A Physician Looks at Abortion On the Biological Basis of the Abortion Issue By N. Karle Mottet "For there is nothing either good or bad, but thinking makes it so. To do o do an abortion is to destroy a human life. The sanctity of human life is the fundamental ethic involved. Evidence is presented herein to show that legal and social considerations in the abortion issue are secondary to this fact. Much of the public debate has glossed over the crucial biologic facts and centered on the social, economic, and legal aspects. My aim is to present some biological information and concepts which should be helpful in considering the derivative issues. Paramount among the latter is the ethical one. Has our civilization evolved to a point where the right officially to sanction the destruction of human life under certain social situations is permissible, desirable, or necessary? If so, in what situations, and who is to decide? Is the sanctity of human life an eternal (divine, if you will) principle, or is it relative like the sense of values expressed by Hamlet? "Life" exists on several levels of organization. That abortion N. KARLE MOTTET, M.D., is professor of pathology in the University of Washington School of Medicine and director of hospital pathology at the University Hospital in Seattle. Recipient of numerous honors, as well as two research fellowships at Cambridge, he is a consulting editor for the Yearbook of Science and the McGraw Hill Encyclopedia of Science and Technology. is the taking of a life in a biological sense is indubitable. To equivocate on whether an embryo (fertilization to two months of development) or a fetus (two months to birth) at a particular stage of development is alive or not is to confuse social with biological existence. To illustrate this distinction one can most easily perceive the separation at the termination of life. The events associated with the assassination of President John F. Kennedy, a man known to all of us and whose biologic and social existence affected us all, is a convenient example. Until that fateful November day in Dallas he was a vigorous, personable, social being, actively learning, thinking, and responding to events around him. A moment later, after the bullet had destroyed his brain, he was still alive in the biological sense that, except for his sensorium, the organs of his body were functioning and working in concert. He was still biologically (and legally) alive though as a social being he was no longer capable of response. Had the situation been different his body might have been hooked up to instruments that would have kept his body alive for months or years. This state of human existence in which the body is alive but the individual is incapable of social response, I shall term "somatic life." As his body died some minutes or hours after his existence ceased as a social being he was not dead on a cellular level. Even after the autopsy and funeral it would have been possible to remove some types of cells from his body and to maintain them in a living state in a nutrient medium in the laboratory. I recount these painful thoughts to illustrate an important principle, namely that an individual is organized in an hierarchical manner and life may exist at one level of organization and be absent from a higher level. Nearly all of us see this in our family lives in a less dramatic way. With advancing age, senility and a gradual destruction of brain function often ensue until a loved one may be completely unaware that he exists in time or space. His social being has ceased to exist though his organs and their component cells continue to be alive. Is he "alive" or "dead"? Genesis Let us now turn to the other extreme of the life spectrumits origin to examine the genesis of a "life" hierarchical order. All animal life from a miscroscopic one-celled creature, such as an ameba, or the human fertilized egg to the most complex multicellular animals such as the human adult, have certain features in common. They are able to take in nutrients, burn the nutrients to produce energy in order to move, reproduce, and eliminate waste. In the multicellular animals these functions are carried out in specialized groupings of cells forming organs and organ systems, whereas in the ameba the functions are carried out within a single cell. The genesis of a human being is the development of a onecelled individual (the fertilized egg) into a complex multicellular one. I use the term "individual" because biologically each fertilized egg is genetically unique from all others on earth and unique from all others throughout history! Within the fertilized egg is the "plan" or genetic program that is the principal determinant of the features of subsequent development. There is no point in this process of transition from fertilization to bodily death where a particular chemical structure, or event, appears that can be identified as a new, unique property only found in the living. There is no break in the continuum from fertilization when the species number of chromosomes is established to somatic death. Life first exists on a cellular level. Atoms are grouped in an orderly manner to produce the structures that make up a cell. The next step in the developing hierarchy of organization is the orderly and controlled integration of cells into tissues and organs. The orderly arrangement of tissues and organs produces, in turn, the somatic (body) level of hierarchical organization. The cellular, tissue, organ, and somatic levels of organization are very rapidly established during the early phases of the development of the human embryo and normally remain intact until somatic death. In the human and some other forms, the orderly grouping of individuals is called society, the top rung of the ladder. Loss of controlled order at this level is called chaos. Development From fertilization to about one week after the first missed menstrual period the human embryo receives its nutrition by diffusion from the surrounding uterine tissues. At about 2 weeks after the first missed period the embryo's heart starts beating and primitive blood circulation is established (the embryo at this time is only 2 mm. long-barely visible to the naked eye). This assures the embryo a source of nutrition and respiration by way of the placenta from the mother. Organization and specialization of cells, tissues, and organs proceeds extremely rapidly. By the eighth week of development the human heart is a miniature of the adult heart, yet its size is slightly larger than the head of a pin. With these essentials assured the embryo rapidly establishes its organ systems which are, for the most part, complete by the end of two months' gestation. The remainder of pregnancy is mainly enlargement of the structures already established. The increasing size is of no significance to our consideration. Whereas most organs are formed and function early in pregnancy, some exceptions exist. For example, whereas an embryo is capable of producing antibodies against some kinds of foreign agent early in development, it is incapable of producing others until some months after birth. These are usually provided in the maternal milk. Brain function, as revealed by recordings of electrical brain wave activity, begins between the twentieth and twenty-fourth week of development (approx. 600 grams body weight). Some organs such as the breast are established very early in development, yet they don't become functional until 12 to 15 years after birth, and then only on demand. Other reproductive organs follow a similar pattern. Birth During part of the period of organization of a miscroscopic single round cell, the fertilized ovum, into an organized, complex individual, it leads a decreasingly dependent existence. At first it is totally dependent in utero, later (at approx. 100 gm.) potentially independent, then largely dependent until after 2 or 3 years of age, and totally independent some time thereafter (usually at age 18 in our culture). The event of birth merely represents a change in the mechanisms of nutrition and respiration from indirect contact with the external environment to direct. With birth the mechanism of nutrition and respiration changes, eliminating the maternal intermediary between the individual and the environment, thereby becoming a free living, rather than parasitic, individual. (Some may accuse me of male chauvinism for de-emphasizing birth as an event. The emotion and beauty of the event are as impressive to me as to others but it is not relevant. I am here referring only to its life support features.) While the human fetus is resting in utero for more than seven months of growth and maturation, species such as the kangaroo give birth to their young relatively early in embryogenesis. The young kangaroo matures and grows in a pouch of the mother as a semi-free living beast. Within the next decade or two medical research will probably make it possible artificially to fertilize a human egg in a test tube and maintain its viability throughout development. Thus there would be only a free living stage, and the parasite phase would be circumvented. The rearing of a fetus extracorporeally is no longer a remote possibility. Man as a social being Superimposed on the process of development of an individual biologically is the genesis of man as a social being. This relates primarily to the growth and maturation of the nervous system. The capstone of the pyramid is the development of social behavior or "personhood." Many psychiatrists contend the development of behavior begins within the womb; however, it is quite obvious that the development of a person, as a unique social individual, gradually occurs following birth and is principally influenced by the social environment of the home, especially during the first few years of life. Those who rely heavily on this humanization to rationalize abortion in effect dehumanize the embryo or fetus. As with the biologic features of life, the sociologic features also present a continual transition and there is no discernible point where one can say "he is now a social being." Indeed social criteria are more murky than the former and are subject to much wider interpretations (and misuse). It would be folly to contend that a newborn infant is any more of a social being than an embryo. Infanticide should be as acceptable as abortion if sociological criteria form the rationale. Birth is a biophysiologic and not a sociologic event for the fetus, although it may be the latter for the parents. The thinking of many of the proponents of abortion seems to rely heavily on social or humanizing features as an essential property of human life. Therefore, they argue the early embryo, lacking these attributes, is not really a life and therefore does not involve the "thou shalt not kill" commandment. Recalling the hierarchy of organization referred to abovecellular, organ, individual somatic, and society-one may as |