer aka cloning), and she's at a certain stage of development that happens to be one celled. We all started out this way. You were a zygote once. You were a four-celled blastocyst once. You were an embryo, a fetus, a neo-nate, an infant, toddler, school child, adolescent, young adult...you are, or will be, mature, then a senior citizen, then you will die. At each of these stages, you are capable of different things, cognitively, socially, and physically. No one expects a new born to look the same as she will when she is 21 years old. It's ludicrous to expect an embryo at 6 wks gestation (usually the earliest a woman suspects she is pregnant) to look like or perform the same functions as a 6 wk old infant.

The chain of human development is continuous, from conception until death. No one says that you are a different person once you have your first tooth fall out than you were when you had all your baby teeth. That's ridiculous. It is similarly ridiculous to say that someone is a different person, in fact, a different type of being entirely when she is born than she was 40 wks earlier when she was conceived. The only difference is that the growth and development, more rapid and amazing during this time of a human's life than at any other, takes place hidden from sight within the mother's womb. The science of embryology has come a long way; scientists know more now than ever before about the development of the pre-born human, and none of them argue that there is no human there, or that there is some magic point when the human changes his or her nature completely. It's all a continuum, and happens so rapidly and exponentially, that it is amazing that there are as many successful pregnancies as there are. Given the fact that there is no way that the successfully conceived human zygote could become anything but a human baby (or twin, and become identical twins), it makes the most sense to say that human personhood, like human development, is constant, present from the beginning, and intrinsic to the human state. Therefore, all humans, at whatever stage of development, deserve the protection of their human rights. At the very least, they deserve the protection of their lives from willful destruction, as do you and I. Nobody can take my life or property without due process of law...and I'd like to know what offense a zygote ever committed just by existing, not through any choice of his own, but through the choices of his father and mother. That is a discussion for another time, however.

In summary, there are three basic points of view on human personhood and when it is achieved and human rights must therefore be granted: the gradualist approach, with its various benchmarks toward personhood; the acquired by sentience approach, with its pitfalls and grim logical conclusion; and the innate personhood approach, which is the most ethically prudent and acceptable approach however socially problematic. The gradualist approach appears to be most common among those who haven't thought much about this issue. In my observation, people are very much against aborting a fetus in the second or third trimester, but not so much against it in the first. Why? Well, because...it's more developed...it looks like a baby...it could live if it were born...etc. All these are variations on the gradualist approach to personhood. I have only met a very few people (thank God) who ascribe to the view that personhood and human rights are not acquired until full self awareness and a sense of future etc. are acquired, and that human rights can therefore be lost. This is the view of Singer and his ilk, and seems to be the undeclared view of certain of our politicians (more on this later) both in the United States and abroad.

The view that I espouse, that personhood and human rights are intrinsic, belong to us from conception until death, and are continuous, is held by multitudes of others, though some have thought about it and others have not. The purpose of this particular blog was to get everyone back to the beginning of the debate: when do we deserve human rights? What are the different views about at what point the title of "person" can be given to a human? And what the heck does all this have to do with the HHS mandate? Well, read the next couple blogs and you'll see.